State, Local, and Tribal Governments Respondents

OMB Control No: 0584-XXXX Expiration Date: XX/XX/XXXX

Expiration Date: 05/31/2025

Expiration Date: 03/31/2019

H.14. Interview Consent Form

S NAP Work Requirements and Employment and Training (E&T) Data Study: Informed Consent

Background

Westat is conducting a study for the U.S. Department of Agriculture’s Food and Nutrition Service, or FNS. The study will examine the data FNS needs to measure equitable program access and outcomes in State agencies’ administration of work requirements and Employment and Training, or E&T, for the Supplemental Nutrition Assistance Program, or SNAP. We are currently conducting interviews with SNAP State and local offices, E&T providers, and other interested parties in six States. Through these interviews, we hope to collect information from a wide range of individuals involved in administering work requirements and SNAP E&T.

What Would I Do in the Study?

Your participation in this interview is voluntary. If you agree to participate, we will schedule a virtual interview to be conducted at a time convenient for you. The interview will include questions about potential areas in the administration of work requirements and E&T where inequities could occur, hiring practices, types of data collected, current policies and practices used to address equity, and recommendations for how FNS should address equity in the future.

What Are the Benefits of Being In This Study?

There are no direct benefits to you for taking part in this study. Your participation will provide the research team and FNS with the best possible understanding of where disparities in work requirements and SNAP E&T may occur and the data FNS can use to monitor program equity in the future. By participating in the interviews, you can help shape future guidance. Please keep in mind that this is a research study; it is not an audit or monitoring visit.

What Are the Risks of Being In This Study?

There is no known risk to you for participating in this study. We will separate any information that identifies you from the rest of your data and store those identifiers separately. Results used for analysis will not include your name or other identifiers. We will summarize the information you share with us today and combine it with information gathered from other people we interview. Nothing you say will ever be linked to your name. Direct quotes included in our reports will be presented without the speaker’s name, role, or title to protect their identity. We will not share information linked to you with FNS or with anyone else who is not on the study staff, unless otherwise required by law.

What Are My Rights As a Participant In the Study?

Taking part in this study is completely voluntary. Giving consent means that you have heard or read the information about this study and that you agree to take part. You may still decide not to answer any questions we ask that you don’t want to answer. If you decide to take part in the study and then change your mind, you can stop at any time.

Who Should I Call if I Have Questions?

If you have questions about the study itself and what we are doing, a member of our study team can help you. For more information, contact the Westat study team via email at [[email protected]] or by phone at [XXX.XXX.XXXX]. You may also contact the Westat Project Director, Jonathan Blitstein ([email protected]). The FNS Project Officer for this study is Kristen Corey ([email protected]).

If you have questions about your rights and welfare as a research participant, please call the Westat Human Subjects Protections office at 1-888-920-7631. Please leave a message with your first name, the name of the research study that you are calling about (Assessing Equity in Work Requirements and SNAP Employment and Training Study), and a phone number beginning with the area code. Someone will return your call as soon as possible.

Public Burden Statement

This information is being collected to assist the Food and Nutrition Service in examining equity in SNAP work requirements and SNAP Employment and Training. This is a voluntary data collection, and FNS will use the information to understand what data are needed to assess equitable program access and outcomes in SNAP and SNAP Employment and Training. This collection does not request any personally identifiable information under the Privacy Act of 1974. According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-XXXX. The time required to complete this information collection 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 collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the following address: U.S. Department of Agriculture, Food and Nutrition Service, Office of Policy Support, 1320 Braddock Place, Alexandria, VA 22314, ATTN: PRA (0584-XXXX). Do not return the completed form to this address.

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