NHTSA Form 1180 Usability Screener

OMB Control Number 2127-0682

Expiration Date 2/28/2015

Screener for Usability Tests

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 2127-0682.  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

This screener is designed to ensure the respondents recruited for this study include a broad mix of consumers based on age, gender, education, vehicle ownership and other demographic characteristics. The screening criteria will ensure that respondents have internet access and either currently own or lease a vehicle, or at a minimum are in the purchase mindset as these consumers are the audience for NHTSA’s web properties. The criteria will also ensure we are speaking with primary or shared decision makers, as these consumers will be the ones researching information about vehicles online.

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

2. Are you…?

   1. Male

   2. Female

3. Do you currently have access to and use the Internet either at home or at your place of work? [ACCEPT MULTIPLE RESPONSE]

   1. Yes, at home

   2. Yes, at work

   3. Yes, somewhere else (Specify)

   4. No [TERMINATE]

4. Do you currently own or lease a car or truck? [ACCEPT MULTIPLE RESPONSE]

   1. Yes – OWN

   2. Yes – LEASE

   3. No

5. Which of the following statements best represents your plans for purchasing or leasing a new vehicle for you or your family?

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

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

   3. I plan to purchase or lease a new vehicle 7 to 12 months from now

   4. I have no plans to purchase or lease a new vehicle

[TERMINATE IF Q4=3 AND Q5=4]

6. [IF Q4=1-3] 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

7. Thinking about purchasing or leasing a vehicle, would you say you are the primary decision maker, have shared responsibility, or does someone else make the decisions 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]

8. Are you interested in participating in a 45-minute website usability study? During this study, you will be asked to participate in a discussion about a website related to vehicle safety and complete various tasks on this website. The interview will be held on [INSERT DATE] at [INSERT TIME].

   1. Yes

   2. No [TERMINATE]

I have just a few final questions for classification purposes only.

9. 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

10. Are you of Hispanic or Latino descent?

1. Yes

2. No

11. 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

12. 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

13. 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

14. 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

[RECRUIT MIX OF DEMOGRAPHICS: AGE, GENDER, INCOME, EDUCATION, ETHNICITY, HH SIZE]

[RECRUIT MINIMUM OF 5 PARENTS PER SITE]

NHTSA Form 1180

NHTSA: Usability Study
Participant Screener

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