Form NHTSA Form 1339 NHTSA Form 1339 Mid-Study Questionnaire

OMB#: 2127-xxxx

Expiration Date: xx/xx/xxxx

Virginia Tech Transportation Institute

HV-CWI Questionnaire – Mid-study

This collection of information is voluntary and will be used to screen for eligible participants. Public reporting burden is estimated to average 10 minutes per person, including the time for reviewing instructions searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Information will be kept confidential, and your name will not be attached to any data. Please note that 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. The OMB control number for this collection is 2127-XXXX. 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 Avenue, SE, Washington, DC 20590.

Trial 3

Please answer each question by selecting a number on the scale that best reflects your response. Half numbers, such as 4.5, are also acceptable.

1. How common is it for you to experience a distraction such as you just experienced in your normal driving?

2. Do you feel your driving performance was changed while performing this task?

3. How likely would you be to perform this task while driving in normal traffic?

Trial 4

Please answer each question by selecting a number on the scale that best reflects your response. Half numbers, such as 4.5, are also acceptable.

1. How common is it for you to experience a distraction such as you just experienced in your normal driving?

2. Do you feel your driving performance was changed while performing this task?

3. How likely would you be to perform this task while driving in normal traffic?

Trial 5

Please answer each question by selecting a number on the scale that best reflects your response. Half numbers, such as 4.5, are also acceptable.

4. How common is it for you to experience a distraction such as you just experienced in your normal driving?

5. Do you feel your driving performance was changed while performing this task?

6. How likely would you be to perform this task while driving in normal traffic?

NHTSA Form 1339