Form NHTSA Form 1218 NHTSA Form 1218 Final Rear SBRS Questionnaire

OMB Control No. 2127-XXXX
Expiration Date xx/xx/xxxx

5757 Rear SBRS Survey
Abt SRBI
February 20, 2013
V2.2

2013 Survey of Principal Drivers of Vehicles with a Rear Belt Reminder System
Questionnaire
Sample Read-ins:
NAME
VEHICLE
VEHICLE_FULL
STYPE [1=Rear SBRS Driver, 2=Non-Rear SBRS Driver]
STATE
PHONE
SPECS
QLAN. WHICH LANGUAGE INTERVIEW CONDUCTED IN
1 English
2 Spanish
Introduction – Screening Questions
CELL SAMPLE
SC1. Hello, I am _____ calling on behalf of the U.S. Department of Transportation. We are conducting a
national study about seat belt safety.
Are you currently driving?
1 Yes
SKIP TO SCR2
2 No
9 Refused
SKIP TO SCR2
SC2. Are you in a safe place to talk right now?
1 Yes
2 No, call me later
SKIP TO SCR2
3 No, CB on land-line
RECORD NUMBER
4 Cell phone for business only
THANK AND END - BUSINESS#
9 Refused
SKIP TO SCR2

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LANDLINE AND CELL SAMPLE
SI1. [CELL SAMPLE: As I mentioned,] I am _______ calling on behalf of the U.S. Department of
Transportation and we are conducting a national study about driver’s attitudes towards the use of seat
belts and opinions regarding Seat Belt Reminders in your car.
This collection of information is voluntary and will be used for statistical purposes only. The interview
will take approximately 15 minutes. Any answers you give are kept strictly private.
[If necessary read: Please note that an agency may not conduct or sponsor, and a person is not required to
respond to, a collection of information unless it displays a current valid OMB Control Number. The OMB
Control Number for this information collection is ***. If you would like to learn more about the survey,
you can call our toll-free number at *** or visit the DOT website at www.nhtsa.gov/***]

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S1. May I please speak with ?
1 Respondent on the line
SKIP TO S3a
2 Respondent called to phone
3 Respondent unavailable
SCHEDULE CALLBACK
9 Refused
THANK AND END
SI2. Hello, I am _______ calling on behalf of the U.S. Department of Transportation. We are conducting
a national study about driver’s attitudes towards the use of seat belts and opinions regarding Seat Belt
Reminders in your car.
This collection of information is voluntary and will be used for statistical purposes only. The interview
will take approximately 15 minutes. Any answers you give are kept strictly private.
[IF NECESSARY READ: Please note that an agency may not conduct or sponsor, and a person is not
required to respond to, a collection of information unless it displays a current valid OMB Control
Number. The OMB Control Number for this information collection is ***. If you would like to learn
more about the survey, you can call our toll-free number at *** or visit the DOT website at
www.nhtsa.gov/***]
S2. First, may I confirm that your name is ?
1 Yes
2 No
8 (VOL) Don’t Know
9 (VOL) Refused
S3a. Can you please confirm that you are a driver, 18 years of age or older?
1 Yes
2 No
SKIP TO SCR1
8 (VOL) Don’t Know SKIP TO SCR1
9 (VOL) Refused
SKIP TO SCR1
S4a. Our records indicate that you own a . Is this correct?
1 Yes
2 No, I have never owned it
SKIP TO SCR1
3 No, I no longer own it
SKIP TO SCR1
4 (VOL) I do not own a car
SKIP TO SCR1
8 (VOL) Don’t know
SKIP TO SCR1
9 (VOL) Refused
SKIP TO SCR1
IF S4a=1, QUAL=1

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S5. Do you transport passengers in the rear seat of the at least once a month?
1 Yes
SKIP TO SA3
2 No
8 (VOL) Don’t know
9 (VOL) Refused
IF S5=1, QUAL=2
S6. Is there someone in your household who transports passengers in the rear seat of the at
least once a month ?
1 Yes
2 No
SKIP TO SCR1
8 (VOL) Don’t know
SKIP TO SCR1
9 (VOL) Refused
SKIP TO SCR1
IF S6=1, QUAL=3
S7. May I speak with that person please?
1 Respondent called to phone
2 Respondent unavailable
SCHEDULE CALLBACK
9 Refused
THANK AND END
SI3. Hello, I am _______ calling on behalf of the U.S. Department of Transportation. We are conducting
a national study about driver’s attitudes towards the use of seat belts and opinions regarding Seat Belt
Reminders in your car.
This collection of information is voluntary and will be used for statistical purposes only. The interview
will take approximately 15 minutes. Any answers you give are kept strictly private.
[IF NECESSARY READ: Please note that an agency may not conduct or sponsor, and a person is not
required to respond to, a collection of information unless it displays a current valid OMB Control
Number. The OMB Control Number for this information collection is ***. If you would like to learn
more about the survey, you can call our toll-free number at *** or visit the DOT website at
www.nhtsa.gov/***]
S3b. Can you please confirm that you are a driver, 18 years of age or older?
1 Yes
2 No
SKIP TO SCR1
8 (VOL) Don’t Know SKIP TO SCR1
9 (VOL) Refused
SKIP TO SCR1
S5b. Can you please confirm that you transport passengers in the rear seat of the at least
once a month?
1 Yes
2 No
SKIP TO SCR1
8 (VOL) Don’t know SKIP TO SCR1
9 (VOL) Refused
SKIP TO SCR1
SA3. Record gender from observation (Ask only if necessary)
1 Male
2 Female
QUAL=4
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S8. HOW OFTEN do you drive the ? READ LIST.
1 Almost every day/everyday
2 Few days a week
3 Few days a month
4 Few days a year
SKIP TO SCR1
5 Less than few days a year
SKIP TO SCR1
6 Never
SKIP TO SCR1
7 (VOL) Other (specify)
8 (VOL) Don’t Know
SKIP TO SCR1
9 (VOL) Refused
SKIP TO SCR1
S9. When you drive the , how often do you transport passengers who do not use a child
safety seat in the rear seat? Is it… READ LIST.
1 Almost every day
2 A few days a week
3 Once a week
4 A few times a month
5 Once a month
6 Less than once a month
SKIP TO SCR1
7 Never
SKIP TO SCR1
8 (VOL) Don’t know
SKIP TO SCR1
9 (VOL) Refused
SKIP TO SCR1
IF S9<6, QUAL=5

