Form 339 CQs for OMB 7- 339 CQs for OMB 7- 339 CQs for OMB 7-6-2010 to 7-18-2010

Customer Satisfaction Measure of Government Websites

2010 339 CQs for OMB 7-6-2010 to 7-18-2010.xlsx

CQs 7-6-2010 to 7-18-2010 DOT VERSION_VHA_Medical_Centers Hoosier Lottery (State of Indiana)

OMB: 1090-0008

Document [xlsx]
Download: xlsx | pdf
Measures Name/Client name (CDs and Answer choices)
























































FBI Internet Satisfaction Survey
























































EDO03720
Please rank the top 3 factors that brought you to the FBI website today. (Rank 1 = Most important)
Rank 1
EDO03720A001 Message/recommendation from someone I know on Facebook, Twitter, LinkedIn, etc.
Drop down, select one Single Y Rank Group





















EDO03720A002 Search engine results



Adjust Template/Style Sheet





















EDO03720A003 Video I saw on YouTube



Randomize





















EDO03720A004 Internet blogs or discussion forums


























EDO03720A005 Advertising on social networks (Facebook, My Space, Twitter)


























EDO03720A006 Message directly from the company on a social network


























EDO03720A007 Mobile phone text messages or alerts


























EDO03720A008 Instant Message from a friend or colleague


























EDO03720A009 Familiarity with site


























EDO03720A010 Word of mouth recommendation from someone I know


























EDO03720A011 TV, radio, newspaper, or magazine advertising


























EDO03720A012 Internet advertising


























EDO03720A013 Don't know



Anchor





















EDO03720A014 Other



Anchor


















EDO03721
Rank 2 EDO03721A001 Message/recommendation from someone I know on Facebook, Twitter, LinkedIn, etc.
Drop down, select one Single N Rank Group





















EDO03721A002 Search engine results



Adjust Template/Style Sheet





















EDO03721A003 Video I saw on YouTube



Randomize





















EDO03721A004 Internet blogs or discussion forums


























EDO03721A005 Advertising on social networks (Facebook, My Space, Twitter)


























EDO03721A006 Message directly from the company on a social network


























EDO03721A007 Mobile phone text messages or alerts


























EDO03721A008 Instant Message from a friend or colleague


























EDO03721A009 Familiarity with site/company/brand


























EDO03721A010 Word of mouth recommendation from someone I know


























EDO03721A011 TV, radio, newspaper, or magazine advertising


























EDO03721A012 Internet advertising


























EDO03721A013 Don't know



Anchor





















EDO03721A014 Other



Anchor


















EDO03722
Rank 3 EDO03722A001 Message/recommendation from someone I know on Facebook, Twitter, LinkedIn, etc.
Drop down, select one Single N Rank Group





















EDO03722A002 Search engine results



Adjust Template/Style Sheet





















EDO03722A003 Video I saw on YouTube



Randomize





















EDO03722A004 Internet blogs or discussion forums


























EDO03722A005 Advertising on social networks (Facebook, My Space, Twitter)


























EDO03722A006 Message directly from the company on a social network


























EDO03722A007 Mobile phone text messages or alerts


























EDO03722A008 Instant Message from a friend or colleague


























EDO03722A009 Familiarity with site


























EDO03722A010 Word of mouth recommendation from someone I know


























EDO03722A011 TV, radio, newspaper, or magazine advertising


























EDO03722A012 Internet advertising


























EDO03722A013 Don't know



Anchor





















EDO03722A014 Other



Anchor


















EDO03723
If you heard about this website from a social network, please specify the site (i.e. Facebook, Twitter)


Text area, no char limit
N
















































VA - My HealtheVet
























































EDO03808
VA is interested in whether you would like to use My HealtheVet to share your information with others involved in your health care (for example, medications, lab results, appointments). EDO03808A001 Spouse/Partner B, C, D Checkbox, one-up vertical Multi Y Who Allowed




















If you could allow one or more people (your "designated persons") to see some or all of your information in your My HealtheVet Personal Health Record, which of the following people might you choose? (Check all that apply) EDO03808A002 Child B, E, F, G

























EDO03808A003 Other family member B, E, F, G

























EDO03808A004 Caregiver not related to me B, H, I

























EDO03808A005 Friend or neighbor B, J, K

























EDO03808A006 VA health care provider B, L

























EDO03808A007 Non-VA health care provider B, M

























EDO03808A008 Other, please specify B, A

























EDO03808A009 Not sure B

























EDO03808A010 None. I don't want to let other people view my health information. B






















EDO03809 A What other person would you like to have access to your information?


