3 Informed Consent

Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration

Informed Consent

HRSA Division of Transplantation (DoT) Formative Evaluation Minority Organ Donation Outreach (Online Focus Groups)

OMB: 0915-0212

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Informed Consent


As part of a project for the Health Resources and Services Administration (HRSA), Crosby Marketing is conducting this online focus group to get your thoughts. A focus group involves a small group of people (up to six) who are asked to review materials and share their opinions. The conversation is led by a professional moderator. The purpose of this group is to review materials related to organ donation. Feedback from the session will be used to finalize the materials before they are published. The session is being held to get your opinions. No one will try to sell you anything or get you to sign-up for anything. Participation is voluntary, and you may leave the session at any time.


Please review the following statements and indicate whether you agree to be in the group:


  • I understand that it is my decision whether or not I want to be in the group.


  • I understand there are no known risks to being in the group. I do not have to answer every question if I do not want to. (If you would like more information about this, please let us know.)


  • My name will not be used in any reports. Crosby will video and audio record the group to make notes from the session. Other people on our team may also be watching the groups so they can hear your ideas, too. Once the final report is complete (anticipated about two months after this session), the recordings will be destroyed. All personal information (e.g., the names of people in the group) is kept separate from these recordings.


  • I will receive money as a thank-you for taking the time to be in the group.


  • I can leave the group at any time, or not answer any question, and I still get the money for your time.


  • I will have the chance to ask any questions at the start of the group. If I think of a question later, I can call the person listed below.


  • The focus group will last approximately 90 minutes.


Contact information: If you have any questions, please contact Anna Zawislanski at 301-951-9200.



Please type your name to say that you understand this information and want to be in the group.



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File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleInformed Consent
AuthorChristine Brittle
File Modified0000-00-00
File Created2023-12-15

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