3245-0392 Appendix C-2 Small Business and Partner Organization Survey Consent Form_6-03-2024

RIC OMB ICR - Appendix C-2 Small Business and Partner Organization Participant Survey Consent Form

OMB Approval number: 3245-0392

Expiration Date: 04/30/2026

Consent Form

The U.S. Small Business Administration (SBA), via the Regional Innovation Clusters (RIC) Initiative, is investing in regional clusters throughout the United States. The [cluster name] ([cluster acronym]) is an implementer of the RIC Initiative.

The SBA has hired Optimal Solutions Group LLC (Optimal) to conduct an evaluation of the RIC Initiative. The objective of this evaluation is to determine if the RIC Initiative is meeting its intended outcomes. To assist in this process, we request that you complete a brief survey.

Based on event sign-up lists or attendance sheets, [Cluster POC name], administrator of the [cluster name], stated that you attended or participated in cluster-organized trainings, events (including networking events), activities, and/or services. The purpose of this survey is to learn about your experiences with these events and/or services. Even if you are unsure, unaware, or don’t recall your attendance in these events or services, we still would like to ask you a few questions that may help [cluster name] or organizations with similar functions to tailor their message and outreach to organizations like yours.

Optimal will collect and store your responses to this survey on a secure server accessible to Optimal staff only. Any information provided in this survey will be kept confidential. No respondent will be identified or named in any publicly available report or other such publication. All survey responses will be presented as aggregated statistics in the form of averages, percentages, and frequency counts. All survey responses will be de-identified and then these data will be provided to the SBA.

The survey is expected to take approximately 20 minutes to complete. Your participation in this survey is completely voluntary. You do not have to answer any questions that you do not want to, and you can stop participating at any time.  Your time and cooperation are greatly appreciated. 

• If you have questions about your cluster please contact [cluster point of contact] at [cluster POC email].

• If you experience any technical difficulties accessing or submitting the survey, try:

  • Using a private or "incognito" window in your browser

  • Clearing your browser’s cache

  • Consider using Google Chrome or Mozilla Firefox

• For anything else, please feel free to contact us at [email protected] or 301-306-1170.

I hereby agree that I have read and understand all of the information presented in this consent form. By checking "Yes," I freely and voluntarily agree to participate in this survey.

• Yes

• No