Redline Attachment G_The Child Assessment & The Obesity and Type II Diabetes Risk Assessment_Assent.

OMB Clearance Number: 2528-0337
Expires: XX/XX/XXXX
Attachment G: The Child Assessment and The Obesity & Type II Diabetes Risk Assessment Assent

If you require information to be presented in an accessible format or reasonable accommodations to
participate in this study, please contact us with any specific requests by calling XXX-XXX-XXXX or
emailing XXXX@XXXX.XXX. If you require language assistance to participate in this study, please
contact us with any specific language assistance requests or needs.

Paperwork Reduction Act Burden Statement
This collection of information is voluntary and will be used to evaluate the US Department of Housing
and Urban Development’s Community Choice Demonstration. Public reporting burden for this collection
of information is estimated to average 8 minutes per response, including the time for reviewing
instructions, gathering and maintaining the data needed, and reviewing the collection of information. An
agency may not conduct or sponsor, and a person is not required to respond to, a collection of information
unless it displays a currently valid OMB control number. The OMB number for this collection is OMB
2528-0337 which expires on XX/XX/XXXX. Send comments regarding this burden estimate or any other
aspect of this collection of information, including suggestions for reducing this burden to NAME at
XXXX@XXXXX.XXX or call XXX-XXX-XXXX.
Privacy Act Statement 
Authority:  Section 502 of the Housing and Urban Development Act of 1970 (Public Law 91-609) (12
U.S.C. §§ 1701z-1; 1701z-2(d) and (g)). 
Purpose:  Evaluation of the Community Choice Demonstration (CCD). 
Routine Use:  The information will be used for the purpose set forth above and may be provided to
Congress or other Federal, state, and local agencies, when determined necessary. 
Disclosure:  Records will be used for research and statistical analysis and will not be used to make
decisions that affect the rights, benefits, or privileges of specific individuals.
SORN ID:  Community Choice Demonstration Evaluation Data Files, HUD/PDR-09 

Note: Some study activities are being funded by the National Institute of Diabetes and Digestive and
Kidney Diseases.

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We want to tell you about a research study we are doing. A research study is a way to learn information
about something. We would like to find out more about how your neighborhood and where you live may
affect your health. You are being asked to join the study because you are 10 to 15 years old and your
family is participating in the Community Choice Demonstration. Your parent or guardian said it was okay
for me to talk with you today. We want to tell you more about the study now.
The name of the study is called Mobility Opportunity Vouchers to Eliminate Disparities (MOVED for
short). Two different U.S. government offices are paying for it. One is called the National Institutes of
Health (NIH). The other is the U.S. Department of Housing and Urban Development (HUD). Researchers
from Johns Hopkins University and Abt Associates are working closely together with these offices to do
this research.
Even though your parent or guardian said yes to you being part of this research, you can decide if you
want to answer the questions or not. Once you start, you can also skip any question you don’t want to
answer. There are no right or wrong answers to my questions. I am interested in your ideas and opinions.
You do not have to join this study. It is up to you. You can say okay now, and you can change your mind
later. All you have to do is tell us. No one will be mad at you if you decide not to join the study or if you
say it’s ok now but change your mind later.
We may learn something from this study that will help other children live healthy lives in their
neighborhood.
If you say yes to joining this study, we will collect your height, weight, and waist measurements. We will
then have you complete a short activity on a tablet. We will also ask you questions about your life, what
you eat, your physical activity, such as playing sports or walking, your school and neighborhood, your
friends, and your mood and feelings. We will collect this information at the beginning of the study and
two years later to see if there has been any change.
[For children 12 and older only: Read this paragraph; For children younger than 12: Skip to next
paragraph] We will also ask you about your gender and sexual orientationsex and sexual orientation.
Remember, you can skip any questions you don’t want to answer.
The whole assessment can take up to 1 hour. You may feel tired or bored when answering survey
questions, but we will do our best to get through everything as quickly as we can.
We may also ask you to wear a device on your wrist that tracks your exercise and sleep.
If you decide to be a part of the study, please be honest when you answer the questions. We will keep
your answers and other information we collect about you private. Your family members will not be able
to hear what we are talking about, and I will not tell them any of your answers. But if keeping the
information you tell us private could mean that you or someone else could be hurt, we will need to tell
someone whose job it is to protect children. This is to keep you and others safe.
We will share what we learn by writing reports. Your answers will be combined with the answers from
other children so no one will be able to identify you in these reports.
Before you say yes to being in this study, we will answer any questions you have. [Answer any questions]

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