Waitlist - 03 - Consent Form - Interview - FINAL

Waitlist Data Management & Burden Improvement

Consent Form – Interview

Consent to Participate

You are invited to participate in a Department of Housing and Urban Development (HUD) customer experience discussion to share your valuable perspective on HUD-assisted housing and local waitlists for housing. Use this form to learn about this research and provide your consent to participate (if you choose to do so).

Overview

What is this project? HUD is exploring how they can support local partners and housing agencies to help improve the experience of individuals and families finding affordable housing through waitlists. To better understand customer needs, HUD is starting by talking to a variety of customers including public housing agencies, housing providers, families, and others. We hope you will consider sharing your valuable feedback with HUD.

What will I be asked to do if I take part? We will ask you to set aside an hour to share your experience and perspective on housing waitlists.

Will you record what I say? No, but we will take notes during the conversation.

What are the benefits of participating? By taking part in this conversation, you will help HUD better serve people in the future. By participating, HUD can better understand the needs of the people it serves and to surface potential roles that HUD can play to improve experiences for customers in the waitlist system.

Will I receive money or another form of compensation for participating? You will not receive money or another form of compensation for participating in this conversation.

How will you use my feedback and how will that information be shared? What you tell us will be disconnected from your identity and anonymized. We will sum up your feedback (along with other participants’ feedback) into research findings that will be shared. We respect your privacy and will never use your name in any reports. Additionally, we will avoid including details that might make it obvious that we are talking about you.

Will you share my name? We will not use your real name in any of our materials. Your name will be stored temporarily in a secure location so we can schedule a conversation with you and will be deleted at the completion of the project. Only those responsible for scheduling and speaking with you will have access.

Will you share other personal information about me? Possibly. In any presentations, we may say “Charles (made-up name) is a man in his 30’s who lives in Texas.” We may also share details about your feedback about a government service. For example, “Charles finds it difficult to find information about benefits for people who’ve purchased cars that have tires that have been recalled.” We may share more than one detail about your experience from our conversation.

What are my rights as a participant in this conversation? Your participation is entirely voluntary. If at any time you do not feel comfortable answering a question as part of the conversation, simply say you’d like to move to the next question, and we’ll move on to the next question. If at any time you would like to end the conversation, you may do so.

What if I am unable to submit the consent online before our conversation? If for any reason you are unable to submit this form online, we will review the form verbally with you during our conversation and you will have the option to provide verbal consent.

Who can I contact about this project and my participation in it? If you have questions about this project and your participation, you can reply directly to this email or contact [Name] at [email].

Your consent

1. I have read the above details and have my questions answered about this feedback session. I consent to take part in this feedback session. I agree to have my quotes and feedback shared. I understand the name I provide will not be connected to any quotes or feedback. *

• Yes, I consent to take part in this feedback session

• No, I do not consent to take part in this feedback session

  

2. Please enter your name (this acts as your digital signature): *

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3. Please enter today’s date: *

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HUD Customer Experience | Draft – For discussion Purposes Only [email protected] 2