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Seat Belt Usage Habits
Now, I’m going to ask you some questions about how often you use your seat belt as a driver. Please
answer the following questions thinking ONLY about trips when you were driving the .
Q1. When you drive your , how often do you wear your seat belt? Please provide a
percentage. Your best estimate is fine.
ENTER PERCENTAGE: _____
998 – DON’T KNOW
999 = REFUSED
IF Q1 > 90, SKIP TO Q3.
Q2. Those times you don’t wear your seat belt while driving the , what is the main reason
that you don’t wear your seat belt?
DO NOT READ. SINGLE RECORD.
1 Only driving short distances
2 Driving in light traffic
3 In a rush
4 Forget to put it on
5 Don’t want my clothes to get wrinkled
6 Seatbelt is uncomfortable
7 Probability of being in a crash is too low
8 People I am with are not wearing seatbelts
9 Don’t like being told what to do
10 Seatbelt hurts
11 May cause injury/trap
12 Was in an accident where seatbelt caused injury
13 Know someone injured/killed because of seatbelt
14 Doesn’t fit
15 Medically exempt
16 (VOL) Can’t say one is most important/all important
17 (VOL) Other (Specify)
98 (VOL) Don’t know
99 (VOL) Refused

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Demographics of Passengers
Now, I would like to know more about the FRONT and the REAR passengers that you transport in your
vehicle once a month or more often. I’m also going to ask you some questions about their seat belt usage
habits. Please answer the following questions thinking ONLY about trips when you were driving the
and transporting at least one passenger in the rear seat.
Q3. During trips when there are passengers in the rear seat, how many total passengers, front and back
seat combined, do you transport?
ENTER NUMBER: _____
RANGE: 1 to 7
7=7 or more
8 (VOL) Don’t know
9 (VOL) Refused

LOOP TWICE
SKIP TO Q9

Now, I am going to ask you about these passengers one at a time.
CATI: LOOP QUESTIONS 4 THRU 8. # OF LOOP BASED ON ANSWER TO Q3
Q4. What is the age of the (next) oldest passenger you transport on a regular basis?
ENTER AGE: _____
RANGE: 1 to 97
97=97 or older
98 (VOL) Don’t know
99 (VOL) Refused
Q5. Please tell me which seat this passenger sits in most of the time in the ?
SINGLE RECORD. READ LIST.
1 Front passenger seat
2 Rear seat behind driver
3 Rear seat behind passenger
4 Rear seat center
5 Third row behind driver
6 Third row behind passenger
7 Third row center
8 Other (Specify)
98 (VOL) Don’t Know
99 (VOL) Refused

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Q6a. What is this passenger’s relationship to you?
MULTIPLE RECORD. READ ONLY IF NECESSARY.
1 Your child
2 Your spouse
3 Your parent
4 Another member of your household
5 Adult relative
6 Child relative
7 Co-worker
8 Neighbor
9 Friend
10 Other (Specify)
98 (VOL) Don’t Know
99 (VOL) Refused
Q6b. How often do you transport this passenger in your car? READ LIST.
1 Almost every day
2 A few days a week
3 Once a week
4 A few times a month
5 Once a month
6 Less than once a month
7 Never
8 (VOL) Don’t know
9 (VOL) Refused
Q7. How often does this passenger wear a seat belt? Please provide a percentage. Your best estimate is
fine.
ENTER PERCENTAGE: _____
998 – DON’T KNOW
999 = REFUSED
IF Q7 > 90, SKIP TO Q8

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IF Q7=998 OR Q7=999, ASK Q7a, ELSE SKIP TO NEXT QUESTION
Q7a. Can you tell me which of the following categories would best describe how often this passenger
wore a seat belt?
1 91-100%
2 81-90%
3 61-80%
4 41-60%
5 40% or less
8 (VOL) Don’t know
9 (VOL) Refused
Q7b. In your opinion, what is the main reason that this passenger doesn’t wear a seat belt all of the time?
DO NOT READ. SINGLE RECORD.
1 Only driving short distances
2 Driving in light traffic
3 In a rush
4 Forget to put it on
5 Don’t want his/her clothes to get wrinkled
6 Seatbelt is uncomfortable
7 Probability of being in a crash is too low
8 People in the vehicle are not wearing seatbelts
9 Doesn’t like being told what to do
10 Seatbelt hurts
11 May cause injury/trap
12 Was in an accident where seatbelt caused injury
13 Knows someone injured/killed because of seatbelt
14 Doesn’t fit
15 Medically exempt
16 (VOL) Can’t say one is most important/all important
17 (VOL) Other (Specify)
98 (VOL) Don’t know
99 (VOL) Refused

