Studies to Enhance FDA Communications Addressing Medical Countermeasures Prescription Drug Products

IMPROVE Study Phase 2

0695 Appendix 2 - Consent Form

Studies to Enhance FDA Communications Addressing Medical Countermeasures Prescription Drug Products

OMB: 0910-0695

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Appendix 2


ONLINE INFORMED CONSENT FORM


Thank you for being part of the KnowledgePanel®. This study is being conducted on behalf of the Food & Drug Administration (FDA). One of the FDA’s responsibilities is providing information about medicines to the public. The purpose of this study is to obtain information that will help FDA communicate effectively about medicines that might be used if a public health emergency occurred.


The survey should take about 20 minutes to complete. You will hear a public announcement about a public health emergency and be asked some questions about it. You will then be shown some related information and asked some more questions. This survey relates to a possible public health emergency, so you may feel some anxiety. You will not receive any direct benefits from participating, but by doing so you can help FDA best communicate with the public if such an emergency occurs.


As with all KnowledgePanel® surveys, your response to it or any individual question is voluntary. There is no penalty if you decline to respond to any question or if you want to stop participating. You will not be individually identified and no personally identifiable information about you will be shared. Your responses will be combined with those of others into a summary report that will not identify you by name.


If you have questions about your rights as a participant or are dissatisfied with any aspect of the survey, you may contact the KnowledgePanel Panel Member Support at 800-782-6899. If you have questions about the research or in the event of a research-related injury, contact Alyssa Snell at asnell@lakeresearch.com.


Please indicate whether you accept or decline to participate in this survey by selecting the appropriate button below. The accept button will take you to the survey; the decline button will end your participation in the survey.


File Typeapplication/msword
AuthorMizrachi, Ila
Last Modified ByMizrachi, Ila
File Modified2017-03-29
File Created2017-03-29

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