507 CMS 507 CMS_NAS_JF Qnaire 2-23-2012
American Customer Satisfaction Index (ACSI) E-Government Website Customer Satisfaction Surveys
2012 507 CMS_NAS_JF Qnaire 2-13-12.xlsx
488 USGS Gap Analysis - 515 SSA Electronic Access
OMB: 1090-0008
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1090-0008 can be found here:
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Current Custom Qsts
Overview
Current Model QstsCurrent Custom Qsts
Sheet 1: Current Model Qsts
| Model Instance Name: | |||||
| CMS - NAS - JF | Use Model #410 | ||||
| MID: | NF4scAwcRwRlh55YUJ4cEw== | ||||
| Date: | 2/10/2012 | ||||
| CMS - NAS - JF MODEL QUESTION LIST | |||||
| Model questions utilize the ACSI methodology to determine scores and impacts | |||||
| ELEMENTS (drivers of satisfaction) | CUSTOMER SATISFACTION | FUTURE BEHAVIORS | |||
| NOTE: All questions under each element are required. Element questions are partitioned among surveys. |
Satisfaction questions are required. Satisfaction questions appear on all surveys. |
Future behaviors may be modified based on your site's objectives. Future behavior questions appear on all surveys. |
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| Content (1=Poor, 10=Excellent, Don't Know) |
Satisfaction (1=Poor, 10=Excellent) |
Likelihood to Return (1=Not Very Likely, 10=Very Likely) |
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| 1 | Please rate the accuracy of information on this site. | 21 | What is your overall satisfaction with this site? | 24 | How likely are you to return to this site? |
| 2 | Please rate the quality of information on this site. | 22 | How well does this site meet your expectations? | ||
| 3 | Please rate the freshness of content on this site. | 23 | How does this site compare to your idea of an ideal website? | Recommend (1=Not Very Likely, 10=Very Likely) |
|
| Functionality (1=Poor, 10=Excellent, Don't Know) |
25 | How likely are you to recommend this site to someone else? | |||
| 4 | Please rate the usefulness of the services provided on this site. | ||||
| 5 | Please rate the convenience of the services on this site. | Primary Resource (1=Not Very Likely, 10=Very Likely) |
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| 6 | Please rate the ability to accomplish what you wanted to on this site. | 26 | How likely are you to use this site as your primary resource for getting information on Medicare? | ||
| Look and Feel (1=Poor, 10=Excellent, Don't Know) |
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| 7 | Please rate the ease of reading this site. | 
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| 8 | Please rate the clarity of site organization. | ||||
| 9 | Please rate the clean layout of this site. | ||||
| Navigation (1=Poor, 10=Excellent, Don't Know) |
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| 10 | Please rate the degree to which the number of steps it took to get where you want is acceptable. | ||||
| 11 | Please rate the ability to find information you want on this site. | ||||
| 12 | Please rate the clarity of the site map/directory. | ||||
| 13 | Please rate the ease of navigation on this site. | ||||
| Site Performance (1=Poor, 10=Excellent, Don't Know) |
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| 14 | Please rate the speed of loading the page on this site. | ||||
| 15 | Please rate the consistency of speed on this site. | ||||
| 16 | Please rate the reliability of site performance on this site. | ||||
| Search (1=Poor, 10=Excellent, Don't Know) |
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| 17 | Please rate the usefulness of search results on this site. | ||||
| 18 | Please rate how this site provides comprehensive search results. | ||||
| 19 | Please rate the organization of search results on this site. | ||||
| 20 | Please rate how the search feature helps you to narrow the results to find the information you want. | ||||
Sheet 2: Current Custom Qsts
| Model Instance Name: | |||||||||
| CMS - NAS - JF | underlined & italicized: RE-ORDER | ||||||||
| MID: | NF4scAwcRwRlh55YUJ4cEw== | pink: ADDITION | |||||||
| Date: | 2/24/2010 | blue + -->: REWORDING | |||||||
| CMS - NAS - JF 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 | Question Label |
| 51958 | Which best describes you? | Provider of medical services | Radio button, one-up vertical | Single | Y | OPS Group | Best describes you | ||
| Supplier of medical equipment or supplies | |||||||||
