AiSense LLP • SINE IIT Bombay Incubated

MANOVEDH

INFORMED CONSENT FORM FOR DATA COLLECTION

Research Purpose: AI-Based Mental Health Screening Model Development

A

Participant Information

Male
Female
Other
Prefer not to say
B

Investigators & Contact

1. Prof. Santosh Bothe
Principal Investigator & Collaborator, AiSense LLP / SINE IIT Bombay
Research inquiry contact: +91-9371550875
C

Purpose of Data Collection

I understand that my data is being collected for the research project titled 'Manovedh for Mental Health Screening' conducted by AiSense LLP. The purpose of this data collection is to train and improve AI-based machine learning models for mental health condition screening. This platform and its data collection are for research purposes only.

D

Data Modalities Collected

Modality 1
Voice / Phonation
Sustained phonation sounds recorded as .wav audio to extract acoustic features for voice analysis.
Modality 2
Facial Video
Short video recording of facial expressions while speaking to extract micro-affect dynamics.
Modality 3
Speech Transcript
Spoken statements transcribed to text via STT to analyse linguistic patterns.
E

How Data Will Be Used

  • Bio-signal data (voice, face, text) will be analyzed and published for research without names attached (de-identified format).
  • Data may be published in printed and electronic editions of suitable scientific and medical journals.
  • Material will NOT be used out of context (e.g. never used for commercial advertising or packaging).
  • Stored securely in de-identified format and accessed only by authorized researchers.
  • Data will NOT be sold or shared with third parties for commercial profit.
F

Your Rights as a Participant

  • Participation is completely voluntary.
  • You have the right to request deletion of your data at any time by contacting the PI.
  • Refusing to participate will not affect any service, care, or relationship with AiSense LLP.
G

Regulatory Framework

DPDP Act 2023
IT Act 2000
ICMR Ethical Guidelines 2017
Indian Contract Act 1872
H

Declaration & Consent

I have read and understood the information provided above. I voluntarily agree to participate in this data collection. Please check all boxes below to confirm:

H2

Participants Below 18 Years — Parent / Guardian Consent

Participant is under 18 years old. A parent or legal guardian must complete this section.
Please complete participant details and accept all declarations.