| Model Instance Name: |
|
|
|
|
|
|
|
|
|
| SSA Main v3 |
|
|
|
|
|
|
|
|
|
| MID: |
|
V1wUw0sAYNUA1pUkAswd1g4C |
|
|
|
|
|
|
| Partitioned (Y/N)? |
|
|
|
|
|
|
|
|
| FPI Included(Y/N)? |
|
|
|
|
|
|
|
|
| NOTE: All non-partitioned surveys will NOT be imputed and the elements will be rotated as a default unless otherwise specified and approved by Research. |
|
|
|
|
|
| Date: |
|
6/12/2013 |
|
|
|
|
|
|
| SSA Main v3 |
| Model questions utilize the ACSI methodology to determine scores and impacts |
|
|
ELEMENTS (drivers of satisfaction) |
|
|
CUSTOMER SATISFACTION |
|
|
FUTURE BEHAVIORS |
FPI |
|
MQ Label |
|
|
MQ Label |
|
|
MQ Label |
|
Y? |
|
|
Look and Feel (1=Poor, 10=Excellent, Don't Know) |
|
|
Satisfaction |
|
|
Recommend (1=Very Unlikely, 10=Very Likely) |
|
| 1 |
Look and Feel - Appeal |
Please rate the visual appeal of this site. |
16 |
Satisfaction - Overall |
What is your overall satisfaction with this site?
(1=Very Dissatisfied, 10=Very Satisfied) |
19 |
Recommend |
How likely are you to recommend this site to someone else? |
|
| 2 |
Look and Feel - Balance |
Please rate the balance of graphics and text on this site. |
17 |
Satisfaction - Expectations |
How well does this site meet your expectations?
(1=Falls Short, 10=Exceeds) |
|
|
Return (1=Very Unlikely, 10=Very Likely) |
|
| 3 |
Look and Feel - Readability |
Please rate the readability of the pages on this site. |
18 |
Satisfaction - Ideal |
How does this site compare to your idea of an ideal website?
(1=Not Very Close, 10=Very Close) |
20 |
Return |
How likely are you to return to this site? |
|
|
|
Navigation (1=Poor, 10=Excellent, Don't Know) |
|
|
|
|
|
|
|
| 4 |
Navigation - Organized |
Please rate how well the site is organized. |
|
|
|
| 5 |
Navigation - Options |
Please rate the options available for navigating this site. |
|
| 6 |
Navigation - Layout |
Please rate how well the site layout helps you find what you are looking for. |
|
|
|
SSA Information(1=Poor, 10=Excellent, Don't Know) |
|
| 7 |
SSA Information - Thoroughness |
Please rate the thoroughness of information you viewed on this site today. |
|
|
|
|
|
|
|
| 8 |
SSA Information - Quality |
Please rate the quality of information you viewed today. |
|
|
|
|
|
|
|
| 9 |
SSA Information - Provided Answers |
Please rate how well the information viewed today provided answers to your questions. |
|
|
|
|
|
|
|
|
|
Site Performance (1=Poor, 10=Excellent, Don't Know) |
|
|
|
|
|
|
|
| 10 |
Site Performance - Loading |
Please rate how quickly pages load on this site. |
|
|
|
|
|
|
|
| 11 |
Site Performance - Consistency |
Please rate the consistency of speed from page to page on this site. |
|
|
|
|
|
|
|
| 12 |
Site Performance - Errors |
Please rate the ability to load pages without getting error messages on this site. |
|
|
|
|
|
|
|
|
|
Plain Language (1=Poor, 10=Excellent, Don't Know) |
|
|
|
|
|
|
|
| 13 |
Plain Language - Clear |
Please rate the clarity of the wording on this site. |
|
|
|
|
|
|
|
| 14 |
Plain Language - Understandable |
Please rate how well you understand the wording on this site. |
|
|
|
|
|
|
|
| 15 |
Plain Language - Concise |
Please rate this site on its use of short, clear sentences. |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| Model Instance Name: |
|
|
red & strike-through: DELETE |
|
|
|
|
|
|
|
|
|
|
|
|
|
| SSA Main v3 |
|
|
underlined & italicized: RE-ORDER |
|
|
|
|
|
|
|
|
|
|
|
|
|
| MID: |
V1wUw0sAYNUA1pUkAswd1g4C |
|
pink: ADDITION |
|
|
|
|
|
|
|
|
|
|
|
|
|
| Date: |
6/14/2011 |
blue + -->: REWORDING |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| SSA Main v3 CUSTOM QUESTION LIST |
|
|
|
|
|
|
|
|
QID
(Group ID) |
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 |
25 character limit. Leave blank if you want DOT to fill this part out.
