Census Digital Function Testing

Generic Clearance for 2010 Census Communications Campaign Testing Activities

Census Digital Function Test Consent Form

Census Digital Function Testing

OMB: 0607-0950

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STATEMENT OF RELEASE



Thank you for agreeing to participate in this study. Your privacy and the privacy of your answers will be respected and maintained. Your personal information will not be disclosed and your individual answers will only be presented at an aggregate level. You will not be sold anything, or asked for money, under the guise of research. Your decision to participate in a study, answer specific questions, or discontinue your participation will be respected without a question. Each interview will be recorded and may be observed.


You acknowledge and agree that you have read this Statement of Release and fully understand its contents. You release and hold harmless Market Analytics and the US Census and its employee(s), officers, owners and directors from any and all injury and damages, which may arise directly or indirectly, from your participation in this study.



Name of Participant: _________________________________ Age: ______


Signature of Participant: ______________________________


Date: _______________


Address: _____________________________


_____________________________


_____________________________












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AuthorLaura Kibala
Last Modified Byboone005
File Modified2009-01-26
File Created2009-01-26

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