Informed Consent 2

OMB# 0584-0524 Exp: 12/31/2022

RETAIN FOR YOUR RECORDS

Attachment D–Producer Informed Consent

OMB BURDEN STATEMENT: This information is being collected to assist the Food and Nutrition Service in assessing knowledge change regarding specific farm to school strategies and topics; your perceptions about usefulness of training topics; your suggestions for improving trainings; and your plans for implementing strategies. This is a voluntary collection and FNS will use the information to evaluate the effectiveness of the farm to school producer training. According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number.  The valid OMB control number for this information collection is 0584-0524.  The time required to complete this information collection is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Service, Office of Policy Support, 1320 Braddock Place, Alexandria, VA 22306 ATTN: PRA (0584-0524).

PRIVACY ACT STATEMENT: This information is being collected for statistical research or reporting purposes only. Please refer to System of Records Notice for FNS-8, “FNS Studies and Reports,” located in Federal Register Volume 56 Number 80, for System location, categories of individuals covered, categories of records, purpose, routine uses, storage, retrieval, safeguards, and retention and disposal. FNS-8 is located here: https://www.govinfo.gov/content/pkg/PAI-2017-USDA/xml/PAI-2017-USDA.xml#fns8. Records will not be retrieved by personally-identifiable information and retention requirements will be followed in accordance with FNS Agency Records Retention Schedule and Records Management Policy 270-1.

Title of Information Collection: Evaluation of Farm to School Program Training and Curricula for State Agencies and Producers

Sponsor: U.S. Department of Agriculture

Principal Investigator: Carolyn Dimitri, PhD

Telephone: 212-992-7899 (9am-5pm)

Address: New York University

411 Lafayette Street, 5th Floor
New York, NY 10003
[email protected]

You will be taking part in a workshop focused on assisting producers in farm to school marketing and other farm to school activities. You are receiving this form because you are being invited to provide feedback on the workshop and help us evaluate the effectiveness of the training.

Please read this document carefully. It contains important information about this research study. If there is any information that you do not understand, we will be happy to answer your questions.

Introduction: About this study

The National Center for Appropriate Technology (NCAT) and National Farm to School Network (NFSN) have a cooperative agreement with the U.S. Department of Agriculture’s (USDA) Food and Nutrition Service (FNS) to develop a producer-focused farm to school curriculum, equip State agencies and their representatives to facilitate trainings using the curriculum, and support State agencies and others as they implement trainings.

The goal of this research is to assess knowledge change regarding specific farm to school strategies and topics; your perceptions about usefulness of training topics; your suggestions for improving trainings; and your plans for implementing strategies. New York University researchers are conducting this research.

Procedure: What will I do during this study?

You are being asked to take part in three surveys. The first survey (which should take approximately 10-15 minutes to complete) will be given prior to the workshop by your trainer. The second survey (10 minutes to complete) will be given to you immediately following the workshop. A final survey (which will take approximately 10 minutes to complete) will be sent you via email six months to one year following your workshop.

Study Benefits: What good comes from this study?

Your feedback will help us assess the effectiveness of the training and the development of the curriculum and will inform revisions made to the curriculum for later use.

Token of Appreciation: Will I be paid for being in this study?

There is no cost to you for taking part in this study. You do not have to answer any questions that you do not want to. You will not receive compensation for the first two surveys. If you complete the first two surveys and the final survey, you will be entered into a lottery to win one of 20 chances for $25.00 in cash.

Anticipated Risks: Could anything bad happen to me during this study?

We will take care to minimize any risks of participating in this study. As with all research, there is a chance that privacy could be breached. For example, despite the best efforts of the research team to keep the information we collect during the study private, a breach may occur as a result of accidental human error or hacking. In the event a breach occurs, all participants will be contacted and notified as to the extent of the breach, any damages incurred, and future potential risks; contact information for additional inquiries will also be provided. If you have any questions about this research study, you may call one of the research team members at 301-891-0470 or email a study representative at [email protected]

Privacy: Who will see the results of this study?

We will not disclose your identity in any report or presentation. We will be collecting some personal demographic information from you, like age and ethnicity, and information that could identify you, like name, farm name, and state, so that we can link your responses from pre-to-post survey. However, only the researchers from NYU will have access to any identifying information. Any data shared with other project partners (NCAT, NFSN, and USDA) will be de-identified, meaning any information (such as your name) that can be tied to your responses will be deleted from your responses before being shared with other project partners.

Everything you share will be kept confidential to the extent allowable by law. This means that we will not share any information you provide with anyone outside the study unless it is necessary to protect you, or required by law. However, if you indicate a direct threat of harm to yourself or others, we reserve the right to take necessary action out of concern for your welfare and the welfare of others.

All of the information we collect, including your individual surveys, will be kept for two years. The information will be stored on a password-protected computer and/or in locked cabinets that only the research team can access. After two years, all of the collected data will be destroyed by securely shredding documents or permanently deleting electronic information. The resulting de-identified datasets (which do not include any personally identifiable information) will be retained for analysis.

Results from this study may appear in professional journals or at scientific conferences. No individual participants will be identified or linked to the results. We will not disclose your identity in any report or presentation. Results may also be used in future research or shared data with other researchers. Other researchers will not have your name or any identifying information.

Participation and Withdrawal: Do I have to be in this study? What if I change my mind?

You can choose to take part in the study or not. You can choose to not complete the survey or leave the survey at any time. You do not have to answer any questions you do not want to. The study is completely voluntary and you can stop participating at any time.

Who do I contact if I have questions about the study?

If you have questions or concerns about the study, you can contact:

Carolyn Dimitri, New York University

[email protected]

orsmarshgroup.com

PLEASE CHECK ONE OF THE BOXES

Yes, I agree to participate in this study. I have read, understand, and had time to consider all of the information above. I have no further questions.

No, I do not agree to participate in this study. I have read, understand, and had time to consider all of the information above. I have no further questions.

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