Consent Form

Research with Adults

Consent Form

Communications Research Copy Testing

The Census Bureau will be conducting a communications campaign to encourage people to fill out their Census form. The Census Bureau will be getting feedback from the public to help make the advertising as effective as possible.

You have volunteered to take part in a study to help improve advertising that will be used in the Communications Research Copy Testing. In order to have a complete record of your comments, your interview session will be audiotaped. We plan to use the tapes to improve the advertising materials. Staff directly involved in the research project will have access to the tapes. Your participation is voluntary and all information will be used only in aggregate, i.e., only in combination with responses from other people.

This study is being conducted under the authority of Title 13 USC, Sections 141 and 193. The OMB control number for this study is 0607-XXXX. This valid approval number legally certifies this information collection.

I have volunteered to participate in this Census Bureau study, and I give permission for my tapes to be used for the purposes stated above.

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Researcher's Signature Participant's Signature

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Researcher’s Name Participant’s Name

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