Form 1000 SSA Diagnostic Survey

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Overview

Qualifer Page text
Welcome and Thank You Text
Diagnostic Survey Model Qsts
Proposed CQs

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Sheet 1: Qualifer Page text

	Trigger Request Form	If you see the Security Warning above, Please go to the options and enable content. Please Mouse Over the Red Triangle->
	Client Name	Social Security Administration
	Site URL	www.ssa.gov www.SocialSecurity.gov	Wiki
	Domains/Subdomains	List the domains and sub-domains.
	SRA Name	Cyndi Lyon
	Team Lead / CS Manager	Erica Noble
	Today's Date	Feb-14
	Customer ID (CID)	Please specify if the client is new. TV7AmpuatC8KshccfhpXDQ==
	True Conversion Events	Is the client using true conversion? N/A
	Multi-language	Is this survey a multi-language? N/A
	Language (Locales)	Please list all languages needed. N/A
	Persistent cookie-accept	The number of days the visitor will not receive an invite, after the accept. N/A
	Persistent cookie-decline	The number of days the visitor will not receive an invite, after the decline.
	Logo	Please attach logo to the ticket. The logo should be around 130x60 in size and jpg or gif format. On file other SSA measures
	Pharmaceutical	Is this a pharmaceutical client? n/a
	Current Code	Are there multiple code packages across the same domain? 16.1.3.7
	Session Replay	Is Session Replay currently implemented? N/A
	IE9 Upgrade	Is this a code upgrade? N/A
P
1	Name	SSA Diagnostic Survey
	MID	Model Instance ID TBD
	Loyalty Factor (LF)	Loyalty Factor: Is the number of pages that needs to be met before receiving a invite. Qualifier page only
	Sampling Percentage (SP)	Sampling Percentage: Is the percent of the visitors to sample.
	Invite	Do you want an invite layer to show to the visitor?
	Pop what	What do you want to pop? qualifer page
	Pop when	When do you want to survey to be presented?
	Pin	Is there precedence over which survey is presented?
	Include areas/pages	What urls are we including for this survey definition? ssa.gov| socialsecurity.gov
	Special Instructions
	Notes
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	Exclude from Invitation
	Do not show a survey invitation on pages where URL contains the following strings:
	Details	Explain what the client wants to exclude here. Please carry over from old/existing code if necessary.
	URLs	List the urls/areas you do not want the invite to show.
	Exclude from running code
	Do not run code at all where the following is true. You may use url, variable or cookie.
	Details	Please carry over from old/existing code if necessary
	Customer Passed Parameters (CPPs)	If you are not sure about CPPs on the site. Please set up a meeting with IS and the client to discuss custom passed parameters.
	Do you need Custom Cpps?
	Name in Portal	Type the name of the cpp that will show in portal. Yes as part of qualifer
	Source	What is the source of the cpp? (Is it coming from a variable? A cookie? A URL parameter?) Qualifer notes below on qualifer page details
	Name from Client	Please type the exact name of the variable that was given from the client. Thinking about your experience today, were you looking for information on SSA’s Main pages or Frequently Asked Questions because you had difficulty using or finding one of Social Security’s online services (e.g., online application, Retirement Estimator, creating or accessing you’re my Social Security account, appealing a decision online)? Answer: Yes, I had difficulty finding an application or online service (triggers the new SSA Main Pages/FAQ survey) qtype:yesdif Answer: Yes, I had difficulty using an online service or filing an application (triggers the new Diagnostic Survey) qtype:usingdif Answer: No, I did not have any difficulty using or finding one of Social Security's online applications or services. (triggers the new SSA Main Pages/FAQ survey)qtype:nodif
	Invitation and tracker text
	Invitation (now)	If you press alt + enter, you can put in spaces where needed.
		If you press alt + enter, you can put in spaces where needed.
	Tracker	If you press alt + enter, you can put in spaces where needed.
	Qualifier Text
	OPTION A--> Preferred - clearer filters in portal with custom question	Thinking about your experience today, were you looking for information on SSA’s Main pages or Frequently Asked Questions because you had difficulty using or finding one of Social Security’s online services (e.g., online application, Retirement Estimator, creating or accessing you’re my Social Security account, appealing a decision online)? Answer: Yes, I had difficulty finding an application or online service (triggers the new SSA Main Pages/FAQ survey) Answer: Yes, I had difficulty using an online service or filing an application (triggers the new Diagnostic Survey) Answer: No, I did not have any difficulty using or finding one of Social Security's online applications or services. (triggers the new SSA Main Pages/FAQ survey)
	Present
	Special instructions
		FM-000023; Rev: 4 (1/11/2012) - Trigger Request Form

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Sheet 2: Welcome and Thank You Text

