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pdfInternet Report Card Survey - Prenotice 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
business that you (or someone else on your behalf) recently completed on our website.
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 online
service.
We look forward to hearing your opinions.
Ronald T. Raborg
Deputy Commissioner for Quality Performance
Social Security Administration
Internet Report Card Survey – Initial Cover Letter
RE: [Insert type of online business from sample file]
Dear [Insert name from sample file]:
As I noted in my recent postcard, Social Security is conducting a survey to find out how well we
served you when you (or someone else on your behalf) used our website to complete the business
shown above. 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
Internet Report Card Survey – Privacy Act
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 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, 1338 Annex
Building, Baltimore, MD 21235-6401. Send only comments relating to our time estimate to this
address, not the completed form.
Internet Report Card Survey – Follow-up Cover Letter
RE: [Insert type of online business from sample file]
Dear [Insert name from sample file]:
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 (or someone else on your behalf) used our website to
complete the business shown above. 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 iApplication
Give Social Security a Report Card...
Please answer the following questions to give us your opinion of the online application you recently
completed on Social Security’s website.
MARKING INSTRUCTIONS
Correct Marking Example:
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Use blue or black pen or a number 2 pencil.
Do not use pens with ink that soaks through the paper.
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Make no stray marks.
Keep all entries within the boxes.
1. How did you hear about Social Security’s online application?
Mark all that apply.
□ From Social Security (an employee, their website, written material, etc.)
□ From a family member or friend
□ From an Internet search engine
□ From a website other than Social Security’s
□ From a doctor or other health care professional, social worker
□ From a nonprofit organization that serves the aged or people with disabilities (United Cerebral
Palsy, ARC, etc.)
□ From an attorney or a paid professional consulting service (Allsup, Binder & Binder, etc.)
□ From the media (newspaper, magazine, TV or radio, etc.)
□ Somewhere else (employer, union, school, church, etc.)
2. Did you fill out the online application by yourself or was someone else there to help you with it?
Mark only ONE answer
□ Filled it out by myself
→Please skip to question 4.
□ Someone else helped me →Please continue with question 3.
3. Who helped you?
Mark only ONE answer
□ Non-professional (family member, friend, etc.)
□ Professional (attorney, social worker, doctor, etc.)
Please continue to the next page
Excellent
Very
Good
Good
Fair
Poor
Very Poor
Not
Applicable
Please use the scale shown to rate the following aspects of your experience using Social Security’s online
application. If a question does not apply to you, please mark Not Applicable.
4.
Ease of finding the online application on Social Security’s
website
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5.
Number of pages you went through before you could start the
online application
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Appearance of the online application pages (amount of
information, how the information is arranged, etc.)
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7.
How well Social Security’s website explained what information
and documents you needed to complete your online application
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Helpfulness of the explanations in the “More Info” links on the
online application
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10. Availability of help from Social Security to complete the online
application
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11. Length of time it took to complete the online application
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Mark [X] ONE answer for every item.
When You Decided to File Online…
Completing the Online Application…
8.
9.
Ease of answering the questions on the online application
12. About how long did it take you complete the online application?
Mark only ONE answer
□ 15 minutes or less
□ Over 15 and up to 30 minutes
□ Over 30 and up to 45 minutes
□ Over 45 and up to 1 hour
□ Over 1 hour and up to 2 hours
□ More than 2 hours
Please continue to the next page
Excellent
Very
Good
Good
Fair
Poor
Very Poor
Not
Applicable
13. What would happen after you submitted your online application
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14. Other information you needed to know about your benefits
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15. The security and privacy features of the website
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Mark [X] ONE answer for every item.
Explanations on Social Security’s Website About…
Your Overall Rating…
Very
Likely
Somewhat
Likely
Not very
Likely
Not at all
Likely
Not
Applicable
16. Overall opinion of Social Security’s online application
17. Recommend Social Security’s online application to others
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18. Use Social Security’s website for your future business (request
information, change your address, etc.)
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Mark [X] ONE answer for every item.
