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Q. Consent Form for Focus Group With SNAP Participants revised
ICR 202105-0584-006 · OMB 0584-0659 · Object 111951101.
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | Q. Consent Form for Focus Group With SNAP Participants revised |
| Author | Rachel Holzwart |
| Last Modified By | Writer |
| File Modified | 2021-05-21 |
| File Created | 2026-10-29 |
| Conversion State | complete |
Extracted Text
Appendix Q. Consent Form for
Virtual Focus Group With SNAP Participants
OMB No. 0584-0659
Modernizing Channels of Communication
With SNAP Participants
February 12, 2020
Project Officer: Andrew Burns
Office of Policy Support
Food and Nutrition Service
U.S. Department of Agriculture
1320 Braddock Place
Alexandria, VA 22314
703.305.1091 [email protected]
Modernizing Channels of Communication With SNAP Participants:
Consent Form for Virtual Focus Group with SNAP Participants
You have been selected to participate in a research study being conducted by the U.S. Department of Agriculture’s (USDA) Food and Nutrition Service (FNS). The purpose of this study is to highlight best practices and lessons learned from various mobile communication strategies tested in State SNAP agencies through case studies.
If you agree to participate, here are some things you should know:
• Your participation is completely voluntary (not required) and will not affect your SNAP benefits in any way.
• Your name will never be used in any reports about this focus group.
• All information collected during this study will be kept private, and your responses will not be identified individually in any way; except as required by law.
• With your permission, the discussion will be audio- and/or video-recorded. We are talking with SNAP participants from many States, so this will help us keep track of and accurately report who said what. We will not share the recording with anyone outside the research team, and we will destroy the recording when the study is over.
• Your input will help FNS and States improve communication with clients and identify best practices that lead to improved program outcomes. This information is particularly important today because advances in mobile communications can help States streamline their operations while improving communication with SNAP participants.
• You may choose not to answer any questions. You may also leave the discussion at any time. You will not be affected in any way if you stop the discussion or decide not to answer a question.
• The discussion leader will answer any questions you have about the discussion.
• The focus group will take about 90 minutes. It will include questions about how you use mobile communications (for example, the SNAP website or an app on your phone), suggestions for improvement, how satisfied you are with the features of your State’s mobile communication strategy, and the ways mobile communications have changed your SNAP application and benefit management experience.
• You will receive a $45 Mastercard, Visa, American Express or Discover gift card at the end of the focus group as a token of appreciation.
Contact Information: USDA/FNS has authorized Insight Policy Research to conduct this study. If you have any concerns about your participation in this discussion or have any questions about the study, please contact the Project Officer, Andrew Burns, at [email protected] or 703.305.1091.
Certification: By verbally agreeing to particpate, you are certifying that we have reviewed this agreement. [FACILITATOR OBTAIN VERBAL CONSENT PER FOCUS GROUP PROTOCOL]