834 2014 834 SSA iClaim2013

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Overview

Current v3 CQs (EE) (7-23-14)
Current CQs v3 (EN)
Current v3 CQs (SP)
v3 CQs (EE) (7-21-14)
v3 CQs (EE) (7-17-14)
CQs v3 (EN) (7-17-14)
v3 CQs (SP) (7-17-14)
v3 CQs (EE) (6-12-14)
CQs v3 (EN) (6-12-14)
v3 CQs (SP) (6-12-14)
v3 CQs (EE) (12-10-13)
CQs v3 (EN) (12-10-13)
v3 CQs (SP) (12-10-13)
v3 CQs (EE) (8-19-13)
CQs v3 (EN) (8-19-13)
v3 CQs (SP) (8-19-13)

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Sheet 1: Current v3 CQs (EE) (7-23-14)

Model Instance Name:			red & strike-through: DELETE
SSA iClaim v3			underlined & italicized: RE-ORDER
MID: xZAAEQw81gIo1Vo4Noc1Rw4C			pink: ADDITION
Date:	7/15/2011		blue + -->: REWORDING
			violet (bold): SKIP-LOGIC
SSA iClaim v3 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
BJL2231		What type of benefits were you applying for?	Retirement		Dropdown (Select-one)	Single	Y		Type of Benefits
			Medicare only
			Disability
			Both Retirement and Disability
			Spouse's
			Other
CAS0045242		Are you applying online for yourself or are you helping someone else?	Myself		Dropdown (Select-one)	Single	Y		Applying for
			Helping a Spouse/Relative/Friend
			Professional Helping a Client
			Other
CAS0045243		How did you learn about this online application? (Select all that apply.)	Official Social Security website		check box one up vertical	Multi	Y	Skip Logic Group	Learn about App
			A general web search (e.g. Google, Bing, etc.)
			The radio
			The television
			An email from Social Security
			A newspaper or magazine article
			An online ad (Banner/Image)
			An online video
			A newspaper or magazine ad
			A billboard or other printed ad
			Social Media (Blog, Facebook, Twitter, etc.)
			Friend, spouse, relative, neighbor or acquaintance
			Social Security statement
			Social Security employee	A
			Community Group or Association
			Other, please specify	B
CAS0045244	A	How did you make contact with a Social Security employee?	Visited a local Social Security office		check box one up vertical	Multi	Y	Skip Logic	SSA Emplyee Contact
			Called a local Social Security office
			Called the national 800 number
			Other, please specify	AA
CAS0045245	AA	Please describe how you made contact with a Social Security employee.			Text box, no char limit		N	Skip Logic	OPS SSA Employe Contact
CAS0045246	B	Please specify how you learned about this online application.			Text box, no char limit		N	Skip Logic	OPS Learn about App
CAS0045262		Did you use any of the following to prepare to apply online? (Select all that apply.)	Reviewed my online Social Security Statement	A	check box one up vertical	Multi	Y	Skip Logic	Prepare for App
			I used the Retirement Estimator or other tools on the Social Security website	B
			I watched the instructional video	C
			I used other information on the Social Security website to prepare	D
			I used another resource to prepare to apply online	E
			I did not use any resources to prepare to apply online
CAS0045263	A	How helpful did you find the online Social Security Statement?	Very helpful		Drop down select one	Single	Y	Skip Logic	Rate Statement
			Somewhat helpful
			Not at all helpful
CAS0045264	B	How helpful did you find the estimator tools on the website?	Very helpful		Drop down select one	Single	Y	Skip Logic	Rate RE Tools
			Somewhat helpful
			Not at all helpful
CAS0045265	C	How helpful did you find the instructional video?	Very helpful		Drop down select one	Single	Y	Skip Logic	Rate Video
			Somewhat helpful
			Not at all helpful
CAS0045266	D	How helpful did you find the other information on the Social Security website?	Very helpful		Drop down select one	Single	Y	Skip Logic	Rate Other Info on Website
			Somewhat helpful
			Not at all helpful
CAS0045267	E	Please describe what other resource(s) you used to prepare to apply online?			Text field, no char limit		N	Skip Logic	OPS Prepare for App
CAS0045247		Did you start a new online application today or did you return to a saved application?	Started a new application		Drop down select one	Single	Y		App Status
			Returned to work on a saved application
CAS0045282		Did you complete and submit this online application today?	Yes		Drop down select one	Single	Y	Skip Logic	Complete App
			No, I plan to complete and submit later	A
			No, I do not plan to complete and submit the online application	A
CAS0045283	A	If you did not complete and submit this online application today, please tell us why.	Too many questions		check box one up vertical	Multi	Y	Skip Logic	Not Complete App
			Takes too long to fill out
			Too complicated to use without help
			Didn't have information I needed like names, addresses, or dates
			Didn't understand what questions meant/how to answer
			I wanted to use the Retirement Estimator to reconsider my retirement options
			I needed to view my Social Security Statement and/or verify that my earnings record is correct
			My disabling condition prevents me from working with a computer for long periods
			I had a limited amount of time/family demands that kept me from working on it for very long
			I had technical problems like an error message or a mistake I couldn't fix
			Other, please specify	AA
CAS0045284	AA	Please tell us why you did not complete and submit this application today.			Text field, no char limit		N	Skip Logic	OPS Why Not Complete today
CAS0045248		So far, how long have you worked on this online application?	Up to 15 minutes		Drop down select one	Single	Y		Time Spent
			16 minutes - 30 minutes
			31 minutes - 1 hour
			More than 1 hour up to 2 hours
			More than 2 hours
CAS0045249		How easy was it for you to find this online application?	Very easy						Find App
			Somewhat easy
			Somewhat hard	A
			Very hard	A
CAS0045250	A	Please tell us why it was hard to find the online application. (Select all that apply.)	Could not find where to start a new online application		check box one up vertical	Multi	Y	Skip Logic	Why hard to find
			Not clear where to go to return to a previously saved application
			It was not clear to me where the links would lead
			Difficulty using a link on the Social Security website
			The information did not seem to be organized in a logical manner
			I used the search feature but the results didn’t seem to apply.
			I tried to use the FAQ's, but couldn't find the online application
			Other reason (please describe)	AA
CAS0045285	AA	Please explain the reason why it was hard for you to find the online application.			N		N	Skip Logic	OPS Hard to Find
CAS0045286		How did you arrive at this online application today?	Used the Online Services link on the Social Security homepage		Radio Button	Single	Y	Skip Logic	Arrive at App
			Followed a link from somewhere else on the Social Security website
			Used the search feature on the Social Security website
			Used an outside search engine (i.e. Google, Bing, yahoo etc.)
			Followed a link from medicare.gov
			Followed a link from another website
			Site was bookmarked
			Other, please specify	A
CAS0045251	A	Please describe how you arrived at this online application today			Text field, no char limit		N		OPS Arrive at app
CAS0045252		Why did you choose to apply online? (Select all that apply.)	I did not want to go to a local Social Security office		check box one up vertical	Multi	Y	Skip Logic	Why Online
			I did not want to apply over the phone
			I prefer to use online services as much as possible
			I learned about applying online while visiting Social Security's website
			A Social Security employee recommended that I apply online
			A friend or relative recommended that I apply online
			I knew that if I had a question or problem applying online, I could still get help from Social Security
			I am filing on behalf of another person
			Other, please specify	A
CAS0045287	A	Please specify why you choose to apply online			Text field, no char limit		N		OPS Why Online
CAS0045289		What is your current marital status?	Married		Radio button, one-up vertical	Single	N	OPS Group	Marital Status
			Separated
			Divorced
			Widowed
			Never married
			Prefer not to answer
			Other, please specify	A
CAS0045290	A	Other marital status			Text field, <100 char		N	OPS Group	OPS Marital Status
STE0059662		Have you registered for a my Social Security account?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic	Have mySSA Account
			No	A
STE0061423	A	What is the main reason you have not registered for a my Social Security account?	I am unaware of what a my Social Security account is.		Radio button, one-up vertical	Single	Y	Skip Logic	Why Not Have mySSA Account
			I tried to register for a my Social Security account, but was unsuccessful.
			I am currently trying to register for a my Social Security account.
			I do not want a my Social Security account.
			Other (please specify):	AA
STE0061395	AA	Please tell us why you have not registered for a my Social Security account.			Text field, no char limit	Single	N	Skip Logic	OPS_Why Not Have mySSA Account
CAS0045291		Do you have any suggestions for improving Social Security's online application.			Text field, no char limit		N		OE_Improvement

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Sheet 2: Current CQs v3 (EN)

Model Instance Name:			red & strike-through: DELETE
SSA iClaim v3			underlined & italicized: RE-ORDER
MID: VgpBBYx9l8JxIFgJlY1Ikg4C			pink: ADDITION
Date:	7/15/2011		blue + -->: REWORDING
			violet (bold): SKIP-LOGIC
SSA iClaim v3 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
ENBJL2231		What type of benefits were you applying for?	Retirement		Dropdown (Select-one)	Single	Y		Type of Benefits
			Medicare only
			Disability
			Both Retirement and Disability
			Spouse's
			Other
ENCAS0045242		Are you applying online for yourself or are you helping someone else?	Myself		Dropdown (Select-one)	Single	Y		Applying for
			Helping a Spouse/Relative/Friend
			Professional Helping a Client
			Other
ENCAS0045243		How did you learn about this online application? (Select all that apply.)	Official Social Security website		check box one up vertical	Multi	Y	Skip Logic Group	Learn about App
			A general web search (e.g. Google, Bing, etc.)
			The radio
			The television
			An email from Social Security
			A newspaper or magazine article
			An online ad (Banner/Image)
			An online video
			A newspaper or magazine ad
			A billboard or other printed ad
			Social Media (Blog, Facebook, Twitter, etc.)
			Friend, spouse, relative, neighbor or acquaintance
			Social Security statement
			Social Security employee	A
			Community Group or Association
			Other, please specify	B
ENCAS0045244	A	How did you make contact with a Social Security employee?	Visited a local Social Security office		check box one up vertical	Multi	Y	Skip Logic	SSA Emplyee Contact
			Called a local Social Security office
			Called the national 800 number
			Other, please specify	AA
ENCAS0045245	AA	Please describe how you made contact with a Social Security employee.			Text box, no char limit		N	Skip Logic	OPS SSA Employe Contact
ENCAS0045246	B	Please specify how you learned about this online application.			Text box, no char limit		N	Skip Logic	OPS Learn about App
ENCAS0045262		Did you use any of the following to prepare to apply online? (Select all that apply.)	Reviewed my online Social Security Statement	A	check box one up vertical	Multi	Y	Skip Logic	Prepare for App
			I used the Retirement Estimator or other tools on the Social Security website	B
			I watched the instructional video	C
			I used other information on the Social Security website to prepare	D
			I used another resource to prepare to apply online	E
			I did not use any resources to prepare to apply online
ENCAS0045263	A	How helpful did you find the online Social Security Statement?	Very helpful		Drop down select one	Single	Y	Skip Logic	Rate Statement
			Somewhat helpful
			Not at all helpful
ENCAS0045264	B	How helpful did you find the estimator tools on the website?	Very helpful		Drop down select one	Single	Y	Skip Logic	Rate RE Tools
			Somewhat helpful
			Not at all helpful
ENCAS0045265	C	How helpful did you find the instructional video?	Very helpful		Drop down select one	Single	Y	Skip Logic	Rate Video
			Somewhat helpful
			Not at all helpful
ENCAS0045266	D	How helpful did you find the other information on the Social Security website?	Very helpful		Drop down select one	Single	Y	Skip Logic	Rate Other Info on Website
			Somewhat helpful
			Not at all helpful
ENCAS0045267	E	Please describe what other resource(s) you used to prepare to apply online?			Text field, no char limit		N	Skip Logic	OPS Prepare for App
ENCAS0045247		Did you start a new online application today or did you return to a saved application?	Started a new application		Drop down select one	Single	Y		App Status
			Returned to work on a saved application
ENCAS0045282		Did you complete and submit this online application today?	Yes		Drop down select one	Single	Y	Skip Logic	Complete App
			No, I plan to complete and submit later	A
			No, I do not plan to complete and submit the online application	A
ENCAS0045283	A	If you did not complete and submit this online application today, please tell us why.	Too many questions		check box one up vertical	Multi	Y	Skip Logic	Not Complete App
			Takes too long to fill out
			Too complicated to use without help
			Didn't have information I needed like names, addresses, or dates
			Didn't understand what questions meant/how to answer
			I wanted to use the Retirement Estimator to reconsider my retirement options
			I needed to view my Social Security Statement and/or verify that my earnings record is correct
			My disabling condition prevents me from working with a computer for long periods
			I had a limited amount of time/family demands that kept me from working on it for very long
			I had technical problems like an error message or a mistake I couldn't fix
			Other, please specify	AA
ENCAS0045284	AA	Please tell us why you did not complete and submit this application today.			Text field, no char limit		N	Skip Logic	OPS Why Not Complete today
ENCAS0045248		So far, how long have you worked on this online application?	Up to 15 minutes		Drop down select one	Single	Y		Time Spent
			16 minutes - 30 minutes
			31 minutes - 1 hour
			More than 1 hour up to 2 hours
			More than 2 hours
ENCAS0045249		How easy was it for you to find this online application?	Very easy						Find App
			Somewhat easy
			Somewhat hard	A
			Very hard	A
ENCAS0045250	A	Please tell us why it was hard to find the online application. (Select all that apply.)	Could not find where to start a new online application		check box one up vertical	Multi	Y	Skip Logic	Why hard to find
			Not clear where to go to return to a previously saved application
			It was not clear to me where the links would lead
			Difficulty using a link on the Social Security website
			The information did not seem to be organized in a logical manner
			I used the search feature but the results didn’t seem to apply.
			I tried to use the FAQ's, but couldn't find the online application
			Other reason (please describe)	AA
ENCAS0045285	AA	Please explain the reason why it was hard for you to find the online application.			N		N	Skip Logic	OPS Hard to Find
ENCAS0045286		How did you arrive at this online application today?	Used the Online Services link on the Social Security homepage		Radio Button	Single	Y	Skip Logic	Arrive at App
			Followed a link from somewhere else on the Social Security website
			Used the search feature on the Social Security website
			Used an outside search engine (i.e. Google, Bing, yahoo etc.)
			Followed a link from medicare.gov
			Followed a link from another website
			Site was bookmarked
			Other, please specify	A
ENCAS0045251	A	Please describe how you arrived at this online application today			Text field, no char limit		N		OPS Arrive at app
ENCAS0045252		Why did you choose to apply online? (Select all that apply.)	I did not want to go to a local Social Security office		check box one up vertical	Multi	Y	Skip Logic	Why Online
			I did not want to apply over the phone
			I prefer to use online services as much as possible
			I learned about applying online while visiting Social Security's website
			A Social Security employee recommended that I apply online
			A friend or relative recommended that I apply online
			I knew that if I had a question or problem applying online, I could still get help from Social Security
			I am filing on behalf of another person
			Other, please specify	A
ENCAS0045287	A	Please specify why you choose to apply online			Text field, no char limit		N		OPS Why Online
ENCAS0045289		What is your current marital status?	Married		Radio button, one-up vertical	Single	N	OPS Group	Marital Status
			Separated
			Divorced
			Widowed
			Never married
			Prefer not to answer
			Other, please specify	A
ENCAS0045290	A	Other marital status			Text field, <100 char		N	OPS Group	OPS Marital Status
ENSTE0059662		Have you registered for a my Social Security account?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic	Have mySSA Account
			No	A
ENSTE0061423	A	What is the main reason you have not registered for a my Social Security account?	I am unaware of what a my Social Security account is.		Radio button, one-up vertical	Single	Y	Skip Logic	Why Not Have mySSA Account
			I tried to register for a my Social Security account, but was unsuccessful.
			I am currently trying to register for a my Social Security account.
			I do not want a my Social Security account.
			Other (please specify):	AA
ENSTE0061395	AA	Please tell us why you have not registered for a my Social Security account.			Text field, no char limit	Single	N	Skip Logic	OPS_Why Not Have mySSA Account
ENCAS0045291		Do you have any suggestions for improving Social Security's online application.			Text field, no char limit		N		OE_Improvement

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Sheet 3: Current v3 CQs (SP)

