Household Consent Form

Household Survey Consent—For use with Appendix A

Choice Neighborhoods Initiative

CATI Consent Script for Household Survey

Intro for CATI calls to sampled households.

Includes information about the study that would have been in the mailing, but is reiterated below.

Thank you for taking the time to speak with me today about the Choice Neighborhoods follow up survey. I just wanted to let you know that this conversation is being recorded for quality control purposes.

On behalf of the Urban Institute, DIR is conducting a survey about the Choice Neighborhoods Initiative, which was designed to help transform [Focal Development] and improve the [Neighborhood Name] community. We do not work for [the Grantee/property manager] and what you tell us today will not get back to them.

The U.S. Department of Housing and Urban Development (HUD) is funding this study to help understand the impact of the Initiative on current and former residents in the neighborhood. The factsheet that was sent to you gives detailed information about the study and collection of this information is authorized by Title V of The Housing and Urban Development Act of 1970, 12 U.S.C 1701z-1 et seq.

A person is not required to respond to a collection of information unless it has been approved by the Office of Management and Budget (OMB) and displays a currently valid OMB control number. This survey has been approved by OMB, and the OMB control number is XXXX-XXXX, which expires XX-XX-XXXX.

Intro for sampled households that call into the CATI using phone number in letter.

Does not include information about the study that was in the mailing.

Thank you for calling about the Choice Neighborhoods follow up survey. I just wanted to let you know that this conversation is being recorded for quality control purposes.

In the letter we sent, we provided information about the study. Do you have any questions about that? [answer any questions about it]

A person is not required to respond to a collection of information unless it has been approved by the Office of Management and Budget (OMB) and displays a currently valid OMB control number. This survey has been approved by OMB, and the OMB control number is XXXX-XXXX, which expires XX-XX-XXXX.

Consent for all sampled households.

Participation in this survey is completely voluntary. You may choose not to answer any questions and you can stop the interview at any time. Your decision to participate will not affect any housing subsidies, social services, or public benefits you might receive now or in the future.

The survey will take about 35 minutes but could take more or less time depending on when you lived in [DEVELOPMENT NAME] and the composition of your household. It will ask about your current housing and economic situation, your children and other questions.

***We must also ensure effective communication and provide reasonable accommodations for individuals with disabilities throughout this study. Please let us know if you require a reasonable accommodation. We will also provide meaningful access to persons with limited English proficiency. You can complete the survey in English, Spanish, Cantonese, Somali, or Vietnamese. Please let us know if you would like to complete the survey or receive consent materials in a different language. The survey can be completed over the phone or online, and the online survey is accessible for individuals with disabilities.

We believe the risks of taking the survey are minor. While unlikely, it is possible that your responses could be exposed. However, we have taken steps to reduce this possibility including the confidentiality processes described below. We will send data from the survey to HUD at the conclusion of the study, but we will remove individual names and identifying information. Survey questions about violence in the neighborhood and family hardships may be upsetting, so we will provide contact information for supports if you would like them.

While taking the survey doesn’t benefit you directly, your responses will be part of an effort to strengthen future programs like Choice Neighborhoods. You will receive a $50 gift card as a thank-you for your time.

Everyone working on this study has promised to protect the confidentiality of your information and your responses to the survey. We recognize that this information is sensitive and protected by the Privacy Act. The Urban Institute’s research team will also keep confidential any information received from other sources. Only the researchers at HUD and other researchers specifically designated by HUD will see your information, and they will keep your information confidential by:

• Keeping information in a locked drawer or in a password-protected computer that is secure;

• Only allowing people on the research team who have signed confidential data use agreements to look at your information;

• Not keeping your name in the same file with your answers;

• Not using your name or any other identifying information in reports;

• Summarizing the data of all residents in the study in any reports to make sure your confidentiality is protected.

Note that we are required to take steps, including reporting to authorities, to address a situation where we believe someone may physically harm themselves or others.

For research purposes, the Urban Institute may link your survey responses to information about any housing assistance you may receive in order to better understand the individuals who live in Choice Neighborhoods and to track your household for a follow-up survey at a later date.

If you have questions about the study, contact Megan Gallagher at the Urban Institute at [email protected] or 202-261-5253. Or visit the Choice Neighborhoods Initiative project page at https://www.huduser.gov/portal/choice_neighborhood_eval.html.

Do you have any questions about the study?

1 YES (ANSWER UNTIL RESPONDENT SATISFIED)

2 NO

8 DON’T KNOW

9 REFUSED

Now that we have talked about the study, I am going to read two statements. For each, please tell me if you agree to it or not.

“I [FLNAME] agree to participate in this survey.”

1 YES

2 NO

9 REFUSED

“I [FLNAME] agree to allow HUD to link my survey responses to information about any housing assistance I may receive.

1 YES

2 NO

9 REFUSED

The remaining questions are about how you would like to complete the survey.

Would you like to complete the survey online?

1 YES

2 NO

8 DON’T KNOW

9 REFUSED

Would you like to complete the survey in one of the following languages?

1. Spanish

2. Canotnese

3. Somali

4. Vietnamese

5. Other_________