2010 378 CQs for O 2010 378 CQs for OMB 10-17-2010 to 11-3-2010

Measures Name/Client name (CDs and Answer choices)
DOD TRICARE
ACQOsl0002176	H	Please describe your experience with the site's search feature?	ACQOsl0002176A01	I had no difficulty using the search feature on this site		Radio button, one-up vertical	Single	No	SKIP LOGIC GROUP
			ACQOsl0002176A02	The search feature was difficult to find
			ACQOsl0002176A03	The search feature was difficult to use
			ACQOsl0002176A04	Returned no results/received an error message
			ACQOsl0002176A05	Could not tell where the search results would take me
			ACQOsl0002176A06	Too many results
			ACQOsl0002176A07	Too few results
			ACQOsl0002176A08	Results were not related to what I was looking for
			ACQOsl0002176A09	Could not sort the results
			ACQOsl0002176A10	Could not refine the results
			ACQOsl0002176A11	Other
ACQOsl0002177	H	What key word(s) did you use to search?				Text area, no char limit		No	SKIP LOGIC GROUP
ACQOsl0002178	H	Please indicate how helpful you feel the search feature was in finding the information you wanted/needed?	ACQOsl0002178A01	Very helpful		Radio button, one-up vertical	Single	No	SKIP LOGIC GROUP
			ACQOsl0002178A02	Somewhat helpful	I
			ACQOsl0002178A03	Not at all helpful	I, J
ACQOsl0002179	J	Why do you feel the search feature was not at all helpful?				Text area, no char limit		No	SKIP LOGIC GROUP
ACQOsl0002180	I	What would make the search feature more helpful?				Text area, no char limit		No	SKIP LOGIC GROUP
VA - My HealtheVet
EDO07291		Did you use a VA medical facility or service for any of your health care needs in the last 12 months?	EDO07291A001	Yes		Dropdown (Select-one)	Single	Y
			EDO07291A002	No
EDO07292		The “VA Blue Button: Download My Data” feature was recently added to My HealtheVet. Have you ever used this VA Blue Button feature?	EDO07292A001	Yes	A, B, C, D, E, F	Drop down, select one	Single	Y
			EDO07292A002	No	G
			EDO07292A003	Not sure
EDO07293	G	Why have you not used the VA Blue Button? (Check all that apply)	EDO07293A001	I was not aware of it		Checkbox, one-up vertical	Multi	Y
			EDO07293A002	I did not know how to use it
			EDO07293A003	I did not think it would be useful
			EDO07293A004	I want to learn more about it before I use it
			EDO07293A005	I was concerned about privacy or the security of my personal health information
			EDO07293A006	Other, please specify	G2
EDO07294	G2	Why else did you not use the VA Blue Button?				Text area, no char limit		Y
EDO07295	A	How did you hear about the VA Blue Button? (Check all that apply)	EDO07295A001	I read about it on the My HealtheVet website		Checkbox, one-up vertical	Multi	Y
			EDO07295A002	I saw the Blue Button icon on the My HealtheVet website
			EDO07295A003	I saw or heard it promoted at a VA facility
			EDO07295A004	From a VA staff member
			EDO07295A005	From my VA health care provider
			EDO07295A006	From another Veteran
			EDO07295A007	From a member of a Veteran Service Organization
			EDO07295A008	I read about it in the news or on another website
			EDO07295A009	Other, please specify	A2
EDO07296	A2	How else did you hear about the VA Blue Button?				Text area, no char limit		Y
EDO07297	B	How many times have you used the VA Blue Button?	EDO07297A001	Once		Drop down, select one	Single	Y
			EDO07297A002	More than once	B2, B3
			EDO07297A003	Not sure
			EDO07297A004	Never
EDO07298	B2	About how many times have you used the VA Blue Button?				Text area, no char limit		Y
EDO07299	B3	For what purposes have you used it more than once?				Text area, no char limit		Y
EDO07300	C	How did you use the VA Blue Button? (Check all that apply)	EDO07300A001	I used it to view my personal health information on the My HealtheVet website		Checkbox, one-up vertical	Multi	Y
			EDO07300A002	I printed a paper copy of my personal health information using the Print button	C2
