25-0003 Eligibility Screener

Form Approved

OMB Control No.: 0920-1154

Expiration date: 3/31/2026

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 shellfish 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?

2. Are you

   1. Female

   2. Male

3. How old are you?

   1. 18–34 years old

   2. 35–49 years old

   3. 50–64 years old

   4. 65 years or older

4. What is your race and/or ethnicity [select all that apply and enter additional details in the spaces below]

   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.]

   • Chinese

   • Vietnamese

   • Asian Indian

   • Korean

   • Filipino

   • Japanese

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

3. Black or African-American [provide details below.]

   • African American

   • Nigerian

   • Jamaican

   • Ethiopian

   • Haitian

   • Somali

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

4. Hispanic or Latino [provide details below.]

   • Mexican

   • Cuban

   • Puerto Rican

   • Dominican

   • Salvadoran

   • Guatemalan

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

5. Middle Eastern or North African [provide details below.]

   • Lebanese

   • Syrian

   • Iranian

   • Iraqi

   • Egyptian

   • Israeli

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

6. Native Hawaiian or Pacific Islander [provide details below.]

   • Native Hawaiian

   • Tongan

   • Samoan

   • Fijian

   • Chamorro

   • Marshallese

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

7. White [provide details below.]

   • English

   • Italian

   • German

   • Polish

   • Irish

   • Scottish

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

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

1. Never attended school

2. Attended some school between kindergarten and high school

3. High school diploma

4. Some college or associate's degree

5. Bachelor’s degree

6. Advanced degree

7. Prefer not to answer/Decline

6. 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/Decline

7. Last year, in 2024, 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/Decline

8. In which region of the U.S. do you currently live?

   1. Northeast (Maine to New York)

   2. Mid-Atlantic (New Jersey to Virginia)

   3. Southeast (North Carolina to eastern Florida)

   4. West Coast (Washington, Oregon, California)

   5. Gulf Coast (Texas to western Florida)

   6. Alaskan Coast

   7. Prefer not to answer/Decline

9. How many years have you been collecting shellfish?

   1. Less than 1 year

   2. 1-2 years

   3. 3-5 years

   4. 6 or more years

10. How often do you typically collect shellfish during the year?

    1. Once or twice

    2. Three to five times

    3. Six to ten times

    4. Eleven or more times

    5. Not sure/Don’t know

11. Why do you collect shellfish? [select all that apply]

    1. Cultural reasons

    2. Subsistence (for food)

    3. Recreation (as a hobby, for fun)

    4. Other (please specify)

    5. Prefer to not answer/Decline

12. What type of shellfish do you collect? [select all that apply]

    1. Cockles

    2. Scallops

    3. Oysters

    4. Clams

    5. Mussels

    6. Other [open-ended response]

    7. Not sure/Don’t know

    8. Prefer not to answer/Decline

13. On a scale of 1-10, how familiar are you with harmful algal blooms (HABs)? [where 1 means you are not familiar at all, 5 means you are somewhat familiar, and 10 means that you are extremely familiar]

14. Where do you go for information about safely collecting shellfish?

    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, ocean nonprofit)

    10. Other [Ask to Specify]

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

15. Who do you trust as a reliable source of information on safely collecting shellfish?

    1. Beach or park staff

    2. Local or state government

    3. Federal government (CDC, NOAA)

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

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

    6. Local news station

    7. Friends or family

    8. Doctor/healthcare professional

    9. Other [Ask to Specify]

16. Thinking of the social media platforms you use, where would it be most helpful to get information about safely collecting shellfish?

    1. X (formerly Twitter)

    2. Facebook

    3. Instagram

    4. TikTok

    5. YouTube

    6. Pinterest

    7. Snapchat

    8. Nextdoor

    9. Something else [Ask to Specify]

17. How would you want to learn more about safely collecting shellfish?

    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 safely collecting shellfish

18. If you are interested in participating in a discussion about safely collecting/harvesting shellfish, please give us your contact information (interviewer will fill out the contact information card) below. Your contact information will only be used to arrange focus group participation and will not be shared with third parties. 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	Number of Participants
General public in Alaska who collect shellfish to eat	1	8
General public in Washington, Oregon, and California who collect shellfish to eat	1	8
General public on the East Coast (Northeast, Mid-Atlantic, and Southeast) who collect shellfish to eat	1	8
General public near the Gulf Coast who collect shellfish to eat	1	8
TOTAL	4	32

CDC estimates the average public reporting burden for this collection of information is 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).

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
Author	Jacobi, Amy (CDC/NCEZID/DFWED/WDPB)
File Modified	0000-00-00
File Created	2025-05-18