Form 333 6-8-2010 333 6-8-2010 333 CQs for OMB 6-8-2010 to 7-6-2010

Measures Name/Client name (CDs and Answer choices)

CMS - Pinnacle BSI

B

What information were you unable to find?

Text area, no char limit

Single

Y

Skip Logic Group

CMS Palmetto GBA J1 MAC

EDO03184

What is your primary reason for visiting this site today?

EDO03184A001

Download forms

Radio buttons

Single

Y

OPS Group

EDO03184A002

Learn of, or register for, workshops, seminars or other training events

EDO03184A003

Find contact information

EDO03184A004

Find general Medicare program information

EDO03184A005

Research a specific question on Medicare policy or billing

EDO03184A006

Access claim status and/or beneficiary eligibility

EDO03184A007

Find information on fees or fee schedules

EDO03184A008

Find out about a Local Coverage Determination (LCD)

EDO03184A009

Read Medicare publications such as newsletters, articles, etc.

EDO03184A010

Find enrollment information

EDO03184A011

Take an on-line training course

EDO03184A012

Other (please specify)

SKIP B

EDO03185

SKIP B

Other - primary reason?

Text field, <100 char

Single

No

OPS Group

FBI Internet Satisfaction Survey

EDO03215

H

Which of the following explains why you are not watching videos on the FBI site? (Please select all that apply)

EDO03215A001

Too long to watch

Radio button, one-up vertical

Multi

Y

Skip Logic

Not Video

EDO03215A002

Not interesting

EDO03215A003

Too small on my screen

EDO03215A004

Do not work on my computer

EDO03215A005

Do not want to click through to another page to play the video

EDO03215A006

Did not know where there were videos on the site

EDO03215A007

Other (please specify)

A

EDO03216

A

What other reasons don't you watch videos on the FBI site?

Text field, <100 char

N

open end

FDA Satisfaction Survey

EDO03237

For this visit to the FDA site, which of the following roles best describes you?

EDO03237A001

Regulated industry

A

Radio Button One Up Vertical

Single

Y

OPS Group

EDO03237A002

Consumer

EDO03237A003

Scientist, researcher

EDO03237A004

Patient

EDO03237A005

Caregiver, friend, family member of a person interested in health issues

EDO03237A006

Physician

EDO03237A007

Nurse, physician's assistant, nurse practitioner

EDO03237A008

Pharmacist

EDO03237A009

Other type of healthcare provider

EDO03237A010

State or local public health professional

EDO03237A011

Not-for-profit public health professional

EDO03237A012

Consultant

EDO03237A013

Attorney/Legal Counsel

EDO03237A014

Educator, professor, teacher

EDO03237A015

Student

EDO03237A016

Journalist/Media

EDO03237A017

Policymaker, legislator, staff

EDO03237A018

FDA grantee

EDO03237A019

FDA employee

EDO03237A020

First responder

EDO03237A021

Other, please specify:

C

EDO03238

A

Which of the following best describes your company/organization?

EDO03238A001

Manufacturer

B

EDO03238A002

Distributor

B

EDO03238A003

Importer

B

EDO03238A004

Other

B

EDO03239

B

Which of the following industry categories is your company/organization a part of? (Please select all that apply)

EDO03239A001

Drugs & Biologics (Human)

EDO03239A002

Drugs & Biologics (Animal)

EDO03239A003

Medical Devices

EDO03239A004

Food

EDO03239A005

Dietary Supplements

EDO03239A006

Cosmetics

EDO03239A007

Tobacco

EDO03240

While on the FDA.gov site, please describe how you reached the page you were on before taking this survey:

Text area, no char limit

Single

Y

Open Navigate

EDO03241

A

What were you hoping to find on the FDA Basics area of the site?

Text area, no char limit

Single

Y

Skip Logic Group

lookingforBasics

EDO03242

A

How did you hear about FDA Basics?

