Consent Form

CONSENT FORM

OMB CONTROL NUMBER: 0703-GLPS

OMB EXPIRATION DATE: X/XX/20XX

Authority to request this information is granted under 5 U.S.C. 301, Departmental Regulations; 10 U.S.C. 5031 and 5032. License to administer this survey is granted per OPNAVINST 5300.8C.

PURPOSE: The purpose of this survey is to collect information about public perceptions of the U.S. Navy and its activities.

ROUTINE USES: The information provided in this survey will be analyzed and maintained by the U.S. Navy and will be used by the U.S. Navy Chief of Information to make policy decisions that will best help sailors.

CONFIDENTIALITY: All responses will be kept confidential. Personal identifiers will be used to evaluate trends and differences in subgroups. All data collected will be statistically summarized with the responses of others and will not be attributable to any single individual.

PARTICIPATION: Completion of this survey is entirely voluntary. Failure to respond to any of the questions will NOT result in any penalties except possible lack of representation of your views in the final results and outcomes. If you agree to participate, you may withdraw your participation in the survey at any time by simply exiting the survey. If you are not comfortable answering one of the survey questions, you are free to leave it blank.

AGENCY DISCLOSURE NOTICE

The public reporting burden for this collection of information, 0703-GLPS, is estimated to average 15 minutes, including the time for reviewing instructions and completing and reviewing the collection of information. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at [email protected]. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.