NHTSA Form 1404 Motorcycle Recruitment Screener

OMB Control No. 2127-0682

Expiration Date 04/31/2018

Motorcycle Focus Groups Recruitment Screener

Thank you for agreeing to participate in this research study. Your participation in this step should take about 5 minutes. This study is being conducted on behalf of the National Highway Traffic Safety Administration (NHTSA). Please note that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a current valid OMB control number. The OMB control number for this study is 2127-0682. Your participation is voluntary. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, National Highway Traffic Safety Administration, 1200 New Jersey Ave, S.E., Washington, DC, 20590

Date: ________

Thank you for calling to learn about the focus group. First, I will explain what the focus group topic is about, and then I will try to answer any questions that you may have. If you are still interested in participating, I will ask you some very basic questions, like what type of motorcycle you ride, your riding experience, and a few other things, to see which focus group is a good fit for you.

Westat is conducting the focus groups for the Department of Transportation (DOT). The purpose of this study is to get opinions from motorcycle riders on a variety of things, including their opinions of riding gear and riding apparel.

The focus group session takes about 90 minutes. If you do participate, you will receive $75 for your time.

Are you interested in participating? (If yes, complete the form below). Next, I’ll ask you a few basic questions to help identify the focus group that best fits. You don’t have to answer any question that you don’t want to.

1. How did you hear about this study? ______________________________________________

2. Are you… a) under 18 b) 18-30 c) 31 or 55 or d) 56 and older

(If under 18, end the screener and tell them that the study can only take riders 18 years or older, and thank them for their time)

3. Do you ever ride on a motorcycle or a scooter?

1. Motorcycle (Go to question 4)

2. Scooter (Go to question 4)

3. No (If no, end screener and thank them for their time)

4. How many years have you been riding? _______________________

5a. What is the make, model and year of the _________ (fill in motorcycle or scooter depending on response to question 3) that you usually ride?

Make: ______________________ Model: _______________________ Year: _________

5b. Do you own this _________ (fill in motorcycle or scooter depending on response to question 3) that you usually ride?

a) Yes

b) No

6. How many days per week do you ride? Would you say…

1. 1-2 days per week,

2. 3-4 days per week, or

3. 5 or more days per week

7. Generally, what is the purpose of the ride? Would you say…

1. Daily commute

2. Recreation

3. Other (specify) ______________________

8. About how many miles do you travel on your _________ (fill in motorcycle or scooter depending on response to question 3) in a normal week? Would you say…

1. under 20 miles

2. 20-49 miles

3. 50-99 miles

4. 100-149 miles

5. 150 miles or more

9. Do you ever ride as a passenger

1. Yes

2. No (If no, skip to Question 11)

10. How often do you ride as a passenger?

1. All the time, I only ride as a passenger

2. On occasion

3. Never

4. Other _________________ (please specify)

11. Do you have a motorcycle endorsement (license)?

a) Yew

b) No

12. What is your first name? __________________________

(first only is OK, but take last name if offered)

13. Can you tell me two phone numbers where we can easily contact you?

14. If you like, you can also provide an email address where we can contact you.

___________________________________

15. From observation, enter sex of respondent. If unsure guess:

a. Male OR b. Female

END

NHTSA Form 1404