CQ Label |
|
|
|
|
|
|
|
| LNH4729 |
|
Prior to receiving this survey today, did you experience any difficulties logging in, applying for benefits or using another service online? |
Yes |
A,B |
Radio Button One up |
Single |
Y |
Skip Logic Group |
Prior Difficulty |
|
|
|
|
|
|
|
|
|
|
No |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Don't remember |
|
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4730 |
A |
Which of the following did you experience difficulties with today? |
Creating a new My Social Security account |
|
Check box one up vertical |
Multi |
Y |
Skip Logic Group |
Difficulty |
|
|
|
|
|
|
|
|
|
|
Problems using a previously created My Social Security account |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Viewing my Social Security Statement |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Checking the status of my application |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Applying for Help with Medicare Prescription Drug Plan Costs |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Using the Retirement Estimator |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Applying for Disability benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Applying for Medicare benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Applying for Retirement benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Filing a Representative Payee Accounting Report |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Appealing a benefits decision |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
None of the above |
|
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4731 |
B |
Please explain your difficulty. |
|
|
Text Area – no character limit |
|
|
Skip Logic Group |
OE_Explain Difficulty |
|
|
|
|
|
|
|
| LNH4732 |
|
How often do you visit this site? |
First time |
|
Dropdown (Select-one) |
Single |
Y |
|
Freq of Visit |
|
|
|
|
Types |
|
|
|
More than once a day |
|
|
|
|
|
|
|
Open-ended |
|
|
|
Daily |
|
|
|
|
|
|
|
Text Field – limited to 100 characters |
|
|
|
About once a week |
|
|
|
|
|
|
|
Text Area – no character limit |
|
|
|
About once a month |
|
|
|
|
|
|
|
Dropdown (Select-one) |
|
|
|
Every 6 months or less frequently |
|
|
|
|
|
|
|
Radio Button One Up Vertical |
|
|
| LNH4733 |
|
Which of the following best describes you? |
I receive Social Security Disability, Retirement, or Survivor's benefits |
|
Radio Button One Up Vertical |
Single |
Y |
OPS Group |
Best Describes |
|
|
|
|
Radio Button Two Up Vertical |
|
|
|
I receive SSI |
|
|
|
|
|
|
|
Radio Button Three Up Vertical |
|
|
|
I am applying for Social Security disability, retirement, survivor's, or SSI |
|
|
|
|
|
|
|
Radio Button Scale Has Don’t Know |
|
|
|
I do not receive Social Security benefits |
|
|
|
|
|
|
|
Radio Button Scale No Don’t Know |
|
|
|
I am an employer |
|
|
|
|
|
|
|
Checkbox One Up Vertical |
|
|
|
I am a professional helping someone else with Social Security business |
|
|
|
|
|
|
|
Checkbox Two Up Vertical |
|
|
|
Other (please specify) |
A |
|
|
|
|
|
|
Select-multiple Show Four |
|
|
| LNH4734 |
A |
Other Role |
|
|
Text Field – limited to 100 characters |
|
N |
OPS Group |
OE - Best Describes |
|
|
|
|
|
|
|
| LNH4735 |
|
What was the main reason for your visit today? |
Apply for benefits online |
|
Radio Button One Up Vertical |
Single |
Y |
OPS Group |
Main Reason |
|
|
|
|
|
|
|
|
|
|
Online check of the status of my application for benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
