Form 1 Recruitment Screening Interview

Attach. 15 Recruitment Screening Script OMB #: 0925-0661

Executive Function Expiration Date: 06/30/2015

Recruitment Screening Script

Delve Marketing Research

A. Select city you are calling from the following list:

1. Minneapolis

2. Philadelphia

3. Phoenix

B. RECRUITER: IF YOU KNOW YOU ARE CALLING A SPANISH-SPEAKING HOUSEHOLD, CHOOSE THE sPANISH sURVEY HERE. OTHERWISE, PROCEED WITH ENGLISH AND CHANGE TO SPANISH AT QA.

1. English - goes to English survey

2. Spanish - goes to Spanish survey

Hello this is _________________ from Delve Market Research. May I speak with someone in the household 18 or older?

[RECRUITER: IF NEED TO WAIT FOR ADULT 18 AND OLDER, BEGIN INTRO AGAIN WITH NEW PERSON ON PHONE.]

We are looking for participants to take part in a research study related to child development. If you qualify, you will be asked to come to our office to complete a series of tests. You will be compensated for your time.

A. We can conduct this interview in English or Spanish. Which language do you prefer?

English……………………………………	1	CONTINUE IN ENGLISH
Spanish…………...………..….….…..…..	2	CONTINUE IN SPANISH
REFUSED ……………………………….	8	THANK, TERMINATE

[If Spanish language ability is confirmed, continue in Spanish. Otherwise SKIP TO the English script.]

To see if you qualify, there are a few questions I would like to ask you.

1. Are you over the age of 18? [RECRUITER: RESPONDENT MUST BE 18 OR OLDER TO CONTINUE.]

1 Yes – Continue

2 No – THANK AND TERMINATE

[RECRUITER: BEFORE TERMINATING, ASK TO SPEAK WITH AN ADULT IN HOME 18 YEARS OR OLDER; IF NONE, TERMINATE. IF YES, ASK TO SPEAK TO THAT PERSON AND CONTINUE.]

[RECRUITER: ANSWER THE FOLLOWING WITHOUT ASKING THE PERSON ON THE PHONE…

Is the person on the phone 18 years or older and the same individual you have been speaking to? If yes, select Yes and continue. If you have a new person 18 or older on the phone, please repeat the introduction by selecting NO.

1 Yes – SKIP TO Q2 BELOW

2 No – CONTINUE WITH INTRO IMMEDIATELY BELOW

[PN: REPEATING PREVIOUS SECTION WITH NEW PERSON ON PHONE.]

Hello this is _________________ from Delve Market Research.

We are looking for families with a child to take part in a research study related to child development. If you qualify, you will be asked to come to our office to complete a series of tests. You will be compensated for your time.

A.2. We can conduct this interview in English or Spanish. Which language do you prefer?

English……………………………………	1	CONTINUE IN ENGLISH
Spanish…………...………..….….…..…..	2	CONTINUE IN SPANISH
REFUSED ……………………………….	8	THANK, TERMINATE

[If Spanish language ability is confirmed, continue in Spanish. Otherwise SKIP TO the English script.]

To see if you qualify, there are a few questions I would like to ask you.

1. Are you over the age of 18? [RECRUITER: RESPONDENT MAY BE 18 OR OLDER TO CONTINUE.]

1 Yes – Continue

2 No – THANK AND TERMINATE

[RECRUITER: IF YOU STILL AREN’T SPEAKING TO SOMEONE 18 OR OLDER, TERMINATE.]

2. Record Gender by observation.

1 MALE

2 FEMALE

3. Are you Hispanic, or Latino/a, or Spanish origin? (One or more categories may be selected)

0. NO, NOT OF HISPANIC, LATINO/A, OR SPANISH ORIGIN

1. YES, MEXICAN, MEXICAN AMERICAN, CHICANO/A

2. YES, PUERTO RICAN

3. YES, CUBAN

4. YES, ANOTHER HISPANIC, LATINO/A OR SPANISH ORIGIN

4. How frequently do you speak Spanish in your day-to-day life?

4	Never
3	Rarely
2	Often
1	Every day

5. If you are asked to participate, we can test you in either English or Spanish. What language do you prefer? [READ LIST]

