Regional Innovation Clusters (RIC) Initiative Evaluation Study

OMB Control Number 3245-0392

Expiration Date:

Appendix C-8 Cluster Administrator Interview Consent Form

Dear Cluster Administrators,

The U.S. Small Business Administration (SBA), via the Regional Innovation Clusters (RIC) Initiative, is investing in regional clusters throughout the United States that span a variety of industries, including energy, manufacturing, agriculture, and advanced defense technologies. SBA has contracted with XXXX, to analyze and report how the RIC projects have been implemented and have evolved over time.

As part of this analysis, the research team will be conducting individual interviews with all RIC Administrators that have participated in RIC-funded activities or services since October 1, 2010. The primary purpose of these interviews is to collect information on the evolution of the clusters’ structure and operations and on challenges and lessons learned. Your participation in this interview is voluntary; however failure to respond may be a violation of the terms and conditions of your contract with SBA. The interview is expected to take no more than 150 minutes to complete. You are not required to respond to this interview unless it displays a currently valid OMB Control (or Approval) Number. Comments or questions regarding the estimated time or other aspects of this interview, may be submitted to Director Records Management Division, 409 Third Street, SW, Washington, DC 20416, or SBA Desk Officer, Office of Management and Budget, New Executive Office Building, Washington DC 20503.

Confidentiality and Usage

During the interviews, the research team will be taking written notes of the conversations, which will be used to develop reports submitted to SBA and the final public report. The research team will provide the option of going “off the record” if requested by the interviewees, in which case the information provided will not be attributed to the program entity and the research team will keep the source confidential in the reports submitted to SBA. Any quotations or information “on the record” will otherwise be attributed to the original source and may be included in the public report through such attributing phrases as “an administrator of the cluster noted that. . . .”

Storage and Access

The interview notes will be stored on a secure platform accessible only to the (contractor) assigned to this project and will not be provided to SBA staff. The interview notes will be retained for no fewer than 3 years after the completion of the interviews.

Your signature on this form grants the research team permission to conduct the interview as described above for the above-referenced study. The research team will not use the information provided for any reason other than those stated in this consent form without your permission.

Thank you in advance for your assistance.

Signature Date

Printed Name