Implied

 Informed  Consent  Form  for  Social  Science  Research  

The Pennsylvania State University

Title of Project: A New Instrument for Mental Models Elicitation

Principal Investigator: Yan Cao, Graduate research assistant, McGill Research Group
104D IST Building, University Park, PA 16802
yancao@psu.edu

1. Purpose of the Study: The purpose of this study is to establish the validity and measure the effectiveness of a new
instrument for eliciting peoples’ mental models toward risks.

2. Procedures to be followed: You will be provided with a username and a password to participate. After submitting
your demographic data (age, gender, etc.), you will be asked to either answer a questionnaire or use the new
instrument we have designed for 30 to 45 minutes. After that, you will be asked to complete a short survey, regarding
your emotions toward the experiment. All activities are computer-based.

3. Payment for participation: You will receive $10.00 for participation.

4. Discomforts and Risks: There is no risk in participating in this research. You should not feel compelled to share any
information or do anything that will cause discomfort. All data will be kept confidential.

5. Benefits: Your participation will contribute to our understanding of methods for eliciting how society understands
different risks.

6. Duration: The total experiment time will take about 60 minutes to complete.

7. Statement of Confidentiality: Your participation in this research is confidential. All private data will be stored and
secured in password protected files. In the event of any publication or presentation resulting from this research, no
personally identifiable information will be disclosed. Your confidentiality will be protected to the degree permitted by
the technology used. No guarantees can be made regarding the interception of data sent via the Internet by any third
parties. The Pennsylvania State University’s Office for Research Protections, the Institutional Review Board and the
Office for Human Research Protections in the Department of Health and Human Services may review records related
to this research study.

8. Right to Ask Questions: Please contact Ms. Yan Cao at yancao@psu.edu with questions, complaints or concerns
about this research. You can also contact this person if you feel this study has harmed you. If you have any question,
concern, or problem about your rights as a research participant or would like to offer input, please contact The
Pennsylvania State University’s Office for Research Protections (ORP) at (814) 865-1775. The ORP cannot answer
questions about research procedures. Questions about research procedures can be answered by the research team.

9. Voluntary Participation: Your decision to participate in this research is voluntary. You may terminate your
involvement at any time. You do not have to do anything you do not want to. Refusal to take part in or withdrawing
from this study will involve no penalty or loss of benefits you would receive otherwise.

You must be 18 years of age or older to take part in this research study. Participation is limited to those whose first
language is English.

Participation in the described procedures implies your consent to participate in this research.

Please keep or save this form for your records or future reference.

ORP OFFICE USE ONLY – DO NOT REMOVE OR MODIFY: This informed consent form (Doc.# 1001) was
reviewed and approved by The Pennsylvania State University’s Office for Research Protections (IRB # 36298)
on 03-16-2011. It will expire on 03-09-2012. (JDM)
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