3 - Consent Materials for Parents of Fathers under 18 (Parent of Applicant)

OMB #: XXXX-XXXX

EXPIRATION: XX/XX/201X

3 – Consent Materials for Parents of Fathers under 18

[VERBAL SCRIPT:]

My name is [GIVE YOUR FULL NAME] and I work for [NAME OF FATHERHOOD PROGRAM]. Our program is participating in the Building Bridges & Bonds evaluation, or B3. Your son -- [MINOR’S NAME] -- is eligible to be in this important study. Since he’s a minor, we are asking you to give consent as his parent or legal guardian.

The study is being conducted for the U.S. Department of Health and Human Services. The goal of the study is to learn more about the effects of parenting and employment services for fathers.

Fathers will participate in this study from around the country. Half the fathers will be offered new services that [NAME OF FATHERHOOD PROGRAM] is offering. The other half will receive the usual services that they offer. Your son has the same chance of getting the new services as everyone else. Picking the fathers who will be offered the new services will be done randomly.

His participation involves:

1. Completing a 30-minute computer-based interview when he enrolls. He’ll receive a $25 gift card for doing the interview.

2. Agreeing to take a similar survey in about six months. He’ll receive a $35 gift card.

3. Allowing us to obtain information about his participation in the fatherhood services. He’ll receive gift cards for participating in focus groups or for short questions he answers via text message.

4. Allowing us to obtain information from state and federal agencies about the services he receives.

5. Allowing us to contact him at some time in the future.

6. Allowing us to share his information with other researchers.

7. [For parenting test sites, allowing us to use his information to grant him access to an App designed for some fathers during the program.]

It’s up to you and him whether he’s in the study. If you decide he shouldn’t be in the study, there is no penalty. It will not affect what services he receives. Your decision will not affect his status with the criminal justice system or the child support enforcement system.

Your son’s name and any information we get from him for this study will be protected. The study team is trained to follow strict rules that protect personal information. His information will not be shared with anyone outside of a research team, unless we are required to do so by law. No reports will describe him in a way that would allow him to be identified. Also, he can refuse to answer any questions in the interview.

There are some risks to being in the study. He might find some of the questions in the interview stressful to answer, but he can always say he doesn’t want to answer the question. There is a small chance someone outside the study team will see his information, but the team has very high standards for keeping his information private. One exception is that if there is concern that someone in your son’s household may be harmed, they would have to report it.

Being in the study will provide information to see what kind of services offered to fathers help them build stronger relationships with their children and/or find and keep better jobs than they would have otherwise.

This evaluation is being conducted on behalf of the Administration for Children and Families (ACF). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this collection is xxxx-xxxx and it expires xx/xx/xxxx.

Do you have any questions? Do you agree to let your son take part in the study?