See if I qualify for benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Get online estimate of my future benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Plan for retirement |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Request a Proof-of-Income letter |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Online request for a Form 1099/1042S -- Social Security Benefit Statement |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Request a Social Security Statement online |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Get information about the disability program |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Learn about the Medicare Prescription Drug Program (Medicare Part D) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Apply online for Help With Medicare Prescription Drug Plan Costs |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Get/replace Social Security card or change my name on my Social Security card |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Online request for a replacement Medicare card |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Get a password for Social Security Online, or change my current password |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Check the contact, direct deposit, Medicare and payment information you have on file for me |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Set up or change Direct Deposit of my check |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Make an online change affecting the benefits I already receive |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Check for popular baby names |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Look for Federal employment |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Find my local office; how to contact Social Security |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Download forms |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Use online services for employers/businesses |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Research Social Security or its financial status |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Other (please specify) |
A |
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4736 |
A |
Other Reason |
|
|
Text Field – limited to 100 characters |
|
|
OPS Group |
OE - Main Reason |
|
|
|
|
|
|
|
| LNH4737 |
|
Thinking about the Social Security web site’s home page (http://www.socialsecurity.gov) please tell us if it made clear to you where you needed to go to accomplish what you wanted. |
Yes |
|
Radio Button One Up Vertical |
Single |
Y |
Skip Logic |
Site Clarity |
|
|
|
|
|
|
|
|
No |
H |
|
|
|
|
|
|
|
|
|
|
Not Sure/Didn't visit the home page |
|
|
|
|
|
|
|
|
|
|
| LNH4738 |
H |
Please explain why it wasn’t clear where you needed to go to accomplish what you wanted. |
|
|
Text Field – limited to 100 characters |
|
N |
Skip Logic |
OE - Homepage |
|
|
|
|
|
|
|
| LNH4741 |
|
Did you find the information you were looking for or did you successfully complete your online transaction? |
Yes |
|
Dropdown (Select-one) |
Single |
Y |
Skip Logic |
Find Info |
|
|
|
|
|
|
|
|
No |
A |
|
|
|
|
|
|
|
|
|
|
Not yet, I am still looking |
A |
|
|
|
|
|
|
|
|
|
|
Not looking for anything specific |
|
|
|
|
|
|
|
|
|
|
| LNH4742 |
A |
Please tell us what you were trying to find or do on the SSA website today. |
|
|
Text Area – no character limit |
|
N |
Skip Logic |
Trying to Do |
|
|
|
|
|
|
|
| LNH4743 |
|
Did you use the Social Security web site's Search (located in the upper right-hand corner of every page) during your visit? |
Yes |
A |
Radio Button One Up Vertical |
Single |
Y |
Skip Logic |
Use Search |
|
|
|
|
|
|
|
|
No |
|
|
|
|
|
|
|
|
|
|
|
Don't know what that is |
|
|
|
|
|
|
|
|
|
|
| LNH4744 |
A |
Which of the following, if any, did you experience while using the search tool today? (check all that apply) |
I found what I was looking for |
|
Checkbox One Up Vertical |
Multi |
N |
Skip Logic |
Search Experience |
|
|
|
|
|
|
|
|
I was not sure what words to use in my search |
C |
|
|
|
|
|
|
|
|
|
|
Results were not relevant to my search terms or needs |
C |
|
|
|
|
|
|
|
|
|
|
Search returned no results |
C |
|
|
|
|
|
|
|
|
|
|
Search returned not enough results |
C |
|
|
|
|
|
|
|
|
|
|
Search returned too many results |
C |
|
|
|
|
|
|
|
|
|
|
Search required too many refinements to get to what I wanted |
C |
|
|
|
|
|
|
|
|
|
|
Search returned results that were too similar/redundant |
C |
|
|
|
