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pdfTablet Survey
1. Why did you come to the office today? (Please check all that apply)
 Obtain a Benefit Verification Letter
 Obtain a Social Security Statement
 Request a Replacement Medicare Card
 To change my address or direct deposit
 Request a Social Security Number Replacement Card
 To file a claim for benefits
 Other (please specify)
________________________________________________________________
____________________
2. What transactions did you complete using the tablet? (Please check all
that apply)
 Created a mySocialSecurity account (No Account Activation Code Used)
 Completed a mySocialSecurity account registration using an Account
Activation Code
 Printed a Benefit Verification Letter
 Printed an Online Social Security Statement
 Requested a Replacement Medicare Card
 Change of address or direct deposit
 Requested a Social Security Number Replacement Card
 Other (please specify)
________________________________________________________________
_____________________
3. Please rate your satisfaction level with the following aspects, features,
and processes during your Social Security Express Tablet experience:
Low
Overall
satisfaction
Appearance of
the
screens/pages
Ease of using
the tablet
Time to complete
your
transaction(s)
Availability of
assistance
Wait time to use
the tablet
mySocialSecurity
registration
Other online
services
Printed
Documentation
Average
Below
Average
High
N/A
Above
Average
4. What did you like best about using the tablet?
________________________________________________________________
___________________________________
5. Please tell us about any problems you had using the tablet. (Please
check all that apply)
 I did not encounter any problems
 It took too long to complete my business
 The language was difficult to understand
 The screen was difficult to read
 The check boxes or text boxes were difficult to use
 Other (please specify)
________________________________________________________________
_____________________
(End of Page 1)
6. Were you able to take care of your business using the tablet?
 Yes
 No
7. Would you recommend the Social Security Express Tablet to others?
 Yes
 No
 Not sure
8. Do you have easy access to the Internet?
 Yes
 No
9. Do you have any other comments related to your experience with
the Social Security Express Tablet?
________________________________________________________________
____________________________________
(End of Page 2)
9. What is your age?
 18 to 24
 25 to 34
 35 to 44
 45 to 54
 55 to 64
 65 to 74
 75 or older
10. Which of the following benefits do you currently receive?
 I do not receive any benefits currently
 I am applying for benefits
 Retirement
 Disability
 Supplemental Security Income (SSI)
 Other (please specify)
________________________________________________________________
________________________________________________________
(End of Page 3)
Paperwork Reduction Act: This information collection meets the requirements
of 44 U.S.C. §3507, as amended by section 2 of the Paperwork Reduction Act of
1995. The OMB approval number is 0960-0788. You may send comments on
this 5-minute time estimate to: Social Security Administration, 6401 Security
Blvd., Baltimore, MD 21235-6401.
| File Type | application/pdf | 
| Author | IWS/LAN | 
| File Modified | 2015-12-02 | 
| File Created | 2015-12-02 |