## Appendix C

Informed Consent and Link to Enter Survey

The Consumer Financial Protection Bureau (CFPB), a U.S. Federal government agency , has asked the Corporation for Enterprise Development (CFED) and the Center for Financial Security (CFS) at the University of Wisconsin Madison, to develop surveys that may later be used to gather
data on financial well

- being and its drivers.

**What is the purpose of this project?**

The purpose of this project is to test financial well

- being

- related survey quest ions. As part of this project, you will be asked to answer a roughly 17 minute online survey asking you about your financial well

- being and about your financial behavior and knowledge

. Your answers will be used to test the use of these questions for later surveys.

**Privacy and Confidentiality** 

You will be asked to provide no information which directly identifies you as part of your participation in this survey. Any directly

- identifying information you have provided to Survey Sampling International (SSI) as part of your pre

- existing agreement to participate in this and other surveys is available only to Survey Sampling International (SSI) , not to the CFPB, and is subject to the terms and conditions of those existing agreements [ This will l ink to SSI privacy policy ]

. Any answers you provide to the survey, including general demographic information such as age and race, will be kept confidential, excep t as otherwise required by law. Additionally, the Bureau will treat the information collected consistent with its confidentiality regulations at 12 C.F.R. Part 1070, et seq. Your responses , but not any information that directly identifies you, will be combined with those of other survey respondents and shared for the purpose of analysis
with members of the st udy team which includes CFED, CFS and the CFPB along with
subcontractors and affiliat es engaged in financial well

- being

- related research

. Among other things, t he Dodd

- Frank Act authorizes the CFPB to conduct research related to
consumer financial behavior and education. 12 USC § 5493(b)(1); i d. § 5493 (d)(3)(B) ; id. 5493(g)(3)(D)

.

**Risks**

There are few risks to you. This project involves you answering questions a bout your financial knowledge, behavior and well

- being

. We recognize that you might be uncomfortable answering some questions about finances or demographic information

.
**Right to Refuse or Withdraw**

You may choose not to participate in the survey at any time. You may choose not to answer a question for whatever reason by selecting the ‘refuse to answer’ option . Participation is completely voluntary. Your incentive payment is, however, dependent on your completion of the survey and subject to the terms of your agreement with SSI

.**Benefits**

S haring your thoughts and ideas will help us and the CFPB better understand how to measure
the financial well

- being of American consumers like you.

**Paperwork Reduction Act**

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The OMB control number for this collection is XXX X . It expires on XX/XX/XXXX

. The time required to complete this information collection is estimated to average 17 minutes

per survey . The obligation to respond to this collection of information is voluntary. Comments regarding this collection of informati on, including the estimated response time, suggestions for improving the usefulness of the information, or suggestions for reducing the burden to respond
to this collection should be submitted to Bureau at the Consumer Financial Protection Bureau (Attentio n: PRA Office), 1700 G Street NW, Washington, DC 20552, or by email to PRA@cfpb.gov.

**Contact Information**

If you have questions about your rights as a participant, you may contact Anita Drever at the Corporation for Enterprise Development at 202.207.0142 o r adrever@cfed.org

.

If you consent to the survey, you may use the link below to begin . Selecting the link indicate s that you have read the above and agre e to take part in this research

.

Do you agree to the terms described above?

Yes : move forward
No: exclude