Appendix 17 Web Retrieval Survey Examples

Participation is voluntary and your information will be kept confidential. The information will be used to analyze travel behaviors of US. Public. Estimated reporting burden is 13 minutes including the time
to review instructions, search existing data sources, gather and maintain the data needed, and complete and review 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 current valid OMB control number. The OMB control number for this collection is 2125-0545. Comments or suggestions regarding
any aspect of burden, collection of information may be sent to: Michael Howell, Information Collection Clearance Officer, Federal Highway Administration, 202 366-5707, [email protected], 1200
New Jersey Avenue, SE, Washington, DC 20590.

WEB RETRIEVAL SURVEY: EXAMPLES OF QUESTIONS
This Appendix provides screen shots of select questions from the Retrieval Survey. They show how the
questions will appear when respondents access the web to complete the Retrieval Survey.
The example below displays the person roster. This information was initially collected during the
Recruitment Survey. Households are asked to review the information displayed and update it if needed.

The example below displays how questions that use the Likert Scale will appear on the web. This screen
display a 5 point Likert Scale ranging from “daily” to “never”.

This screen displays examples of two other types of questions. The first question captures just a value.
Whereas, the second question allows respondents to provide multiple responses.

This screen is designed to allow the respondent to list all the places they went to on their assigned travel
day. In the example below, the respondent has recorded 3 trips so far.