Attachment MICS-4_MICS Informed Consent_Revised_11-21-22_Tracked Changes

Attachment MICS-4_MICS Informed Consent_Revised_11-21-22_Tracked Changes.docx

2022 National Survey on Drug Use and Health (NSDUH)

Attachment MICS-4_MICS Informed Consent_Revised_11-21-22_Tracked Changes

OMB: 0930-0110

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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. If you agree to be recorded, please know that your recording and interview responses may be de-identified and used for quality or training purposes for this research project, but will not be used for other research studies in the future. 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 know the full risks and benefits of the study, and how the information will be used, 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?

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorAlward, David
File Modified0000-00-00
File Created2023-08-17

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