Parent Consent for Parent and Youth Recruited Together
Dear Parent,
On behalf of the Administration for Children and Families (ACF), Mathematica Policy Research is conducting voluntary survey pretests with youth age 14-24 and the parents of youth age 14-18. The purpose of these pretests is to solicit feedback about surveys for the Youth Empowerment Information, Data Collection, and Exploration on Avoidance of Sex (Youth Empowerment IDEAS) national research study. The study has a Youth Survey, Young Adult Survey and a Parent Survey.
ACF and Mathematica would like to know how long it takes to complete each survey and whether the survey questions are easy to understand. You will be asked to participate in a 2 hour session. Your child will each be asked to participate in a separate 1.5 hour session. Each of you will be asked to complete a survey on your own—your child will be asked to complete the Youth Survey and you will be asked to complete the Parent Survey. You will then be asked to provide feedback on the survey with a small group. The youth group and the parent group will each meet with a researcher to share whether the questions were easy or hard to understand and how to improve the questions. These discussions will be audio-recorded so that the study team can review the recordings later. No one else will hear the recordings. Participation is entirely voluntary and all feedback will be used only for revising the surveys. No participants’ names or feedback will be disclosed or used, in identifiable form, for any other purpose except as required by law. The study team will also ask all participants in the group to keep the information discussed private. There is a chance others might share information from the discussion with people who did not participate.
The feedback received from youth and parents will provide ACF and Mathematica with valuable information to improve the surveys that will be included in the national research study. Your child will be given a $25 debit card as a thank you for his or her participation. You will be given a $50 debit card as a thank you for your participation.
If you have any questions about the pretest, please contact Tiffany Waits, the Youth Empowerment IDEAS survey director, at twaits@mathematica-mpr.com or (202) 264-3498. If you have any questions or concerns about your rights as a study participant, please contact the Health Media Lab Institutional Review Board at (202) 753-5040.
Youth Survey Pretest Consent
By signing below, you agree that your child may participate in the Youth Survey pretest. Your child may decide on his or her own whether to participate. Your signature below will indicate that your questions have been answered satisfactorily, and that you have read and understood the information provided above.
I hereby accept the terms described above and give permission for my child ____________________________ to
Print Child’s Name
participate voluntarily in the Youth Empowerment IDEAS Youth Survey pretest.
__________________________________
Print Name
____________________________________ _______________________
Signature Date
Parent Survey Pretest Consent
By signing below, you agree that you will participate in the Parent Survey Pretest. Your signature below will indicate that your questions have been answered satisfactorily, and that you have read and understood the information provided above.
__________________________________
Print Name
____________________________________ _______________________
Signature Date
THE PAPERWORK REDUCTION ACT OF 1995 Public reporting burden for this collection of information is estimated to average 120 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. 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 collection of this information is voluntary and responses will be kept private to the extent allowed by law. The OMB number for this information collection is 0970-0355 and the expiration date is 05/31/2021. |
Dear Parent,
On behalf of the Administration for Children and Families (ACF), Mathematica Policy Research is conducting voluntary survey pretests with youth age 14-24. The purpose of this pretest is to solicit feedback about surveys for the Youth Empowerment Information, Data Collection, and Exploration on Avoidance of Sex (Youth Empowerment IDEAS) national research study. The study has a Youth Survey, Young Adult Survey and a Parent Survey.
ACF and Mathematica would like to know how long it takes to complete each survey and whether the survey questions are easy to understand. Your child will be asked to participate in a 1.5 hour session. They will be asked to complete a survey andl then be asked to provide feedback on the survey with a small group. The group will meet with a researcher to share whether the questions were easy or hard to understand and how to improve the questions. These discussions will be audio-recorded so that the study team can review the recordings later. No one else will hear the recordings. Participation is entirely voluntary and all feedback will be used only for revising the surveys. No participants’ names or feedback will be disclosed or used, in identifiable form, for any other purpose except as required by law. The study team will also ask all participants in the group to keep the information discussed private. There is a chance others might share information from the discussion with people who did not participate.
The feedback received from youth will provide ACF and Mathematica with valuable information to improve the Youth survey that will be included in the national research study. Your child will be given a $25 debit card as a thank you for his or her participation.
If you have any questions about the pretest, please contact Tiffany Waits, the Youth Empowerment IDEAS survey director, at twaits@mathematica-mpr.com or (202) 264-3498. If you have any questions or concerns about your rights as a study participant, please contact the Health Media Lab Institutional Review Board at (202) 753-5040.
Youth Survey Pretest Consent
By signing below, you agree that your child may participate in the Youth Survey pretest. Your child may decide on his or her own whether to participate. Your signature below will indicate that your questions have been answered satisfactorily, and that you have read and understood the information provided above.