Text area, no char limit

Single

Y

Skip Logic Group

HearaboutBasics

EDO03243

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

Text area, no char limit

Open

N

One Improvement

NIH genome.gov

EDO03285

What best describes you?

EDO03285A001

Educator

Single

Y

Skip Logic Group

EDO03285A002

Student (high school/college)

A

EDO03285A003

Pursing a graduate degree (Master’s, PhD, and/or MD)

EDO03285A004

Researcher

B

EDO03285A005

Health care provider

EDO03285A006

Other

C

EDO03286

A

Which type of student are you?

EDO03286A001

High school

Single

Y

EDO03286A002

Undergraduate

EDO03287

B

Which type of researcher are you?

EDO03287A001

Researcher at NIH

Single

Y

EDO03287A002

Research not at NIH

EDO03288

C

Which of the following specifically describes you?

EDO03288A001

Patient

Single

Y

EDO03288A002

Scientific administrator

EDO03288A003

Author

EDO03288A004

Job/Career seeker

EDO03288A005

Reporter/member of a news organizations

EDO03288A006

Policy maker/writer

EDO03288A007

Other (please specify)

D

EDO03289

D

Please describe your role in coming to this site.

N

EDO03290

B

Which of the following did you use to look for information on the site?

EDO03290A001

Links across the top of the page

Check box one up vertical

Multi

Y

EDO03290A002

Links within the pages

EDO03290A003

Links along the left side of the page

EDO03290A004

For You sections

EDO03290A005

Site map

EDO03290A006

Staff Directory

EDO03290A007

Links under see also

EDO03290A008

Links on the keyword list

EDO03290A009

Site search

BB

EDO03290A010

Other

EDO03291

D

Which one of the following led you to what you were looking for?

EDO03291A001

Links across the top of the page

Radio button, one-up vertical

Single

Y

EDO03291A002

Links within the pages

EDO03291A003

Links along the left side of the page

EDO03291A004

For You sections

EDO03291A005

Site map

EDO03291A006

Staff Directory

EDO03291A007

Links under see also

EDO03291A008

Links on the keyword list

EDO03291A009

Site search

EDO03291A010

Other

EDO03292

BB

Please indicate how useful the site search was in helping you find what you were looking for.

Very useful

Radio button, one-up vertical

Single

Y

Somewhat useful

C

Not at all Useful

C

EDO03293

C

What would have made the site search more useful to you?

Open ended

N

NPR Customer Satisfaction Survey v2

EDO03454

Before taking this survey, had you ever heard of the NPR Shop (online shop that sells official NPR branded merchandise)?

EDO03454A001

Yes

A

Radio button, one-up vertical

Single

Y

Skip Logic

NPR Shop_heard

EDO03454A002

No

EDO03454A003

Don’t know/Not sure

EDO03455

A

Have you ever visited the NPR Shop (online shop that sells official NPR branded merchandise)?

EDO03455A001

Yes

B

Radio button, one-up vertical

Single

Y

Skip Logic

NPR Shop_visited

EDO03455A002

No

EDO03455A003

Don’t know/Not sure

EDO03456

B

In your last visit to the NPR Shop, how well did the NPR Shop meet your expectations?

EDO03456A001

1=Poor

radio button, scale, has Don't Know

Single

Y

Skip Logic

NPR Shop_opinion

EDO03456A002

2

EDO03456A003

3

EDO03456A004

4

EDO03456A005

5

EDO03456A006

6

EDO03456A007

7

EDO03456A008

8

EDO03456A009

9

EDO03456A010

10=Excellent

EDO03456A011

Don't Know

GAO Main Site

EDO03461

What GAO site content do you most often seek from a mobile phone/device?

Text area, no char limit

Single

N

EDO03457

Have you accessed GAO.gov from a mobile phone/device in the past 30 days?

