Internet Panel Recruitment

Form Approved

OMB No. 0920-1291

Exp. Date 3/31/2023

Attachment 3:

Internet Panel Recruitment

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

Filters for persons included in the commercially available internet panel:

1. 18 years or older

2. Private residence or college housing (By private residence we mean someplace like a house or apartment. By college housing we mean dormitory, graduate student or visiting faculty housing, or other housing arrangement provided by a college or university.)

3. Currently live in one of the states included in the project (NY, TX, WA, ID, IL, LA, FL, IA, NM, and RI)

Introductory Script:

HELLO, I am a (name) with (contractor name) working with Centers for Disease Control and Prevention. We are gathering information about the health of US residents. You have been selected from among persons included in [internet panel name], and I would like to ask some questions about health and health practices.

The next few questions are to determine your eligibility.

1. Do you live in a private residence or college housing?

[By private residence we mean someplace like a house or apartment. By college housing we mean dormitory, graduate student or visiting faculty housing, or other housing arrangement provided by a college or university.[

2. Do you currently live in__(state)____?

3. Are you 18 years of age or older?