Other Adult Household Member Informed Consent For Study Participation

ATTACHMENT D: PHASE 1- OTHER ADULT HOUSEHOLD MEMBER INFORMED CONSENT FOR STUDY PARTICIPATION

Evaluation of the Housing Choice Voucher Mobility Demonstration

If you would like translated consent materials, or to complete the survey in a language other than English, please let the staff person you are talking to know. Please let them know if you need information to be presented in an accessible format, for example, Braille, audio, large type, or sign language interpreters. The staff person will do their best to provide a reasonable accommodation (a change or adjustment) so that you can participate.

The head of your household agreed to take part in an important study called the [LOCAL MOBILITY PROGRAM OR HOUSING CHOICE VOUCHER (HCV) MOBILITY DEMONSTRATION]. The study is sponsored by the U.S. Department of Housing and Urban Development (HUD). The purpose of this study is to help HUD understand how well different types of services help families move to different neighborhoods of their choice. You and the other members of your household are also invited to take part in this study. The [PHA] is operating the [HCVMD] program, with support provided by [LOCAL PROVIDER PARTNER(S)]. HUD contracted with Abt Associates and their research team to conduct the study. The research team includes Abt Associates, the Urban Institute, MEF Associates, Social Policy Research Associates, Sage Computing, a team of consultants, and other researchers that may be added in the future.

What is the [HCVMD] study?

The [HCVMD] study will help us to learn how to help households find housing that can help children succeed in life. Some households will receive a special set of services to help them move to a new neighborhood of their choice. The [HCVMD] study will measure whether children in households that move to these new neighborhoods do better in school and earn more later in life. The study will also measure how well these services help adults in the households.

Over 10,000 families from the participating public housing agencies will be enrolled in this study. Families in the study will be put into one of two groups, at random:

• The “Standard Services Group”: this group will get all the existing services that [PHA] normally provides to families with a Housing Choice Voucher.

• The “[HCVMD] Comprehensive Mobility Related Services Group”: this group will get ongoing guidance from a staff member who will help them get ready to search for housing, connect them with landlords in specific areas they would like to move to, and provide funds to help pay for some housing search and certain leasing expenses, such as rental application fees, holding fees, and security deposits.

Your household will have the same chance of being offered the comprehensive services as all the other households that agree to be in the study. Families will be put into groups randomly by a computer process that is like pulling names from a hat. Getting picked is not based on anything you tell us about you or your household. You cannot choose which group you will be in.

Who can be in the [HCVMD] study?

The head of your household was found to be eligible to participate in the study. Since they agreed to take part in the study, you and the members of your household are also eligible to participate.

The rest of this form explains what it means to be in the study. This form also describes the type of information that the research team will collect. We hope you will agree to participate.

What does it mean to be in the [HCVMD] study?

If you choose to join the HCVMD study, the research team will collect information about you and other members in your household in up to three ways. We will collect this information from all individuals no matter which group your household is placed in.

1. Current Information Collection: We will collect general and specific information about you at enrollment from the head of your household. This includes information about your employment, your age, and your email and cell phone contact information. We will also collect information on you from [PHA] records.

2. Other Surveys and Interviews: We might contact you in the future to collect additional information, which may be done either by the study team or other HUD-approved researchers. The long-term outcomes, especially for children, are important to the HUD and the research team, so you may be contacted during the next fifteen years to complete one or more surveys. The follow-up surveys or interviews may ask about experiences since your household enrolled in the [HCVMD] study. They may also ask about other topics such as searching for housing, education, work status, living situation, your and your children’s health, and your children’s schooling. Your children may also be asked to participate in future information collection efforts including interviews. These follow-up surveys or interviews will be voluntary. You do not have to participate.

3. Longer-Term Information Collection: Because we are interested in long-term outcomes, especially for kids, part of the research includes getting information about you and other members of your household members from federal agencies, state departments of labor, local school districts, child welfare agencies, and credit bureaus. The information will be combined with the information you provide today and any future surveys to help HUD understand how families that participated in the [HCVMD] Study are doing. This will help the research team learn how different kinds of housing and services helps families. This information will only be used for research. HUD will never use these data to determine your ability to participate in different programs.

Here are some examples of the types of information the research team may collect:

• The dates and nature of your participation in housing services and programs, including information on the neighborhood where you live;

• Records of how much money you earned from federal agencies or from your state’s department of labor;

• Information about your financial well-being from databases maintained by credit bureaus (the study’s collection of this information will have no effect on your credit score);

• Your children’s school records, including information about how they scored on achievement tests, their school absences, if they repeated a grade, how they are doing in school, and data from other educational agencies about whether they enrolled in college, and whether they graduated from college;

• Information about receipt of public assistance or disability benefits;

• Your and your children’s health records, including Medicare or Medicaid;

• Your and your children’s records from federal government agencies, including information on employment, individual and household earnings, family composition, health and health care, education, residency, neighborhood quality, and information found in tax returns; and

• Your and your children’s participation in TANF, SNAP, or other social programs.

You can leave the HCVMD study at any time. If you wish to leave the HCVMD study at any time, please see “Can I stop being in the study after I join” section on page 3.

What are the benefits of being in the study?

