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Appendix B. Short Screener to Collect Telephone Number B-1
B-2
What is the Survey of Community Attitudes? This is a survey of households that asks questions about your community. The survey covers different topics about what it is like living in your community. Who is the Conducting this Survey? Westat, a social science research firm, is collecting this information through a contract awarded by the National Academy of Sciences. Why are you asking for my phone number? We sampled your household by your address. Since the survey will be conducted by telephone, we need your number to call you to complete the survey. How long will it take to complete this survey? It will take 3 minutes to complete this mail survey. The follow-up telephone interview will take approximately 15 minutes to complete. Am I required to complete this survey? Participation is voluntary and there are no penalties for refusing to answer. However, your household was randomly selected for this scientific sample survey and you cannot be replaced with another household. Your cooperation is extremely important to help ensure the completeness and accuracy of the study. Who will use this information? Westat, a social science research firm, is collecting this information through a contract awarded by the National Academy of Sciences. The information will be used to measure residentsâ attitudes about their environment. Who can I call with questions? Westat, a private research firm is collecting the data. If you would like further information, you can contact Westat at 1-###-###-####. How was my household selected? Households were selected at random from all residential addresses in your community. By selecting households randomly, we will be able to create scientific estimates about households in your community. Itâs important to participate, so that we have an accurate picture of all communities. B-3
This survey will be conducted by telephone. In order to get in touch with you, we need to collect some information on your household. Please have this filled out by an adult household member living at this address. Please use a blue or black pen if available. 1. Including yourself, how many people age 18 or older live in this household? (Please include both children and adults, as well as persons who are temporarily away at this time, for example, anyone temporarily hospitalized or on a vacation or business trip.) |__|__| 2. What is the best phone number to use to contact you? (This phone number will only be used for the purpose of this research study.) |__|__|__| - |__|__|__| - |__|__|__|__| Thank you. Please return this form in the postage paid envelope provided or mail it to: Community Environmental Survey Westat 1600 Research Blvd. Room ## ### Rockville, MD 20850 Toll-free number for questions: XXX-XXX-XXXX B-4