Model Instance Name:			red & strike-through: DELETE
SSA iClaim v3 (Spanish)			underlined & italicized: RE-ORDER
MID:	Q0ExM1xNQRl9JJUR0M0JlA4C		pink: ADDITION
Date:	7/15/2011		blue + -->: REWORDING
			violet (bold): SKIP-LOGIC
SSA iClaim v3 (Spanish) 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
SPBJL2231		¿Qué tipo de beneficios estaba solicitando?	Por jubilación		Dropdown (Select-one)	Single	Y		Type of Benefits
			Solo Medicare
			Por incapacidad
			Tanto Jubilación y Discapacidad
			Coomo cónyuge
			Otro
SPCAS0045242		¿Es esta solicitud en línea para sí mismo o estás ayudando a alguien más?	Yo mismo		Dropdown (Select-one)	Single	Y		Applying for
			Cómo ayudar a un cónyuge / pariente / amigo
			Profesional Ayudar a un cliente
			Otro
SPCAS0045243		¿Cómo se enteró acerca de esta solicitud en línea? (Seleccione todas las que apliquen.)	Sitio web oficial de la Seguridad Social		check box one up vertical	Multi	Y	Skip Logic Group	Learn about App
			Una búsqueda web general (por ejemplo, Google, Bing, etc)
			La radio
			La televisión
			Un correo electrónico de la Seguridad Social
			Un periódico o la revista
			Un anuncio en línea (Banner / Imagen)
			Un video en línea
			Un periódico o una revista de anuncios
			Un anuncio impreso cartelera u otro
			Medios de Comunicación Social (Blog, Facebook, Twitter, etc)
			Amigo, cónyuge, pariente, vecino o conocido
			Declaración del Seguro Social
			Empleado del Seguro Social	A
			Grupo de la comunidad o de la Asociación
			Otro, especificar	B
SPCAS0045244	A	¿Cómo se hace el contacto con un empleado del Seguro Social?	Visitado una oficina local del Seguro Social		check box one up vertical	Multi	Y	Skip Logic	SSA Emplyee Contact
			Llamado a la oficina local del Seguro Social
			Llamado el número nacional 800
			Otro, especificar	AA
SPCAS0045245	AA	Por favor describa cómo se hizo contacto con un empleado del Seguro Social.			Text box, no char limit		N	Skip Logic	OPS SSA Employe Contact
SPCAS0045246	B	Por favor, especifique cómo se enteró de esta aplicación en línea.			Text box, no char limit		N	Skip Logic	OPS Learn about App
SPCAS0045262		¿Ha usado alguna de las siguientes acciones para prepararse para aplicar en línea? (Seleccione todas las que apliquen.)	Comentado mi Declaración del Seguro Social en línea	A	check box one up vertical	Multi	Y	Skip Logic	Prepare for App
			He utilizado el Retirement Estimator u otras herramientas en el sitio web de la Seguridad Social	B
			Vi el video de instrucciones	C
			Usé otra información en la página web de la Seguridad Social para preparar	D
			Utilicé otro recurso que se preparen para aplicar en línea	E
			No hice uso de los recursos para prepararse para aplicar en línea
SPCAS0045263	A	¿Qué tan útil ha encontrado el Declaración del Seguro Social en línea?	Muy útil		Drop down select one	Single	Y	Skip Logic	Rate Statement
			algo útil
			Para nada útil
SPCAS0045264	B	¿Qué tan útil encontraste las herramientas estimador en el sitio web?	Muy útil		Drop down select one	Single	Y	Skip Logic	Rate RE Tools
			algo útil
			Para nada útil
SPCAS0045265	C	¿Qué tan útil le parecen la video instructivo?	Muy útil		Drop down select one	Single	Y	Skip Logic	Rate Video
			algo útil
			Para nada útil
SPCAS0045266	D	¿Qué tan útil le parecen la otra información en el sitio web de la Seguridad Social?	Muy útil		Drop down select one	Single	Y	Skip Logic	Rate Other Info on Website
			algo útil
			Para nada útil
SPCAS0045267	E	Por favor describa lo otro recurso (s) que utilizó para prepararse para aplicar en línea.			Text field, no char limit		N	Skip Logic	OPS Prepare for App
SPCAS0045247		¿Comenzó una nueva aplicación en línea hoy mismo o que te vuelva a una solicitud guardada?	Comenzó una nueva aplicación		Drop down select one	Single	Y		App Status
			Volvió a trabajar en una solicitud guardada
SPCAS0045282		¿Sabía usted completar y presentar esta solicitud en línea hoy en día?	Sí		Drop down select one	Single	Y	Skip Logic	Complete App
			No, tengo la intención de completar y enviar más tarde	A
			No, no tengo planes para completar y enviar la solicitud en línea	A
SPCAS0045283	A	Si no logró completar y presentar esta solicitud en línea hoy, por favor díganos por qué.	Demasiadas preguntas		check box one up vertical	Multi	Y	Skip Logic	Not Complete App
			Toma demasiado tiempo para llenar
			Demasiado complicado de usar sin ayuda
			No tenía la información que necesitaba como nombres, direcciones o fechas
			No entendía lo que significaba preguntas / cómo responder
			Que quería utilizar el estimador de jubilación reconsiderar mis opciones
			Que tenía que ver mi Declaración del Seguro Social y / o comprobar que mi registro de ganancias es el correcto
			Mi condición de discapacidad me impide trabajar con una computadora por largos periodos
			Yo tenía una cantidad limitada de demandas de tiempo / de la familia que me impedía trabajar en ella por mucho tiempo
			Tuve problemas técnicos, como un mensaje de error o un error que no podía fijar
			Otro, especificar	AA
SPCAS0045284	AA	Haznos saber por qué no se ha completado y se somete esta solicitud hoy.			Text field, no char limit		N	Skip Logic	OPS Why Not Complete today
SPCAS0045248		Hasta el momento, ¿cuánto tiempo ha trabajado en esta solicitud en línea?	Hasta 15 minutos		Drop down select one	Single	Y		Time Spent
			16 minutos - 30 minutos
			31 minutos - 1 hora
			Más de 1 hora hasta 2 horas
			Más de 2 horas
SPCAS0045249		¿Fue fácil para usted para encontrar esta aplicación en línea?	Muy fácil						Find App
			algo fácil
			algo duro	A
			Muy difícil	A
SPCAS0045250	A	Haznos saber por qué era difícil encontrar la aplicación en línea. (Seleccione todas las que apliquen.)	No se pudo encontrar por dónde empezar una nueva aplicación en línea		check box one up vertical	Multi	Y	Skip Logic	Why hard to find
			Donde no está claro que vaya a volver a una solicitud previamente guardada
			No estaba claro para mí cuando los vínculos conducirían
			Dificultad para utilizar un enlace en la página web de la Seguridad Social
			La información no parecía estar organizados de una manera lógica
			Usé la función de búsqueda, pero los resultados no parecen aplicarse.
			Traté de usar el FAQ, pero no pude encontrar la solicitud en línea
			Otro, especificar	AA
SPCAS0045285	AA	Por favor, explique la razón por la que era difícil para usted para encontrar la solicitud en línea.			N		N	Skip Logic	OPS Hard to Find
SPCAS0045286		¿Cómo llegaste a esta solicitud en línea hoy en día?	Se utiliza el enlace de los servicios en línea en la página web de la Seguridad Social		Radio Button	Single	Y	Skip Logic	Arrive at App
			Seguido de un enlace de algún otro lugar en el sitio web de la Seguridad Social
			Se utiliza la función de búsqueda en la página web de la Seguridad Social
			Se utiliza un motor de búsqueda fuera (es decir, Google, Bing, Yahoo, etc)
			Seguido de un enlace desde medicare.gov
			Seguido un enlace desde otro sitio web
			Este sitio fue bookmarked
			Otro, especificar	A
SPCAS0045251	A	Por favor describa cómo llegó a esta solicitud en línea hoy			Text field, no char limit		N		OPS Arrive at app
SPCAS0045252		¿Por qué eligió para aplicar en línea? (Seleccione todas las que apliquen.)	Yo no quería ir a una oficina local del Seguro Social		check box one up vertical	Multi	Y	Skip Logic	Why Online
			Yo no quería que la solicitud por teléfono
			Yo prefiero usar los servicios en línea tanto como sea posible
			Aprendí acerca de la aplicación en línea durante su visita a la página web de la Seguridad Social
			Un empleado del Seguro Social recomienda que aplico en línea
			Un amigo o familiar recomendaron que aplico en línea
			Yo sabía que si tenía alguna pregunta o problema la aplicación en línea, todavía podía recibir ayuda de la Seguridad Social
			Estoy presentando en nombre de otra persona
			Otro, especificar	A
SPCAS0045287	A	Por favor, especifique qué decide aplicar en línea			Text field, no char limit		N		OPS Why Online
SPCAS0045289		¿Cuál es su estado civil actual?	casado		Radio button, one-up vertical	Single	N	OPS Group	Marital Status
			apartado
			divorciado
			viudo
		`	Nunca se ha casado
			Prefiero no responder
			Otro, especificar	A
SPCAS0045290	A	Otro estado civil			Text field, <100 char		N	OPS Group	OPS Marital Status
ENSTE0059662		¿Ya se registró para una cuenta de mi Seguro Social?	Sí		Radio button, one-up vertical	Single	Y	Skip Logic	Have mySSA Account
			No	A
SPSTE0061423	A	¿Cuál es la razón principal por la que no se haya registrado para una cuenta de mi Seguro Social?	No tengo conocimiento de lo que una cuenta de mi Seguro Social es.		Radio button, one-up vertical	Single	Y	Skip Logic	Why Not Have mySSA Account
			Traté de registrar una cuenta de mi Seguro Social, pero no tuvo éxito.
			Actualmente estoy tratando de registrar una cuenta de mi Seguro Social.
			Yo no quiero una cuenta de mi Seguro Social.
			Otro (especificar):	AA
SPSTE0061395	AA	Por favor, díganos por qué usted no está registrado para obtener una cuenta de mi Seguridad Social.			Text field, no char limit	Single	N	Skip Logic	OPS_Why Not Have mySSA Account
SPCAS0045291		¿Tiene alguna sugerencia para mejorar la aplicación en línea de la Seguridad Social?			Text field, no char limit		N		OE_Improvement

---

Sheet 4: v3 CQs (EE) (7-21-14)

Model Instance Name:			red & strike-through: DELETE
SSA iClaim v3			underlined & italicized: RE-ORDER
MID: xZAAEQw81gIo1Vo4Noc1Rw4C			pink: ADDITION
Date:	7/15/2011		blue + -->: REWORDING
			violet (bold): SKIP-LOGIC
SSA iClaim v3 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
BJL2231		What type of benefits were you applying for?	Retirement		Dropdown (Select-one)	Single	Y		Type of Benefits
			Medicare only
			Disability
			Both Retirement and Disability
			Spouse's
			Other
CAS0045242		Are you applying online for yourself or are you helping someone else?	Myself		Dropdown (Select-one)	Single	Y		Applying for
			Helping a Spouse/Relative/Friend
			Professional Helping a Client
			Other
CAS0045243		How did you learn about this online application? (Select all that apply.)	Official Social Security website		check box one up vertical	Multi	Y	Skip Logic Group	Learn about App
			A general web search (e.g. Google, Bing, etc.)
			The radio
			The television
			An email from Social Security
			A newspaper or magazine article
			An online ad (Banner/Image)
			An online video
			A newspaper or magazine ad
			A billboard or other printed ad
			Social Media (Blog, Facebook, Twitter, etc.)
			Friend, spouse, relative, neighbor or acquaintance
			Social Security statement
			Social Security employee	A
			Community Group or Association
			Other, please specify	B
CAS0045244	A	How did you make contact with a Social Security employee?	Visited a local Social Security office		check box one up vertical	Multi	Y	Skip Logic	SSA Emplyee Contact
			Called a local Social Security office
			Called the national 800 number
			Other, please specify	AA
CAS0045245	AA	Please describe how you made contact with a Social Security employee.			Text box, no char limit		N	Skip Logic	OPS SSA Employe Contact
CAS0045246	B	Please specify how you learned about this online application.			Text box, no char limit		N	Skip Logic	OPS Learn about App
CAS0045262		Did you use any of the following to prepare to apply online? (Select all that apply.)	Reviewed my online Social Security Statement	A	check box one up vertical	Multi	Y	Skip Logic	Prepare for App
			I used the Retirement Estimator or other tools on the Social Security website	B
			I watched the instructional video	C
			I used other information on the Social Security website to prepare	D
			I used another resource to prepare to apply online	E
			I did not use any resources to prepare to apply online
CAS0045263	A	How helpful did you find the online Social Security Statement?	Very helpful		Drop down select one	Single	Y	Skip Logic	Rate Statement
			Somewhat helpful
			Not at all helpful
CAS0045264	B	How helpful did you find the estimator tools on the website?	Very helpful		Drop down select one	Single	Y	Skip Logic	Rate RE Tools
			Somewhat helpful
			Not at all helpful
CAS0045265	C	How helpful did you find the instructional video?	Very helpful		Drop down select one	Single	Y	Skip Logic	Rate Video
			Somewhat helpful
			Not at all helpful
CAS0045266	D	How helpful did you find the other information on the Social Security website?	Very helpful		Drop down select one	Single	Y	Skip Logic	Rate Other Info on Website
			Somewhat helpful
			Not at all helpful
CAS0045267	E	Please describe what other resource(s) you used to prepare to apply online?			Text field, no char limit		N	Skip Logic	OPS Prepare for App
CAS0045247		Did you start a new online application today or did you return to a saved application?	Started a new application		Drop down select one	Single	Y		App Status
			Returned to work on a saved application
CAS0045282		Did you complete and submit this online application today?	Yes		Drop down select one	Single	Y	Skip Logic	Complete App
			No, I plan to complete and submit later	A
			No, I do not plan to complete and submit the online application	A
CAS0045283	A	If you did not complete and submit this online application today, please tell us why.	Too many questions		check box one up vertical	Multi	Y	Skip Logic	Not Complete App
			Takes too long to fill out
			Too complicated to use without help
			Didn't have information I needed like names, addresses, or dates
			Didn't understand what questions meant/how to answer
			I wanted to use the Retirement Estimator to reconsider my retirement options
			I needed to view my Social Security Statement and/or verify that my earnings record is correct
			My disabling condition prevents me from working with a computer for long periods
			I had a limited amount of time/family demands that kept me from working on it for very long
			I had technical problems like an error message or a mistake I couldn't fix
			Other, please specify	AA
CAS0045284	AA	Please tell us why you did not complete and submit this application today.			Text field, no char limit		N	Skip Logic	OPS Why Not Complete today
CAS0045248		So far, how long have you worked on this online application?	Up to 15 minutes		Drop down select one	Single	Y		Time Spent
			16 minutes - 30 minutes
			31 minutes - 1 hour
			More than 1 hour up to 2 hours
			More than 2 hours
CAS0045249		How easy was it for you to find this online application?	Very easy						Find App
			Somewhat easy
			Somewhat hard	A
			Very hard	A
CAS0045250	A	Please tell us why it was hard to find the online application. (Select all that apply.)	Could not find where to start a new online application		check box one up vertical	Multi	Y	Skip Logic	Why hard to find
			Not clear where to go to return to a previously saved application
			It was not clear to me where the links would lead
			Difficulty using a link on the Social Security website
			The information did not seem to be organized in a logical manner
			I used the search feature but the results didn’t seem to apply.
			I tried to use the FAQ's, but couldn't find the online application
			Other reason (please describe)	AA
CAS0045285	AA	Please explain the reason why it was hard for you to find the online application.			N		N	Skip Logic	OPS Hard to Find
CAS0045286		How did you arrive at this online application today?	Used the Online Services link on the Social Security homepage		Radio Button	Single	Y	Skip Logic	Arrive at App
			Followed a link from somewhere else on the Social Security website
			Used the search feature on the Social Security website
			Used an outside search engine (i.e. Google, Bing, yahoo etc.)
			Followed a link from medicare.gov
			Followed a link from another website
			Site was bookmarked
			Other, please specify	A
CAS0045251	A	Please describe how you arrived at this online application today			Text field, no char limit		N		OPS Arrive at app
CAS0045252		Why did you choose to apply online? (Select all that apply.)	I did not want to go to a local Social Security office		check box one up vertical	Multi	Y	Skip Logic	Why Online
			I did not want to apply over the phone
			I prefer to use online services as much as possible
			I learned about applying online while visiting Social Security's website
			A Social Security employee recommended that I apply online
			A friend or relative recommended that I apply online
			I knew that if I had a question or problem applying online, I could still get help from Social Security
			I am filing on behalf of another person
			Other, please specify	A
CAS0045287	A	Please specify why you choose to apply online			Text field, no char limit		N		OPS Why Online
CAS0045289		What is your current marital status?	Married		Radio button, one-up vertical	Single	N	OPS Group	Marital Status
			Separated
			Divorced
			Widowed
			Never married
			Prefer not to answer
			Other, please specify	A
CAS0045290	A	Other marital status			Text field, <100 char		N	OPS Group	OPS Marital Status
STE0059662		Have you registered for a my Social Security account?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic	Have mySSA Account
			No	A
STE0061423	A	What is the main reason you have not registered for a my Social Security account?	I am unaware of what a my Social Security account is.		Radio button, one-up vertical	Single	Y	Skip Logic	Why Not Have mySSA Account
			I tried to register for a my Social Security account, but was unsuccessful.
			I am currently trying to register for a my Social Security account.
			I do not want a my Social Security account.
			Other (please specify):	AA
STE0061395	AA	Please tell us why you have not registered for a my Social Security account.			Text field, no char limit	Single	N	Skip Logic	OPS_Why Not Have mySSA Account
CAS0045291		Do you have any suggestions for improving Social Security's online application.			Text field, no char limit		N		OE_Improvement

---

Sheet 5: v3 CQs (EE) (7-17-14)

