DGA 2020-2025 Survey and Focus Group (English and Spanish)

Generic Clearance to Conduct Formative Research/CNPP

Attachment A-1 Screener (English) clean OCIO 081120

DGA 2020-2025 Survey and Focus Group (English and Spanish)

OMB: 0584-0523

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OMB CONTROL NO.: 0584-0523

EXPIRATION DATE: 11/30/2022


OMB BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-0523 and the expiration date is 11/30/2022. The time to complete this information collection is estimated at 10 minutes per initial screening for non-qualifying participants and 15 minutes per initial screening for qualifying participants. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Services, Braddock Metro Center II, 1320 Braddock Place, Alexandria, VA 22314, ATTN: PRA (0584-0523). Do not return the completed form to this address.


Attachment A-1 Screener (English)

(Pregnant Women)


  • Audience 1: SNAP-eligible (Q10-Q10d), 1st-time moms (Q2), Female (Q1), English-speaking (Q11-Q12), Mixed race/ethnicity (Q5-Q6)

  • Audience 2: SNAP-eligible (Q10-Q10d), Moms with children (Q2), Female (Q1), English-speaking (Q11-Q12), Mixed race/ethnicity (Q5-Q6)

  • Audience 3: Higher income (Q10-Q10d), 1st-time moms (Q2), Female (Q1), English-speaking (Q11-Q12), Mixed race/ethnicity (Q5-Q6)

  • Audience 4: Higher income (Q10-Q10d), Moms with children (Q2), Female (Q1), English-speaking (Q11-Q12), Mixed race/ethnicity (Q5-Q6)

  • Audience 5: SNAP-eligible (Q10-Q10d), 1st-time moms (Q2), Female (Q1), Spanish-speaking (Q5, Q11-Q12)

  • Audience 6: Higher income (Q10-Q10d), Moms with children (Q2), Female (Q1), English-speaking (Q11-Q12), African American (Q6)

  • All audiences to be ages 26-40 (Q7)


All groups recruit 10 to seat six.

Hello, My name is_______________________, and I am calling from Edge Research, a research company in CITY/LOCATION. We are calling on behalf of the United States Department of Agriculture (USDA) Food and Nutrition Service (FNS) Center for Nutrition Policy and Promotion (CNPP) to ask for your participation in a discussion about how USDA can best communicate about nutrition information to people like you. Your participation is voluntary and as a token of our appreciation, we will provide a $90 gift card as an incentive for your participation in a 2-hour discussion on this subject (including 30 minutes to log in). There are no penalties if you chose not to participate. This feedback session will be private, which means that nothing that you say will be seen by anyone other than qualified researchers working on this project, except as otherwise required by law. Your responses will be combined with others and you will never be personally identified.

Are you interested in participating?

IF NO: Thank you and have a great day/evening.

IF YES: Great! First, I need to ask you a few questions to find out if your background meets the needs of this study.


Before the questions, I need to inform you about the process.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-0523 and the expiration date is 11/30/2022. The time to complete this information collection is estimated at 10 minutes per initial screening for non-qualifying participants and 15 minutes per initial screening for qualifying participants. If you have comments on any aspect of this information collection, there is a mailing address to send comment to USDA. Would you like that address? [IF YES: U.S. Department of Agriculture, Food and Nutrition Services, Braddock Metro Center II, 1320 Braddock Place, Alexandria, VA 22314, ATTN: PRA (0584-0523).]



  1. DO NOT READ: RECORD GENDER

  1. Male [THANK AND TERMINATE]

  2. Female


  1. Are you the parent of a child 17 or younger who lives with you, even part-time?

  1. Yes [MUST SELECT TO CONTINUE SCREEN FOR AUDIENCE 2, 4, 6]

  2. No [MUST SELECT TO CONTINUE SCREEN FOR AUDIENCE 1, 3, 5]


  1. Are you currently pregnant or trying to become pregnant within the next year?

    1. Trying to become pregnant within next year [THANK AND TERMINATE]

    2. Currently pregnant [MUST SELECT TO CONTINUE FOR ALL AUDIENCES]

    3. No, none of these [THANK AND TERMINATE]


  1. In what state do you live?
    (DROPDOWN; ONLY ACCEPT
    WA, MD, FL, TX)
    RECRUIT MIX ACROSS STATES TO EXTENT POSSIBLE


