508 CQs 2-9-2012 508 CQs for OMB 2-9-2012

Measures Name/Client name (CQs and Answer choices)

Department of State V2

AKR5757

What primary method are you using to locate the information you are looking for?

"Find it by" feature -> "Browse by" feature

C,E,F

Radio button, one-up vertical

single

y

Skip Logic Group

Categories on the TOP blue navigation bar (e.g. multimedia, blog, etc.)

E

Categories on the TOP white navigation bar (e.g. about state, policy issues, etc.)

E

Links in the page

E

Search feature on this site

C,G

Third-party search feature (such as Google, Yahoo, etc.)

Other

US Courts

SAC2322

What is your primary reason for visiting the site today?

SAC2322A001

Read news News from the federal Judiciary

Radio button, one-up vertical

Single

Y

Skip Logic Group

Primary Reason

8

SAC2322A002

Find general General information about the Federal Courts

SAC2322A003

Find your local court

SAC2322A004

Find court records or case information

SAC2322A005

Find a court form or fee

SAC2322A006

Find Federal Court rules or policies

SAC2322A007

Find information Information on / about federal judges or judgeships

SAC2322A008

Find statistics Statistics

SAC2322A009

Find educational resources

SAC2322A010

Find homework Homework help

SAC2322A011

Find Get bankruptcy forms or information

SAC2322A012

Search for a job

SAC2322A013

Other, please specify:

B

SAC2323

B

Other primary reason for visiting the site today

Text area, no char limit

N

Skip Logic Group

OE_Primary Reason

9

SAC2324

Did you find the information you were looking for?

SAC2324A001

Yes

Radio button, one-up vertical

Single

Y

Skip Logic Group

Did you find

10

SAC2324A002

No

E

SAC2325

E

What information were you unable to find?

Text area, no char limit

N

Skip Logic Group

OE_Looking for

11

SAC2326

How did you look for information on the site today? (Please select all that apply.)

SAC2326A001

Search feature

A,Z

Checkbox, one-up vertical

Multi

Y

Skip Logic Group

How look for information

12

SAC2326A002

Top navigation bar

B,Y

SAC2326A003

Left navigation bar

B,Y

SAC2326A004

Links in the center of the page

B,Y

SAC2326A005

Information For list (upper right corner of homepage)

B,Y

SAC2326A006

Other, please specify:

C

SAC2327

C

Please specify what other way you looked for information:

Text area, no char limit

N

Skip Logic Group

OE_How look for

13

SAC2328

A

Please tell us about your experience with the site's search feature today. (Please select all that apply.)

SAC2328A001

Search results were helpful

Multiple

Y

Skip Logic Group

Search experience

14

SAC2328A002

Results were not relevant/not what I wanted

SAC2328A003

Too many results/I needed to refine my search

SAC2328A004

Not enough results

SAC2328A005

Returned NO results

SAC2328A006

Received error message(s)

SAC2328A007

Search speed was too slow

SAC2328A008

I experienced a different search issue (please explain):

D

SAC2329

D

Please explain what other search issue you experienced:

Text Area – no character limit

N

Skip Logic Group

OE_Search experience

15

SAC2330

Z

How can we make the search feature more useful to you?

Text Area – no character limit

N

Skip Logic Group

OE_Search improve

16

SAC2331

B

How would you describe your navigation experience on this site today? (Please select all that apply.)

SAC2331A001

I had no difficulty navigating this site

Checkbox, one-up vertical

Multiple

Y

Skip Logic Group

Navigation experience

17

SAC2331A002

Links often did not take me where I expected

SAC2331A003

Had difficulty finding relevant information

SAC2331A004

Links/labels are difficult to understand

SAC2331A005

Too many links/navigational options to choose from

SAC2331A006

Had technical difficulties (error messages, broken links, etc.)

SAC2331A007

Could not navigate back to previous information

SAC2331A008

I had a navigation difficulty not listed above:

F

SAC2332

F

Please explain what other navigation difficulty issue you experienced:

Text Area – no character limit

N

Skip Logic Group

OE_Navigation experience

18

SAC2333

Y

What specific ways can we improve your experience navigating on this site?

Text Area – no character limit

N

Skip Logic Group

OE_Navigation improve

19

Have you visited the News Section today?

Yes

AA, BB

Radio button, one-up vertical

Single

Y

Skip Logic Group

News Section

20

No

Don't know

AA

What were you looking for in the News Section?