Ask if Q5> or =2 and Q5< or = 7
Q8. How often did this passenger wear a seat belt in your previous vehicle? Please provide a percentage.
Your best estimate is fine.
1 91-100%
2 81-90%
3 61-80%
4 41-60%
5 40% or less
6 (VOL) I didn’t transport passengers in the rear seat
8 (VOL) Don’t know
9 (VOL) Refused
END LOOP
IF STYPE=1, CONTINUE, ELSE SKIP TO NI
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Rear SBRS Drivers Acceptability and Preferences
Now, I would like to ask you a few questions about Rear Seat Belt Reminders. A Rear Seat Belt
Reminder alerts the driver or other occupants of the vehicle when a rear seat belt is being used at the
beginning of a trip and provides a reminder if one of the rear passengers has unbuckled his/her seat belt
during a trip.
Q9. Is your equipped with a reminder which to inform
you of the status of the rear seat belts?
1 Yes
2 No
SKIP TO NI2
8 (VOL) Don’t know
SKIP TO NI2
9 (VOL) Refused
SKIP TO NI2
Q10. When you transport passengers in the rear seat, on how many trips do you check the Rear Seat Belt
Reminder to find out the status of the rear seat belts? READ LIST.
1 All trips
SKIP TO Q12
2 Most trips
3 Some trips
4 A few trips
5 None
6 (VOL) Not Relevant, Passengers always wear their seat belt SKIP TO Q12
8 (VOL) Don’t know
9 (VOL) Refused
Q11. During the last trip when you transported rear passengers and you did NOT check the Rear Seat
Belt Reminder to know about the status of the rear seat belts, what were the reasons for this?
MULTIPLE RESPONSE. DO NOT READ LIST.
1 I always make sure that my passengers are wearing their seat belts before turning the engine on
2 The Rear Seat Belt Reminder doesn’t alert me and I still have to make sure that my passengers are
wearing their seat belts
3 My passengers always wear their seat belts and I never pay attention to the alert
4 It does not work properly
5 It is broken
6 I am often in a hurry and I don’t pay attention to the alerts
7 It does not stay on long enough
8 I ignore the alerts
9 (VOL) Other (specify)
98 (VOL) Don’t know
99 (VOL) Refused

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Q12. When you bought or leased the , were you aware it was equipped with a Rear Seat Belt
Reminder?
1 Yes
2 No
3 (VOL) I did not buy/lease this vehicle
8 (VOL) Don’t know
9 (VOL) Refused

SKIP TO Q14
SKIP TO Q14
SKIP TO Q14
SKIP TO Q14

Q13. And when you bought or leased the , was the Rear Seat Belt Reminder a factor that
influenced you in making the decision to purchase this specific model?
1 Yes
2 No
8 (VOL) Don’t know
9 (VOL) Refused

Now, I am going to ask you specific questions about your Rear Seat Belt Reminder when you first get in
the and begin a trip.
Q14. How does the Rear Seat Belt Reminder in your alert you that a rear passenger is not
wearing the seat belt before you begin a trip? Does it alert you with . . .
READ LIST. MULTIPLE RECORD.
1 A chime
2 A buzz
3 A flashing light
4 A flashing icon representing each rear position on the dashboard
5 A warning message on the dashboard and/or the console ceiling
6 A voice message
7 Anything else? (Specify)
8 (VOL) Don’t know
9 (VOL) Refused

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Q15. How satisfied are you with your current Rear Seat Belt Reminder in terms of how well it notifies
you whether a rear seat belt is being used when you start your vehicle? Are you…READ LIST.
1 Very satisfied
SKIP TO Q17
2 Somewhat satisfied
SKIP TO Q17
3 Neither satisfied nor dissatisfied
SKIP TO Q17
4 Somewhat dissatisfied
5 Very dissatisfied
6 (VOL) Passengers always wear their seat belts
SKIP TO Q17
8 (VOL) Don’t know
SKIP TO Q17
9 (VOL) Refused
SKIP TO Q17
Q16. Why are you dissatisfied with your current Rear Seat Belt Reminder in this situation?
DO NOT READ. MULTIPLE RECORD.
1 It does not alert me
2 It does not alert the concerned passenger
3 I still need to check if my passengers are buckled/tell my passengers to buckle
4 It is annoying
5 I can hardly see/hear the alerts
6 It does not stay on long enough
7 It is hard to understand/too complicated
8 It is useless
9 It does not work/reset properly after dropping off a passenger
10 I have no information about which seat belt is being used
11 Other (specify)
98 (VOL) Don’t know
99 (VOL) Refused
Q17. Which of these indicators would you prefer in your vehicle to let you know about the status of the
rear seat belts when you start your vehicle? READ LIST. MULTIPLE RECORD.
1 A chime
2 A buzz
3 A flashing light
4 A flashing icon representing each rear position
5 A warning message
6 A voice message
7 Anything else? (Specify)
8 (VOL) None of these
98 (VOL) Don’t know
99 (VOL) Refused

