Seven Quantitative Customer Satisfaction Surveys - Mail and Telephone Surveys

FY 15 HPRC AWARD SURVEY - ENGLISH

Hearings Process Report Card Survey
Social Security is continually working to improve the service we provide to the public. Please complete
this questionnaire to give us your opinion of the service you received when you requested a hearing on
your application for disability benefits.
MARKING INSTRUCTIONS
Correct Marking Example: 

• Use blue or black pen or a number 2 pencil.
• Make no stray marks.
• Do not use pens with ink that soaks through the • Keep all entries within the boxes.
paper.

Please use the scale shown to rate the following aspects of your hearing experience.

Excellent

Very Good

Good

Fair

Poor

Very Poor

Not
Applicable

Mark [X] ONE answer for every item. If a question does not apply to you, please mark Not Applicable.

1.

Ease of finding information about how to file
your hearing request















2.

Quality of information you got from Social
Security explaining the hearing process















When you decided to request a hearing…

While you were waiting for your hearing to be held…
3.

Ease of contacting Social Security about your
hearing request















4.

Helpfulness of the information Social Security
gave you about your hearing request















How your hearing was held…
5. Did you have a representative, either an attorney or some other person, handle your hearing?
Mark only ONE answer.



6.

Yes
No

Did you have a hearing with a judge face-to-face or by video conference?
Mark only ONE answer.





Hearing was face-to-face with a judge.

 Please continue with question 7

Hearing was by video conference with a judge.

 Please continue with question 7

No hearing was held with a judge.

 Please continue with question 14

PLEASE CONTINUE TO PAGE 2

Excellent

Very Good

Good

Fair

Poor

Very Poor

Not
Applicable

Please use the scale shown to rate the following aspects of your hearing experience.
Mark [X] ONE answer for every item

7.

Location of the office where your hearing was
held















8.

How well the judge explained what would
happen at your hearing















9.

How prepared the judge was to talk about the
facts of your case















10. Opportunity the judge gave you or your
representative to present the facts of your case















11. Courtesy of the judge















12. Length of time from the date you first
requested your hearing until it was held















13. Length of time from the date your hearing was
held until you received the decision















14. Overall length of time from the date you first
requested your hearing until you received the
decision















15. How well the notice explained the decision on
your hearing















16. How well the notice explained the amount of
your benefits and when they would start

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









17. Helpfulness of the staff















18. Courtesy of the staff















19. How well the staff knew their jobs















20. Overall experience with the hearing on your
disability application















21. Overall opinion of Social Security’s service















When your hearing was held…

Waiting for the hearing and decision…

Notice of Social Security’s decision on your hearing…

Your overall experience with Social Security…

A little more about you…
22. When you do business with Social Security, in person, on the telephone, or online, do you need them to
provide any special accommodations because of a medical condition?
Mark [X] ONE answer.
 Yes
 No  SKIP to Question 25.
23. Do you need special accommodations because of a:
Mark [X] all that apply.
 Physical limitation (for example, wheelchair access)
 Visual limitation (for example, large print or Braille documents)
 Deafness or difficulty hearing (for example, sign language interpreter or video relay)
 Other limitation (for example, a learning disability)
24. How satisfied are you with how well Social Security meets your need for special accommodations?
Are you:
Mark [X] ONE answer.
 Very satisfied
 Somewhat satisfied
 Somewhat dissatisfied, or
 Very dissatisfied
25. Please use this space to explain any of your answers, especially any reasons for dissatisfaction, or to
provide any other comments about the service you received in connection with your hearing.
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
OMB Control Number 0960-0526, Expiration Date: November 2015

FY 15 HPRC DENIAL SURVEY - ENGLISH

Hearings Process Report Card Survey
Social Security is continually working to improve the service we provide to the public. Please complete
this questionnaire to give us your opinion of the service you received when you requested a hearing on
your application for disability benefits.
MARKING INSTRUCTIONS
Correct Marking Example: 

• Use blue or black pen or a number 2 pencil.
• Make no stray marks.
• Do not use pens with ink that soaks through the • Keep all entries within the boxes.
paper.

Please use the scale shown to rate the following aspects of your hearing experience.

Excellent

Very Good

Good

Fair

Poor

Very Poor

Not
Applicable

Mark [X] ONE answer for every item. If a question does not apply to you, please mark Not Applicable.

1.

Ease of finding information about how to file
your hearing request















2.

Quality of information you got from Social
Security explaining the hearing process















When you decided to request a hearing…

While you were waiting for your hearing to be held…
3.

Ease of contacting Social Security about your
hearing request















4.

Helpfulness of the information Social Security
gave you about your hearing request















How your hearing was held…
5. Did you have a representative, either an attorney or some other person, handle your hearing?
Mark only ONE answer.



6.

Yes
No

Did you have a hearing with a judge face-to-face or by video conference?
Mark only ONE answer.





Hearing was face-to-face with a judge.

 Please continue with question 7

Hearing was by video conference with a judge.

 Please continue with question 7

No hearing was held with a judge.

 Please continue with question 14

PLEASE CONTINUE TO PAGE 2

Excellent

Very Good

Good

Fair

Poor

Very Poor

Not
Applicable

Please use the scale shown to rate the following aspects of your hearing experience.
Mark [X] ONE answer for every item

7.

Location of the office where your hearing was
held















8.

How well the judge explained what would
happen at your hearing















9.