Text Area – no character limit

N

Skip Logic Group

OE_News looking for

21

BB

Are there other features or information that you would like to see in the News Section?

Text Area – no character limit

N

Skip Logic Group

OE_News other info

22

Do you access the internet on your mobile device?

Yes

CC, DD

Radio Button One Up Vertical

Single

Y

Skip Logic Group

Mobile Use

23

No

CC

What type(s) of mobile devices do you use to access the internet? (Please select all that apply.)

Smartphone

Checkbox One Up Vertical

Multi

N

Skip Logic Group

Mobile Device

24

Tablet

Other, please specify:

EE

EE

Other mobile device you use to access the internet

Text Area – no character limit

N

Skip Logic Group

OE_Mobile Device

25

DD

How would you want to interact with uscourts.gov on your mobile device? (Please select all that apply.)

Not at all

Checkbox One Up Vertical

Multi

Y

Skip Logic Group

Mobile Interaction

26

Read news from the federal Judiciary

Find general information about the Federal Courts

Find your local court

Find court records or case information

Find a court form or fee

Find Federal Court rules or policies

Find information on / about federal judges or judgeships

Find statistics

Find educational resources

Find homework help

Find bankruptcy forms or information

Search for a job

Other, please specify:

Please specify what other ways you would like to interact with the site on your mobile device

Text Area – no character limit

N

OPS Group

Mobile Interact

27

SAC2334

What is your gender?

SAC2334A001

Male

Radio button, one-up vertical

Single

N

Gender

28

SAC2334A002

Female

SAC2334A003

Prefer not to answer

SAC2335

What best describes your age range?

SAC2335A001

under 18

Radio button, one-up vertical

Single

N

Age

29

SAC2335A002

18-24

SAC2335A003

25-34

SAC2335A004

35-44

SAC2335A005

45-54

SAC2335A006

55-64

SAC2335A007

65-74

SAC2335A008

75 or older

SAC2335A009

Prefer not to answer

PBGC gov v3

ACQLiv0010397

Please rate your overall impression of PBGC's work as it carries out its mission to protect pensions.

1=Poor

A

Radio button, scale, has don't know

S

y

Skip logic group

Overall Impression

2

A

3

A

4

A

5

A

6

A

7

8

9

10=Excellent

Don't Know

ACQLiv0010398

A

Please specify your reason for this score.

Text area, no char limit

S

N

OE_Overall impression

ACQLiv0010399

Please rate the clarity of information you received from PBGC.

1=Poor

A

Radio button, scale, has don't know

S

y

Skip logic group

Info Received

2

A

3

A

4

A

5

A

6

A

7

8

9

10=Excellent

Don't Know

ACQLiv0010400

A

Please specify your reason for this score.

Text area, no char limit

S

N

OE_Info Received

ACQLiv0010401

Please rate how confident you are that future interactions with PBGC will meet your needs.

1=Not At All Confident

A

Radio button, scale, has don't know

S

y

Skip logic group

Future Interact

2

A

3

A

4

A

5

A

6

A

7

8

9

10=Very Confident

Don't Know

ACQLiv0010402

A

Please specify your reason for this score.

Text area, no char limit

S

N

OE_Future Interact

ACQLiv0010403

How confident are you that the PBGC will preserve defined benefit pension plans and protect workers' pensions?

1=Not At All Confident

A

Radio button, scale, has don't know

S

y

Skip logic group

Preserve Plans

2

A

3

A

4

A

5

A

6

A

7

8

9

10=Very Confident

Don't Know

ACQLiv0010404

A

Please specify your reason for this score.

Text area, no char limit

Single

N

OE_Preserve Plans

SAC7383

Thinking about the agency as a whole, please rate your perception of the thoroughness of the information that the PBGC provides.

1=Poor

Radio button, scale, has don't know

S

Y

2

3

4

5

6

7

8

9

10=Excellent

Don't Know

SAC7384

Please rate how understandable you find the information that the PBGC provides.

1=Poor

Radio button, scale, has don't know

S

Y

2

3

4

5

6

7

8

9

10=Excellent

Don't Know

SAC7385

Please rate how well the agency's information provides answers to your questions.

1=Poor

Radio button, scale, has don't know

S

Y

2

3

4

5

6

7

8

9

10=Excellent

Don't Know

SAC7386

Thinking about the agency's services as a whole, please rate the extent to which the PBGC provides needed services.

