Fiscal Year (FY) 2016 Customer Satisifaction Surveys

Field and Hearing Office Survey Questionnaire

Give Social Security a Report Card…

Using the rating scale shown below, please rate the service you received the day of your visit. There is space at the end of the survey where you can explain your answers.

E = Excellent VG = Very Good G = Good F = Fair P = Poor VP = Very Poor NA = Not Applicable
Based on your recent visit, mark [X] ONE rating for:	E	VG	G	F	P		VP	NA
1. Office location	E	VG	G	F	P		VP	NA
2. Office hours	E	VG	G	F	P		VP	NA
3. Signs/instructions explaining how to check in when you got to the office	E	VG	G	F	P		VP	NA
4. Usefulness of Social Security information in the waiting area (posters, pamphlets, TV presentations, etc.)	E	VG	G	F	P		VP	NA
5. Office comfort (seating, temperature, etc.)	E	VG	G	F	P		VP	NA
6. Office appearance (clean, pleasant, etc.)	E	VG	G	F	P		VP	NA
7. Office privacy	E	VG	G	F	P		VP	NA
8. Did you have an appointment? Mark [X] one.  Yes  (Go to 9.)  No  (Skip to 11.)
9. How quickly you got an appointment	E	VG	G	F	P		VP	NA
10. Convenience of the date and time of the appointment	E	VG	G	F	P		VP	NA
11. Waiting time to be served in the office	E	VG	G	F	P		VP	NA
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
13. Helpfulness of the staff	E	VG	G	F	P		VP	NA
14. Courtesy of the staff	E	VG	G	F	P		VP	NA
15. How well the staff knew their jobs	E	VG	G	F	P		VP	NA
16. How clearly the staff explained things	E	VG	G	F	P		VP	NA
17. Was the staff able to take care of your business completely when you visited the office that day? Mark [X] one.  Yes  No
Mark [X] ONE rating.	E	VG	G	F	P		VP	NA
18. Overall, how would you rate Social Security’s service during your recent office visit?	E	VG	G	F	P		VP	NA
We would like to know a little more about how you took care of your recent business. 19. Before you were served in the office, did you try to take care of this same business earlier? Mark [X] one.  Yes  (Go to 20.)  No  (Skip to 22.)
20. What else did you do? Did you: Mark [X] all that apply.  Call Social Security’s National 800 Number  Call the local office Visit a local office, or  Try to use Social Security’s website
21. Why weren’t you able to take care of your business in your earlier contact? Mark [X] all that apply.  I couldn’t get through on the phone  The wait was too long at the office The office was closed  The staff told me I had to come into the office  I didn’t have all the information or documents I needed  The staff couldn’t answer my question  I couldn’t find what I needed on the website  I tried an online service but it didn’t work for me
Now we would like to ask you about doing business on the Internet. 22. First, do you currently use the Internet? Mark [X] one  Yes  No  (Skip to 34.)
23. How do you access the Internet? Do you use: Mark [X] only ONE  Only a personal computer or laptop computer  Only a wireless handheld device (smartphone, tablet, etc.)  Both a PC and a wireless handheld device
The list below describes different activities people can do on the Internet. Please tell us whether you do each of the online activities listed below often, sometimes, or never. Mark [X] ONE answer for each question.
24. Send email	Often		Sometimes			Never
25. Look for information online	Often		Sometimes			Never
26. Make purchases online	Often		Sometimes			Never
27. Bank or pay bills online	Often		Sometimes			Never
28. Text message or chat	Often		Sometimes			Never
29. Use Facebook, Twitter, or some other social networking site	Often		Sometimes			Never
30. Social Security offers a service called “my Social Security” where people can create a secure online account with a user name and password to conduct various types of business. For example, people who receive benefits can use it to change their address. Have you heard about the “my Social Security” account? Mark [X] only ONE. Yes  (Go to 31.) No  (Skip to 32.)
31. Have you already created your “my Social Security” account? Mark [X] only ONE. Yes  (Skip to 34.) No  (Go to 32.)
32. How likely would you be to create a “my Social Security” account for handling future business on Social Security’s website? Mark [X] only ONE.  Very Likely (Skip to 34.)  Somewhat Likely (Skip to 34.) Not Very Likely, or (Go to 33.) Not at all likely (Go to 33.)

