Eligibility Screener - English

Form Approved

OMB No. 0920-xxxx

Exp. Date xx/xx/xxxx

Public reporting burden of this collection of information is estimated to average 2 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-xxxx).

Attachment E-1. Eligibility Screener - English

Table of Contents

Introduction 2

Respondent Selection – LL (calltype=1) 2

Respondent Selection – Cell (calltype=2) 3

Variables used in Programming:

CALLTYPE denotes if the sample is for a landline or cell phone number

1 = LANDLINE

2 = CELL

Introduction

INTRO1. Hello, my name is ____ calling on behalf of the Centers for Disease Control and Prevention. We’re conducting a nationwide study about head injuries in children and adults. You may have heard about head injuries in the news, in particular those experienced by children who play sports or military veterans. Let me assure you that this is not a sales call. Your phone number has been chosen at random to represent thousands of others in the country.

01 CONTINUE

CFM00026. if ***([CALLTYPE#2])*** goto cell

Respondent Selection – LL (calltype=1)

ASK if calltype = 1 and intro1=01

ISADLT. Are you at least 18 years old and a resident of the United States?

01 YES

02 NO

98 DON’T KNOW [TERMINATE, ASSIGN DISPO]

99 REFUSED [TERMINATE, ASSIGN DISPO ]

IF ISADLT=98, 99

TERM_ISADLT. We are only interviewing adults 18 years and older at this time.

ASK IF CALLTYPE=1 AND ISADLT=2

GETADLT. May we please speak with an adult, 18 years of age or older?

01 YES

02 NO [schedule call back]

99 REFUSED [TERMINATE, ASSIGN DISPO]

IF GETADLT=99

TERM_GETADLT. We are only interviewing adults 18 years and older at this time.

ASK IF CALLTYPE=1 and getadlt=1

INTRO1A. Hello, my name is ____ calling on behalf of the Centers for Disease Control and Prevention. We’re conducting a nationwide study about head injuries in children and adults. You may have heard about head injuries in the news, in particular those experienced by children who play sports or military veterans. Let me assure you that this is not a sales call. Your phone number has been chosen at random to represent thousands of others in the country.

1. CONTINUE

ASK if calltype=1

PRIVRES. Is this a private residence?

01 YES

02 NO [TERMINATE, ASSIGN DISPO]

99 REFUSED [TERMINATE, ASSIGN DISPO]

Respondent Selection – Cell (calltype=2)

ASK if calltype = 2 and intro1=01

CISADLT. Are you at least 18 years old and a resident of the United States?

01 YES

02 NO [TERMINATE, ASSIGN DISPO]

98 DON’T KNOW [TERMINATE, ASSIGN DISPO]

99 REFUSED [TERMINATE, ASSIGN DISPO]

ASK IF CALLTYPE=2 and CISADLT=2,98,99

TERM. We are only interviewing adults 18 years and older at this time.

ASK if calltype=2 AND CISADLT=01

CPRIVRES. Do you live in a private residence?

01 YES

02 NO [TERMINATE, ASSIGN DISPO]

99 REFUSED [TERMINATE, ASSIGN DISPO]

ask if calltype=2 and cprivres=01

CADLTS. How many adults 18 years of age or older, including yourself, are in your household?

__ Number of adults [RANGE=0-18]

0. [TERMINATE, ASSIGN DISPO]

ASK IF CALLTYPE =2

SAFE. Your safety is important. Are you driving in a car, or in a place where talking on the phone might distract you or jeopardize your safety or confidentiality?

01 YES

02 NO

99 REFUSED [TERMINATE, ASSIGN DISPO]

ASK IF CALLTYPE=2 AND SAFE=01

UNSAFE. I would like to call you at a more convenient time. What day and time would be best?

01 SCHEDULE CALLBACK

99 REFUSED [TERMINATE, ASSIGN DISPO]

3