Form 0920-24ID Recruitment Screener

OMB Approved

Control No. 0920-1154

Exp. 3/31/2026

RECRUITMENT SCREENER

Focus Groups with International Travelers Visiting Friends and Relatives

July 2024

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

You indicated that you are interested in participating in a group discussion, conducted virtually, to discuss your experiences and opinions regarding a health topic. DO NOT DISCLOSE THE EXACT TOPIC OF DISCUSSION BEFORE THE FOCUS GROUP. The discussion will last up to 1 hour and 30 minutes. This activity is supported by the U.S. Centers for Disease Control and Prevention and focus groups are being conducted by their contractual partner KRC Research.

I have a few questions to start.

I have a few questions to start. But first, remember that participating is completely voluntary. You can choose not to answer any questions and stop at any time. To maintain participants’ confidentiality, we will use first names only during the focus group and your name will not be used in any study materials. CDC will not receive any personally identifying information that you provide. We will be asking you a few questions to ensure we are recruiting a variety of people, but the information will not be associated with your specific name.

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: Confirm willingness to continue before beginning the screening process. If an individual expresses concern at any point during the screening process, please note their concern and reassure them appropriately. Remind them that participation is voluntary, they can choose not to answer any questions, and their answers and participation will be completely confidential.

Name: _______________________________________________________

Address (residence): _______________________________________________________

City, State, ZIP: _______________________________________________________

Phone: _______________________________________________________

Email: _______________________________________________________

Recruiter: _______________________________________________________

RECRUIT 32 PARTICIPANTS TOTAL. SEPARATE CONTACT SHEET FROM THE REST OF THE SCREENER AND SHRED AT THE END OF THE PROJECT.

RECRUIT SUMMARY

Segment	Audience	FGs / Recruits
A	International travelers to South Asia - English	2 / 16
B	International travelers to Central America or Mexico - English	2 / 16
C	International travelers to Central America or Mexico - Spanish	2 / 16

SCREENER

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

Under 18		TERMINATE
18-29		RECRUIT MIX
30-39	
40-49	
50-59	
60 or older		MAX 4 PER GROUP

2. Do you have access to a reliable internet connection and a desktop or laptop computer?

Yes		CONTINUE
No		TERMINATE

3. What sex were you assigned at birth, on your original birth certificate?

Female		CONTINUE
Male	
Unknown	

4. How do you describe your current gender? You can select all that apply.

Male		MINIMUM 3 PER GROUP
Female		MINIMUM 3 PER GROUP
Transgender		CONTINUE
Something else	

5. IF Q3 RESPONSE DOES NOT MATCH Q4 RESPONSE Just to confirm, you were assigned [Q3 RESPONSE] at birth and now you describe yourself as [Q4 RESPONSE]. Is that correct?

Yes		CONTINUE
No		REPEAT Q3 and Q4

6. Do you currently live in the U.S. for more than 50% of the year?

Yes		CONTINUE
No		TERMINATE

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

Northeast		RECRUIT MIX
South	
Midwest	
West	

8. In the past five years, have you traveled to another country outside the U.S. with the purpose of visiting…?

Friends who live in that country		CONTINUE
Relatives who live in that country	
Neither of these		TERMINATE

9. In the past five years, what country or countries have you visited where friends or relatives live?

Afghanistan		REQUIRED FOR SOUTH ASIA GROUPS. MAX 4 ANY ONE COUNTRY PER GROUP
Bangladesh	
Bhutan	
India	
Maldives	
Nepal	
Pakistan	
Sri Lanka	
Belize		REQUIRED FOR CENTRAL AMERICA & MEXICO GROUPS. MAX 4 ANY ONE COUNTRY PER GROUP
Costa Rica	
El Salvador	
Guatemala	
Honduras	
Mexico	
Nicaragua	
Panama	
Another country		RECORD

TERMINATE IF NO SOUTH ASIA OR CENTRAL AMERICA AND MEXICO

10. In the past five years, approximately how many times have you traveled to [S. ASIAN OR C. AM./MX COUNTRY] where friends or relatives live? DO NOT READ LIST

1		TERMINATE
2	
3		CONTINUE
4	
5	
6	
7	
8	
9	
More than 10 times	

11. In the past five years, what is the longest amount of time you have spent on a trip to [S. ASIAN OR C. AM./MX COUNTRY] where friends or relatives live?