Model Instance Name:			red & strike-through: DELETE
SSA iClaim v3			underlined & italicized: RE-ORDER
MID: xZAAEQw81gIo1Vo4Noc1Rw4C			pink: ADDITION
Date:	7/15/2011		blue + -->: REWORDING
			violet (bold): SKIP-LOGIC
SSA iClaim v3 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
BJL2231		What type of benefits were you applying for?	Retirement		Dropdown (Select-one)	Single	Y		Type of Benefits
			Medicare only
			Disability
			Both Retirement and Disability
			Spouse's
			Other
CAS0045242		Are you applying online for yourself or are you helping someone else?	Myself		Dropdown (Select-one)	Single	Y		Applying for
			Helping a Spouse/Relative/Friend
			Professional Helping a Client
			Other
CAS0045243		How did you learn about this online application? (Select all that apply.)	Official Social Security website		check box one up vertical	Multi	Y	Skip Logic Group	Learn about App
			A general web search (e.g. Google, Bing, etc.)
			The radio
			The television
			An email from Social Security
			A newspaper or magazine article
			An online ad (Banner/Image)
			An online video
			A newspaper or magazine ad
			A billboard or other printed ad
			Social Media (Blog, Facebook, Twitter, etc.)
			Friend, spouse, relative, neighbor or acquaintance
			Social Security statement
			Social Security employee	A
			Community Group or Association
			Other, please specify	B
CAS0045244	A	How did you make contact with a Social Security employee?	Visited a local Social Security office		check box one up vertical	Multi	Y	Skip Logic	SSA Emplyee Contact
			Called a local Social Security office
			Called the national 800 number
			Other, please specify	AA
CAS0045245	AA	Please describe how you made contact with a Social Security employee.			Text box, no char limit		N	Skip Logic	OPS SSA Employe Contact
CAS0045246	B	Please specify how you learned about this online application.			Text box, no char limit		N	Skip Logic	OPS Learn about App
CAS0045262		Did you use any of the following to prepare to apply online? (Select all that apply.)	Reviewed my online Social Security Statement	A	check box one up vertical	Multi	Y	Skip Logic	Prepare for App
			I used the Retirement Estimator or other tools on the Social Security website	B
			I watched the instructional video	C
			I used other information on the Social Security website to prepare	D
			I used another resource to prepare to apply online	E
			I did not use any resources to prepare to apply online
CAS0045263	A	How helpful did you find the online Social Security Statement?	Very helpful		Drop down select one	Single	Y	Skip Logic	Rate Statement
			Somewhat helpful
			Not at all helpful
CAS0045264	B	How helpful did you find the estimator tools on the website?	Very helpful		Drop down select one	Single	Y	Skip Logic	Rate RE Tools
			Somewhat helpful
			Not at all helpful
CAS0045265	C	How helpful did you find the instructional video?	Very helpful		Drop down select one	Single	Y	Skip Logic	Rate Video
			Somewhat helpful
			Not at all helpful
CAS0045266	D	How helpful did you find the other information on the Social Security website?	Very helpful		Drop down select one	Single	Y	Skip Logic	Rate Other Info on Website
			Somewhat helpful
			Not at all helpful
CAS0045267	E	Please describe what other resource(s) you used to prepare to apply online?			Text field, no char limit		N	Skip Logic	OPS Prepare for App
CAS0045247		Did you start a new online application today or did you return to a saved application?	Started a new application		Drop down select one	Single	Y		App Status
			Returned to work on a saved application
CAS0045282		Did you complete and submit this online application today?	Yes		Drop down select one	Single	Y	Skip Logic	Complete App
			No, I plan to complete and submit later	A
			No, I do not plan to complete and submit the online application	A
CAS0045283	A	If you did not complete and submit this online application today, please tell us why.	Too many questions		check box one up vertical	Multi	Y	Skip Logic	Not Complete App
			Takes too long to fill out
			Too complicated to use without help
			Didn't have information I needed like names, addresses, or dates
			Didn't understand what questions meant/how to answer
			My disabling condition prevents me from working with a computer for long periods
			I had a limited amount of time/family demands that kept me from working on it for very long
			I had technical problems like an error message or a mistake I couldn't fix
			Other, please specify	AA
CAS0045284	AA	Please tell us why you did not complete and submit this application today.			Text field, no char limit		N	Skip Logic	OPS Why Not Complete today
CAS0045248		So far, how long have you worked on this online application?	Up to 15 minutes		Drop down select one	Single	Y		Time Spent
			16 minutes - 30 minutes
			31 minutes - 1 hour
			More than 1 hour up to 2 hours
			More than 2 hours
CAS0045249		How easy was it for you to find this online application?	Very easy						Find App
			Somewhat easy
			Somewhat hard	A
			Very hard	A
CAS0045250	A	Please tell us why it was hard to find the online application. (Select all that apply.)	Could not find where to start a new online application		check box one up vertical	Multi	Y	Skip Logic	Why hard to find
			Not clear where to go to return to a previously saved application
			It was not clear to me where the links would lead
			Difficulty using a link on the Social Security website
			The information did not seem to be organized in a logical manner
			I used the search feature but the results didn’t seem to apply.
			I tried to use the FAQ's, but couldn't find the online application
			Other reason (please describe)	AA
CAS0045285	AA	Please explain the reason why it was hard for you to find the online application.			N		N	Skip Logic	OPS Hard to Find
CAS0045286		How did you arrive at this online application today?	Used the Online Services link on the Social Security homepage		Radio Button	Single	Y	Skip Logic	Arrive at App
			Followed a link from somewhere else on the Social Security website
			Used the search feature on the Social Security website
			Used an outside search engine (i.e. Google, Bing, yahoo etc.)
			Followed a link from medicare.gov
			Followed a link from another website
			Site was bookmarked
			Other, please specify	A
CAS0045251	A	Please describe how you arrived at this online application today			Text field, no char limit		N		OPS Arrive at app
CAS0045252		Why did you choose to apply online? (Select all that apply.)	I did not want to go to a local Social Security office		check box one up vertical	Multi	Y	Skip Logic	Why Online
			I did not want to apply over the phone
			I prefer to use online services as much as possible
			I learned about applying online while visiting Social Security's website
			A Social Security employee recommended that I apply online
			A friend or relative recommended that I apply online
			I knew that if I had a question or problem applying online, I could still get help from Social Security
			I am filing on behalf of another person
			Other, please specify	A
CAS0045287	A	Please specify why you choose to apply online			Text field, no char limit		N		OPS Why Online
CAS0045289		What is your current marital status?	Married		Radio button, one-up vertical	Single	N	OPS Group	Marital Status
			Separated
			Divorced
			Widowed
			Never married
			Prefer not to answer
			Other, please specify	A
CAS0045290	A	Other marital status			Text field, <100 char		N	OPS Group	OPS Marital Status
STE0059662		Have you registered for a my Social Security account?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic	Have mySSA Account
			No	A
	A	What is the main reason you have not registered for a my Social Security account?	I am unaware of what a my Social Security account is.		Radio button, one-up vertical	Single	Y	Skip Logic	Why Not Have mySSA Account
			I tried to register for a my Social Security account, but was unsuccessful.
			I am currently trying to register for a my Social Security account.
			I do not want a my Social Security account.
			Other (please specify):	AA
	AA	Please tell us why you have not registered for a my Social Security account.			Text field, no char limit	Single	N	Skip Logic	OPS_Why Not Have mySSA Account
CAS0045291		Do you have any suggestions for improving Social Security's online application.			Text field, no char limit		N		OE_Improvement

---

Sheet 6: CQs v3 (EN) (7-17-14)

Model Instance Name:			red & strike-through: DELETE
SSA iClaim v3			underlined & italicized: RE-ORDER
MID: VgpBBYx9l8JxIFgJlY1Ikg4C			pink: ADDITION
Date:	7/15/2011		blue + -->: REWORDING
			violet (bold): SKIP-LOGIC
SSA iClaim v3 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
ENBJL2231		What type of benefits were you applying for?	Retirement		Dropdown (Select-one)	Single	Y		Type of Benefits
			Medicare only
			Disability
			Both Retirement and Disability
			Spouse's
			Other
ENCAS0045242		Are you applying online for yourself or are you helping someone else?	Myself		Dropdown (Select-one)	Single	Y		Applying for
			Helping a Spouse/Relative/Friend
			Professional Helping a Client
			Other
ENCAS0045243		How did you learn about this online application? (Select all that apply.)	Official Social Security website		check box one up vertical	Multi	Y	Skip Logic Group	Learn about App
			A general web search (e.g. Google, Bing, etc.)
			The radio
			The television
			An email from Social Security
			A newspaper or magazine article
			An online ad (Banner/Image)
			An online video
			A newspaper or magazine ad
			A billboard or other printed ad
			Social Media (Blog, Facebook, Twitter, etc.)
			Friend, spouse, relative, neighbor or acquaintance
			Social Security statement
			Social Security employee	A
			Community Group or Association
			Other, please specify	B
ENCAS0045244	A	How did you make contact with a Social Security employee?	Visited a local Social Security office		check box one up vertical	Multi	Y	Skip Logic	SSA Emplyee Contact
			Called a local Social Security office
			Called the national 800 number
			Other, please specify	AA
ENCAS0045245	AA	Please describe how you made contact with a Social Security employee.			Text box, no char limit		N	Skip Logic	OPS SSA Employe Contact
ENCAS0045246	B	Please specify how you learned about this online application.			Text box, no char limit		N	Skip Logic	OPS Learn about App
ENCAS0045262		Did you use any of the following to prepare to apply online? (Select all that apply.)	Reviewed my online Social Security Statement	A	check box one up vertical	Multi	Y	Skip Logic	Prepare for App
			I used the Retirement Estimator or other tools on the Social Security website	B
			I watched the instructional video	C
			I used other information on the Social Security website to prepare	D
			I used another resource to prepare to apply online	E
			I did not use any resources to prepare to apply online
ENCAS0045263	A	How helpful did you find the online Social Security Statement?	Very helpful		Drop down select one	Single	Y	Skip Logic	Rate Statement
			Somewhat helpful
			Not at all helpful
ENCAS0045264	B	How helpful did you find the estimator tools on the website?	Very helpful		Drop down select one	Single	Y	Skip Logic	Rate RE Tools
			Somewhat helpful
			Not at all helpful
ENCAS0045265	C	How helpful did you find the instructional video?	Very helpful		Drop down select one	Single	Y	Skip Logic	Rate Video
			Somewhat helpful
			Not at all helpful
ENCAS0045266	D	How helpful did you find the other information on the Social Security website?	Very helpful		Drop down select one	Single	Y	Skip Logic	Rate Other Info on Website
			Somewhat helpful
			Not at all helpful
ENCAS0045267	E	Please describe what other resource(s) you used to prepare to apply online?			Text field, no char limit		N	Skip Logic	OPS Prepare for App
ENCAS0045247		Did you start a new online application today or did you return to a saved application?	Started a new application		Drop down select one	Single	Y		App Status
			Returned to work on a saved application
ENCAS0045282		Did you complete and submit this online application today?	Yes		Drop down select one	Single	Y	Skip Logic	Complete App
			No, I plan to complete and submit later	A
			No, I do not plan to complete and submit the online application	A
ENCAS0045283	A	If you did not complete and submit this online application today, please tell us why.	Too many questions		check box one up vertical	Multi	Y	Skip Logic	Not Complete App
			Takes too long to fill out
			Too complicated to use without help
			Didn't have information I needed like names, addresses, or dates
			Didn't understand what questions meant/how to answer
			My disabling condition prevents me from working with a computer for long periods
			I had a limited amount of time/family demands that kept me from working on it for very long
			I had technical problems like an error message or a mistake I couldn't fix
			Other, please specify	AA
ENCAS0045284	AA	Please tell us why you did not complete and submit this application today.			Text field, no char limit		N	Skip Logic	OPS Why Not Complete today
ENCAS0045248		So far, how long have you worked on this online application?	Up to 15 minutes		Drop down select one	Single	Y		Time Spent
			16 minutes - 30 minutes
			31 minutes - 1 hour
			More than 1 hour up to 2 hours
			More than 2 hours
ENCAS0045249		How easy was it for you to find this online application?	Very easy						Find App
			Somewhat easy
			Somewhat hard	A
			Very hard	A
ENCAS0045250	A	Please tell us why it was hard to find the online application. (Select all that apply.)	Could not find where to start a new online application		check box one up vertical	Multi	Y	Skip Logic	Why hard to find
			Not clear where to go to return to a previously saved application
			It was not clear to me where the links would lead
			Difficulty using a link on the Social Security website
			The information did not seem to be organized in a logical manner
			I used the search feature but the results didn’t seem to apply.
			I tried to use the FAQ's, but couldn't find the online application
			Other reason (please describe)	AA
ENCAS0045285	AA	Please explain the reason why it was hard for you to find the online application.			N		N	Skip Logic	OPS Hard to Find
ENCAS0045286		How did you arrive at this online application today?	Used the Online Services link on the Social Security homepage		Radio Button	Single	Y	Skip Logic	Arrive at App
			Followed a link from somewhere else on the Social Security website
			Used the search feature on the Social Security website
			Used an outside search engine (i.e. Google, Bing, yahoo etc.)
			Followed a link from medicare.gov
			Followed a link from another website
			Site was bookmarked
			Other, please specify	A
ENCAS0045251	A	Please describe how you arrived at this online application today			Text field, no char limit		N		OPS Arrive at app
ENCAS0045252		Why did you choose to apply online? (Select all that apply.)	I did not want to go to a local Social Security office		check box one up vertical	Multi	Y	Skip Logic	Why Online
			I did not want to apply over the phone
			I prefer to use online services as much as possible
			I learned about applying online while visiting Social Security's website
			A Social Security employee recommended that I apply online
			A friend or relative recommended that I apply online
			I knew that if I had a question or problem applying online, I could still get help from Social Security
			I am filing on behalf of another person
			Other, please specify	A
ENCAS0045287	A	Please specify why you choose to apply online			Text field, no char limit		N		OPS Why Online
ENCAS0045289		What is your current marital status?	Married		Radio button, one-up vertical	Single	N	OPS Group	Marital Status
			Separated
			Divorced
			Widowed
			Never married
			Prefer not to answer
			Other, please specify	A
ENCAS0045290	A	Other marital status			Text field, <100 char		N	OPS Group	OPS Marital Status
ENSTE0059662		Have you registered for a my Social Security account?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic	Have mySSA Account
			No	A
	A	What is the main reason you have not registered for a my Social Security account?	I am unaware of what a my Social Security account is.		Radio button, one-up vertical	Single	Y	Skip Logic	Why Not Have mySSA Account
			I tried to register for a my Social Security account, but was unsuccessful.
			I am currently trying to register for a my Social Security account.
			I do not want a my Social Security account.
			Other (please specify):	AA
	AA	Please tell us why you have not registered for a my Social Security account.			Text field, no char limit	Single	N	Skip Logic	OPS_Why Not Have mySSA Account
ENCAS0045291		Do you have any suggestions for improving Social Security's online application.			Text field, no char limit		N		OE_Improvement

---

Sheet 7: v3 CQs (SP) (7-17-14)

Model Instance Name:			red & strike-through: DELETE
SSA iClaim v3 (Spanish)			underlined & italicized: RE-ORDER
MID:	Q0ExM1xNQRl9JJUR0M0JlA4C		pink: ADDITION
Date:	7/15/2011		blue + -->: REWORDING
			violet (bold): SKIP-LOGIC
SSA iClaim v3 (Spanish) 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
SPBJL2231		¿Qué tipo de beneficios estaba solicitando?	Por jubilación		Dropdown (Select-one)	Single	Y		Type of Benefits
			Solo Medicare
			Por incapacidad
			Tanto Jubilación y Discapacidad
			Coomo cónyuge
			Otro
SPCAS0045242		¿Es esta solicitud en línea para sí mismo o estás ayudando a alguien más?	Yo mismo		Dropdown (Select-one)	Single	Y		Applying for
			Cómo ayudar a un cónyuge / pariente / amigo
			Profesional Ayudar a un cliente
			Otro
SPCAS0045243		¿Cómo se enteró acerca de esta solicitud en línea? (Seleccione todas las que apliquen.)	Sitio web oficial de la Seguridad Social		check box one up vertical	Multi	Y	Skip Logic Group	Learn about App
			Una búsqueda web general (por ejemplo, Google, Bing, etc)
			La radio
			La televisión
			Un correo electrónico de la Seguridad Social
			Un periódico o la revista
			Un anuncio en línea (Banner / Imagen)
			Un video en línea
			Un periódico o una revista de anuncios
			Un anuncio impreso cartelera u otro
			Medios de Comunicación Social (Blog, Facebook, Twitter, etc)
			Amigo, cónyuge, pariente, vecino o conocido
			Declaración del Seguro Social
			Empleado del Seguro Social	A
			Grupo de la comunidad o de la Asociación
			Otro, especificar	B
SPCAS0045244	A	¿Cómo se hace el contacto con un empleado del Seguro Social?	Visitado una oficina local del Seguro Social		check box one up vertical	Multi	Y	Skip Logic	SSA Emplyee Contact
			Llamado a la oficina local del Seguro Social
			Llamado el número nacional 800
			Otro, especificar	AA
SPCAS0045245	AA	Por favor describa cómo se hizo contacto con un empleado del Seguro Social.			Text box, no char limit		N	Skip Logic	OPS SSA Employe Contact
SPCAS0045246	B	Por favor, especifique cómo se enteró de esta aplicación en línea.			Text box, no char limit		N	Skip Logic	OPS Learn about App
SPCAS0045262		¿Ha usado alguna de las siguientes acciones para prepararse para aplicar en línea? (Seleccione todas las que apliquen.)	Comentado mi Declaración del Seguro Social en línea	A	check box one up vertical	Multi	Y	Skip Logic	Prepare for App
			He utilizado el Retirement Estimator u otras herramientas en el sitio web de la Seguridad Social	B
			Vi el video de instrucciones	C
			Usé otra información en la página web de la Seguridad Social para preparar	D
			Utilicé otro recurso que se preparen para aplicar en línea	E
			No hice uso de los recursos para prepararse para aplicar en línea
SPCAS0045263	A	¿Qué tan útil ha encontrado el Declaración del Seguro Social en línea?	Muy útil		Drop down select one	Single	Y	Skip Logic	Rate Statement
			algo útil
			Para nada útil
SPCAS0045264	B	¿Qué tan útil encontraste las herramientas estimador en el sitio web?	Muy útil		Drop down select one	Single	Y	Skip Logic	Rate RE Tools
			algo útil
			Para nada útil
SPCAS0045265	C	¿Qué tan útil le parecen la video instructivo?	Muy útil		Drop down select one	Single	Y	Skip Logic	Rate Video
			algo útil
			Para nada útil
SPCAS0045266	D	¿Qué tan útil le parecen la otra información en el sitio web de la Seguridad Social?	Muy útil		Drop down select one	Single	Y	Skip Logic	Rate Other Info on Website
			algo útil
			Para nada útil
SPCAS0045267	E	Por favor describa lo otro recurso (s) que utilizó para prepararse para aplicar en línea.			Text field, no char limit		N	Skip Logic	OPS Prepare for App
SPCAS0045247		¿Comenzó una nueva aplicación en línea hoy mismo o que te vuelva a una solicitud guardada?	Comenzó una nueva aplicación		Drop down select one	Single	Y		App Status
			Volvió a trabajar en una solicitud guardada
SPCAS0045282		¿Sabía usted completar y presentar esta solicitud en línea hoy en día?	Sí		Drop down select one	Single	Y	Skip Logic	Complete App
			No, tengo la intención de completar y enviar más tarde	A
			No, no tengo planes para completar y enviar la solicitud en línea	A
SPCAS0045283	A	Si no logró completar y presentar esta solicitud en línea hoy, por favor díganos por qué.	Demasiadas preguntas		check box one up vertical	Multi	Y	Skip Logic	Not Complete App
			Toma demasiado tiempo para llenar
			Demasiado complicado de usar sin ayuda
			No tenía la información que necesitaba como nombres, direcciones o fechas
			No entendía lo que significaba preguntas / cómo responder
			Mi condición de discapacidad me impide trabajar con una computadora por largos periodos
			Yo tenía una cantidad limitada de demandas de tiempo / de la familia que me impedía trabajar en ella por mucho tiempo
			Tuve problemas técnicos, como un mensaje de error o un error que no podía fijar
			Otro, especificar	AA
SPCAS0045284	AA	Haznos saber por qué no se ha completado y se somete esta solicitud hoy.			Text field, no char limit		N	Skip Logic	OPS Why Not Complete today
SPCAS0045248		Hasta el momento, ¿cuánto tiempo ha trabajado en esta solicitud en línea?	Hasta 15 minutos		Drop down select one	Single	Y		Time Spent
			16 minutos - 30 minutos
			31 minutos - 1 hora
			Más de 1 hora hasta 2 horas
			Más de 2 horas
SPCAS0045249		¿Fue fácil para usted para encontrar esta aplicación en línea?	Muy fácil						Find App
			algo fácil
			algo duro	A
			Muy difícil	A
SPCAS0045250	A	Haznos saber por qué era difícil encontrar la aplicación en línea. (Seleccione todas las que apliquen.)	No se pudo encontrar por dónde empezar una nueva aplicación en línea		check box one up vertical	Multi	Y	Skip Logic	Why hard to find
			Donde no está claro que vaya a volver a una solicitud previamente guardada
			No estaba claro para mí cuando los vínculos conducirían
			Dificultad para utilizar un enlace en la página web de la Seguridad Social
			La información no parecía estar organizados de una manera lógica
			Usé la función de búsqueda, pero los resultados no parecen aplicarse.
			Traté de usar el FAQ, pero no pude encontrar la solicitud en línea
			Otro, especificar	AA
SPCAS0045285	AA	Por favor, explique la razón por la que era difícil para usted para encontrar la solicitud en línea.			N		N	Skip Logic	OPS Hard to Find
SPCAS0045286		¿Cómo llegaste a esta solicitud en línea hoy en día?	Se utiliza el enlace de los servicios en línea en la página web de la Seguridad Social		Radio Button	Single	Y	Skip Logic	Arrive at App
			Seguido de un enlace de algún otro lugar en el sitio web de la Seguridad Social
			Se utiliza la función de búsqueda en la página web de la Seguridad Social
			Se utiliza un motor de búsqueda fuera (es decir, Google, Bing, Yahoo, etc)
			Seguido de un enlace desde medicare.gov
			Seguido un enlace desde otro sitio web
			Este sitio fue bookmarked
			Otro, especificar	A
SPCAS0045251	A	Por favor describa cómo llegó a esta solicitud en línea hoy			Text field, no char limit		N		OPS Arrive at app
SPCAS0045252		¿Por qué eligió para aplicar en línea? (Seleccione todas las que apliquen.)	Yo no quería ir a una oficina local del Seguro Social		check box one up vertical	Multi	Y	Skip Logic	Why Online
			Yo no quería que la solicitud por teléfono
			Yo prefiero usar los servicios en línea tanto como sea posible
			Aprendí acerca de la aplicación en línea durante su visita a la página web de la Seguridad Social
			Un empleado del Seguro Social recomienda que aplico en línea
			Un amigo o familiar recomendaron que aplico en línea
			Yo sabía que si tenía alguna pregunta o problema la aplicación en línea, todavía podía recibir ayuda de la Seguridad Social
			Estoy presentando en nombre de otra persona
			Otro, especificar	A
SPCAS0045287	A	Por favor, especifique qué decide aplicar en línea			Text field, no char limit		N		OPS Why Online
SPCAS0045289		¿Cuál es su estado civil actual?	casado		Radio button, one-up vertical	Single	N	OPS Group	Marital Status
			apartado
			divorciado
			viudo
		`	Nunca se ha casado
			Prefiero no responder
			Otro, especificar	A
SPCAS0045290	A	Otro estado civil			Text field, <100 char		N	OPS Group	OPS Marital Status
ENSTE0059662		¿Ya se registró para una cuenta de mi Seguro Social?	Sí		Radio button, one-up vertical	Single	Y	Skip Logic	Have mySSA Account
			No	A
	A	¿Cuál es la razón principal por la que no se haya registrado para una cuenta de mi Seguro Social?	No tengo conocimiento de lo que una cuenta de mi Seguro Social es.		Radio button, one-up vertical	Single	Y	Skip Logic	Why Not Have mySSA Account
			Traté de registrar una cuenta de mi Seguro Social, pero no tuvo éxito.
			Actualmente estoy tratando de registrar una cuenta de mi Seguro Social.
			Yo no quiero una cuenta de mi Seguro Social.
			Otro (especificar):	AA
	AA	Por favor, díganos por qué usted no está registrado para obtener una cuenta de mi Seguridad Social.			Text field, no char limit	Single	N	Skip Logic	OPS_Why Not Have mySSA Account
SPCAS0045291		¿Tiene alguna sugerencia para mejorar la aplicación en línea de la Seguridad Social?			Text field, no char limit		N		OE_Improvement

