1 Qualitative and 4 Quanatative Surveys

Generic Clearance of Customer Satisfaction Surveys

Usability Testing Instrument

1 Qualitative and 4 Quanatative Surveys

OMB: 0960-0526

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FY11 Project List
mySSA/Online Statement (includes COA, DD, iBEVE)
Registration on Most Everyone(ROME) to include end to end testing
Visitor Intake Process (VIP)
iAppeals Mandate
Spanish iClaim
eIAR - Electronic Interim Assistance Reimbursement Process Enhancements
Electronic Authorization (eAuthorization) FY11-FY14
Health IT Enhancements Release 6
FY12 Project List
eCDR Long-Term
Automated Scheduling FY12-13 (Registration)
ETNG - Continue to Upgrade and Improve EWR User-Centered Design (UCD)
Social Security Number Application Number Process (SSNAP) Rel 4.0 FY12-14
Health Information Technology Rel 3, FY11 - FY13
Medical and Vocational expert (ME/VE) online access to the CEF
iClaim Enhancements for FY11-14
Internet Benefit Verification (iBEVE) Application FY11-14
Electronic Authorization (eAuthorization) FY11-FY14
Medicare FY 11-14
National Vendor File FY11 - FY14
Online Decision Tree
Field Office Fee Charging System
eMail
eIAR - Electronic Interim Assistance Reimbursement Process FY12

iAppeals
ERE Enhancements FY12 - FY14

Typical User-Centered Design Interview Questions
1. Do you use the Internet? If so, how long have you been using it? How often do you use the
Internet?
2. What types of things do you do on the Internet?
• Banking/Bills
• Shopping
• Social Networking
• E-Mail
• Other
3. Have you ever had to do any business with the Social Security Administration (SSA)
before?
4. Do you have an expectation of what kind of services you may want or need from SSA in
the future?
5. If you were interested in getting Retirement, Medicare, or Disability benefits through SSA,
how would you contact us?
• Do you know where your local field office is? If not, how would you find it?
• How would you find the phone number to call?
• Do you know what SSA’s web address is? If not, how would you find SSA on the
web?
6. You may know that SSA has a website to offer information and services to the public. Have
you ever visited SSA.gov? What were your impressions?
7. What do you expect you might be able to do at SSA.gov?
From this point, we would start to focus on the tasks more specifically related to the
application we’re building; but only as it is applicable. Meaning that many of our applications
would only be used once (iClaim, i3368), but some may be used more often or some may
emulate other Internet processes that a user might use (Change of Address, FOLO,
iAppointment). Questions may include:
8. How do you currently do X process?
9. What materials to you have with you when you perform X process?
10. What are your expectations when you are finished performing X process?
11. Would you please walk us through how you perform X process?
12. What do you find difficult about the current process?
13. What would improve the current process?
The answers to these questions would likely lead to follow-up/clarifying questions so that we
can get into the detail of users’ goals and needs.

Demographics Questionnaire
About You: Please select your answer for the following questions to help us understand you better. No
information is stored that could identify you personally.
1. How many hours per week do you use a computer? (Select only one)
____ 21 or more hours per week
____ 11 to 20 hours per week
____ 1 to 10 hours per week
____ Less than 1 hour per week
2. How often do you use the Internet for any reason? (Select only one)
____ 20 or more hours per week
____ 10 – 19 hours per week
____ 1 – 9 hours per week
____ Never (please go to Question 3)
If you use the Internet:
 Which of the following activities do you do online? (Select all that apply)
Banking and/or investing
Read the news
Shopping/Travel
Email
Government information
Games
Search for topical information
Maps, directions

□
□
□
□

□
□
□
□

3. Have you ever applied for Social Security (SS) benefits for yourself or anyone else, using paper
forms?
____ Yes ____ No
4. Have you ever applied for Social Security (SS) benefits for yourself or anyone else, using SSA
website?
____ Yes ____ No
5. What is your gender?
____ Female ____ Male
6. What is your age?
____ 18-39
____ 40-54
____ 55-65
____ 66+
7. What is the highest education level you completed? (Select only one)
___ Some high school
___ High school graduate/GED
___ Post high-school training certificate
___ Some college/Associate’s degree
___ 4-year college degree
___ Graduate degree

