EBSA Participant Assistance Program Customer Survey

Outbound
Export Date: 10/25/2010 10:37:04 AM	QBank Id: 4996
PROJECT REGISTRATION # 158527
US Department of Labor	Translations: NO
	Verbatims: YES
City Center:
US Department of Labor - EBSA CE11 1010	___SURVEY DESIGN: JENNIFER PETERSON
TODD JENSEN/ALISON SIMON
October, 2010	Quota: 6200

QID:120772 Gallup^®, The Gallup Poll^®, and CE^11® are trademarks of Gallup, Inc. All other trademarks are the property of their respective owners. Copyright © 1994-2000, 2010 Gallup, Inc. All rights reserved.

CASEID

QID:36526 I.D.#

CASEID(1-6)

FVALIFON

QID:1528 **AREA CODE AND TELEPHONE NUMBER:

FVALIFON(1161-1179)

CINTTIME

QID:963 **INTERVIEW TIME:

CINTTIME(1716-1721)

(Programmer: All interviews are recorded. The recording begins when the respondent answers the phone. This statement is read after the "Continue" response is entered after the Introduction and before the first question.)

FRECCON

QID:98881 This interview will be recorded for internal quality assurance.

1 (Continue)

2 (Refused) - (Thank and Terminate)

FRECCONS(1984)

SA

QID:134507 DATE OF INTERVIEW:

SB

QID:134508 INQUIRY RECORD NUMBER (CONTROLID):

(Programmer: Code from fone file)

SC

QID:134509 BENEFIT ADVISOR NAME/ID (STAFF_NAME):

(Programmer: Code from fone file)

SD

QID:134510 CLOSE DATE (CLOSE_DATE):

(Programmer: Code from fone file)

SE

QID:45204 INQUIRER FIRST NAME (FIRSTNAME):

(Programmer: Code from fone file)

SF

QID:3213 INQUIRER LAST NAME (LASTNAME):

(Programmer: Code from fone file)

SG

QID:133961 INQUIRER STREET ADDRESS 1 (ADDRESS):

(Programmer: Code from fone file)

SH

QID:133962 INQUIRER STREET ADDRESS 2 (ADDRESS2):

(Programmer: Code from fone file)

SI

QID:47254 INQUIRER CITY (CITY):

(Programmer: Code from fone file)

SJ

QID:49149 INQUIRER STATE (STATE):

(Programmer: Code from fone file)

SK

QID:47255 INQUIRER ZIP CODE (ZIPCODE 1):

(Programmer: Code from fone file)

SL

QID:134511 CLOSURE ANALYSIS (CLOSE_ANAL):

(Programmer: Code from fone file)

01 Benefit Claim – Assistance (BCA)

02 Claim Valid

03 Enforcement Referral

04 Secondary Lead (BVESL)

05 Referral as Abandoned Plan (BVADV)

06 Referral to Advocate

07 AOA Counselor/Pension Rights Center (BVACP)

08 Pro-Bono Attorney Services (BVAS)

09 Patient Rights (BVPR)

10 Actuarial (BVAI)

11 Refer to Private Counsel (BVPC)

12 Claim-Not Valid (BN)

SM

QID:134512 SUBJECT ENTRY CODE (SUBJ_INQ):

(Programmer: Code from fone file)

001 Welfare-Other

002 COBRA

003 Health Reform

004 Pension

999 Other

SN

QID:134513 REGION (OFFICE):

(Programmer: Code from fone file)

01 Atlanta and Miami (40 and 42)

02 Boston (31)

03 Chicago (50)

04 Cincinnati (43)

05 Dallas (63)

06 Kansas City (60)

07 Los Angeles (72)

08 New York (30)

09 Philadelphia and Washington DC (20 and 22)

10 San Francisco and Seattle (70 and 71)

11 National Office/OPA/DTAI (88)

SO

QID:134979 METHOD OF INQUIRY (TYP_INQURY):

