869 2014 869 PSC Email

American Customer Satisfaction Index (ACSI) E-Government Website Customer Satisfaction Surveys

2014 869 PSC Email.xlsx

2014 865 NIAMS - 2014 870 DoDEA

OMB: 1090-0008

Document [xlsx]
Download: xlsx | pdf

Overview

Guidelines
Welcome and Thank You Text
Current Model Qsts
Model Qsts (8-16-12)
Current CQs
CQs (7-2-14)
CQs (6-17-14)
CQs (6-12-14)
CQs (5-6-14)
CQs (4-30-14)
CQs (4-25-14)
CQs (4-16-14)
CQs (8-21-13)
CQs (8-28-12)
CQs (8-16-12)
PRE DL v2 CQs


Sheet 1: Guidelines























Questionnaire Management Guidelines








































Goals:



















One consolidated document to track all model and CQ changes throughout the life of the project


















Questionnaire always matches the live survey


















Easy and error-free way to submit CQ changes


















All changes tracked and reflected in one document (DOT will help)







































Questionnaire Resources:








































1
Questionnaire Design and Approval Process














2
Question Grouping Rules















3
OPS vs. Skip Logic Decision for "Other, Please Specify"











4
Foreign Language Survey Instructions


































Sheet 2: Welcome and Thank You Text

Model Instance Name:








DHHS-PSC Offline Support Services v2







MID: 4AFVdB88Aw1dk0QocxcEtw==






Date: 8/6/2012








Welcome and Thank You Text













Directions:










This welcome text is shown at the top of the questionnaire window and the thank you text at the bottom. This is a good place to mention the site/company/agency name so the visitor knows whom they are taking the survey for. Feel free to modify the standard Welcome and Thank you text shown in the boxes below. Please read comments before using any of the text.









Examples


Welcome Text Example































Welcome Text









Based upon your most recent experience with PSC we ask that you please complete this brief survey to let us know what we're doing well and where we can improve.


























































































Thank You Text Example


















DEFAULT Thank You Text












“Thank you for taking our survey - and for helping us serve you better. We appreciate your input!”


























































































































































































































































Sheet 3: Current Model Qsts

Model Instance Name:






DHHS-PSC Offline Support Services v2






MID:
4AFVdB88Aw1dk0QocxcEtw==



Partitioned (N)





NOTE: All non-partitioned surveys will NOT be imputed and the elements will be rotated as a default unless otherwise specified and approved by Research.


Date:
8/6/2012


DHHS-PSC Offline Support Services v2
Model questions utilize the ACSI methodology to determine scores and impacts


ELEMENTS (drivers of satisfaction)

CUSTOMER SATISFACTION
FUTURE BEHAVIORS

MQ Label

MQ Label
MQ Label


Representative (1=Poor, 10=Excellent, Don't Know)

Satisfaction
Use Again (1=Very Unlikely, 10=Very Likely)

Representative - Professionalism Thinking about the representative who worked with you, please rate the following:
Please rate the professionalism of the representative.

Satisfaction - Overall What is your overall satisfaction with this service experience?
(1=Very Dissatisfied, 10=Very Satisfied)
Use Again How likely are you to use these services in the future?

Representative - Knowledge Please rate the knowledge of the representative.
Satisfaction - Expectations How well did this service experience meet your expectations?
(1=Falls Short, 10=Exceeds)

Recommend (1=Very Unlikely, 10=Very Likely)

Representative - Courtesy Please rate the courtesy of the representative.
Satisfaction - Ideal How does this experience compare to your idea of an ideal service experience?
(1=Not Very Close, 10=Very Close)
Recommend How likely are you to recommend this service provider to someone else?


Response Speed (1=Poor, 10=Excellent, Don't Know)





Reponses -Time Thinking about the responsiveness of service delivery, please rate the following:
Length of time it took to get the service delivered.




Response - Speed The speed with which the service was completed.


Response - Timeliness The overall timeliness of the service delivery process.



Service Quality (1=Poor, 10=Excellent, Don't Know)





Service - Completeness Thinking about the services received, please rate the following aspects of those services:
The completeness of the services you received.






Service - reliability The reliability of the service delivery you received.





Service - Quality The quality of the services you received.






























































































































































Sheet 4: Model Qsts (8-16-12)

Model Instance Name:






DHHS-PSC Offline Support Services v2






MID:
4AFVdB88Aw1dk0QocxcEtw==



Partitioned (N)





NOTE: All non-partitioned surveys will NOT be imputed and the elements will be rotated as a default unless otherwise specified and approved by Research.


Date:
8/6/2012


DHHS-PSC Offline Support Services v2
Model questions utilize the ACSI methodology to determine scores and impacts


ELEMENTS (drivers of satisfaction)

CUSTOMER SATISFACTION
FUTURE BEHAVIORS

MQ Label

MQ Label
MQ Label


Representative (1=Poor, 10=Excellent, Don't Know)

Satisfaction
Use Again (1=Very Unlikely, 10=Very Likely)

Representative - Professionalism Thinking about the representative you who worked with you, please rate the following:
Please rate the professionalism of the representative.

Satisfaction - Overall What is your overall satisfaction with this service experience?
(1=Very Dissatisfied, 10=Very Satisfied)
Use Again How likely are you to use these services in the future?

Representative - Knowledge Please rate the knowledge of the representative.
Satisfaction - Expectations How well did this service experience meet your expectations?
(1=Falls Short, 10=Exceeds)

Recommend (1=Very Unlikely, 10=Very Likely)

Representative - Courtesy Please rate the courtesy of the representative.
Satisfaction - Ideal How does this experience compare to your idea of an ideal service experience?
(1=Not Very Close, 10=Very Close)
Recommend How likely are you to recommend this service provider to someone else?


Response Speed (1=Poor, 10=Excellent, Don't Know)





Reponses -Time Thinking about the responsiveness of service delivery, please rate the following:
Length of time it took to get the service delivered.




Response - Speed The speed with which the service was completed.


Response - Timeliness The overall timeliness of the service delivery process.



Service Quality (1=Poor, 10=Excellent, Don't Know)





Service - Completeness Thinking about the services received, please rate the following aspects of those services:
The completeness of the services you received.






Service - reliability The reliability of the service delivery you received.





Service - Quality The quality of the services you received.






























































































































































Sheet 5: Current CQs

Model Instance Name:

red & strike-through: DELETE





DHHS-PSC Offline Support Services v2

underlined & italicized: RE-ORDER





MID: 4AFVdB88Aw1dk0QocxcEtw==

pink: ADDITION





Date: 3/1/2008 blue + -->: REWORDING















DHHS-PSC Offline Support Services v2 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
CAS0056633
Please select the service for which you would like to provide feedback today. Select from the below list to reveal the individual services. Administrative A Radio button, one-up vertical Single Y Skip Logic Group* Service Type



Finance B







Occupational Health C







Acquisition D







Real Estate and Logistics E







Other, please specify Z




CAS0056641 A Select the administrative service you are providing feedback on: Customer Contact Center
Radio button, one-up vertical single Y
Administration Service



Departmental Forms Management








Digital Conversion and Archiving of Documents








Driver Services








Freedom of Information Act (FOIA)








Graphic Arts








Mail Operations








Mail Screening








Payroll Liaison








Printing








Section 508 Compliance Testing and Remediation








Transit Subsidy Program Management








Travel Charge Card Services








Travel Management Company Services








Travel Program Management








Vehicle Leasing Services








Vehicle Rental Services





CAS0056643 B Select the financial service you are providing feedback on: Accounting
Radio button, one-up vertical single Y
Financial Service



Debt Collection








Financial Reporting








Grant Payments








Indirect Cost Negotiations





CAS0056647 C Select the occupational service you are providing feedback on: Automated External Defibrillator
Radio button, one-up vertical single Y
Occupational Service



Employee Assistance Program








Environmental Health








Health Clinics








Organizational Development and Leadership








Wellness and Fitness








Work/Life Programs








Workers Compensation Management





CAS0056636 D Select the acquisition service you are providing feedback on: Negotiated Contracts and Simplified Acquisitions
Radio button, one-up vertical single Y
Acquisition Service



Purchase Card Management





CAS0056646 E Select the logistics service you are providing feedback on: Child Care Subsidy Program
Radio button, one-up vertical single Y
Logistics Service



Employee Child Care Centers








Facilities Operations and Management








Federal Real Property Assistance Program








Labor and Moving








Medical Supply








Parking Services








Personal Property Services








Product Distribution








Property Disposal








Real Property Management








Real Property Strategy








Regional Services








Shredding








Storage





CAS0056604 Z What product or service would you like to provide feedback on:

Text area, no char limit
N
OPS_Product/Service Type
CJI3627
Please specify the customer service representative who assisted you.

