ETA Interview Consent Form

12/2/22, 9:29 AM

Introduction

Introduction
OMB Control No. 1225-0093 | Expiration Date: 02/29/2024

Thank you for taking the time to speak with us.  The purpose of this form is share
information about our study and obtain your informed consent to participate. 
Please read the statements below and fill in your name where indicated.
By submitting this form you are indicating that you have read the description of the study and
that you agree to the terms as described.  
If you have any questions, or would like a copy of this consent form, please contact
[email protected]
Thank you!
* Required

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12/2/22, 9:29 AM

Introduction

OMB Control No. 1225-0093 | Expiration Date: 02/29/2024 
What this study is about
This interview is part of a series of interviews conducted by the
Technology Transformation Service on behalf of the Department of
Labor as part of a project aiming to improve the American Job
Center experience and CareerOneStop website.
Your Involvement in the Study
We will ask you questions about your experience with job searching,
gaining needed training and with the CareerOneStop website. With
your permission, we will record you on audio and/or video, and we
will take notes to document your comments. We may ask you to
share your screen and try some activities on the CareerOneStop
website as well as at least one other career website as we watch
and ask questions. The interview should take a maximum of 1 hour
altogether.
Your Participation is Voluntary
Participation is completely voluntary. You may refuse to answer any
questions or end participation at any time.  
Confidentiality

Informed
Consent for
Research
Participation

We will take necessary and appropriate precautions to keep what
you tell us confidential. We may publish research reports, articles, or
training content that includes your anonymous comments and
experiences shared. We will not use your real name in any of our
published or presented research materials.
Storage of Personal Information and Session Data 
We will store and process your personal information and session
data until we deem the content no longer necessary for the research
purposes outlined above. This data can include your name, email
address, and phone number. 
Statement of Consent
I have read the above information and received answers to any
questions I have asked. I consent to take part in this interview and to
have any information I provide be used in the manner described
above. I understand that my name will not be used in connection to
my words or any recordings taken during the duration of this
interview. I expressly release the Technology Transformation Service
from and against any and all claims that I have or may have for
invasion of privacy, defamation, or any other cause of action arising
out of the production, distribution, display, or publication of the

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Introduction

results of the project, so long as the conditions of use described
above are met.

If you agree to participate in this study, please type your name in
the box below.

1.

If you agree to participate in this study, please type your name in the box
below.

*

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 Forms

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