Download:
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pdfOMB Control No.
0960-0526
Expiration 11/2015
Social Security Survey
Social Security records show that you wrote to the main office in Baltimore, MD for help with your question or
situation. Please give us your opinion of the written response you received from Social Security in reply to
your letter.
MARKING INSTRUCTIONS
Correct Marking Example: X
•
Use blue or black pen or a number 2 pencil.
•
Make no stray marks.
•
Do not use pens with ink that soaks through the paper.
•
Keep all entries within the boxes.
1.
Before you wrote to the main office in Baltimore, did you contact Social Security any other way about your
question or situation?
Mark [X] only ONE.
2.
Yes
Go to question 2.
No
Go to question 4.
How many times did you contact Social Security before writing to the Baltimore address?
Enter the number of times here: ___________________
3.
How did you make those earlier contacts with Social Security about this matter?
Mark [X] all that apply.
Called Social Security’s national toll-free number
Called a local Social Security office
Visited a local Social Security office
Emailed Social Security
Wrote or faxed a local office
Did something else: (Please explain here: ______________________________________________)
Mark [X] ONE rating for every item.
Excellent
Very Good
Good
Fair
Poor
Very Poor
Please use the scale shown below to rate the following aspects of the written response you received from Social
Security.
4.
Clarity of Social Security’s written response
E
VG
G
F
P
VP
5.
Helpfulness of Social Security’s written response
E
VG
G
F
P
VP
6.
Logical organization of Social Security’s written response
E
VG
G
F
P
VP
7.
Thoroughness of Social Security’s written response
E
VG
G
F
P
VP
8.
How long it took to receive Social Security’s written
response
E
VG
G
F
P
VP
9.
Overall quality of Social Security’s written response
E
VG
G
F
P
VP
10. Did Social Security’s written response resolve your question or situation completely?
Mark [X] only ONE.
Yes
Go to question 12.
No
Go to question 11.
11. What will you do next to resolve the matter?
Mark [X] all that apply.
Wait to hear from Social Security
Call Social Security’s national toll-free number
Call a local Social Security office
Visit a local Social Security office
Write to Social Security
Email Social Security
Get help from someplace other than Social Security
Don’t plan to take any action
12. Please use this space to explain any of your answers, especially any reasons for dissatisfaction, or to provide any
other comments about the written response you received from Social Security.
OPI RESPONSE SURVEY
PRENOTICE 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 the public. That’s why we will soon be asking you participate in a survey to give us
your opinions.
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. We look forward to hearing your opinions.
Social Security Administration
OPI RESPONSE SURVEY
INITIAL COVER LETTER
Dear Social Security Customer:
Social Security records show that you sent an inquiry to our main office in Baltimore, MD about
a particular issue or problem. We are conducting a survey to get your opinion of the letter we
recently mailed you in reply to your inquiry. 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 [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. Your participation in this
survey will not affect any business you have with Social Security.
If you have any questions about Social Security benefits, please call our 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
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.
OPI RESPONSE SURVEY
FOLLOW-UP COVER LETTER
Dear Social Security Customer:
About three weeks ago we mailed you a brief survey asking for your opinion of the letter we sent
in response to your inquiry to our main office in Baltimore, MD. We haven’t yet heard from you
and it’s important that we gather opinions from as many people as possible.
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 any business you have with Social Security.
If you have any questions about Social Security benefits, please call our 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
| File Type | application/pdf |
| Author | dpse |
| File Modified | 2014-08-11 |
| File Created | 2014-08-06 |