Your Likelihood to…
19. Please use this space to explain why you chose a rating of “fair,” “poor,” or “very poor” in any question on
this form, or to provide any other comments you may have about Social Security’s online application.
OMB Control Number 0960-0562, Expiration Date: August 2012
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.
FY 2011 iChange
Give Social Security a Report Card...
Please answer the following questions to give us your opinion of the change of address or direct deposit
service you recently used on Social Security’s website.
MARKING INSTRUCTIONS
Correct Marking Example:
•
•
Use blue or black pen or a number 2 pencil.
Do not use pens with ink that soaks through the paper.
1.
How did you hear about the change of address or direct deposit service on Social Security’s website?
•
•
Make no stray marks.
Keep all entries within the boxes.
Mark all that apply.
□ From Social Security (an employee, their website, written material, etc.)
□ From a family member or friend
□ From an Internet search engine
□ From a website other than Social Security’s
□ From the media (newspaper, magazine, TV or radio, etc.)
□ From a bank or financial institution
□ Somewhere else (employer, school, church, etc.)
2.
Did you complete the online request for a change of address or direct deposit by yourself or was someone
else there to help you?
Mark only ONE answer
3.
□ Completed it by myself
→ Please skip to question 4.
□ Someone else helped me
→ Please continue with question 3.
Who helped you?
Mark only ONE answer
□ Non-professional (family member, friend, etc.)
□ Professional (bank employee, attorney, social worker, etc.)
4.
To protect your personal information Social Security requires you to confirm your identity when you use
the online change of address or direct deposit service. How did you confirm your identity?
Mark only ONE answer
□ I requested a password specifically to report my change → Please continue with question 5.
□ I used a password I already had
→
□ I answered personal information questions (place of birth,
mother's maiden name, etc.)
→
Please continue to the next page
Please skip to question 6.
Please skip to question 6.
Excellent
Very
Good
Good
Fair
Poor
Very Poor
Not
Applicable
Please use the scale shown to rate the following aspects of your experience using Social Security’s online
change of address or direct deposit service. If a question does not apply to you, please
mark Not Applicable.
5.
Ease of obtaining a password to use Social Security’s change of
address or direct deposit service
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6.
Ease of finding the change of address or direct deposit service
on Social Security’s website
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7.
Number of pages you went through before you could start the
change of address or direct deposit report
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8.
Appearance of the online pages (amount of information, how
the information is arranged, etc.)
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9.
How well Social Security’s website explained what information
you needed to complete your report
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10. Ease of answering the questions for your change of address or
direct deposit report
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11. Helpfulness of the explanations and examples about how to
complete your report
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12. Availability of help from Social Security to complete your
report
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13. Length of time it took to complete your report
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Mark [X] ONE answer for every item.
When You Decided to Report Your Change Online…
Completing the Online Report…
14. About how long did it take you complete your change of address or direct deposit report online?
Mark only ONE answer
□ 10 minutes or less
□ Over 10 and up to 20 minutes
□ More than 20 minutes
Please continue to the next page
Excellent
Very
Good
Good
Fair
Poor
Very Poor
Not
Applicable
15. Confirming that they received your report
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16. Explaining how they will process your report
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Mark [X] ONE answer for every item.
Information from Social Security …
17. Explaining the security and privacy features of the website
Your Overall Rating…
Very
Likely
Somewhat
Likely
Not very
Likely
Not at all
Likely
Not
Applicable
18. Overall opinion of Social Security’s online change of address or
direct deposit service
19. Recommend Social Security’s website to others
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20. Use Social Security’s website for your future business (request
information, report a change, etc.)
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Mark [X] ONE answer for every item.
Your Likelihood to…
20. Please use this space to explain why you chose a rating of “fair,” “poor,” or “very poor” in any question on
this form, or to provide any other comments you may have about Social Security’s online change of address
or direct deposit service.
OMB Control Number 0960-0562, Expiration Date: August 2012
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.
| File Type | application/pdf |
| File Title | In a few days, you will receive a questionnaire in the mail from [insert contractor name], who is conducting the survey for Soci |
| Author | OQP |
| File Modified | 2010-07-02 |
| File Created | 2010-07-02 |