577 Medicare Questionnaire Sept 26 2012 FINAL

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Overview

Welcome and Thank You Text
Current Model Qsts
Current CQs

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Sheet 1: Welcome and Thank You Text

Model Instance Name:
Medicare Main
MID:	New Measure - DOT will fill in
Date:	9/5/2012
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 and Thank you text shown in the boxes below. Please read comments before using any of the text.
					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
	DEFAULT Thank You Text
	“Thank you for taking our survey - and for helping us serve you better. We appreciate your input!”
	ALTERNATE WEB Thank You Text
	Thank you for taking our survey - and for helping us serve you better. 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:
Medicare Main
MID:		New Measure - DOT will fill in
Partitioned (Y/N)?		Yes
Date:		9/5/2012
Medicare Main
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
		Content (1=Poor, 10=Excellent, Don't Know)			Satisfaction			Return (1=Very Unlikely, 10=Very Likely)
1	Content - Accuracy	Please rate your perception of the accuracy of information on this site.	20	Satisfaction - Overall	What is your overall satisfaction with this site? (1=Very Dissatisfied, 10=Very Satisfied)	23	Return	How likely are you to return to this site?
2	Content - Quality	Please rate the quality of information on this site.	21	Satisfaction - Expectations	How well does this site meet your expectations? (1=Falls Short, 10=Exceeds)			Recommend (1=Very Unlikely, 10=Very Likely)
3	Content - Up-To-Date	Please rate how up-to-date this site's content is.	22	Satisfaction - Ideal	How does this site compare to your idea of an ideal website? (1=Not Very Close, 10=Very Close)	24	Recommend	How likely are you to recommend this site to someone else?
		Functionality (1=Poor, 10=Excellent, Don't Know)						Primary Resource (1=Very Unlikely, 10=Very Likely)
4	Functionality - Usefulness	Please rate the usefulness of the website tools (search, print, bookmark, RSS, etc.) provided on this site.				25	Primary Resource	How likely are you to use this site as your primary resource for getting information on Medicare?
5	Functionality - Convenient	Please rate the convenient placement of the website tools (search, print, bookmark, RSS, etc.) on this site.						Trust (1=Strongly Disagree, 10=Strongly Agree)
6	Functionality - Variety	Please rate the variety of website tools (search, print, bookmark, RSS, etc.) on this site.				26	Trust - Best Interests	I can count on this agency to act in my best interests.
		Look and Feel (1=Poor, 10=Excellent, Don't Know)				28	Trust - Do Right	This agency can be trusted to do what is right.
7	Look and Feel - Appeal	Please rate the visual appeal of this site.						Future Participation (1=Very Unlikely, 10=Very Likely)
8	Look and Feel - Balance	Please rate the balance of graphics and text on this site.				29	Future Participation	How likely are you to express your thoughts or ideas to Medicare in the next 90 days?
9	Look and Feel - Readability	Please rate the readability of the pages on this site.
		Navigation (1=Poor, 10=Excellent, Don't Know)
10	Navigation - Organized	Please rate how well the site is organized.
11	Navigation - Options	Please rate the options available for navigating this site.
12	Navigation - Layout	Please rate how well the site layout helps you find what you are looking for.
13	Navigation - Clicks	Please rate the number of clicks to get where you want on this site.
		Online Transparency (1=Poor, 10=Excellent, Don't Know)
14	Online Transparency - Disclose	Please rate how thoroughly this site discloses information about what this agency is doing.
15	Online Transparency - Quick	Please rate how quickly agency information is made available on this site.
16	Online Transparency - Access	Please rate how well information about this agency's actions can be accessed by the public on this site.
		Site Performance (1=Poor, 10=Excellent, Don't Know)
17	Site Performance - Loading	Please rate how quickly pages load on this site.
18	Site Performance - Consistency	Please rate the consistency of speed from page to page on this site.
19	Site Performance - Errors	Please rate the ability to load pages without getting error messages on this site.

