Form 2026 Form 2026 Cognitive Testing Screener

OMB Control No. 2127-New

NHTSA FORM 2026

Expiration Date: Three years from date of approval

5-Star Safety Ratings Label Quantitative Concept Testing

COGNITIVE TESTING SCREENER

Cognitive Testing IDIs – Study Overview

• RECRUIT: Online/Phone screening

• MODE: Webcam IDI

• LENGTH: Up to 60-minutes

• SAMPLE: n=9

• SAMPLE SOURCE: Recruiter Database

• QUALIFICATION CRITERIA:

  • U.S. Nationwide

  • Ages 18+

  • Possess current driver's license

  • Primary/shared decision maker for vehicle purchases in household

  • In purchase mindset (have purchased or leased a new vehicle in last 6 months or planning to purchase/lease new vehicle in next 12 months)

5-STAR SAFETY RATINGS QUANT COGNITIVE TESTING IDI—SCREENER

INTRODUCTION

Thank you for taking this survey. Your opinions are important to us! Please be honest when answering the survey. Your answers are anonymous and confidential, and none of your individual information will be shared with any third parties.

[INCLUDE ON ITS OWN SEPARATE SCREEN AFTER THE INTRODUCTION SCREEN] Thank you for agreeing to participate in this study that is being conducted on behalf of the National Highway Traffic Safety Administration (NHTSA). This collection of information is voluntary and will be used for formative purposes only so that we may develop communications programs designed to reduce the number of traffic-related injuries and deaths. We will not collect any personal information that would allow anyone to identify you. 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 2127- NEW.

Completion of this survey is estimated to take an average of 5 minutes, including the time for reviewing instructions, completing, and reviewing the collection of information. All responses to this collection of information are voluntary. If you have comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, send them to: Information Collection Clearance Officer, National Highway Traffic Safety Administration, 1200 New Jersey Ave, SE, Washington, DC, 20590.

Hello, may I please speak with ______________________? This is _________ from a national opinion research company.

If on the phone, continue.

If not on the phone/voicemail/no answer, arrange for callback.

If someone other than participant is on the phone, continue with screen.

Good morning/afternoon/evening. I am calling to see if you would be interested in participating in a research discussion about the decision-making process and experiences related to shopping for new vehicles with a select group of people from your area. I have just a few questions to ask you to be sure that we have a good balance of qualified participants. All answers to these questions remain confidential. May I ask you a few questions?

S1. Are you:

[RECRUIT A MIX]

1. Male

2. Female

S2. What is your age? [RECRUIT A MIX]

______________

1. <18 THANK & TERMINATE

2. 18-34

3. 35-54

4. 55+

S3a. Do you or does any member of your household currently work for/in…?

[THANK & TERMINATE 1-12]

1. Marketing, advertising, public relations or marketing research firm or division of a company

2. Graphic design

3. News media or journalism organization, including newspaper, television, radio or publishing

4. Law enforcement (including corrections officers, police officers, etc.)

5. A legal organization or legal division of a company

6. Auto insurance

7. An automobile manufacturer or dealership

8. An automotive parts manufacturer

9. Online automotive company or association

10. Local, state or federal government

11. A taxi service or part-time or full-time ridesharing, such as Uber or Lyft

12. Commercial or professional driving (NOTE TO RECRUITER: If necessary, to clarify, “commercial driving” means driving as a primary part of one’s occupation or job)

13. None of the above

S3b. What is your profession (i.e., job title)? [NOTE TO RECRUITER: Check to see if response to S3b aligns with any field in S3a; if so, THANK AND TERM]

_________________________

99. I am not employed

S4. Have you participated in a focus group in the past six months?

1. Yes THANK & TERMINATE

2. No

3. Don’t Know/refused THANK & TERMINATE

S5. Do you currently have a valid driver’s license?

1. Yes

2. No THANK & TERMINATE

S6. Who is responsible for making vehicle-related purchase or leasing decisions in your household?

1. I am primarily responsible

2. I share this responsibility with someone else in the household

3. Someone else in the household is responsible THANK & TERMINATE
   
   
   

____________________________________________________________________________

S7a. Have you purchased or leased a new vehicle in the last 6 months?

