Day Use on National Forests of Southern California

OMB# 0596-0129	Group #
Exp. X/XX/20XX	Date
FORM C	Site Location

Welcome to Your National Forest!

To help understand visitor preferences and provide the best services possible at day use sites on the National Forests of Southern California, we are asking if you will take about 8 minutes to fill out this questionnaire. Your participation is voluntary. All responses will be kept anonymous.

1. Have you ever been to this site before? ____ No ____ Yes

If yes, about how many times in the past 12 months? _______times

If yes, about how many years have you been coming here? _______years

2. Do you plan to return to this site again in the next 12 months?

____ No ____ Yes ____ Don’t know

3. Which of the following statements describe why you visit this recreation site? (Check all that apply)

___	Being at this site reminds me of my childhood recreation experience.	___	I am comfortable with this site because I have been here before.
___	This site is close to my home.	___	This site is peaceful and quiet.
___	Visiting here is affordable.	___	I meet my friends and/or family here.
___	This is my first visit to this site.	___	I like the activities I can do here.
___	Other (Please describe) _____________

4. Please indicate which of the following activities you participated in while on the visit to this National Forest when our field team contacted you. (Check all that apply)

___	Fishing	___	Picnicking/barbeque
___	Swimming/wading	___	Rock climbing
___	Hiking	___	Photography
___	Nature study (for example, bird watching, identifying wildflowers, rock study)	___	Collecting berries, mushrooms, or other
___	Relaxing	___	Other, please specify __________________

5. If a fire had burned through here is the past two years would you come back here to recreate?

____Yes

____No

6. Sometimes restrictions or management actions are in place to prevent fires in fire prone recreation areas. Which of the following restrictions or management actions would influence your decision to avoid a site where wildfires could occur? If you are not sure, mark ‘dk’. (Circle one number for each statement)

Influence Your Decision to Avoid a Site
Restrictions/Management Actions	not an influence	a slight influence	somewhat of an influence	a moderate influence	a large influence	don’t know
a. Knowing I would not be allowed to have fires in fire pits or on cooking grills in developed campgrounds or picnic areas	1	2	3	4	5	dk
b. Knowing that I would not be allowed to have fires and stoves in backcountry areas	1	2	3	4	5	dk
c. Knowing I would not be allowed to smoke except in designated campground areas	1	2	3	4	5	dk
d. Knowing that I would not be allowed to have fireworks in the forest	1	2	3	4	5	dk
e. Knowing that a campground I like is likely to be closed
f. Knowing that a picnic area I like is likely to be closed	1	2	3	4	5	dk
g. Knowing that a trail I like is likely to be closed	1	2	3	4	5	dk
h. Knowing that I am likely to be delayed in traffic due to fire suppression activities	1	2	3	4	5	dk
i. Knowing that I am likely to see burned areas from a wildfire	1	2	3	4	5	dk
j. Knowing that I am likely to see smoke from a wildfire	1	2	3	4	5	dk
k. Knowing that a fire might start while I am on the forest	1	2	3	4	5	dk

7. Your gender _____ Female _____ Male

8. Your age _____ years

9. What was your last year of school completed? (Please circle the number of the last year of school completed)

Elementary School	Middle School	High School	College	Graduate School
1 2 3 4 5	6 7 8	9 10 11 12	13 14 15 16	17 18 19 20

10. Are you of Hispanic or Latino origin? ___ Hispanic or Latino ___ Not Hispanic or Latino

11. What racial category or categories best describes you? (Please select one or more)

___	American Indian or Alaska Native	___	Native Hawaiian or Other Pacific Islander
___	Asian	___	White
___	Black or African American

12. What language do you speak most of the time?

___ English ___ Spanish ___ Other ___________

What language do you read most of the time?

___ English ___ Spanish ___ Other ___________

13. Place of birth _____ United States _____ Other country __________________________

14. What is your annual household income (before taxes)?

_____ $25,000 or less

_____ $25,001 - $50,000

_____ $50,001 - $75,000

_____ $75,001 - $100,000

_____ $100,001 or more

Thank You So Much!

Enjoy your stay on your National Forest.

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0596-0129. The time required to complete this information is estimated at 8 minutes per response, including the time for reviewing instructions, searching data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

The U.S. Department if Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, gender, religion, age, disability, political beliefs, sexual orientation, and marital or family status. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA TARGET Center at 202-720-2600 (voice and TDD).

To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call (800) 975-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.