Attachment C revised

2487-02_AttachC revised.docx

Safer Choice Label Consultations

Attachment C revised

OMB: 2070-0189

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ATTACHMENT C


Screening Questionnaire for “Leaning Green” Consumer Focus Group












OMB Control No. 2070-0189

Approval expires 02/28/17


The annual public burden for this collection of information is estimated at 0.17 hours per response for screened respondents. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a current and valid OMB control number. The OMB control number for this collection is 2070-0189. This collection is voluntary. Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed application to this address.

Screening Questionnaire for “Leaning Green” Consumer Focus Group


Interviewer: _______________


Date: _______________


Letter sent: _______________


Reconfirmation Call: _______________





CALL FROM DATABASE OR AT RANDOM

RECRUIT 9 PER GROUP FOR 8-9 TO SHOW


Hello, I’m __________ with __________________, an independent consumer research firm. We are not selling or promoting any product or service. We are conducting a research study on behalf of the United States Environmental Protection Agency about providing information to help consumers select products that are safer for people, families and pets and can help protect the environment, and would like to include your views. My questions will take approximately 10 minutes, and your response is voluntary.


1. First, do you, or does any member of your household or immediate family, work for or is retired from:

A market research company _____

A direct mail company or direct marketing company _____

An advertising agency or public relations firm _____

The media (TV/radio/newspapers/magazines) _____


[IF YES TO ANY >> TERMINATE]


2. Are you a chemist, chemical engineer, or organic farmer – or do you work for EPA, an environmental agency or environmental non-profit, or the organic food industry?


[IF YES TO ANY >> TERMINATE]


3. In a typical month, how frequently do you shop at a grocery store, supermarket, hardware store, home improvement store (such as Home Depot or Lowe’s) or general retail store (such as Walmart, Target, Costco, or Sam’s Club) for your household?

4 or more times _____

2 or 3 times _____

TERMINATE >> Fewer than 2 times _____


4. When you select products for your household, such as cleaning products or personal care, how important is it to you to select products that can help protect the health of yourself, your family, or your pet? Please rate this on a scale from 1 to 5, where 1 is “not at all important” and 5 is “very important.”


TERMINATE >> 1 – Not at all important ____

TERMINATE >> 2 – Somewhat unimportant ____

TERMINATE >> 3 – No opinion either way ____

4 – Somewhat important____

TERMINATE >> 5 – Very important____


5. In the last three months, did you choose to buy a product over another because it was better for the environment?

Yes ____

No ____



6. If “Yes,” about how many times did you choose a product that was better for the environment?

# of times ____


7. How knowledgeable are you about environment issues (climate change, pollution…)? Please rate this on a scale from 1 to 4, where 1 is “not at all knowledgeable” and 4 is “very knowledgeable.”

TERMINATE >> 1 – Not at all knowledgeable ____

2 – Not very knowledgeable ____

3 – Somewhat knowledgeable ____

TERMINATE >> 4 – Very knowledgeable____


8. How knowledgeable are you about selecting products that can help protect the environment? Please rate this on a scale from 1 to 4, where 1 is “not at all knowledgeable” and 4 is “very knowledgeable.”

TERMINATE >> 1 – Not at all knowledgeable ____

2 – Not very knowledgeable ____

3 – Somewhat knowledgeable ____

TERMINATE >> 4 – Very knowledgeable____


9. Which of the following categories best describes your total annual household income? [GOOD MIX]

TERMINATE >> Under $15,000 _____

$15,000 - $24,999 _____

$25,000 - $34,999 _____

$35,000 - $54,999 _____

$55,000 - $74,999 _____

$75,000 - $100,000 _____

TERMINATE >> Over $100,000 _____


10. Please tell us your age. [Record age;


11. What is your current marital status? Are you ….. ?

Married or living with a partner_____

Single _____

Divorced _____

Widowed _____


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

Less than high school graduate _____

High school graduate _____

Some college _____

College graduate _____

Post graduate studies or degree _____


13. So that we can be sure that all backgrounds are represented in our study, please tell me your ethnic or race background. Are you … ?

Ethnicity


Hispanic or Latino_____

Not Hispanic or Latino_____


Race


American-Indian or Alaska Native _____

Asian _____

Black or African American _____

Native Hawaiian-Indian or Other Pacific Islander _____

White _____

Other _____



14. [Record gender]

Male _____

Female _____


15. Have you ever attended a focus group discussion or individual interview? By that we mean an informal, round-table discussion, conducted by a professional moderator in which you were asked your opinions regarding a product, a service, or advertising?

MAX. ½ GROUP >> ASK A-C >> Yes _____

INVITE TO GROUP >> No _____

  1. How many of these groups have you attended?

______________________________ [MAX. 3 EVER]

  1. What was/were the topics discussed?

______________________________ [IF CHEMICAL SAFETY, TERMINATE]

  1. How long ago was the last one of these groups you attended?

______________________________ [MUST BE AT LEAST 6 MONTHS AGO]

[INVITE TO GROUP]

Thank you for answering all of my questions. As I mentioned earlier, we are conducting a research study regarding information to help consumers select products that are safer for families and pets and can help protect the environment. We are conducting an informal, round-table discussion to be held on ________ at _____. The discussion will last about two hours and will be both fun and informative. No one will attempt to sell you anything and no one will call on you as a result of your participation. As a token of our appreciation for your help in our research effort, you will receive a $75 cash honorarium at the time of the session. This is an important research effort and we hope that you will be part of it. We can only invite about a dozen people to take part. Can we schedule your attendance?

[If yes, read … ]

If you need glasses for reading or for watching TV, please be sure to bring them with you to the group.


ID Number _________________________________________________


NAME: _________________________________________________

ADDRESS: _________________________________________________

CITY: _________________________________________________

ZIP CODE: _________________________________________________

PHONE: (DAY) _____________________________________

(EVE) _____________________________________

(CELL) _____________________________________

(EMAIL) _____________________________________


Interviewer: ____________________

Supervisor Confirm: ____________________



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AuthorCarlson, Ron
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File Created2021-01-22

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