Consent Form Example

Consent Form

For Individual Participants

Usability Testing of the Census Business Development Tool

Each year the Census Bureau conducts many different usability evaluations. For example, the Census Bureau routinely tests the wording, layout and behavior of products, such as Web sites and online surveys and questionnaires in order to obtain the best information possible.

You have volunteered to take part in a study to improve the usability of the Census Business Builder. In order to have a complete record of your comments, your usability session will be audio recorded. We plan to use the recordings to improve the design of the product. Only staff directly involved in the research project will have access to the tapes. Your participation is voluntary and your answers will remain strictly confidential.

This usability study is being conducted under the authority of Title 13 USC. The OMB control number for this study is 0607-0725. This valid approval number legally certifies this information collection.

I have volunteered to participate in this Census Bureau usability study, and I give permission for my tapes to be used for the purposes stated above.

Participant’s Name: ______________________________________

Participant's Signature: ____________________________________ Date: ­­­­­__________

Researcher’s Name: _____________________________________

Researcher's Signature: ___________________________________ Date: __________