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Now, I am going to ask you specific questions about your Rear Seat Belt Reminder during a trip.
Q18. During a trip, how does the Rear Seat Belt Reminder in your alert you that a rear
passenger has unbuckled the seat belt? Does it alert you with . . .
READ LIST. MULTIPLE RECORD.
1 A chime
2 A buzz
3 A flashing light
4 A flashing icon representing each rear position on the dashboard
5 A warning message on the dashboard/console ceiling
6 A voice message
7 Anything else? (Specify)
8 (VOL) Don’t know
9 (VOL) Refused
Q19. Within the past year, did the Rear Seat Belt Reminder indicate a passenger had unbuckled his or her
seat belt during a trip?
1 Yes
2 No
SKIP TO Q21
8 (VOL) Don’t know SKIP TO Q21
9 (VOL) Refused
SKIP TO Q21
Q20. What was your reaction the last time this occurred? DO NOT READ LIST.
1 My passenger heard the reminder and refastened his or her seat belt on his or her own and I did not need
to intervene
2 My passenger heard the reminder but I had to intervene and encourage him or her to refasten his or her
seat belt, after which they refastened their seat belt.
3 My passenger did not hear/see the reminder and I had to intervene and encourage him or her to refasten
his or her seat belt, after which they refastened their seat belt.
4 My passenger did not refasten his or her seat belt, I tried to encourage him or her but I gave up
5 My passenger did not refasten his or her seat belt and I did nothing
6 (VOL) Other (specify)
8 (VOL) Don’t Know
9 (VOL) Refused
Q21. How satisfied are you with your current Rear Seat Belt Reminder in terms of how well it alerts you
when a rear passenger has unbuckled his or her seat belt during a trip? Are you…READ LIST.
1 Very satisfied
SKIP TO Q23
2 Somewhat satisfied
SKIP TO Q23
3 Neither satisfied nor dissatisfied
SKIP TO Q23
4 Somewhat dissatisfied
5 Very dissatisfied
6 (VOL) My passengers never unbuckle during a trip
SKIP TO Q23
8 (VOL) Don’t know
SKIP TO Q23
9 (VOL) Refused
SKIP TO Q23

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Q22. Why are you dissatisfied with your Rear Seat Belt Reminder in this situation?
DO NOT READ. MULTIPLE RECORD.
1 I still need to check if my passenger refastens his or her seat belt
2 I still need to tell my passenger to refasten his or her seat belt
3 I don’t know which of my passengers has unbuckled his or her seat belt
4 It does not alert the unbuckled passenger
5 I hardly see/hear the alerts
6 It is too stressful
7 It is too annoying
8 It is too distracting
9 It is too intrusive
10 It does not work properly
11 It does not stay on long enough
12 It stays on too long
13 It is too loud
14 It is too bright
15 Other (specify)
98 (VOL) Don’t know
99 (VOL) Refused
Q23. Which of these indicators would you prefer in your vehicle to let you know that a rear passenger has
unbuckled his or her seat belt? READ LIST. MULTIPLE RECORD.
1 A chime
2 A buzz
3 A flashing light
4 A flashing icon representing each rear position on the dashboard
5 A warning message on the dashboard
6 A voice message
7 Anything else? (Specify)
8 (VOL) Don’t know
9 (VOL) Refused

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These next few questions are about FRONT Seat Belt Reminders.
Q24a. If a front passenger is not wearing his or her seat belt, which of the following VISUAL alerts do
you think would be the most effective in encouraging him or her to fasten the seat belt and to keep it on
during a trip?
READ LIST. SINGLE RECORD.
1 A visual reminder that stays on continuously
2 A visual reminder that stays on for some period then goes off and stays off
3 A visual reminder that comes on periodically
4 A visual reminder that gets progressively brighter or flashes faster as time goes on
5 Other (Specify)
8 (VOL) Don’t know
SKIP TO Q25a
9 (VOL) Refused
SKIP TO Q25a
Q24b. Why did you select that one? [SBRS]
MULTIPLE RESPONSE. DO NOT READ.
1 More acceptable
2 Safer
3 Less annoying
4 Less stressful
5 Less distracting
6 Less intrusive
7 Other (Specify)
8 (VOL) Don’t know
9 (VOL) Refused
Q25a. If a front passenger is not wearing his or her seat belt, which of the following AUDIO alerts do you
think would be most effective in encouraging him or her to fasten their seat belt and to keep it on during a
trip?
READ LIST. SINGLE RECORD.
1 A sound that stays on continuously
2 A sound that stays on for some period, then goes off and stays off
3 A sound that comes on periodically
4 A voice message that comes on periodically,
5 A sound that gets progressively louder or beeps faster as time goes on
6 Other (Specify)
8 (VOL) Don’t know
SKIP TO Q27
9 (VOL) Refused
SKIP TO Q27