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Sheet 8: v3 CQs (EE) (6-12-14)

Model Instance Name:			red & strike-through: DELETE
SSA iClaim v3			underlined & italicized: RE-ORDER
MID: xZAAEQw81gIo1Vo4Noc1Rw4C			pink: ADDITION
Date:	7/15/2011		blue + -->: REWORDING
			violet (bold): SKIP-LOGIC
SSA iClaim v3 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
BJL2231		What type of benefits were you applying for?	Retirement		Dropdown (Select-one)	Single	Y	Skip Logic Group	Type of Benefits
			Medicare only
			Disability
			Both Retirement and Disability
			Spouse's
			Other
CAS0045242		Are you applying online for yourself or are you helping someone else?	Myself		Dropdown (Select-one)	Single	Y		Applying for
			Helping a Spouse/Relative/Friend
			Professional Helping a Client
			Other
CAS0045243		How did you learn about this online application? (Select all that apply.)	Official Social Security website		check box one up vertical	Multi	Y	Skip Logic Group	Learn about App
			A general web search (e.g. Google, Bing, etc.)
			The radio
			The television
			An email from Social Security
			A newspaper or magazine article
			An online ad (Banner/Image)
			An online video
			A newspaper or magazine ad
			A billboard or other printed ad
			Social Media (Blog, Facebook, Twitter, etc.)
			Friend, spouse, relative, neighbor or acquaintance
			Social Security statement
			Social Security employee	A
			Community Group or Association
			Other, please specify	B
CAS0045244	A	How did you make contact with a Social Security employee?	Visited a local Social Security office		check box one up vertical	Multi	Y	Skip Logic	SSA Emplyee Contact
			Called a local Social Security office
			Called the national 800 number
			Other, please specify	AA
CAS0045245	AA	Please describe how you made contact with a Social Security employee.			Text box, no char limit		N	Skip Logic	OPS SSA Employe Contact
CAS0045246	B	Please specify how you learned about this online application.			Text box, no char limit		N	Skip Logic	OPS Learn about App
CAS0045262		Did you use any of the following to prepare to apply online? (Select all that apply.)	Reviewed my online Social Security Statement	A	check box one up vertical	Multi	Y	Skip Logic	Prepare for App
			I used the Retirement Estimator or other tools on the Social Security website	B
			I watched the instructional video	C
			I used other information on the Social Security website to prepare	D
			I used another resource to prepare to apply online	E
			I did not use any resources to prepare to apply online
CAS0045263	A	How helpful did you find the online Social Security Statement?	Very helpful		Drop down select one	Single	Y	Skip Logic	Rate Statement
			Somewhat helpful
			Not at all helpful
CAS0045264	B	How helpful did you find the estimator tools on the website?	Very helpful		Drop down select one	Single	Y	Skip Logic	Rate RE Tools
			Somewhat helpful
			Not at all helpful
CAS0045265	C	How helpful did you find the instructional video?	Very helpful		Drop down select one	Single	Y	Skip Logic	Rate Video
			Somewhat helpful
			Not at all helpful
CAS0045266	D	How helpful did you find the other information on the Social Security website?	Very helpful		Drop down select one	Single	Y	Skip Logic	Rate Other Info on Website
			Somewhat helpful
			Not at all helpful
CAS0045267	E	Please describe what other resource(s) you used to prepare to apply online?			Text field, no char limit		N	Skip Logic	OPS Prepare for App
CAS0045247		Did you start a new online application today or did you return to a saved application?	Started a new application		Drop down select one	Single	Y		App Status
			Returned to work on a saved application
CAS0045282		Did you complete and submit this online application today?	Yes		Drop down select one	Single	Y	Skip Logic	Complete App
			No, I plan to complete and submit later	A
			No, I do not plan to complete and submit the online application	A
CAS0045283	A	If you did not complete and submit this online application today, please tell us why.	Too many questions		check box one up vertical	Multi	Y	Skip Logic	Not Complete App
			Takes too long to fill out
			Too complicated to use without help
			Didn't have information I needed like names, addresses, or dates
			Didn't understand what questions meant/how to answer
			My disabling condition prevents me from working with a computer for long periods
			I had a limited amount of time/family demands that kept me from working on it for very long
			I had technical problems like an error message or a mistake I couldn't fix
			Other, please specify	AA
CAS0045284	AA	Please tell us why you did not complete and submit this application today.			Text field, no char limit		N	Skip Logic	OPS Why Not Complete today
CAS0045248		So far, how long have you worked on this online application?	Up to 15 minutes		Drop down select one	Single	Y		Time Spent
			16 minutes - 30 minutes
			31 minutes - 1 hour
			More than 1 hour up to 2 hours
			More than 2 hours
CAS0045249		How easy was it for you to find this online application?	Very easy						Find App
			Somewhat easy
			Somewhat hard	A
			Very hard	A
CAS0045250	A	Please tell us why it was hard to find the online application. (Select all that apply.)	Could not find where to start a new online application		check box one up vertical	Multi	Y	Skip Logic	Why hard to find
			Not clear where to go to return to a previously saved application
			It was not clear to me where the links would lead
			Difficulty using a link on the Social Security website
			The information did not seem to be organized in a logical manner
			I used the search feature but the results didn’t seem to apply.
			I tried to use the FAQ's, but couldn't find the online application
			Other reason (please describe)	AA
CAS0045285	AA	Please explain the reason why it was hard for you to find the online application.			N		N	Skip Logic	OPS Hard to Find
CAS0045286		How did you arrive at this online application today?	Used the Online Services link on the Social Security homepage		Radio Button	Single	Y	Skip Logic	Arrive at App
			Followed a link from somewhere else on the Social Security website
			Used the search feature on the Social Security website
			Used an outside search engine (i.e. Google, Bing, yahoo etc.)
			Followed a link from medicare.gov
			Followed a link from another website
			Site was bookmarked
			Other, please specify	A
CAS0045251	A	Please describe how you arrived at this online application today			Text field, no char limit		N		OPS Arrive at app
CAS0045252		Why did you choose to apply online? (Select all that apply.)	I did not want to go to a local Social Security office		check box one up vertical	Multi	Y	Skip Logic	Why Online
			I did not want to apply over the phone
			I prefer to use online services as much as possible
			I learned about applying online while visiting Social Security's website
			A Social Security employee recommended that I apply online
			A friend or relative recommended that I apply online
			I knew that if I had a question or problem applying online, I could still get help from Social Security
			I am filing on behalf of another person
			Other, please specify	A
CAS0045287	A	Please specify why you choose to apply online			Text field, no char limit		N		OPS Why Online
CAS0045289		What is your current marital status?	Married		Radio button, one-up vertical	Single	N	OPS Group	Marital Status
			Separated
			Divorced
			Widowed
			Never married
			Prefer not to answer
			Other, please specify	A
CAS0045290	A	Other marital status			Text field, <100 char		N	OPS Group	OPS Marital Status
		Do you presently have an active my Social Security account established?	Yes		Radio button, one-up vertical	Single	Y		Have mySSA Account
			No
CAS0045291		Do you have any suggestions for improving Social Security's online application.			Text field, no char limit		N		OE_Improvement

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Sheet 9: CQs v3 (EN) (6-12-14)

Model Instance Name:			red & strike-through: DELETE
SSA iClaim v3			underlined & italicized: RE-ORDER
MID: VgpBBYx9l8JxIFgJlY1Ikg4C			pink: ADDITION
Date:	7/15/2011		blue + -->: REWORDING
			violet (bold): SKIP-LOGIC
SSA iClaim v3 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
ENBJL2231		What type of benefits were you applying for?	Retirement		Dropdown (Select-one)	Single	Y	skip logic group	Type of Benefits
			Medicare only
			Disability
			Both Retirement and Disability
			Spouse's
			Other
ENCAS0045242		Are you applying online for yourself or are you helping someone else?	Myself		Dropdown (Select-one)	Single	Y		Applying for
			Helping a Spouse/Relative/Friend
			Professional Helping a Client
			Other
ENCAS0045243		How did you learn about this online application? (Select all that apply.)	Official Social Security website		check box one up vertical	Multi	Y	Skip Logic Group	Learn about App
			A general web search (e.g. Google, Bing, etc.)
			The radio
			The television
			An email from Social Security
			A newspaper or magazine article
			An online ad (Banner/Image)
			An online video
			A newspaper or magazine ad
			A billboard or other printed ad
			Social Media (Blog, Facebook, Twitter, etc.)
			Friend, spouse, relative, neighbor or acquaintance
			Social Security statement
			Social Security employee	A
			Community Group or Association
			Other, please specify	B
ENCAS0045244	A	How did you make contact with a Social Security employee?	Visited a local Social Security office		check box one up vertical	Multi	Y	Skip Logic	SSA Emplyee Contact
			Called a local Social Security office
			Called the national 800 number
			Other, please specify	AA
ENCAS0045245	AA	Please describe how you made contact with a Social Security employee.			Text box, no char limit		N	Skip Logic	OPS SSA Employe Contact
ENCAS0045246	B	Please specify how you learned about this online application.			Text box, no char limit		N	Skip Logic	OPS Learn about App
ENCAS0045262		Did you use any of the following to prepare to apply online? (Select all that apply.)	Reviewed my online Social Security Statement	A	check box one up vertical	Multi	Y	Skip Logic	Prepare for App
			I used the Retirement Estimator or other tools on the Social Security website	B
			I watched the instructional video	C
			I used other information on the Social Security website to prepare	D
			I used another resource to prepare to apply online	E
			I did not use any resources to prepare to apply online
ENCAS0045263	A	How helpful did you find the online Social Security Statement?	Very helpful		Drop down select one	Single	Y	Skip Logic	Rate Statement
			Somewhat helpful
			Not at all helpful
ENCAS0045264	B	How helpful did you find the estimator tools on the website?	Very helpful		Drop down select one	Single	Y	Skip Logic	Rate RE Tools
			Somewhat helpful
			Not at all helpful
ENCAS0045265	C	How helpful did you find the instructional video?	Very helpful		Drop down select one	Single	Y	Skip Logic	Rate Video
			Somewhat helpful
			Not at all helpful
ENCAS0045266	D	How helpful did you find the other information on the Social Security website?	Very helpful		Drop down select one	Single	Y	Skip Logic	Rate Other Info on Website
			Somewhat helpful
			Not at all helpful
ENCAS0045267	E	Please describe what other resource(s) you used to prepare to apply online?			Text field, no char limit		N	Skip Logic	OPS Prepare for App
ENCAS0045247		Did you start a new online application today or did you return to a saved application?	Started a new application		Drop down select one	Single	Y		App Status
			Returned to work on a saved application
ENCAS0045282		Did you complete and submit this online application today?	Yes		Drop down select one	Single	Y	Skip Logic	Complete App
			No, I plan to complete and submit later	A
			No, I do not plan to complete and submit the online application	A
ENCAS0045283	A	If you did not complete and submit this online application today, please tell us why.	Too many questions		check box one up vertical	Multi	Y	Skip Logic	Not Complete App
			Takes too long to fill out
			Too complicated to use without help
			Didn't have information I needed like names, addresses, or dates
			Didn't understand what questions meant/how to answer
			My disabling condition prevents me from working with a computer for long periods
			I had a limited amount of time/family demands that kept me from working on it for very long
			I had technical problems like an error message or a mistake I couldn't fix
			Other, please specify	AA
ENCAS0045284	AA	Please tell us why you did not complete and submit this application today.			Text field, no char limit		N	Skip Logic	OPS Why Not Complete today
ENCAS0045248		So far, how long have you worked on this online application?	Up to 15 minutes		Drop down select one	Single	Y		Time Spent
			16 minutes - 30 minutes
			31 minutes - 1 hour
			More than 1 hour up to 2 hours
			More than 2 hours
ENCAS0045249		How easy was it for you to find this online application?	Very easy						Find App
			Somewhat easy
			Somewhat hard	A
			Very hard	A
ENCAS0045250	A	Please tell us why it was hard to find the online application. (Select all that apply.)	Could not find where to start a new online application		check box one up vertical	Multi	Y	Skip Logic	Why hard to find
			Not clear where to go to return to a previously saved application
			It was not clear to me where the links would lead
			Difficulty using a link on the Social Security website
			The information did not seem to be organized in a logical manner
			I used the search feature but the results didn’t seem to apply.
			I tried to use the FAQ's, but couldn't find the online application
			Other reason (please describe)	AA
ENCAS0045285	AA	Please explain the reason why it was hard for you to find the online application.			N		N	Skip Logic	OPS Hard to Find
ENCAS0045286		How did you arrive at this online application today?	Used the Online Services link on the Social Security homepage		Radio Button	Single	Y	Skip Logic	Arrive at App
			Followed a link from somewhere else on the Social Security website
			Used the search feature on the Social Security website
			Used an outside search engine (i.e. Google, Bing, yahoo etc.)
			Followed a link from medicare.gov
			Followed a link from another website
			Site was bookmarked
			Other, please specify	A
ENCAS0045251	A	Please describe how you arrived at this online application today			Text field, no char limit		N		OPS Arrive at app
ENCAS0045252		Why did you choose to apply online? (Select all that apply.)	I did not want to go to a local Social Security office		check box one up vertical	Multi	Y	Skip Logic	Why Online
			I did not want to apply over the phone
			I prefer to use online services as much as possible
			I learned about applying online while visiting Social Security's website
			A Social Security employee recommended that I apply online
			A friend or relative recommended that I apply online
			I knew that if I had a question or problem applying online, I could still get help from Social Security
			I am filing on behalf of another person
			Other, please specify	A
ENCAS0045287	A	Please specify why you choose to apply online			Text field, no char limit		N		OPS Why Online
ENCAS0045289		What is your current marital status?	Married		Radio button, one-up vertical	Single	N	OPS Group	Marital Status
			Separated
			Divorced
			Widowed
			Never married
			Prefer not to answer
			Other, please specify	A
ENCAS0045290	A	Other marital status			Text field, <100 char		N	OPS Group	OPS Marital Status
		Do you presently have an active my Social Security account established?	Yes		Radio button, one-up vertical	Single	Y		Have mySSA Account
			No
ENCAS0045291		Do you have any suggestions for improving Social Security's online application.			Text field, no char limit		N		OE_Improvement

