Form NHTSA Form 1413 NHTSA Form 1413 Drunk Driver Concepts Screener

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 Alcohol-Impaired-Driving

NOTE TO RECRUITER: Ask to speak to any male age 21 to 34 (note: sex and age range are critical). If none available, terminate.

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?

Do you, or does anyone in your immediate family, work in any of the following industries or professions? (NOTE TO RECRUITER: Read list. Terminate if “yes”

to any)

____ Marketing, advertising, public relations or marketing research

____ Graphic design

____ News media, including newspaper, television, radio or publishing

____ Alcohol, beer, wine and spirits

____ Law enforcement

____ Legal

____ Local, state or federal government

Are you a licensed driver?

____ Yes ____ No (terminate)

In which of these age groups is your age? (NOTE TO RECRUITER: Read list of the

two age groups)

NOTE TO RECRUITER IN EACH CITY WHERE

FOCUS GROUPS ARE HOSTED:

Recruit for a total of two groups. One group will be composed of

men ages 21-25; the other group will be men ages 26-34.

____ 21-25

____ 26-34

____ “Neither,” other or refused (terminate)

During a typical week, do you drive at least 10 miles per day on average?

____ Yes

____ No (terminate)

____ Not sure (terminate)

NOTE TO RECRUITER: The next question is an articulation question. What the respondent says is not important; rather, judge his ability and willingness to comment with a specific point-of-view.

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

____ Articulate

____ Not articulate (terminate)

For this focus group project, the research sponsor is especially interested in hearing opinions about advertising from people who drink alcohol on a fairly-regular basis. If you consume alcohol, about how frequently do you drink? (NOTE TO RECRUITER: read list)

____ Less than once a week (terminate)

____ About once a week (terminate)

____ 2-4 times per week

____ 5 or more times per week

____ Don’t consume alcohol; or refused to answer (terminate)

During most occasions when you consume alcohol, about how many servings do you drink? (NOTE TO RECRUITER: read list)

____ 1 or 2 (terminate)

____ 3 or 4

____ 5 or more

____ Refused (terminate)

I’m going to read a series of statements. Please tell me on a scale of 1 to 5 -- where 1 means “that’s just like me” and 5 means “that’s not like me at all,” – how you would rate yourself for each statement. (NOTE TO RECRUITER: Read each statement. OK to repeat and/or clarify rating instructions)

1 2 3 4 5 Even after you’ve had a few drinks when away from

home, in most cases you feel like you’re able to drive

home OK.

1 2 3 4 5 You consider yourself more of a risk-taker compared

to most people.

1 2 3 4 5 After you’ve been drinking away from home, only

when it’s absolutely necessary will you use a

designated driver, taxi, ride-share or other

alternative form of transportation.

1 2 3 4 5 In your opinion or from what you’ve heard, police

tend to over-enforce DUI in our area.

1 2 3 4 5 For many occasions when you drink, it’s hard to have

a good time unless you get a bit buzzed.

1 2 3 4 5 At least one-fourth of the times you drink, you’re at a

location other than home.

(NOTE TO RECRUITER: Accept if person rates himself “1” or ”2” for at least two of the statements; if not at least two, terminate.)

Are you of Hispanic or Latino descent?

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

group)

____ No

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: at least 2, but

no more than 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)

NHTSA Form 1413 4