OMB Control No. 0970-0531
Expiration Date 9/30/25
Screening Questionnaire for Virtual Focus Groups
And In-Depth Interviews
Nationwide
Recruit 6 to interview 4 per group
IDIs recruit 8 to interview 6 (2-extra)
Each Group 90 minutes and IDIs 60 minutes
Hello, this is __________________, from (Insert name of market research firm), calling on behalf of the U.S. Department of Health and Human Services. We are conducting a study of Americans’ opinions about fatherhood. I would like to ask you a few questions to determine if you are eligible for the study which will be in the form of a focus group or one on one interview. Can you confirm if now is a good time?
(NOTE TO RECRUITER: please read):
This collection of information is voluntary and will be used for formative purposes only so that we may develop well informed public communications programs. A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 0970-0531. Public reporting for this collection of information is estimated to be approximately ten minutes per response, including the time for reviewing instructions, completing and reviewing the collection of information. All responses to this collection of information are voluntary. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: C&C Multicultural, 8041 San Hilario Cir, Buena Park, California, 90620.
All your answers will be private. Could we begin now?
2E. Is there a dad, meaning any male who has children, in your household?
( ) If no dad present, thank and TERMINATE
( ) If there is a dad present, continue with screening questions
1. |
Have you ever participated in a research discussion group, focus group or one on one interview? |
|
Yes [ ] CONTINUE
2. No……………………..........[ ] SKIP TO Q3.
2b. |
When was the last time you participated in a research discussion group, focus group, or one on one interview? |
|
RECORD ANSWER IF WITHIN THE
PAST 6 MONTHS THANK AND TERMINATE.
2C. |
How many focus group discussions or one on one interviews have you participated in in the past 12 months? |
|
|
None 1 SKIP TO Q3
1 2 SKIP TO Q2D
2 or more 2 TERMINATE
2D. What was the topic of discussion during the interview had in the last 12 months? [OPEN ENDED – listen for Terminate categories below]
Automobiles 1 CONTINUE
Household products 2 CONTINUE
Beauty products 3 CONTINUE
Fatherhood/family matters 4 TERMINATE
Weight loss 5 CONTINUE
Food products 6 CONTINUE
Other…………………………………………………………..….7 CONTINUE
IF THEY MENTION Fatherhood/Family matters TERMINATE
2F. Into which of the following age brackets do you fall? RECRUIT GOOD MIX OF AGES
( ) 15 or Younger -- TERMINATE
( ) 16-17 CONTINUE
( ) 18-24 CONTINUE
( ) 25-34 TERMINATE
( ) 35-39 TERMINATE
( ) 40+ TERMINATE
IF RESPONDENT IS OVER 25, ASK IF THERE IS ALSO A YOUNGER FATHER AGES 16-24 IN THE HOUSEHOLD.
3. How many children do you have that are 10 years old or under?
RECRUIT A GOOD MIX
( ) One……………….CONTINUE
( ) Two to three…CONTINUE
( ) Four or more…CONTINUE
( ) None………………TERMINATE
3a. How old are your children?______ _______ _____ _____ _____ _____
AT LEAST ONE CHILD MUST BE BETWEEN 0 AND 10--GET A GOOD MIX OF AGES. Recruit at least one third of all respondents who are “new dads” who *only* have children ages 0-3.
4. Are any of your children disabled or have special needs?
( ) Yes
( ) No
LIMIT TO NO MORE THAN ONE DAD WITH DISABLED CHILDREN PER GROUP
Minimum quota of 16-17 year olds: one full group of non-custodial/partial custody fathers should be ages 16-18 if possible; and one IDI should be a father age 16 or 17.
5. What do you consider to be your ethnic background? Select all that apply.
Caucasian or white 1 SKIP TO Q6
African American 2 SKIP TO Q6
Hispanic or Latino 3 CONTINUE
Asian 4 SKIP TO Q6
Native American 5 SKIP TO Q6
Alaska Native or American Indian 6 SKIP TO Q6
Other_____________ 7 SKIP TO Q6
Refused 8 TERMINATE
Minimum quotas: out of the 34 English speaking, non-Alaska Native Native/American Indian respondents, a minimum of 12 should be African-American, and 1-2 should be Asian.
Half of respondents overall (including all Spanish dominant respondents) should be Hispanic.
