Ticket to Work (TTW) Outreach Effectiveness Survey

BASS Outreach Effectiveness Survey
Section 1: About SSA program
1. In the past three months, have you seen or heard about any Social Security programs that would
help someone find work?
a. Yes
b. No
c. Don’t know/Do not remember
2. Where would you find information about Social Security programs that would help you find work?
Please choose all that apply.
a. Social Security office (e.g., in person, phone, or writing )
b. Social Security Website (e.g., socialsecurity.gov and choosework.net)
c. Social media sites (e.g., Facebook, Twitter, LinkedIn, YouTube)
d. Television
e. Radio (over the air, satellite, Internet)
f. Magazines or newspapers
g. From the State Vocational Rehabilitation (VR) agency
h. An organization I am a member of (insert name)
i. Other (Please Specify): ________
3. Are you aware of the Ticket to Work program?
a. Yes  Go to Question 4
b. No  Skip to Question 12
If you selected “NO”, please SKIP Questions 4-11

4. In your opinion, which of the following statements are true or false?
True
Ticket to Work is a Social Security program
People (ages 18-64) receiving Social Security benefits are eligible to
participate in the Ticket to Work program
Participation in the Ticket to Work program is voluntary
Ticket to Work is a program that can help me to find and keep a job
Ticket to Work is a free program

Proprietary – Booz Allen Hamilton

False

Don’t Know

Statement of Work: Outreach Effectiveness Survey Support
24 June 2014
Page 2
5. How did you learn about the Ticket to Work program? Please choose all that apply.
a. The Ticket to Work website (e.g., choosework.net)
b. Telephone call from Social Security
c. A conference where Ticket to Work exhibited
d. A Ticket to Work webinar
e. Ticket to Work Help Line
f. Social media sites (e.g., Facebook, Twitter, LinkedIn, YouTube)
g. Magazines or newspapers
h. Television
i. Radio (over the air, satellite, Internet)
If you did not learn about the Ticket to Work program from social media, please SKIP this question.
5b. From which of the following social media sites did you learn about the Ticket to Work program?
Please choose all that apply.
a. Facebook
b. Twitter
c. LinkedIn
d. YouTube
5c. Did you learn about the Ticket to Work program from any of these other sources? Please choose all
that apply.
a. A paper Ticket in the mail
b. The Social Security office
c. The Social Security website (e.g., socialsecurity.gov/work)
d. My Vocational Rehabilitation (VR) agency
e. My Employment Network
f. Another organization’s webinar
g. Another organization’s conference
h. An organization I am a member of (insert name)
6. When did you first learn about the Ticket to Work Program?
a. Before I was awarded disability benefits
b. 1-3 months after I was awarded disability benefits
c. 4-7 months after I was awarded disability benefits
d. 8-12 months after I was awarded disability benefits
e. More than a year after I was awarded disability benefits
f. Don’t know/Do Not Remember

Proprietary – Booz Allen Hamilton

Statement of Work: Outreach Effectiveness Survey Support
24 June 2014
Page 3
Section 2: About your participation
7. After you heard about the Ticket to Work program, have you participated in any of the following
activities?
Yes

No

Searched the Internet for information about the Ticket to Work program

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Talked to someone about the Ticket to Work program

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Considered taking part in the Ticket to Work program

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Discussed my plans to join the Ticket to Work program

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8. Please indicate which of the following Ticket to Work activities you have participated in. Please
choose all that apply.
a. Attended a Ticket to Work webinar
b. Called the Ticket to Work Help Line
c. Visited the Ticket to Work website (e.g., socialsecurity.gov/work)
d. Met with an Employment Network or Vocational Rehabilitation Agency
e. Met with a Work Incentive Planning and Assistance (WIPA) project benefits counselor
f. None of the above
9. Are you currently participating in the Ticket to Work program?
a. Yes  Continue with Question 10
b. No  Skip to Question 11
c. Participated in the past, but I am no longer participating in the Ticket to Work program 
Continue with Question 10
d. Don’t know/Do Not Remember  Skip to Question 12
10. Why did you choose to participate in the Ticket to Work program? Please choose all that apply.
a. Training or employment support matched my interests
b. To take advantage of Social Security work incentives (special rules that allow me to test my
ability to work without immediately losing my cash or health care benefits)
c. Wanted something to occupy my time
d. Wanted to meet people
e. Needed more income
f. Recommended by family, a friend, or a doctor
g. Wanted to contribute to my community
h. Other (Please Specify): ________
Please GO TO Question 12 once you have made your selection(s)

Proprietary – Booz Allen Hamilton

Statement of Work: Outreach Effectiveness Survey Support
24 June 2014
Page 4
11. Why haven’t you participated in the Ticket to Work program? Please choose all that apply
a. Don’t want or need employment
b. Don’t want to lose Social Security benefits
c. Don’t want to lose health coverage
d. Don’t trust Social Security
e. Not able to work because of my disability
f. Not sure if I would succeed at work
g. It’s too complicated
h. Don’t know enough about it
i. Other (Please Specify): ________

Section 3: Access to and use of information
12. Please indicate how often you do the following activities:

Use the Internet
Listen to the radio
Watch TV
Read newspapers/magazines
Read promotional materials in the mail

Daily

A few
times a
week

Once a
week

A few
times a
month

Once a
month

A few
times a
year

Never

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Yes

No

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If you NEVER use the Internet, SKIP to Question 15.
13. Do you use the Internet…

At home on a computer?
On a mobile device?
At a public facility on a computer (e.g.,
library)?