Text area, no char limit
Y
Service Provided by
CJI3628
How often do you transact with this organization or division? This is my first experience with this organization.
Radio button, one-up vertical Single Y
Frequency



A few times per year








A few times per month








A few times per week








Everyday








Multiple times per day








Not sure/NA





CAS0056148
Thinking about the entire service you have received, what changes can we make to improve your customer experience?

Text area, no char limit
Y
OE_Improvement

Sheet 6: CQs (7-2-14)

Model Instance Name:

red & strike-through: DELETE





DHHS-PSC Offline Support Services v2

underlined & italicized: RE-ORDER





MID: 4AFVdB88Aw1dk0QocxcEtw==

pink: ADDITION





Date: 3/1/2008 blue + -->: REWORDING















DHHS-PSC Offline Support Services v2 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
CAS0056633
Please select the service for which you would like to provide feedback today. Select from the below list to reveal the individual services. Administrative A Radio button, one-up vertical Single Y Skip Logic Group* Service Type



Finance B







Occupational Health C







Acquisition D







--> Real Estate and Logistics E







Other, please specify Z




CAS0056641 A Select the administrative service you are providing feedback on: Customer Contact Center
Radio button, one-up vertical single Y
Administration Service



Departmental Forms Management








Digital Conversion and Archiving of Documents








Driver Services








Freedom of Information Act (FOIA)








Graphic Arts








Mail Operations








Mail Screening








Payroll Liaison








Printing








Section 508 Compliance Testing and Remediation








Transit Subsidy Program Management








Travel Charge Card Services








Travel Management Company Services








Travel Program Management








Vehicle Leasing Services








Vehicle Rental Services





CAS0056643 B Select the financial service you are providing feedback on: Accounting
Radio button, one-up vertical single Y
Financial Service



Debt Collection








Financial Reporting








Grant Payments








Indirect Cost Negotiations





CAS0056647 C Select the occupational service you are providing feedback on: Automated External Defibrillator
Radio button, one-up vertical single Y
Occupational Service



Employee Assistance Program








Environmental Health








Health Clinics








Organizational Development and Leadership








Wellness and Fitness








Work/Life Programs








Workers Compensation Management





CAS0056636 D Select the acquisition service you are providing feedback on: Negotiated Contracts and Simplified Acquisitions
Radio button, one-up vertical single Y
Acquisition Service



Purchase Card Management





CAS0056646 E Select the logistics service you are providing feedback on: Child Care Subsidy Program
Radio button, one-up vertical single Y
Logistics Service



Employee Child Care Centers








Facilities Operations and Management








Federal Real Property Assistance Program








Labor and Moving








Medical Supply








Parking Services








Personal Property Services








Product Distribution








Property Disposal








Real Property Management








Real Property Strategy








Regional Services








Shredding








Storage





CAS0056604 Z What product or service would you like to provide feedback on:

Text area, no char limit
N
OPS_Product/Service Type
CJI3627
Please specify the customer service representative who assisted you.

Text area, no char limit
Y
Service Provided by
CJI3628
How often do you transact with this organization or division? This is my first experience with this organization.
Radio button, one-up vertical Single Y
Frequency



A few times per year








A few times per month








A few times per week








Everyday








Multiple times per day








Not sure/NA





CAS0056148
Thinking about the entire service you have received, what changes can we make to improve your customer experience?

Text area, no char limit
Y
OE_Improvement

Sheet 7: CQs (6-17-14)

Model Instance Name:

red & strike-through: DELETE





DHHS-PSC Offline Support Services v2

underlined & italicized: RE-ORDER





MID: 4AFVdB88Aw1dk0QocxcEtw==

pink: ADDITION





Date: 3/1/2008 blue + -->: REWORDING















DHHS-PSC Offline Support Services v2 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
CAS0056633
Please select the service for which you would like to provide feedback today. Select from the below list to reveal the individual services. Administrative A Radio button, one-up vertical Single Y Skip Logic Group* Service Type



Finance B







Occupational Health C







Acquisition D







Logistics E







Other, please specify Z




CAS0056641 A Select the administrative service you are providing feedback on: Customer Contact Center
Radio button, one-up vertical single Y
Administration Service



Departmental Forms Management








Digital Conversion and Archiving of Documents








Driver Services








Freedom of Information Act (FOIA)








Graphic Arts








Mail Operations








Mail Screening








Payroll Liaison








Printing








Section 508 Compliance Testing and Remediation








Transit Subsidy Program Management








Travel Charge Card Services








Travel Management Company Services








Travel Program Management








Vehicle Leasing Services








Vehicle Rental Services





CAS0056643 B Select the financial service you are providing feedback on: Accounting
Radio button, one-up vertical single Y
Financial Service



Debt Collection








Financial Reporting








Grant Payments








Indirect Cost Negotiations





CAS0056647 C Select the occupational service you are providing feedback on: Automated External Defibrillator
Radio button, one-up vertical single Y
Occupational Service



Employee Assistance Program








Environmental Health








Health Clinics








Organizational Development and Leadership








Wellness and Fitness








Work/Life Programs








Workers Compensation Management





CAS0056636 D Select the acquisition service you are providing feedback on: Negotiated Contracts and Simplified Acquisitions
Radio button, one-up vertical single Y
Acquisition Service



Purchase Card Management





CAS0056646 E Select the logistics service you are providing feedback on: Child Care Subsidy Program
Radio button, one-up vertical single Y
Logistics Service



Employee Child Care Centers








Facilities Operations and Management








Federal Real Property Assistance Program








Labor and Moving








Medical Supply








Parking Services








Personal Property Services








Product Distribution








Property Disposal








Real Property Management








Real Property Strategy








Regional Services








Shredding








Storage





CAS0056604 Z What product or service would you like to provide feedback on:

Text area, no char limit
N
OPS_Product/Service Type
CJI3627
Please specify the customer service representative who assisted you.

Text area, no char limit
Y
Service Provided by
CJI3628
How often do you transact with this organization or division? This is my first experience with this organization.
Radio button, one-up vertical Single Y
Frequency



A few times per year








A few times per month








A few times per week








Everyday








Multiple times per day








Not sure/NA





CAS0056148
Thinking about the entire service you have received, what changes can we make to improve your customer experience?

Text area, no char limit
Y
OE_Improvement
CJI3632
If we may contact you regarding your experience with this product or service, please provide your name, email address, and agency affiliation.

Text area, no char limit
N
OE_Contact Yes

Sheet 8: CQs (6-12-14)

Model Instance Name:

red & strike-through: DELETE





DHHS-PSC Offline Support Services v2

underlined & italicized: RE-ORDER





MID: 4AFVdB88Aw1dk0QocxcEtw==

pink: ADDITION





Date: 3/1/2008 blue + -->: REWORDING















DHHS-PSC Offline Support Services v2 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
CAS0056633
Please select the service for which you would like to provide feedback today. Select from the below list to reveal the individual services. Administrative A Radio button, one-up vertical Single Y Skip Logic Group* Service Type



Finance B







Occupational Health C







Acquisition D







Logistics E







Other, please specify Z




CAS0056641 A Select the administrative service you are providing feedback on: Customer Contact Center
Radio button, one-up vertical single Y
Administration Service



Departmental Forms Management








Digital Conversion and Archiving of Documents








Driver Services








Freedom of Information Act (FOIA)








Graphic Arts








Mail Operations








Mail Screening








Payroll Liaison








Printing








Section 508 Compliance Testing and Remediation








Transit Subsidy Program Management








Travel Charge Card Services








Travel Management Company Services








Travel Program Management








Vehicle Leasing Services








Vehicle Rental Services





CAS0056643 B Select the financial service you are providing feedback on: Accounting
Radio button, one-up vertical single Y
Financial Service



Debt Collection








Financial Reporting








Grant Payments








Indirect Cost Negotiations





CAS0056647 C Select the occupational service you are providing feedback on: Automated External Defibrillator
Radio button, one-up vertical single Y
Occupational Service



Employee Assistance Program








Environmental Health








Health Clinics








Organizational Development and Leadership








Wellness and Fitness








Work/Life Programs








Workers Compensation Management





CAS0056636 D Select the acquisition service you are providing feedback on: Negotiated Contracts and Simplified Acquisitions
Radio button, one-up vertical single Y
Acquisition Service



Purchase Card Management





CAS0056646 E Select the logistics service you are providing feedback on: Child Care Subsidy Program
Radio button, one-up vertical single Y
Logistics Service



Employee Child Care Centers








Facilities Operations and Management








Federal Real Property Assistance Program








Labor and Moving








Medical Supply








Parking Services








Personal Property Services








Product Distribution








Property Disposal








Real Property Management








Real Property Strategy








Regional Services








Shredding








Storage





CAS0056604 Z What product or service would you like to provide feedback on:

Text area, no char limit
N
OPS_Product/Service Type
CJI3627
Please specify the customer service representative who assisted you.

