| Model Instance Name: | 
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		| FTC ComplaintAssistant | 
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		| MID: | hI0JsEZkMIQJ5F5wwQ48og== | 
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		| Date: | 6/26/2009 | 
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		| Model questions utilize the ACSI methodology to determine scores and impacts | 
	
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 | ELEMENTS (drivers of satisfaction) | 
 | CUSTOMER SATISFACTION | 
 | FUTURE BEHAVIORS | 
	
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 | Instructions for Completion (1=Poor, 10=Excellent, Don't Know) | 
 | Satisfaction (1=Poor, 10=Excellent) | 
 | Recommend (1=Not Very Likely, 10=Very Likely) | 
	
		| 1 | Please rate the simplicity of instructions for completing the ComplaintAssistant process. | 13 | What is your overall satisfaction with the ComplaintAssistant process? | 16 | How likely are you to recommend  the FTC ComplaintAssistant process to someone else? | 
	
		| 2 | Please rate how well the instructions for completing the ComplaintAssistant process provide answers to your questions. | 14 | How well does the ComplaintAssistant process meet your expectations? | 
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		| 3 | Please rate the clarity of instructions for completing the ComplaintAssistant process. | 15 | How does the ComplaintAssistant process compare to your idea of an ideal complaints process? | 
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 | Look and Feel (1=Poor, 10=Excellent, Don't Know) | 
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		| 4 | Please rate the visual appeal of the ComplaintAssistant process. | 
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		| 5 | Please rate the balance of graphics and text throughout the ComplaintAssistant process. | 
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		| 6 | Please rate the readability of the pages in the ComplaintAssistant process. | 
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 | Navigation (1=Poor, 10=Excellent, Don't Know) | 
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		| 7 | Please rate how well the ComplaintAssistant process is organized. | 
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		| 8 | Please rate the options available for navigating the ComplaintAssistant process. | 
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		| 9 | Please rate the number of clicks it takes to complete the ComplaintAssistant process. | 
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 | Site Performance (1=Poor, 10=Excellent, Don't Know) | 
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		| 10 | Please rate how quickly pages load in the ComplaintAssistant process. | 
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		| 11 | Please rate the consistency of speed from page to page in the ComplaintAssistant process. | 
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		| 12 | Please rate the ability to load pages without getting error messages in the ComplaintAssistant process. | 
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		| Model Instance Name: | 
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 | red & strike-through:  DELETE | 
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		| FTC ComplaintAssistant | 
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 | underlined & italicized: RE-ORDER | 
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		| MID: | hI0JsEZkMIQJ5F5wwQ48og== | 
 | pink: ADDITION | 
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		| Date: | 6/26/2009 | blue + -->: REWORDING | 
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		| FTC ComplaintAssistant CUSTOM QUESTION LIST | 
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		| 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 | 
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		| AKR5413 | 
 | Were you aware of the FTC ComplaintAssistant before visiting the site today? | Yes | B | Radio button,  one-up vertical | Single | Y | Skip Logic Group | Aware Before Visit | 
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 | No | C | 
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 | Not sure | C | 
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		| AKR5414 | B | If you were aware of the FTC ComplaintAssistant process, how many times have you used it in the past to register a complaint? | 0 | 
 | Radio button,  one-up vertical | Single | Y | Skip Logic Group | Times Used | 
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 | 3 or more | 
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		| AKR5415 | C | If you were not aware of the FTC ComplaintAssistant before today, how did you find us? | FTC Website | 
 | Checkbox,  one-up vertical | Multi | Y | Skip Logic Group | How Did You Find | 
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 | FTC Publication | 
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 | Search engine | 
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 | Another website | 
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 | Referral from another agency, please specify | A | 
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 | Friend/family member | 
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 | Contacted the FTC | 
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 | Other, please specify | A | 
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		| AKR5416 | A | Please let us know how you found us. | 
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 | Text area,  no char limit | 
 | N | Skip Logic Group | OE_How Did You Find | 
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		| AKR5417 | 
 | Was the FTC ComplaintAssistant easy to use? | Yes | 
 | Radio button,  one-up vertical | Single | Y | Skip Logic Group | Easy to Use | 
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 | No | D | 
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 | Not sure | D | 
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		| AKR5418 | D | If it was not easy to use, what did you find difficult? | I did not understand which category I should have selected (i.e. automobile, internet, etc.). | 
 | Checkbox,  one-up vertical | Multi | Y | Skip Logic Group | Difficulties | 
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 | I did not understand what I was supposed to do. | 
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 | I was unable to submit my complaint. | 
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 | Other, please specify | A | 
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		| AKR5419 | A | Please let us know what other difficulties you had. | 
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 | Text area,  no char limit | 
 | N | Skip Logic Group | OE_Difficulties | 
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		| AKR5420 | 
 | If you could make one improvement to the FTC ComplaintAssistant process, what would it be? | 
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 | Text area,  no char limit | 
 | N | 
 | OE_One Improvement | 
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