Proprietary – Booz Allen Hamilton

Statement of Work: Outreach Effectiveness Survey Support
24 June 2014
Page 5
If you NEVER use the Internet, SKIP to Question 15.
14. Please indicate whether you use the Internet to do the following activities.
Yes

No

Check e-mail
Send and receive messages (text or instant messages)
Access Social media sites
Watch videos, movies, or television shows
Look for trainings or take online training
Look for job opportunities
Listen to podcasts (an audio recording available on the Internet)
Read the news
Research government benefits
Play online games

If you NEVER listen to the radio or watch TV, SKIP to Question 16.
15. Please select when you usually do the following activities. (Select all that apply. It is okay to check
all boxes or not check any box.)

Mornings

Weekday
Afternoons

Listen to the radio
Watch TV

Proprietary – Booz Allen Hamilton

Evenings

Mornings

Weekend
Afternoons

Evenings

Statement of Work: Outreach Effectiveness Survey Support
24 June 2014
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Section 4: Some additional information about you
16. Please indicate how often you use the following types of public transportation.

Bus
Subway/train
Paratransit (e.g., special transport
services for people with disabilities)

Daily

A few
times a
week

Once a
week

A few
times a
month

Once a
month

A few
times a
year

Never

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17. What is the last grade or school year that you completed?
a. Nursery school to 8th grade
b. Some high school
c. High school graduate
d. Technical post-secondary
e. Some college
f. Two year college graduate
g. Four year college graduate
h. Post-graduate school

Section 5: Media profile
18. Do you receive information or offers from organizations or companies via text messaging on your
mobile device?
a. Yes
b. No
c. My mobile device does not have text messaging
d. I do not own a mobile device
19. Where do you go in your community to find information about programs, events, or resources?
Please choose all that apply.
a. Public libraries
b. Post offices
c. Place of worship (e.g., church, synagogue, temple, or mosque)
d. Schools
e. Other (Please Specify): ________

Proprietary – Booz Allen Hamilton

OMB Control No. 0960-0526
Expiration Date: 11/30/2015

[SSA LOGO]

Dear ,
EurekaFacts is contacting you on behalf of the Social Security Administration because you are a
Social Security beneficiary. We are asking for you to help us learn about the effectiveness of
Social Security outreach efforts and how you access information about Social Security
programs by completing a short, 10-minute survey.
We would like to make it easy for you to participate in this study. You may complete the survey
either on the Internet or by mail using the paper survey form included with this letter. You do not
need to do both. If you complete the paper survey, we have provided a postage-paid envelope
in which you may return the paper survey. To complete the survey online please do the
following:
Go to the website: www.eurekafacts.com/oes
and enter your unique ID [abc123]
Social Security staff will not see your answers and your name will not appear on the survey.
Social Security will use all responses to improve communication about its programs. The survey
is voluntary.
Please complete this survey by . The survey will take you approximately 10
minutes to complete. Thank you in advance for your help.
EurekaFacts is conducting this survey on behalf of the Social Security Administration. If you
have any questions about this survey, you may contact EurekaFacts at 1-855-403-4800 or email
[email protected].

Sincerely,

David Weaver
Associate Commissioner
Social Security Administration

OMB Control No. 0960-0526
Expiration Date: 11/30/2015

Paperwork Reduction Act Statement

Paperwork Reduction Act Statement – This information collection meets the requirements of 44 U.S.C. §3507, as
amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless
we display a valid Office of Management and Budget control number. We estimate that it will take about 10
minutes to complete this survey. You may send comments on our time estimate above: SSA, 6401 Security Blvd.,
Baltimore, MD 21235-6401. Send only comments relating to our time estimate to this address.

Dear :
EurekaFacts is conducting a survey to help Social Security evaluate its outreach efforts on behalf
of the Ticket to Work program. We are asking for you to help us learn about the effectiveness of
Social Security’s outreach efforts and how you access information about Social Security
programs by completing a short, 10-minute survey. You were selected because you are a Social
Security beneficiary. To protect the confidentiality of your responses, Social Security staff will not
see your answers.
To participate in this study,
Go to the website: http://www.eurekafacts.com/oes
and enter your unique ID number [abc123]
The survey will take you approximately 10 minutes to complete.
Please complete this survey by [Insert Date].
You may call EurekaFacts at 1-855-403-4800 or email [email protected]. TDD/TTY users
please contact your local Relay Center.

We want to thank you in advance for sharing your opinions.

SSA Beneficiary Outreach Effectiveness Survey
EurekaFacts Survey Center
51 Monroe Street, Plaza East 10
Rockville, MD 20850

Please go to the website: http://www.eurekafacts.com/oes and enter your unique
ID number [abc123]