Adult Protective Services Outcomes Study

OMB Control Number 0985-New
Expiration Date: xx/xx/xx

Information Sheet
You are invited to participate in a research study. Your participation is voluntary. This document
explains information about this study. It also provides contact information for individuals who
can answer questions you may have about this study.
STUDY TITLE: Adult Protective Services (APS) Client Outcomes Study
FUNDING: This study is funded by the Department of Health and Human Services,
Administration for Community Living.
PURPOSE: APS programs aim to help older adults and adults with disabilities who may have
experienced abuse, neglect, self-neglect, or financial exploitation. The purpose of this study is to
learn about APS programs, client experiences using APS, and the effect APS services have on
clients.
YOUR PARTICIPATION: Your participation is completely voluntary. If you decide to
participate, please follow the instructions to complete and return the form labeled: Client
Questionnaire. This study will not collect any information that identifies you, like your name or
address, so no one can find out that you participated in this study. Your identity will not even be
known to the researchers unless you contact them and ask that they make a note that you
participated in this study. You have the right to ask that your name be included and may do so by
contacting the research team (see below for contact information), but you do not have to do this.
RESEARCH TEAM CONTACT INFORMATION: This study is being conducted by New
Editions Consulting, Inc. under contract with the Department of Health and Human Services,
Administration for Community Living. If you have questions (which can be asked without giving
your name) or if you want to provide information that links you to this research study, please
contact Raphael Gaeta, PhD at New Editions Consulting, Inc. by calling 703-356-8035 (ext. 143)
or e-mailing rgaeta@neweditions.net.
INSTITUTIONAL REVIEW BOARD (IRB) CONTACT INFORMATION: The IRB
reviews and monitors research studies to protect the rights and welfare of participants. If you
have any questions about your rights as a research participant, please contact Amanda Gmyrek,
PhD at the JBS International IRB by calling (240) 645-4848 or emailing
agmyrek@jbsinternationl.com.
Public Burden Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a
collection of information unless such collection displays a valid OMB control number (OMB
0985-xxxx). Public reporting burden for this collection of information is estimated to average 10
minutes per response, including time for gathering and maintaining the data needed and
completing and reviewing the collection of information. The obligation to respond to this
collection is voluntary.