EDO03457A001

Yes

A

Radio button, one-up vertical

Single

Y

Skip Logic Group

EDO03457A002

No

EDO03458

A

What type of mobile phone/device did you use: (check one)

EDO03458A001

Blackberry

Radio button, one-up vertical

Single

Y

Skip Logic Group

EDO03458A002

iPhone/iTouch

EDO03458A003

Droid

EDO03458A004

Other: please describe

B

EDO03459

B

Other: please describe

Text field, <100 char

Single

N

Skip Logic Group

EDO03460

A

Were you successful in viewing the content that you were seeking with your mobile phone/device?

EDO03460A001

Yes

Radio button, one-up vertical

Single

Y

Skip Logic Group

EDO03460A002

No

CMS.HHS.gov

EDO03462

C

Did you know that Medicare.gov contains the information and tools most often needed by beneficiaries?

EDO03462A001

Yes

Radio buttons

SINGLE

Yes

Skip Logic Group

Benefciary

EDO03462A002

No

D

EDO03462A003

I don't know

D

EDO03463

D

Why did you come to the Centers of Medicare and Medicaid Services website?

Text field, <100 char

No

Skip Logic Group

OE_ben_use

ASHP

EDO03468

Which of the following social media services have you participated with ASHP during the last month? (Select all that apply)

EDO03468A001

I do not use ASHP's social media services

Checkbox, one-up vertical

Multi

Y

Social Media-ASHP

EDO03468A002

Social Networking Sites (ASHP on Facebook, Twitter, LinkedIn, YouTube)

B

EDO03468A003

Blog

B

EDO03468A004

Discussion Board

B

EDO03468A005

RSS News Feeds

B

EDO03468A006

Photo/Video Gallery

B

EDO03468A007

Other, please specify:

A, B

EDO03469

A

What other ASHP social media services do you use?

Text area, no char limit

OE_ASHP Social Media

EDO03470

B

How often do you participate with ASHP in social media activities?

EDO03470A001

More than once a day

Radio Button One Up Vertical

Single

Y

SM Frequency-ASHP

EDO03470A002

Daily

EDO03470A003

About once a week

EDO03470A004

About once a month

EDO03470A005

Every 6 months or less

IADB

EDO03483

C

I am most interested in the following topic(s):

Agriculture

check boxes

Multi

Y

Skip Logic

Climate change and renewable energy

Children and youth

Civil society

Cities

Corporate social responsibility

Cross-border projects

Culture

Decentralization

Demographics

Democracy

Economic growth

Education

Electricity

Energy

Environment

Finance

Forestry

Government

Gender

Health

Highways and roads

Housing

Human rights

Indigenous peoples

information and communcation technology

Labor

Macroeconomics

Management

MicroEnterprise

Migration issues

Natural disasters

Neighborhood upgrading

Oil and mining

Opportunities for the majority

Pensions

Ports and airports

Pollution

Poverty reduction

Private sector

Public finances

Public-private partnerships

Race and ethnicity issues

Regional integration

Remittances

Rural development

Science and technology

Small and medium enterprise

Sports

Sustainability

Tourism

Trade

Transparency

Transportation

Violence and security

Other (please specify):

A

EDO03484

A

What other topics are you interested in?

open ended

Single

N

Skip Logic

EDO03485

In your opinion, what organization is the leader when it comes to addressing the crisis in Haiti?

United Nations

Radio button, one-up vertical

Single

Y

Skip Logic

World Bank

Inter-American Development Bank

USAID

None

Other, please specify:

A

EDO03486

A

Who do you think is the leader in addressing the Haiti crisis?

open ended

Single

N

Skip Logic

EDO03487

In your opinion, what organization is a good representative of transparency within government?

United Nations

Radio button, one-up vertical

Single

Y

Skip Logic

World Bank

Inter-American Development Bank

USAID

None

Other, please specify:

A

EDO03488

A

Who do you think represents transparency in government?

open ended

Single

N

Skip Logic

EDO03489

Please rate your level of trust in the IDB.

1=Not at all Trustworthy

Radio Button Scale, Has Don't Know

Single

Y

2

3

4

5

6

7

8

9

10=Very Trustworthy

Don't know

EDO03490

I can count on the IDB to act in my best interests.