(Programmer: Code from fone file)

01 Phone (T)

02 Routine Mail (M)

03 Web-based (W)

(Interviewer: ASK TO SPEAK TO INQUIRER NAME FROM FONE FILE:)

INTRO1

QID:120821 Hello, this is __________, from The Gallup Poll. We are calling on behalf of the Employee Benefits Security Administration or EBSA (say: E-B-S-A) of the U.S. Department of Labor. Our records indicate that you recently contacted EBSA concerning a pension or health benefits issue. We are conducting a very short poll about your interaction with this agency. It should take about eight minutes.less than five minutes.

I want to assure you that Gallup and EBSA will protect your confidentiality and privacy. Your voluntary cooperation is requested to make the results of this study complete and accurate. Gallup will not share your specific responses with anyone (including EBSA), and your data will only be used in aggregate with responses of others like you.

By law, I must inform you that the Paperwork Reduction Act requires Federal agencies to obtain Office of Management and Budget authorization before conducting any information collection, and persons are not required to respond to an information collection that is not currently approved. The Office of Management and Budget has authorized this survey for use through November 2012 under control number 1220-0059.

1 Respondent available - (Continue)

4 No such person - (Thank and Terminate)

7 Respondent not available - (Set time to call back)

8 (Soft Refusal)

9 (Hard Refusal) - (Thank and Terminate)

INTRO1(2001)

S1

QID:134516 Do you recall [(If code 11 in SN, read:) sending a note to/(If code1-10 in SN, read:) contacting] the Employee Benefits Security Administration or EBSA? This probably would have occurred within the past few weeks. (If necessary, read:) Again, this agency is part of the Department of Labor and provides assistance to employees and beneficiaries regarding employee retirement, pension or 401k benefits, and health benefits such as COBRA (say: CO-bruh) and HIPAA (say: HIP-uh).

1 Yes

2 No

3 (DK)

4 (Refused)

QID:134517 Skip: (If code 1 in S1, Continue;
Otherwise, Thank and Terminate)

(Interviewer: READ:)

QID:134518 Throughout the remainder of the survey, we will refer to the Employee Benefits Security Administration as EBSA.

CE1

QID:21495 Taking into account all the information, products, and services you receive from them, how satisfied are you with EBSA overall? Please use a five-point scale, where 5 means you are extremely satisfied and 1 means you are not at all satisfied. You may use any of the numbers 1, 2, 3, 4, or 5 for your rating.

1 Not at all satisfied

2

3

4

5 Extremely satisfied

7 (Not applicable)

8 (DK)

9 (Refused)

CE1(2301)

CE2

QID:21496 If you had a similar need for information or assistance in the future, how likely would you be to contact EBSA again? Please use a five-point scale, where 5 means extremely likely and 1 means not at all likely. You may use any of the numbers 1, 2, 3, 4, or 5.

1 Not at all likely

2

3

4

5 Extremely likely

7 (Not applicable)

8 (DK)

9 (Refused)

CE2(2302)

CE3

QID:21497 If a friend or a colleague had a similar need for information or assistance, how likely would you be to recommend EBSA? Please use a five-point scale, where 5 means extremely likely and 1 means not at all likely. You may use any of the numbers 1, 2, 3, 4, or 5.

1 Not at all likely

2

3

4

5 Extremely likely

7 (Not applicable)

8 (DK)

9 (Refused)

CE3(2303)

(Interviewer: READ:)

QID:134980 Now, I am going to read a number of statements. Using a five-point scale, where 5 means you strongly agree and 1 means you strongly disagree, please tell me how much you agree or disagree with each statement as it applies to EBSA. You may use any of the numbers 1, 2, 3, 4, or 5 for your rating. How about (read CE4-CE9A)?

CE4

QID:21499 EBSA is a name I can always trust.

