Various Demographic Pretesting Activities

Cognitive Testing of the Spanish Language Translations of the ACS Interview

Participant Informed Consent

Cognitive Interview

You are invited to participate voluntarily in this interview, which is being conducted by RTI International, a not-for-profit research firm, and Research Support Services (RSS), a contract research firm, for the U.S. Census Bureau. The purpose of this interview is to help the Census Bureau review some of the questions included in the American Community Survey (ACS) to ensure that the questions are well understood.

The interview and discussion will take approximately between 60 and 75 minutes. There are no right or wrong answers to the questions we ask—we just want to ask your opinion about some of the questions from the survey. You can help us by describing anything you find confusing or difficult to understand. This type of survey is conducted either by phone or in person. In appreciation for your participation in this project, you will receive $40.00 at the end of the interview.

Your participation in this study is voluntary, and you may stop at any time. Even if you choose not to participate, you will not lose any benefits or services that you may be receiving from any governmental agency. Also, you may choose not to answer any questions you don’t want to answer. You will be paid $40 in appreciation for your time, even if you decide to stop the interview. We will not be asking about your legal or immigration status. Your participation will be kept confidential, and the information you give us will be combined with the responses of others in a summary report that does not identify you as an individual. We will not share any personal information you give us during the interview with any person outside the project staff at RTI, RSS, and the Census Bureau. There are no expected risks to participating in this study. Your identifying information is protected by Title 13 of the United States Code.

If you have any questions about the study you may contact Rosanna Quiroz at 1-800-334-8571 ext. 27172. If you have any questions about your rights as a research participant in this study, you may contact the Office of Research Protection at RTI International at 1-866-214-2043, a toll-free number.

______________________________________________________________________________

The above document describing the benefits, risks and procedures for this research study has been explained to me. I agree to participate.

Signature of participant________________________________ Date ___/___/___

I certify that the nature and purpose, the potential benefits, and possible risks associated with participating in this research have been explained to the above individual.

Signature of Person Who Obtained Consent___________________________ Date ___/___/___

The OMB control number for this study is 0607-0725.

T his valid approval number legally certifies this information collection.

Turn to other side

Audio-taping the interview:

In order to make best use of our findings, we also request that you allow the interview to be audio-recorded, through the use of a tape recorder that will be on the table. The audio-tape recording will only be heard by people who are working on this project from RTI, RSS, and the Census Bureau. The only purpose of recording the interview is to allow us to review the interview as we document our findings. If you would rather that your interview not be recorded, or if any time during the interview you decide that you would like the recording to be stopped, please tell the interviewer and we will stop recording.

______________________________________________________________________________

I agree to allow the interview to be audio-taped and to be listened to by others who are working on this project:

Signature of participant ________________________________ Date ___/___/___

Disposition: Participant signs original. Interviewer submits to RTI/RSS. Participant keeps another original for records.