Form NHTSA Form 1161 NHTSA Form 1161 Screener for Qualitative Focus Groups

OMB Control No. 2127-xxxx

Expiration Date xx/xx/xxxx

Appendix B: Screener for Qualitative Focus Groups

Please note that 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 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

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 for an automobile manufacturer?

   1. Yes [TERMINATE]

   2. No

   3. DON’T KNOW [TERMINATE]

4. Do you currently own or lease a car or truck?

   1. Yes – OWN

   2. Yes – LEASE

   3. No

   4. REFUSED [TERMINATE]

5. What model vehicle is the primary vehicle you own? [PROVIDE PRE-CODE LIST OF VEHICLE BRANDS]

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

7. Which of the following statements best represents your plans for purchasing or leasing a new vehicle for you or your family? By new vehicle, we mean new model year vehicle, not used or previously owned.

   1. I purchased or leased a new vehicle longer than 6 months ago [TERMINATE]

   2. I purchased or leased a new vehicle in the past 6 months

   3. I plan to purchase or lease a new vehicle in the next 6 months

   4. I plan to purchase or lease a new vehicle 6 to 12 months from now

   5. I plan to purchase or lease a new vehicle longer than 12 months from now [TERMINATE]

   6. I have no plans to purchase or lease a new vehicle [TERMINATE]

   7. DON’T KNOW [TERMINATE]

8. And which of the following best describes the stage in the vehicle purchasing process at which you currently find yourself?

   1. I’ve considered purchasing a new vehicle

   2. I’ve actively sought out information online or in other sources about vehicles I would consider purchasing

   3. I’ve visited a dealership

   4. I’ve test driven a vehicle

   5. I’ve decided on the vehicle I’m going to purchase

9. Thinking about your [SELECT BASED ON Q3 RESPONSE: recent/next] vehicle purchase or lease, would you say you [are/were] the primary decision maker, [have/had] shared responsibility, or [will/did] someone else make the decision on which vehicle to purchase or lease?

   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]

10. Are you interested in participating in a 2-hour focus group discussion about the vehicle purchase process? The group will be held on [INSERT DATE] at [INSERT TIME].

    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 following that best describes your race? [ACCEPT MULTIPLE RESPONSES]

1. American Indian or Alaska Native

2. Asian

3. Black or African American

4. Native Hawaiian or Other Pacific Islander

5. White

3. Are you of Hispanic or Latino descent?

1. Yes

2. No

4. What is your marital status?

1. Never married

2. Married

3. Living together with someone but not married

4. Separated

5. Divorced

6. Widowed

7. Other

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. Unsure

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. 3

5. 4

6. 5 or more

7

NHTSA: Monroney Label Consumer Research ICR
Focus Group Screener

NHTSA Form 1161