Consent Form

2024 SIPP Redesign Cognitive Interviewing Consent Form

Each year the U.S. Census Bureau conducts many different surveys.  The Census Bureau routinely tests survey questions and materials used for these surveys in order to produce the best information possible. The purpose of this research is to interview adults living in the United States to assess their understanding of proposed new questions and response options for the Survey of Income Program Participation (SIPP)

The U.S. Census Bureau is conducting this survey under Title 13, United States Code, Section182, which allows the Census Bureau to conduct current surveys. The OMB control number for this study is 0607-0725 (expiration 12/31/25). This valid approval number legally certifies this information collection. We estimate that completing this study will take 60 minutes on average. If you have comments or questions about this study, please email [email protected].

In order to have a complete record of your comments, your interview session will be recorded and saved in a secure location.  We will use the recordings to refresh our memories while we make recommendations on improving the materials.  Only staff directly involved in this research will have access to the recordings. The U.S. Census Bureau is required by law (Title 13, United States Code, Section 9) to protect your information and is not permitted to publicly release your responses in a way that could identify you.

Participation in this survey is voluntary and there are no penalties for refusing to answer questions. However, your cooperation in obtaining this much needed information is extremely important to ensure complete and accurate results. After completion of this session, we will send you $50 by USPS Priority Mail for your participation in this study.  Please provide your mailing address and signature below. 

Participant’s signature:

Participant’s Name:

Participant’s Mailing Address:

This study is being conducted under the authority of Title 13 U.S. Code. The OMB control number for this study is 0607-0725. Federal law protects your privacy and keeps your answers confidential under 13 U.S.C. Section 9. Per the Federal Cybersecurity Enhancement Act of 2015, your data are protected from cybersecurity risks through screening of the systems that transmit your data.