EBSA Participant Assistance Program Customer Survey

Outbound
US Department of Labor - EBSA CE11 1410		Export Date: 10/15/2014 8:53:08 PM
US Department of Labor
Project #		Translations: yes	Verbatims: YES
Practice: Customer	QBank Id: 9711	Field Date:	Quota:
PA: TODD JENSEN		CS: DAWN ROYAL
DESIGNER: TERI FISHER		PROGRAMMER: MARK PETERSON

QID:120772 Gallup^®, The Gallup Poll^®, and CE^11® are trademarks of Gallup, Inc. All other trademarks are the property of their respective owners. Copyright © 1994-2000, 2010-2014 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:

(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)

SQ

QID:512331 OFFICE:

(Programmer: Code from fone file)

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

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 five minutes.

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 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

health benefit claims.

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)

(If code 1-4 in CE1 ask:)

CE9B

QID:495717 You gave EBSA a (response in CE1) overall satisfaction rating.  What could EBSA have done differently for you to have been extremely satisfied?

(Open ended and code)

01	Other (list)
02	(DK)
03	(Refused)
04	HOLD
05	HOLD

List Other:Y

CE9B(2117-2118)

CE9B_T(8004)

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-J, then K):

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)
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)
Q1I			QID:	EBSA thoroughly answers all of my questions
Q1J			QID:	EBSA is proactive in addressing my question or issue
Q1K			QID:	If you had a need to work with EBSA again in the future you would want to interact with this same benefit advisor

(If code 1-4 in Q1K, continue, otherwise skip to Q14a)

Q13

QID:xxx What could have the benefits advisor (if necessary read: the person you talked with on the phone) have done differently to make you want to interact with them again if you needed help from EBSA?

(Open ended and code)

01	Other (list)
02	(DK)
03	(Refused)
04	HOLD
05	HOLD

List Other:Y

Q13(xxxx-xxxx)

Q13_T(xxxx)

Q14A Were you referred to another person, agency or company for you to follow-up

with to resolve your issue or question?

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

Skip: (If code 02, 07, 08 OR 09 in Q14a, Skip to Q2;
Otherwise, Continue)

Q14B Please tell me whether or not each of the following happened during your referral? READ A-D

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

A.  The referral phone number was a working number

B. The EBSA representative made the call with you on the line

C. The referral was to the right agency, organization or person

D. The referral resulted in an answer to your question or a resolution to your issue?

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)

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)

Q15 Did you access the EBSA website at any point in your inquiry process?

1	Yes
2 8 9	No (DK) (Refused)

Skip: (If code 02, 08 OR 09 in Q15, Skip to Q9;
Otherwise, Continue)

Q15A Did you access the website____?

1	Before you called EBSA or
2 8 9	During the time EBSA was handling your inquiry (DK) (Refused)

Skip: (If code 02, 08 OR 09 in Q15A, Skip to Q15C;
Otherwise, Continue)

Q15B Did you use the website ____?

1	To look for a phone number
2 3 4 8 9	To try to answer your question To submit an inquiry OR For some other reason (DK) (Refused)

Q15C Using a scale from 1 to 5 with 1 being ‘not at all helpful’ and 5 being ‘very helpful’, how helpful was the EBSA website?

1	Strongly disagree
2
3
4
5	Strongly agree
7	(Not applicable)
8	(DK)
9	(Refused)

1	Not at all helpful
2
3
4
5	Very helpful
7	(Not applicable)
8	(DK)
9	(Refused)

Q9

QID:134594 In the future, would you prefer to contact EBSA

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)

QID:495720 (Deleted Q12)

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:)

QID:229796 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)

US Department of Labor - EBSA CE11 1410_Outbound

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