Your Money, Your Goals Impact Research

Your Money, Your Goals Survey Consent Form

You are invited to participate in 2 phone or online survey related to the a program to help consumers better understand a range of financial topics. We are interested in knowing how people like you think about financial decisions. This is a research project being conducted by the RAND Corporation on behalf of the Consumer Financial Protection Bureau. Our partner, Davis Research, is administering the survey.

This survey is about how you make financial decisions. You're eligible to be in this study because you are a client of XXX. Please note that we are not conducting this survey to evaluate you or this organization. The focus of this survey is to understand how the CFPB can develop new resources for organizations and individuals interested like XXX and like you.

Each survey should take approximately 15-20 minutes to complete.

Your answers will help to inform current and future CFPB programs and toolkits and will benefit organizations like you.

Your participation in this survey is voluntary. You may refuse to take part in the survey or decline to answer any particular question you do not wish to answer for any reason. You may exit the survey at any time and come back later and resume the survey where you left off.

There are no foreseeable risks involved in participating in this survey other than those encountered in day-to-day life.

Your survey answers will be collected by our partner Davis Research and stored in a password protected electronic format. Your name and the name of XXX organization will not be linked to your survey responses. Therefore, your responses will remain anonymous. Information about whether your participated will be kept separate from your responses. No one will be able to identify you or your answers. No names or identifying information about you or your organization will be included in any publications or presentations based on this data, and your responses to this survey will remain private.

Privacy Act Statement

5 U.S.C. 552a(e)(3)

The information you provide through your responses to Davis Research and the RAND Corporation will assist the study sponsor, the Consumer Financial Protection Bureau (CFPB or “Bureau”), in collecting feedback about consumers’ experiences receiving services at organizations that have been trained to use the Your Money, Your Goals (YMYG) toolkit and educational materials.

The CFPB will not obtain or access personally identifiable information. The Bureau will only obtain and access de-identified results and aggregated analyses of those results.

Information collected on behalf of the Bureau by Davis Research and the RAND Corporation will be treated in accordance with the System of Records Notice (SORN), CFPB.021 Consumer Education and Engagement Records SORN, 83 FR 23435. This information may be disclosed as outlined in the Routine Uses for the SORN. Direct identifying information will only be used by Davis Research and the RAND Corporation to facilitate the survey and will be kept private except as required by law.

This collection of information is authorized by Pub. L. No. 111-203, Title X, Sections 1013 and 1022, codified at 12 U.S.C. §§ 5493 and 5512.

Participation in this study is voluntary, you are not required to participate or share any identifying information with Davis Research or the RAND Corporation.

Paperwork Reduction Act Statement

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and not withstanding any other provision of law a person is not required to respond to a collection of information unless it displays a valid OMB control number. The OMB control number for this collection is 3170-0036. It expires on 10/31/2022. Comments regarding this collection of information, including the estimated response time, suggestions for improving the usefulness of the information, or suggestions for reducing the burden to respond to this collection should be submitted to the Consumer Financial Protection Bureau (Attention: PRA Office), 1700 G Street NW, Washington, DC 20552, or by email to PRA_Comments@cfpb.gov.

CONTACT

If you have questions at any time about the study or the procedures, you may contact Katherine Carman at xxxxxxxx@rand.org. If you have questions about your rights as a research participant or need to report a research-related injury or concern, you can contact RAND's Human Subjects Protection Committee toll-free at (866) 697-5620 or by emailing hspcinfo@​rand.org​. If possible, when you contact the Committee, please reference Study #XXXX-XXXX.

ELECTRONIC CONSENT: Please select your choice below. You may print a copy of this consent form for your records. Clicking on the “Agree” button indicates that

• You have read the above information

• You voluntarily agree to participate

• You are 18 years of age or older

 Agree

 Disagree