3170-0024 YMYG Process Eval - Informed consent OMB

Your Money, Your Goals Survey Consent Form
You are invited to participate in a web-based online survey related to the Your Money, Your Goals
(YMYG) program. This is a research project being conducted by the RAND Corporation on behalf of the
Consumer Financial Protection Bureau. Our partner, Davis Research, is administering the survey.
This survey is about your satisfaction with the YMYG training and materials that you received. You're
eligible to be in this study because you attended a YMYG training on behalf of your organization. Please
note that we are not conducting this survey to evaluate you or your organization. The focus of this
survey is to understand how the CFPB can improve the training and develop new resources for
organizations and individuals interested in using YMYG.
It should take approximately 25 minutes to complete the survey.
Your answers will help to inform the YMYG program and toolkit and will benefit those who are trained
to use YMYG.
Your participation in this survey is voluntary. You may refuse to take part in the survey or decline to
answer any particular question you do not wish to answer for any reason. You may exit the survey at any
time and come back later and resume the survey where you left off.
There are no foreseeable risks involved in participating in this survey other than those encountered in
day-to-day life.
Your survey answers will be collected by our partner Davis Research and stored in a password protected
electronic format. Your name and employer name will not be linked to your survey responses.
Therefore, your responses will remain anonymous. Information about whether your participated will be
kept separate from your responses. No one will be able to identify you or your answers. No names or
identifying information about you or your organization will be included in any publications or
presentations based on this data, and your responses to this survey will remain private.
Privacy Notice The information you provide will assist the Consumer Financial Protection Bureau gather
data to understand how Your Money, Your Goals (YMYG) organizations integrate YMYG into their social
service programs. You will be asked a series of open ended questions. Participation is voluntary. You are
not required to participate, nor are you are not required to provide any identifying information.

Paperwork Reduction Act Statement
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and
not withstanding any other provision of law a person is not required to respond to a collection
of information unless it displays a valid OMB control number. The OMB control number for this
collection is 3170-0024. It expires on 5/31/2022. Comments regarding this collection of
information, including the estimated response time, suggestions for improving the usefulness
of the information, or suggestions for reducing the burden to respond to this collection should
be submitted to the Consumer Financial Protection Bureau (Attention: PRA Office), 1700 G
Street NW, Washington, DC 20552, or by email to [email protected].

CONTACT
If you have questions at any time about the study or the procedures, you may contact Katherine Carman
at [email protected]. If you have questions about your rights as a research participant or need to
report a research-related injury or concern, you can contact RAND's Human Subjects Protection
Committee toll-free at (866) 697-5620 or by emailing [email protected]. If possible, when you contact
the Committee, please reference Study #XXXX-XXXX.
ELECTRONIC CONSENT: Please select your choice below. You may print a copy of this consent form for
your records. Clicking on the “Agree” button indicates that
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You have read the above information
You voluntarily agree to participate
You are 18 years of age or older

 Agree
 Disagree