Form 1077 2014 832 SSA iAppeal 2013

E-Government Website Customer Satisfaction Surveys

2014 832 SSA iAppeal 2013.xlsx

2014 832 SSA iAppeal 2013

OMB: 1090-0008

Document [xlsx]
Download: xlsx | pdf

Overview

Survey Invite Text
Welcome and Thank You Text
W & TY (3-15-13)
Model Qsts
Proposed v2 Model Qs
Current Custom Qsts
Custom Qsts (5-23-14)
Custom Qsts (12-17-13)
Element Rotations

Sheet 1: Survey Invite Text
Note: Changes to the invitation text will require an update to the foresee-surveydef.js file. Upon request ForeSee can provide an updated file for SSA to implement.




























Survey Invitation Text






SSA iAppeals Invitation Text
Thank you for using the Social Security Administration's Internet Appeal application --> online disability appeal. You have been randomly selected to participate in a customer satisfaction survey to let us know how we can improve your website experience.



































































Sheet 2: Welcome and Thank You Text
Model Instance Name:








SSA - iAppeals







MID:
ZpNoNJE50NYgMZApls95Eg==






Date: 8/11/2010








Welcome and Thank You Text













Directions:










This welcome text is shown at the top of the questionnaire window and the thank you text at the bottom. This is a good place to mention the site/company/agency name so the visitor knows whom they are taking the survey for. Feel free to modify the standard Welcome text shown in the box below. These changes will be done by ForeSee.













SSA iAppeals Welcome Text






















































Welcome Text





















Thanks for using the Social Security Administration’s online disability appeal. You've been randomly chosen to take part in a brief survey to let us know what we're doing well and where we can improve.

Please take a few minutes to share your opinions, which are essential in helping us provide the best online experience possible.


























































































































































































































Thank You Text













Thank You Text Example






Thank you for taking our survey - and for helping us serve you better.

Please note you will not receive a response from us based on your survey comments. If you would like us to contact you about your feedback, please visit the Contact Us section of our web site, http://www.socialsecurity.gov/pgm/reach.htm














































































































































































































































































































Sheet 3: W & TY (3-15-13)
Model Instance Name:








SSA - iAppeals







MID:
ZpNoNJE50NYgMZApls95Eg==






Date: 8/11/2010








Welcome and Thank You Text













Directions:










This welcome text is shown at the top of the questionnaire window and the thank you text at the bottom. This is a good place to mention the site/company/agency name so the visitor knows whom they are taking the survey for. Feel free to modify the standard Welcome text shown in the box below. These changes will be done by ForeSee.













SSA iAppeals Welcome Text






















































Welcome Text





















Thanks for using the Social Security Administration’s Internet Appeal application --> online disability appeal. You've been randomly chosen to take part in a brief survey to let us know what we're doing well and where we can improve.

Please take a few minutes to share your opinions, which are essential in helping us provide the best online experience possible.


























































































































































































































Thank You Text













Thank You Text Example






Thank you for taking our survey - and for helping us serve you better.

Please note you will not receive a response from us based on your survey comments. If you would like us to contact you about your feedback, please visit the Contact Us section of our web site, http://www.socialsecurity.gov/pgm/reach.htm














































































































































































































































































































Sheet 4: Model Qsts






SSA - iAppeals


MID: tEtMY0Q8EMsQlUkRVwUM4w4C

Date: 3/1/2013
Model questions utilize the ACSI methodology to determine scores and impacts

ELEMENTS (drivers of satisfaction)
CUSTOMER SATISFACTION
FUTURE BEHAVIORS







Look and Feel (1=Poor, 10=Excellent, Don't Know)
Satisfaction
Use other online applications (1=Very Unlikely, 10=Very Likely)

Please rate the visual appeal of the online disability appeal.
What is your overall satisfaction with the online disability appeal?
(1=Very Dissatisfied, 10=Very Satisfied)
How likely are you to use other on-line applications/forms on the Social Security web site?

Please rate the balance of graphics and text on the online disability appeal.
How well does the online disability appeal meet your expectations?
(1=Falls Short, 10=Exceeds)


Please rate the readability of the pages on the online disability appeal.
How does the online disability appeal compare to your idea of an ideal online form?
(1=Not Very Close, 10=Very Close)


Site Performance (1=Poor, 10=Excellent, Don't Know)




Please rate how quickly pages load on the online disability appeal.


Please rate the consistency of speed from page to page of the online disability appeal.

Please rate the ability to load pages without getting error messages on the online disability appeal.

Online Application Process (1=Poor, 10=Excellent, Don't Know)

Please rate the clarity of the instructions to complete the online disability appeal.




Please rate the simplicity of completing the online disability appeal.




Please rate the number of steps for entering the information into the online disability appeal.










