DTV Retailer Site Visit Program

Approved by OMB

3060-1118

DTV Transition and Converter Box Program Questions

Date of Interview:	Time of Interview:	Agent:	Manager Name:
Name of Retailer:		Store Number:	Interview With:
Retailer Address:

Note: For questions with “Y” or “N” or “DN” responses, please circle the appropriate Yes (Y) or No (N) or Doesn’t Know(DN) response. For check boxes, please check box for “Yes” responses and leave blank for “No” responses.

General DTV Questions
Y N	Q01: Did retailer employees receive any training regarding the digital transition?
	Q02: Which of these characterized your training on the digital transition? (Check all that apply).
						Video presentation
						In-person presentation
						Written materials
						On-line training
_____	Q03: What is the deadline date for the digital television transition? (Enter date)
Y N DN	Q04: Are existing analog televisions of any use after the digital television transition?
Y N DN	Q05: Do I need a High Definition television to be able to receive digital television?
Y N	Q06: Does retailer sell antennas?
Y N	Q07: Are you aware that some people may need to upgrade their existing antenna system to receive signals after the DTV transition?
Y N DN	Q08: Do I need an “HDTV antenna” to receive DTV broadcasts?
Y N DN	Q09: Are you aware of any broadcasters switching to exclusively digital broadcasting before February 17, 2009?
					Q09b: List all such stations:
					_______________________________________________________________________________________________________
Converter Box Program Questions
Y N		Q10: Are you familiar with the Digital to Analog Converter Box Coupon program?
		Q11: Which of these characterized retailer training on the coupon program? (Check all that apply)
						Video presentation
						In-person presentation
						Written materials
						On-line training
___________		Q12: When did your store begin selling converter boxes?(Enter date)
Y N		Q13: Does your store have converter boxes in stock?
			Q13b: If not: Why not? When will your store have boxes in stock?
			_________________________________________________________________________________________________________
		Q14: What is the return policy for converter boxes? _____________________________________________________________________________________________________________
Y N DN		Q15: Has your store had many returns of converter boxes?
Y N DN		Q16: Has your store had any problems with accepting the NTIA coupons?
			Q16b: If so, then please describe: ___________________________________________________________________________________
			_______________________________________________________________________________________________________________
Y N DN		Q17: Are all of the boxes sold by retailer eligible for NTIA coupons?
						Q17b: List makes and models of boxes sold by retailer: ___________________________________________________________________________________________________________
						___________________________________________________________________________________________________________
Y N DN						Q17c: Are these converter boxes on the list of NTIA-approved boxes at https://www.ntiadtv.gov/cecb_list.cfm ?
Y N DN		Q18: Can I use more than one coupon to purchase a single box?
Y N DN		Q19: Do I need to have a coupon to buy a converter box?
Y N		Q20: Does retailer train its employees on how to hook up a converter box?
Y N		Q21: Would you feel comfortable demonstrating for a customer how to hook up a converter box?
Y N DN		Q22: Do I need a converter box if I have cable, satellite or any paid subscription service?
Y N DN		Q23: Can I hook up more than one TV or other device to a single converter box?
Y N DN		Q24: Does retailer sell any converter boxes that will pass through analog signals as well as digital signals?
		Q24b: If so, then please identify: __________________________________________________________________________________________________________________
			_______________________________________________________________________________________________________________
Y N DN			Q24c: If items listed, then have they been verified? https://www.ntiadtv.gov/cecb_list.cfm

LPTV/Class A Station Questions
Y N DN	Q25: Do low-power stations like translators also have to convert to digital broadcasting by February 17, 2009?
	Q26: How do I know if my television station is one of the stations that doesn’t have to go digital in 2009?
		Enter response here:_______________________________________________________________________________________________
Y N DN	Q27: Does the interviewee have any questions or wish to convey any additional information to the Commission?
		If so, enter response here: __________________________________________________________________________________________
		_______________________________________________________________________________________________________________
		_______________________________________________________________________________________________________________

Page 2

May 2008