NHTSA FORM 1347 Informed Consent

OMB Control No. 2127-XXXX

Expiration Date XX/XX/XXXX

This collection of information is voluntary and will be used to screen for eligible participants. Public reporting burden is estimated to average 5 minutes, including the time for reviewing instructions searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Information will be kept confidential, and your name will not be attached to any data. Please note that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this collection is 2127-XXXX. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, National Highway Traffic Safety Administration, 1200 New Jersey Avenue, SE, Washington, DC 20590.

VIRGINIA POLYTECHNIC INSTITUTE AND STATE UNIVERSITY

Informed Consent for Participants of Investigative Projects

Title of Project: Head-Up Display and Distraction Potential

Investigators: Sheldon Russell, Josh Radlbeck, Pete Hill, and Myra Blanco

1. The Purpose of this Research/Project

The purpose of this study is to examine the distraction potential of Head-Up Displays.

We deliberately created a situation where the vehicle you were asked to follow would drop an object in the road, requiring an evasive maneuver. The dropping of the object was coordinated to occur as you took your eyes off of the forward roadway. This was done to test if reaction times are different when using Head-Up Displays when compared to Head-Down Displays. All drivers were in communication during the event to ensure safety. Furthermore, the object was an empty cardboard box and would pose little to no safety risks if a collision were to occur.

The results of this study will contribute to our understanding of how Head-Up Displays can benefit or distract drivers. This understanding will provide improvements in future system design and guidelines.

Your performance in this test trial is not an indication of your driving ability. We ask that you do not talk about the details of this study to others after your participation because this may invalidate future data that may be collected.

Please initial one of the following: (Provide a general statement about voluntary statement of us to use the data). _______ I give my consent to use the data in the analysis for this research project. _______ I do not give my consent for the data to be used in the analysis for this research project.

All other aspects of the earlier information sheet you signed, including risks, benefits, safety precautions, use of video for presentations, and your responsibilities, continue to apply to the remainder of this experiment.

2. Participant’s Permission

I have read and understood the Informed Consent and conditions of this project. I have had all my questions answered. I hereby acknowledge the above and give my voluntary consent for participation in this project. If I participate, I may withdraw at any time without penalty. I agree to abide by the rules of this project.

Participant’s Name (Print) Signature Date

Experimenter’s Name (Print) Signature Date

Should I have any questions about this research or its conduct, I may contact:

Myra Blanco	mblanco@vtti.vt.edu	(540)231-1500
Sheldon Russell	srussell@vtti.vt.edu	(540)231-1500

If I should have any questions about the protection of human research participants regarding this study, I may contact: Dr. David Moore, Chair of the Virginia Tech Institutional Review Board for the Protection of Human Subjects, telephone: (540) 231-4991; email: moored@vt.edu.

NHTSA Form 1347