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pdfCFPB Young Consumers Interview Screener
Recruitment Language
Seeking Consumers for Interviews Regarding Personal Finances
We are currently recruiting adults ages 22 to 36 to participate in one-on-one interviews about their
experiences and decision-making processes regarding personal finances.
The interviews will last 60 minutes and participants will be paid $75 in the form of a gift card. The
study will take place at [location] and we are currently scheduling participants for [dates]. This
research is being sponsored by the Consumer Financial Protection Bureau (CFPB), a federal
government agency that was created to help consumers in the financial marketplace. Feedback from
the interviews will be used to help the CFPB understand consumers’ financial experiences and to
refine products and services available for consumers.
If you are interested in participating, please contact us at [contact info]. We will ask you to complete
a short screener and we will notify you if you qualify for the study.
Thank you!
Web-Based Screener
[NEW SCREEN]
Thank you for your interest in participating in a study with Fors Marsh Group. We are seeking
participants for one-on-one interviews to discuss your experiences and decision-making processes
with regard to your personal finances.
Interviews will take place the week of [month/date] at [location]. If you are interested in
participating, please complete this questionnaire. If you qualify for this study, we will contact you to
schedule a time that is convenient for you. Compensation ($75) in the form of a gift card will be
provided to those who participate.
Thank you for your interest.
[NEW SCREEN]
Please note that your responses to these questions will remain private and will only be used for the
purpose of scheduling your session if you qualify for the study. The following Privacy Act Statement
guides the handling of your responses.
Privacy Act Statement
5 U.S.C. 552(a)(e)(3)
The information you provide through your responses to Fors Marsh Group will assist the study
sponsor, the Consumer Financial Protection Bureau (“CFPB”), in determining your eligibility to
participate in a study that will focus on the development and improvement of CFPB tools and
resources to assist consumers.
Information collected on behalf of the Bureau by Fors Marsh Group will be treated in accordance
with the System of Records Notice (“SORN”), CFPB.021 – CFPB Consumer Education and
Engagement Records, 79 FR 78839. This information will only be disclosed as outlined in the
Routine Uses for the SORN. Direct identifying information will only be used to facilitate the study and
will be kept private except as required by law.
This collection of information is authorized by Pub. L. No. 111-203, Title X, Sections 1013 and 1022,
codified at 12 U.S.C. §§ 5493 and 5512.
Participation in this study is voluntary, you are not required to participate or share any identifying
information with Fors Marsh Group, including name, email address, video recording, and you may
withdraw participation at any time. However, if you do not include the requested information, you
may not participate in the interview.
Paperwork Reduction Act
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 OMB control number for this collection is 3170-0036. It expires on 08/31/2019. The
time required to complete this information collection is estimated to average approximately 5
minutes per response. Comments regarding this collection of information, including the estimated
response time, suggestions for improving the usefulness of the information, or suggestions for
reducing the burden to respond to this collection should be submitted to Bureau at the Consumer
Financial Protection Bureau (Attention: PRA Office), 1700 G Street NW, Washington, DC 20552, or by
email to [email protected].
[NEW SCREEN]
Q1_1. First name:
[Open-end text box]
Q1_2. Last name:
[Open-end text box]
Q1_3. Email:
[Open-end text box]
[Validate email]
Q1_4. Mobile number:
[Open-end text box]
[Validate telephone]
Q1_5. Alternate number:
[Open-end text box]
[Validate telephone]
2
Q1_6. What is your zip code?
[Open-end text box]
[Validate zip code]
[NEW SCREEN]
Q2. What is your age?
[Single Punch]
0–17
18–21
01
02
Ineligible
Ineligible
22–26
03
27–31
32–36
37–41
42–46
47–51
52–56
57–61
62–66
66+
Refused
04
05
06
07
08
09
10
11
12
-99
Eligible
Eligible
Eligible
Ineligible
Ineligible
Ineligible
Ineligible
Ineligible
Ineligible
Ineligible
Ineligible
Q3. Who is responsible for paying bills in your household?