Text area, no char limit
Y
Service Provided by
CJI3628
How often do you transact with this organization or division? This is my first experience with this organization.
Radio button, one-up vertical Single Y
Frequency



A few times per year








A few times per month








A few times per week








Everyday








Multiple times per day








Not sure/NA















CAS0056148
Thinking about the entire service you have received, what changes can we make to improve your customer experience?

Text area, no char limit
Y
OE_Improvement
ACQinh0014765
Are you a Health & Human Services Employee? Yes
Radio button, one-up vertical Single Y Skip Logic Group* HHS Employee



No A




CJI3630 A What Agency do you work for? (If not part of a Federal Agency please select Other) Agency for International Development
Radio button, one-up vertical Single Y Skip Logic Group* Fed_Agency



Department of Agriculture








Department of Commerce








Department of Defense








Department of Education








Department of Homeland Security








Department of Housing and Urban Development








Department of the Interior








Department of Justice








Department of Labor








Department of State








Department of the Interior








Department of the Treasury








Department of Transportation








Department of Veterans Affairs








Executive Office of the President








Federal Legislative Branch








General Accounting Office








General Services Administration








Independent Agencies








Judicial Branch








National Aeronautics and Space Administration








Office of Personnel Management








Peace Corps








Postal Service








Private Vendor








Quasi Official INTNL & Non Govt








Railroad Retirement Board








Securities and Exchange Commission








Other (please specify) A




CJI3631 A Other agency:

Text area, no char limit
N
OE_Other Agency
CJI3632
If we may contact you regarding your experience with this product or service, please provide your name, email address, and agency affiliation.

Text area, no char limit
N
OE_Contact Yes

Sheet 9: CQs (5-6-14)

Model Instance Name:

red & strike-through: DELETE





DHHS-PSC Offline Support Services v2

underlined & italicized: RE-ORDER





MID: 4AFVdB88Aw1dk0QocxcEtw==

pink: ADDITION





Date: 3/1/2008 blue + -->: REWORDING















DHHS-PSC Offline Support Services v2 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
CAS0056633
Please select the service for which you would like to provide feedback today. Select from the below list to reveal the individual services. Administrative A Radio button, one-up vertical Single Y Skip Logic Group* Service Type



Finance B







Occupational Health C







Acquisition D







Logistics E







Other, please specify Z




CAS0056641 A Select the administrative service you are providing feedback on: Customer Contact Center
Radio button, one-up vertical single Y
Administration Service



Departmental Forms Management








Digital Conversion and Archiving of Documents








Driver Services








Freedom of Information Act (FOIA)








Graphic Arts








Mail Operations








Mail Screening








Payroll Liaison








Printing








Section 508 Compliance Testing and Remediation








Transit Subsidy Program Management








Travel Charge Card Services








Travel Management Company Services








Travel Program Management








Vehicle Leasing Services








Vehicle Rental Services





CAS0056643 B Select the financial service you are providing feedback on: Accounting
Radio button, one-up vertical single Y
Financial Service



Debt Collection








Financial Reporting








Grant Payments








Indirect Cost Negotiations





CAS0056647 C Select the occupational service you are providing feedback on: Automated External Defibrillator
Radio button, one-up vertical single Y
Occupational Service



Employee Assistance Program








Environmental Health








Health Clinics








Organizational Development and Leadership








Wellness and Fitness








Work/Life Programs








Workers Compensation Management





CAS0056636 D Select the acquisition service you are providing feedback on: Negotiated Contracts and Simplified Acquisitions
Radio button, one-up vertical single Y
Acquisition Service



Purchase Card Management





CAS0056646 E Select the logistics service you are providing feedback on: Child Care Subsidy Program
Radio button, one-up vertical single Y
Logistics Service



Employee Child Care Centers








Facilities Operations and Management








Federal Real Property Assistance Program








Labor and Moving








Medical Supply








Parking Services








Personal Property Services








Product Distribution








Property Disposal








Real Property Management








Real Property Strategy








Regional Services








Shredding








Storage





CAS0056604 Z What product or service would you like to provide feedback on:

Text area, no char limit
N
OPS_Product/Service Type
CJI3627
Please specify the customer service representative who assisted you.

Text area, no char limit
Y
Service Provided by
CJI3628
How often do you transact with this organization or division? This is my first experience with this organization.
Radio button, one-up vertical Single Y
Frequency



Once a year or less








A few times per year








A few times per month








A few times per week








Everyday








Multiple times per day








Monthly








Weekly








Daily or more often








Not sure/NA





CAS0056148
Thinking about the entire service you have received, what changes can we make to improve your customer experience?

Text area, no char limit
Y
OE_Improvement
ACQinh0014765
Are you a Health & Human Services Employee? Yes
Radio button, one-up vertical Single Y Skip Logic Group* HHS Employee



No A




CJI3630 A What Agency do you work for? (If not part of a Federal Agency please select Other) Agency for International Development
Radio button, one-up vertical Single Y Skip Logic Group* Fed_Agency



Department of Agriculture








Department of Commerce








Department of Defense








Department of Education








Department of Homeland Security








Department of Housing and Urban Development








Department of the Interior








Department of Justice








Department of Labor








Department of State








Department of the Interior








Department of the Treasury








Department of Transportation








Department of Veterans Affairs








Executive Office of the President








Federal Legislative Branch








General Accounting Office








General Services Administration








Independent Agencies








Judicial Branch








National Aeronautics and Space Administration








Office of Personnel Management








Peace Corps








Postal Service








Private Vendor








Quasi Official INTNL & Non Govt








Railroad Retirement Board








Securities and Exchange Commission








Other (please specify) A




CJI3631 A Other agency:

Text area, no char limit
N
OE_Other Agency
CJI3632
If we may contact you regarding your experience with this product or service, please provide your name, email address, and agency affiliation.

Text area, no char limit
N
OE_Contact Yes

Sheet 10: CQs (4-30-14)

Model Instance Name:

red & strike-through: DELETE





DHHS-PSC Offline Support Services v2

underlined & italicized: RE-ORDER





MID: 4AFVdB88Aw1dk0QocxcEtw==

pink: ADDITION





Date: 3/1/2008 blue + -->: REWORDING















DHHS-PSC Offline Support Services v2 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
CAS0056633
Please select the service for which you would like to provide feedback today. Select from the below list to reveal the individual services. Administrative A Radio button, one-up vertical Single Y Skip Logic Group* Service Type



Finance B







Occupational Health C







Acquisition D







Logistics E







Other, please specify Z




CAS0056641 A Select the administrative service you are providing feedback on: Customer Contact Center
Radio button, one-up vertical single Y
Administration Service



Departmental Forms Management








Digital Conversion and Archiving of Documents








Driver Services








Freedom of Information Act (FOIA)








Graphic Arts








Mail Operations








Mail Screening








Payroll Liaison








Printing








Section 508 Compliance Testing and Remediation








Transit Subsidy Program Management








Travel Charge Card Services








Travel Management Company Services








Travel Program Management








Vehicle Leasing Services








Vehicle Rental Services





CAS0056643 B Select the financial service you are providing feedback on: Accounting
Radio button, one-up vertical single Y
Financial Service



Debt Collection








Financial Reporting








Grant Payments








Indirect Cost Negotiations





CAS0056647 C Select the occupational service you are providing feedback on: Automated External Defibrillator
Radio button, one-up vertical single Y
Occupational Service



Employee Assistance Program








Environmental Health








Health Clinics








Organizational Development and Leadership








Wellness and Fitness








Work/Life Programs








Workers Compensation Management





CAS0056636 D Select the acquisition service you are providing feedback on: Negotiated Contracts and Simplified Acquisitions
Radio button, one-up vertical single Y
Acquisition Service



Purchase Card Management





CAS0056646 E Select the logistics service you are providing feedback on: Child Care Subsidy Program
Radio button, one-up vertical single Y
Logistics Service



Employee Child Care Centers








Facilities Operations and Management








Federal Real Property Assistance Program








Labor and Moving








Medical Supply








Parking Services








Personal Property Services








Product Distribution








Property Disposal








Real Property Management








Real Property Strategy








Regional Services








Shredding








Storage





CAS0056604 Z What product or service would you like to provide feedback on:

Text area, no char limit
N
OPS_Product/Service Type
CJI3627
Please specify the customer service representative who assisted you.

