290 Custom Questio 290 Custom Questions for Clearance

Measures Name/Client name (CDs and Answer choices)

FEMA Main v2 Survey

B

Did you use the narrow you search suggestions at the top of the search results page?

Yes

Y

Radio button, one-up vertical

Single

Y

narrow-use

No

Don't Know

Y

How helpful were these suggestions in narrowing your search results?

1=not helpful at all

Radio button, scale, no don't know

Single

Y

Skip Logic Group

narrow-helpful

2

3

4

5

6

7

8

9

10=very helpful

C

Did you use the Advanced Search tool today?

Yes

Radio button, one-up vertical

Single

Y

Skip Logic Group

Advanced Search

No

Don't Know

D

Did you use the Frequently Asked Questions (FAQ) today?

Yes

Radio button, one-up vertical

Single

Y

Skip Logic Group

FAQ

No

Don't Know

CWS02185

B

In which section of the government are you an official or employee?

Federal

Radio button, one-up vertical

Single

Y

Skip Logic Group

Government

FEMA employee/contractor

Other Federal employee

State

Local

Tribal

Other

C

CMS - Pinnacle BSI

Did you use the site-wide search feature of the website today?

Yes

A

Drop Down

Single

Y

No

Not Sure

A

Which of the following best describes your experience with the site-wide search feature today?

Returned too many results

Radio buttons

Single

Y

Returned too few results

Returned results that were too similar or redundant

Results were helpful

Results were not helpful

Which of the following best describes your Navigation experience on this site?

I did not have difficulty navigating site

Radio buttons

Single

Y

Are you subscribed to our list-serv?

Yes

A

Radio buttons

Single

Y

Skip Logic Group

No

B

A

Please rate your satisfaction with the frequency of communications you receive via the Listserv.

1-to-10 scale (with "does not apply) - 1 - too often, 10 - not often enough

Radio button, scale, no don't know

Single

Y

Skip Logic Group

B

Why don't you use E-mail Updates (listserv)?

Text area, no char limit

Single

Y

Skip Logic Group

If you are over the age of 18 and would like to be contacted by Pinnacle Business Solutions, Inc. (PBSI) regarding your feedback, please provide your email address, name and/or phone number?

Text area, no char limit

Single

N

Healthfinder

Which of the following best describes the reason for your visit today?

Wellness/Prevention information for myself

Radio Button One Up Vertical

Single

Y

OPS Group

Reason

Wellness/Prevention information for someone else (loved one, family, friend)

Wellness/Prevention information for a patient or client

Wellness/Prevention information for my work

Other, please specify:

A

A

Other reason for your visit

Text area, no char limit

Single

N

OPS Group

Other Reason

Which of the following best describes the type of information you were looking for today?

Cancer Screening and Prevention

Radio button, one-up vertical

Single

Y

OPS Group

Health News

Heart Health

HIV and STDs

Nutrition and Fitness

Pregnancy

Other, please specify

A

A

Other information you are seeking

OPS Group

Were you able to find what you were looking for?

Yes

Radio Button Two Up Vertical

Single

Y

OPS Group

Find

No, please specify:

A

Partially

A

No, please specify:

Text area, no char limit

Single

N

OPS Group

Did Not Find

After using the healthfinder website today, how likely are you to do one of the following activities: [Please select all that apply]

Bookmark this page for later use

Checkbox One Up Vertical

Multi

Y

OPS Group

After Visit Activities

Do additional research online

Download content to a portable device, like a mobile phone, PDA, or ipod

Email the information to a friend or family member

Join a health program, such as an exercise, weight loss or smoking cessation program

Make an appointment with a doctor or healthcare provider

Post Healthfinder content on your social networking profile, such as Facebook or MySpace

Print the information and share it

Send an e-card

Talk to a friend or family member about the information I found today

Watch an online video about this topic

Write in an online diary or blog

Other, please specify:

A

A

Other activity:

Text area, no char limit

N

OPS Group

Other Activity

Which of the following navigation problems, if any, did you encounter on the healthfinder.gov site today?

