Research Team: Principal Investigators – Teri Ooms, Andrew Chew and Researchers Erin McCormick, Duncan Mayer, and Saidat Sanni.

Purpose of the Study: The purpose of the project is to gain an understanding of the needs of care givers that support senior citizens in Lackawanna County. Survey data will be analyzed to identify high priority needs and the most effective way to deliver services.

Procedures to be followed: You will be asked about a variety of needs you have regarding the senior you care for including, but not limited to housing, health, activities, transportation, etc.; delivery of those services and programs and other resources. You will choose the most appropriate response and check the box. You can skip any question you do not want to answer.

Duration: The survey should take about 13 minutes.

Risk, Benefits and Informed Consent: There is no personal or identifying information required in the survey. Respondents can skip any question they do not want to answer or close out of the survey at any time. There is little or no risk to the individual responding to the survey.

Statement of Confidentiality: The information you provide will be kept confidential. Only the investigators listed above will have access to the raw data.

Right to Ask Questions: Participants have the right to ask questions and have those questions answered. Please contact Teri Ooms at 570.408.9850 or or Linda Gutierrez, Ph.D., Chairman, Wilkes IRB at 570.408.4636 or with any questions, complaints or concerns about this research.

Voluntary Participation: Your decision to be in this research is voluntary and if you participate, there is no compensation. You do not have to answer any questions you do not want to answer. You must be 18 years of age or older to participate.

* 1. Indicate if you agree to the above terms.