Consent Form

Consent Form

For Individual Participants

Usability Testing of the Economic Census

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 applications in order to obtain the best information possible.

You have volunteered to take part in a study to improve the usability of the Economic Census Survey online instrument. In order to have a complete record of your comments, your usability session may be recorded. We plan to use the recording to improve the design of the product. Only staff directly involved in the research project will have access to the recording. 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 Name (print): ______________________________________

Participant's Signature: ____________________________________ Date: ­­­­­__________

Researcher’s Name (print): _____________________________________

Researcher's Signature: ____________________________________ Date: ­­­­­__________