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Q25b. Why did you select that one?
MULTIPLE RESPONSE. DO NOT READ.
1 More acceptable
2 Safer
3 Less annoying
4 Less stressful
5 Less distracting
6 Less intrusive
7 Other (Specify)
8 (VOL) Don’t know
9 (VOL) Refused
Q26. For those passengers who do not normally buckle up, how effective is the FRONT Seat Belt
Reminder in getting those in the front seat to buckle up?
READ LIST.
1 Very effective
SKIP TO Q28
2 Somewhat effective
SKIP TO Q28
3 Not too effective
4 Not at all effective
5 (VOL) My front passengers always wear their seat belts anyway
SKIP TO Q28
8 (VOL) Don’t Know
SKIP TO Q28
9 (VOL) Refused
SKIP TO Q28
Q27. Why is the FRONT Seat Belt Reminder not effective in getting those in the front seat to buckle up?
DO NOT READ. MULTIPLE RECORD
1 It does not stay on long enough
2 The front passenger can barely hear/see the alerts
3 It goes off randomly
4 The occupant seat detector is not sensitive enough
5 It will stop regardless of whether the passenger refastens his or her seat belt
6 It doesn’t work
7 Other (specify)
8 (VOL) Don’t know
9 (VOL) Refused
Now I would like to ask some questions about the effectiveness of the REAR Seat Belt Reminder.
Q28. Among the following types of alerts, which one do you think would be the most likely to get your
rear passengers to fasten their seat belts? READ LIST. SINGLE RECORD.
1 Visual alert
2 Audio alert
3 Both
4 Anything else? (Specify)
SKIP TO Q31
8 (VOL) Don’t know
SKIP TO Q31
9 (VOL) Refused
SKIP TO Q31

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IF Q28=1 OR Q28=3, ASK Q29a, ELSE SKIP TO Q29a
Q29a. If a REAR passenger is not wearing his or her seat belt, which of the following VISUAL alerts do
you think would be the most effective in encouraging him or her to fasten their seat belt and to keep it on
during a trip?
READ LIST. SINGLE RECORD.
1 A visual reminder that stays on continuously
2 A visual reminder that stays on for some period then goes off and stays off
3 A visual reminder that comes on periodically
4 A visual reminder that gets progressively brighter or flashes faster as time goes on
5 Other (Specify)
8 (VOL) Don’t know
SKIP TO Q30a
9 (VOL) Refused
SKIP TO Q30a
Q29b. Why did you select that one?
MULTIPLE RESPONSE. DO NOT READ.
1 More acceptable
2 Safer
3 Less annoying
4 Less stressful
5 Less distracting
6 Less intrusive
7 Other (Specify)
8 (VOL) Don’t know
9 (VOL) Refused

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IFQ28=2 OR Q28=3, ASK Q30a
Q30a. If a rear passenger is not wearing his or her seat belt, which of the following AUDIO alerts do you
think would be most effective in encouraging him or her to fasten their seat belt and to keep it on during a
trip?
READ LIST. SINGLE RECORD.
1 A sound that stays on continuously
2 A sound that stays on for some period of time, then goes off and stays off
3 A sound that comes on periodically
4 A voice message that comes on periodically
5 A sound that gets progressively louder or beeps faster as time goes on
6 Other (Specify)
8 (VOL) Don’t know
SKIP TO Q31
9 (VOL) Refused
SKIP TO Q31
Q30b. Why did you select that one?
MULTIPLE RESPONSE. DO NOT READ.
1 More acceptable
2 Safer
3 Less annoying
4 Less stressful
5 Less distracting
6 Less intrusive
7 Other (Specify)
8 (VOL) Don’t know
9 (VOL) Refused
Q31. When purchasing or leasing your next vehicle, how important is it that the vehicle you choose come
with a Rear Seat Belt Reminder? READ LIST.
1 Very important
2 Somewhat important
3 Not very important
4 Not important at all
5 (VOL) I don’t intend to buy or lease a vehicle in the future
8 (VOL) Don’t know
9 (VOL) Refused
Q32. Which of the following features or options would you like to have available on the Rear Seat Belt
Reminder in your vehicle? READ LIST. MULTIPLE RECORD.
1 An occupant detection sensor for the rear seat
2 Being able to set the length of time the alert is on
3 A system that alerts only the driver
4 A system that alerts both the driver and the passengers
5 An option that allows you to turn off the Rear Seat Belt Reminder
6 Being able to acknowledge the alert
7 Being able to replay the alert
8 Having the information always available
9 Anything else? (Specify)
98 (VOL) Don’t know
99 (VOL) Refused

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Q33. Since you began driving a vehicle equipped with a Rear Seat Belt Reminder, would you say that the
rear passengers are wearing their seat belt more often, less often, or is it about the same compared to your
last vehicle without a reminder?
1 More often
2 Less often
3 About the same
4 (VOL) It is the first vehicle I have driven
8 (VOL) Don’t know
9 (VOL) Refused
Q34. For each of the following situations, please tell me whether the Rear Seat Belt Reminder has
increased the use of seat belts in the rear seat.
(READ AND ROTATE A-F)
A. When driving short distances
B. When making frequent stops
C. Driving in residential areas
D. Driving on major highways
E. Being in a hurry
F. Forgetting to put the seat belt on
1 Yes
2 No
3 (VOL) I do not drive on these types of roads (C and D ONLY)
8 (VOL) Don’t know
9 (VOL) Refused
SKIP TO Q37

