Form 362 Final Q's Medi 362 Final Q's Medi 362 Final Q's Medicare 09.07.2010

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Overview

Guidelines
Custom Qsts

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Sheet 1: Guidelines

Questionnaire Management Guidelines

Goals:

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One consolidated document to track all model and CQ changes throughout the life of the project

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Questionnaire always matches the live survey

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Easy and error-free way to submit CQ changes

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All changes tracked and reflected in one document (DOT will help)

Questionnaire Resources:

1

Questionnaire Design and Approval Process

2

Question Grouping Rules

3

OPS vs. Skip Logic Decision for "Other, Please Specify"

4

Model and Custom Question Checks_ SRA

5

Model and Custom Question Checks_ Team LeadManager

6

Model and Custom Question Checks_ DOT

7

Foreign Language Survey Instructions

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Sheet 2: Custom Qsts

#REF!

red & strike-through: DELETE

#REF!

underlined & italicized: RE-ORDER

MID: 4VxYMQAFQtEwVk8MQ4FApg==

pink: ADDITION

Date:

6/21/2010

blue + -->: REWORDING

#REF!

QID (Group ID)

Skip Logic Label

Question Text

Answer Choices (limited to 50 characters)

Skip to

Type (select from list)

Single or Multi

Required Y/N

Special Instructions

25 character limit. CQ Label

EDO06081

How often do you visit Medicare.gov?

First time

Drop down, select one

single

N

Visit frequency

15

Daily or more often

About once a week

About once a month

Less than once a month, but more than once a year

Once a year or less

EDO06082

What is your role in visiting Medicare.gov today?

I am a Medicare beneficiary, I receive benefits from Medicare

Radio button, one-up vertical

single

N

OPS Group

Role

4

I am a friend or family member of someone who is a Medicare beneficiary/receives benefits from Medicare

I am a healthcare professional

I am a healthcare partner

I am an administrator who works with Medicare beneficiaries

I represent an employer

Other (please specify):

A

EDO06083

A

Other role in visiting Medicare.gov

Text field, <100 char

N

OPS Group

Other role

10

EDO06084

How did you first find out about Medicare.gov?

Internet search

Radio button, one-up vertical

single

N

OPS Group

Site Awareness

14

Another Web site

Recommended by someone I know

In a printed article (newspaper, magazine, newsletter)

At a meeting or conference I attended

Read about Medicare.gov in a blog

Twitter

LinkedIn page

RSS Feed

Bookmarking site

Poster or pamphlet

YouTube

Don't recall/ Don't know

Other (please specify):

A

EDO06085

A

Other (please specify source)

Text field, <100 char

N

OPS Group

Other awareness

15

EDO06086

What was your primary reason for visiting Medicare.gov?

Find basic information about Medicare

Radio button, one-up vertical

single

N

OPS Group

Visit Reason

12

Apply for Medicare benefits

Review, manage or change my Medicare plan choice(s)

Check for Medicare eligibility

Locate a resource (Drug Plans, Health Plans, Physicians, Compare Hospitals and Nursing Home)

Find contact information

Order a new Medicare card

Change of address

Download a database

File a complaint or grievance

Other (please specify):

A

EDO06087

A

Other (please specify reason)

Text field, <100 char

N

OPS Group

Other Visit Reason

18

EDO06088

jyotsna.bisaro: Shorter list What sections of Medicare.gov did you visit today? (please select all that apply.)

New to Medicare

Checkbox, one-up vertical

multi

N

Skip Logic Group

Site sections visited

22

Health & Drug Plans

Facilities & Doctors

MyMedicare.gov

Manage your Health

Medicare Basics

Resource Locator

A

Help & Support

Don't know

EDO06089

A

Did you find the Resource Locator drop down menu useful?

Yes

Drop down, select one

single

N

Skip Logic Group

Tools Useful

12

No

Not Sure

EDO06090

Did you accomplish what you wanted on Medicare.gov today?

Yes

Drop down, select one

single

N

Skip Logic Group

Accomplish goal

15

No

A

EDO06091

A

Please describe in detail what you were trying to do or find.

Text area, no char limit

N

Skip Logic Group

What was goal

13

EDO06092

A

What would you like to do or accomplish next?

Come back to Medicare.gov later

Radio button, one-up vertical

single

N

Skip Logic Group

Do next

8

Look at other Web sites for Medicare information

Look other places online

E-mail Medicare.gov

Call 1-800-Medicare for information

Call your State Health Insurance Assistance Program (SHIP) for information

Give up

Other (please specify):

B

EDO06093

B

Other do next

Text field, <100 char

N

Skip Logic Group

Other do next

13

EDO06094

Did you use the "search" box to search for anything on Medicare.gov today?

Yes

A

Drop down, select one

single

N

Skip Logic Group

Use of search

13

No

Don't know

EDO06095

A

Please describe your experience with the Medicare.gov search engine.

Too many results

Checkbox, one-up vertical

multi

N

Skip Logic Group

Search experience

17

Too few results

Returned no results

Received an error message

Results were not what I was looking for

Other search issue (please specify):

B

I had no difficulty searching on this site

EDO06096

B

Other search issue

Text field, <100 char

N

Skip Logic Group

Other search issue

18

EDO06097

Do you currently subscribe to Medicare.gov RSS news service?

Yes

A

Drop down, select one

single

N

Skip Logic Group

Subscriptions

13

No

Don't know

EDO06098

A

Do you find Medicare.gov's RSS news service updates helpful?

Yes

Drop down, select one

single

N

Skip Logic Group

EmailUpdates

12

No

EDO06099

Do you have any suggestions for ways to improve Medicare.gov?

Text area, no char limit

N

Improvement Suggestions

23

EDO06100

We're working to improve Medicare.gov. Please consider providing your email address for us to contact you for either one of the following reasons: To discuss specific details about your current experience using our website To request your comments on proposed future changes to our website.

Text field, <100 char

N

Opt-in E-mail

13