33. What is the main reason you might not be likely to create a “my Social Security” account?

Mark [X] only ONE.

 Prefer to speak to a person

 Concerned about security of my information

• Problem with computer or Internet access

• Concerned that completing my business online might be too hard

• Some other reason Explain:_____________________________________________

34. Sometimes because of a medical condition, people need special accommodations to conduct their business with Social Security. 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  (Go to 35.)

 No  (Skip to 37.)

35. 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, trouble understanding or remembering things)

36. 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

37. 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.

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.
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  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. There is space at the end of the survey where you can explain your answers.
E = Excellent VG = Very Good G = Good F = Fair P = Poor VP = Very Poor NA = Not Applicable
Mark [X] ONE rating for each question.			E	VG	G	F	P	VP	NA
3. Information you received before your visit about how to apply for a new or replacement Social Security card			E	VG	G	F	P	VP	NA
4. Office location			E	VG	G	F	P	VP	NA
5. Office hours			E	VG	G	F	P	VP	NA
6. Signs/instructions explaining how to check in when you got to the office			E	VG	G	F	P	VP	NA
7. Usefulness of Social Security information in the waiting area (posters, pamphlets, TV presentations, etc.)			E	VG	G	F	P	VP	NA
8. Office comfort (seating, temperature, etc.)			E	VG	G	F	P	VP	NA
9. Office appearance (clean, pleasant, etc.)			E	VG	G	F	P	VP	NA
10. Office privacy			E	VG	G	F	P	VP	NA
11. Waiting time to be served in the office			E	VG	G	F	P	VP	NA
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
Mark [X] ONE rating.			E	VG	G	F	P	VP	NA
13. Helpfulness of the staff			E	VG	G	F	P	VP	NA
14. Courtesy of the staff			E	VG	G	F	P	VP	NA
15. How well the staff knew their jobs			E	VG	G	F	P	VP	NA
16. How clearly the staff explained things			E	VG	G	F	P	VP	NA
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.		E		VG	G	F	P	VP	NA
18. Overall, how would you rate Social Security’s service during your recent visit?		E		VG	G	F	P	VP	NA
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  No  (Skip to 33.)
21. 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
The list below describes different activities people can do on the Internet. Please tell us whether you do each of the online activities listed below often, sometimes, or never. Mark [X] ONE answer for each question.
22. Send email	Often		Sometimes			Never
23. Look for information online	Often		Sometimes			Never
24. Make purchases online	Often		Sometimes			Never
25. Bank or pay bills online	Often		Sometimes			Never
26. Text message or chat	Often		Sometimes			Never
27. Use Facebook, Twitter, or some other social networking site	Often		Sometimes			Never
28. Social Security offers a service called “my Social Security” where people can create a secure online account with a user name and password to conduct various types of business. For example, people who receive benefits can use it to change their address. Have you heard about the “my Social Security” account? Mark [X] only ONE. Yes  (Go to 29.) No  (Skip to 30.)
29. Have you already created your “my Social Security” account? Mark [X] only ONE. Yes  (Skip to 32.) No  (Go to 30.)
30. How likely would you be to create a “my Social Security” account for handling future business on Social Security’s website? Mark [X] only ONE.  Very Likely (Skip to 32.)  Somewhat Likely (Skip to 32.) Not Very Likely, or (Go to 31.) Not at all likely (Go to 31.)

31. What is the main reason you might not be likely to create a “my Social Security” account? Mark [X] only ONE.  Prefer to speak to a person  Concerned about security of my information Problem with computer or Internet access Concerned that completing my business online might be too hard Some other reason Explain:_____________________________________________
32. Sometimes because of a medical condition, people need special accommodations to conduct their business with Social Security. 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  (Go to 33)  No  (Skip to 35.)
33. 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, trouble understanding or remembering things)
34. 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
35. 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.

Please continue on the next page  OMB Control N0. 0960-0526 Expiration Date: Month/Year