Form 008-0-18 Message Recruit Screener

OMB Control Number: 1660-NWXX

Expiration: None

FEMA Form Number: 008-0-18

PAPERWORK BURDEN DISCLOSURE NOTICE

(Recruit/Screener)

Public reporting burden for this form is estimated to average 3 minutes per response. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and submitting the form. This collection of information is voluntary. You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 1800 South Bell Street, Arlington VA 20598-3005, Paperwork Reduction Project (1660-NEW). NOTE: DO NOT SEND YOUR COMPLETED FORM TO THIS ADDRESS.

National Preparedness Message Framing Focus Groups

Recruit/Screener Phone Script

Sample Selection Criteria

• Participants should be recruited for 1 of XX focus groups.

• A total of 12 participants should be recruited for each group. Only 8 participants will be required for each group.

• Only one participant per household.

Introduction

Hello, my name is ____________ and I am calling from Gallup. We are interested in talking to individuals living in your area to gather insights to help the U.S. Government better understand how best to communicate with citizens about readiness for disasters. This is a unique opportunity to make a valuable contribution to your community and the Nation.

If you agree to participate, you will join approximately 8 others for about an hour and a half at a professional market research facility in your community. We would also contact you around three weeks later for a short 5 minute telephone survey. We are offering a $150 as a way to say thank you for participating.

INTERVIEWER

1. May I ask you a few questions to see if you qualify for our focus groups? This survey will take approximately 3 minutes to complete.

01 YES (Continue)

2. NO (Thank and terminate)

2. In thinking about preparing yourself for a major disaster, which best represents your

preparedness?

1. I am not planning to do anything about preparing

2. I have not yet prepared, but I intend to in the next 6 months

3. I have not yet prepared, but I intend to in the next month

4. I have recently begun preparing

5. I have been preparing for at least the past 6 months

Using a five point scale, where a ‘1’ is strongly disagree and a ‘5’ is strongly agree. To what extent do you agree with the following statement?

3. If a disaster were to hit my area/community I would consider taking steps to prepare.

1. Strongly disagree

5. Strongly agree

97 (DK)

98 (REFUSED)

4. In the past, I have thought about preparing for a disaster.

1. Strongly disagree

5. Strongly agree

97 (DK)

98 (REFUSED)

(RECRUITER NOTE: IF codes 02, 03, 04 , or 05 IN Q2 OR IF code 03, 04 or 05 in ANY for Q3 THRU Q4 RECRUIT FOR GROUP##)

5. Have you ever attended a group discussion for market research purposes?

01 Yes—go to item 5b below

02 No—Continue to #6

5b. How many group discussions have you attended in the past 12 months?

RECORD #_______________

IF MORE THAN 3, THANK AND TERMINATE

6. Have you recently participated in any Gallup focus group?

01 Yes—THANK AND TERMINATE

02 No—Continue

7. On a scale of 1 to 6, where “1” is “Very Uncomfortable” and “6” is “Very Comfortable,” how comfortable do you feel expressing your opinion in a group with 8 or 9 other people?

VERY UNCOMFORTABLE VERY COMFORTABLE

1 2 3 4 5 6

MUST ANSWER 4, 5, OR 6

CLOSE

Our group will be held on DATE at TIME at LOCATION. Will you be able to participate?

DATE TIME LOCATION

IF GROUP ## participant READ: TBD TBD TBD

IF GROUP ## participant READ: TBD TBD TBD

If YES to participating, READ and collect the following information.

Thanks for agreeing to participate. I just have a few additional questions.

8. What is a telephone number where we can reach you to remind you of the date and time of the group session?

Telephone #: ___________________________

9. Do you have e-mail address we can also use to contact you? If YES, record address below.

E-MAIL: _______________________________________________

DEMOGRAPHICS

D1. Gender: (CODE DON’T ASK)

1. Female (RECRUIT A MIX FOR ALL GROUPS)

2. Male (RECRUIT A MIX FOR ALL GROUPS)

D2. Age:

1. 18-34 (RECRUIT A MIX FOR ALL GROUPS)

2. 35-49 (RECRUIT A MIX FOR ALL GROUPS)

3. 50+ (RECRUIT A MIX FOR ALL GROUPS)

D3. Would you say your race is? (RECRUIT A MIX)

1. American Indian or Alaska Native

2. Asian

3. Black or African American

4. Native Hawaiian or Other Pacific Islander

5. White

D4. Would you say your ethnicity is? (RECRUIT A MIX)

1. Hispanic or Latino

2. Not Hispanic or Latino

D5. Annual household income? (RECRUIT A MIX)

01 Less than $25,000

02 $25,000 to $49,999

03 $50,000 to $74,999

04 $75,000 or more

D6. Education? (RECRUIT A MIX)

1. Less than 12^th grade (no diploma)

2. High School Graduate/GED

3. Some college but No Degree

4. Associate Degree

5. Bachelor’s Degree

6. Master’s Degree

7. PhD. Or Professional Degree

D6. Do you personally or are you providing care to someone who has a disability or a health

condition that might affect your capacity to respond to an emergency situation?

1. Yes

2. No

FEMA Form 008-0-18