M002071




















Sheet 5: Proposed v2 Model Qs
Model Instance Name:








iAppeals v2








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





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:
6/12/2013





iAppeals v2
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
Use Other Online Services Use other online applications (1=Very Unlikely, 10=Very Likely)

Look and Feel - Appeal Please rate the visual appeal of the online disability appeal.
Satisfaction - Overall What is your overall satisfaction with the online disability appeal? (1=Very Dissatisfied, 10=Very Satisfied)

How likely are you to use other Social Security online services?

Look and Feel - Balance Please rate the balance of graphics and text in the online disability appeal.
Satisfaction - Expectations How well does the online disability appeal meet your expectations? (1=Falls Short, 10=Exceeds)




Look and Feel - Readability Please rate the readability of the pages in the online disability appeal.
Satisfaction - Ideal How does the online disability appeal compare to your idea of an ideal online form? (1=Not Very Close, 10=Very Close)





Site Performance (1=Poor, 10=Excellent, Don't Know)







Site Performance - Loading Please rate how quickly pages load in the online disability appeal.







Site Performance - Consistency Please rate the consistency of speed from page to page in the online disability appeal.







Site Performance - Errors Please rate the ability to load pages without getting error messages in the online disability appeal.








Plain Language (1=Poor, 10=Excellent, Don't Know)







Plain Language - Clear Please rate the clarity of the wording in the online disability appeal.







Plain Language - Understandable Please rate how well you understand the wording in the online disability appeal.




Plain Language - Concise Please rate the online disability appeal on its use of short, clear sentences.























































































































































































































Sheet 6: Current Custom Qsts



red & strike-through: DELETE









SSA - iAppeals

underlined & italicized: RE-ORDER









MID: tEtMY0Q8EMsQlUkRVwUM4w4C
pink: ADDITION









Date: 5/7/2014 blue + -->: REWORDING























SSA - iAppeals 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 25 character limit. CQ Label



MAC0707
Which of the following best describes your role in using the online disability appeal today? Self
Radio Button One Up Vertical Single Y Skip Logic Role




Attorney or Attorney's Staff










Non-Attorney Representative or Non-Attorney Representative's Staff










Other Third Party Representative (e.g. Family Member, Social Service Agency Worker, Case Manager)









MAC0708
Did you start a new online disability appeal today or did you return to work on an appeal you previously started? I started a new appeal
Radio Button One Up Vertical Single Y Skip Logic New or Repeat?






I returned to work on an appeal previously started A








STE0058576 A Please tell us why you did not complete your appeal during your initial session.

Text Field, 1,000 char limit
N Skip Logic OE_Why Returned



STE0058578
How often do you use the online disability appeal? This was the first time
Radio Button One Up Vertical Single Y
Frequency






Less than five times a week












5-10 times per week












11-25 times per week












More than 25 times per week









MAC0709
Did you complete your online disability appeal today? Yes, I completed my online appeal today
Radio Button One Up Vertical Single Y
Complete today






No, I plan to complete it later B











No, I do not plan to complete it B








STE0058579 B Please tell us why you did not complete your appeal during today’s session.

Text Field, 1,000 char limit
N Skip Logic OE_Did not complete today



MAC0710
How much time have you spent on your online disability appeal? Less than 20 minutes
Radio Button One Up Vertical Single Y
Time






20 – 40 minutes












40 minutes - 1 hour












1 - 2 hours












2 or more hours












Not sure









MAC0711
The questions did not seem to be organized in a logical manner
Checkbox, one-up vertical Multi N Skip Logic Form Experience






I had difficulty understanding the questions because they were not clearly written











I did not have the information necessary to answer the questions










I had difficulty editing the medical information (e.g. doctors, medication, etc.)










I had difficulty editing other information











I was unable to print











I did not have enough time to complete











I received an error message or was “kicked out” of the appeal











The text box blanks did not allow enough characters for my answers











Other












Matthew Castillo: I made this mutually exclusive. Let me know if you want it removed please. I did not have any difficulties









MAC0712
So that we can better identify the difficulties you indicated above, please provide specific information if possible. (i.e. Which questions or sections were difficult? Where did you receive an error message? etc.)

Text Field, 1,000 char limit
N
Difficult



MAC0714
How helpful was the information on the online disability appeal Welcome Page? Very helpful
Drop Down, Select one Single Y
Welcome Page Angie Kiger: DOT - Please note the reordering of questions. Previously, the Ease of Navigating was first, now we want the Welcome Page first, then the new Pop ups question, then Ease of Navigating.