|
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Staff of provider/supplier working primarily with billing/insurance | CMS Required | |||||||
| Administrative staff of a provider/supplier | |||||||||
| Other staff of a provider/supplier | |||||||||
| Consultant or attorney | |||||||||
| Billing service | |||||||||
| Other (please specify) | A | ||||||||
| 7000003 | A | Other - which best describes you? | Text field, <100 char | No | OPS Group | Other-Best Describes You | |||
| CWS03909 | What is your primary reason for visiting this site today? | Access claim status and/or beneficiary eligibility | Radio button, one-up vertical | Single | Y | OPS Group | Visit Reason | ||
| Download forms | |||||||||
| Learn of, or register for, workshops, seminars or other training events | |||||||||
| Find contact information | CMS Required | ||||||||
| Find general Medicare program information | |||||||||
| Research a specific question on Medicare policy or billing | |||||||||
| 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 (please specify) | A | ||||||||
| CWS03910 | A | Other - primary reason? | Text field, <100 char | No | OPS Group | Other Visit Reason | |||
| MMM00313 | What led you to visit this site? | New provider to Noridian | Radio button, one-up vertical | Single | Y | OPS Group | |||
| Electronic Mailing list | |||||||||
| Prior experience with Noridian | |||||||||
| Recommendation | |||||||||
| Remittance Advice/Noridian Letter | |||||||||
| Peer or Association Referral | |||||||||
| Search Engine | |||||||||
| Other (please specify) | C | ||||||||
| MMM00314 | C | Other - led you to visit | Text field, <100 char | N | OPS Group | ||||
| 51957 | In the last 30 days, how many times have you visited this website? | This is my first time | Radio button, one-up vertical | Single | Y | Visit Frequency | |||
| Once or twice | CMS Required | ||||||||
| Three or four times | |||||||||
| More than once per week but not every day | |||||||||
| Every day | |||||||||
| MMM00318 | Please select the contract that bests describes what you are looking for. | Medicare Part A | Drop down, select one | Single | Y | Medicare Contract | |||
| Medicare Part B | |||||||||
| Other | |||||||||
| EDO08161 | How did you primarily look for information on this site today? | Browsed pages by clicking links | Drop down, select one | Single | Y | Skip Group | Look for Info | ||
| Searched using the site search feature | D | ||||||||
| Used the site map | |||||||||
| EDO08162 | D | What keywords did you use? | Text area, no char limit | N | Skip Group | Keywords | |||
| JKR00175 | Did you find what you were looking for? | Yes | Radio button, one-up vertical | Single | Y | Skip Group | Did You Find | ||
| No | E,F | ||||||||
| I'm still searching | |||||||||
| KFB04014 | E | Please tell us what you were trying to do or find on the website. | Text area, no char limit | No | Skip Group | Trying to Find | |||
| KFB04015 | F | What will you do next? | Call the Noridian Medicare call center | Radio button, one-up vertical | Single | No | Skip Group | Do Next | |
| Nothing, although I did not find what I wanted | |||||||||
| Return to the Noridian Medicare Web site later and try again | |||||||||
| Send an email | |||||||||
| Try another website | |||||||||
| Try the CMS Website | |||||||||
| Write a letter | |||||||||
| Other | C | ||||||||
| KFB04016 | C | Please explain what you will do next. | Text area, no char limit | No | Skip Group | Other-Looking For | |||
| 51965 | If you could identify one improvement to the Web site, what would that improvement be? | Text area, no char limit | N | Open-Improvement | |||||
| JKR00076 | Are you part of the Noridian Medicare electronic mailing list? | Yes - I am a member of the Noridian Medicare electronic mailing list | Radio button, one-up vertical | Single | Y | Mailing List | |||
| Yes - Someone in my office is a member | |||||||||
| No - I choose not to be part of Noridian Medicare's electronic mailing list | |||||||||
| No - please supply me with the link to the subscription page upon survey completion | |||||||||
| CWS02766 | If you are over the age of 18 and would like Noridian Administrative Services (NAS) to respond to your feedback regarding this website, please provide your email address here. | Text field, <100 char | N | Feedback email | |||||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |
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