Homebuyer Survey

Form Approved

OMB No. 0920-xxxx

Exp. Date xx/xx/xxxx

Homebuyer Survey

CDC ID Number: _____________

(CDC use only)

Public reporting burden of this collection of information is estimated to average 8 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-XXXX).

Dear recent homebuyer,

Researchers from auto-populate state and county health department names here via mail merge, the Centers for Disease Control and Prevention (CDC), the Environmental Protection Agency (EPA), Department of Housing and Urban Development (HUD), , and SciMetrika are sending out a survey to people who have recently purchased single-family homes. The study will allow us to learn more about the understanding and practices of recent homebuyers in relation to radon and lead, substances found in some homes that can be harmful to your health. As someone identified through tax records as having purchased a home in the last 12 months, we would like to get your input about your experiences in regard to these substances and the laws that involve them during your recent home buying process. We are distributing this survey to 3,000 recent single-family homebuyers in four states. Please note the following:

1. Please note that we are asking the homebuyer to fill out this survey. If you are renting this home please send this to the person who recently purchased this home.

2. You can take this survey online at (SURVEY MONKEY LINK HERE) instead of filling out the paper form below.

3. Please circle or check the appropriate boxes as indicated below

*PROTECTION OF PRIVACY INFORMATION

Public Law 93-579 entitled the Privacy Act of 1974 requires that individuals asked to furnish information such as that requested in this form be informed of the purpose for collecting such information and what the information will generally be used for. The following information is accordingly provided:

Authority: The Centers for Disease Control and Prevention, and agency of the Department of Health and Human Services, is authorized to solicit the information requested in this form under the authority of the Public Health Service Act, Section 301,361 (42 U.S.C. 241,264).

Purpose and Uses: The information requested will be used to better understand the knowledge, attitudes, and practices of recent homebuyers and real estate agents in regard to radon and lead in single-family homes.

Effects of Non-Disclosures: Your disclosure of the requested information is voluntary, and no penalty will be imposed if you choose not to respond. However, if you do not fill out the questionnaire, it will be more difficult for us to determine what people understand about radon and lead in the home environment.

DEPARTMENT OF HEALTH AND HUMAN SERVICES

PUBLIC HEALTH SERVICE

CENTERS FOR DISEASE CONTROL AND PREVENTION

ATLANTA, GEORGIA 30333

PLEASE MAKE SURE THAT THE PERSON WHO PURCHASED THIS HOME IS THE ONE WHO COMPLETES THIS SURVEY

CDC ID Number: _____________ (CDC use only)
The following section asks questions about this home that was bought in the last 12 months
State, county, and zip code the home was purchased in:	State ____ County___________ Zip code_______________
Month/year this home was bought	_________________
Year this home was built	_________________
Were you the first owner of this home? (i.e., Was it newly built?)	□ Yes □ No
Did the sale of this home involve special paperwork related to a homeowners association?	□ Yes □ No
The following section asks questions about radon
Have you heard about health issues related to radon?	□ Yes □ No
If yes, you have heard about radon as a health issue, please place a check next to all the sources of your information	(Check ALL boxes that apply) Television or web advertisement Brochure Family member, friend, neighbor, or coworker Real estate agent Home inspector Contractor who works on home repair or remodeling Professional radon testing company Other (write-in)____________________________
Did your understanding of the health issues related to radon affect your decisions at any point during the home buying process? (For example, did you consider radon issues when looking for and deciding on which home to buy?)	(Check ONE box that most applies to you) Yes, part of my reason in choosing this house was that it had been tested for radon and it was below the action level. Yes, I wanted to know the radon level but was not sure what to do about it. No, I know about radon but do not believe it is a health concern. No, I was not familiar with the health issues related to radon and did not consider it during the home buying process.
Please tell us more about how it affected your decision…	_____________________________________________ _____________________________________________
Did any real estate agent discuss radon with you during the homebuying experience that led to the purchase of this home?	□ Yes □ No □ Not sure
Did you or the sellers have to sign any paperwork during the negotiation or closing to indicate specifically whether the home was tested for radon?	□ Yes □ No □ Not sure
Did you receive any brochures about radon during the home inspection or closing?	□ Yes □ No □ Not sure
Has the home you bought been tested for radon since you became interested in purchasing this home?	□ Yes □ No □ Not sure
If yes, who was the first to recommend testing for radon?	(Check ONE box) The sellers tested before I/we became interested Myself, a family member, or friend A home inspector A radon professional other than a home inspector Other (write-in) ________________________
If it was elevated (> 4 pCi/L) was it fixed?	□ Yes □ No □ Not sure □ Not Applicable
If yes, who fixed it? (Check one)	(Check ONE box) Seller Myself, a family member, or friend A home inspector A radon professional who was not a home inspector for the home you bought Other (write-in) ________________________
Do you know if there are people who test for and fix radon issues in your area?	□ Yes □ No □ Not sure
Radon professionals can be certified by an exam to test for and fix radon issues but it depends on state law. If yes, there are people who test and fix radon issues in your area, do you know if they are certified by the state or a national organization?	□ Yes □ No □ Not sure □ Not Applicable
Assume you needed someone to test for or fix a radon problem in the home you bought. Please rank the factors that you would consider in choosing them with 1 being the most important criteria and 4 being the least important.	Rank with 1 = Most Important to 4 = Least Important ___ Distance from this home ___ Referred from a source or person I trust ___ Certified by a state or national organization ___ Prior experience fixing radon problems