1=Poor

Radio button, scale, has don't know

S

Y

2

3

4

5

6

7

8

9

10=Excellent

Don't Know

SAC7387

Please rate the range of services offered by the PBGC.

1=Poor

Radio button, scale, has don't know

S

Y

2

3

4

5

6

7

8

9

10=Excellent

Don't Know

SAC7388

Please rate how well the PBGC delivers its services.

1=Poor

Radio button, scale, has don't know

S

Y

2

3

4

5

6

7

8

9

10=Excellent

Don't Know

SAC7389

Please rate your impression of the PBGC's level of responsiveness to those served by the agency.

1=Poor

Radio button, scale, has don't know

S

Y

2

3

4

5

6

7

8

9

10=Excellent

Don't Know

SAC7390

Please rate the options available for the delivery of PBGC services.

1=Poor

Radio button, scale, has don't know

S

Y

2

3

4

5

6

7

8

9

10=Excellent

Don't Know

SAC7391

Please rate your overall impression of the PBGC's work as it carries out its mission to protect pensions.

1=Poor

Radion button, scale, no don't know

S

Y

2

3

4

5

6

7

8

9

10=Excellent

SAC7392

Please rate how well the PBGC shows that it takes responsibility for preserving pension plans.

1=Poor

Radion button, scale, no don't know

S

Y

2

3

4

5

6

7

8

9

10=Excellent

SAC7393

Please rate how effectively you feel the PBGC perserves pension plans.

1=Poor

Radion button, scale, no don't know

S

Y

2

3

4

5

6

7

8

9

10=Excellent

SAC7394

Please rate how effectively you feel the PBGC protects pensioners.

1=Poor

Radion button, scale, no don't know

S

Y

2

3

4

5

6

7

8

9

10=Excellent

Careers.state V2

ACQOsl0004504

Please tell us which, if any, of the forums and blogs you interacted with today on the careers.state.gov website?

ACQOsl0004504A01

Did not interact with any forums or blogs

B

Checkbox, one-up vertical

Multi

Y

Skip Logic

Forums

ACQOsl0004504A02

Not sure

ACQOsl0004504A03

Chose one of the blog links

A

ACQOsl0004504A04

[email protected] forum

A

ACQOsl0004504A05

Diplomatic Security Recruitment forum

A

ACQOsl0004504A06

Medical Specialists Recruitment forum

A

Information Technology Specialists

A

ACQOsl0004504A08

Foreign Service Mentors forum

A

ACQOsl0004504A09

Family Life forum

A

ACQOsl0004504A10

Veterans forum

A

ACQOsl0004504A11

Student Programs forum

A

ACQOsl0004504A12

Disability and Reasonable Accommodations forum

A

ACQOsl0004504A07

Franklin Fellows forum

A

ACQCol0010730

A

Do you ever access the careers.state.gov website from a mobile device (e.g. Smartphone, Tablet)?

ACQCol0010730A01

Yes

Radio button one up vertical

Single

N

Skip Logic

Forum - Mobile Site

ACQCol0010730A02

No

ACQCol0010853

B

Please tell us why you did not interact with the forums.

I was not interested

Radio button one up vertical

Single

Y

Skip Logic

Forums - Did NOT interact

I did not know that the site had forums

I had technical issues accessing the forums

Other, please specify

C

ACQCol0010854

C

Please tell us the other reason you did not interact with the forums.

Text area, no char limit

N

Skip Logic

OE_No Forum Interaction

Careers.state V2

ACQCol0010857

Please rate the clarity of the wording on this site.

1 = Poor

Radio button, scale, has don't know

Single

Y

PL_Clarity

2

3

4

5

6

7

8

9

10 = Excellent

Don't know

ACQCol0010858

Please rate how well you understand the wording on this site.

1 = Poor

Radio button, scale, has don't know

Single

Y

PL_Understand

2

3

4

5

6

7

8

9

10 = Excellent

Don't know

ACQCol0010859

Please rate this site on its use of short, clear sentences.

1 = Poor

Radio button, scale, has don't know

Single

Y

PL_Sentences

2

3

4

5

6

7

8

9

10 = Excellent

Don't know

Regulations.gov

eRulemeRulemaking Initiative - Private

ALM0030

How frequently do you visit this site?