1. Yes

2. No

ASK IF NO TO S7a

S7b. How likely are you to purchase or lease a new vehicle in the next 12 months?

1. Not at all likely THANK & TERMINATE

2. Not too likely THANK & TERMINATE

3. Somewhat likely

4. Very likely

5. Extremely likely

___________________________________________________________________________

S8. What is the last grade of formal education you completed? [RECRUIT A MIX]

1. Less than high school [RECRUIT 2 MAX]

2. High school graduate

3. Vocational/technical

4. Some college

5. College graduate

6. Post graduate

7. [DO NOT READ] Decline to answer THANK & TERMINATE

S9. What is your race? Select all that apply. [RECRUIT A MIX]

1. 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.

2. Asian

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

3. Black or African American

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

4. Hispanic or Latino

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

5. Middle Eastern or North African

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

6. Native Hawaiian or other Pacific Islander

For example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc.

7. White

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

S10. Which of the following best describes your employment status? [RECRUIT A MIX]

1. Employed full-time

2. Employed part-time

3. Retired [RECRUIT MAX 2]

4. Unemployed [RECRUIT MAX 2]

5. Student

6. Homemaker

7. Other: _________________ [IF MILITARY RECODE TO 1 ‘Employed full-time’]

S11. What was the total combined annual income before taxes, of all the members of your household including yourself in 2023? [RECRUIT A MIX]

1. Less than $25,000

2. $25,000-$49,999

3. $50,000-$74,999

4. $75,000-$99,999

5. $100,000-$149,999

6. $150,000 or more

7. [DO NOT READ] Decline to answer THANK & TERMINATE

S12. Now I’d like you to use your imagination a bit. If you could plan your perfect trip to any location in America where would you go and whom would you take with you? Why? What would you do while you’re there?

[RECORD RESPONSE IN RECRUIT GRID]

[THANK & TERMINATE IF PARTICIPANT IS UNABLE TO FORMULATE A THOUGHTFUL AND COHERENT RESPONSE OR IF ACCENT IMPEDES COMPREHENSION]

INVITATION

Thank you for answering my questions. We are inviting a select number of people to participate in an online, one-on-one research discussion. During this conversation, you will be asked to share your thoughts and reactions to an online survey that is being developed for drivers like yourself across the country. The discussion will last about an hour and during that time you will complete an online survey and talk about the experience. The goal is to evaluate the survey to make sure the questions are clear, easy to understand and the response options all make sense. You will share your feedback on the process with a research interviewer who will be observing. Again, this interview is for research purposes only. You will never be asked to purchase anything, and all of your responses and comments will remain strictly confidential. In appreciation for your feedback, we are offering $100 for your participation.

The interviews will be held on the following days/times (Eastern Time):

[RESEARCH CALENDAR]

S13. Would you be available to join us during one of those days/times?

1. Yes

2. No THANK & TERMINATE

S14. Will you be able to participate in a safe, stationary environment—meaning not while in a vehicle—during the interview? Please note that if you are in a vehicle at ANY time during the session, you will not be eligible to participate or receive an incentive.

1. Yes

2. No THANK & TERMINATE

S15. Will you be able to participate in a quiet, distraction-free environment?

1. Yes

2. No THANK & TERMINATE

S16. Will you have access to a computer (laptop or desktop—not a tablet or smartphone) with a high-speed internet connection so you can participate in the online interview during that day/time?

1. Yes

2. No THANK & TERMINATE

S17. Does your computer have a working webcam?

1. Yes

2. No THANK & TERMINATE

S18. Are you comfortable participating in a video call and sharing your screen so the interviewer can observe you while you complete the online survey?

1. Yes

2. No THANK & TERMINATE

Just so I can confirm what we just talked about, what is your name and email address?

NAME: ______________________________________________

EMAIL ADDRESS: [CONFIRM FROM ABOVE]

[THANK, TELL THEM THEY WILL RECEIVE A “REMINDER” CALL AND A VERIFICATION EMAIL AS THE DATE GETS NEARER AND POLITELY END THE CALL.]

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