NHTSA Form 1064 Interview Form Tire Pressure

United States Department of Transportation National Highway Traffic Safety Administration

INTERVIEW FORM TIRE PRESSURE (2/26/10 Draft)

Form Approved O.M.B. No. 2127-0626 Expiration Date: XXXX National Automotive Sampling System Tire Pressure Monitoring System – Special Study

1. Primary Sampling Unit Number ____ ____

2. Site Number ____ ____

3. Observation Number ____ ____

4. Date of Observation ____ ____/____/2010

5. Interview in: English Spanish

6. Observations: ( Interviewed Refused <2004)

   1. Body Type: Auto SUV Van PU

   2. Sex: Male Female

   3. Age: Young Adult Adult Senior

   4. Race: Indian Asian Black

Hispanic Hawaiian White

[Questions about Vehicle]

7. Who is the owner of this vehicle? (Check One)

   1. Joint with other

   2. Self

   3. Partner/spouse/significant other

   4. Parent or Other family member

   5. Friend or neighbor

   6. Lease

   7. Short-term rental

   8. Car-share

   9. Company/work

   10. Other

8. How long have you had this vehicle?

Years: _______ Months: _______ Days: _______

(< 1 month)

9. Was this vehicle new when you obtained it?

No Yes

10. Have any of the original tires on this vehicle been replaced? If yes, which ones and when?

Tire	Years	Months
1) No, none
2) Yes, LF
3) Yes, LR
4) Yes, RR
5) Yes, RF
6) Yes, Spare
7) Yes, Don’t know
8) Yes, Other (specify)

[Questions about tire pressure]

11. Drivers keep their tires at their proper pressure for different reasons. List the reasons that are important to you for keeping tires properly inflated. (Do not read categories, but check all that apply)

    1. Improved safety

    2. Improved vehicle performance/handling

    3. Improved fuel economy

    4. Longer lasting tires

    5. Other (specify) ________________________

12. Where would you, or do you, primarily turn for information on what pressure to set your tires for this vehicle? (Check one)

    1. Intuition/prior knowledge

    2. Owner’s manual

    3. Vehicle placard

    4. Tire sidewall labeling

    5. A service technician

    6. OnStar or other automatic system

    7. Relative or friend

    8. Don’t know

    9. Other (specify)_________________________

13. Whose responsibility is it to check the tire pressure? (Check one)

    1. Self

    2. Relative or friend

    3. Service station/dealer

    4. TPMS

    5. OnStar or other automatic system

    6. Owner (other than self, relative or friend)

    7. No one

    8. Other (specify) _________________________

14. Under what circumstances do you have the tire pressure on this vehicle checked, either by yourself or someone else? (Check all that apply)

    1. Never (Skip to Q 15—Add Air)C

    2. Before a long trip

    3. When tires look or feel low

    4. When tire pressure warning light comes on

    5. When car is serviced

    6. When the load being carried is changed

    7. Tire pressure is checked on a regular basis

    8. By OnStar or other automatic system

    9. Don’t know

    10. Other (specify) _________________________

15. When was the last time that you, or someone else, checked the tire pressure on this vehicle?

    1. Never

    2. Within the past month

    3. 1-2 months ago

    4. 3-4 months ago

    5. More than 4 months ago

    6. Continuously (as with TPMS or OnStar)

    7. Don’t know

16. When was the last time that you, or someone else, put air in the tires on this vehicle?

    1. Never (Skip to Q17-Have TPMS)

    2. Within the past month

    3. 1-2 months ago

    4. 3-4 months ago

    5. More than 4 months ago

    6. Don’t know

17. By what method was air added the last time that you, or someone else, put air in the tires on this vehicle?

    1. Used pump owned by self or other person

    2. Gas station air pump by self or other

    3. Asked a relative/friend to do it

    4. When vehicle was serviced

    5. Has not needed to put air into a tire

    6. Other

18. Does this vehicle have a Tire Pressure Monitoring System – also known as a TPMS system?

    1. No

    2. Yes

    3. Don’t know

Now I need to ask you some basic information about yourself. [Demographic Information]

19. What is your home zip code? ___ ___ ___ ___ ___

20. How old are you? __________ (Code to nearest yr)

21. What is the highest grade or year of school you completed?

    1. Less than high school

    2. High school / GED

    3. Some college

    4. College graduate

    5. Higher degree

    6. (Vol) Refused

(Continue only for vehicles that have TPMS-Q#18)

22. Would you have time now to answer a few additional questions?

    1. No (Go to Q 23-Do Later)

    2. Yes (Go to Supplemental Form)

23. Would you be willing to answer a few additional questions at a later date, using:

    1. On-line

    2. Mail-back form

    3. Phone call back

    4. Refuse (End)

24. What is your name? ___________________________

25. At what phone number(s) would you like to be called? _______________________________________

26. What are good times to call? ___________________

27. SUP ID: _______________________________

Paperwork Reduction Act Burden Statement

A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2127-0626. Public reporting for this collection of information is estimated to be approximately 10 minutes per response, including the time for reviewing instructions, completing and reviewing the collection of information. All responses to this collection of information are voluntary. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, National Highway Traffic Safety Administration, 1200 New Jersey Ave, S.E., Washington, DC, 20590. NHTSA Form 1064