373 CQs for OMB 9- 373 CQs for OMB 9-21-2010 to 10-17-2010

Measures Name/Client name (CDs and Answer choices)
DHS Satisfaction Survey - Transparency
ACQOsl0001999		What is your primary purpose for visiting this site today?	ACQOsl0001999A01	Seeking a job		Radio button, one-up vertical	Single	Y	Other, please specify
			ACQOsl0001999A02	I am a student conducting research
			ACQOsl0001999A03	Other, please specify	A
ACQOsl0002000	A	What other purpose did you have for visiting this site today?				Text area, no char limit		Y
ACQOsl0002001		Were you able to complete your task?	ACQOsl0002001A01	Yes		Radio button, one-up vertical		Y	Skip Logic Group
			ACQOsl0002001A02	No	A
ACQOsl0002002	A	Why were you unable to complete your task?				Text area, no char limit		Y
NIAMS Survey
ACQOsl0002004	A	What type of health related information were you primarily looking for today?	ACQOsl0002004A01	Arthritis/rheumatic diseases		Radio button, one-up vertical	Single	Y
			ACQOsl0002004A02	Bone health and/or diseases
			ACQOsl0002004A03	Skin diseases
			ACQOsl0002004A04	Muscle injury and/or diseases
			ACQOsl0002004A05	Other	C
ACQOsl0002005	C	What other type of health related information were you looking for?				Text field, <100 char	Open	N
SSA Retirement Estimator v3
EDO06581		What is your preferred language for conducting business with the Social Security Administration?	EDO06581A001	English		Radio button, one-up vertical	Single	Y	OPS Group	Preferred language	This is not a new question
			EDO06581A002	Spanish
			EDO06581A003	Other, please specify	A
EDO06582	A	Other preferred language				Text field, <100 char		N	OPS Group	Other learned about
EDO06583		What is your current marital status?	EDO06583A001	Married		Radio button, one-up vertical	Single	N	OPS Group	Marital Status
			EDO06583A002	Separated
			EDO06583A003	Divorced
			EDO06583A004	Widowed
			EDO06583A005	Never married
			EDO06583A006	Prefer not to answer
			EDO06583A007	Other, please specify	x
EDO06584	X	Other marital status				Text field, <100 char		N	OPS Group	Other Marital
Farm Bureau Financial Services
EDO06713	B	Please rate the process for making a payment on this site.	EDO06713A001	1-Very Difficult		Radio button, scale, has don't know	Single	Y	Skip Logic Group	Making a Payment
			EDO06713A002	2
			EDO06713A003	3
			EDO06713A004	4
			EDO06713A005	5
			EDO06713A006	6
			EDO06713A007	7
			EDO06713A008	8
			EDO06713A009	9
			EDO06713A010	10- Very Easy
			EDO06713A011	N/A
EDO06714		Did you have trouble signing into your account today?	EDO06714A001	Yes	A, B	Radio button, one-up vertical	Single	Y	Skip Logic Group	Difficulty Logging In
			EDO06714A002	No	B
			EDO06714A003	Does not apply
EDO06715	A	What specifically caused you to have trouble while trying to login?	EDO06715A001	Forgot password		Radio button, one-up vertical	Open	N	Skip Logic Group	Specific Login Difficulty
			EDO06715A002	Forgot User Name
			EDO06715A003	System didn't recognize my User Name or Password
			EDO06715A004	Other	A1
EDO06716	A1	Other login issues you encountered.				Text area, no char limit	Single	N	Skip Logic	OE_Login Difficulty
EDO06717	B	Please rate how satisfied you were with the ease of the login/registration process.	EDO06717A001	1-Very Dissatisfied		Radio button, scale, has don't know	Single	Y	Skip Logic	Rate Login
			EDO06717A002	2
			EDO06717A003	3
			EDO06717A004	4
			EDO06717A005	5
			EDO06717A006	6
			EDO06717A007	7
			EDO06717A008	8
			EDO06717A009	9
			EDO06717A010	10- Very Satisfied
			EDO06717A011	N/A
EDO06718		Have you ever accessed fbfs.com from a mobile device? (Cell phone, iPhone, iPad, Blackberry, etc.)	EDO06718A01	Yes	A	Radio button, one-up vertical	Single	Y		Mobile
			EDO06718A02	No	B
EDO06719	A	Please rate how satisfied you were with your experience visiting fbfs.com using a mobile device.	EDO06719A001	1-Very Dissatisfied						Satisfaction with Mobile
			EDO06719A002	2
			EDO06719A003	3
			EDO06719A004	4
			EDO06719A005	5
			EDO06719A006	6
			EDO06719A007	7
			EDO06719A008	8
			EDO06719A009	9
			EDO06719A010	10- Very Satisfied
			EDO06719A011	N/A
EDO06720	B	How interested would you be in accessing fbfs.com through your mobile device? (Cell phone, iPhone, iPad, Blackberry, etc.)	EDO06720A001	1-Not Interested						Interest in Mobile
			EDO06720A002	2
			EDO06720A003	3
			EDO06720A004	4
			EDO06720A005	5
			EDO06720A006	6
			EDO06720A007	7
			EDO06720A008	8