The following section asks questions about lead-based paint
Have you heard about health issues related to lead-based paint?	□ Yes □ No
If yes, please place a check next to all the sources of your information.	(Check ALL boxes that apply to you) Television or web advertisement Brochure Family member, friend, neighbor, or coworker Real estate agent Home inspector Contractor who works on home repair or remodeling Professional lead testing company Other (write-in)____________________________
Did your understanding of the health issues related to lead-based paint affect your decisions at any point during the home buying process? (For example, did you consider lead-based paint issues when looking for and deciding on which home to buy?)	(Check ONE box that most applies to you) Yes, I did not want to buy a home that had lead-based paint Yes, I wanted a home that had paint that was in good repair to decrease my risk of lead exposure Yes, I bought a house that was built after 1978 because that is when lead-based paint was discontinued No, I know about lead-based paint but do not think it is a health concern No, I was not familiar with the health issues related to lead-based paint
Please tell us more about how it affected your decision…	_____________________________________________ _____________________________________________
Did any real estate agent discuss lead-based paint with you during the home buying experience that led to the purchase of this home?	□ Yes □ No □ Not sure
Has the home you bought been tested for lead-based paint?	□ Yes □ No □ Not sure
a. If yes, who was the first to recommend testing for lead-based paint?	(Check ONE box) The sellers tested before I/we became interested Myself, a family member, or friend A home inspector A lead-based paint professional other than a home inspector Other (write-in) ________________________
Did you or the sellers have to sign any paperwork during the closing to indicate specifically whether lead-based paint was present?	□ Yes □ No □ Not sure
Did you receive any brochures about lead-based paint during the negotiation or closing?	□ Yes □ No □ Not sure
Are contractors who work on lead-based paint available in your area?	□ Yes □ No □ Not sure
Contractors should be certified to work on homes that have lead-based paint. If yes, contractors who work on lead-based paint are available, do you know if they are certified by the state or a national organization?	□ Yes □ No □ Not sure
Assume you needed a contractor to fix a lead-based paint problem in the home you just bought. Please rank the factors that you would consider in choosing them with 1 being the most important criteria and 4 being the least important.	Rank with 1 = Most Important to 4 = Least Important ___ Distance from this home ___ Referred from a source or person I trust ___ Certified by a state or national organization ___ Prior experience in fixing lead problems
The following section asks questions about the homebuyer If the home was purchased jointly, please select the homebuyer with the most experience in this process to answer the following questions
Age (in years) of person (at the time of purchase) who bought this home	_________________
How many total homes have YOU bought in your lifetime? (including this one)	_________________
Please select the group that represents your ethnicity	(Check ONE box) Hispanic or Latino Not Hispanic or Latino Prefer not answer

Please describe your race	(Check ALL THAT APPLY) White Black or African American Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native Prefer not answer
What is the highest grade or year of school you completed?	(Check ONE box that most applies to you) Never attended school or only attended kindergarten Grades 1 through 8 (Elementary) Grades 9 through 11 (Some high school) Grade 12 or GED (High school graduate) College 1 year to 3 years (Some college or technical school) College 4 years or more (College graduate) Prefer not answer

If you have not received your pre-paid credit card within a month of submitting this survey please email (study email address here) or call us (phone number here).