Customer Screener Survey

NAXION Study # U002-XX-XXX

Date

SCREENER

UNITED STATES MINT CUSTOMERS – City A

ask TO SPEAK TO PERSON NAMED on list

GET A MIX

GET A MIX

( ) female

( ) male

FROM LIST

( )	High Spend (“$500+”)		GET A MIX
( )	Mid Spend (“$100 - $499.99”)
( )	Low Spend (“$.01-$99.99”)

RESPONDENT NAME:

ADDRESS:

CITY/STATE: ZIP CODE:

TELEPHONE #: FAX #:

GROUP SCHEDULE

Attending:

Date

Group 1( ) 6:00 PM – 8:00 PM – General U.S. Mint Customers

Date

Group 2 ( ) 8:00 PM – 10:00 PM – General U.S. Mint Customers

SUGGESTED INTRODUCTION: Hello, I'm __________________________ calling for NAXION, a marketing research firm based in Philadelphia. This is not a sales call. We are conducting a research study for The United States Mint, and are inviting people who meet certain qualifications to participate in an informal group discussion on (DAY/DATE).

Are you free on that date?

Yes ( )

No ( ) THANK AND TERMINATE

I’d like to ask you a few questions. This survey is strictly voluntary. We are also required, by law, to report to you the OMB Control Number for this public information request. That number is OMB#1525-0012-XXXX.

1. Do you, or does anyone in your household or family, own or work for? (READ AND SELECT ALL THAT APPLY)

Yes No

A) A coin dealer, or a retail store that sells coins? ( ) ( )

B) A newspaper, radio station, or television station? ( ) ( )

C) The United States Mint? ( ) ( )

D) An advertising agency? ( ) ( )

E) A market research company? ( ) ( )

F) A company that manufactures or markets ( ) ( )

collectible items (dolls, cards, memorabilia, etc.)?

IF "YES" TO ANY THANK AND TERMINATE

2. Have you ever attended a group discussion for market research purposes or participated in an over-the-phone research interview?

Yes ( )

___________________________________

No ( ) SKIP TO Q.4

3. When was the last time you did so?

MONTH YEAR

TERMINATE IF WITHIN THE PAST 6 MONTHS

4a. In the past year, have you sold any U.S. coins for income purposes other than to round out a personal collection?

Yes ( )

__________________________________________

No ( ) SKIP TO Q5

4b. To confirm, are you a coin dealer?

Yes ( ) THANK AND TERMINATE

__________________________________________

No ( )

5. When was the first time that you purchased coins or coin-related items from the United States Mint? Was it: (READ. CHECK APPROPRIATE BOX.)

Within the past 12 months,	( )	SKIP TO Q.7
1 to 2 years ago,	( )
3 to 4 years ago, or	( )
More than 4 years ago?	( )

TRY TO RECRUIT 1-2 “Within the past 12 months” PER GROUP

6. When was the most recent time that you purchased coins or coin-related items from the United States Mint? Was it: (READ. CHECK APPROPRIATE BOX.)

Within the past 12 months,			( )
1 to 2 years ago,			( )
3 to 4 years ago, or			( )		THANK AND TERMINATE
More than 4 years ago?			( )		THANK AND TERMINATE

7. In the past year, which of the following items, if any, did you purchase from the United States Mint? (READ AND CHECK ALL THAT APPLY.)

		Yes
A.	Annual Proof – Full Set	( )
B.	Annual Silver Proof – Full Set	( )
C.	Annual Uncirculated – P and D Set	( )
D.	American Eagle Silver Coins	( )
E.	Other United States Mint Products	( )

RECRUIT AT LEAST 7 ANSWERING “YES” TO “A”

RECRUIT AT LEAST 7 ANSWERING “YES” TO “B”

RECRUIT AT LEAST 7 ANSWERING “YES” TO “C”

RECRUIT AT LEAST 7 ANSWERING “YES” TO “D”

TRY TO RECRUIT AT LEAST 7 RESPONDENTS WHO PURCHASED FROM TWO OR MORE OF THESE CATEGORIES

IF A CUSTOMER ANSWERS “YES” ONLY TO “E” (Other), THANK AND TERMINATE.

8. Were these purchases: (READ AND CHECK ALL THAT APPLY.)

A. For yourself?	( )
B. For a gift?	( )
C. Both?	( )

IF A “$500+ CUSTOMER” ANSWERS “YES” ONLY TO B, CONTINUE THROUGH THE REST OF THE SCREENER AND TERMINATE AT END OF SCREENER.

9. Is your age: (READ. CHECK APPROPRIATE BOX.)

Under 18,	( )	TERMINATE AT END OF SCREENER
18 to 30,	( )	GET
31 to 39,	( )	AN
40 to 49,	( )	EVEN
50 to 59,	( )	MIX
60 to 70, or	( )	NO MORE THAN ONE PER GROUP
Over 70?	( )	TERMINATE AT END OF SCREENER

10. The United States Mint is interested in getting the opinions of people of diverse cultural backgrounds, and we would like to ask you a few questions about your background. (READ)

Are you Latino or Hispanic Yes ( ) No ( )

___________________________________________________________________________

What is your race? Please select one or more. (READ)

American Indian or Alaska Native	( )	GET
Asian	( )
Black or African-American	( )	A
Native Hawaiian or other Pacific Islander, or	( )
White?	( )	MIX
_____________________________________________________________
(DO NOT READ) Prefer not to answer.	( )

11. The interview will be recorded for quality control purposes and may be reviewed by others. In rare circumstances, NAXION may include an anonymous audio or video clip of a portion of your interview within the report to the client.

If selected to participate, do you agree to have the group discussion recorded and/or listened to/viewed by others?

Yes ( )

__________________________________________

No ( ) THANK AND TERMINATE

EXTEND INVITATION TO ELIGIBLE RESPONDENT AND RECORD INFORMATION ON FRONT. We'd like to invite you to participate in this research project.

You will receive an honorarium of $XX for your participation.

Note to recruiters: As part of our ISO certification, we require that the following be read to each respondent.

Thank you for your time. If you are selected, we look forward to having a discussion with you regarding the United States Mint. We want to remind you that your participation is voluntary and will not be used in an attempt to sell you anything. Further, it is NAXION’s policy to keep interviews anonymous and responses confidential. At no stage will your name or other identifying information be associated with your responses.

For further information on NAXION’s privacy policy, you can visit their website at http://www.naxionthinking.com/privacy-policy/naxion-research-participant-privacy-notice. You can also view their incentive statement at www.naxionthinking.com/incentive-statement. Please let us know if you have any questions or concerns.

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