Feedback Sessions for IdentityTheft.gov

Approximate time: 10 minutes
CIRCLE
DATE
Group 1 Time

1

Group 2 Time

2

RECRUITMENT SCREENER
RESPONDENT NAME:
ADDRESS:
CITY:

STATE:

ZIP:

TELEPHONE:
DATE RECRUITED:

RECRUITED BY:

DATE CONFIRMED:

CONFIRMED BY:

(RECRUIT FOR A SHOW OF 8 TO 10)
Hello, this is

calling from Shugoll Research, an independent

survey research company. May I please speak with

? (CONTINUE WHEN

REACH NAME ON LIST)
We are conducting a research study in order to improve a government website. We
are looking for individuals to spend an hour using the website and answering
questions about their experience. Participants in this study will receive $40 for
their time.
The sessions will be conducted on
1.

via phone and screen-sharing technology.

Would you be interested in participating in the study?
CIRCLE
No

1

Yes

2

Don’t know

3

(THANK AND TERMINATE)

FTC IdentityTheft.gov Usability Test – Screener
Page 1 of 3

2.

Which of the following applies to you: (READ LIST)
CIRCLE
Your identity has never been
stolen

1

You have been a victim of
fraudulent credit card charges

2

You have been a victim of banking,
tax, or identity fraud

3

(DO NOT Don't know
READ)
3.

4

(ATTEMPT A MIX,
9-10 ideal)
(ATTEMPT A MIX,
9-10 ideal)

(THANK AND
TERMINATE)

Record gender for all groups:
CIRCLE

4.

Male

1

Female

2

(ATTEMPT A MIX)

Please stop me when I reach the category that includes your age. (READ LIST)
CIRCLE

5.

Under 18

1

18 to 29

2

30 to 39

3

40 to 49

4

50 to 64

5

65 or older

6

Refused

7

(THANK AND TERMINATE)

(ATTEMPT A MIX, 2-3 from each group is ideal)

(THANK AND TERMINATE)

What is your home city, state, and zip code?
City, State, Zip Code:

1

(ATTEMPT A MIX)

Not continental U.S. (i.e.

2

(THANK AND TERMINATE)

Alaska or Hawaii)

FTC IdentityTheft.gov Usability Test – Screener
Page 2 of 3

6.

What is your time zone:

Pacific

1

Mountain

2

Central

3

Eastern

4

(ATTEMPT A MIX)

7.
The session will be conducted remotely. You will be required to access the
Internet and talk on the phone at the same time. Do you have a high-speed Internet
connection or a dial-up connection?

Dial-up

1

(THANK AND TERMINATE)

Don’t know

2

(THANK AND TERMINATE)

High-speed

3

FTC IdentityTheft.gov Usability Test – Screener
Page 3 of 3