Form NHTSA Form 1406 NHTSA Form 1406 Drugged Driver Recruitment Sceener

OMB Control No. 2127-0682

Expiration Date 04/30/2018

Recruitment Screener for Focus Groups

OMB Control No: 2127-0682: Focus Groups for Assessment of

Creative Concepts Supporting a National Awareness Campaign to

Reduce Drug-Impaired Driving

NOTE TO RECRUITER: Ask to speak to any person in the household between

the ages of 18 and 34.

Hello, this is __________________, from (NAME OF FOCUS GROUP COMPANY), calling on behalf of the U.S. Department of Transportation. We are conducting a study of drivers’ opinions about advertising ideas. I would like to ask you a few questions to determine if you are eligible for the study which will be in the form of a focus group. (NOTE TO RECRUITER: If necessary, read:)

This collection of information is voluntary and will be used for formative purposes only so that we may develop communications programs designed to reduce the number of traffic-related injuries and deaths. A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2127-0682. Public reporting for this collection of information is estimated to be approximately six minutes per response, including the time for reviewing instructions, completing and reviewing the collection of information. All responses to this collection of information are 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

All of your answers will be confidential. Could we begin now?

1. Are you a licensed driver?

( ) Yes

( ) No (TERMINATE)

2. Do you, or does anyone living in your household, work in any of the following industries or professions? (TERMINATE if “yes” to any)

( ) Marketing, advertising, public relations or marketing research

( ) Graphic design

( ) News media, including newspaper, television, radio or publishing

( ) Law enforcement

( ) Legal

( ) Local, state or federal government

( ) Manufacturing, distribution or sales of pharmaceutical medications

3. (NOTE TO RECRUITER: Based on person’s name and/or voice, determine and record gender; in this case, no need to ask. However, if uncertain, ask):

Are you…

( ) Female (NOTE TO RECRUITER: Recruit 7 or 8 per group)

( ) Male (NOTE TO RECRUITER: Recruit 7 or 8 per group)

( ) Refused (TERMINATE)

(NOTE TO RECRUITER: At this stage, disclose the following information, then ask question 4)

Again, I remind you that all your answers are confidential. Likewise, the focus group discussion and people’s participation will also be confidential. For these focus groups, the research sponsor wants to hear the opinions and comments from people who have used any of several drugs recreationally at least once within the past three months. This research is not for law enforcement efforts, nor will law enforcement be involved in the research. Rather, the research is solely to gather opinions. So let me ask…

4. Please let me know which of these drugs (if any) you have used recreationally at least once within the past three months:

( ) Marijuana

( ) Cocaine

( ) Heroin

( ) Opioids

( ) Not used any of these (TERMINATE)

( ) Refused or not sure (TERMINATE)

(NOTE TO RECRUITER: question 5 is an articulation question. What the respondent says is not important; rather, judge her/his ability and willingness to comment with a specific point-of-view and ideally with more than just a few words.)

5. In your opinion, what would be the best way to minimize traffic congestion on highways in the (name of city) area?

( ) Articulate

( ) Not articulate (TERMINATE)

6. Are you of Hispanic or Latino descent?

( ) Yes (NOTE TO RECRUITER: Quota: at least 1, but no more than 3 per group)

( ) No

7. Which one or more of these best describes your race? (NOTE TO RECRUITER: Read list. OK to accept multiple responses.)

( ) American Indian or Alaska Native

( ) Asian

( ) Black or African American (NOTE TO RECRUITER: Quota: 2, 3 or 4 per group)

( ) Native Hawaiian or Other Pacific Islander

( ) White

Based on your responses, we would like to invite you to participate in a focus group research study about advertising ideas. The group discussion will be about an hour-and-a-half in length, and that time includes your early arrival time approximately fifteen minutes before the group discussion begins. For your participation, you will receive $75 cash. As many as eight others will participate. The meeting will be on (SCHEDULED DATE) at (SCHEDULED START TIME) p.m. It will be at our focus group research facility at (FOCUS GROUP FACILITY ADDRESS/LOCATIONAL INFORMATION).

(Exchange additional appropriate details if respondent is willing to participate)

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NHTSA Form 1406