523 CMS Palmetto J1 MAC 4-9-12.xlsx
American Customer Satisfaction Index (ACSI) E-Government Website Customer Satisfaction Surveys
2012 523 CMS Palmetto J1 MAC 4-9-12.xlsx
516 CQs for OMB - 532 VBA Survey
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⚠️ Notice: This form may be outdated.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 Palmetto GBA J1 MAC | |||||
| MID: | RBxtxA4RMoVt1851dddcBQ== | ||||
| Date: | 8/19/2008 | CMS Model 410 | |||
| CMS Palmetto GBA J1 MAC MODEL QUESTION LIST | |||||
| 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. | 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) |
|||
| 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. | ||||
| 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) |
|||||
| 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 Palmetto GBA J1 MAC | underlined & italicized: RE-ORDER | ||||||||||||||||||||||||
| MID: RBxtxA4RMoVt1851dddcBQ== | pink: ADDITION | ||||||||||||||||||||||||
| Date: | 4/5/2012 | blue + -->: REWORDING | |||||||||||||||||||||||
| CMS Palmetto GBA J1 MAC CUSTOM QUESTION LIST | |||||||||||||||||||||||||
| CQID | Skip From | Question Text | Answer IDs | Answer Choices (limited to 50 characters) |
Skip to | Type (select from list) | Single or Multi | Required Y/N |
Special Instructions | Short Name | |||||||||||||||
| 51958 | Which best describes you? | Provider of medical services | Radio buttons | Single | Y | OPS Group | |||||||||||||||||||
| Supplier of medical equipment or supplies | |||||||||||||||||||||||||
| Staff of provider/supplier working primarily with billing/insurance | |||||||||||||||||||||||||
| Administrative staff of a provider/supplier | |||||||||||||||||||||||||
| Other staff of a provider/supplier | |||||||||||||||||||||||||
| Consultant or attorney | |||||||||||||||||||||||||
| Billing service | |||||||||||||||||||||||||
| Other (please specify) | SKIP A | ||||||||||||||||||||||||
| 7000003 | SKIP A | Other - which best describes you? | Text field, <100 char | Single | N | OPS Group | |||||||||||||||||||
| EDO03184 | What is your primary reason for visiting this site today? | EDO03184A001 | Download forms | Radio buttons | Single | Y | OPS Group | ||||||||||||||||||
| EDO03184A002 | Learn of, or register for, workshops, seminars or other training events | ||||||||||||||||||||||||
| EDO03184A003 | Find contact information | ||||||||||||||||||||||||
| EDO03184A004 | Find general Medicare program information | ||||||||||||||||||||||||
| EDO03184A005 | Research a specific question on Medicare policy or billing | ||||||||||||||||||||||||
| EDO03184A006 | Access claim status and/or beneficiary eligibility | ||||||||||||||||||||||||
| EDO03184A007 | Find information on fees or fee schedules | ||||||||||||||||||||||||
| EDO03184A008 | Find out about a Local Coverage Determination (LCD) | ||||||||||||||||||||||||
| EDO03184A009 | Read Medicare publications such as newsletters, articles, etc. | ||||||||||||||||||||||||
| EDO03184A010 | Find enrollment information | ||||||||||||||||||||||||
| EDO03184A011 | Take an on-line training course | ||||||||||||||||||||||||
| EDO03184A012 | Other (please specify) | SKIP B | |||||||||||||||||||||||
| EDO03185 | SKIP B | Other - primary reason? | Text field, <100 char | Single | No | OPS Group | |||||||||||||||||||
| KFB01527 | <b>Did you find</b> what you were looking for? | Yes | Radio button, one-up vertical | Single | Y | OPS Group | Looking For | ||||||||||||||||||
| No, I was looking for: | D | ||||||||||||||||||||||||
| KFB01528 | D | No, I was looking for: | Text field, <100 char | Open | YES | OPS Group | Didn't Find | ||||||||||||||||||
| ACQCol0003519 | Did you use the site-wide search feature on this site? (open text box in the upper right) | ACQCol0003519A01 | Yes | 2A, 2F | Radio button, one-up vertical | Single | Yes | Skip Group | Use Search | ||||||||||||||||
| ACQCol0003519A02 | No | ||||||||||||||||||||||||
| ACQCol0003520 | 2A | How would you rate the helpfulness of the site-wide search? | ACQCol0003520A01 | Very helpful | Radio button, one-up vertical | Single | No | Skip Group | Rate Search | ||||||||||||||||
