Consent Form

Consent Form

2020 Census CPEX Cognitive Interview

Each year the Census Bureau conducts many different surveys. The Census Bureau routinely tests the invitation materials for these surveys in order to produce the best mailing materials possible.

______________________ [NAME] consents to take part in a study to test possible mail materials for the 2020 Census. In order to have a complete record of all comments, the interview session will be audio recorded. The Census Bureau plans to use the tapes to improve the materials. Staff directly involved in the project will have access to the recordings. Participation is voluntary and answers will remain strictly confidential.

This study is being conducted under the authority of Title 13 USC. The OMB control number for this study is 0607-0725. This valid approval number legally certifies this information collection.

I have agreed to participate in this Census Bureau research study, and I give permission for my tapes to be used for the purposes stated above.

____________________________ ___________________________

Participant's Signature Researcher's Signature

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Printed Name Printed Name

___________________________ _______________________

Date Date