Interview and Focus Group Consent Form 02OCT2025

CONSENT FORM

In-Depth Interviews and Focus Groups

Introduction and Purpose:

You have been asked to take part in a/an interview/focus group that is being conducted on behalf of the Centers for Disease Control and Prevention (CDC). Your participation in this interview/focus group is voluntary. If you agree to participate, we ask you to read and sign this consent form. You may withdraw your consent to participate, for any reason, at any time.

You are the expert on your experience, and your thoughts and opinions are greatly valued and appreciated. We want to learn from you. We encourage you to speak openly and honestly about your experience. There are no right or wrong answers.

Details about this project are discussed in the following sections. It is important that you make an informed choice about participating. You should ask the interviewers named below any questions you have at any time.

Should you agree to participate in the discussion, here are some points you should know:

• Rights Regarding Participation: This interview/focus group is completely voluntary. If any questions make you feel uncomfortable, you may choose not to answer.

• Privacy: We will take every precaution to protect your identity and ensure your privacy unless required by law. We will keep your full name and identifying information private and your identity will not be disclosed, nor included in any reports. Your contact information and name will not be attached to any of your responses.

• Benefits: Your participation in the interview/focus group will not result in any direct benefits to you. However, your input will help to develop effective CDC communication materials.

• Risks: The interview/focus group poses minimal, if any, risks to you.

• Incentive: You will receive a token of appreciation for participating.

• Audio Recordings, and Notes: The interview/focus group will be audio recorded. No quotes or comments you make will be linked with your name in any way. We will keep all information, notes, and audio recordings stored securely. Only project staff will be able to access the information. These notes and recordings will be stored in accordance with federal records retention laws.

• Cell phones: If held online, we ask that you not join the interview/focus group meeting on your cell phone and instead use a laptop, desktop, or tablet computer in order to see the materials that may be displayed. During the interview/focus group, we also request that you put aside your cell phone and send calls to voicemail to ensure the conversation is free of distractions.

• Questions: We will answer any questions you have about this interview/focus group.

Your Consent

I have read this consent form. I had a chance to ask questions, and my questions were answered. I was given a copy of this consent form. The above document describing the benefits, risks, and procedures for this project has been explained to me. I agree to participate in the project.

_________________________________ _________________

Signature of Participant Date

_________________________________ _________________

Signature of Person Obtaining Consent Date

In-Depth Interview and Focus Group Consent Form 1