| Model Instance Name: |
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| FILL IN MEASURE NAME |
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| MID: |
Existing Measure - Please fill in; New Measure - DOT will fill in |
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| Date: |
Fill In Date |
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| Welcome and Thank You Text |
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Directions: |
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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. |
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Examples |
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Welcome Text Example |
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Welcome Text |
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bharati.hulbanni:
if STORES MEASURE:
do NOT use any 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. |
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Thank You Text Example |
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DEFAULT Thank You Text |
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bharati.hulbanni:
TY text can be used for all measure types (call center, web, stores, mobile etc.)
Thank you for taking our survey - and for helping us serve you better. We appreciate your input! |
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ALTERNATE WEB Thank You Text |
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bharati.hulbanni:
Use this TY text ONLY for WEB
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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| Model Instance Name: |
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| FILL IN MEASURE NAME |
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| MID: |
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Existing Measure - Please fill in; New Measure - DOT will fill in |
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| Partitioned (Y/N)? N |
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| FPI Included(Y/N)? N |
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| 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. |
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| Date: |
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1/27/2014 |
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| FILL IN MEASURE NAME |
| Model questions utilize the ForeSee CXA methodology to determine scores and impacts |
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ELEMENTS (drivers of satisfaction) |
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CUSTOMER SATISFACTION |
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FUTURE BEHAVIORS |
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MQ Label |
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MQ Label |
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MQ Label |
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Navigation (1=Poor, 10=Excellent, Don't Know) |
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Satisfaction |
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Use Web Channel Over Others (1=Very Unlikely, 10=Very Likely) |
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Navigation - Organized |
Please rate how well the site is organized. |
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Satisfaction - Overall |
What is your overall satisfaction with this site?
(1=Very Dissatisfied, 10=Very Satisfied) |
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Use Web Channel Over Others |
How likely are you to use this site rather than seeking information from other channels (e.g., telephone)? |
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Navigation - Options |
Please rate the options available for navigating this site. |
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Satisfaction - Expectations |
How well does this site meet your expectations?
(1=Falls Short, 10=Exceeds) |
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Recommend |
Recommend (1=Very Unlikely, 10=Very Likely) |
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Navigation - Layout |
Please rate how well the site layout helps you find what you need. |
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Satisfaction - Ideal |
How does this site compare to your idea of an ideal website?
(1=Not Very Close, 10=Very Close) |
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How likely are you to recommend this site to someone else? |
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Site Performance (1=Poor, 10=Excellent, Don't Know) |
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Return |
Return (1=Very Unlikely, 10=Very Likely) |
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Site Performance - Loading |
Please rate how quickly pages load on this site. |
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How likely are you to return to this site? |
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Site Performance - Consistency |
Please rate the consistency of speed from page to page on this site. |
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Site Performance - Completeness |
Please rate how completely the page content loads on this site. |
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Look and Feel (1=Poor, 10=Excellent, Don't Know) |
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Look and Feel - Appeal |
Please rate the visual appeal of this site. |
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Look and Feel - Balance |
Please rate the balance of graphics and text on this site. |
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Look and Feel - Readability |
Please rate the readability of the pages on this site. |
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Site Information (1=Poor, 10=Excellent, Don't Know) |
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Site Information - Thoroughness |
Please rate the thoroughness of information provided on this site. |
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Site Information - Understandable |
Please rate how understandable this site’s information is. |
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Site Information - Answers |
Please rate how well the site’s information provides answers to your questions. |
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red & strike-through: DELETE |
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underlined & italicized: RE-ORDER |
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pink: ADDITION |
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| 1/27/2014 |
blue + -->: REWORDING |
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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 |
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How frequently do you visit the USDA Food and Nutrition Service website? |
This is my first visit |
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Drop down, select one |
Single |
Y |
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FNS_Visit Frequency |
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Every few months or less often |
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Monthly |
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Weekly |
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Daily/more than once a day |
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What is your role in visiting the USDA Food and Nutrition Service website today? |
General Public |
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Drop down, select one |
Single |
Y |
Skip Logic Group* |
FNS_Role |
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Government Employee |
