Appendix E Consent Form

Appendix E: Informed Consent Document

Consumer Expenditure Survey Informed Consent Form

Westat, a private research firm, has been hired by the U.S. Bureau of Labor Statistics (BLS) to test survey questions about the purchases made by people in the United States. The BLS is conducting this study to make it easier for people to report the purchases that they make. The survey questions and procedures that you will be testing today will eventually be used on a survey of household across the United States to learn about the products and services that they purchase.

Your task during this interview will be to take the survey on a laptop computer and tell us if you have any problems doing so. We will ask you about your understanding of the survey and the user-friendliness of the questions and the computer used to complete the survey.

The BLS, 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. The Privacy Act notice on the back of this form describes the conditions under which information related to this study will be used by BLS employees and agents.

• Your participation is completely voluntary. You may stop at any time, and you can skip any questions you do not wish to answer.

• All information obtained during this study will be treated as secure and will only be used to develop and improve the questionnaire. We will not share your answers with anyone outside of the Consumer Expenditure Survey project research team.

• The interviewer will video record the discussion and take notes. In addition, project researchers may observe the interview. The researchers will destroy the video recording as soon as they complete the questionnaire development process.

• The interview should take about an hour.

• The report summarizing the findings will not contain any names or identifying information.

• You will receive $40 cash as a token of our appreciation for completing the session.

• If you have questions about this research, please contact Aaron Maitland, the Project Director at (240-314-2595; [email protected])

• If you have questions about your rights and welfare as a research participant, please call the Westat Human Subjects Protections office at 1-888-920-7631. Please leave a message with your full name, mention that you are calling about the consumer expenditure study, and leave a phone number beginning with the area code. Someone will return your call as soon as possible.

• A copy of this consent form has been provided for your records.

• Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. The OMB control number is 1220-0141 and expires on April 30, 2018.

If you agree to participate in this interview, please sign the following statement.

I have read this form (or this form was read to me).

□ I agree to participate in this study.

□ I agree to be video recorded.

___________________________________ ___________________________

Participant's signature Date

___________________________________

Participant's printed name

___________________________________

Researcher's signature

PRIVACY ACT STATEMENT

In accordance with the Privacy Act of 1974, as amended (5 U.S.C. 552a), you are hereby notified that this study is sponsored by the U.S. Department of Labor, Bureau of Labor Statistics (BLS), under authority of 29 U.S.C. 2. Your voluntary participation is important to the success of this study and will enable the BLS to better understand the behavioral and psychological processes of individuals, as they reflect on the accuracy of BLS information collections. The BLS, 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.