Consent Form

Consent Form

2018 Census Test – eResponse Debriefings

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

______________________ [NAME] consents to take part in a study to improve the eResponse data collection system used to enumerate residents of group quarters. In order to have a complete record of all comments, the interview session will be audio-recorded. The Census Bureau plans to use the recordings to improve the survey. Only staff directly involved in this research project will have access to the recordings. Participation is voluntary and 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 participate in this Census Bureau study, and I give permission for my recordings to be used for the purposes stated above.

____________________________ ___________________________

Participant's Signature Researcher's Signature

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Printed Name Printed Name

___________________________ _______________________

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