Mail Survey
Section D
Personal Motor Vehicles Section
This section of the questionnaire is about the use and ownership of personal motor
vehicles, such as cars, trucks, vans, SUVs, motorcycles, and RVs.
10. (D2) Do you currently drive a car or other motor vehicle?
Please circle Yes or No
- Yes - 1 Continue with next question
- No - 2 Please skip now to question 12
11. (D3) On average, how many days a week do you drive?
Number of days a week - |__|
If you drive less than one day a week, please enter "8" in the box
12. (D6a) How many personal motor vehicles, such as cars, trucks, vans, SUVs,
motorcycles and RVs, are owned or leased by someone in your household?
Number of vehicles - |__|__|
If no one in your household owns any personal vehicles, please enter "0" in the box
and then skip to question 22 on page 10. Otherwise, continue with next question.
13. (D7) Are any of the vehicles owned or leased by household members modified with
adaptive devices or equipment for use by persons with disabilities?
Please circle Yes or No
- Yes -1 Continue with next question
- No - 2 Please skip now to question 22 on page 10
14. (D8) How many vehicles are modified?
Number of modified vehicles - |__|__|
Enter the number of vehicles that are owned or leased by household members that are
modified with adaptive devices or equipment for use by persons with disabilities
15. (D9) Do you ever drive or ride in a modified household vehicle?
Please circle Yes or No
- Yes - 1 Continue with next question
- No - 2 Please skip now to question 22 on page 10
16. (D10) What type of modified household vehicle do you use most
frequently?
Please circle only one answer.
- Car or station wagon - 1
- Sport Utility Vehicle (SUV) - 2
- Full-sized van - 3
- Mini-van - 4
- Pickup truck - 5
- RV - 6
- Motorcycle or moped - 7
- Other vehicle - 8
17. (D12) Does the vehicle have:
Please circle Yes or No for each vehicle modification.
(a) Accelerator / braking system modifications?
Such as pedal extenders or levers, reduced or zero effect brakes, left-foot accelerator,
powered hand brake control, mechanical hand controls
|
1 |
2 |
(b) Air bag modifications?
Such as removed or disconnected bags, driver-controlled or passenger-controlled on-off
switch |
1 |
2 |
(c) Controls relocated or modified?
Such as touch pad controls, crossover gear shift lever |
1 |
2 |
(d) Ramps or lifts installed?
Either portable or permanent |
1 |
2 |
(e) Roof or doorway modifications?
Such as a raised roof or doorway, power door opener |
1 |
2 |
(f) Seating adapted?
Such as a transfer-assist seat, power seat base, swivel seat, modified headrest,
tie-downs for wheelchairs |
1 |
2 |
(g) Steering adapted?
Such as a spinner knob, reduced diameter steering wheel, extended steering column,
reduced/zero effort steering, horizontal steering system, foot steering |
1 |
2 |
(h) Storage capability for unoccupied
wheelchair / scooter?
Such as a car top carrier, hoist, tie-downs |
1 |
2 |
(i) Structural modifications such as a lowered
floor?
Such as floor pan or floor modifications
|
1 |
2 |
18. (D15) Do you use this modified vehicle as the driver,
the passenger, or both?
Please circle only one answer.
- Driver - 1
- The passenger or - 2
- Both driver and passenger - 3
19. (D16) Do you think that the safe operation of the vehicle has decreased,
increased or remained the same because of its modifications?
Please circle only one answer.
- Decreased - 1
- Increased - 2
- Remained the same - 3
20. (D17) Have you experienced any problems with the special devices or equipment?
Please circle only one answer.
- Yes - 1 Continue with next question
- No - 2 Please skip now to question 22 on this page.
21. (D18) What kinds of problems?
__________________________________________________________________________________
__________________________________________________________________________________
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22. (D28) The National Highway Traffic Safety Administration, also called NHTSA,
works to improve vehicle safety. Have you heard about their toll-free telephone
hotline (1-888-327-4236) that people can call to report suspected defects in
automobiles and automotive equipment, including special equipment?
Please circle Yes or No
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