CATI Screener

Form Approved

OMB No. 0920-xxxx

Exp. Date xx/xx/xxxx

Screener/CATI Recruitment

Public reporting burden of this collection of information is estimated to average one minute 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. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-xxxx)

• /CELL SCREENER/

• /ask of all/

CLINTRO. [INTERVIEWER INSTRUCTION: READ SLOWLY AND DISTINCTLY] Hello, my name is [NAME FILL]. I'm calling for the CDC, the Centers for Disease Control and Prevention. I’m calling with an important, five minute health survey. Anything you tell me will be kept private to the extent permitted by law.

if necessary: the results of the survey will be used to create programs to keep americans healthy.

if necessary: your name and address are not collected in this survey.

If necessary: your number is one of just a few chosen randomly to represent all cell phone numbers in the United States

[Is respondent continuing with the interview?]

1. /CONTINUE/

2. NO  /TERMINATE/

CCELL. First, I need to confirm that this is a cell phone. Is this a cell phone?

[INTERVIEWER: PLEASE CONFIRM NEGATIVE RESPONSES TO ENSURE THAT RESPONDENT HAS HEARD AND UNDERSTOOD CORRECTLY.]

1. YES

2. NO

3. DOES NOT WANT TO BE CALLED AT THIS NUMBER

4. NOT A SAFE TIME—DRIVING OR OTHER REASON

97. DON’T KNOW/NOT SURE

99. REFUSED (Including hang-up)

• /ASK IF CCELL IN (2,3,7,99)/

THNKC1 Thank you very much but we are only interviewing people who we reach on cell phones at this time.

• /ASK IF CCELL =1/

CDRV. Your safety is important to us. Are you driving a car or other vehicle right now?

1. YES

2. NO

97. DON’T KNOW/NOT SURE

99. REFUSED (Including hang-up)  / TERm/

• /ASK IF CCELL =4 OR CDRV IN (1,97)/

THNKC2 Thank you very much. We will contact you at a later time.

• ask if cdrv=2

What is your age?

enter age /range=0-96

97 DK

99 REF

• ask if age in (97,99)

CADLT. Are you between 18 and 65 years of age?

1. YES

2. NO

97. DON’T KNOW/NOT SURE

99. REFUSED (Including hang-up)

• /ASK IF cadlt in (2,97,99) or age<18 or age>65/

THNK18 Thank you very much, but we are only interviewing people between 18 and 65 today.