Text area, no char limit
Y
Service Provided by
CJI3628
How often do you transact with this organization or division? This is my first experience with this organization.
Radio button, one-up vertical Single Y
Frequency



Once a year or less








A few times per year








Monthly








Weekly








About once a month








A few times per month








About once a week








A few times per week








Daily or more often








Not sure/NA





CAS0056148
Thinking about the entire service you have received, what changes can we make to improve your customer experience?

Text area, no char limit
Y
OE_Improvement
ACQinh0014765
Are you a Health & Human Services Employee? Yes
Radio button, one-up vertical Single Y Skip Logic Group* HHS Employee



No A




CJI3630 A What Agency do you work for? (If not part of a Federal Agency please select Other) Agency for International Development
Radio button, one-up vertical Single Y Skip Logic Group* Fed_Agency



Department of Agriculture








Department of Commerce








Department of Defense








Department of Education








Department of Homeland Security








Department of Housing and Urban Development








Department of the Interior








Department of Justice








Department of Labor








Department of State








Department of the Interior








Department of the Treasury








Department of Transportation








Department of Veterans Affairs








Executive Office of the President








Federal Legislative Branch








General Accounting Office








General Services Administration








Independent Agencies








Judicial Branch








National Aeronautics and Space Administration








Office of Personnel Management








Peace Corps








Postal Service








Private Vendor








Quasi Official INTNL & Non Govt








Railroad Retirement Board








Securities and Exchange Commission








Other (please specify) A




CJI3631 A Other agency:

Text area, no char limit
N
OE_Other Agency
CJI3632
If we may contact you regarding your experience with this product or service, please provide your name, email address, and agency affiliation.

Text area, no char limit
N
OE_Contact Yes

Sheet 11: CQs (4-25-14)

Model Instance Name:

red & strike-through: DELETE





DHHS-PSC Offline Support Services v2

underlined & italicized: RE-ORDER





MID: 4AFVdB88Aw1dk0QocxcEtw==

pink: ADDITION





Date: 3/1/2008 blue + -->: REWORDING















DHHS-PSC Offline Support Services v2 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


Please select the service for which you would like to provide feedback today. Select from the below list to reveal the individual services. Acquisition A Radio button, one-up vertical Single Y Skip Logic Group* Service Type



Administrative B







Finance C







Logistics D







 Occupational Health E







Other, please specify Z





A Select the acquisition service you are providing feedback on: Negotiated Contracts and Simplified Acquisitions
Radio button, one-up vertical single Y
Acquisition Service



Purchase Card Management






B Select the administrative service you are providing feedback on: Driver Services
Radio button, one-up vertical single Y
Administration Service



Transit Subsidy Program Management








Travel Charge Card Services








Travel Management Company Services








Travel Program Management








Vehicle Leasing Services








Vehicle Rental Services








Departmental Forms Management








Digital Conversion and Archiving of Documents








Graphic Arts








Printing








Section 508 Compliance Testing and Remediation








Mail Operations








Mail Screening








Customer Contact Center








Payroll Liaison








Freedom of Information Act (FOIA)






C Select the financial service you are providing feedback on: Indirect Cost Negotiations
Radio button, one-up vertical single Y
Financial Service



Financial Reporting








Grant Payments








Accounting








Debt Collection






D Select the occupational service you are providing feedback on: Employee Assistance Program
Radio button, one-up vertical single Y
Occupational Service



Organizational Development and Leadership








Work/Life Programs








Automated External Defibrillator








Health Clinics








Workers Compensation Management








Environmental Health








Wellness and Fitness






E Select the logistics service you are providing feedback on: Facilities Operations and Management
Radio button, one-up vertical single Y
Logistics Service



Parking Services








Real Property Strategy








Regional Services








Shredding








Labor and Moving








Medical Supply








Product Distribution








Property Disposal








Storage








Personal Property Services








Child Care Subsidy Program








Employee Child Care Centers








Federal Real Property Assistance Program








Real Property Management






Z What product or service would you like to provide feedback on:

Text area, no char limit
N
OPS_Product/Service Type
CAS0056041
Please select the product or service for which you would like to provide feedback today. Accounting Services A Radio button, one-up vertical Single Y Skip Logic Group* Product/Service Type



Acquisition Management Services B







Behavioral Health Services C







Clinical Health Services D







Cost Allocation Services








Customer Care Services E







Enterprise Support Services F







Environmental, Health and Safety Services G







Facilities Management Services H







Financial Reporting Services








Freedom of Information Act Services








Grant Payment Services








Mail Services I







Publishing Services J







Real Property Management Services K







Transportation Services L







Warehouse and Logistics Services M







Wellness and Health Promotion Services








Other, please specfiy Z




CAS0056104 Z What product or service would you like to provide feedback on:

Text area, no char limit
N
OPS_Product/Service Type
CAS0056105 A Select the accounting service you are providing feedback on: Debt Collection
Radio button, one-up vertical Single Y
Accounting service



Accounting





CAS0056106 B Select the acquisition management service you are providing feedback on: Negotiated Contracts and Simplified Acquisitions
Radio button, one-up vertical single Y
Acquistion Mgt Systems



Purchase Card Management





CAS0056107 C Select the behavioral health service you are providing feedback on: Employee Assistance Program
Radio button, one-up vertical single Y
Behavorial Health Services



Organizational Development and Leadership








Work/Life Programs





CAS0056124 D Select the clinical health service you are providing feedback on: Automated External Defibrillator
Radio button, one-up vertical single Y
Clinical Health Services



Health Clinics








Workers Compensation Management





CAS0056125 E Select the customer care service you are providing feedback on: Payroll Liaison
Radio button, one-up vertical single Y
Customer Care Services



Customer Contact Center





CAS0056126 F Select the enterprise support service you are providing feedback on: Child Care Subsidy Program
Radio button, one-up vertical single Y
Enterprise Support Services



Employee Child Care Centers








Personal Property








OSHA/Safety








Sustainability Program








Fleet








Personal Property Services








Federal Real Property Assistance Program





CAS0056127 G Select the environmental, health and safety service you are providing feedback on: Environmental Programs
Radio button, one-up vertical single Y
Environmental Health



Environmental Health





CAS0056142 H Select the facilities management service you are providing feedback on: Real Property Strategy
Radio button, one-up vertical single Y
Facilities Management



Facilities Operations and Management








Shredding








Parking Services








Regional Services





CAS0056143 I Select the mail Service you are providing feedback on: Mail
Radio button, one-up vertical single Y
Mail Services



Mail Operations








Mail Screening





CAS0056144 J Select the publishing service you are providing feedback on: Printing
Radio button, one-up vertical single Y
Publishing Services



Digital Conversion and Archiving of Documents








Graphic Arts








Section 508 Compliance Testing and Remediation








Departmental Forms Management








Printing





CAS0056145 K Select the real property management service you are providing feedback on: Real Property
Radio button, one-up vertical single Y
Real Property Mgt Services



Real Property Management





CAS0056146 L Select the transportation service you are providing feedback on: Travel Charge Card Services
Radio button, one-up vertical single Y
Transportation Services



Travel Management Company Services








Travel Program Management








Travel








Transit Subsidy Program Management








Driver Services








Vehicle Leasing Services








Vehicle Rental Services





CAS0056147 M Select the warehouse and logistics service you are providing feedback on: Labor and Moving
Radio button, one-up vertical single Y
Warehouse and Logistic Services



Product Distribution








Property Disposal








Storage








Medical Supply





CJI3627
Please specify the customer service representative who assisted you. provided you with this product or service.

