Attachment A-14. State Agency Leadership IDI Letter and Consent

Attachment 15. Invitation and Consent to Participate in In-Depth Interviews with State and Agency Leadership

[Date]
Dear [Respondent Name],
We are writing to inform you about an upcoming Social Security Administration (SSA) study, the
Beyond Benefits Study and to request your support and participation.
SSA is conducting the Beyond Benefits Study to collect information about the service, medical and
employment needs of working-age adults who are currently in disability programs or are leaving
disability programs due to medical improvement. This study will help SSA identify potential
interventions and inform policy recommendations to help people who are leaving disability benefit
programs and may be considering going back to work. SSA has hired Westat, a national research
firm, to conduct the study.
As part of the study, Westat will be conducting in-depth interviews with state and agency leadership
about the challenges and facilitators of funding services for people exiting disability programs, the
local policy and funding environment around service provision and the needs for additional services
and funding for those exiting disability programs. The interview will be conducted virtually (video
conference call using Microsoft Teams) or by phone, according to your preference, last an hour or
less, and be scheduled at your convenience. You will have the opportunity to share your thoughts
about how policy around serving those exiting disability programs could be improved.
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. More information about
this study can be found at [INSERT STUDY URL HERE].
The Westat Study team will be reaching out to solicit your participation and schedule a time to
conduct an interview.
I hope you will agree to participate in this very important study.
[INSERT SIGNATURE OF SSA SIGNATORY]

Attachment 15. Invitation and Consent to Participate in In-Depth Interviews with State and Agency Leadership

BEYOND BENEFITS STUDY
SOCIAL SECURITY ADMINISTRATION

Consent to Participate in In-Depth Interviews
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 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 this research study. The purpose of the
research is to help SSA identify ways to help people who are leaving disability benefit programs
and may be considering going back to work. You will participate in a one-time virtual (video
conference call using Microsoft Teams 1) or telephone call that will take one hour, or less, and will
be scheduled at your convenience. We will ask you about the role of your state
agency/department in financing and providing employment and support services to people with
disabilities, in order for us to understand barriers and facilitators in serving these populations. 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
0F

1F

Your state received an invitation from us to participate in an in-depth interview about the
challenges and facilitators of funding services for people exiting disability programs, the local
policy and funding environment around service provision and the needs for additional services
and funding for those exiting disability programs. You will have the opportunity to share your
thoughts about how the policy around serving those exiting disability programs could be
improved. You may skip any question that you prefer not to answer.
We ask for your permission to record the interview, so we accurately capture what you tell us. If
your interview takes place via Microsoft Teams and at any point you do not wish to be videorecorded, you may turn off your camera. If at any point you do not wish to be audio-recorded,
the interviewer will stop the audio-recording. The recording will be used to develop the report
and will be destroyed once the study is completed.
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.

Attachment 15. Invitation and Consent to Participate in In-Depth Interviews with State and Agency Leadership

What benefits will you get for participating?
There are no direct benefits to you for taking part in this interview. However, your participation
will contribute to SSA’s understanding regarding what policies and programs might be helpful to
people who leave disability programs. Your participation may help SSA improve their programs.
What is the study doing to minimize your risks?
There is a small risk of disclosure of your personal information. To reduce this risk, we will
separate any information that identifies you from the rest of your data and store those identifiers
separately.
How will we protect your privacy?
We will summarize the information from these interviews 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. The information we collect will focus on broader service needs for
the population of Exiters and Possible Exiters and how service provision would need to change
to meet these 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.
Questions about the Study?
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 1-888-920-7631. 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,
please do not leave any other personal information in the message.