  1. Are you Hispanic, Latino or of Spanish descent?

  1. Yes, Hispanic or Latino [CONTINUE SCREEN FOR ALL GROUPS; MUST SELECT FOR AUDIENCE 5]

  2. No, not Hispanic or Latino

  3. Prefer not to answer



  1. Which of the following best describes your race? Select all that apply. [ACCEPT MULTIPLE RESPONSES; RECRUIT A MIX FOR AUDIENCES 1,2,3,4 INCLUDING HISPANIC AND NATIVE AMERICAN]

  1. American Indian or Alaska Native

  2. Asian

  3. Black or African American [MUST SELECT TO CONTINUE FOR AUDIENCE 6]

  4. Native Hawaiian or Other Pacific Islander

  5. White [MAX 4 PER GROUP THAT SELECT WHITE ONLY]



  1. Prefer not to answer [EXCLUSIVE; THANK AND TERMINATE]



  1. Please stop me when I come to the category that includes your age.

  1. Under 18 [THANK AND TERMINATE: Based on the requirements of the study, it looks like we can’t include you at this time. It is possible we will be calling you in the future for other studies.]

  2. 18 – 25 [THANK AND TERMINATE]

  3. 26 – 30

  4. 31 – 35

  5. 36 – 40

  6. 41 or older [THANK AND TERMINATE]

RECRUIT A MIX OF AGES


  1. Please select the category that best represents your living situation:

  1. Live in parent/guardian’s home

  2. Live in dorm/group home

  3. Live with spouse/significant other

  4. Live with children/other family members [CHECK AGAINST PARENT Q2 FOR AUDIENCE 2, 4, 6]


  1. In your household, who is responsible for making choices regarding the food you and your household eat?

  1. I am primary responsible for making choices regarding the food I/my household eats

  2. I share responsibility for making choices regarding the food I/my household eats

  3. Someone else is primarily responsible for making choices regarding the food I/my household eats [THANK AND TERMINATE]


  1. How many people live with you regularly and make up your “household”, including yourself? Please exclude any roommates/boarders/etc. __ __ [NUMERIC 1-99; REQUIRED]



10a. [ASK ONLY TEXAS] What was your approximate annual household income for 2019, before taxes, from all sources? This includes salaries, Social Security, pension, interest, and investment earnings.

SNAP Eligibility:

Household size

Annual Income

1

$16,248.00

2

$21,984.00

3

$27,732.00

4

$33,480.00

5

$39,228.00

6

$44,976.00

7

$50,724.00

8

$56,460.00

IF SNAP ELIGIBLE, CONTINUE FOR GROUPS 1, 2, 5

IF NOT SNAP ELIGIBLE , RECRUIT FOR HIGHER INCOME GROUPS (3, 4, 6)

MUST BE SNAP-ELIGIBLE TO QUALIFY FOR AUDIENCE 1, 2, 5
MUST BE HIGHER INCOME TO QUALIFY FOR AUDIENCE 3, 4, 6


10b. [ASK ONLY MARYLAND] What was your approximate annual household income for 2019, before taxes, from all sources? This includes salaries, Social Security, pension, interest, and investment earnings.

SNAP Eligibility:

Household size

Annual Income

1

$16,248

2

$21,984

3

$27,732

4

$33,480

5

$39,228

6

$44,976

7

$50,724

8

$56,460

IF SNAP ELIGIBLE, CONTINUE FOR GROUPS 1, 2, 5

IF NOT SNAP ELIGIBLE , RECRUIT FOR HIGHER INCOME GROUPS (3, 4, 6)

MUST BE SNAP-ELIGIBLE TO QUALIFY FOR AUDIENCE 1, 2, 5
MUST BE HIGHER INCOME TO QUALIFY FOR AUDIENCE 3, 4, 6



10c. [ASK ONLY FLORIDA] What was your approximate annual household income for 2019, before taxes, from all sources? This includes salaries, Social Security, pension, interest, and investment earnings.