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Sheet 3: Current CQs

Model Instance Name:			red & strike-through: DELETE
Medicare Main			underlined & italicized: RE-ORDER
MID: New Measure - DOT will fill in			pink: ADDITION
Date:	9/5/2012		blue + -->: REWORDING
Medicare Main CUSTOM QUESTION LIST
bharati.hulbanni: Hide (DO NOT DELETE) this column before sending to a client. QID	bharati.hulbanni: there should be NO MORE THAN ONE LETTER IN HERE (Skip Logic Label) Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	bharati.hulbanni: Can not have more than one CQ GroupType (denoted by an *) within one colored group in 'Special Instructions' . Special Instructions	CQ Label
		How frequently do you visit Medicare.gov?	Daily		Radio button, one-up vertical	Single	Y	Skip Logic Group*	Visit Frequency
			A few times a week
			Monthly
			Every few months
			Every 6 months or less often
			This is my first time visiting this site
		What was your primary reason for visiting the website?	Get an answer to a coverage question		Radio button, one-up vertical	Single	Y	Skip Logic Group*	Reason
			Fix a Medicare card issue
			Find a health and drug plan
			Find out how Medicare works with other insurance
			Get help with costs
			Find doctors and hospitals
			Apply online for Medicare
			Opt out of the handbook
			Find someone local
			Login to www.MyMedicare.gov
			Other	A
	A	What was your other primary reason?			Text area, no char limit		N	Skip Logic Group*	Other Reason
		What was your primary role while visiting the website?	Person with Medicare		Radio button, one-up vertical	Single	Y		Role
			Caregiver
			Family member or friend of a person with Medicare
			Doctor or health care provider
			Other
		What information about Medicare were you looking for?	Part A (Hospital Insurance)		Radio button, one-up vertical	Single	Y		Contract
			Part B (Medical Insurance)
			Part C (Medicare Advantage)
			Part D (Prescription Drug Coverage)
			Not Applicable
		How did you primarily look for information on the website today?	Search feature	D, E	Radio button, one-up vertical	Single	Y	Skip Logic Group*	Look for Info
			Top navigation bar	G
			Left navigation bar	G
			Links in the center of the page	G
			A-Z Index	G
			Other	C, G
	C	What other way did you primarily look for information?			Text area, no char limit		N	Skip Logic Group*	Other Look for Info
	D	What was your experience with the website's search feature today? (Please select all that apply.)	The search feature met my needs today		Checkbox, one-up vertical	Multi	Y	Skip Logic Group*	Search Experience
			Results were not relevant
			Too many results
			Not enough results
			Returned no results
			Got error message(s)
			Search speed was too slow
			I experienced a different search issue:	F
	F	What other experience did you have while using the search feature?			Text area, no char limit		N	Skip Logic Group*	Other Search Exp
	G	Please tell us about your navigation experience on the website today. (Please select all that apply.)	Denise.Philips: If selected, please eliminate all other options. I navigated this website easily		Checkbox, one-up vertical	Multi		Skip Logic Group*	Nav Experience
			Links often didn't take me where I expected	O
			I had difficulty finding relevant information
			Links/labels are difficult to understand	P
			Too many links/navigational options to choose from
			I had technical difficulties (error messages, broken links, etc.)	O
			I couldn't navigate back to previous information
			I had a navigation problem not listed above:	M
	M	What other navigation difficulty did you experience?			Text area, no char limit		N	Skip Logic Group*	Other Nav Exp
	O	What links or paths didn't take you where they should have?			Text area, no char limit		N	Skip Logic Group*	Nav Path Unexpected
	P	What specific links/labels were difficult to understand?			Text area, no char limit		N	Skip Logic Group*	Nav Link Labels
		Were you able to find what you were looking for today?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group*	Able to Find
			No	Q, R
			Not sure	Q, R
	Q	Please describe in detail what you were unable to do or find.			Text area, no char limit		N	Skip Logic Group*	Unable to Find
	R	What will you do next?	Return to Medicare.gov another time		Radio button, one-up vertical	Single	Y	Skip Logic Group*	Do Next
			Look at other websites for Medicare information
			Look other places online
			E-mail Medicare.gov
			Call 1-800-MEDICARE for information
			Call your State Health Insurance Assistance Program (SHIP) for information
			Stop looking
			Other	S
	S	What else will you do next?			Text area, no char limit		N	Skip Logic Group*	Other Do Next
		Which of the following sources drove you to visit the website today? Please rank the top 3 (Rank 1 is most important). Rank 1 (Required)	Message or recommendation from a friend on a social network		Drop down, select one	Single	Y	Rank Group	SV - Rank 1
			Video I saw on YouTube
			Internet blogs or discussion forums					Adjust Template/Style Sheet
			Advertising on social networks (Facebook, Twitter)					Randomize
			Message directly from the company on a social network
			Online Pinboard (Pinterest)
			Mobile phone text messages or alerts
			Instant Message from a friend or colleague
			Familiarity with Medicare
			Promotional email(s) from Medicare
			Search engine results
			Word of mouth recommendation from someone I know
			Printed article (newspaper, magazine, newsletter)
			Meeting or conference I attended
			Don't know					Anchor Answer Choice
			Other					Anchor Answer Choice
		Rank 2 (Optional)	Message or recommendation from a friend on a social network		Drop down, select one	Single	N	Rank Group	SV - Rank 2
			Video I saw on YouTube
			Internet blogs or discussion forums					Adjust Template/Style Sheet
			Advertising on social networks (Facebook,Twitter)					Randomize
			Message directly from the company on a social network
			Online Pinboard (Pinterest)
			Mobile phone text messages or alerts
			Instant Message from a friend or colleague
			Familiarity with Medicare
			Promotional email(s) from Medicare
			Search engine results
			Word of mouth recommendation from someone I know
			Printed article (newspaper, magazine, newsletter)
			Meeting or conference I attended
			Don't know					Anchor Answer Choice
			Other					Anchor Answer Choice
		Rank 3 (Optional)	Message or recommendation from a friend on a social network		Drop down, select one	Single	N	Rank Group	SV - Rank 3
			Video I saw on YouTube
			Internet blogs or discussion forums					Adjust Template/Style Sheet
			Advertising on social networks (Facebook,Twitter)					Randomize
			Message directly from the company on a social network
			Online Pinboard (Pinterest)
			Mobile phone text messages or alerts
			Instant Message from a friend or colleague
			Familiarity with Medicare
			Promotional email(s) from Medicare
			Search engine results
			Word of mouth recommendation from someone I know
			Printed article (newspaper, magazine, newsletter)
			Meeting or conference I attended
			Don't know					Anchor Answer Choice
			Other					Anchor Answer Choice
		If you could change or improve one thing about the website, what would it be?			Text area, no char limit		N		Improvement