| ACQCol0003520A02 | Somewhat helpful | ||||||||||||||||||||||||
| ACQCol0003520A03 | Fair | ||||||||||||||||||||||||
| ACQCol0003520A04 | Somewhat unhelpful | 2B | |||||||||||||||||||||||
| ACQCol0003520A05 | Very unhelpful | 2B | |||||||||||||||||||||||
| ACQCol0003521 | 2B | Which of the following describes your experience with the site-wide search? | ACQCol0003521A01 | Search difficult to use | Radio button, one-up vertical | Single | No | Skip Group | Search Experience | ||||||||||||||||
| ACQCol0003521A02 | Received too few results | 2C | |||||||||||||||||||||||
| ACQCol0003521A03 | Received too many results | ||||||||||||||||||||||||
| ACQCol0003521A04 | Search results were not what I was looking for | 2D | |||||||||||||||||||||||
| ACQCol0003521A05 | Could not sort or refine results | ||||||||||||||||||||||||
| ACQCol0003521A06 | Other | 2E | |||||||||||||||||||||||
| ACQCol0003522 | 2C | What search term(s) did you use? | Text area, no char limit | Single | No | Skip Group | Terms - Too Few | ||||||||||||||||||
| ACQCol0003523 | 2D | What search term(s) did you use? | Text area, no char limit | Single | No | Skip Group | Terms - Not What Look For | ||||||||||||||||||
| ACQCol0003524 | 2E | Please briefly explain your experience with the site-wide search. | Text area, no char limit | Single | No | Skip Group | Other_Search Experience | ||||||||||||||||||
| ACQCol0003506 | 2F | What one improvement to the site-wide search feature would be most beneficial? | Text area, no char limit | Single | No | Skip Group | Other-Search Improvement | ||||||||||||||||||
| ACQwil0012031 | Do you use E-mail Updates (listserv)? | ACQwil0012031A01 | Yes | Radio button, one-up vertical | Single | N | Use Listserv | ||||||||||||||||||
| ACQwil0012031A02 | No, but please show me the link to sign up after I submit this survey | ||||||||||||||||||||||||
| 51957 | In the last 30 days, how many times have you visited this website? | This is my first time | Radio buttons | Single | Y | select one | |||||||||||||||||||
| Once or twice | |||||||||||||||||||||||||
| Three or four times | |||||||||||||||||||||||||
| More than once per week but not every day | |||||||||||||||||||||||||
| Every day | |||||||||||||||||||||||||
| EDO04159 | Please rank the top 3 factors that brought you to the website today. (Rank 1 = Most important) Rank 1 |
EDO04159A001 | Message or recommendation from a friend on a social network | Drop down, select one | Single | Y | Rank Group | SV - Rank 1 | |||||||||||||||||
| EDO04159A002 | Video I saw on YouTube | Adjust Template/Style Sheet | |||||||||||||||||||||||
| EDO04159A003 | Internet blogs or discussion forums | Randomize | |||||||||||||||||||||||
| EDO04159A004 | Advertising on social networks (Facebook, LinkedIn, Twitter) | ||||||||||||||||||||||||
| EDO04159A005 | Message directly from Palmetto GBA on a social network | ||||||||||||||||||||||||
| EDO04159A006 | Mobile phone text messages or alerts | ||||||||||||||||||||||||
| EDO04159A007 | Instant Message from a friend or colleague | ||||||||||||||||||||||||
| EDO04159A008 | Typed in the URL | ||||||||||||||||||||||||
| EDO04159A009 | Bookmarked the website | ||||||||||||||||||||||||
| EDO04159A010 | Search engine results | ||||||||||||||||||||||||
| EDO04159A011 | Word of mouth recommendation from someone I know | ||||||||||||||||||||||||
| EDO04159A012 | Link from the CMS website | ||||||||||||||||||||||||
| EDO04159A013 | Listserv or email updates from Palmetto GBA | ||||||||||||||||||||||||
| EDO04159A014 | Mobile apps | ||||||||||||||||||||||||
| EDO04159A015 | None of the above | Anchor | |||||||||||||||||||||||
| EDO04159A016 | Don't know | Anchor | |||||||||||||||||||||||
| EDO04159A017 | Other | Anchor | |||||||||||||||||||||||
| EDO04160 | Rank 2 | EDO04160A001 | Message or recommendation from a friend on a social network | Drop down, select one | Single | Y | Rank Group | SV - Rank 2 | |||||||||||||||||
| EDO04160A002 | Video I saw on YouTube | Adjust Template/Style Sheet | |||||||||||||||||||||||
| EDO04160A003 | Internet blogs or discussion forums | Randomize | |||||||||||||||||||||||
