Attachment E - Study Information Sheet for Individuals Completing Matrix

OMB Control Number: ####

Expiration Date: ####

Affordable Housing and Supportive Services Demonstration

Study Information Sheet for Individuals Invited to Participate in Service Receipt and Outcome Data Collection

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?

You will be asked to complete a short survey about services you may have received in the past six months. Your caseworker can help you complete this survey during your meeting. The survey will take less than 15 minutes to complete, and you will be asked to complete it again in 6 months.

You will also be asked to have a conversation with your caseworker to complete an assessment about your needs. Before beginning this conversation, your caseworker will explain that the data from your assessment will be shared with the study team. These data will not include information that can be used to identify you, like your name, address, or social security number. Your caseworker will also explain how they will use the information they learn from the conversation to support you.

Do I have to participate?

No, you are not required to participate. You do not need to complete the data collection, and you can ask that your information not be shared with the study team. You are also not required to answer any questions that are asked during the data collection.

What are the risks and benefits of participating in the study?

If you choose to participate in this study, you may experience some discomfort in being asked questions about yourself or your family. You are not required to answer any questions or tell us information that you do not want to share. A benefit of completing the survey is that 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 $25 gift card after participating in the baseline collection and the six-month follow-up as a token of our appreciation. The gift cards will be distributed by your case manager.

Will my information be kept private?

The data submitted to the study team will not include information that can be used to identify you, like your name or social security number. The information submitted to the study team will include a separate study identifier that your local program will provide to you. The research team will not know the identities of the people assigned to the study identifier, but we will use this identifier to link together the information you submit for the study at baseline and during follow-up periods. Once data collection is complete, the research team will destroy the study identifier. The study team will use the information you provide us for research only. Because your case manager will also use this information to provide services to you, they will explain their organization’s privacy practices. As a likely mandated reporter, your case manager would be required to report abuse or neglect of a minor or intentions to harm yourself or others.

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?

Your case manager will review this consent information with you prior to beginning the survey or discussion of your needs. At that time, they will ask you to confirm that you consent to participate in the study. You will be given the opportunity to confirm your consent prior to every survey and needs discussion. You are not required to answer any questions during the discussions, and you can withdraw your consent at any time.

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].