Consent form

Usability Consent Form.docx

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Consent form

OMB: 0935-0179

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What this study is about

The purpose of this study is to see how users interact with the website. Your participation will help us determine areas for improvement.


Your participation in this study is voluntary

You can take a break at any time or leave at any time without giving a reason.


Information we are collecting

We will ask you to share your screen via Zoom or Microsoft Teams so we can see how you interact with a prototype of a new website design. We will watch how you do various tasks, and we will ask you some questions. We will record the session and take notes to record your comments and actions.


How we ensure your privacy

If you choose to move forward as a participant of this study, you may watch the recording of your session in the future. These recordings will be treated as confidential and will not be shared outside of those who are working on this project.

We may publish research reports that include your comments and actions, but your data will stay anonymous - meaning, your name and identity will not be included within any of our research reports.


Your consent

Please sign this form showing that you consent to us collecting these data. I give my consent (please tick all that apply):

  • For people to observe me during the test.

  • For the session to be recorded.

  • For people on the project design team to watch the recording in the future.

If you wish to withdraw your consent in the future, contact [email protected].

  • I agree

  • I disagree



Your Name

_______________________



File Typeapplication/zip
AuthorMark Hallett
File Modified0000-00-00
File Created2023-11-13

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