Consent and Landing Page

Attachment 5a Consent & Landing Page.docx

Using Social Media for Recruitment in Cancer Prevention and Control Survey-based Research (SMFR Study)

Consent and Landing Page

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< PROGRAMMER: CDC/NORC LOGOS GO HERE >


Welcome to the What do you have to say about cancer? Survey


NORC at the University of Chicago is conducting a survey sponsored by the Centers for Disease Control and Prevention. This survey is to learn about your medical history and how your family talks about health. You taking the survey will help us to identify aspects of family communication about health and risk.

The survey will take about 20 minutes to complete. The survey will include general demographics and questions related to health and cancer in your family.

Any information you provide will be maintained in a secure manner. No one will know how you answered the questions. Only project staff will have access to the study data. The data we collect from you will be combined with data from other participants.

This research is covered by a Certificate of Confidentiality from the Centers for Disease Control and Prevention. The researchers with this Certificate may not disclose or use information or documents that may identify you in any federal, state, or local civil, criminal, administrative, legislative, or other action, suit, or proceeding, or be used as evidence, for example, if there is a court subpoena, unless you have consented for this use.

You taking the survey is your choice. You may skip questions you do not want to answer and you can stop the survey at any time. Eligible participants will receive a $5 electronic gift code at the end of the survey.

If you have any questions about the survey, you can call the NORC IRB Administrator toll-free at:

866-309-0542.


Your opinions are very important to us,

and we appreciate your help.



<PROGRAMMER: Please provide a “Start Survey” button.>





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