Text area, no char limit

OE_Other Allowed


















EDO03810 B Please share your thoughts or concerns about allowing others to see your My HealtheVet information


Text area, no char limit

OE_Comment on Allow


















EDO03811 C Which parts, if any, of the My HealtheVet website would you want your spouse/partner to be able to see? (check all that apply) EDO03811A001 Information about my scheduled VA appointments
Checkbox, one-up vertical

Spouse/Partner See





















EDO03811A002 My medication list


























EDO03811A003 Results from my laboratory tests and other tests


























EDO03811A004 Wellness Reminders about tests or care that I need (such as blood pressure check, vaccines, or cancer screen)


























EDO03811A005 Information that I've entered about my health (such as blood sugar, blood pressure, or weight)


























EDO03811A006 Information about my doctor(s)


























EDO03811A007 My secure messages (secure electronic messages sent to or received from my VA health care team through My HealtheVet Secure Messaging)


























EDO03811A008 Other, please specify CC

























EDO03811A009 All of my information


























EDO03811A010 None























EDO03812 CC What other information would you like your spouse/partner to be able to see?


Text area, no char limit

OE_Spouse/Partner See


















EDO03813 D Which of the following, if any, would you want your spouse/partner to be able to do on your behalf? (check all that apply) EDO03813A001 Enter personal information (such as contact information, emergency contacts)
Checkbox, one-up vertical

Spouse Partner Do





















EDO03813A002 Enter information about my health (such as blood pressure, weight, medication list, allergy list)


























EDO03813A003 Refill prescriptions for me


























EDO03813A004 Schedule or manage my VA appointments


























EDO03813A005 Communicate electronically with my VA health care team through My HealtheVet Secure Messaging


























EDO03813A006 Save information from my personal health record to some place outside of My HealtheVet (for example another program or non-VA personal health record)


























EDO03813A007 Other, please specify DD

























EDO03813A008 None























EDO03814 DD What else would you like your spouse/partner to do on your behalf?


Text area, no char limit

OE_Spouse Partner Do


















EDO03815 E Which parts, if any, of the My HealtheVet website would you want your designated child or other family member to be able to see? (check all that apply) EDO03815A001 Information about my scheduled VA appointments
Checkbox, one-up vertical Multi Y Family Member See





















EDO03815A002 My medication list


























EDO03815A003 Results from my laboratory tests and other tests


























EDO03815A004 Wellness Reminders about tests or care that I need (such as blood pressure check, vaccines, or cancer screen)


























EDO03815A005 Information that I've entered about my health (such as blood sugar, blood pressure, or weight)


























EDO03815A006 Information about my doctor(s)


























EDO03815A007 My secure messages (secure electronic messages sent to or received from my VA health care team through My HealtheVet Secure Messaging)


























EDO03815A008 Other, please specify EE

























EDO03815A009 All of my information


























EDO03815A010 None























EDO03816 EE What other information would you like your child or family member to be able to see?


Text area, no char limit

OE_Family Member See


















EDO03817 F Which of the following, if any, would you want your designated child or other family member to be able to do on your behalf? (check all that apply) EDO03817A001 Enter personal information (such as contact information, emergency contacts)
Checkbox, one-up vertical Multi
Family Member Do





















EDO03817A002 Enter information about my health (such as blood pressure, weight, medication list, allergy list)


























EDO03817A003 Refill prescriptions for me


























EDO03817A004 Schedule or manage my VA appointments


























EDO03817A005 Communicate electronically with my VA health care team through My HealtheVet Secure Messaging


























EDO03817A006 Save information from my personal health record to some place outside of My HealtheVet (for example another program or non-VA personal health record)


























EDO03817A007 Other, please specify FF

























EDO03817A008 None























EDO03818 FF What else would you like your child or other family member to do on your behalf?


