### EPA ICR No. **2487 .**  **01 ; OMB Control No. 2070** **- NEW** 

**ATTACHMENT B**  **Screening Questionnaire for “Leaning Green” Consumer Focus Group**



### OMB Control No. **2070 -** **NEW Approval expires**  **XX/XX/XX** The annual public burden for this collection of information is estimated at 0.17 hours per response for screened respondents , 2 hours for respondents that participate in the focus groups , 0.33 hours per response for pre - launch consumer online survey respondents, and 0.17 hours per response for post- launch online survey respondents . Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460 . Include the OMB control number in any correspondence . Do not send the completed application to this address.**Screening Questio nnaire for “Leaning Green” Consumer Focus Group** 

Interviewer: _______________ Date: _______________ Letter sent: _______________ Reconfirmation Call: _______________ **CALL FROM DATABASE OR AT RANDOM**  **RECRUIT 9 PER GROUP FOR 8 -** **9 TO SHOW** Hello, I’m __________ with __________________, an independent consumer research firm . We are not selling or promoting any product or service. We are conducting a research study on behalf of th e United States Environmental Protection Agency about providing information to help consumers select products that are safer for people, families and pets and can help protect the environment, and would like to include your views. My questions will only ta ke a couple of minutes. 1. First, do you, or does any member of your household or immediate family, work for or is retired from: A market research company _____ A direct mail company or direct marketing company _____ An advertising agency or public relat ions firm _____ The media (TV/radio/newspapers/magazines) _____ **[IF YES TO ANY >> TERMINATE]** 2. Are you a chemist, chemical engineer, or organic farmer – or do you work for EPA, an environmental agency or environmental non - profit, or the organic food industry? **[IF YES TO ANY >> TERMINATE]** 3. In a typical month, how frequently do you shop at a grocery store, supermarket, hardware store, home improvement store (such as Home Depot or Lowe’s) or ge neral retail store (such as Walm art, Target, Costco, or Sam’s Club ) for your household? 4 or more times _____ 2 or 3 times _____ TERMINATE **>>** Fewer than 2 times _____ 4. When you select products for your household, such as clea ning products or personal care, how important is it to you to select products that can help protect the health of yourself, your family, or your pet ? Please rate this on a scale from 1 to 5, where 1 is “not at all important” and 5 is “very important .”TERMINATE >> 1 – Not at all important ____ TERMINATE >> 2 – Somewhat unimportant ____ TERMINATE >> 3 – No opinion either way ____

4 – Somewhat important____ TERMINATE >> 5 – Very important____ 5. In the last three months, did you choose to buy a product over another because it was better for the environment? Yes ____ No ____ 6. If “Yes,” about how many times did you choose a product that was better for the environment? # of times

____ [MAX 1⁄2 > 3 TIMES] 7 . How knowledgeable are you about environment issues (climate change, pollution...)? Please rate this on a scale f rom 1 to 4, where 1 is “not at all knowledgeable” and 4 is “very knowledgeable.” TERMINATE >> 1 – Not at all knowledgeable

____

2 – Not very knowledgeable

____ 3 – Somewhat knowledgeable

____ TERMINATE >> 4 – Very knowledgeable

____ 8 . How knowledgeab le are you about selecting products that can help protect the environment? Please rate this on a scale from 1 to 4, where 1 is “not at all knowledgeable” and 4 is “very knowledgeable.” TERMINATE >> 1 – Not at all knowledgeable

____ 2 – Not very knowle dgeable

____ 3 – Somewhat knowledgeable

____ TERMINATE >> 4 – Very knowledgeable

____ 9. Which of the following categories best describes your total annual household income? [GOOD MIX] TERMINATE >> Under $15,000 _____

$15,000 - $2 4,999 _____ $25,000 - $3 4,999 _____ $35,000 - $54,999 _____ $55,000 - $74,999 _____ $75,000 - $100,000 _____ TERMINATE >> Over $100,000 _____ 10 . Please tell us your age. [Record age; GOOD MIX OF AGES 21 +] 11 . What is your current marital status? Are you ..... ? Married or living with a partner_____ Single _____Divorced _____ Widowed _____ 12 . What is the highest level of education you have completed? [GOOD MIX] Less than high school graduate _____ High school graduate _____ Some college _____ College graduate _____ Post graduate studies or degree _____ 13 . So that we can be sure that all backgrounds are represented in our study, please tell me your ethnic or race background . Are you ... ? [ RECRUIT 3 -4 MINORITIES ] **Ethnicity** Hispanic or Latino_____ Not Hispanic or Latino_____ **Race** American - Indian or Alaska Native _____ Asian _____ Black or African American _____ Native Hawaiian - Indian or Other Pacific Islander _____ White _____ Other _____ 14 . [Record gender] [GOOD MIX] Male _____ Female _____ 1 5 . Have you ever attended a focus group discussion or individual interview? By that we mean an informal, round -table discussion, conducted by a professional moderator in which you were asked your opinions regarding a p roduct, a service, or advertising? MAX. 1⁄2 GROUP >> ASK A- C >> Yes _____

INVITE TO GROUP >> No _____ A. How many of these groups have you attended? ______________________________ [MAX. 3 EVER] B. What was/were the topics discussed?

_____________________________ _ [IF CHEMICAL SAFETY, TERMINATE] C. How long ago was the last one of these groups you attended? ______________________________ [MUST BE AT LEAST 6 MONTHS AGO] [INVITE TO GROUP] Thank you for answering all of my questions . As I mentioned earlier, we are conducting a research study regarding information to help consumers select products that are safer for families and pets and can help protect the environment . W e are conducting an informal, round -table discussion to be held o n________ at _____. The discussion will last about two hours and will be both fun and informative . No

one will attempt to sell you anything and no one will call on you as a result of your participation . As a token of our appreciation for your help in our research effort, you will receive a $100 cash honorarium at the time of the session . This is an important research effort and we hope that you will be part of it . We can only invite about a dozen people to take part . Can we schedule your attendance? [If ye s, read ..... ] If you need glasses for reading or for watching TV, please be sure to bring them with you to the group. ID Number

_________________________________________________ NAME:

_________________________________________________ ADDRESS:

___________ ______________________________________ CITY:

_________________________________________________ ZIP CODE:

_________________________________________________ PHONE: (DAY)

_____________________________________

(EVE)

_____________________________________ (CELL)

_____________________________________ (EMAIL)

_____________________________________ Interviewer:

____________________ Supervisor Confirm:

____________________