Consent Form and Questions

OMB Control No. 0651-0080

Expiration Date: XX/XX/XXXX

United States Patent and Trademark Office (USPTO)

Council for Inclusive Innovation (CI²)

Concept Testing Consent Form and Questions

Consent Form

OMB Control No. 0651-0080 Expiration Date: XX/XX/XXXX

A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with an information collection subject to the requirements of the Paperwork Reduction Act of 1995, unless the information collection has a valid OMB Control Number. The OMB Control Number for this information collection is 0651-0080. Public burden for this form is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the information collection. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden to the Office of the Chief Administrative Officer, United States Patent and Trademark Office, P.O. Box 1450, Alexandria, VA 22313-1450 or email [email protected].

Informed Consent for Research Participation:
Thanks for taking the time to complete the questions in the chat/discussion board. Please read the statements below and electronically sign where indicated.

By submitting this form you are indicating that you have read the description of the study and that you agree to the terms as described.

If you have any questions, or would like a copy of this consent form, please contact [email protected].

What this study is about
This concept testing is being conducted by the CMRignite on behalf of the U.S. Patent and Trademark Office (USPTO). The review and testing of concepts will help enhance the information and resources provided by USPTO to people who may submit patents or who may need other legal protections for their ideas or creations.

Your Involvement in the Study
We will ask you a series of questions about your perceptions, opinions, and feedback on ad concepts that can help you learn more about USPTO and the information and resources that can support inventors. The concept testing activities should take a maximum of 10 minutes total over one week.

Your Participation is Voluntary
Participation is completely voluntary. You may refuse to answer any questions or end participation at any time.

Confidentiality
We will take necessary and appropriate precautions to keep what you tell us confidential. We may develop and present research reports that summarize the results of all the participants who complete the survey. The reports are for internal use only. We will not use your real name in any of our materials.

Storage of Personal Information and Session Data
We will securely store and process your personal information and session data until we deem the content no longer necessary for the research purposes outlined above. This data can include your name, email address, and phone number.

Statement of Consent
I have read the above information and received answers to any questions I have asked. I consent to take part in this survey and to have any information I provide be used in the manner described above. I understand that my name will not be used in connection to responses. I expressly release CMRignite from and against any and all claims that I have or may have for invasion of privacy, defamation, or any other cause of action arising out of the production, distribution, display, or publication of the results of the project, so long as the conditions of use described above are met.

Click to electronically sign

Concept Testing Questions

Participants who have agreed to participate in concept testing will receive these questions on the discussion board. Ahead of time, CMRignite will remind and confirm their participation in this activity.

A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with an information collection subject to the requirements of the Paperwork Reduction Act of 1995, unless the information collection has a valid OMB Control Number. The OMB Control Number for this information collection is 0651-0080. Public burden for this discussion board is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the information collection. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden to the Office of the Chief Administrative Officer, United States Patent and Trademark Office, P.O. Box 1450, Alexandria, VA 22313-1450 or email [email protected].

Discussion Board Introductions and Ground Rules are posted in the group chat (see previous section for this information).

Introduction:

The U.S. Patent and Trademark Office (USPTO) thanks you for joining us in the group chat. The USPTO is an agency that supports people who come up with unique ideas, creations, and inventions. For this activity, you will review some ad concepts. Concepts are ideas for ads that will share information about USPTO. They are not fully developed in the words or images, so they may change. You have one week to answer these questions, from October x to October x.

1. Insert Concept 1 (please focus on the story/theme because the images and words could change)

Which statements apply to this concept? (Select all that apply)

1. Is easy to understand

2. Makes you want to know more about the USPTO

3. Is relevant to you

4. Grabs your attention

5. Makes you think more positively about the USPTO

6. Says something different than other ads you’ve seen before

7. Imagery is culturally relevant

8. Messaging is culturally relevant

9. Aligns with information about the USPTO and the patent application process

10. Other

11. None of these

2. What do you like about the concept?

2. Quick Poll: Would you change anything about the concept? (Select one)

Yes

No

2. [If yes in Q3] What would you change?

[Repeat questions for all concepts tested]

2. Quick Poll: Which concept do you prefer? (Select one)

Concept 1

Concept 2

Concept 3

2. Why do you prefer that concept?

2. Quick Poll: What concept slogan (phrase) most resonates with you when thinking about the USPTO? (Select one)

Phrase 1

Phrase 2

Phrase 3

2. Why do you prefer that slogan (phrase)?

Wrap-up and Closing:

• Thank you so much for participating in the group chat and providing feedback on ad concepts.

• This will help guide what USPTO shares in the future about the services and support it provides to inventors, creators, and those who have ideas.

• CMRignite will reach out to each of you to send you the electronic gift card as a thank you for joining us in the group chat.

Privacy Act Statement

The United States Patent and Trademark Office (USPTO) collects this information under authority of 35 U.S.C. 2(b)(2). The information you provide will be used to register to participate in Agency-sponsored events and programs designed to disseminate information to the public on topics related to patents and trademarks.  This system includes information about individuals who have requested participation in an Agency-sponsored event or program. The information is protected from disclosure to third parties in accordance with the Privacy Act. However, routine uses of this information may include disclosure to the following: to non-Federal personnel under contract to the Agency; to a court for adjudication and litigation; to the Department of Justice for Freedom of Information Act (FOIA) assistance; to members of Congress; and to National Archives and Records Administration. If you do not furnish the requested information, the USPTO may not be able to process your request for participation in the event or program. The applicable Privacy Act System of Records Notice for this information request is PAT-TM-19, Dissemination Events and Registrations: Federal Register vol. 71 December 27, 2006, page 77739, available at https://www.federalregister.gov/documents/2006/12/27/E6-22122/privacy-act-of-1974-system-of-records

CMRignite

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