Text area, no char limit
Y
Service Provided by
CJI3628
How often do you transact with this organization or division? This is my first experience with this organization.
Radio button, one-up vertical Single Y
Frequency



Once a year or less








A few times per year








About once a month








A few times per month








About once a week








A few times per week








Daily or more often








Not sure/NA





CAS0056148
Thinking about the entire service you have received, what changes can we make to improve your customer experience?

Text area, no char limit
Y
OE_Improvement
ACQinh0014765
Are you a Health & Human Services Employee? Yes
Radio button, one-up vertical Single Y Skip Logic Group* HHS Employee



No A




CJI3630 A What Agency do you work for? (If not part of a Federal Agency please select Other) Agency for International Development
Radio button, one-up vertical Single Y Skip Logic Group* Fed_Agency



Department of Agriculture








Department of Commerce








Department of Defense








Department of Education








Department of Homeland Security








Department of Housing and Urban Development








Department of the Interior








Department of Justice








Department of Labor








Department of State








Department of the Interior








Department of the Treasury








Department of Transportation








Department of Veterans Affairs








Executive Office of the President








Federal Legislative Branch








General Accounting Office








General Services Administration








Independent Agencies








Judicial Branch








National Aeronautics and Space Administration








Office of Personnel Management








Peace Corps








Postal Service








Private Vendor








Quasi Official INTNL & Non Govt








Railroad Retirement Board








Securities and Exchange Commission








Other (please specify) A




CJI3631 A Other agency:

Text area, no char limit
N
OE_Other Agency
CJI3632
If we may contact you regarding your experience with this product or service, please provide your email address.

Text area, no char limit
N
OE_Contact Yes

Sheet 12: CQs (4-16-14)

Model Instance Name:

red & strike-through: DELETE






DHHS-PSC Offline Support Services v2

underlined & italicized: RE-ORDER






MID: 4AFVdB88Aw1dk0QocxcEtw==

pink: ADDITION






Date: 3/1/2008 blue + -->: REWORDING

















DHHS-PSC Offline Support Services v2 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


Please select the product or service for which you would like to provide feedback today. Accounting Services A Radio button, one-up vertical Single Y Skip Logic Group* Product/Service Type



Acquisition Management Services B








Behavioral Health Services C








Clinical Health Services D








Cost Allocation Services









Customer Care Services E








Enterprise Support Services F








Environmental, Health and Safety Services G








Facilities Management Services H








Financial Reporting Services









Freedom of Information Act Services









Grant Payment Services









Mail Services I








Publishing Services J








Real Property Management Services K








Transportation Services L








Warehouse and Logistics Services M








Wellness and Health Promotion Services









Other, please specfiy Z






Z What product or service would you like to provide feedback on:

Text area, no char limit
N
OPS_Product/Service Type

A Select the accounting service you are providing feedback on: Debt Collection
Radio button, one-up vertical Single Y
Accounting service



Accounting







B Select the acquisition management service you are providing feedback on: Negotiated Contracts and Simplified Acquisitions
Radio button, one-up vertical single Y
Acquistion Mgt Systems



Purchase Card Management







C Select the behavioral health service you are providing feedback on: Employee Assistance Program
Radio button, one-up vertical single Y
Behavorial Health Services



Organizational Development and Leadership









Work/Life Programs







D Select the clinical health service you are providing feedback on: Automated External Defibrillator
Radio button, one-up vertical single Y
Clinical Health Services



Health Clinics









Workers Compensation Management







E Select the customer care service you are providing feedback on: Payroll Liaison
Radio button, one-up vertical single Y
Customer Care Services



Customer Contact Center







F Select the enterprise support service you are providing feedback on: Child Care Subsidy Program
Radio button, one-up vertical single Y
Enterprise Support Services



Employee Child Care Centers









Personal Property









OSHA/Safety









Sustainability Program









Fleet









Personal Property Services









Federal Real Property Assistance Program







G Select the environmental, health and safety service you are providing feedback on: Environmental Programs
Radio button, one-up vertical single Y
Environmental Health



Environmental Health







H Select the facilities management service you are providing feedback on: Real Property Strategy
Radio button, one-up vertical single Y
Facilities Management



Facilities Operations and Management









Shredding









Parking Services









Regional Services







I Select the mail Service you are providing feedback on: Mail
Radio button, one-up vertical single Y
Mail Services



Mail Operations









Mail Screening







J Select the publishing service you are providing feedback on: Printing
Radio button, one-up vertical single Y
Publishing Services



Digital Conversion and Archiving of Documents









Graphic Arts









Section 508 Compliance Testing and Remediation









Departmental Forms Management









Printing







K Select the real property management service you are providing feedback on: Real Property
Radio button, one-up vertical single Y
Real Property Mgt Services



Real Property Management







L Select the transportation service you are providing feedback on: Travel Charge Card Services
Radio button, one-up vertical single Y
Transportation Services



Travel Management Company Services









Travel Program Management









Travel









Transit Subsidy Program Management









Driver Services









Vehicle Leasing Services









Vehicle Rental Services







M Select the warehouse and logistics service you are providing feedback on: Labor and Moving
Radio button, one-up vertical single Y
Warehouse and Logistic Services



Product Distribution









Property Disposal









Storage









Medical Supply






CJI3615
Please select the product or service for which you would like to provide feedback today. Acquisition Services A Radio button, one-up vertical Single Y Skip Logic Group* Product/Service Type



Commissioned Corps Support Services B








Customer Contact Centers C








Financial Services D








Freedom of Information Act Services









Logistics Services F








Occupational Health Services G








Property Management Services H








Regional Support Services









Transportation, Travel, and Telework Services J








Visual Media Services K








Administrative Offices L








Other, please specify Z





CJI3616 Z What product or service would you like to provide feedback on:

Text area, no char limit
N
OE_Product/Service Type
CJI3617 A Select the acquisition service you are providing feedback on: Negotiated Contracts
Radio button, one-up vertical
Y
Acquisition Service Type



Simplified Acquisitions









Purchase Card Management






CJI3618 B Select the Commissioned Corps Support Services you are providing feedback on: Board for Corrections (CCSS)
Radio button, one-up vertical
Y
Commissioned Corp Support
CJI3619 C Select the customer contact center you are providing feedback on: ONE-DHHS Contact Center
Radio button, one-up vertical
Y
Customer Contact Center



Payroll Services






CJI3620 D Select the financial services products you are providing feedback on: Accounting Services
Radio button, one-up vertical
Y
Financial Services



Business Office









Business Process Improvement









Cost Allocation/Indirect Cost Negotiations









Debt Collection Center Services









Financial Reporting









Payment Management (Grant) Services









Payroll Accounting Services






CJI3621 F Select the logistics services you are providing feedback on: Labor and Moving
Radio button, one-up vertical
Y
Logistics Services



Mail Operations









Supply Service Center (Medical Supply)









Product Distribution









Storage






CJI3622 G Select the occupational health services you are providing feedback on: Automated External Defibrillator (AED)
Radio button, one-up vertical
Y
Occupational Health



Clinical Services









Employee Assistance Program (EAP)









Environmental Health Services









Wellness/Fitness









Work/Life






CJI3623 H Select the property management services you are providing feedback on: Asset Management
Radio button, one-up vertical
Y
Property Mgt



Building Management









Employee Child Care Services









Property Disposal









Real Property Management









Shredding Services









Space Acquisition and Alterations






CJI3624 J Select the transportation, travel and telework services you are providing feedback on: Employee Relocation
Radio button, one-up vertical
Y
Trans, Travel & Telework Service



Travel Services









Telework Strategy Solutions









Transhare









Vehicle Rental






CJI3625 K Select the visual media services you are providing feedback on: Graphic Arts
Radio button, one-up vertical
Y
Visual Media



Departmental Forms Management









Printing Procurement






CJI3626 L Select the administrative office you are providing feedback on: AOS Office of the Director
Radio button, one-up vertical
Y
Administrative Offices



FMS Office of the Director









FLS Office of the Director









SAS Office of the Director









FOH Office of the Director









PSC Office of the Director






CJI3627
Please specify who provided you with this product or service.

