Category A Sample

DOCUMENTATION FOR THE GENERIC CLEARANCE
OF CUSTOMER SATISFACTION SURVEYS
TITLE OF INFORMATION COLLECTION: eSS-5 Project Focus Groups
SSA SUB-NUMBER: A-07
DESCRIPTION OF ACTIVITY (give purpose of activity, provide specific information; i.e.,
date(s) of survey, number of focus groups, locations, etc.): Focus Groups
BACKGROUND
The e-Services Public Insight Process (PIP) is an ongoing initiative which the Social Security
Administration (SSA) uses to assess public perception of existing and proposed online SSA
services. The PIP is used to help the Agency accomplish its strategic goal of significantly
increasing the number of transactions conducted via the Internet.
Work related to the Social Security Number and card is the second highest field office workload
by volume. There were over 13 million requests for new or replacement cards in 2006, and
almost 40% of all field office traffic is related to the SSN and card. Of that number, 25-33% are
repeat visits due to the public’s failure to submit proper proof documents on the first visit.
Current procedures require that members of the public who access SSA’s website for the purpose
of requesting a replacement card must download a hardcopy of the Application for a Social
Security Card (Form SS-5), complete the form and either mail or bring it into a local office with
the proper proofs of identify. Proofs can be different depending on the reason for requesting a
replacement card. For example, for a name change, the applicant would need to provide a copy
of her marriage license, divorce papers or a court order of name change. We have found that the
reason for many of the 25-33% repeat visits is the lack of proper proofs.
Moving a portion of this large workload to an online transaction would result in faster turnaround times and a more efficient process for both the public and SSA employees. In an effort to
reduce the volume of walk-in traffic to the local field offices, SSA wishes to develop an online
SS-5 application that the public can complete and submit online. After the applicant submits the
electronic Application for a Social Security Card, the system would provide the applicant with a
list of documents - customized for that individual - that SSA needs to process the application.
This should reduce the number of repeat visits. In this focus group, we are assessing public
perceptions to the proposed new electronic version of form SS-5.
SURVEY
Description of Focus Groups
We propose a two-phase approach:
Generic Clearance eSS-5 Focus Groups
November 2007

1



Phase One – In mid-February, we will conduct three mini-focus groups (with three people
each) composed of respondents who are representative of each targeted audience:
 Women between the ages of 20 to 50 who have changed their names because of marriage
or divorce;
 Parents of children under age 16; and
 Members of general public between ages 40-60.

This first focus group testing will be conducted in the Baltimore-Washington area.


Phase Two – Conduct six additional sessions in two locations outside of the BaltimoreWashington area with similar respondents as in Phase One.

See attached copy of the proposed Focus Group Discussion Guide Questions
IF FOCUS GROUP MEMBERS WILL RECEIVE A PAYMENT, INDICATE AMOUNT:
$60 (Rationale for payment amount: Although this amount is somewhat higher than
compensation for previous studies, we believe it is justified in this case. Our contractors, who
are experienced in conducting these types of studies, have informed us that this amount is
consistent with compensation for other, similar focus groups conducted in the BaltimoreWashington area, which has a higher cost of living.)
USE OF SURVEY RESULTS:
The results of this study will be used by SSA to evaluate and improve the proposed electronic
SS-5 application. SSA’s overall goal in this phase of testing is to obtain customer feedback on
the proposed process/service and refine the electronic SS-5 based on this feedback.
BURDEN HOUR COMPUTATION (Number of responses (X) estimated response time (/60) =
annual burden hours):
Number of Responses: 27
Estimated Response Time: 100 minutes
Annual Burden Hours: 45 hours
NAME OF CONTACT PERSON: Faye Lipsky
TELEPHONE NUMBER: 410-956-8783

Generic Clearance eSS-5 Focus Groups
November 2007

2

ESK/eSS-5 – Usability/Focus Group
Draft Moderator Guide
I.

Ground Rules, Introductions and Warm-up – 5 minutes

II.

Step 1 – Exploratory Phase - 15 minutes


Before we get started, I’d like to take the “internet temperature” of the group.
How often and for what purpose(s) do you use the Internet?



Has anyone used the internet to conduct government business? What kind?

Social Security is looking for new ways that the public can do business with SSA via
the internet. And, we have invited you here to get your impression of one of these
services. We would like you to break into separate spaces to review this internet
product. Then we’ll come back together to get your experiences.
III.

