2015 Text to Speech Investigation and Report

2017-2020 NSDUH Methodological Field
Tests, Supporting Statement
Attachment B – Data Collection Agreement

Project Name:
DATA COLLECTION AGREEMENT

Project No.:

National Survey on Drug
Use and Health
.
0213986
.

I, __________________________________________, an employee of Headway, agree to provide field data collection
services for the benefit of RTI in connection with the RTI Project shown above (“the Project”). Further, I
1)

am aware that the research being conducted by RTI is being performed under contractual arrangement with the
Substance Abuse and Mental Health Services Administration (SAMHSA);

2)

hereby accept all duties and responsibilities of performing specified data collection tasks and will do so
personally, in accordance with the training and guidelines provided to me. At no time will I engage the services
of another person to perform any data collection tasks for me without the prior written approval of both my
employer (Headway) and RTI;

3)

agree to treat as confidential all information secured during interviews or obtained in any Project-related way
during the period I am working on the Project, as required by the Confidential Information Protection and
Statistical Efficiency Act of 2002 (CIPSEA), and understand, under Section 513 of this Act, I am subject to
criminal felony penalties of imprisonment for not more than five years, or fines of not more than $250,000, or
both, for voluntary disclosure of confidential information. Any breach of confidentiality must be reported
immediately to the National Field Director. This information will be shared with the SAMHSA Project Officer
and Headway. I have also completed and fully understand the CIPSEA training provided to me;

4) agree to treat as confidential and proprietary to RTI/SAMHSA any and all information provided by the
public, whether collected or accessed in electronic or printed form during the course of my service on this
Project, including but not limited to all data collection computer software and respondent data, and will protect
such items from unauthorized use or disclosure;
5) am aware that the survey instruments completed form the basis from which all analyses will be drawn, and
therefore, agree that all work for which I submit invoices will be legitimate, of high quality and performed in
compliance with all Project specifications to ensure the scientific integrity of the data;
6) understand that I am fully and legally responsible for taking all reasonable and appropriate steps to ensure that
any computer equipment issued to me for use on this Project is safeguarded against damage, loss, or theft. I also
understand that I have a legal obligation to immediately return all equipment at the conclusion of my
assignment or at the request of my supervisor;
7) fully agree to conduct myself at all times in a manner that will obtain the respect and confidence of all
individuals that I encounter as a representative of the Project and I will not betray this confidence by divulging
information obtained to anyone other than authorized Project representatives of RTI;
8) understand that evidence of falsification, fabrication or distortion of any data collected for this Project will
be reported to RTI's Scientific Integrity Committee, and such acts are grounds for immediately removing me
from the Project and can result in my suspension from any government-funded research. Also, if falsification of
data is substantiated, I understand a formal fraud complaint will be submitted to the U.S. Department of
Health and Human Services’ Office of Inspector General (OIG) and I could be subject to criminal and/or
civil prosecution and thereby face imprisonment, financial penalties or both;
9)

understand my obligations under this agreement supersede any prior or existing agreements on the same subject
matter and will survive the termination of any assignment with RTI and/or my employment by Headway.

_________________________________________________________

__________________________

Employee Signature

Date