| EDO04160A004 | Advertising on social networks (Facebook, LinkedIn, Twitter) | ||||||||||||||||||||||||
| EDO04160A005 | Message directly from Palmetto GBA on a social network | ||||||||||||||||||||||||
| EDO04160A006 | Mobile phone text messages or alerts | ||||||||||||||||||||||||
| EDO04160A007 | Instant Message from a friend or colleague | ||||||||||||||||||||||||
| EDO04160A008 | Typed in the URL | ||||||||||||||||||||||||
| EDO04160A009 | Bookmarked the website | ||||||||||||||||||||||||
| EDO04160A010 | Search engine results | ||||||||||||||||||||||||
| EDO04160A011 | Word of mouth recommendation from someone I know | ||||||||||||||||||||||||
| EDO04160A012 | Link from the CMS website | ||||||||||||||||||||||||
| EDO04160A013 | Listserv or email updates from Palmetto GBA | ||||||||||||||||||||||||
| EDO04160A014 | Mobile apps | ||||||||||||||||||||||||
| EDO04160A015 | None of the above | Anchor | |||||||||||||||||||||||
| EDO04160A016 | Don't know | Anchor | |||||||||||||||||||||||
| EDO04160A017 | Other | Anchor | |||||||||||||||||||||||
| EDO04161 | Rank 3 | EDO04161A001 | Message or recommendation from a friend on a social network | Drop down, select one | Single | Y | Rank Group | SV - Rank 3 | |||||||||||||||||
| EDO04161A002 | Video I saw on YouTube | Adjust Template/Style Sheet | |||||||||||||||||||||||
| EDO04161A003 | Internet blogs or discussion forums | Randomize | |||||||||||||||||||||||
| EDO04161A004 | Advertising on social networks (Facebook, LinkedIn, Twitter) | ||||||||||||||||||||||||
| EDO04161A005 | Message directly from Palmetto GBA on a social network | ||||||||||||||||||||||||
| EDO04161A006 | Mobile phone text messages or alerts | ||||||||||||||||||||||||
| EDO04161A007 | Instant Message from a friend or colleague | ||||||||||||||||||||||||
| EDO04161A008 | Typed in the URL | ||||||||||||||||||||||||
| EDO04161A009 | Bookmarked the website | ||||||||||||||||||||||||
| EDO04161A010 | Search engine results | ||||||||||||||||||||||||
| EDO04161A011 | Word of mouth recommendation from someone I know | ||||||||||||||||||||||||
| EDO04161A012 | Link from the CMS website | ||||||||||||||||||||||||
| EDO04161A013 | Listserv or email updates from Palmetto GBA | ||||||||||||||||||||||||
| EDO04161A014 | Mobile apps | ||||||||||||||||||||||||
| EDO04161A015 | None of the above | Anchor | |||||||||||||||||||||||
| EDO04161A016 | Don't know | Anchor | |||||||||||||||||||||||
| EDO04161A017 | Other | Anchor | |||||||||||||||||||||||
| EDO04162 | If you heard about the website from a social network, please specify the site. | EDO04162A001 | Single | No | OPS Group | ||||||||||||||||||||
| EDO04162A002 | |||||||||||||||||||||||||
| EDO04162A003 | YouTube | ||||||||||||||||||||||||
| EDO04162A004 | |||||||||||||||||||||||||
| EDO04162A005 | Mobile apps | ||||||||||||||||||||||||
| EDO04162A006 | Other, please specify | E | |||||||||||||||||||||||
| EDO04163 | E | Please specify the other social network. | Text field, <100 char | Single | No | OPS Group | |||||||||||||||||||
| CWS03680 | Please select your location and contract: (please select all that apply) | California - Part B | Checkbox, one-up vertical | Multi | Yes | Location | |||||||||||||||||||
| California - Part A | |||||||||||||||||||||||||
| Nevada - Part B | |||||||||||||||||||||||||
| Nevada - Part A | |||||||||||||||||||||||||
| Hawaii - Part B | |||||||||||||||||||||||||
| Hawaii - Part A | |||||||||||||||||||||||||
| Guam/American Samoa/the Northern Mariana Islands - Part B | |||||||||||||||||||||||||
| Guam/American Samoa/Northern Mariana Islands - Part A | |||||||||||||||||||||||||
| Not applicable | |||||||||||||||||||||||||
| CWS01455 | <b>If you are over the age of 18 and would like to be contacted by Palmetto GBA regarding your feedback</b>, please provide your e-mail address and/or phone number. | Text area, no char limit | Open | No | Contact Me | ||||||||||||||||||||
| CWS03681 | If you could change anything about our site, what would it be? | Text area, no char limit | Open | no | |||||||||||||||||||||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |
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