Study # 0911000824
Indiana University
Study Information Sheet
You are invited to complete a survey about livable communities with the goal of fostering independence, choice, and control for people with disabilities in Indiana. People with disabilities, their family members and disability advocates are being asked to share their thoughts about how “livable” Indiana communities are for people with disabilities. This project is a collaborative effort between the Governor’s Council for People with Disabilities (GCPD), Indiana Protection and Advocacy (IPAS), and the Indiana Institute on Disability and Community (IIDC).
PROCEDURES FOR THE STUDY
The Disability Poll should take you about 15 minutes to complete. You will be one of approximately 400-500 people who we hope will complete this poll. You can answer the questions online on a secure web site or you can request the survey in an alternative formats.
Your answers will be combined with others for all reports. Your participation in this poll is completely voluntary, and you may stop answering at any time.
BENEFITS
The information collected from this survey will help us better understand the issues related to how well Indiana communities are supporting and welcoming people with disabilities. Your responses will be used in the development of programs in Indiana communities to make life better for people with disabilities.
CONFIDENTIALITY
Efforts will be made to keep your personal information confidential. You will not be asked to identify yourself for this study and your answers will be anonymous. This means that we will not give out any information that identifies you. We cannot guarantee absolute confidentiality. Your personal information may be disclosed if required by law. Your identity will be held in confidence in reports in which the study may be published. Your responses will be stored on a secure server (computer) at the Indiana Institute on Disability and Community. Only authorized research staff will have access to the information.
Organizations that may inspect and/or copy your research records for quality assurance and data analysis include groups such as the study investigator and his/her research associates, the Indiana University Institutional Review Board or its designees, the study sponsor, and (as allowed by law) state or federal agencies, specifically the Office for Human Research Protections (OHRP) who may need to access your research records.
PAYMENT
You will not receive payment for taking part in this study.
VOLUNTARY NATURE OF STUDY
Taking part in this study is voluntary. You may choose not to take part or may leave the study at any time. Leaving the study will not result in any penalty or loss of benefits to which you are entitled. Your decision whether or not to participate in this study will not affect your current or future relations with Indiana University.
CONTACTS FOR QUESTIONS OR PROBLEMS
If you have questions about this survey or our procedures, you may contact Vicki Pappas, Ph.D., Principal Investigator, at the Indiana Institute on Disability and Community, Indiana University, 2853 E. 10th Street, Bloomington, IN 47408, or by e-mail at cwlab@indiana.edu or you may phone her at 812-855-6508.
For questions about your rights as a research participant or to discuss problems, complaints or concerns about a research study, or to obtain information, or offer input, contact the IU Human Subjects Office at (812) 856-4242 or (800) 696-2949.
Please print a copy of this for your records.
Information sheet date: October 21, 2011
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