Form 1 Participant Screener

Attachment A: Participant Screener

Record Gender: recruit a mix

Male

Female

NAME

ADDRESS

CITY/STATE/ZIP

HOME PHONE WORK PHONE

FAX E-MAIL

RECRUITED BY DATE

CONFIRMED BY DATE

PROJECT OVERVIEW

• Recruit 13 for at least 9-10 to participate per group

• Represent a mix of ethnicity, employment status, gender, age, education level, U.S. born vs. foreign born, and English as primary/secondary languages.

• Phase 1 Focus Groups will focus specifically on Average Citizens and Interested Citizens

• Ensure 508 compliance representation

Proposed Research Locations/Schedule

Locations recommended based on the following:

• Media market population: mix of metro, suburban and rural areas (based on Metropolitan Statistical Area rankings)

• Diversity in markets: gender, ethnicity, disabled residents

• Range of unemployment rates: high, low (based on BLS June 2009 data)

Day	Date	Region	Times	Market	Unemployment Rate	MSA Rank
Thursday	July 8	Northeast	5:30 and 7:30 p.m.	BALTMORE	7.2	20
Monday	July 12	Southeast	5:30 and 7:30 p.m.	MEMPHIS	10.40	50
Tuesday	July 13	Midwest	5:30 and 7:30 p.m.	DETROIT	14.8	41
Wednesday	July 14	West	5:30 and 7:30 p.m.	PHOENIX	8.4	12

Target Audience

• Group 1: Average citizens/Interested Citizens

• Group 2: Potential funding recipients/Recipients/Citizens that use Recovery.gov in a professional capacity.

And represent a mix of ethnicity, employment status, gender, age, education level, U.S. born vs. foreign born and English as primary/secondary languages.

Recruiting notes:

Since we are testing creative, we will not be able to include any no/low vision 508 compliance respondents

Hello, my name is _________________from C² Consumer Research. I am calling to invite you to join a paid market research study to discuss government websites. We will pay you $100 to simply share your thoughts and opinions for a little less than 2 hours of your time. This is not a sales presentation or recruiting event. It is merely for market research purposes. We have a number of evening sessions available based on your interests.

VM: If interested or would like to get more information please call us at (877) 222-2909 Ext. xx again that’s (877) 222-2909 Ext. xx.

Live: Does this sound like something you would be interested in participating in? (if yes) Is this a convenient time to ask you a few questions?

a. Yes 1 CONTINUE

b. No 2 ESTABLISH CONVENIENT TIME

TO CALL BACK

1. When was the last time, if ever, you participated in a market research study either at our facility or for another research company? (DO NOT READ)

a. Within the past 6 months 1 TERMINATE

b. Longer than 6 months ago 2 ASK Q2a/2b

c. Never 3 SKIP TO Q3

If within the past 6 months, terminate

2a. How many market research group discussions have you ever participated in?

2b. How many market research one-on-one, in-depth interviews have you ever participated in?

No more than 3 focus groups or one-on-one interviews ever

3. Which of the following categories includes your age? (READ) Recruit a mix.

a. Under 18 1 TERMINATE

b. 18-24 2 CONTINUE

c. 25-34 3 CONTINUE

d. 35-45 4 CONTINUE

e. 45-54 5 CONTINUE

f. 55-64 6 CONTINUE

g. 65+ 7 CONTINUE

4. Which of the following best describes your current residency status?

a. I am a U.S. Citizen 1 CONTINUE

b. I am a Naturalized U.S. Citizen 2 CONTINUE

c. I am not a U.S. Citizen 3 TERMINATE

5. What languages are spoken in your home? ___________________ Recruit a mix of English only and bilingual households

6. On a scale from 1 to 10, where 1= not very interested and 10= very interested, how interested are you in the following subjects?

a. Professional Sports (such as football, baseball, basketball, racing)

b. Fashion & Beauty

c. Internet and/or social networking websites (such as Facebook, Twitter, YouTube)

d. Travel

e. Gardening/Home Decoration/Architecture

f. Politics and government affairs

7. Are you a registered voter?

a. Yes 1 CONTINUE

b. No 2 CONTINUE

8. Which of the following activities have you ever participated in? Again, I want to stress that we are looking for a wide array of Americans so please be as honest as possible.

(Note to recruiter: If A-E—may qualify for Potential funding recipients, Recipients, Interested Citizens quotas. If F—Continue for Average Citizen Quota

a. I voted in the last General Election (November 2008)

b. I follow local, state and national politics closely

c. I have contacted an elected official regarding my thoughts on current events and government policies

d. I have searched the internet/watched TV/listened to the radio/read the newspaper/journals for more information on current events and government policies

e. I have campaigned/volunteered/actively supported initiatives of personal interest

f. None of the above—categorize as Average Citizen

9. Please share an example of your level of inquiry/interests_________________________

10. Are you aware of the American Recovery and Reinvestment Act of 2009 often referred to as the economic stimulus package or Recovery Act?

a. Yes 1 CONTINUE

b. No 2 CONTINUE

10b. What is it? ___________________________________________________________

11A. Do you use the internet?

a. Yes 1 CONTINUE

b. No 2 CONTINUE, SKIP TO 12

11B. If Yes, where do you access the internet?

a. Work 1 CONTINUE

b. Home 2 CONTINUE

c. Library 3 CONTINUE

d. Pay per use (e.g. internet café) 4 CONTINUE

12. On a scale from 1 to 10, where 1=not very comfortable and 10=very comfortable, how comfortable are you with using the Internet? _____________________ (Recruit a mix.)

