Debt Collection Disclosure Forms Focus Groups and User Experience Study (Round 2)

INFORMED CONSENT FORM

You are being asked to participate in a research study. This form describes the purpose, procedures, benefits, risks and
precautions of the study. It also describes your right to withdraw from the study at any time. A member of the study staff is
available to read through this form with you and discuss all the information, if you wish.
Why is this study being done?
This study is being conducted to help us determine effective way to so inform consumers about the credit and debt collection
process. We will ask participants to talk about their own debt collection experiences, and we will also show sample forms to
discuss. Receiving feedback on this topic will help us understand how to make future consumers feel more prepared and
knowledgeable when their debts go to collection.
What do I need to know about this study?
Adults 18 and older will participate in this study. Each session will last [60 (UX) or 90 (FG)] minutes, and participants will work [oneon-one with a moderator (UX) or in a group (FG)]. The sessions will be video recorded, and individuals’ names will not be used in
any description of findings. In accordance with the Paperwork Reduction Act of 1995, the questions asked as part of this study
have been approved by the Federal government’s Office of Management and Budget (OMB) under OMB control number 31700022. Without this approval, we could not ask these questions.
Fors Marsh Group is working on this project to help the Consumer Financial Protection Bureau gather information that will help the
government understand how financial companies interact with consumers. Participants will be asked to share information about
their experiences with debt collection. Fors Marsh Group is in no way affiliated with any debt collectors, attorneys, collection firms,
or others trying to recover a debt from you. Information you share will not affect your credit or your credit score. Information will
only be used to help us understand how consumers manage the credit and debt collection process.
What are the potential risks of being in the study?
There are minimal risks associated with this study. Participants will complete short questionnaires and provide feedback about
their experiences. Participation is voluntary and participants do not have to answer any questions that they do not want to answer.
Any responses you provide will be kept private. We will not provide information that identifies you to anyone outside the research
team, except as required by law. Your personal information, such as your name, will not be associated with any videos recorded or
notes taken during the session.
Does being in this study provide any benefit?
The study will help to improve the debt collection process for other consumers.
Will it cost me anything to be in this study?
There are no costs to participate in the study, other than transportation costs to and from the facility. Participants in the study will
receive $75 for their participation.
Do I have to be in this study?
Participation is voluntary.
Who will have access to this study and/or contact information?
Only the researchers working on this project will have access to the information provided in the study. CFPB may view the
recordings and notes. CFPB receives final results that are stripped of direct identifiers like name and email.
Who do I contact if I have questions about the study?
If you have questions or concerns about the study, you can contact
Jennifer Romano Bergstrom, Fors Marsh Group, jbergstrom@forsmarshgroup.com, 571-858-3795.
I, _______________________________________, have read this form and agree to participate in this study.
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Participant’s Signature

Date

_____________________________________________________________________________
Researcher’s Signature

Date

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