1689 Focus Group Consent Form - Drivers

OMB Control Number: 2127-NEW

Expiration Date: xx/xx/xxxx

Under the Paperwork Reduction Act, a Federal agency may not conduct or sponsor, and a person is not required to respond to collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control number. The OMB Control Number for this information collection is 2127-NEW (expiration date: xx/xx/xxxx). The average amount of time to complete the informed consent is 5 minutes. Your participation and all your responses to this collection of information are voluntary. The purpose of this research study is to examine public attitudes toward child passenger safety and relationships between attitudes, behaviors, and demographics. The information collected will be summarized in a report to support future countermeasure development. If you have comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden send them to Information Collection Clearance Officer, National Highway Traffic Safety Administration, 1200 New Jersey Ave, S.E., Washington, DC, 20590.

Child Passenger Safety Perceptions and Practices in Ridesharing Vehicles

Focus Group Participant Consent Form

Drivers

Under the Paperwork Reduction Act, a Federal agency may not conduct or sponsor, and a person is not required to respond to collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control number. The OMB Control Number for this information collection is 2127-NEW (expiration date: xx/xx/xxxx). The average amount of time to complete the informed consent is 5 minutes. Your participation and all your responses to this collection of information are voluntary. The purpose of this research study is to examine public attitudes toward child passenger safety and relationships between attitudes, behaviors, and demographics. The information collected will be summarized in a report to support future countermeasure development. If you have comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden send them to Information Collection Clearance Officer, National Highway Traffic Safety Administration, 1200 New Jersey Ave, S.E., Washington, DC, 20590.

This study will inform the National Highway Traffic Safety Administration (NHTSA) on rideshare drivers’ views and experiences when transporting a passenger with a child that requires a child restraint (child seats, boosters, etc.). NHTSA has hired Westat, Inc. to perform the study.

To help you decide if you want to participate in this study, this form provides important information about what you will be asked to do during the focus group, the risks and benefits of the focus group, and your rights as a research participant.

• If you have any questions or do not understand something in this form, you should ask the researcher for more information.

• Before you make a decision about your participation, you can also discuss your participation with anyone you choose, such as family or friends.

• Do not agree to participate in this focus group unless the research team has answered all your questions and you decide that you want to be part of this focus group.

• You are being asked to participate in a focus group to gather information to help NHTSA understand the attitudes and practices of drivers with respect to using child restraint systems in rideshare vehicles.

If you agree to participate in this study, please sign your name at the end of this form. You will receive a copy of the signed version for your records.

Purposes and Procedures. The purpose of this focus group is to collect information about your perceptions and behaviors of child restraint systems in rideshare vehicles. You will participate in one (1) session lasting approximately 90 minutes. We will record both the audio and video of this discussion to help with our analysis and to draft a report of our findings. The focus group session will take place as a video conference call using the [Zoom or Microsoft Teams] platform.

Participation. Your participation in the focus group is completely voluntary. You may agree or refuse to participate. If you agree to participate, you may withdraw from the focus group at any time without penalty. If you complete the focus group, you will receive a total of $50 your participation.

Confidentiality. All information collected during the study is confidential to the fullest extent of Federallaw and will not be presented in any form that identifies you. You will never be identified in any reports that we write. The information gathered during the focus group will be used only by Westat and NHTSA staff who are involved in the project. All documents containing identifying information about you will be destroyed within twelve months of the end of this research study.

Risks. There are no expected risks in participating in this focus group.

Benefits. The findings of this study will identify how people are restraining children in rideshare vehicles, identify driver perceptions of restraint use in rideshare vehicles relative to personal vehicles, and will be used to develop countermeasures to enact change and improve child restraint use in rideshare vehicles. There are no direct benefits to you.

Questions. If you have any questions about this study, please contact:

Dr. Doreen De Leonardis

(301) 315 - 5963

Westat

1550 Research Boulevard

Rockville, MD 20850

If you have any questions at any point during this study about your rights and welfare as a research participant, please call the Westat Human Subjects Protection office at 1-888-920-7631. Please leave a message with your first name and the name of the study, “Child Passenger Safety Perceptions and Practices in Ridesharing and Autonomous Vehicles”, and a phone number beginning with the area code. Someone will return your call as soon as possible.

Authorization. By signing this form, you certify that you have read this form and that you agree to take part in the study. By signing this form you also agree to be video and audio recorded.

I _____________________ (participant’s name) have received information about being involved in the Child Passenger Safety Perceptions and Practices in Ridesharing and Autonomous Vehicles. I have read this form, I understand it, and my questions have been answered. I agree to participate in the study.

__________________________________________

Participant’s Name – printed

__________________________________________ ___________

Participant Signature Date

Statement of Person Who Obtained Consent

I have discussed the above points with the participant. It is my opinion that the participant understands the risks, benefits, and procedures involved with participation in this research study.

__________________________________________ ___________

Signature of Person who Obtained Consent Date

NHTSA Form No. 1689