Form 17wl Attachment A - Respondent Screeners

Attachment A – Respondent Screeners

Form Approved

OMB No. 0923-0047

Exp. Date: 12/31/2018

CDC-002 – Business & Industry Professionals

February 20^th-27^th, 2017: 9am, 10:30am, 12:30pm, 2pm, 3:30pm

Schedule a total of 5 in-lab interviews over the course of these dates/times

February 27^th-March 3rd, 2017: 9am, 10:30am, 12:30pm, 2pm, 3:30pm Schedule a total of 4 remote interviews over the course of these dates/times

Name: ________________________________________

Street: ________________________________________

City: ________________________________________

State & Zip: ________________________________________

Home Phone: ( ) ______________ Work Phone: ( ) ______________

Fax Number: ( ) ______________ Cell Phone: ( ) ______________

E-mail address: ______________________________________

Hello. I’m ______________ calling from User Insight, Inc., a marketing research firm. This is not a sales call of any type. We are conducting a brief survey with Professionals and would like to include your opinion. It is possible that we may also invite you to participate in a study that would be held in our office or by phone. First of all… (Go straight to question 1)

CDC estimates the average public reporting burden for this collection of information as approximately 5 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. An agency may not conduct or sponsor, and a person is not required to respond to collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden statement or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ ATSDR Reports Clearance Officer, 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA (0923-0047).

General Information Questions

1. Record Gender. (Do not Ask)

Male

Female

Obtain Mix of Gender

2. We want to recruit users from a variety of age groups. Please tell me in
   which category does your age fall?

18-24 years (Terminate)

25-29 years

30-39 years

40-49 years

50-59 years

60 years or older (Terminate)

3. How would you describe your employment status?

Full-Time

Part-Time (Terminate)

Homemaker (Terminate)

Retired (Terminate)

Other (specify) ___________ (Terminate)

4. What is your occupation? ___________________________

5. What is your job title? _________________________

6. What company do you work for? _____________________

For Q4-6, recruit individuals that work for chemical companies, laboratory testing (i.e., mold, radon testing)

7. In what city and state are you located? _____________________

Obtain a mix of National regions for the Remote interviews.

8. Do you use the Internet?

□ Yes □ No (Terminate)

9. When you have a computer problem, which statement best describes what you would most likely do:

□ I know very little about computers, I would call Family / Friend / Support because I wouldn’t know where to start (Beginner)

□ I would attempt to fix the problem on my own, but would probably have to call Family / Friend / Support if it was very difficult (Intermediate)

□ I would fix the problem on my own, I generally know more than Family / Friends / Support (Advanced)

(Obtain a mix.)

Invitation for In-Labs:

Thank you! We would like to invite you to participate in a 60-minute usability research project in person at our User Experience Facility in Atlanta, GA. This study will be on ________. Please do not schedule any appointments or meetings within ½ hour of the end time of your scheduled appointment.

Recruit 5 Business & Industry Professionals for IN-LAB interviews during any of the following days/times

Monday, February 20, 2017

□ 9:00 AM

□ 10:30 AM

□ 12:30 PM

□ 2:00 PM

□ 3:30 PM

Tuesday, February 21^st, 2017

□ 9:00 AM

□ 10:30 AM

□ 12:30 PM

□ 2:00 PM

□ 3:30 PM

Wednesday, February 22^nd, 2017

□ 9:00 AM

□ 10:30 AM

□ 12:30 PM

□ 2:00 PM

□ 3:30 PM

Thursday, February 23^rd, 2017

□ 9:00 AM

□ 10:30 AM

□ 12:30 PM

□ 2:00 PM

Recruit 4 Business & Industry Professionals for REMOTE interviews during any of the following days/times

Monday, February 27th, 2017

□ 9:00 AM

□ 10:30 AM

□ 12:30 PM

□ 2:00 PM

□ 3:30 PM

Tuesday, February 28^TH , 2017

□ 9:00 AM

□ 10:30 AM

□ 12:30 PM

□ 2:00 PM

□ 3:30 PM

Wednesday, March 1^st, 2017

□ 9:00 AM

□ 10:30 AM

□ 12:30 PM

□ 2:00 PM

□ 3:30 PM

Thursday, March 2^nd, 2017

□ 9:00 AM

□ 10:30 AM

□ 12:30 PM

□ 2:00 PM

Invitation for Remote Interviews:

Thank you! We would like to invite you to participate in a 60-minute usability research project via phone and Internet. This study will be on ________. Please do not schedule any appointments or meetings within ½ hour of the end time of your scheduled appointment. For your time you will receive a gift up to $40 in value.

