Individual Generic Surveys (4 mail surveys)

Generic Clearance of Customer Satisfaction Surveys

FY 2011 Office Visitor Surveys and Correspondence

Individual Generic Surveys (4 mail surveys)

OMB: 0960-0526

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0960-0526 can be found here:

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Give Social Security a Report Card…
Using the rating scale shown below, please rate the service that you received on the day
you visited the local Social Security office.
E = Excellent

VG = Very Good

G = Good

F = Fair

P = Poor

VP = Very Poor

Based on your recent visit, mark [X] ONE rating for:

Office location

Office hours

Signs/instructions explaining how to check in
when you got to the office

Usefulness of Social Security information in the
waiting area (posters, pamphlets, TV
presentations, etc.)

Office comfort (seating, temperature, etc.)

Office appearance (clean, pleasant, etc.)

Office privacy

Did you have an appointment?
Mark [X] one.
Yes

 (Go to 9.)

No  (Skip to 10.)

Convenience of your appointment

10. Waiting time to be served in the office

11. About how many minutes did you have to wait?
Mark [X] only ONE.
Up to 10 minutes
More than 10 and up to 30 minutes
More than 30 and up to 60 minutes
More than 60 minutes
12.

Helpfulness of the staff

13.

Courtesy of the staff

14.

How well the staff knew their jobs

Please continue on the next page 

OMB Control N0. 0960-0526

Expiration Date: August 2012

Mark [X] ONE rating.

15.

How clearly the staff explained things

16.

Were you able to take care of your business in one visit to the office?

Mark [X] one.
Yes

17.

Overall, how would you rate Social Security’s
service during your recent office visit?

18.

If you contact Social Security again, what are you most likely to do? Will you:

Mark [X] only ONE.
Call Social Security’s National 800 number
Call the local Social Security office
Visit the local Social Security office
Use the Internet or email
Other Explain:__________________________________________
Social Security has its own Internet site, www.socialsecurity.gov, that provides Social Security
information and services online. We’d like to ask you a few questions about doing business on
the Internet.
19.

First, do you currently use the Internet?
Mark [X] one
Yes

20.

No  (Skip to 21.)

Have you ever visited Social Security’s Internet site?
Mark [X] one
Yes

21.

If you could have taken care of your recent business by using the Internet instead of
visiting Social Security, how likely would you have been to do that? Would you have
been:
Mark [X] only ONE.
Very likely
Somewhat likely
Not very likely, or
Not at all likely to use the Internet instead of visiting

22.

Please use this space to explain why you rated any item “F” (fair), “P” (poor), or “VP”
(very poor) or to explain any of your other answers.
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
_______________________________________________________________________________________

Thank you for taking the time to rate Social Security!
Please send us your “Report Card” in the enclosed postage-paid envelope as soon as possible.

[Identifier – Number and Bar Code]

Give Social Security a Report Card…
We would like to ask you a few questions about how you found out what you needed to do
to apply for a Social Security card.
1. First, did you contact Social Security to find out how to apply for a new or replacement
Social Security card before you visited the Social Security Card Center?
Mark [X] one
No  (Skip to 4)

Yes
2.

How did you contact Social Security for that information? Did you:
Mark [X] all that apply.
Call Social Security’s National 800 number
Call the local Social Security office
Visit the local Social Security office, or
Visit Social Security’s website

3. How clear was the information you received about how to apply for a new or replacement
Social Security card? Was it:
Mark [X] one
Very clear
Somewhat clear
Not very clear, or
Not at all clear
Using the rating scale shown below, please rate the service that you received on the day
you visited the Social Security Card Center.
E = Excellent

VG = Very Good

G = Good

F = Fair

P = Poor

VP = Very Poor

Based on your recent visit, mark [X] ONE rating for:

Office location

Office hours

Signs/instructions explaining how to check in
when you got to the office

Usefulness of Social Security information in the
waiting area (posters, pamphlets, TV
presentations, etc.)

Office comfort (seating, temperature, etc.)

Office appearance (clean, pleasant, etc.)

Please continue on the next page 

OMB Control N0. 0960-0526

Expiration Date: August 2012

Mark [X] ONE rating.

10. Office privacy

11. Waiting time to be served in the office

13. Helpfulness of the staff

14. Courtesy of the staff

15. How well the staff knew their jobs

16. How clearly the staff explained things

12. About how many minutes did you have to wait?
Mark [X] only ONE.
Up to 10 minutes
More than 10 and up to 30 minutes
More than 30 and up to 60 minutes
More than 60 minutes

17. Were you able to take care of your business in one visit to the Social Security Card Center?
Mark [X] one
Yes

18. Overall, how would you rate Social Security’s
service during your recent visit?

19. To serve you better in the future, Social Security would like to know your preferred
language.
Mark [X] only ONE.
English
Spanish
Other Explain:______________________________________________
Social Security has its own Internet site, www.socialsecurity.gov, that provides Social Security
information and services online. We’d like to ask you a few questions about doing business on
the Internet.
20. First, do you currently use the Internet?
Mark [X] one
Yes

No  (Skip to 23.)

