Cognitive Interview Screener (telephone and mail)

OMB No: 0910-0345 Expiration Date: xx/xx/2028

Paperwork Reduction Act Statement: The Paperwork Reduction Act of 1995 provides that 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 valid OMB control number for this information collection is 0910-0345 and the expiration date is xx/xx/2028. The time required to complete this information collection is estimated to average 5 minutes per response, including the time for reviewing instructions and completing and reviewing the collection of information.

Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing burden to PRAStaff@fda.hhs.gov.

Food Safety and Nutrition Survey

Cognitive Interview Screener

Food Safety Version

[Recruit 6 to have 4 completes. 2 of these should be lower ed.]

We are recruiting for an upcoming online interview study sponsored by the U.S. Food and Drug Administration (FDA) to test a new survey. You will be asked to share your thoughts and experiences about food safety and nutrition.

The interview will be conducted through the Zoom online video platform. Participants will need to have access to a computer with a web camera and the internet during the interview. The interview will last about 60 minutes and you will receive $60 for completing the study.

We need you answer a few questions to see if you are eligible for the study. Are you interested in participating?

• YES  continue TO SCREENER

• NO  Thank you for your time. END SURVEY

RECRUITMENT SCREENER

[IF INELIGIBLE, GO TO END OF PAGE 3]

1. The interviews will be conducted in English. Are you comfortable reading, understanding, and speaking English? [NOTE TO RECRUITER: We will be recruiting Hispanic individuals, but the interviews will be conducted in English.]

• Yes

• No  INELIGIBLE

2. How old are you?

• 17 or younger  INELIGIBLE

• 18-24

• 25-39

• 40-54

• 55-64

• 65 or older

(NOTE: Please recruit a range of ages.)

3. Do you or someone from your immediate family work for any of the following:

• A Market Research Firm  INELIGIBLE

• A Food Industry, Restaurant or Food Retailer  INELIGIBLE

• A Public Health Organization  INELIGIBLE

• A State or local food agency, or the

U.S. Department of Agriculture  INELIGIBLE

• The Food and Drug Administration  INELIGIBLE

4. Have you participated in a focus group or individual interview research within the past six months?

[RECRUITER: Participation in telephone or internet surveys is allowed]

• Yes  INELIGIBLE

• No

5. How often do you prepare the main meal in your household? Do you prepare the main meal…?

• All or nearly all the time

• Some of the time

• Never  INELIGIBLE

6. How much of your household's food shopping do you do?

[IF NEEDED: This can be either online or in-person shopping.]

• All of the food shopping

• Most of it

• About half of it

• Only a little of it

• None of it  INELIGIBLE

• Don’t know  INELIGIBLE

7. In the past 12 months, did you eat any fish or shellfish? [IF NEEDED: Please include any foods that had fish or shellfish in them such as sandwiches, soups, or salads. Please include all types of fish and shellfish like canned tuna fish, breaded fish such as fish sticks, as well as baked or fried fish. Shellfish includes things like–shrimp, clams, crab, crayfish, lobster, mussels, oysters, and scallops.]

• Yes

• No  INELIGIBLE

8. What is your sex?

• Male

• Female

(NOTE: Please recruit a mix of male and female participants.)

9. Are you Hispanic or Latino?

• No, not Hispanic or Latino

• Yes, Hispanic or Latino

10. What is your race? (Select All that Apply)

• American Indian or Alaska Native

• Asian

• Black or African American

• Native Hawaiian or Other Pacific Islander

• White

(NOTE: Please recruit a mix of race and ethnicity.)

11. What is the highest level of education you have completed?

• Less than high school

• High school graduate/GED

• Some college /Technical School/Associate Degree

• Undergraduate degree

• Master’s degree

• PhD or Other professional school

[NOTE: Please recruit 2 with lower education levels (Less than HS/HS Grad/GED) and 2 from higher ed levels]

Thank you for your answers to these questions. If you are chosen for an interview, someone will contact you within the next 1-2 days.

Please provide your name, email address, and phone number so that we can contact you if you are selected to participate in this study. Be assured that your contact information will be kept secure to the extent permitted by law and will only be used for the purpose of contacting you about this interview.

Name: ____________________________________________________________

Email: _____________________________________________________________

Phone: ____________________________________________________________

IF INELIGIBLE: Thank and Terminate

Thank you for answering these questions. Unfortunately, based on your responses, you are not eligible for this study.

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