Seven Quantitative Customer Satisfaction Surveys - Mail and Telephone Surveys

Generic Clearance of Customer Satisfaction Surveys

Survey Instrument FY 15 Office Visitor Survey and Correspondence

Seven Quantitative Customer Satisfaction Surveys - Mail and Telephone Surveys

OMB: 0960-0526

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0960-0526 can be found here:

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FO/HO Questionnaire

Give Social Security a Report Card…
Using the rating scale shown below, please rate the service you received the day of
your visit.
E = Excellent

VG = Very Good

G = Good

F = Fair

P = Poor

VP = Very Poor

Based on your recent visit, mark [X] ONE rating for:

Office location

Office hours

Signs/instructions explaining how to check in
when you got to the office

Usefulness of Social Security information in the
waiting area (posters, pamphlets, TV
presentations, etc.)

Office comfort (seating, temperature, etc.)

Office appearance (clean, pleasant, etc.)

Office privacy

Did you have an appointment?
Mark [X] one.
Yes

 (Go to 9.)

No  (Skip to 11.)

How quickly you got an appointment

10. Convenience of the date and time of the
appointment

11. Waiting time to be served in the office

12. About how many minutes did you have to wait?
Mark [X] only ONE.
Up to 10 minutes
More than 10 and up to 30 minutes
More than 30 and up to 60 minutes
More than 60 minutes

Please continue on the next page 

OMB Control N0. 0960-0526

Expiration Date: November 2015

Mark [X] ONE rating.

13.

Helpfulness of the staff

14.

Courtesy of the staff

15.

How well the staff knew their jobs

16.

How clearly the staff explained things

17.

Were you able to take care of your business in one visit to the office?
Mark [X] one.
Yes

Mark [X] ONE rating.

18.

Overall, how would you rate Social Security’s
service during your recent office visit?

To serve you better in the future, we would like to know how you prefer to do business with
Social Security.
19.

First, do you currently use the Internet?
Mark [X] one
No  (Skip to 22.)

Yes
20.

How do you access the Internet? Do you use:
Mark [X] only ONE
Only a personal computer or laptop
Only a wireless handheld device (smartphone, tablet, etc.)
Both a personal computer and a wireless handheld device

21.

If you could have taken care of your recent business by using the Internet instead of
visiting Social Security, how likely would you have been to do that? Would you have
been:
Mark [X] only ONE.
Very likely
Somewhat likely
Not very likely, or
Not at all likely to use the Internet instead of visiting

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
Yes 
No  (Skip to 25.)

Please continue on the next page



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
Another 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] only ONE.
Very satisfied
Somewhat satisfied
Somewhat dissatisfied, or
Very dissatisfied

25.

Please use this space to explain why you rated any item “F” (fair), “P” (poor), or “VP”
(very poor) or to explain any of your other answers.
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

Thank you for taking the time to rate Social Security!
Please send us your “Report Card” in the enclosed postage-paid envelope as soon as possible.

SSCC Questionnaire

Give Social Security a Report Card…
We would like to ask you a few questions about how you found out what you needed to do to
apply for a Social Security card.
1. First, did you contact Social Security to find out how to apply for a new or replacement
Social Security card before you visited the Social Security Card Center?
Mark [X] one
Yes
2.

No  (Skip to 4)

How did you contact Social Security for that information? Did you:
Mark [X] all that apply.
Call Social Security’s National 800 number
Call a Social Security office
Visit a Social Security office, or
Visit Social Security’s website

Using the rating scale shown below, please rate the following items about your experience
applying for a Social Security card. Mark [X] ONE rating for each question.
E = Excellent

VG = Very Good

G = Good

F = Fair

P = Poor

VP = Very Poor

3. Information you received before your visit about how
to apply for a new or replacement Social Security
card

Office location

Office hours

Signs/instructions explaining how to check in
when you got to the office

Usefulness of Social Security information in the
waiting area (posters, pamphlets, TV presentations,
etc.)

Office comfort (seating, temperature, etc.)

Office appearance (clean, pleasant, etc.)

10. Office privacy

11. Waiting time to be served in the office

12. About how many minutes did you have to wait?
Mark [X] only ONE.
Up to 10 minutes
More than 10 and up to 30 minutes
More than 30 and up to 60 minutes
More than 60 minutes

Please continue on the next page 

OMB Control N0. 0960-0526

Expiration Date: November 2015

Mark [X] ONE rating.

13. Helpfulness of the staff

14. Courtesy of the staff

15. How well the staff knew their jobs

16. How clearly the staff explained things

17. Were you able to take care of your business in one visit to the Social Security Card Center?
Mark [X] one
Yes
No
Mark [X] ONE rating.

18. Overall, how would you rate Social Security’s
service during your recent visit?

19. To serve you better in the future, we would like to know how you prefer to do business with
Social Security. First, what is your preferred language?
Mark [X] only ONE.
English
Spanish
Other Explain:______________________________________________
20. Do you currently use the Internet?
Mark [X] one
Yes
21.

No  (Skip to 23.)

