Consumer Pilot Test Survey

OMB Control No. 0660-XXXX

Expiration Date: XX-XX-XXXX

PRELIMINARY SCRIPT FOR CONVERTER BOX COUPON PROGRAM CONSUMER PILOT TEST SURVEY

Name _______________________________________

Address_____________________________________

Phone _____________________

Email Information ____________________________

Question 1: Did you know that TV stations were changing from analog to digital TV broadcasting by February 17, 2009 (The Digital TV Transition) before taking part in this pilot test? ________Yes ________No.

If “Yes” how did you hear about it? (Check all that apply)

• Television (News or Advertising)

• Radio (News or Advertising)

• Internet

• Web site

• Print Media (Newspaper, magazine, etc.

• Family Member

• Friend

• Workplace

• Social or Community Organization

• Church

• Other ________________________________

Question 2: Did you know about the Digital TV Converter Box Coupon Program before taking part in this pilot test? ________Yes _________No

If “Yes” how did you hear about it? (Check all that apply)

• Television (News or Advertising)

• Radio (News or Advertising)

• Internet

• Web site

• Print Media (Newspaper, magazine, etc.

• Family Member

• Friend

• Workplace

• Social or Community Organization

• Church

• Other ________________________________

APPLICATION PHASE

Question 3: How did you apply for your coupon?

• Telephone

• Internet/Web site

• U.S. Mail

• Fax

Question 3-1: Where did you get your application form?

• Electronics Retailer

• U.S. Mail

• Library

• Community Center

• U.S. Post Office

• Friend or Colleague

• WWW. DTV2009.Gov Web site

• Other Internet Web site

• Social or Community event

• Other______________________________________

Question 4: How would you rate your experience with the following coupon application, receipt, redemption and installation phases of the pilot test?

[Use the “Poor to Excellent” rating scale of “1-9” for each element below.]

APPLICATION PHASE

Call Center Experience:

1. Use of recorded phone menus (clarity) __

2. Finding supplementary (additional) information __

3. Transferring to live telephone agent if needed __

4. Telephone agent knowledge __

5. Telephone agent courtesy __

6. Waiting period __

7. Ease of completing of application form __

8. Overall telephone/call center experience __

Web site Experience

1. Understanding of Web site information (clarity) __

2. Use of Web site menu __

3. Navigating (finding information) Web site __

4. Finding supplementary (additional) information __

5. Ease of completing of application form __

6. Overall Web site experience __

Mail-in Experience

1. Clarity of instructions __

2. Ease of completing of application form __

3. [Note: Provide additional elements]

Fax Experience—Add Elements __

Overall Coupon Application Experience

1. Coupon application method convenience __

2. Ease of use of the process __

3. Clarity of materials included with Coupon Card Mailer __

4. Overall coupon application experience __

RECEIPT OF COUPON PHASE

How would you rate the converter box coupon receipt process? (Use “1-9” Scale)

• Timeliness __

• Clarity of materials, e.g., easy to understand instructions __

• Instructions on how to use the card __

• Information on where to redeem coupons __

• What coupon could be used for __

• Explanation of expiration date __

• Overall coupon receipt process __

REDEMPTION PHASE

Question 5: Did you redeem your coupon for the purchase of a TV Converter Box? ____Yes ________No

Question 6: If “Yes” Where did you redeem your coupon?

Retailer Name__________________________________

Retailer Location________________________________

Is this a place you normally shop? _________Yes _________No

Question 7: If you did not redeem your coupon select the reason(s) why you did not redeem your coupon.

• Planned to purchase a new digital TV with built-in tuner

• Plan to subscribe to cable, satellite, or other pay TV service

• I ran out of time—coupon expired

• I did not understand my choices

• I did not know where to buy a box

• There was no store/retailer near me

• I did not have transportation

• I lost my coupon

• I did not receive my coupon

• The store did not have any converters

• The store did not have the specific converter brand I wanted

• Other_____________________________

Question 8: How would you rate the coupon redemption process? (Use “1-9” Scale)

1. Help given/provided by the retail store __

2. Sales Clerk knowledge of the Coupon Program __

3. Availability/Supply of converter boxes at retail store __

4. Coupon Eligible Boxes were easy to find—Clear signage __

5. Actual use of the coupon—efficient transacton __

6. Retailer customer service __

7. Overall retailer experience __

INSTALLATION PHASE

Question 9: Please rate your experience with installation of the box.

(Use “1-9” Scale)

• Retailer written installation instructions (if any) __

• Sales associate explaining installation in store __

• Owners’ Manual or installation instructions from Manufacturer __

• Reception of standard channels __

• Reception of digital channels __

Question 10: Do you have any feedback, comments, or suggestions for improvement of the TV Converter Box Coupon Program?

Paperwork Reduction Act Information: Public reporting burden for this collection of information is estimated to be 15 minutes per response. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestion for reducing this burden, to Milton Brown, NTIA, U.S. Department of Commerce, Room 4713, 14^th and Constitution Avenue, NW, Washington, DC 20230 or at MBrown@ntia.doc.gov.

Notwithstanding any other provisions of the law, no person is required to respond to, nor shall any person be subjected to a penalty for failure to comply with, a collection of information subject to the requirements of the Paperwork Reduction Act, unless that collection of information displays a currently valid OMB Control Number.

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