Form 1322 Impaired Driving Survey

OMB Control No. 2127-XXXX

Expiration Date XX/XX/XXXX

Appendix B

Impaired Driving Survey

Form 1322

Several Driver Licensing Offices are participating in a study about community-oriented law enforcement. Your answers to the following questions are voluntary and anonymous. Please complete the survey and drop it in the box before you leave.

This collection of information is voluntary and will be used for statistical purposes only so that we may develop and evaluate programs designed to reduce the number of traffic-related injuries and deaths. The public reporting burden is estimated to average 10 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. Your participation is anonymous, and 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 # XXXX-XXXX.

1. Your sex: [] Male [] Female

2. Your age: [] Under 18 [] 18-20 [] 21-34 [] 35-49 [] 50-59 [] 60 Plus

3. What is your zip code? __ __ __ __ __

4. Do you consider yourself Hispanic or Latino? [] Yes [] No

5. Your race: Check all that apply: [] White [] Black or African American [] American Indian or Alaska Native [] Asian [] Native Hawaiian or other Pacific Islander

6. What is the highest grade or year of school you completed?

[] Less than HS

[] HS or equivalent

[] Some college but no degree

[] College graduate and beyond

7. How often do you typically drive a car or other motor vehicle?

[] Everyday [] Several Days a Week [] Once a Week or Less [] Only Certain Times a Year [] Never

8. What type of vehicle do you drive most often?

[] Passenger car [] Pickup truck [] Sport utility vehicle [] Mini-van [] Full-van [] Other

9. In the past 12 months, have you ever driven a motor vehicle within 2 hours of drinking any alcoholic beverages?

[] Yes [] No If yes, how many times? _______

10. Have you been arrested for a drinking and driving violation anytime in the past year?

[] Yes [] No If yes, how many times? _______

11. In the past 30 days, have you experienced a decrease, increase, or no change in the number of times you have driven within 2 hours of drinking any alcoholic beverages?

[] Increase [] Decrease [] Stayed the Same

12. If a decrease, what caused your drinking and driving to decrease?

[] Increased awareness of safety [] Don’t want to get pulled over or arrested [] Stayed the Same

[] Other? ___________________________________________________________

13. How likely is it that drivers who have had too much to drink to drive safely will get stopped by the police?

[] Very Likely [] Somewhat Likely [] Somewhat Unlikely [] Very Unlikely

14. To what degree do you agree with the following statements?

14a. Police in my community generally will not bother to identify drunk drivers.

[] Strongly Agree [] Somewhat Agree [] Somewhat Disagree [] Strongly Disagree

14b. Police in my community are identifying more drunk drivers and making more drunk driving arrests than they were a few months ago.

[] Strongly Agree [] Somewhat Agree [] Somewhat Disagree [] Strongly Disagree

15. In the past 30 days, have you seen or heard of any special effort by police to identify and arrest drunk drivers in your community?

[] Yes [] No

16. Have you recently read, seen or heard any messages about drunk driving programs happening in your community?

[] Yes [] No

If yes, where did you see or hear about it? (Select all that apply)

[] Newspaper [] Radio [] TV [] Billboards [] Brochure [] Online [] Police Enforcement [] Other

If yes, what did it say? ___________________________________________________________

17. Are any of these drunk driving programs happening in your community?

(Select all that apply)

[] Drive Sober or Get Pulled Over [] Community Program Slogan #1 [] Community Program Slogan #2

18. To what degree do you support drunk driving enforcement as an important police activity in your community?

[] Strongly Support [] Somewhat Support [] Somewhat Don’t Support [] Don’t Support at all

19. In the past 12 months, have you been in contact with the local police in your community for any reason?

[] Yes [] No

20. How would you best describe your contact with the police? (Select all that apply)

[] Reported a crime to police

[] Traffic violation stop

[] Car crash

[] Casual conversation with a police officer

[] Officer responding to call for service

[] Participated in a survey given by the police department

[] Asked the police for information or advice

[] Participated in a community activity that involved the police (e.g., clean-up, social event, community meeting)

[] Working with police to address specific problems

[] Other? ___________________________________________________________

21. In the past 12 months, have you observed any increases or decreases in police officer presence in your community or did the police presence stay the same?

[] Increase [] Decrease [] No change

[] Never see police in my community

22. In the past 12 months, what activities have you seen police doing in your community? (Select all that apply)

[] Police talking with residents in the community

[] Police talking with business owners in the community

[] Police attending community meetings

[] Police facilitating traffic watch and drunk driving enforcement

[] Police involved with kids through recreational or school activities (e.g., DARE)

[] Other activities you have noticed? ___________________________________________________________

23. In the past 12 months, have you heard about any community meetings concerning drunk driving taking place in your community?

[] Yes [] No

24. In the past 12 months, have you attended any of these community meetings?

[] Yes [] No

25. What are your reasons for not attending any meetings? (Select all that apply)

[] Don’t have time to attend

[] Aware of meetings, but do not know location and/or dates/times

[] Unable to obtain transportation

[] Unable to obtain child care

[] Meetings held in unsafe/scary part of town

[] Attendance would not help drunk driving problem in community

[] Meeting place is too far

[] Meetings take place during work hours

[] Not especially concerned about drunk driving in my community

[] Other? (Please list) ___________________________________________________________

26. How much work are police doing with the residents of your community to stop drunk driving?

[] A lot [] Some [] Very Little [] Nothing at all

27. Are you familiar with community-oriented policing?

[] Yes [] No

28. Community-oriented policing involves police officers working in partnership with the community to address community concerns regarding drunk driving. Based upon this definition, do you think the police in your community practice community-oriented drunk driving enforcement?

[] Yes [] No

29. Do you have any additional thoughts or comments regarding community-oriented drunk driving enforcement programs taking place in your community?

NHTSA Form #1322