Consent Form

Consent Form

For Individual Participants

Usability Testing of the Census Website

Each year the Census Bureau conducts many different usability evaluations. For example, the Census Bureau routinely tests the wording, layout and behavior of products, such as Web sites and online surveys and questionnaires in order to obtain the best information possible.

You have volunteered to take part in a study to improve the usability of the Census Website. In order to have a complete record of your comments, your usability session will be video or audio recorded. We plan to use these recordings to improve the design of the product. Only staff directly involved in the research project will have access. Your participation is voluntary and your answers will remain strictly confidential.

The OMB control number for this study is 0607-0725. This valid approval number legally certifies this information collection.

Privacy Notice

The U.S. Census Bureau is required by law to protect your information. The Census Bureau is not permitted to publicly release your statements in a way that could identify you. We are conducting this focus group under the authority of 5 U.S.C., Section 301 and 44 U.S.C., Section 3101. Federal law protects your privacy and keeps your answers confidential (13 U.S.C., Section 9). Your voluntary response will be used to improve the usability of the Census Bureau Website.

Your privacy is protected by the Privacy Act (5 U.S.C., Section 552a). The information provided may be shared with other Census Bureau staff for the work-related purposes identified in this statement. Participating in this focus group implies consent for the purposes stated. Your information is secured by the Census Bureau by strictly adhering to the provisions of the Privacy Act, and other regulations and policies to protect the privacy and confidentiality of the information.

I have volunteered to participate in this Census Bureau usability study, and I give permission for my video and audio recordings to be used for the purposes stated above.

Participant’s Name: ______________________________________

Participant's Signature: ____________________________________ Date: ­­­­­__________

Researcher’s Name: _____________________________________

Researcher's Signature: ___________________________________ Date: __________