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1. How would you describe your attitude towards the amount of sex, violence and
profanity used on television and in videos, based on the following 5 choices?
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Very concerned
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Quite Concerned
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Somewhat Concerned
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Hardly concerned
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Not at all
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2. How would you describe your attitude towards the amount of sex, violence and
profanity in movies that come out on video, based on the following 5 choices?
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Very concerned
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Quite Concerned
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Somewhat Concerned
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Hardly concerned
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Not at all
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3. Does anyone in your family use closed captioning?
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Yes
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No
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4. Is anyone in your household deaf or hard of hearing?
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Yes
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No
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CC+ can offer you the choice to mute out any specific words you select on the
television or videos that you consider undesirable. So any time a word is spoken
that is on your list of words that you do or do not want to be heard or seen by
yourself or any member of your household, that word is muted from the soundtrack
and deleted in the captions. Imagine having the choice to cover up any type of
nudity or violent scenes you personally feel is objectionable, without disturbing the
program in play. CC+ can be turned on/off at will, at any time, under your control.
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5. Does this sound like a product that you would be interested in? (If No skip to
Question 7)
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Yes
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No
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6. Regardless of price, how interested would you be in purchasing such a device?
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Very Interested
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Quite Interested
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Somewhat Interested
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Not at all Interested
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7. How much do you think a product such as this should cost?
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8. How much would you be willing to pay?
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9. How often do you think you would use this device if it were already in the TV
that you have?
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Always
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Frequently
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Sometimes
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Rarely
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Never
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10. How many televisions do you have in your household?
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11. Would you prefer your cable provider offer this service?
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Yes
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No
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12. On average, approximately how many hours a day would you say a television
is on in your household, including watching videos?
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13. How many people in your household are 18 and over?
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14. For each person 18 and over, starting with yourself, please indicate the gender
and which of the following age groups that they fit into.
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Adult 1
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M
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F
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Adult 2
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M
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F
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Adult 3
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M
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F
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Adult 4
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M
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F
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15. How many people in your household under 18 years of age?
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16. For each of them, please indicate the gender and which of the following age
groupings that they fit into.
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Child 1
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M
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F
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Child 2
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F
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M
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Child 3
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M
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F
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Child 4
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M
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F
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17. According to the following 6 choices, what is the highest level of education that
you have completed?
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18. Which of the following choices best describes your religious beliefs?
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19. Which of the following five categories does your total household annual
income fall into ?
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Please enter your state/province and country.
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Thank you!
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