Text area, no char limit
Y
Service Provided by
CJI3628
How often do you transact with this organization or division? This is my first experience with this organization.
Radio button, one-up vertical Single Y
Frequency



Once a year or less









A few times per year









About once a month









A few times per month









About once a week









A few times per week









Daily or more often









Not sure/NA








Thinking about the entire service you have received, what changes can we make to improve your customer experience?

Text area, no char limit
Y
OE_Improvement
CJI3629
Thinking about the entire service you have received, what did we do well and what changes can we make to improve your customer experience?

Text area, no char limit
Y
Improvement
ACQinh0014765
Are you a Health & Human Services Employee? Yes
Radio button, one-up vertical Single Y Skip Logic Group* HHS Employee



No A





CJI3630 A What Agency do you work for? (If not part of a Federal Agency please select Other) Agency for International Development
Radio button, one-up vertical Single Y Skip Logic Group* Fed_Agency



Department of Agriculture









Department of Commerce









Department of Defense









Department of Education









Department of Homeland Security









Department of Housing and Urban Development









Department of the Interior









Department of Justice









Department of Labor









Department of State









Department of the Interior









Department of the Treasury









Department of Transportation









Department of Veterans Affairs









Executive Office of the President









Federal Legislative Branch









General Accounting Office









General Services Administration









Independent Agencies









Judicial Branch









National Aeronautics and Space Administration









Office of Personnel Management









Peace Corps









Postal Service









Private Vendor









Quasi Official INTNL & Non Govt









Railroad Retirement Board









Securities and Exchange Commission









Other (please specify) A





CJI3631 A Other agency:

Text area, no char limit
N
OE_Other Agency
CJI3632
If we may contact you regarding your experience with this product or service, please provide your email address.

Text area, no char limit
N
OE_Contact Yes

Sheet 13: CQs (8-21-13)

Model Instance Name:

red & strike-through: DELETE






DHHS-PSC Offline Support Services v2

underlined & italicized: RE-ORDER






MID: 4AFVdB88Aw1dk0QocxcEtw==

pink: ADDITION






Date: 3/1/2008 blue + -->: REWORDING

















DHHS-PSC Offline Support Services v2 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
CJI3615
Please select the product or service for which you would like to provide feedback today. Acquisition Services A Radio button, one-up vertical Single Y Skip Logic Group* Product/Service Type



Commissioned Corps Support Services B








Customer Contact Centers C








Financial Services D








Freedom of Information Act Services









Logistics Services F








Occupational Health Services G








Property Management Services H








Regional Support Services









Transportation, Travel, and Telework Services J








Visual Media Services K








Administrative Offices L








Other, please specify Z





CJI3616 Z What product or service would you like to provide feedback on:

Text area, no char limit
N
OE_Product/Service Type
CJI3617 A Select the acquisition service you are providing feedback on: Negotiated Contracts
Radio button, one-up vertical
Y
Acquisition Service Type



Simplified Acquisitions









Purchase Card Management






CJI3618 B Select the Commissioned Corps Support Services you are providing feedback on: Board for Corrections (CCSS)
Radio button, one-up vertical
Y
Commissioned Corp Support



Commissioned Corps Systems Branch (CCSS)









Compensation and Retirement Branch (CCSS)









Medical Affairs Branch (CCSS)






CJI3619 C Select the customer contact center you are providing feedback on: ONE-DHHS Contact Center
Radio button, one-up vertical
Y
Customer Contact Center



Payroll Services






CJI3620 D Select the financial services products you are providing feedback on: Accounting Services
Radio button, one-up vertical
Y
Financial Services



Business Office









Business Process Improvement









Cost Allocation/Indirect Cost Negotiations









Debt Collection Center Services









Financial Reporting









Payment Management (Grant) Services









Payroll Accounting Services






CJI3621 F Select the logistics services you are providing feedback on: Labor and Moving
Radio button, one-up vertical
Y
Logistics Services



Mail Operations









Supply Service Center (Medical Supply)









Product Distribution









Storage






CJI3622 G Select the occupational health services you are providing feedback on: Automated External Defibrillator (AED)
Radio button, one-up vertical
Y
Occupational Health



Clinical Services









Employee Assistance Program (EAP)









Environmental Health Services









Wellness/Fitness









Work/Life






CJI3623 H Select the property management services you are providing feedback on: Asset Management
Radio button, one-up vertical
Y
Property Mgt



Building Management









Employee Child Care Services









Property Disposal









Real Property Management









Shredding Services









Space Acquisition and Alterations






CJI3624 J Select the transportation, travel and telework services you are providing feedback on: Employee Relocation
Radio button, one-up vertical
Y
Trans, Travel & Telework Service



Travel Services









Telework Strategy Solutions









Transhare









Vehicle Rental






CJI3625 K Select the visual media services you are providing feedback on: Graphic Arts
Radio button, one-up vertical
Y
Visual Media



Departmental Forms Management









Printing Procurement






CJI3626 L Select the administrative office you are providing feedback on: AOS Office of the Director
Radio button, one-up vertical
Y
Administrative Offices



FMS Office of the Director









FLS Office of the Director









SAS Office of the Director









FOH Office of the Director









PSC Office of the Director






CJI3627
Please specify who provided you with this product or service.

Text area, no char limit
Y
Service Provided by
CJI3628
How often do you transact with this organization or division? This is my first experience with this organization.
Radio button, one-up vertical Single Y
Frequency



Once a year or less









A few times per year









About once a month









A few times per month









About once a week









A few times per week









Daily or more often









Not sure/NA






CJI3629
Thinking about the entire service you have received, what did we do well and what changes can we make to improve your customer experience?

Text area, no char limit
Y
Improvement
ACQinh0014765
Are you a Health & Human Services Employee? Yes
Radio button, one-up vertical Single Y Skip Logic Group* HHS Employee



No A





CJI3630 A What Agency do you work for? (If not part of a Federal Agency please select Other) Agency for International Development
Radio button, one-up vertical Single Y Skip Logic Group* Fed_Agency



Department of Agriculture









Department of Commerce









Department of Defense









Department of Education









Department of Homeland Security









Department of Housing and Urban Development









Department of the Interior









Department of Justice









Department of Labor









Department of State









Department of the Interior









Department of the Treasury









Department of Transportation









Department of Veterans Affairs









Executive Office of the President









Federal Legislative Branch









General Accounting Office









General Services Administration









Independent Agencies









Judicial Branch









National Aeronautics and Space Administration









Office of Personnel Management









Peace Corps









Postal Service









Private Vendor









Quasi Official INTNL & Non Govt









Railroad Retirement Board









Securities and Exchange Commission









Other (please specify) A





CJI3631 A Other agency:

Text area, no char limit
N
OE_Other Agency
CJI3632
If we may contact you regarding your experience with this product or service, please provide your email address.

