Employee Benefits Security Administration Participant Assistance Program Customer Survey

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US DEPARTMENT OF LABOR-EBSA 2013
FIELD FINAL
Export Date: 6/28/2013 12:44:48 PM
QBank Id: 6607
PROJECT REGISTRATION # 160506

US Department of Labor
Translations:  NO

Verbatims:  YES
City Center:

US Department of Labor - EBSA CE11 1210
_X_SURVEY DESIGN: TERI FISHER
TODD JENSEN/

MARK PETERSON, Programmer

October, 2012
Quota: 6,200

QID:120772	Gallup®, The Gallup Poll®, and CE11® are trademarks of Gallup, Inc. All other trademarks are the property of their respective owners. Copyright © 1994-2000, 2010-2012 Gallup, Inc. All rights reserved.

CASEID		
QID:36526	I.D.#
											CASEID(1-6)

FVALIFON		
QID:1528	**AREA CODE AND TELEPHONE NUMBER:
											FVALIFON(1161-1179)

CINTTIME		
QID:963	**INTERVIEW TIME:
											CINTTIME(1716-1721)

		(Programmer: All interviews are recorded. The recording begins when the respondent answers the phone. This statement is read after the "Continue" response is entered after the Introduction and before the first question.) 
FRECCONS		
QID:98881	This interview will be recorded for internal quality assurance.

1
(Continue)
2
(Refused) - (Thank and Terminate)

											FRECCONS(1984)

SA		
QID:134507	DATE OF INTERVIEW:
											SA(1931-1938)

SB		
QID:134508	INQUIRY RECORD NUMBER (CONTROL_ID):
		(Programmer: Code from fone file) 
											SB(60-74)

SC		
QID:134509	BENEFIT ADVISOR NUMBER/ID (STAFF):
		(Programmer: Code from fone file) 
											SC(195-204)

SD		
QID:134510	DATE CLOSED (CLOSING_DATE):
		(Programmer: Code from fone file) 
											SD(245-264)

SE		
QID:45204	INQUIRER FIRST NAME (FIRST_NAME):
		(Programmer: Code from fone file) 
											SE(75-109)

SF		
QID:3213	INQUIRER LAST NAME (LAST_NAME):
		(Programmer: Code from fone file) 
											SF(110-154)

SK		
QID:47255	INQUIRER ZIP CODE (ZIP_CODE):
		(Programmer: Code from fone file) 
											SK(175-184)

SL		
QID:134511	CLOSURE ANALYSIS (CLOSURE_ANALYSIS):
		(Programmer: Code from fone file) 
		(Programmer: Allow 5 entries) 

01
Benefit Claim – Assistance (BCA)
02
Recovery (BVR)
03
Referral for Enforcement (BVE)
04
Secondary Lead (BVESL)
05
Referral as Abandoned Plan (BVADV)
06
Not Valid (BN)

		# of Responses: 5
											SL(401-402)
											SL_1(516-517)
											SL_2(518-519)
											SL_3(520-521)
											SL_4(522-523)
											SL_5(524-525)

SM		
QID:134512	SUBJECT ENTRY CODE (SUBJECT):
		(Programmer: Code from fone file) 
		(Programmer: Allow 5 entries) 