Model Instance Name:
SSA Diagnostic Survey
MID:	Existing Measure - Please fill in; New Measure - DOT will fill in
Date:	2/10/2014
Welcome and Thank You Text
	Directions:
	This welcome text is shown at the top of the questionnaire window and the thank you text at the bottom. This is a good place to mention the site/company/agency name so the visitor knows whom they are taking the survey for. Feel free to modify the standard Welcome and Thank you text shown in the boxes below. Please read comments before using any of the text.
					Examples
					Welcome Text Example
	Welcome Text
	Thank you for visiting the Social Security website. You've been randomly chosen to take part in a brief survey to let us know what we're doing well and where we can improve. Please take a few minutes to share your opinions, which are essential in helping SSA provide the best online experience possible.
					Thank You Text Example
	DEFAULT Thank You Text
	Thank you for taking our survey - and for helping SSA serve you better. We appreciate your input!
	ALTERNATE WEB Thank You Text
	Thank you for taking our survey - and for helping us serve you better. Please note you will not receive a response from us based on your survey comments. If you would like us to contact you about your feedback, please visit the Contact Us section of our website.

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Sheet 3: Diagnostic Survey Model Qsts

Model Instance Name:
SSA Diagnostic Survey
MID:		Existing Measure - Please fill in; New Measure - DOT will fill in
Partitioned (Y/N)?
FPI Included(Y/N)?
NOTE: All non-partitioned surveys will NOT be imputed and the elements will be rotated as a default unless otherwise specified and approved by Research.
Date:		2/10/2014
SSA Diagnostic Survey
Model questions utilize the ForeSee CXA methodology to determine scores and impacts
		ELEMENTS (drivers of satisfaction)			CUSTOMER SATISFACTION			FUTURE BEHAVIORS	FPI
	MQ Label			MQ Label			MQ Label		Y?
		Plain Language (1=Poor, 10=Excellent, Don't Know)			Satisfaction			Return (1=Very Unlikely, 10=Very Likely)
	Plain Language - Clear	Please rate the clarity of the wording on this site.		Satisfaction - Overall	What is your overall satisfaction with this site? (1=Very Dissatisfied, 10=Very Satisfied)		Return	How likely are you to return to this website? in the next 30 days?
	Plain Language - Understandable	Please rate how well you understand the wording on this site.		Satisfaction - Expectations	How well does this site meet your expectations? (1=Falls Short, 10=Exceeds)			Use Web Channel Over Others
	Plain Language - Concise	Please rate this site on its use of short, clear sentences.		Satisfaction - Ideal	How does this site compare to your idea of an ideal website? (1=Not Very Close, 10=Very Close)		Use Web Channel Over Others	How likely are you to use this site rather than seek information from other channels (i.e. local field office, call center)?
		Navigation (1=Poor, 10=Excellent, Don't Know)
	Navigation - Organized	Please rate how well the site is organized.
	Navigation - Options	Please rate the options available for navigating this site.
	Navigation - Layout	Please rate how well the site layout helps you find what you need.
	Navigation - Clicks	Please rate the number of clicks to get where you want on this site.
		SSA Information (1=Poor, 10=Excellent, Don't Know)
	Site Information - Thoroughness	Please rate the thoroughness of information you viewed on this site today.
	Site Information - Understandable	Please rate the quality of information you viewed today.
	Site Information - Answers	Please rate how well the information viewed today provided answers to your questions.
		Site Performance (1=Poor, 10=Excellent, Don't Know)
	Site Performance - Loading	Please rate how quickly pages load on this site.
	Site Performance - Consistency	Please rate the consistency of speed from page to page on this site.
	Site Performance - Completeness	Please rate how completely the page content loads on this site.
		Functionality (1=Poor, 10=Excellent, Don't Know)
	Functionality - Usefulness	Please rate the usefulness of the features provided on this site.
	Functionality - Convenient	Please rate the convenient placement of the features on this site.
	Functionality - Variety	Please rate the variety of features on this site.

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Sheet 4: Proposed CQs

red & strike-through: DELETE

SSA Diagnostic Survey

underlined & italicized: RE-ORDER

MID: Existing Measure - Please fill in; New Measure - DOT will fill in

pink: ADDITION

Date:

2/10/2014

blue + -->: REWORDING

SSA Diagnostic Survey CUSTOM QUESTION LIST

QID

Skip Logic Label

Question Text

Answer Choices (limited to 50 characters)

Skip to

Type (select from list)

Single or Multi

Required Y/N

Special Instructions

CQ Label

Reminder - Bill we need to add a question to the Main survey for difficulties "finding the service or application" I include with my next draft.

You indicated that you had difficulty today using or finding one of Social Security’s online services. Which of the following online services or applications did you have difficulty with? (Select All That Apply)

Creating  a new  My Social Security account

A, A1

Checkbox, one-up vertical

Single

Yes

Skip Logic Group*

Difficulty

Accessing a previously created My Social Security account

B, B1

Using one of the services located within your my Social Security account (e.g., online Statement, Change of Address or Direct Deposit, Check Your Benefits, etc.)

