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This information sheet is not valid without a TTUHSC El Paso IRB stamp in the lower left corner of each page.  
   
RESEARCH STUDY INFORMATION SHEET

This is a research study for people who voluntarily choose to take part.  Please take your time to make a decision, and discuss the study with anyone you think could help you with your decision.

STUDY TITLE:  (This title must match in all study documents)

INVESTIGATOR(s):  

CONTACT TELEPHONE NUMBERS:  
(You may contact the investigator(s) at the number(s) listed above during normal business hours if you have any questions.

INSTITUTION: Texas Tech University Health Sciences Center El Paso 

KEY INFORMATION

1.	What am I being asked to do?
We are asking you to take part in a research study about [insert general description of the study. This study is being done because we are interested in (General topic of study).  We hope that the results of this study will help us to learn whether (Specific research questions).  

2.	Do I have to take part in this study?
You can choose to take part or you can choose not to take part in this study.  You also can change your mind at any time.  Whatever choice you make, you will not give up any legal rights or benefits. If you are a student or employee, your participation in this study will have no effect on your grades or employment status (if students/employees is selected on the application).

This document has important information to help you make your choice. Take time to read it. It is important that you have as much information as you need and that all your questions are answered.  

3.	What is this study about?  How long will it last?
Provide a description of the study procedures. Include length of time and a description of the intervention. Example: You will be asked to complete one questionnaire per month over a four-month period. This will occur after your scheduled class time.  The questionnaires are anonymous and will not identify you. Each questionnaire is estimated to take 15 minutes to complete.  After completing the four questionnaires, your study involvement will end.

4.	What other choices do I have if I do not take part in the research study?
This should include information related to alternatives (i.e. students not participating may be doing something else while others complete the study).  
	
5.	What are the key reasons I might choose to take part in this study?
Briefly state the most important reason(s) [potential benefit(s)] a person may want to volunteer to be in this study.  If there is no direct benefit, state that. Payment is not a benefit. 

6.	What are the key reasons I might choose not to take part in this study?
Briefly state the most important reason(s) [risk(s)] why a person may not want to volunteer for this study i.e. possible loss of confidentiality is a common risk. If you list this risk, also include your plan to minimize the possibility. 

There may be some risks that we do not yet know about.

7.	Will I receive anything for taking part in this research study? (Here is where you can discuss payment. This question may be deleted if it does not apply. The following two paragraphs need to be included for all studies with compensation of more than $25):
 
Payment for participation in this research is considered taxable income. In order for you to receive payment for this research, we will need to collect your name, address, and social security number.   If you are not able to provide this information, 30% of the amount being paid for this research study will be automatically deducted and sent to the Internal Revenue Service (IRS).
 
If you receive payments that total more than $600 in one calendar year, Texas Tech University Health Sciences Center El Paso is required to report this information to the IRS.  A Miscellaneous Income form (1099-MISC) will be sent to you and to the IRS.
 
(If payment is $25 or less and there is a possibility of enrolling non-resident aliens, please include only the following paragraph and delete the previous two):
 
If you are a non-resident alien, payment for participation in this research is considered taxable income and 30% of the amount being paid for this research study will be automatically deducted and sent to the Internal Revenue Service (IRS). In order for you to receive payment for this research, we will need to collect your name and address. 

8.	What if I have questions?
For questions about this study, contact the Investigator, NAME, at xxx-xxx-xxxx.  

If you would like to speak to someone who is not involved in the study about your rights as a participant, research-related injuries, or any other matter related to the study, you can call the TTUHSC EthicsPoint Hotline:  1-866-294-9352.

Or, you can file an EthicsPoint report online: 
https://secure.ethicspoint.com/domain/media/en/gui/44534/index.html.  Please choose the “Regulatory Compliance” option when making an online report.  

By participating in the research procedures, you agree to take part in this study.  You will be given a copy of this form.