In Lab Interviews:

For participating in this usability study you will receive a gift up to $40 in value. We will ask you sign a release form that allows us to videotape your activity for research purposes.

Would you allow us to videotape you? Yes No (Terminate)

We are inviting only a small number of people to participate in this research. The success of this project depends on your commitment to be available for the time slot we agreed on. If you are not able to keep your appointment, please call _____ immediately at 770-391-1099.

CDC-002 – General Consumer Screener

February 20^th-23^rd, 2017: 9am, 10:30am, 12:30pm, 2pm, 3:30pm

(Double recruit each time slot. Schedule a total of 9 interviews over the course of these dates)

Name:

Street:

City:

State & Zip:

Home Phone: Work Phone:

Fax Number: Cell Phone:

E-mail address:

Hello, I’m _______ calling from User Insight, Inc., a marketing research firm. This is not a sales call of any type. We are conducting a brief survey and would like to include your opinion. It is possible that we may also invite you to participate in a study that would be held at User Experience facility here in Atlanta, GA. First of all… (Go straight to question 1)

General Information Questions

10. Record Gender. (Do not Ask)

Male

Female

Obtain Mix of Gender

11. Have you participated in a focus group or other user testing in the past 6 months?

Yes (Terminate) No

12. Do you or anyone in your immediate household work or volunteer for an advertising company, market research company, a government agency, or in the medical field?

Yes (Terminate) No

13. We want to recruit users from a variety of age groups. Please tell me in
    which category does your age fall?

18-24 years

25-29 years

30-39 years

40-49 years

50-55 years

56 years or older

Recruit a mixed group of ages

14. What is your marital status?

Single, never been married

Single, divorced or widowed

Married

Recruit Mix of Marital Status

15. Which of the following best describes your annual household income?

Under $25K

$25K – $75K

$76K+

16. What is the highest level of education you have completed?

Less than High School

Completed High School

Some College or Trade School or Graduate of Trade School

Graduated College

Post Grad

Recruit Mix of Education Levels

17. What is your current occupation?

(specify) _____________________________

18. Which of the following best describes your ethnicity?

Caucasian/White

African American/Black

Asian

Hispanic or Latino

Other (Native American or Other Pacific Islander ▪ American Indian or Alaskan Native ▪ Two or More Races)

Obtain Mix of Ethnicity

19. Do you use the Internet?

Yes No (Terminate)

11. When you have a computer problem, which statement best describes what you would most likely do:

□ I know very little about computers, I would call Family / Friend / Support because I wouldn’t know where to start (Beginner)

□ I would attempt to fix the problem on my own, but would probably have to call Family / Friend / Support if it was very difficult (Intermediate)

□ I would fix the problem on my own, I generally know more than Family / Friends / Support (Advanced)

12. When you buy new hardware to be installed inside your computer (i.e. memory, network card), which statement best describes you:

□ I would not buy new hardware on my own – I would take Family / Friend to help me make the decision. After purchasing the hardware, I would have Family / Friend or Store install it for me. (Beginner)

□ I would buy new hardware on my own after asking Family / Friend what I should buy. After purchasing the hardware, I would attempt to install it on my own until I ran into a problem (Intermediate)

□ I would definitely buy new hardware on my own – I generally know more about it than the person at the store. (Advanced)

Note: Recruit a mix of Beginner, intermediate and advanced respondents

Invitation

Thank you! We would like to invite you to participate in a 60-minute usability research project at our User Experience Center. This study will be on _______. Please do not schedule any appointments or meetings within ½ hour of the end time of your scheduled appointment.

Recruit 9 Times Slots with Consumers in any of the following dates/times (Double Recruit each time slots).