			EDO06720A009	9
			EDO06720A010	10- Very Interested
			EDO06720A011	N/A
FBI Internet Satisfaction Survey
ACQOsl0002099	B	How does the new FBI.gov site compare to the previous website design?	ACQOsl0002099A01	Better than the previous design		Radio button, one-up vertical	Single	Y		Redesign Q1
			ACQOsl0002099A02	The same as the previous design
			ACQOsl0002099A03	Worse than the previous design
			ACQOsl0002099A04	Don't Know
ACQOsl0002100	C	Please select the statement which best describes your experience with the new FBI.gov site redesign:	ACQOsl0002100A01	It is easier to find what I am looking for		Radio button, one-up vertical	Single	Y		Redesign Q2
			ACQOsl0002100A02	It is harder to find what I am looking for
			ACQOsl0002100A03	My experience is no different when looking for information on the new site
ACQOsl0001974	D	Please tell us what you think of the new FBI.gov site:				Text area, no char limit		N		Redesign Open
USDA FSA v2
	C	Would a wizard (a step-by-step user interface; ex. Benefits Finder Wizard) to help you find the information be useful?		Yes
				No
	D	What do you plan to do next?
	M	Please tell us what links were broken or the errors received.
		Where are you located?		Alabama		Drop down, select one
				Alaska
				Arizona
				Arkansas
				California
				Colorado
				Connecticut
				Delaware
				District of Columbia
				Florida
				Georgia
				Hawaii
				Idaho
				Illinois
				Indiana
				Iowa
				Kansas
				Kentucky
				Louisiana
				Maine
				Maryland
				Massachusetts
				Michigan
				Minnesota
				Mississippi
				Missouri
				Montana
				Nebraska
				Nevada
				New Hampshire
				New Jersey
				New Mexico
				New York
				North Carolina
				North Dakota
				Ohio
				Oklahoma
				Oregon
				Pennsylvania
				Rhode Island
				South Carolina
				South Dakota
				Tennessee
				Texas
				Utah
				Vermont
				Virginia
				Washington
				West Virginia
				Wisconsin
				Wyoming
				US Territory
				I live outside the U.S.	F
		Would an app (ex. Program Eligibility Analyzer) to help determine which programs apply to you be helpful?		Yes
				No
		Would an app (ex. Program Finder) to help you find the notices and directives that apply to you be helpful?		Yes
				No
SSA iClaim
ACQDom0001966	X	Did you visit the Social Security home page (www.socialsecurity.gov) today?		Yes
				No
	Y	Did you use the SEARCH box on our website to find what you needed?		Yes
				No
	Z	Please tell us how easy it was for you to find the application for benefits:		I had little or no difficulty getting to the application
				I found it somewhat difficult to find the application	Z1
	Z1	I found it somewhat difficult to find the application because (check all that apply):		I did not know where to begin looking
				It was not clear to me where the links would lead
				The information did not seem to be organized in a logical manner
				On the home page, it was not clear where the Medicare related links would lead
				I used the search function but the results didn’t seem to apply to Medicare specifically
				Other reason (please describe)	Z2
	Z2	Other:
		How did you arrive on the Social Security website today?		Typed ssa.gov or socialsecurity.gov into the browser
				Did a search (i.e. Google, Bing, Yahoo)
				Followed a link from medicare.gov
				Followed a link from another website
Healthfinder.gov
ACQOsl0002106	A	Please list the search terms you typed into the search box on the Healthfinder.gov site:				Text field, <100 char	Single	N	Skip Logic Group	Search Terms
ACQOsl0002107		Which of the following social media do you use regularly (at least once a month)? (Please select all that apply)	ACQOsl0002107A01	Facebook		Checkbox, one-up vertical	Multi	Y		Social Media
			ACQOsl0002107A02	Twitter
			ACQOsl0002107A03	LinkedIn
			ACQOsl0002107A04	Discussion boards
			ACQOsl0002107A05	Blogs
NIDCR Spanish (Engl Equiv)
ACQOsl0002108		How would you best describe the Spanish-language information on this website?	ACQOsl0002108A01	Very difficult to understand		Radio button, one-up vertical	Single	Yes		Comprehension
			ACQOsl0002108A02	Somewhat difficult to understand
			ACQOsl0002108A03	Somewhat easy to understand
			ACQOsl0002108A04	Very easy to understand
CMS - Highmark J12
ACQOsl0002163	F	What specific search terms did you use to try to find the information you were looking for?				Text field, <100 char		N