558 PBGC Perception Questionnaire

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Overview

Welcome and Thank You Text
Current Model Qsts
Current Custom Qsts
Current Custom Qsts (8-15-12)
Custom Qsts (7-9-12)
Custom Qsts (5-3-12)

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Sheet 1: Welcome and Thank You Text

Model Instance Name:
PBGC - Perception Survey
MID:	lUx1IFIhgp5YEpxx5JlVIw==
Date:	3/2/2012
Welcome and Thank You Text
	Directions:
	This welcome text is shown at the top of the questionnaire window and the thank you text at the bottom. This is a good place to mention the site/company/agency name so the visitor knows whom they are taking the survey for. Feel free to modify the standard Welcome text shown in the box below.
					Examples
					Welcome Text Example
	Welcome Text
	Thank you for visiting our site. You've been randomly chosen to take part in a brief survey to let us know what we're doing well and where we can improve. Please take a few minutes to share your opinions, which are essential in helping us provide the best online experience possible.
					Thank You Text Example
	Thank You Text
	Thank you for taking our survey - and for helping us serve you better. Pursuant to 29 U.S.C. § 1302(b)(4), PBGC is authorized to collect the following personally identifiable information: name, telephone, number, and email address. PBGC is collecting this information for the sole purpose of contacting you to follow up on your responses to the survey questions, as you are requesting. This information will be used by PBGC personnel. Furnishing this information is voluntary and will not impact other business you may have with PBGC. The data will be maintained on our secure server. Please note you will not receive a response from us based on your survey comments. If you would like us to contact you about your feedback, please visit the Contact Us section of our website.

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Sheet 2: Current Model Qsts

Model Instance Name:
PBGC - Perception Survey
MID:	lUx1IFIhgp5YEpxx5JlVIw==
Partitioned (Y/N)?		NO
Date:		3/2/2012
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Model questions utilize the ACSI methodology to determine scores and impacts
		ELEMENTS (drivers of satisfaction)			CUSTOMER SATISFACTION			FUTURE BEHAVIORS
	MQ Label			MQ Label			MQ Label
		Agency Information (1=Poor, 10=Excellent, Don't Know)			Satisfaction			Goal Accomplishment Index (1=Strongly Disagree, 10=Strongly Agree)
1	Agency Information - Thoroughness	Thinking about the agency as a whole, please rate your perception of the thoroughness of the information that the PBGC provides.	6	Satisfaction - Overall	What is your overall satisfaction with the PBGC agency? (1=Very Dissatisfied, 10=Very Satisfied)	9	Goal Accomplishment - Mission	Please indicate how much you agree or disagree with the following statements. The PBGC carries out its mission to protect pensions.
2	Agency Information - Understandable	Please rate how understandable you find the information that the PBGC provides.	7	Satisfaction - Expectations	How well does the PBGC meet your expectations? (1=Falls Short, 10=Exceeds)	10	Goal Accomplishment - Responsibility	The PBGC shows that it takes responsibility for preserving pension plans.
3	Agency Information - Answers	Please rate how well the agency's information provides answers to your questions.	8	Satisfaction - Ideal	How does the PBGC compare to your idea of an ideal federal agency? (1=Not Very Close, 10=Very Close)	11	Goal Accomplishment - Preserve	The PBGC efficiently preserves pension plans.
		Agency Services (1=Poor, 10=Excellent, Don't Know)				12	Goal Accomplishment - Protect	The PBGC protects pensioners effectively.
4	Agency Services - Provision	Thinking about the agency's services as a whole, please rate the extent to which the PBGC provides needed services.						Trust (1=Strongly Disagree, 10=Strongly Agree)
5	Agency Services - Range	Please rate your perception of the range of services offered by the PBGC.				13	Trust - Best Interests	I can count on this agency to act in my best interests.
						14	Trust - Trustworthy	I consider this agency to be trustworthy.
						15	Trust - Do Right	This agency can be trusted to do what is right.
								Future Participation (1=Very Unlikely, 10=Very Likely)
							16	Future Participation	How likely are you to express your thoughts or ideas to this agency in the next 90 days?
									Brand Confidence (1=Not At All Confident, 10=Very Confident)
							17	Brand Confidence	How confident are you that your future interactions with the PBGC will meet your needs?

