Screener Survey

OMB No. 1625-0089
Expiration Date: / /

The National Recreational Boating Survey
Screener Questionnaire
(For States Not Sharing Boat Registration Data)
Hello. My name is ____________________.
I am calling to invite you to participate in a survey that is being conducted by [contractor name] for
the U.S. Coast Guard. The purpose of this survey is to find out about people’s recreational
boating experiences and to improve the effectiveness of boating safety programs. Your telephone
number has been randomly selected as part of this study.
1.

Are you a person 16 years of age or older who resides in a U.S. household?
 YES
→ (skip to question #3)
 NO
 REFUSED → (End screener)
 ANSWERING MACHINE → (Leave a message and call back)
 NONWORKING, DISCONNECTED, CHANGED
→ (End screener)

2.

May I speak to a household member who is at least 16 years old?




YES
(ask to speak to that household member)
NO ONE LIVING IN HH IS 16 OR OLDER → (end screener)
NOT AVAILABLE → (call back or end screener)1

3. What is the primary use of this phone number?




HOME USE
HOME AND BUSINESS USE
BUSINESS USE ONLY→ (end screener)

4. How many working home-use telephone numbers do you have? ____
5. Did anyone in this household participate in any recreational boating activity during the
year 2007:
 YES
 NO
→ (skip to question #10)
6. Starting with yourself, what is the age and first name of everyone living in your
household?

1

Call back only if the adult household member can be reached at a later time
U.S.C.G. Screener Survey for States Not Providing Registration Data
FORM NRBS – 2SCR2007
10/3/2007

Persons

Gender

Age

Boated in
2007?

Boated prior
to 2007?

Yourself

 Male

 Female

______





Person 2

 Male

 Female

______





Person 3

 Male

 Female

______





Person 4

 Male

 Female

______





Person 5

 Male

 Female

______





Person 6

 Male

 Female

______





Person 7

 Male

 Female

______





Person 8

 Male

 Female

______





Person 9

 Male

 Female

______





7. Does any one in this household own a REGISTERED recreational vessel?



Yes
No (skip to question #9)

8. What type of registered boat does your household own?
Boat Type

Power Boat

Sail Boat

Pontoon Boat

Personal Watercraft

Other type (specify): _________

Other type (specify): _________

Other type (specify): _________

Other type (specify): _________

Other type (specify): _________

Boat Size (ft)

How Many?

9. What language do the adults in this household speak most of the time they are at home?


ENGLISH



SPANISH



JAPANESE



CHINESE



VIETNAMESE



KOREAN



FILIPINO



OTHER _______________

10. What county do you live in?
County name: _______________

U.S.C.G. Screener Survey for States Not Providing Registration Data
FORM NRBS – 2SCR2007
10/3/2007

2

11. What is your zip code?

12. May I have your household’s Mailing Address?
STREET:

____________________________________

CITY:

____________________________________

ZIP:

____________________________________

U.S.C.G. Screener Survey for States Not Providing Registration Data
FORM NRBS – 2SCR2007
10/3/2007

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