Text area, no char limit

OE_Family Member Do


















EDO03819 G Does the family member that you would most likely designate to have access to information in your My HealtheVet Personal Health Record live with you? EDO03819A001 Yes, they live with me
Radio button, one-up vertical Single
Family Member Live





















EDO03819A002 No, they do not live with me, but they visit me regularly


























EDO03819A003 No, they do not live with me, but we are in frequent contact by phone or email


























EDO03819A004 No, they do not live with me, and we are less frequently in contact























EDO03820 H Which parts, if any, of the My HealtheVet website would you want your designated caregiver to be able to see? (check all that apply) EDO03820A001 Information about my scheduled VA appointments
Checkbox, one-up vertical Multi
Caregiver See





















EDO03820A002 My medication list


























EDO03820A003 Results from my laboratory tests and other tests


























EDO03820A004 Wellness Reminders about tests or care that I need (such as blood pressure check, vaccines, or cancer screen)


























EDO03820A005 Information that I've entered about my health (such as blood sugar, blood pressure, or weight)


























EDO03820A006 Information about my doctor(s)


























EDO03820A007 My secure messages (secure electronic messages sent to or received from my VA health care team through My HealtheVet Secure Messaging)


























EDO03820A008 Other, please specify HH

























EDO03820A009 All of my information


























EDO03820A010 None























EDO03821 HH What other information would you like your caregiver to be able to see?


Text area, no char limit

OE_Caregiver See


















EDO03822 I Which of the following, if any, would you want your designated caregiver to be able to do on your behalf? (check all that apply) EDO03822A001 Enter personal information (such as contact information, emergency contacts)
Checkbox, one-up vertical Multi
Caregiver Do





















EDO03822A002 Enter information about my health (such as blood pressure, weight, medication list, allergy list)


























EDO03822A003 Refill prescriptions for me


























EDO03822A004 Schedule or manage my VA appointments


























EDO03822A005 Communicate electronically with my VA health care team through My HealtheVet Secure Messaging


























EDO03822A006 Save information from my personal health record to some place outside of My HealtheVet (for example another program or non-VA personal health record)


























EDO03822A007 Other, please specify II

























EDO03822A008 None























EDO03823 II What else would you like your caregiver to do on your behalf?


Text area, no char limit

OE_Caregiver Do


















EDO03824 J Which parts, if any, of the My HealtheVet website would you want your designated friend or neighbor to be able to see? (check all that apply) EDO03824A001 Information about my scheduled VA appointments
Checkbox, one-up vertical Multi
Friend See





















EDO03824A002 My medication list


























EDO03824A003 Results from my laboratory tests and other tests


























EDO03824A004 Wellness Reminders about tests or care that I need (such as blood pressure check, vaccines, or cancer screen)


























EDO03824A005 Information that I've entered about my health (such as blood sugar, blood pressure, or weight)


























EDO03824A006 Information about my doctor(s)


























EDO03824A007 My secure messages (secure electronic messages sent to or received from my VA health care team through My HealtheVet Secure Messaging)


























EDO03824A008 Other, please specify JJ

























EDO03824A009 All of my information


























EDO03824A010 None























EDO03825 JJ What other information would you like your friend or neighbor to be able to see?


Text area, no char limit

OE_Friend See


















EDO03826 K Which of the following, if any, would you want your designated friend or neighbor to be able to do on your behalf? (check all that apply) EDO03826A001 Enter personal information (such as contact information, emergency contacts)
Checkbox, one-up vertical Multi
Friend Do





















EDO03826A002 Enter information about my health (such as blood pressure, weight, medication list, allergy list)


























EDO03826A003 Refill prescriptions for me


























EDO03826A004 Schedule or manage my VA appointments


























EDO03826A005 Communicate electronically with my VA health care team through My HealtheVet Secure Messaging


























EDO03826A006 Save information from my personal health record to some place outside of My HealtheVet (for example another program or non-VA personal health record)


























EDO03826A007 Other, please specify KK

























EDO03826A008 None























EDO03827 KK What else would you like your friend or neighbor to do on your behalf?


