NHTSA Form 1010A Clickk it or Ticket Mobilization Screener

OMB #2127—0646

Exp Date: August 31, 2011

NATIONAL CLICK IT OR TICKET MOBILIZATION SCREENER

Cell Sample

Screener

//ASK ALL//

INTRO

Hello, I'm ______________ calling for the U.S. Department of Transportation. We are conducting a study of Americans' driving habits and attitudes. The interview is voluntary and the information you provide us will be used for statistical purposes only.

Please note: 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

2127-0646. 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

//ASK ALL//

ISCELL

Is this a cellular telephone?

01 YES

02 NO

03 NOT A SAFE TIME //TERMINATE and SET UNSCHEDULED CALLBACK//

97 DON’T KNOW

99 REFUSED

//ASK IF ISCell=02, 97, 99//

NOCELL

Thank you very much, but we are only interviewing cell telephones at this time.

01 TERMINATE

// ASK all//

SAFETY

Are you currently driving or doing anything else that would make it unsafe for you to be on the phone?

01 YES //TERMINATE and SET UNSCHEDULED CALLBACK//

02 NO

97 DON’T KNOW //TERMINATE and SET UNSCHEDULED CALLBACK//

99 REFUSED //TERMINATE and SET UNSCHEDULED CALLBACK//

//ASK IF SAfety=01, 97, 99//

SAFETYT

Thank you very much, but we will call you back later.

01 TERMINATE

//ASK all//

S2C

Are you at least 18 years old?

01 YES

02 NO //TERMINATE and SET INELIGIBLE <18//

97 DON’T KNOW //TERMINATE and SET INELIGIBLE <18//

99 REFUSED //TERMINATE and SET INELIGIBLE <18//

//ask if S2c=02,97,99//

S2T

I am very sorry; I’m only interviewing people over 18. Thank you, goodbye.

01 TERMINATE

//ASK ALL//

S3

I’d like to confirm that you live in {RESTORE STATE FROM SAMPLE}?

01 YES

02 NO

97 DON’T KNOW

99 REFUSED

//ASK IF S3=02//

S3a

And what is the correct state in which you live?

01-50 LIST OF STATE ABBR.

97 DON’T KNOW

99 REFUSED

Continue with Main Questionnaire

NATIONAL CLICK IT OR TICKET MOBILIZATION SCREENER

Landline Sample

Screener

//ASK ALL//

INTRO

Hello, I'm ______________ calling for the U.S. Department of Transportation. We are conducting a study of Americans' driving habits and attitudes. The interview is voluntary and the information you provide us will be used for statistical purposes only. It only takes about 10 minutes to complete.

Please note that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a current valid OMB control number. The OMB control number for this study is 2127-0646.

//ASK ALL//

ISCELL

Is this a cellular telephone?

01 YES

02 NO

97 DON’T KNOW

99 REFUSED

//ASK IF ISCell=01,97,99//

NOLL

Thank you very much, but we are only interviewing landline telephones and private residences.

01 TERMINATE

//ASK ALL//

S1

Is your landline telephone number for…?

01 Home use

02 Home and business use

03 Business use only

97 DON’T KNOW

99 REFUSED

//ask if S1=03//

S1b

I am very sorry; I’m trying to reach a residence. Thank you, goodbye.

01 TERMINATE

//ASK ALL//

S2

How many persons, age 18 and older, live in this household?

00 NONE //TERMINATE and SET HH INELIGIBLE//

___ NUMBER OF PERSONS 18+ IN HH

97 DON’T KNOW

99 REFUSED

//ask if S2=0, 97,99//

S2T

I am very sorry; I’m only interviewing people over 18. Thank you, goodbye.

01 TERMINATE

//ASK IF S2=1//

S2a

May I please speak to the person in your household who is age 18 or older?

01 YES – ON PHONE Continue with main questionnaire

02 YES – COMING TO PHONE Go To Q3

03 NO – UNAVAILABLE Schedule Callback

97 DON’T KNOW Thank and end

99 REFUSED Thank and end

//ASK IF S2=2 OR MORE//

S2b

In order to select just one person to interview, may I please speak to the person in your household, age 18 or older, who (has had the most recent/will have the next) birthday?

01 YES – ON PHONE Continue with main questionnaire

02 YES – COMING TO PHONE Go to Q3

03 NO – UNAVAILABLE Schedule callback

97 DON’T KNOW Thank and end

99 REFUSED Thank and end

//ASK IF S2a = 02 or S2b= 02//

Q3

Hello, I'm ______________ calling for the U.S. Department of Transportation. We are conducting a study of Americans' driving habits and attitudes. The interview is voluntary and the information you provide us will be used for statistical purposes only. It only takes about 10 minutes to complete.

Please note that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a current valid OMB control number. The OMB control number for this study is 2127-0646.

01 CONTINUE

02 TERMINATE

Continue with Main Questionnaire

NHTSA Form 1010-A Page 9