Flexible Video Proof of Concept Survey

Approved, OMB No. 0960-0788; exp. 07/31/17

Social Security Administration Video Conference Survey

1. Which of the following Social Security offices did you travel to for your video hearing?

 Waukegan, Illinois

 Harrisburg, Illinois

 Rockford, Illinois

 Chicago (North), Illinois

 Carbondale, Illinois

 Chicago Disability Hearings Unit

2. How satisfied were you that the video hearing was a convenient way to conduct business with Social Security?

 Very satisfied

 Somewhat satisfied

 Nether satisfied nor dissatisfied

 Somewhat dissatisfied

 Very dissatisfied

3. Please rate your satisfaction with the sound quality of the video hearing:

 Very satisfied

 Somewhat satisfied

 Nether satisfied nor dissatisfied

 Somewhat dissatisfied

 Very dissatisfied

4. Please rate your satisfaction with the video quality of the video hearing:

 Very satisfied

 Somewhat satisfied

 Nether satisfied nor dissatisfied

 Somewhat dissatisfied

 Very dissatisfied

6. In the future, how do you prefer to conduct business with the SSA?

 In person

 Telephone only

 Video conferencing (live audio and video)

7. Please explain any problems you experienced with the conferencing process during the hearing

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Thank you for your feedback!

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