Text area, no char limit
N
OE_Contact Yes

Sheet 14: CQs (8-28-12)

Model Instance Name:

red & strike-through: DELETE






DHHS-PSC Offline Support Services v2

underlined & italicized: RE-ORDER






MID: 4AFVdB88Aw1dk0QocxcEtw==

pink: ADDITION






Date: 3/1/2008 blue + -->: REWORDING

















DHHS-PSC Offline Support Services v2 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
CJI3615
Please select the product or service for which you would like to provide feedback today. Acquisition Services A Radio button, one-up vertical Single Y Skip Logic Group* Product/Service Type



Commissioned Corps Support Services B








Customer Contact Centers C








Financial Services D








Freedom of Information Act Services









Logistics Services F








Occupational Health Services G








Property Management Services H








Regional Support Services









Transportation, Travel, and Telework Services J








Visual Media Services K








Administrative Offices L








Other, please specify Z





CJI3616 Z What product or service would you like to provide feedback on:

Text area, no char limit
N
OE_Product/Service Type
CJI3617 A Select the acquisition service you are providing feedback on: Negotiated Contracts
Radio button, one-up vertical
Y
Acquisition Service Type



Simplified Acquisitions









Purchase Card Management






CJI3618 B Select the Commissioned Corps Support Services you are providing feedback on: Board for Corrections (CCSS)
Radio button, one-up vertical
Y
Commissioned Corp Support



Commissioned Corps Systems Branch (CCSS)









Compensation and Retirement Branch (CCSS)









Medical Affairs Branch (CCSS)






CJI3619 C Select the customer contact center you are providing feedback on: ONE-DHHS Contact Center
Radio button, one-up vertical
Y
Customer Contact Center



Payroll Services






CJI3620 D Select the financial services products you are providing feedback on: Accounting Services
Radio button, one-up vertical
Y
Financial Services



Business Office









Business Process Improvement









Cost Allocation/Indirect Cost Negotiations









Debt Collection Center Services









Financial Reporting









Payment Management (Grant) Services









Payroll Accounting Services






CJI3621 F Select the logistics services you are providing feedback on: Labor and Moving
Radio button, one-up vertical
Y
Logistics Services



Mail Operations









Supply Service Center (Medical Supply)









Product Distribution









Storage






CJI3622 G Select the occupational health services you are providing feedback on: Automated External Defibrillator (AED)
Radio button, one-up vertical
Y
Occupational Health



Clinical Services









Employee Assistance Program (EAP)









Environmental Health Services









Wellness/Fitness









Work/Life






CJI3623 H Select the property management services you are providing feedback on: Asset Management
Radio button, one-up vertical
Y
Property Mgt



Building Management









Employee Child Care Services









Property Disposal









Real Property Management









Shredding Services









Space Acquisition and Alterations






CJI3624 J Select the transportation, travel and telework services you are providing feedback on: Employee Relocation
Radio button, one-up vertical
Y
Trans, Travel & Telework Service



Travel Services









Telework Strategy Solutions









Transhare









Vehicle Rental






CJI3625 K Select the visual media services you are providing feedback on: Graphic Arts
Radio button, one-up vertical
Y
Visual Media



Departmental Forms Management









Printing Procurement






CJI3626 L Select the administrative office you are providing feedback on: AOS Office of the Director
Radio button, one-up vertical
Y
Administrative Offices



FMS Office of the Director









FLS Office of the Director









SAS Office of the Director









FOH Office of the Director









PSC Office of the Director






CJI3627
Please specify who provided you with this product or service.

Text area, no char limit
Y
Service Provided by
CJI3628
How often do you transact with this organization or division? This is my first experience with this organization.
Radio button, one-up vertical Single Y
Frequency



Once a year or less









A few times per year









About once a month









A few times per month









About once a week









A few times per week









Daily or more often









Not sure/NA






CJI3629
Thinking about the entire service you have received, what did we do well and what changes can we make to improve your customer experience?

Text area, no char limit
Y
Improvement
ACQinh0014765
Are you a Health & Human Services Employee? Yes
Radio button, one-up vertical Single Y Skip Logic Group* HHS Employee



No A





CJI3630 A What Agency do you work for? (If not part of a Federal Agency please select Other) Agency for International Development
Radio button, one-up vertical Single Y Skip Logic Group* Fed_Agency



Department of Agriculture









Department of Commerce









Department of Defense









Department of Education









Department of Homeland Security









Department of Housing and Urban Development









Department of the Interior









Department of Justice









Department of Labor









Department of State









Department of the Interior









Department of the Treasury









Department of Transportation









Department of Veterans Affairs









Executive Office of the President









Federal Legislative Branch









General Accounting Office









General Services Administration









Independent Agencies









Judicial Branch









National Aeronautics and Space Administration









Office of Personnel Management









Peace Corps









Postal Service









Private Vendor









Quasi Official INTNL & Non Govt









Railroad Retirement Board









Securities and Exchange Commission









Other federal agency (please specify) A





CJI3631 A Other agency:

Text area, no char limit
N
OE_Other Agency
CJI3632
If we may contact you regarding your experience with this product or service, please provide your email address.

Text area, no char limit
N
OE_Contact Yes

Sheet 15: CQs (8-16-12)

Model Instance Name:


red & strike-through: DELETE






DHHS-PSC Offline Support Services v2


underlined & italicized: RE-ORDER






MID: 4AFVdB88Aw1dk0QocxcEtw==


pink: ADDITION






Date: 3/1/2008
blue + -->: REWORDING


















DHHS-PSC Offline Support Services v2 CUSTOM QUESTION LIST
QID Skip Logic Label Question Text bharati.hulbanni: Hide (DO NOT DELETE) this column before sending to a client. AnswerIDs (DOT) Answer Choices
(limited to 50 characters)
Skip to Type (select from list) Single or Multi Required
Y/N
Special Instructions CQ Label
CJI3615
Please select the product or service for which you would like to provide feedback today. CJI3615A01 Acquisition Services A Radio button, one-up vertical Single Y Skip Logic Group* Product/Service Type



CJI3615A02 Commissioned Corps Support Services B








CJI3615A03 Customer Contact Centers C








CJI3615A04 Financial Services D








CJI3615A05 Information Management Services REWORD _ Freedom of Information Act Services









CJI3615A06 Logistics Services F








CJI3615A07 Occupational Health Services G








CJI3615A08 Property Management Services H








CJI3615A09 Regional Support Services









CJI3615A10 Transportation, Travel, and Telework Services J








CJI3615A11 Visual Media Services K








CJI3615A12 Administrative Offices L








CJI3615A13 Other, please specify Z





CJI3616 Z What product or service would you like to provide feedback on:


Text area, no char limit
N
OE_Product/Service Type
CJI3617 A Select the acquisition service you are providing feedback on: CJI3617A01 Negotiated Contracts
Radio button, one-up vertical
Y
Acquisition Service Type



CJI3617A02 Simplified Acquisitions









CJI3617A03 Purchase Card Management






CJI3618 B Select the Commissioned Corps Support Services you are providing feedback on: CJI3618A01 Board for Corrections (CCSS)
Radio button, one-up vertical
Y
Commissioned Corp Support



CJI3618A02 Commissioned Corps Systems Branch (CCSS)









CJI3618A03 Compensation and Retirement Branch (CCSS)









CJI3618A04 Medical Affairs Branch (CCSS)






CJI3619 C Select the customer contact center you are providing feedback on: CJI3619A01 ONE-DHHS Contact Center
Radio button, one-up vertical
Y
Customer Contact Center



CJI3619A02 Payroll Services






CJI3620 D Select the financial services products you are providing feedback on: CJI3620A01 Accounting Services
Radio button, one-up vertical
Y
Financial Services



CJI3620A02 Business Office









CJI3620A03 Cost Allocation/Indirect Cost Negotiations









CJI3620A04 Debt Collection Center Services









CJI3620A05 Financial Reporting









CJI3620A06 Payment Management (Grant) Services









CJI3620A07 Payroll Accounting Services






CJI3621 F Select the logistics services you are providing feedback on: CJI3621A01 Labor and Moving
Radio button, one-up vertical
Y
Logistics Services



CJI3621A02 Mail Operations









CJI3621A03 Supply Service Center (Medical Supply)









CJI3621A04 Product Distribution









CJI3621A05 Storage






CJI3622 G Select the occupational health services you are providing feedback on: CJI3622A01 Automated External Defibrillator (AED)
Radio button, one-up vertical
Y
Occupational Health



CJI3622A02 Clinical Services









CJI3622A03 Employee Assistance Program (EAP)









CJI3622A04 Environmental Health Services









CJI3622A05 Wellness/Fitness









CJI3622A06 Work/Life






CJI3623 H Select the property management services you are providing feedback on: CJI3623A01 Asset Management
Radio button, one-up vertical
Y
Property Mgt



CJI3623A02 Building Management









CJI3623A03 Employee Child Care Services









CJI3623A04 Property Disposal









CJI3623A05 Real Property Management









CJI3623A06 Shredding Services









CJI3623A07 Space Acquisition and Alterations






CJI3624 J Select the transportation, travel and telework services you are providing feedback on: CJI3624A01 Employee Relocation
Radio button, one-up vertical
Y
Trans, Travel & Telework Service



CJI3624A02 Travel Services









CJI3624A03 Telework Strategy Solutions









CJI3624A04 Transhare









CJI3624A05 Vehicle Rental






CJI3625 K Select the visual media services you are providing feedback on: CJI3625A01 Graphic Arts
Radio button, one-up vertical
Y
Visual Media



CJI3625A02 Departmental Forms Management









CJI3625A03 Printing Procurement






CJI3626 L Select the administrative office you are providing feedback on: CJI3626A01 AOS Office of the Director
Radio button, one-up vertical
Y
Administrative Offices



CJI3626A02 FMS Office of the Director









CJI3626A03 FLS Office of the Director









CJI3626A04 SAS Office of the Director









CJI3626A05 FOH Office of the Director









CJI3626A06 PSC Office of the Director






CJI3627
Please specify who provided you with this product or service.


