Form NHTSA Form 1167 NHTSA Form 1167 Recruitment: Driving Research Study

OMB Control No. 2127-(pending)
Expiration Date (pending)

Subject: Invitation to be a Participant in a
Driving Research Study
Dear Vehicle Owner:
The U.S. Department of Transportation’s National Highway Traffic Safety Administration (NHTSA)
is seeking drivers to participate in an experiment relating to driving safety. The focus of this study
is driver distraction. The study involves a driving experiment that will gather information regarding
the impact of performing distracting tasks (such as radio tuning, talking on a cell phone) on driving
performance. Drivers participating in the study will be asked to drive a vehicle equipped with data
recording equipment while performing non-driving tasks.
You received this invitation letter because the records of the Ohio Bureau of Motor Vehicles
indicate that you have registered a vehicle that is one of the models being used in this study:
Vehicle: ____Nissan Altima________
Any household member aged 18 years or older who has been a regular (e.g., at least weekly)
driver of this vehicle for 6 months or longer is invited to participate in the study.
What to expect: If you express interest and are chosen to participate, you would be required to
make a visit to Transportation Research Center (TRC) in East Liberty, OH. TRC is off of State
Route 33 between Marysville and Bellefontaine.
Participation in the study is anticipated to take approximately 1 hour. When you arrive to
participate in the study, you will be briefed on the study procedure and be allowed to ask any
questions you may have. Next, you will take a short familiarization drive in a test vehicle under the
direction of a member of our research staff. Once the familiarization drive is complete, you would
be given instruction regarding the tasks you will be asked to perform while driving and then
complete the study drive.
Payment: Upon completion of your participation you would receive compensation at a rate of $54
per hour for the time you spent participating. In addition, you would be compensated 51¢ for
each mile that you drove from your residence or workplace to our facility to participate. Total pay
for the visit is estimated to be $54 plus any mileage reimbursement (up to $200).
To Participate: If you are at least 18 years old and are interested in participating in this study,
complete the response form online at http://www.trcpg.com/researchstudy.asp or fill out the
attached form and place it in the enclosed postage-paid envelope for return mailing to us. If more
than one adult member of the household has at least 6 months of driving experience in the vehicle
noted above and would like to participate, please have each person complete the online response
form or enter their name and contact information on the enclosed response form.

NHTSA Form 1167

OMB Control No. 2127-(pending)
Expiration Date (pending)

If you have any questions regarding this study, call the Principal Investigator, Elizabeth Mazzae, at
937-666-3314.
What Happens Next?: Upon receipt of your completed response form (by mail or online), your
information will be reviewed. If you meet the criteria for participation and we need additional test
participants who own the particular vehicle you drive, a member of the research staff will contact
you to arrange your participation.
Help us improve driving safety!

Thank you for your consideration!

Go to the following link at: http://www.trcpg.com/researchstudy.asp
OR
Use the enclosed self-addressed, stamped envelope to return the following response form to:
Attention: Test Participation Recruitment
National Highway Traffic Safety Administration
Vehicle Research and Test Center
P.O. Box B37
Bldg. 60
10820 State Route 347
East Liberty, OH 43319

NHTSA Form 1167

OMB Control No. 2127-(pending)
Expiration Date (pending)

Driving Research Study - RESPONSE FORM
If interested in study participation, complete this form by hand or on the web at:
http://www.trcpg.com/researchstudy.asp
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 9 minutes, 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.
All information you provide is confidential and will only be used in determining qualification for this study.
If you are not selected for the study, this information will be destroyed.

Please complete the questions below for the primary driver of the above vehicle by circling the most
appropriate response or filling in the blank.
How long have you regularly (at least once per week) driven the above vehicle? _____Years _____Months
Name (first, last): _______________________________________ Age: ________________
Phone Number: ___________________________

Email: __________________________________

Home address: ______________________________________________________________________
Do you hold a valid Ohio driver’s license:

Yes

No

Other U.S. (List State:_____________)

Are there any restrictions on that license?