SNAP Eligibility:

Household size

Annual Income

1

$25,520

2

$34,480

3

$43,440

4

$52,400

5

$61,360

6

$70,320

7

$79,280

8

$88,240

IF SNAP ELIGIBLE, CONTINUE FOR GROUPS 1, 2, 5

IF NOT SNAP ELIGIBLE , RECRUIT FOR HIGHER INCOME GROUPS (3, 4, 6)

MUST BE SNAP-ELIGIBLE TO QUALIFY FOR AUDIENCE 1, 2, 5
MUST BE HIGHER INCOME TO QUALIFY FOR AUDIENCE 3, 4, 6



10d. [ASK ONLY WASHINGTON] What was your approximate annual household income for 2019, before taxes, from all sources? This includes salaries, Social Security, pension, interest, and investment earnings.

SNAP Eligibility:

Household size

Annual Income

1

$25,520

2

$34,480

3

$43,440

4

$52,400

5

$61,360

6

$70,320

7

$79,280

8

$88,240

IF SNAP ELIGIBLE, CONTINUE FOR GROUPS 1, 2, 5

IF NOT SNAP ELIGIBLE, RECRUIT FOR HIGHER INCOME GROUPS (3, 4, 6)

MUST BE SNAP-ELIGIBLE TO QUALIFY FOR AUDIENCE 1, 2, 5
MUST BE HIGHER INCOME TO QUALIFY FOR AUDIENCE 3, 4, 6

[ADDITIONAL SCREEN FOR HISPANIC PARTICIPANTS]

  1. What language do you usually speak at home?

  1. Only Spanish

  2. Mostly Spanish

  3. Spanish and English equally

  4. Mostly English

  5. Only English [SKIP TO RESUME ALL QUESTION]



  1. Thinking of your media habits, including television, the internet, social media, radio, and print newspapers and magazines, would you say you use …

  1. Only Spanish language media

  2. Mostly Spanish language media

  3. Spanish and English language media equally

  4. Mostly English language media

  5. Only English language media



MUST BE MOSTLY SPANISH IN MEDIA AND/OR AT HOME (Q11 or Q12 = 1,2) TO QUALIFY FOR SPANISH-SPEAKING AUDIENCE 5. IF EQUAL OR MOSTLY ENGLISH ON BOTH (Q11 and Q12=3-5), MAY QUALIFY FOR AUDIENCE 1,2,3,4,6.


[RESUME ASKING ALL]

  1. For each statement, please tell me whether you strongly agree, somewhat agree, somewhat disagree, or strongly disagree with that statement.

  1. Strongly agree

  2. Somewhat agree

  3. Somewhat disagree

  4. Strongly disagree

  5. Don’t know/Not sure

[RANDOMIZE]

    1. I am confident in my ability to make nutritious eating choices

    2. The people closest to me have nutritious eating habits

    3. I know where to find/purchase nutritious foods near me

    4. Eating food you know is not good for you is fine as long as you have a balanced diet

    5. Nutritious food is expensive

    6. I eat whatever I want, whenever I want

    7. I eat whatever I know my kids/family will eat

RECRUIT FOR A MIX OF ATTITUDES/LIFESTYLE


  1. How familiar are you with each of the following programs from USDA?

  1. Very familiar

  2. Somewhat familiar

  3. Not too familiar

  4. Never heard of/don’t know

[ROTATE]

  1. SNAP” or the Supplemental Nutritional Assistance Program. It is sometimes referred to and formerly known as “Food Stamps”

  2. WIC” or the Special Supplemental Nutrition Program for Women, Infants, and Children 

  3. MyPlate”

MAX 2 PER GROUP OF GROUPS 1, 2, 5 “NEVER HEARD OF” SNAP (Q14A=4)
MIN 2 PER GROUP OF GROUPS 1, 2, 5 “VERY FAMILIAR” WITH SNAP (Q14A=1)


  1. What is your zip code? __ __ __ __ __ __ __ [NUMERIC, RECORD]



  1. In what type of community do you live? [CONFIRM AGAINST ZIP CODE. RECRUIT A MIX REFLECTIVE OF THE CITY/LOCATION]

  1. Urban, which is inside a city

  2. Suburban, which is just outside of a city

  3. Rural, which is farther outside of a city, like in the country [MIN. 4 PER GROUP IN “RURAL” CITY/LOCATIONS]


IF HIGHER INCOME: The discussion we are recruiting for is virtual, meaning that you can participate from the comfort of your own home, but you would need to be in front of a computer with internet access, as well as on a telephone and in a quiet place. Please make sure and confirm that you can be in a quiet place and can commit to the full 2 hours (including 30 minutes to log on) without many interruptions. To better simulate a discussion, you would also need to be visible to the interviewer via a web camera. Someone will call you before the group to help you get set up the webcam and make sure all the technology needed for the discussion is working properly.

