Form 6700-009 Filter Adoption Survey

Filter Adoption Survey (Form Number: 6700–009)

This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2008-NEW). Responses to this collection of information are voluntary. 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 public reporting and recordkeeping burden for this collection of information is estimated to 1.25 minutes per response. Send comments on the Agency’s need for this formation, the accuracy of the provided burden estimates and any suggested methods for minimizing respondent burden including through the use of automated collection techniques to the Director, Regulatory Support Division, U.S. Environmental Protection Agency (2821T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.

1. Do you always, or most of the time, use your pitcher provided by Denver Water for drinking water?

· Yes.

· No – I use unfiltered tap water.

· No – I use bottled water or a different type of filtration system certified to remove lead in accordance with NSF/ANSI 53 standards (e.g., fridge, under the sink filter, sink-mounted filter).

2. Do you always, or most of the time, use your pitcher when you are cooking foods where water is a base ingredient (examples: making rice, beans, soup)?

· Yes

· No

2a. If your answer to No. 2 above is no, why are you not using the pitcher for cooking?

· Prefer to use unfiltered tap water.

· Prefer to use bottled water for cooking food.

· Prefer to use a different type of filtration system certified to remove lead in accordance with NSF/ANSI 53 standards (e.g., fridge filter, under the sink filter, sink-mounted filter).

· Do not cook.

· Other ___________________________

3. Do you have a formula-fed infant (under 24 months of age) in your household?

· Yes

· No

3a. If yes, what water do you always use to mix the formula (select all that apply)?

· Not applicable (I don’t feed formula to my infant, or use pre-mix/ready mix)

· Water from the pitcher filter

· Bottled water

· Water filtered by an alternative filter device (fridge filter, under the sink filter, sink-mounted filter or other filter) certified to remove lead in accordance with NSF/ANSI 53 standards

· Unfiltered tap water

4. Have you or will you be replacing the pitcher’s filter with the Denver Water provided replacement filters as recommended by the manufacturer?

· Yes

· No

o If no, why not? (please describe)

5. The filter manufacturer recommends hand-washing the pitcher with a mild detergent. Are you cleaning your pitcher as recommended by the manufacturer?

· Yes

· No

6. What would make you more likely to use the pitcher provided? (Check all that apply)

¨ Larger pitcher

¨ Lighter pitcher

¨ Pitcher that fits in the refrigerator

¨ Pitcher that takes less time to fill

¨ Pitcher that takes less effort to use

¨ Not interested in filtering drinking water

¨ Do not cook or use tap water for cooking

¨ Other, please specify: (fill in the blank)

The questions below are optional. Denver Water will only use your demographic information for research purposes and to better inform our outreach and communication activities.

7a. Are you of Hispanic, Latino, or of Spanish origin?

Yes

No

7 b. How would you describe yourself? (Check all that apply)

White

Black or African American

Native American or Alaska Native

Asian

Native Hawaiian and Other Pacific Islander

Multi-racial

Other (specify)

I do not know

Prefer not to say

8. What is the age of the youngest person in your household?

Someone in the household is expecting

Under 2 years old

2-6 years old

7-17 years old

18-24 years old

25-34 years old

35-44 years old

45-54 years old

Over 55 years old

Prefer not to say

9. What is the primary language of your household? (Check all that apply)

English

Spanish

Other (specify)

Prefer not to say

10. How much total combined money did all members of your household earn in 2018 (gross income)?

$0-$29,999

$30,000-49,999

$50,000-79,999

$80,000-99,999

$100,000 or more

Prefer not to say

11. What is the highest level of school you have completed, or the highest degree you have received?

Less than high school degree

High school degree or equivalent (e.g., GED)

Some college but no degree

Associate degree

Bachelor’s degree

Graduate degree

Prefer not to say

12. To which gender identity do you most identify?

Female

Male

Other

Prefer not to say