1=Strongly Disagree

Radio Button Scale, Has Don't Know

Single

Y

2

3

4

5

6

7

8

9

10=Strongly Agree

Don't know

EDO03491

I consider the IDB to be trustworthy.

1=Strongly Disagree

Radio Button Scale, Has Don't Know

Single

Y

2

3

4

5

6

7

8

9

10=Strongly Agree

Don't know

EDO03492

The IDB can be trusted to do what is right.

1=Strongly Disagree

Radio Button Scale, Has Don't Know

Single

Y

2

3

4

5

6

7

8

9

10=Strongly Agree

Don't know

USITC

EDO03576

A

Other role

EDO03577

If you could make one improvement to this site, what would it be?

Text area, no char limit

N

EDO03578

From time to time, the USITC likes to reach out to website visitors to follow up regarding their feedback concerning the website. If you are over the age of 18 and would be willing to be contacted in the future, please provide your email address.

Text field, <100 char

N

Regulations.gov

EDO03616

What brought you to the site today?

EDO03616A001

Followed a link from an email

Radio Button One Up Vertical

Single

Y

Skip Logic

Learned about site

EDO03616A002

Followed a link/recommendation from a website or news article

EDO03616A003

Heard about the site from a friend, co-worker, etc.

EDO03616A004

Did an online search which brought me here

EDO03616A005

I need this site for my job

EDO03616A006

Other, please specify

D

EDO03617

D

Please specify what brought you to the site today.

Text field, no char limit

N

Skip Logic

Other Brought to site

EDO03618

X

Please specify what keywords you typed into the search box today.

Text field, no char limit

N

Skip Logic

Search Keyword

FDIC Application V2

EDO03712

Please rank the top 3 factors that brought you to the FBI website today. (Rank 1 = Most important) Rank 1

EDO03712A001

Message/recommendation from a friend on a social network

Drop down, select one

Single

Y

Rank Group

EDO03712A002

Video I saw on YouTube

Randomize

EDO03712A003

Internet blogs or discussion forums

EDO03712A004

Advertising on social networks (Facebook, My Space, Twitter)

EDO03712A005

Message directly from the company on a social network

EDO03712A006

Mobile phone text messages or alerts

EDO03712A007

Instant Message from a friend or colleague

EDO03712A008

Familiarity with site/company/brand

EDO03712A009

Promotional email(s) from the company

EDO03712A010

Search engeine results

EDO03712A011

Word of mouth recommendation from someone I know

EDO03712A012

TV, radio, newspaper, or magazine advertising

EDO03712A013

Internet advertising

EDO03712A014

Don't know

Anchor

EDO03712A015

Other

Anchor

EDO03713

Rank 2

EDO03713A001

Message/recommendation from a friend on a social network

Drop down, select one

Single

N

Rank Group

EDO03713A002

Video I saw on YouTube

Randomize

EDO03713A003

Internet blogs or discussion forums

EDO03713A004

Advertising on social networks (Facebook, My Space, Twitter)

EDO03713A005

Message directly from the company on a social network

EDO03713A006

Mobile phone text messages or alerts

EDO03713A007

Instant Message from a friend or colleague

EDO03713A008

Familiarity with site/company/brand

EDO03713A009

Promotional email(s) from the company

EDO03713A010

Search engeine results

EDO03713A011

Word of mouth recommendation from someone I know

EDO03713A012

TV, radio, newspaper, or magazine advertising

EDO03713A013

Internet advertising

EDO03713A014

Don't know

Anchor

EDO03713A015

Other

Anchor

EDO03714

Rank 3

EDO03714A001

Message/recommendation from a friend on a social network

Drop down, select one

Single

N

Rank Group

EDO03714A002

Video I saw on YouTube

Randomize

EDO03714A003

Internet blogs or discussion forums

EDO03714A004

Advertising on social networks (Facebook, My Space, Twitter)

