Final - Appendix B_Family Consent Form

IRB# 17269
Approved on: 08/25/2023
Valid until: 06/06/2024

Consent Form (Families) – HUD Child Care Study
Researchers from Child Trends and Summit Consulting LLC are jointly conducting a research study with funding from the
U.S. Department of Housing and Urban Development. For the study, we will be talking with approximately 108 parents or
caregivers living in public housing developments. This form has information to help you decide if you want to participate in
the study.
1. PURPOSE:
We would like to talk with you about the child care
needs and preferences of families who live in public
housing developments. The lessons learned from the
project will be used to help public housing
developments and policymakers better understand
and address families’ child care needs.
2. PROCEDURES:
You are being asked to participate in an hour long inperson or virtual interview (whichever you prefer) on
Date-Date. Your participation in this interview is
completely optional.
3. RISKS AND/OR DISCOMFORTS:
Risks associated with participation include potential
loss of confidentiality and psychological discomfort. To
protect your confidentiality, your name will not be
used in reports, and your individual responses will not
be shared with anyone outside the study team. During
the interview some questions may make you
uncomfortable. If we come to a question you do not
wish to answer, you do not have to answer the
question, and we can continue with a different
question.
4. VOLUNTARY PARTICIPATION:
Your participation in any activities as part of this study
is voluntary. You can choose to leave or stop the
interview at any point. If you decide at any point that
you no longer wish to be included in the study, you can
let a member of the study team know or you can
contact us at [email protected].
5. CONFIDENTIALITY:
During the interview the study team will record the
conversations and take notes so that we don’t miss

anything you say. Recordings, notes, and transcriptions
will all be stored on a secure drive, will only be
accessible by the study team, and will be destroyed
after we finish the study. Study reports will describe
findings in general terms. No one outside the study
team will not have access to names of those who have
participated in the study.

6. COSTS AND BENEFITS:
There are no costs associated with the study other
than the time you spend participating in the interview.
You will not benefit personally from being involved in
the study. To thank you for your participation, you will
receive a $50 gift card.
7. QUESTIONS:
If you have any comments or concerns about
participating in this study or about your rights as a
participant in this study, you can contact Sara Shaw at
[email protected] or (240) 223-9222

8.

PRA BURDEN STATEMENT:

Public Reporting Burden for this information collection
is estimated to average 60 minutes, including the time
to administer informed consent. The collection is
designed to gather information to support the Study of
Childcare in Public Housing. Send comments regarding
this burden estimate or any other aspect of this
collection of information, including suggestions to
reduce this burden, to U.S. Department of Housing and
Urban Development, Office of the Chief Data Officer,
R, 451 7th Street SW, Room 8210, Washington, DC
20410–5000 or e-mail:
[email protected]. When

providing comments, please refer to OMB Control No.
XXXXX. 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.