1 Strongly disagree

2

3

4

5 Strongly agree

7 (Not applicable)

8 (DK)

9 (Refused)

CE4(2304)

CE5

QID:21500 EBSA always delivers on what they promise.

1 Strongly disagree

2

3

4

5 Strongly agree

7 (Not applicable)

8 (DK)

9 (Refused)

CE5(2305)

CE6A

QID:21501 EBSA always treats me fairly.

1 Strongly disagree

2

3

4

5 Strongly agree

7 (Not applicable)

8 (DK)

9 (Refused)

CE6A(2306)

CE7A

QID:21502 If a problem arises, I can always count on EBSA to reach a fair and satisfactory resolution.

1 Strongly disagree

2

3

4

5 Strongly agree

7 (Not applicable)

8 (DK)

9 (Refused)

CE7A(2307)

CE9A

QID:21504 EBSA always treats me with respect.

1 Strongly disagree

2

3

4

5 Strongly agree

7 (Not applicable)

8 (DK)

9 (Refused)

CE9A(2309)

Q1

QID:134520 Again using a five-point scale, where 5 means you strongly agree and 1 means you strongly disagree, please tell me how much you agree or disagree with each statement as it applies to EBSA. How about (read and rotate A-H)?

1 Strongly disagree

2

3

4

5 Strongly agree

7 (Not applicable)

8 (DK)

9 (Refused)

Q1A	QID:134521	EBSA treats me like a valued customer.
Q1B	QID:134522	EBSA is willing to work with me to make sure my needs are met.
Q1C	QID:134523	EBSA acts in a timely fashion.
Q1D	QID:134524	EBSA does what it says it will do.
Q1E	QID:134525	EBSA services are available when I need them.
Q1F	QID:134526	EBSA is easy to reach.
Q1G	QID:134527	The information I receive from EBSA is clear and easy to understand.
Q1H	QID:134528	EBSA does its best to help me out.

Q2

QID:134529 After your interaction with EBSA, did you feel (read 3-1)?

3 Much more knowledgeable about your benefits rights

2 Somewhat more knowledgeable about your benefits rights, or

1 Not any more knowledgeable about your benefits rights

7 (Not applicable)

8 (DK)

9 (Refused)

Q3

QID:134530 Please rate your level of agreement with each of the following statements using a five-point scale, where 5 means you strongly agree and 1 means you strongly disagree. You may use any of the numbers 1, 2, 3, 4, or 5 for your rating. How about (read A-B)?

1 Strongly disagree

2

3

4

5 Strongly agree

7 (Not applicable)

8 (DK)

9 (Refused)

Q3A	QID:134531	As a result of the interaction I had with EBSA, I feel better informed to protect my benefits in the future.
Q3B	QID:134532	As a result of the interaction I had with EBSA, I feel my benefits are more secure.

Q4

QID:134552 Compared to interactions you may have had with other government agencies, would you say your interaction with EBSA was better, worse, or about the same as what you’ve experienced elsewhere?

3 Better

2 About the same

1 Worse

7 (Not applicable)

8 (DK)

9 (Refused)

Q5

QID:134557 Compared to interactions you may have had with businesses and non-governmental agencies, would you say your interaction with EBSA was better, worse, or about the same as what you’ve experienced elsewhere?

3 Better

2 About the same

1 Worse

7 (Not applicable)

8 (DK)

9 (Refused)

Q6

QID:134559 Did you share any of the information you obtained from EBSA with anyone else?

1 Yes

2 No

7 (Not applicable)

8 (DK)

9 (Refused)

QID:134981 Skip: (If code 1 in Q6, Continue;
Otherwise, Skip Q7)

Q6A

QID:134562 Please tell me whether you shared this information with any of the following. (Read and rotate A-C)

1 Yes

2 No

7 (Not applicable)

8 (DK)

9 (Refused)

Q6AA	QID:134563	Coworkers
Q6AB	QID:134564	Family or friends
Q6AC	QID:134565	Your employer

Q7

QID:134580 Can you briefly tell me how you first found out about EBSA? (Interviewer: Open ended and code)

01 Other (list)

02 (DK)

03 (Refused)

04 HOLD

05 HOLD

06 Referred by another agency (IRS, Social Security Administration, Health and Human Services, State Department of Insurance, etc.)

