Request for Approval for Cognitive Testing of Innovation Activities as Input to Annual Business Survey

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.

_________________________
Researcher’s Signature

____________________________
Participant’s Signature

_________________________
Printed Name

____________________________
Printed Name

_________________________
Date

____________________________
Date

19