Text area, no char limit

OE_Friend Do


















EDO03828 L Which parts, if any, of the My HealtheVet website would you want your designated VA health care provider to be able to see (check all that apply): EDO03828A001 Information about my scheduled VA appointments
Checkbox, one-up vertical Multi
VA HCP See





















EDO03828A002 My medication list


























EDO03828A003 Results from my laboratory tests and other tests


























EDO03828A004 Information that I've entered about my health (such as blood sugar, blood pressure, or weight)


























EDO03828A005 Information about my doctor(s)


























EDO03828A006 Other, please specify LL

























EDO03828A007 All of my information


























EDO03828A008 None























EDO03829 LL What other information would you like your VA health care provider to be able to see?


Text area, no char limit

OE_VA HCP See


















EDO03830 M Which parts, if any, of the My HealtheVet website would you want your designated Non-VA health care provider to be able to see (check all that apply): EDO03830A001 Information about my scheduled VA appointments
Checkbox, one-up vertical Multi Y Non-VA HCP See





















EDO03830A002 My medication list


























EDO03830A003 Results from my laboratory tests and other tests


























EDO03830A004 Wellness Reminders about tests or care that I need (such as blood pressure check, vaccines, or cancer screen)


























EDO03830A005 Information that I've entered about my health (such as blood sugar, blood pressure, or weight)


























EDO03830A006 Information about my doctor(s)


























EDO03830A007 My secure messages (secure electronic messages sent to or received from my VA health care team through My HealtheVet Secure Messaging)


























EDO03830A008 Other, please specify MM

























EDO03830A009 All of my information


























EDO03830A010 None























EDO03831 MM What other information would you like your non-VA health care provider to be able to see?


Text area, no char limit

OE_Non-VA HCP See


















EDO03832
At your last VA health care visit, who did you discuss your medications with? (check all that apply) EDO03832A001 Health care provider (doctor, physicians assistant, nurse practitioner)
Checkbox, one-up vertical Multi Y Who Discuss Meds





















EDO03832A002 Nurse


























EDO03832A003 Pharmacist


























EDO03832A004 Medical assistant or health technician


























EDO03832A005 Other staff member, please specify A

























EDO03832A006 No one. I did not discuss my medications


























EDO03832A007 I don't take any medications


























EDO03832A008 I do not remember























EDO03833 A What other staff member did you discuss medications with?





OE_Who Discuss Meds


















EDO03834
If you had a choice, which member of the health care team would you most like to talk with about your medications at your next VA health care visit? (check all that apply) EDO03834A001 Health care provider (doctor, physicians assistant, nurse practitioner)
Checkbox, one-up vertical Multi Y Discuss Meds Choice





















EDO03834A002 Nurse


























EDO03834A003 Pharmacist


























EDO03834A004 Medical assistant or health technician


























EDO03834A005 Other staff member, please specify A

























EDO03834A006 No one


























EDO03834A007 I don't take any medications


























EDO03834A008 Not sure























EDO03835 A What other staff member would you like to talk with about medications?


Text area, no char limit

OE_Discuss Meds Choice


















EDO03836
Do you use the My HealtheVet Pharmacy Self-Entered Medications + Supplements feature to keep track of any changes to your prescription medications, over-the-counter medications, herbals and/or supplements? EDO03836A001 Yes A, B, C Radio button, one-up vertical Single Y Use Self Entered Meds





















EDO03836A002 No


























EDO03836A003 Not sure























EDO03837 A Which kinds of medications do you keep track of in My HealtheVet? (check all that apply) EDO03837A001 Prescription medications from my home VA healthcare provider filled at the VA pharmacy
Checkbox, one-up vertical Multi Y Med type tracked





















EDO03837A002 Prescription medications from my home VA healthcare provider filled at non VA pharmacies


























EDO03837A003 Prescription medications from VA healthcare providers at VA facilities other than my home VA facility


























EDO03837A004 Prescription medications from my non-VA healthcare provider(s)


























EDO03837A005 Over-the-counter medications


























EDO03837A006 Herbals and/or supplements


























EDO03837A007 Other, please specify AA






















EDO03838 AA What other medications do you keep track of in My HealtheVet?


