Form 1 Assent

ABCD Study Audience Feedback Teams
Teen Assent

OMB #0925-0781 | Expiration 03/03/2027

PAPERWORK REDUCTION ACT STATEMENT
Paperwork Reduction Act Statement: The public reporting burden for this information collection has

been estimated to average 5 minutes per response, including the time to review instructions and
respond to questions. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden to NIH, Project Clearance
Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, Attn: OMB-PRA 0925-0781.

Teen Assent Form
Study Title: Feedback Activities with Parents and Teens to Inform the Adolescent Brain Cognitive
Development (ABCD) StudySM
Thank you for your interest in participating in our feedback teams! We are talking with teens who are
aged 17 to 19 years old to get their perspectives on parts of a research study with other teens who are
the same age. (We are also talking with parents and caregivers of teens who are aged 17 to 19 to get
their perspectives.)
You will need to electronically sign, date, and return this form to [RECRUITER] before the first
feedback team activity. Please email the completed form to [NAME] at [EMAIL ADDRESS]. If you have
any questions, please feel free to contact the project lead at the below email address:
Project Lead: Rachael Picard
Email Address: rpicard@iqsolutions.com
About this project:
• The goal of this project is to get feedback on parts of a research study like survey questions on
life and health, documents explaining what happens in the Study, and materials that
communicate Study findings.
• These materials are for the Adolescent Brain Cognitive Development (ABCD) Study, a study
managed by the National Institutes of Health. The ABCD Study® is run by researchers from
universities and hospitals across the country to help understand how children’s life experiences
affect the brain as they grow. For more information on the ABCD Study, please visit:
www.abcdstudy.org.
• We are inviting teens and parent/caregivers who are at the same stage of life as the individuals
in the ABCD Study to join feedback teams.
• The feedback teams are groups of people who provide their thoughts and opinions through
surveys, interviews, or bulletin board discussions. The input from these feedback teams will help
the ABCD Study researchers ask questions about life experiences in the best way possible.
• Feedback teams will run for up to three years. Team members will be invited to at least one but
no more than three feedback activities per year.

03-20-24

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Study #24032
Approved 03/20/2024

ABCD Study Audience Feedback Teams
Teen Assent

OMB #0925-0781 | Expiration 03/03/2027

What will happen?
• You will join a feedback team made up of other teens, for a total of 36 team members. Feedback
team members will receive invitations to activities where they can provide their opinions on
questions, instructions, and other forms that are used in the ABCD Study.
• These activities include:
o Online surveys
o Virtual discussion groups
o Online bulletin boards
• If you take a survey: You will be asked for your feedback on questions about health, life
experiences, activities, and parts of your identities. Surveys will take no longer than 30 minutes
to complete. You will have several days to complete the survey.
• If you join a virtual discussion group: You will join two or three other teens for a 60-minute live,
video-recorded, virtual discussion on Zoom. In the discussion, we will ask you to share your
thoughts and opinions on things like survey questions or instructions for being part of a research
study, so that these are written in the best way possible in future research with other teens.
• If you join an online bulletin board: You and other teens will be invited to give feedback on
questions, images, or instructions. This feedback includes things like polls or short-answer
questions. Team members can see and comment on each other’s responses and a moderator
may ask some follow-up questions in the discussion. These questions are longer than a survey
but you can participate on your own time (no more than 60 minutes) over a 2 to 3 day period.
Who will see the information that I provide?
• Only project staff will have access to feedback team activity responses. When summarizing the
feedback for our report, we will communicate general themes and patterns and will not identify
any individual team member.
• The discussion on Zoom will be recorded for reporting purposes. If you do not want to be
recorded, you cannot take part in that activity.
o Only the people in that group, the moderator, and project staff watching the discussion
will know what you say during the discussion.
o To protect your privacy, we will only use the recording to create an accurate written
record of the conversation (a transcript).
o All recordings will be deleted 30 days after completing the last discussion.
• We will ONLY collect contact information and your full name for three purposes:
1) Scheduling and reminders.
2) Documenting that you agree to participate.
3) Recording that you received a payment.
• Only first names will be used during the interviews and on the recording/transcripts. Any full names
will not be shared with the moderator or other feedback team members. If someone mentions
something specific to them during a discussion, such as the name of their town or school, we will
censor that word or phrase in the transcripts.
How will my information be protected?
• Signed consent forms will be stored in a secured, password-protected file only as a record that all
participants agreed to be part of the study. Only the lead researcher and one back-up researcher will
have that password.

03-20-24

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Study #24032
Approved 03/20/2024

ABCD Study Audience Feedback Teams
Teen Assent
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OMB #0925-0781 | Expiration 03/03/2027

All activity data, any recordings, and all transcript files from the feedback teams will be stored
on a password-protected cloud server. Only the project staff will be able to access them.
The research team will summarize everyone’s thoughts and opinions in a final report. The report
will not have your name or other information that identifies you.
The research team will share the report with the researchers who are managing the ABCD Study.
Summarized information from the feedback teams may be published in professional journals or
at scientific conferences, but you will not be identified or linked to the results.
Your information will be kept as confidential as possible according to all local, state, and federal
laws. The National Institutes of Health and the Institutional Review Board (IRB)—a team of
reviewers that makes sure your rights and welfare as a research participant are protected—may
also have access to records for monitoring purposes, but names and information will not be
used in any way that would help someone outside of the research team identify you.
All study data (your answers to feedback activity questions) will be stored for no longer than 36
months. No information that could identify an individual person will be included in any of these
data sets.

