Download:
pdf |
pdfConsumer Financial Protection Bureau Older Americans Participant Screener
Quota:
•
Focus Groups
o Six groups of 8-10 participants.
o 3 groups at Fors Marsh Group (FMG) facility, 3 groups in location to be determined.
o All participants should be 62 years or older, and should have a bank/credit union
checking account.
o Participants should be conversant in English.
o We will seek to recruit a diverse mix of gender, age (groups should be a mix of
participants in 60s, 70s, and, if possible, 80s), and household income level.
o Roughly 25 percent of participants should also be providing assistance with finances
to an older relative.
Recruitment Plan:
• The study will be advertised by:
o Emailing and calling contacts in the facility databases;
• Respondents must first complete a screener to determine if they qualify for the study;
• Respondents who qualify are then contacted to schedule a session;
• Respondents are sent a confirmation email with directions to the facility
• Respondents are contacted the day before the session to remind them about their
appointment;
• Participants’ information is reconfirmed upon arrival; and
• Participants are compensated $75 in the form of a prepaid Visa gift card for their time (60
minutes) upon completion.
Recruitment Language
Seeking Older Consumers for Interviews Regarding Personal Finances
We are currently recruiting adults age 62 and older to participate in focus groups about their
experiences and decision-making processes regarding personal finances.
The groups will last 60 minutes and participants will be paid $75 in the form of a prepaid Visa gift
card. The study will take place at [location] and we are currently scheduling participants for [dates].
This research is being sponsored by the Consumer Financial Protection Bureau (CFPB), a Federal
Government agency that was created to help consumers. Feedback from the interviews will be used
to help the CFPB understand consumers’ experiences and to recommend that financial institutions
offer certain product/account features and services to consumers.
If you are interested in participating, please contact us at [contact info]. We will ask you to complete
a short screener and we will notify you if you qualify for the study.
Thank you!
Page 1 of 8
Web-Based Screener
[NEW SCREEN]
Thank you for your interest in participating in a study with Fors Marsh Group. We are seeking
participants for focus groups to discuss your experiences and decision-making processes with regard
to your personal finances.
Groups will take place the week of [month/date] at [location]. If you are interested in participating,
please complete this questionnaire. If you qualify for this study, we will contact you to schedule a
time that is convenient for you. Compensation ($75) in the form of a prepaid Visa gift card will be
provided to those who participate.
Thank you for your interest.
[NEW SCREEN]
Please note that your responses to these questions will remain private and will only be used for the
purpose of scheduling your session if you qualify for the study. The following Privacy Act Statement
guides the handling of your responses.
Privacy Act Statement
5 U.S.C. 552(a)(e)(3)
The information you provide through your responses to Fors Marsh Group will assist the
study sponsor, the Consumer Financial Protection Bureau (“CFPB”), in determining your
eligibility to participate in a study that will focus on the development and improvement of
CFPB tools and resources to assist consumers.
The CFPB will not obtain and access identifying information from Fors Marsh about
study participants including name, email, gender, race and ethnic origin related to study
participants. The agency will only obtain and access de-identified results and
aggregated analyses of those results.
Information collected on behalf of the Bureau by Fors Marsh will be treated in
accordance with the System of Records Notice (“SORN”), CFPB.021: CFPB Consumer
Education and Engagement Records, 77 FR 60382. This information will not be
disclosed as outlined in the Routine Uses for the SORN. Direct identifying information
will only be used by Fors Marsh to facilitate the study and will be kept private except as
required by law.
This collection of information is authorized by Pub. L. No. 111-203, Title X, Sections
1013 and 1022, codified at 12 U.S.C. §§ 5493 and 5512.
Page 2 of 8
Participation in this study is voluntary, you are not required to participate or share any
identifying information with Fors Marsh Group, including name, email address, audio
recording, and you may withdraw participation at any time. However, if you do not
include the requested information, you may not be eligible to participate in the study.
Paperwork Reduction Act
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a
person is not required to respond to a collection of information unless it displays a valid OMB control
number. The OMB control number for this collection is 3170-0036. It expires on 08/31/2019. The
time required to complete this information collection is estimated to average approximately 5
minutes per response. Responding to this collection of information is voluntary. Comments
regarding this collection of information, including the estimated response time, suggestions for
improving the usefulness of the information, or suggestions for reducing the burden to respond to
this collection should be submitted to Bureau at the Consumer Financial Protection Bureau
(Attention: PRA Office), 1700 G Street NW, Washington, DC 20552, or by email to
CFPB_PRA@cfpb.gov.
[NEW SCREEN]
Q1_1. First name:
[Open-end text box]
Q1_2. Last name:
[Open-end text box]
Q1_3. Email:
[Open-end text box]
[Validate email]
Q1_4. Mobile number:
[Open-end text box]
[Validate telephone]
Q1_5. Alternate number:
[Open-end text box]
[Validate telephone]
[NEW SCREEN]
Q2. What is your age?
[Single Punch]
0–17
18–36
37–46
47–61
62–69
70–79
01
02
03
04
05
06
Ineligible
Ineligible
Ineligible
Ineligible
Eligible
Eligible
Page 3 of 8
80+
Refused
07
-99
Eligible
Ineligible
Q3_1. Do you have a checking account at a bank or credit union?
[Single Punch]
Yes
No
Refused
01
02
-99
Eligible
Ineligible
Ineligible
Q4. Who typically makes decisions about money in your household?
[Single Punch]
You
Your spouse/partner
You and your spouse/partner
You and another family member (or family members)
Another family member (or family members)
Someone else
Nobody
Don’t Know/Not Sure
Refused
01
02
03
04
05
06
07
98
-99
Eligible
Ineligible
Eligible
Eligible
Ineligible
Ineligible
Ineligible
Ineligible
Ineligible
[NEW SCREEN]
Q5. Within the last 5 years, have you or an immediate family member worked for any of the following
types of business? Select all that apply.
