Form CMS-10816 Recruitment Script

Attachment A: Recruitment Script
Recruitment Script

Hello. My name is [NAME] and I work for NORC at the University of Chicago. I’m calling
about an opportunity to participate in an interview on enrolling in a Medicare Advantage or
Prescription Drug plan. The interview will take no more than 45 minutes and you will receive
$75 for participating in this interview. Is this a good time?
[IF YES] Let me tell you a little bit about what we are going to do and then you can let me know
if you are still interested. First, are you 18 years or older? [IF NO, let individual know we are
only interviewing people aged 18 or older and thank them for interest]
[IF YES] We are conducting this study to improve the way information is collected on race and
ethnicity when people enroll in a Medicare Advantage (Part C) or Prescription Drug (Part D)
plan.
If you agree to participate in this interview, we will ask you to speak with an interviewer who
will ask you some questions about when you completed your enrollment form. Some people may
view some of the questions the interviewer asks as sensitive – the questions you will be asked
range from how you answered the questions on the enrollment form to what you think about the
different types of questions.
Would you like to participate?
[IF YES] Great. I am going to ask you a few background questions to confirm that you
are eligible to participate. Then we can schedule an appointment time for you.  GO TO
ELIGIBILITY SCREENER QUESTIONNAIRE
[IF NO] That's okay. We appreciate your time. But for research purposes, we would like
to know why you are choosing not to participate. NOTE TO RECRUITER: IF
POTENTIAL RESPONDENT DECIDES AFTER HEARING ABOUT THE STUDY
THAT HE/SHE DOES NOT WANT TO PARTICIPATE, ASK WHY NOT AND
OFFER TO ANSWER QUESTIONS. RECORD THE RESPONDENT’S REASONS
FOR NOT PARTICIPATING BELOW:
Thank you. Have a nice day.
Notes: