Form 1053 2014 808 VA eBenefits 5-13-14

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Overview

Model Qsts
Current CQs
Custom Qsts (3-07-2014)
Custom Qsts (3-7-14)
Answer Choice Bulk Load
Custom Qsts (3-03-2014)
Custom Qsts (2-14-2014)
Current Custom Qsts
Custom Qsts (11-1-13)
Custom Qsts (8-29-12)
Custom Qsts (3-20-12)

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Sheet 1: Model Qsts

Model Instance Name:
VA eBenefits
MID:	YdlIhdA4VstB05QNd8wgAA==
Date:
eBenefits
Model questions utilize the ACSI methodology to determine scores and impacts
	ELEMENTS (drivers of satisfaction)		CUSTOMER SATISFACTION		FUTURE BEHAVIORS
	Content (1=Poor, 10=Excellent, Don't Know)		Satisfaction (1=Poor, 10=Excellent)		Likelihood to Return (1=Not Very Likely, 10=Very Likely)
1	Please rate the <b>accuracy of information</b> on this site.	17	What is your <b>overall satisfaction</b> with this site?	20	How likely are you to <b>return to this site</b>?
2	Please rate the <b>quality of information</b> on this site.	18	How well does this site <b>meet your expectations</b>?		Recommend (1=Not Very Likely, 10=Very Likely)
3	Please rate the <b>freshness of content</b> on this site.	19	How does this site <b>compare to your idea of an ideal website</b>?	21	How likely are you to <b>recommend this site to someone else</b>?
	Functionality (1=Poor, 10=Excellent, Don't Know)				Primary Resource (1=Not Very Likely, 10=Very Likely)
4	Please rate the <b>usefulness of the features provided</b> on this site.			22	How likely are you to use this site as your <b>primary resource for obtaining benefit information</b>?
5	Please rate the <b>convenience of the features</b> on this site.
6	Please rate the <b>variety of features</b> on this site.
	Look and Feel (1=Poor, 10=Excellent, Don't Know)
7	Please rate the <b>visual appeal</b> of this site.
8	Please rate the <b>balance of graphics and text</b> on this site.
9	Please rate the <b>readability of the pages</b> on this site.
	Navigation (1=Poor, 10=Excellent, Don't Know)
10	Please rate <b>how well the site is organized</b>.
11	Please rate the <b>options available for navigating</b> this site.
12	Please rate <b>how well the site layout helps you find what you are looking for</b>.
13	Please rate the <b>number of clicks to get where you want</b> on this site.
	Site Performance (1=Poor, 10=Excellent, Don't Know)
14	Please rate how <b>quickly pages load</b> on this site.
15	Please rate the <b>consistency of speed from page to page</b> on this site.
16	Please rate the <b>ability to load pages without getting error messages</b> on this site.

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Sheet 2: Current CQs

Model Instance Name:			red & strike-through: DELETE
VA eBenefits			underlined & italicized: RE-ORDER
MID: YdlIhdA4VstB05QNd8wgAA==			pink: ADDITION
Date:			blue + -->: REWORDING
VA eBenefits CUSTOM QUESTION LIST
QID (Group ID)	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
AKR4145		Which of the following best describes your role in visiting this site today? (Check all that apply)	Veteran	B	Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Role
(AKR4145G5)			Active duty	B
			Wounded, injured, or ill service member	B
			Family of a service member or veteran
			Caregiver or delegate of a service member or veteran
			Health care team member for a service member or veteran
			Other (please specify)	A
AKR4146	A	Please tell us what your role is.			Text area, no char limit	Single	N	Skip Logic Group	OE_Role
AKR4147	B	Please check the conflict(s) in which you served. (Check all that apply)	World War II		Checkbox, one-up vertical	Multi	N	Skip Logic Group	Conflicts Served
			Korean Conflict
			Vietnam Era
			Persian Gulf War
			Operation Enduring Freedom
			Operation Iraqi Freedom
			Cold War Era or Other Period of Service
AKR4150		How frequently do you visit this site?	First time		Radio button, one-up vertical	Single	Y		Frequency of Visit
			Daily
			About once a week
			About once a month
			About once or twice a year
			Less frequently than once a year
ACQOsl0002983		Did you register for this site today?	Yes		Radio button, one-up vertical	Single	Y		Register
			No, I have already registered
			No, I tried to but was not successful
			No, I am not registered for this site.
CAS0042289		For what reason(s) did you visit the eBenefits site today? (Check all that apply)	Register for eBenefits		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Primary reason
			Apply for benefits	A
			To check the status of a claim for benefits	A
			To check the status of an appeal for a claim for benefits	A
			To check the status of a benefit payment
			To view my benefit payment history
			Obtain a benefit verification letter
			Change my direct deposit information
			Change my profile (i.e. change contact or dependent information)
			Looking for available benefits and resources (including employment and/or employment support)	A
			Just browsing/Curious what site offered
			Other (please specify)	B
CAS0042290	B	Why else were you visiting the eBenefits site today?			Text area, no char limit		N	Skip Logic Group	OE_Primary reason
CAS0042291	A	What type(s) of benefit or resource were you looking for, applying for, or checking on today? (Check all that apply)	Disability benefits and compensation		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Benefit type
			Pension
			Education and training
			Employment	D
			Family and caregiver support
			Health
			Homeless assistance
			Housing
			Transportation and travel
			Volunteer opportunities
			Other (please specify)	C
MAD0049988	C	What other type of benefit or resource?			Text area, no char limit		N	Skip Logic Group	OE_Benefit type
MAD0049959	D	What type(s) of employment support were you looking for today?	Job training		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Mark Madonna: This Question did not have a Label, so I added this one Employment Support
			Look for job openings	G
			Apply for job(s)	G
			Tips for interviewing
			Create or improve resume
			Other (please specify)	F
MAD0049961	F	What other type of employment support?			Text area, no char limit		N	Skip Logic Group	Mark Madonna: This Question did not have a Label, so I added this one OE_Employment Support
MAD0049960	G	What type of jobs were you looking for?	Federal or government jobs only		Radio button, one-up vertical	Single	Y	Skip Logic Group	Mark Madonna: This Question did not have a Label, so I added this one Other Jobs
			Private sector jobs only
			Both government and private sector jobs
CWS01722		Did you accomplish what you wanted to on the site today?	Yes	A, C	Radio button, one-up vertical	Single	Y	Skip Logic Group	Task Accomplishment
			Partially	A, B, C
			I wasn’t planning to accomplish anything in particular
			No	B, C
ACQinh0011648	A	What task(s) did you accomplish today? (Check all that apply)	Register		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Acc-Task
			Log in
			I checked my claim status for compensation or pension
			I checked my education claim status
			I registered for eBenefits
			I applied for a benefit	B-4
			I changed my profile or direct deposit information
			I looked for employment support or jobs
			Other (please specify)	A-1
ACQinh0011649	A-1	What other task(s) did you accomplish?			Text area, no char limit		N	Skip Logic Group	OE_Acc-Task
CAS0042328	B-4	Which type(s) of benefit were you applying for today? (Check all that apply)	Life insurance		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Type Benefit
			Compensation
			Pension
			Education, employment or training
			Other
ACQinh0011650	B	What task(s) were you unable to accomplish today? (Check all that apply)	Register	B-1, B1-B	Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Not Acc-Task
			Log in	B-1, B1-C
			Check claim status for compensation or pension	B-2
			Check education claim status	B-3
			Apply for a benefit	B-7, BB
			Manage my profile or direct deposit
			Find employment support or jobs	B-6
			Other (please specify)	B-5
ACQinh0011651	B-5	What other task(s) were you trying to accomplish?			Text area, no char limit		N	Skip Logic Group	OE_Not Acc-Other Task
ACQinh0011652	B-1	What difficulty did you have registering or logging into your account? (Check all that apply)	The site was down		Checkbox, one-up vertical	Multi	Y		Not Acc-Reg/Login
			My password expired
			I could not register for a Premium (Level 2) Account because I need to get approved in-person
			The information to register that I received in the mail did not work
			Other (please specify)	B-1A
ACQinh0011671	B-1A	What is the other issue you had registering or logging into your account?			Text area, no char limit			Skip Logic Group	OE_Not Acc-Reg/Login
ACQOsl0002984	B-1B	Is there any additional information that would be helpful in the registration process?			Text area, no char limit		N	Skip Logic Group	OE_Reg Info
ACQOsl0002988	B1-C	What, if anything, would you like improved about the log in process?			Text area, no char limit		N	Skip Logic Group
ACQinh0011672	B-2	What difficulty did you have checking your compensation or pension claim status? (Check all that apply)	I found my status, but I don't think the data is correct		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Not Acc-C/P Claim
			I could not get status because I do not have a Premium (Level 2) account
			I could login, but my page did not display	B-2B
			Other (please specify)	B-2A
ACQinh0011675	B-2A	What is the other reason that you could not check your claim status?			Text area, no char limit			Skip Logic Group	OE_Not Acc-C/P Claim
ACQhar0015092	B-2B	Have you been able to see a status view in previous visits?	No, I've never been able to get a status view.		Radio button, one-up vertical	Single	Y	Skip Logic Group	Status View
			Sometimes I get a status view, sometimes I don't.
			This is the first time I've had this problem.
ACQinh0011673	B-3	What difficulty did you have checking your education claim status? (Check all that apply)	I wanted payment status		Checkbox, one-up vertical	Multi		Skip Logic Group	Not Acc-Edu. Claim
			I needed certificate of eligibility
			Other (please specify)	B-3A
ACQinh0011676	B-3A	What is the other reason you could not check your education claim status?			Text area, no char limit			Skip Logic Group	OE_Not Acc-Edu. Claim
MAD0049973	B-7	Which type of benefit were you unable to apply for today? (Check all that apply)	Life insurance		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Type Benefit Unsuccessful
			Compensation
			Pension
			Education, employment or training
			Other
CAS0042254	BB	Why were you unable to complete your online application today?	I did not have enough time to complete it today		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Why Not Complete
			I did not have enough information or evidence to complete the application
			System failure
			Other (please specify)	BB1
CAS0042255	BB1	Please explain why you were unable to complete your online application today.			Text area, no char limit		N	Skip Logic Group	OE_unable to complete
MAD0050002	B-6	Why were you unable to find the employment support you were looking for? (Check all that apply)	There were no job openings that I wanted to apply for		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Not Acc_Empl Support
			There was too much information on the site
			I didn't understand the information I was given
			The information wasn't specific to my needs
			Technical or website error
			Trouble navigating through the site
			Other (please specify)	B-6A
MAD0050003	B-6A	What other reason were you unable to find the employment support you were looking for?			Text area, no char limit		N	Skip Logic Group	OE_Not Acc-Empl Support
CAS0042256	C	Do you have any suggestions for improving your online application experience?			Text area, no char limit		N	Skip Logic Group	OE_App Improvement
ACQOsl0002979	C	What will you do next? (Check all that apply)	Nothing, although I did not find/complete what I wanted		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Mark Madonna: This Question did not have a Label, so I added this one Do Next
			Call the eBenefits call center
			Return to the eBenefits site later and try again
			Send an email
			Other (please specify)	C-1
ACQOsl0002980	C-1	What else will you do next?			Text area, no char limit		Y	Skip Logic Group	Mark Madonna: This Question did not have a Label, so I added this one OE_Do Next
CAS0042292		Thinking about the eBenefits homepage, was it clear where you needed to go to find what you were looking for today?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group	Homepage clarity
			No	A
CAS0042293	A	What could have improved your ability to find what you were looking for on the eBenefits homepage?			Text area, no char limit		N	Skip Logic Group	Homepage Improvement
CWS01724		If you could identify one improvement to this site, what improvement would you suggest?			Text area, no char limit	Single	N
AKR4148		Please select your age range.	17 or under		Radio button, one-up vertical	Single	N		Age
			18-24
			25-34
			35-44
			45-54
			55-64
			65+
AKR4149		Please select your gender:	Male		Radio button, one-up vertical	Single	N		Gender
			Female

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Sheet 3: Custom Qsts (3-07-2014)

Model Instance Name:			red & strike-through: DELETE
VA eBenefits			underlined & italicized: RE-ORDER
MID: YdlIhdA4VstB05QNd8wgAA==			pink: ADDITION
Date:			blue + -->: REWORDING
VA eBenefits CUSTOM QUESTION LIST
QID (Group ID)	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
AKR4145		Which of the following best describes your role in visiting this site today? (Check all that apply)	Veteran	B	Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Role
(AKR4145G5)			Active duty	B
			Wounded, injured, or ill service member	B
			Family of a service member or veteran
			Caregiver or delegate of a service member or veteran
			VA eBenefits
			Other (please specify)	A
AKR4146	A	Other Please Specify: Please tell us who you are. what your role is.			Text area, no char limit	Single	N	Skip Logic Group	OE_Role
AKR4147	B	Please check the conflict(s) in which you served. (Check all that apply)	World War II		Checkbox, one-up vertical	Multi	N	Skip Logic Group	Conflicts Served
			Korean Conflict
			Vietnam Era
			Persian Gulf War
			Operation Enduring Freedom
			Operation Iraqi Freedom
			Cold War Era or Other Period of Service
AKR4150		How frequently do you visit this site?	First time		Radio button, one-up vertical	Single	Y		Frequency of Visit
			Daily
			About once a week
			About once a month
			About once or twice a year
			Less frequently than once a year
ACQOsl0002983		Did you register for this site today?	Yes		Radio button, one-up vertical	Single	Y		Register
			No, I have already registered
			No, I tried to but was not successful
			No, I am not registered for this site.
CAS0042289		For what reason(s) did you visit the eBenefits site today? (Check all that apply)	Register for eBenefits		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Primary reason
			Apply for benefits	A
			To check the status of a claim for benefits	A
			To check the status of an appeal for a claim for benefits	A
			To check the status of a benefit payment
			To view my benefit payment history
			Obtain a benefit verification letter
			Change my direct deposit information
			Change my profile (i.e. change contact or dependent information)
			Looking for available benefits and resources (including employment and/or employment support)	A
			Just browsing/Curious what site offered
			Other (please specify)	B
CAS0042290	B	Why else were you visiting the eBenefits site today?			Text area, no char limit		N	Skip Logic Group	OE_Primary reason
CAS0042291	A	What type(s) of benefit or resource were you looking for, applying for, or checking on today? (Check all that apply)	Disability benefits and compensation		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Benefit type
			Pension
			Education and training
			Employment	D
			Family and caregiver support
			Health
			Homeless assistance
			Housing
			Transportation and travel
			Volunteer opportunities
			Other (please specify)	C
MAD0049988	C	What other type of benefit or resource?			Text area, no char limit		N	Skip Logic Group	OE_Benefit type
MAD0049959	D	What type(s) of employment support were you primarily looking for today?	Job training		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Mark Madonna: This Question did not have a Label, so I added this one Employment Support
			Look for job openings	G
			Apply for job(s)	G
			Tips for interviewing
			Create or improve resume
			Other (please specify)	F
MAD0049961	F	What other type of employment support?			Text area, no char limit		N	Skip Logic Group	Mark Madonna: This Question did not have a Label, so I added this one OE_Employment Support
MAD0049960	G	What type of jobs were you looking for?	Federal or government jobs only		Radio button, one-up vertical	Single	Y	Skip Logic Group	Mark Madonna: This Question did not have a Label, so I added this one Other Jobs
			Private sector jobs only
			Both government and private sector jobs
CWS01722		Did you accomplish what you wanted to on the site today?	Yes	A, C	Radio button, one-up vertical	Single	Y	Skip Logic Group	Task Accomplishment
			Partially	A, B, C
			I wasn’t planning to accomplish anything in particular
			No	B, C
ACQinh0011648	A	What task(s) did you accomplish today? (Check all that apply)	Register		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Acc-Task
			Log in
			I checked my claim status for compensation or pension
			I checked my education claim status
			I registered for eBenefits
			I applied for a benefit	B-4
			I changed my profile or direct deposit information
			I looked for employment support or jobs
			Other (please specify)	A-1
ACQinh0011649	A-1	What other task(s) did you accomplish?			Text area, no char limit		N	Skip Logic Group	OE_Acc-Task
CAS0042328	B-4	Which type(s) of benefit(s) were you applying for today? (Check all that apply)	Life insurance		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Type Benefit
			Compensation
			Pension
			Education, employment or training
			Other
ACQinh0011650	B	What task(s) were you unable to accomplish today? (Check all that apply)	Register	B-1, B1-B	Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Not Acc-Task
			Log in	B-1, B1-C
			Check claim status for compensation or pension	B-2
			Check education claim status	B-3
			Apply for a benefit	B-7, BB
			Manage my profile or direct deposit
			Find employment support or jobs	B-6
			Other (please specify)	B-5
ACQinh0011651	B-5	What other task(s) were you trying to accomplish?			Text area, no char limit		N	Skip Logic Group	OE_Not Acc-Other Task
ACQinh0011652	B-1	What difficulty did you have registering or logging into your account? (Check all that apply)	The site was down		Checkbox, one-up vertical	Multi	Y		Not Acc-Reg/Login
			My password expired
			I could not register for a Premium (Level 2) Account because I need to get approved in-person
			The information to register that I received in the mail did not work
			Other (please specify)	B-1A
ACQinh0011671	B-1A	What is the other issue you had registering or logging into your account?			Text area, no char limit			Skip Logic Group	OE_Not Acc-Reg/Login
ACQOsl0002984	B-1B	Is there any additional information that would be helpful in the registration process?			Text area, no char limit		N	Skip Logic Group	OE_Reg Info
ACQOsl0002988	B1-C	What, if anything, would you like improved about the log in process?			Text area, no char limit		N	Skip Logic Group
ACQinh0011672	B-2	What difficulty did you have checking your compensation or pension claim status? (Check all that apply)	I found my status, but I don't think the data is correct		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Not Acc-C/P Claim
			I could not get status because I do not have a Premium (Level 2) account
			I could login, but my page did not display	B-2B
			Other (please specify)	B-2A
ACQinh0011675	B-2A	What is the other reason that you could not check your claim status?			Text area, no char limit			Skip Logic Group	OE_Not Acc-C/P Claim
ACQhar0015092	B-2B	Have you been able to see a status view in previous visits?	No, I've never been able to get a status view.		Radio button, one-up vertical	Single	Y	Skip Logic Group	Status View
			Sometimes I get a status view, sometimes I don't.
			This is the first time I've had this problem.
ACQinh0011673	B-3	What difficulty did you have checking your education claim status? (Check all that apply)	I wanted payment status		Checkbox, one-up vertical	Multi		Skip Logic Group	Not Acc-Edu. Claim
			I needed certificate of eligibility
			Other (please specify)	B-3A
ACQinh0011676	B-3A	What is the other reason you could not check your education claim status?			Text area, no char limit			Skip Logic Group	OE_Not Acc-Edu. Claim
MAD0049973	B-7	Which type of benefit were you unable to apply for today? (Check all that apply)	Life insurance		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Type Benefit Unsuccessful
			Compensation
			Pension
			Education, employment or training
			Other
CAS0042254	BB	Why were you unable to complete your online application today?	I did not have enough time to complete it today		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Why Not Complete
			I did not have enough information or evidence to complete the application
			System failure
			Other (please specify)	BB1
CAS0042255	BB1	Please explain why you were unable to complete your online application today.			Text area, no char limit		N	Skip Logic Group	OE_unable to complete
MAD0050002	B-6	Why were you unable to find the employment support you were looking for? (Check all that apply)	There were no job openings that I wanted to apply for		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Not Acc_Empl Support
			There was too much information on the site
			I didn't understand the information I was given
			The information wasn't specific to my needs
			Technical or website error
			Trouble navigating through the site
			Other (please specify)	B-6A
MAD0050003	B-6A	What other reason were you unable to find the employment support you were looking for?			Text area, no char limit		N	Skip Logic Group	OE_Not Acc-Empl Support
CAS0042256	C	Do you have any suggestions for improving your online application experience?			Text area, no char limit		N	Skip Logic Group	OE_App Improvement
ACQOsl0002979	C	What will you do next? (Check all that apply)	Nothing, although I did not find/complete what I wanted		Checkbox, one-up vertical	Multi	Y	Skip Logic Group
			Call the eBenefits call center
			Return to the eBenefits site later and try again
			Send an email
			Other (please specify)	C-1
ACQOsl0002980	C-1	What else would will you do next?			Text area, no char limit		Y	Skip Logic Group
CAS0042292		Thinking about the eBenefits homepage, was it clear where you needed to go to find what you were looking for today?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group	Homepage clarity
			No	A
CAS0042293	A	What could have improved your ability to find what you were looking for from on the eBenefits homepage?			Text area, no char limit		N	Skip Logic Group	Homepage Improvement
CWS01724		If you could identify one improvement to this site, what improvement would you suggest?			Text area, no char limit	Single	N
AKR4148		Please select your age range.	17 or under		Radio button, one-up vertical	Single	N		Age
			18-24
			25-34
			35-44
			45-54
			55-64
			65+
AKR4149		Please select your gender:	Male		Radio button, one-up vertical	Single	N		Gender
			Female

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Sheet 4: Custom Qsts (3-7-14)

Model Instance Name:			red & strike-through: DELETE
VA eBenefits			underlined & italicized: RE-ORDER
MID: YdlIhdA4VstB05QNd8wgAA==			pink: ADDITION
Date:			blue + -->: REWORDING
VA eBenefits CUSTOM QUESTION LIST
QID (Group ID)	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
AKR4145		Which of the following best describes your role in visiting this site today? (Check all that apply)	Veteran	B	Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Role
(AKR4145G5)			Active duty	B
			Wounded, injured, or ill service member	B
			Family of a service member or veteran
			Caregiver or delegate of a service member or veteran
			Health Care team member for a service member or veteran
			Other (please specify)	A
AKR4146	A	Other Please Specify: Please tell us who you are.			Text area, no char limit	Single	N	Skip Logic Group	OE_Role
AKR4147	B	Please check the conflict(s) in which you served. (Check all that apply)	World War II		Checkbox, one-up vertical	Multi	N	Skip Logic Group	Conflicts Served
			Korean Conflict
			Vietnam Era
			Persian Gulf War
			Operation Enduring Freedom
			Operation Iraqi Freedom
			Cold War Era or Other Period of Service
AKR4150		How frequently do you visit this site?	First time		Radio button, one-up vertical	Single	Y		Frequency of Visit
			Daily
			About once a week
			About once a month
			About once or twice a year
			Less frequently than once a year
ACQOsl0002983		Did you register for this site today?	Yes		Radio button, one-up vertical	Single	Y		Register
			No, I have already registered
			No, I tried to but was not successful
			No, I am not registered for this site.
CAS0042289		For what reason(s) did you visit the eBenefits site today? (Check all that apply)	Register for eBenefits		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Primary reason
			Apply for benefits	A
			To check the status of a claim for benefits	A
			To check the status of an appeal for a claim for benefits	A
			To check the status of a benefit payment
			To view my benefit payment history
			Obtain a benefit verification letter
			Change my direct deposit information
			Change my profile (i.e. change contact or dependent information)
			Looking for available benefits and resources (including employment and/or employment support)	A
			Just browsing/Curious what site offered
			Other (please specify)	B
CAS0042290	B	Why else were you visiting the eBenefits site today?			Text area, no char limit		N	Skip Logic Group	OE_Primary reason
CAS0042291	A	What type of benefit or resource were you looking for, applying for, or checking on today? (Check all that apply)	Disability benefits and compensation		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Benefit type
			Pension
			Education and training
			Employment	D
			Family and caregiver support
			Health
			Homeless assistance
			Housing
			Transportation and travel
			Volunteer opportunities
			Other (please specify)	C
MAD0049988	C	What other type of benefit or resource?			Text area, no char limit		N	Skip Logic Group	OE_Benefit type
MAD0049959	D	What type of employment support were you primarily looking for today?	Job training		Checkbox, one-up vertical	Single	Y	Skip Logic Group	Mark Madonna: This Question did not have a Label, so I added this one Employment Support
			Look for job openings	G
			Apply for job(s)	G
			Tips for interviewing
			Create or improve resume
			Other (please specify)	F
MAD0049961	F	What other type of employment support?			Text area, no char limit		N	Skip Logic Group	Mark Madonna: This Question did not have a Label, so I added this one OE_Employment Support
MAD0049960	G	What type of jobs were you looking for?	Federal or government jobs only		Radio button, one-up vertical	Single	Y	Skip Logic Group	Mark Madonna: This Question did not have a Label, so I added this one Other Jobs
			Private sector jobs only
			Both government and private sector jobs
CWS01722		Did you accomplish what you wanted to on the site today?	Yes	A	Radio button, one-up vertical	Single	Y	Skip Logic Group	Task Accomplishment
			Partially	A, B
			I wasn’t planning to accomplish anything in particular
			No	B, C
ACQinh0011648	A	What task(s) did you accomplish today? (Check all that apply)	Register		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Acc-Task
			Log in
			I checked my claim status for compensation or pension
			I checked my education claim status
			I registered for eBenefits
			I applied for a benefit	B-4
			I changed my profile or direct deposit information
			I looked for employment support or jobs
			Other (please specify)	A-1
ACQinh0011649	A-1	What other task(s) did you accomplish?			Text area, no char limit		N	Skip Logic Group	OE_Acc-Task
CAS0042328	B-4	Which type of benefit(s) were you applying for today? (Check all that apply)	Life insurance		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Type Benefit
			Compensation
			Pension
			Education, employment or training
			Other
ACQinh0011650	B	What task(s) were you unable to accomplish today? (Check all that apply)	Register	B-1, B1-B	Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Not Acc-Task
			Log in	B-1, B1-C
			Check claim status for compensation or pension	B-2
			Check education claim status	B-3
			Apply for a benefit	B-7, BB
			Manage my profile or direct deposit
			Find employment support or jobs	B-6
			Other (please specify)	B-5
ACQinh0011651	B-5	What other task(s) were you trying to accomplish?			Text area, no char limit		N	Skip Logic Group	OE_Not Acc-Other Task
ACQinh0011652	B-1	What difficulty did you have registering or logging into your account? (Check all that apply)	The site was down		Checkbox, one-up vertical	Multi	Y		Not Acc-Reg/Login
			My password expired
			I could not register for a Premium (Level 2) Account because I need to get approved in-person
			The information to register that I received in the mail did not work
			Other (please specify)	B-1A
ACQinh0011671	B-1A	What is the other issue you had registering or logging into your account?			Text area, no char limit			Skip Logic Group	OE_Not Acc-Reg/Login
ACQOsl0002984	B-1B	Is there any additional information that would be helpful in the registration process?			Text area, no char limit		N	Skip Logic Group	OE_Reg Info
ACQOsl0002988	B1-C	What, if anything, would you like improved about the log in process?			Text area, no char limit		N	Skip Logic Group
ACQinh0011672	B-2	What difficulty did you have checking your compensation or pension claim status? (Check all that apply)	I found my status, but I don't think the data is correct		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Not Acc-C/P Claim
			I could not get status because I do not have a Premium (Level 2) account
			I could login, but my page did not display	B-2B
			Other (please specify)	B-2A
ACQinh0011675	B-2A	What is the other reason that you could not check your claim status?			Text area, no char limit			Skip Logic Group	OE_Not Acc-C/P Claim
ACQhar0015092	B-2B	Have you been able to see a status view in previous visits?	No, I've never been able to get a status view.		Radio button, one-up vertical	Single	Y	Skip Logic Group	Status View
			Sometimes I get a status view, sometimes I don't.
			This is the first time I've had this problem.
ACQinh0011673	B-3	What difficulty did you have checking your education claim status? (Check all that apply)	I wanted payment status		Checkbox, one-up vertical	Multi		Skip Logic Group	Not Acc-Edu. Claim
			I needed certificate of eligibility
			Other (please specify)	B-3A
ACQinh0011676	B-3A	What is the other reason you could not check your education claim status?			Text area, no char limit			Skip Logic Group	OE_Not Acc-Edu. Claim
MAD0049973	B-7	Which type of benefit were you unable to apply for today? (Check all that apply)	Life insurance		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Type Benefit Unsuccessful
			Compensation
			Pension
			Education, employment or training
			Other
CAS0042254	BB	Why were you unable to complete your online application today?	I did not have enough time to complete it today		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Why Not Complete
			I did not have enough information or evidence to complete the application
			System failure
			Other (please specify)	BB1
CAS0042255	BB1	Please explain why you were unable to complete your online application today.			Text area, no char limit		N	Skip Logic Group	OE_unable to complete
MAD0050002	B-6	Why were you unable to find the employment support you were looking for? (Check all that apply)	There were no job openings that I wanted to apply for		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Not Acc_Empl Support
			There was too much information on the site
			I didn't understand the information I was given
			The information wasn't specific to my needs
			Technical or website error
			Trouble navigating through the site
			Other (please specify)	B-6A
MAD0050003	B-6A	What other reason were you unable to find the employment support you were looking for?			Text area, no char limit		N	Skip Logic Group	OE_Not Acc-Empl Support
CAS0042256	C	Do you have any suggestions for improving your online application experience?			Text area, no char limit		N	Skip Logic Group	OE_App Improvement
ACQOsl0002979	C	What will you do next? (Check all that apply)	Nothing, although I did not find/complete what I wanted		Checkbox, one-up vertical	Multi	Y	Skip Logic Group
			Call the eBenefits call center
			Return to the eBenefits site later and try again
			Send an email
			Other (please specify)	C-1
ACQOsl0002980	C-1	What else would you do next?			Text area, no char limit		Y	Skip Logic Group
CAS0042292		Thinking about the eBenefits homepage, was it clear where you needed to go to find what you were looking for today?	Yes		Drop down, select one	Single	Y	Skip Logic Group	Homepage clarity
			No	A
CAS0042293	A	What could have improved your ability to find what you were looking for from the eBenefits homepage?			Text area, no char limit		N	Skip Logic Group	Homepage Improvement
CWS01724		If you could identify one improvement to this site, what improvement would you suggest?			Text area, no char limit	Single	N
AKR4148		Please select your age range.	17 or under		Radio button, one-up vertical	Single	N		Age
			18-24
			25-34
			35-44
			45-54
			55-64
			65+
AKR4149		Please select your gender:	Male		Radio button, one-up vertical	Single	N		Gender
			Female

---

Sheet 5: Answer Choice Bulk Load

Answer Text	Answer value	Statement
Life insurance	1	Life insurance|1|true|false
Compensation	2	Compensation|2|true|false
Pension	3	Pension|3|true|false
Education, employment or training	4	Education, employment or training|4|true|false
Other	5	Other|5|true|false
	6	|6|true|false
	7	|7|true|false
	8	|8|true|false
	9	|9|true|false
	10	|10|true|false
	11	|11|true|false
	12	|12|true|false

---

Sheet 6: Custom Qsts (3-03-2014)

Model Instance Name:			red & strike-through: DELETE
VA eBenefits			underlined & italicized: RE-ORDER
MID: YdlIhdA4VstB05QNd8wgAA==			pink: ADDITION
Date:			blue + -->: REWORDING
VA eBenefits CUSTOM QUESTION LIST
QID (Group ID)	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
AKR4145		Which of the following best describes your role in visiting this site today? (Check all that apply)	Veteran	B	Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Role
(AKR4145G5)			Active duty	B
			Wounded, injured, or ill service member	B
			Family of a service member or veteran
			Caregiver or delegate of a service member or veteran
			Health Care team member for a service member or veteran
			Other (please specify)	A
AKR4146	A	Other Please Specify: Please tell us who you are.			Text area, no char limit	Single	N	Skip Logic Group	OE_Role
AKR4147	B	Please check the conflict(s) in which you served. (Check all that apply)	World War II		Checkbox, one-up vertical	Multi	N	Skip Logic Group	Conflicts Served
			Korean Conflict
			Vietnam Era
			Persian Gulf War
			Operation Enduring Freedom
			Operation Iraqi Freedom
			Cold War Era or Other Period of Service
AKR4150		How frequently do you visit this site?	First time		Radio button, one-up vertical	Single	Y		Frequency of Visit
			Daily
			About once a week
			About once a month
			About once or twice a year
			Less frequently than once a year
ACQOsl0002983		Did you register for this site today?	Yes	A, B	Radio button, one-up vertical	Single	Y	Skip Logic Group	Register
			No, I have already registered	B
			No, I tried to but was not successful
			No, I am not registered for this site.
CAS0042289		What was your primary For what reason(s) did you for visiting the eBenefits site today? (Check all that apply)	Register for eBenefits		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Primary reason
			Apply for benefits	A
			To check the status of a claim for benefits	A
			To check the status of an appeal for a claim for benefits	A
			To check the status of a benefit payment
			To view my benefit payment history
			Obtain a benefit verification letter
			Change my direct deposit information
			Change my profile (i.e. change contact or dependent information)
			Looking for available benefits and resources	A
			Looking for employment and/or employment support	D
			Just browsing/Curious what site offered
			Other, (please specify)	B
CAS0042290	B	Why else were you visiting the eBenefits site today?			Text area, no char limit		N	Skip Logic Group	OE_Primary reason
CAS0042291	A	What type of benefit status or resource were you looking for, applying for, or checking on today? (Check all that apply)	Disability benefits and Ccompensation	H	Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Benefit type
			Pension	H
			Education and training	H
			Employment	D
			Family and caregiver support	H
			Health	H
			Homeless assistance	H
			Housing	H
			Transportation and travel	H
			Volunteer opportunities	H
			Other (please specify)	C
	C	What other type of benefit or resource?			Text area, no char limit		N	Skip Logic Group	OE_Benefit type
	D	What type of employment support were you primarily looking for today?	Job training	H	Checkbox, one-up vertical	Single	Y	Skip Logic Group
			Look for job openings	G, H
			Apply for job(s)	G, H
			Tips for interviewing	H
			Create or improve resume	H
			Other (please specify)	F, H
	F	What other type of employment support?			Text area, no char limit		N	Skip Logic Group
	G	What type of jobs were you looking for?	Federal or government jobs only		Radio button, one-up vertical	Single	Y	Skip Logic Group
			Private sector jobs only
			Both government and private sector jobs
	H	Were you able to find the benefit or resource you were looking for?	Yes	K	Radio button, one-up vertical	Single	Y	Skip Logic Group
			No	I, K
CWS01722		Did you accomplish what you wanted to on the site today?	Yes	A	Radio button, one-up vertical	Single	Y	Skip Logic Group	Task Accomplishment
			Partially	A, B
			I wasn’t planning to accomplish anything in particular
			No	B, C
ACQinh0011648	A	What primary task(s) did you accomplish today? (Check all that apply)	Register		Radio button, one-up vertical	Multi	Y	Skip Logic Group	Acc-Primary Task
			Log in
			I checked my claim status for compensation or pension
			I checked my education claim status
			I registered for eBenefits
			I applied for a benefit	B-4
			I changed my profile or direct deposit information
			I looked for employment support or jobs
			Other (please specify)	A-1
ACQinh0011649	A-1	What other task(s) did you primarily accomplish?			Text area, no char limit		N	Skip Logic Group	OE_Acc-Primary Task
ACQinh0011650	B	What primary task(s) were you unable to accomplish today? (Check all that apply)	Register or Login	B-1, B1-B	Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Not Acc-Primary Task
			Log in	B-1, B1-C
			Check claim status for compensation or pension	B-2
			Check education claim status	B-3
			Apply for a benefit	B-4, BB
			Manage my profile or direct deposit
			Find employment support or jobs	B-6
			Other, (please specify)	B-5
ACQinh0011651	B-5	What other task(s) were you trying to accomplish?			Text area, no char limit		N	Skip Logic Group	OE_Not Acc-Other Task
ACQinh0011652	B-1	What difficulty did you have registering or logging into your account? (Check all that apply)	The site was down		Checkbox, one-up vertical	Multi	Y		Not Acc-Reg/Login
			My password expired
			I could not register for a Premium (Level 2) Account because I need to get approved in-person
			The information to register that I received in the mail did not work
			Other, (please specify)	B-1A
ACQinh0011671	B-1A	What is the other issue you had registering or logging into your account?			Text area, no char limit			Skip Logic Group	OE_Not Acc-Reg/Login
	A B-1B	Is there any additional information that would be helpful in the registration process?			Text area, no char limit		N	Skip Logic Group	OE_Reg Info
ACQOsl0002985	B	Did you try to log in on this site today?	Yes	C	Radio button, one-up vertical	Single	Y	Skip Logic Group
			No
ACQOsl0002986	C	Were you able to log in successfully?	Yes, the first time I tried	D	Radio button, one-up vertical	Single	Y	Skip Logic Group
			Yes, after more than one try	D
			No, I was unable to log in	CC,D
ACQOsl0002987	CC	Why were you unable to log in?			Text area, no char limit		Y	Skip Logic Group
ACQOsl0002988	D B1-C	What, if anything, would you like improved about the log in process?			Text area, no char limit		N	Skip Logic Group
ACQinh0011672	B-2	What difficulty did you have checking your compensation or pension claim status? (Check all that apply)	I found my status, but I don't think the data is correct		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Not Acc-C/P Claim
			I could not get status because I do not have a Premium (Level 2) account
			I could login, but my page did not display	B-2B
			Other, (please specify)	B-2A
ACQinh0011675	B-2A	What is the other reason that you could not check your claim status?			Text area, no char limit			Skip Logic Group	OE_Not Acc-C/P Claim
ACQhar0015092	B-2B	Have you been able to see a status view in previous visits?	No., I've never been able to get a status view.		Radio button, one-up vertical	Single	Y	Skip Logic Group	Status View
			Sometimes I get a status view., Ssometimes I don't.
			This is the first time I've had this problem.
ACQinh0011673	B-3	What difficulty did you have checking your education claim status? (Check all that apply)	I wanted payment status		Checkbox, one-up vertical	Multi		Skip Logic Group	Not Acc-Edu. Claim
			I needed certificate of eligibility
			Other, (please specify)	B-3A
ACQinh0011676	B-3A	What is the other reason you could not check your education claim status?			Text area, no char limit			Skip Logic Group	OE_Not Acc-Edu. Claim
ACQinh0011674	B-4	What type of benefit did you try to apply for?			Text area, no char limit			Skip Logic Group	OE_Not Acc-Ben Type
CAS0042328	B B-4	Which type of benefit were you applying for today?	Life insurance		Drop down, select one	Single	Y	Skip Logic Group	Type Benefit
			Compensation
			Pension
			Education, employment or training
			Other
CAS0042254	BB	Why were you unable to complete your online application today?	I did not have enough time to complete it today		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Why Not Complete
			I did not have enough information or evidence to complete the application
			System failure
			Other, (please specify)	BB1
CAS0042255	BB1	Please explain why you were unable to complete your online application today.			Text area, no char limit		N	Skip Logic Group	OE_unable to complete
CAS0042256	C	Do you have any suggestions for improving your online application experience?			Text area, no char limit		N	Skip Logic Group	OE_App Improvement
	B-6	Why were you unable to find the employment support you were looking for? (Check all that apply)	There were no job openings that I wanted to apply for		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Not Acc_Empl Support
			There was too much information on the site
			I didn't understand the information I was given
			The information wasn't specific to my needs
			Technical or website error
			Trouble navigating through the site
			Other (please specify)	B-6A
	B-6A	What other reason were you unable to find the employment support you were looking for?			Text area, no char limit		N		OE_Not Acc-Empl Support
	K	Do you have any comments about improving the benefit or resource support (including employment support) in eBenefits?			Text area, no char limit		N		OE_Improve Empl Support
ACQOsl0002979	C	What will you do next? (Check all that apply)	Nothing, although I did not find/complete what I wanted		Checkbox, one-up vertical	Multi	Y	Skip Logic Group
			Call the eBenefits call center
			Return to the eBenefits site later and try again
			Send an email
			Other, (please specify)	C-1
ACQOsl0002980	C-1	What else would you do next?			Text area, no char limit		Y	Skip Logic Group
CAS0042292		Thinking about the eBenefits homepage, did it make was it clear where you needed to go to find what you were looking for today?	Yes		Drop down, select one	Single	Y	Skip Logic Group	Homepage clarity
			No	A
CAS0042293	A	What could have improved your ability to find what you were looking for from the eBenefits homepage?			Text area, no char limit		N	Skip Logic Group	Homepage Improvement
CAS0042294		Did you try to log in on this site today?	Yes	A,B	Drop down, select one	Single	Y	Skip Logic Group	Log In
			No
CAS0042295	A	Were you able to log in successfully today?	Yes, the first time I tried		Drop down, select one	Single	Y	Skip Logic Group	Log in Success
			Yes, after more than one try
			No, I was unable to log in	C
CAS0042325	C	Why were you unable to log in today?			Text area, no char limit		N	Skip Logic Group	OE_Unalbe to Log in
CAS0042326	B	What, if anything, would you like improved about the log in process?			Text area, no char limit		N	Skip Logic Group	OE_Reg Improvement
CAS0042327		Did you attempt to complete an online application for benefits today?	Yes	A, B,C	Drop down, select one	Single	Y	Skip Logic Group	Apply for benefit
			No
CAS0042329	B	Were you able to complete your application today?	Yes		Drop down, select one	Single	Y	Skip Logic Group	Complete App
			No	BB
CWS01724		If you could identify one improvement to this site, what improvement would you suggest?			Text area, no char limit	Single	N
AKR4148		Please select your age range.	17 or under		Radio button, one-up vertical	Single	N		Age
			18-24
			25-34
			35-44
			45-54
			55-64
			65+
AKR4149		Please select your gender:	Male		Radio button, one-up vertical	Single	N		Gender
			Female

---

Sheet 7: Custom Qsts (2-14-2014)

Model Instance Name:			red & strike-through: DELETE
VA eBenefits			underlined & italicized: RE-ORDER
MID: YdlIhdA4VstB05QNd8wgAA==			pink: ADDITION
Date:			blue + -->: REWORDING
VA eBenefits CUSTOM QUESTION LIST
QID (Group ID)	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
AKR4145		Which of the following best describes your role in visiting this site today? (Check all that apply)	Veteran	B	Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Role
(AKR4145G5)			Active duty	B
			Wounded, injured, or ill service member	B
			Family of a service member or veteran
			Caregiver or delegate of a service member or veteran
			Health Care team member for a service member or veteran
			Other (please specify)	A
AKR4146	A	Other Please Specify: Please tell us who you are.			Text area, no char limit	Single	N	Skip Logic Group	OE_Role
AKR4147	B	Please check the conflict(s) in which you served. (Check all that apply)	World War II		Checkbox, one-up vertical	Multi	N	Skip Logic Group	Conflicts Served
			Korean Conflict
			Vietnam Era
			Persian Gulf War
			Operation Enduring Freedom
			Operation Iraqi Freedom
			Cold War Era or Other Period of Service
AKR4148		Please select your age range.	17 or under		Radio button, one-up vertical	Single	N		Age
			18-24
			25-34
			35-44
			45-54
			55-64
			65+
AKR4149		Please select your gender:	Male		Radio button, one-up vertical	Single	N		Gender
			Female
AKR4150		How frequently do you visit this site?	First time		Radio button, one-up vertical	Single	Y		Frequency of Visit
			Daily
			About once a week
			About once a month
			About once or twice a year
			Less frequently than once a year
CAS0042289		What was your primary For what reason(s) did you for visiting the eBenefits site today? (Check all that apply)	Register for eBenefits		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Primary reason
			Apply for benefits	A
			To check the status of a claim for benefits	A
			To check the status of an appeal for a claim for benefits	A
			To check the status of a benefit payment
			To view my benefit payment history
			Obtain a benefit verification letter
			Change my direct deposit information
			Change my profile (i.e. change contact or dependent information)
			Looking for available benefits and resources	A
			Looking for employment and/or employment support	D
			Just browsing/Curious what site offered
			Other, (please specify)	B
CAS0042290	B	Why else were you visiting the eBenefits site today?			Text area, no char limit		N	Skip Logic Group	OE_Primary reason
CAS0042291	A	What type of benefit status or resource were you looking for, applying for, or checking on today? (Check all that apply)	Benefits and Ccompensation	H	Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Benefit type
			Pension	H
			Education and training	H
			Employment	D
			Family and caregiver support	H
			Health	H
			Homeless assistance	H
			Housing	H
			Transportation and travel	H
			Volunteer opportunities	H
			Other (please specify)	C
	C	What other type of benefit or resource?			Text area, no char limit		N	Skip Logic Group	OE_Benefit type
	D	What type of employment support were you primarily looking for today?	Job training	H	Checkbox, one-up vertical	Single	Y	Skip Logic Group
			Look for job openings	G, H
			Apply for job(s)	G, H
			Tips for interviewing	H
			Create or improve resume	H
			Other (please specify)	F, H
	F	What other type of employment support?			Text area, no char limit		N	Skip Logic Group
	G	What type of jobs were you looking for?	Federal or government jobs only		Radio button, one-up vertical	Single	Y	Skip Logic Group
			Private sector jobs only
			Both government and private sector jobs
	H	Were you able to find the benefit or resource you were looking for?	Yes	K	Radio button, one-up vertical	Single	Y	Skip Logic Group
			No	I, K
CAS0042292		Thinking about the eBenefits homepage, did it make was it clear where you needed to go to find what you were looking for today?	Yes		Drop down, select one	Single	Y	Skip Logic Group	Homepage clarity
			No	A
CAS0042293	A	What could have improved your ability to find what you were looking for from the eBenefits homepage?			Text area, no char limit		N	Skip Logic Group	Homepage Improvement
CWS01722		Did you accomplish what you wanted to on the site today?	Yes	A	Radio button, one-up vertical	Single	Y	Skip Logic Group	Task Accomplishment
			I wasn’t planning to accomplish anything in particular
			No	B, C
ACQinh0011648	A	What primary task did you accomplish today? (Check all that apply)	I checked my claim status for compensation or pension		Radio button, one-up vertical	Multi	Y	Skip Logic Group	Acc-Primary Task
			I checked my education claim status
			I registered for eBenefits
			I applied for a benefit
			I changed my profile or direct deposit information
			I looked for employment support or jobs
			Other (please specify)	A-1
ACQinh0011649	A-1	What other task(s) did you primarily accomplish?			Text area, no char limit		N	Skip Logic Group	OE_Acc-Primary Task
ACQinh0011650	B	What primary task were you unable to accomplish today? (Check all that apply)	Register or Login	B-1	Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Not Acc-Primary Task
			Check claim status for compensation or pension	B-2
			Check education claim status	B-3
			Apply for a benefit	B-4
			Manage my profile or direct deposit
			Find employment support or jobs	B-6
			Other, (please specify)	B-5
ACQinh0011651	B-5	What other task(s) were you trying to accomplish?			Text area, no char limit		N	Skip Logic Group	OE_Not Acc-Other Task
ACQinh0011652	B-1	What difficulty did you have registering or logging into your account? (Check all that apply)	The site was down		Checkbox, one-up vertical	Multi	Y		Not Acc-Reg/Login
			My password expired
			I could not register for a Premium (Level 2) Account because I need to get approved in-person
			The information to register that I received in the mail did not work
			Other, (please specify)	B-1A
ACQinh0011671	B-1A	What is the other issue you had registering or logging into your account?			Text area, no char limit			Skip Logic Group	OE_Not Acc-Reg/Login
ACQinh0011672	B-2	What difficulty did you have checking your compensation or pension claim status? (Check all that apply)	I found my status, but I don't think the data is correct		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Not Acc-C/P Claim
			I could not get status because I do not have a Premium (Level 2) account
			I could login, but my page did not display	B-2B
			Other, (please specify)	B-2A
ACQinh0011675	B-2A	What is the other reason that you could not check your claim status?			Text area, no char limit			Skip Logic Group	OE_Not Acc-C/P Claim
ACQhar0015092	B-2B	Have you been able to see a status view in previous visits?	No. I've never been able to get a status view.		Radio button, one-up vertical	Single	Y	Skip Logic Group	Status View
			Sometimes I get a status view. Sometimes I don't.
			This is the first time I've had this problem.
ACQinh0011673	B-3	What difficulty did you have checking your education claim status? (Check all that apply)	I wanted payment status		Checkbox, one-up vertical	Multi		Skip Logic Group	Not Acc-Edu. Claim
			I needed certificate of eligibility
			Other, (please specify)	B-3A
ACQinh0011676	B-3A	What is the other reason you could not check your education claim status?			Text area, no char limit			Skip Logic Group	OE_Not Acc-Edu. Claim
ACQinh0011674	B-4	What type of benefit did you try to apply for?			Text area, no char limit			Skip Logic Group	OE_Not Acc-Ben Type
	B-6	Why were you unable to find the employment support you were looking for? (Check all that apply)	There were no job openings that I wanted to apply for		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Not Acc_Empl Support
			There was too much information on the site
			I didn't understand the information I was given
			The information wasn't specific to my needs
			Technical or website error
			Trouble navigating through the site
			Other (please specify)	B-6A
	B-6A	What other reason were you unable to find the employment support you were looking for?			Text area, no char limit		N		OE_Not Acc-Empl Support
	K	Do you have any comments about improving the benefit or resource support (including employment support) in eBenefits?			Text area, no char limit		N		OE_Improve Empl Support
ACQOsl0002979	C	What will you do next? (Check all that apply)	Nothing, although I did not find/complete what I wanted		Checkbox, one-up vertical	Multi	Y	Skip Logic Group
			Call the eBenefits call center
			Return to the eBenefits site later and try again
			Send an email
			Other, (please specify)	C-1
ACQOsl0002980	C-1	What else would you do next?			Text area, no char limit		Y	Skip Logic Group
ACQOsl0002983		Did you register for this site today?	Yes	A, B	Radio button, one-up vertical	Single	Y	Skip Logic Group	Register
			No, I have already registered	B
			No, I am not registered for this site.
	A	Is there any additional information that would be helpful in the registration process?			Text area, no char limit		N	Skip Logic Group	OE_Reg Info
ACQOsl0002985	B	Did you try to log in on this site today?	Yes	C	Radio button, one-up vertical	Single	Y	Skip Logic Group
			No
ACQOsl0002986	C	Were you able to log in successfully?	Yes, the first time I tried	D	Radio button, one-up vertical	Single	Y	Skip Logic Group
			Yes, after more than one try	D
			No, I was unable to log in	CC,D
ACQOsl0002987	CC	Why were you unable to log in?			Text area, no char limit		Y	Skip Logic Group
ACQOsl0002988	D	What, if anything, would you like improved about the log in process?			Text area, no char limit		N	Skip Logic Group
CAS0042294		Did you try to log in on this site today?	Yes	A,B	Drop down, select one	Single	Y	Skip Logic Group	Log In
			No
CAS0042295	A	Were you able to log in successfully today?	Yes, the first time I tried		Drop down, select one	Single	Y	Skip Logic Group	Log in Success
			Yes, after more than one try
			No, I was unable to log in	C
CAS0042325	C	Why were you unable to log in today?			Text area, no char limit		N	Skip Logic Group	OE_Unalbe to Log in
CAS0042326	B	What, if anything, would you like improved about the log in process?			Text area, no char limit		N	Skip Logic Group	OE_Reg Improvement
CAS0042327		Did you attempt to complete an online application for benefits today?	Yes	A, B,C	Drop down, select one	Single	Y	Skip Logic Group	Apply for benefit
			No
CAS0042328	A	Which type of benefit were you applying for today?	Life insurance		Drop down, select one	Single	Y	Skip Logic Group	Type Benefit
			Compensation
			Pension
			Education, employment or training
			Other
CAS0042329	B	Were you able to complete your application today?	Yes		Drop down, select one	Single	Y	Skip Logic Group	Complete App
			No	BB
CAS0042254	BB	Why were you unable to complete your online application today?	I did not have enough time to complete it today		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Why Not Complete
			I did not have enough information or evidence to complete the application
			System failure
			Other, (please specify)	BB1
CAS0042255	BB1	Please explain why you were unable to complete your online application today.			Text area, no char limit		N	Skip Logic Group	OE_unable to complete
CAS0042256	C	Do you have any suggestions for improving your online application experience?			Text area, no char limit		N	Skip Logic Group	OE_App Improvement
CWS01724		If you could identify one improvement to this site, what improvement would you suggest?			Text area, no char limit	Single	N

---

Sheet 8: Current Custom Qsts

Model Instance Name:			red & strike-through: DELETE
VA eBenefits			underlined & italicized: RE-ORDER
MID: YdlIhdA4VstB05QNd8wgAA==			pink: ADDITION
Date:			blue + -->: REWORDING
VA eBenefits CUSTOM QUESTION LIST
QID (Group ID)	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
AKR4145		Which of the following best describes your role in visiting this site today? (Check all that apply)	Veteran	B	Checkbox, one-up vertical	Multi	Y	Skip Logic Group
(AKR4145G5)			Active duty	B
			Wounded, injured, or ill service member	B
			Family of a service member or veteran
			Caregiver or delegate of a service member or veteran
			Health Care team member for a service member or veteran
			Other	A
AKR4146	A	Other Please Specify: Please tell us who you are.			Text area, no char limit	Single	N	Skip Logic Group
AKR4147	B	Please check the conflict(s) in which you served.	World War II		Checkbox, one-up vertical	Multi	N	Skip Logic Group
			Korean Conflict
			Vietnam Era
			Persian Gulf War
			Operation Enduring Freedom
			Operation Iraqi Freedom
			Other
AKR4148		Please select your age range.	17 or under		Radio button, one-up vertical	Single	N
			18-24
			25-34
			35-44
			45-54
			55-64
			65+
AKR4149		Please select your gender:	Male		Radio button, one-up vertical	Single	N
			Female
AKR4150		How frequently do you visit this site?	First time		Radio button, one-up vertical	Single	Y
			Daily
			About once a week
			About once a month
			About once or twice a year
			Less frequently than once a year
CAS0042289		What was your primary reason for visiting the eBenefits site today?	Register for eBenefits		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Primary reason
			Apply for benefits	A
			To check the status of a claim for benefits	A
			To check the status of an appeal for a claim for benefits	A
			To check the status of a benefit payment
			To view my benefit payment history
			Obtain a benefit verification letter
			Change my direct deposit information
			Change my profile (i.e. change contact or dependent information)
			Just browsing/Curious what site offered
			Other, please specify	B
CAS0042290	B	Why else were you visiting the eBenefits site today?			Text area, no char limit		N		OE_Primary reason
CAS0042291	A	What type of benefit status were you applying for or checking on today?	Compensation						Benefit type
			Pension
			Education
CAS0042292		Thinking about the eBenefits homepage, did it make it clear where you needed to go to find what you were looking for today?	Yes		Drop down, select one	Single	Y	Skip Logic Group	Homepage clarity
			No	A
CAS0042293	A	What could have improved your ability to find what you were looking for from the eBenefits homepage?			Text area, no char limit		N		Homepage Improvement
CWS01722		Did you accomplish what you wanted to on the site today?	Yes	A				Skip Logic Group	Task Accomplishment
			I wasn’t planning to accomplish anything in particular		Radio button, one-up vertical	Single	Y
			No	B, C
ACQinh0011648	A	What primary task did you accomplish today?	I checked my claim status for compensation or pension		Radio button, one-up vertical	Single	Y	Skip Logic Group	Acc-Primary Task
			I checked my education claim status
			I registered for eBenefits
			I applied for a benefit
			I changed my profile or direct deposit information
			I looked for employment support
			Other (please specify)	A-1
ACQinh0011649	A-1	What other task did you primarily accomplish?			Text area, no char limit		N	Skip Logic Group	OE_Acc-Primary Task
ACQinh0011650	B	What primary task were you unable to accomplish today?	Register or Login	B-1	Radio button, one-up vertical	Single	Y	Skip Logic Group	Not Acc-Primary Task
			Check claim status for compensation or pension	B-2
			Check education claim status	B-3
			Apply for a benefit	B-4
			Manage my profile or direct deposit
			Find employment support
			Other, please specify	B-5
ACQinh0011651	B-5	What other task were you trying to accomplish?			Text area, no char limit		N	Skip Logic Group	OE_Not Acc-Other Task
ACQinh0011652	B-1	What difficulty did you have registering or logging into your account?	The site was down		Radio button, one-up vertical				Not Acc-Reg/Login
			My password expired
			I could not register for a Premium (Level 2) Account because I need to get approved in-person
			The information to register that I received in the mail did not work
			Other, please specify	B-1A
ACQinh0011671	B-1A	What is the other issue you had registering or logging into your account?			Text area, no char limit				OE_Not Acc-Reg/Login
ACQinh0011672	B-2	What difficulty did you have checking your compensation or pension claim status?	I found my status, but I don't think the data is correct		Radio button, one-up vertical				Not Acc-C/P Claim
			I could not get status because I do not have a Premium (Level 2) account
			I could login, but my page did not display	B-2B
			Other, please specify	B-2A
ACQinh0011675	B-2A	What is the other reason that you could not check your claim status?			Text area, no char limit				OE_Not Acc-C/P Claim
ACQhar0015092	B-2B	Have you been able to see a status view in previous visits?	No. I've never been able to get a status view.		Radio button, one-up vertical	Single	Y		Status View
			Sometimes I get a status view. Sometimes I don't.
			This is the first time I've had this problem.
ACQinh0011673	B-3	What difficulty did you have checking your education claim status?	I wanted payment status		Radio button, one-up vertical				Not Acc-Edu. Claim
			I needed certificate of eligibility
			Other, please specify	B-3A
ACQinh0011676	B-3A	What is the other reason you could not check your education claim status?			Text area, no char limit				OE_Not Acc-Edu. Claim
ACQinh0011674	B-4	What type of benefit did you try to apply for?			Text area, no char limit				OE_Not Acc-Ben Type
ACQOsl0002979	C	What will you do next?	Nothing, although I did not find/complete what I wanted		Radio button, one-up vertical	Single	Y	Skip Logic Group
			Call the eBenefits call center
			Return to the eBenefits site later and try again
			Send an email
			Other (please specify)	C-1
ACQOsl0002980	C-1	What else would you do next?			Text area, no char limit		Y	Skip Logic Group
ACQOsl0002983		Did you register for this site today?	Yes	A, B	Radio button, one-up vertical	Single	Y	Skip Logic Group	Register
			No, I have already registered	B
			No, I am not registered for this site.
	A	Is there any additional information that would be helpful in the registration process?			Text area, no char limit		N		OE_Reg Info
ACQOsl0002985	B	Did you try to log in on this site today?	Yes	C	Radio button, one-up vertical	Single	Y	Skip Logic Group
			No
ACQOsl0002986	C	Were you able to log in successfully?	Yes, the first time I tried	D	Radio button, one-up vertical	Single	Y	Skip Logic Group
			Yes, after more than one try	D
			No, I was unable to log in	CC,D
ACQOsl0002987	CC	Why were you unable to log in?			Text area, no char limit		Y	Skip Logic Group
ACQOsl0002988	D	What, if anything, would you like improved about the log in process?			Text area, no char limit		N	Skip Logic Group
CAS0042294		Did you try to log in on this site today?	Yes	A,B	Drop down, select one	Single	Y	Skip Logic Group	Log In
			No
CAS0042295	A	Were you able to log in successfully today?	Yes, the first time I tried		Drop down, select one	single	Y		Log in Success
			Yes, after more than one try
			No, I was unable to log in	C
CAS0042325	C	Why were you unable to log in today?			Text area, no char limit		N		OE_Unalbe to Log in
CAS0042326	B	What, if anything, would you like improved about the log in process?			Text area, no char limit	single	N		OE_Reg Improvement
CAS0042327		Did you attempt to complete an online application for benefits today?	Yes	A, B,C	Drop down, select one	single	Y	Skip Logic Group	Apply for benefit
			No
CAS0042328	A	Which type of benefit were you applying for today?	Life insurance		Drop down, select one	single	Y	Skip Logic Group	Type Benefit
			Compensation
			Pension
			Education, employment or training
			Other
CAS0042329	B	Were you able to complete your application today?	Yes		Drop down, select one	single	Y	Skip Logic Group	Complete App
			No	BB
CAS0042254	BB	Why were you unable to complete your online application today?	I did not have enough time to complete it today		Checkbox, one-up vertical	Multiple	Y	Skip Logic Group	Why Not Complete
			I did not have enough information or evidence to complete the application
			System failure
			Other, please specify	BB1
CAS0042255	BB1	Please explain why you were unable to complete your online application today.			Text area, no char limit		n	Skip Logic Group	OE_unable to complete
CAS0042256	C	Do you have any suggestions for improving your online application experience?			Text area, no char limit		N	Skip Logic Group	OE_App Improvement
CWS01724		If you could identify one improvement to this site, what improvement would you suggest?			Text area, no char limit	Single	N

---

Sheet 9: Custom Qsts (11-1-13)

Model Instance Name:			red & strike-through: DELETE
VA eBenefits			underlined & italicized: RE-ORDER
MID: YdlIhdA4VstB05QNd8wgAA==			pink: ADDITION
Date:			blue + -->: REWORDING
VA eBenefits CUSTOM QUESTION LIST
QID (Group ID)	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
AKR4145		Which of the following best describes your role in visiting this site today? (Check all that apply)	Veteran	B	Checkbox, one-up vertical	Multi	Y	Skip Logic Group
(AKR4145G5)			Active duty	B
			Wounded, injured, or ill service member	B
			Family of a service member or veteran
			Caregiver or delegate of a service member or veteran
			Health Care team member for a service member or veteran
			Other	A
AKR4146	A	Other Please Specify: Please tell us who you are.			Text area, no char limit	Single	N	Skip Logic Group
AKR4147	B	Please check the conflict(s) in which you served.	World War II		Checkbox, one-up vertical	Multi	N	Skip Logic Group
			Korean Conflict
			Vietnam Era
			Persian Gulf War
			Operation Enduring Freedom
			Operation Iraqi Freedom
			No conflict/war service
			Other
AKR4148		Please select your age range.	17 or under		Radio button, one-up vertical	Single	N
			18-24
			25-34
			35-44
			45-54
			55-64
			65+
AKR4149		Please select your gender:	Male		Radio button, one-up vertical	Single	N
			Female
AKR4150		How frequently do you visit this site?	First time		Radio button, one-up vertical	Single	Y
			Daily
			About once a week
			About once a month
			About once or twice a year
			Less frequently than once a year
		What was your primary reason for visiting the eBenefits site today?	Register for eBenefits		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Primary reason
			Apply for benefits	A
			To check the status of a claim for benefits	A
			To check the status of an appeal for a claim for benefits	A
			To check the status of a benefit payment
			To view my benefit payment history
			Obtain a benefit verification letter
			Change my direct deposit information
			Change my profile (i.e. change contact or dependent information)
			Just browsing/Curious what site offered
			Other, please specify	B
	B	Why else were you visiting the eBenefits site today?			Text area, no char limit		N		OE_Primary reason
	A	What type of benefit status were you applying for or checking on today?	Compensation						Benefit type
			Pension
			Education
		Thinking about the eBenefits homepage, did it make it clear where you needed to go to find what you were looking for today?	Yes		Drop down, select one	Single	Y	Skip Logic Group	Homepage clarity
			No	A
	A	What could have improved your ability to find what you were looking for from the eBenefits homepage?			Text area, no char limit		N		Homepage Improvement
CWS01722		Did you accomplish what you wanted to on the site today?	Yes	A				Skip Logic Group	Task Accomplishment
			I wasn’t planning to accomplish anything in particular		Radio button, one-up vertical	Single	Y
			No	B, C
ACQinh0011648	A	What primary task did you accomplish today?	I checked my claim status for compensation or pension		Radio button, one-up vertical	Single	Y	Skip Logic Group	Acc-Primary Task
			I checked my education claim status
			I registered for eBenefits
			I applied for a benefit
			I changed my profile or direct deposit information
			I looked for employment support
			Other (please specify)	A-1
ACQinh0011649	A-1	What other task did you primarily accomplish?			Text area, no char limit		N	Skip Logic Group	OE_Acc-Primary Task
ACQinh0011650	B	What primary task were you unable to accomplish today?	Register or Login	B-1	Radio button, one-up vertical	Single	Y	Skip Logic Group	Not Acc-Primary Task
			Check claim status for compensation or pension	B-2
			Check education claim status	B-3
			Apply for a benefit	B-4
			Manage my profile or direct deposit
			Find employment support
			Other, please specify	B-5
ACQinh0011651	B-5	What other task were you trying to accomplish?			Text area, no char limit		N	Skip Logic Group	OE_Not Acc-Other Task
ACQinh0011652	B-1	What difficulty did you have registering or logging into your account?	The site was down		Radio button, one-up vertical				Not Acc-Reg/Login
			My password expired
			I could not register for a Premium (Level 2) Account because I need to get approved in-person
			The information to register that I received in the mail did not work
			Other, please specify	B-1A
ACQinh0011671	B-1A	What is the other issue you had registering or logging into your account?			Text area, no char limit				OE_Not Acc-Reg/Login
ACQinh0011672	B-2	What difficulty did you have checking your compensation or pension claim status?	I found my status, but I don't think the data is correct		Radio button, one-up vertical				Not Acc-C/P Claim
			I could not get status because I do not have a Premium (Level 2) account
			I could login, but my page did not display	B-2B
			Other, please specify	B-2A
ACQinh0011675	B-2A	What is the other reason that you could not check your claim status?			Text area, no char limit				OE_Not Acc-C/P Claim
ACQhar0015092	B-2B	Have you been able to see a status view in previous visits?	No. I've never been able to get a status view.		Radio button, one-up vertical	Single	Y		Status View
			Sometimes I get a status view. Sometimes I don't.
			This is the first time I've had this problem.
ACQinh0011673	B-3	What difficulty did you have checking your education claim status?	I wanted payment status		Radio button, one-up vertical				Not Acc-Edu. Claim
			I needed certificate of eligibility
			Other, please specify	B-3A
ACQinh0011676	B-3A	What is the other reason you could not check your education claim status?			Text area, no char limit				OE_Not Acc-Edu. Claim
ACQinh0011674	B-4	What type of benefit did you try to apply for?			Text area, no char limit				OE_Not Acc-Ben Type
ACQOsl0002979	C	What will you do next?	Nothing, although I did not find/complete what I wanted		Radio button, one-up vertical	Single	Y	Skip Logic Group
			Call the eBenefits call center
			Return to the eBenefits site later and try again
			Send an email
			Other (please specify)	C-1
ACQOsl0002980	C-1	What else would you do next?			Text area, no char limit		Y	Skip Logic Group
ACQOsl0002983		Did you register for this site today?	Yes	A, B	Radio button, one-up vertical	Single	Y	Skip Logic Group	Register
			No, I have already registered	B
			No, I am not registered for this site.
	A	Is there any additional information that would be helpful in the registration process?			Text area, no char limit		N		OE_Reg Info
ACQOsl0002985	B	Did you try to log in on this site today?	Yes	C	Radio button, one-up vertical	Single	Y	Skip Logic Group
			No
ACQOsl0002986	C	Were you able to log in successfully?	Yes, the first time I tried	D	Radio button, one-up vertical	Single	Y	Skip Logic Group
			Yes, after more than one try	D
			No, I was unable to log in	CC,D
ACQOsl0002987	CC	Why were you unable to log in?			Text area, no char limit		Y	Skip Logic Group
ACQOsl0002988	D	What, if anything, would you like improved about the log in process?			Text area, no char limit		N	Skip Logic Group
		Did you try to log in on this site today?	Yes	A,B	Drop down, select one	Single	Y	Skip Logic Group	Log In
			No
	A	Were you able to log in successfully today?	Yes, the first time I tried		Drop down, select one	single	Y		Log in Success
			Yes, after more than one try
			No, I was unable to log in	C
	C	Why were you unable to log in today?			Text area, no char limit		N		OE_Unalbe to Log in
	B	What, if anything, would you like improved about the log in process?			Text area, no char limit	single	N		OE_Reg Improvement
		Did you attempt to complete an online application for benefits today?	Yes	A, B,C	Drop down, select one	single	Y	Skip Logic Group	Apply for benefit
			No
	A	Which type of benefit were you applying for today?	Life insurance		Drop down, select one	single	Y	Skip Logic Group	Type Benefit
			Compensation
			Pension
			Education, employment or training
			Other
	B	Were you able to complete your application today?	Yes		Drop down, select one	single	Y	Skip Logic Group	Complete App
			No	BB
	BB	Why were you unable to complete your online application today?	I did not have enough time to complete it today		Checkbox, one-up vertical	Multiple	Y	Skip Logic Group	Why Not Complete
			I did not have enough information or evidence to complete the application
			System failure
			Other, please specify	BB1
	BB1	Please explain why you were unable to complete your online application today.			Text area, no char limit		n	Skip Logic Group	OE_unable to complete
	C	Do you have any suggestions for improving your online application experience?			Text area, no char limit		N	Skip Logic Group	OE_App Improvement
ACQDom0007579		Which of the following eBenefits features would you be likely to use on a mobile device? (Select all that apply.)	Access your eBenefits Message Center		Checkbox, one-up vertical	Multi	Y	Skip Logic Group
			Request documents from your Official Military Personnel file (such as your DD-214)
			Share your health records with private health care providers, the VA and the DoD
			Update your contact information for Compensation & Pension and Post-9/11 GI Bill Education benefits
			Browse and apply for state benefits
			Find an attorney, Claims Agent, or VSO to represent you for VA benefits claims
			View your Federal Individual Recovery Plan (FIRP)
			Other, please specify	A
			None, I would not access eBenefits features through a mobile device
ACQDom0007606	A	Other, please specify
CWS01724		If you could identify one improvement to this site, what improvement would you suggest?			Text area, no char limit	Single	N

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Sheet 10: Custom Qsts (8-29-12)

Model Instance Name:
VA eBenefits
MID: YdlIhdA4VstB05QNd8wgAA==			eBenefits Custom Questions
Date:
VA eBenefits CUSTOM QUESTION LIST
QID (Group ID)	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
AKR4145		Which of the following best describes your role in visiting this site today? (Check all that apply)	Veteran	B	Checkbox, one-up vertical	Multi	Y	Skip Logic Group
(AKR4145G5)			Active duty	B
			Wounded, injured, or ill service member	B
			Family of a service member or veteran
			Caregiver or delegate of a service member or veteran
			Health Care team member for a service member or veteran
			Other	A
AKR4146	A	Other Please Specify: Please tell us who you are.			Text area, no char limit	Single	N	Skip Logic Group
AKR4147	B	Please check the conflict(s) in which you served.	World War II		Checkbox, one-up vertical	Multi	N	Skip Logic Group
			Korean Conflict
			Vietnam Era
			Persian Gulf War
			Operation Enduring Freedom
			Operation Iraqi Freedom
			No conflict/war service
AKR4148		Please select your age range.	17 or under		Radio button, one-up vertical	Single	N
			18-24
			25-34
			35-44
			45-54
			55-64
			65+
AKR4149		Please select your gender:	Male		Radio button, one-up vertical	Single	N
			Female
AKR4150		How frequently do you visit this site?	First time		Radio button, one-up vertical	Single	Y
			Daily
			About once a week
			About once a month
			About once or twice a year
			Less frequently than once a year
CWS01722		Did you accomplish what you wanted to on the site?	Yes	A				Skip Logic Group
			I wasn’t planning to accomplish anything in particular
			No	B, C	Radio button, one-up vertical	Single	Y
ACQinh0011648	A	What primary task did you accomplish today?	I checked my claim status for compensation or pension		Radio button, one-up vertical	Single	Y	Skip Logic Group	Acc-Primary Task
			I checked my education claim status
			I registered for eBenefits
			I applied for a benefit
			I changed my profile or direct deposit information
			I looked for employment support
			Other (please specify)	A-1
ACQinh0011649	A-1	What other task did you primarily accomplish?			Text area, no char limit		N	Skip Logic Group	OE_Acc-Primary Task
ACQinh0011650	B	What primary task were you unable to accomplish today?	Register or Login	B-1	Radio button, one-up vertical	Single	Y	Skip Logic Group	Not Acc-Primary Task
			Check claim status for compensation or pension	B-2
			Check education claim status	B-3
			Apply for a benefit	B-4
			Manage my profile or direct deposit
			Find employment support
			Other, please specify	B-5
ACQinh0011651	B-5	What other task were you trying to accomplish?			Text area, no char limit		N	Skip Logic Group	OE_Not Acc-Other Task
ACQinh0011652	B-1	What difficulty did you have registering or logging into your account?	The site was down		Radio button, one-up vertical				Not Acc-Reg/Login
			My password expired
			I could not register for a Premium (Level 2) Account because I need to get approved in-person
			The information to register that I received in the mail did not work
			Other, please specify	B-1A
ACQinh0011671	B-1A	What is the other issue you had registering or logging into your account?			Text area, no char limit				OE_Not Acc-Reg/Login
ACQinh0011672	B-2	What difficulty did you have checking your compensation or pension claim status?	I found my status, but I don't think the data is correct		Radio button, one-up vertical				Not Acc-C/P Claim
			I could not get status because I do not have a Premium (Level 2) account
			I could login, but my page did not display	B-2B
			Other, please specify	B-2A
ACQinh0011675	B-2A	What is the other reason that you could not check your claim status?			Text area, no char limit				OE_Not Acc-C/P Claim
	B-2B	Have you been able to see a status view in previous visits?	No. I've never been able to get a status view.		Radio button, one-up vertical	Single	Y		Status View
			Sometimes I get a status view. Sometimes I don't.
			This is the first time I've had this problem.
ACQinh0011673	B-3	What difficulty did you have checking your education claim status?	I wanted payment status		Radio button, one-up vertical				Not Acc-Edu. Claim
			I needed certificate of eligibility
			Other, please specify	B-3A
ACQinh0011676	B-3A	What is the other reason you could not check your education claim status?			Text area, no char limit				OE_Not Acc-Edu. Claim
ACQinh0011674	B-4	What type of benefit did you try to apply for?			Text area, no char limit				OE_Not Acc-Ben Type
ACQOsl0002979	C	What will you do next?	Nothing, although I did not find/complete what I wanted		Radio button, one-up vertical	Single	Y	Skip Logic Group
			Call the eBenefits call center
			Return to the eBenefits site later and try again
			Send an email
			Other (please specify)	C-1
ACQOsl0002980	C-1	What else would you do next?			Text area, no char limit		Y	Skip Logic Group
ACQOsl0002981		How did you primarily look for information on the site today?	Chose a main menu item e.g. My eBenefits, Benefits Links etc.		Radio button, one-up vertical	Single	Y	OPS Group
			Clicked a link on the homepage
			Used the search box
			Narrowed choices by using the checkboxes on a Benefits Links page
			Other, please specify	A
ACQOsl0002982	A	How else did you look for information on the site?			Text area, no char limit		Y	OPS Group
ACQOsl0002983		Did you register for this site today?	Yes	A, B	Radio button, one-up vertical	Single	Y	OPS Group
			No, I have already registered	B
			No, I am not registered for this site.
ACQOsl0002984	A	Is there any additional information that would be helpful in the registration process?
ACQOsl0002985	B	Did you try to log in on this site today?	Yes	C	Radio button, one-up vertical	Single	Y	Skip Logic Group
			No
ACQOsl0002986	C	Were you able to log in successfully?	Yes, the first time I tried	D	Radio button, one-up vertical	Single	Y	Skip Logic Group
			Yes, after more than one try	D
			No, I was unable to log in	CC,D
ACQOsl0002987	CC	Why were you unable to log in?			Text area, no char limit		Y	Skip Logic Group
ACQOsl0002988	D	What, if anything, would you like improved about the log in process?			Text area, no char limit		N	Skip Logic Group
ACQDom0007579		Which of the following eBenefits features would you be likely to use on a mobile device? (Select all that apply.)	Access your eBenefits Message Center		Checkbox, one-up vertical	Multi	Y	Skip Logic Group
			Request documents from your Official Military Personnel file (such as your DD-214)
			Share your health records with private health care providers, the VA and the DoD
			Update your contact information for Compensation & Pension and Post-9/11 GI Bill Education benefits
			Browse and apply for state benefits
			Find an attorney, Claims Agent, or VSO to represent you for VA benefits claims
			View your Federal Individual Recovery Plan (FIRP)
			Other, please specify	A
			None, I would not access eBenefits features through a mobile device
ACQDom0007606	A	Other, please specify
CWS01724		If you could identify one improvement to this site, what improvement would you suggest?			Text area, no char limit	Single	N

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Sheet 11: Custom Qsts (3-20-12)

Model Instance Name:
VA eBenefits
MID: YdlIhdA4VstB05QNd8wgAA==			eBenefits Custom Questions
Date:
VA eBenefits CUSTOM QUESTION LIST
QID (Group ID)	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
AKR4145		Which of the following best describes your role in visiting this site today? (Check all that apply)	Veteran	B	Checkbox, one-up vertical	Multi	Y	Skip Logic Group
(AKR4145G5)			Active duty	B
			Wounded, injured, or ill service member	B
			Family of a service member or veteran
			Caregiver or delegate of a service member or veteran
			Health Care team member for a service member or veteran
			Other	A
AKR4146	A	Other Please Specify: Please tell us who you are.			Text area, no char limit	Single	N	Skip Logic Group
AKR4147	B	Please check the conflict(s) in which you served.	World War II		Checkbox, one-up vertical	Multi	N	Skip Logic Group
			Korean Conflict
			Vietnam Era
			Persian Gulf War
			Operation Enduring Freedom
			Operation Iraqi Freedom
			No conflict/war service
AKR4148		Please select your age range.	17 or under		Radio button, one-up vertical	Single	N
			18-24
			25-34
			35-44
			45-54
			55-64
			65+
AKR4149		Please select your gender:	Male		Radio button, one-up vertical	Single	N
			Female
AKR4150		How frequently do you visit this site?	First time		Radio button, one-up vertical	Single	Y
			Daily
			About once a week
			About once a month
			About once or twice a year
			Less frequently than once a year
AKR4151		What information were you primarily looking for today?	Financial		Radio button, one-up vertical	Single	Y	OPS Group
(AKR4151G1)			Education
			Employment
			Housing
			Health
			Burial
			Benefits
			Compensation
			Other, please specify	A
AKR4152	A	Other, please specify: What information were you primarily looking for today?			Text area, no char limit	Single	N	OPS Group
CWS01722		Did you accomplish what you wanted to on the site?	Yes	A				Skip Logic Group
			I wasn’t planning to accomplish anything in particular
			No, I wanted to:	B, C	Radio button, one-up vertical	Single	Y
CWS01723	A	No, I wanted to:			Text area, no char limit	Single	N	Skip Logic Group
	A	What primary task did you accomplish today?	I checked my claim status for compensation or pension		Radio button, one-up vertical	Single	Y	Skip Logic Group	Acc-Primary Task
			I checked my education claim status
			I registered for eBenefits
			I changed my profile or direct deposit information
			I looked for employment support
			Other (please specify)	A-1
	A-1	What other task did you primarily accomplish?			Text area, no char limit		N	Skip Logic Group	OE_Acc-Primary Task
	B	What primary task were you unable to accomplish today?	Register or Login	B-1	Radio button, one-up vertical	Single	Y	Skip Logic Group	Not Acc-Primary Task
			Check claim status for compensation or pension	B-2
			Check education claim status	B-3
			Apply for a benefit	B-4
			Manage my profile or direct deposit
			Find employment support
			Other, please specify	B-5
	B-1	What difficulty did you have registering or logging into your account?	The site was down		Radio button, one-up vertical				Not Acc-Reg/Login
			My password expired
			I could not register for a Premium (Level 2) Account because I need to get approved in-person
			The information to register that I received in the mail did not work
			Other, please specify	B-1A
	B-1A	What is the other issue you had registering or logging into your account?			Text area, no char limit				OE_Not Acc-Reg/Login
	B-2	What difficulty did you have checking your compensation or pension claim status?	I found my status, but I don't think the data is correct		Radio button, one-up vertical				Not Acc-C/P Claim
			I could not get status because I do not have a Premium (Level 2) account
			I could login, but my page did not display
			Other, please specify	B-2A
	B-2A	What is the other reason that you could not check your claim status?			Text area, no char limit				OE_Not Acc-C/P Claim
	B-3	What difficulty did you have checking your education claim status?	I wanted payment status		Radio button, one-up vertical				Not Acc-Edu. Claim
			I needed certificate of eligibility
			Other, please specify	B-3A
	B-3A	What is the other reason you could not check your education claim status?			Text area, no char limit				OE_Not Acc-Edu. Claim
	B-4	What type of benefit did you try to apply for?			Text area, no char limit				OE_Not Acc-Ben Type
	B-5	What other task were you trying to accomplish?			Text area, no char limit		N	Skip Logic Group	OE_Not Acc-Other Task
ACQOsl0002979	C	What will you do next?	Nothing, although I did not find/complete what I wanted		Radio button, one-up vertical	Single	Y	Skip Logic Group
			Call the eBenefits call center
			Return to the eBenefits site later and try again
			Send an email
			Other (please specify)	C-1
ACQOsl0002980	C-1	What else would you do next?			Text area, no char limit		Y	Skip Logic Group
ACQOsl0002981		How did you primarily look for information on the site today?	Chose a main menu item e.g. My eBenefits, Benefits Links etc.		Radio button, one-up vertical	Single	Y	OPS Group
			Clicked a link on the homepage
			Used the search box
			Narrowed choices by using the checkboxes on a Benefits Links page
			Other, please specify	A
ACQOsl0002982	A	How else did you look for information on the site?			Text area, no char limit		Y	OPS Group
ACQOsl0002983		Did you register for this site today?	Yes	A, B	Radio button, one-up vertical	Single	Y	OPS Group
			No, I have already registered	B
			No, I am not registered for this site.
ACQOsl0002984	A	Is there any additional information that would be helpful in the registration process?
ACQOsl0002985	B	Did you try to log in on this site today?	Yes	C	Radio button, one-up vertical	Single	Y	Skip Logic Group
			No
ACQOsl0002986	C	Were you able to log in successfully?	Yes, the first time I tried	D	Radio button, one-up vertical	Single	Y	Skip Logic Group
			Yes, after more than one try	D
			No, I was unable to log in	CC,D
ACQOsl0002987	CC	Why were you unable to log in?			Text area, no char limit		Y	Skip Logic Group
ACQOsl0002988	D	What, if anything, would you like improved about the log in process?			Text area, no char limit		N	Skip Logic Group
ACQDom0007579		Which of the following eBenefits features would you be likely to use on a mobile device? (Select all that apply.)	Access your eBenefits Message Center		Checkbox, one-up vertical	Multi	Y	Skip Logic Group
			Request documents from your Official Military Personnel file (such as your DD-214)
			Share your health records with private health care providers, the VA and the DoD
			Update your contact information for Compensation & Pension and Post-9/11 GI Bill Education benefits
			Browse and apply for state benefits
			Find an attorney, Claims Agent, or VSO to represent you for VA benefits claims
			View your Federal Individual Recovery Plan (FIRP)
			Other, please specify	A
			None, I would not access eBenefits features through a mobile device
ACQDom0007606	A	Other, please specify
CWS01724		If you could identify one improvement to this site, what improvement would you suggest?			Text area, no char limit	Single	N