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Sheet 10: v3 CQs (SP) (6-12-14)

Model Instance Name:			red & strike-through: DELETE
SSA iClaim v3 (Spanish)			underlined & italicized: RE-ORDER
MID:	Q0ExM1xNQRl9JJUR0M0JlA4C		pink: ADDITION
Date:	7/15/2011		blue + -->: REWORDING
			violet (bold): SKIP-LOGIC
SSA iClaim v3 (Spanish) 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
SPBJL2231		¿Qué tipo de beneficios estaba solicitando?	Por jubilación		Dropdown (Select-one)	Single	Y	Skip Logic Group	Type of Benefits
			Solo Medicare
			Por incapacidad
			Tanto Jubilación y Discapacidad
			Coomo cónyuge
			Otro
SPCAS0045242		¿Es esta solicitud en línea para sí mismo o estás ayudando a alguien más?	Yo mismo		Dropdown (Select-one)	Single	Y		Applying for
			Cómo ayudar a un cónyuge / pariente / amigo
			Profesional Ayudar a un cliente
			Otro
SPCAS0045243		¿Cómo se enteró acerca de esta solicitud en línea? (Seleccione todas las que apliquen.)	Sitio web oficial de la Seguridad Social		check box one up vertical	Multi	Y	Skip Logic Group	Learn about App
			Una búsqueda web general (por ejemplo, Google, Bing, etc)
			La radio
			La televisión
			Un correo electrónico de la Seguridad Social
			Un periódico o la revista
			Un anuncio en línea (Banner / Imagen)
			Un video en línea
			Un periódico o una revista de anuncios
			Un anuncio impreso cartelera u otro
			Medios de Comunicación Social (Blog, Facebook, Twitter, etc)
			Amigo, cónyuge, pariente, vecino o conocido
			Declaración del Seguro Social
			Empleado del Seguro Social	A
			Grupo de la comunidad o de la Asociación
			Otro, especificar	B
SPCAS0045244	A	¿Cómo se hace el contacto con un empleado del Seguro Social?	Visitado una oficina local del Seguro Social		check box one up vertical	Multi	Y	Skip Logic	SSA Emplyee Contact
			Llamado a la oficina local del Seguro Social
			Llamado el número nacional 800
			Otro, especificar	AA
SPCAS0045245	AA	Por favor describa cómo se hizo contacto con un empleado del Seguro Social.			Text box, no char limit		N	Skip Logic	OPS SSA Employe Contact
SPCAS0045246	B	Por favor, especifique cómo se enteró de esta aplicación en línea.			Text box, no char limit		N	Skip Logic	OPS Learn about App
SPCAS0045262		¿Ha usado alguna de las siguientes acciones para prepararse para aplicar en línea? (Seleccione todas las que apliquen.)	Comentado mi Declaración del Seguro Social en línea	A	check box one up vertical	Multi	Y	Skip Logic	Prepare for App
			He utilizado el Retirement Estimator u otras herramientas en el sitio web de la Seguridad Social	B
			Vi el video de instrucciones	C
			Usé otra información en la página web de la Seguridad Social para preparar	D
			Utilicé otro recurso que se preparen para aplicar en línea	E
			No hice uso de los recursos para prepararse para aplicar en línea
SPCAS0045263	A	¿Qué tan útil ha encontrado el Declaración del Seguro Social en línea?	Muy útil		Drop down select one	Single	Y	Skip Logic	Rate Statement
			algo útil
			Para nada útil
SPCAS0045264	B	¿Qué tan útil encontraste las herramientas estimador en el sitio web?	Muy útil		Drop down select one	Single	Y	Skip Logic	Rate RE Tools
			algo útil
			Para nada útil
SPCAS0045265	C	¿Qué tan útil le parecen la video instructivo?	Muy útil		Drop down select one	Single	Y	Skip Logic	Rate Video
			algo útil
			Para nada útil
SPCAS0045266	D	¿Qué tan útil le parecen la otra información en el sitio web de la Seguridad Social?	Muy útil		Drop down select one	Single	Y	Skip Logic	Rate Other Info on Website
			algo útil
			Para nada útil
SPCAS0045267	E	Por favor describa lo otro recurso (s) que utilizó para prepararse para aplicar en línea.			Text field, no char limit		N	Skip Logic	OPS Prepare for App
SPCAS0045247		¿Comenzó una nueva aplicación en línea hoy mismo o que te vuelva a una solicitud guardada?	Comenzó una nueva aplicación		Drop down select one	Single	Y		App Status
			Volvió a trabajar en una solicitud guardada
SPCAS0045282		¿Sabía usted completar y presentar esta solicitud en línea hoy en día?	Sí		Drop down select one	Single	Y	Skip Logic	Complete App
			No, tengo la intención de completar y enviar más tarde	A
			No, no tengo planes para completar y enviar la solicitud en línea	A
SPCAS0045283	A	Si no logró completar y presentar esta solicitud en línea hoy, por favor díganos por qué.	Demasiadas preguntas		check box one up vertical	Multi	Y	Skip Logic	Not Complete App
			Toma demasiado tiempo para llenar
			Demasiado complicado de usar sin ayuda
			No tenía la información que necesitaba como nombres, direcciones o fechas
			No entendía lo que significaba preguntas / cómo responder
			Mi condición de discapacidad me impide trabajar con una computadora por largos periodos
			Yo tenía una cantidad limitada de demandas de tiempo / de la familia que me impedía trabajar en ella por mucho tiempo
			Tuve problemas técnicos, como un mensaje de error o un error que no podía fijar
			Otro, especificar	AA
SPCAS0045284	AA	Haznos saber por qué no se ha completado y se somete esta solicitud hoy.			Text field, no char limit		N	Skip Logic	OPS Why Not Complete today
SPCAS0045248		Hasta el momento, ¿cuánto tiempo ha trabajado en esta solicitud en línea?	Hasta 15 minutos		Drop down select one	Single	Y		Time Spent
			16 minutos - 30 minutos
			31 minutos - 1 hora
			Más de 1 hora hasta 2 horas
			Más de 2 horas
SPCAS0045249		¿Fue fácil para usted para encontrar esta aplicación en línea?	Muy fácil						Find App
			algo fácil
			algo duro	A
			Muy difícil	A
SPCAS0045250	A	Haznos saber por qué era difícil encontrar la aplicación en línea. (Seleccione todas las que apliquen.)	No se pudo encontrar por dónde empezar una nueva aplicación en línea		check box one up vertical	Multi	Y	Skip Logic	Why hard to find
			Donde no está claro que vaya a volver a una solicitud previamente guardada
			No estaba claro para mí cuando los vínculos conducirían
			Dificultad para utilizar un enlace en la página web de la Seguridad Social
			La información no parecía estar organizados de una manera lógica
			Usé la función de búsqueda, pero los resultados no parecen aplicarse.
			Traté de usar el FAQ, pero no pude encontrar la solicitud en línea
			Otro, especificar	AA
SPCAS0045285	AA	Por favor, explique la razón por la que era difícil para usted para encontrar la solicitud en línea.			N		N	Skip Logic	OPS Hard to Find
SPCAS0045286		¿Cómo llegaste a esta solicitud en línea hoy en día?	Se utiliza el enlace de los servicios en línea en la página web de la Seguridad Social		Radio Button	Single	Y	Skip Logic	Arrive at App
			Seguido de un enlace de algún otro lugar en el sitio web de la Seguridad Social
			Se utiliza la función de búsqueda en la página web de la Seguridad Social
			Se utiliza un motor de búsqueda fuera (es decir, Google, Bing, Yahoo, etc)
			Seguido de un enlace desde medicare.gov
			Seguido un enlace desde otro sitio web
			Este sitio fue bookmarked
			Otro, especificar	A
SPCAS0045251	A	Por favor describa cómo llegó a esta solicitud en línea hoy			Text field, no char limit		N		OPS Arrive at app
SPCAS0045252		¿Por qué eligió para aplicar en línea? (Seleccione todas las que apliquen.)	Yo no quería ir a una oficina local del Seguro Social		check box one up vertical	Multi	Y	Skip Logic	Why Online
			Yo no quería que la solicitud por teléfono
			Yo prefiero usar los servicios en línea tanto como sea posible
			Aprendí acerca de la aplicación en línea durante su visita a la página web de la Seguridad Social
			Un empleado del Seguro Social recomienda que aplico en línea
			Un amigo o familiar recomendaron que aplico en línea
			Yo sabía que si tenía alguna pregunta o problema la aplicación en línea, todavía podía recibir ayuda de la Seguridad Social
			Estoy presentando en nombre de otra persona
			Otro, especificar	A
SPCAS0045287	A	Por favor, especifique qué decide aplicar en línea			Text field, no char limit		N		OPS Why Online
SPCAS0045289		¿Cuál es su estado civil actual?	casado		Radio button, one-up vertical	Single	N	OPS Group	Marital Status
			apartado
			divorciado
			viudo
		`	Nunca se ha casado
			Prefiero no responder
			Otro, especificar	A
SPCAS0045290	A	Otro estado civil			Text field, <100 char		N	OPS Group	OPS Marital Status
		¿Tiene actualmente una cuenta activa de my Social Security establecido?	Sí		Radio button, one-up vertical	Single	Y		Have mySSA Account
			No
SPCAS0045291		¿Tiene alguna sugerencia para mejorar la aplicación en línea de la Seguridad Social?			Text field, no char limit		N		OE_Improvement

---

Sheet 11: v3 CQs (EE) (12-10-13)

Model Instance Name:

red & strike-through: DELETE

SSA iClaim v3

underlined & italicized: RE-ORDER

MID: xZAAEQw81gIo1Vo4Noc1Rw4C

pink: ADDITION

Date:

7/15/2011

blue + -->: REWORDING

violet (bold): SKIP-LOGIC

SSA iClaim v3 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

BJL2230

Please rate your impression of the level of security in completing tasks on this application.

1 = Poor

Radio Button Scale Has Don’t Know

Single

Y

Level of Security

2

3

4

5

6

7

8

9

10 = Excellent

Don't know

BJL2231

What type of benefits were you applying for?

Retirement

M, Q, R, X, Y, Z, U, E, W

Dropdown (Select-one)

Single

Y

Skip Logic Group

Type of Benefits

Medicare only

Disability

M, Q, R, X, Y, Z, U, E, G, W

Both Retirement and Disability

Spouse's

M, Q, R, X, Y, Z, U, E, W

Other

M, Q, R, X, Y, Z, U, E, W

I am not applying today

Are you applying online for yourself or are you helping someone else?

Myself

Dropdown (Select-one)

Single

Y

Applying for

Helping a Spouse/Relative/Friend

Professional Helping a Client

Other

How did you learn about this online application? (Select all that apply.)

Official Social Security website

check box one up vertical

Multi

Y

Skip Logic Group

Learn about App

A general web search (e.g. Google, Bing, etc.)

The radio

The television

An email from Social Security

A newspaper or magazine article

An online ad (Banner/Image)

An online video

A newspaper or magazine ad

A billboard or other printed ad

Social Media (Blog, Facebook, Twitter, etc.)

Friend, spouse, relative, neighbor or acquaintance

Social Security statement

Social Security employee

A

Community Group or Association

Other, please specify

B

A

How did you make contact with a Social Security employee?

Visited a local Social Security office

check box one up vertical

Multi

Y

Skip Logic

SSA Emplyee Contact

Called a local Social Security office

Called the national 800 number

Other, please specify

AA

AA

Please describe how you made contact with a Social Security employee.

Text box, no char limit

N

Skip Logic

OPS SSA Employe Contact

B

Please specify how you learned about this online application.

Text box, no char limit

N

Skip Logic

OPS Learn about App

Did you use any of the following to prepare to apply online? (Select all that apply.)

Reviewed my online Social Security Statement

A

check box one up vertical

Multi

Y

Skip Logic

Prepare for App

I used the Retirement Estimator or other tools on the Social Security website

B

I watched the instructional video

C

I used other information on the Social Security website to prepare

D

I used another resource to prepare to apply online

E

I did not use any resources to prepare to apply online

A

How helpful did you find the online Social Security Statement?

Very helpful

Drop down select one

Single

Y

Skip Logic

Rate Statement

Somewhat helpful

Not at all helpful

B

How helpful did you find the estimator tools on the website?

Very helpful

Drop down select one

Single

Y

Skip Logic

Rate RE Tools

Somewhat helpful

Not at all helpful

C

How helpful did you find the instructional video?

Very helpful

Drop down select one

Single

Y

Skip Logic

Rate Video

Somewhat helpful

Not at all helpful

D

How helpful did you find the other information on the Social Security website?

Very helpful

Drop down select one

Single

Y

Skip Logic

Rate Other Info on Website

Somewhat helpful

Not at all helpful

E

Please describe what other resource(s) you used to prepare to apply online?

Text field, no char limit

N

Skip Logic

OPS Prepare for App

Did you start a new online application today or did you return to a saved application?

Started a new application

Drop down select one

Single

Y

App Status

Returned to work on a saved application

Did you complete and submit this online application today?

Yes

Drop down select one

Single

Y

Skip Logic

Complete App

No, I plan to complete and submit later

A

No, I do not plan to complete and submit the online application

A

A

If you did not complete and submit this online application today, please tell us why.

Too many questions

check box one up vertical

Multi

Y

Skip Logic

Not Complete App

Takes too long to fill out

Too complicated to use without help

Didn't have information I needed like names, addresses, or dates

Didn't understand what questions meant/how to answer

My disabling condition prevents me from working with a computer for long periods

I had a limited amount of time/family demands that kept me from working on it for very long

I had technical problems like an error message or a mistake I couldn't fix

Other, please specify

AA

AA

Please tell us why you did not complete and submit this application today.

Text field, no char limit

N

Skip Logic

OPS Why Not Complete today

So far, how long have you worked on this online application?

Up to 15 minutes

Drop down select one

Single

Y

Time Spent

16 minutes - 30 minutes

31 minutes - 1 hour

More than 1 hour up to 2 hours

More than 2 hours

How easy was it for you to find this online application?

Very easy

Find App

Somewhat easy

Somewhat hard

A

Very hard

A

A

Please tell us why it was hard to find the online application. (Select all that apply.)

Could not find where to start a new online application

check box one up vertical

Multi

Y

Skip Logic

Why hard to find

Not clear where to go to return to a previously saved application

It was not clear to me where the links would lead

Difficulty using a link on the Social Security website

The information did not seem to be organized in a logical manner

I used the search feature but the results didn’t seem to apply.

I tried to use the FAQ's, but couldn't find the online application

Other reason (please describe)

AA

AA

Please explain the reason why it was hard for you to find the online application.

N

N

Skip Logic

OPS Hard to Find

How did you arrive at this online application today?

Used the Online Services link on the Social Security homepage

Radio Button

Single

Y

Skip Logic

Arrive at App

Followed a link from somewhere else on the Social Security website

Used the search feature on the Social Security website

Used an outside search engine (i.e. Google, Bing, yahoo etc.)

Followed a link from medicare.gov

Followed a link from another website

Site was bookmarked

Other, please specify

A

A

Please describe how you arrived at this online application today

Text field, no char limit

N

OPS Arrive at app

Why did you choose to apply online? (Select all that apply.)

I did not want to go to a local Social Security office

check box one up vertical

Multi

Y

Skip Logic

Why Online

I did not want to apply over the phone

I prefer to use online services as much as possible

I learned about applying online while visiting Social Security's website

A Social Security employee recommended that I apply online

A friend or relative recommended that I apply online

I knew that if I had a question or problem applying online, I could still get help from Social Security

I am filing on behalf of another person

Other, please specify

A

A

Please specify why you choose to apply online

Text field, no char limit

N

OPS Why Online

What is your current marital status?

Married

Radio button, one-up vertical

Single

N

OPS Group

Marital Status

Separated

Divorced

Widowed

Never married

Prefer not to answer

Other, please specify

A

A

Other marital status

Text field, <100 char

N

OPS Group

OPS Marital Status

Do you have any suggestions for improving Social Security's online application.

Text field, no char limit

N

OE_Improvement

BJL2232

M

How did you learn about the Social Security online application? (Select all that apply.)

Official Social Security website

Checkbox One Up Vertical

Multi

Y

Skip Logic Group

Learn About Online App

Types

A general web search (e.g. Google, Bing, etc.)

The radio

The television

An email from Social Security

A newspaper or magazine article

An online ad (Banner/Image)

An online video

A newspaper or magazine ad

A billboard or other printed ad

Social Media (Blog, Facebook, Twitter, etc.)

Friend, spouse, relative, neighbor or acquaintance

Social Security statement

Social Security employee

B

Community Group or Association

Other, please specify

A

BJL2233

A

Please specify how you learned of Social Security online.

Text area, no char limit

N

Skip Logic Group

OE_Learn about online app

BJL2234

B

How did you make contact with a Social Security employee?

Visited a local Social Security office

Radio Button One Up Vertical

Single

Y

Skip Logic Group

Contact SSA Employee

Called a local Social Security office

Called the national 800 number

Other, please specify

D

BJL2235

D

Please describe the way you made contact with a social security employee.

Text field, <100 char

N

Skip Logic Group

OE_Contact SSA Employee

BJL2236

Q

Did you complete your application today?

Yes, I completed my new application today

C

Radio Button One Up Vertical

Single

Y

Skip Logic Group

Complete App

Yes, I restarted and completed my earlier application today

C

No, I did not complete my new application, but I plan to complete it later

C

No, I did not complete my re-started earlier application, but I plan to complete it later

C

No, I do not plan to complete my application at all

C

I'm not applying for benefits today

BJL2237

C

For whom are you filing this online application for Social Security benefits?

Myself

Radio Button One Up Vertical

Single

Y

Skip Logic Group

Whose Behalf

My spouse

My parent

Another relative

My friend

My client

Other

BJL2238

R

If you stopped working on your application, please tell us why. (Select all that apply.)

I finished my application today

Checkbox One Up Vertical

Multi

Y

Skip Logic Group

Why Stopped App

Needed to find documents/other information for my application

Too many questions

Takes too long

Too complicated to use without help

My medical/physical condition prevents me from working on the computer for long periods

Application wouldn't accept empty/blank fields

Received an error message or was "kicked out" of the application

I had a problem entering dates or other information in some of the pages

Other Reason

zz

BJL2239

zz

Please tell us the other reason you stopped working on your application.

