300 CQs 300 CQs 1-16-10
American Customer Satisfaction Index (ACSI) E-Government Website Customer Satisfaction Surveys
300 Multiple Custom Questions for OMB 1-16-2010 to 2-5-2010.xls
Previously Cleared ICs from prior Generic ICR
OMB: 1090-0008
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1090-0008 can be found here:
Document [xlsx]
Download: xlsx | pdf
| Measures Name/Client name (CDs and Answer choices) | |||||||||
| USITC | 
|
||||||||
| 5014 | A | Text area, no char limit | Single | Y | |||||
| EN00003 | B | Continue looking on this site | Drop down, select one | Single | Y | ||||
| Come back to this site later | |||||||||
| Look for an e-mail address and send an e-mail | |||||||||
| Look for a phone number and call | |||||||||
| Look elsewhere online | |||||||||
| Give up | |||||||||
| Other (please specify): | A | ||||||||
| KFB00715 | A | Text area, no char limit | Single | N | |||||
| EN00004 | Which of the following sections of the USITC web site do you recall visiting today? (Please select all that apply.) | Antidumping and Countervailing Duty Investigations | Checkbox, one-up vertical | Multi | |||||
| Industry and Economic Analysis | |||||||||
| Tariff Information Center | |||||||||
| News Releases | |||||||||
| Federal Registry Notices | |||||||||
| Opinions/Reports | |||||||||
| Intellectual property infringement and other unfair acts | |||||||||
| None of the above | |||||||||
| AA | Were you able to find what you were looking for using search? | Yes | Drop down, select one | Single | Y | ||||
| No | C, D | ||||||||
| Partially | |||||||||
| EN00008 | C | Text area, no char limit | Single | N | |||||
| EN00009 | D | Please describe in more detail the information you were hoping to find using these search terms. | Text area, no char limit | Single | N | ||||
| EN00007 | B | I had no difficulty searching on this site | Checkbox, one-up vertical | Multi | |||||
| Too many results | |||||||||
| Too few results | |||||||||
| Returned no results/received error message | |||||||||
| Results were not pertinent to my search terms | |||||||||
| Other search issue (please specify): | A | ||||||||
| National Ocean Services | |||||||||
| If National Ocean Service were to offer mobile content, which would you prefer? | Mobile site (example - m.XXX.gov) | Drop down, select one | Single | Y | |||||
| Downloadable Application (example – iPhone application, Android Application, Blackberry Application) | |||||||||
| What types of information on the National Ocean Service site would you find most useful to have on your mobile device? | NOS news stories | Drop down, select one | S | Y | |||||
| Ocean Facts | |||||||||
| Tides Information | |||||||||
| Nautical Charts | |||||||||
| Image and Video Agallery | |||||||||
| About NOS | |||||||||
| Other: Please specify | A | ||||||||
| I would not use a mobile device to find information on National Ocean Service | |||||||||
| A | Other info types for mobile device | Text area, no char limit | N | ||||||
| SSA Main | |||||||||
| A | Which of the following, if any, did you experience while using the search tool today? (check all that apply) | I found what I was looking for | Checkbox One Up Vertical | Multi | N | Skip Logic | |||
| I was not sure what words to use in my search | |||||||||
| Results were not relevant to my search terms or needs | |||||||||
| Search returned no results | |||||||||
| Search returned not enough results | |||||||||
| Search returned too many results | |||||||||
| Search required too many refinements to get to what I wanted | |||||||||
| Search returned results that were too similar/redundant | |||||||||
| Other (please specify) | B | ||||||||
| B | Please tell us what else you experienced while using the search tool today. | Text Area – no character limit | N | Skip Logic | |||||
| SSA Estimator (New) | |||||||||
| We would like to get your input on creating a Retirement Estimator in the Spanish language. Are you able to read and write in Spanish? | Yes | A,B | Radio Button One Up Vertical | Single | Y | Skip Logic | Spanish_Read & Write | ||
| No | |||||||||
| A | If a Spanish language version of the Retirement Estimator were available, how likely would you be to use it? | 1=Not Very Likely | Radio Button Scale No Don’t Know | Single | Y | Skip Logic | Spanish_Likely to use | ||
| 2 | |||||||||
| 3 | |||||||||
| 4 | |||||||||
| 5 | |||||||||
| 6 | |||||||||
| 7 | |||||||||
| 8 | |||||||||
| 9 | |||||||||
| 10=Very Likely | |||||||||
| B | Are you aware that Social Security has a Spanish website (www.ssa.gov/espanol)? | Yes | C | Radio Button One Up Vertical | Single | Y | Skip Logic | Spanish_aware of Main | |
| No | |||||||||
| C | How often do you use www.ssa.gov/espanol? | First time | Radio Button One Up Vertical | Single | Y | Skip Logic | Spanish_visited Main | ||
| More than once a day | |||||||||
| Daily | |||||||||
| About once a week | |||||||||
| About once a month | |||||||||
| Every 6 months or less frequently | |||||||||
| Never | |||||||||
| BEA | |||||||||
| CMB085 | A | 1 = Very Dissatisfied | Radio button, one-up vertical | Single | y | Satisfaction w Table | |||
| 2 | |||||||||
| 3 | |||||||||
| 4 | |||||||||
| 5 | |||||||||
| 6 | |||||||||
