Screening Questionnaire for “Leaning Green” Consumer Focus Group
OMB Control No. 2070-0189
Approval expires 02/28/17
The annual public burden for this collection of information is estimated at 0.17 hours per response for screened respondents. Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed application to this address.
Screening Questionnaire for “Leaning Green” Consumer Focus Group
Interviewer: _______________
Date: _______________
Letter sent: _______________
Reconfirmation Call: _______________
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CALL FROM DATABASE OR AT RANDOM
RECRUIT 9 PER GROUP FOR 8-9 TO SHOW
Hello, I’m __________ with __________________, an independent consumer research firm. We are not selling or promoting any product or service. We are conducting a research study on behalf of the United States Environmental Protection Agency about providing information to help consumers select products that are safer for people, families and pets and can help protect the environment, and would like to include your views. My questions will only take a couple of minutes.
1. First, do you, or does any member of your household or immediate family, work for or is retired from:
A market research company _____
A direct mail company or direct marketing company _____
An advertising agency or public relations firm _____
The media (TV/radio/newspapers/magazines) _____
[IF YES TO ANY >> TERMINATE]
2. Are you a chemist, chemical engineer, or organic farmer – or do you work for EPA, an environmental agency or environmental non-profit, or the organic food industry?
[IF YES TO ANY >> TERMINATE]
3. In a typical month, how frequently do you shop at a grocery store, supermarket, hardware store, home improvement store (such as Home Depot or Lowe’s) or general retail store (such as Walmart, Target, Costco, or Sam’s Club) for your household?
4 or more times _____
2 or 3 times _____
TERMINATE >> Fewer than 2 times _____
4. When you select products for your household, such as cleaning products or personal care, how important is it to you to select products that can help protect the health of yourself, your family, or your pet? Please rate this on a scale from 1 to 5, where 1 is “not at all important” and 5 is “very important.”
TERMINATE >> 1 – Not at all important ____
TERMINATE >> 2 – Somewhat unimportant ____
TERMINATE >> 3 – No opinion either way ____
4 – Somewhat important____
TERMINATE >> 5 – Very important____
5. In the last three months, did you choose to buy a product over another because it was better for the environment?
Yes ____
No ____
6. If “Yes,” about how many times did you choose a product that was better for the environment?
# of times ____
7. How knowledgeable are you about environment issues (climate change, pollution…)? Please rate this on a scale from 1 to 4, where 1 is “not at all knowledgeable” and 4 is “very knowledgeable.”
TERMINATE >> 1 – Not at all knowledgeable ____
2 – Not very knowledgeable ____
3 – Somewhat knowledgeable ____
TERMINATE >> 4 – Very knowledgeable____
8. How knowledgeable are you about selecting products that can help protect the environment? Please rate this on a scale from 1 to 4, where 1 is “not at all knowledgeable” and 4 is “very knowledgeable.”
TERMINATE >> 1 – Not at all knowledgeable ____
2 – Not very knowledgeable ____
3 – Somewhat knowledgeable ____
TERMINATE >> 4 – Very knowledgeable____
9. Which of the following categories best describes your total annual household income? [GOOD MIX]
TERMINATE >> Under $15,000 _____
$15,000 - $24,999 _____
$25,000 - $34,999 _____
$35,000 - $54,999 _____
$55,000 - $74,999 _____
$75,000 - $100,000 _____
TERMINATE >> Over $100,000 _____
10. Please tell us your age. [Record age;
11. What is your current marital status? Are you ….. ?
Married or living with a partner_____
Single _____
Divorced _____
Widowed _____
12. What is the highest level of education you have completed?
Less than high school graduate _____
High school graduate _____
Some college _____
College graduate _____
Post graduate studies or degree _____
13. So that we can be sure that all backgrounds are represented in our study, please tell me your ethnic or race background. Are you … ?
Ethnicity
Hispanic or Latino_____
Not Hispanic or Latino_____
Race
American-Indian or Alaska Native _____
Asian _____
Black or African American _____
Native Hawaiian-Indian or Other Pacific Islander _____
White _____
Other _____
14. [Record gender]
Male _____
Female _____
15. Have you ever attended a focus group discussion or individual interview? By that we mean an informal, round-table discussion, conducted by a professional moderator in which you were asked your opinions regarding a product, a service, or advertising?
MAX. ½ GROUP >> ASK A-C >> Yes _____
INVITE TO GROUP >> No _____
How many of these groups have you attended?
______________________________ [MAX. 3 EVER]
What was/were the topics discussed?
______________________________ [IF CHEMICAL SAFETY, TERMINATE]
How long ago was the last one of these groups you attended?
______________________________ [MUST BE AT LEAST 6 MONTHS AGO]
[INVITE TO GROUP]
Thank you for answering all of my questions. As I mentioned earlier, we are conducting a research study regarding information to help consumers select products that are safer for families and pets and can help protect the environment. We are conducting an informal, round-table discussion to be held on ________ at _____. The discussion will last about two hours and will be both fun and informative. No one will attempt to sell you anything and no one will call on you as a result of your participation. As a token of our appreciation for your help in our research effort, you will receive a $100 cash honorarium at the time of the session. This is an important research effort and we hope that you will be part of it. We can only invite about a dozen people to take part. Can we schedule your attendance?
[If yes, read … ]
If you need glasses for reading or for watching TV, please be sure to bring them with you to the group.
ID Number _________________________________________________
NAME: _________________________________________________
ADDRESS: _________________________________________________
CITY: _________________________________________________
ZIP CODE: _________________________________________________
PHONE: (DAY) _____________________________________
(EVE) _____________________________________
(CELL) _____________________________________
(EMAIL) _____________________________________
Interviewer: ____________________
Supervisor Confirm: ____________________
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Carlson, Ron |
| File Modified | 0000-00-00 |
| File Created | 2021-01-22 |