First time

Radio Button One Up Vertical

Single

Y

Skip Logic

More than once a day

B

Once a day

B

Once a week

B

Once a month

B

Twice a year or less

ACQCol0010883

B

Please tell us more about your impressions of the recent site changes. (check all that apply)

The design of the site pages are more streamlined

Checkbox, one-up vertical

Multi

Y

Skip Logic

Redesign Impressions

The design of the site pages are less streamlined

The design of the site pages are about the same

The navigation of the site is more user friendly

The navigation of the site is less user friendly

The navigation of the site is about the same

It is easier to find what I'm looking for

It is harder to find what I'm looking for

I have the same level of difficulty in finding information

Other Comments (please specify)

C

ACQCol0010901

C

Please tell us about your other impressions of the recent redesign.

Text field, no char limit

N

Skip Logic

Other Redesign

AED08171

Which features on the homepage did you use today? (check all that apply)

Search box/Search tab

A,B, X

Checkbox, one-up vertical

Multi

Y

Skip Logic

Home Page Features

Browse tab

M, N, O

Learn tab

L

Advanced Search

A,B, X

Are you new to the site?' links

Site Map

What's Hot

Closing Soon --> Regulations with comments due soon

Newly Posted Regulations

EO 13563 and Regulatory Resources

Other (please specify):

C

None of the above

ACQCol0010894

M

Are the documents shown under each category grouped logically?

Yes

Radio Button One Up Vertical

Single

Y

Skip Logic Group

Browse Tab

No

G

ACQCol0010895

G

Please tell us how you feel the document categories could be grouped more logically.

Text field, no char limit

N

Skip Logic

OE_Logical Categorization

ACQCol0010896

N

Each featured regulation on the Browse tab has a 'Comment Now' icon next to it, which links directly to the Submit a Comment page. Did you find this resource useful?

Yes, it was useful

Radio Button One Up Vertical

Single

N

Skip Logic Group

Submit a Comment Page

No, I did not see that icon

No, I did not realize where that icon would lead

No, I wanted to read the regulation first

No, I did not want to submit a comment

ACQCol0010897

O

Each featured regulation also has a Social Media Share icon. Did you use the Social Media Share functionality today?

Yes, it was useful

Radio Button One Up Vertical

Single

N

Skip Logic Group

SM Share Functionality

No, I did not see that icon

No, I did not want to share any regulations

ACQCol0010898

L

Which of these statements best describes your experience with the Regulatory Timeline.

I learned information about the process I did not know

Radio Button One Up Vertical

Single

N

Skip Logic Group

Regulatory Timeline

I have a better understanding of the Regulatory process

I still have questions about the Regulatory process that were not answered

I found the explanations confusing

I expected different information within the Learn tab

None of the above

AED08172

C

What other homepage features did you use today?

Text field, <100 char

N

Skip Logic

Other Home Page Features

AED08173

A

Which features of --> on the search results page did you use today? (check all that apply)

Used the Sort By dropdown

Checkbox, one-up vertical

Multi

Y

Skip Logic

Search Features

Filtering results by agency --> Filtered results by Agency

R

Filtered results by Category

Filtering results by type of document --> Filtered results by Document Type

S

Filtering results by type of docket folder --> Filtered results by Docket Type

T

Filtered by Posted

Filtered by Comment Period

Filtered by Comments Due

Searching within results --> Searched within Results

W

Document preview (magnifying glass icon) --> Used the Document Spotlight (magnifying glass icon)

Z

None of the above

Other (please specify):

D

AED08174

R

How useful was filtering the results by agency?

Very useful

Dropdown (Select-one)

Single

Y

Skip Logic

Filtering_Agency

Somewhat useful

Not useful

AED08175

S

How useful was filtering the results by type of document?

Very useful

Dropdown (Select-one)

Single

Y

Skip Logic

Filtering_Document

Somewhat useful

Not useful

AED08176

T

How useful was filtering the results by type of docket folder?

Very useful

Dropdown (Select-one)

Single

Y

Skip Logic

Filtering_docket folder

Somewhat useful

Not useful

AED08179

W

How useful was the ability to search within results?

Very useful

Dropdown (Select-one)

Single

Y

Skip Logic

Search within Results

Somewhat useful

Not useful

ACQWro0008337

Z

How useful was the document preview --> Document Spotlight feature?

