Form NHTSA Form 1201 NHTSA Form 1201 NVS Tagline & Logo Research-Participant Screener

OMB Control No. 2127-0682

Expiration Date 02/28/2015

NVS Tagline & Logo Research

Participant Screener

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 criteria will also ensure we are speaking with primary or shared decision makers, as these consumers will be the ones researching information about vehicle safety.

This collection of information is VOLUNTARY and will be used for formative purposes only so that we may develop and evaluate programs designed to reduce the number of traffic-related injuries and deaths. 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 15 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

2. Are you…?

   1. Male

   2. Female

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

   1. Yes – OWN

   2. Yes – LEASE [SKIP TO Q5]

   3. No [SKIP TO Q5]

4. [IF Q3=1] Thinking about maintaining your current vehicle, would you say you have primary responsibility, have shared responsibility, or is someone else responsible for maintaining the vehicle over its lifecycle?

   1. I take primary responsibility

   2. I have shared responsibility with someone else

   3. Someone else takes primary responsibility

[RECRUIT 4-5 OWNERS PER GROUP (Q4=01). RECRUIT MIX OF PRIMARY AND SHARED RESPONSIBILITY]

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

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

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

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

   4. I have no plans to purchase a new vehicle

[TERMINATE IF Q3=02,03 AND Q5=03,04]

6. [IF Q5=1-2] 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. [IF Q5=1-2] 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

[RECRUIT 4-5 PURCHASERS PER GROUP (Q5=01,02 AND Q7=01,02). RECRUIT MIX OF PRIMARY AND SHARED RESPONSIBILITY]

8. 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

9. [IF Q8=02-06] What are the ages of your children? [OPEN END]

[RECRUIT AT LEAST 5 PARENTS PER GROUP (Q8=02-06)]

10. How likely are you to seek out information about vehicle safety?

    1. Very likely

    2. Somewhat likely

    3. Not very likely

    4. Not at all likely [TERMINATE]

11. 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

12. Are you of Hispanic or Latino descent?

1. Yes

2. No

13. 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

14. 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

15. 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

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

NHTSA Form 1201 Page 7