Could not navigate back to previous information

Checkbox, one-up vertical

Multi

Y

OPS Group

Had difficulty finding detailed information

Had technical difficulties (error messages, broken links, etc)

I did not have any navigation difficulty

Links did not take me where I expected

Links/labels are difficult to understand

Too many links or navigational choices

Other, please specify:

B

B

Other Navigational difficulty, please specify

Text area, no char limit

Single

N

OPS Group

What primary method did you use to locate information on the site?

Search Tool

A

Checkbox, one-up vertical

Multi

Y

Skip Logic Group

Method

Left Navigation Bar

Links in the center of the page

My Healthfinder Feature

Site Map

Other, please specify

B

Skip Logic Group

A

Please tell us what term(s) you used in your search

Text area, no char limit

N

N

Skip Logic Group

Search Term

B

What other method did you use to locate information?

Text area, no char limit

N

N

Skip Logic Group

Other Method

Did you use the Search feature today?

Yes

A

Radio button, one-up vertical

Single

Y

Skip Logic Group

Search Usage

No

A1

Which of the following best describes your experience with the search feature?

Search worked well/returned the results I needed

Radio button, one-up vertical

Single

Y

Skip Logic Group

Search Experience

I was not sure what words to use in my search

Results were not relevant to my search terms or needs

Returned results that were similar/redundant

Returned too many results

Search returned no results at all

The organization of the results was confusing

Other, please specify

B

B

Other Search experience, please specify

Skip Logic Group

Other Search Experience

A2

If you could make one improvement to the Search feature, which of the following would you make:

Narrow results by a specific date

Radio button, one-up vertical

Single

Y

Skip Logic Group

Search Improvement

Narrow results by the most popular to least popular

Narrow by searching within the first set of results I receive

Search by URL

Search by document type, pdf, .wav., etc.

Other, please specify

C

C

Other Search improvement

Text area, no char limit

Single

N

Skip Logic Group

Other Search Improvement

How often have you visited the site in the last month?

This is my first time

Radio Button One Up Vertical

Single

Y

Frequency

Two or three times

Four or five times

A few times a week

Daily

More than a day

How did you find out about this website?

Advertisement

Conference/presentation

E-card

Email

News story

Personal recommendation

Twitter/Other social media tool

Other, please specify

Which best describes your role?

Caretaker

Radio button, one-up vertical

Single

Y

OPS Group

Doctor/Nurse/Health Care Provider

Government Employee

General Public

Librarian

Public Health Professional

Researcher

Student

Teacher/Educator

Other, please specify

A

A

Other role

Text area, no char limit

Single

N

OPS Group

How old are you?

19 or under

Dropdown (Select-one)

Single

Y

Age

20-34 years old

35-49 years old

50-64 years old

65 or older

Prefer not to answer

How would you describe yourself?

Hispanic or Latino

Checkbox, one-up vertical

Multi

Y

Ethnicity

Black or African American

White

Asian

American Indian or Alaska Native

Native Hawaiian or Other Pacific Islander

Prefer not to answer

What is the highest level of education you have completed?

High school or less

Radio Button One Up Vertical

Single

Y

Education

Some college

College degree

Advanced degree

Prefer not to answer

If you could make one improvement to the healthfinder site what would it be?

Text area, no char limit

Single

Y

One Improvement

How likely are you to make a healthy lifestyle change within 2 months based on the information you found on this site?

3712

A

Other Organizational Affiliation

Text field, <100 char

S

N

OPS Group

OE_org.Affiliation

Did you do any of the follow the NCJRS site today? (select all that apply)

Found information or data on a topic

Checkbox, one-up vertical

M

Y

OPS Group

Activities

Read or ordered a specific publication

Identified grant/funding opportunities

Subscribed to a mailing list, listserv, or RSS feed

Located conferences

Updated mailing list, listserv, or other account information

Other, please specify:

A

A

Other Activity

OE_Activites

Were you able to find what you were looking for?

I found the information, and it was VERY HELPFUL

Radio button, one-up vertical

S

Y

Found Info

I found the information, but it was TOO MUCH INFORMATION to be useful

I found the information, but it was HARD TO UNDERSTAND

I found related information but it was NOT ENOUGH

I was NOT able to find the information I was looking for

I was JUST BROWSING

Don't know yet

CNPP MyPyramid.gov_CNPP v3

What is your age?