21. Have you ever visited Social Security’s Internet site?
Mark [X] one
Yes

22. If you could have taken care of your recent business by using the Internet instead of visiting
Social Security, how likely would you have been to do that? Would you have been:
Mark [X] only ONE.
Very likely
Somewhat likely
Not very likely, or
Not at all likely to use the Internet instead of visiting
23. Please use this space to explain why you rated any item “F” (fair), “P” (poor), or “VP”
(very poor) or to explain any of your other answers.
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________

Thank you for taking the time to rate Social Security!
Please send us your “Report Card” in the enclosed postage-paid envelope as soon as possible.

[Identifier – Number and Bar Code]

FY 2011 Office Visitor Survey - Pre-Notice Postcard

Dear Social Security Customer:
Social Security believes that conducting surveys is one of the best ways to find out how
well we are serving you. That’s why we will soon be asking you to give us your opinion
about the service you received during a recent visit [to a local Social Security office or
Social Security hearing office] [to a Social Security Card Center].
In a few days, you will receive a short questionnaire in the mail from [insert contractor
name], who is conducting this survey for Social Security. When you receive their
envelope, we hope that you will take the time to answer our questions and tell us what
you think of our service.
We look forward to hearing your opinions.
Ronald T. Raborg
Deputy Commissioner for Quality Performance
Social Security Administration

FY 2011 Office Visitor Survey – Initial Cover Letter

Dear Social Security Customer:
As I noted in my recent postcard, Social Security is conducting a survey to find out how
well we served you during your recent visit [to a local Social Security office or
Social Security hearing office] [to a Social Security Card Center]. Please take 5 minutes
to fill out the enclosed "Report Card" and return the form as soon as possible in the
postage-paid envelope provided.
Please be assured that [insert contractor name], who is conducting this survey for us, will
only give your responses to my staff here at Social Security and will not use them for any
other purpose. Social Security will report the survey results by summarizing the answers
of everyone who takes the survey; we will not report any individual responses.
If you have a question about Social Security benefits, please visit our web site
at www.socialsecurity.gov or call our toll-free information line at 1-800-772-1213. (To
protect your privacy, my staff cannot answer questions about your eligibility or benefits.)
We appreciate your taking time out of your busy schedule to answer our survey.
Sincerely,

Ronald T. Raborg
Deputy Commissioner for Quality Performance
Social Security Administration
Enclosures

FY 2011 Office Visitor Survey – Follow-up Cover Letter

Dear Social Security Customer:
About a week ago we sent you a survey form, “Give Social Security a Report Card,” to
find out how well we served you when you visited [a local Social Security office or
Social Security hearing office] [a Social Security Card Center]. We haven’t yet heard
from you and it’s important that we gather opinions from as many people as possible. If
you have already mailed in your completed survey form, please discard this letter. We
sincerely appreciate your help, and we look forward to receiving your response.
However, if you have not yet had time to fill out and return your survey, please take a
few minutes right now to do that. The form is short and takes less than 5 minutes to
complete. In case you misplaced the survey, we have enclosed another copy along with a
postage-paid return envelope.
Please be assured that [insert contractor name], who is conducting this survey for us, will
only give your responses to my staff here at Social Security and will not use them for any
other purpose. Social Security will report the survey results by summarizing the answers
of everyone who takes the survey; we will not report any individual responses.
If you have a question about Social Security benefits, please visit our web site
at www.socialsecurity.gov or call our toll-free information line at 1-800-772-1213. (To
protect your privacy, my staff cannot answer questions about your eligibility or benefits.)
We would appreciate receiving your completed survey as soon as possible.
Sincerely,

Ronald T. Raborg
Deputy Commissioner for Quality Performance
Social Security Administration
Enclosures

FY 2011 Office Visitor Survey
Privacy Act and Paperwork Reduction Act Statements

PRIVACY ACT STATEMENT
The Social Security Administration is authorized to collect the information for this survey
under Executive Order 12862, “Setting Customer Service Standards.” Your response to
these questions is strictly voluntary. The information you provide will be used to help us
improve the service that we give you. Your response will not be disclosed to any other
government or private agency.

PAPERWORK REDUCTION ACT STATEMENT
This information collection, OMB No. 0960-0526, meets the requirements of 44 U.S.C. §
3507, as amended by Section 2 of the Paperwork Reduction Act of 1995. You do not
need to answer these questions unless we display a valid Office of Management and
Budget control number. We estimate that it will take about 5 minutes to read the
instructions, gather the facts, and answer the questions. You may send comments on our
time estimate above to: Social Security Administration, 6401 Security Blvd, Baltimore,
MD 21235-0001. Send only comments relating to our time estimate to this address, not
the completed form.

File Type	application/pdf
File Title	Help us improve the service you get from Social Security
Author	dpse
File Modified	2010-06-01
File Created	2010-06-01