Form 1076 2014 831 SSA Extra Help

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Overview

English Welcome & ThankYou Text
Spanish Welcome & ThankYou text
v3 Model Qsts (EE)
v3 Model Qsts (EN)
v3 Model Qsts (SP)
EE v3 Custom Qsts
EN v3 Custom Qsts
SP v3 Custom Qsts
Element Rotations

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Sheet 1: English Welcome & ThankYou Text

Model Instance Name:
SSA Extra Help v2
MID:
Date:	9/15/2011
Welcome and Thank You Text
					Examples
					Current Welcome Text
	Welcome Text
	Thank you for visiting the Social Security Administration (SSA). You have been randomly selected to take part in this survey that is being conducted by ForeSee Results on behalf of SSA. Please take a minute or two to give us your opinions about the Application for Help with Medicare Prescription Drug Plan Costs. The feedback you provide will help SSA enhance its site and serve you better in the future. All results are strictly confidential.
	Thank You Text				Current Thank You Text
	Thank you for your time in completing this survey about the Application for Help with Medicare Prescription Drug Plan Costs. Your input is very valuable will be taken into consideration.
	Invitation Text
					Current Invitation Text
	We'd like your feedback.
	Thank you for visiting the SSA.gov site and using the online application for Help with Medicare Prescription Plan Drug Costs. You have been randomly selected to participate in a customer satisfaction survey to let us know how we can improve your website experience.
	This survey is conducted by an independent company, ForeSee Results.

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Sheet 2: Spanish Welcome & ThankYou text

Model Instance Name:
SSA Extra Help v2
MID:
Date:	9/1/2011
Welcome and Thank You Text
					Examples
					Current Welcome Text
	Welcome Text
	Gracias por visitar la Administración del Seguro Social. Usted ha sido seleccionado para participar en esta encuesta conducida por ForeSee Results de parte del Seguro Social. Por favor tomese un minuto o dos para darnos sus opiniones sobre la Solicitud para el Beneficio Adicional con los gastos del plan de medicamentos recetados de Medicare. Los comentarios que proporcione ayudará al Seguro Social a mejorar la página de Internet y servirle mejor en el futuro. Todos los resultados son estrictamente confidenciales.
	Thank You Text				Current Thank You Text
	Gracias por su tiempo para completar esta encuesta sobre la Solicitud para el Beneficio Adicional con los gastos del plan de medicamentos recetados de Medicare. Su opinión es muy valiosa y la tomaremos en cuenta.
	Invitation Text
					Current Invitation Text
	Nos gustaría recibir sus comentarios
	Gracias por visitar el sitio de Internet segurosocial.gov y usar la solicitud para El Beneficio Adicional con los gastos del plan de medicamentos recetados de Medicare. Usted ha sido seleccionado para participar en una encuesta de satisfacción del cliente para hacernos saber cómo podemos mejorar su experiencia por Internet.
	Esta encuesta la lleva a cabo una empresa independiente llamada, ForeSee Results.

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Sheet 3: v3 Model Qsts (EE)

Model Instance Name:
SSA Extra Help v3 (English)
MID:		IVsQkEQIoMBUUs049xE45w4C
Partitioned (Y/N)?		N			Element rotation scheme has been added
FPI Included(Y/N)?
Date:		7/19/2013
SSA Extra Help v3 (English)
Model questions utilize the ACSI methodology to determine scores and impacts
		ELEMENTS (drivers of satisfaction)			CUSTOMER SATISFACTION			FUTURE BEHAVIORS	FPI
	MQ Label			MQ Label			MQ Label		Y?
		Look and Feel (1=Poor, 10=Excellent, Don't Know)			Satisfaction			Recommend (1=Very Unlikely, 10=Very Likely)
	Look and Feel - Appeal	Please rate the visual appeal of the online application for Help with Medicare Prescription Plan Drug Costs.		Satisfaction - Overall	What is your overall satisfaction with the online application for Help with Medicare Prescription Plan Drug Costs? (1=Very Dissatisfied, 10=Very Satisfied)		Recommend	How likely are you to recommend the online application for Help with Medicare Prescription Plan Drug Costs to someone else?
	Look and Feel - Balance	Please rate the balance of graphics and text in the online application for Help with Medicare Prescription Plan Drug Costs.		Satisfaction - Expectations	How well does the online application for Help with Medicare Prescription Plan Drug Costs meet your expectations? (1=Falls Short, 10=Exceeds)			Use Other Applications (1=Very Unlikely, 10=Very Likely)
	Look and Feel - Readability	Please rate the readability of the pages in the online application for Help with Medicare Prescription Plan Drug Costs.		Satisfaction - Ideal	How does the online application for Help with Medicare Prescription Plan Drug Costs compare to your idea of an ideal online application? (1=Not Very Close, 10=Very Close)		Use Other Online Services	How likely are you to use other Social Security online services?
		Site Performance (1=Poor, 10=Excellent, Don't Know)
	Site Performance - Loading	Please rate how quickly pages load in the online application for Help with Medicare Prescription Plan Drug Costs.
	Site Performance - Consistency	Please rate the consistency of speed from page to page in the online application for Help with Medicare Prescription Plan Drug Costs.
	Site Performance - Errors	Please rate the ability to load pages without getting error messages in the online application for Help with Medicare Prescription Plan Drug Costs.
		Plain Language (1=Poor, 10=Excellent, Don't Know)
	Plain Language - Clear	Please rate the clarity of the wording in the Help with Medicare Prescription Plan Drug Costs application.
	Plain Language - Understandable	Please rate how well you understand the wording in the Help with Medicare Prescription Plan Drug Costs application.
	Plain Language - Concise	Please rate the Help with Medicare Prescription Plan Drug Costs application on its use of short, clear sentences.

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Sheet 4: v3 Model Qsts (EN)

Model Instance Name:
SSA Extra Help v3 (English)
MID:		RQFJlkpspsRxQIxpY0s1ZQ4C
Partitioned (Y/N)?		N			Element rotation scheme has been added
FPI Included(Y/N)?
Date:		7/19/2013
SSA Extra Help v3 (English)
Model questions utilize the ACSI methodology to determine scores and impacts
		ELEMENTS (drivers of satisfaction)			CUSTOMER SATISFACTION			FUTURE BEHAVIORS	FPI
	MQ Label			MQ Label			MQ Label		Y?
		Look and Feel (1=Poor, 10=Excellent, Don't Know)			Satisfaction		Recommend	Recommend (1=Very Unlikely, 10=Very Likely)
	Look and Feel - Appeal	Please rate the visual appeal of the online application for Help with Medicare Prescription Plan Drug Costs.		Satisfaction - Overall	What is your overall satisfaction with the online application for Help with Medicare Prescription Plan Drug Costs? (1=Very Dissatisfied, 10=Very Satisfied)			How likely are you to recommend the online application for Help with Medicare Prescription Plan Drug Costs to someone else?
	Look and Feel - Balance	Please rate the balance of graphics and text in the online application for Help with Medicare Prescription Plan Drug Costs.		Satisfaction - Expectations	How well does the online application for Help with Medicare Prescription Plan Drug Costs meet your expectations? (1=Falls Short, 10=Exceeds)		Use Other Online Services	Use Other Applications (1=Very Unlikely, 10=Very Likely)
	Look and Feel - Readability	Please rate the readability of the pages in the online application for Help with Medicare Prescription Plan Drug Costs.		Satisfaction - Ideal	How does the online application for Help with Medicare Prescription Plan Drug Costs compare to your idea of an ideal online application? (1=Not Very Close, 10=Very Close)			How likely are you to use other Social Security online services?
		Site Performance (1=Poor, 10=Excellent, Don't Know)
	Site Performance - Loading	Please rate how quickly pages load in the online application for Help with Medicare Prescription Plan Drug Costs.
	Site Performance - Consistency	Please rate the consistency of speed from page to page in the online application for Help with Medicare Prescription Plan Drug Costs.
	Site Performance - Errors	Please rate the ability to load pages without getting error messages in the online application for Help with Medicare Prescription Plan Drug Costs.
		Plain Language (1=Poor, 10=Excellent, Don't Know)
	Plain Language - Clear	Please rate the clarity of the wording in the Help with Medicare Prescription Plan Drug Costs application.
	Plain Language - Understandable	Please rate how well you understand the wording in the Help with Medicare Prescription Plan Drug Costs application.
	Plain Language - Concise	Please rate the Help with Medicare Prescription Plan Drug Costs application on its use of short, clear sentences.

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Sheet 5: v3 Model Qsts (SP)

Model Instance Name:
SSA Extra Help v3 (Spanish)
MID:		wcscht14I5kxFEcp45Bg0Q4C
Partitioned (Y/N)?		N			Element rotation scheme has been added
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:		7/19/2013
SSA Extra Help v3 (English)
Model questions utilize the ACSI methodology to determine scores and impacts
		ELEMENTS (drivers of satisfaction)			CUSTOMER SATISFACTION			FUTURE BEHAVIORS	FPI
	MQ Label			MQ Label			MQ Label		Y?
		Apariencia y función (1=Mala, 10=Excelente, No sé)			Satisfacción		Recommend	Recomendar (1=Muy improbablemente, 10=Muy probablemente)
	Look and Feel - Appeal	Por favor califique la apariencia de la solicitud por Internet del Beneficio Adicional con los gastos de los planes de las recetas médicas de Medicare.		Satisfaction - Overall	¿Cómo calificaría su satisfacción en general de la solicitud por Internet del Beneficio Adicional con los gastos de los planes de las recetas médicas de Medicare? (1=Totalmente insatisfecho, 10=Totalmente satisfecho)			¿Cuáles son las posibilidades de que le recomiende a otra persona la solicitud por Internet del Beneficio Adicional con los gastos de los planes de las recetas médicas de Medicare ?
	Look and Feel - Balance	Por favor califique el equilibrio entre gráficas y texto de la solicitud por Internet del Beneficio Adicional con los gastos de los planes de las recetas médicas de Medicare.		Satisfaction - Expectations	¿Con cuánta exactitud la solicitud por Internet del Beneficio Adicional con los gastos de los planes de las recetas médicas de Medicare satisfizo sus expectativas? (1=No llenó mis expectativas, 10=Totalmente satisfecho)		Use Other Online Services	Usar por Internet otros programas de computadora del Seguro Social (1=Muy improbablemente, 10=Muy probablemente)
	Look and Feel - Readability	Por favor califique la fluidez del texto de la solicitud por Internet del Beneficio Adicional con los gastos de los planes de las recetas médicas de Medicare.		Satisfaction - Ideal	¿Cómo se compara la solicitud por Internet del Beneficio Adicional con los gastos de los planes de las recetas médicas de Medicare con lo que se imaginaría que sería su programa de computadora ideal? (1=No se asemeja, 10=Se asemeja)			¿Cuáles son las posibilidades de que use otros programas de computadora en este sitio de Internet del Seguro Social?
		Rendimiento del sitio de Internet (1=Mala, 10=Excelente, No sé)
	Site Performance - Loading	Por favor califique la rapidez con que suben las páginas de la solicitud por Internet del Beneficio Adicional con los gastos de los planes de las recetas médicas de Medicare.
	Site Performance - Consistency	Por favor califique la consistencia de la rapidez para moverse de una página a la otra en la solicitud por Internet del Beneficio Adicional con los gastos de los planes de las recetas médicas de Medicare.
	Site Performance - Errors	Por favor califique la capacidad para subir las páginas sin que reciba un error en la solicitud por Internet del Beneficio Adicional con los gastos de los planes de las recetas médicas de Medicare.
		Simpleza del vocabulario (1=Malo, 10=Excelente, No sé)
	Plain Language - Clear	Por favor califique la claridad de las palabras usadas en la solicitud por Internet del Beneficio Adicional con los gastos de los planes de las recetas médicas de Medicare.
	Plain Language - Understandable	Por favor califique su comprensión de las palabras usadas en la solicitud por Internet del Beneficio Adicional con los gastos de los planes de las recetas médicas de Medicare.
	Plain Language - Concise	Por favor califique la solicitud por Internet del Beneficio Adicional con los gastos de los planes de las recetas médicas de Medicare basado en el uso de oraciones cortas y claras.

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Sheet 6: EE v3 Custom Qsts

Model Instance Name:

red & strike-through: DELETE

SSA Extra Help v3 (English)

underlined & italicized: RE-ORDER

MID: IVsQkEQIoMBUUs049xE45w4C

pink: ADDITION

Date:

9/15/2011

blue + -->: REWORDING

violet (bold): SKIP-LOGIC

SSA Extra Help v2 (English Equiv) CUSTOM QUESTION LIST

QID

Skip Logic Label

Question Text

Answer Choices (limited to 50 characters)

Skip to:

Type

Single or Multi

Required Y/N

Special Instructions

CQ Label

BJL2281

Did you complete your application today?

BJL2281A01

Not yet, but I plan to finish today

B-I

Radio

Single

Y

Skip Logic

App Status

Types

BJL2281A02

Yes, I completed my new application today

B-I

Open-ended

BJL2281A03

Yes, I resumed and completed my earlier application

B-I

Text Field – limited to 100 characters

BJL2281A04

No, I did not complete my new application

A, L

Text Area – no character limit

BJL2281A05

No, I did not complete my partial application

A, L

Dropdown (Select-one)

BJL2281A06

I'm not applying for Help with Medicare Prescription Plan Drug Costs today

Radio Button Two Up Vertical

BJL2282

B

How did you first hear about the on-line Application for Help with the Medicare Prescription Plan Drug Costs?

BJL2282A01

A Social Security Representative told me about it

Radio

Single

Y

Skip Logic

Hear About App

Radio Button Three Up Vertical

BJL2282A02

Saw it on the Social Security Website

Radio Button Scale Has Don’t Know

BJL2282A03

Received a letter about it in the mail from SSA

Radio Button Scale No Don’t Know

BJL2282A04

Read about it in a Social Security publication

Checkbox One Up Vertical

BJL2282A05

Read about it in a Medicare publication

Checkbox Two Up Vertical

BJL2282A06

Saw it on the Medicare website

Checkbox Three Up Vertical

BJL2282A07

Saw it in a newspaper, magazine, television or other media source

Select-multiple Show Two

BJL2282A08

Heard about it at my Senior/Community Center

Select-multiple Show Three

BJL2282A09

My doctor, or another professional, told me about it

Select-multiple Show Four

BJL2282A10

Got it from a Search Engine

BJL2282A11

Linked from another website

BJL2282A12

Word-of-mouth

BJL2282A13

Other

BJL2283

D

For whom are you completing the on-line Help with Medicare Prescription Drug Plan Costs application?

BJL2283A01

Myself

Dropdown (select one)

Single

Y

Skip Logic

App For

BJL2283A02

Myself and my spouse

BJL2283A03

My Spouse

BJL2283A04

My parent

BJL2283A05

My client

BJL2283A06

My relative

BJL2283A07

My friend

BJL2284

A

If you have decided to stop working on your application for now, do you plan to return to complete it later?

BJL2284A01

Yes

Dropdown (select one)

Single

Y

Skip Logic

Plan to return?

BJL2284A02

No

BJL2285

L

If you stopped working on your application, please tell us why: (Select all that apply)

BJL2285A01

I'm not applying for Help with Medicare Prescription Plan Drug Costs today

checkbox one up vertical

Multi

Y

Skip Logic

Why did you stop?

BJL2285A02

Needed to find documents/other information for my application

BJL2285A03

Too complicated/Takes too long/Too many questions to answer without help

BJL2285A04

My medical/physical condition prevents me from working on the computer for long periods

BJL2285A05

I don't have the necessary computer skills to complete the application

BJL2285A06

Received an error message/Kicked off

BJL2285A07

Tried to use my Reentry Number to resume my application, but it wouldn't work

BJL2285A08

Didn't have the Reentry Number needed to resume application

BJL2285A09

Application wouldn't accept empty fields

BJL2285A10

I had problem(s) entering information in some of the pages

BJL2285A11

I made a mistake on one of the screens, but couldn't correct it

BJL2285A12

I was working on my application when the site shut down for the night

BJL2285A13

Other Reason

BJL2286

G

Please rate your level of experience using the Internet.

BJL2286A01

Very experienced

Radio

Single

Y

Skip Logic

Internet Experience

BJL2286A02

Somewhat experienced

BJL2286A03

Almost no experience

BJL2286A04

Filing for Extra Help for Prescription Costs online is the first I’ve used the Internet.

BJL2287

H

If you answered you heard about the on-line Application for Help with Medicare Prescription Plan Drug Costs from another website or a search engine, please tell us which one:

text area - no character limit

N

Skip Logic

OE_heard about

BJL2288

I

Do you have any problems with, or specific suggestions to improve, this on-line Application for Help with Medicare Prescription Plan Drug Costs? (Please do not include any personal information in your answer.)

text area - no character limit

N

Skip Logic

OE_Problems

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Sheet 7: EN v3 Custom Qsts

Model Instance Name:

red & strike-through: DELETE

SSA Extra Help v3 (English)

underlined & italicized: RE-ORDER

MID: RQFJlkpspsRxQIxpY0s1ZQ4C

pink: ADDITION

Date:

9/15/2011

blue + -->: REWORDING

violet (bold): SKIP-LOGIC

SSA Extra Help v2 (English) CUSTOM QUESTION LIST

QID

Skip Logic Label

Question Text

Answer Choices (limited to 50 characters)

Skip to:

Type

Single or Multi

Required Y/N

Special Instructions

CQ Label

ENBJL2281

Did you complete your application today?

Not yet, but I plan to finish today

B-I

radio button one-up vertical

Single

Y

Skip Logic

App Status

Types

Yes, I completed my new application today

B-I

Open-ended

Yes, I resumed and completed my earlier application

B-I

Text Field – limited to 100 characters

No, I did not complete my new application

A, L

Text Area – no character limit

No, I did not complete my partial application

A, L

Dropdown (Select-one)

I'm not applying for Help with Medicare Prescription Plan Drug Costs today

Radio Button Two Up Vertical

ENBJL2282

B

How did you first hear about the on-line Application for Help with the Medicare Prescription Plan Drug Costs?

A Social Security Representative told me about it

radio button one-up vertical

Single

Y

Skip Logic

Hear About App

Radio Button Three Up Vertical

Saw it on the Social Security Website

Radio Button Scale Has Don’t Know

Received a letter about it in the mail from SSA

Radio Button Scale No Don’t Know

Read about it in a Social Security publication

Checkbox One Up Vertical

Read about it in a Medicare publication

Checkbox Two Up Vertical

Saw it on the Medicare website

Checkbox Three Up Vertical

Saw it in a newspaper, magazine, television or other media source

Select-multiple Show Two

Heard about it at my Senior/Community Center

Select-multiple Show Three

My doctor, or another professional, told me about it

Select-multiple Show Four

Got it from a Search Engine

Linked from another website

Word-of-mouth

Other

ENBJL2283

D

For whom are you completing the on-line Help with Medicare Prescription Drug Plan Costs application?

Myself

Dropdown (select one)

Single

Y

Skip Logic

App For

Myself and my spouse

My Spouse

My parent

My client

My relative

My friend

ENBJL2284

A

If you have decided to stop working on your application for now, do you plan to return to complete it later?

Yes

Dropdown (select one)

Single

Y

Skip Logic

Plan to return?

No

ENBJL2285

L

If you stopped working on your application, please tell us why: (Select all that apply)

I'm not applying for Help with Medicare Prescription Plan Drug Costs today

checkbox one up vertical

Multi

Y

Skip Logic

Why did you stop?

Needed to find documents/other information for my application

Too complicated/Takes too long/Too many questions to answer without help

My medical/physical condition prevents me from working on the computer for long periods

I don't have the necessary computer skills to complete the application

Received an error message/Kicked off

Tried to use my Reentry Number to resume my application, but it wouldn't work

Didn't have the Reentry Number needed to resume application

Application wouldn't accept empty fields

I had problem(s) entering information in some of the pages

I made a mistake on one of the screens, but couldn't correct it

I was working on my application when the site shut down for the night

Other Reason

ENBJL2286

G

Please rate your level of experience using the Internet.

Very experienced

Radio button one-up vertical

Single

Y

Skip Logic

Internet Experience

Somewhat experienced

Almost no experience

Filing for Extra Help for Prescription Costs online is the first I’ve used the Internet.

ENBJL2287

H

If you answered you heard about the on-line Application for Help with Medicare Prescription Plan Drug Costs from another website or a search engine, please tell us which one:

text area - no character limit

N

Skip Logic

OE_heard about

ENBJL2288

I

Do you have any problems with, or specific suggestions to improve, this on-line Application for Help with Medicare Prescription Plan Drug Costs? (Please do not include any personal information in your answer.)

text area - no character limit

N

Skip Logic

OE_Problems

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Sheet 8: SP v3 Custom Qsts

Model Instance Name:			red & strike-through: DELETE
SSA Extra Help v3 (Spanish)			underlined & italicized: RE-ORDER
MID: wcscht14I5kxFEcp45Bg0Q4C			pink: ADDITION
Date:	9/15/2011		blue + -->: REWORDING
			violet (bold): SKIP-LOGIC
SSA Extra Help v2 (Spanish) CUSTOM QUESTION LIST
QID	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to:	Type	Single or Multi	Required Y/N	Special Instructions	CQ Label
SPBJL2281		¿Completó su solicitud hoy?	Todavía no, pero tengo la intención de terminar hoy.	B-I	Radio	Single	Y	Skip Logic	App Status
			Sí, he terminado mi nueva solicitud hoy.	B-I
			Sí, he resumido y completado mi solicitud anterior.	B-I
			No, no he completado mi nueva solicitud.	A, L
			No, no he completado mi solicitud parcial.	A, L
			No estoy solicitando para recibir el Beneficio Adicional con los gastos del plan de medicamentos recetados de Medicare hoy.
SPBJL2282	B	¿Cómo se enteró de la solicitud por Internet para recibir el Beneficio Adicional con los gastos del plan de medicamentos recetados de Medicare?	Un representante del Seguro Social me dijo sobre este		Radio	Single	Y	Skip Logic	Hear About App
			Lo ví en el sitio de Internet del Seguro Social
			Recibí una carta por correo del Seguro Social
			Leí sobre esta en una publicación del Seguro Social
			Leí sobre esta en una publicación de Medicare
			Lo ví en el sitio de Internet de Medicare
			Lo ví en un periódico, revista, televisión u otros medios de comunicación
			Oí hablar de esta en un centro de comunidad para ancianos.
			Mi médico u otro profesional me dijo sobre este
			Lo obtuve en un lugar de búsqueda por Internet.
			Por un enlace en otro sitio de Internet.
			Lo escuché por otro personas
			Otro modo
SPBJL2283	D	¿Para quién esta completando la solicitud por Internet para el Beneficio Adicional con los gastos del plan de medicamentos recetados?	Para mi mismo		Dropdown (select one)	Single	Y	Skip Logic	App For
			Para mi mismo y mi cónyuge
			Para mi cónyuge
			Para mi padre o madre
			Para mi cliente
			Para mi pariente
			Para mi amigo
SPBJL2284	A	Si ha decidido dejar de trabajar en la solicitud por ahora, ¿espera regresar y completarla mas tarde?	Sí		Dropdown (select one)	Single	Y	Skip Logic	Plan to return?
			No
SPBJL2285	L	Si dejo de trabajar en su solicitud, por favor háganos por qué: (Seleccione todos los que aplican)	No estoy solicitando el Beneficio Adicional con los gastos del plan de medicamentos recetados de Medicare hoy.		checkbox one up vertical	Multi	Y	Skip Logic	Why did you stop?
			Necesitaba encontrar documentos/otra información para mi solicitud
			Muy complicada/Toma mucho tiempo/Demasiadas preguntas que contestar sin ayuda
			Mi padecimiento médico/físico me impide trabajar en la computadora por períodos largos
			No tengo las destrezas de computadora necesarias para completar la solicitud
			Recibí en mensaje de error/El sistema me expulsó
			Traté de usar my Número de Reingreso para regresar a mi solicitud, pero no funcionó
			No tenia el Número de Reingreso para regresar a la solicitud
			La solicitud no aceptó campos en blanco
			Tuve problemas ingresando información en alguna de las páginas
			Cometí un error en una de las pantallas y no pude corregirlo
			Estaba trabajando en mi solitud cuando apagaron el sitio de Internet por la noche.
			Otra razón
SPBJL2286	G	Por favor evalue su nivel de experiencia usando la Internet.	Muy experimentado		Radio	Single	Y	Skip Logic	Internet Experience
			Algo de experiencia
			Inexperto
			Solicitando el Beneficio Adicional con los gastos de medicamentos recetados es la primara vez que uso el Internet.
SPBJL2287	H	Si contestó que escuchó acerca de la solicitud para el Beneficio Adicional con los gastos del plan de medicamentos recetados en otro sitio de Internet o lugar de búsqueda, por favor háganos saber el nombre del sitio:			text area - no character limit		N	Skip Logic	OE_heard about
SPBJL2288	I	¿Tiene algun problema con, o sugerencias especificas para mejorar esta solicitud de Internet para el Beneficio Adicional con los gastos del plan de medicamentos recetados de Medicare? (Por favor no incluya ninguna informacion personal en sus respuestas.)			text area - no character limit		N	Skip Logic	OE_Problems

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Sheet 9: Element Rotations

Base Element Order	Version 2	Version 3	Version 4
Look and Feel	Plain Language	Site Performance	Look and Feel
Site Performance	Site Performance	Look and Feel	Plain Language
Plain Language	Look and Feel	Plain Language	Site Performance
1	7	4	1
2	8	5	2
3	9	6	3
4	4	1	7
5	5	2	8
6	6	3	9
7	1	7	4
8	2	8	5
9	3	9	6