1 English – goes toward English quota

0. Spanish – goes toward Spanish quota

6. What is your age? [READ LIST]

1. Under 18 – [Ask to speak to someone over 18; if none, thank and terminate]

2 18-29 years

3 30-39 years

4 40-49 years

5 50–59 years

6 60–69 years

9 70+ THANK AND TERMINATE

98 Refused – THANK AND TERMINATE

99 Don’t Know – THANK AND TERMINATE

[PN: AGE QuotaS – SEE QUOTA SHEET]

7. What is the highest level or grade you completed in school?

1. Less than High School

2. High School

3. More than High School

8. What is your race? [READ LIST; MULTIPLE RESPONSE]

[RECRUITERS: IF RESPONDENT IS HAVING DIFFICULTY SELECTING A RACE, EXPLAIN: HISPANIC IS CONSIDERED AN ETHNICITY SO PLEASE SELECT ONE OR MORE RACES FROM THIS LIST THAT YOU IDENTIFY WITH. IF RESPONDENT CONTINUES TO HAVE TROUBLE, MARK AS OTHER.]

1 White

2 Black or African American

3 American Indian or Alaska Native

4 Asian Indian

5 Chines

6 Filipino

7 Japanese

8 Korean

9 Vietnamese

10 Other Asian

11 Native Hawaiian

12 Guamanian or Chamorro

13 Samoan

14 Other Pacific Islander

15 Refused – DO NOT READ

16 Other – DO NOT READ

9. Are you the parent or custodial grandparent to any children who are 2½ to 5½ years of age?

1. One or more - CONTINUE to CQ 1

2. Zero – TERMINATE

[PN: REPEAT QUESTIONS BELOW FOR EACH child AGE 2½ TO 5½: name, age, gender, preferred language, education level OF PARENT & race.]

I need to ask a few questions about your child/children. Please think of one child at a time as we go through the list of questions. We will repeat the questions for each child age 2½ to 5½ years of age.

CQ1. What is the name of your child age 2½ to 5½ years old?

CQ2. What is [INSERT NAME FROM CQ1]’s gender?

1 MALE

2 FEMALE

[PN: Gender Quota 50% Male/50% Female – SEE QUOTA SHEET]

CQ3. Is [INSERT NAME FROM CQ1] of Hispanic, or Latino/a, or Spanish origin?

0 NO, NOT OF HISPANIC, LATINO/A, OR SPANISH ORIGIN

1 YES, MEXICAN, MEXICAN AMERICAN, OR CHICANO/A

2 YES, PUERTO RICAN

3 YES, CUBAN

4 YES, ANOTHER HISPANIC, LATINO/A, OR SPANISH ORIGIN

CQ4. How frequently does [INSERT NAME FROM CQ1] speak Spanish in his/her day-to-day life?

4	Never – GOES TO ENGLISH QUOTA
3	Rarely – GOES TO ENGLISH QUOTA
2	Often
1	Every day

[PN: SPANISH-SPEAKING Quota – SEE QUOTA SHEET]

[PN: IF HISPANIC (^1, 2, 3 or 4 AT CQ3) AND SELECTS OFTEN OR EVERY DAY (^1 OR ^2 AT CQ4)–GO TO CQ5.]

[PN: IF HISPANIC OR NON HISPANIC AND SELECTS RARELY OR NEVER (^3 OR ^4 AT CQ4) GOES TOWARD ENGLISH QUOTA - SKIP TO Q6.]

[PN: IF NON HISPANIC (^0 AT CQ3) AND SELECTS OFTEN OR EVERY DAY (^1 OR ^2 AT Q4), ASK CQ5]

CQ5. If [INSERT NAME FROM CQ1] were asked to participate, we can test in either English or Spanish. What language do you think [INSERT NAME FROM CQ1] would prefer? [READ LIST]

1. English – goes toward English quota

2. Spanish – goes toward Spanish quota

[PN: SPANISH-SPEAKING Quota – SEE QUOTA SHEET]

CQ6. What is [INSERT NAME FROM CQ1]’s age? [READ LIST]

[Children under 2½ YEARS & over 5½ YEARS do not qualify.]

1 Under 30 months- TERMINATE

2 30 months – 35 months (2 ½ - under 3 years)

3 36 months – 41 months (3 - 3 ½ years)

4 42 months – 47 months (3 ½ - under 4 years)

5 48 months – 53 months (4 - 4 ½ years)

6 54 months – 59 months (4 ½ - under 5 years)

7 60 months – 66 months (5 - 5 ½ years)

8 Over 67 months (5 ½ years)TERMINATE

98 Refused – NOT ELIGIBLE TO PARTICIPATE

99 Don’t Know – NOT ELIGIBLE TO PARTICIPATE

[PN: AGE QuotaS – SEE QUOTA SHEET]

CQ7. Can your child speak English?