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Q37. Since you began driving a vehicle equipped with a Rear Seat Belt Reminder, have you heard any
complaints from your passengers?
1 Yes
2 No
SKIP TO Q39
8 (VOL) Don’t know
SKIP TO Q39
9 (VOL) Refused
SKIP TO Q39
Q38. What are they? DO NOT READ. MULTIPLE RECORD
1 It is annoying
2 It is stressful
3 It is too intrusive
4 It is too loud
5 The passenger hardly see/hear the alerts
6 It is annoying for the other passengers
7 The passenger cannot switch seats while the car is in motion
8 It goes off when the passenger unbuckles for a few seconds to reach something
9 Other (specify)
98 (VOL) Don’t know
99 (VOL) Refused
Q39. Who would you prefer the Rear Seat Belt Reminder to alert?
READ LIST. SINGLE RECORD.
1 Only the driver
2 Only the unbuckled passenger
3 Both the driver and the unbuckled passenger
4 The unbuckled passenger and others in the rear seat
5 Everyone in the car
8 (VOL) Don’t know
9 (VOL) Refused

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Q40. Please tell me if you strongly agree, agree, neither agree nor disagree, disagree or strongly disagree
with each of the following statements.
(READ A – G)
A. It is very important that all my passengers buckle their seat belts.
B. When the Seat Belt Reminder notifies me that my seat belt is unfastened, I buckle up right away.
C. The Seat Belt Reminder makes it easier for me to encourage my passengers to fasten their seat
belt.
D. I rely on the Seat Belt Reminder to know about the status of the rear seat belts.
E. I am able to better concentrate on the road with a Rear Seat Belt Reminder in my vehicle.
F. I prefer a Rear Seat Belt Reminder that I could turn on or off depending on the situation, for
example I could turn it on if I am carrying passengers.
G. I prefer a Rear Seat Belt Reminder that has rear seat occupant detection.
1 Strongly agree
2 Agree
3 Neither agree nor disagree
4 Disagree
5 Strongly disagree
8 (VOL) Don’t know
9 (VOL) Refused
Q41. Are there any features you particularly LIKE about your current Seat Belt Reminder?
1 Yes
2 No
SKIP TO Q43
8 (VOL) Don’t know
SKIP TO Q43
9 (VOL) Refused
SKIP TO Q43
Q41a. What are they? Anything else?
[Open ended question]
Q42. Are there any features you particularly DISLIKE about your current Seat Belt Reminder?
1 Yes
2 No
SKIP TO DH1
8 (VOL) Don’t know
SKIP TO DH1
9 (VOL) Refused
SKIP TO DH1
Q42a. What are they? Anything else?
[Open ended question]

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Q43. Have you ever tried to take action to disable the Rear Seat Belt Reminder System of the
?
DO NOT READ LIST.
1 Yes
2 No
SKIP TO DH1
8 (VOL) Don’t know
SKIP TO DH1
9 (VOL) Refused
SKIP TO DH1
Q43a.. Why did you try to disable the Rear Seat Belt Reminder System?
DO NOT READ. MULTIPLE RECORD.
1 It is annoying
2 It is stressful
3 It is too intrusive
4 It is too loud
5 The passenger hardly see/hear the alerts
6 It is annoying for the other passengers
7 The passenger cannot switch seats while the car is in motion
8 It goes off when the passenger unbuckles for a few seconds to reach something
9 The rear passengers won’t buckle regardless of hearing/seeing the alerts
10 I have to tell my passengers to buckle up anyway.
11 Other (specify)
98 (VOL) Don’t know
99 (VOL) Refused
Non-Rear SBRS Drivers Acceptability and Preferences
READ NI IF STYPE=2, ELSE SKIP TO Instruction before NI2.
NI. Now, I am going to ask you some questions about Rear Seat Belt Reminders. A Rear Seat Belt
Reminder alerts the driver or other occupants of the vehicle when a rear seat belt is being used at the
beginning of a trip and notifies those in the vehicle if one of the rear passengers has unbuckled his/her
seat belt during a trip.
I realize you may not have such a reminder in your vehicle, however please answer each question the best
you can.
IF STYPE=2 GO TO NR1.
READ IF STYPE=1 AND Q9>1, ELSE SKIP TO DH1.
NI2. I realize you may not have such a reminder in your vehicle, however I would like to ask you some
questions about Rear Seat Belt Reminders in general. Please answer each question the best you can.
NR1. Which of these alerts would you prefer in your vehicle to let you know that the rear passenger is not
wearing his or her seat belt? READ LIST. MULTIPLE RECORD.
1 A chime
2 A buzz
3 A flashing light
4 A flashing icon representing each rear position
5 A warning message
6 A voice message
7 Anything else? (Specify)
8 (VOL) None
98 (VOL) Don’t know
99 (VOL) Refused
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NR2. Which of these indicators do you think would be the most likely to get the rear passengers to fasten
their seat belts? READ LIST. SINGLE RECORD.
1 A chime
2 A buzz
3 A flashing light
4 A flashing icon representing each rear position
5 A warning message
6 A voice message
7 Anything else? (Specify)
8 (VOL) None
98 (VOL) Don’t know
99 (VOL) Refused
NR3. Who should the Rear Seat Belt Reminder alert? READ LIST.
1 Only the driver
2 Only the unbuckled passenger
3 Both the driver and the unbuckled passenger
4 The unbuckled passenger and others in the rear seat
5 Everyone in the car
8 (VOL) Don’t know
9 (VOL) Refused

