Non-Customer Screener Survey

NAXION Study #U002-XX-XXX

Date

SCREENER

NON-CUSTOMERS – City B

IDENTIFY MALE OR FEMALE 18 TO 69 YEARS OF AGE

BY OBSERVATION CHECK ONE

( ) female

( ) male

RESPONDENT NAME:

ADDRESS:

CITY/STATE: ZIP CODE:

TELEPHONE #: FAX #:

GROUP SCHEDULE

Attending:

Date

Group 1 ( ) 6:00 PM – 8:00 PM – General Non-Customers

Group 2 ( ) 8:00 PM – 10:00 PM – General Non-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 PAST 6 MONTHS

4. In the past year, have you sold any U.S. coins for income purposes other than to round out a personal collection? (IF NECESSARY, PROBE: Are you a coin dealer?)

Yes ( ) THANK AND TERMINATE

__________________________________________

No ( )

5. Have you ever purchased U.S. coins or other merchandise directly from the United States Mint?

Yes ( ) TERMINATE

__________________________________________

No ( )

6. In the past two years, have you purchased U.S. coins?

Yes ( )

__________________________________________

No ( ) SKIP TO Q.8

7. From which sources have you purchased U.S. coins? (READ AND SELECT ALL THAT APPLY)

		Yes	No
A.	Coin dealers?	( )	( )
B.	Internet auctions?	( )	( )
C.	Flea markets?	( )	( )
D.	Other? (please specify)	( )	( )

8. Do you currently collect, occasionally save, or sometimes put aside… (READ AND SELECT ALL THAT APPLY)

A. America the Beautiful quarters?	( )
B. 50-state quarters?	( )
C. Other current U.S. coins?	( )
______________________________________________________
D. Stamps?	( )
E. Cards (e.g., baseball cards, etc.)?	( )
F. Military items/historical memorabilia?	( )
G. Small, other collectibles?	( )
H.   Other (Specify ________________)?	( )
I. None	( )

IF ONLY ITEMS FROM “D-I” SELECTED, SKIP TO Q.10

9. How many months or years have you collected or saved U.S. coins?

_______________________ ______________________

RECORD # OF MONTHS OR RECORD # OF YEARS

GET A MIX

10. Please indicate how likely or unlikely you would be to buy U.S. coins or U.S. collectible coins in the next 12 months either for yourself or as a gift using a scale from “1” to “6” where “1” means “Not at all Likely” and ”6” means “Extremely Likely.”

_______________________

RECORD NUMBER

MUST HAVE MIX OF “4” THROUGH “6”

11. 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.	( )

12. Is your age: (READ)

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 69, or ( ) NO MORE THAN ONE PER GROUP ______________________________________________________

Over 70? ( ) TERMINATE AT END OF SCREENER

13. 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. We look forward to having a discussion with you regarding the U.S. Mint. We want to assure you that it is NAXION’s policy to keep interviews anonymous and responses secured. The information you provide during the interview will be reported in aggregate and at no stage will your name or other identifying information be associated with your responses.

The interview may be recorded or viewed 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.

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 about your upcoming appointment with NAXION.