Attachment M - 3M Pledge of Confidentiality

HEALTHY MARRIAGE MODELS AND MEASURES COGNITIVE INTERVIEWS

CHILD TRENDS PLEDGE OF CONFIDENTIALITY

I understand that:

• Individuals participating in this study have been assured that their names will not be disclosed and that all the information they provide will be kept confidential.

• The responsibility of fulfilling this assurance of confidentiality begins with me.

In recognition of this responsibility, I hereby give my personal pledge to:

1. Keep confidential the names of all respondents, all information and opinions collected during the data collection process, and any information learned incidentally while collecting the data.

2. Refrain from discussing or disclosing, except privately with my data collection supervisor, information that might in any way identify or be linked to a particular individual.

3. Terminate data collection immediately if I encounter a respondent or begin reviewing a record for an individual whom I know personally, and contact my supervisor for further instructions.

4. Take precautions to prevent access by others to data in my possession by keeping hard copies of data collection materials, notes, and records in locked files with limited access; separating files with identifying information from other records; storing electronic copies of data files on secure drives with limited access and password-protected; electronic files with identifying sensitive information will also be encrypted.

5. Take all other actions within my power to safeguard the privacy of respondents and protect the confidentiality of information I collect.

6. Devote my best effort to ensure that there is compliance with the required procedures by persons whom I supervise.

Signed: _________________________________

Date: ___________________________________