Attachment MICS-4_Full Informed Consent_Final_9-12-22

Clinical Interview Informed Consent
First, I need to share some key information about the study. You have been selected for a follow-up
study to the National Survey on Drug Use and Health. This study, sponsored by the U.S. Department of
Health and Human Services, will ask questions about mental health and consists of one interview.
The interview should take about 60 minutes to complete. Your participation is voluntary, and you can
refuse to answer any questions. If you decide to participate, I will ask you questions using a laptop
computer. I will ask for permission to record the interview to ensure I did it properly. You can still be
interviewed even if you do not allow the interview to be recorded. Your interview recording may be
used for quality or training purposes. You have received $30 for agreeing to participate in this interview.
All information collected for this study will be kept confidential and used only for statistical purposes.
You cannot be identified through any information you give us. Your name and address will never be
connected to your answers. However, there are some exceptions to this privacy rule. If you tell me
about the abuse of a child or that you plan to hurt yourself or others, we may need to notify a mental
health professional or other authorities.
If you would like to hear more about the study, I can read the more detailed informed consent to you
now, or you can read it at https://nsduhappt.rti.org.
Do you agree to participate in this study?