OMB Control No. 0910-0695
Expiration date: 2/28/2021
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0910-0695 and the expiration date is 2/28/2021. The time required to complete this information collection is estimated to average 3 minutes per response, including the time for reviewing instructions and completing and reviewing the collection of information.
FDA RAPID – MESSAGE #18
CBD Messages
Introduction
The U.S. Food and Drug Administration, or FDA, hired Westat to help them get opinions about health information. Prodege is helping Westat and FDA find people who may be interested in being interviewed about health information. To make sure you are a good fit for the interview, please take about 3 minutes to answer the questions below.
1. Do you, or does any member of your household or immediate family work…?
For a market research company INELIGIBLE
For an advertising agency or public relations firm INELIGIBLE
In the media (TV, radio, newspapers, magazines) INELIGIBLE
As a healthcare professional (doctor, nurse, pharmacist, dietician, etc.) INELIGIBLE
In the pharmaceutical industry INELIGIBLE
In food manufacturing or retailing INELIGIBLE
None of the above GO TO Q2
2. Are you an…?
Employee of the U.S. Department of Health and Human Services, or any of its agencies including the Food and Drug Administration, Centers for Disease Control and Prevention, and National Institutes of Health INELIGIBLE
Employee of a state or local health department INELIGIBLE
None of the above GO TO Q3
3. What is your age?
Under 18 INELIGIBLE
18 to 44
45 to 64
65 or older
4. Have you ever used cannabidiol or CBD?
YES GO TO Q5
NO GO TO Q6
Don’t Know INELIGIBLE
5. How recently have you used cannabidiol or CBD?
Within the past 3 months
More than 3 months ago INELIGIBLE
Don’t Know INELIGIBLE
6. What is your sex?
Female
Male
7. What is the highest grade or level of education you have completed?
Less than High School
High School Diploma or GED
Some College, including Associate’s Degree
Bachelor’s Degree (for example: BA, BS) INELIGIBLE
Graduate or Professional Degree INELIGIBLE
8. Are you of Hispanic, Latino, or Spanish origin?
YES
NO
9. What is your race? Please select one or more.
White
Black or African-American
American Indian or Alaska Native
Asian
Native Hawaiian or other Pacific Islander
10. What state do you live in? [DROP DOWN LIST OF US STATES, INCLUDING “OUTSIDE OF THE US”] [“OUTSIDE OF THE US” INELIGIBLE]
Request for Contact Information
C1. Thank you for answering the questions. Based on your answers, you may be selected for an interview that will take about 30 minutes. If you are chosen for the interview and you finish it, you will get $35. At the start of the interview, the interviewer will ask if it’s okay to audio record it. This helps Westat make sure they hear everything you say correctly. If you are chosen for an interview, you will get a packet in the mail. Make sure to have the packet with you during the interview. Is it okay with you for Prodege to share your contact information with Westat?
YES
NO INELIGIBLE
Thank and Terminate
Thank you for taking our survey. Unfortunately, based on your responses, you are not eligible for this study. However, we appreciate you taking the time to answer our questions today.
Contact Information
C2. In the space below, please give us the best information to contact you by phone, email, and regular mail. Please know that Westat will not share your information with anyone else. Your personal information will be deleted upon completion of the research project.
Contact Information
Name ______________________________________________________________________
Address 1 ___________________________________________________________________
Address 2 ___________________________________________________________________
City, State, ZIP _______________________________________________________________
Phone Number _______________________________________________________________
Email Address________________________________________________________________
Technology Preferences
C3. The Westat interviewer would like to be able to show you information on her computer screen during the interview. Westat will send directions for how to do this. Which app do you prefer for screen sharing? [SINGLE SELECT]
Skype
Google Hangouts
WebEx
I am not able to use any of these, please just call me
Closing
Thank you for your answers to these questions. If you are chosen for an interview, someone will contact you within the next 1-2 days.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Weinberg, Jessica |
File Modified | 0000-00-00 |
File Created | 2021-01-14 |