Step 2 Usability Testing – one-on-one sessions – 30 minutes
Home and Welcome pages Questions
Let’s start at Social Security’s website homepage.
1. What was your impression of the design and format of the welcome and
instructions pages?
2. How easy was it for you to access the online application form?
3. What problems, if any, did you have with navigation or text on the home and
welcome pages?
Online SS-5 application form
1. Did you encounter any errors while using the online form?
 If so, what was the error?
 If so, did you recover to complete the task?
2. Did you find the instructions to be clear?
 If not, in what form would you expect to have the instructions presented
(i.e. link, pop-up, etc.)?
3. Did you feel confident enough, after reading the instructions, to complete the
application?

4. What kind of help do you want when filling out the form? Online edits, help
box, etc?
5. What was your reaction to the “application status” summary provided before
submission?
6. What was your reaction to the “successful completion” receipt received after
you submit the form?
 Is there another way that you would like to receive confirmation? Explain.
7. Do you understand what kind of documents you will need to provide to obtain
a replacement card? If not, why?
8. On the following 5-point scale, how important is it for you to know the exact
documents that you need to provide to SSA?
1 - Not Important
2 – Moderately Important
3 – Doesn’t matter
4 – Important
5 - Essential
IV.

Step 3 - Shared Impressions and Experiences – 40 minutes
1. What is your overall impression of the online SS-5 application for a Social
Security card?
2. What is your impression of the design and format of the welcome and
instructions pages?
3. How easy is it to find the instructions and screening questions?
4. What would you change or improve on these pages?
5. Do you understand and agree with the overall eSS-5 process?
6. Do you understand the value of completing the online application?
7. How important is it for you to know the exact documents that you need to
provide to SSA?
8. Would knowing that you will still need to take your original documents into a
field office influence your decision to complete the online application?
9. What do you see as possible benefits to using this program?
10. What incentives would encourage you to complete the online application?

11. Do you have any security concerns?
12. Would you recommend this service to others? Why or why not?
V.

Recommendations – 10 minutes
1. What are your recommendations on how to improve this online service?
2. Is there anything else that SSA could do to encourage people to complete and
submit this form online?

OCOMM Social Security Number and Card Page

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http://www.socialsecurity.gov/xxxxxx

Online
OnlineSocial
SocialSecurity
SecurityCard
CardApplication
Application
Welcome to Online Replacement Card

This online Social Security Card Application
process is available for United States citizens
who have been assigned a Social Security
Number and are requesting a:
- Replacement card (lost, damaged, or stolen)
- Correction card (change of information)
We estimate that it will take about XX minutes
to read the instructions, gather the facts, and
answer the questions. For more information go
to the Paperwork Reduction Act.
Who can use this application?
You may apply for yourself; or for a child
provided that you are the child’s:

To Start The Card Replacement Process...
The following pages will guide you through the
application process, tell you what information
you will need to answer the questions on the
application, and describe the documents you
may need to present after you apply.
Check all the boxes that apply – These
statements apply to the applicant, the person
requiring the replacement card.
The applicant is a US Citizen
The applicant has a Social Security
Number

Apply for a Replacement Card

• parent with legal custody;
• legal guardian; or a
• court appointed legal guardian.
Important Information:
- You will need to provide proof of identity via
walk-in or mail to complete this process.
- This brief online application will need to be
completed in one sitting.
- You will need to print and sign the
confirmation page at the end of this application.

There are two options for proceeding after
successful completion of this online application:
Walk-in to your nearest Social Security office
with the specified proofs, or
- Mail the required proofs to your nearest Social
Security office.

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Online Social Security Card Application
About You

Demographics and
Contact

Family History

Summary

Print and Sign

Application Summary
Ensure that the following information is correct. You may update
any incorrect information by clicking on the edit button located next
to the information that you would like to change.
Applicant’s Name
Name to be Shown on Card
SSN
Date of Birth
Sex
Address
Daytime Phone
Citizenship
Race/ Ethnicity
Place of Birth
Mother’s Name at Her Birth
Mother’s SSN
Father’s Name at His Birth
Father’s SSN
Applicant has Received SSN
Card Before?
Relationship to Applicant

John Henry Doe, Jr.
John Henry Doe, Jr.
123-45-6789
01/01/1960
Male
1111 Anyplace Road
Anytown MD, 11111
555-555-5000
US Citizen
n/a
Baltimore, MD
Mary Joan Adams
n/a
John Henry Doe
n/a
Yes

edit
edit
edit
edit
edit
edit

Self

edit

edit
edit
edit
edit
edit
edit
edit
edit
edit

I accept that the following information is true.

Cancel

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Online Social Security Card Application
About You

Demographics and
Contact

Family History

Summary

Print and Sign

Application Summary
We have not been able to match the information you entered with our
records.
Take another look at this page and make the appropriate edits to resolve
the issue.

