Form NHTSA Form 1746 NHTSA Form 1746 Pre-Drive Questionnaire

Under the Paperwork Reduction Act, a federal agency may not conduct or sponsor, and a person is not required to respond to a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control number. The OMB Control Number for this information collection is xxxx-xxxx (expiration date: MM/DD/YYYY). Responding to this collection of information is estimated to be approximately 15 minutes per response, including the time for reviewing instructions, completing, and reviewing the collection of information. All responses to this collection of information are voluntary. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: Information Collection Clearance Officer, National Highway Traffic Safety Administration, 1200 New Jersey Ave, S.E., Washington, DC, 20590

Pre-Drive Questionnaire

As part of this study, it is useful to collect information describing each participant. The following questions ask about your basic demographic information, your trust in automation, and your understanding of a driving automation system. Please read each question carefully. If something is unclear, ask the researcher for help. Your participation is voluntary, and you may skip any questions that you do not wish to answer.

Demographics

1. What is your age?

2. What is the sex listed on your driver’s license?

   1. Male

   2. Female

   3. X

3. How do you identify with respect to your gender identity?

4. What is your race and/or ethnicity?

   1. American Indian or Alaska Native – Enter, for example Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, Aztec, maya, etc.

_____________________________________________________________

2. Asian – Provide details below.

   1. Chinese

   2. Vietnamese

   3. Asian Indian

   4. Korean

   5. Filipino

   6. Japanese

   7. Enter, for example, Pakistani, Hmong, Afghan, etc. ________________

3. Black or African American – Provide details below.

   1. African American

   2. Nigerian

   3. Jamaican

   4. Ethiopian

   5. Haitian

   6. Somali

   7. Enter, for example, Trinidadian and Tobagonian, Ghanaian, Congolese, etc. _____________________________

4. Hispanic or Latino – Provide details below.

   1. Mexican

   2. Cuban

   3. Puerto Rican

   4. Dominican

   5. Salvadoran

   6. Guatemalan

   7. Enter, for example, Colombian, Honduran, Spaniard, etc. ___________________________________________

5. Middle Eastern or North African – Provide details below.

   1. Lebanese

   2. Syrian

   3. Iranian

   4. Iraqi

   5. Egyptian

   6. Israeli

   7. Enter, for example, Moroccan, Yemeni, Kurdish, etc. _________________

6. Native Hawaiian or Pacific Islander – Provide details below.

   1. Native Hawaiian

   2. Tongan

   3. Samoan

   4. Fijian

   5. Chamorro

   6. Marshallese

   7. Enter, for example, Chuukese, Palauan, Tahitian, etc. ___________________________

7. White – Provide details below.

   1. English

   2. Italian

   3. German

   4. Polish

   5. Irish

   6. Scottish

   7. Enter, for example, French, Swedish, Norwegian, etc. _______________________________________

Trust Scale

Below is a list of statements for evaluating trust between people and automation. There are several scales for you to rate the intensity of your feeling of trust, or your impression of the system while operating a machine. Please select the value (1 – Not at all through 7 - Extremely) that best describes your feeling or your impression.

Scale: (Not at all) 1-2-3-4-5-6-7 (Extremely)

Define the system to which they were randomly assigned.

1. The [condition]system is deceptive

2. The system behaves in an underhanded manner

3. I am suspicious of the system’s intent, action, or outputs

4. I am wary of the system

5. The system’s actions will have a harmful or injurious outcome

6. I am confident in the system

7. The system provides security

8. The system has integrity

9. The system is dependable

10. The system is reliable

11. I can trust the system

12. I am familiar with the system

Mental Model Assessment

The following questions will ask you about a driving automation system you might experience today. For each question, please indicate whether the statement is “True” or “False”, then rate your confidence in your response (No Confidence, Slight Confidence, Moderate Confidence, High Confidence).

1. While the system is active/engaged, the driver needs to monitor surroundings in case they need to take over control of the vehicle

2. The system will monitor the driving conditions and will notify the driver when they need to resume control

3. When active/engaged, the system is completely self-driving and requires no monitoring by the driver

4. The system will alert you when you are looking away from the road for too long

5. The system will deactivate when you come to a complete stop

6. The system can handle gentle corners

7. Inclement weather may impede the system's ability to identify objects and road markings

8. The system can assist you while you enter or exit the interstate

9. The system will work on roads without lines or markings

10. The system will be deactivated if it no longer senses a vehicle ahead

11. You may read a book while the system is active/engaged

12. The system can be deactivated at any time

13. The system automatically suspends itself when the vehicle exceeds a certain speed

14. The system will be automatically suspended when the windshield wipers are set to high

15. Pressing the brake or the accelerator will deactivate the system

16. The system responds to pedestrians walking on the sidewalk

17. The system provides both steering and braking to avoid a pedestrian

18. The system may not detect a pedestrian who suddenly crosses in front of you

19. Dark conditions may reduce the system's ability to respond to pedestrians

20. The system will warn you when you enter an area with heavy congestion

21. The system may react to traffic lights and/or signs

22. The system will provide steering input to keep the vehicle in its lane

23. The system can drive in a work zone where lanes have shifted from their usual location

24. The system will change lanes to pass a slower moving vehicle ahead

25. The systems maintains the speed that you have set when there are no vehicles detected in the lane ahead

26. The system will accelerate if a slower vehicle ahead moves out of the detection zone

27. The system ss meant to be used on highways and interstates

28. The system may not correctly detect stopped vehicles in your lane

29. The system reacts to stationary objects on the road (construction cone, tire, ball)

30. The system is meant to be used in slow and heavy traffic

31. The system will react immediately to vehicles merging onto the road in front of you

32. The system reacts to oncoming traffic

33. The system adjusts the vehicle speed when approaching tight curves

34. The system works even when the radar sensor is dirty