Form NHTSA Form 1437 NHTSA Form 1437 CIOT Screener Spanish-Reliant

OMB Control Number: 2127-0682

Expiration Date: 04/30/2018

OMB Control No: 2127-0682:

Focus Groups for Assessment of Spanish-language Creative Concepts Supporting a

National Communications Campaign to Increase Seat Belt Use

Focus Group Recruiting Screener

PHONE SCREENING INTERVIEW GUIDE

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. What language do you speak most often in your home and with your friends?

( ) English (TERMINATE)

( ) Both English & Spanish, but more English (TERMINATE)

( ) Both English & Spanish equally (TERMINATE)

( ) Both Spanish & English, but more Spanish (CONTINUE)

( ) Spanish (CONTINUE)

( ) Other (TERMINATE)

2. Do you, or does anyone in your immediate family, work in any of the following industries or professions? (Read list - 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.)

3. How old are you? _______

( ) less than 18 (TERMINATE)

( )18 – 34 (CONTINUE)

( ) 35+ (TERMINATE)

( ) Refused (TERMINATE)

4. What country were you born in? (TERMINATE IF BORN IN USA)

[NOTE TO RECRUITER: Recruit a representative mix of the Hispanic national population (for example, for a group of 8 participants: 4-5 Mexican, 1-2 Puerto Rican/Cuban, 1-2 Central American (at least one Salvadorean) and 1-2 South American)]

4. (NOTE TO RECRUITER: If possible, judge respondent’s gender per name and/or voice; if this can be done, no need to ask. However, if not certain, ask…)

Are you male or female?

( ) Male (CONTINUE)

( ) Female (TERMINATE)

4. When you watch television, which channel do you watch to get news and information?

( ) Spanish channels like Univision and Telemundo

( ) Both Spanish and English channels (TERMINATE)

( ) English channels (TERMINATE)

4. About how many hours of Spanish language TV do you watch during a regular week?______ HOURS (If less than 8 hours a week, TERMINATE)

(NOTE TO RECRUITER: question 8 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 ideally with more than just a few words.)

4. 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)

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)

END OF SCREENER GUIDE

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NHTSA Form 1437