Other Adult Household Member Informed Consent For Study Participation

ATTACHMENT D: OTHER ADULT HOUSEHOLD MEMBER INFORMED CONSENT

Evaluation of the Community Choice Demonstration

TO BE TRANSLATED: If you would like translated consent materials, or to complete the survey in a language other than English, please let the staff person you are talking to know. Please let them know if you need information to be presented in an accessible format, for example, Braille, audio, large type, or sign language interpreters. The staff person will do their best to provide a reasonable accommodation (a change or adjustment) so that you can participate.

The head of your household agreed to take part in an important study called the [LOCAL MOBILITY PROGRAM OR Community Choice Demonstration (CCD)]. The study is sponsored by the U.S. Department of Housing and Urban Development (HUD).

• This form asks you to provide consent to participate in the Community Choice Demonstration study. The purpose of this study is to help HUD understand how well different types of services help families move to different neighborhoods of their choice. Your participation in this study may help other families in the future.

• Your participation in the study is completely voluntary.

• In order to participate in the study, you need to allow the study to collect information about you. The study will use your social security number to collect this information. The study will get your social security number from PHA records.

• You may be asked to participate in future surveys or interviews for up to 15 years. Your participation in those future study activities is voluntary.

• Researchers approved by HUD may be provided with data from other agencies for up to 30 years as described more under “What does it mean to be in the [CCD] study?” and “Will my information be used in the future? Can it be used for additional studies?” sections below.

• Your information will be kept private to the full extent provided by law and will be protected as described in the section “How will my information be protected?”

You and the other members of your household are also invited to take part in this study. The [PHA] is operating the [CCD] program, with support provided by [LOCAL PROVIDER PARTNER(S)]. HUD contracted with Abt Associates and their research team to conduct the study. The research team includes Abt Associates, the Urban Institute, MEF Associates, Social Policy Research Associates, Sage Computing, a team of consultants, and other researchers that may be added in the future.

What is the [CCD] study?

The [CCD] study will allow us to learn how to help households find housing that can help children succeed in life. Some households will receive a special set of services to help them move to a new neighborhood of their choice. The [CCD] study will measure whether children in households that move to these new neighborhoods do better in school and earn more money later in life. The study will also measure how well these services help adults in the households.

Over 16,000 families from the participating public housing agencies will be invited to participate in this study. Families in the study will be put into one of two groups, at random:

• The “Standard Services Group”: this group will get a Housing Choice Voucher and all the existing services that [PHA] normally provides to families with a Housing Choice Voucher.

• The “[CCD] Comprehensive Mobility Related Services Group”: this group will get a Housing Choice Voucher and ongoing guidance from a staff member who will help them get ready to search for housing, connect them with landlords in specific areas, and provide funds to help pay for some housing search and certain leasing expenses, such as rental application fees, holding fees, and security deposits. Some services, such as guidance from a staff member on how to overcome obstacles to renting a new unit, will be offered to all families in this group. Other services, such as assistance paying a security deposit or an application fee, will be available only to help families move to specific areas. These are the neighborhoods that past research has suggested are particularly beneficial to children.

Your household will have the same chance of being offered the comprehensive services as all the other households that agree to be in the study. Families will be put into groups randomly by a computer process that is like pulling names from a hat. Group assignment is not based on anything you tell us about you or your household. You cannot choose which group you will be in.

Who can be in the [CCD] study?

The head of your household was found to be eligible to participate in the study. Since they agreed to take part in the study, you and the members of your household are also eligible to participate.

The rest of this form explains what it means to be in the study. This form also describes the type of information that the research team will collect. We hope you will agree to participate.

What does it mean to be in the [CCD] study?

If you choose to join the [CCD] study, the research team will collect information about you and other members in your household in up to three ways. We will collect this information from all individuals no matter which group your household is placed in.

1. Current Information Collection: We will collect information about you at enrollment from the head of your household. This includes information about your employment, your age, and your email and cell phone contact information. We will also collect information about you from [PHA] records. We will use your social security number to gather your data from other state and federal agencies.

