Consent form

Attachment C:

Draft Consent Form (10.13.2023)

PURPOSE

The National Instutite of Justice, in coordination with the Office of Juvenile Justice and Delinquency Prevention, is conducting a short study, with assistance from the U.S. Census Bureau, to improve questions on the Juvenile Residential Facility Census and Census of Juveniles in Residential Placement. The purpose of this study is to test modifications to questions and definitions included in the JRFC and CJRP. If you agree to participate, you will be asked to complete a few survey questions and discuss how you answer these questions during a confidential interview. Your responses and feedback will help improve the quality of the JRFC and CJRP survey forms.

AUTHORITY AND CONFIDENTIALITY

This survey is conducted by the OJJDP under the authority 34 U.S.C. § 10121-10122 and 34 U.S. Code § 11114. OJJDP awarded funds through an Interagency Agreement to the U.S. Census Bureau to operate as OJJDP’s data collection agent and administer the JRFC and CJRP surveys. OJJDP and the Census Bureau are both required by law to protect the privacy and confidentiality of the data you provide (Title 34 U.S.C. Section 10231 and 28 C.F.R. Part 22).

OJJDP and the Census Bureau can use your responses only for statistical and research purposes and are not permitted to publicly release your responses in a way that could identify you, your facility, organization, or instiutition. Additionally, per the Federal Cybersecurity Enhancement Act of 2015, your data are protected from cybersecurity risks through screening of the systems that transmit your data.

This study has been approved by the Office of Management and Budget (OMB). This eight-digit OMB number, [insert here], confirms this approval and expires on [date]. Without this approval, we could not conduct this study.

BURDEN ESTIMATE

We estimate that completing this interview will take no more than 45 minutes. You may send comments regarding this estimate or any other aspect of this survey, including suggestions for reducing the time it takes to complete this survey, to [email protected].

CONSENT FORM

You have volunteered to take part in a study of data collection procedures. You will connect with our interviewer via Microsoft Teams for the virtual interview, in which you will answer the survey questions and then discuss the questions with the interviewer via computer audio or telephone. The interview will be conducted by a staff member from the U.S. Census Bureau. We plan to use your feedback to improve the content, design and layout of the Juvenile Residential Facility Census and Census of Juveniles in Residential Placement .

We would like to audio record what you say during the interview. Only the people who work on this study will hear the recording, which will simply be used to ensure we have understood your answers. If you don’t want to be recorded, that’s okay.

Please Check the appropriate options below to indicate your consent.

 I have read the above, understand that my participation is voluntary, and I agree to participate.

 I agree for this interview to be audio-recorded.

 I do not agree for this interview to be audio-recorded.

 I do not agree to participate in the study.

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Signature of Research Participant Date

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Printed Name of Research Participant