United States Department of Transportation National Highway Traffic Safety Administration |
INTERVIEW FORMTIRE PRESSURE (5/18/10 Draft) |
Form Approved O.M.B. No. 2127-0626 Expiration Date: XXXX
National Automotive Sampling System Tire Pressure Monitoring System – Special Study |
Primary Sampling Unit Number ____ ____
Site Number ____ ____
Observation Number ____ ____
Date of Observation ____ ____/____/2010
Interview in: O English O Spanish
Observations: ( O Interviewed O Refused O <2004)
Body Type: Auto: O Small O Large
O SUV O Van O PU
Sex: O Male O Female
Age: O Young Adult O Adult O Senior
# in Vehicle: _____________ O Unknown
[Questions about Vehicle]
Who is the owner of this vehicle? (Check One)
O Joint with other
O Self
O Partner/spouse/significant other
O Parent or Other family member
O Friend or neighbor
O Lease
O Short-term rental
O Car-share
O Company/work
O Other
How long have you had this vehicle?
Years: _______ Months: _______ Days: _______
(< 1 month)
Was this vehicle new when you obtained it?
O No O Yes
Have any of the original tires on this vehicle been replaced? If yes, which ones and when?
Tire |
Years |
Months |
1) No, none |
|
|
2) Yes, LF |
|
|
3) Yes, LR |
|
|
4) Yes, RR |
|
|
5) Yes, RF |
|
|
6) Yes, Spare |
|
|
7) Yes, Don’t know |
|
|
8) Yes, Other (specify) |
|
|
[Questions about tire pressure]
Drivers keep their tires at their proper pressure for different reasons. List the reasons that are important to you for keeping tires properly inflated. (Do not read categories, but check all that apply)
Improved safety
Improved vehicle performance/handling
Improved fuel economy
Longer lasting tires
Other (specify) ________________________
Where would you, or do you, primarily turn for information on what pressure to set your tires for this vehicle? (Check one)
O Intuition/prior knowledge
O Owner’s manual
O Vehicle placard
O Tire sidewall labeling
O A service technician
O OnStar or other automatic system
O Relative or friend
O Don’t know
O Other (specify)_________________________
Whose responsibility is it to check the tire pressure? (Check one)
O Self
O Relative or friend
O Service station/dealer
O TPMS
O OnStar or other automatic system
O Owner (other than self, relative or friend)
O No one
O Other (specify) _________________________
Under what circumstances do you have the tire pressure on this vehicle checked, either by yourself or someone else? (Check all that apply)
Never (Skip to Q 16—Add Air)C
Before a long trip
When tires look or feel low
When tire pressure warning light comes on
When car is serviced
When the load being carried is changed
Tire pressure is checked on a regular basis
By OnStar or other automatic system
Don’t know
Other (specify) _________________________
When was the last time that you, or someone else, checked the tire pressure on this vehicle?
O Never
O Within the past month
O 1-2 months ago
O 3-4 months ago
O More than 4 months ago
O Continuously (as with TPMS or OnStar)
O Don’t know
When was the last time that you, or someone else, put air in the tires on this vehicle?
O Never (Skip to Q18-Have TPMS)
O Within the past month
O 1-2 months ago
O 3-4 months ago
O More than 4 months ago
O Don’t know
The last time that you, or someone else, put air in the tires on this vehicle—how did you do it?
O Used pump owned by self or other person
O Gas station air pump by self or other
O Asked a relative/friend to do it
O When vehicle was serviced
O Has not needed to put air into a tire
O Other
Does this vehicle have a Tire Pressure Monitoring System – also known as a TPMS system?
O No
O Yes
O Don’t know
Now I need to ask you some basic information about yourself. [Demographic Information]
What is your home zip code? ___ ___ ___ ___ ___
How old are you? __________ (Code to nearest yr)
What is the highest grade or year of school you completed?
O Less than high school
O High school / GED
O Some college
O College graduate
O Higher degree
O (Vol) Refused
(Continue only for vehicles that have TPMS-Q#18)
Would you have time now to answer a few questions on TPMS?
O No (Go to Q 23-Do Later)
O Yes (Go to Supplemental Form)
Would you be willing to answer a few questions on TPMS at a later date, using:
O On-line
O Mail-back form
O Phone call back
O Refuse (End)
What is your name? ___________________________
At what phone number(s) would you like to be called? _______________________________________
What are good times to call? ___________________
SUP ID: _______________________________
File Type | application/msword |
Author | Charlene.Doyle |
Last Modified By | charlene.doyle |
File Modified | 2010-06-02 |
File Created | 2010-05-18 |