Text area, no char limit

OE_Med type tracked


















EDO03839 B In the last 12 months, did you share your My HealtheVet My Complete Medications List with any of your VA health care providers? EDO03839A001 Yes
Radio button, one-up vertical Single Y Share med list w/ VA HCP





















EDO03839A002 No


























EDO03839A003 Not sure























EDO03840 C In the last 12 months, did you share your My HealtheVet My Complete Medications List with any of your Non-VA health care providers? EDO03840A001 Yes
Radio button, one-up vertical Single Y Share med list w/Non-VA HCP





















EDO03840A002 No


























EDO03840A003 Not sure

















































































CMS - FCSO J9 MAC
























































EDO03940
Please rank the top 3 sources that brought you to the website today. (1 = strongest influence)
Rank 1
EDO03940A001 Message or recommendation from a friend on a social network
Drop down, select one Single Y Rank Group SV - Rank 1




















EDO03940A002 Video I saw on YouTube



Adjust Template/Style Sheet





















EDO03940A003 Internet blogs or discussion forums



Randomize





















EDO03940A004 Advertising on social networks (Facebook, My Space, Twitter)


























EDO03940A005 Message directly from the company on a social network


























EDO03940A006 Mobile phone text messages or alerts


























EDO03940A007 Instant Message from a friend or colleague


























EDO03940A008 Familiarity with website or First Coast Service Options


























EDO03940A009 Promotional e-mail(s) from First Coast Service Options


























EDO03940A010 Search engine results


























EDO03940A011 Word of mouth recommendation from someone I know


























EDO03940A012 TV, radio, newspaper, or magazine advertising


























EDO03940A013 Internet advertising


























EDO03940A014 Don't know



Anchor





















EDO03940A015 Other



Anchor


















EDO03941
Rank 2 EDO03941A001 Message or recommendation from a friend on a social network
Drop down, select one Single N Rank Group SV - Rank 2




















EDO03941A002 Video I saw on YouTube



Adjust Template/Style Sheet





















EDO03941A003 Internet blogs or discussion forums



Randomize





















EDO03941A004 Advertising on social networks (Facebook, My Space, Twitter)


























EDO03941A005 Message directly from the company on a social network


























EDO03941A006 Mobile phone text messages or alerts


























EDO03941A007 Instant Message from a friend or colleague


























EDO03941A008 Familiarity with website or First Coast Service Options


























EDO03941A009 Promotional e-mail(s) from First Coast Service Options


























EDO03941A010 Search engine results


























EDO03941A011 Word of mouth recommendation from someone I know


























EDO03941A012 TV, radio, newspaper, or magazine advertising


























EDO03941A013 Internet advertising


























EDO03941A014 Don't know



Anchor





















EDO03941A015 Other



Anchor


















EDO03942
Rank 3 EDO03942A001 Message or recommendation from a friend on a social network
Drop down, select one Single N Rank Group SV - Rank 3




















EDO03942A002 Video I saw on YouTube



Adjust Template/Style Sheet





















EDO03942A003 Internet blogs or discussion forums



Randomize





















EDO03942A004 Advertising on social networks (Facebook, My Space, Twitter)


























EDO03942A005 Message directly from the company on a social network


























EDO03942A006 Mobile phone text messages or alerts


























EDO03942A007 Instant Message from a friend or colleague


























EDO03942A008 Familiarity with website or First Coast Service Options


























EDO03942A009 Promotional e-mail(s) from First Coast Service Options


























EDO03942A010 Search engine results


























EDO03942A011 Word of mouth recommendation from someone I know


























EDO03942A012 TV, radio, newspaper, or magazine advertising


























EDO03942A013 Internet advertising


























EDO03942A014 Don't know



Anchor





















EDO03942A015 Other



Anchor















































Consumer Reports Main Site
























































EDO03981
How could we improve the content on ConsumerReports.org so it's more useful? EDO03981A001 Update current ratings and reviews for products more frequently (ie: on cars, digital cameras, refrigerators, etc)
Checkbox, one-up vertical Multi N OPS Group Content



















EDO03981A002 Test and review more new products that aren't currently being reviewed (ie: outdoor products, sporting goods, toys, games, car aftermarket products, etc)


























EDO03981A003 Test and review services (ie: plumbers, auto mechanics, electricians contractors etc.)


