EDO03714A005

Message directly from the company on a social network

EDO03714A006

Mobile phone text messages or alerts

EDO03714A007

Instant Message from a friend or colleague

EDO03714A008

Familiarity with site/company/brand

EDO03714A009

Promotional email(s) from the company

EDO03714A010

Search engeine results

EDO03714A011

Word of mouth recommendation from someone I know

EDO03714A012

TV, radio, newspaper, or magazine advertising

EDO03714A013

Internet advertising

EDO03714A014

Don't know

Anchor

EDO03714A015

Other

Anchor

EDO03715

If you heard about this website from a social network, please specify the site (i.e. Facebook, Twitter)

Text area, no char limit

N

FDIC Main v2

EDO03716

Please rank the top 3 factors that brought you to the FBI website today. (Rank 1 = Most important) Rank 1

EDO03716A001

Message/recommendation from a friend on a social network

Drop down, select one

Single

Y

Rank Group

EDO03716A002

Video I saw on YouTube

EDO03716A003

Internet blogs or discussion forums

Adjust Template/Style Sheet

EDO03716A004

Advertising on social networks (Facebook, My Space, Twitter)

Randomize

EDO03716A005

Message directly from the company on a social network

EDO03716A006

Mobile phone text messages or alerts

EDO03716A007

Instant Message from a friend or colleague

EDO03716A008

Search engine

EDO03716A009

Bookmark/Favorite

EDO03716A010

Another website/link

EDO03716A011

Brochure

EDO03716A012

Email from my banker

EDO03716A013

E-mail from FDIC Online Subscription Service

EDO03716A014

Newspaper article

EDO03716A015

Prior experience with FDIC

EDO03716A016

Business Card

EDO03716A017

Other government agency

EDO03716A018

Don't know

Anchor

EDO03716A019

Other

Anchor

EDO03717

Rank 2

EDO03717A001

Message/recommendation from a friend on a social network

Drop down, select one

Single

N

Rank Group

EDO03717A002

Video I saw on YouTube

EDO03717A003

Internet blogs or discussion forums

Adjust Template/Style Sheet

EDO03717A004

Advertising on social networks (Facebook, My Space, Twitter)

Randomize

EDO03717A005

Message directly from the company on a social network

EDO03717A006

Mobile phone text messages or alerts

EDO03717A007

Instant Message from a friend or colleague

EDO03717A008

Search engine

EDO03717A009

Bookmark/Favorite

EDO03717A010

Another website/link

EDO03717A011

Brochure

EDO03717A012

Email from my banker

EDO03717A013

E-mail from FDIC Online Subscription Service

EDO03717A014

Newspaper article

EDO03717A015

Prior experience with FDIC

EDO03717A016

Business Card

EDO03717A017

Other government agency

EDO03717A018

Don't know

Anchor

EDO03717A019

Other

Anchor

EDO03718

Rank 3

EDO03718A001

Message/recommendation from a friend on a social network

Drop down, select one

Single

N

Rank Group

EDO03718A002

Video I saw on YouTube

EDO03718A003

Internet blogs or discussion forums

Adjust Template/Style Sheet

EDO03718A004

Advertising on social networks (Facebook, My Space, Twitter)

Randomize

EDO03718A005

Message directly from the company on a social network

EDO03718A006

Mobile phone text messages or alerts

EDO03718A007

Instant Message from a friend or colleague

EDO03718A008

Search engine

EDO03718A009

Bookmark/Favorite

EDO03718A010

Another website/link

EDO03718A011

Brochure

EDO03718A012

Email from my banker

EDO03718A013

E-mail from FDIC Online Subscription Service

EDO03718A014

Newspaper article

EDO03718A015

Prior experience with FDIC

EDO03718A016

Business Card

EDO03718A017

Other government agency

EDO03718A018

Don't know

Anchor

EDO03718A019

Other

Anchor

EDO03719

If you heard about this website from a social network, please specify the site (i.e. Facebook, Twitter)

Text area, no char limit

N