Form 5800-015 Final Screener

OMB No: 2010-0042

Exp. Date: 3/31/2021

Pretesting Outreach and Web Materials for Fish Consumption Advisories

Final Screener

December 10, 2020

This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 201711-2010-001). Responses to this collection of information are voluntary (authorized under 42 USC 241, Section 301 of the Public Health Service Act and Public Health Service Act 308). 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 5 minutes per response. Send comments on the Agency’s need for this information, the accuracy of the provided burden estimates and any suggested methods for minimizing respondent burden to the Regulatory Support Division Director, 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.

Draft Screener

Introduction

Hello, my name is ____________________. I am working with RTI International, a nonprofit research organization. We are not selling anything. The Environmental Protection Agency or EPA, a federal government agency, has hired us to get feedback on pictures that are being developed about eating fish.

For in-person individual interviews: If you are interested in participating, we would ask you to sit down, look at the pictures, and answer some questions about what you think of the pictures. The purpose of the interviews is to gather feedback to improve the pictures before a lot of people see them. The interviews will take no more than 20 minutes and we will give you a $20 gift card as a token of our appreciation.

For in-person group interviews: If you are interested in participating, we would ask you to participate in a group interview. During the group discussion, we will look at the pictures and discuss them as a group. The purpose of the interviews is to gather feedback to improve the pictures before a lot of people see them. The interviews will take no more than 60 minutes and we will give you a $50 gift card as a token of our appreciation.

For virtual individual interviews: If you are interested in participating, we will ask you to participate in an online call using Zoom. During the interview, we will show you the pictures on screen and then we will ask you to answer some questions about what you think of them. The purpose of the interviews is to gather feedback to improve the pictures before a lot of people see them. The interviews will take no more than 20 minutes and we will give you a $20 digital gift card as a token of our appreciation.

For virtual group interviews: If you are interested in participating, we will ask you to participate in a group interview online using Zoom. During the group discussion, we will show the pictures on the screen and discuss them as a group. The purpose of the interviews is to gather feedback to improve the pictures before a lot of people see them. The interviews will take no more than 60 minutes and we will give you a $50 digital gift card as a token of our appreciation.

Before we go any further, I need to ask you a few questions to see if you are eligible to participate. May I ask you the questions now?

What sex were you assigned at birth on your original birth certificate?

1. Male

2. Female

3. Refused

4. I don’t know

1. Do you currently describe yourself as male, female, or transgender?

   1. Male

   2. Female

   3. Transgender

   4. None of these

2. What is your age?

   1. ______________ [Interviewer records age]

   2. Prefer not to answer.

[Must be age 18 years or older to participate. If prefer not to answer or under age 18, skip to Closing for ineligible participants]

4. Do you eat fish?

   1. Yes

   2. No

   3. Prefer not to answer

5. Do you ever catch fish to eat or share with others?

   1. Yes

   2. No

   3. Prefer not to answer

6. Do you ever buy or receive locally caught fish to eat?

   1. Yes

   2. No

   3. Prefer not to answer

7. Do you ever prepare (clean, gut, skin or fillet) fish to eat?

   1. Yes

   2. No

   3. Prefer not to answer

[Must answer “Yes” to Q 5, 6 or 7 to be eligible. Otherwise, skip to Closing for ineligible participants]

8. What is your primary language? This would be the language that you use when talking with your family or friends.

   1. English

   2. Spanish

   3. Tagalog

   4. Hmong

   5. Vietnamese

   6. Chinese

   7. Korean

   8. Arabic

   9. French

   10. Cambodian

   11. Portuguese

   12. Russian

   13. German

   14. Haitian Creole

   15. Hindi

   16. Italian

   17. Polish

   18. Other [specify] _____________________ [Interviewer records language]

   19. Prefer not to answer

9. Are you the parent, guardian or primary caretaker of a child under age 11?

   1. Yes

   2. No

   3. Prefer not to answer

[Question 10 and 11 for women only; Skip to Invitation for male participants]

10. Are you currently pregnant?

    1. Yes [Skip to Invitation]

    2. No

    3. Don’t know

    4. Prefer not to answer

11. Are you planning or hoping to get pregnant within the next year?

    1. Yes

    2. No

    3. Prefer not to answer

Closing for Ineligible Individuals

Thank you for answering my questions. I’m sorry, you are not eligible to participate. The eligibility criteria were determined in advance by the study team. Thank you for being willing to help us.

Invitation and Follow-Up Scripts for Eligible Participants

See next page

In-Person Individual Interviews

Invitation to Participate (Phone after completing screener)

Thank you for answering my questions. I would like to invite you to participate in an in-person individual interview. The interview will take place at [LOCATION] and will last no more than 20 minutes. The interview will be audio recorded. The recording will be kept on a password protected computer accessible only to study staff. You will receive a $20 gift card after your interview as a token of our appreciation.

