Form NHTSA 1145 NHTSA 1145 Tire Fuel Efficiency Consumer Screener

OMB Control No. 2127-XXXX

Expiration Date xx/xx/xxxx

Appendix B: Consumer Research Screening Criteria and Demographic Questionnaire

Tire Fuel Efficiency Consumer Information Program

May 16, 2011

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 approximately10 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

1. In which of the following categories is your age?

   1. Under 18 [TERMINATE]

   2. 18 to 24

   3. 25 to 34

   4. 35 to 44

   5. 45 to 54

   6. 55 to 64

   7. 65 or older

   8. REFUSED [TERMINATE]

2. Are you…?

   1. Male

   2. Female

   3. REFUSED [TERMINATE]

3. Do you or a family member currently, or have you or a family member previously worked in any of the following industries?

   1. Automobile manufacturer or retail

   2. Tire manufacturing or retail

   3. Market research or the market research department of a company

01 Yes [TERMINATE]

2. No

3. DON’T KNOW [TERMINATE]

4. How many passenger vehicles does your household currently own or lease?

   1. Owned: [ENTER NUMBER]

   2. Leased: [ENTER NUMBER]

[TERMINATE IF ZERO VEHICLES ARE CURRENTLY OWNED OR LEASED]

5. What model year is the primary vehicle you own?

6. Which of the following best describes how often you drive?

   1. The majority of my day is spent driving

   2. I drive once or twice a day

   3. I drive multiple times in a week, but not every day

   4. I only drive on weekends

   5. I seldom drive

   6. I never drive

7. Which of the following statements best represents your plans for purchasing replacement tires for your vehicle? This means purchasing one to four tires to replace worn or damaged tires on your current vehicle.

   1. I purchased replacement tires longer than 6 months ago [TERMINATE]

   2. I purchased replacement tires in the past 6 months

   3. I plan to purchase replacement tires in the next 6 months

   4. I plan to purchase replacement tires longer than 6 months from now [TERMINATE]

   5. I have no plans to purchase replacement tires [TERMINATE]

   6. DON’T KNOW [TERMINATE]

8. Thinking about purchasing replacement tires for your vehicle, would you say you [SELECT BASED ON RESPONSE IN Q7: are/were] the primary decision maker, [have/had] shared responsibility, or [will/did] someone else make the decision on which tires to purchase?

   1. I am the primary decision maker

   2. I have shared responsibility with someone else

   3. Someone else is the primary decision maker [TERMINATE]

   4. DON’T KNOW [TERMINATE]

9. We would like to invite you to participate in a research discussion at [FACILITY] on [DATE] at [TIME].  This discussion will be about vehicle replacement tires and will be in a group setting with other individuals like you. The group will last approximately 2 hours and you would be paid $### for your time and cooperation.  Would you be willing to participate?

   1. Yes

   2. No [TERMINATE]

The demographic information we plan to collect as a part of the screening process is to ensure we are obtaining a broad cross-section of American opinion in this research. The demographic information will remain completely anonymous, as will all identifying respondent information. This information is used for classification purposes only, and results will never be linked back to an individual. The demographic questions to be asked are:

1. What is the last grade you completed in school?

1. Some grade school (1-8)

2. Some high school (9-11)

3. High school graduate (12)

4. Technical or vocational school

5. Some College

6. College Graduate

7. Graduate or Professional School

8. Other

2. Select one or more of the following that best describes your race? [ACCEPT MULTIPLE RESPONSES]

1. American Indian or Alaska Native

2. Asian

3. Black or African American

4. White

5. Native Hawaiian or other Pacific Islander

3. Are you of Hispanic or Latino descent?

1. Yes

2. No

4. What is your marital status?

1. Single

2. Married or living together

3. Separated, divorced, or widowed

4. Other

5. Refused

5. What is your current employment status?

1. Employed full-time

2. Employed part-time

3. Not employed

4. Retired

5. Student

6. Homemaker / Caregiver / Stay-at-home parent

7. Other

6. Which ONE of the following best describes your total household income?

1. Under $25,000

2. $25,000 to less than $50,000

3. $50,000 to less than $75,000

4. $75,000 to less than $100,000

5. $100,000 to less than $150,000

6. $150,000 to less than $200,000

7. $200,000 or more

8. Refused

7. How many children under the age of 18, if any, do you currently have living in your household?

1. None

2. 1

3. 2 - 4

4. 5 or more

NHTSA Form 1145 Page 7