NCSES Generic Clearance Package: HERD COVID-19 Cognitive Interviews and Webinar Poll

Attachment D: Consent Form
The National Center for Science and Engineering Statistics (NCSES), within the National Science
Foundation (NSF), designs, conducts, and sponsors surveys on science, engineering, and technology. In
order to produce the best information possible, NCSES routinely evaluates its surveys.
You have volunteered to take part in a study to improve one of the NCSES’s surveys. In order to have a
complete record of your comments, your interview session will be recorded (audio and/or video). We
plan to use the recordings to improve the survey. Staff directly involved in this research project will
have access to the recordings. In addition, a transcription service may have access to the recordings, to
provide us with a written version of your comments. They may also be used for training others to
conduct this type of research, and in presentations to professional audiences. Specific results or quotes
will not be attributed directly to you in any summaries or reports.
This study is authorized by law (42 U.S.C. 1862 Section 3.a.6.). The OMB control number for this study is
3145-0174.
I have volunteered to participate in this study, and I give permission for my recordings to be used for the
purposes stated above.

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Researcher’s Signature

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Participant’s Signature

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Printed Name

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Printed Name

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Date

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Date

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