2. Factsheet_ questionnaire_final3.17.21 (1)

OMB Control No: 1230-0NEW

Expiration Date: XX/XX/20XX

Investigation of State Vocational Rehabilitation Agencies’

Implementation of Pre-Employment Transition Services (Pre-ETS)

A CAPE-Youth Research Project

FACT SHEET

1. As someone involved in delivering or designing Pre-ETS in your state, you are invited to participate in a web questionnaire for a CAPE-Youth research study titled, “Investigation of State Vocational Rehabilitation Agencies’ Implementation of Pre-Employment Transition Services (Pre-ETS)”. CAPE-Youth is a collaboration between The Council of State Governments, the K. Lisa Yang and Hock E. Tan Institute on Employment and Disability at Cornell University, and the Transitions to Adulthood Center for Research at the University of Massachusetts Medical School. You were selected because you are the Chief Administrator of the public rehabilitation agency in your state, or designee.

2. The purpose of this research is to better understand Pre-ETS implementation across states, including strategies for delivering Pre-ETS, challenges encountered, and indicators for measuring success. This information will be used to help states effectively deliver Pre-ETS to various eligible populations of students with disabilities.

3. You have been asked to participate in this research study because you have both extensive knowledge of your programs, as well as global knowledge of the Pre-ETS policy roll out in your state. As a key informant, you will be asked to participate in a web questionnaire lasting a maximum of 30 minutes. The aim of this web questionnaire is to help us understand more about how Pre-ETS services are being delivered nationally. If you agree to participate, we will ask you questions about how Pre-ETS are being provided in your state and about the distribution (number and proportion) of Pre-ETS being delivered to VR potentially eligible students by disability type.

4. Participation is voluntary. You do not have to be in this study, and if you do join, you can stop or leave at any time. In either case there are no penalties and you do not lose any benefits to which you are otherwise entitled. In the event you decide to withdraw, any information we gathered prior to your withdrawal will not be disseminated in any of our aggregate data.

5. A minimal risk to participating in this questionnaire is that your responses may be accidentally linked to you outside the study. This is highly unlikely to happen, and we are very experienced in keeping data like this completely private. These web questionnaire responses will be stored on an encrypted password protected secure computer. Any information you give us will never be reported with your name and individually identified results will not be shared with supervisors or co-workers. Individuals outside the CAPE-Youth research team will not have access to individual-level responses. There is a minimal risk in that you could experience discomfort with the questions being asked during the questionnaire. You only have to answer questions you feel comfortable with and can request a break at any point or stop the questionnaire at any time.

6. The information gathered will be used to develop a report for CAPE-Youth that includes a summary of results and a discussion of the implications of results for future Pre-ETS policy and implementation. The report will be widely distributed to state agencies and policymakers and used for technical assistance. Your state agency and your name and identity will not be disclosed on public materials unless you give us express permission to do so.

7. The research team at CAPE-Youth will use the information you provide for statistical purposes only and will hold the information private to the full extent permitted by law. We will limit access to your personal information to people who have a need to review this information. We cannot promise complete privacy. The CAPE-Youth collaborative partner at UMass Medical School’s Institutional Review Board and other representatives of UMass Medical School may see your information.

7. Privacy Act Statement: Collection and Use of Personal Information

The following statement is made in accordance with the Privacy Act of 1974 (5. U. S. C. 552a). Information collected will be handled and stored in compliance with the Freedom of Information Act and the Privacy Act of 1974, as amended (5 U.S.C. 552a). Furnishing the Pre-ETS data requested is voluntary.

We will use the Pre-ETS data you provide for the CAPE-Youth Pre-ETS Research Project, funded by The United States Department of Labor, Office of Disability Employment Policy. In accordance with the Confidential Information Protection and Statistical Efficiency Act of 2002 (Title 5 of Public Law 107-347) and other applicable Federal laws, your responses will not be disclosed in identifiable form without your informed consent. Per the Federal Cybersecurity Enhancement Act of 2015, Federal information systems are protected from malicious activities through cybersecurity screening of transmitted data.

If you have any questions, concerns, or complaints, or think that the research has harmed you, you can talk to the Principal Investigator Marsha Ellison, PhD. at (508) 856-2816. This research has been reviewed and approved by the UMass Medical School Institutional Review Board. You can reach them at (508) 856-4261 or [email protected] if you would prefer to speak with someone not associated with the study.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays an Office of Management and Budget (OMB) control number. The valid OMB Control Number for this information collection is xxxx-xxxx. The time required to participate in the questionnaire is estimated to average 30 minutes, including the time to review instructions, search existing data resources, gather the data needed and complete and review the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to US Department of Labor, Office of Disability Employment Policy, 200 Constitution Ave., N.W. Washington, DC 20210 and reference the OMB Control Number xxxx-xxxx.

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