IF SNAP ELIGIBLE: The discussion we are recruiting for is virtual, meaning that you can participate from the comfort of your own home, but you would need to be in front of a device with internet access, in a quiet place. Please make sure and confirm that you can be in a quiet place and can commit to the full 2 hours (including 30 minutes to log on) without many interruptions. To better simulate a discussion, you would also need to be visible to the interviewer via a web camera.

ALL: This is for research purposes only, and all of your feedback during the group would be anonymous and private, and the remote connection is safe and secure. To thank you for participating in this study, we will give you a $90 gift card at the end of the group.

  1. Is this something you are interested in and comfortable with?

    1. Yes

    2. No THANK AND TERMINATE



Now, just a couple of questions about your technology usage.

  1. How would you describe your comfort level with using the internet?

  1. Very comfortable

  2. Somewhat comfortable

  3. Neutral

  4. Not that comfortable THANK AND TERMINATE

  5. Not comfortable at all THANK AND TERMINATE

  6. Not sure THANK AND TERMINATE



  1. Do you have a high-speed internet connection that you can use while participating in this research?

  1. Yes CONTINUE

  2. No THANK AND TERMINATE



ASK Q20 AND Q21 IF SNAP ELIGIBLE

  1. What type of device will you be using to participate?

  1. Computer/laptop

  2. Tablet

  3. Phone

  1. Do you have a webcam on your computer, laptop, tablet, or smartphone that you can use for the discussion?

  1. Yes          CONTINUE

  2. No           PLEASE HOLD FOR EDGE REVIEW, IDEALLY ALL RESPONDENTS HAVE WEBCAMS. PRIORITIZE RESPONDENTS WITH WEBCAMS OVER RESPONDENTS WITHOUT WEBCAMS.





Thank you for completing the screening questions. As I mentioned previously, you have been invited to participate in a small discussion group regarding how USDA can best communicate about nutrition information to people like you. Your participation means that you would participate in the 2-hour discussion (including 30 minutes to log on) that will be held virtually on DATE/TIME. As a token of our appreciation, you will receive a $90 gift card upon completion of the group.

Would you still like to participate?


[If Respondent seems uncomfortable, explain, “This information will be used only to send you a confirmation and details for the group.”]

Respondent’s name _____________________________________

Address ______________________________________________

Email Address__________________________________________

Telephone Number: ________________

Alternate Number: ___________________________



Privacy Act Statement:

Legal Authority: The United States Department of Agriculture (USDA) Food and Nutrition Service (FNS) is authorized to collect this information under Section 19 of the Child Nutrition Act of 1966 (42 U.S.C. 1787), Section 5 of the Richard B. Russell National School Lunch Act (42 U.S.C. 1754) and Section 11(f) of the Food and Nutrition Act of 2008 (7 U.S.C.2020).

Purpose: This information will be used in to inform the 2020-2025 Dietary Guidelines for Americans about how Americans make food choices and think about health-related issues.

Routine Use: Information may be disclosed for any routine uses listed in the published System of Record Notice titled FNS-8 USDA/FNS Studies and Reports Federal Register published on April 25, 1991, Volume 56, Number 80, on pages 19078 discusses the terms of protections that will be provided to respondents.; the SORNs can be found at: https://tile.loc.gov/storage-services/service/ll/fedreg/fr056/fr056080/fr056080.pdf.


Disclosure: All information collected will be collected privately and only reported anonymously, without any associated with your information or personal information. Any information which would permit identification of the individual will be safeguarded and will be used only by persons engaged in and for the purpose of the survey, except as otherwise required by law.

Participation in this research is voluntary and there are no penalties for refusing to answer any question. However, your cooperation in obtaining this much needed information is extremely important in order to insure the completeness of the results.





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