			EDO07300A003	I used the download button to create a text file of my personal health information	C4
EDO07301	C2	What did you do with the printed paper copy of your personal health information? (Check all that apply)	EDO07301A001	I read it		Checkbox, one-up vertical	Multi	Y
			EDO07301A002	I saved it for my records
			EDO07301A003	I shared it (or plan to share it) with my VA health care provider
			EDO07301A004	I shared it (or plan to share it) with my Non-VA health care provider
			EDO07301A005	I shared it (or plan to share it) with my spouse, child, or other family member
			EDO07301A006	I discarded it
			EDO07301A007	Other, please specify	C3
EDO07302	C3	What else did you do with the printed paper copy?				Text area, no char limit		Y
EDO07303	C4	What did you do with the Blue Button file containing your personal health information? (Check all that apply)	EDO07303A001	I saved it to my computer		Checkbox, one-up vertical	Multi	Y
			EDO07303A002	I stored the file on a CD, portable drive, or other media
			EDO07303A003	I uploaded the file to another website or software system
			EDO07303A004	I added the information to another personal health record
			EDO07303A005	I shared it (or plan to share it) with my VA health care provider
			EDO07303A006	I shared it (or plan to share it) with my Non-VA health care provider
			EDO07303A007	I shared it (or plan to share it) with my spouse, child, or other family member
			EDO07303A008	I deleted it
			EDO07303A009	I was not able to locate the file
			EDO07303A010	Nothing
			EDO07303A011	Other, please specify	C5
EDO07304	C5	What else did you do with the Blue Button file?				Text area, no char limit		Y
EDO07305	D	Did you make any changes to the VA Blue Button file such as adding, changing, or removing information?	EDO07305A001	Yes		Drop down, select one	Single	Y
			EDO07305A002	No
			EDO07305A003	Not sure
EDO07306	E	What did you find useful about your use of the VA Blue Button (Check all that apply)	EDO07306A001	Having my VA personal health information in one place		Checkbox, one-up vertical	Multi	Y
			EDO07306A002	Having an electronic file of my VA personal health information
			EDO07306A003	Being able to share a copy of my VA personal health information with someone else
			EDO07306A004	Being able to edit the copy of my personal health information
			EDO07306A005	Other, please specify	E2
			EDO07306A006	Did not find it useful
EDO07307	E2	What else did you find useful about the VA Blue Button?				Text area, no char limit		Y
EDO07308	F	What information in the VA Blue Button file was most useful? (Check all that apply	EDO07308A001	My self-entered information		Checkbox, one-up vertical	Multi	Y
			EDO07308A002	My HealtheVet Account Summary
			EDO07308A003	My VA Medication History (available to In-Person Authenticated veterans)
			EDO07308A004	My VA Wellness Reminders (available to In-Person Authenticated veterans)
			EDO07308A005	Other, please specify	F2
EDO07309	F2	What information was most useful?				Text area, no char limit		Y
EDO07310		What additional features would you find useful if added to the VA Blue Button? (Check all that apply)	EDO07310A001	Being able to include additional kinds of information as it becomes available in My HealtheVet, such as VA lab test results		Checkbox, one-up vertical	Multi	Y
			EDO07310A002	Being able to select a date range for the data included in my VA Blue Button download
			EDO07310A003	Being able to pick which portions of my personal health information are included in my VA Blue Button download
			EDO07310A004	Being able to transfer my personal health information to a non-VA personal health record or application
			EDO07310A005	Being able to access the information on other devices (for example a portable drive or mobile device)