0. NO

1 YES - goes toward English quota

CQ8. What is [INSERT NAME FROM CQ1]’s race? [READ LIST; MULTIPLE RESPONSE]

[RECRUITERS: IF RESPONDENT IS HAVING DIFFICULTY SELECTING A RACE, EXPLAIN: HISPANIC IS CONSIDERED AN ETHNICITY SO PLEASE SELECT ONE OR MORE RACES FROM THIS LIST THAT YOU IDENTIFY WITH. IF RESPONDENT CONTINUES TO HAVE TROUBLE, MARK AS OTHER.]

1 American Indian or Alaska Native

2 Asian

3 Black or African-American

4 Native Hawaiian or Other Pacific Islander

5 White

8 Refused – DO NOT READ

9 Other – DO NOT READ

CQ9. Do you have another child in your household who is between the ages of 2½ to 5½ ears old?

0 NO – GO TO INVITATION

1 YES – REPEAT CQ SERIES FOR EACH CHILD AGE 2½ to 5½

[PN: PROGRAM EVALUATES QUOTAS AND DETERMINES WHICH MEMBER(S) OF THE HOUSEHOLD ARE INVITED TO PARTICIPATE.]

[PN: DISPLAY APPROPRIATE INVITATION FOR PERSON CHOSEN TO PARTICIPATE.

Invitation (Child ages 2½ to 5½):

We would like to invite you and your child to take part in our research study. To participate, you and your child would come to our facility located at [insert agency address]. The testing session would last for about one hour; the questionnaires we ask you to fill out should take about 45 minutes to complete, while the testing of your child will take about 60 minutes. Some families will be randomly chosen to come back for a second, shorter, session one or two weeks later, which would last 30 minutes. In the second session, the parent questionnaires will take 10-15 minutes, while the testing of your child will take approximately 30 minutes.

During that time, your child will answer questions, and we will also ask your child to do several other activities, including puzzles and games on a computer that measure thinking and learning skills. Not everyone will take all of the tests. You will be able to stay with your child at all times. We will also ask you to complete some questionnaires about your family and your child’s behavior.

If you or your child need glasses for reading, please be sure to bring those with you to our agency. We will ask that your cell phone be turned off during our testing to avoid interruptions.

Only bring the child participating in the study. We will not be able to accommodate additional children.

Please make sure your child wears comfortable clothes and brings (or wears)

• glasses for distance and close-up vision if your child uses them in everyday life;

• hearing aid if your child uses it

You would be paid $____ for your time.

Does this sound like something you would be interested in?

[ ] Yes  CONTINUE WITH SCHEDULING

[ ] No / Not available  THANK & TERMINATE

APPOINTMENT SCHEDULING

Great! Let’s go ahead and get your appointment scheduled. Right now, we’re looking at the next 2 weeks. We have the following days and times available:

[PN: INSERT DATES AND TIMES AVAILABLE FOR CITY AND ADULT VS CHILD INTERVIEW LENGTH.]

Thank you! Please arrive 30 minutes early to allow time to check in. We will be sending you directions to our facility.

Since you will be participating in the study, it is very important that we have the correct spelling of your name and address: [BE SURE TO REPEAT EVERYTHING TO RESPONDENT – SPELLING OF NAMES AND STREETS, PHONE NUMBERS, AND EMAIL ADDRESSES – WE MUST HAVE THE CORRECT INFORMATION.]

ADULT NAME:_______________ _____________________________

CHILD #1 NAME: ______________ _____________________________

CHILD #2 NAME: ______________ _____________________________

ADDRESS: ___________________________ _____________________

CITY: ________________ ____STATE: _____________ ZIP: ________

E-mail ADDRESS: _________ ________________

HOME PHONE: _____________________CELL PHONE:____ ____________

APPT. DATE: ______________________APPT. TIME: ____________

From time to time, unexpected events take place forcing us to change plans. If you find that you can no longer participate or you need to reschedule, please notify us immediately at the following number__________ [insert agency number].

Thank you again for agreeing to participate! We appreciate your help with this study.

Public reporting burden for this collection of information is estimated to average 10 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: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0661). Do not return the completed form to this address. 1