Ensure that the following information is correct. You may update
any incorrect information by clicking on the edit button located next
to the information that you would like to change.
Applicant’s Name
Name to be Shown on Card
SSN
Date of Birth
Sex
Address
Daytime Phone
Citizenship
Race/ Ethnicity
Place of Birth
Mother’s Name at Her Birth
Mother’s SSN
Father’s Name at His Birth
Father’s SSN
Applicant has Received SSN
Card Before?
Relationship to Applicant

John Henry Doe, Jr.
John Henry Doe, Jr.
123-45-6789
01/01/1960
Male
1111 Anyplace Road
Anytown MD, 11111
555-555-5000
US Citizen
n/a
Baltimore, MD
Mary Joan Adams
n/a
John Henry Doe
n/a
Yes

edit
edit
edit
edit
edit
edit

Self

edit

edit
edit
edit
edit
edit
edit
edit
edit
edit

I accept that the following information is true.

Cancel

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Online Social Security Card Application
About You

Demographics and
Contact

Family History

Summary

Print and Sign

Print and Sign
Thank you for beginning the application process online!

Print This Page

Print and Sign by the ARROW at the bottom of this page and either bring or mail
this along with the below listed proofs to the appropriate processing center.
The documents that you need to provide in order to complete this application are outlined
below along with your local Social Security office.
Proofs You Need to Provide
One of the following documents to prove citizenship:
U.S. birth certificate
U.S. consular report of birth
U.S. passport
Certificate of Naturalization, or
Certificate of Citizenship.
One of the following documents to prove the applicant’s identity:
U.S. driver’s license
State-issued non-driver identification card, or
U.S. passport.
All documents must be either originals or copies certified by the
issuing agency. We cannot accept photocopies or notarized copies of
documents. For more information you my read the following:
Evidence documents we need to see
Where to Go or Send Mail
Social Security
Suite 100
5 Park Center Court
Owings Mills, MD 21117
Directions to our office
Office Hours: Monday – Friday 8:30 AM – 3:30 PM except federal holidays
Next Steps
You will now need to either visit or mail your documents with the required proofs to the
specified field office.
Walk-in applicants:
If you plan to walk-in to the processing center listed above, you’ll need to bring at least
one of each of the above listed proofs. You will also need to bring a signed copy of this
page.
Mail-in applicants:
If you plan to mail your proof documents to the processing center listed above, you’ll need
to send at least one of each of the above listed proofs. You will also need to include a
signed copy of this page. This process typically takes x to x weeks from the date that we
receive your records.

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SOCIAL SECURITY ADMINISTRATION
Application for a Social Security Card

1

NAME

First

TO BE SHOWN ON CARD

John

Full Middle Name

FULL NAME AT BIRTH IF
OTHER THAN ABOVE

First

Last

Henry

Doe, Jr.

Full Middle Name

Last

OTHER NAMES USED ON
YOUR SOCIAL SECURITY
CARD

2
3

Enter the Social Security number previously assigned to the
person listed in item 1.
PLACE
OF BIRTH

Baltimore
City

1

Office
Use
Only

Maryland
State or Foreign Country

FCI

U.S. Citizen

5

CITIZENSHIP

6

RACE/ETHNIC
DESCRIPTION

2

3

4

Yes

6

DATE
OF
BIRTH

4

Legal Alien
Allowed To Work

Are you Hispanic or Latino?

5

7

8

9

01 / 01 / 1960
Month

Day Year

Legal Alien Not
Allowed To Work

Other

No

WHAT IS YOUR RACE? PLEASE SELECT ONE OR MORE:
Alaska Native

Black or African American

Other Pacific Islander

Native Hawaiian

White

American Indian
Asian

7

SEX

Male

A. MOTHER’S NAME AT
HER BIRTH

8

10

First

Full Middle Name

Last Name At Her Birth

Mary

Joan

Adams

First

Full Middle Name

Last

John

Henry

Doe

B. MOTHER’S SOCIAL SECURITY
NUMBER
A. FATHER’S NAME

9

Female

B. FATHER’S SOCIAL SECURITY
NUMBER

Has the applicant or anyone acting on his/her behalf ever filed for or received a Social Security Number
Before?
Yes (If “yes”, answer questions 11 -12.)
No (If “no”, go on to question 13.)
Don’t Know (If “Don’t Know”, go on to
question 13.)

11

Enter the name shown on the most recent Social
Security card issued for the person in item 1.

12

Enter any different date of birth if used on an earlier
application for a card.

13

TODAY’S
DATE

02 / 01 / 2008
Month Day Year

14

First

Full Middle Name

John

Henry
Month Day

DAYTIME
PHONE NUMBER

Last

Doe, Jr.
Year

( 555 )

555 -- 5000

Area Code

Number

Street Address, Apt. No., PO Box, Rural Route No.

15

MAILING
ADDRESS

1111 Anyplace Road