001
NBI: Not Benefits Issue
002
NCP: Not Covered Pension
003
NCW: Not Covered Welfare
004
NTI: Not Title I Issue
005
PRE: Pre-ERISA
006
UNK: Unknown
007
GER: General EBSA Request
008
RD: Reporting & Disclosure
009
PDD: Disclosure Requirements
010
PDR: Reporting Requirements
011
JSQDRO: Joint & Survivor, QDRO
012
PJS: Joint and Survivor
013
PQD: Qualified Domestic Relations Order
014
PF: Fiduciary
015
PFB: Bankruptcy
016
PFC: Participant Contributions
017
PFE: Employer Contributions
018
PFN: Abandoned Plan
019
PFA: Administrative Fees
020
PFF: Fund Investment Fees
021
PFI: Investment of Funds
022
PFD: Default Investments
023
PFT: Prohibited Transaction
024
PGA: Plan General Administration
025
PB: Pension Benefits
026
PBE: Benefit Eligibility
027
PBD: Benefit Distributions
028
PBC: Pension Benefits, Can't Locate Plan
029
PBS: Pension Benefits, Social Security Notice
030
WRD: Reporting & Disclosure
031
WDD: Disclosure Requirements
032
WDR: Reporting Requirements
033
WF: Fiduciary
034
WFA: Administrative Fees
035
WFB: Bankruptcy
036
WFI: Paid Premiums/Insurance Cancelled
037
WFS: Self-Insured, No Funds
038
WGA: Plan General Administration
039
WWB: Welfare Benefits
040
WBE: Benefit Eligibility/Participating
041
WBP: Benefit Payments
042
WRC: Retiree Health
043
WCOBRA: COBRA
044
WCE: COBRA Eligibility
045
WCU: COBRA Under 20 Employees
046
WCN: COBRA Notices
047
WCD: COBRA Duration Coverage
048
WCP: COBRA Premiums
049
WCS: COBRA Successor Plans/Employer
050
WCI: COBRA Conversion to Individual Coverage
051
COBRA_CPA: COBRA Premium Assistance
052
WCX: General ARRA Assistance
053
WCC: COBRA Subsidy Denial
054
WHIPAA: HIPAA
055
WHP: HIPAA Pre-Existing Conditions
056
WHC: HIPAA Certificates of Creditable Coverage
057
WHS: HIPAA Special Enrollment Rights
058
WHD: HIPAA Discrimination/Health Status
059
WHG: HIPAA Group to Individual Policy
060
WHM: Mental Health Parity
061
WHN: Newborns' & Mothers' Act
062
WHW: Women’s Health & Cancer Rights Act
063
WRA: Health Reform Assistance
064
OTH: Other

		# of Responses: 5
											SM_1(501-503)
											SM_2(504-506)
											SM_3(507-509)
											SM_4(510-512)
											SM_5(513-515)

SN		
QID:134513	REGION (OFFICE):
		(Programmer: Code from fone file) 

01
Atlanta and Miami (40 and 42)
02
Boston (31)
03
Chicago (50)
04
Cincinnati (43)
05
Dallas (63)
06
Kansas City (60)
07
Los Angeles (72)
08
New York (30)
09
Philadelphia and Washington DC (20 and 22)
10
San Francisco and Seattle (70 and 71)
11
National Office/OPA/DTAI (88)

											SN(403-404)

SO		
QID:134979	METHOD OF INQUIRY (CORRESPONDENCE_TYPE):
		(Programmer: Code from fone file) 

01
Telephone (T)
02
Routine Mail (M)
03
Web site (W)

											SO(405-406)

SP		
QID:153217	INITIAL DATE OF INQUIRY (INQUIRY START DATE):
		(Programmer: Code from fone file) 
											SP(300-309)

		(Interviewer: ASK TO SPEAK TO INQUIRER NAME FROM FONE FILE:) 
INTRO1		
QID:120821	Hello, this is __________, from The Gallup Poll. We are calling on behalf of the Employee Benefits Security Administration or EBSA (say: E-B-S-A) of the U.S. Department of Labor. Our records indicate that you recently contacted EBSA concerning a pension or health benefits issue. We are conducting a very short poll about your interaction with this agency. It should take less than eight minutes.

QID:228828	By law, I must inform you that the Paperwork Reduction Act requires Federal agencies to obtain Office of Management and Budget authorization before conducting any information collection, and persons are not required to respond to an information collection that is not currently approved. The Office of Management and Budget has authorized this survey for use through January 2016 under control number 1225-0059.


I want to assure you that Gallup and EBSA will protect your confidentiality and privacy. Your voluntary cooperation is requested to make the results of this study complete and accurate. Gallup will not share your individual responses with EBSA and your data will only be used in aggregate with responses of others like you.

