Online Study Screener

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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



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 ___

    a. Car seat

(     )
(     )
(     )
(     )
(     )
    b. Booster seat
(     )
(     )
(     )
(     )
(     )
    c. Seat belt
(     )
(     )
(     )
(     )
(     )
    d. No car seat or seat belt
(     )
(     )
(     )
(     )
(     )
    e. 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