EDO03981A004 Provide more testing data/information on current product ratings and reviews


























EDO03981A005 Make the ratings simpler and easier to understand


























EDO03981A006 Provide more detailed test review narratives about the specific products


























EDO03981A007 Other, please specify: F






















EDO03982 F Other Content


Text field, <100 char Single N OPS Group Other Content

















EDO03983
If you would like us to review more products please tell us which categories are most important… EDO03983A001 Cars
Checkbox, one-up vertical Multi N OPS Group Categories



















EDO03983A002 Appliances

























EDO03983A003 Electronics and Computers

























EDO03983A004 Home and Garden

























EDO03983A005 Babies and Kids

























EDO03983A006 Money and Finance

























EDO03983A007 Health


























EDO03983A008 None of the above


























EDO03983A009 Other, please specify: F






















EDO03984 F Other categories for review


Text field, <100 char Single N OPS Group Other for review

















EDO03985
If you have any specific new products or services that you would like us to test please tell us about them.


Text area, no char limit
N
OE_To Test

















EDO03986
How did you look for information on the site today? EDO03986A001 Used the ConsumerReports.org search tool A, W, X, Y, Z Checkbox, one-up vertical Multi Y Skip Logic How Navigated




















EDO03986A002 Used the left navigation bar


























EDO03986A003 Used the top navigation bar


























EDO03986A004 Other, please specify M

























EDO03986A005 Not Sure























EDO03987 M Please specify the other way you looked for information today.


Text area, no char limit

Skip Logic Group OE_How Navigated

















EDO03988
Please tell us what you experienced on the site today. (Select all that apply) EDO03988A001 I had little to no difficulty getting to the information I wanted
Checkbox, one-up vertical Multi N OPS Group Site Experience



















EDO03988A002 I navigated to the general area but could not find the specific information I wanted


























EDO03988A003 It was not clear to me where the links would lead


























EDO03988A004 It was difficult for me to locate the links necessary to lead to the information I wanted


























EDO03988A005 I experienced technical difficulties (i.e. error messages)


























EDO03988A006 I was often confused about where I was on the site


























EDO03988A007 The information did not seem to be organized in a logical manner  


























EDO03988A008 Other, please specify: F






















EDO03989 F Other site Experience


Text field, <100 char Single N OPS Group Other Site Experience














































FSIS Content + Search
























































EDO04067
Please describe your experience with navigation on this site today. EDO04067A001 I had no difficulty browsing on this site
Radio button, one-up vertical s y OPS Group





















EDO04067A002 Could not navigate back to previous information


























EDO04067A003 Would often feel lost, not know where I was


























EDO04067A004 Links did not take me where I expected


























EDO04067A005 Links/labels are difficult to understand


























EDO04067A006 Too many links or navigational choices


























EDO04067A007 Had technical difficulties (e.g. broken link)


























EDO04067A008 Other, please specify: A






















EDO04068 A Other navigational difficulties:


Text field, <100 char S N OPS Group


















EDO04069
If you used the search/text box feature of the site today to find your information, what was your experience with the search functionality? EDO04069A001 I did not encounter any difficulties
Radio button, one-up vertical s y OPS Group





















EDO04069A002 Search results were helpful


























EDO04069A003 Search results were not helpful


























EDO04069A004 Returned too many results


























EDO04069A005 Returned not enough results


























EDO04069A006 Returned no results


























EDO04069A007 Returned results that were too similar/redundant


























EDO04069A008 Results were not relevant to my search


























EDO04069A009 Other, please specify: B

























EDO04069A010 I did not use the search tool today.























EDO04070 B Other search difficulties:


Text field, <100 char S N OPS Group


















EDO04071
Did you use the Ask Karen virtual representative system to ask a food safety question today? EDO04071A001 Yes C


Skip Logic Group





















EDO04071A002 No























EDO04072
Did you use the askFSIS system to ask a food regulation question today? EDO04072A001 Yes D


Skip Logic Group





















EDO04072A002 No




















































CMS Palmetto GBA J1 MAC
























































EDO04162
If you heard about the website from a social network, please specify the site. EDO04162A001 Facebook

Single No OPS Group





















EDO04162A002 LinkedIn


























EDO04162A003 YouTube


























EDO04162A004 Twitter


























EDO04162A005 Mobile apps


























EDO04162A006 Other, please specify E






















EDO04163 E Please specify the other social network.


Text field, <100 char Single No OPS Group


















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