5. Factsheet_Model State Interview _final draft 3.8.21. (1)

OMB Control No: 1230-0NEW

Expiration Date: XX/XX/20XX

Investigation of State Vocational Rehabilitation Agencies’

Implementation of Pre-Employment Transition Services (Pre-ETS)

A CAPE-Youth Research Project

FACT SHEET

1. As someone involved in delivering or designing Pre-ETS in your state or a collaborative partner in delivering Pre-ETS, you are invited to participate in an interview for a CAPE-Youth research study titled, “Investigation of State Vocational Rehabilitation Agencies’ Implementation of Pre-Employment Transition Services (Pre-ETS)”. CAPE-Youth is a collaboration between The Council of State Governments, the K. Lisa Yang and Hock E. Tan Institute on Employment and Disability at Cornell University, and the Transitions to Adulthood Center for Research at the University of Massachusetts Medical School. Your state has been selected as part of a case study for delivering Pre-ETS to students with disabilities.

2. Participation is voluntary. You do not have to be in this study, and if you do join, you can stop or leave at any time. In either case there are no penalties and you do not lose any benefits to which you are otherwise entitled. In the event you decide to withdraw, any information we gathered prior to your withdrawal will not be disseminated in any of our aggregate data. A copy of the questionnaire for your review will be provided prior to the scheduled interview.

3. The information we gather will be used to develop a report for CAPE-Youth. The report will contain a description of how Pre-ETS has been delivered in the case study states, along with strategies and suggestions that may benefit Pre-ETS administration in other states. The report will be widely distributed to state agencies and policymakers and used for technical assistance. Your state agency and your name and identity will not be disclosed on public materials unless you give us express permission to do so.

In addition to an interview, we may request to view relevant documents, such as reports, program descriptions, regulations and policies, training or instructional guides, vendor requirements, summaries of data on Pre-ETS and the state VR agency.

4. We are recording our discussion, so we don’t have to take notes. This audio of your responses will not be shared with anyone outside of our research team. These interviews will be recorded to a UMass Medical School password protected secure computer and the audio files will be deleted after they are transcribed. These recorded interview responses will be stored on an encrypted password protected secure computer. We will ensure that any personal information that could identify you (i.e. names or places) will be taken out when audio recordings are transcribed. Your name will never be reported, and we will not share individually identified results with your supervisors or co-workers. Individuals outside the CAPE-Youth research team will not have access to individual-level responses.

5. A minimal risk to participating in this interview is that your responses may be inadvertently linked to you outside the study. This is highly unlikely to happen, and we are very experienced in keeping data like this completely private. The research team at CAPE-Youth will use the information you provide for research purposes only and will keep the information private to the full extent permitted by law. We will limit access to your personal information to people who have a need to review this information. We cannot promise complete privacy. The CAPE-Youth collaborative partner at UMass Medical School’s Institutional Review Board and other representatives of UMass Medical School may see your information.

There is a minimal risk that you could experience discomfort with the questions being asked during the interviews. You only have to answer questions you feel comfortable with and can request a break at any point or stop the interview at any time.

6. Privacy Act Statement: Collection and Use of Personal Information

The following statement is made in accordance with the Privacy Act of 1974 (5. U. S. C. 552a). Information collected will be handled and stored in compliance with the Freedom of Information Act and the Privacy Act of 1974, as amended (5 U.S.C. 552a). Furnishing us the Pre-ETS data requested is voluntary.

We will use the Pre-ETS data that you provide for the CAPE-Youth Pre-ETS Research Project, funded by The United States Department of Labor, Office of Disability Employment Policy. In accordance with the Confidential Information Protection and Statistical Efficiency Act of 2002 (Title 5 of Public Law 107-347) and other applicable Federal laws, your responses will not be disclosed in identifiable form without your informed consent. Per the Federal Cybersecurity Enhancement Act of 2015, Federal information systems are protected from malicious activities through cybersecurity screening of transmitted data.

If you have any questions, concerns, or complaints, or think that the research has harmed you, you can talk to the Principal Investigator Marsha Ellison, PhD. at (508) 856-2816. This research has been reviewed and approved by the UMass Medical School Institutional Review Board. You can reach them at (508) 856-4261 or irb@umassmed.edu if you would prefer to speak with someone not associated with the study.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays an Office of Management and Budget (OMB) control number. The valid OMB Control Number for this information collection is xxxx-xxxx. The time required to participate in the interview is estimated to average 60 minutes, including the time to review instructions, search existing data resources, gather the data needed and complete and review the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to US Department of Labor, Office of Disability Employment Policy, 200 Constitution Ave., N.W. Washington, DC 20210 and reference the OMB Control Number xxxx-xxxx.

2