			EDO07310A006	Being able to choose the format of the VA Blue Button file
			EDO07310A007	Other, please specify	A
			EDO07310A008	None
EDO07311	A	What other features would you find useful?				Text area, no char limit		Y
EDO07312		About how often do you plan to download your personal health information using the VA Blue Button?	EDO07312A001	One time only		Radio button, one-up vertical	Singly	Y
			EDO07312A002	About once a month
			EDO07312A003	About once every three months
			EDO07312A004	About once every six months
			EDO07312A005	About once a year
			EDO07312A006	Less frequently than once a year
			EDO07312A007	Only when I have a VA health care visit
			EDO07312A008	Other, please specify	A
			EDO07312A009	Not sure
			EDO07312A010	Never
EDO07313	A	How often do you plan to download your information?						Y
EDO07314		How can you see yourself using the VA Blue Button download in the future? (Check all that apply)	EDO07314A001	Save the information to another place (for example, by copying to a file on my computer)		Radio button, one-up vertical	Multi	Y
			EDO07314A002	Share the information with a family member or friend
			EDO07314A003	Share the information with my VA health care provider
			EDO07314A004	Share the information with my Non-VA health care provider
			EDO07314A005	Use the information with another program (for example, to check for drug interactions)
			EDO07314A006	Put the information into another Personal Health Record
			EDO07314A007	Put the information in another website (for example, to receive customized care recommendations or to apply other kinds of tools to my personal health information)
			EDO07314A008	I do not plan to use the VA Blue Button
			EDO07314A009	Not sure
EDO07315		Veterans who have completed In-Person Authentication (IPA) can download additional information using the VA Blue Button, including their VA Medication History and VA Wellness Reminders. Do you plan to complete In-Person Authentication in order to have access to this additional information?	EDO07315A001	Yes		Drop down, select one	Single	Y
			EDO07315A002	No, I am already In-Person Authenticated
			EDO07315A003	No
			EDO07315A004	Not sure
SSA Main
ACQOsl0002189		Please rate how thoroughly this website discloses information about what this agency is doing.	ACQOsl0002189A01	1=Poor		radio button, scale, has Don't Know	Single	Y	Skip Logic	Transparency CQ 1
			ACQOsl0002189A02	2
			ACQOsl0002189A03	3
			ACQOsl0002189A04	4
			ACQOsl0002189A05	5
			ACQOsl0002189A06	6
			ACQOsl0002189A07	7
			ACQOsl0002189A08	8
			ACQOsl0002189A09	9
			ACQOsl0002189A10	10=Excellent
			ACQOsl0002189A11	Don't Know
ACQOsl0002190		Please rate how quickly agency information is made available on this website.	ACQOsl0002190A01	1=Poor		radio button, scale, has Don't Know	Single	Y	Skip Logic	Transparency CQ 2
			ACQOsl0002190A02	2
			ACQOsl0002190A03	3
			ACQOsl0002190A04	4
			ACQOsl0002190A05	5
			ACQOsl0002190A06	6
			ACQOsl0002190A07	7
			ACQOsl0002190A08	8
			ACQOsl0002190A09	9
			ACQOsl0002190A10	10=Excellent
			ACQOsl0002190A11	Don't Know
ACQOsl0002191		Please rate how well information about this agency's actions can be accessed by the public on this website.	ACQOsl0002191A01	1=Poor		radio button, scale, has Don't Know	Single	Y	Skip Logic	Transparency CQ 3
			ACQOsl0002191A02	2
			ACQOsl0002191A03	3
			ACQOsl0002191A04	4
			ACQOsl0002191A05	5
			ACQOsl0002191A06	6
			ACQOsl0002191A07	7
			ACQOsl0002191A08	8
			ACQOsl0002191A09	9
			ACQOsl0002191A10	10=Excellent
			ACQOsl0002191A11	Don't Know
Highmark BCBS
EDO07331		What language do you speak most of the time at home?	EDO07331A001	English		Radio button, one-up vertical	Single	Y	OPS Group	Language
			EDO07331A002	Spanish
			EDO07331A003	Other, please specify	A
EDO07332	A	What language do you speak at home? (other)				Text field, <100 char		N	OPS Group