[Single Punch]
You
Your partner
You and your partner
You and another family member (or family members)
Another family member (or family members)
Someone else
Nobody
Don’t Know/Not Sure
Refused
01
02
03
04
05
06
07
98
-99
Eligible
Ineligible
Eligible
Eligible
Ineligible
Ineligible
Ineligible
Ineligible
Ineligible
[NEW SCREEN]
Q4. Within the last 5 years, have you or an immediate family member worked for any of the following
types of business? Select all that apply.
[Multi-Punch]
Yes
No
Refused
01
02
-99
An advertising or public relations firm
A marketing or market research firm or department
A marketing or market research consultant
Any kind of media company, like a TV or radio station or
newspaper
Ineligible
Ineligible
Ineligible
Ineligible
3
A Government agency that regulates the financial industry
A financial intuition, like a credit union, bank, credit-card
company, insurance company, consumer-finance company, etc.
None of the above
Ineligible
Ineligible
Eligible
Q5. When, if ever, was the last time you participated in a marketing research study, such as a
consumer interview or a group discussion?
[Single Punch]
Within the past three months
More than three months ago
Never
Refused
01
02
03
-99
Ineligible
Eligible
Eligible
Ineligible
[IF INELIGIBLE, TERMINATE HERE USING THE LANGUAGE BELOW; IF ELIGIBLE, CONTINUE TO
SECTION 2]
[NEW SCREEN]
We’re sorry, but you do not qualify for this study. Thank you for your interest.
[End Survey]
Section 2: Demographic Items
[NEW SCREEN]
Q6. What is your gender?
[Single Punch]
Male
Female
Other
Refused
01
02
03
-99
Q7_1. Do you have any children under the age of 18?
[Single Punch]
Yes
No
Refused
01
02
-99
[If Q7 = 02, or -99, skip to Q8]
Q7_2. How many children under the age 18 do you have?
[Open-end text box]
Q8. Are you of Hispanic or Latin American origin?
[Single Punch]
Yes
01
4
No
Don’t Know/Not Sure
Refused
02
98
-99
Q9. Which of the following best describes your race? Select all that apply.
[Multi-Punch]
[RANDOMIZE ORDER, BUT ALWAYS ASK “Some other race”
LAST.]
White
Black/African American
American Indian or Alaska Native
Asian
Native Hawaiian or Pacific Islander
Some Other Race
Yes
No
Refused
01
01
01
01
01
01
02
02
02
02
02
02
-99
-99
-99
-99
-99
-99
[NEW SCREEN]
Q10. Is English your first language?
[Single Punch]
Yes
No
Refused
01
02
-99
Q11. What is the highest level of education you have completed?
[Single Punch]
Less than high school degree or equivalent
High school graduate (GED or Diploma)
Some certificate or trade school courses completed
01
02
03
Trade school or coding academy certificate
04
Some college courses completed
Associate degree (2-year)
Bachelor’s degree (4-year)
Some graduate courses completed
Post-graduate degree (master’s or doctorate)
05
06
07
08
09
No
College
Some
College
College
Graduate
Q12. Are you the first person in your family to attend college?
[Single Punch]
Yes
No
Don’t Know/Not Sure
01
02
98
[NEW SCREEN]
Q13. Which of the following best describes what you are currently doing? Select all that apply.
[Multi-Punch]
Yes
No
Refused
5
01
02
03
04
05
06
07
08
09
10
Employed full-time
Employed part-time
Full-time student
Part-time student
Homemaker
Self-employed
Retired
Disabled
Not currently employed
Other
01
01
01
01
01
01
01
01
01
01
02
02
02
02
02
02
02
02
02
02
-99
-99
-99
-99
-99
-99
-99
-99
-99
-99
[If Q13 = 03, 05, 07, 08 or 09, skip to Q15_1]
Q14_1. What type of organization are you employed by?
[Single Punch]
Private for-profit company or business
Not-for-profit (tax exempt) company or charitable organization
Government (Federal, U.S. Military civilian, state, or local)
U.S. Military (Army, Navy, Air Force, Marines)
Self-employed business or professional practice
Refused
[If Q14_1 = 01, or 05 skip to Q15_1]
Yes
01
02
03
04
05
-99
Q14_2. What’s your career field?
