Form NHTSA Form 1195 NHTSA Form 1195 Screener for Qualitative Focus Groups

OMB Control No. 2127-xxxx

Expiration Date xx-xx-xxxx

Appendix A: Screener for Qualitative Focus Groups

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. We will not collect any personal information that would allow anyone to identify you. 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 130 minutes per response for general consumers or parents and approximately 40 minutes per response for dealer interview, 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 [QUALIFY AS GENERAL CONSUMER]

   3. 25 to 34 [QUALIFY AS GENERAL CONSUMER OR PARENTS]

   4. 35 to 44 [QUALIFY AS GENERAL CONSUMER OR PARENTS]

   5. 45 to 54 [QUALIFY AS GENERAL CONSUMER OR PARENTS]

   6. 55 to 64 [QUALIFY AS GENERAL CONSUMER OR PARENTS]

   7. 65 or older [QUALIFY AS GENERAL CONSUMER OR PARENTS]

   8. REFUSED [TERMINATE]

2. Are you…?

   1. Male [GENERAL CONSUMER: 12, PARENTS: 7 MAX]

   2. Female [GENERAL CONSUMER: 12, PARENTS: 7 MAX]

   3. REFUSED [TERMINATE]

3. Do you or a family member currently, or have you or a family member previously worked for any of the following industries? [RANDOMIZE]

   1. Automotive

   2. Marketing, advertising or public relations

   3. Market research

   4. Retail

   5. Food service

1. Yes [IF Q3 ii, or iii=01, TERMINATE]

2. No

3. DON’T KNOW [IF Q3i, ii, or iii=01, TERMINATE]

4. Do you currently work at a new vehicle dealership?

   1. Yes

   2. No

[IF Q4=01, CONTINUE AS DEALER]

[IF Q3i=01 and Q4=02, TERMINATE]

[IF Q4=01]

5. Which of the following best describes your level of interaction with customers who are purchasing new model year vehicles?

   1. I am a primary sales contact, interacting with customers on a daily basis

   2. I have some responsibility selling new model year vehicles, but do not interact with customers regularly

   3. I have no responsibility selling new model year vehicles

[IF Q5=1, INVITE FOR DEALER INTERVIEW]

[IF Q5=1, ASK Q6, THEN SKIP TO Q16]

6. What is the vehicle make that you are primarily responsible for selling?

[OPEN END]

7. Do you currently own or lease a car or truck?

   1. Yes – OWN

   2. Yes – LEASE

   3. No [TERMINATE]

   4. REFUSED [TERMINATE]

8. What model vehicle is the primary vehicle you own? [PROVIDE PRE-CODE LIST OF VEHICLE BRANDS]

9. What model year is the primary vehicle you own?

10. How recently did you last purchase or lease a new vehicle? By new vehicle, we mean new model year vehicle, not used or previously owned.

    1. Within the last month

    2. 1-2 months ago

    3. 3-6 months ago

    4. 7-12 months ago

    5. More than a year ago

11. Which of the following statements best represents your plans for purchasing or leasing a new vehicle for you or your family? By new vehicle, we mean new model year vehicle, not used or previously owned.

    1. I plan to purchase or lease a new vehicle in the next 6 months

    2. I plan to purchase or lease a new vehicle 6 to 12 months from now

    3. I plan to purchase or lease a new vehicle longer than 12 months from now

    4. I have no plans to purchase or lease a new vehicle

[IF Q10=4 or 5 AND Q11=3 or 4, TERMINATE]

12. 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

13. How familiar are you with each of the following vehicle safety technologies?

1. Lane departure warning

2. Forward collision warning

3. Electronic stability control

4. Blind spot detection

5. Advanced lighting systems

1. I have never heard of this technology

2. I have heard of this technology, but I am not familiar with it

3. I am familiar with this technology, but do not currently have it installed on one of my vehicles

4. I have this technology on one or more of my vehicles

[RESPONDENT MUST ANSWER ‘03’ TO AT LEAST ONE TECHNOLOGY]

14. Thinking about your next vehicle purchase or lease, would you say you are the primary decision maker, have shared responsibility, or will someone else make the decision 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 [TERMINATE]

    4. DON’T KNOW [TERMINATE]

15. 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

16. What are the ages of your children? [OPEN END]

[IF Q16=13-18, QUALIFY FOR PARENT GROUP]

17. 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

18. Are you of Hispanic or Latino descent?

1. Yes

2. No

19. 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

20. What is your marital status?

1. Never married

2. Married

3. Living together with someone but not married

4. Separated

5. Divorced

6. Widowed

7. Other

21. 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

22. 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. Unsure

23. Are you interested in participating in a 2-hour focus group discussion about the vehicle purchase process? The group will be held on [INSERT DATE] at [INSERT TIME].

    1. Yes

    2. No [TERMINATE]

NHTSA: Advanced Crash Technologies Research ICR
Focus Group Screener

NHTSA Form 1195

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