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Sheet 3: Current Custom Qsts

Model Instance Name:			red & strike-through: DELETE
PBGC - Perception Survey			underlined & italicized: RE-ORDER
MID:	lUx1IFIhgp5YEpxx5JlVIw==		pink: ADDITION
Date:	7/5/2012		blue + -->: REWORDING
PBGC - Perception Survey CUSTOM QUESTION LIST
QID	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	CQ Label
MMW1759		Which best describes you?	United Airlines worker or retiree		Radio button, one-up vertical	S	Y	Skip Logic Group	Best Describes
			Worker
			Retiree
			Disabled Worker or Retiree
			Widow(er) or spouse or beneficiary
			Practitioner or pension professional
			Media or press representative
			Congressional or regulatory researcher
			Trade association or business organization
			Job seeker
			Student
			Other (please specify)	A
MMW1760	A	Other - best describes you:			Text area, no char limit	S	N		Other Best Describes
MMW1761		What is your primary interest in PBGC?	To learn if my pension plan is insured or covered by the PBGC		Radio button, one-up vertical	S	Y		Primary Interest
			To learn what to expect if PBGC takes over my pension plan
			To better understand the extent to which my benefits (pension, health care, etc.) are insured
			To find out if I am entitled to a benefit (unclaimed pension, not listed in a plan, etc.)
			To get an estimate of my benefit
			To file a premium
			To submit a standard termination
			To submit a distress termination
			To submit a reportable event
			To obtain interest rates
			To look for a job
			To learn more about PBGC's mission to protect pensions
MMW1762		As an agency, what could PBGC do differently to better meet your needs?			Text area, no char limit	S	N		Better Meet Needs
ACQinh0014010		Would you like PBGC to contact you regarding your response?	Yes	A	Radio button, one-up vertical	S	Y	Skip Logic Group	Contact
			No
ACQinh0014011	A	Please provide the following information, and a PBGC representative will contact you. Name: (First/Last Name)			Text field, <100 char	S	N		Name
ACQinh0014012	A	Email: (e.g. [email protected])			Text field, <100 char	S	N		Email
ACQinh0014013	A	Telephone: (e.g. 555-555-5555)			Text field, <100 char	S	N		Telephone
ACQinh0014014	A	Best weekday to be reached:	Monday		Drop down, select one	S	N		Best Day to Reach
			Tuesday
			Wednesday
			Thursday
			Friday
ACQinh0014015	A	Best time to be reached:	9 - 10 AM (EST)		Drop down, select one	S	N		Best hour to Reach
			10 - 11 AM (EST)
			11 - 12 PM (EST)
			12 - 1 PM (EST)
			1 - 2 PM (EST)
			2 - 3 PM (EST)
			3 - 4 PM (EST)
			4 - 5 PM (EST)
			5 - 6 PM (EST)
ACQinh0014016	A	Type of assistance requested from PBGC:			Text area, no char limit	S	N		Assistance requested

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Sheet 4: Current Custom Qsts (8-15-12)

Model Instance Name:			red & strike-through: DELETE
PBGC - Perception Survey			underlined & italicized: RE-ORDER
MID:	lUx1IFIhgp5YEpxx5JlVIw==		pink: ADDITION
Date:	7/5/2012		blue + -->: REWORDING
PBGC - Perception Survey CUSTOM QUESTION LIST
QID	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	CQ Label
MMW1759		Which best describes you?	United Airlines worker or retiree		Radio button, one-up vertical	S	Y	Skip Logic Group	Best Describes
			Worker
			Retiree
			Disabled Worker or Retiree
			Widow(er) or spouse or beneficiary
			Practitioner or pension professional
			Media or press representative
			Congressional or regulatory researcher
			Trade association or business organization
			Job seeker
			Student
			Other (please specify)	A
MMW1760	A	Other - best describes you:			Text area, no char limit	S	N		Other Best Describes
MMW1761		What is your primary interest in PBGC?	To learn if my pension plan is insured or covered by the PBGC		Radio button, one-up vertical	S	Y		Primary Interest
			To learn what to expect if PBGC takes over my pension plan
			To better understand the extent to which my benefits (pension, health care, etc.) are insured
			To find out if I am entitled to a benefit (unclaimed pension, not listed in a plan, etc.)
			To get an estimate of my benefit
			To file a premium
			To submit a standard termination
			To submit a distress termination
			To submit a reportable event
			To obtain interest rates
			To look for a job
			To learn more about PBGC's mission to protect pensions
MMW1762		As an agency, what could PBGC do differently to better meet your needs?			Text area, no char limit	S	N		Better Meet Needs
ACQinh0014010		Would you like PBGC to contact you regarding your response?	Yes	A	Radio button, one-up vertical	S	Y	Skip Logic Group	Contact
			No
ACQinh0014011	A	Please provide the following information, and a PBGC representative will contact you. Name: (First/Last Name)			Text field, <100 char	S	N		Name
ACQinh0014012	A	Email: (e.g. [email protected])			Text field, <100 char	S	N		Email
ACQinh0014013	A	Telephone: (e.g. 555-555-5555)			Text field, <100 char	S	N		Telephone
ACQinh0014014	A	Best weekday to be reached:	Monday		Drop down, select one	S	N		Best Day to Reach
			Tuesday
			Wednesday
			Thursday
			Friday
ACQinh0014015	A	Best time to be reached:	9 - 10 AM (EST)		Drop down, select one	S	N		Best hour to Reach
			10 - 11 AM (EST)
			11 - 12 PM (EST)
			12 - 1 PM (EST)
			1 - 2 PM (EST)
			2 - 3 PM (EST)
			3 - 4 PM (EST)
			4 - 5 PM (EST)
			5 - 6 PM (EST)
ACQinh0014016	A	Type of assistance requested from PBGC:			Text area, no char limit	S	N		Assistance requested