Text area, no char limit

N

Skip Logic Group

OE_Stopped Application

BJL2240

X

Did you visit the Social Security home page (www.socialsecurity.gov) today?

Yes

Dropdown (Select-one)

Single

Y

Skip Logic Group

Homepage

No

BJL2241

Y

Did you use the SEARCH box on our website to find what you needed?

Yes

Dropdown (Select-one)

Single

Y

Skip Logic Group

Search

No

BJL2242

Z

Please tell us how easy it was for you to find the application for benefits.

I had little or no difficulty getting to the application

Radio Button One Up Vertical

Single

Y

Skip Logic Group

Find app

I found it somewhat difficult to find the application

Z1

BJL2243

Z1

I found it somewhat difficult to find the application because: (Select all that apply.)

I did not know where to begin looking

Checkbox One Up Vertical

Multi

Y

Skip Logic Group

Difficult to Find

It was not clear to me where the links would lead

The information did not seem to be organized in a logical manner

I used the search function but the results didn’t seem to apply.

Other reason (please describe)

Z2

BJL2244

Z2

Please explain the reason you found it somewhat difficult to find the application.

Text area, no char limit

N

Skip Logic Group

OE_Difficult to Find

BJL2245

U

How did you arrive on the Social Security website today?

Typed ssa.gov or socialsecurity.gov into the browser

Dropdown (Select-one)

Single

Y

Skip Logic Group

Arrive

Did a search (i.e. Google, Bing, Yahoo)

Followed a link from medicare.gov

Followed a link from another website

BJL2246

E

Please rate the clarity of the instructions provided for this Social Security online application.

1 = Not At All Clear

F

Radio Button Scale Has Don’t Know

Single

Y

Skip Logic Group

Clarity of Instructions

2

F

3

F

4

F

5

F

6

7

8

9

10 = Very Clear

Don't know

BJL2247

F

What part of the instructions was not clear?

Text area, no char limit

N

Skip Logic Group

OE_Clarity of Instructions

BJL2248

G

Did you complete the Online Disability Report today?

Yes

Radio Button One Up Vertical

Single

Y

Skip Logic Group

Disability Report

No

Don't recall

BJL2249

W

Do you have any other problems with this Social Security Online application that weren't covered in earlier questions, or any suggestions on how we can improve it? (Please do not include any personal information in your answer.)

Text area, no char limit

N

Skip Logic Group

Other Problems

BJL2250

What influenced your decision to use our online benefit application? (Select all that apply.)

I did not want to go to an SSA field office

Checkbox One Up Vertical

Multi

Y

Skip Logic Group

Influenced Decision Benefits

I did not want to do business over the phone

I prefer to use online services as much as possible

I learned about filing online while visiting socialsecurity.gov

Someone from SSA recommended filing online

A friend, relative, or colleague recommended filing online

I knew that if I had a question, I could then call or visit SSA

I am filing on behalf of another person

A

Other, please specify

B

BJL2251

B

Please specify what influenced your decision to file for benefits online.

Text area, no char limit

N

Skip Logic Group

OE_Influenced Decision

BJL2252

A

Please specify your role.

I am a non-profit professional

Radio button, one-up vertical

Single

Y

Skip Logic Group

Role

I am a for-profit professional

I am a friend or relative

Other, please specify

C

BJL2253

C

Please describe your role.

Text field, <100 char

N

Skip Logic Group

OE_Role

---

Sheet 12: CQs v3 (EN) (12-10-13)

Model Instance Name:

red & strike-through: DELETE

SSA iClaim v3

underlined & italicized: RE-ORDER

MID: VgpBBYx9l8JxIFgJlY1Ikg4C

pink: ADDITION

Date:

7/15/2011

blue + -->: REWORDING

violet (bold): SKIP-LOGIC

SSA iClaim v3 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

ENBJL2230

Please rate your impression of the level of security in completing tasks on this application.

1 = Poor

Radio Button Scale Has Don’t Know

Single

Y

Level of Security

2

3

4

5

6

7

8

9

10 = Excellent

Don't know

ENBJL2231

What type of benefits were you applying for?

Retirement

M, Q, R, X, Y, Z, U, E, W

Dropdown (Select-one)

Single

Y

skip logic group

Type of Benefits

Medicare only

Disability

M, Q, R, X, Y, Z, U, E, G, W

Both Retirement and Disability

Spouse's

M, Q, R, X, Y, Z, U, E, W

Other

M, Q, R, X, Y, Z, U, E, W

I am not applying today

Are you applying online for yourself or are you helping someone else?

Myself

Dropdown (Select-one)

Single

Y

Applying for

Helping a Spouse/Relative/Friend

Professional Helping a Client

Other

How did you learn about this online application? (Select all that apply.)

Official Social Security website

check box one up vertical

Multi

Y

Skip Logic Group

Learn about App

A general web search (e.g. Google, Bing, etc.)

The radio

The television

An email from Social Security

A newspaper or magazine article

An online ad (Banner/Image)

An online video

A newspaper or magazine ad

A billboard or other printed ad

Social Media (Blog, Facebook, Twitter, etc.)

Friend, spouse, relative, neighbor or acquaintance

Social Security statement

Social Security employee

A

Community Group or Association

Other, please specify

B

A

How did you make contact with a Social Security employee?

Visited a local Social Security office

check box one up vertical

Multi

Y

Skip Logic

SSA Emplyee Contact

Called a local Social Security office

Called the national 800 number

Other, please specify

AA

AA

Please describe how you made contact with a Social Security employee.

Text box, no char limit

N

Skip Logic

OPS SSA Employe Contact

B

Please specify how you learned about this online application.

Text box, no char limit

N

Skip Logic

OPS Learn about App

Did you use any of the following to prepare to apply online? (Select all that apply.)

Reviewed my online Social Security Statement

A

check box one up vertical

Multi

Y

Skip Logic

Prepare for App

I used the Retirement Estimator or other tools on the Social Security website

B

I watched the instructional video

C

I used other information on the Social Security website to prepare

D

I used another resource to prepare to apply online

E

I did not use any resources to prepare to apply online

A

How helpful did you find the online Social Security Statement?

Very helpful

Drop down select one

Single

Y

Skip Logic

Rate Statement

Somewhat helpful

Not at all helpful

B

How helpful did you find the estimator tools on the website?

Very helpful

Drop down select one

Single

Y

Skip Logic

Rate RE Tools

Somewhat helpful

Not at all helpful

C

How helpful did you find the instructional video?

Very helpful

Drop down select one

Single

Y

Skip Logic

Rate Video

Somewhat helpful

Not at all helpful

D

How helpful did you find the other information on the Social Security website?

Very helpful

Drop down select one

Single

Y

Skip Logic

Rate Other Info on Website

Somewhat helpful

Not at all helpful

E

Please describe what other resource(s) you used to prepare to apply online?

Text field, no char limit

N

Skip Logic

OPS Prepare for App

Did you start a new online application today or did you return to a saved application?

Started a new application

Drop down select one

Single

Y

App Status

Returned to work on a saved application

Did you complete and submit this online application today?

Yes

Drop down select one

Single

Y

Skip Logic

Complete App

No, I plan to complete and submit later

A

No, I do not plan to complete and submit the online application

A

A

If you did not complete and submit this online application today, please tell us why.

Too many questions

check box one up vertical

Multi

Y

Skip Logic

Not Complete App

Takes too long to fill out

Too complicated to use without help

Didn't have information I needed like names, addresses, or dates

Didn't understand what questions meant/how to answer

My disabling condition prevents me from working with a computer for long periods

I had a limited amount of time/family demands that kept me from working on it for very long

I had technical problems like an error message or a mistake I couldn't fix

Other, please specify

AA

AA

Please tell us why you did not complete and submit this application today.

Text field, no char limit

N

Skip Logic

OPS Why Not Complete today

So far, how long have you worked on this online application?

Up to 15 minutes

Drop down select one

Single

Y

Time Spent

16 minutes - 30 minutes

31 minutes - 1 hour

More than 1 hour up to 2 hours

More than 2 hours

How easy was it for you to find this online application?

Very easy

Find App

Somewhat easy

Somewhat hard

A

Very hard

A

A

Please tell us why it was hard to find the online application. (Select all that apply.)

Could not find where to start a new online application

check box one up vertical

Multi

Y

Skip Logic

Why hard to find

Not clear where to go to return to a previously saved application

It was not clear to me where the links would lead

Difficulty using a link on the Social Security website

The information did not seem to be organized in a logical manner

I used the search feature but the results didn’t seem to apply.

I tried to use the FAQ's, but couldn't find the online application

Other reason (please describe)

AA

AA

Please explain the reason why it was hard for you to find the online application.

N

N

Skip Logic

OPS Hard to Find

How did you arrive at this online application today?

Used the Online Services link on the Social Security homepage

Radio Button

Single

Y

Skip Logic

Arrive at App

Followed a link from somewhere else on the Social Security website

Used the search feature on the Social Security website

Used an outside search engine (i.e. Google, Bing, yahoo etc.)

Followed a link from medicare.gov

Followed a link from another website

Site was bookmarked

Other, please specify

A

A

Please describe how you arrived at this online application today

Text field, no char limit

N

OPS Arrive at app

Why did you choose to apply online? (Select all that apply.)

I did not want to go to a local Social Security office

check box one up vertical

Multi

Y

Skip Logic

Why Online

I did not want to apply over the phone

I prefer to use online services as much as possible

I learned about applying online while visiting Social Security's website

A Social Security employee recommended that I apply online

A friend or relative recommended that I apply online

I knew that if I had a question or problem applying online, I could still get help from Social Security

I am filing on behalf of another person

Other, please specify

A

A

Please specify why you choose to apply online

Text field, no char limit

N

OPS Why Online

What is your current marital status?

Married

Radio button, one-up vertical

Single

N

OPS Group

Marital Status

Separated

Divorced

Widowed

Never married

Prefer not to answer

Other, please specify

A

A

Other marital status

Text field, <100 char

N

OPS Group

OPS Marital Status

Do you have any suggestions for improving Social Security's online application.

Text field, no char limit

N

OE_Improvement

ENBJL2232

M

How did you learn about the Social Security online application? (Select all that apply.)

Official Social Security website

Checkbox One Up Vertical

Multi

Y

Skip Logic Group

Learn About Online App

Types

A general web search (e.g. Google, Bing, etc.)

The radio

The television

An email from Social Security

A newspaper or magazine article

An online ad (Banner/Image)

An online video

A newspaper or magazine ad

A billboard or other printed ad

Social Media (Blog, Facebook, Twitter, etc.)

Friend, spouse, relative, neighbor or acquaintance

Social Security statement

Social Security employee

B

Community Group or Association

Other, please specify

A

ENBJL2233

A

Please specify how you learned of Social Security online.

Text area, no char limit

N

Skip Logic Group

OE_Learn about online app

ENBJL2234

B

How did you make contact with a Social Security employee?

Visited a local Social Security office

Radio Button One Up Vertical

Single

Y

Skip Logic Group

Contact SSA Employee

Called a local Social Security office

Called the national 800 number

Other, please specify

D

ENBJL2235

D

Please describe the way you made contact with a social security employee.

Text field, <100 char

N

Skip Logic Group

OE_Contact SSA Employee

ENBJL2236

Q

Did you complete your application today?

Yes, I completed my new application today

C

Radio Button One Up Vertical

Single

Y

Skip Logic Group

Complete App

Yes, I restarted and completed my earlier application today

C

No, I did not complete my new application, but I plan to complete it later

C

No, I did not complete my re-started earlier application, but I plan to complete it later

C

No, I do not plan to complete my application at all

C

I'm not applying for benefits today

ENBJL2237

C

For whom are you filing this online application for Social Security benefits?

Myself

Radio Button One Up Vertical

Single

Y

Skip Logic Group

Whose Behalf

My spouse

My parent

Another relative

My friend

My client

Other

ENBJL2238

R

If you stopped working on your application, please tell us why. (Select all that apply.)

I finished my application today

Checkbox One Up Vertical

Multi

Y

Skip Logic Group

Why Stopped App

Needed to find documents/other information for my application

Too many questions

Takes too long

Too complicated to use without help

My medical/physical condition prevents me from working on the computer for long periods

Application wouldn't accept empty/blank fields

Received an error message or was "kicked out" of the application

I had a problem entering dates or other information in some of the pages

Other Reason

zz

ENBJL2239

zz

Please tell us the other reason you stopped working on your application.

Text area, no char limit

N

Skip Logic Group

OE_Stopped Application

ENBJL2240

X

Did you visit the Social Security home page (www.socialsecurity.gov) today?

Yes

Dropdown (Select-one)

Single

Y

Skip Logic Group

Homepage

No

ENBJL2241

Y

Did you use the SEARCH box on our website to find what you needed?

Yes

Dropdown (Select-one)

Single

Y

Skip Logic Group

Search

No

ENBJL2242

Z

Please tell us how easy it was for you to find the application for benefits.

I had little or no difficulty getting to the application

Radio Button One Up Vertical

Single

Y

Skip Logic Group

Find app

I found it somewhat difficult to find the application

Z1

ENBJL2243

Z1

I found it somewhat difficult to find the application because: (Select all that apply.)

I did not know where to begin looking

Checkbox One Up Vertical

Multi

Y

Skip Logic Group

Difficult to Find

It was not clear to me where the links would lead

The information did not seem to be organized in a logical manner

I used the search function but the results didn’t seem to apply.

Other reason (please describe)

Z2

ENBJL2244

Z2

Please explain the reason you found it somewhat difficult to find the application.

Text area, no char limit

N

Skip Logic Group

OE_Difficult to Find

ENBJL2245

U

How did you arrive on the Social Security website today?

Typed ssa.gov or socialsecurity.gov into the browser

Dropdown (Select-one)

Single

Y

Skip Logic Group

Arrive

Did a search (i.e. Google, Bing, Yahoo)

Followed a link from medicare.gov

Followed a link from another website

ENBJL2246

E

Please rate the clarity of the instructions provided for this Social Security online application.

1 = Not At All Clear

F

Radio Button Scale Has Don’t Know

Single

Y

Skip Logic Group

Clarity of Instructions

2

F

3

F

4

F

5

F

6

7

8

9

10 = Very Clear

Don't know

ENBJL2247

F

What part of the instructions was not clear?

Text area, no char limit

N

Skip Logic Group

OE_Clarity of Instructions

ENBJL2248

G

Did you complete the Online Disability Report today?

Yes

Radio Button One Up Vertical

Single

Y

Skip Logic Group

Disability Report

No

Don't recall

ENBJL2249

W

Do you have any other problems with this Social Security Online application that weren't covered in earlier questions, or any suggestions on how we can improve it? (Please do not include any personal information in your answer.)

Text area, no char limit

N

Skip Logic Group

Other Problems

ENBJL2250

What influenced your decision to use our online benefit application? (Select all that apply.)

I did not want to go to an SSA field office

Checkbox One Up Vertical

Multi

Y

Skip Logic Group

Influenced Decision Benefits

I did not want to do business over the phone

I prefer to use online services as much as possible

I learned about filing online while visiting socialsecurity.gov

Someone from SSA recommended filing online

A friend, relative, or colleague recommended filing online

I knew that if I had a question, I could then call or visit SSA

I am filing on behalf of another person

A

Other, please specify

B

ENBJL2251

B

Please specify what influenced your decision to file for benefits online.

Text area, no char limit

N

Skip Logic Group

OE_Influenced Decision

ENBJL2252

A

Please specify your role.

I am a non-profit professional

Radio button, one-up vertical

Single

Y

Skip Logic Group

Role

I am a for-profit professional

I am a friend or relative

Other, please specify

C

ENBJL2253

C

Please describe your role.

Text field, <100 char

N

Skip Logic Group

OE_Role

---

Sheet 13: v3 CQs (SP) (12-10-13)

Model Instance Name:

red & strike-through: DELETE

SSA iClaim v3 (Spanish)

underlined & italicized: RE-ORDER

MID:

Q0ExM1xNQRl9JJUR0M0JlA4C

pink: ADDITION

Date:

7/15/2011

blue + -->: REWORDING

violet (bold): SKIP-LOGIC

SSA iClaim v3 (Spanish) 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

SPBJL2230

Por favor califique su impresión del nivel de seguridad al completar las tareas en esta solicitud.

1 = Decificente

Radio Button Scale Has Don’t Know

Single

Y

Level of Security

Excelente = 10

No sé

SPBJL2231

¿Qué tipo de beneficios estaba solicitando?

Por jubilación

M, Q, R, X, Y, Z, U, E, W

Dropdown (Select-one)

Single

Y

Skip Logic Group

Type of Benefits

Solo Medicare

M, Q, R, X, Y, Z, U, E, W

Por incapacidad

M, Q, R, X, Y, Z, U, E, G, W

Tanto Jubilación y Discapacidad

Coomo cónyuge

M, Q, R, X, Y, Z, U, E, W

Otro

No estoy solicitando hoy

¿Es esta solicitud en línea para sí mismo o estás ayudando a alguien más?

Yo mismo

Dropdown (Select-one)

Single

Y

Applying for

Cómo ayudar a un cónyuge / pariente / amigo

Profesional Ayudar a un cliente

Otro

¿Cómo se enteró acerca de esta solicitud en línea? (Seleccione todas las que apliquen.)

Sitio web oficial de la Seguridad Social

check box one up vertical

Multi

Y

Skip Logic Group

Learn about App

Una búsqueda web general (por ejemplo, Google, Bing, etc)

La radio

La televisión

Un correo electrónico de la Seguridad Social

Un periódico o la revista

Un anuncio en línea (Banner / Imagen)

Un video en línea

Un periódico o una revista de anuncios

Un anuncio impreso cartelera u otro

Medios de Comunicación Social (Blog, Facebook, Twitter, etc)

Amigo, cónyuge, pariente, vecino o conocido

Declaración del Seguro Social

Empleado del Seguro Social

A

Grupo de la comunidad o de la Asociación

Otro, especificar

B

A

¿Cómo se hace el contacto con un empleado del Seguro Social?

Visitado una oficina local del Seguro Social

check box one up vertical

Multi

Y

Skip Logic

SSA Emplyee Contact

Llamado a la oficina local del Seguro Social

Llamado el número nacional 800

Otro, especificar

AA

AA

Por favor describa cómo se hizo contacto con un empleado del Seguro Social.

