Attachment F_Data Linkage Form- SYTFC

OMB Control Number: 0970-XXXX

Expiration Date: XX/XX/XXXX

Consent for Combining

Survey of Youth Transitioning from Foster Care Information with Other Research Information

We want to ask for your okay to add other types of information to the information you will provide in the Survey of Youth Transitioning from Foster Care.

Why should I grant permission to combine my interview data with other data?

The information you give us in this interview will be even more helpful to researchers if it can be combined with other information.

What kinds of information would you gather?

We would add historical information collected by the child welfare agency that provided foster care services. Adding this information will help us to learn more about your experiences with the child welfare system, including the circumstances that led to your involvement with child protective services, places you have lived, times you may have left foster care, and other services you may have received.

Your okay allows us to add these types of information to your interview data. Only the RTI research team will have access to this information.

What are the risks and benefits for saying OK to this request?

We have significant protections in place to collect and store your information securely. However, there is a small risk that if someone doesn’t follow the rules we set, someone outside the study team might see your information. We minimize this risk by transferring and storing your information and interview data using a study ID and not your name .

Combining your interview data with other information presents no direct benefits to you. Your decision will not affect any services you receive now or in the future. By answering “yes”, you give your okay for us to link your interview data with information in your case file.

What are my choices?

You have the right to say yes or no to this request. If you change your mind about this, please contact the study director, Deborah Gibbs, toll-free at 1-800-334-8571 extension 26942. You may also call the Coordinator of RTI’s Office of Human Research Protections (toll-free at 866-214-2043), to confirm that you want to change your answer.

Check one box.

		Yes, it’s OK to link and share information collected by the child welfare agency to my Survey of Youth Transitioning from Foster Care interview. .
		No, I do not want add information collected by the child welfare agency to my Survey of Youth Transitioning from Foster Care interview.
Signature				Printed Name		Date

The Survey of Youth Transitioning from Foster Care is voluntary and will be used to make improvements to the child welfare system and better support youth during and after foster care. Public reporting burden for the survey collection of information is estimated to average 70 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 OMB number and expiration date for the Survey of Youth Transitioning from Foster Care collection are OMB #: 0970-XXXX, Exp: XX/XX/XXXX. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Deborah Gibbs; 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194.

The Federal Government has issued a Certificate of Confidentiality (authorized by the Public Health Service Act Section 301(d), 42 U.S.C Section 241 (d), 1988) to the researchers who are conducting this study which authorizes us to protect the privacy of individuals who participate.

Disposition: Original to RTI; Copy to Respondent July 2019