Less than 1 week		TERMINATE
1 week or slightly more	
2 weeks or slightly more		CONTINUE
3 weeks or slightly more	
4 weeks or more	

12. IF “RELATIVES” IN Q8 What relatives live in [S. ASIAN OR C. AM./MX COUNTRY]? Select all that apply.

Parent(s)		RECORD
Sibling(s)	
Spouse or partner	
Child or children	
Grandparents, aunts, uncles, or cousins	
Other SPECIFY	

13. Do you think you will travel to [S. ASIAN OR C. AM./MX COUNTRY] again at some point in the next several years?

Yes		CONTINUE
No		TERMINATE

14. IF CENTRAL AMERICA OR MEXICO IN Q9 When you travel to [COUNTRY], do you usually travel by air, automobile, or another way? ALLOW MULTIPLE

Air		GOAL OF MIN 2 FOR EACH OF AIR AND AUTOMOBILE
Automobile	
Other SPECIFY	

15. In which country were you born? DO NOT READ LIST

United States		MIN 2 PER GROUP
Other country RECORD COUNTRY		MIN 2 PER GROUP
Prefer not to answer		CONTINUE

16. For how long have you lived in the United States? DO NOT READ LIST

RECORD YEARS		CONTINUE
Prefer not to answer	

17. What language do you speak at home most of the time?

English		CONTINUE
Spanish		CONTINUE
Other RECORD		CONTINUE

18. How well do you speak English?

Very well		CONTINUE
Not very well		TERMINATE FOR ENGLISH GROUPS
Not at all	

19. IF CENTRAL AMERICA OR MEXICO IN Q9 How well do you speak Spanish?

Very well		CONTINUE
Not very well		TERMINATE FOR SPANISH GROUPS
Not at all	

FOR CENTRAL AMERICA AND MEXICO TRAVELERS:

• PRIORITIZE FOR ENGLISH GROUPS IF ONLY ENGLISH = “VERY WELL” (Q18)

• PRIORITIZE FOR SPANISH GROUPS IF ONLY SPANISH = “VERY WELL” (Q19)

20. IF CENTRAL AMERICA OR MEXICO IN Q9, AND SPEAK BOTH ENGLISH AND SPANISH “VERY WELL” If given the choice, would you prefer to participate in a focus group in English or Spanish, or do you have no preference?

English		CONTINUE
Spanish	
No preference	

PRIORITIZE FOR GROUP DEPENDING ON PREFERENCE. IF NO PREFERENCE, FILL AS NEEDED

21. Do you, a spouse or partner, or a child work in any of the following fields, or have any of these individuals worked in these fields in the past?

Market research, communications, or public relations		TERMINATE
Health care or public health	
Pharmaceuticals, health sciences, or medical device manufacturing	
Federal or state government	
Travel industry	
None of the above		CONTINUE
Don’t know	

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

0 or 1		CONTINUE
2 or more		TERMINATE

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

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

Urban (a densely populated area or city)		RECRUIT MIX
Suburban (a residential area near a city)	
Small town (a few hundred to a few thousand people not near a city)	
Rural (an open area with few homes or other buildings)	

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

Less than high school graduate		MINIMUM 2 PER GROUP
High school graduate or completed GED	
Technical or vocational degree	
Four-year college degree		MINIMUM 2 PER GROUP
Postgraduate or professional degree	
Other SPECIFY		CONTINUE

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

Less than $20,000		MINIMUM 2 PER GROUP
$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		MINIMUM 2 PER GROUP
$80,000 to less than $90,000	
$90,000 to less than $100,000	
$100,000 or more	
Prefer not to answer/Decline		TERMINATE

26. What best describes your current employment status?

Employed, full-time		CONTINUE
Employed, part-time		CONTINUE
Student		MAX 2 PER GROUP
Homemaker		CONTINUE
Unemployed		MAX 2 PER GROUP
Other SPECIFY		CONTINUE

INVITATION

Thank you for answering all 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 virtual focus group that will last approximately 90 minutes. The focus group will be held in [ENGLISH / SPANISH]. During the virtual discussion, you will need to have a reliable internet connection and use a desktop or laptop computer.

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

All of your feedback will be confidential and will never be reported in association with any personally identifying details like your name. To make sure we capture your remarks accurately, we will record the discussion. The purpose of the audio recording is to make sure we report accurately, but without any personally identifying information. We will use the recording to make a written record of the conversation. Once we have done that and the project is complete, we will destroy the recording. Is this something you are interested in and comfortable with?

Yes		SHARE DATE AND TIME OF FG
No		TERMINATE

The discussion 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 or tablet with internet access. The information or materials you will review will include reading and visual content, so we request that you do not participate using a cell phone. You will also have to be in a quiet place. Someone will call you before the focus group to make sure all the technology needed for the discussion is working properly. Is this focus group something you are interested in and comfortable with?

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 necessary 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.