NHTSA Form 1306 Online Study Screener

OMB Control No. 2127-0682

Expiration Date 08-31-2021

CONFIDENTIAL

Online Study Screener

Generic Clearance OMB Control No: 2127-0682: Generic Clearance for the Collection of Online Quantitative and Qualitative Feedback on Creative Message Testing for Traffic and Motor Vehicle Safety Programs and Activities

This collection of information is voluntary and will be used for guidance in increasing the use of booster car seats.  We will not collect any personal information that would allow anyone to identify you. 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 current valid OMB Control Number.  The OMB Control Number for this information collection is 2127-0682.  Public reporting for this collection of information is estimated to be approximately 2 minutes per response, including the time for reviewing instructions, completing and reviewing the collection of information.  All responses to this collection of information are voluntary.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, National Highway Traffic Safety Administration, 1200 New Jersey Ave, S.E., Washington, DC, 20590

Participant Criteria: Recruit n=50

• National geography

• Mix of genders, HHI, race/ethnicity

• Ages 25 and older

• Has a child or is a caregiver for a child between the ages of 7-10

• Possess valid driver’s license

• Drive at least 3 times per week with the child(ren)

• Knows what kind of car safety restraint their child uses when in the car

SCREENER QUESTIONS

1. Are you male or female?

• Male

• Female

2. Which of the following groups does your age fall into?

• ( ) Under 18 (TERMINATE)

• ( ) 18 – 24 (TERMINATE)

• ( ) 25 – 34 (CONTINUE)

• ( ) 35 – 44 (CONTINUE)

• ( ) 45 – 54 (CONTINUE)

• ( ) 55 – 64 (CONTINUE)

• ( ) 65+ (CONTINUE)

• ( ) Refused (TERMINATE)

3. Do you, or does anyone in your immediate family, work in any of the following industries or professions?

( ) Marketing or marketing research (TERMINATE)

( ) Advertising or public relations (TERMINATE)

( ) News media, including newspaper, television, radio or publishing (TERMINATE)

( ) A company that manufactures, distributes, or sells automobiles or automobile

parts (TERMINATE)

( ) A company that manufactures, distributes, or sells car seats (TERMINATE)

( ) None of the above

[IF YES TO ANY ANSWER, TERMINATE]

4. Which of the following states do you live in?

1. Alabama

2. Alaska

3. Arizona

4. Arkansas

5. California

6. Colorado

7. Connecticut

8. Delaware

9. District of Columbia

10. Florida

11. Georgia

12. Hawaii

13. Idaho

14. Illinois

15. Indiana

16. Iowa

17. Kansas

18. Kentucky

19. Louisiana

20. Maine

21. Maryland

22. Massachusetts

23. Michigan

24. Minnesota

25. Mississippi

26. Missouri

27. Montana

28. Nebraska

29. Nevada

30. New Hampshire

31. New Jersey

32. New Mexico

33. New York

34. North Carolina

35. North Dakota

36. Ohio

37. Oklahoma

38. Oregon

39. Pennsylvania

40. Rhode Island

41. South Carolina

42. South Dakota

43. Tennessee

44. Texas

45. Utah

46. Vermont

47. Virginia

48. Washington

49. West Virginia

50. Wisconsin

51. Wyoming

5. Do you currently have a valid driver’s license?

• Yes [CONTINUE]

• No [TERMINATE]

6. How many children do you have?

   • 1 [CONTINUE]

   • 2 [CONTINUE]

   • 3 [CONTINUE]

   • 4+ [CONTINUE]

   • I do not have any children [TERMINATE]

[TERMINATE ANYONE WHO SELECTS “I DO NOT HAVE ANY CHILDREN”]

7. What are the ages of your children? Select all that apply.

   • 0-6 [TERMINATE]

   • 7-10 [CONTINUE]

   • 11-17 [TERMINATE]

   • 18+ [TERMINATE]

[TERMINATE ANYONE WHO DOES NOT SELECT “7-10”]

8. What are the ages of your children age 7-10 who currently live with you?

	Age
Child 1	_____
Child 2	_____
Child 3	_____
Child 4	_____
Child 5	_____

[Recruiter: Ensure child(ren) are between the ages of 7-10]

9. On average, how often do your child(ren) age 7-10 travel with you when you are driving?

( ) 3 days per week or more (CONTINUE)

( ) Less than 3 days per week (TERMINATE)

( ) None. I do not drive with them. (TERMINATE)

10. For each child AGE 7-10, please select the following type of car safety restraint you use for that child when they ride in the car with you when you’re driving.

	Child 1 Age ___	Child 2 Age ___	Child 3 Age ___	Child 4 Age ___	Child 5 Age ___
Car seat	( )	( )	( )	( )	( )
Booster seat	( )	( )	( )	( )	( )
Seat belt	( )	( )	( )	( )	( )
No car seat or seat belt	( )	( )	( )	( )	( )
Don’t know	( )	( )	( )	( )	( )

NOTE TO RECRUITER: TERMINATE IF RESPOND “DON’T KNOW” FOR ALL CHILDREN.

11. Which of the following best describes your total annual household income before taxes?

( ) Less than $30,000

( ) Between $30,000 and $49,999

( ) Between $50,000 and $74,999

( ) Between $75,000 and $99,999

( ) More than $100,000

( ) Prefer not to answer

12. What is your marital status?

• Single, never married

• Living with partner

• Married

• Widowed

• Divorced or separated

13. What is the last formal grade of education you have completed?

1. Less than high school (8th grade or less)

2. Some high school (9th-12th grade)

3. High school graduate

4. Some college, but no degree

5. Associate’s Degree (Vocational / Technical)

6. Bachelor’s degree

7. Master’s degree

8. Professional degree

9. Doctorate degree

10. Prefer not to answer

14. Are you of Hispanic or Latino descent?

1. Yes

2. No

15. Select one or more of the following that best describes your race?

[ACCEPT MULTIPLE RESPONSES]

1. American Indian or Alaska Native

2. Asian

3. Black or African-American

4. Native Hawaiian or other Pacific Islander

5. White

16. Do you speak Spanish fluently at home?

• Yes

• No

WINDOW FOR THOSE WHO QUALIFY

We would like you to participate in our online survey to answer some questions and record a few video responses. This is a research study and in no way a sales effort of any kind. We are only interested in your candid opinions. There are no right or wrong answers. Just keep talking - whatever comes to mind. And have fun!

The Details - You'll be paid $20 USD by PayPal after we review your responses. Rewards are processed once a day. Responses to this survey will be shared in aggregate form with our client and will NOT be made public. 

For questions or help, email us at [email protected].

This collection of information is voluntary and will be used for guidance in increasing the use of booster car seats.  We will not collect any personal information that would allow anyone to identify you. 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 current valid OMB Control Number.  The OMB Control Number for this information collection is 2127-0682.  Public reporting for this collection of information is estimated to be approximately 15 minutes per response, including the time for reviewing instructions, completing and reviewing the collection of information.  All responses to this collection of information are voluntary.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, National Highway Traffic Safety Administration, 1200 New Jersey Ave, S.E., Washington, DC, 20590

NHTSA Form No 1306