Participant Consent Form

OMB Approval No. XXXX-XXXX

Expiration Date: XX/XX/20XX

Agreement to Take Part in the TechHire Study

You are invited to take part in the TechHire study. The study is being run by a research organization called Westat and its partner MDRC. This form explains what the TechHire study is and what it means for you to be a part of it. Your participation is voluntary and by signing this form, you agree to participate in the study. We hope you will agree to participate.

What is the TechHire study?

TechHire is a program designed to help people get training and obtain the skills needed for well-paying jobs. The TechHire study is testing whether the program helps people and, if so, how it helps.

Space is limited in the TechHire program. So, we will use a computerized lottery, called “random assignment,” to assign people to two groups:

• TechHire group members will be offered TechHire training and support services.

• Control group members will not be offered TechHire training and support services but will be able to access services in their communities.

About half the people who join the study will be placed in the TechHire group. The other half will be placed in the control group. The decision about who is assigned to which group is random—like flipping a coin. It has nothing to do with anything about you, like your age, race, gender or other personal traits. You will have the same chance of getting the TechHire services as everyone else, and using a lottery makes sure everyone is treated fairly.

To have a chance to receive the TechHire services, you will first have to provide some information about yourself and agree to be a part of the random assignment. Both the TechHire and control groups will be in the study. If you choose not to be in the study, you cannot receive TechHire services. You can still enroll in other employment and training services available elsewhere in your community.

If you are selected to be in the control group you will receive $50 as a thank you for completing the screening and assessment process.

What does it mean to be a part of this study?

If you agree to be in the TechHire study by signing this form, researchers will collect some information about you. This information will help us understand how well the program is working. This information will be used only for research purposes, and will be collected whether or not you are placed in the TechHire group.

We will ask you to do the following:

• Agree to provide information about yourself when you enroll in the study.

  • This will take about 10 to 15 minutes.

  • We will ask about such things as your name, date of birth, social security number, household composition, and employment and education history. The answers you provide will not affect which group the computer selects you into. You can refuse to answer any question you do not want to answer.

  • We will ask you to tell us how we can reach you in the future, for follow-up surveys. This will include the names of people who will know how to reach you. As a way to “thank you” for returning your contact information, you will receive $2.

• Agree to take surveys in the future, about 6 months and 18 months from today.

  • We will contact you and ask about such things as your employment since enrolling in the study. As a way to say “thank you” for taking the time to complete the surveys, you will receive a $25 gift card if you complete the first survey (about 6 months from today) within four weeks of when we contact you and $15 if you complete it after that time. You will receive a $30 gift card if you complete the second survey (about 18 months from today) within the first four weeks of when we contact you and $20 if you complete it after that time. When taking the surveys, you can refuse to answer any question you do not want to answer.

• Allow us to obtain information about your participation in training and employment services.

  • This will include your eligibility for and use of TechHire services, like how often you attend training in the program and other services you might receive.

• Allow us to obtain information from community, state and federal agencies, and federal administrative databases, about you, such as your employment and earnings, and benefits or services you receive.

  • This will include information for up to two years prior to today and for at least five years after today, and for more years if a longer-term study is conducted.

  • This may include information about any involvement you have had or might have with the criminal justice system.

• Allow us to share your information with other researchers.

• At the end of the study, we will deliver study data to the federal government. This file will not contain your name, address, date of birth, SSN, or other ID numbers that could identify you. Other researchers will then be able to continue to learn about the services that families like yours could benefit from.

How will my information be protected?

The study team will follow strict rules to protect your personal information. The study team is trained to protect your information and signs a pledge to do so. Any papers that include your name or other ID’s will be kept in a locked area, and any computer files with your name will be protected by a password. The information about you will be marked with a special code number, not your name. About 3,600 people will be in this study. When we write a report, the information you give us will be combined with information from other people in the study. No reports will describe you in a way that would allow you to be identified. All information the study team gets about you will be used for research only.

The study has a Certificate of Confidentiality from the U.S. government. This certificate says that we do not have to identify you, even under a court order or subpoena. However, please keep in mind: If there is concern that you or someone else may be harmed, we will have to tell the appropriate agencies to protect you or the other person.

What are the benefits and risks of participating in the study?

The information obtained from the study will help governments and other organizations learn how programs can best help people get ahead financially.

The risks of participating in the TechHire study are small. If random assignment places you in the control group, you may still seek out employment and training services in the community. But for three years after the date on which you are assigned to the control group, you cannot use TechHire services.

Being part of the study is your choice.

Taking part in the study is your choice. If you decide not to be in the TechHire study, there is no penalty. Your decision will not affect the employment and training services you receive in the community. However, only people who are in the study will have a chance to receive TechHire employment and training services.

If you agree to participate in the study and change your mind later, you can opt out of the study at any time by contacting the study team at the email or phone number below. If you choose to leave the study, the study team may still use information that was collected about you while you were in the TechHire study, but no new information will be collected from you or about you. But, if you leave the study and you were assigned to the TechHire group, you will no longer be eligible for additional TechHire services.

Who can I call with questions?

If you have questions about the study or about your rights as a participant, you may contact the study team. The phone number is 1-xxx-xxx-xxxx. The email address is [email protected]. If you have questions about the TechHire program itself, call xxx-xxx-xxxx.

Statement of Study Participant

I have read and understood this form and agree to join the TechHire study. I know that my participation is voluntary and that I can refuse to answer questions or can stop being in the study at any time. I know that all information about me will be kept confidential unless doing so would put me or someone else in danger.

[Check-Box] I consent to allow researchers to use my information as described above.

[Check-Box] I do not consent to allow researchers to use my information as described above.

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Name (Print)

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Date

Public reporting burden for this collection of information is estimated to average 10 minutes per respondent. Send comments concerning this burden estimate or any other aspect of this collection of information to the U.S. Department of Labor, Chief Evaluation Office, Room 2218, Constitution Ave., Washington, DC 20210. 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 OMB control number for this information collection is xxxx-xxxx.