0920-24CX Eligible Participant Screener

Form Approved

OMB No. 0920-1154

Exp. Date: 3/31/26

Eligible Participant Screener for Focus Group (to be conducted over the phone by recruiter)

Good news. You are eligible to participate in this project.

If you agree to participate in this project, we will ask you to take part in a web-based focus group. We will ask a series of questions about water safety. This focus group will take about 60 minutes. To thank you for your time, you will receive a $75 gift card for your participation.

Do you have any questions?

Are you interested in participating in the focus group?

□ Yes (CONTINUE)

□ No, okay, thank you for your time today. (STOP HERE)

CONFIRM NAME, DEMOGRAPHICS, EMAIL, AND PHONE

1. Could you please spell your first and last name?

I have a few additional questions to ensure we get a good mix of participants in this study.

2. In what ZIP code do you currently live? [ENTER FIVE DIGIT ZIP CODE]

3. Do you live within 10 miles of a freshwater body, such as a lake, reservoir, or river?

   1. Yes

   2. No

   3. I don’t know

   4. Prefer to not answer

4. Are you the parent or caregiver of any children (0-18 years) who currently live in your household?

   1. Yes [IF YES, ASK QUESTION 5]

   2. No [IF NO, SKIP TO QUESTION 6]

   3. Prefer to not answer [SKIP TO QUESTION 6]

5. Do you visit freshwater bodies in the summer months with your children?

   1. Yes

   2. No

   3. Prefer to not answer

6. Do you own or take care of any dogs?

   1. Yes [IF YES, ASK QUESTION 7]

   2. No [IF NO, SKIP TO QUESTION 8]

   3. Prefer to not answer [SKIP TO QUESTION 8]

7. Do you visit freshwater bodies, like lakes, ponds, or rivers, in the summer months with dog(s) you own or take care of?

   1. Yes

   2. No

   3. Prefer to not answer

8. On a scale of 1-10, how familiar are you with harmful algal blooms (HABs)? [where 1 means you are not familiar at all, and 10 means that you are extremely familiar]

9. Are you: Mark all that apply

   1. Female

   2. Male

   3. Transgender, non-binary, or another gender

   4. Prefer not to answer/Decline

10. Which of the following best describes your ethnicity?

1. Hispanic or Latino

2. Not Hispanic or Latino

3. Prefer not to answer/Decline

11. Which of the following best describes your race? [Please select one or more as applicable].

1. American Indian or Alaska Native

2. Asian

3. Black or African American

4. Native Hawaiian or Other Pacific Islander

5. White

6. Prefer not to answer/Decline

12. What is the highest level of education you have completed?

1. Some high school

2. High school diploma

3. Some college or associate's degree

4. Bachelor’s degree

5. Advanced degree

6. Prefer not to answer/Decline

13. What is your current occupational status? Would you say…?

    1. Employed full time

    2. Employed part time

    3. Unemployed

    4. Stay at home parent

    5. Student

    6. Retired

    7. Disabled

    8. Other:_______________

    9. Don’t Know/Not Sure [DO NOT READ]

    10. Prefer not to answer

14. Last year, in 2023, what was your total household income from all sources, before taxes?

    1. Less than $15,000

    2. $15,000 to $24,999

    3. $25,000 to $34,999

    4. $35,000 to $49,999

    5. $50,000 to $74,999

    6. $75,000 to $99,999

    7. $100,000 to $149,999

    8. $150,000+

    9. Prefer not to answer

15. Do you have any of the following conditions?

    1. Inflammatory bowel disease (IBD)

    2. Asthma

    3. Skin conditions causing rash or hives

    4. Any conditions that weaken your immune system (for example, diabetes, kidney disease, HIV, or cancer)?

    5. Prefer not to answer

16. Where do you go for information about water safety related to visiting lakes, rivers, or other water bodies?

    1. Signage near water; park signage

    2. Park, water body, or beach website

    3. State or local government website

    4. Federal government website (CDC, EPA, NPS)

    5. Family or friends

    6. Social media

    7. News (online, TV)

    8. Location, weather, or business app (e.g., Google Maps, Yelp)

    9. Academic or nonprofit organization website (water research center, river keepers)

    10. Other [Ask to Specify]

    11. Probe: Where would you like to see information about water safety?

17. Who do you trust as a reliable source of information on water safety?

    1. Beach or park staff

    2. Local or state government

    3. Federal government (CDC, EPA)

    4. Academic or nonprofit organization (water research center, river keepers)

    5. Sports or recreation organization (fishing club, scouts)

    6. Local news station

    7. Friends or family

    8. Doctor/healthcare professional

    9. [For dog owners] Veterinarian

    10. Other [Ask to Specify]

    11. Probe: Why would you trust or distrust a particular source of information?

18. Thinking of the social media platforms you use, where would it be most helpful to get information about water safety? And why?

    1. X (formerly Twitter)

    2. Facebook

    3. Instagram

    4. TikTok

    5. YouTube

    6. Pinterest

    7. Snapchat

    8. Nextdoor

    9. Something else [Ask to Specify]

19. How would you want to learn more about water safety? And why?

    1. Print materials (posters, factsheets)

    2. Webpages

    3. Videos

    4. Email listservs

    5. Text messages

    6. Something else [Ask to Specify]

    7. I don’t want to learn more about water safety

20. If you are interested in participating in a discussion about water safety, please give us your contact information (interviewer will fill out contact information card) below. If you are chosen for the project, a team member will contact you to arrange a convenient time for the focus group.

PARTICIPANT PREFERRED CONTACT INFORMATION
PARTICIPANT NAME:
Cell:	Home (other phone):
EMAIL (must be an email address that is used frequently):
Best time and way to reach:

Segmentation Table (for recruiter use)

Population	Number of FGDs
General population (18+), who visit freshwater bodies	2
Parents (18+), who visit freshwater bodies with their kids/teens	1
Dog owners or caretakers (18+), who visit freshwater bodies with their dogs	1
TOTAL	4

CDC estimates the average public reporting burden for this collection of information as 10 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and completing and reviewing 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 currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS H21-8, Atlanta, Georgia 30333; ATTN: PRA (0920-1154).