1
Respondent available - (Continue)
4
No such person - (Thank and Terminate)
7
Respondent not available - (Set time to call back)
8
(Soft Refusal)
9
(Hard Refusal) - (Thank and Terminate)

											INTRO1(2001)






S1		
QID:134516	Do you recall [(If code 11 in SN, read:) sending a note to/(If code 01-10 in SN, read:) contacting] the Employee Benefits Security Administration or EBSA? This probably would have occurred within the past few weeks. (If necessary, read:) Again, this agency is part of the Department of Labor and provides assistance to employees and beneficiaries regarding employee retirement, pension or 401k benefits, and health benefits such as COBRA (say: CO-bruh) and HIPAA (say: HIP-uh).  

1
Yes
2
No
3
(DK)
4
(Refused)

											S1(2011)

QID:135095	Skip: (If code 1 in S1, Continue; 
Otherwise, Thank and Terminate)

		(Interviewer: READ:) 
QID:135096	Throughout the remainder of the survey, we will refer to the Employee Benefits Security Administration as EBSA.   

CE1		HC - DB,CE - DB
QID:21495	Taking into account all the information, products, and services you receive from them, how satisfied are you with EBSA overall? Please use a five-point scale, where 5 means you are extremely satisfied and 1 means you are not at all satisfied. You may use any of the numbers 1, 2, 3, 4, or 5 for your rating.

1
Not at all satisfied
2

3

4

5
Extremely satisfied
7
(Not applicable)
8
(DK)
9
(Refused)

											CE1(2101)

CE2		HC - DB,CE - DB
QID:21496	If you had a similar need for information or assistance in the future, how likely would you be to contact EBSA again? Please use a five-point scale, where 5 means extremely likely and 1 means not at all likely. You may use any of the numbers 1, 2, 3, 4, or 5.

1
Not at all likely
2

3

4

5
Extremely likely
7
(Not applicable)
8
(DK)
9
(Refused)

											CE2(2102)

CE3		HC - DB,CE - DB
QID:21497	If a friend or a colleague had a similar need for information or assistance, how likely would you be to recommend EBSA? Please use a five-point scale, where 5 means extremely likely and 1 means not at all likely. You may use any of the numbers 1, 2, 3, 4, or 5.  

1
Not at all likely
2

3

4

5
Extremely likely
7
(Not applicable)
8
(DK)
9
(Refused)

											CE3(2103)

		(Interviewer: READ:) 
QID:143535	Now, I am going to read a number of statements. Using a five-point scale, where 5 means you strongly agree and 1 means you strongly disagree, please tell me how much you agree or disagree with each statement as it applies to EBSA. You may use any of the numbers 1, 2, 3, 4, or 5 for your rating. How about (read CE4-CE9A):

CE4		HC - DB,CE - DB
QID:21499	EBSA is a name I can always trust.

1
Strongly disagree
2

3

4

5
Strongly agree
7
(Not applicable)
8
(DK)
9
(Refused)

											CE4(2111)

CE5		HC - DB,CE - DB
QID:21500	EBSA always delivers on what they promise.

1
Strongly disagree
2

3

4

5
Strongly agree
7
(Not applicable)
8
(DK)
9
(Refused)

											CE5(2112)

CE6A		HC - DB,CE - DB
QID:21501	EBSA always treats me fairly.

1
Strongly disagree
2

3

4

5
Strongly agree
7
(Not applicable)
8
(DK)
9
(Refused)

											CE6A(2113)

CE7A		HC - DB,CE - DB
QID:21502	If a problem arises, I can always count on EBSA to reach a fair and satisfactory resolution.

1
Strongly disagree
2

3

4

5
Strongly agree
7
(Not applicable)
8
(DK)
9
(Refused)

											CE7A(2114)

CE9A		HC - DB,CE - DB
QID:21504	EBSA always treats me with respect.