How do you access the Internet? Do you use:
Mark [X] only ONE.
Only a personal computer or laptop
Only a wireless handheld device (smartphone, tablet, etc.)
Both a personal computer and a wireless handheld device

22. If you could have taken care of your recent business by using the Internet instead of visiting
Social Security, how likely would you have been to do that? Would you have been:
Mark [X] only ONE.
Very likely
Somewhat likely
Not very likely, or
Not at all likely to use the Internet instead of visiting

Please continue on the next page 

23.

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
Yes



 (Skip to 26.)

24. 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
Another limitation (for example, a learning disability)
25.

26. Please use this space to explain why you rated any item “F” (fair), “P” (poor), or “VP”
(very poor) or to explain any of your other answers.
__________________________________________________________________________________________
__________________________________________________________________________________________
Thank you for taking the time to rate Social Security!
Please send us your “Report Card” in the enclosed postage-paid envelope as soon as possible.

FY 2015 Office Visitor (FO/HO) Survey - Pre-Notice Postcard

Dear Social Security Customer:
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 during a recent visit to a local Social Security office or
Social Security hearing office.
In a few days, you will receive a short questionnaire in the mail from [insert contractor
name], 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.
Peter D. Spencer
Deputy Commissioner for Budget, Finance, Quality, and Management
Social Security Administration

FY 2015 Office Visitor (FO/HO) Survey – Initial Cover Letter

Dear Social Security Customer:
As I noted in my recent postcard, Social Security is conducting a survey to find out how
well we served you during your recent visit to a local Social Security office or
Social Security hearing office. Please take 5 minutes to fill out the enclosed "Report
Card" and return the form as soon as possible in the postage-paid envelope provided.
Please be assured that [insert contractor name], who is conducting this survey for us, will
only give your responses to my 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.
If you have a question about Social Security benefits, please visit our web site
at www.socialsecurity.gov or call our toll-free information line at 1-800-772-1213.
We appreciate your taking time out of your busy schedule to answer our survey.
Sincerely,

Peter D. Spencer
Deputy Commissioner for Budget, Finance, Quality, and Management
Social Security Administration

Enclosures

FY 2015 Office Visitor (FO/HO) Survey – Follow-up Cover Letter

Dear Social Security Customer:
About a week ago we sent you a survey form, “Give Social Security a Report Card,” to
find out how well we served you when you visited a local Social Security office or
Social Security hearing office. We haven’t yet heard from you and it’s important that we
gather opinions from as many people as possible. If you have already 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 had time to fill out and return your survey, please take a
few minutes right now to do that. The form is short and takes less than 5 minutes to
complete. In case you misplaced the survey, we have enclosed another copy along with a
postage-paid return envelope.
Please be assured that [insert contractor name], who is conducting this survey for us, will
only give your responses to my 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.
If you have a question about Social Security benefits, please visit our web site
at www.socialsecurity.gov or call our toll-free information line at 1-800-772-1213.
We would appreciate receiving your completed survey as soon as possible.
Sincerely,

Peter D. Spencer
Deputy Commissioner for Budget, Finance, Quality, and Management
Social Security Administration

Enclosures

FY 2015 Social Security Card Center Survey - Pre-Notice Postcard

Dear Social Security Customer:
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 (or someone else on your behalf) received during a recent visit to a
Social Security Card Center.
In a few days, you will receive a short questionnaire in the mail from [insert contractor
name], 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.
Peter D. Spencer
Deputy Commissioner for Budget, Finance, Quality, and Management
Social Security Administration

FY 2015 Social Security Card Center Survey – Initial Cover Letter

Dear Social Security Customer:
As I noted in my recent postcard, Social Security is conducting a survey to find out how
well we served you (or someone else on your behalf) during your recent visit to a
Social Security Card Center. Please take 5 minutes to fill out the enclosed "Report Card"
and return the form as soon as possible in the postage-paid envelope provided.
Please be assured that [insert contractor name], who is conducting this survey for us, will
only give your responses to my 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.
If you have a question about Social Security benefits, please visit our web site
at www.socialsecurity.gov or call our toll-free information line at 1-800-772-1213.
We appreciate your taking time out of your busy schedule to answer our survey.
Sincerely,

Peter D. Spencer
Deputy Commissioner for Budget, Finance, Quality, and Management
Social Security Administration
Enclosures

FY 2014 Social Security Card Center Survey – Follow-up Cover Letter

Dear Social Security Customer:
About a week ago we sent you a survey form, “Give Social Security a Report Card,” to
find out how well we served you when you (or someone else on your behalf) visited a
Social Security Card Center. We haven’t yet heard from you and it’s important that we
gather opinions from as many people as possible. If you have already 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 had time to fill out and return your survey, please take a
few minutes right now to do that. The form is short and takes less than 5 minutes to
complete. In case you misplaced the survey, we have enclosed another copy along with a
postage-paid return envelope.
Please be assured that [insert contractor name], who is conducting this survey for us, will
only give your responses to my 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.
If you have a question about Social Security benefits, please visit our web site
at www.socialsecurity.gov or call our toll-free information line at 1-800-772-1213.
We would appreciate receiving your completed survey as soon as possible.
Sincerely,

Peter D. Spencer
Deputy Commissioner for Budget, Finance, Quality, and Management
Social Security Administration
Enclosures

Office Visitor (FO/HO) Survey and Social Security Card Center Survey

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.

File Type	application/pdf
Author	dpse
File Modified	2014-08-11
File Created	2014-08-06