FAA Public Site
EDO07333		Did you use the search feature during your visit today?	EDO07333A001	Yes	A	Radio button, one-up vertical	Single	Y		Search Usage
			EDO07333A002	No
			EDO07333A003	Don't remember
EDO07334	A	Please tell us about your experience with the search feature today. (Select all that apply.)	EDO07334A001	The search feature met my needs.		Checkbox, one-up vertical	Multi	Y		Search Experience
			EDO07334A002	I had issues with the searching process (how to use it, what to enter).	B
			EDO07334A003	I had issues with the design and layout of the search results (text size, colors).	C
			EDO07334A004	I had issues with the results of the search.	D
			EDO07334A005	None of these
EDO07335	B	What were your issues with the searching process? (Select all that apply.)	EDO07335A001	It was not clear how to use the search feature		Checkbox, one-up vertical	Multi	N		Search Process
			EDO07335A002	I did not know what terms to use to get the results I wanted
			EDO07335A003	I wanted more advanced search capabilities (exclude certain terms, limit search scope)
			EDO07335A004	I had a different issue with the searching process:	E
EDO07336	E	My Issue was:				Text area, no char limit				Other Search Process
EDO07337	C	What were your issues with the design and layout of the search results? (Select all that apply.)	EDO07337A001	The link colors were hard to read		Checkbox, one-up vertical	Multi	N		Search Design
			EDO07337A002	I could not see enough of the descriptions to decide which link to choose
			EDO07337A003	The text was too small
			EDO07337A004	The page was too crowded
			EDO07337A005	I had a different issue with the design and layout of the results:	F
EDO07338	F	My Issue was:				Text area, no char limit				Other Search Design
EDO07339	D	What were your issues with the results of the search? (Select all that apply.)	EDO07339A001	Results were not relevant or not what I wanted		Checkbox, one-up vertical	Multi	N		Search Results
			EDO07339A002	The order of the results was not what I expected
			EDO07339A003	There were no results or too few results
			EDO07339A004	The titles were not helpful
			EDO07339A005	The descriptions were not helpful
			EDO07339A006	I could not narrow the results of my search
			EDO07339A007	I had a different issue with the results of the search:	G
EDO07340	G	My issue was:				Text area, no char limit				Other Search Results
RRB - Browse
ACQOsl0002311	X	What type of benefit information were you looking for today?	ACQOsl0002311A01	Retirement		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Other Benefit Information
			ACQOsl0002311A02	Survivor
			ACQOsl0002311A03	Disability
			ACQOsl0002311A04	Medicare
			ACQOsl0002311A05	Unemployment Benefits
			ACQOsl0002311A06	Sickness Benefits
			ACQOsl0002311A07	Change mailing address
			ACQOsl0002311A08	Reporting Death
			ACQOsl0002311A09	Enrolling in or Changing Direct Deposit
			ACQOsl0002311A10	Income Verification
			ACQOsl0002311A11	Other (please specify)	Y
ACQOsl0002312	Y	What other type of benefit information were you looking for today?				Text area, no char limit	Single	N	Skip Logic Group	Other Benefit Information
ACQOsl0002313	E	Please share with us any details about your experience while claiming bi-weekly sickness benefits that could have been improved.				Text area, no char limit	Single	N	Skip Logic Group	Sickness Benefits
ACQOsl0002314		Did you need to login today in order to access the information you wanted?	ACQOsl0002314A01	Yes		Drop down, select one	Single	Y		Login
			ACQOsl0002314A02	No
			ACQOsl0002314A03	Not Sure
ACQOsl0002315	B	Please tell us what you typed into search today.				Text area, no char limit		N	Skip Logic Group	Search Keyword
NIH - Main
ACQOsl0002316		Are you looking for health information today?	ACQOsl0002316A01	Yes	SKIP 1AA	Radio-button	Yes	Single	Skip Logic Group	Look For Health Info