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NR4. If a REAR passenger is not wearing their seat belt, which of the following VISUAL alerts do you
think would be the most effective in encouraging them to buckle up and stay buckled during a trip?
READ LIST. SINGLE RECORD.
1 A visual reminder that stays on continuously
2 A visual reminder that stays on for some period then goes off and stays off
3 A visual reminder that comes on periodically
4 A visual reminder that gets progressively brighter or flashes faster as time goes on
5 Other (Specify)
8 (VOL) Don’t know
SKIP TO NR6
9 (VOL) Refused
SKIP TO NR6
NR5. Why did you select that one?
MULTIPLE RESPONSE. DO NOT READ.
1 More acceptable
2 Safer
3 Less annoying
4 Less stressful
5 Less distracting
6 Less intrusive
7 Other (Specify)
8 (VOL) Don’t know
9 (VOL) Refused
NR6. If a rear passenger is not wearing their seat belt, which of the following AUDIO alerts do you think
would be most effective in encouraging them to buckle up and stay buckled during a trip?
READ LIST. SINGLE RECORD.
1 A sound that stays on continuously
2 A sound that stays on for some period of time, then goes off and stays off
3 A sound that comes on periodically
4 A voice message that comes on periodically
5 A sound that gets progressively louder or beeps faster as time goes on
6 Other (Specify)
8 (VOL) Don’t know
SKIP TO NR8
9 (VOL) Refused
SKIP TO NR8
NR7. Why did you select that one?
MULTIPLE RESPONSE. DO NOT READ.
1 More acceptable
2 Safer
3 Less annoying
4 Less stressful
5 Less distracting
6 Less intrusive
7 Other (Specify)
8 (VOL) Don’t know
9 (VOL) Refused

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NR8. Which of the following features or options would you like to have available on the Rear Seat Belt
Reminder in your vehicle? READ LIST. MULTIPLE RECORD.
1 A rear occupant detection
2 Being able to set the length of time the alert is on
3 A system that alerts only the driver
4 A system that alerts both the driver and the passengers
5 An option that allows you to turn off the Rear Seat Belt Reminder
6 Being able to acknowledge the alert
7 Being able to replay the alert
8 Having the information always available
9 Anything else? (Specify)
98 (VOL) Don’t know
99 (VOL) Refused
NR9. For each of the following situations, please tell me whether you think a Rear Seat Belt Reminder
would increase the use of seat belts in the rear seat.
(READ AND ROTATE A-D)
A. Driving short distances
B. Making frequent stops
C. Being in a hurry
D. Forgetting to put the seat belt on
1 Yes
2 No
8 (VOL) Don’t know
9 (VOL) Refused
NR10. When purchasing or leasing your next vehicle, how important is it that the vehicle you choose
come with a Rear Seat Belt Reminder? READ LIST.
1 Very important
2 Somewhat important
3 Not very important
4 Not important at all
5 (VOL) I don’t intend to buy or lease a vehicle in the future
8 (VOL) Don’t know
9 (VOL) Refused

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Now, I would like to ask you some questions about FRONT Seat Belt Reminders in general. Please
answer each question the best you can.
NR12. If a FRONT seat passenger is not wearing his or her seat belt, which of the following VISUAL
alerts do you think would be the most effective in encouraging him or her to fasten the seat belt and to
keep it on during a trip?
READ LIST. SINGLE RECORD.
1 A visual reminder that stays on continuously
2 A visual reminder that stays on for some period then goes off and stays off
3 A visual reminder that comes on periodically
4 A visual reminder that gets progressively brighter or flashes faster as time goes on
5 Other (Specify)
8 (VOL) Don’t know
SKIP TO NR14
9 (VOL) Refused
SKIP TO NR14
NR13. Why did you select that one?
MULTIPLE RESPONSE. DO NOT READ.
1 More acceptable
2 Safer
3 Less annoying
4 Less stressful
5 Less distracting
6 Less intrusive
7 Other (Specify)
8 (VOL) Don’t know
9 (VOL) Refused
NR14. If a front passenger is not wearing his or her seat belt, which of the following AUDIO alerts do
you think would be most effective in encouraging him or her to fasten the seat belts and to keep it on
during a trip?
READ LIST. SINGLE RECORD.
1 A sound that stays on continuously
2 A sound that stays on for some period, then goes off and stays off
3 A sound that comes on periodically
4 A voice message that comes on periodically
5 A sound that gets progressively louder or beeps faster as time goes on
6 Other (Specify)
8 (VOL) Don’t know
SKIP TO NR16
9 (VOL) Refused
SKIP TO NR16
NR15. Why did you select that one?
MULTIPLE RESPONSE. DO NOT READ.
1 More acceptable
2 Safer
3 Less annoying
4 Less stressful
5 Less distracting
6 Less intrusive
7 Other (Specify)
8 (VOL) Don’t know
9 (VOL) Refused
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NR16. For those passengers who don’t buckle up, how effective is the FRONT Seat Belt Reminder in
encouraging those in the front seat to fasten their seat belt?
READ LIST.
1 Very effective
2 Somewhat effective
3 Not too effective
4 Not at all effective
5 (VOL) My front passengers always wear their seat belt anyway
8 (VOL) Don’t Know
9 (VOL) Refused
NR17. Please tell me if you strongly agree, agree, neither agree nor disagree, disagree or strongly disagree
with each of the following statements.
READ A – G
A. It is very important that all my passengers buckle their seat belt.
B. I am more likely to buckle up if the Seat Belt Reminder reminds me to fasten my seat belt.
C. The Seat Belt Reminder makes it easier for me to encourage my passengers to fasten their seat
belt.
D. I rely on the Seat Belt Reminder to let me know if any of my passengers are not wearing their seat
belt.
E. I would be able to better concentrate on the road with a Rear Seat Belt Reminder in my vehicle.
F. I would prefer a Rear Seat Belt Reminder that I could turn on or off as required depending on the
situation, for example I could turn it on if I am carrying passengers.
G. I would prefer a Rear Seat Belt Reminder that has rear seat occupant detection.

