433 Benefits.gov 433 Benefits.gov

Model Instance Name:			red & strike-through: DELETE
			underlined & italicized: RE-ORDER
MID: 1QRBQVt00VlYwxsMAAs01A==			pink: ADDITION
Date:			blue + -->: REWORDING
CUSTOM QUESTION LIST
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
EDO11044		Which of the following best describes you?	Agency Representative		Radio button, one-up vertical	Single	Y	OPS Group
			Benefit Advocate/Caseworker
			Disabled
			Disabled Veteran
			Disaster Victim
			Federal employee or retiree
			Injured/Sick
			Low Income
			Military (Active)
			Military Dependent
			Student
			Senior/Retiree
			Veteran
			Veteran Dependent
			Unemployed
			Other, please specify:	A
EDO11045	A	Other role			Text area, no char limit	Single	N	OPS Group
EDO11046		Is this your first time visiting BENEFITS.GOV?	Yes
			No
EDO11047		What was your primary purpose for visiting today?	To find more information about a specific program		Radio button, one-up vertical	Single	Y
			I need help, but do not know what is available
			I am looking for free money from the government
			I want to apply for a specific benefit online
			I am curious about programs available to me
			Other
EDO11048		What kind of information were you looking for today?	Disability benefits		Radio button, one-up vertical	Single	Y	Skip Logic Group
			Financial assistance
			Grants
			Housing assistance
			Loans
			Lost money
			Medicaid
			General program information
			Other, please specify:
EDO11049		What kind of information were you looking for today?			Text area, no char limit		N
EDO11050		Did you find what you were looking for?	Yes		Radio button, one-up vertical	Single	Y	OPS Group
			Not yet, I was looking for:	B
EDO11051	B				Text area, no char limit	Single	N	OPS Group
EDO11052		What is the primary search method you used to search for benefits while on the site?	Benefit Finder tool	Y				Skip Logic Group
			Search (located in the top right corner of the homepage)	Y,D
			Browse by category	Y,D
			Browse by state	Y,D
			Browse by federal agency	Y,D
			Other resources	Y,D
EDO11053	Y	Was the primary search method you used helpful?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group
			No	C
EDO11054	C	Why don't you feel the primary search method you used was helpful?			Text area, no char limit		N	Skip Logic Group
EDO11055	D	Why didn't you use the Benefit Finder tool?	I did not see it					Skip Logic Group
			It asked too many questions
			I had a specific program I was looking for
			I chose to use one of the other ways to search
			Other, please specify:	Z
EDO11056	Z	Why didn't you use the Benefit Finder tool?			Text area, no char limit	Single	N	Skip Logic Group
EDO11057		Were you (or the person for whom you were searching) eligible for any program(s)?	Yes - eligible for at least one program	DD	Radio button, one-up vertical	Single	Y	Skip Logic Group
			No
			I don't know yet
			Not Applicable
EDO11058	DD	Did you successfully email your results?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group
			No	E
EDO11059	E	Why didn't you successfully email your results?			Text area, no char limit		N	Skip Logic Group
EDO11060		Did the Benefits detail provide enough information for you to move forward in your efforts to obtain help?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group
			No	F
EDO11061	F	What additional information do you need?			Text area, no char limit		N	Skip Logic Group
EDO11062		How did you find out about our site?	E-mail/Mail		Radio button, one-up vertical	Single	Y	OPS Group
			GovBenefits.gov Connection Newsletter
			Government Website
			Non-government Website
			Newspaper/TV/Radio
			Referral from a friend
			Search Engine
			Social Services/Counselor
			Other, please specify:	A
EDO11063	A	Other, Find out about site			Text area, no char limit	Single	N	OPS Group
EDO11064		Do you subscribe to the GovBenefits.gov Connections e-newsletter?	Yes		Radio button, one-up vertical	Single	Y	OPS Group
			No
			No, but I'd like to. My e-mail is	A
EDO11065	A				Text area, no char limit	Single	N	OPS Group
EDO11066		What is your gender?	Male		Radio button, one-up vertical	Single	N
			Female
EDO11067		How do you describe your race or ethnicity?	Alaska Native		Radio button, one-up vertical	Single	N
			American Indian
			Asian
			Black or African American
			Hispanic
			Native American
			Pacific Islander
			White or Caucasian
EDO11068		What is your age range?	Under 18		Radio button, one-up vertical	Single	N
			18-24
			25-34
			35-44
			45-54
			55-64
			65 and older
EDO11069		What best describes your income range?	Under $25,000		Radio button, one-up vertical	Single	N
			$25,000 - $49,999
			$50,000 - $74,999
			$75,000 or higher
EDO11070		Which of the following best describes the highest level of education you have completed?	Did not complete high school		Radio button, one-up vertical	Single	N
			High school graduate
			Some college/vocational school
			College graduate
			Some postgraduate school
			Graduate/professional degree
EDO11071		We're trying to understand if visitors are finding programs and aren't eligible, or aren't finding programs at all. Do you have any thoughts on this topic?			Text area, no char limit	Single	N
EDO11072		If you could make one improvement to the site, what would it be?			Text area, no char limit	Single	N