			ACQOsl0002316A02	No
ACQOsl0002317	1AA	What specific health topic are you looking for?				Text field, <100 char	No		Skip Logic Group	What Topic
Travel.State Satisfaction Survey v2
ACQOsl0002318		How often have you visited this site to accomplish this task?	ACQOsl0002318A01	This is my first time		Radio Button One Up Vertical	Single	Y
			ACQOsl0002318A02	2-5 times
			ACQOsl0002318A03	More than 5 times
ACQOsl0002319		Did you find everything you were looking for?	ACQOsl0002319A01	Yes, I found it quicklly		Radio Button One Up Vertical	Single	Y
			ACQOsl0002319A02	Yes, but it took longer than expected
			ACQOsl0002319A03	No, please specify what you were looking for:	A
ACQOsl0002320	A	Information not found:				Open-ended		Y
ACQOsl0002322		Please rate how clear and concise you found the writing on this site?	ACQOsl0002322A01	1=Difficult to understand		Radio button, scale, has don't know	Single	Y
			ACQOsl0002322A02	2
			ACQOsl0002322A03	3
			ACQOsl0002322A04	4
			ACQOsl0002322A05	5
			ACQOsl0002322A06	6
			ACQOsl0002322A07	7
			ACQOsl0002322A08	8
			ACQOsl0002322A09	9
			ACQOsl0002322A10	10=very clear and concise
ACQOsl0002297		What is your primary language?	ACQOsl0002297A01	English		Radio Button One Up Vertical	Single	Y	Skip Logic
			ACQOsl0002297A02	Spanish
			ACQOsl0002297A03	French
			ACQOsl0002297A04	Arabic
			ACQOsl0002297A05	Mandarin
			ACQOsl0002297A06	Russian
			ACQOsl0002297A07	Hindi
			ACQOsl0002297A08	Other, please specify:	A
ACQOsl0002298	A	Other language
ACQOsl0002323		We're thinking of adding features to our site. Which of the following features would you use if available?	ACQOsl0002323A01	Mobile-friendly version of the site		Checkbox One Up Vertical	Multi	Y
			ACQOsl0002323A02	Mobile app for smartphones
			ACQOsl0002323A03	Live chat help
			ACQOsl0002323A04	More robust Frequency Asked Questions feature
			ACQOsl0002323A05	Website in additional languages
			ACQOsl0002323A06	None of these features
AAMC Site
ACQOsl0002370	A	If you had visited the AAMC site before and noticed the recent redesign, please rate this change:	ACQOsl0002370A01	Positive		Radio button, one-up vertical	Single	Y	Skip Logic Group	Redesign - Overall
			ACQOsl0002370A02	Negative	E
			ACQOsl0002370A03	Neutral
ACQOsl0002371	E	Please tell us why it is negative:				Text area, no char limit		N	Skip Logic Group	OE_Redesign Overall
ACQOsl0002372	B	How would you rate the site navigation?	ACQOsl0002372A01	More user friendly.		Radio button, one-up vertical	Single	Y	Skip Logic Group	Redesign - Navigation
			ACQOsl0002372A02	Less user friendly.	F
			ACQOsl0002372A03	About the same.
ACQOsl0002373	F	Please explain how it is less user friendly:				Text area, no char limit		N	Skip Logic Group	OE_ Redesign - Navigation
ACQOsl0002374	C	How would you rate the site content?	ACQOsl0002374A01	Easier to understand.		Radio button, one-up vertical	Single	Y	Skip Logic Group	Redesign - Content
			ACQOsl0002374A02	More difficult to understand.	G
			ACQOsl0002374A03	About the same.
ACQOsl0002375	G	Please explain how it is more difficult to understand:				Text area, no char limit		N	Skip Logic Group	OE_ Redesign - Content
ACQOsl0002376	D	How would you rate the organization of the site?	ACQOsl0002376A01	Better organized - it's easier to find information.		Radio button, one-up vertical	Single	Y	Skip Logic Group	Redesign - Organization
			ACQOsl0002376A02	Not as well organized - it's harder to find information.	H
			ACQOsl0002376A03	Finding the information has the same level of difficulty it had before.
ACQOsl0002377	H	Please explain how it is more difficult to understand:				Text area, no char limit		N	Skip Logic Group	OE_ Redesign - Organization
ACQOsl0002378	D	Please tell us what links were broken.				Text area, no char limit		N	Skip Logic Group	Other - Broken Links