Various Demographic Pretesting Activities

CONSENT TO PARTICIPATE IN A

U. S. CENSUS BUREAU RESEARCH STUDY

Each year the Census Bureau conducts many forms of research. The goal of this project is to ask you questions about yourself that match the Census reports done in the community. We are also interested in your thoughts about your home in the community. It is very important that everyone in the US is counted in the right place and at the right time. Your answers will help the Census Bureau meet this goal.

Thank you for volunteering to take part in this research. We will use the information you provide about your experience to improve the approach for Census 2020. THE ANSWERS YOU GIVE US ARE STRICTLY CONFIDENTIAL. Only Census Bureau staff and contract researchers will look at this interview information and no information will be released to anyone outside of that staff which could associate your name with any of your answers.

This study is being conducted under the authority of Title 13 United States Code. The Office of Management and Budget (OMB) control number for this study is 0607-0725. This valid approval number legally certifies this information collection. Barbara Owen, a professor at CSU-Fresno will be conducting the interviews. She can be reached at 559/278-5715.

CONSENT:

I have volunteered to participate in the Census Bureau’s study, and understand that Barbara Owen, the contract researcher, will protect the confidentiality of my interviews information and will only use my information to help improve this work in the next Census.

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Signature

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Printed Name

_______/_______/ 2011

Date