1 Strongly agree
2 Agree
3 Neither agree nor disagree
4 Disagree
5 Strongly disagree
8 (VOL) Don’t know
9 (VOL) Refused

NR18a. Are there any features you particularly LIKE about your current Seat Belt Reminder?
1 Yes
2 No
SKIP TO NR19a
8 (VOL) Don’t know
SKIP TO NR19a
9 (VOL) Refused
SKIP TO NR19a
NR18b. What are they? Anything else?
[Open ended question]

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NR19a. Are there any features you particularly DISLIKE about your current Seat Belt Reminder?
1 Yes
2 No
SKIP TO DH1
8 (VOL) Don’t know
SKIP TO DH1
9 (VOL) Refused
SKIP TO DH1
NR19b. What are they? Anything else?
[Open ended question]

Driving Habits and Seat Belt Law Awareness
DH1. When driving your vehicle and transporting passengers in the rear seat, do these trips occur mostly
during the
READ LIST. MULTIPLE RECORD.
1 Spring
2 Summer
3 Fall
4 Winter
5 School year
6 All year long
7 (VOL) I just bought/leased my vehicle
8 (VOL) Don’t Know
9 (VOL) Refused
DH2. Are you aware of any existing seat belt laws in your State, county, or city?
DO NOT READ LIST.1 Yes
2 No
8 (VOL) Don’t know
9 (VOL) Refused

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Demographics
Now, I have just a few last questions for classification purposes only.
D1. What is your age?
ENTER AGE: _____
RANGE: 18 to 97
97=97 or older
98 Don’t know
99 Refused
If DK or RF in D1 Continue, ELSE SKIP TO D2
D1a. Please stop me when I reach the category that includes your age?
READ LIST.
1 18 to 24
2 25 to 34
3 35 to 44
4 45 to 54
5 55 to 64
6 65 to 74, or
7 75 or older
8 (VOL) Don’t know
9 (VOL) Refused
D2. Are you currently employed full-time, part-time, un-employed and looking for work, retired, going to
school, a homemaker, or do you do something else? MULTIPLE RECORD.
1 Employed full-time
2 Employed part-time
3 Unemployed and looking for work
4 Retired
5 Going to school
6 Homemaker
7 (VOL) Disabled
8 Something else (Specify)
98 (VOL) Don’t know
99 (VOL) Refused
D3. What is the highest grade or year of school you have completed?
DO NOT READ LIST.
1 No formal education
2 First through 7th grade
3 8th grade
4 Some high school
5 High school graduate or GED
6 Some college
7 2-year technical/Associates degree
8 Four-year college graduate
9 Some graduate school
10 Graduate degree
98 (VOL) Don’t know
99 (VOL) Refused
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D4. Are you currently married, divorced, separated, widowed, or single?
1 Married
2 Divorced
3 Separated
4 Widowed
5 Single
8 (VOL) Don’t Know
9 (VOL) Refused
D5. Do you have any children, under the age of 18, living in your household?
1 Yes
2 No
8 (VOL) Don’t know
9 (VOL) Refused
D6. Are you of Hispanic or Latino origin or descent?
1 Yes
2 No
8 (VOL) Don’t know
9 (VOL) Refused
D7. Which of the following racial categories describes you? You may select more than one.
READ LIST AND MULTIPLE RECORD.
1 American Indian or Alaska Native
2 Asian
3 Black or African American
4 Native Hawaiian or Other Pacific Islander
5 White
6 (VOL) Hispanic/Latino
7 (VOL) Other (SPECIFY)
8 (VOL) Don’t know
9 (VOL) Refused
If code 6 ONLY in D7, Continue, ELSE SKIP TO D8
D7a. Do you consider yourself to be white-Hispanic or black-Hispanic?
1 White-Hispanic
2 Black-Hispanic
3 (VOL) Hispanic/Respondent refused to discriminate
4 Other (Specify)
8 (VOL) Don’t know
9 (VOL) Refused

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D8. Which of the following categories best describes your total household income before taxes in 2012?
Your best estimate is fine. Would it be . . .
READ LIST.
1 Less than $5,000
2 $5,000 to less than $15,000
3 $15,000 to less than $30,000
4 $30,000 to less than $50,000
5 $50,000 to less than $75,000
6 $75,000 to less than $100,000, OR
7 $100,000 or more
8 (VOL) Don’t know
9 (VOL) Refused
READ: That completes the survey. Thank you very much for your time and cooperation. If you would like
information about traffic safety, please visit www.nhtsa.gov.
SCR1. I am sorry but you are not eligible to participate in the survey today. Thank you for your cooperation
and I hope you have a pleasant evening.
SCR2. Thank you, we will call back at a later time.

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