HHFKA CACFP State Agencies

Attachment E1

OMB Control # 0584-0524

Expiration Date: 06/30/2016

OMB BURDEN STATEMENT:  According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-0524. The time required to complete this information collection is estimated to average 15 minutes per response including time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.

FOCUS GROUP SCREENING AND DEMOGRAPHIC QUESTIONS

This document includes recruitment screeners for the following audiences:

• State and tribal agency staff administering the CACFP

STATE AND TRIBAL AGENCY STAFF ADMINISTERING CACFP

Hello, my name is _________. I’m calling from KRC Research. May I speak with [INSERT NAME]? WHEN CORRECT INDIVIDUAL HAS BEEN REACHED, CONTINUE.

Hello, my name is _________. I’m calling from KRC Research. You participated in a USDA Food and Nutrition Survey last [INSERT FIELD DATE]. You indicated in the survey that you might be willing to participate in a follow-up small group discussion. Is that correct?

	Yes, that is correct		CONTINUE
	No, that is not correct		THANK AND TERMINATE

Terrific! We are calling today to find out if you would be willing to participate in a small group telephone discussion with a few other people like yourself who work in child care about nutrition, physical activity and electronic media use among children 5 years and younger while they are in a child care setting. We are not selling anything and we will not ask for any contributions or donations. This is not a marketing call. If you qualify to participate and agree to do so, your answers will be completely anonymous and neither you nor your agency will be identified. Do you think you are interested in participating in a small group discussion?

	Yes, interested		CONTINUE
	No, not interested		THANK AND TERMINATE

May I ask you a few questions to see if you qualify to participate in this research?

RECORD:

	Male		CONTINUE
	Female		CONTINUE

To confirm, do you work at [INSERT STATE AGENCY/DIVISION FROM SAMPLE]?

	Yes		CONTINUE
	No		TERMINATE
	IF NOT CONTACT FROM SAMPLE, ASK TO SEE IF RESPONDENT HAS CONTACT INFORMATION FOR NAME ON LIST OR FOR AN ALTERNATIVE CONTACT WHO HAS RESPONSIBILITY FOR ADMINISTERING THE CACFP

Have you previously or do you currently work for any of the following? [READ LIST]

	YES	NO
In advertising or public relations?		
In marketing or opinion research?		
In journalism or for the news media?		
TERMINATE IF YES TO ANY OF ABOVE.

To ensure that we include the opinions of a variety of participants could you please tell me your age?

	Under 18		TERMINATE
	18 – 20		RECRUIT A MIX
	21 – 34	
	35 – 44	
	45 – 54	
	55 – 64	
	65 or older	

What is your job title or role?

Director/Chief		CONTINUE
Program Manager/Supervisor/ Administrator		CONTINUE
Nutritionist		CONTINUE
Program Specialist		CONTINUE
Education/Training Specialist		CONTINUE
Field Staff/Monitor		CONTINUE
Secretary		TERMINATE
Other		TERMINATE

Does your agency or division work with sponsoring organizations, child care centers and/or day care homes to administer the Child and Adult Care Food Program, or CACFP in your state or tribe?

	Yes		CONTINUE
	No		TERMINATE

Are you responsible for administering the CACFP in your state or tribe?

	Yes		CONTINUE
	No		TERMINATE

What is the total number of child care centers and day care homes enrolled in the CACFP in your state or tribe? [READ LIST AND RECORD NUMERIC RESPONSE.]

	NUMERIC RESPONSE	None
Child care centers	_______	
Day care homes	_______	

RECRUIT A MIX OF TOTAL NUMBER OF CENTERS AND DAY CARE HOMES; TOTAL NUMBER BREAKS TO FOLLOW BASED UPON QUANTITATIVE FINDINGS

What is the total number of sponsor organizations that you work with to administer CACFP?

NUMERIC RESPONSE

______

CONTINUE

RECRUIT A MIX OF TOTAL NUMBER OF SPONSOR ORGANIZATIONS; TOTAL NUMBER BREAKS TO FOLLOW BASED UPON QUANTITATIVE FINDINGS

Please tell me, what is the last grade of school you have completed? If you are currently in college, just say so.

	Some university/college or vocational school		RECRUIT A MIX
	College	
	Postgraduate degree (Masters, Ph.D., professional degree)	

Are you of Hispanic or Latino background – such as Mexican, Puerto Rican, Cuban, or another Latin American background??

Hispanic or Latino		CONTINUE
Not Hispanic or Latino	

[IF NOT HISPANIC OR LATINO IN Q47] Which of the following categories best describes your race or ethnicity?

	American Indian or Alaska Native		RECRUIT A MIX
	Asian	
	Black or African American	
	Native Hawaiian or Other Pacific Islander	
	White	

INVITATION:

We would like to invite you to participate in a research discussion group. The group will take 90 minutes of your time. The discussion group will be held on [INSERT DATE] at [INSERT TIME].

Will you be available on _______ from _______ to _______ p.m.?

	Yes		CONFIRM DATE & TIME
	No		THANK & TERMINATE

We will send you an email confirming the time and how to participate. May I have your email address where it is best to reach you?

____________________________________________________________________________________________________________

To verify, do you have access to a computer where you can go to a link or a website?

	Yes	
	No		THANK & TERMINATE

USDA/FNS/CND

1.27.2021

Screening: Phase 2 Research

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