Form 4 Form 4 Hearing Test

OMB Control No.: 2126-00XX

Expiration Date: MM/DD/YYYY

Public Burden Statement

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 2126-00XX. Public reporting for this collection of information is estimated to be approximately 1 minute per response, including the time for reviewing instructions, gathering the data needed, and 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 Samuel.White@dot.gov.

Virginia Tech Transportation Institute

Compass Hearing and Visual Acuity Test Protocol and Script

Hearing Test

Next we are going to be performing an informal hearing test. This test will take no more than five minutes.

Please have a seat in this chair and face the wall. I will read a sentence. After I have completed reading a sentence, please repeat the sentence. I will then read the next sentence.

Hearing Test: Stand approximately 3 feet behind participant. Read one sentence and wait for the participant to repeat the sentence.

Repeat after me:

• A car is approaching in the left lane.

• Please turn right at the next intersection.

• The vehicle is running smoothly.

• The car ahead of me has its high-beams on.

If the participant repeats the sentences, read the following:

Good. You passed the hearing test. Now we will proceed with the vision testing.

If the participant does not repeat the sentences, read the following:

Unfortunately you are not eligible for this particular study as you may have trouble hearing the experimenter or instruments in our experiment. Thank you for your time.

We will compensate you for your time. Would you like to be called for future studies? [End]