Panel_Informed_Consent_ENG

CONSENT TO PARTICIPATE IN THE ASK U.S. PANEL PILOT

[TO BE PRESENTED AT THE BEGINNING OF THE BASELINE ENROLLMENT SURVEY]

Description and Purpose of the Ask U.S. Panel Pilot: The Ask U.S. Panel pilot is a large, nationally-representative survey panel pilot led by the U.S. Census Bureau. The purpose of the Ask U.S. Panel pilot is to track public opinion on a variety of topics of interest to numerous federal agencies and their partners, and for conducting experimentation on alternative question wording and methodological approaches. A key objective of the Panel will be to produce representative and reliable statistics on a rapid turnaround suitable for use by federal agencies. The Panel will ensure availability of frequent data collection for nationally representative estimates on a variety of topics and a variety of subgroups of the population. The panel pilot also will also test feasibility and procedures that may be used to develop and implement future panels. The pilot will consist of individuals and households living across the U.S. that have agreed to be contacted and invited to participate in surveys led by the U.S. Census Bureau and other federal statistical agencies.

Privacy Act Statement: The legal authority for the Ask U.S. Panel Pilot is provided under 13 U.S.C §§ 8(b), 131, 141, 161, 181, 182, and 193; 49 U.S.C. § 329; the Education Sciences Reform Act of 2002, 20 U.S.C. §9543, Section 1110(a) of the Social Security Act as amended, 42 U.S.C. 1310(a); 7 U.S.C. § 3318; 7 U.S.C. 2204(a); Section 306 of the Public Health Service Act, 42 U.S.C. 242k; and 10 U.S.C. § 1782.

The U.S. Census Bureau is conducting this survey in partnership with the Economic Research Service of the USDA, Food and Nutrition Service of the USDA, Social Security Administration, National Center for Education Statistics, National Center for Health Statistics, Department of Labor, Department of Defense, and the Department of Transportation (partner agencies).

Personally-identifiable information (PII) collected includes: Name, Address, Telephone/cell phone number, Date of Birth or age, Email address, Race or ethnicity, and Unique Identifier (Code).

Your privacy is protected by the Privacy Act of 1974 (5 U.S.C. § 552a). Disclosure and use of this information are subject to the published routine uses identified in the Privacy Act System of Records Notice COMMERCE/Census-3 Demographic Survey Collection (Census Bureau Sampling Frame); COMMERCE/Census-5 (Decennial Census Program); and COMMERCE/Census-7 Demographic Survey Collection (non-Census Bureau Sampling Frame). Partner agencies may provide PII to the Census Bureau under the Privacy Act ((5 U.S.C. § 552a(b)(4)). All PII will be secured by staff (employees and contractors) that have received training on privacy and confidentiality laws, policies, and practices. Access to the information that you provide is restricted to authorized personnel. The information will be shared only with staff, contractors, and non-Census sponsors that are authorized and have a need to know.

Furnishing this information is Voluntary. Failure to do so will result in the Census Bureau’s inability to create a robust probability-based nationwide survey panel.

Sponsor: The Ask U.S. Panel pilot is sponsored by the U.S. Census Bureau in partnership with partner agencies listed above. RTI International, a not-for-profit research organization, is establishing and maintaining the panel pilot under a cooperative agreement awarded by the Census Bureau pursuant to the Consolidated Appropriations Act of 2021, Public Law 116-260, Section 110. The Census Bureau will provide reports and other statistical products on the results of the panel collection to partner agencies, as authorized by 13 U.S.C. 8(b).

Procedures: This is a panel pilot that will test procedures and feasibility for future panels. Your participation in the panel pilot will last up to 1 year, during which time you will be asked to complete a 20-minute enrollment survey, followed by an additional 15-minute survey later in 2022.

Financial Considerations: Participation in the Ask U.S. Panel pilot will involve no cost to you. For completing the baseline questionnaire to enroll in the Ask U.S. Panel pilot, you will receive $20. Once enrolled in the panel, you will receive $10.00 for completing an additional 15-minute panel survey later in 2022.

Voluntary Participation: Your participation in the panel pilot is completely voluntary. While your responses are very important to us, you can refuse to answer any and all questions, or choose not to participate in future surveys. You can also elect to leave the panel pilot at any time.

Possible Benefits and Risks: There are no direct benefits to you for participating in the panel pilot. The potential exists for loss of privacy, though our procedures are designed to protect and secure your personal information. Please see the Privacy section above for details on the procedures in place to protect your privacy.

Further Questions: If you have any questions about the research now or in the future, including the surveys, you can contact the Ask U.S. Panel pilot project team at askuspanel@rti.org or at 1-866-558-0774 from 9:00 am-12:00 am Monday through Thursday, 9:00 am-11:00 pm on Fridays, 10:00 am-9:00 pm on Saturdays, and 1:30 pm-11:00 pm on Sundays (EST). If you have any questions or concerns about your rights as a research subject, you may call the University of Southern Maine Office of Research Integrity and Outreach at (207) 780-4517 and/or email usmorio@maine.edu.

By clicking “Next” below, you are agreeing to enroll in the Ask U.S. Panel pilot and receive an invitation to a future Ask U.S. Panel pilot survey.