Form 0920-1154 RECRUITMENT SCREENER In-Depth Interviews with Hispanic o

Form Approved

OMB Control No.: 0920-1154

Expiration date: 3/31/2026

RECRUITMENT SCREENER

In-Depth Interviews with Hispanic or Latina Women

July 13, 2023 DRAFT

Hello. My name is ________ and I’m calling from _________, an independent communications firm.

You indicated that you are interested in participating in a one-on-one conversation on topics that may matter or be interesting to you. DO NOT DISCLOSE THE EXACT TOPIC OF DISCUSSION BEFORE THE INTERVIEW. The discussion will last approximately 60 minutes. The sole sponsor of this activity is the Centers for Disease Control and Prevention (CDC). To maintain participants’ confidentiality, the interviewer will use first names only during the discussion, and no part of your name be used in any transcripts or reports available to CDC. CDC is not interested in any of your personal information. At this stage, we will be asking you a few questions to ensure we are recruiting a variety of people only.

I have a few questions to start.

IF TERMINATED DURING SCREENING PROCESS, READ: I’m sorry, we already have enough individuals in that category. Thank you very much for your time.

INTERVIEWER INSTRUCTION: If an individual expresses concern at any point during the screening process, please note their concern and reassure them appropriately. Remind them that their answers and participation will be completely confidential.

Name: _______________________________________________________

Address (residence): _______________________________________________________

City, State, ZIP: _______________________________________________________

Phone: _______________________________________________________

Email: _______________________________________________________

Recruiter: _______________________________________________________

RECRUIT 9 PARTICIPANTS TOTAL. SEPARATE CONTACT SHEET FROM THE REST OF THE SCREENER AND SHRED AT THE END OF THE PROJECT.

1. Are you…?

Female	
Male		TERMINATE
Transgender, non-binary, or another gender	
Prefer not to answer	

1. What is your age? RECORD EXACT AGE; DO NOT READ LIST

Under 18		TERMINATE
18-29		RECRUIT 3
30-39	
40-49		RECRUIT 3
50-59	
60 or older		RECRUIT 3

3. Do you live full-time in the US?

Yes	
No		TERMINATE

4. In what town or city and state do you live? RECORD CITY & STATE; ALSO CODE TO TABLE

Northeast (Census region)		RECRUIT 2
West (Census region)		RECRUIT 2
South (Census region)		RECRUIT 2
Flexible, any state		RECRUIT 3

5. Which of the following best describes the area where you live?

Urban		MAX 4
Suburban		MAX 4
Rural		MAX 4

6. Are you…?

Hispanic or Latina	
Not Hispanic or Latina		TERMINATE

7. What is your race? (Select all that apply.)

American Indian or Alaska Native		RECORD
Asian	
Black or African American	
Native Hawaiian or Other Pacific Islander	
White	
Prefer not to answer	

8. Are you a primary caregiver to any children under the age of 18?

Yes		MINIMUM 4
No	

9. Including yourself, how many individuals live in your household full-time? RECORD NUMBER

10. Which of the following includes your total annual household income for the last year?

Less than $20,000	
$20,000 to less than $30,000	
$30,000 to less than $40,000	
$40,000 to less than $50,000	
$50,000 to less than $60,000	
$60,000 to less than $70,000	
$70,000 to less than $80,000	
$80,000 to less than $90,000		TERMINATE
$90,000 to less than $100,000		TERMINATE
$100,000 or more		TERMINATE
Refused		TERMINATE

TO QUALIFY AS LOW INCOME (APPROX.) AND CONTINUE, MUST FULFILL CRITERIA IN ANY OF THE FOLLOWING ROWS, BASED ON PREVIOUS 2 QUESTIONS:

Household Size		Household Income
1 or more	and	Less than $20,000
2 or more	and	$20,000 to less than $30,000
3 or more	and	$30,000 to less than $40,000
4 or more	and	$40,000 to less than $50,000
5 or more	and	$50,000 to less than $60,000
6 or more	and	$60,000 to less than $70,000
7 or more	and	$70,000 to less than $80,000