I hereby accept the terms described above and give permission for my child ____________________________ to
Print Child’s Name
participate voluntarily in the Youth Empowerment IDEAS Youth Survey pretest.
__________________________________
Print Name
____________________________________ _______________________
Signature Date
THE PAPERWORK REDUCTION ACT OF 1995 Public reporting burden for this collection of information is estimated to average 90 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. 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 collection of this information is voluntary and responses will be kept private to the extent allowed by law. The OMB number for this information collection is 0970-0355 and the expiration date is 05/31/2021. |
Youth Survey Pretest Assent Form
On behalf of the Administration for Children and Families (ACF), Mathematica Policy Research is conducting voluntary survey pretests with youth and young adults age 14-24. The purpose of these pretests is to solicit feedback about surveys for the Youth Empowerment Information, Data Collection, and Exploration on Avoidance of Sex (Youth Empowerment IDEAS) national research study. The study has a Youth Survey, Young Adult Survey and a Parent Survey.
ACF and Mathematica would like to know how long it takes to complete each survey and whether the survey questions are easy to understand. You will be asked to participate in up to a 90-minute session session. You will be asked to complete a survey on your own. You will then be asked to provide feedback on the survey with a small group. The group will meet with a researcher to share whether the questions were easy or hard to understand and how to improve the questions. These discussions will be audio-recorded so that the study team can review the recordings later. No one else will hear the recordings. Participation is entirely voluntary and all feedback will be used only for revising the surveys. No participants’ names or feedback will be disclosed or used, in identifiable form, for any other purpose except as required by law. The study team will also ask all participants in the group to keep the information discussed private. There is a chance others might share information from the discussion with people who did not participate.
The feedback received from you will provide ACF and Mathematica with valuable information to improve the surveys that will be included in the national research study. You will be given a $25 debit card as a thank you for your participation.
If you have any questions about the pretest, please contact Tiffany Waits, the Youth Empowerment IDEAS survey director, at twaits@mathematica-mpr.com or (202) 264-3498. If you have any questions or concerns about your rights as a study participant, please contact the Health Media Lab Institutional Review Board at (202) 753-5040.
Youth Survey Pretest Assent
By signing below, you agree that you will participate in the Youth Survey Pretest. Your signature below will indicate that your questions have been answered satisfactorily, and that you have read and understood the information provided above.
__________________________________
Print Name
____________________________________ _______________________
Signature Date
Public reporting burden for this collection of information is estimated to average 90 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. 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 collection of this information is voluntary and responses will be kept private to the extent allowed by law. The OMB number for this information collection is 0970-0355 and the expiration date is 05/31/2021. |
Young Adult Survey Pretest Consent Form
On behalf of the Administration for Children and Families (ACF), Mathematica Policy Research is conducting voluntary survey pretests with youth and young adults age 14-24. The purpose of these pretests is to solicit feedback about surveys for the Youth Empowerment Information, Data Collection, and Exploration on Avoidance of Sex (Youth Empowerment IDEAS) national research study. The study has a Youth Survey, Young Adult Survey and a Parent Survey..
ACF and Mathematica would like to know how long it takes to complete each survey and whether the survey questions are easy to understand. You will be asked to participate in up to a 2 hour session. You will be asked to complete a survey on your own. You will then be asked to provide feedback on the survey with a small group. The group will meet with a researcher to share whether the questions were easy or hard to understand and how to improve the questions. These discussions will be audio-recorded so that the study team can review the recordings later. No one else will hear the recordings. Participation is entirely voluntary and all feedback will be used only for revising the surveys. No participants’ names or feedback will be disclosed or used, in identifiable form, for any other purpose except as required by law. The study team will also ask all participants in the group to keep the information discussed private. There is a chance others might share information from the discussion with people who did not participate.
The feedback received from you will provide ACF and Mathematica with valuable information to improve the surveys that will be included in the national research study. You will be given a $50 debit card as a thank you for your participation.
If you have any questions about the pretest, please contact Tiffany Waits, the Youth Empowerment IDEAS survey director, at twaits@mathematica-mpr.com or (202) 264-3498. If you have any questions or concerns about your rights as a study participant, please contact the Health Media Lab Institutional Review Board at (202) 753-5040.
Young Adult Survey Pretest Consent
By signing below, you agree that you will participate in the Young Adult Survey Pretest. Your signature below will indicate that your questions have been answered satisfactorily, and that you have read and understood the information provided above.
__________________________________
Print Name
____________________________________ _______________________
Signature Date
THE PAPERWORK REDUCTION ACT OF 1995 Public reporting burden for this collection of information is estimated to average 120 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. 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 collection of this information is voluntary and responses will be kept private to the extent allowed by law. The OMB number for this information collection is 0970-0355 and the expiration date is 05/31/2021. |
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Modified | 0000-00-00 |
| File Created | 2021-01-15 |