0920-1050 Recruitment Screener

Form Approved

OMB Control No. 0920-1050

Exp. Date: 06/30/2025

ATTACHMENT 1

Recruitment Screener Questions for MFHP Usability Study

Recruitment Screener

Introduction

Hi, my name is [RECRUITER’S NAME] from the [COMPANY NAME]. We are currently trying to improve our mobile application (app), and in order to so, we are looking for people who might be interested in trying out our app and providing feedback.

If you qualify for this study, we will pay you [$XX] to participate. To see if you meet the qualifications for this study, I’d like to ask you some questions. These questions are completely voluntary, and we’ll only use the information for screening purposes. It will take about 10 minutes to complete.

If you are asked to be in the study, you will be provided with more details and information soon. May we continue?

Device Questions

1. Do you own and regularly use a personal mobile device, for example a smartphone or tablet?

   1. [ ] Yes

   2. [ ] No TERMINATE

2. Which, if any, of the following do you currently use:

   1. [ ] Android mobile or tablet

   2. [ ] iPhone or iPad

   3. [ ] Both

   4. [ ] Neither TERMINATE

   5. [ ] I don’t know TERMINATE

   6. [ ] Other TERMINATE

3. Will you have access to reliable, high-speed internet and/or cellular service/data for the pre and post study calls with the study moderator?

   1. [ ] Yes

   2. [ ] No TERMINATE

   3. [ ] I don’t know TERMINATE

4. Are you willing to install teleconferencing software on your personal mobile device or computer? (Software will only be used for communication with the study moderator. Data will not be stored or collected, and calls will not be recorded.)

   1. [ ] Yes

   2. [ ] No TERMINATE

5. Are you willing to install and use a specific mobile application related to this study on your personal mobile device?

   1. [ ] Yes

   2. [ ] No TERMINATE

6. How would you rate your level of experience using mobile applications?

   1. I am fairly new to using mobile applications

   2. I have some experience, but still have a lot to learn about using mobile applications

   3. I have moderate (average) experience using mobile applications

   4. I have a lot of experience using mobile applications

   5. I have extensive experience using mobile applications

Demographic Questions

7. Do you currently work as a web or application designer or in user experience?

   1. [ ] Yes TERMINATE

   2. [ ] No

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

1. [ ] Some high school

2. [ ] High school/or GED

3. [ ] Some college

4. [ ] College degree

5. [ ] Advanced degree

6. [ ] Trade School

7. [ ] Prefer not to answer

9. What is your age?

1. [ ] 18- 29 years old

2. [ ] 30- 49 years old

3. [ ] 50- 64 years old

4. [ ] 65 years old or older

5. [ ] Prefer not to answer

10. How would you describe the region in which you live?

    1. [ ] Rural

    2. [ ] Suburban/Urban*

    3. [ ] Prefer not to answer

* At least 2,000 housing units, or a population of at least 5,000. (Note: This definition will be provided to participants.)

11. What sex were you assigned at birth, on your original birth certificate?

    1. [ ] Female

    2. [ ] Male

12. How do you currently describe yourself? Select all that apply.

    1. [ ] Female

    2. [ ] Male

    3. [ ] Transgender

    4. [ ] I use a different term: _______________

    5. [ ] Prefer not to answer

13. Just to confirm, you were assigned [FILL] at birth and now you describe yourself as [FILL]. Is that correct?

    1. Yes

    2. No <skip back to Q11 and/or Q12 to correct>

14. What is your race and/or ethnicity? Select all that apply.

    1. [ ] American Indian or Alaska Native

    2. [ ] Asian

    3. [ ] Black or African American

    4. [ ] Hispanic or Latino

    5. [ ] Middle Eastern or North African

    6. [ ] Native Hawaiian or Other Pacific Islander

    7. [ ] White

15. Do you know if you are at an increased risk of cancer due to your family history of cancer?

    1. [ ] Yes

    2. [ ] No

    3. [ ] Don’t know

Public reporting burden of this collection of information is estimated to average 10 minutes per response to account for initial recruitment communications, as well as complete the recruitment screener questions. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-1050).