496 Disability 496 Disability.gov V3

Model Instance Name				red & strike-through: DELETE
Disability.gov V3				underlined & italicized: RE-ORDER
MID: 5l0gF1IR98F1NkBM0FUZBw==				pink: ADDITION
Date:	1/17/2012			blue + -->: REWORDING
Disability.gov V3 CUSTOM QUESTION LIST
QID	Skip Logic Label	Question Text	AnswerIDs (DOT)	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
SAC6941		What information were you looking for on Disability.gov today? Please select the best answer.	SAC6941A001	Only information on programs or services in my state		Radio button, one-up vertical	Single	Y		Type of Information
			SAC6941A002	Only information on national programs or services
			SAC6941A003	Information on both national and state programs or services
SAC6942		Which of the following statements best describes you? Please select the best answer.	SAC6942A001	I am a person with a disability or am disabled		Radio button, one-up vertical	single	N	Skip Logic Group	Role
			SAC6942A002	I am a friend or family member of someone with a disability
			SAC6942A003	I am a professional who works with people with disabilities
			SAC6942A004	I am an educator who works with students with disabilities
			SAC6942A005	I am a student who is doing research
			SAC6942A006	I am an employer or human resource (HR) professional
			SAC6942A007	Other (please specify):	A
SAC6943	A	Other reason for visiting Disability.gov				Text field, <100 char		N	Skip Logic Group	Other role
SAC6944		In general, which subject(s) did you want to get information about? Please select all that apply.	SAC6944A001	Employment (such as finding a job, starting a business or hiring someone with a disability)		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Specific Information
			SAC6944A002	Benefits (such as getting Social Security (SSI/SSDI), Veterans or other benefits, paying for prescriptions or home energy assistance)
			SAC6944A003	Housing (such as getting Section 8 housing, finding an affordable apartment, buying a house or housing discrimination)
			SAC6944A004	Civil Rights (such as information about the Americans with Disabilities Act (ADA) and other laws and regulations or filing a complaint)
			SAC6944A005	Education (such as money for school, going to college or teaching students with disabilities)
			SAC6944A006	Health (such as specific disabilities, getting health insurance, dental or health care or caregiver resources)
			SAC6944A007	Community Life (such as accessible sports, volunteering or independent living)
			SAC6944A008	Technology (such as assistive technology, accessible technology or help paying for technology)
			SAC6944A009	Transportation (such as getting a ride, accessible transportation and paying for vehicle modifications)
			SAC6944A010	Emergency Preparedness (such as emergency or disaster preparedness at home or work or emergency management)
			SAC6944A011	I’m not sure which subject to choose	A
SAC6945	A	Please explain what information you were looking for on Disability.gov. (open-ended)				Text area, no char limit			Skip Logic Group	OE_Information
SAC6946		How did you look for information on Disability.gov? Please select the best answer.	SAC6946A001	I used the search engine at the top of the page	A, B	Radio button, one-up vertical	Single	Y	Skip Logic Group	Look for Information
			SAC6946A002	I used the “Information by Topic” and other menus on the left side of the page	G
			SAC6946A003	I used both the search engine at the top of the page, as well as the "Information by Topic” and other menus on the left side of the page	M, N, R
SAC6947	A	Please rate your overall happiness with the site’s search engine.	SAC6947A001	1 = Very unhappy		Radio button, scale, no don't know	Single	Y	Skip Logic Group	S_Search Rating
			SAC6947A002	2
			SAC6947A003	3
			SAC6947A004	4
			SAC6947A005	5
			SAC6947A006	6
			SAC6947A007	7
			SAC6947A008	8
			SAC6947A009	9
			SAC6947A010	10=Very happy
SAC6948	B	Did the search engine help you find the information you were looking for on Disability.gov today?	SAC6948A001	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group	S_Search Helped
			SAC6948A002	No	F, I , Y
SAC6949	F	How can we make the search engine more useful to you?				Text area, no char limit	Single	N	Skip Logic Group	S_OE_Search Changes
SAC6950	I	Tell us more about your search experience. Please select all that apply.	SAC6950A001	I didn’t know which word or phrase to enter into the search engine to find the information I was looking for		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	S_Search Experience
			SAC6950A002	The results were not what I was looking for
			SAC6950A003	There were not enough results
			SAC6950A004	There was not enough information in the description of the results to decide which resource to choose
			SAC6950A005	Many of the search results looked like the same resource
			SAC6950A006	There were too many results
			SAC6950A007	The results were not organized in a helpful way
			SAC6950A008	The link didn’t take me to where I thought it was going to go	J
			SAC6950A009	I had a different problem with the search results	K
SAC6951	Y	Please tell us if there are any other websites you like to use to find similar information. (open-ended)				Text area, no char limit	Single	N	Skip Logic Group	S_OE_Other Sites
SAC6952	J	Please explain where you thought the link would take you.				Text area, no char limit	Single	N	Skip Logic Group	S_OE_Unexpected Link