Yes

No

If yes, list:__________________

Years of driving experience: ______ years

Approximate miles driven per year: ___________ miles

How many trips (i.e., going from place to place) per day?
Have you participated in a research study with us before?

0-1
Yes

2-3
No

4-5

6+

If yes, what year? ________

Do you have any health conditions that may adversely affect your driving ability?

Yes

No

Do you wear the vehicle safety belt while driving?

Always

Sometimes

Rarely

Never

Do you tune the vehicle radio while driving?

Always

Sometimes

Rarely

Never

Do you use a cell phone while driving

Always

Sometimes

Rarely

Never

NHTSA Form 1167

OMB Control No. 2127-(pending)
Expiration Date (pending)

Do you use a route navigation system while driving?

Always

Sometimes

Rarely

Never

Do you regularly communicate using text messages?

Always

Sometimes

Rarely

Never

How comfortable are you with multi-tasking while driving?
(e.g., playing music, using a cell phone, talking with passengers)?

Very

Somewhat

Not at all

Please indicate the model and trim level of the vehicle that you have registered in Ohio:
Model
Year

Vehicle Model
(circle one)

Number of
Doors (2 or 4)

Trim Level or Package (circle one)

Ford Focus

S

SE

SEL

Titanium

Other

Acura TL

SH

Technology

Advance

Other

N/A

Nissan Altima

Convenience

Premium

Premium Audio

Technology

Other

Do you still own/lease this vehicle?

:

Yes

No

If no, what year/month did your ownership/lease of this vehicle end? ______________________
Put an ‘x’ in the boxes next to any features that the vehicle is equipped with:
Factoryinstalled

Dealer or
Aftermarket Add-On

Equipment on Your Vehicle

Satellite Radio System

GPS-based route navigation system

Rear-time traffic

DVD entertainment system (in rear seat)

iPod / auxiliary input

Voice recognition

Bluetooth connectivity

Electronic stability control system (e.g., ESC, ESP)

Adaptive cruise control

Brake assist

HID headlights

Rearview video camera system (i.e., backup camera, rearview monitor)

Tire pressure monitoring system

SYNC, OnStar, or similar driver assistance system

NHTSA Form 1167

OMB Control No. 2127-(pending)
Expiration Date (pending)

Participation Availability
Circle below the week(s) in which you could participate:
July 9-14

July 16-21

July 23-28

July 30 –
Aug. 4

Aug. 6-11

Aug. 13-18

Aug. 20-25

Aug. 27-31

Circle the days/times in which you could begin a 1-hour appointment:

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

830 AM

830 AM

830 AM

830 AM

830 AM

830 AM

930 AM

930 AM

930 AM

930 AM

930 AM

930 AM

1030 AM

1030 AM

1030 AM

1030 AM

1030 AM

1030 AM

1130 AM

1130 AM

1130 AM

1130 AM

1130 AM

1130 AM

1230 PM

1230 PM

1230 PM

1230 PM

1230 PM

1230 PM

130 PM

130 PM

130 PM

130 PM

130 PM

130 PM

230 PM

230 PM

230 PM

230 PM

230 PM

230 PM

330 PM

330 PM

330 PM

330 PM

330 PM

330 PM

430 PM

430 PM

430 PM

430 PM

430 PM

430 PM

530 PM

530 PM

530 PM

530 PM

530 PM

530 PM

Would you be available on short notice (e.g., same day) to participate in our study?

Yes

No

Do other household members drive this vehicle on a regular basis?

Yes

No

If another person would also like to participate, please have them complete the online response form or
enter their contact information here:
Name (first, last): _______________________________________ Age: _________________
Phone Number: ____________________________ Email: ____________________________________

Return this completed form in the enclosed postage-paid envelope to:
Attention: Test Participation Recruitment
National Highway Traffic Safety Administration
Vehicle Research and Test Center
P.O. Box B37
East Liberty, OH 43319
If you meet the criteria for participation and have compatible schedule preferences, a member of the research staff will
contact you to arrange your participation.
Thanks for your consideration!
NHTSA Form 1167