2. Other Surveys and Interviews: We might contact you in the future to collect additional information, which may be done either by the study team or other HUD-approved researchers. The long-term outcomes, especially for children, are important to HUD and the research team, so you may be contacted during the next fifteen years to complete one or more surveys. The follow-up surveys or interviews may ask about topics such as experiences with the program, searching for housing, education, work status, living situation, your and your children’s health, and your children’s schooling. Your children may also be asked to participate in future information collection efforts including interviews. We will use your SSN to locate you through credit bureau data and other directories for follow up surveys and interviews over the life of the study. These follow-up surveys or interviews will also be voluntary. You do not have to participate.

3. Longer-Term Information Collection: Because we are interested in long-term outcomes, especially for children, part of the research includes getting information about you and other members of your household members from federal agencies, state departments of labor, local school districts, child welfare agencies, and credit bureaus. Getting these types of data about you from other agencies means we can learn about some of the long-term outcomes of interest without asking you to do too many surveys. The information will be combined with the information you provide today and any future surveys to help HUD understand how families that enrolled in the [CCD] Study are doing. This will help the research team learn how different kinds of housing and services helps families. This information will only be used for research. HUD will never use these data to determine your ability to participate in different programs.

Here are some examples of the types of information the research team may collect about you for up to 30 years:

• Information from PHA records such as your address, your voucher issuance and expiration dates, characteristics of your rental unit, and your household’s total income, assets, and rent;

• How much money you earned maintained by federal agencies or your state’s department of labor;

• Your financial well-being from databases maintained by credit bureaus (the study’s collection of this information will have no effect on your credit score);

• Your children’s school records from kindergarten through high school, including information about how they scored on achievement tests, their school absences, if they repeated a grade, if they had any disciplinary actions, how they are doing in school, and as they age out of high school, data from other educational agencies about whether they enrolled in college, and whether they graduated from college;

• Information from other educational agencies about whether you enrolled in college, and whether you graduated from college;

• Receipt of disability benefits;

• Health records, including Medicare or Medicaid;

• Information from federal government agencies, including employment, individual and household earnings, family composition, education, residency, neighborhood quality, and information found in tax returns; and

• Participation in Temporary Assistance for Needy Families (TANF) or Supplemental Nutrition Assistance Program (SNAP) programs.

You can stop being in the [CCD] study at any time. If you wish to stop being in the [CCD] study at any time, please see “Can I stop being in the study after I join?” section on page 4.

What are the benefits of being in the study?

Your household may be randomly chosen to be offered special help in searching for housing and exploring new neighborhoods and financial help to cover some leasing expenses. If you do join the study, you are helping the research team and HUD learn about ways to help households move to specific neighborhoods and whether moving to these neighborhoods improves the lives of families with children.

What are the risks of being in the study?

There are very few risks involved. You may be uncomfortable with the questions asked in future interviews or surveys. You can refuse to answer any question. There is a small risk that your information could be lost or misused, even though the research team takes great care to protect it. The research team has strict requirements to notify you if any of your information is lost or misused.

Do I have to participate?

No, your participation in the study is completely voluntary. Neither you nor your household will lose any assistance you may be receiving now or in the future based on your choice to not participate in this study.

Can I stop being in the study after I join?

Yes, you can choose to stop being in the study at any time. To do so, contact the research team, as listed below. If you choose to stop being in the study, your family will still keep its Housing Choice Voucher (if eligible) and neither you nor your family will lose any current or future [PHA] benefits or standard services that you are entitled to. The research team will still use the information that was collected about you while you were in the study. The research team will not continue to collect information about you after you tell the study team that you want to stop being in the study. You may contact XXX XXXXX at XXX-XXX-XXXX (a toll-free number) to withdraw from the study.

How will my information be protected?

