ConnectHome Focus Groups Screener

OMB Approval No. XXX-XXXX Expires: MM-DD-YYYY

Paperwork Reduction Act Notice. Public reporting burden for this collection of information is estimated to be .083 hours (5 minutes) per PHA resident, and includes time for reviewing the instructions, and completing and reviewing the responses. Your completion of this information collection is voluntary. HUD may not collect this information, and you are not required to complete this form, unless it displays a current, valid OMB control number.

PHA Residents: ConnectHome Focus Group Screener

Hello, my name is [NAME] and I’m calling from [PHA NAME] to ask you to participate in an in-person focus group discussion about [COMMUNITY]’s [LOCAL CONNECTHOME PROGRAM NAME]. That is the program that provides residents in [COMMUNITY] high-speed internet access through [ISP]. The focus group will be 90 minutes long. You will receive a $50 gift card for participating in the focus group discussion. Are you interested and willing to participate?

IF YES: Thank you. I just have a few questions to ask you to see if you are eligible to participate.

IF NO: Thank you for your time.

1. Are you age 18 or older?

1. Yes [Continue]

2. No [Terminate]

2. How many children under the age of 18 are living in your household?

   1. 1 or more [Continue]

   2. None [Terminate]

3. In the last 12 months, have you or someone living in your household received [ISP]’s high-speed internet at home through the [LOCAL CONNECTHOME PROGRAM NAME]?

Yes [Recruit to subscriber group] No/ Don’t know [Continue]

4. 

   1. Are you able to participate in a 90 minute focus group on [DATE] and [TIME] at [LOCATION]?

   Do you have internet access at home?

Yes [Continue] No [Recruit to nonsubscriber group]

Are you able to participate in a 90 minute focus group on [DATE] and [TIME] at [LOCATION]?

5. Is your cell phone data plan the only way you access the internet at home?

Yes [Recruit to nonsubscriber group] No [Terminate]

Are you able to participate in a 90 minute focus group on [DATE] and [TIME] at [LOCATION]?