Your household may be randomly chosen to be offered special help in searching for housing and exploring new neighborhoods and financial help to cover some leasing expenses. However, your household must be determined eligible for both the Housing Choice Voucher Program and this study.

What are the risks of being in the study?

There are very few risks involved. You may be uncomfortable with the questions asked at enrollment or in interviews or surveys. You can refuse to answer any question. There is a small risk that your information could be lost or misused, even though the research team takes great care to protect it. The research team has strict requirements to notify you if any of your information is lost or misused.

Do I have to participate?

No, your participation in the study is completely voluntary. Neither you nor your household will lose any assistance you may be receiving now or in the future based on your choice to not participate in this study.

Can I stop being in the study after I join?

Yes, you can choose to stop being in the study at any time. To do so, contact the research team, as listed below. If you choose to withdraw from the study, you will still keep your Housing Choice Voucher (if eligible) and you will not lose any current or future [PHA] benefits or standard services that you are entitled to. However, if you were selected to receive the comprehensive mobility-related services when you enrolled in the study, you will no longer be able to get any of those services after you withdraw. The research team will still use the information that was collected about you while you were in the study. The research team will not collect any information about you and your family after you tell the study team that you want to leave the study. You may contact XXX XXXXX at XXX-XXX-XXXX (not a toll-free number) or xx@xxxx to withdraw from the study.

How will my information be protected?

We want to assure you that all your responses and personal information that you provide will be kept private to the full extent provided by law. This research is conducted under the authority of the Secretary of the U.S. Department of Housing and Urban Development (HUD) to undertake programs of research, studies, testing, and demonstration related to the mission and programs of HUD (12 USC 1701z-1 et seq.). The research team will never use your name or other personally identifiable information (PII) that could identify you in reports about the research. Your personally identifiable information will be removed from your responses before they are combined with responses from over 10,000 other participants.

All information will be analyzed and reported for groups of individuals. There will be no way to link your responses back to you. The research team has been trained in protecting private information. The team uses safety procedures like secure computers and data storage systems to help protect data from being seen by anyone other than the researchers. You should know that the research team may need to report information about you to the appropriate authorities if it learns that you or someone else may be at risk of physical harm.

[PHA] will have access to some of the study participation data, such as the mobility services you received as part of this study. [PHA] will not have access to other data (including non-housing-related administrative data, follow-up surveys or interviews, and college or school records) collected by the research team. The [PHA] will not be able to use any of the study data to determine your eligibility for the HCV program or any other assistance it may offer.

The research team will maintain the privacy of the information you provide from the start of the study until the end of their contract with HUD. At that time, all data, including your personal information, will be provided to HUD. Your data and personal information will be kept private by HUD to the full extent provided by law. The information requested under this collection is protected and held private in accordance with 5 U.S.C. 552a (Privacy Act of 1974) and OMB Circular No. A-130. Please remember, HUD will use this information only for research purposes. HUD will not use these data to determine your eligibility for any current or future housing assistance or receipt of other benefits.

Will my information be used in the future? Can it be used for additional studies?

To fully understand how the program helped you and the other members of your household long-term, HUD may wish to continue learning from this study for up to 30 years. We understand that sounds like a very long time, but research from an earlier HUD study has shown the benefits of moving to a different neighborhood for families and especially their children as they grow into adults. HUD and the research team want to be able to continue that research with this new study.

HUD and the research team may share data collected for the study with other HUD-approved researchers to conduct additional analysis, including using information provided in the surveys, using information already obtained from [PHA], or other agencies, and obtaining new information from [PHA], or other agencies. Anyone who HUD provides access to these data, will be required to commit to protecting and securing the data, and to only presenting results in the aggregate and so no individual could be identified.

You can leave the HCVMD study at any time. If you wish to leave the study at any time, please see “Can I stop being in the study after I join” section on page 3.

Who can I call with questions?

If you have any questions about this study or about your rights as a participant in the study, you may contact the research team:

• Melissa Vandawalker, the Abt Associates Project Manager, at 617-349-2611, or by email at [email protected].

• Abt Associates Institutional Review Board Administrator at 877-520-6835, or by email at [email protected].

• Marina Myhre, study contact for HUD at 202-402-5705 or by email at [email protected].

• Leah Lozier, study contact for HUD at 202-402-3013 or by e-mail at [email protected].

Statement

I have read this document, or had the document read to me. I had my questions answered. I agree to be part of the study. I know that my participation is voluntary and that I can refuse to answer any question or leave the study at any time. I know all information about me will be kept private unless doing so would put me or someone else in danger. I consent to the data collection as described above, for as long as the study is ongoing. I understand that a copy of this consent form will be given to me to keep for my records.

____ Yes, I agree to be part of the HCVMD study.

____ No, I do not agree to be part of the HCVMD study.

E-signature__________________________________ Date: __________

The Paperwork Reduction Act Statement: This collection of information is voluntary and will be used to evaluate the US Department of Housing and Urban Development’s Housing Choice Voucher Mobility Demonstration. Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, gathering, and maintaining the data needed, and reviewing the collection of information. 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 number and expiration date for this collection are OMB #: XXX-XXXX, Exp: XX/XX/XXXX. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to XX at XXXX@XXX or call at XXX-XXX-XXXX.