Cellphone Screener

Attachment 8B: Cell Phone Screener

Cell Phone

Form Approved

OMB No. 0920-1061

Exp. Date 3/31/2018

Public reporting burden of this collection of information is estimated to average [XX] 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 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 CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-1061).

NOTE: Interviewers do not need to read any part of the burden estimate nor provide the OMB number unless asked by the respondent for specific information. If a respondent asks for the length of time of the interview provide the most accurate information based on the version of the questionnaire that will be administered to that respondent. If the interviewer is not sure, provide the average time as indicated in the burden statement. If data collectors have questions concerning the BRFSS OMB process, please contact Carol Pierannunzi at [email protected].

HELLO, I am calling for the (health department). My name is (name) . We are gathering information about the health of (state) residents. This project is conducted by the health department with assistance from the Centers for Disease Control and Prevention. Your telephone number has been chosen randomly, and I would like to ask some questions about health and health practices.

Is this a safe time to talk with you?

Yes [Go to phone]

No

If "No”,

Thank you very much. We will call you back at a more convenient time. ([Set appointment if possible]) STOP

Phone

Is this (phone number) ?

Yes [Go to cellular phone]

No [Confirm phone number]

If "No”,

Thank you very much, but I seem to have dialed the wrong number. It’s possible that your number may be called at a later time. STOP

Cellular Phone

Is this a cellular telephone?

READ ONLY IF NECESSARY: “By cellular telephone, we mean a telephone that is mobile and usable outside of your neighborhood.”

Yes [Go to adult]

No

If "No”,

Thank you very much, but we are only interviewing cell telephones at this time. STOP

Adult

Are you 18 years of age or older?

1 Yes, respondent is male [Go to Private Residence]

2 Yes, respondent is female [Go to Private Residence]

3 No

If "No”,

Thank you very much, but we are only interviewing persons aged 18 or older at this time. STOP

Private Residence

Do you live in a private residence?

READ ONLY IF NECESSARY: “By private residence, we mean someplace like a house or apartment.”

Yes [Go to state of residence]

No [Go to college housing]

College Housing

Do you live in college housing?

READ ONLY IF NECESSARY: “By college housing we mean dormitory, graduate student or visiting faculty housing, or other housing arrangement provided by a college or university.”

Yes [Go to state of residence]

No

If "No”,

Thank you very much, but we are only interviewing persons who live in a private residence or college housing at this time. STOP

State of Residence

Do you currently live in ____(state)____?

Yes [Go to landline]

No [Go to state]

State

In what state do you currently live?

ENTER FIPS STATE

Landline

Do you also have a landline telephone in your home that is used to make and receive calls?

READ ONLY IF NECESSARY: “By landline telephone, we mean a “regular” telephone in your home that is used for making or receiving calls.” Please include landline phones used for both business and personal use.”

Interviewer Note: Telephone service over the internet counts as landline service (includes Vonage, Magic Jack and other home-based phone services.).

Yes

No

If College Housing = “Yes”, do not ask Number of adults Questions, go to Core.

NUMADULT

How many members of your household, including yourself, are 18 years of age or older?

__ Number of adults

(Note: If college housing = ”yes” then number of adults is set to 1.)