Monday, February 20, 2017

□ 9:00 AM

□ 10:30 AM

□ 12:30 PM

□ 2:00 PM

□ 3:30 PM

Tuesday, February 21, 2017

□ 9:00 AM

□ 10:30 AM

□ 12:30 PM

□ 2:00 PM

□ 3:30 PM

Wednesday, February 22, 2017

□ 9:00 AM

□ 10:30 AM

□ 12:30 PM

□ 2:00 PM

□ 3:30 PM

Thursday, February 23, 2017

□ 9:00 AM

□ 10:30 AM

□ 12:30 PM

□ 2:00 PM

For participating in this usability study you will receive a gift up to $40 in value. When you come to our center we will ask you sign a release form that allows us to videotape your activity for research purposes.

Would you allow us to videotape you? Yes No (Terminate)

We are inviting only a small number of people to participate in this research. The success of this project depends on your commitment to show up at our center at the time we agreed on. If you are not able to keep your appointment, please call _______ immediately at 770-391-1099.

CDC-002 – Public Health Professionals Screener

February 20^th-23^rd, 2017: 9am, 10:30am, 12:30pm, 2pm, 3:30pm

Schedule a total of 5 in-lab interviews over the course of these dates/times

February 27^th-March 3rd, 2017: 9am, 10:30am, 12:30pm, 2pm, 3:30pm

Schedule a total of 4 remote interviews over the course of these dates/times

Name:

Street:

City:

State & Zip:

Home Phone: Work Phone:

Fax Number: Cell Phone:

E-mail address:

Hello, I’m _______ calling from User Insight, Inc., a marketing research firm. This is not a sales call of any type. We are conducting a brief survey and would like to include your opinion. It is possible that we may also invite you to participate in a study that would be held at a local research facility. First of all… (Go straight to question 1)

General Information Questions

20. Record Gender. (Do not Ask)

Male

Female

Obtain Mix of Gender

21. We want to recruit users from a variety of age groups. Please tell me in
    which category does your age fall?

18-24 years

25-29 years

30-39 years

40-49 years

50-59 years

60 years or older (Terminate)

22. How would you describe your employment status?

Full-Time

Part-Time (Terminate)

Homemaker (Terminate)

Retired (Terminate)

Other (specify) ___________ (Terminate)

23. What is your occupation? ___________________________

(If not in the medical/healthcare use for general consumer quota.)

24. What is your job title?

Nurse (Recruit 3 Time Slots)

Doctor (Recruit 2 Time Slots)

Other: (specify) ___________ (consider for general consumer quota)

25. What type of medicine is your job associated with?

Type of medicine _____________________

26. (If Nurse or Doctor in Q8 Ask) In what type of facility do you work?

Clinic

Hospital

Private practice

Other (specify) ___________ (Hold and Check with PM)

27. Which of the following best describes your ethnicity?

Caucasian/White

African American/Black

Asian

Hispanic or Latino

Other (Native American or Other Pacific Islander ▪ American Indian or Alaskan Native ▪ Two or More Races)

Obtain Mix of Ethnicity

28. Do you use the Internet?

Yes No (Terminate)

Invitation

Thank you! We would like to invite you to participate in a 60-minute usability research project at our User Experience Center in Atlanta, GA. This study will be on _______. Please do not schedule any appointments or meetings within ½ hour of the end time of your scheduled appointment.

Recruit 5 HealthCare Providers for IN-LAB interviews during any of the following days/times

Monday, February 20, 2017

□ 9:00 AM

□ 10:30 AM

□ 12:30 PM

□ 2:00 PM

□ 3:30 PM

Tuesday, February 21^st, 2017

□ 9:00 AM

□ 10:30 AM

□ 12:30 PM

□ 2:00 PM

□ 3:30 PM

Wednesday, February 22^nd, 2017

□ 9:00 AM

□ 10:30 AM

□ 12:30 PM

□ 2:00 PM

□ 3:30 PM

Thursday, February 23^rd, 2017

□ 9:00 AM

□ 10:30 AM

□ 12:30 PM

□ 2:00 PM

Recruit 4 HealthCare Providers for REMOTE interviews during any of the following days/times

Monday, February 27th, 2017

□ 9:00 AM

□ 10:30 AM

□ 12:30 PM

□ 2:00 PM

□ 3:30 PM

Tuesday, February 28^TH, 2017

□ 9:00 AM

□ 10:30 AM

□ 12:30 PM

□ 2:00 PM

□ 3:30 PM

Wednesday, March 1^st, 2017

□ 9:00 AM

□ 10:30 AM

□ 12:30 PM

□ 2:00 PM

□ 3:30 PM

Thursday, March 2^nd, 2017

□ 9:00 AM

□ 10:30 AM

□ 12:30 PM

□ 2:00 PM

For participating in this usability study you will receive a gift up to $40 in value. When you come to our center we will ask you sign a release form that allows us to videotape your activity for research purposes.

