On-site interview

BEACH INTERVIEW FORM
If Interview is Not Conducted, Provide Reason:
Interviewers Initials:
Date:

Time:

Beach:

City:

Respondent Gender

Refusal

Male

Under 18

Female

Language Barrier

Sampling Fraction for Day Trips:

Other ________________________

1. Hello, my name is
. I am doing research on beach recreation for the federal government.
Is your visit here today part of a trip away from home lasting more than one day?
Yes 

No

1a. How many days will your trip last in total?

days

1b. How many days will you spend time at the beach?

days

1c. Is going to the beach the main reason for your trip?
Yes

No

2. Could you tell me how many hours in total you will spend at the beach today?
3. What is your age?

hours

years

4. What is the highest degree or level of school you have completed?
Less than high school graduate

Some college or Associate’s degree

High school graduate (includes GED)

Bachelor’s degree
Graduate or professional degree, beyond
a bachelor's degree

5. How many adults and children live in your household?
Adults (18 and older)

Children (Under 18)

6. Would you be willing to take part in a short mail survey that we will send to your home?
Yes 

Could I get your name and address?
First and last name
Street address
City and State
ZIP code
Could I get your email address?
Yes 

No 

No

Could I get your ZIP code?
Yes 

OMB Control Number XXXX I Current Expiration Date: XX/XX/2018

ZIP code

No

The National Oceanic and Atmospheric Administration (NOAA) is authorized by 33 U.S.C. 1951 et seq. to conduct this survey. The information collected
will be used by NOAA to estimate economic impacts associated with marine debris on beaches.
Public reporting burden for this collection of information is estimated to average 4 minutes per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send
comments regarding this burden estimate or any other suggestions for reducing this burden to Amy V. Uhrin, NOAA NOS, 1305 East-West Hwy, SSMC4,
Room 10240, Silver Spring. MD 20910.
The questionnaire has an identification number for mailing purposes only. Your name, street address, and email address will be deleted after we
receive your completed questionnaire. Notwithstanding any other provisions of the law, no person is required to respond to, nor shall any person
be subjected to a penalty for failure to comply with, a collection of information subject to the requirements of the Paperwor k Reduction Act,
unless that collection of information displays a currently valid OMB Control Number.
OMB Control Number XXXX I Current Expiration Date: XX/XX/2018