Form NHTSA Form 1433 NHTSA Form 1433 CIOT Recruitment Screener

OMB Control Number: 2127-0682

Expiration Date: 04/30/2018

OMB Control No: 2127-0682:

Focus Groups for Assessment of Creative Concepts Supporting a

National Communications Campaign to Increase Seat Belt Use

Focus Group Recruiting Screener

NOTE TO RECRUITER: Recruit from only zip codes/communities that are not central-business-district centers or suburban areas in close proximity to the central-business-district centers. Rather, recruit from areas/communities/ counties that are more “rural” than suburban in their characteristics.

NOTE TO RECRUITER: Ask to speak to any male age 18 to 34 (note: sex and age range are critical). If none available, terminate.

Hello, I'm __________________ calling for (name of focus group company). In (metro name), a research project is being planned. It will consist of focus group discussions about advertising ideas. It is not being done for selling purposes, rather it is true research to gather information and opinions. Once it begins, the focus group will be approximately an hour and fifteen minutes, and for your time and participation, you would be paid $75.

(NOTE TO RECRUITER: Gauge interest; continue if positive. If he requests clarification about focus groups, briefly explain.)

This research requires that participants have particular characteristics. So to see if you match those characteristics, I need to ask you a few questions.

(NOTE TO RECRUITER: Continue if OK)

First, I need to read this statement. This collection of information is voluntary and will be used to recruit individuals to participate in a focus group meeting. Public reporting burden for this survey is estimated to average six 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. We will not collect any personal information that would allow anyone to identify you. Please note that 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 currently valid OMB control number. The OMB control number for this collection is number 2127-0682.

So let’s begin.

1. Do you, or does anyone in your immediate family, work in any of the following industries or professions?

(NOTE TO RECRUITER: terminate if “yes” to any)

____ Marketing, advertising, public relations or marketing research

____ Graphic design

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

____ Professional and/or commercial drivers, including ride-sharing services

such as Uber and Lyft

____ Law enforcement

____ Legal

____ Vehicle or automobile insurance

____ Local, state or federal government (NOTE TO RECRUITER: an exception

to this would be people who are school teachers and/or school support

staff. These individuals would be acceptable.)

2. Are you a licensed driver?

____ Yes ____ No (NOTE TO RECRUITER: terminate)

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

____ 18-25 (NOTE TO RECRUITER: quota per group: at least 5, but no more

than 7)

____ 26-34 (NOTE TO RECRUITER: quota per group: at least 5, but no more

than 7)

____ “Neither,” other or refused (NOTE TO RECRUITER: terminate)

4. During a typical week, about how many days do you drive at least 10 miles per day? (NOTE TO RECRUITER: OK to read list):

____ About once a week or less (NOTE TO RECRUITER: terminate)

____ 2 or more times per week

5. Which of the following types of vehicles do you drive most often for personal, non-business travel? (NOTE TO RECRUITER: Read list; accept only the one driven most often):

____ Automobile

____ Mini-van

____ Full-size van

____ Sport utility vehicle

____ Pick-up truck

____ None of these (NOTE TO RECRUITER: terminate)

(NOTE TO RECRUITER: “none of these” includes motorcycles)

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; and his ability to speak clearly in a way that is easily understood.

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

____ Articulate

____ Not articulate (NOTE TO RECRUITER: terminate)

7. The next question is about seat belts. Tell me if in any of the situations I’ll describe, you sometimes don’t wear a seat belt while driving. (NOTE TO RECRUITER: Read list; a “yes” answer to at least three of these qualifies the respondent. If “no” to three or more, terminate):

____ Just a short trip to a store or nearby place

____ When wearing nice clothes that might get wrinkled by a seatbelt

____ When on a road with little or no traffic

____ Sometimes when you just forget to buckle up

____ When driving on roads at low speeds

____ When driving on a road that you’re very familiar with

8. Are you of Hispanic or Latino descent?

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

group)

____ No

____ Refused (NOTE TO RECRUITER: terminate)

9. 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

____ Refused (NOTE TO RECRUITER: terminate)

Based on your responses, we would like to invite you to participate in a focus group research study about advertising campaign ideas. The group discussion will be about an hour-and-fifteen-minutes in length, and 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).

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

NHTSA Form 1433 4