Form VA e-Benefits VA e-Benefits VA e-Benefits

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

VA-eBenefits_Questionnaire FINAL.xls

Previously Cleared ICs from prior Generic ICR

OMB: 1090-0008

Document [xlsx]
Download: xlsx | pdf

Overview

Model Qsts
Custom Qsts
Types


Sheet 1: Model Qsts


E-Benefits Suggested Model Questions





E-Benefits
Model questions utilize the ACSI methodology to determine scores and impacts

ELEMENTS (drivers of satisfaction)
CUSTOMER SATISFACTION
FUTURE BEHAVIORS







Content (1=Poor, 10=Excellent, Don't Know)
Satisfaction (1=Poor, 10=Excellent)
Likelihood to Return (1=Not Very Likely, 10=Very Likely)
1 Please rate the accuracy of information on this site. 17 What is your overall satisfaction with this site? 20 How likely are you to return to this site?
2 Please rate the quality of information on this site. 18 How well does this site meet your expectations?
Recommend (1=Not Very Likely, 10=Very Likely)
3 Please rate the freshness of content on this site. 19 How does this site compare to your idea of an ideal website? 21 How likely are you to recommend this site to someone else?

Functionality (1=Poor, 10=Excellent, Don't Know)


Primary Resource (1=Not Very Likely, 10=Very Likely)
4 Please rate the usefulness of the features provided on this site.

22 How likely are you to use this site as your primary resource for obtaining benefit information?
5 Please rate the convenience of the features on this site.



6 Please rate the variety of features on this site.




Look and Feel (1=Poor, 10=Excellent, Don't Know)



7 Please rate the visual appeal of this site.



8 Please rate the balance of graphics and text on this site.

9 Please rate the readability of the pages on this site.

Navigation (1=Poor, 10=Excellent, Don't Know)
10 Please rate how well the site is organized.
11 Please rate the options available for navigating this site.



12 Please rate how well the site layout helps you find what you are looking for.



13 Please rate the number of clicks to get where you want on this site.




Site Performance (1=Poor, 10=Excellent, Don't Know)



14 Please rate how quickly pages load on this site.



15 Please rate the consistency of speed from page to page on this site.



16 Please rate the ability to load pages without getting error messages on this site.





Sheet 2: Custom Qsts




E-Benefits Custom Questions





















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


Which of the following best describes your role in visiting this site today? (Check all that apply) Veteran B Radio button, one-up vertical Single Y


Active duty B





Wounded, injured, or ill service member B





Family of a service member or veteran






Caregiver or delegate of a service member or veteran






Health Care team member for a service member or veteran






Other A




A Other Please Specify: Please tell us who you are.

Text area, no char limit Single N

B Please check the conflict(s) in which you served. World War II
Checkbox, one-up vertical Multi N


Korean Conflict






Vietnam Era






Persian Gulf War






Operation Enduring Freedom






Operation Iraqi Freedom






No conflict/war service






Please select your age range. 17 or under
Radio button, one-up vertical Single N


18-24






25-34






35-44






45-54






55-64






65+






Please select your gender: Male
Radio button, one-up vertical Single N


Female






How frequently do you visit this site? First time
Radio button, one-up vertical Single Y


Daily






About once a week






About once a month






About once or twice a year






Less frequently than once a year






What information were you primarily looking for today? Financial
Radio button, one-up vertical Single Y


Education






Employment






Housing






Health






Burial






Benefits






Compensation






Other, please specify A




A Other, please specify: What information were you primarily looking for today?

Text area, no char limit Single N

Sheet 3: Types

Types
Instructions
Text field, <100 char
Randomize
Text area, no char limit
Shared
Drop down, select one
OPS Group
Radio button, one-up vertical
Matrix Group
Radio button, two-up vertical
Rank Group
Radio button, three-up vertical
Comparative Matrix Group
Radio button, scale, has don't know
Skip Logic Group
Radio button, scale, no don't know
Multiple Lists Group
Checkbox, one-up vertical
Partitioned
Checkbox, two-up vertical

Checkbox, three-up vertical

File Typeapplication/vnd.ms-excel
File TitleQuestionnaire Production Guidelines_Template
AuthorProfessional Services
Last Modified ByGabriela.Smith
File Modified2009-04-15
File Created2001-08-03

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