|
|
|
|
|
|
|
Other (please specify) |
B,C |
|
|
|
|
|
|
|
|
|
| LNH4745 |
B |
Please tell us what else you experienced while using the search tool today. |
|
|
Text Area – no character limit |
|
N |
Skip Logic |
Other Search Experience |
|
|
|
|
|
|
|
| LNH4746 |
C |
What word(s) did you enter into the search box? |
|
|
Text Area – no character limit |
|
N |
Skip Logic |
Search Word |
|
|
|
|
|
|
|
| LNH4750 |
|
After viewing our website, what do you plan to do next? |
Nothing, I found /completed what I wanted |
|
Dropdown (Select-one) |
Single |
Y |
|
Do Next |
|
|
|
|
|
|
|
|
Nothing, although I did not find/complete what I wanted |
|
|
|
|
|
|
|
|
|
|
|
Send Social Security an e-mail |
|
|
|
|
|
|
|
|
|
|
|
Call Social Security's 800 number |
|
|
|
|
|
|
|
|
|
|
|
Call my local Social Security office |
|
|
|
|
|
|
|
|
|
|
|
Visit my local Social Security office |
|
|
|
|
|
|
|
|
|
|
|
Write a letter to Social Security |
|
|
|
|
|
|
|
|
|
|
|
Return to the Social Security website later and try again |
|
|
|
|
|
|
|
|
|
|
| LNH4751 |
|
If there was one thing you could change about the Social Security web site, please tell us what it would be. |
|
|
Text Area – no character limit |
|
N |
|
Change One Thing |
|
|
|
|
|
|
|
| LNH4752 |
|
Do you ever access the Internet using a mobile phone or tablet? |
Yes |
A, B |
Radio button, one-up vertical |
Single |
Y |
Skip Logic Group |
Access Mobile Internet |
|
|
|
|
|
|
|
|
|
|
No |
|
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4753 |
A |
Which of the following devices do you have? |
A SmartPhone |
W |
Checkbox, one-up vertical |
Multi |
Y |
Skip Logic Group |
Phone or Tablet |
|
|
|
|
|
|
|
|
|
|
A tablet |
X |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
None of these |
|
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4754 |
W |
Specifically, which type of mobile phone do you have? |
iPhone |
|
Radio button, one-up vertical |
Single |
Y |
Skip Logic Group |
Phone Type |
|
|
|
|
|
|
|
|
|
|
Android |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Blackberry |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Another phone |
|
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4755 |
X |
Specifically, which type of tablet do you have? |
iPad |
|
Radio button, one-up vertical |
Single |
Y |
Skip Logic Group |
Tablet Type |
|
|
|
|
|
|
|
|
|
|
Kindle |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Android |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Blackberry |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Another tablet |
|
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4756 |
B |
Have you ever accessed ANY federal website using a mobile phone or tablet? |
Yes |
C |
Radio button, one-up vertical |
Single |
Y |
Skip Logic Group |
Federal Mobile Site Usage |
|
|
|
|
|
|
|
|
|
|
No, but I plan to do so |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
No, but I might in the future |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
No, and I don't plan to do so |
|
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4757 |
C |
Have you ever accessed the Social Security website using a mobile phone or tablet? |
Yes |
Y, Z |
Radio button, one-up vertical |
Single |
Y |
Skip Logic Group |
Mobile Site Usage |
|
|
|
|
|
|
|
|
|
|
No, but I plan to do so |
Z |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
No, but I might in the future |
Z |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
No, and I don't plan to do so |
|
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4758 |
Y |
What was the main reason you last visited the Social Security website using a mobile phone or tablet? |
|
|
Text area, no char limit |
Single |
N |
Skip Logic Group |
Mobile Primary Reason |
|
|
|
|
|
|
|
| LNH4759 |
Z |
What additional resources might you want to access from the Social Security website using a mobile phone or tablet? |
|
|
Text area, no char limit |
Single |
N |
Skip Logic Group |
MobileDesired Resources |
|
|
|
|
|
|
|