consent form

Form Approved

OMB No. 0607-0725

Exp. Date 12/31/2025

Consent to Participate in a Virtual Focus Group about using an online questionnaire for counting residents living in Group Quarters

Purpose. The purpose of this study is to obtain feedback on whether the residents of group quarters facilities can complete an online questionnaire for the 2030 Census. We also would like to determine the best method to coordinate participation so that everyone living in group quarter facilities is counted in the 2030 census.

Approval. This focus group is sponsored by U.S. Census Bureau and is approved by the Office of Management and Budget (OMB) as indicated by the OMB number 0607-0725 on this form. This OMB number legally certifies this data collection.

Procedures. If you agree to participate, you will be assigned to a focus group session time that works with your schedule. You will join the virtual focus group using Microsoft Teams using your device. You and approximately five other administrators from other group quarter facilities will participate in the same session. We will ask you questions about

• whether your residents have internet access

• whether you think an online questionnaire is a good way to collect the census information

• how best to get residents to report using the questionnaire

• how much assistance you, as an administrator, can provide during the census to get the correct count

None of the questions will ask you to share any names or other identifying characteristics of your residents.

The focus group should take 60 to 90 minutes. If you have any questions about the time needed for the focus group or the questions that will be asked, please contact [email protected].

Audio and Screen Recording. During the focus group, you will use your camera and computer audio. A screen and audio recording of this virtual focus group will be captured for quality assurance purposes and to review when summarizing the findings. You will not share your screen.

Confidentiality. This session is being conducted under the authority of 13 U.S.C., Sections 141 and 193. The U.S. Census Bureau is required by law to protect your information (13 U.S.C. § 9 and § 214). The Census Bureau is not permitted to publicly release your responses in a way that could identify you or your group quarter facility. Only research staff from the U.S. Census Bureau working on this project have access to the focus group sessions, either live or through the recording.  

Voluntary Participation. Your participation is completely voluntary. Should you feel uncomfortable with any question asked, you do not have to answer it. Participation will not have any adverse effect on your relationship with the Census Bureau.

 

 

I have read and understand the statements above. I consent to participate in this study and to being recorded during the focus group.

Use your mouse or finger to sign your name in the box below.

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