[Multi-Punch]
Yes
No
Refused
01
02
-99
An advertising or public relations firm
A marketing or market research firm or department
A marketing or market research consultant
Any kind of media company, like a TV or radio station or
newspaper
A Government agency that regulates the financial industry
None of the above
Ineligible
Ineligible
Ineligible
Ineligible
Ineligible
Eligible
Q6. When, if ever, was the last time you participated in a marketing research study, such as a
consumer interview or a group discussion?
[Single Punch]
Within the past three months
More than three months ago
Never
Refused
01
02
03
-99
Ineligible
Eligible
Eligible
Ineligible
Page 4 of 8
[IF INELIGIBLE, TERMINATE HERE USING THE LANGUAGE BELOW; IF ELIGIBLE, CONTINUE TO
SECTION 2]
[NEW SCREEN]
We’re sorry, but you do not qualify for this study. Thank you for your interest.
[End Survey]
Section 2: Demographic Items
[NEW SCREEN]
Q7. What is your gender?
[Single Punch]
Male
Female
Other
Refused
01
02
03
-99
Q8. Are you of Hispanic or Latin American origin?
[Single Punch]
Yes
No
Don’t Know/Not Sure
Refused
01
02
98
-99
Q9. Which of the following best describes your race? Select all that apply.
[Multi-Punch]
[RANDOMIZE ORDER, BUT ALWAYS ASK “Some other race”
LAST.]
White
Black/African American
American Indian or Alaska Native
Asian
Native Hawaiian or Pacific Islander
Some Other Race
Yes
No
Refused
01
01
01
01
01
01
02
02
02
02
02
02
-99
-99
-99
-99
-99
-99
[NEW SCREEN]
Q10. What is the highest level of education you have completed?
[Single Punch]
Less than high school degree or equivalent
High school graduate (GED or Diploma)
Some certificate or trade school courses completed
01
02
03
Trade school certificate
04
Some college courses completed
Associate degree (2-year)
05
06
Page 5 of 8
Bachelor’s degree (4-year)
Some graduate courses completed
Post-graduate degree (master’s or doctorate)
Refused
07
08
09
-99
Q11. Which of the following best describes what you are currently doing? Select all that apply.
[Multi-Punch]
01
02
03
04
05
06
07
08
09
10
Yes
01
01
01
01
01
01
01
01
01
01
Employed full-time
Employed part-time
Full-time student
Part-time student
Homemaker
Self-employed
Retired
Disabled
Not currently employed
Other
No
02
02
02
02
02
02
02
02
02
02
Refused
-99
-99
-99
-99
-99
-99
-99
-99
-99
-99
[If Q11 = 03, 05, 07, 08 or 09, skip to Q13]
[NEW SCREEN]
Q12. What type of organization are you employed by?
[Single Punch]
Private for-profit company or business
Not-for-profit (tax exempt) company or charitable organization
Government (Federal, state, or local)
Public Service (Teaching)
Self-employed business or professional practice
Refused
Yes
01
02
03
04
05
-99
Q13. Are you currently serving or have you ever served in the U.S. Military?
[Single Punch]
Yes
No
Refused
01
02
-99
Q14. What is the monetary value of your total net worth (e.g., income, personal property, stocks)?
[Single Punch]
Less than $30,000
$30,000 to $49,999
$50,000 to $99,999
$100,000 to $150,000
More than $150,000
Don’t Know/Not Sure
Refused
01
02
03
04
05
98
-99
Page 6 of 8
[NEW SCREEN]
Q15. Do you have any responsibility for managing the finances of a relative or someone else?
[Single Punch]
Yes, for someone 61 or younger
Yes, for someone 62 or older
No
Refused
01
02
03
-99
[NEW SCREEN]
Final Message [if they qualify and complete survey]
Thank you for completing this questionnaire. If you qualify for this study, we will be in contact with
you to schedule a time that is convenient for you.
If you have any questions, please contact us at ux@forsmarshgroup.com or call us at 571-858-3817.
You can also visit our website at www.forsmarshgroup.com or our Facebook page:
http://www.facebook.com/ForsMarshGroup.
Page 7 of 8
Phone-Based Screener (for those who qualify based on web-based screener)
Hello ______. Thank you for your interest in participating in our interviews about your experiences
and decision-making processes regarding personal finances. My name is ________ and I wanted to
follow up regarding a screener that you completed recently for an upcoming study. I wanted to ask a
couple more questions and see if we can schedule you. Your participation is completely voluntary. Do
you have a few minutes?
Privacy Act Statement
5 U.S.C. 552(a)(e)(3)
The information you provide through your responses to Fors Marsh Group will assist the study sponsor,
the Consumer Financial Protection Bureau (“CFPB”), in determining your eligibility to participate in a
study that will focus on the development and improvement of CFPB tools and resources to assist
consumers.
A federal law called the Privacy Act directs how the CFPB collects, keeps and shares your personal,
private information- including the personal information contained in your answers to these questions.
Your participation is completely voluntary, and is subject to the CFPB privacy policy that can be found on
our website, consumerfinance.gov.
Abbreviated Paperwork Reduction Act
This survey has been approved under the Paperwork Reduction act of 1995 by the Federal
Government’s Office of Management and Budget and assigned OMB control number 31700036. Without this OMB control number we could not conduct this survey. The is voluntary
and will only take about 5 minutes.
1. Can you please verify your age?
3. Can you please verify your highest level of education?
[If responses are confirmed – proceed with scheduling.]
Thank you for your time.
Page 8 of 8
File Type | application/pdf |
Author | David Hawkins |
File Modified | 2017-11-15 |
File Created | 2017-11-15 |