Appendix A-3
Disclaimer
National Food Study Pilot
Agency: Economic Research Service
Contractor: Westat, Inc.
OMB Control Number: xxxx-xxxx
Expiration Date: xx/xx/xxxx
Disclaimer
(Given to the adult household member before the Screener Interview)
The Economic Research Service (ERS) of the U.S. Department of Agriculture and Westat are conducting a study to understand the food and drinks people buy or obtain for free. The results of the study will help to advance our understanding of what food and drinks people buy or obtain and whether families in the US can get what they need.
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is xxxx-xxxx (expires xx/xx/xxxx). This information collection asks an adult household member to complete a screener to determine if the household is eligible. If the household is eligible, the primary shopper completes an initial interview, a final interview, and a recall interview. People in eligible households report food or drinks they buy or obtain for free for seven days and also which meals (e.g., breakfast) and snacks were eaten during this period, complete an income worksheet, and if selected, participate in a recall interview. If your household has 2 persons, you will earn an incentive of $197, and the time required for both members in your household to participate in this Study is estimated to average 10.6 hours, or 636 minutes over the week-long period as shown below.
Read the Advance Letter 3 minutes per household
Read the Disclaimer 2 minutes per household
Complete Household Screener 12 minutes per household
Read and sign Household Consent Forms 5 minutes per household
Complete Initial Interview 30 minutes per household
Complete Final Interview 30 minutes per household
Complete Respondent Feedback 2 minutes per household
Training 45 minutes per person or 90 minutes for 2 persons
Assent Form 1 minute per person or 2 minutes for 2 persons
Complete Income Worksheet 15 minutes per person or 30 minutes for 2 persons
Complete Food Log 175 minutes per person or 350 minutes for 2 persons
Meals and Snacks Form 21 minutes per person or 42 minutes for 2 persons
Recall Interview 20 minutes per person or 40 minutes for 2 persons
This information collection is not mandatory and your participation is voluntary.
Statement of confidentiality: We are required by law (read box below) to use your information for statistical research only and to keep it confidential. The law prohibits us from giving anyone any information that may identify you or your family without your consent.
Assurance of Confidentiality: The Economic Research Service, its employees, agents, and partner statistical agencies, will use the information you provide for statistical purposes only and will hold the information in confidence to the full extent permitted by law. In accordance with the Confidential Information Protection and Statistical Efficiency Act of 2002 (Title 5 of Public Law 107-347) and other applicable Federal laws, your responses will not be disclosed in identifiable form without your informed consent. Per the Federal Cybersecurity Enhancement Act of 2015, Federal information systems are protected from malicious activities through cybersecurity screening of transmitted data.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | bonilla_e |
| File Modified | 0000-00-00 |
| File Created | 2021-01-23 |