Consent Form for Survey Participants

Attachment #12 - Respondent Consent Form_Survey.docx

[OS] CDC/ATSDR Formative Research and Tool Development

Consent Form for Survey Participants

OMB: 0920-1154

Document [docx]
Download: docx | pdf



GenIC Clearance for CDC/ATSDR

Formative Research and Tool Development



Food Safety Communication Evaluation: Assessing Food Safety Messages, Knowledge, and Attitudes









Attachment 12 - Respondent Consent Form for Rapid Survey


















Contact: Sara Bresee, MPH

Office of the Director

Division of Foodborne, Waterborne, and Environmental Diseases

Centers for Disease Control and Prevention

1600 Clifton Road, NE

Atlanta, Georgia 30333

Phone: (404) 639.3371

Email: [email protected]






BANYAN COMMUNICATIONS CONSENT FORM

Please read and sign this sheet before you participate in survey


We’re pleased you have accepted our invitation to participate.


You will be responding to topics of interest to the Centers for Disease Control and Prevention (CDC). CDC engaged us to recruit for their survey.


Since your opinions, observations, reactions, and other expressions are the reason for conducting this survey, we hope you will participate fully in the process. You do not have to respond to all survey questions.


We will not sell, distribute, or otherwise release personally identifiable information we collect to CDC unless it is a necessary part of this project.


By proceeding to the survey, you acknowledge that you understand, agree to, and consent to the above and that you waive and release any claim you may have against Banyan Communications and its clients, owners, agents, affiliates, employees and managers arising out of your voluntary participation in this survey.



_______________________________

Sign


_______________________________

Print Name


_______________________________

Date



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
Authorserecept
File Modified0000-00-00
File Created2025-05-19

© 2025 OMB.report | Privacy Policy