Request for Approval for Cognitive Testing of Innovation Module for the 2017 Survey of Business Owners (SBO)

Attachment 4: NSF/NCSES CONSENT FORM

The National Science Foundation designs, conducts, and sponsors surveys on science, engineering, and technology. In order to produce the best information possible, the National Science Foundation routinely evaluates its surveys.

You have volunteered to take part in a study to improve one of the National Science Foundation’s surveys. In order to have a complete record of your comments, your interview session will be audio taped (and/or videotaped). We plan to use the tapes to improve the survey. Staff directly involved in this research project will have access to the tapes. In addition, a transcription service may have access to the audiotapes, to provide us with a written version of your comments. The tapes may also be used for training others to conduct this type of research, and in presentations to professional audiences.

This study is authorized by law (42 U.S.C. 1862 Section 3.a.6.). The OMB control number for this study is 3145-0174.

I have volunteered to participate in this 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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Printed Name Printed Name

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