Very useful

Dropdown (Select-one)

Single

Y

Skip Logic

Document Preview --> Document Spotlight

Somewhat useful

Not useful

AED08180

D

Which other search result features were most useful to you today? --> did you use today?

Text field, <100 char

N

Skip Logic

Other Search Features Used

AED08181

B

What was your impression of the search feature --> results? (check all that apply)

Results were relevant to my search terms or needs

Checkbox, one-up vertical

Multi

Y

Skip Logic

Impression of Search Feature

Results were not relevant to my search terms or needs

Too many results displayed

Results required too many refinements to get to what I wanted

Returned not enough/no results

I could not open the link

Search speed was too slow

Other (please specify):

E

AED08182

E

Please tell us about your impression of the search feature.

Text field, <100 char

N

Skip Logic

Other Impression of Search Feature

EDO03618

X

Please specify what keywords you typed into the search box today.

Text field, no char limit

N

Skip Logic

Search Keyword

AED05844

What did you come to the site to do today? (check all that apply)

Find a document

Checkbox, one-up vertical

MULTI

Y

Skip Logic

Submit a comment

A

Browse by topic

Download documents

Browse Featured Regulations

Just wanted to explore the site

Bookmark a docket or document

Set up an e-mail notification

Other, please specify

ZZ

ACQCol0010884

A

When preparing to submit a comment, how do you prefer to read the document? (select all that apply)

Print it out

Checkbox, one-up vertical

MULTI

N

Skip Logic

Document Preference

Download and read the PDF on the computer

Read it on the website

Read it on a tablet or other mobile device

CWS01241

ZZ

Other reason for visiting the site today --> Please tell us your other reason for visiting the site today.

Text field, <100 char

N

Skip Logic

ACQWro0008361

Which of the following services would you use to stay connected to Regulations.gov?

Facebook

Checkbox, one-up vertical

Multi

Y

Skip Logic Group

Social Media

Twitter

YouTube

Blogs

Podcasts/Online webcasts

RSS feeds

API/Widgets

None

Other, please specify

A

ACQWro0008362

A

Please tell us which other online services you would use to stay connected to Regulations.gov.

Text field, no char limit

N

Skip Logic

Other Social Media

ACQCol0010885

Which of the following social media tools and services do you use to share information or stay connected to Regulations.gov?

Email/Email Alert

Checkbox, one-up vertical

Multi

Y

Skip Logic Group

Social Media

Facebook

Twitter

YouTube

Blogs

Podcasts/Online webcasts

RSS feeds

API/Widgets

None

Other, please specify

A

ACQCol0010886

A

Please tell us which other online services you use to stay connected to Regulations.gov.

Text field, no char limit

N

Skip Logic

Other Social Media

DOD TRICARE

MMM00067

Which of the following best describes your role in visiting our site today?

TRICARE beneficiary

E, F, G

Radio button, one-up vertical

Single

Y

Family, friend or caregiver of TRICARE beneficiary

Future TRICARE beneficiary

TRICARE Network Provider or Provider Staff

TRICARE Non-Network Provider or Provider Staff

Prospective TRICARE Provider or Provider Staff

Military Treatment Facility Clinical Staff

TRICARE Beneficiary Advisors and Customer Service Staff

All other Military Health System/TRICARE staff (Including government and supporting contractors)

Media/Researcher

Other

5929

E

For TRICARE beneficiaries only- which best describes your status?

Active Duty Service Member

Radio button, one-up vertical

Single

N

Family of Active Duty Service Member

Family of Deceased Active Duty Service Member

National Guard or Reserve Member (Activated)

Family of National Guard or Reserve Member (Activated)

National Guard or Reserve member (Non-Activated)

Family of National Guard or Reserve Member (Non-Activated)

Retired Service Member

Family of Retired Service Member

Family of Deceased Retired Service Member

Other Beneficiary

Not Applicable

MMM00068

F

For TRICARE beneficiaries only: which of the following best describes your TRICARE enrollment option?

Sponsor is active duty (no premium paid)

Radio button, one-up vertical

Sponsor is active duty and family member has disenrolled from Prime to use TRICARE Standard

Single

N

Sponsor is retired and we pay either $230/individual or $460/family per year Sponsor is retired and we pay either $260/individual or $520/family per year

Sponsor is retired and we pay the Medicare Part B premium; TRICARE for Life

Sponsor is retired (and we do NOT pay either a TRICARE or Medicare Part B premium; TRICARE Standard)

Not applicable

5928

G

For TRICARE beneficiaries only- do you receive most of your care from:

A military clinic or hospital

Radio button, one-up vertical

Single

N

A civilian clinic or hospital

Not applicable

SSA iClaim V2 English Equiv

Social Security Administration

SAC3074

What type of benefits were you applying for?

