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350 A p p e n d i x V Driver Demographics Questionnaire
351 Appendix V - Demographic Questionnaire SHRP2 NDS There are 21 questions in this survey Demographic Data 1 What is your gender: Please choose only one of the following: Female Male 2 What is your date of birth? Please enter a date: 3 What do you consider your ethnicity to be? Please choose only one of the following: Hispanic or Latino Not Hispanic or Latino 4 What do you consider your race to be? Please choose all that apply: Black or African American White Asian American Indian or Alaska Native Native Hawaiian or Other Pacific Islander Other: 5 What is your country of birth? Please choose only one of the following:
352 United States Other 6 What is the highest level of education you have completed? Please choose only one of the following: Some high school High school diploma or G.E.D. Some education beyond high school but no degree College degree Some graduate or professional school, but no advanced degree (e.g., J.D.S., M.S. or Ph.D.) Advanced degree (e.g., J.D.S., M.S. or Ph.D.) 7 What is your marital status? Please choose only one of the following: single married divorced widow(er) unmarried partners 8 What is your current household status? Please choose only one of the following: Two-parent household One-parent household Other 9 Is your primary household: Please choose only one of the following: Owned Rented
353 10 What is your current work status? Please choose only one of the following: Not working outside the home Part-time Full-time 11 What is your current job title or profession? Please write your answer here: 12 What is your family's annual household income (from all sources and before taxes)? Please choose only one of the following: Under $29,000 $30,000 to $39,999 $40,000 to $49,999 $50,000 to $69,999 $70,000 to $99,999 $100,000 to $149,999 $150,000 + 13 How many people including yourself live in your household? Please write your answer here: 14 Of these, how many are: Please write your answer(s) here: Less than 16 years old? 16 - 20?
354 21 - 25? 26 - 30? 31 - 35? 36 - 40? 41 - 45? 46 - 50? 51 - 55? 56 - 60? 61 - 65? 65 +
355 15 How many vehicles are there in your household? Please write your answer here: 16 What is your ZIP Code? Please write your answer here: 17 How long have you lived in your neighborhood? Please choose only one of the following: Less than 1 year 1 to 5 years more than 5 years 18 Approximately how many miles did you drive last year? Please write your answer here: 19 Do you use the study vehicle for any business purposes (such as pizza delivery or realtor activities)? Please choose only one of the following: Yes No 20 If 'Yes', please indicate the business purpose. Only answer this question if the following conditions are met: ° Answer was 'Yes' at question '19 [19]' (Do you use the study vehicle for any business purposes (such as pizza delivery or realtor activities)?) Please write your answer here:
356 21 At what age did you receive your driver's license (i.e., when did you drive legally by yourself)? Please choose only one of the following: < 15 15 15.5 16 16.5 17 17.5 18 > 18 Submit your survey. Thank you for completing this survey.
