Attachment C - Focus Group Consent Form

OMB Control Number: ####

Expiration Date: ####

Affordable Housing and Supportive Services Demonstration

Informed Consent Form to Participate in the Focus Group

What is the purpose of this study?

The Administration of Children and Families (ACF) at the U.S. Department of Health and Human Services is conducting this study to understand how the Affordable Housing and Supportive Services Demonstration has strengthened and expanded the availability of wraparound supportive services for residents of affordable housing communities receiving funding from the program. The types of wraparound supportive services funded differs for each housing community in the study, but they may include services like child care, transportation, financial literacy training, referrals to other services, and many more types of services. We are interested in learning the types of services residents are able to use in their communities, how they are able to access them, and how the services have benefited them or their families. We are particularly interested in learning how the services have improved safety, stability, and economic mobility.

What will I need to do if I participate?

We are inviting you to participate in a focus group. During the focus group, we will ask you and a few other residents of your housing community to come together for a group discussion. During the discussion, we will ask the group to share information about their experiences with the supportive services in your housing community and how you or your family have benefited from the services. The focus group will take about 90 minutes to complete. During this time, we will provide an overview of the study, review the consent form, and answer any questions you have before beginning our group discussion.

Do I have to participate?

No, you are not required to attend the focus group. If you do attend the focus group, you can leave at any time. You are also not required to answer any questions that are asked during the focus group.

What are the risks and benefits of participating in the focus group?

If you choose to participate in this voluntary focus group, you may experience some discomfort in being asked questions about yourself or your family with the study team or others in the group setting. You are not required to answer any questions or tell us information that you do not want to share. A benefit of participating in the focus group is your lived experiences and insights will help ACF to improve supportive service programs in the future and can call policy makers’ attention to the benefits of supportive services.

Will there be financial incentives for participation?

You will receive $50 gift card after participating as a token of our appreciation. The gift cards will be distributed at the end of the focus group session.

Will my information be kept private?

The study team will keep your information private. We plan to record the focus group discussion if all members in the group consent to recording. We will temporarily store the recording on a secure system and transcribe it. We will remove names from the transcript and destroy the recording once the transcripts are completed and accurate. ACF will store transcript for this study on a secure system.

The study team will use the information you provide us for research only, except if we are required to disclose information by law. For example, we are required to report abuse or neglect of a minor or intentions to harm yourself or others. We will not share your information with [program] in a way that can be linked back to you. When we analyze and report the information from your focus group, we will combine it with information from other focus group participants. We will not identify you as an individual in any of the materials we produce. We will provide you with a summary of what we learn from the focus groups in the study.

However, we cannot promise that the other participants of the focus group will keep your information private. We will encourage everyone to respect one another’s privacy and not share the information learned in the focus group, but we cannot guarantee that they will.

How can I find more information about this study?

If you have any questions, please feel free to contact [name, title] at [number] or [email].

How can I consent to participate?

You can consent to participate by attending and responding to questions at the focus group. At the start of the focus group, we will review this consent form and provide time for you to ask questions. You may leave the focus group at any time if you do not wish to participate.

PAPERWORK REDUCTION ACT OF 1995 (Public Law 104-13) STATEMENT OF PUBLIC BURDEN: Through this information collection, ACF is gathering data on your grant program to understand the design and effectiveness of the program and to inform technical assistance needs. Public reporting burden for this collection of information is estimated to average 1.5 hours per respondent, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The OMB # is 0970-0XXX and the expiration date is XX/XX/XXXX. If you have any comments on this collection of information, please contact [email protected].