FDA CTP Industry Public Meeting Study

Appendix D. FDA CTP Industry Public Meeting Study Informed Consent Information

Welcome to the FDA Center for Tobacco Product’s (CTP) INDUSTRY SURVEY!

You must be 18 years of age or older to be eligible to complete this survey.

The purpose of this Customer Satisfaction Survey research study is for us to learn a little bit about you and to see how satisfied you are with CTP’s online resources.

This 5-minute survey is completely voluntary and you may quit, without penalty, at any time. The questions being asked are to try and understand how you and your industry can best use the information and the systems that are in place that the Center for Tobacco Products provides. As such, no personal identifying information is required to complete the survey. One item, at the end, requests your name and email address. You may give this information only if you would like to participate in an additional study in the future. There are no foreseeable risks or discomforts by participating in this survey. There are no additional costs that may result from participating in this study. There are no benefits for you personally; your answers will help us better understand the needs and what informational resources employees of the tobacco industry use. If provided, your name and email address will be stored separately from your survey responses and not connected to your survey data.

Privacy: Who will see the information I during this study?

We will take care to protect your privacy. The survey will be on a secure website that is password protected. That means we will not share your answers with anyone outside the study unless it is necessary to protect you.

One item will ask if you would like to participate in a future study. If you decide to provide your name and email address, these items will remain separate from your survey responses. The research team will not use your contact information for any purpose other than contacting you about a future study and all the information regarding that study. Your contact information will not be shared with others.

We will not share your identity in any report or presentation.

We will keep your answers for three years after the end of the study. The data will be stored on a password-protected computer. Three years after the end of the study, we will destroy all of the data by permanently deleting records.

Your answers will help us better understand the needs and what informational resources employees of the tobacco industry use.

It is possible that you may not want to answer some questions in the survey. If you do not want to answer a question, you may skip that question or choose the “prefer not to answer” response.

Remember that you can stop participating in this study at any time.

If you have any questions about this survey, or any problems completing the survey, please contact Dr. Everly Macario at IQ Solutions, Inc., at 224-244-3965

If you click on “Start survey now,” you are voluntarily agreeing to take part in this survey. Click one of the options below.

I have read, understand, and had time to consider all the information above. My questions have been answered and I have no further questions.

_____ Start survey now / I voluntarily agree to participate in this study.
[Go to Age Screener]

_____ Exit survey / I do not want to participate in this study. [TERMINATE SURVEY; GO TO TERMINATION TEXT 1]

[TERMINATION TEXT 1:] You have indicated that you do not want to participate in the CTP Industry Survey and will now exit the survey. If you decide later that you would like to participate, you can use the same email invitation to access the survey. Thank you for your time!

Paperwork Reduction Act Statement: The public reporting burden for this information collection has been estimated to average 5 minutes per response to review this informed consent form (the time estimated to read, review, and complete). Send comments regarding this burden estimate or any other aspects of this information collection, including suggestions for reducing burden, to PRAStaff@fda.hhs.gov.

OMB#: 0910-0697 | Exp. 12/31/20

RIHSC #18-058CTP

Rev. 11/14/2018