5ª. ¿Dígame, en qué idioma prefiere hablar? LEER LISTA. ACEPTAR SOLO UNA RESPUESTA.
(Tell me, which language do you prefer speaking?) READ LIST. ACCEPT ONLY 1 RESPONSE.
Español / Spanish |
|
Español e inglés por igual Spanish and English equally |
|
Inglés / English |
|
Otro idioma / Another language |
|
5b. ¿Qué idioma habla usted la mayor parte del tiempo en su hogar? LEER LISTA. ACEPTAR SOLO UNA RESPUESTA.
(Which language do you speak at home most of the time?) READ LIST. ACCEPT ONLY 1 RESPONSE.
Unicamente español Only Spanish |
|
Español más que inglés Spanish more than English |
|
Español e inglés por igual Spanish and English equally |
|
Inglés más que español English more than Spanish |
RECRUIT FOR GENERAL MARKET (LIMIT 1 PER GROUP) |
Unicamente inglés Only English |
RECRUIT FOR GENERAL MARKET (LIMIT 1 PER GROUP) |
Otro idioma / Another language |
|
If Hispanics are functionally bilingual or English dominant recruit for the General Market Groups BUT Limit 2-Hispanics per group. Ensure they are VERY COMFORTABLE speaking English. FOR HISPANIC GROUPS THEY MUST BE COMFORTABLE SPEAKING SPANISH
6. Where do your children live? RECRUIT GOOD MIX.
IF RESPONDENT IS UNSURE HOW TO ANSWER, CAN CLARIFY THAT WE WOULD LIKE TO KNOW WHERE THE CHILD SPENDS THE MAJORITY OF HIS/HER TIME
( ) With me and my spouse/partner/the child’s mother all the time
( ) With me all the time, I do not live with a spouse or partner
IF EITHER OF ABOVE ANSWERS ARE CHECKED, QUALIFIES AS CUSTODIAL DAD-/FULL TIME DAD - SKIP TO Q8
( ) With my spouse/partner/child’s mother most or all of the time
( ) With some other family member most or all of the time
IF EITHER OF ABOVE ANSWERS ARE CHECKED, QUALIFIES AS
NON-CUSTODIAL DAD – ASK Q7
( ) Sometimes with my spouse or partner, sometimes with me
( ) Sometimes with some other family member, sometimes with me
IF EITHER OF ABOVE ANSWERS ARE CHECKED, QUALIFIES AS
PARTIAL CUSTODY DAD – ASK Q7
**NOTE: NEED TO DISCUSS WITH MODERATOR HOW TO QUALIFY DADS IF THEY LIVE WITH ONLY SOME OF THEIR CHILDREN**
ENSURE THAT NON-CUSTODIAL/PARTIAL CUSTODY GROUPS HAVE A GOOD MIX OF PARTIAL AND NON-CUSTODIAL DADS
7. You said that your children don’t live with you. How often would you say you generally spend time with your child or children?
( ) Less than once every 3 months [TERMINATE]
( ) Once every month or two
( ) Once a month
( ) Two-four times a month
( ) Five times or more a month
RECRUIT FOR NON-CUSTODIAL/PARTIAL CUSTODY DAD GROUP
7a. How involved and in touch - meaning playing, disciplining, schoolwork, talking, texting, Facetiming, etc. - do you feel you are with your child(ren)?
( ) Not that involved
( ) Somewhat involved
( ) Involved
( ) Very involved
LIMIT 1 “VERY INVOLVED” PARENT PER GROUP
7b. What is your zip code where you currently live? _____________________________________
RECRUIT A MIX OF STATES AND REGIONS
7c. Is the neighborhood you live in...?
( ) Urban
( ) Suburban
( ) Rural
RECRUIT A MIX, INCLUDING A MINIMUM OF 9 RESPONDENTS OVERALL FROM RURAL AREAS (18% OF TOTAL RECRUITED)
8. What is your current marital status? RECRUIT GOOD MIX
( ) Single
( ) Married
( ) In a committed relationship/live with significant other or partner
( ) Divorced
( ) Separated
( ) Widowed
9. Are you currently employed outside the home or attending school? Would you say you: RECRUIT GOOD MIX (Accept multiple responses – some students may also be working)
( ) Work full time (40+ hours a week) – ASK OCCUPATION QUESTION
( ) Work part time (less than 40 hours a week) – ASK OCCUPATION QUESTION
( ) Student
( ) Not currently employed
( ) Retired
10. What is your present occupation? ______________________________
TERMINATE IF THEY MENTION: MARKETING, ADVERTISING, MARKET RESEARCH, SOCIAL WORK, FAMILY SERVICES AND RELATED OCCUPATIONS
What is your current, annual approximate household income?