| 7 | |||||||||
| 8 | |||||||||
| 9 | |||||||||
| Very Satisfied = 10 | |||||||||
| EDO0587 | Did you find what you were looking for today? | Yes | |||||||
| No | A | ||||||||
| CMB086 | No | Text area, no char limit | n | Not Find | |||||
| HHS | |||||||||
| CWS02127 | What is your primary reason for visiting this site today? | Careers | Radio buttons | SINGLE | Yes | OPS Group | Visit_Reason | ||
| Manuals / Transmitals | |||||||||
| CMS forms and documents | |||||||||
| Find contact information | |||||||||
| Find general Medicare program information | |||||||||
| Find information on fees or fee schedules | |||||||||
| Find training resources | |||||||||
| Medicaid program information | |||||||||
| Read Medicare publications such as newsletters, press releases, etc. | |||||||||
| Research data | |||||||||
| Research a specific question on Medicare coding, policy or billing | |||||||||
| Research health care plans, coverage, eligibility, enrollment, prescription coverage or demonstration projects | |||||||||
| Find billing codes | |||||||||
| Other (please specify) | A | ||||||||
| CWS02129 | Which best describes you? | General Public | Radio buttons | SINGLE | Yes | OPS Group | Role | ||
| Health Professional | |||||||||
| Supplier | |||||||||
| Beneficiary | |||||||||
| Physician | |||||||||
| Lawyer | |||||||||
| Consultant | |||||||||
| Provider | |||||||||
| Insurance billing | |||||||||
| CMS employee | |||||||||
| Other Federal Government | |||||||||
| State / Tribal / Local Government | |||||||||
| Employer | |||||||||
| Journalist | |||||||||
| CMS or Medicare Partner | |||||||||
| Representative from a State Health Insurance Program office. | |||||||||
| Other (please specify) | B | ||||||||
| CWS02135 | How did you learn about this website? | Search Engine (Google, yahoo, etc) | Radio buttons | SINGLE | Yes | OPS Group | Site_Learn | ||
| USA.gov | |||||||||
| Link from another website | |||||||||
| Friend or collegue | |||||||||
| Newspaper or magazine | |||||||||
| Television or Radio | |||||||||
| Information Center Referral | |||||||||
| Bookmark | |||||||||
| Federal Register Notice | |||||||||
| Job | |||||||||
| Training | |||||||||
| Letter | |||||||||
| Insurance | |||||||||
| Other (please specify) | D | ||||||||
| Regulations.gov | |||||||||
| Question Text | Answer Choices (limited to 50 characters) |
Skip to | Type (select from list) | Single or Multi | Required Y/N |
Special Instructions | |||
| Planned enhancements to Regulations.gov include: subscribe to RSS feeds based on a specific topic (or subject), filter topics to focus on documents open for comment, and filter topics to focus on documents posted by a specific federal department or agency. Do you have any additional suggestions to improve these features? | Text field no char. Limit | N | |||||||
| Regulations.gov has recently included on their homepage summary statistics and a graphic of site content for 2009. This is the first of many forthcoming dashboard and graphic tools intended to make information from Regulations.gov more accessible and useful. How useful do you feel the following features would be: Additional types of summary data |
Very Useful | Dropdown (Select-one) | Single | N | Multiple List | ||||
| Somewhat Useful | |||||||||
| Not Useful | |||||||||
| Don't Know | |||||||||
| Dynamically generate summary data and display in real-time |
Very Useful | Dropdown (Select-one) | Single | N | Multiple List | ||||
| Somewhat Useful | |||||||||
| Not Useful | |||||||||
| Don't Know | |||||||||
| Highlight effective dates and impacted industries | Very Useful | Dropdown (Select-one) | Single | N | Multiple List | ||||
| Somewhat Useful | |||||||||
| Not Useful | |||||||||
| Don't Know | |||||||||
| Display geographic areas identified or affected by regulatory actions | Very Useful | Dropdown (Select-one) | Single | N | Multiple List | ||||
| Somewhat Useful | |||||||||
| Not Useful | |||||||||
| Don't Know | |||||||||
| What other types of summary data would you find useful? | Text field no char. Limit | N | |||||||
| If the following features were added to the site, how useful would they be to you? Ability to find information and stay informed about initiatives and projects affecting specific industries (e.g. highway projects and food safety) |
Very Useful | Dropdown (Select-one) | Single | N | Multiple List | ||||
| Somewhat Useful | |||||||||
| Not Useful | |||||||||
| Don't Know | |||||||||
| Ability to search for initiatives and projects within a specific proximity (e.g. proposed rule affecting a location or area within 10 miles of Washington, DC) | Very Useful | Dropdown (Select-one) | Single | N | Multiple List | ||||
| Somewhat Useful | |||||||||
| Not Useful | |||||||||
| Don't Know | |||||||||
| Ability to engage with other MyRegulations.gov users with system messages and/or forum discussions | Very Useful | Dropdown (Select-one) | Single | N | Multiple List | ||||
| Somewhat Useful | |||||||||
| Not Useful | |||||||||
| Don't Know |
| File Type | application/vnd.ms-excel |
| Author | silvina diaz |
| Last Modified By | sgrow |
| File Modified | 2010-02-12 |
| File Created | 2009-11-17 |
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