C, C1, C2

Using the Retirement Estimator

D, D1, D2

Applying for Extra Help with Medicare Prescription Drug Plan

D, D1, D2

Applying for Disability benefits

D, D1, D2

Applying for Medicare benefits

D, D1, D2

Applying for retirement benefits

D, D1, D2

Applying for spousal benefits

D, D1, D2

Checking the status of my application

E, E1,

Other Difficulty

ZZ

ZZ

Please describe the specific online service or application you had difficulty with today:

Text area, no char limit

No

Skip Logic Group*

A

How would you best describe the difficulty you had with creating a NEW my Social Security account? (Select all that apply)

I had difficulty finding where to create a new account

Checkbox, one-up vertical

Multi

Y

Skip Logic Group*

New MySSA

I did not understand the instructions for creating a username

I did not understand the instructions for creating a password

The pages did not load

I received an error message

Other (please specify)

AA

AA

Please describe the difficulty you encountered creating a new my Social Security account

Text area, no char limit

N

Skip Logic Group*

OPS_MySSA Difficulty

A1

Thinking about your experience today, please offer one suggestion for improving the my Social Security registration process.

Text area, no char limit

N

Skip Logic Group*

OE_Reg Improvement

B

How would you best describe the difficulty you had accessing a previously created my Social Security account? (Select all that apply)

It was unclear where to go to access my previously created account

Checkbox, one-up vertical

Multi

Y

Skip Logic Group*

Return to MySSA

I had difficulty remembering my username and password

I had difficulty resetting my username and password

Other (please specify)

BB

BB

Please describe the difficulty you had accessing a previously created account:

Text area, no char limit

N

Skip Logic Group*

OPS_Return to MySSA

B1

Thinking about your experience today, please offer one suggestion for improving the my Social Security re-entry process.

Text area, no char limit

N

Skip Logic Group*

OE_Imp Reentry

C

How would you best describe the difficulty you had using one of the services located within your my Social Security account (e.g., online Statement, Change of Address or Direct Deposit, Check Your Benefits, etc.) (Select all that apply)

I had difficulty printing or downloading my online Social Security statement

Checkbox, one-up vertical

Multi

Y

Skip Logic Group*

MySSA Acct

I had difficulty changing my address

I had difficulty adding or changing my banking information

The system was unavailable

I received an error message

Bill pleases review list and add other difficulties-->

I was unable to request a benefit verification letter

Other (please specify)

CC

CC

Please describe the difficulty you had using one of the services within your My Social Security account:

Text area, no char limit

N

Skip Logic Group*

OPS_MySSA Acct

C1

Thinking about your experience today, please offer one suggestion for improving the online services availabe within your my Social Security account.

Text area, no char limit

N

Skip Logic Group*

OE_IMP MySSA Acct

D

How would you best describe the difficulty you had with filing your application today? (Select all that apply)

I had difficulty deciding where to go to start my application

Checkbox, one-up vertical

Multi

Y

Skip Logic Group*

App Difficulty

I had difficulty deciding where to go to restart my previously saved application

Links did not take me where I expected

The system was unavailable

I encountered error messages

The system timed out

I did not have all the information necessary to complete the application

I encountered another difficulty today trying to file my online application

DD

DD

Please describe the difficulty you encountered today filing your online application.

Text area, no char limit

N

OPS_App Difficulty

D1

Thinking about your experience today, please offer one suggestion for improving your ability to file an application online with Social Security.

Text area, no char limit

N

Skip Logic Group*

OE_File App Improve

D2

How many times did you attempt to file your application today before you returned to the main website including FAQs for help?

I only tried once

Radio button, one-up vertical

Single

Y

Skip Logic Group*

App Attempts

2 - 5 times

6-9

10 or more times

E

How would you best describe the difficulty you had checking the status of a previously submitted application? (Select all that apply)

I had difficulty determining where to go to check the status of my application

Checkbox, one-up vertical

Multi

Y

Skip Logic Group*

App Status

Information was not accurate

Information was not current

System was unavailable

There was no information available within my Social Security account

I encountered another difficulty today trying to check the status of my previously submitted application

DD

EE

Please describe the difficulty you encountered today checking the status of a previously submitted application.

Text area, no char limit

N

Skip Logic Group*

OPS_App Status

E1

Thinking about your experience today, please offer one suggestion for improving your ability to check the status of a previously submitted application.

Text area, no char limit

N

Skip Logic Group*

OE_Impr Previously Submit app

Thinking about your difficulty today, do you plan to contact Social Security for further information?

No, I found the information or service I wanted.

Radio button, one-up vertical

Single

Y

Do Next

Yes, I plan to call on the phone.

Yes, I plan to visit an office.

Yes, I plan to send an email or letter.

None of the above

Which of the following best describes you?

I receive Social Security retirement, disability or survivor’s benefits

Radio button, one-up vertical

Single

Y

Skip Logic Group*

Role

I receive Supplemental Security Income (SSI)

I am applying for Social Security or Supplemental Security Income (SSI) benefits or Medicare.

I am an employer looking for Social Security information and services

I do not receive Social Security benefits

Other (please specify)

A

A

Other Role:

Text area, no char limit

N

Skip Logic Group*

OPS_Role

Including today, how often do you the Social Security website?

First time

Drop down, select one

Single

Y

Frequency

More than once a day

Daily

About once a week

About once a month

Every 6 months or less frequently