DoD_Informed_Consent

CONSENT TO PARTICIPATE IN THE ASK U.S. PANEL PILOT

[TO BE PRESENTED AT THE BEGINNING OF THE BASELINE ENROLLMENT SURVEY]

Description and Purpose of the Ask U.S. Panel pilot: The Ask U.S. Panel is a national survey panel by the U.S. Census Bureau. The purpose for collecting this information is to track public opinion on a variety of topics of interest to numerous federal agencies and their partners, and for conducting experimentation on alternative question wording and methodological approaches. A key objective of the Panel will be to produce representative and reliable statistics on a rapid turnaround suitable for use by federal agencies. The Panel will ensure availability of frequent data collection for nationally representative estimates on a variety of topics and a variety of subgroups of the population. The panel pilot also will test feasibility and procedures that will be used to develop and implement future panels. The panel pilot will consist of individuals and households living across the U.S., including active-duty service members and spouses of active-duty service members, that have agreed to be contacted and invited to participate in surveys led by the U.S. Census Bureau and other federal agencies, including Department of Defense (DoD).

Privacy Act Statement: The legal authority for the Ask U.S. Panel Pilot is provided under 13 U.S.C §§ 8(b), 131, 141, 161, 181, 182, and 193; 49 U.S.C. § 329; the Education Sciences Reform Act of 2002, 20 U.S.C. §9543. Section 1110(a) of the Social Security Act as amended, 42 U.S.C. 1310(a); 7 U.S.C. § 3318; 7 U.S.C. 2204(a); Section 306 of the Public Health Service Act, 42 U.S.C. 242k; and 10 U.S.C. § 1782.

The U.S. Census Bureau is conducting this survey in partnership with the Department of Defense, as well as other federal agencies under the authority of 13 U.S.C. Section 8(b).

Personally identifiable information (PII) collected includes: Name, Address, Telephone/cell phone number, Date of Birth or age, Email address, Race or ethnicity, and Unique Identifier (Code).

Your privacy is protected by the Privacy Act of 1974 (5 U.S.C. § 552a). Disclosure and use of this information are subject to the published routine uses identified in the Privacy Act System of Records Notice COMMERCE/Census-3 Demographic Survey Collection (Census Bureau Sampling Frame); COMMERCE/Census-5 (Decennial Census Program); and COMMERCE/Census-7 Demographic Survey Collection (non-Census Bureau Sampling Frame).Partner agencies may provide PII to the Census Bureau under the Privacy Act ((5 U.S.C. § 552a(b)(4)). All PII will be secured by staff (employees and contractors) that have received training on privacy and confidentiality laws, policies, and practices. Access to the information that you provide is restricted to authorized personnel. The information will be shared only with staff, contractors, and non-Census sponsors that are authorized and have a need to know.

Furnishing this information is voluntary. Failure to do so will result in the Census Bureau’s inability to create a robust probability-based nationwide survey panel.

Sponsor: The Ask U.S. Panel pilot is sponsored by the U.S. Census Bureau in partnership with DoD and other federal agencies. RTI International, a not-for-profit research organization, is establishing and maintaining the pilot panel on behalf of the U.S. Census Bureau and DoD.

Procedures: Your participation in the pilot panel will last up to 1 year, during which time you will be asked to complete a 20-minute enrollment survey, followed by an additional 15-minute survey later in 2022.

Financial Considerations: Participation in the Ask U.S. Panel pilot will involve no cost to you. You previously received $5 in your initial invitation letter. If you complete the enrollment survey, you will receive an additional $20. Once enrolled in the panel, you will receive $10 for completing an additional 15-minute panel survey later in 2022.

Voluntary Participation: Your participation in the pilot panel is completely voluntary. While your responses are very important to us, you can refuse to answer any and all questions, or choose not to participate in future surveys. You can elect to leave the panel at any time. You may also withdraw your response at any time by contacting the panel project team.

Possible Benefits and Risks: There are no direct benefits to you for participating in the pilot panel, but your answers may help improve military policies. The potential exists for loss of privacy, though our procedures are designed to protect and secure your personal information. Please see the Privacy section above for details on the procedures in place to protect your privacy.

Further Questions: If you have any questions about the research now or in the future you can contact the Ask U.S. Panel pilot project team at [email protected] or at 1-866-558-0774 from 9:00 am-12:00 am Monday through Thursday, 9:00 am-11:00 pm on Fridays, 10:00 am-9:00 pm on Saturdays, and 1:30 pm-11:00 pm on Sundays (EST). If you have any questions or concerns about your rights as a research subject, you may call the University of Southern Maine Office of Research Integrity and Outreach at (207) 780-4517 and/or email [email protected].

By clicking “Next” below, you are agreeing to enroll in the Ask U.S. Panel pilot and receive an invitation to a future Ask U.S. Panel pilot survey.