Text box, no char limit

N

Skip Logic

OPS SSA Employe Contact

B

Por favor, especifique cómo se enteró de esta aplicación en línea.

Text box, no char limit

N

Skip Logic

OPS Learn about App

¿Ha usado alguna de las siguientes acciones para prepararse para aplicar en línea? (Seleccione todas las que apliquen.)

Comentado mi Declaración del Seguro Social en línea

A

check box one up vertical

Multi

Y

Skip Logic

Prepare for App

He utilizado el Retirement Estimator u otras herramientas en el sitio web de la Seguridad Social

B

Vi el video de instrucciones

C

Usé otra información en la página web de la Seguridad Social para preparar

D

Utilicé otro recurso que se preparen para aplicar en línea

E

No hice uso de los recursos para prepararse para aplicar en línea

A

¿Qué tan útil ha encontrado el Declaración del Seguro Social en línea?

Muy útil

Drop down select one

Single

Y

Skip Logic

Rate Statement

algo útil

Para nada útil

B

¿Qué tan útil encontraste las herramientas estimador en el sitio web?

Muy útil

Drop down select one

Single

Y

Skip Logic

Rate RE Tools

algo útil

Para nada útil

C

¿Qué tan útil le parecen la video instructivo?

Muy útil

Drop down select one

Single

Y

Skip Logic

Rate Video

algo útil

Para nada útil

D

¿Qué tan útil le parecen la otra información en el sitio web de la Seguridad Social?

Muy útil

Drop down select one

Single

Y

Skip Logic

Rate Other Info on Website

algo útil

Para nada útil

E

Por favor describa lo otro recurso (s) que utilizó para prepararse para aplicar en línea.

Text field, no char limit

N

Skip Logic

OPS Prepare for App

¿Comenzó una nueva aplicación en línea hoy mismo o que te vuelva a una solicitud guardada?

Comenzó una nueva aplicación

Drop down select one

Single

Y

App Status

Volvió a trabajar en una solicitud guardada

¿Sabía usted completar y presentar esta solicitud en línea hoy en día?

Sí

Drop down select one

Single

Y

Skip Logic

Complete App

No, tengo la intención de completar y enviar más tarde

A

No, no tengo planes para completar y enviar la solicitud en línea

A

A

Si no logró completar y presentar esta solicitud en línea hoy, por favor díganos por qué.

Demasiadas preguntas

check box one up vertical

Multi

Y

Skip Logic

Not Complete App

Toma demasiado tiempo para llenar

Demasiado complicado de usar sin ayuda

No tenía la información que necesitaba como nombres, direcciones o fechas

No entendía lo que significaba preguntas / cómo responder

Mi condición de discapacidad me impide trabajar con una computadora por largos periodos

Yo tenía una cantidad limitada de demandas de tiempo / de la familia que me impedía trabajar en ella por mucho tiempo

Tuve problemas técnicos, como un mensaje de error o un error que no podía fijar

Otro, especificar

AA

AA

Haznos saber por qué no se ha completado y se somete esta solicitud hoy.

Text field, no char limit

N

Skip Logic

OPS Why Not Complete today

Hasta el momento, ¿cuánto tiempo ha trabajado en esta solicitud en línea?

Hasta 15 minutos

Drop down select one

Single

Y

Time Spent

16 minutos - 30 minutos

31 minutos - 1 hora

Más de 1 hora hasta 2 horas

Más de 2 horas

¿Fue fácil para usted para encontrar esta aplicación en línea?

Muy fácil

Find App

algo fácil

algo duro

A

Muy difícil

A

A

Haznos saber por qué era difícil encontrar la aplicación en línea. (Seleccione todas las que apliquen.)

No se pudo encontrar por dónde empezar una nueva aplicación en línea

check box one up vertical

Multi

Y

Skip Logic

Why hard to find

Donde no está claro que vaya a volver a una solicitud previamente guardada

No estaba claro para mí cuando los vínculos conducirían

Dificultad para utilizar un enlace en la página web de la Seguridad Social

La información no parecía estar organizados de una manera lógica

Usé la función de búsqueda, pero los resultados no parecen aplicarse.

Traté de usar el FAQ, pero no pude encontrar la solicitud en línea

Otro, especificar

AA

AA

Por favor, explique la razón por la que era difícil para usted para encontrar la solicitud en línea.

N

N

Skip Logic

OPS Hard to Find

¿Cómo llegaste a esta solicitud en línea hoy en día?

Se utiliza el enlace de los servicios en línea en la página web de la Seguridad Social

Radio Button

Single

Y

Skip Logic

Arrive at App

Seguido de un enlace de algún otro lugar en el sitio web de la Seguridad Social

Se utiliza la función de búsqueda en la página web de la Seguridad Social

Se utiliza un motor de búsqueda fuera (es decir, Google, Bing, Yahoo, etc)

Seguido de un enlace desde medicare.gov

Seguido un enlace desde otro sitio web

Este sitio fue bookmarked

Otro, especificar

A

A

Por favor describa cómo llegó a esta solicitud en línea hoy

Text field, no char limit

N

OPS Arrive at app

¿Por qué eligió para aplicar en línea? (Seleccione todas las que apliquen.)

Yo no quería ir a una oficina local del Seguro Social

check box one up vertical

Multi

Y

Skip Logic

Why Online

Yo no quería que la solicitud por teléfono

Yo prefiero usar los servicios en línea tanto como sea posible

Aprendí acerca de la aplicación en línea durante su visita a la página web de la Seguridad Social

Un empleado del Seguro Social recomienda que aplico en línea

Un amigo o familiar recomendaron que aplico en línea

Yo sabía que si tenía alguna pregunta o problema la aplicación en línea, todavía podía recibir ayuda de la Seguridad Social

Estoy presentando en nombre de otra persona

Otro, especificar

A

A

Por favor, especifique qué decide aplicar en línea

Text field, no char limit

N

OPS Why Online

¿Cuál es su estado civil actual?

casado

Radio button, one-up vertical

Single

N

OPS Group

Marital Status

apartado

divorciado

viudo

`

Nunca se ha casado

Prefiero no responder

Otro, especificar

A

A

Otro estado civil

Text field, <100 char

N

OPS Group

OPS Marital Status

¿Tiene alguna sugerencia para mejorar la aplicación en línea de la Seguridad Social?

Text field, no char limit

N

OE_Improvement

SPBJL2232

M

¿Cómo se enteró de la solicitud por Internet del Seguro Social? (Seleccione todo lo que aplique.)

El sitio de Internet del Seguro Social

Checkbox One Up Vertical

Multi

Y

Skip Logic Group

Learn About Online App

Types

Una búsqueda por Internet (usando Google, Bing, etc.)

Una promoción en la radio

Una promoción en la televisión

Un e-mail del Seguro Social

Un artículo en un diario o una revista

Una  promoción por Internet (anuncio web/imagen)

Un video en la Internet

Una promoción en un diario o una revista

Una pancarta u otro tipo de promoción impresa

En las redes sociales (un blog, en Facebook, Twitter, etc.)

Un amigo, mi cónyuge, un familiar, un vecino o un conocido

La Declaración del Seguro Social

Un agente del Seguro Social

B

Una asociación o un grupo comunitario

Otro modo, por favor especifique el modo

A

SPBJL2233

A

Por favor especifique cómo se enteró del sitio de Internet del Seguro Social.

Text area, no char limit

N

Skip Logic Group

OE_Learn about online app

SPBJL2234

B

¿Cómo se comunicó con un empleado del Seguro Social?

Visitando una de las oficinas locales del Seguro Social

Radio Button One Up Vertical

Single

Y

Skip Logic Group

Contact SSA Employee

Llamando la oficina local del Seguro Social

Llamando el número 800 nacional

Otro modo, por favor especifique

D

SPBJL2235

D

Por favor describa la manera en la que se comunicó con un empleado del Seguro Social.

Text field, <100 char

N

Skip Logic Group

OE_Contact SSA Employee

SPBJL2236

Q

¿Completó la solicitud hoy?

Sí, llené mi solicitud hoy mismo.

C

Radio Button One Up Vertical

Single

Y

Skip Logic Group

Complete App

Sí, reanudé y llené la solicitud que ya había comenzado.

C

No, no terminé de llenar la solicitud pero la terminaré más adelante.

C

No, no terminé de llenar la solicitud que ya había comenzado pero la terminaré más adelante.

C

No, no tengo intención de terminar la solicitud.

C

No voy a solicitar los beneficios hoy.

SPBJL2237

C

¿Para quién está llenando esta solicitud por Internet para beneficios de Seguro Social?

Para mi mismo.

Radio Button One Up Vertical

Single

Y

Skip Logic Group

Whose Behalf

Para mi cónyuge.

Para mis padres.

Para un familiar.

Para un amigo.

Para un cliente.

Para otra persona

SPBJL2238

R

Si dejó de llenar su solicitud, por favor díganos por qué. (Seleccione todo lo que aplique)

Terminé de llenar mi solicitud hoy.

Checkbox One Up Vertical

Multi

Y

Skip Logic Group

Why Stopped App

Necesitaba conseguir algunos documentos u otra información para terminar mi solicitud.

Demasiadas preguntas

Me demoró mucho.

La solicitud es muy compllicada sin la ayuda de alguien.

Mi impedimento físico/médico me impide trabajar con una computadora por periodos prolongados.

La solicitud no aceptaba que dejara preguntas sin contestar.

Recibí un mensage haciendo saber que había sido «expulsado» de la solicitud.

Tuve problemas ingresando fechas y otra información en algunas de las páginas.

Por otras razones

zz

SPBJL2239

zz

Por favor díganos la razón por la que dejó de llenar su solicitud.

Text area, no char limit

N

Skip Logic Group

OE_Stopped Application

SPBJL2240

X

¿Visitó la página principal del Seguro Social (www.segurosocial.gov) hoy?

Sí

Dropdown (Select-one)

Single

Y

Skip Logic Group

Homepage

No

SPBJL2241

Y

¿Usó el encasillado de BUSCAR en nuestro sitio de Internet para encontrar lo que necesitaba?

Sí

Dropdown (Select-one)

Single

Y

Skip Logic Group

Search

No

SPBJL2242

Z

Por favor díganos que tan fácil fue para que encontrara la solicitud para beneficios.

Tuve un poco de dificultad para ingresar a la solicitud.

Radio Button One Up Vertical

Single

Y

Skip Logic Group

Find app

Se me hizo un poco dificultoso el encontrar la solicitud.

Z1

SPBJL2243

Z1

Encontré que fue un poco difícil encontrar la solicitud debido a que: (Seleccione todo lo que aplique.)

No sabía por dónde comenzar a buscar.

Checkbox One Up Vertical

Multi

Y

Skip Logic Group

Difficult to Find

No estaba claro a dónde me llevarían los enlaces.

No me pareción que la información estaba organizada en una manera lógica.

Usé la herramienta de búsqueda pero los resultados no parecían ser relevantes.

Por otras razones (por favor explique)

Z2

SPBJL2244

Z2

Por favor explique la razón por la que encontró que la solicitud fue un poco difícil de encontrar.

Text area, no char limit

N

Skip Logic Group

OE_Difficult to Find

SPBJL2245

U

¿Cómo llegó al sitio de Internet del Seguro Social hoy?

Ingresé la dirección ssa.gov o segurosocial.gov en el navegador de Internet.

Dropdown (Select-one)

Single

Y

Skip Logic Group

Arrive

Hice una búsqueda (usando Google, Bing, Yahoo)

Oprimí en un enlace que encontré en medicare.gov

Oprimí en un enlace que encontré en otro sitio de Internet.

SPBJL2246

E

Por favor califique la claridad de las instrucciones provistas para esta solicitud por Internet del Seguro Social.

1 = No lo entiendo

F

Radio Button Scale Has Don’t Know

Single

Y

Skip Logic Group

Clarity of Instructions

F

F

F

F

Muy claro = 10

No sé

SPBJL2247

F

¿Qué parte de las instrucciones no estaban claras?

Text area, no char limit

N

Skip Logic Group

OE_Clarity of Instructions

SPBJL2248

G

¿Llenó el informe de incapacidad por Internet hoy?

Sí.

Radio Button One Up Vertical

Single

Y

Skip Logic Group

Disability Report

No.

No me acuerdo.

SPBJL2249

W

¿Tiene algún otro problema con la solicitud por Internet del Seguro Social que no se cubrió en las preguntas anteriores, o alguna sugerencia sobre cómo podemos mejorarla? (Por favor no incluya ninguna información personal en su respuesta.)

Text area, no char limit

N

Skip Logic Group

Other Problems

SPBJL2250

¿Qué influyó su decisión para usar nuestra solicitud de beneficios por Internet? (Seleccione todo lo que aplique.)

No quería ir a la oficina del Seguro Social.

Checkbox One Up Vertical

Multi

Y

Skip Logic Group

Influenced Decision Benefits

No quería transactar mis asuntos por teléfno.

Prefiero usar los servicio por Internet lo más posible.

Me informé acerca de los servicios por Internet al visitar el sitio de Internet segurosocialove

Uno de los agentes del Seguro Social sugirió el que solicitara los beneficios por Internet.

Un amigo, familiar o un colega sugirió el que solicitiara los beneficios por Internet.

Sabía que si tenía alguna pregunta podría llamar o visitar al Seguro Social.

Estoy llenando el formulario a nombre de otra persona.

A

Otro razón, por favor especifique

B

SPBJL2251

B

Por favor especifique que influyó su decisión para solicitar los beneficios por Internet.

Text area, no char limit

N

Skip Logic Group

OE_Influenced Decision

SPBJL2252

A

Por favor especifique el papel que desempeña:

Proveo servicios como profesional sin fines de lucro.

Radio button, one-up vertical

Single

Y

Skip Logic Group

Role

Proveo servicios como profesional por honorario.

Soy un amigo o familiar del reclamante.

Otra persona, por favor especifique.

C

SPBJL2253

C

Por favor describa qué papel desempeña.

Text field, <100 char

N

Skip Logic Group

OE_Role

---

Sheet 14: v3 CQs (EE) (8-19-13)

Model Instance Name:

red & strike-through: DELETE

SSA iClaim v3

underlined & italicized: RE-ORDER

MID: xZAAEQw81gIo1Vo4Noc1Rw4C

pink: ADDITION

Date:

7/15/2011

blue + -->: REWORDING

violet (bold): SKIP-LOGIC

SSA iClaim v3 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

BJL2230

Please rate your impression of the level of security in completing tasks on this application.

1 = Poor

Radio Button Scale Has Don’t Know

Single

Y

Level of Security

2

3

4

5

6

7

8

9

10 = Excellent

Don't know

BJL2231

What type of benefits were you applying for?

Retirement

M, Q, R, X, Y, Z, U, E, W

Dropdown (Select-one)

Single

Y

Skip Logic Group

Type of Benefits

Disability

M, Q, R, X, Y, Z, U, E, G, W

Spouse's

M, Q, R, X, Y, Z, U, E, W

Medicare only

M, Q, R, X, Y, Z, U, E, W

I am not applying today

BJL2232

M

How did you learn about the Social Security online application? (Select all that apply.)

+-->Official Social Security website

Checkbox One Up Vertical

Multi

Y

Skip Logic Group

Learn About Online App

Types

A general web search (e.g. Google, Bing, etc.)

The radio

The television

An email from Social Security

A newspaper or magazine article

An online ad (Banner/Image)

An online video

A newspaper or magazine ad

A billboard or other printed ad

Social Media (Blog, Facebook, Twitter, etc.)

B

Social Security statement

Social Security employee

Community Group or Association

Another website or search engine

News (TV, radio, newspaper or Internet)

Advertisement

Other, please specify

A

BJL2233

A

Please specify how you learned of Social Security online.

Text area, no char limit

N

Skip Logic Group

OE_Learn about online app

BJL2234

B

How did you make contact with a Social Security employee?

Visited a local Social Security office

Radio Button One Up Vertical

Single

Y

Skip Logic Group

Contact SSA Employee

Called a local Social Security office

Called the national 800 number

Other, please specify

D

BJL2235

D

Please describe the way you made contact with a social security employee.

Text field, <100 char

N

Skip Logic Group

OE_Contact SSA Employee

BJL2236

Q

Did you complete your application today?

Yes, I completed my new application today

C

Radio Button One Up Vertical

Single

Y

Skip Logic Group

Complete App

Yes, I restarted and completed my earlier application today

C

No, I did not complete my new application, but I plan to complete it later

C

No, I did not complete my re-started earlier application, but I plan to complete it later

C

No, I do not plan to complete my application at all

C

I'm not applying for benefits today

BJL2237

C

For whom are you filing this online application for Social Security benefits?

Myself

Radio Button One Up Vertical

Single

Y

Skip Logic Group

Whose Behalf

My spouse

My parent

Another relative

My friend

My client

Other

BJL2238

R

If you stopped working on your application, please tell us why. (Select all that apply.)

I finished my application today

Checkbox One Up Vertical

Multi

Y

Skip Logic Group

Why Stopped App

Needed to find documents/other information for my application

Too many questions

Takes too long

Too complicated to use without help

My medical/physical condition prevents me from working on the computer for long periods

Application wouldn't accept empty/blank fields

Received an error message or was "kicked out" of the application

I had a problem entering dates or other information in some of the pages

Other Reason

zz

BJL2239

zz

Please tell us the other reason you stopped working on your application.

Text area, no char limit

N

Skip Logic Group

OE_Stopped Application

BJL2240

X

Did you visit the Social Security home page (www.socialsecurity.gov) today?

Yes

Dropdown (Select-one)

Single

Y

Skip Logic Group

Homepage

No

BJL2241

Y

Did you use the SEARCH box on our website to find what you needed?

Yes

Dropdown (Select-one)

Single

Y

Skip Logic Group

Search

No

BJL2242

Z

Please tell us how easy it was for you to find the application for benefits.

I had little or no difficulty getting to the application

Radio Button One Up Vertical

Single

Y

Skip Logic Group

Find app

I found it somewhat difficult to find the application

Z1

BJL2243

Z1

I found it somewhat difficult to find the application because: (Select all that apply.)

I did not know where to begin looking

Checkbox One Up Vertical

Multi

Y

Skip Logic Group

Difficult to Find

It was not clear to me where the links would lead

The information did not seem to be organized in a logical manner

I used the search function but the results didn’t seem to apply.

