NYC-WTC_000199633

NYC 9/11 Public Portal Document

Results

Upon conclusion of this investigation, NYCDOH will prepare a written report that discusses the findings. The report will be available to the public but will not contain personal identifiers.

NYCDOH will provide your test results to you and an explanation of their significance. Any future symptoms or illness related to the dust or air in your home will need to be addressed by you and your personal physician and will not be the responsibility of the New York City Department of Health.

Individual test results will not be made available to the public, but may be shared with other local, state, or federal health or environmental agencies. Confidentiality will be protected according to local, State, and Federal laws.

Questions

Before you decide whether to accept this invitation to take part in this study, please ask any questions that might come to mind now. Later, if you have questions about the study, you can contact the investigator, Stephen Titus, PhD(C), MPH, Chairperson or Berton Freedman, MPH, Vice Chairperson at the New York City Department of Health’s Institutional Review Board at 212-442-3385 or 347-538-0089. We will give you a copy of this consent form to take with you.

What Else Do I Need to Know?

You will be told if any new information is learned which may affect your condition or influence your willingness to continue taking part in this study.

I consent to having my test results shared with other local. State, or Federal health or environmental agencies.

Please check one Yes □ No □

Signature Date

Directions; If you do not understand the description of the pilot investigation, please ask questions. If you agree to participate, please sign the consent form below.

Signature Date

CITY_21MC100_003050318

NYC-WTC_000199634