SAC3074A001

Retirement

M, Q, R, X, Y, Z, U, E, W

Dropdown (Select-one)

Single

Y

Skip Logic Group

Type of Benefits

SAC3074A002

Disability

M, Q, R, X, Y, Z, U, E, G, W

SAC3074A003

Spouse's

M, Q, R, X, Y, Z, U, E, W

SAC3074A004

Medicare only

M, Q, R, X, Y, Z, U, E, W

SAC3074A005

I am not applying today

SAC3075

M

How did you learn about the Social Security online application? (Select all that apply.)

SAC3075A001

Social Security website

Checkbox One Up Vertical

Multi

Y

Skip Logic Group

Learn About Online App

Types

SAC3075A002

Friend, spouse, relative, neighbor or acquaintance

SAC3075A003

Social Security employee

B

SAC3075A004

Another website or search engine

SAC3075A005

News (TV, radio, newspaper or Internet)

SAC3075A006

Advertisement

SAC3075A007

Social Security statement

SAC3075A008

Community Group or Association

SAC3075A009

Other, please specify

A

SAC3076

A

Please specify how you learned of Social Security online.

Text area, no char limit

N

Skip Logic Group

OE_Learn about online app

SAC3077

B

How did you make contact with a Social Security employee?

SAC3077A001

Visited a local Social Security office

Radio Button One Up Vertical

Single

Y

Skip Logic Group

Contact SSA Employee

SAC3077A002

Called a local Social Security office

SAC3077A003

Called the national 800 number

SAC3077A004

Other, please specify

D

SAC3078

D

Other: +__>PLEASE DESCRIBE THE WAY YOU MADE CONTACT WITH A SOCIAL SECURITY EMPLOYEE.

Text field, <100 char

N

Skip Logic Group

OE_Contact SSA Employee

SAC3079

Q

Did you complete your application today?

SAC3079A001

Yes, I completed my new application today

C

Radio Button One Up Vertical

Single

Y

Skip Logic Group

Complete App

SAC3079A002

Yes, I restarted and completed my earlier application today

C

SAC3079A003

No, I did not complete my new application, but I plan to complete it later

C

SAC3079A004

No, I did not complete my re-started earlier application, but I plan to complete it later

C

SAC3079A005

No, I do not plan to complete my application at all

C

SAC3079A006

I'm not applying for benefits today

SAC3080

C

For whom are you filing this online application for Social Security benefits?

SAC3080A001

Myself

Radio Button One Up Vertical

Single

Y

Skip Logic Group

Whose Behalf

SAC3080A002

My spouse

SAC3080A003

My parent

SAC3080A004

Another relative

SAC3080A005

My friend

SAC3080A006

My client

SAC3080A007

Other

SAC3081

R

If you stopped working on your application, please tell us why. (Select all that apply.)

SAC3081A001

I finished my application today

Checkbox One Up Vertical

Multi

Y

Skip Logic Group

Why Stopped App

SAC3081A002

Needed to find documents/other information for my application

SAC3081A003

Too many questions

SAC3081A004

Takes too long

SAC3081A005

Too complicated to use without help

SAC3081A006

My medical/physical condition prevents me from working on the computer for long periods

SAC3081A007

Application wouldn't accept empty/blank fields

SAC3081A008

Received an error message or was "kicked out" of the application

SAC3081A009

I had a problem entering dates or other information in some of the pages

SAC3081A010

Other Reason

zz

SAC3082

zz

Please tell us the other reason you stopped working on your application.

Text area, no char limit

N

Skip Logic Group

OE_Stopped Application

SAC3083

X

Did you visit the Social Security home page (www.socialsecurity.gov) today?

SAC3083A001

Yes

Dropdown (Select-one)

Single

Y

Skip Logic Group

Homepage

SAC3083A002

No

SAC3084

Y

Did you use the SEARCH box on our website to find what you needed?

SAC3084A001

Yes

Dropdown (Select-one)

Single

Y

Skip Logic Group

Search

SAC3084A002

No

SAC3085

Z

Please tell us how easy it was for you to find the application for benefits.

