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NAXION	Study #U002-25-XXX
	Date


SCREENER
NON-CUSTOMERS – City B

IDENTIFY MALE OR FEMALE 18 TO 69 YEARS OF AGE
BY OBSERVATION CHECK ONE
	(   )	female
	(   )	male



RESPONDENT NAME: 	

ADDRESS:	

	

CITY/STATE:	ZIP CODE:	

TELEPHONE #:	FAX #:	

GROUP SCHEDULE

Attending:

Date

Group 1 (    )  6:00 PM – 8:00 PM – General Non-Customers
Group 2 (    )  8:00 PM – 10:00 PM – General Non-Customers


SUGGESTED INTRODUCTION:  Hello, I'm __________________________ calling for NAXION, a marketing research firm based in Philadelphia.  This is not a sales call.  We are conducting a research study for The United States Mint, and are inviting people who meet certain qualifications to participate in an informal group discussion on (DAY/DATE).

Are you free on that date?
	Yes	(   )
	No	(   )	THANK AND TERMINATE

I’d like to ask you a few questions.  This survey is strictly voluntary.  We are also required, by law, to report to you the OMB Control Number for this public information request. That number is OMB #1525-0012-0196(b).

1.	Do you, or does anyone in your household or family, own or work for?  (READ AND SELECT ALL THAT APPLY)
		Yes	No

	A) A coin dealer, or a retail store that sells coins?	(   )	(   )

	B) A newspaper, radio station, or television station?	(   )	(   )

	C) The United States Mint?	(   )	(   )

	D) An advertising agency?	(   )	(   )

	E) A market research company?	(   )	(   )

	F) A company that manufactures or markets	(   )	(   )
	collectible items (dolls, cards, memorabilia, etc.)?

IF "YES" TO ANY THANK AND TERMINATE


2.	Have you ever attended a group discussion for market research purposes or participated in an over-the-phone research interview?

	Yes	(   )
                                              __________________________________________
	No	(   )	SKIP TO Q.4


3.	When was the last time you did so?

				
	MONTH	YEAR

TERMINATE IF WITHIN PAST 6 MONTHS

4.	In the past year, have you sold any U.S. coins for income purposes other than to round out a personal collection?  (IF NECESSARY, PROBE:  Are you a coin dealer?)

	Yes	(   )  THANK AND TERMINATE
                                                        __________________________________________                         
	No	(   )


5.	Have you ever purchased U.S. coins or other merchandise directly from the United States Mint?

	Yes	(   )	TERMINATE
                                              __________________________________________
	No	(   )


6.	In the past two years, have you purchased U.S. coins?

	Yes	(   )	
                                              __________________________________________
	No	(   )	SKIP TO Q.8


7.	From which sources have you purchased U.S. coins? (READ AND SELECT ALL THAT APPLY)



Yes
No
A.
Coin dealers?
(   )
(   )
B.
Internet auctions?
(   )
(   )
C.
Flea markets?
(   )
(   )
D.
Other? (please specify)
(   )
(   )

8.	Do you currently collect, occasionally save, or sometimes put aside… (READ AND SELECT ALL THAT APPLY)

A.    America the Beautiful quarters?
(  )
B.    50-state quarters?
(  )
C.    New nickels?
(  )
D.    Other current U.S. coins?
(  )
______________________________________________________
E.    Stamps?
(  )
F.    Cards (e.g., baseball cards, etc.)?
(  )
G.   Military items/historical memorabilia?
(  )
H.   Small, other collectibles?
(  )
I.     Other (Specify ________________)?
(  )
J.     None
(  )

IF ONLY ITEMS FROM “E-J” SELECTED, SKIP TO Q.10


9.	How many months or years have you collected or saved U.S. coins?

_______________________				______________________
RECORD # OF MONTHS		OR		RECORD # OF YEARS

GET A MIX


10.	Please indicate how likely or unlikely you would be to buy U.S. coins or U.S. collectible coins in the next 12 months either for yourself or as a gift using a scale from “1” to “6” where “1” means “Not at all Likely” and ”6” means “Extremely Likely.”

_______________________
RECORD NUMBER

MUST HAVE MIX OF “4” THROUGH “6”


11.	The United States Mint is interested in getting the opinions of people of diverse cultural backgrounds, and we would like to ask you a few questions about your background. (READ)

Are you Latino or Hispanic
Yes (   )   No (   )

			___________________________________________________________________________

	What is your race?  Please select one or more. (READ)

White
(   )

_______________________________________________________________________________
Black or African-American
(   )

_______________________________________________________________________________
Asian,
(   )

Native Hawaiian or other Pacific Islander, or
(   )

American Indian or Alaska Native?
(   )

_______________________________________________________________________________
(DO NOT READ) Prefer not to answer.
(   )



12.	Is your age: (READ)

	Under 18,	(   )  	TERMINATE AT END OF SCREENER
	________________________________________________________
	18 to 30,	(   )   GET
			
	31 to 39,	(   )   AN

	40 to 49,	(   )   EVEN
	
	50 to 59,	(   )   MIX
	______________________________________________________
	60 to 69, or	(   )	NO MORE THAN ONE PER GROUP	______________________________________________________
	Over 70?	(   )  TERMINATE AT END OF SCREENER


13.	Is your total annual household income before taxes: (READ)

		Under $30,000,				(   )  	TERMINATE AT END OF SCREENER
		_____________________________________________________________________
		$30,000 to $49,000,			(   )		CONTINUE RECRUITING AND
											CONTACT NAXION
		_____________________________________________________________________
		$50,000 to $75,000,			(   )	       GET

		$75,000 to $99,999, or		(   )	        A

		$100,000 or more?			(   )         MIX


14.	What is the last grade of school you completed?  Is it: (READ)

			Less than high school,			(   )	  TERMINATE AT END OF SCREENER
			____________________________________________________________________
			High school,					(   )

			Some College,					(   )	  GET

			College, or						(   )	  A

			Graduate school?				(   )	  MIX



15.	Are you employed?  (READ)

	Full time,				(    )	   GET

	Part time, 				(    )	   A

	Retired, or			(    )	   

	Not Employed?		(    )	   MIX




EXTEND INVITATION TO ELIGIBLE RESPONDENT AND RECORD INFORMATION ON FRONT.  We'd like to invite you to participate in this research project.

You will receive an honorarium of $75 for your participation

Note to recruiters: As part of our ISO certification, we require that the following be read to each respondent.

Thank you for your time.  We look forward to having a discussion with you regarding the U.S. Mint.  We want to assure you that it is NAXION’s policy to keep interviews anonymous and responses secured.  The information you provide during the interview will be reported in aggregate and at no stage will your name or other identifying information be associated with your responses.

The interview may be recorded or viewed by others.

For further information on NAXION’s privacy policy, you can visit their website at http://www.naxionthinking.com/privacy-policy/information-privacy-policy

Please let us know if you have any questions or concerns about your upcoming appointment with NAXION.