Form NHTSA Form 1812 NHTSA Form 1812 Informed Consent

consent Welcome to the research study! We are interested in understanding what motorcyclists think about new safety technologies. For this study, we will ask you about yourself, your motorcycle use, and thoughts on motorcycle safety technology. Some questions are open-ended, where you can tell us anything you would like about the topic. Type as much as you would like in the open text box. Your responses will be kept completely anonymous and confidential.

  As part of their review, the University of Michigan Institutional Review Board Health Sciences and Behavioral Sciences has determined that this study is no more than minimal risk and exempt from on-going IRB oversight (Study #HUM00238521). The study should take you around five to ten minutes to complete. Although you will not be compensated for your participation, your information and thoughts will be used to inform new motorcycle technology policy and procedures.  Your participation in this research is voluntary. You have the right to withdraw at any point during the study. The Principal Investigator (Kathy Klinich) of this study can be contacted at motorcycle-tech-survey@umich.edu. By clicking the button below, you acknowledge:    Your participation in the study is voluntary.  You are 18 years of age.  You are aware that you may choose to terminate your participation at any time for any reason.

• I consent, begin the study (1)

• I do not consent, I do not wish to participate (2)

End of Block: Informed Consent

*This is an electronically-administered survey instrument. The site that contains this information will also display the following: 

 

NHTSA Form 1812 

OMB Control No: 2127-XXXX 

Expiration: XX-XX-2028 

 

Paperwork Reduction Act Statement: A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with, a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2127-XXXX. The information collected on this form will be used to better understand current consumer perceptions of the utility and availability of crash avoidance technologies for motorcycles, including consumer willingness to use and the impact of various contextual factors.  The information will be used to inform agency policymaking and consumer education efforts.  We estimate that it will take approximately 1 minute to complete the survey. The information collected is voluntary.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, National Highway Traffic Safety Administration, 1200 New Jersey Ave, S.E., Room W45-205, Washington, DC, 20590. 

Page 1 of 1