SAC3085A001

I had little or no difficulty getting to the application

Radio Button One Up Vertical

Single

Y

Skip Logic Group

Find app

SAC3085A002

I found it somewhat difficult to find the application

Z1

SAC3086

Z1

I found it somewhat difficult to find the application because: (Select all that apply.)

SAC3086A001

I did not know where to begin looking

Checkbox One Up Vertical

Multi

Y

Skip Logic Group

Difficult to Find

SAC3086A002

It was not clear to me where the links would lead

SAC3086A003

The information did not seem to be organized in a logical manner

SAC3086A004

I used the search function but the results didn’t seem to apply.

SAC3086A005

Other reason (please describe)

Z2

SAC3087

Z2

Other: +__>PLEASE EXPLAIN THE REASON YOU FOUND IT SOMEWHAT DIFFICULT TO FIND THE APPLICATION.

Text area, no char limit

N

Skip Logic Group

OE_Difficult to Find

SAC3088

U

How did you arrive on the Social Security website today?

SAC3088A001

Typed ssa.gov or socialsecurity.gov into the browser

Dropdown (Select-one)

Single

Y

Skip Logic Group

Arrive

SAC3088A002

Did a search (i.e. Google, Bing, Yahoo)

SAC3088A003

Followed a link from medicare.gov

SAC3088A004

Followed a link from another website

SAC3089

E

Please rate the clarity of the instructions provided for this Social Security online application.

SAC3089A001

1 = Not At All Clear

F

Radio Button Scale Has Don’t Know

Single

Y

Skip Logic Group

Clarity of Instructions

SAC3089A002

2

F

SAC3089A003

3

F

SAC3089A004

4

F

SAC3089A005

5

F

SAC3089A006

6

SAC3089A007

7

SAC3089A008

8

SAC3089A009

9

SAC3089A010

10 = Very Clear

SAC3089A011

Don't know

SAC3090

F

What part of the instructions was not clear?

Text area, no char limit

N

Skip Logic Group

OE_Clarity of Instructions

SAC3091

G

Did you complete the Online Disability Report today?

SAC3091A001

Yes

Radio Button One Up Vertical

Single

Y

Skip Logic Group

Disability Report

SAC3091A002

No

SAC3091A003

Don't recall

SAC3092

W

Do you have any other problems with this Social Security Online application that weren't covered in earlier questions, or any suggestions on how we can improve it? (Please do not include any personal information in your answer.)

Text area, no char limit

N

Skip Logic Group

Other Problems

SAC3093

What influenced your decision to use our online benefit application? (Select all that apply.)

SAC3093A001

I did not want to go to an SSA field office

Checkbox One Up Vertical

Multi

Y

Skip Logic Group

Influenced Decision Benefits

SAC3093A002

I did not want to do business over the phone

SAC3093A003

I prefer to use online services as much as possible

SAC3093A004

I learned about filing online while visiting socialsecurity.gov

SAC3093A005

Someone from SSA recommended filing online

SAC3093A006

A friend, relative, or colleague recommended filing online

SAC3093A007

I knew that if I had a question, I could then call or visit SSA

SAC3093A008

I am filing on behalf of another person

A

SAC3093A009

Other, please specify

B

SAC3094

B

Please specify what influenced your decision to file for benefits online.

Text area, no char limit

N

Skip Logic Group

OE_Influenced Decision

SAC3095

A

Please specify your role.

SAC3095A001

I am a non-profit professional

Radio button, one-up vertical

Single

Y

Skip Logic Group

Role

SAC3095A002

I am a for-profit professional

SAC3095A003

I am a friend or relative

SAC3095A004

Other, please specify

C

SAC3096

C

Other: +__>PLEASE DESCRIBE YOUR ROLE.

Text field, <100 char

N

Skip Logic Group

OE_Role

CMS Palmetto GBA J11 MAC

CMS

SAC1434

Please select your location and contract: (please select all that apply)

SAC1434A001

South Carolina – Part A

Checkbox, one-up vertical

Multi

Y

Location

SAC1434A002

South Carolina – Part B

SAC1434A003

North Carolina – Part A

SAC1434A004

North Carolina – Part B

SAC1434A005

Virginia – Part A

SAC1434A006

Virginia – Part B

SAC1434A007

West Virginia – Part A

SAC1434A008

West Virginia – Part B

Home Health and Hospice

SAC1434A009

Not applicable