What are the benefits of being part of the feedback teams?
• There is no direct benefit to you for being part of the feedback teams. However, your thoughts and
opinions may help researchers improve questions for future research with other teens and parents
of teens from across the country. The alternative is to not participate.
Will I be paid for taking part in this study? Are there any costs?
• You will receive a token of appreciation in the form of check or electronic payment (such as a
prepaid gift card) for participating in feedback activities:
o Teen survey activity: $20
o Teen discussion group or online bulletin board: $50
• The token of appreciation for participating in a feedback activity will be sent shortly after the
close of the activity.
• Team may be eligible for a bonus for feedback activities after the first year.
• You do not have to answer any questions that you do not want to and will still receive the token
of appreciation.
• There is no cost to you for taking part in the feedback team. However, your usual internet
access costs may still apply.
What are the risks?
• The risks for taking part in the feedback team are low. You can ask the project leads or
discussion moderators any questions.
• These activities do not try to embarrass or upset you. If any of the questions do upset you, you
can choose not to answer them. You can stop answering questions and leave the activity at
any time.
• You will not be asked to answer any sensitive questions about personal life experiences. However, it
is possible during these conversations that you could disclose information during the discussion that
would require the research team to share your private information with federal, state, or local
authorities ONLY IF someone is at risk of being harmed.

03-20-24

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Study #24032
Approved 03/20/2024

ABCD Study Audience Feedback Teams
Teen Assent
•

•

OMB #0925-0781 | Expiration 03/03/2027

If someone is at risk of being harmed, we are required to try to keep them safe. If we learn you
plan to harm yourself or others, or if a child or elder is being abused, we may need to tell someone
(such as the authorities) to make sure people are safe.
No computer system is 100 percent secure, so there is some risk that your information could be
part of a data breach. We will do our best to protect against this unauthorized access to private
information by keeping information password-protected, enabling two-factor authentication on all
staff devices, limiting access to ONLY the people who need it, and using services like ZoomGov that
have enhanced security and privacy protections.

Do I have to take part in the feedback teams? What if I change my mind or no longer want to be part
of a feedback team?
• Joining the feedback teams and taking part in any activity is completely voluntary. You can
choose whether or not to join the feedback team and whether or not to join or complete any
individual feedback activity.
• You can agree to join the feedback teams now and change your mind later with no penalty. You
can also choose to stop participating in the feedback teams at any time.
• You can choose whether or not to join a feedback activity.
• When participating in a feedback activity, you do not have to answer any questions that you do
not want to.
• You can join an activity and decide to stop early without penalty or loss of benefits to which you
are otherwise entitled. This means:
o You will still receive the token of appreciation for participating in the activity even if you
choose not to answer some questions or leave the activity before it ends.
o You will still be invited to participate in future activities.
o We expect all team members to make a good faith effort to participate in an activity;
otherwise, we may award a partial token of appreciation.
• Please note, if any participant makes inappropriate comments, repeatedly responds off-topic, or is
otherwise inappropriate in a feedback activity, they will receive a warning. If inappropriate behavior
continues, they may be removed from the activity.
Whom do I contact if I have questions?
If you have any questions about the feedback team, would like to offer input, or if you feel that you may
have been harmed by participating in the feedback team, you should contact the project lead, Rachael
Picard at rpicard@iqsolutions.com or 240-221-4336.
If you have questions about your rights as a research participant or if you have questions, concerns, or
complaints about the research, you may contact Salus IRB at 1-800-472-3241, or by email at
subject@salusirb.com. You may also contact Salus IRB if the research staff cannot be reached or if you wish
to talk to someone other than the research staff. Reference study number: 24032.
Please keep a copy of this form for your records. If you would like an additional blank copy of this
form, you can print or save a copy.

03-20-24

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Study #24032
Approved 03/20/2024

ABCD Study Audience Feedback Teams
Teen Assent

OMB #0925-0781 | Expiration 03/03/2027

Assent to Join the Feedback Teams:
•

Your assent indicates that you have read the information about the feedback teams and agree to
take part. By providing electronic assent to participate in the feedback team, you do not give up any
of your legal rights.

•

Do you agree to join the feedback team and take part in feedback activities, some of which may be
recorded?

Yes, I agree to participate in the feedback team, which will include recording. I have read
and had time to consider all of the information above. My questions have been answered and I
have no further questions. By checking this box and typing my name on the signature line below, I
am electronically signing this assent form.
No, I do not agree to participate in the feedback team. I have read and had time to consider
all of the information above. My questions have been answered and I have no further questions.
__________________________________

___________________

Teen Assent Signature

Date

___________________________
Age

03-20-24

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Study #24032
Approved 03/20/2024