Form NHTSA Form 1128 NHTSA Form 1128 Appendix D - Focus Group Screener

OMB Control No. 2127-xxxx

Expiration Date xx-xx-xxxx

Appendix D:

Fuel Economy, GHG, Other Emissions, and Alternative Fuels Education Program

Qualitative Focus Group Screener

Paperwork Reduction Act Burden Statement

A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject 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 current valid OMB Control Number. The OMB Control Number for this information collection is 2127-XXXX. Public reporting for this collection of information is estimated to be approximately120 minutes per response, including the time for reviewing instructions, completing and reviewing the collection of information. All responses to this collection of information are voluntary. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, National Highway Traffic Safety Administration, 1200 New Jersey Ave, S.E., Washington, DC, 20590

1. In which of the following categories is your age?

   1. Under 18 [TERMINATE]

   2. 18 to 24

   3. 25 to 34

   4. 35 to 44

   5. 45 to 54

   6. 55 to 64

   7. 65 or older

   8. REFUSED [TERMINATE]

2. Are you…?

   1. Male

   2. Female

   3. REFUSED [TERMINATE]

3. Do you or a family member currently, or have you or a family member previously worked for any of the following?

   1. The automotive industry [TERMINATE]

   2. An ethanol or alternative fuel producer [TERMINATE]

   3. A market research company or department [TERMINATE]

   4. A marketing company or department [TERMINATE]

   5. None of the above

   6. DON’T KNOW [TERMINATE]

4. Are you a licensed driver?

   1. Yes

   2. No [TERMINATE]

   3. REFUSED [TERMINATE]

5. Do you currently own or lease a passenger vehicle?

   1. Yes – OWN

   2. Yes – LEASE

   3. No [TERMINATE]

   4. REFUSED [TERMINATE]

6. Which of the following statements best represents your plans for purchasing or leasing a new vehicle for you or your family? By new vehicle, we mean new model year vehicle, not used or previously owned.

   1. I plan to purchase or lease a new vehicle in the next 1 to 3 months

   2. I plan to purchase or lease a new vehicle in the next 4 to 6 months

   3. I plan to purchase or lease a new vehicle in the next 7 to 12 months

   4. I plan to purchase or lease a new vehicle longer than 12 months from now

   5. I have no plans to purchase or lease a new vehicle

   6. DON’T KNOW

7. Thinking about your next vehicle purchase or lease, would you say you are the primary decision maker, have shared responsibility, or will someone else make the decision?

   1. I am the primary decision maker

   2. I have shared responsibility with someone else

   3. I do not have any responsibility for vehicle purchasing decisions [TERMINATE]

8. Approximately how many miles do you drive your primary vehicle per week? [ENSURE BROAD MIX OF DRIVING DISTANCES IN EACH GROUP]

   1. 0 to 49 miles

   2. 50 to 99 miles

   3. 100 to 199 miles

   4. 200 to 299 miles

   5. 300 to 499 miles

   6. 500 miles or more

   7. DON’T KNOW

9. What type of vehicle(s) do you currently own or lease? [MULTIPLE RESPONSE]

   1. Gasoline-engine vehicle

   2. Gasoline-electric hybrid vehicle

   3. Diesel engine vehicle

   4. Flex-fuel or alternative fuel vehicle

   5. DON’T KNOW

[REPEAT FOR EACH TYPE OF VEHICLE FROM Q9]

10. What is the make of this [INSERT FROM Q9] vehicle?

[DROP DOWN LIST OF VEHICLE MAKES]

[REPEAT FOR EACH TYPE OF VEHICLE FROM Q9]

11. What is the model of this [INSERT FROM Q9] vehicle?

[DROP DOWN LIST OF VEHICLE MODELS, FILTERED BY MAKE]

12. Which of the following statements best describes you?¹

    1. I prefer to be the first to buy and try new technologies

    2. I prefer to wait until new product hype has calmed before I purchase and try new technologies

    3. I prefer to wait until new technologies have been thoroughly tested and reviewed, and others I know have purchased and used new technologies before I purchase

    4. None of the above

13. What is the last grade you completed in school?

1. Some grade school (1-8)

2. Some high school (9-11)

3. High school graduate (12)

4. Technical or vocational school

5. Some College

6. College Graduate

7. Graduate or Professional School

8. Other

14. Select one or more of the following that best describes your race? [ACCEPT MULTIPLE RESPONSES]

1. American Indian or Alaskan Native

2. Asian

3. Black or African-American

4. Native Hawaiian or other Pacific Islander

5. White

15. Are you of Hispanic or Latino descent?

1. Yes

2. No

16. Which ONE of the following best describes your total household income?

1. Under $25,000

2. $25,000 to less than $50,000

3. $50,000 to less than $75,000

4. $75,000 to less than $100,000

5. $100,000 to less than $150,000

6. $150,000 to less than $200,000

7. $200,000 or more

8. Unsure or Refused

1 The purpose of this question is to identify early adopters of technology prior to the group to observe their reactions to the educational information being developed versus laggards.

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NHTSA Fuel Economy, GHG, Other Emissions

and Alternative Fuels Education Program ICR Package

January 4, 2011 NHTSA Form 1128