Attachment A - VA Research Participation Consent.docx
DOCX document 39 KB Posted
- Solicitation number
- 36C10B22Q0037
About this file
This document contains a consent form for participation in user research for the Department of Veterans Affairs Office of the Chief Technology Officer. The consent form outlines that participants will take part in a one hour feedback session on a VA website, where they will be asked questions and have their comments, actions, voice, and screen recorded. Participants may opt out of any recording method and take breaks as needed. By signing the form, participants agree to the recording of their verbal statements, voice, and screen for use in improving websites, and release the VA from related claims. The form must be printed, signed, and initialed where indicated by the participant.
The associated federal contract opportunity is a solicitation for user research recruitment services to support the VA OCTO. Interested parties should review the full details in the attached Combined Synopsis/Solicitation and ensure any communications are sent to all four points of contact listed within. The solicitation number and agency are provided.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C10B22Q0037 A0001_1.docx | DOCX document | |
| Attachment B - Recruiting Screener Questionnaire.docx | DOCX document | |
| 36C10B22Q0037.docx | DOCX document | |
| Attachment C - Study Checklist.xlsx | XLSX spreadsheet | |
| 36C10B22Q0037_1.docx | DOCX document |
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Text version
VA Research Participation Consent
Session Description You are being asked to participate in a feedback session to give your opinion on a website created by the Department of Veterans Affairs. By participating in this feedback session, you will help the VA improve this website.
This feedback session will take about 1 hour. We'll ask you some questions and watch how you use the website. We'll also record your comments and actions using written notes, audio recording, and screen recording. If you don’t want us to record one of these things, you can say no. We won't use your name when we're presenting the results of this feedback session. We may use the recording in the future to help show others how to improve websites.
You may quit the session at any time. If you need a break, just tell the moderator. If you have questions, go ahead and ask them whenever you like.
Consent By initialing below and signing this form, I give my permission for the VA to use:
· Written notes of verbal statements (initial here ______)
· Recorded voice (initial here ______)
· Screen recording (initial here ______)
I understand that I may quit the session at any time. If I need a break at any time, I will tell the moderator. I agree to ask questions about the session if I don't understand something. If I have questions after the session is over, I can contact [name] at [email]@va.gov.
I expressly release the Department of Veterans Affairs from and against any and all claims, which I have or may have for invasion of privacy, defamation, or any other cause of action arising out of the production, distribution, display or publication of the results of the project, as the conditions described above are met.
By signing below, I indicate agreement with these terms above.
| Name (printed) | ___________________________________ | ||
| Signature | ___________________________________ | ||
| Date | ___________________________________ |
File details come from the government source that posted it. Updated .