Text area, no char limit
Y
Service Provided by
CJI3628
How often do you transact with this organization or division? CJI3628A01 This is my first experience with this organization.
Radio button, one-up vertical Single Y
Frequency



CJI3628A02 Once a year or less









CJI3628A03 A few times per year









CJI3628A04 About once a month









CJI3628A05 A few times per month









CJI3628A06 About once a week









CJI3628A07 A few times per week









CJI3628A08 Daily or more often









CJI3628A09 Not sure/NA






CJI3629
Thinking about the entire service you have received, what did we do well and what changes can we make to improve your customer experience?


Text area, no char limit
Y
Improvement


Are you a Health & Human Services Employee?
Yes
Radio button, one-up vertical Single Y Skip Logic Group* HHS Employee




No A





CJI3630 A What Agency do you work for? (If not part of a Federal Agency please select Other) CJI3630A01 Agency for International Development
Radio button, one-up vertical Single Y Skip Logic Group* Fed_Agency



CJI3630A02 Department of Agriculture









CJI3630A03 Department of Commerce









CJI3630A04 Department of Defense









CJI3630A05 Department of Education









CJI3630A06 Department of Homeland Security









CJI3630A07 Department of Housing and Urban Development









CJI3630A08 Department of the Interior









CJI3630A09 Department of Justice









CJI3630A10 Department of Labor









CJI3630A11 Department of State









CJI3630A12 Department of the Interior









CJI3630A13 Department of the Treasury









CJI3630A14 Department of Transportation









CJI3630A15 Department of Veterans Affairs









CJI3630A16 Executive Office of the President









CJI3630A17 Federal Legislative Branch









CJI3630A18 General Accounting Office









CJI3630A19 General Services Administration









CJI3630A20 Independent Agencies









CJI3630A21 Judicial Branch









CJI3630A22 National Aeronautics and Space Administration









CJI3630A23 Office of Personnel Management









CJI3630A24 Peace Corps









CJI3630A25 Postal Service









CJI3630A26 Private Vendor









CJI3630A27 Quasi Official INTNL & Non Govt









CJI3630A28 Railroad Retirement Board









CJI3630A29 Securities and Exchange Commission









CJI3630A30 Other federal agency (please specify) A





CJI3631 A Other agency:


Text area, no char limit
N
OE_Other Agency
CJI3632
If we may contact you regarding your experience with this product or service, please provide your email address.


Text area, no char limit
N
OE_Contact Yes

Sheet 16: PRE DL v2 CQs

Model Instance Name:


red & strike-through: DELETE






DHHS-PSC Offline Support Services v2


underlined & italicized: RE-ORDER






MID: 4AFVdB88Aw1dk0QocxcEtw==


pink: ADDITION






Date: 3/1/2008
blue + -->: REWORDING


















DHHS-PSC Offline Support Services v2 CUSTOM QUESTION LIST
QID Skip Logic Label Question Text bharati.hulbanni: Hide (DO NOT DELETE) this column before sending to a client. AnswerIDs (DOT) Answer Choices
(limited to 50 characters)
Skip to Type (select from list) Single or Multi Required
Y/N
Special Instructions CQ Label


Please select the product or service for which you would like to provide feedback today.
Acquisition Services A Radio button, one-up vertical Single Y Skip Logic Group* Product/Service Type




Commissioned Corps Support Services B









Customer Contact Centers C









Financial Services D









Information Management Services E









Logistics Services F









Occupational Health Services G









Property Management Services H









Regional Support Services I









Transportation, Travel, and Telework Services J









Visual Media Services K









Administrative Offices L









Other, please specify Z






Z What product or service would you like to provide feedback on:


Text area, no char limit
N
OE_Product/Service Type

A Select the acquisition service you are providing feedback on:
Negotiated Contracts
Radio button, one-up vertical


Acquisition Service Type




Simplified Acquisitions










Purchase Card Management







B Select the Commissioned Corps Support Services you are providing feedback on:
Board for Corrections (CCSS)
Radio button, one-up vertical


Commissioned Corp Support




Commissioned Corps Systems Branch (CCSS)










Compensation and Retirement Branch (CCSS)










Medical Affairs Branch (CCSS)







C Select the customer contact center you are providing feedback on:
ONE-DHHS Contact Center
Radio button, one-up vertical


Customer Contact Center




Payroll Services







D Select the financial services products you are providing feedback on:
Accounting Services
Radio button, one-up vertical


Financial Services




Business Office










Cost Allocation/Indirect Cost Negotiations










Debt Collection Center Services










Financial Reporting










Payment Management (Grant) Services










Payroll Accounting Services







E Select the information management services you are providing feedback on:
FOIA & Records Management
Radio button, one-up vertical


Information Mgt Services
F Select the logistics services you are providing feedback on:
Labor and Moving
Radio button, one-up vertical


Logistics Services




Mail Operations









Supply Service Center (Medical Supply)









Product Distribution









Storage






G Select the occupational health services you are providing feedback on:
Automated External Defibrillator (AED)
Radio button, one-up vertical


Occupational Health



Clinical Services









Employee Assistance Program (EAP)









Environmental Health Services









Wellness/Fitness









Work/Life






H Select the property management services you are providing feedback on:
Asset Management
Radio button, one-up vertical


Property Mgt



Building Management









Employee Child Care Services









Property Disposal









Real Property Management









Shredding Services









Space Acquisition and Alterations






I Select the regional support service you are providing feedback on:
Regional Support
Radio button, one-up vertical


Regional Support

J Select the transportation, travel and telework services you are providing feedback on:
Employee Relocation
Radio button, one-up vertical


Trans, Travel & Telework Service




Travel Services










Telework Strategy Solutions










Transhare










Vehicle Rental







K Select the visual media services you are providing feedback on:
Graphic Arts
Radio button, one-up vertical


Visual Media




Departmental Forms Management










Printing Procurement







L Select the administrative office you are providing feedback on:
AOS Office of the Director
Radio button, one-up vertical


Administrative Offices




FMS Office of the Director










FLS Office of the Director










SAS Office of the Director










FOH Office of the Director










PSC Office of the Director








Please specify who provided you with this product or service.


Text area, no char limit
Y
Service Provided by


How often do you transact with this organization or division?
This is my first experience with this organization.
Radio button, one-up vertical Single Y
Frequency




Once a year or less










A few times per year










About once a month










A few times per month










About once a week










A few times per week










Daily or more often










Not sure/NA








Thinking about the entire service you have received, what did we do well and what changes can we make to improve your customer experience?


Text area, no char limit
Y
Improvement


What Agency do you work for? (If not part of a Federal Agency please select Other)
Agency for International Development

Single Y Skip Logic Group* Agency




Department of Agriculture










Department of Commerce










Department of Defense










Department of Education










Department of Homeland Security










Department of Housing and Urban Development










Department of the Interior










Department of Justice










Department of Labor










Department of State










Department of the Interior










Department of the Treasury










Department of Transportation










Department of Veterans Affairs










Executive Office of the President










Federal Legislative Branch










General Accounting Office










General Services Administration










Independent Agencies










Judicial Branch










National Aeronautics and Space Administration










Office of Personnel Management










Peace Corps










Postal Service










Private Vendor










Quasi Official INTNL & Non Govt










Railroad Retirement Board










Securities and Exchange Commission










Other federal agency (please specify) A






A Other agency:


Text area, no char limit
N
OE_Other Agency


If we may contact you regarding your experience with this product or service, please provide your email address.


Text area, no char limit
N
OE_Contact Yes
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