How prepared the judge was to talk about the
facts of your case















10. Opportunity the judge gave you or your
representative to present the facts of your case















11. Courtesy of the judge















12. Length of time from the date you first
requested your hearing until it was held















13. Length of time from the date your hearing was
held until you received the decision















14. Overall length of time from the date you first
requested your hearing until you received the
decision















15. How well the notice explained the decision on
your hearing















16. How well the notice explained what to do if
you disagreed with the decision















17. Helpfulness of the staff















18. Courtesy of the staff















19. How well the staff knew their jobs















20. Overall experience with the hearing on your
disability application















21. Overall opinion of Social Security’s service















When your hearing was held…

Waiting for the hearing and decision…

Notice of Social Security’s decision on your hearing…

Your overall experience with Social Security…

A little more about you…
22. When you do business with Social Security, in person, on the telephone, or online, do you need them to
provide any special accommodations because of a medical condition?
Mark [X] ONE answer.
 Yes
 No  SKIP to Question 25.
23. Do you need special accommodations because of a:
Mark [X] all that apply.
 Physical limitation (for example, wheelchair access)
 Visual limitation (for example, large print or Braille documents)
 Deafness or difficulty hearing (for example, sign language interpreter or video relay)
 Other limitation (for example, a learning disability)
24. How satisfied are you with how well Social Security meets your need for special accommodations?
Are you:
Mark [X] ONE answer.
 Very satisfied
 Somewhat satisfied
 Somewhat dissatisfied, or
 Very dissatisfied
25. Please use this space to explain any of your answers, especially any reasons for dissatisfaction, or to
provide any other comments about the service you received in connection with your hearing.
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
OMB Control Number 0960-0526, Expiration Date: November 2015

FY 2015 Hearing Process Report Card Survey Correspondence
PRENOTICE POSTCARD

Dear Social Security Applicant:
Social Security believes that conducting surveys is one of the best ways to find out how well we
are serving you. That’s why we will soon be asking you to give us your opinion about the
service you received for your recent business with Social Security.
In a few days, you will receive a short questionnaire in the mail from [Contractor], who is
conducting this survey for Social Security. When you receive their envelope, we hope that you
will take the time to answer our questions and tell us what you think of our service.
We look forward to hearing your opinions.

Social Security Administration

FY 2015 Hearing Process Report Card Survey Correspondence
INITIAL COVER LETTER

Dear Social Security Applicant:
As noted in our recent postcard, Social Security is conducting a survey to get your opinion of the
service you received when you requested a hearing on your application for Social Security
disability benefits. We would like to hear from you even if you did not attend a hearing with a
judge.
The survey is short and should only take 5 minutes to complete. Please take a few minutes now
to answer the questions and return the form as soon as possible in the postage-paid envelope
provided. While you are not required to respond, your opinions are very important to us and we
would like to hear from as many people as possible. Please do not put any information related
to your Social Security business in the envelope with your completed survey.
Please be assured that [Contractor], who is conducting this survey for us, will only give your
responses to the staff here at Social Security and will not use them for any other purpose. Social
Security will report the survey results by summarizing the answers of everyone who takes the
survey; we will not report any individual responses. Your participation in this survey will not
affect your eligibility for benefits or any business you have with Social Security.
If you have any questions about your hearing request or benefits, please call Social Security’s
toll-free information line at 1-800-772-1213 or visit our web site at www.socialsecurity.gov.
Thank you for sharing your opinions with us.
Sincerely,

Social Security Administration

FY 2015 Hearing Process Report Card Survey Correspondence
FOLLOW-UP POSTCARD

Dear Social Security Applicant:
About two weeks ago we sent you a survey form asking for your opinion of the service you
received for your recent business with Social Security.
•
•
•

If you have already mailed back your completed survey, thank you for your
quick response.
If not, please take 5 minutes now to complete and return the survey in the
postage-paid envelope provided.
If you no longer have the survey, you don’t need to do anything. [Contractor],
who is conducting the survey for us, will be mailing another form to you shortly.

Thank you for your help with this survey.

Social Security Administration

FY 2015 Hearing Process Report Card Survey Correspondence
FOLLOW-UP COVER LETTER

Dear Social Security Applicant:
About a month ago we sent you a brief survey asking about the service you received when you
requested a hearing on your application for Social Security disability benefits. We haven’t yet
heard from you and it’s important that we gather opinions from as many people as possible. We
would like you to answer our survey even if you did not attend a hearing with a judge.
If you recently mailed in your completed survey form, please discard this letter. We sincerely
appreciate your help and we look forward to receiving your response. However, if you have not
yet returned the survey, please take 5 minutes now to complete it and send it back. For your
convenience, we have enclosed another copy along with a postage-paid return envelope. Please
do not put any information related to your Social Security business in the envelope with
your completed survey.
Please be assured that [Contractor], who is conducting this survey for us, will only give your
responses to the staff here at Social Security and will not use them for any other purpose. Social
Security will report the survey results by summarizing the answers of everyone who takes the
survey; we will not report any individual responses. Your participation in this survey will not
affect your eligibility for benefits or any business you have with Social Security.
If you have any questions about your hearing request or benefits, please call Social Security’s
toll-free information line at 1-800-772-1213 or visit our web site at www.socialsecurity.gov.
We would appreciate receiving your completed survey as soon as possible.
Sincerely,

Social Security Administration

FY 2015 Hearing Process Report Card Survey Correspondence

PRIVACY ACT STATEMENT
The Social Security Administration is authorized to collect the information for this survey under
Executive Order 12862, “Setting Customer Service Standards.” Your response to these
questions is strictly voluntary. The information you provide will be used to help us improve the
service that we give you. Your response will not be disclosed to any other government or private
agency.

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 5 minutes to read the instructions, gather the facts, and answer the questions. You
may send comments on our time estimate above to: Social Security Administration,
6401 Security Blvd., Baltimore, MD 21235-6401. Send only comments relating to our time
estimate to this address, not the completed form.