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USDA FNS Program Advocate |
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Healthcare Professional |
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Recipient of Food Assistance Benefits |
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School Official (e.g., Teacher, Principal, Administrator) |
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Student |
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Media |
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Job Searcher |
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Other (please specify) |
A |
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| A |
Please specify your role: |
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Text area, no char limit |
Single |
N |
Skip Logic Group* |
FNS_OE:Role |
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What is your primary reason for visiting the USDA Food and Nutrition Service website today? |
How to apply for SNAP benefits |
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Drop down, select one |
Single |
Y |
Skip Logic Group* |
FNS_Visit Reason |
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How to apply for WIC benefits |
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Become a SNAP retailer |
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Food safety |
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Child nutrition |
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Disaster assistance |
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Apply for a grant |
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Fact Sheets (e.g., USDA Foods Fact Sheets, etc.) |
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Learn about USDA FNS initiatives (e.g., Farm to School,etc.) |
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Agency information for USDA FNS (e.g., contact, history, careers,etc.) |
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Find volunteer opportunities |
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Other (please specify) |
B |
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| B |
Please tell us your primary reason for visiting: |
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Text area, no char limit |
Single |
N |
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FNS_OE:Reason |
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Did you find what you were looking for on the USDA Food and Nutrition Service website today? |
Yes |
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Drop down, select one |
Single |
Y |
Skip Logic Group* |
FNS_Able To Find |
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No |
C |
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| C |
Please tell us specifically what you were looking for: |
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Text area, no char limit |
Single |
N |
Skip Logic Group* |
FNS_OE:Find |
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How did you look for information on/navigate the USDA Food and Nutrition Service website today? (Please select all that apply) |
Search feature |
D |
Checkbox, one-up vertical |
Multi |
Y |
Skip Logic Group* |
FNS_Look For Info |
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Advanced search feature |
D |
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Top navigation bar |
E |
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Left navigation bar |
E |
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Links in the center of the page |
E |
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A-Z map |
E |
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Site map |
E |
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Other |
E |
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| D |
Please tell us about your experience with the search feature today. (Please select all that apply) |
DOT: mutually exclusive
I had no difficulty using the search feature on this site |
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Checkbox, one-up vertical |
Multi |
N |
Skip Logic Group* |
FNS_Search Experience |
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Results were not relevant/not what I wanted |
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Too many results/I needed to refine my search |
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Not enough results |
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Returned NO results |
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Received error message(s) |
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Search speed was too slow |
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I experienced a different search issue |
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| E |
How would you describe your navigation experience on the USDA Food and Nutrition Service website today? (Please select all that apply) |
DOT: mututally exclusive
I had no difficulty navigating/browsing on this site |
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Checkbox, one-up vertical |
Multi |
N |
Skip Logic Group* |
FNS_Navigation Experience |
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Links often did not take me where I expected |
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Had difficulty finding relevant information |
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Links/labels are difficult to understand |
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Too many links/navigational options to choose from |
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Had technical difficulties (e.g., error messages, broken links, etc.) |
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Could not navigate back to previous information |
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I had a navigation difficulty not listed |
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Do you interact with USDA through any of the following social media sites? (Please select all that apply) |
Facebook |
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Checkbox, one-up vertical |
Multi |
N |
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FNS_SocialMedia |
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Twitter |
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YouTube |
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Flickr |
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ThunderClap |
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DOT: mututally exclusive
No, I do not interact with USDA through social media sites |
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Other |
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If you could make one improvement to the USDA Food and Nutrition Service website, what would it be? |
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Text area, no char limit |
Single |
N |
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FNS_OE:Improvement |
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red & strike-through: DELETE |
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underlined & italicized: RE-ORDER |
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pink: ADDITION |
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| 1/27/2014 |
blue + -->: REWORDING |
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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 |
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How frequently do you visit the Summer Food Service Program pages? |
This is my first visit |
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Drop down, select one |
Single |
Y |
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SFSP_Visit Frequency |
