Attachment A: Consent Forms

Demographic Pretesting With Adults

Consent Form

Name of Survey—e.g., National Crime

Victimization Survey

Identity Theft Supplement

Each year the Census Bureau conducts many different surveys. The Census Bureau routinely tests the questions used on these surveys in order to produce the best information possible.

You have volunteered to take part in a study to improve the questions that will be used in the [name of survey—e.g., National Crime Victimization Survey Identity Theft Supplement]. In order to have a complete record of your comments, your interview session will be audiotaped. We plan to use the tapes to improve the questionnaire. Staff directly involved in the questionnaire design research project will have access to the tapes. Your participation is voluntary and your answers will remain strictly confidential.

This study is being conducted under the authority of Title 13 USC. The OMB control number for this study is 0607-0725. This valid approval number legally certifies this information collection.

I have volunteered to participate in this Census Bureau questionnaire design study, and I give permission for my tapes to be used for the purposes stated above.

__________________________ ___________________________________

Researcher's Signature Participant's Signature

____________________________ ____________________________________

Researcher’s Name Participant’s Name

__________________ _________________________ Date Date

Demographic Pretesting With Minors

Consent Form

Name of Survey—e.g., National Crime

Victimization Survey

Internet Predation Questions

Each year the Census Bureau conducts many different surveys. The Census Bureau routinely tests the questions used on these surveys in order to produce the best information possible.

______________________[CHILD’S NAME] has my permission to take part in a study to improve the questions that will be used in the [name of survey—e.g., National Crime Victimization Survey Internet Predation Questions]. In order to have a complete record of your comments, your interview session will be audiotaped. We plan to use the tapes to improve the questionnaire. Staff directly involved in the questionnaire design research project will have access to the tapes. Your participation is voluntary and your answers will remain strictly confidential.

This study is being conducted under the authority of Title 13 USC. The OMB control number for this study is 0607-0725. This valid approval number legally certifies this information collection.

I have agreed to allow my child to participate in this Census Bureau questionnaire design study, and I give permission for his/her tapes to be used for the purposes stated above.

____________________________ ___________________________

Parent's Signature Researcher's Signature

____________________________ __________________________

Printed Name Printed Name Printed Name Printed Name

___________________________ _______________________

Date Date

Usability Interviews With Adults

Consent Form

Name of Usability Test—e.g., Usability

Evaluation of the Online Form for

Coverage Followup (CFU)

Each year the Census Bureau conducts many different usability evaluations. For example, the Census Bureau routinely tests the wording, layout and behavior of products, such as Web sites and online surveys, in order to obtain the best information possible.

You have volunteered to take part in a study to improve the usability of [name of survey—e.g., the online form for Coverage Followup]. In order to have a complete record of your comments, your usability session will be videotaped. We plan to use the tapes to improve the design of the product. Staff directly involved in the usable design research project will have access to the tapes. Your participation is voluntary and your answers will remain strictly confidential.

This usability study is being conducted under the authority of Title 13 USC. The OMB control number for this study is 0607-0725. This valid approval number legally certifies this information collection.

I have volunteered to participate in this Census Bureau usability study, and I give permission for my tapes to be used for the purposes stated above.

________________________ ____________________________

Participant's Signature Researcher's Signature

_________________________ _____________________________

Printed Name Printed Name Printed Name Printed Name

________________________ _____________________________

Date Date

Usability Interviews With Minors

Consent Form

Usability of Web site — e.g.,

Census in the Schools

Kids’ Page

Each year the Census Bureau conducts many different usability studies of its public Web sites. For example, the Census Bureau routinely tests the wording, layout and behavior of online sites in order to provide the best possible experience for visitors.

______________________[CHILD’S NAME] has my permission to take part in a study to improve the design of [name of Web site—e.g., Kids’ Page for Census in the Schools]. In order to have a complete record of your child’s comments, his/her usability session will be videotaped. We plan to use the tapes to improve the design of the Web site. Staff directly involved in the research project will have access to the tapes. Your child’s participation is voluntary, and his/her comments will remain strictly confidential.

This study is being conducted under the authority of Title 13 USC. The OMB control number for this study is 0607-0725. This valid approval number legally certifies this information collection.

I have agreed to allow my child to participate in this Census Bureau Web site design study, and I give permission for his/her tapes to be used for the purposes stated above.

_____________________________ ___________________________

Parent's Signature Researcher's Signature

_____________________________ __________________________

Printed Name Printed Name Printed Name Printed Name

______________________________ __________________________

Date Date

Economic Pretesting

CONSENT FORM

Name of Survey– e.g., Survey of

Business Owners

The U.S. Census Bureau routinely tests products used for collecting data or disseminating data in order to produce the best products possible.

You have volunteered to take part in a study to test [name of data collection–e.g., a draft of the Survey of Business Owners]. In order to have a complete record of your comments, your interview session will be audio-recorded. We plan to use the tapes to improve the survey. Only staff involved in this product design research will have access to the tapes.

This study is being conducted under the authority of Title 13 USC. The OMB control number for this study is 0607-0725. This valid approval number legally certifies this information collection.

I have volunteered to participate in this U.S. Census Bureau product design study, and I give permission for my audio recordings to be used for the purposes stated above.

__________________________ __________________________

Researcher’s Signature Participant’s Signature

__________________________ __________________________

Printed Name Printed Name

__________________________ __________________________

Date Date