Other reason (please describe)

Z2

BJL2244

Z2

Please explain the reason you found it somewhat difficult to find the application.

Text area, no char limit

N

Skip Logic Group

OE_Difficult to Find

BJL2245

U

How did you arrive on the Social Security website today?

Typed ssa.gov or socialsecurity.gov into the browser

Dropdown (Select-one)

Single

Y

Skip Logic Group

Arrive

Did a search (i.e. Google, Bing, Yahoo)

Followed a link from medicare.gov

Followed a link from another website

BJL2246

E

Please rate the clarity of the instructions provided for this Social Security online application.

1 = Not At All Clear

F

Radio Button Scale Has Don’t Know

Single

Y

Skip Logic Group

Clarity of Instructions

2

F

3

F

4

F

5

F

6

7

8

9

10 = Very Clear

Don't know

BJL2247

F

What part of the instructions was not clear?

Text area, no char limit

N

Skip Logic Group

OE_Clarity of Instructions

BJL2248

G

Did you complete the Online Disability Report today?

Yes

Radio Button One Up Vertical

Single

Y

Skip Logic Group

Disability Report

No

Don't recall

BJL2249

W

Do you have any other problems with this Social Security Online application that weren't covered in earlier questions, or any suggestions on how we can improve it? (Please do not include any personal information in your answer.)

Text area, no char limit

N

Skip Logic Group

Other Problems

BJL2250

What influenced your decision to use our online benefit application? (Select all that apply.)

I did not want to go to an SSA field office

Checkbox One Up Vertical

Multi

Y

Skip Logic Group

Influenced Decision Benefits

I did not want to do business over the phone

I prefer to use online services as much as possible

I learned about filing online while visiting socialsecurity.gov

Someone from SSA recommended filing online

A friend, relative, or colleague recommended filing online

I knew that if I had a question, I could then call or visit SSA

I am filing on behalf of another person

A

Other, please specify

B

BJL2251

B

Please specify what influenced your decision to file for benefits online.

Text area, no char limit

N

Skip Logic Group

OE_Influenced Decision

BJL2252

A

Please specify your role.

I am a non-profit professional

Radio button, one-up vertical

Single

Y

Skip Logic Group

Role

I am a for-profit professional

I am a friend or relative

Other, please specify

C

BJL2253

C

Please describe your role.

Text field, <100 char

N

Skip Logic Group

OE_Role

---

Sheet 15: CQs v3 (EN) (8-19-13)

Model Instance Name:

red & strike-through: DELETE

SSA iClaim v3

underlined & italicized: RE-ORDER

MID: VgpBBYx9l8JxIFgJlY1Ikg4C

pink: ADDITION

Date:

7/15/2011

blue + -->: REWORDING

violet (bold): SKIP-LOGIC

SSA iClaim v3 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

ENBJL2230

Please rate your impression of the level of security in completing tasks on this application.

1 = Poor

Radio Button Scale Has Don’t Know

Single

Y

Level of Security

2

3

4

5

6

7

8

9

10 = Excellent

Don't know

ENBJL2231

What type of benefits were you applying for?

Retirement

M, Q, R, X, Y, Z, U, E, W

Dropdown (Select-one)

Single

Y

Skip Logic Group

Type of Benefits

Disability

M, Q, R, X, Y, Z, U, E, G, W

Spouse's

M, Q, R, X, Y, Z, U, E, W

Medicare only

M, Q, R, X, Y, Z, U, E, W

I am not applying today

ENBJL2232

M

How did you learn about the Social Security online application? (Select all that apply.)

+-->Official Social Security website

Checkbox One Up Vertical

Multi

Y

Skip Logic Group

Learn About Online App

Types

A general web search (e.g. Google, Bing, etc.)

The radio

The television

An email from Social Security

A newspaper or magazine article

An online ad (Banner/Image)

An online video

A newspaper or magazine ad

A billboard or other printed ad

Social Media (Blog, Facebook, Twitter, etc.)

Social Security statement

Social Security employee

B

Community Group or Association

Another website or search engine

News (TV, radio, newspaper or Internet)

Advertisement

Other, please specify

A

ENBJL2233

A

Please specify how you learned of Social Security online.

Text area, no char limit

N

Skip Logic Group

OE_Learn about online app

ENBJL2234

B

How did you make contact with a Social Security employee?

Visited a local Social Security office

Radio Button One Up Vertical

Single

Y

Skip Logic Group

Contact SSA Employee

Called a local Social Security office

Called the national 800 number

Other, please specify

D

ENBJL2235

D

Please describe the way you made contact with a social security employee.

Text field, <100 char

N

Skip Logic Group

OE_Contact SSA Employee

ENBJL2236

Q

Did you complete your application today?

Yes, I completed my new application today

C

Radio Button One Up Vertical

Single

Y

Skip Logic Group

Complete App

Yes, I restarted and completed my earlier application today

C

No, I did not complete my new application, but I plan to complete it later

C

No, I did not complete my re-started earlier application, but I plan to complete it later

C

No, I do not plan to complete my application at all

C

I'm not applying for benefits today

ENBJL2237

C

For whom are you filing this online application for Social Security benefits?

Myself

Radio Button One Up Vertical

Single

Y

Skip Logic Group

Whose Behalf

My spouse

My parent

Another relative

My friend

My client

Other

ENBJL2238

R

If you stopped working on your application, please tell us why. (Select all that apply.)

I finished my application today

Checkbox One Up Vertical

Multi

Y

Skip Logic Group

Why Stopped App

Needed to find documents/other information for my application

Too many questions

Takes too long

Too complicated to use without help

My medical/physical condition prevents me from working on the computer for long periods

Application wouldn't accept empty/blank fields

Received an error message or was "kicked out" of the application

I had a problem entering dates or other information in some of the pages

Other Reason

zz

ENBJL2239

zz

Please tell us the other reason you stopped working on your application.

Text area, no char limit

N

Skip Logic Group

OE_Stopped Application

ENBJL2240

X

Did you visit the Social Security home page (www.socialsecurity.gov) today?

Yes

Dropdown (Select-one)

Single

Y

Skip Logic Group

Homepage

No

ENBJL2241

Y

Did you use the SEARCH box on our website to find what you needed?

Yes

Dropdown (Select-one)

Single

Y

Skip Logic Group

Search

No

ENBJL2242

Z

Please tell us how easy it was for you to find the application for benefits.

I had little or no difficulty getting to the application

Radio Button One Up Vertical

Single

Y

Skip Logic Group

Find app

I found it somewhat difficult to find the application

Z1

ENBJL2243

Z1

I found it somewhat difficult to find the application because: (Select all that apply.)

I did not know where to begin looking

Checkbox One Up Vertical

Multi

Y

Skip Logic Group

Difficult to Find

It was not clear to me where the links would lead

The information did not seem to be organized in a logical manner

I used the search function but the results didn’t seem to apply.

Other reason (please describe)

Z2

ENBJL2244

Z2

Please explain the reason you found it somewhat difficult to find the application.

Text area, no char limit

N

Skip Logic Group

OE_Difficult to Find

ENBJL2245

U

How did you arrive on the Social Security website today?

Typed ssa.gov or socialsecurity.gov into the browser

Dropdown (Select-one)

Single

Y

Skip Logic Group

Arrive

Did a search (i.e. Google, Bing, Yahoo)

Followed a link from medicare.gov

Followed a link from another website

ENBJL2246

E

Please rate the clarity of the instructions provided for this Social Security online application.

1 = Not At All Clear

F

Radio Button Scale Has Don’t Know

Single

Y

Skip Logic Group

Clarity of Instructions

2

F

3

F

4

F

5

F

6

7

8

9

10 = Very Clear

Don't know

ENBJL2247

F

What part of the instructions was not clear?

Text area, no char limit

N

Skip Logic Group

OE_Clarity of Instructions

ENBJL2248

G

Did you complete the Online Disability Report today?

Yes

Radio Button One Up Vertical

Single

Y

Skip Logic Group

Disability Report

No

Don't recall

ENBJL2249

W

Do you have any other problems with this Social Security Online application that weren't covered in earlier questions, or any suggestions on how we can improve it? (Please do not include any personal information in your answer.)

Text area, no char limit

N

Skip Logic Group

Other Problems

ENBJL2250

What influenced your decision to use our online benefit application? (Select all that apply.)

I did not want to go to an SSA field office

Checkbox One Up Vertical

Multi

Y

Skip Logic Group

Influenced Decision Benefits

I did not want to do business over the phone

I prefer to use online services as much as possible

I learned about filing online while visiting socialsecurity.gov

Someone from SSA recommended filing online

A friend, relative, or colleague recommended filing online

I knew that if I had a question, I could then call or visit SSA

I am filing on behalf of another person

A

Other, please specify

B

ENBJL2251

B

Please specify what influenced your decision to file for benefits online.

Text area, no char limit

N

Skip Logic Group

OE_Influenced Decision

ENBJL2252

A

Please specify your role.

I am a non-profit professional

Radio button, one-up vertical

Single

Y

Skip Logic Group

Role

I am a for-profit professional

I am a friend or relative

Other, please specify

C

ENBJL2253

C

Please describe your role.

Text field, <100 char

N

Skip Logic Group

OE_Role

---

Sheet 16: v3 CQs (SP) (8-19-13)

Model Instance Name:

red & strike-through: DELETE

SSA iClaim v3 (Spanish)

underlined & italicized: RE-ORDER

MID:

Q0ExM1xNQRl9JJUR0M0JlA4C

pink: ADDITION

Date:

7/15/2011

blue + -->: REWORDING

violet (bold): SKIP-LOGIC

SSA iClaim v3 (Spanish) 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

SPBJL2230

Por favor califique su impresión del nivel de seguridad al completar las tareas en esta solicitud.

1 = Decificente

Radio Button Scale Has Don’t Know

Single

Y

Level of Security

Excelente = 10

No sé

SPBJL2231

¿Qué tipo de beneficios estaba solicitando?

Por jubilación

M, Q, R, X, Y, Z, U, E, W

Dropdown (Select-one)

Single

Y

Skip Logic Group

Type of Benefits

Por incapacidad

M, Q, R, X, Y, Z, U, E, G, W

Coomo cónyuge

M, Q, R, X, Y, Z, U, E, W

Solo Medicare

M, Q, R, X, Y, Z, U, E, W

No estoy solicitando hoy

SPBJL2232

M

¿Cómo se enteró de la solicitud por Internet del Seguro Social? (Seleccione todo lo que aplique.)

El sitio de Internet del Seguro Social

El sitio de Internet del Seguro Social

Checkbox One Up Vertical

Multi

Y

Skip Logic Group

Learn About Online App

Types

Por un amigo, mi cónyuge, un familiar, un vecino o un conocido

Una búsqueda por Internet (usando Google, Bing, etc.)

Agente del Seguro Social

Una promoción en la radio

B

Por medio de otro sitio de Internet o un buscador de internet

Una promoción en la televisión

Las noticias (TV, radio, diario o Internet)

Un e-mail del Seguro Social

Promoción

Un artículo en un diario o una revista

La Declaración del Seguro Social

Una  promoción por Internet (anuncio web/imagen)

Grupo o asociación comunitaria

Un video en la Internet

Otro modo, por favor especifique

Una promoción en un diario o una revista

A

Una pancarta u otro tipo de promoción impresa

En las redes sociales (un blog, en Facebook, Twitter, etc.)

Un amigo, mi cónyuge, un familiar, un vecino o un conocido

La Declaración del Seguro Social

Un agente del Seguro Social

Una asociación o un grupo comunitario

Otro modo, por favor especifique el modo

SPBJL2233

A

Por favor especifique cómo se enteró del sitio de Internet del Seguro Social.

Text area, no char limit

N

Skip Logic Group

OE_Learn about online app

SPBJL2234

B

¿Cómo se comunicó con un empleado del Seguro Social?

Visitando una de las oficinas locales del Seguro Social

Radio Button One Up Vertical

Single

Y

Skip Logic Group

Contact SSA Employee

Llamando la oficina local del Seguro Social

Llamando el número 800 nacional

Otro modo, por favor especifique

D

SPBJL2235

D

Por favor describa la manera en la que se comunicó con un empleado del Seguro Social.

Text field, <100 char

N

Skip Logic Group

OE_Contact SSA Employee

SPBJL2236

Q

¿Completó la solicitud hoy?

Sí, llené mi solicitud hoy mismo.

C

Radio Button One Up Vertical

Single

Y

Skip Logic Group

Complete App

Sí, reanudé y llené la solicitud que ya había comenzado.

C

No, no terminé de llenar la solicitud pero la terminaré más adelante.

C

No, no terminé de llenar la solicitud que ya había comenzado pero la terminaré más adelante.

C

No, no tengo intención de terminar la solicitud.

C

No voy a solicitar los beneficios hoy.

SPBJL2237

C

¿Para quién está llenando esta solicitud por Internet para beneficios de Seguro Social?

Para mi mismo.

Radio Button One Up Vertical

Single

Y

Skip Logic Group

Whose Behalf

Para mi cónyuge.

Para mis padres.

Para un familiar.

Para un amigo.

Para un cliente.

Para otra persona

SPBJL2238

R

Si dejó de llenar su solicitud, por favor díganos por qué. (Seleccione todo lo que aplique)

Terminé de llenar mi solicitud hoy.

Checkbox One Up Vertical

Multi

Y

Skip Logic Group

Why Stopped App

Necesitaba conseguir algunos documentos u otra información para terminar mi solicitud.

Demasiadas preguntas

Me demoró mucho.

La solicitud es muy compllicada sin la ayuda de alguien.

Mi impedimento físico/médico me impide trabajar con una computadora por periodos prolongados.

La solicitud no aceptaba que dejara preguntas sin contestar.

Recibí un mensage haciendo saber que había sido «expulsado» de la solicitud.

Tuve problemas ingresando fechas y otra información en algunas de las páginas.

Por otras razones

zz

SPBJL2239

zz

Por favor díganos la razón por la que dejó de llenar su solicitud.

Text area, no char limit

N

Skip Logic Group

OE_Stopped Application

SPBJL2240

X

¿Visitó la página principal del Seguro Social (www.segurosocial.gov) hoy?

Sí

Dropdown (Select-one)

Single

Y

Skip Logic Group

Homepage

No

SPBJL2241

Y

¿Usó el encasillado de BUSCAR en nuestro sitio de Internet para encontrar lo que necesitaba?

Sí

Dropdown (Select-one)

Single

Y

Skip Logic Group

Search

No

SPBJL2242

Z

Por favor díganos que tan fácil fue para que encontrara la solicitud para beneficios.

Tuve un poco de dificultad para ingresar a la solicitud.

Radio Button One Up Vertical

Single

Y

Skip Logic Group

Find app

Se me hizo un poco dificultoso el encontrar la solicitud.

Z1

SPBJL2243

Z1

Encontré que fue un poco difícil encontrar la solicitud debido a que: (Seleccione todo lo que aplique.)

No sabía por dónde comenzar a buscar.

Checkbox One Up Vertical

Multi

Y

Skip Logic Group

Difficult to Find

No estaba claro a dónde me llevarían los enlaces.

No me pareción que la información estaba organizada en una manera lógica.

Usé la herramienta de búsqueda pero los resultados no parecían ser relevantes.

Por otras razones (por favor explique)

Z2

SPBJL2244

Z2

Por favor explique la razón por la que encontró que la solicitud fue un poco difícil de encontrar.

Text area, no char limit

N

Skip Logic Group

OE_Difficult to Find

SPBJL2245

U

¿Cómo llegó al sitio de Internet del Seguro Social hoy?

Ingresé la dirección ssa.gov o segurosocial.gov en el navegador de Internet.

Dropdown (Select-one)

Single

Y

Skip Logic Group

Arrive

Hice una búsqueda (usando Google, Bing, Yahoo)

Oprimí en un enlace que encontré en medicare.gov

Oprimí en un enlace que encontré en otro sitio de Internet.

SPBJL2246

E

Por favor califique la claridad de las instrucciones provistas para esta solicitud por Internet del Seguro Social.

1 = No lo entiendo

F

Radio Button Scale Has Don’t Know

Single

Y

Skip Logic Group

Clarity of Instructions

F

F

F

F

Muy claro = 10

No sé

SPBJL2247

F

¿Qué parte de las instrucciones no estaban claras?

Text area, no char limit

N

Skip Logic Group

OE_Clarity of Instructions

SPBJL2248

G

¿Llenó el informe de incapacidad por Internet hoy?

Sí.

Radio Button One Up Vertical

Single

Y

Skip Logic Group

Disability Report

No.

No me acuerdo.

SPBJL2249

W

¿Tiene algún otro problema con la solicitud por Internet del Seguro Social que no se cubrió en las preguntas anteriores, o alguna sugerencia sobre cómo podemos mejorarla? (Por favor no incluya ninguna información personal en su respuesta.)

Text area, no char limit

N

Skip Logic Group

Other Problems

SPBJL2250

¿Qué influyó su decisión para usar nuestra solicitud de beneficios por Internet? (Seleccione todo lo que aplique.)

No quería ir a la oficina del Seguro Social.

Checkbox One Up Vertical

Multi

Y

Skip Logic Group

Influenced Decision Benefits

No quería transactar mis asuntos por teléfno.

Prefiero usar los servicio por Internet lo más posible.

Me informé acerca de los servicios por Internet al visitar el sitio de Internet segurosocialove

Uno de los agentes del Seguro Social sugirió el que solicitara los beneficios por Internet.

Un amigo, familiar o un colega sugirió el que solicitiara los beneficios por Internet.

Sabía que si tenía alguna pregunta podría llamar o visitar al Seguro Social.

Estoy llenando el formulario a nombre de otra persona.

A

Otro razón, por favor especifique

B

SPBJL2251

B

Por favor especifique que influyó su decisión para solicitar los beneficios por Internet.

Text area, no char limit

N

Skip Logic Group

OE_Influenced Decision

SPBJL2252

A

Por favor especifique el papel que desempeña:

Proveo servicios como profesional sin fines de lucro.

Radio button, one-up vertical

Single

Y

Skip Logic Group

Role

Proveo servicios como profesional por honorario.

Soy un amigo o familiar del reclamante.

Otra persona, por favor especifique.

C

SPBJL2253

C

Por favor describa qué papel desempeña.

Text field, <100 char

N

Skip Logic Group

OE_Role