RDD Push to Web Recruitment

Form Approved

OMB No. 0920-1291

Exp. Date 3/31/2023

Attachment 2

RDD Push-to-Web Screening and Recruitment Text

for use by

Feasibility Testing for Collection of BRFSS Supplemental Data Using Web-Based Methods

GenIC Submitted Under

Cognitive Testing and Pilot Testing for the National Center for Chronic Disease Prevention and Health Promotion

OMB Control Number: 0920-1291 Expiration 3/31/3023

OMB Header

Read if necessary	Read	Interviewer instructions (not read)
Public reporting burden of this collection of information is estimated to average 27 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 (0920-1061).		Form Approved OMB No. 0920-1291 Exp. Date 3/31/2021 Interviewers do not need to read any part of the burden estimate nor provide the OMB number unless asked by the respondent for specific information. If a respondent asks for the length of time of the interview provide the most accurate information based on the version of the questionnaire that will be administered to that respondent. If the interviewer is not sure, provide the average time as indicated in the burden statement. If data collectors have questions concerning the BRFSS OMB process, please contact Carol Pierannunzi at [email protected].
	HELLO, I am calling for the [STATE OF xxx] Department of Health. My name is (name). We are gathering information about the health of US residents. This project is conducted by the health department with assistance from the Centers for Disease Control and Prevention. Your telephone number has been chosen randomly, and I would like to ask if you would be willing to participate by taking an online survey on health status.

Cell Phone Recruitment Text

Question Number	Question text	Variable names	Responses (DO NOT READ UNLESS OTHERWISE NOTED)	SKIP INFO/ CATI Note	Interviewer Note (s)	Column(s)
CP01.	Is this a safe time to talk with you?	SAFETIME	1 Yes	Go to CP02
			2 No	([set appointment if possible]) TERMINATE]	Thank you very much. We will call you back at a more convenient time.
CP02.	Is this [PHONE NUMBER]?	CTELNUM1	1 Yes	Go to CP03
			2 No	TERMINATE
CP03.	Is this a cell phone?	CELLFON5	1 Yes	Go to CADULT1
			2 No	TERMINATE	If "no”: thank you very much, but we are only interviewing persons on cell telephones at this time
CP04.	Are you 18 years of age or older?	CADULT1	1 Yes
			2 No	TERMINATE	Read: Thank you very much but we are only interviewing persons aged 18 or older at this time.
CP05.	Are you male or female?	CELLSEX	1 Male 2 Female
			7 Don’t Know/ Not sure 9 Refused	TERMINATE	Thank you for your time, your number may be selected for another survey in the future.
CP06.	Do you live in a private residence?	PVTRESD3	1 Yes	Go to CP08	Read if necessary: By private residence we mean someplace like a house or apartment Do not read: Private residence includes any home where the respondent spends at least 30 days including vacation homes, RVs or other locations in which the respondent lives for portions of the year.
			2 No	Go to CP07
CP07.	Do you live in college housing?	CCLGHOUS	1 Yes	Go to CP08	Read if necessary: By college housing we mean dormitory, graduate student or visiting faculty housing, or other housing arrangement provided by a college or university.
			2 No	TERMINATE	Read: Thank you very much, but we are only interviewing persons who live in private residences or college housing at this time.
CP08.	Do you currently live in___(state)____?	CSTATE1	1 Yes	Go to CP09
			2 No	Terminate	Thank you, but at this time, we are only asking for information from residents of [STATE].
CP09			Thank you. You have qualified for the survey. May I send you a text link to access the questionnaire?
CP10			Is this the correct phone number to send the link?