We want to assure you that all your responses and personal information that you provide will be kept private to the full extent provided by law. This research is conducted under the authority of the Secretary of the U.S. Department of Housing and Urban Development (HUD) to undertake programs of research, studies, testing, and demonstration related to the mission and programs of HUD (12 USC 1701z-1 et seq.). The research team will never use your name or other personally identifiable information (PII) that could identify you in reports about the research. Your personally identifiable information will be removed from your responses before they are combined with responses from over 16,000 other participants.

All information will be analyzed and reported for groups of individuals. There will be no way to link your responses back to you in reports. The research team has been trained in protecting private information. The team uses safety procedures like secure computers and data storage systems to help protect data from being seen by anyone other than the researchers. The research team may need to report information about you to the appropriate authorities if it learns that you or someone else may be at risk of harm.

[PHA] will have access to some of your study data, such as the mobility services you received as part of this study. [PHA] will not have access to other data (including non-housing-related administrative data, follow-up surveys or interviews, and college or school records) collected by the research team. The [PHA] will not be able to use any of the study data to determine your or your family’s eligibility for the Housing Choice Voucher program or any other assistance it may offer.

The research team will maintain the privacy of the information you provide from the start of the study until the end of their contract with HUD. At that time, all data, including your personal information, will be provided to HUD. Your data and personal information will be kept private by HUD to the full extent provided by law. The information requested under this collection is protected and held private in accordance with 5 U.S.C. 552a (Privacy Act of 1974) and OMB Circular No. A-130. Please remember, HUD will use this information only for research purposes. HUD will not use these data to determine your eligibility for any current or future housing assistance or receipt of other benefits.

Will my information be used in the future? Can it be used for additional studies?

To fully understand how the program helped you and the other members of your household long-term, HUD may wish to continue learning from this study for up to 30 years. We understand that sounds like a very long time, but research from an earlier HUD study has shown the benefits of moving to a different neighborhood for families and especially their children as they grow into adults. HUD and the research team want to be able to continue that research with this new study.

The information you will provide for this study is important for research on how to help families with housing. HUD will make this data available to other people to maximize the benefits of this research. HUD will make two versions of the data available. Neither version of the data will include any identifying information about you. Only HUD-approved researchers will be able to use the first version of the data. HUD will require anyone who they provide access to these data, to commit to protecting the data, and to presenting results in summary form only. The other version of the data will be available to the public. There will be no restrictions on who can use the public version of the data. Because there are no limits on who could use the public data, HUD will take additional steps to make sure your identity is protected. They will do this by including more summarized information. For example, rather than showing that a study participant is 30 years old it would show that the study participant is between 25 and 35 years old.

Who can I call with questions?

If you have any questions about this study or about your rights as a participant in the study, you may contact the research team:

• The Abt Associates Project Manager, at xxx-xxx-xxxx, or by email at xxxxx @abtassoc.com.

• The study contact for HUD at xxx-xxx-xxxx or by email at xxxxxx@hud.gov.

• The study contact for HUD at xxx-xxx-xxxx or by email at xxxx@hud.gov.

If you have any questions about your rights as a participant in the study, you may contact:

• Abt Associates Institutional Review Board Administrator at xxx-xxx-xxxx, or by email at xxxx@abtassoc.com.

Statement

I have read this document, or had the document read to me. I had my questions answered. I agree to be part of the study. I agree that my participation is voluntary and that I can refuse to answer any question or stop being in the study at any time. I agree all information about me will be kept private unless doing so would put me or someone else in danger. I consent to the data collection as described above, for as long as the study is ongoing. I agree that a copy of this consent form will be given to me to keep for my records.

____ Yes, I agree to be part of the [CCD] study.

____ No, I do not agree to be part of the [CCD] study.

E-signature: __________________________________ Date: __________

The Paperwork Reduction Act Statement: This collection of information is voluntary and will be used to evaluate the US Department of Housing and Urban Development’s Community Choice Demonstration. Public reporting burden for this collection of information is estimated to average 15 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 this collection are OMB #: XXX-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 XX at XXXX@XXX or call at XXX-XXX-XXXX.