Final - Appendix F - Informed Consent and Agreement to Participate

Evaluation of the Eviction Protection Grant Program

INFORMED CONSENT AND AGREEMENT TO PARTICIPATE

OMB Control # __-__

PRA Burden Statement: ­­Public Reporting Burden for this information collection is estimated to average 5 minutes. The collection is designed to provide potential study participants with sufficient information for individuals to provide informed consent to participate in a future focus group. This collection is related to the Evaluation of the Eviction Protection Grant Program.

Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions to reduce this burden, to Anna P. Guido, Reports Management Officer, REE, Department of Housing and Urban Development, 451 7th Street SW, Room 8210, Washington, DC 20410–5000. When providing comments, please refer to OMB Control No. 2528–XXXX. HUD may not conduct and sponsor, and a person is not required to respond to, a collection of information unless the collection displays a valid OMB Control Number.

You are being invited to participate in a focus group to provide your input on a study of the U.S. Department of Housing and Urban Development’s (HUD) Eviction Protection Grant Program. Please read this Informed Consent and Agreement to Participate form carefully. Before the start of the focus group, we will review this information together. You may ask as many questions as you would like before you decide whether you would like to continue participation in the focus group session. You are also free to reach out to the study’s project manager, Dr. Hiren Nisar ([email protected]), to ask questions at any time before, during, or after your participation in the focus group.

Why You Were Invited to the Study: You indicated your willingness to participate in a focus group about the eviction-related services you received from [insert grantee/subgrantee name], which received funds to provide these services from the Eviction Protection Grant Program. 2M Research (2M) is inviting up to five clients served by [insert grantee/subgrantee name] to participate in this focus group.

Purpose of the Focus Group: The purpose of this focus group is to hear from you directly, in your own words, about your overall experience with the [insert program name/grantee here]. You will be invited to share your experiences, both positive and negative, related to the services and support that you received from [insert grantee/subgrantee name]. We are also interested in any suggestions you might have regarding how to make the program even better for those who may need eviction-related assistance in the future.

Participation is Always Voluntary: Your participation in this study is voluntary. As a participant, you have the right to get answers to any questions you have about the study. You are free to withdraw from the study at any time. If you choose to stop participating in this study, you can do so at any time without any penalty or loss of benefits you may receive now or in the future.

Procedures: The focus group will last approximately 90 minutes, during which time you will be asked to share your honest thoughts and opinions about your experiences. There will be up to five clients participating in each focus group, creating an open atmosphere like a group conversation. There will be a group facilitator who will ask questions and ensure the focus group wraps up in the allotted time.

Possible Discomfort or Risks: The risks to you of participating in this study are minimal. We understand that some of these experiences may be difficult to remember or talk about. You do not need to answer any questions that you do not wish to answer, and you may stop participating in the focus group at any time. If you decide not to participate, that is completely fine.

Privacy and Confidentiality: All the information we gather in this focus group will be kept private and will be used for research purposes only. Your name will never be used in any reports. Your individual responses will not be shared with [insert grantee/subgrantee name] or HUD. The information collected by the study team will be mostly aggregated for reporting purposes to HUD. Interesting quotes, however, may be included in the report mainly to illustrate a point. These quotes will be untraceable to the speaker. Instead, we will use pseudonyms to represent speakers. Your contact information will not be shared with other focus group participants.

We request that all participants keep any information shared during the focus group confidential. Because the focus group will have multiple participants, however, we are unable to guarantee complete confidentiality.

Incentives: Participants will receive a $50 gift card in appreciation for their time. At the end of the focus group session, 2M will confirm their contact information for providing the gift card to the participant.

Accommodations: If you require information to be presented in an accessible format or reasonable accommodations to participate in this study, please contact us with any specific requests. If you require language assistance to participate in this study, please contact us with any specific language assistance requests or needs.

Questions: If you have any questions, concerns, or complaints about this study, please contact the study’s principal investigator, Dr. Hiren Nisar ([email protected]).

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