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Every few months or less often |
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Monthly |
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Weekly |
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Daily/more than once a day |
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What is your role in visiting the Summer Food Service Program pages today? |
General Public |
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Drop down, select one |
Single |
Y |
Skip Logic Group* |
SFSP_Role |
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Student |
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Parent |
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School Official (e.g., Teacher, Principal, Administrator) |
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Site Representative for SFSP |
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Sponsor Representative for SFSP |
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Partnering Organization of SFSP |
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Government Employee |
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Media |
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Other (please specify) |
A |
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| A |
Please specify your role: |
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Text area, no char limit |
Single |
N |
Skip Logic Group* |
SFSP_OE:Role |
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What is your primary reason for visiting the Summer Food Service Program pages today? |
How to become a Sponsor (Manages SFSP Feeding Site) |
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Drop down, select one |
Single |
Y |
Skip Logic Group* |
SFSP_Visit Reason |
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How to become a Site (Physical Location to Serve SFSP Meals) |
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Income eligibility guidelines |
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Contact information for state agency |
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Volunteer opportunities |
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State agency toolkit Information (e.g., Policy, Tip Sheets for Gov't) |
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Partnering organizations toolkit information (e.g., Outreach, Hosting Events) |
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Sponsorship toolkit information (e.g., Meal Planning, Vendor Relations) |
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Sites toolkit information (e.g., Site Programming, Sponsor Relations) |
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Other (please specify) |
B |
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| B |
Please tell us your primary reason for visiting: |
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Text area, no char limit |
Single |
N |
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SFSP_OE:Reason |
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Did you find what you were looking for on the Summer Food Service Program pages today? |
Yes |
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Drop down, select one |
Single |
Y |
Skip Logic Group* |
SFSP_Able To Find |
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No |
C |
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| C |
Please tell us specifically what you were looking for: |
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Text area, no char limit |
Single |
N |
Skip Logic Group* |
SFSP_OE:Find |
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How did you look for information on/navigate the Summer Food Service Program pages today? (Please select all that apply) |
Search feature |
D |
Checkbox, one-up vertical |
Multi |
Y |
Skip Logic Group* |
SFSP_Look For Info |
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Advanced search feature |
D |
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Top navigation bar |
E |
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Left navigation bar |
E |
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Links in the center of the page |
E |
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A-Z map |
E |
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Site map |
E |
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Other |
E |
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| D |
Please tell us about your experience with the search feature today. (Please select all that apply) |
DOT: mutually exclusive
I had no difficulty using the search feature on this site |
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Checkbox, one-up vertical |
Multi |
N |
Skip Logic Group* |
SFSP_Search Experience |
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Results were not relevant/not what I wanted |
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Too many results/I needed to refine my search |
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Not enough results |
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Returned NO results |
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Received error message(s) |
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Search speed was too slow |
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I experienced a different search issue |
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| E |
How would you describe your navigation experience on the Summer Food Service Program pages today? (Please select all that apply) |
DOT: mututally exclusive
I had no difficulty navigating/browsing on this site |
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Checkbox, one-up vertical |
Multi |
N |
Skip Logic Group* |
SFSP_Navigation Experience |
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Links often did not take me where I expected |
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Had difficulty finding relevant information |
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Links/labels are difficult to understand |
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Too many links/navigational options to choose from |
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Had technical difficulties (e.g., error messages, broken links, etc.) |
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Could not navigate back to previous information |
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I had a navigation difficulty not listed |
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Do you interact with USDA through any of the following social media sites? (Please select all that apply) |
Facebook |
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Checkbox, one-up vertical |
Multi |
N |
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SFSP_SocialMedia |
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Twitter |
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YouTube |
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Flickr |
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ThunderClap |
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DOT: mututally exclusive
No, I do not interact with USDA through social media sites |
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Other |
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If you could make one improvement to the Summer Food Service Program pages, what would it be? |
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Text area, no char limit |
Single |
N |
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SFSP_OE:Improvement |
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