07 Referred by a colleague

08 Referred by a lawyer or other professional

09 Found them on the Internet

10 Referred by employer or HR Department

11 Phone book

12 Congressperson

13 Received a publication

14 Media (newspaper article, press release, public service announcement, etc.)

15 Insurance company

List Other:Y

QID:134982 Skip: (If code 11 in SN, Skip to Q8A;
Otherwise, Continue)

Q8

QID:134983 When you first contacted EBSA, did you speak with a benefits advisor right away, or did you leave a message to have someone return your call?

1 Spoke with a benefits advisor right away

2 Left a message

3 (Left a message and no one called me back—I called again)

8 (DK)

9 (Refused)

QID:134985 Skip: (If code 11 in SN, Continue;
Otherwise, Skip to Q9)

Q8A

QID:134988 When you first sent a note to EBSA, how long did it take them to respond?

(Interviewer: Open ended and code)

1 Responded the same day

2 Responded within one day

3 Responded within two days

4 Responded within three or more days

7 (Have not yet responded)

8 (DK)

9 (Refused)

Q9

QID:134594 In the future, would you prefer to contact EBSA (read and rotate 1-5)?

1 By phone

2 By e-mail

3 By submitting an online form

4 Through live chat on the Internet, or

5 Through the mail

6 Other

7 (No preference)

8 (DK)

9 (Refused)

Q10

QID:134989 Was EBSA able to assist you with your questions, problem, or recovering the benefit?

1 Yes

2 No

3 Still working on it/not yet resolved

4 (DK)

5 (Refused)

QID:134990 Skip: (If code 2 in Q10, Continue;
Otherwise, Skip to Q12)

(Programmer: If code 2 in Q10, ask:)

Q11

QID:134605 Why was EBSA not able to assist you with your question or problem?

(Interviewer: Read 06-10, then read 01)

01 Or some other reason (list)

02 (DK)

03 (Refused)

04 (No reason given)

05 HOLD

06 There were limitations because of the law

07 There were limitations because of the plan rules

08 The company has terminated the plan

09 The company went bankrupt

10 The EBSA representative did not understand your question or problem

List Other:Y

Q12

QID:134608 What ONE thing could EBSA do to better improve the service it provides?

(Interviewer: Open ended)

01 Other (list)

02 (DK)

03 (Refused)

04 Nothing

05 Everything

List Other:Y

QID:68754 DEMOGRAPHICS BEGIN HERE:

D1

QID:30962 GENDER:

(Interviewer: Code only; Do NOT ask)

1 Male

2 Female

D3(2547)

(Interviewer: VALIDATE PHONE NUMBER AND THANK RESPONDENT BY SAYING:)

QID:134610 Again, this is _____, with Gallup of _____. I would like to thank you on behalf of EBSA and Gallup for your time. Our mission is to "help people be heard" and your opinions are important to Gallup in accomplishing this.

FINTVID

QID:98976 INTERVIEWER I.D. #:

FINTVID(1571-1574)

Questionnaire Workflow

Date	User	Status	Comments
10/19/2010 8:49:37 AM	MEGHAN ORR	Survey Specialist - Questionnaire Creation	Copied from survey Stryker 2010 Endoscopy CE11 1010 (QID: 4955) by MEGHAN MCKERNAN.
10/19/2010 2:35:16 PM	MEGHAN ORR	Survey Design - Proofing	Survey is created and ready for proofing.
10/19/2010 3:15:24 PM	JEN PETERSON	Survey Specialist - Edits	Back to Meghan before proofing -- changes are coming in

US Department of Labor - EBSA CE11 1010_Outbound

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