11. How many times within the past three months have you participated in a focus group or one-on-one research interview? DON’T READ LIST

None	
1 or more		TERMINATE

12. In your opinion, is climate change a…?

Very serious issue		MINIMUM 4
Somewhat serious issue	
Not very serious issue		TERMINATE
Not at all serious issue	
Don’t know / not sure	

13. How knowledgeable do you feel about the topic of climate change?

Very knowledgeable		RECORD
Somewhat knowledgeable	
Not very knowledgeable	
Not at all knowledgeable	
Don’t know / not sure		MAX 2

14. How concerned or unconcerned do you feel about the impact, or possible impact, of climate change on the region where you live?

Very concerned		MINIMUM 4
Somewhat concerned	
Not very concerned		TERMINATE
Not at all concerned	
Don’t know / not sure	

15. One effect of climate change is an increase in infectious diseases and the spread of these diseases to new areas. Have you heard about this particular effect of climate change before?

Yes		RECORD
No	
Don’t know / not sure	

16. How concerned or unconcerned do you feel about an increase or spread of infectious diseases due to climate change?

Very concerned		MINIMUM 4
Somewhat concerned	
Not very concerned		TERMINATE
Not at all concerned	
Don’t know / not sure	

17. Are you comfortable participating in a conversation in English on some of the topics you’ve answered about here?

Yes	
No		TERMINATE

Finally, to ensure we understand the individuals who are answering these questions…

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

Less than high school graduate		RECORD
High school graduate or completed GED	
Technical or vocational degree	
Four-year college degree	
Postgraduate or professional degree	
Other SPECIFY	

19. What best describes your current employment status?

Employed, full-time		RECORD
Employed, part-time	
Student	
Homemaker	
Unemployed	
Other SPECIFY	

INVITATION

Thank you for answering all of my questions. As I mentioned, we respect your privacy and understand this information is confidential, and we will not disclose this information to anyone. We asked these questions because we want to speak with a wide variety of people who can review important information and provide their feedback. Based on your answers to the questions, we would like to invite you to participate in a one-hour virtual interview.

You will receive $75 as a token of appreciation for your participation, which will be provided to you after you complete the interview.

All of your feedback will be confidential, never in association with your name. To make sure we capture your remarks accurately, we will audio and video record the interview (over Microsoft Teams). The purpose of the recording is to make sure we report accurately, we will not include your name in the transcript. Is this discussion something you are interested in and comfortable with?

Yes		SHARE DATE AND TIME OF INTERVIEW
No		TERMINATE

Additionally, the interview is virtual, meaning that you can participate from the comfort of your home or office. You will not need to come to a facility and can meet us from wherever you are, but you will need to be in front of a computer, tablet, or smartphone with internet access and camera so you can be on screen with the interviewer. You will also have to be in a quiet place. Someone will call you before the interview to make sure all the technology needed for the discussion is working properly. Is this something you are interested in and comfortable with, and do you have access to a computer, tablet, or smartphone to fulfill these requirements?

Yes		CONTINUE
No		TERMINATE

FOR SCHEDULED PARTICIPANTS:

The discussion can occur during the weeks of INSERT WEEKS, during the hours of INSERT HOURS. What date and time works best for you within that timeframe? Before your scheduled discussion, we will send you confirmation with all the required logistical and technological information. If you wear reading glasses or use a hearing aid, please remember to have those with you at the interview.

If you must cancel, please let us know immediately, so we can find someone to take your place. My name is ___________ and you can reach me at _____________.

SEPARATE FIRST PAGE (CONTACT SHEET) AND SHRED AT THE END OF THE PROJECT

Public reporting burden of this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data 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 Reports Clearance Officer, 1600 Clifton Road NE, MS H21-8, Atlanta, Georgia 30333; ATTN: PRA 0920-1154