Form FEMA Form 008-0-10 FEMA Form 008-0-10 Sandy Focus Group Recruit / Screener

OMB Control Number: 1660-NEW

Expiration: None

FEMA Form Number: 008-0-10

PAPERWORK BURDEN DISCLOSURE NOTICE

(Sandy Focus Group Recruit / Screener)

Public reporting burden for this form is estimated to average 3 minutes per response. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and submitting the form. This collection of information is voluntary. You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 1800 South Bell Street, Arlington VA 20598-3005, Paperwork Reduction Project (1660-NEW). NOTE: DO NOT SEND YOUR COMPLETED FORM TO THIS ADDRESS.

Hurricane Sandy Survivor Focus Groups

Recruit/Screener

Sample Selection

• A total of 12 participants should be recruited for each group. Only 8 participants will be required for each group.

• The objective is to obtain individuals who experienced the effects of Hurricane Sandy.

• Participants should be recruited from a cross section of race/ethnicity, and socioeconomic status.

• Participants will be from the closely surrounding counties of Staten Island, NY; Manhattan, NY and Atlantic City, NJ.

• Only one participant per household.

INTRODUCTION

Hello, my name is ____________ and I am calling from Gallup. We are interested in talking to groups of individuals who were recently impacted by Hurricane Sandy.

The purpose of these groups is to gather insights to help the U.S. Government better understand how best to serve the public before, during and after a natural disaster. This is a unique opportunity to make a valuable contribution to your community and the Nation.

The discussion groups will be held at a professional market research facility in your community. We are offering a $75 gift card as a way to say thank you for participating in the discussion.

INTERVIEWER

1. We estimate that this survey will take approximately 3 minutes to complete. May I ask you a few questions to see if you qualify for our focus groups?

01 YES (Continue)

02 NO (Thank and terminate)

2. Gender:

1. Female (RECRUIT A MIX FOR ALL GROUPS)

2. Male (RECRUIT A MIX FOR ALL GROUPS)

3. Were you in the area last October in the days before Hurricane Sandy made landfall?

1. YES (Continue to Q4)

2. NO (THANK AND TERMINATE)

4. Have you ever attended a group discussion for market research purposes?

01 Yes—go to item 5b below

02 No—Continue to #6

5. How many group discussions have you attended in the past 12 months?

RECORD #_______________

IF MORE THAN 3, THANK AND TERMINATE

6. Have you recently participated in any Gallup focus group?

01 Yes—THANK AND TERMINATE

02 No—Continue

7. On a scale of 1 to 6, where “1” is “Very Uncomfortable” and “6” is “Very Comfortable,” how comfortable do you feel expressing your opinion in a group with 8 or 9 other people?

VERY UNCOMFORTABLE VERY COMFORTABLE

1 2 3 4 5 6

MUST ANSWER 4, 5, OR 6

And to ensure we have a range of perspectives, I’d like to ask you some demographic questions.

DEMOGRAPHICS

D1. Age (RECRUIT A MIX):

1. Below 40

2. 40-55

3. 55-65

4. 65+

D2. Would you say your ethnicity is? (RECRUIT A MIX)

1. Hispanic or Latino

2. Not Hispanic or Latino

D2a. Would you say your race is? (RECRUIT A MIX) (Allow for more than one selection)

1. American Indian or Alaska Native

2. Asian

3. Black or African American

4. Native Hawaiian or Other Pacific Islander

5. White

D3. Annual household income? (RECRUIT A MIX)

01 Less than $25,000

02 $25,000 to $34,999

03 $35,000 to $49,999

04 $50,000 to $74,999

05 $75,000 to $99,999

06 $100,000 to $149,999

07 $150,000 or more

D4. Would you say you live in a coastal community? (RECRUIT A MIX)

1. Yes

2. No

D5. Are you the primary caretaker for another person in your household? (y/n)

CLOSE

Our group will be held on DATE at TIME at LOCATION. Will you be able to participate?

If YES to participating, READ and collect the following information:

Thanks for agreeing to participate. I just have a few additional questions.

8. What is a telephone number where we can reach you to remind you of the date and time of the group session?

Telephone #: ___________________________

9. Do you have e-mail address we can also use to contact you? If YES, record address below.

E-MAIL: _______________________________________________

Final Notes and Incentive Information

• Participants must show up at the facility at least 15 minutes prior to the start of the group.

• Participants will receive a $75 cash inventive. If they arrive after the group has begun they will not the incentive.

21 Focus Groups

10 Race/Ethnicity (5 groups x 2 income levels high/low)

6 Groups in Coastal Areas

3 Age Level

1 Caregiver

1 General Mix, Non-Caregiver

7

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