Attachment A-11. Exiter and Possible Exiter Focus Group Letter and Consent

Appendix A-12: Invitation and Consent to Participate in the Focus Groups with Exiters and Possible Exiters

[Date]
Dear [Respondent Name]:
You are invited to participate in the Beyond Benefits Study, a national study paid for by the Social Security
Administration (SSA). This study will collect information about the service, medical and employment needs of
working-age adults who get disability payments now or stopped receiving disability payments due to medical
improvement. By participating in this study, you will help SSA understand the policies and programs that may help
people who stop receiving disability payments.
SSA hired Westat, a national research company, to conduct the study. Westat is inviting you to participate in a focus
group that will last an hour or less, with others whose disability-related payments have ended or are likely to end
soon. During the focus group, a facilitator will ask questions about your health, employment situation, and
experience with using different services in the community. The focus group will be virtual (video conference using
Microsoft Teams) and scheduled at a time that works for all participants between [TIME FRAME]. If you do not
have the technology to participate in an online meeting, we can send you appropriate equipment. Once you have
completed the focus group, we will mail you a $40 Visa gift card. You can choose not to answer one or more of
the questions and you can stop the interview at any time without penalty.
Participation in this study is voluntary. Participation in this study will not affect your eligibility for benefits now or
in the future. SSA and Westat will protect all information that could identify you. As described in the Study
Consent, we will safeguard the information you provide and will use it for limited purposes, consistent with
applicable Federal law, regulations, and directives. Your name or other identifying information will not be included
in any published reports.
If you would like to participate, visit Westat’s website link below and use the PIN to log in.

Website: https://xxxxx.org
PIN: XXXXXX

Or, you can scan the QR code below using the camera on a smart device to get to the website.

For questions about the study, call the Study Help Desk toll-free number at 1-855-516-3665. For questions about
your rights and welfare as a research participant, call Westat Human Subjects Protections office at 1-888-920-7631.
Leave a message only with your first name, the name of the research study (Beyond Benefits Study) and a phone
number beginning with the area code.
I hope you will agree to participate in this very important focus group.
Sincerely,
[INSERT SIGNATURE OF SSA SIGNATORY]

Appendix A-12: Invitation and Consent to Participate in the Focus Groups with Exiters and Possible Exiters

BEYOND BENEFITS STUDY
SOCIAL SECURITY ADMINISTRATION

Consent to Participate in a Focus Group
What is the purpose of the study?
The Social Security Administration (SSA) is conducting the Beyond Benefits Study to collect information about
the service, medical and employment needs of working-age adults who currently receive disability-related
payments or stopped receiving disability-related payments from SSA due to medical improvement. SSA hired
Westat, a national research company, to carry out the study. The purpose of the research is to help SSA identify
ways to help people who may be leaving or have left SSA disability benefit programs.
What are we asking of you?
We seek your consent for your voluntary participation in a focus group with 8 to 12 participants who have
received disability payments from SSA. The focus group will take an hour or less. We will schedule it at a time
that works for you and the other participants and conduct it via Microsoft Teams video conference 1. We will
ask for your permission to send text message reminders about the study. Depending on your texting plan, you
may incur a charge for these texts. If you agree, you will be able to opt-out of receiving these reminders at any
time by replying “STOP” to the text or by calling the Help Desk at Westat. 2 A member of the research team
will lead the focus group and ask participants questions about their health and health history, health needs, work
histories, needs for support and employment goals.
0F

1F

We ask for your permission to record the focus group so we accurately capture what you tell us. If at any point
you do not wish to be audio-recorded, you will need to leave the focus group. The recording will be used to
develop the report and will be destroyed once the study is completed. The report will not contain information
that could identify you. If you decide not to volunteer, it will not affect any decision SSA makes about your
current, or future, disability benefits or payments.
What benefits will you get for participating?
You will not benefit directly from participation. By participating in this study, you will contribute to SSA’s
understanding of policies and programs that might be helpful to people who leave disability programs. After
completing the focus group, we will mail you a $40 Visa gift card.
Persons eligible for participation in the study.
You were randomly selected to participate in the study from a list of current and former Social Security
Disability Insurance (SSDI) and Supplemental Security Income (SSI) program beneficiaries. Everyone on the list
had the same chance of being selected.
What is the study doing to minimize your risks?
There is a small risk of disclosure of your personal information. The participants in the focus group may
recognize each other. There is also the chance that some focus group members might share what they hear in
the focus group with others outside the group. The researcher leading the focus group will instruct all
participants that everything discussed in the focus group should be kept private.
1

Privacy Notice : Microsoft Teams is a nongovernment application that may have different privacy policies from those of the Social Security Administration

(SSA). This application is not under SSA’s control and may not follow SSA’s privacy, security, or accessibility policies located on their official website at
https://www.ssa.gov/privacy. Once you access this application, you are subject to Microsoft’s policies. As such, by using this application, you may be providing
non-government third parties access to your personally identifiable information (PII). Westat is taking precautions to protect your privacy and PII, such as by using
secure equipment in a private location. To minimize any risk of access by unauthorized third parties, we recommend that you use a reliable, secured, and private
internet connection and ensure no one enters the room with you during the meeting. General information about SSA programs may be found at
http://www.ssa.gov/.

2

Each text message sent by the study will also include these opt-out instructions.

Appendix A-12: Invitation and Consent to Participate in the Focus Groups with Exiters and Possible Exiters

How will we protect your privacy?
We will summarize the information from these focus groups to SSA. We may use anonymous quotes from you
or other participants in these summarizes but no names or other personal information will be linked to those
quotes or any responses. We will follow Federal law and regulations to protect your privacy. SSA and Westat
will protect your personal information collected during the study, consistent with applicable Federal law,
regulations, and directives. The information we collect is used for research in limited ways. For example, we use
your thoughts and comments about employment support needed, combined with thoughts and comments
about employment support from other people interviewed, to help understand employment support needs.
Your name or other identifying information will not be included in any published reports.
Privacy Act Statement Collection and Use of Personal Information. Section 1110(a) of the Social Security
Act, as amended, allows us to collect this information, which we will use to help the Social Security
Administration (SSA) identify ways to help people who may be leaving or have left disability programs.
Providing us this information is voluntary; not providing all or part of the information will not affect your SSA
benefit. As law permits, we may use and share the information you submit, including with other Federal
agencies, contractors, student volunteers, and others, as outlined in the routine uses within System of Records
Notice (SORN) 60-0218, available at www.ssa.gov/privacy. The information you submit may also be used in
computer matching programs to establish or verify eligibility for Federal benefit programs and to recoup debts
under these programs.
Who you can contact if you have questions?
For questions about the study, call the study’s toll-free number at 1-855-516-3665. For questions about your
rights and welfare as a research participant, call the Westat Human Subjects Protections office at 1-888-9207631. Leave a message only with your first name, the name of the research study (Beyond Benefits Study) and a
phone number beginning with the area code; please do not leave any other personal information in the message.