SAC6953	K	Please explain the problem you had with your search results.				Text area, no char limit	Single	N	Skip Logic Group	S_OE_Problem with Search
SAC6954	G	Did you have any problems using the “Information by Topic” and other menus on the left side of the page to find information on the site?	SAC6954A001	Yes	L, AA	Radio button, one-up vertical	Single	Y	Skip Logic Group	T_Info by Topic Usage
			SAC6954A002	No
SAC6955	L	How can we make the “Information by Topic” and other menus on the left side of the page easier to use? (open-ended)				Text area, no char limit	Single	Y	Skip Logic Group	T_OE_Improve Info by Topic
SAC6956	AA	Please tell us if there are any other websites you like to use to find similar information. (open-ended)				Text area, no char limit	Single	N	Skip Logic Group	S_OE_Other Sites
SAC6957	M	Which option was more helpful?	SAC6957A001	I liked using the “Information by Topic” and other menus on the left side of the page to find resources on the site		Radio button, one-up vertical	Single	Y	Skip Logic Group	B_Option
			SAC6957A002	I liked using the search engine at the top of the page to find resources on the site
SAC6958	N	Did the search engine at the top of the page help you find the information you were looking for on Disability.gov today?	SAC6958A001	Yes		Radio button, one-up vertical				B_Search Helped
			SAC6958A002	No	T, U, Z
SAC6959	T	How can we make the search engine more useful to you?				Text area, no char limit				B_OE_Search Changes
SAC6960	U	Tell us more about your search experience. (Please select all that apply)	SAC6960A001	I didn’t know which word or phrase to enter into the search engine to find the information I was looking for		Checkbox, one-up vertical				B_Search Experience
			SAC6960A002	The results were not what I was looking for
			SAC6960A003	There were not enough results
			SAC6960A004	There was not enough information in the description of the results to decide which resource to choose
			SAC6960A005	Many of the search results looked like the same resource
			SAC6960A006	There were too many results
			SAC6960A007	The results were not organized in a helpful way
			SAC6960A008	The link didn’t take me to where I thought it was going to go	V
			SAC6960A009	I had a different problem with the search results	W
SAC6961	V	Please explain where you thought the link would take you.				Text area, no char limit	Single	N	Skip Logic Group	B_OE_Unexpected Link
SAC6962	Z	Please tell us if there are any other websites you like to use to find similar information. (open-ended)				Text area, no char limit	Single	N	Skip Logic Group	B_OE_Other Sites
SAC6963	W	Please explain the problem you had with your search results.				Text area, no char limit	Single	N	Skip Logic Group	B_OE_Problem with Search
SAC6964	R	Did you have any problems using the “Information by Topic” and other menus on the left side of the page to find information on the site?	SAC6964A001	Yes	X	Radio button, one-up vertical	Single	Y	Skip Logic Group	B_Info by Topic Usage
			SAC6964A002	No
SAC6965	X	How can we make the “Information by Topic” and other menus on the left side of the page easier to use?				Text area, no char limit	Single	Y	Skip Logic Group	B_OE_Improve Info by Topic
SAC6966		Disability.gov is a web portal that directs people to information and resources on other websites. Before reading this statement, did you know that Disability.gov is a portal that sends you to other sites for information?	SAC6966A001	Yes		Drop down, select one	Single	Y		Portal
			SAC6966A002	No
SAC6967		How often do you visit Disability.gov?	SAC6967A001	Today was my first time		Drop down, select one	single	N		Visit frequency
			SAC6967A002	Every day
			SAC6967A003	A few times a week
			SAC6967A004	At least once a week
			SAC6967A005	At least once a month
			SAC6967A006	Every few months
			SAC6967A007	Once a year or less
SAC6968		How old are you?	SAC6968A001	Under 18		Drop down, select one	single	N		Age
			SAC6968A002	18 - 24
			SAC6968A003	25 - 34
			SAC6968A004	35 - 44
			SAC6968A005	45 - 54
			SAC6968A006	55 - 64
			SAC6968A007	65 or older
			SAC6968A008	I prefer not to answer
SAC6969		What is the highest level of education you have completed?	SAC6969A001	Some high school or less		Drop down, select one	single	N		Education
			SAC6969A002	Graduated high school
			SAC6969A003	Some college
			SAC6969A004	Trade, technical or vocational training
			SAC6969A005	Graduated from college
			SAC6969A006	Post-graduate work or degree
			SAC6969A007	I prefer not to answer
SAC6970		What racial group do you most strongly identify with?	SAC6970A001	American Indian or Alaskan Native		Drop down, select one	single	N		Race
			SAC6970A002	Asian
			SAC6970A003	Black or African-American
			SAC6970A004	White
			SAC6970A005	Native Hawaiian or other Pacific Islander
			SAC6970A006	Hispanic or Latino
			SAC6970A007	Other
			SAC6970A008	I prefer not to answer
SAC6971		What was your total household income last year?	SAC6971A001	Below $25,000		Drop down, select one	single	N		Income
			SAC6971A002	$25,000 - $49,999
			SAC6971A003	$50,000 - $74,999
			SAC6971A004	$75,000 - $99,999
			SAC6971A005	$100,000 - $124,999
			SAC6971A006	$125,000 or over
			SAC6971A007	I prefer not to answer
SAC6972		What is your gender?	SAC6972A001	Female		Drop down, select one	single	N		Gender
			SAC6972A002	Male
			SAC6972A003	I prefer not to answer