1
Strongly disagree
2

3

4

5
Strongly agree
7
(Not applicable)
8
(DK)
9
(Refused)

											CE9A(2115)

Q1
QID:134520	Again using a five-point scale, where 5 means you strongly agree and 1 means you strongly disagree, please tell me how much you agree or disagree with each statement as it applies to EBSA. How about (read and rotate A-H):

1
Strongly disagree
2

3

4

5
Strongly agree
7
(Not applicable)
8
(DK)
9
(Refused)

Q1A
QID:134521
EBSA treats me like a valued customer.
Q1A(2121)
Q1B
QID:134522
EBSA is willing to work with me to make sure my needs are met.
Q1B(2122)
Q1C
QID:134523
EBSA acts in a timely fashion.
Q1C(2123)
Q1D
QID:134524
EBSA does what it says it will do.
Q1D(2124)
Q1E
QID:134525
EBSA services are available when I need them.
Q1E(2125)
Q1F
QID:134526
EBSA is easy to reach.
Q1F(2126)
Q1G
QID:134527
The information I receive from EBSA is clear and easy to understand.
Q1G(2127)
Q1H
QID:134528
EBSA does its best to help me out.
Q1H(2128)

Q2		
QID:135100	After your interaction with EBSA, did you feel (read 3-1)? 

3
Much more knowledgeable about your benefits rights
2
Somewhat more knowledgeable about your benefits rights, or
1
Not any more knowledgeable about your benefits rights
7
(Not applicable)
8
(DK)
9
(Refused)

											Q2(2141)

Q3
QID:134530	Please rate your level of agreement with each of the following statements using a five-point scale, where 5 means you strongly agree and 1 means you strongly disagree. You may use any of the numbers 1, 2, 3, 4, or 5 for your rating. How about (read A-B):

1
Strongly disagree
2

3

4

5
Strongly agree
7
(Not applicable)
8
(DK)
9
(Refused)

Q3A
QID:134531
As a result of the interaction I had with EBSA, I feel better informed to protect my benefits in the future.
Q3A(2151)
Q3B
QID:134532
As a result of the interaction I had with EBSA, I feel my benefits are more secure.
Q3B(2152)

Q4		
QID:134552	Compared to interactions you may have had with other government agencies, would you say your interaction with EBSA was better, worse, or about the same as what you’ve experienced elsewhere?

3
Better
2
About the same
1
Worse
7
(Not applicable)
8
(DK)
9
(Refused)

											Q4(2161)

Q5		
QID:134557	Compared to interactions you may have had with businesses and non-governmental agencies, would you say your interaction with EBSA was better, worse, or about the same as what you’ve experienced elsewhere?

3
Better
2
About the same
1
Worse
7
(Not applicable)
8
(DK)
9
(Refused)

											Q5(2163)

Q6		
QID:134559	Did you share any of the information you obtained from EBSA with anyone else?

1
Yes
2
No
7
(Not applicable)
8
(DK)
9
(Refused)

											Q6(2165)

QID:134560	Skip: (If code 1 in Q6, Continue;
Otherwise, Skip to Q7)

Q6A
QID:134562	Please tell me whether you shared this information with any of the following. (Read and rotate A-C)  

1
Yes
2
No
7
(Not applicable)
8
(DK)
9
(Refused)

Q6AA
QID:134563
Coworkers
Q6AA(2171)
Q6AB
QID:134564
Family or friends
Q6AB(2172)
Q6AC
QID:134565
Your employer
Q6AC(2173)

Q7		
QID:134580	Can you briefly tell me how you first found out about EBSA?
		(Interviewer: Open ended and code) 

01
Other (list)
02
(DK)
03
(Refused)
04
HOLD
05
HOLD
06
Referred by another agency (IRS, Social Security Administration, Health and Human Services, State Department of Insurance, etc.)
07
Referred by a colleague
08
Referred by a lawyer or other professional
09
Found them on the Internet
10
Referred by employer or HR Department
11
Phone book
12
Congressperson
13
Received a publication
14
Media (newspaper article, press release, public service announcement, etc.)
15
Insurance company

		 List Other:Y
											Q7(2181-2182)
											Q7_T(8001)

QID:213175	Skip: (If code 02 OR 03 in SO, Skip to Q8A;
Otherwise, Continue)

Q8		
QID:134983	When you first contacted EBSA, did you speak with a benefits advisor right away, or did you leave a message to have someone return your call?

