C1a_EDECH final FG screener 2015.3.13

OMB Control No: 0584-XXXX

Expiration date: XX/XX/XXXX

Evaluation of Demonstration Projects to End Childhood Hunger (EDECH)

ATTACHMENT C.1.a. PARTICIPANT FOCUS GROUP TELEPHONE SCREENER (ENGLISH)

EVALUATION OF DEMONSTRATIONS TO END CHILDHOOD HUNGER (EDECH)

FOCUS GROUP TELEPHONE SCREENER

RECRUIT 14 PEOPLE TO SEAT 8-10

Public reporting burden is estimated to average 15 minutes per response. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Services, Office of Research and Analysis, 3101 Park Center Drive, Room 1014, Alexandria, VA 22302 ATTN: PRA (XXXX-XXXX).

ASK FOR PERSON NAMED ON RECRUITMENT LIST

Hello. My name is ____________________, and I'm calling from Mathematica Policy Research, a private research organization. We are conducting a study for the U.S. Department of Agriculture, Food and Nutrition Service on [RECOGNIZABLE NAME OF DEMONSTRATION PROJECT]. We are located in Washington, DC and are not from any agency that is directly involved with [RECOGNIZABLE NAME OF DEMONSTRATION PROJECT].

We were given your name by [NAME OF AGENCY ADMINISTERING THE STATE/ITO DEMONSTRATION PROJECT] specifically to conduct this research to help the government better understand how [RECOGNIZABLE NAME OF DEMONSTRATION PROJECT]. is working and needs to be improved for families like yours.

Let me assure you that this is not a sales call. We’re calling to see if you may be eligible to participate in a group discussion about [RECOGNIZABLE NAME OF DEMONSTRATION PROJECT] for our study. (IF NEEDED: At no time during our discussion will you be asked to donate money.)

If you are able to participate, the group discussion will take place at [PLACE] on a different day. If you attend the group discussion, you will be given a $50 gift card as a thank you gift and to offset your transportation and childcare costs. And, we will provide food and beverages during the group session.

Now, I need to ask a few questions to see if you are eligible for our discussion group. This will take only 2 to 3 minutes. The answers you give me will not be shared with anyone outside of our research team, except as required by law. Your answers to these questions will not affect any benefits you receive from the government.

May I continue?

¨ Yes SKIP TO “RECORD GENDER”

¨ No.............................................................................................THANK AND TERMINATE

Is there a better time to call you back to see whether you might be eligible to participate in the group discussion and to receive the $50 payment?

¨ Yes

¨ No...........................................................................................THANK AND TERMINATE

Great! What numbers can I reach you at and when is the best time to call?

HOME PHONE:

CELL PHONE:

WORK PHONE:

BEST TIMES TO CALL:

THANK AND TERMINATE.

RECORD GENDER:

¨ Female ¨ Male

1. QUESTION(S) TO DETERMINE WHETHER INDIVIDUAL ACTUALLY PARTICIPATED IN/ ENGAGED IN THE PROJECT AND/OR WHETHER THEY ARE THE PRIMARY CAREGIVER FOR A CHILD ENGAGED IN THE PROJECT: WE WILL USE THE QUESTIONS FROM THE REVISED HOUSEHOLD SURVEY.

2. How old are you? (READ CATEGORIES)

¨ 0-17 (THANK AND TERMINATE: Thank you for answering these questions.

Only people who are at least 18 years old are eligible to participate. Thank you for your time today. Goodbye)

¨ 18-29

¨ 30-44

¨ 45-59

¨ 60-75

¨ 75 or older

3. Can you please tell me the name of the town or city that you live in:

_____________________________________________________

4. What language are you most comfortable speaking?

• English (SKIP TO INVITATION)

• Spanish

• Other

5. How well would you say you understand and speak English? (READ CATEGORIES)

• Not at all

• Not well

• Well

• Very Well

INTERVIEWER: FOR SITES 1, 2, 3, OR 4, IF YOU DETERMINE THE RESPONDENT WOULD NOT BE A GOOD CANDIDATE FOR FOCUS GROUP BASED ON HIS/HER ABILITY AND WILLINGNESS TO COMMUNICATE IN ENGLISH AND OPENLY, THANK AND TERMINATE: Thank you for talking with me today. If we need you for the discussion group, we will call you back. I appreciate that you took the time to answer my questions. FOR SITE 5: CONTINUE TO INVITATION (EITHER TO THE GROUP CONDUCTED IN SPANISH OR THE GROUP CONDUCTED IN ENGLISH, ACCORDING TO RESPONDENT’S ABILITY AND WILLINGNESS TO COMMUNICATE IN ENGLISH).

INVITATION

Thank you for answering all of my questions. You are eligible to participate in the group discussion about [RECOGNIZABLE NAME OF DEMONSTRATION PROJECT]. The group will consist of approximately 10 other people and a discussion leader from Mathematica; nobody from the [AGENCIES ADMINISTERING AND OPERATING THE DEMONSTRATION PROJECT] will be there. The discussion will last 1 ½ to 2 hours and food and beverages will be served. Afterwards, any personal information we have about you will be destroyed. You will be given a $50 gift card as a token of our appreciation and to offset your transportation costs and any childcare you may need to participate. The discussion will take place at [TIME] on [DAY, DATE]. It will be held at the [PLACE at ADDRESS]. Is this location convenient for you and will you be able to attend?

¨ YES CONTINUE WITH “MORE INFORMATION” BELOW

¨ NO THANK AND TERMINATE

MORE INFORMATION

• So that we can start and end on time, please plan to arrive about 15 minutes early to meet the other participants and have [dinner/breakfast/refreshments].

• We are counting on your participation, so please be sure to call our office’s toll-free number as soon as possible if you find you can't attend so we can find a replacement. Can you write this number down? The toll-free number is XXX-XXX-XXXX.

• Only one parent or guardian from each family will be able to participate. If another adult comes with you they will not be able to join you in the room where the discussion is held. We will not be able to accommodate your children in the discussion group.

Before we finish, let me make sure I have the correct spelling of your name and also get your address and phone number(s) so that we can send you a confirmation letter with directions and give you a reminder phone call.

FIRST AND LAST NAME:

HOME PHONE:

ADDRESS:

PERSONAL E-MAIL ADDRESS:

WORK PHONE:

CELL PHONE:

Thank you very much for your time today. We look forward to meeting you at the discussion group and learning about your experiences with the [RECOGNIZABLE NAME OF DEMONSTRATION PROJECT]. We’ll see you there!

Recruiter’s name _______________________________ Date____________________

Confirmed by __________________________________ Date____________________

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-XXXX. The time required to complete this information collection is estimated to average 15 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.