BTS Consent Form for OSRA

CONSENT FORM

The U.S. Department of Transportation, Bureau of Transportation Statistics whenever possible conducts research on how we collect information in order to produce the best statistics possible.

You have volunteered to take part in a pilot study of data collection procedures for the Ocean Shipping Reform Act of 2022. In order to have a complete record of your comments, your interview will be audio- recorded. We plan to use your feedback to improve the sampling frame, sample design, and data collection protocol for a new national data collection in accordance with OSRA 22. For any data collected as part of the pilot, only regional or national statistics will be shared, not the raw data and appropriate disclosure avoidance methods will be applied if there is any disclosure risk. Only staff involved in this research will have access to the interview recording.

This collection has been approved by the Office of Management and Budget (OMB). This eight-digit OMB approval number, XXXX-XXXX, confirms this approval and expires on XX/XX/XXXX. Without this approval, we could not conduct this study.

I have volunteered to participate in this Bureau of Transportation Statistics study, and I give permission for my audio recordings and data to be used for the purposes stated above.

Participant’s Signature Researcher’s Signature

Printed Name Printed Name

Date Date

Authority and Confidentiality

This collection is authorized under OSRA 22, Section 16. BTS will protect the confidentiality of the data under its own confidentiality statute (49 U.S.C. 6307(b)), the Confidential Information Protection and Statistical Efficiency Act (CIPSEA) (44 U.S.C. § 3501), and the Foundations for Evidence-Based Policymaking Act of 2018 (Title 3 of Public Law 115-438). The Bureau of Transportation Statistics is not permitted to publicly release your responses in a way that could identify you, your business, organization, or institution.

Burden Estimate

We estimate that completing the interview and uploading pilot data will take 120 minutes on average, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. You may send comments regarding this estimate or any other aspect of this survey, including suggestions for reducing the time it takes to complete this survey to Janine.mcfadden@dot.gov.