Form 533 CQs for OMB started 5-3-12

Measures Name/Client name (CQs and Answer choices)
Palmetto GBA Railroad
NEW		In the past 90 days, have you visited the Web site of another Medicare contractor?		Yes	1A	Radio button, one-up vertical	Single	y	Skip Group	Visit Other Site
				No
NEW	1A	Please rate this Web site compared to the other Medicare Web site you visited in the past 90 days: Amount of Content		1=Poor		Radio button, scale, no don't know	Single	Yes	Matrix	Amount of Content
				2					Skip Group
				3
				4
				5
				6
				7
				8
				9
				Excellent=10
NEW	1A	Ease of Use		1=Poor		Radio button, scale, no don't know	Single	Yes	Matrix	Ease of Use
				2					Skip Group
				3
				4
				5
				6
				7
				8
				9
				Excellent=10
NEW	1A	Ability to find what you are looking for		1=Poor		Radio button, scale, no don't know	Single	Yes	Matrix	Ability to find what you are looking for
				2					Skip Group
				3
				4
				5
				6
				7
				8
				9
				Excellent=10
Regulations.gov
	Y	How useful was having your search keyword highlighted within the search results?		Very useful		Dropdown (Select-one)	Single	Y	Skip Logic	Keyword Highlight
				Somewhat useful
				Not useful
	F	Do you prefer viewing results in the default List view or in the Table view?		List view	T	Dropdown (Select-one)	Single	Y	Skip Logic	Table Format Opinion
				Table view	K
				Not Sure/No Opinion
	T	Please tell us why you prefer the List view to the Table view.				Text field, no char limit		N	Skip Logic	Prefer List
	K	Please tell us why you prefer the Table view to the List view.				Text field, no char limit		N	Skip Logic	Prefer Table
USGS - Transparency Model
		Have you accessed USGS.gov from a mobile device in the past 30 days?		Yes	A,B,C	Radio button, one-up vertical	Single	N	Skip Logic Group	Mobile Device Use
				No
	A	What type of mobile device did you use: (check one)		Blackberry						Mobile Device Type
				Android
				iPhone/iTouch
				iPad/iPod
				Tablet
				Other (please specify):	AA
	AA	Please describe the type of most device you used:								OE_Mobile Device Type
	B	Were you successful in viewing the content that you were seeking with your mobile phone/device?		Yes		Radio button, one-up vertical	Single	N		Mobile Success
				No
	C	What USGS site content do you most often seek from a mobile device?				Text field, <100 char		N		OE_Mobile Content seeking
		Do you use social media regularly (at least once a month)?		Yes	A,B	Radio button, one-up vertical	single	N	Skip Logic Group	SM Use
				No
				I don't know
	A	Which of the following social media services do you regularly participate with? (please select all that apply)		Facebook		Checkbox, one-up vertical				SM Type
				Twitter
				YouTube
				Google+
				LinkedIn
				Internet Forums
				Blogs
				Other, (please specify):	AA
	AA	What other social media services do you use?				Text field, <100 char		N		OE_SM Type
	B	How would you like to use social media to interact with the USGS.gov site? (please select all that apply)		Facebook		Checkbox, one-up vertical		N		SM like to Interact Type
				Twitter
				YouTube
				Google+
				LinkedIn
				Internet Forums
				Blogs
				Audio/video podcasts
				I'd prefer not to interact with this site through social media
				Other, (please specify):	BB
	BB	Please tell us another way you would like to use social media to interact with us:				Text field, <100 char		N		OE_SM Other Ways to interact
		Did you visit the site today from a social media services?		Yes	A	Drop down, select one		N	Skip Logic Group	SM Directed to site
				No
	A	Which social media service were you using that directed you to USGS?		Facebook		Checkbox, one-up vertical		N		SM Service Directed
				Twitter
				YouTube
				Google+
				LinkedIn
				Other, (please specify):	AA
	AA	What other social media service brought you to USGS?				Text field, <100 char		N		OE_SM Service Directed
Mint,gov
MMW0986	A	Which of the following activities do you do with your mobile phone or device?  Please select all that apply:	MMW0986A01	Send or receive text messages		Checkbox, one-up vertical	M	Y	Skip Logic Group	Mobile Activites Preference	Mobile Activites Preference
			MMW0986A02	Browse websites
			MMW0986A03	Download an application (“app”)
				Read emails
			MMW0986A04	None of the above
HealthyPeople
		Did you visit the Leading Health Indicators section of the website today?		Yes	A	Drop down, select one	Single	Y	Skip Logic Group	LHI Visit
				No
	A	Which of the following Leading Health Indicators were you interested in today? (Please select all that apply.)		Access to Health Services		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Specific LHI of Interest
				Clinical Preventive Services
				Environmental Quality
				Injury and Violence
				Maternal, Infant, and Child Health
				Mental Health
				Nutrition, Physical Activity, and Obesity
				Oral Health
				Reproductive and Sexual Health
				Social Determinants
				Substance Abuse
				Tobacco