Appendix A - Cognitive Interview Screener and Guide Survey and Experiment

Appendix A
OMB Control No: 0910-New

Expiration Date: xx/xx/2022

Paperwork Reduction Act Statement: 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-New. The
time required to complete this information collection is estimated to average 5 minutes per response, including
the time for reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information.
Send comments regarding this burden estimate or any other aspects of this collection of information, including
suggestions for reducing burden to PRAStaff@fda.hhs.gov.

Quantitative Research on a Voluntary Symbol
Depicting the Nutrient Content Claim “Healthy” on Packaged Foods
APPENDIX A
Cognitive Interview Screener for Experiment and Surveys
Hello, my name is [ ] and I work for _______, a local research firm. We’re doing research for
the Food and Drug Administration about food and nutrition. If you are eligible and you agree to
participate, we will provide you with $75 as a token of appreciation to complete an in-person
interview that should last about an hour. In order to find out if you are eligible to be interviewed,
I’d like to get some background information.
1. Before I proceed, may I ask to which of the following age groups you belong?
17 years or younger _____ [THANK AND END]
18 to 35 years old _____
36 to 50 years old _____
51 to 65 years old_____
66 years or older _____
2. Do you work either full- or part-time in market research company, a food company, or a
nutrition company?
YES_____[THANK AND END]
NO _____
3. In an average week, about how many hours would you say you use the Internet?
NONE _____ [THANK AND END]
1 HOUR OR MORE _____
DON’T KNOW_____ [THANK AND END]
4. How much of your household’s food shopping do you do?
All of the food shopping_____

Most of it_____
About half of it _____
Only a little of it _____ [THANK AND END]
None of it _____ [THANK AND END]
Don’t know_____ [THANK AND END]
5. [RECORD GENDER. IF NOT OBVIOUS, ASK; RECRUIT 4-5 OF EACH]
Are you male or female?
FEMALE _____
MALE_____
6. What is the highest level of education that you have completed? [CODE INTO ONE OF THE
FOLLOWING CATEGORIES]
LESS THAN A HIGH SCHOOL DIPLOMA _____
HIGH SCHOOL GRADUATE OR GED _____
SOME COLLEGE, ASSOCIATES DEGREE _____
COLLEGE GRADUATE _____
ADVANCED DEGREE _____
[RECRUIT 2 WITH HIGH SCHOOL DIPLOMA OR LESS]
7. Are you of Hispanic or Latino origin?
YES _____
NO _____
8. What is your race? You may choose one or more categories as they apply.
WHITE _____
BLACK OR AFRICAN AMERICAN _____
ASIAN _____
NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER _____
AMERICAN INDIAN OR ALASKA NATIVE
PREFER NOT TO ANSWER_____
[RECRUIT 3-4 WHO ARE NOT WHITE]
9. What is your occupation?
______________________________________________________________________
INVITATION
[IF ELIGIBLE AND QUOTA REMAINS UNFILLED]
Thank you for answering all my questions. I’d like to invite you to participate in an in-person
interview that will take about an hour to complete. We’ll offer you, as a token of our
appreciation, $75 for your participation. Let me give you some available times and you tell me
what would be best for you.

INTERVIEW DATE AND TIME:
The interview will be held at (location). I would like to send you directions. Where can I send
them? Also, may I please have your phone number in case we need to get hold of you for any
reason?
COLLECT RESPONDENT NAME, ADDRESS (AND EMAIL ADDRESS, IF APPLICABLE)
AND PHONE
Name: _____________________________________________________________
Address: _____________________________________________________________
City: _________________________________ State: ______ Zip Code: __________
Phone: ________________________________________
E-mail: ________________________________________
In case you need to contact me for any reason, you can reach me at 1-800-xxx-xxxx.

COGNITIVE INTERVIEW GUIDE
FOR EXPERIMENT AND SURVEYS
Observation of respondent completing questionnaire:
1. Does respondent need assistance to answer questions?
2. Does respondent seem to struggle answering any parts? Appear confused, hesitant, etc.
3. Check body language; Engaged? Bored?
Following administration of questionnaire:
1. Please describe to me your experiences taking this survey. Describe it in any way you wish.
Probe if needed:
What do you think of the topic?
Is the topic anything you have thought about before?
Are there any questions that can be made clearer?
Were there questions that did not make sense?
Were there questions that seemed difficult to answer?
Did it seem too long?
Was any part boring?
Was any part too personal?
[FOR EXPERIMENT ONLY]
What is your opinion of the product labels you were asked to look at?
How were they similar to a real product you would see on the shelf at the store?
How were they different from a real product you would see on the shelf at the store?