When you enroll as a participant in BeHeardCVA, you will be asked to review the details of what your enrollment will involve, before you agree to become a participant. For your convenience, here’s a preview of the Informed Consent Agreement you will see when you fill out our enrollment form, along with details on whom to contact if you have questions or concerns about the research procedures:
Informed Consent Agreement
BeHeardCVA is a community survey panel designed to give residents of Charlottesville, Albemarle, Nelson, Fluvanna, Greene, and Louisa Counties the opportunity to make their voices heard by participating in short surveys about topics such as access to affordable health care, education, public safety, the environment, or other local issues. The surveys will be sponsored by local governments, public agencies, non-profit organizations, and university researchers, among others. By agreeing to join BeHeardCVA, you will have an opportunity to participate in these short surveys.
This consent form is an agreement to join BeHeardCVA and have your information kept on file so we can contact you to participate in future studies.
Please read this consent agreement carefully before you decide to participate in the BeHeardCVA survey panel.
What you will do if you join BeHeardCVA: Once enrolled in BeHeardCVA, you will be asked to complete an occasional questionnaire about yourself, including your demographic and academic background, your attitudes about issues, and certain aspects of your current situation. You are not obligated to participate in any of the surveys or to answer any question in any survey that makes you uncomfortable. If you find yourself in that situation, you are free to skip a question or exit the survey at any time.
Time required for the surveys: The length of the subsequent surveys will vary. Typically, a survey will take about 10 minutes to complete, but a few may take as long as 30 minutes. We will let you know, before you begin a survey, what general information and opinions it requests, and how long we estimate it will take to complete it.
Risks: There are no anticipated risks to these surveys. You do not have to answer any questions you do not want to answer. Any surveys you are asked to participate in will first inform you of its purpose, its expected length, the confidentiality of the results, and any possible risks involved in participating.
Benefits: There are no direct benefits to you for taking the intake survey or joining BeHeardCVA. BeHeardCVA studies may help bring to light the opinions of people in Central Virginia pertaining to issues that may be important to policymakers and others. When possible, we hope to publicize survey findings and share them with decision makers so that the opinions and needs of the public will be considered.
Confidentiality: Information about you and your individual survey responses will be kept confidential and kept highly secure with access restricted only to the BeHeardCVA research team at UVA.
Your responses to survey questions will be combined with others and only published in a way that would not allow anyone to identify you. We may examine the answers you have provided to our surveys to help us decide whether you should be selected to receive an invitation to participate in the next study.
Voluntary participation: Your participation in BeHeardCVA and in each individual survey is completely voluntary.
Payment: You will receive no payment for completing the intake questionnaire. For subsequent surveys, you may be offered various small monetary incentives in the form of gift cards, a chance at a lottery prize, or points that can be accumulated and redeemed for cash. Details of the incentives will be provided when you receive a survey invitation.
Right to withdraw from the study: You have the right to withdraw from BeHeardCVA or from any of the individual surveys at any time without penalty. However, if you choose not to participate in a survey or do not complete the survey questionnaire, you will not be eligible for any payment, points, or other incentives offered for that survey.
How to withdraw from the study: If you wish to withdraw from any particular survey, simply close your browser window. If you wish to withdraw from BeHeardCVA, please notify Kara Fitzgibbon, Senior Project Coordinator, at email@example.com, or call the Center for Survey Research at 434-243-5232. There is no penalty for withdrawing from BeHeardCVA.
Removal from BeHeardCVA: You may decline to participate in any of the surveys you are offered. However, if you do not respond to any surveys for a period of one year or more, you may be removed from BeHeardCVA or placed on inactive status, which means you will no longer receive invitations. You will also be removed if you no longer reside in one of the six localities in the BeHeardCVA area.
If you have questions about the study, contact:
Thomas M. Guterbock, Ph.D.
University of Virginia Center for Survey Research
P.O. Box 400767
Charlottesville, VA 22904.
Email address: firstname.lastname@example.org
To obtain more information about the study, ask questions about the research procedures, express concerns about your participation, or report any problems, please contact:
Tonya R. Moon, Ph.D.
Chair, Institutional Review Board for the Social and Behavioral Sciences
One Morton Dr, Suite 500
University of Virginia, P.O. Box 800392
Charlottesville, VA 22908-0392
This research has been approved by the Institutional Review Board at the University of Virginia (#IRB-SBS-2201). For questions or information about your rights as a participant in this study, please contact Tonya R. Moon, Ph.D., Chair, Institutional Review Board for the Social and Behavioral Sciences, 1 Morton Dr, Suite 500, University of Virginia, P.O. Box 800392, Charlottesville, VA 22908-0392; (434) 924-5999; email@example.com; www.virginia.edu/vpr/irb/sbs