Form NHTSA Form 1293 NHTSA Form 1293 Recruitment Screener

OMB#: 2127-0682

Expiration Date:02/28/2015

RECRUITMENT SCREENER FOR FOCUS GROUPS

TO ASSESS ADVERTISING CONCEPTS SUPPORTING

2015 SEAT BELT ENFORCEMENT AND SOCIAL NORMING CAMPAIGNS

OMB# 2127-0682

NOTE TO RECRUITER: Ask to speak to any male age 18 to 34 (note: sex and age range are critical). If none available, terminate.

Hello, I'm __________________ calling for (name of focus group company). In (metro name), a research project is being planned. It will consist of focus group discussions about advertising ideas. It is not being done for selling purposes, rather it is true research to gather information and opinions. Once it begins, the focus group will be approximately an hour and fifteen minutes, and for your time and participation, you would be paid $75.

(NOTE TO RECRUITER: Gauge interest; continue if positive. If he requests clarification about focus groups, briefly explain.)

This research requires that participants have particular characteristics. So to see if you match those characteristics, I need to ask you a few questions.

(NOTE TO RECRUITER: Continue if OK)

First, I need to read this statement. This collection of information is voluntary and will be used to recruit individuals to participate in a focus group meeting. Public reporting burden for this survey is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. We will not collect any personal information that would allow anyone to identify you. 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 currently valid OMB control number. The OMB control number for this collection is 2127-0682. 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, W51-316, 1200 New Jersey Ave, S.E., Washington, DC, 20590.

So let’s begin.

1. Do you, or does anyone in your immediate family, work in any of the following industries or professions? (NOTE TO RECRUITER: terminate if “yes” to any)

____ Marketing, advertising, public relations or marketing research

____ Graphic design

____ News media, including newspaper, television, radio or publishing

____ Professional and/or commercial drivers

____ Law enforcement

____ Legal

____ Local, state or federal government

2. Are you a licensed driver?

____ Yes ____ No (NOTE TO RECRUITER: terminate)

3. In which of these age groups is your age? (NOTE TO RECRUITER: Read list of the two age groups)

____ 18-25 (NOTE TO RECRUITER: quota per group: at least 5, but no more

than 7)

____ 26-34 (NOTE TO RECRUITER: quota per group: at least 5, but no more

than 7)

____ “Neither,” other or refused (NOTE TO RECRUITER: terminate)

NOTE TO RECRUITER IN ATLANTA: Recruit for a total of four (4) groups. One (1) group will be composed of men who are “law enforcement sensitive,” per questions 8, 9 and 10 below, and who meet special quota specifications noted under question 12. Three (3) other groups will be composed of men screened without questions 8, 9 and 10 and without the special quota specification unique to the “law enforcement sensitive” group.

NOTE TO RECRUITERS IN HOUSTON, PHOENIX AND (OTHER CITY TO BE DETERMINED): Recruit for a total of two (2) groups. One (1) group will be composed of men who are “law enforcement sensitive,” per questions 8, 9 and 10 below, and who meet special quota specifications noted under question 11 (Phoenix) or question 12 (Houston and other tbd city). The other group will be composed of men screened without questions 8, 9 and 10 and without the special quota specifications unique to the “law enforcement sensitive” group.

4. During a typical week, about how many days do you drive at least 10 miles per day? (NOTE TO RECRUITER: OK to read list):

____ About once a week or less (NOTE TO RECRUITER: terminate)

____ 2 or more times per week

5. Which of the following types of vehicles do you drive most often for personal, non-business travel? (NOTE TO RECRUITER: Read list; accept only the one driven most often):

____ Automobile

____ Mini-van

____ Full-size van

____ Sport utility vehicle

____ Pick-up truck

____ None of these (NOTE TO RECRUITER: terminate)

(NOTE TO RECRUITER: “none of these” includes motorcycles)

NOTE TO RECRUITER: The next question is an articulation question. What the respondent says is not important; rather, judge his ability and willingness to comment with a specific point-of-view.

6. In your opinion, what would be the best way to minimize traffic congestion on highways in the (name of metro) area?

____ Articulate

____ Not articulate (NOTE TO RECRUITER: terminate)

7. The next question is about seatbelts. Tell me if in any of the situations I’ll describe, you sometimes don’t wear a seatbelt while driving. (NOTE TO RECRUITER: Read list; a “yes” answer to any one or more qualifies the respondent. If “no” to all, terminate):

____ Just a short trip to a store or nearby place

____ When wearing nice clothes that might get wrinkled by a seatbelt

____ When on a road with little or no traffic

____ Sometimes when you just forget to buckle up

____ When driving on roads at low speeds

- - - - - - - - - - - - - - - - - - - - - - -

FOR “LAW ENFORCEMENT SENSITIVE” GROUPS

NOTE TO RECRUITER: The next three questions may cause some people to be reluctant to answer. If hesitation or reluctance is sensed, assure respondent (as appropriate) that no law enforcement agency is involved in this research, no judgments are being made about his character, and that we’re merely seeking certain opinions.

8. When you think about local police departments in general here in the (metro name) area, how good a job do you think they do to help make driving safer through law enforcement? Use a scale of one to five, where one means a poor job, and five means an excellent job.

1 2 3 4 5

9. Among all the drivers on our roads, how fair are they in enforcement? Again, use a scale of one to five, where one means not fair at all, and five means very fair.

1 2 3 4 5

10. How respectful are officers when interacting with drivers such as yourself? Again, use a scale of one to five, where one means not respectful at all, and five means very respectful.

1 2 3 4 5

NOTE TO RECRUITER: If 1 or 2 to at least two of the above, continue. Otherwise, terminate.

- - - - - - - - - - - - - - - - - - - - - - -

11. Do you consider yourself Hispanic or Latino?

____ Hispanic or Latino (NOTE TO RECRUITER: quota per group: need at

least 2, but no more than 3)

(NOTE TO RECRUITER IN PHOENIX: In the Law

Enforcement Sensitive group, this quota will be

at least six)

____ Not Hispanic or Latino

____ Refused (NOTE TO RECRUITER: terminate)

12. Do you consider yourself ---- (NOTE TO RECRUITER: Read list and check all that apply; OK to repeat list if asked)

____ American Indian or Alaska Native

____ Asian

____ Black or African American (NOTE TO RECRUITER: quota per group: need

at least 2, but no more than 3)

(NOTE TO RECRUITERS IN ATLANTA,

HOUSTON AND OTHER TBD CITY): In the

Law Enforcement Sensitive group,

this quota will at least six)

____ Native Hawaiian or Other Pacific Islander

____ White

____ Refused (NOTE TO RECRUITER: terminate)

Based on your responses, we would like to invite you to participate in a focus group research study about advertising campaign ideas. The group discussion will be about an hour-and-fifteen-minutes in length, and for your participation, you will receive $75 cash. As many as eight others will participate. The meeting will be on (SCHEDULED DATE) at (SCHEDULED START TIME) p.m. It will be at our focus group research facility at (FOCUS GROUP FACILITY ADDRESS/LOCATIONAL INFORMATION).

(Convey additional appropriate details if respondent is willing to participate)

NHTSA Form 1293