Intro - Assent for Adolescent - English

F-5 Intro-Assent for Adol-English.docx

Traumatic Brain Injury (TBI) Surveillance System

Intro - Assent for Adolescent - English

OMB: 0920-1240

Document [docx]
Download: docx | pdf

Attachment F-5. Intro-Assent for Adol – English

ask if SPST2=1

ADOL1. Hello, my name is ____ calling on behalf of the Centers for Disease Control and Prevention. We’re conducting a nationwide study about head injuries in children and adults.

You may have heard about head injuries, especially those experienced by children who play sports.

Even if you haven’t had an injury in the past 12 months, you can still participate in this important study. We have asked your parents to give their permission for you to participate; they have said “yes.” However, even though your parents said “yes,” you can still say “no” and not participate. And you can skip any question or stop the survey at any time. The majority of respondents will complete the survey in less than 7 minutes.

There are minimal risks, and no known direct benefits to being in this voluntary study. CDC will keep the information that you provide private and secure to the extent permitted by the law. Your name will never be connected to your answers. We will not share your answers with your parents.

If you have questions or concerns about participating in the study, you may contact ICF International, the independent health research company hired to conduct this survey. They can be reached toll-free at 1-844-604-4399. If you have any questions about your rights as a research participant, please contact Sophia Zanakos at 301-572-0239. This call may be monitored for quality assurance purposes.

May we begin?

01. YES [SKIP TO TRANS1]

02. NO




File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorShelley N. Osborn
File Modified0000-00-00
File Created2021-01-20

© 2024 OMB.report | Privacy Policy