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Sheet 5: Custom Qsts (7-9-12)

Model Instance Name:			red & strike-through: DELETE
PBGC - Perception Survey			underlined & italicized: RE-ORDER
MID:	lUx1IFIhgp5YEpxx5JlVIw==		pink: ADDITION
Date:	7/5/2012		blue + -->: REWORDING
PBGC - Perception Survey CUSTOM QUESTION LIST
QID	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	CQ Label
MMW1759		Which best describes you?	Worker		Radio button, one-up vertical	S	Y	Skip Logic Group	Best Describes
			Retiree
			Disabled Worker or Retiree
			Widow(er) or spouse or beneficiary
			Practitioner or pension professional
			Media or press representative
			Congressional or regulatory researcher
			Trade association or business organization
			Job seeker
			Student
			Other (please specify)	A
MMW1760	A	Other - best describes you:			Text area, no char limit	S	N		Other Best Describes
MMW1761		What is your primary interest in PBGC?	To learn if my pension plan is insured or covered by the PBGC		Radio button, one-up vertical	S	Y		Primary Interest
			To learn what to expect if PBGC takes over my pension plan
			To better understand the extent to which my benefits (pension, health care, etc.) are insured
			To find out if I am entitled to a benefit (unclaimed pension, not listed in a plan, etc.)
			To get an estimate of my benefit
			To file a premium
			To submit a standard termination
			To submit a distress termination
			To submit a reportable event
			To obtain interest rates
			To look for a job
			To learn more about PBGC's mission to protect pensions
MMW1762		As an agency, what could PBGC do differently to better meet your needs?			Text area, no char limit	S	N		Better Meet Needs
		Would you like PBGC to contact you regarding your response?	Yes	A	Radio button, one-up vertical	S	Y	Skip Logic Group	Contact
			No
	A	Please provide the following information, and a PBGC representative will contact you. Name: (First/Last Name)			Text field, <100 char	S	N		Name
	A	Email: (e.g. [email protected])			Text field, <100 char	S	N		Email
	A	Telephone: (e.g. 555-555-5555)			Text field, <100 char	S	N		Telephone
	A	Best weekday to be reached:	Monday		Drop down, select one	S	N		Best Day to Reach
			Tuesday
			Wednesday
			Thursday
			Friday
	A	Best time to be reached:	9 - 10 AM (EST)		Drop down, select one	S	N		Best hour to Reach
			10 - 11 AM (EST)
			11 - 12 PM (EST)
			12 - 1 PM (EST)
			1 - 2 PM (EST)
			2 - 3 PM (EST)
			3 - 4 PM (EST)
			4 - 5 PM (EST)
			5 - 6 PM (EST)
	A	Type of assistance requested from PBGC:			Text area, no char limit	S	N		Assistance requested

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Sheet 6: Custom Qsts (5-3-12)

Model Instance Name:			red & strike-through: DELETE
PBGC - Perception Survey			underlined & italicized: RE-ORDER
MID:	lUx1IFIhgp5YEpxx5JlVIw==		pink: ADDITION
Date:	5/3/2012		blue + -->: REWORDING
PBGC - Perception Survey CUSTOM QUESTION LIST
QID	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	CQ Label
MMW1759		Which best describes you?	Worker		Radio button, one-up vertical	S	Y	Skip Logic Group	Best Describes
			Retiree
			Disabled Worker or Retiree
			Widow(er) or spouse or beneficiary
			Practitioner or pension professional
			Media or press representative
			Congressional or regulatory researcher
			Trade association or business organization
			Job seeker
			Student
			Other (please specify)	A
MMW1760	A	Other - best describes you:			Text area, no char limit	S	N		Other Best Describes
MMW1761		What is your primary interest in PBGC?	To learn if my pension plan is insured or covered by the PBGC		Radio button, one-up vertical	S	Y		Primary Interest
			To learn what to expect if PBGC takes over my pension plan
			To better understand the extent to which my benefits (pension, health care, etc.) are insured
			To find out if I am entitled to a benefit (unclaimed pension, not listed in a plan, etc.)
			To get an estimate of my benefit
			To file a premium
			To submit a standard termination
			To submit a distress termination
			To submit a reportable event
			To obtain interest rates
			To look for a job
			To learn more about PBGC's mission to protect pensions
MMW1762		As an agency, what could PBGC do differently to better meet your needs?			Text area, no char limit	S	N		Better Meet Needs