[Single Punch]
Education and Social Services
Computers and Technology
Health Care and Allied Health
Business and Management
Public Administration
Science
Transportation
Arts and Communications
Manufacturing and Engineering
Law and Law Enforcement
AmeriCorps or Peace Corps
Refused
01
02
03
04
05
06
07
08
09
10
11
-99
Q15_1. Are you currently a veteran of the U.S. Military?
[Single Punch]
Yes
No
Refused
01
02
-99
Q15_2. Are you currently a reservist in the U.S. Military?
[Single Punch]
Yes
01
6
No
Refused
02
-99
Q16. What is your total household income?
[Single Punch]
Less than $30,000
$30,000 to $49,999
$50,000 to $99,999
$100,000 to $150,000
More than $150,000
Don’t Know/Not Sure
Refused
01
02
03
04
05
98
-99
[NEW SCREEN]
Q17. Which of the following financial accounts or cards do you have? Select all that apply.
[Multi-Punch]
Credit card
Savings account
Checking account
Prepaid debit card
Retirement account (e.g. 401(k), IRA, etc.)
None of the above
Yes
01
01
01
01
01
01
No
02
02
02
02
02
02
Refused
-99
-99
-99
-99
-99
-99
Q18. Do you currently have (in your name) or are you responsible for any of the following types of
loans? Select all that apply.
[Multi-Punch]
Yes
01
01
01
01
01
01
Student loan debt
Auto loan debt
Mortgage loan debt
Pay day or auto title loans
Other type of loan
None of the above
No
02
02
02
02
02
02
Refused
-99
-99
-99
-99
-99
-99
Q19. Are you currently experiencing difficulty making your monthly bill payments?
[Single Punch]
Yes
No
Don’t Know/Not Sure
Refused
01
02
98
-99
Q20. Have you ever had to dispute a claim on your credit report?
[Single Punch]
Yes
No
Refused
01
02
-99
7
Q21. Have you ever used any of the following alternative financial services? Select all that apply.
[Multi-Punch]
Wire transfer
Money transfer applications
Money order or check cashing service
Yes
01
01
01
No
02
02
02
Refused
-99
-99
-99
[NEW SCREEN]
Final Message [if they qualify and complete survey]
Thank you for completing this questionnaire. If you qualify for this study, we will be in contact with
you to schedule a time that is convenient for you.
If you have any questions, please contact us at [email protected] or call us at (571) 8583817. You can also visit our website at www.forsmarshgroup.com or our Facebook page:
http://www.facebook.com/ForsMarshGroup.
8
Phone-Based Screener (for those who qualify based on web-based screener)
Hello ______. Thank you for your interest in participating in our interviews about your experiences
and decision-making processes regarding your personal finances. My name is ________ and I
wanted to follow up regarding a screener that you completed recently for an upcoming study. I
wanted to ask a couple more questions and see if we can schedule you. Your participation is
completely voluntary. Do you have a few minutes?
Privacy Act Statement
5 U.S.C. 552(a)(e)(3)
The information you provide through your responses to Fors Marsh Group will assist the survey
sponsor, the Consumer Financial Protection Bureau (CFPB), in in determining your eligibility to
participate in a study that will focus on the development and improvement of CFPB tools and
resources to assist consumers.
A federal law called the Privacy Act directs how the CFPB collects, keeps and shares your personal,
private information- including the personal information contained in your answers to these
questions. Your participation is completely voluntary, and is subject to the CFPB privacy policy that
can be found on our website, consumerfinance.gov.
Abbreviated Paperwork Reduction Act
This survey has been approved under the Paperwork Reduction act of 1995 by the Federal
Government’s Office of Management and Budget and assigned OMB control number 3170-0036.
1. Can you please verify your age?
3. Can you please verify your highest level of education?
[If responses are confirmed – proceed with scheduling.]
Thank you for your time.
9
File Type | application/pdf |
Author | David Hawkins |
File Modified | 2017-10-20 |
File Created | 2017-10-20 |