Various Demographic Pretesting Activities

U.S. Census Bureau Research Study: Participant Informed Consent

Cognitive Interview for Rental Housing Finance Survey

You are invited to participate voluntarily in this interview, which is being conducted by 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 determine how well the Rental Housing Finance Survey questionnaire works and make recommendations for improvements as needed, based on evidence from the testing.

The interview and discussion will take on average 60 minutes. There are no right or wrong answers to the questions we ask—we just want to ask your opinion about the type of questions asked and how easy they are to understand.

In appreciation for your participation in this project, you will receive $40.00.

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 question. You will be paid $40 in appreciation for your time, even if you decide to stop the interview. Your participation will be kept confidential by RSS, and the Census Bureau, 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 information you give us during the interview with any person outside the project staff. There are no expected risks to participating in this study. Your identifying information is protected by Title 13 of the United States Code. For some interviews, one or more researchers from the U.S. Census Bureau or another governmental agency may observe and take notes, with your permission. These researchers designed this questionnaire and the observation will help them better understand how people respond.

_______________________________________________________________________________________________

The above document describing this research study has been explained to me. I agree to participate.

Please choose one of the following if Census Bureau researchers requested to observe this interview.

___I agree to have Census Bureau or other governmental researcher(s) observe.

___I do not agree to have Census Bureau or other governmental researcher(s) observe.

Signature of participant __________________________________________________

I certify that the nature and purpose of this research have been explained to the above individual.

Signature of Person Who Obtained Consent __________________________________

The OMB control number for this study is xxxx-xxx. This valid approval number legally certifies this information

collection. The expiration date is xx-xx-xxxx.

Audio-taping the interview:

In order to make best use of our findings, we also request that you allow the interview to be audio-taped. The audio-tape will only be heard by people who are working on this project. The only purpose of audio-taping is to allow us to review the interview as we document our findings. We will destroy the tapes upon completion of the project. If you would rather that your interview not be audio-taped, or if any time during the interview you decide that you would like the audio-taping to be stopped, please tell the interviewer and we will stop taping.

__________________________________________________________________________________________

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 ____ / ____ /________