419 CMS 419 CMS Palmetto GBA J11 MAC

American Customer Satisfaction Index (ACSI) E-Government Website Customer Satisfaction Surveys

2011 419 CMS Palmetto GBA J11 MAC Questionnaire 3-10-11.xlsx

Previously Cleared ICs from prior Generic ICR

OMB: 1090-0008

Document [xlsx]
Download: xlsx | pdf
Model Instance Name:









CMS Palmetto GBA J11 MAC









MID: xVtkhQ8Yh84FUFVxYcpsBg==









Date: 2/24/2011


















CMS Palmetto GBA J11 MAC CUSTOM QUESTION LIST
CQID 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 CQ Label
SAC1415
Which best describes you? Provider of medical services
Radio buttons Single Y Skip Group Best Describes You

Supplier of medical equipment or supplies



Staff of a provider/supplier working primarily with billing/insurance



Administrative staff of a provider/supplier



Other staff of a provider/supplier



Consultant or attorney



Billing service



Other A

SAC1416 A Please explain briefly your role in visiting this site.

Text area, no char limit Single N Skip Group OPS_Best Describes You
SAC1417
What is your primary reason for visiting this site today? Download forms
Radio buttons Single Y Skip Group Visit Reason


Learn of, or register for, workshops, seminars or other training events




Find contact information




Find general Medicare program information




Research a specific question on Medicare policy or billing




Access claim status and/or beneficiary eligibility




Find information on fees or fee schedules




Find out about a Local Coverage Determination (LCD)




Read Medicare publications such as newsletters, articles, etc.




Find enrollment information




Take an on-line training course




Other B

SAC1418 B Please explain briefly your primary reason for visiting this site.

Text area, no char limit Single N Skip Group OPS_Visit Reason
SAC1419
Did you find what you were looking for? Yes
Radio button, one-up vertical Single Y Skip Group Looking For


No C




SAC1420 C No, I was looking for:

Text area, no char limit Open Y Skip Group Didn't Find
SAC1421
Did you use the site-wide search feature on this site? (open text box in the upper right) Yes D, E Radio button, one-up vertical Single Y Skip Group Use Search



No






SAC1422 D How would you rate the helpfulness of the site-wide search? Very helpful
Radio button, one-up vertical Single Y Skip Group Rate Search



Somewhat helpful









Fair









Somewhat unhelpful F








Very unhelpful F





SAC1423 F Which of the following describes your experience with the site-wide search? Search difficult to use
Radio button, one-up vertical Single Y Skip Group Search Experience



Received too few results G








Received too many results









Search results were not what I was looking for H








Could not sort or refine results









Other I





SAC1424 G What search term(s) did you use?

Text area, no char limit Single N Skip Group Terms - Too Few
SAC1425 H What search term(s) did you use?

Text area, no char limit Single N Skip Group Terms - Not What Look For
SAC1426 I Please briefly explain your experience with the site-wide search.

Text area, no char limit Single N Skip Group Other_Search Experience
SAC1427 E What one improvement to the site-wide search feature would be most beneficial?

Text area, no char limit Single N Skip Group Other-Search Improvement
SAC1428
In the last 30 days, how many times have you visited this website? This is my first time
Radio buttons Single Y
Visit Frequency

Once or twice




Three or four times




More than once per week but not every day




Every day



SAC1429
Please rank the top 3 factors that brought you to the website today. (Rank 1 = Most important)
Rank 1
Message or recommendation from a friend on a social network
Drop down, select one Single Y Rank Group SV - Rank 1



Video I saw on YouTube



Adjust Template/Style Sheet




Internet blogs or discussion forums



Randomize




Advertising on social networks (Facebook, LinkedIn, Twitter)









Message directly from Palmetto GBA on a social network









Mobile phone text messages or alerts









Instant Message from a friend or colleague









Typed in the URL









Bookmarked the website









Search engine results









Word of mouth recommendation from someone I know









Link from the CMS website









Listserv or email updates from Palmetto GBA









Mobile apps









None of the above



Anchor




Don't know



Anchor




Other



Anchor

SAC1430
Rank 2 Message or recommendation from a friend on a social network
Drop down, select one Single N Rank Group SV - Rank 2



Video I saw on YouTube



Adjust Template/Style Sheet




Internet blogs or discussion forums



Randomize




Advertising on social networks (Facebook, LinkedIn, Twitter)









Message directly from Palmetto GBA on a social network









Mobile phone text messages or alerts









Instant Message from a friend or colleague









Typed in the URL









Bookmarked the website









Search engine results









Word of mouth recommendation from someone I know









Link from the CMS website









Listserv or email updates from Palmetto GBA









Mobile apps









None of the above



Anchor




Don't know



Anchor




Other



Anchor

SAC1431
Rank 3 Message or recommendation from a friend on a social network
Drop down, select one Single N Rank Group SV - Rank 3



Video I saw on YouTube



Adjust Template/Style Sheet




Internet blogs or discussion forums



Randomize




Advertising on social networks (Facebook, LinkedIn, Twitter)









Message directly from Palmetto GBA on a social network









Mobile phone text messages or alerts









Instant Message from a friend or colleague









Typed in the URL









Bookmarked the website









Search engine results









Word of mouth recommendation from someone I know









Link from the CMS website









Listserv or email updates from Palmetto GBA









Mobile apps









None of the above



Anchor




Don't know



Anchor




Other



Anchor

SAC1432
If you heard about the website from a social network, please specify the site. Facebook

Single N Skip Group Heard About On Site



LinkedIn









YouTube









Twitter









Mobile apps









Other, please specify J





SAC1433 J Please specify the other social network.

Text area, no char limit Single N Skip Group OPS_Heard About
SAC1434
Please select your location and contract: (please select all that apply) South Carolina – Part A
Checkbox, one-up vertical Multi Y
Location


South Carolina – Part B






North Carolina – Part A






North Carolina – Part B






Virginia – Part A






Virginia – Part B






West Virginia – Part A






West Virginia – Part B






Not applicable




SAC1435
If you do not use E-mail Updates (listserv), please tell us why not.

Text area, no char limit Open N
Why Not Use Listserv
SAC1436
If you are over the age of 18 and would like to be contacted by Palmetto GBA regarding your feedback, please provide your e-mail address and/or phone number.

Text area, no char limit Open N
Contact Me
SAC1437
If you could change anything about our site, what would it be?

Text area, no char limit Open N
Change One Thing

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