Are you interested in being in this study?

Yes  CONTINUE

No  [Thank respondent and end call]

Great, right now we have openings on [READ DATES/TIMES]. What time works best for you?

SCHEDULE DATE/TIME

I have you scheduled for an in-person interview on [DATE/TIME] at [LOCATION]. I will send you a confirmation email with this information later today.

Thank you. Goodbye.

Confirmation Email

Subject: EPA Fish Study

Dear <NAME>:

Thank you for agreeing to participate in an individual interview for the EPA Fish Study. We have you scheduled for an interview on [DATE/TIME] at [LOCATION]. The interview will last no more than 20 minutes and you will receive a $20 gift card as a token of our appreciation.

If you have any questions, or need to reschedule, please contact me at [PHONE] or you can reply to this email.

Thank you and we look forward to your participation!

Reminder Email

Subject: EPA Fish Study: Interview Reminder

Dear <NAME>:

Thank you for agreeing to participate in an interview for the EPA Fish Study. Your interview is scheduled to take place on [DATE/TIME] at [LOCATION]. If you have any questions, or need to reschedule, please contact me at [PHONE] or you can reply to this email.

Phone Reminder

Hi, my name is [NAME] and I’m calling to remind you that we have you scheduled for an interview for the EPA Fish Study on [DATE/TIME] at [LOCATION]. If you have any questions, or need to reschedule, please contact me at [PHONE NUMBER]. Thank you.

In-Person Group Interview

Invitation to Participate (Phone after completing screener)

Thank you for answering my questions. I would like to invite you to participate in an in-person group interview. It will involve participating in a discussion with 6 or 7 other people. The interview will take place at [LOCATION] and will last no more than 60 minutes. The interview will be audio recorded. The recording will be kept on a password protected computer accessible only to study staff. You will receive a $50 gift card after your interview as a token of our appreciation.

Are you interested in being in this study?

Yes  CONTINUE

No  [Thank respondent and end call]

Great, right now we have openings on [READ DATES/TIMES]. What time works best for you?

SCHEDULE DATE/TIME

I have you scheduled for an in-person interview on [DATE/TIME] at [LOCATION]. I will send you a confirmation email with this information later today.

Thank you. Goodbye.

Confirmation Email

Subject: EPA Fish Study

Dear <NAME>:

Thank you for agreeing to participate in an individual interview for the EPA Fish Study. We have you scheduled for a group interview on [DATE/TIME] at [LOCATION]. The interview will last no more than 50 minutes and you will receive a $50 gift card as a token of our appreciation.

If you have any questions, or need to reschedule, please contact me at [PHONE] or you can reply to this email.

Thank you and we look forward to your participation!

Reminder Email

Subject: EPA Fish Study: Interview Reminder

Dear <NAME>:

Thank you for agreeing to participate in a group interview for the EPA Fish Study. Your interview is scheduled to take place on [DATE/TIME] at [LOCATION]. If you have any questions, or need to reschedule, please contact me at [PHONE] or you can reply to this email.

Phone Reminder

Hi, my name is [NAME] and I’m calling to remind you that we have you scheduled for a group interview for the EPA Fish Study on [DATE/TIME] at [LOCATION]. If you have any questions, or need to reschedule, please contact me at [PHONE NUMBER]. Thank you.

Virtual Individual Interview

Invitation to Participate (Phone after completing screener)

Thank you for answering my questions. I would like to invite you to participate in a virtual interview. The interview will last no more than 20 minutes. In order to participate, you will need a stable internet connection. We will be showing material on screen, so using a computer is best [CALLER NOTE: A TABLET WILL ALSO WORK, BUT WE’D LIKE TO AVOID USE OF MOBILE PHONES]. The interview will be audio recorded. The recording will be kept on a password protected computer accessible only to study staff. You will receive a $20 digital gift card within 5 days of your interview as a token of our appreciation.

Are you interested in being in this study?

Yes  CONTINUE

No  [Thank respondent and end call]

Great, right now we have openings on [READ DATES/TIMES]. What time works best for you?

SCHEDULE DATE/TIME

I have you scheduled for a virtual interview on [DATE/TIME]. I will send you a confirmation email with information on how to access the interview later today.

Thank you. Goodbye.

Confirmation Email

Subject: EPA Fish Study

Dear <NAME>:

Thank you for agreeing to participate in a virtual interview for the EPA Fish Study. Detailed in this email are some general instructions, followed by specific information needed to participate in the interview.

Your interview is scheduled to take place on [DATE/TIME]. The interview will be conducted online using Zoom, a video and audio platform. You can access Zoom from any web browser using the link listed below. For audio, you can use either your computer or a phone. After you login into Zoom using the link provided below, you will be given the option of using your computer for the audio, inputting your phone number for Zoom to call you, or you can call the phone number listed below. You will then be connected to the interview.

