ADULT CONSENT FORM
1) Title of Research Study: An investigation of Veterans with injuries or illness from war
2) Investigator(s): Michael P. Frain, PhD, Pablo Gonzalez, Julianne Agonis, Ayse Torres
3) Purpose: The purpose of this research study is to determine the employment status of returning military reservists and veterans who became disabled due to injuries related to military action in Afghanistan or Iraq. And to understand which variables effect the change in employment status prior to service and injury.
4) Procedure: You will be requested to complete an on-line survey of 192 questions concerning your experiences with deployment and the injury you acquired during military service and the vocational services you received concerning your injuries. Overall, the time required to complete the question will usually be between 25-40 minutes. You will receive a $20 gift card from Target or Home Depot for completing this survey in whole or in part. You may donate the gift card to wounded warriors or we will send the gift card to any address you wish. You do not have to include your name to have the gift card sent. After sending the gift card we will delete the address and will have no way of recovering that information.
5) Risks: The risks involved with participation in this study are no more than you would experience in regular daily activities. It is unlikely you will experience any harm or discomfort. However, some questions concerning your experiences may bring up memories or upset you in some way. If you should experience any negative psychological impact due to these questions please contact the principle investigator listed below or an appropriate mental health service worker.
6) Benefits: We do not know if you will receive any direct benefits by taking part in this study. However, this research will contribute to a greater understanding of the services needed by veterans with disabilities to successfully return to work after being injured during deployment.
7) Data Collection & Storage: Data will be stored in a double password protected database. Any information collected about you will be kept confidential and secure and only the people working with the study will see your data, unless required by law. There will be no identifiable information asked in the survey. Only the PI will have access to the data which will be deleted after being kept seven years. There will be no on-line cookie or computer information (e.g. ID) saved with the on-line submission, therefore the PI will not have information on which survey came from which computer.
8) Contact Information: For questions or problems regarding your rights as a research subject, you can contact the Florida Atlantic University Division of Research at (561) 297-0777. For other questions about the study, you should call the principal investigator(s), Michael Frain at (561)297-3626.
9) Consent Statement: I have read or had read to me the preceding information describing this study. All my questions have been answered to my satisfaction. I am 18 years of age or older and freely consent to participate. I understand that I am free to withdraw from the study at any time without penalty. I have received a copy of this consent form.