RECRUIT GOOD MIX OF INCOME
( ) Under $10,000 CONTINUE
( ) $10,000 to $20,999 CONTINUE
( ) $21,000 to $29,999 CONTINUE
( ) $30,000 to $39,999 CONTINUE
( ) $40,000 to $49,999 CONTINUE
( ) $50,000 to $59,999 CONTINUE
( ) $60,000 and above CONTINUE
SKEW LOWER INCOME: 2-3 out of 6 recruited for groups, and at least half of those recruited for IDIs should be below $40k – the rest can fall out naturally.
12. What is your educational background? RECRUIT GOOD MIX
( ) Less than HS
( ) HS Grad (HS diploma, GED, or equivalent)
( ) Some College
( ) College Graduate
( ) Master’s Degree
ARTICULATION QUESTION:
If you could go anywhere in the world to visit and money was no object, where would you go and what would you do there?
INVITATION
We would like to invite you to a group (or one on one interview) discussion. The discussion will last about 1.5hrs (or 45 minutes for IDIs) on [INSERT DATE/TIME/LOCATION]. We don’t have anything to sell you and are only interested in your honest opinions. To thank you for your cooperation, we will give you a token of appreciation of $[$75 for IDI/$125 for focus group] in cash
The groups will be small (/the IDI will only be you and the moderator). If you agree to attend it is very important that we be able to count on you. May we count on your participation?
Can we count on your participation?
1 |
Yes |
Continue |
2 |
No |
TERMINATE |
INTERNET QUESTIONS
13. Do you have an Internet connection at home?
Yes
No [TERMINATE]
14. Which of the following do you use to log in to the internet? (Multiple Responses Allowed)
Laptop
Desktop
Tablet
Cell Phone
I don’t have internet access [TERMINATE]
15. Does your laptop, desktop, tablet, cell phone, have a working video camera with sound?
Yes
No [TERMINATE]
16. We will be conducting the interview via online conference. How comfortable are you using online video conference calling like Zoom, WebEx, Google Meet, Microsoft Teams, etc.?
Very comfortable
Comfortable
Somewhat comfortable
Somewhat uncomfortable [TERMINATE]
Not comfortable [TERMINATE]
17. During the interview you will be required to be in your home in a quiet place with no noise or distractions around you. Are you ok with that setting and are you able to find that kind of space in your home?
Yes
No [TERMINATE]
18. During the interview you will be required to have a pen/pencil and notepad to take notes. Are you ok with that?
Yes
No [TERMINATE]
RESEARCH INVITATION
Based on the information you have provided me, I would like to invite you to participate in an important research project. Your answers will represent the opinions of others and, therefore, your participation is of vital importance.
As I mentioned, this will be a 1.5-hour long focus group discussion (or 45-minute IDI), held on (Insert qualifying date/time based on market and group/segment).
In appreciation of your time and feedback, you will receive a token of appreciation for: [INSERT TOKEN OF APPRECIATION AMOUNT].
19. Do we have your consent to [audio record/video record] this interview for our own internal purposes?
(
) Yes
(
) No/hesitant (THANK
& TERMINATE anyone who seems unwilling to commit to both)
20. For this research, the interview may be [viewed/listened to] live by our clients. Our clients may also wish to [view/listen to] the [video/audio] recordings. We will only use your first name and your personal details will remain strictly private. Do we have your consent for this? (Select one.)
(
) Yes
(
) No/hesitant
(THANK &
TERMINATE anyone who seems unwilling to commit to both)
21. Are you interested in participating?
Yes
No [TERMINATE]
Great! Please provide us with the following information.
Name
Address or City/State
e-mail address
Cell phone number
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | FCIC Screener |
Author | Campbell-Ewald |
File Modified | 0000-00-00 |
File Created | 2024-10-06 |