Would you allow us to videotape you? Yes No (Terminate)

We are inviting only a small number of people to participate in this research. The success of this project depends on your commitment to show up at our center at the time we agreed on. If you are not able to keep your appointment, please call _______ immediately at 770-391-1099.

CDC-002 – Politicos & Media Professionals Screener

February 27^th-March 3rd, 2017: 9am, 10:30am, 12:30pm, 2pm, 3:30pm Schedule a total of 9 Remote interviews over the course of these dates/times

Name: ________________________________________

Street: ________________________________________

City: ________________________________________

State & Zip: ________________________________________

Home Phone: ( ) ______________ Work Phone: ( ) ______________

Fax Number: ( ) ______________ Cell Phone: ( ) ______________

E-mail address: ______________________________________

Hello. I’m ______________ calling from User Insight, Inc., a marketing research firm. This is not a sales call of any type. We are conducting a brief survey with Professionals and would like to include your opinion. It is possible that we may also invite you to participate in a study that would be held in our office or by phone. First of all… (Go straight to question 1)

General Information Questions

29. Record Gender. (Do not Ask)

Male

Female

Obtain Mix of Gender

30. We want to recruit users from a variety of age groups. Please tell me in
    which category does your age fall?

18-24 years (Terminate)

25-29 years

30-39 years

40-49 years

50-59 years

60 years or older (Terminate)

31. How would you describe your employment status?

Full-Time

Part-Time (Terminate)

Homemaker (Terminate)

Retired (Terminate)

Other (specify) ___________ (Terminate)

32. What is your occupation? ___________________________

33. What is your job title? _________________________

34. What company do you work for? _____________________

For Q4-6, Possible Job Titles:

Politicos and Media Professionals

- Communications Professionals

-  Bloggers, especially with health- or environment-centered blogs

-  Science writers/reporters

-  Health writers/reporters 

35. In what city and state are you located? _____________________

Obtain a mix of National regions for the Remote interviews.

36. Do you use the Internet?

□ Yes □ No (Terminate)

37. When you have a computer problem, which statement best describes what you would most likely do:

□ I know very little about computers, I would call Family / Friend / Support because I wouldn’t know where to start (Beginner)

□ I would attempt to fix the problem on my own, but would probably have to call Family / Friend / Support if it was very difficult (Intermediate)

□ I would fix the problem on my own, I generally know more than Family / Friends / Support (Advanced)

(Obtain a mix.)

Recruit 9 Politicos & Media Professionals for REMOTE interviews during any of the following days/times

Monday, February 27th, 2017

□ 9:00 AM

□ 10:30 AM

□ 12:30 PM

□ 2:00 PM

□ 3:30 PM

Tuesday, February 28^TH, 2017

□ 9:00 AM

□ 10:30 AM

□ 12:30 PM

□ 2:00 PM

□ 3:30 PM

Wednesday, March 1^st, 2017

□ 9:00 AM

□ 10:30 AM

□ 12:30 PM

□ 2:00 PM

□ 3:30 PM

Thursday, March 2^nd, 2017

□ 9:00 AM

□ 10:30 AM

□ 12:30 PM

□ 2:00 PM

Invitation for Remote Interviews:

Thank you! We would like to invite you to participate in a 60-minute usability research project via phone and Internet. This study will be on ________. Please do not schedule any appointments or meetings within ½ hour of the end time of your scheduled appointment.

For participating in this usability study you will receive a gift up to $40 in value.

We are inviting only a small number of people to participate in this research. The success of this project depends on your commitment to be available for the time slot we agreed on. If you are not able to keep your appointment, please call _____ immediately at 770-391-1099.