NHTSA Form 1116 Data Collection Recruitment Screener Guide

OMB Control No. 2127-XXXX

Expiration Date XX, XX, XXXX

Attachment E

Speed Warning System

Contract No. DTNH22-09-R-00256, Westat Project No. 8427.03

Data Collection

Recruitment Screener Guide

Date: ______________________

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-XXXX. Public reporting for this collection of information is estimated to be approximately 30 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

Thank you for calling about our study. Let me explain to you what the study will be about. Then if you are interested, I will need to get some background information from you. We will not be scheduling you for participation in the study today. If you are eligible, we will add your name to the list of potential participants. We need to identify a group of available people before we try to schedule anyone.

The study participants are drivers who have received multiple speeding violations over the past few years and are the principal drivers of a vehicle. A GPS-enabled device will be affixed inside the windshield of the vehicle. It will collect data on where, when, and how the vehicle is driven (including speed, braking, and sudden changes in direction). The device will transmit data to Westat whenever the vehicle is being driven. Your name and any other identifying information will not be identified in any report that we write about the project nor will your information be released to any administrative agencies. The device is designed to sound an alert when you exceed the speed limit, speed up or stop suddenly, or make an erratic change in course.

Each study participant will be asked to keep this device in their vehicle for approximately 12 weeks. After the data collection period, study participants will be interviewed about their experience with the device. Installation and removal of the device should take no more than an hour, and will take place at the Westat offices in Rockville, Maryland. If you complete the study you will be paid $150 for your participation.

If you are interested, I will need to ask you a few questions to determine your eligibility. Are you interested in participating? (If yes, complete rest of form).

(If no, ask:) Would you be interested in being contacted for other studies? If so we will add your name to our recruitment database. (if so, just fill out items 1-2)

______________________________________________________________________________

1 How old are you?:

a. 21-30 years OR b. 30 and above

(If not 21 or above, stop asking and thank them for their time)

Now I have a few questions about your travel patterns:

2. Do you have a valid driver license? (if No, skip to items 8)

a. Yes b. No

3. What type of vehicle do you usually drive?

Make: ________________ Model:_________________ Year:________________

4. How frequently do you drive your vehicle? (Read Aloud)

1. Almost everyday

2. 2-3 days a week

3. Once a week

4. Less than once a week

5. Can you estimate the number of miles you travel in a normal week? (Read Aloud)

5. 0-19 miles

6. 20-49 miles

7. 50-99 miles

8. 100 miles or more

6. Does anyone else drive this vehicle on a regular basis?

a. Yes b. No (if No, skip to item 7)

6a. How often?

1. Almost everyday

2. 2-3 days a week

3. Once a week

4. Less than once a week

7. Have you ever received a speeding violation or warning?

a. Yes b. No

8. Over the past three years how many speeding violations have you received? (Read Aloud)

1. None

2. One

3. Two

4. Three

5. More than three

9. Name:_________________________

10. Can you tell me a phone number where we can easily contact you?

___________________________________________________

11. From observation, enter sex of respondent. If unsure ask: Would you please tell me your gender?

a. Male OR b. Female,

Closing:

Thank you for your time and interest. Once we get a pool of names together, we will schedule an installation date and begin data collection. We cannot guarantee that you will be selected for the study. However, if you qualify, we will make every effort to include you.

Hang up phone.

Notes for the Screener:

• As for eligibility, they will need to drive a vehicle for at least 100 miles a week. In addition, we would like the participant to be over 21 and have received multiple speeding violations over the past few years.

NHTSA Form 1116 Page 1