Consent Form

Form Approved

OMB No. 0607-0725

Exp. Date 12/31/2025

Consent to Participate in a Virtual Focus Group about how to Count People Using Soup Kitchen Services in the Census

Purpose. The purpose of this study is to gather ideas about how to best count people who use soup kitchen services in the Census. We would like to receive feedback from soup kitchen staff to help improve operations in the 2030 Census.

Approval. This focus group is sponsored by U.S. Census Bureau and is approved by the Office of Management and Budget (OMB) as indicated by the OMB number 0607-0725 on this form. Without this number, we could not conduct this data collection.

Procedures. If you agree to participate, you will be assigned to a focus group session time that works with your schedule. You will join the virtual focus group using Microsoft Teams using your device. You and approximately five other soup kitchen staff members will participate in the same session. We will ask you questions about

• How we might count people who regularly visit soup kitchens in the Census;

• What other facilities or service providers may be good locations to count the population that is experiencing homelessness; and

• The definitions the Census Bureau uses to classify soup kitchens.

None of the questions will ask you to share any names or other identifying characteristics of your clients.

The focus group should take 90 minutes. If you have any questions about the time needed for the focus group or the questions that will be asked, please contact adrm.pra@census.gov.

Audio and Screen Recording. During the focus group, you will use your camera and computer audio. A screen and audio recording of this virtual focus group will be captured for quality assurance purposes and to review when summarizing the findings. You will not share your screen.

Confidentiality. This study is being conducted under the authority of 13 U.S.C. Sections 141, 182, and 193. The U.S. Census Bureau is required by law to protect your information (13 U.S.C. § 9 and § 214). The Census Bureau is not permitted to publicly release your responses in a way that could identify you or your group quarter facility. Only research staff from the U.S. Census Bureau working on this project have access to the focus group sessions, either live or through the recording.  

Voluntary Participation. Your participation is completely voluntary. Should you feel uncomfortable with any question asked, you do not have to answer it. Participation will not have any adverse effect on your relationship with the Census Bureau.

 

 

I have read and understand the statements above. I consent to participate in this study and to being recorded during the focus group.

Use your mouse or finger to sign your name in the box below.

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