1
Spoke with a benefits advisor right away
2
Left a message
3
(Left a message and no one called me back—I called again)
8
(DK)
9
(Refused)

		(Skip: All in Q8, Skip to Q9) 
											Q8(2185)

Q8A		
QID:134988	When you first sent a note to EBSA, how long did it take them to respond?
		(Interviewer: Open ended and code) 

1
Responded the same day
2
Responded within one day
3
Responded within two days
4
Responded within three or more days
7
(Have not yet responded)
8
(DK)
9
(Refused)

											Q8A(2187)

Q9		
QID:134594	In the future, would you prefer to contact EBSA (read and rotate 1-5)?

1
By phone
2
By e-mail
3
By submitting an online form
4
Through live chat on the Internet
5
Through the mail
6
Other
7
(No preference)
8
(DK)
9
(Refused)

											Q9(2189)

Q10		
QID:134989	Was EBSA able to assist you with your questions, problem, or recovering the benefit?

1
Yes
2
No
3
(Still working on it/Not yet resolved)
4
(DK)
5
(Refused)

											Q10(2191)

QID:134990	Skip: (If code 2 in Q10, Continue;
Otherwise, Skip to Q12)

Q11		
QID:134605	Why was EBSA not able to assist you with your question or problem?
		(Interviewer: Read 06-10, then read 01) 

01
Or some other reason (list)
02
(DK)
03
(Refused)
04
(No reason given)
05
HOLD
06
There were limitations because of the law
07
There were limitations because of the plan rules
08
The company has terminated the plan
09
The company went bankrupt
10
The EBSA representative did not understand your question or problem

		 List Other:Y
											Q11(2193-2194)
											Q11_T(8002)

Q12		
QID:134608	What ONE thing could EBSA do to better improve the service it provides?
		(Interviewer: Open ended) 

01
Other (list)
02
(DK)
03
(Refused)
04
Nothing
05
Everything

		 List Other:Y
											Q12(2197-2198)
											Q12_T(8003)

QID:68754	DEMOGRAPHICS BEGIN HERE:

D1		
QID:30962	GENDER:
		(Interviewer: Code only; Do NOT ask) 

1
Male
2
Female

											D1(2301)
											D3(2547)

		(Interviewer: VALIDATE PHONE NUMBER AND THANK RESPONDENT BY SAYING:) 

Again, this is _____, with Gallup. I would like to thank you on behalf of EBSA and Gallup for your time. Our mission is to "help people be heard" and your opinions are important to Gallup in accomplishing this.

FINTVID		
QID:98976	INTERVIEWER I.D. #:
											FINTVID(1571-1574)

					Questionnaire Workflow
Date
User
Status
Comments
9/27/2012 9:42:36 AM
MEGHAN ORR
Survey Specialist - Questionnaire Creation
Copied from survey US Department of Labor - EBSA CE11 1109 (QID: 5574) by MEGHAN MCKERNAN.
10/9/2012 8:58:21 PM
MARK PETERSON
Survey Specialist - Questionnaire Creation
Please find exported to Eldorado.
10/10/2012 8:53:01 AM
MEGHAN ORR
Field Final
Field Final
11/19/2012 9:19:44 AM
MEGHAN ORR
Survey Specialist - Edits
Unlocking for edits
11/19/2012 9:50:54 AM
TERI FISHER
Programming
Ready for programming.
1/1/2013 11:15:36 PM
MARK PETERSON
Survey Specialist - Edits
2013 Startup fielded.
1/7/2013 9:08:44 AM
MEGHAN ORR
Field Final
FF
4/8/2013 3:07:34 PM
MARK PETERSON
Programming
Unlocking.
4/8/2013 3:09:17 PM
MARK PETERSON
Field Final
Back to FF.
6/28/2013 12:42:03 PM
JEANNE WEISBROOK
Survey Specialist - Edits
Unlocking to revise wording in Validate and Thank message as per interviewing request to match programming.
6/28/2013 12:43:28 PM
JEANNE WEISBROOK
Field Final
Locking back as FF.