Form NHTSA Form 1247 NHTSA Form 1247 Tagline Assessment Screener

OMB Control No. 2127-0682

Expiration Date 02/28/2015

Questionnaire-Screener

Questionnaire for email survey assessments of 8 taglines for

USDOT/Anti-Distracted Driving Project

(Notes to survey programmer indicated in gray and italics)

Sample:

• n=400 responses past the five screening questions

• U.S. adults ages 18-49; 50%/50% mix of males and females

• Operate cars and/or trucks for an average of at least 25 miles per week)

Intro:

Your opinions about several advertising slogans may actually help save lives and prevent serious injuries as a result of highway crashes in which distracted driving is a cause.

There are many ways drivers can be distracted. Mobile phones, GPS devices, eating, personal grooming, reaching across the vehicle for other items are some of the examples. Unfortunately, these distractions sometimes result in driver error and crashes. The number of such crashes could be decreased if drivers had more top-of-mind awareness of the risks of distracted driving.

 

This survey is to gather your feedback about eight slogan ideas that are intended to remind people to not drive distracted.

 

It will take only about 8 to 10 minutes of your time to offer your opinions.  Yet your input, along with that of other survey respondents, can help prevent serious vehicle crashes, prevent injuries and save lives.

 

So thank you in advance for participating.

Email Assessment of Taglines Supporting National Anti-Distracted-Driving Efforts-Screener

This collection of information is voluntary and will be used for formative purposes only so that we may develop communications 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 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

Five screening questions ---

First, so we can be sure we get a good representation of people to respond to

this survey ---

What is your age?

____ 17 or younger (terminate)

____ 18-34

____ 35-49

____ 65 or older (terminate)

____ Prefer to not answer (terminate)

Are you?…

____ Female

____ Male

____ Prefer to not answer (terminate)

(Programming note: set for completion quotas of 200 females and 200 males)

Are you currently a licensed driver?

____ Yes

____ No (terminate)

____ Not sure (terminate)

____ Prefer to not answer (terminate)

Which of these types of vehicles is the one you operate most often?

____ Car, truck and/or van

____ Motorcycle (terminate)

____ Other type of motorized vehicle (terminate)

____ Other type of non-motorized vehicle (terminate)

____ Prefer to not answer (terminate)

Approximately how many miles per week (on average) do you drive?

____ Fewer than 25 miles per week (on average) (terminate)

____ 25 or more miles per week (on average)

____ Not sure (terminate)

____ Prefer to not answer (terminate)

NHTSA Form 1247 Page 6