12B. Which of the following government websites have you ever visited?

a. IRS.gov 1 CONTINUE

b. WhiteHouse.gov 2 CONTINUE

c. Recovery.gov 3 CONTINUE

d. Weather.gov 4 CONTINUE

e. Census2010.gov 5 CONTINUE

f. Other (specify) 6 CONTINUE

The following questions are intended to ensure we get a wide variety of respondents represented in our research study

Note to recruiters: Targets to include in the focus groups

• Group 1: Average citizens and Interested Citizens

• Group 2: Recipients and Potential funding recipients

13. Which of the following best describes your current work status or occupation? (Read. Recruit a mix.)

1. Professional/Executive/Owner

2. White Collar/ Administrative/ Clerical

3. Blue Collar/ Service/ Manufacturing 

4. Part Time Work Outside of the Home

5. Stay at Home Full Time/Do Not Work

6. Unemployed/Looking for Work

7. Student

8. Retired

9. Other_____ (Record verbatim, do not read.)

10. Do Not Know (Do not read.)

11. Refused (Do not read.)

If A-D ask:

13a. What is your current job title? _________________________________

13b. What is the name of your current employer? _________________________________

14. Have you ever researched or applied for government funding (e.g. grants, contracts or loans) on behalf of your organization?

1. Yes

2. No, I do not foresee the need to apply

3. No but we have considered it—continue for potential funding recipient

15. Did your organization receive government funding/grants/loans/contracts?

1. Yes—Classify as Funding Recipient

2. No—Classify as Potential Funding Recipient

The following questions are merely for classification purposes only.

16. Which of the following best describes your last level of education completed? (READ. Data collection purposes only.)

a. No high school diploma 1 CONTINUE

b. High School 2 CONTINUE

c. Associate’s Degree 3 CONTINUE

d. Bachelor’s Degree 4 CONTINUE

e. Masters Degree 5 CONTINUE

f. JD/PhD/MD 6 CONTINUE

g. Post Doctorate 7 CONTINUE

17. Which of the following best describes your ethnicity? (READ. Recruit a mix.)

a. Black/African American 1 CONTINUE

b. Asian 2 CONTINUE

c. White 3 CONTINUE

d. Native Hawaiian or other Pacific Islander 4 CONTINUE

e. Hispanic/Latino 5 CONTINUE

f. American Indian or Alaska Native 6 CONTINUE

g. Other 7 CONTINUE

h. Decline to state 8 CONTINUE

18. For classification purposes only, please tell me into which of the following categories your TOTAL HOUSEHOLD income falls before taxes? (READ LIST.)

a. Under $35,000 1 CONTINUE

b. Between $35,000 and $45,000 2 CONTINUE

c. Between $45,000 and $60,000 3 CONTINUE

d. Between $60,000 and $80,000 4 CONTINUE

e. Between $80,000 and $100,000 5 CONTINUE

f. Over $100,000 6 CONTINUE

g. Refused 7 CONTINUE

19. To ensure our research program is compliant with Section 508 of the Rehabilitation Act and accessible to all segments of the US population, please indicate which of the following applies to you:

(If possible—low/no vision respondents may not be possible for in-person creative concept testing)

a. No vision 1 CONTINUE

b. Low vision 2 CONTINUE

c. Hearing impaired 3 CONTINUE

d. Motor impairments 4 CONTINUE

e. Speech impairment 5 CONTINUE

f. Spinal impairment 6 CONTINUE

g. None of the above 7 CONTINUE

INVITATION

We would like to invite you to participate in a paid market research study to discuss government websites. The focus group is scheduled to last less than 2 hours and will take place on [insert date based on market].

Are you interested in participating in the research discussion?

a. Yes CONTINUE

b. No TERMINATE

That is great, the session will last approximately 2 hours. For your participation we will pay you $xxx. Does this sound like something you would be interested in participating in?

We are investing a great deal of time and effort to coordinate this research study. Your participation and attendance is vital to the success of our study. If for any reason, you are unable to attend the focus group, please notify us in advance so we may find a replacement.

Get mailing address, fax number or email address to send confirmation information.

We are counting on your attendance.  Please do not schedule yourself for this research if you feel that you are not going to be able to attend the focus group discussion. If an emergency does arise, it is imperative that you call us immediately at (877) 222-2909 Ext. xx as we will need to find your replacement as soon as possible. Since our clients expect our respondents to all show up for their research, and since it is necessary that we provide them with the most accurate information, you will be receiving 2 calls confirming your attendance. The first call will be 3-4 days after you are recruited and we will need to re-ask you some of the screening questions, you will also receive a final call to confirm the day before your scheduled appointment. We do need to speak with you on each of these occasions, and we appreciate your prompt return calls.  

Do you have any objection to us placing the 2 calls to confirm your information and attendance?

a. Yes TERMINATE

b. No CONTINUE

You will also be videotaped for market research purposes only during this discussion. Do you have any objection to the use of video?

a. Yes TERMINATE

b. No CONTINUE

If you wear glasses please be certain to bring with you to the session.

Thank you for your understanding and patience during these confirmation calls, and we look forward to having you participate in this study!