17 and under

Radio button, one-up vertical

Single

Y

Age

18 to 24

25 to 34

35 to 44

45 to 54

55 to 64

65 and over

I prefer not to respond

Are you visiting MyPyramid.gov for your own personal knowledge or for someone else?

My own personal knowledge

Radio button, one-up vertical

Single

Y

Reason visit

Someone else

UNICOR Satisfaction Survey

KFB05130

Which best describes you?

Administrative Assistant

Radio button, one-up vertical

Single

Y

Role

Contracting Officer --> Contracting Officer/Specialist

Program Manager

Project Manager

End user --> End user of UNICOR products

Procurement (Buyer, Purchaser, etc.)

Researcher / Academic

Vendor

Competitor

Other (Please Specify)

A

Are you visiting UNICOR.gov to conduct market research?

Yes

Radio button, one-up vertical

Single

Y

Mkt Research

No

Where are you in the purchase process?

I have no intentions of purchasing UNICOR products

Radio button, one-up vertical

Single

Y

Cycle

Just browsing to see what is available.

Gathering product information for later purchase (Conducting market research)

I am ready to make a purchase from UNICOR

What government agency/department do you work for?

Department of Agriculture

Drop down, select one

Single

Y

Agency Work For

Department of Commerce

Department of Defense

Department of Education

Department of Health and Human Services

Department of Homeland Security

Department of Housing and Urban Development

Department of Justice

Department of Labor

Department of State

Department of the Interior

Department of the Treasury

Department of Transportation

Department of Veterans Affairs

Executive Office of the President

Federal Legislative Branch

Independent Agencies

Judicial Branch

Private Vendor

Quasi Official INTNL & Non Govt

Other

A

None of the above

A

What agency do you work for?

Text field, <100 char

Single

N

Agency

NCI Main 2009

CWS03656

AD

Please specify what other research partnership or collaboration funding information you were looking for.

Text field, <100 char

Single

Optional

SKIP LOGIC GROUP

CMS Palmetto GBA J1 MAC

KFB01529

Which of the following self-service tools did you use on the site today? (please select all that apply) Which of the following self-service tools or top links did you use on the site today? (please select all that apply)

Advance Payments to Providers

Checkbox, one-up vertical

Multi

Yes

Self-Service Tools

Alerts

Appeals

Beneficiary Eligibility

Claims Status

Claims Processing Issues Log

Denial Finder

Drug Lookup and Calculator Tool

EDI System Status

FAQs

Fee schedules

Forms

Global Surgery Denial Tool

HIGLAS

Interactive CMS 1500 Claim Form

Interactive Voice Response (IVR) Job Aids

LCDs

MA Plan Lookup

MSP lookup

New to Medicare?

NPI

Overpayment Form

Physician-Suppler Guide

Provider Enrollment

Provider Enrollment Application Finder Help Tool

Provider Enrollment Application Status Lookup

Provider Enrollment Applications

Provider Lookup

Reason/Remark Code Lookup

Recovery Audit Contractor (RAC)

Self Administered Drugs

Understanding the Remittance Advice

I didn’t use any self-service tools or top links today

DOD HEALTH MIL v2

AKR6299

Which of the following best describes your status?

A DIRECT CARE Military Health System (MHS) staff member. This includes military, civil service, and contractors working at a military treatment facility (MTF) or a military headquarters

Radio button, one-up vertical

Single

Yes

OPS Group

Status

A PURCHASED CARE staff member. This includes TRICARE managed care contractors, network providers, and their support staff

An MHS staff member supporting BOTH direct care and purchased care

Not an MHS staff member, but a TRICARE health plan beneficiary

Member of the general public

NEITHER a TRICARE health plan beneficiary nor an MHS staff member (please specify)

A

Other (please specify)

A

AKR6311

Which community or social media website(s) did you use to discuss or research military health topics? (pick all that you used)

AOL

Checkbox, one-up vertical

Multi

Y

OPS Group

Which Site Research Discuss

CNET

Del.icio.us

Digg

Facebook

Flickr

Google

LinkedIn

MSN

MySpace

Twitter

Yahoo

Yahoo Buzz

YouTube

Other (please specify)

SKIP AA

None / Not applicable

NEW

SKIP AA

Please specify the site(s).

Text field, <100 char

Single

No

OPS Group