Meeting ID:

Link:

Phone:

Please keep this information accessible for your interview.

Your interview is scheduled for 20 minutes. Please plan to login at least 5 minutes prior to your interview to make sure that you don’t have any technical difficulties.

In appreciation for your time, you will receive a $20 digital gift card by email within five days of completing the interview.

If you need to cancel, please let us know as soon as possible by replying to this email or by phone: [PHONE NUMBER].

Thank you and we look forward to your participation!

Reminder Email

Subject: EPA Fish Study: Interview Reminder

Dear <NAME>:

Thank you for agreeing to participate in a virtual interview for the EPA Fish Study. Your interview is scheduled to take place on [DATE/TIME]. Instructions for logging into the interview are included below. If you have any questions, or need to reschedule, please contact me at [PHONE] or you can reply to this email.

Instructions for Logging into Your Interview

The interview will be conducted online using Zoom, a video and audio platform. You can access Zoom from any web browser using the link listed below. For audio, you can use either your computer or a phone. After you login into Zoom using the link provided below, you will be given the option of using your computer for the audio, inputting your phone number for Zoom to call you, or you can call the phone number listed below. You will then be connected to the interview.

Meeting ID:

Link:

Phone:

Phone Reminder

Hi, my name is [NAME] and I’m calling to remind you that we have you scheduled for a virtual interview for the EPA Fish Study on [DATE/TIME]. If you have any questions, or need to reschedule, please contact me at [STUDY PHONE NUMBER]. Thank you.

Virtual Group Interview

Invitation to Participate (Phone after completing screener)

Thank you for answering my questions. I would like to invite you to participate in a virtual group interview. The interview will last no more than 60 minutes. In order to participate, you will need a stable internet connection. We will be showing material on screen, so using a computer is best [CALLER NOTE: A TABLET WILL ALSO WORK, BUT WE’D LIKE TO AVOID USE OF MOBILE PHONES]. The interview will be audio recorded. The recording will be kept on a password protected computer accessible only to study staff. You will receive a $50 digital gift card within 5 days of your interview as a token of our appreciation.

Are you interested in being in this study?

Yes  CONTINUE

No  [Thank respondent and end call]

Great, right now we have openings on [READ DATES/TIMES]. What time works best for you?

SCHEDULE DATE/TIME

I have you scheduled for a virtual group interview on [DATE/TIME]. I will send you a confirmation email with information on how to access the interview later today.

Thank you. Goodbye.

Confirmation Email

Subject: EPA Fish Study

Dear <NAME>:

Thank you for agreeing to participate in a virtual group interview for the EPA Fish Study. Detailed in this email are some general instructions, followed by specific information needed to participate in the interview.

Your interview is scheduled to take place on [DATE/TIME]. The interview will be conducted online using Zoom, a video and audio platform. You can access Zoom from any web browser using the link listed below. For audio, you can use either your computer or a phone. After you login into Zoom using the link provided below, you will be given the option of using your computer for the audio, inputting your phone number for Zoom to call you, or you can call the phone number listed below. You will then be connected to the interview.

Meeting ID:

Link:

Phone:

Please keep this information accessible for your interview.

Your interview is scheduled for 50 minutes. Please plan to login at least 10 minutes prior to your interview to make sure that you don’t have any technical difficulties.

In appreciation for your time, you will receive a $50 digital gift card by email within five days of completing the interview.

If you need to cancel, please let us know as soon as possible by replying to this email or by phone: [PHONE NUMBER].

Thank you and we look forward to your participation!

Reminder Email

Subject: EPA Fish Study: Interview Reminder

Dear <NAME>:

Thank you for agreeing to participate in a virtual group interview for the EPA Fish Study. Your interview is scheduled to take place on [DATE/TIME]. Instructions for logging into the interview are included below. If you have any questions, or need to reschedule, please contact me at [PHONE] or you can reply to this email.

Instructions for Logging into Your Interview

The interview will be conducted online using Zoom, a video and audio platform. You can access Zoom from any web browser using the link listed below. For audio, you can use either your computer or a phone. After you login into Zoom using the link provided below, you will be given the option of using your computer for the audio, inputting your phone number for Zoom to call you, or you can call the phone number listed below. You will then be connected to the interview.

Meeting ID:

Link:

Phone:

Phone Reminder

Hi, my name is [NAME] and I’m calling to remind you that we have you scheduled for a group interview for the EPA Fish Study on [DATE/TIME]. If you have any questions, or need to reschedule, please contact me at [STUDY PHONE NUMBER]. Thank you.

EPA Form Number: 5800-015