Form 0929-1050 Recruitment Screener - English

OMB Control No. 0920-1050

Exp. Date 06/30/2025

The public reporting burden of this collection of information is estimated to average 2 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. 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).

Attachment 1: Recruitment Screener

Project summary

The purpose of this project is to gather feedback on materials for parents and caregivers of toddlers and preschoolers. This project is being conducted for the Centers for Disease Control and Prevention (CDC).

Participant screener

Hello, I’m __________ with [focus group facility], an independent consumer research firm. We are recruiting participants for 60-minute, online discussions to talk about updated materials for parents and caregivers of children ages 2-4 years old. I would like to ask you a few questions to see if you are eligible to participate in one of these discussions. My questions will only take a couple of minutes.

1. Are you a parent or caregiver of a toddler or preschooler ages 2-4 years? Caregivers may include biological parents, adoptive parents, grandparents, extended family members, step-parents, foster parents, and others.

Yes _____

TERMINATE >> No_____

2. We are holding a virtual group discussion online where you would use your phone, tablet, or computer to join. Are you comfortable participating in a virtual discussion?

Yes _____

TERMINATE >> No _____

3. Do you have a device that has a camera that faces you that would allow you to participate in a virtual discussion?

Yes _____

TERMINATE >> No _____

4. What kind of device or devices do you have with a camera that faces you that would allow you to participate in a virtual discussion?
   [No screener based on this, but please encourage individuals who have both a phone and another video-capable device to use the largest device available to allow them to see other participants and information shared on the screen]

Tablet _____

Desktop computer _____

Laptop computer _____

Phone ____

5. Do you have access to Zoom on this device?

Skip to Question 7>> Yes _____

Proceed to Question 6 >> No _____

6. [If answered “no” on Question 5] Can you download and install new programs on your device, or do you need someone to help you?
   [No screener based on this, but please track respondents who answer “Can install with help” or “Don’t know” so [focus group facility] can walk them through installation in advance]

Yes, can install _____

Can install with help _____

Don’t know _____

TERMINATE>>No, cannot install/need administrator _____

7. How many toddlers or preschoolers do you care for between the ages of 2-4?
   [No screener based on this, but please track responses to share with the research team as contextual information on participants]

Number _____

8. Do you care for this toddler or preschooler/these toddlers or preschoolers part-time or full-time?
   [No screener based on this, but please track responses to share with the research team as contextual information on participants]

Part-time _____

Full-time _____

9. How would you describe the area in which you live? Is it …..? [NEED MIX]

Large city _____

Suburb near a large city _____

Small city or town _____

Rural area _____

10. What is the highest level of education you have completed? [NEED MIX]

High school graduate or less_____

Some college, technical, or trade school _____

Bachelor’s degree or beyond _____

11. What is your race and/or ethnicity? [select all that apply] [NEED GOOD MIX]

Black or African-American _____

(For example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc.)

Asian _____

(For example, Chinese, Asian Indian, Filipino, Vietnamese, Korean, Japanese, etc.)

White _____

(For example, English, German, Irish, Italian, Polish, Scottish, etc.)

Hispanic or Latino _____

(For example, Mexican, Puerto Rican, Salvadoran, Cuban, Dominican, Guatemalan, etc.)

American Indian or Alaska Native _____

(For example, Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, Aztec, Maya, etc.)

Native Hawaiian or Pacific Islander _____

(For example, Native Hawaiian, Samoan, Chamorra, Tongan, Fijian, Marshallese, etc.)

Middle Eastern or North African _____

(For example, Lebanese, Iranian, Egyptian, Syrian, Iraqi, Israeli, etc.)

12. How do you currently describe yourself? [NEED GOOD MIX]

Female _____

Male _____

Transgender _____

I use a different term [open-text box]_____

Prefer not to answer/decline _____