Post Questionnaire
1. How well did the software match your expectations? (Please circle one.)
Did not match at all
Neutral
Matched very well
1

2

3

4

5

Please Explain:_____________________________________________________

_______________________________________________________________
_______________________________________________________________
2. How well did the software support the task that you were asked to perform? (Please circle
one.)
Did not support at all
Neutral
Supported very well
1

2

3

4

5

Please Explain:_____________________________________________________

_______________________________________________________________
_______________________________________________________________
3. How difficult or easy was the software to use? (Please circle one.)
Very difficult
Neutral
Very easy
1

2

3

4

5

Please Explain:_____________________________________________________

_______________________________________________________________
_______________________________________________________________
4. Are you satisfied with the content? (Please circle one.)
Very dissatisfied
Neutral
1

2

3

4

Very satisfied
5

Please Explain:_____________________________________________________

_______________________________________________________________
_______________________________________________________________

5. How difficult or easy was it to move through sections of the software? (Please circle one.)
Very difficult
Neutral
Very easy
1

2

3

4

5

Please Explain:_____________________________________________________

_______________________________________________________________
_______________________________________________________________

6. How understandable was the terminology? (Please circle one.)
Very difficult
Neutral
Very easy
1

2

3

4

5

Please Explain:_____________________________________________________

_______________________________________________________________
_______________________________________________________________
7. How satisfied are you with the speed at which you can complete tasks? (Please circle
one.)
Very dissatisfied
Neutral
Very satisfied
1

2

3

4

5

Please Explain:_____________________________________________________

_______________________________________________________________
_______________________________________________________________
8. How difficult or easy was it to find information you needed? (Please circle one.)
Very difficult
Neutral
Very easy
1

2

3

4

5

Please Explain:_____________________________________________________

_______________________________________________________________
_______________________________________________________________

9. How long would it take you to learn to use this software? (Please Circle one.)
A long time
Neutral
Very little time
1

2

3

4

5

Please Explain:_____________________________________________________

_______________________________________________________________
_______________________________________________________________
10. How confident did you feel using this application? (Please circle one.)
Neutral
Very Confident
Not at all confident
1

2

3

4

5

Please Explain:_____________________________________________________

_______________________________________________________________
_______________________________________________________________

Additional comments and Suggestions
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________

Title: Project Name
Version: Version Number
Date:

Instructions:
Please enter your selection ranging in scale from “strongly disagree” to “strongly agree” for each
of the 10 questions based on your experience with the (Projects name) Site. For example
marking a “3” would indicate that you neither agree nor disagree with the statement asked in the
corresponding question.
Strongly
disagree

1. I think that I would like to
use this system frequently

Strongly
agree

1

2

3

4

5

1

2

3

4

5

1

2

3

4

5

1

2

3

4

5

1

2

3

4

5

1

2

3

4

5

1

2

3

4

5

1

2

3

4

5

1

2

3

4

5

1

2

3

4

5

2. I found the system unnecessarily
complex

3. I thought the system was easy
to use

4. I think that I would need the
support of a technical person to
be able to use this system

5. I found the various functions in
this system were well integrated

6. I thought there was too much
inconsistency in this system

7. I would imagine that most people
would learn to use this system
very quickly
8. I found the system very
cumbersome to use

9. I felt very confident using the
system

10. I needed to learn a lot of
things before I could get going
with this system

© Digital Equipment Corporation

Title: Project Name
Version: Version Number
Date:

Suggestions for Improvement:
Please indicate any suggestions for improvement in the below space (if any).
Thank you!

We will share this Paperwork Reduction Act statement with respondents during
usability testing session:
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 2 hours to participate in this usability testing session. Send only
comments relating to our time estimate above to: SSA, 6401 Security Blvd,
Baltimore, MD 21235-6401.
OMB No.
0960-0526


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