Somewhat helpful












Not helpful at all












Did not read the Welcome Page












Don't remember









CAS0045693
How helpful were the links to pop-up help pages (as indicated by a blue question mark) throughout the online disability appeal application? Very helpful
Drop Down, Select one Single Y
Pop-up Help Links






Somewhat helpful












Not helpful at all












Did not read the help links












Don't remember









MAC0713
Please rate the ease of navigating through the online disability appeal. Very easy
Drop Down, Select one Single Y
Ease of Navigating






Somewhat easy












Somewhat difficult












Very difficult









MAC0715
Did you have ALL of your personal and medical information ready when you started? Yes
Radio Button One Up Vertical Single Y Skip Logic Necessary Documents






No C, D








STE0058580 C What personal and/or medical information did you not have ready when you started?

Text Field, 1,000 char limit
N Skip Logic OE_Info Needed



STE0058581 D Could we have provided any additional information or assistance to help you be more prepared?

Text Field, 1,000 char limit
N Skip Logic OE_Improve Info Needed



MAC0716
How can we improve the online disability appeal? Please be as specific as possible. (Examples: What information we could have provided upfront? Do you have any suggested changes or updates?)

Text Field, 1,000 char limit
N
Improvement

















Sheet 7: Custom Qsts (5-23-14)



red & strike-through: DELETE








SSA - iAppeals

underlined & italicized: RE-ORDER








MID: tEtMY0Q8EMsQlUkRVwUM4w4C
pink: ADDITION








Date: 5/7/2014 blue + -->: REWORDING





















SSA - iAppeals 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 25 character limit. CQ Label


MAC0707
Which of the following best describes your role in using the online disability appeal today? Self
Radio Button One Up Vertical Single Y Skip Logic Role



Attorney or Attorney's Staff









Non-Attorney Representative or Non-Attorney Representative's Staff









Other Third Party Representative (e.g. Family Member, Social Service Agency Worker, Case Manager)








MAC0708
Did you start a new online disability appeal today or did you return to work on an appeal you previously started? I started a new appeal
Radio Button One Up Vertical Single Y Skip Logic New or Repeat?





I returned to work on an appeal previously started A








A Please tell us why you did not complete your appeal during your initial session.

Text Field, 1,000 char limit
N Skip Logic OE_Why Returned




How often do you use the online disability appeal? This was the first time
Radio Button One Up Vertical Single Y
Frequency





Less than five times a week











5-10 times per week











11-25 times per week











More than 25 times per week








MAC0709
Did you complete your online disability appeal today? Yes, I completed my online appeal today
Radio Button One Up Vertical Single Y
Complete today





No, I plan to complete it later B










No, I do not plan to complete it B








B Please tell us why you did not complete your appeal during today’s session.

Text Field, 1,000 char limit
N Skip Logic OE_Did not complete today


MAC0710
How much time have you spent on your online disability appeal? Less than 20 minutes
Radio Button One Up Vertical Single Y
Time





20 – 40 minutes











40 minutes - 1 hour











1 - 2 hours











2 or more hours











Not sure








MAC0711
The questions did not seem to be organized in a logical manner
Checkbox, one-up vertical Multi N Skip Logic Form Experience





I had difficulty understanding the questions because they were not clearly written










I did not have the information necessary to answer the questions









I had difficulty editing the medical information (e.g. doctors, medication, etc.)









I had difficulty editing other information










I was unable to print










I did not have enough time to complete










I received an error message or was “kicked out” of the appeal










The text box blanks did not allow enough characters for my answers










Other











Matthew Castillo: I made this mutually exclusive. Let me know if you want it removed please. I did not have any difficulties








MAC0712
So that we can better identify the difficulties you indicated above, please provide specific information if possible. (i.e. Which questions or sections were difficult? Where did you receive an error message? etc.)

Text Field, 1,000 char limit
N
Difficult


MAC0714
How helpful was the information on the online disability appeal Welcome Page? Very helpful
Drop Down, Select one Single Y
Welcome Page Angie Kiger: DOT - Please note the reordering of questions. Previously, the Ease of Navigating was first, now we want the Welcome Page first, then the new Pop ups question, then Ease of Navigating.





Somewhat helpful











Not helpful at all











Did not read the Welcome Page











Don't remember








CAS0045693
How helpful were the links to pop-up help pages (as indicated by a blue question mark) throughout the online disability appeal application? Very helpful
Drop Down, Select one Single Y
Pop-up Help Links





Somewhat helpful











Not helpful at all











Did not read the help links











Don't remember








MAC0713
Please rate the ease of navigating through the online disability appeal. Very easy
Drop Down, Select one Single Y
Ease of Navigating





Somewhat easy











Somewhat difficult











Very difficult








MAC0715
Did you have ALL of your personal and medical information ready when you started? Yes
Radio Button One Up Vertical Single Y Skip Logic Necessary Documents





No C, D








C What personal and/or medical information did you not have ready when you started?

Text Field, 1,000 char limit
N Skip Logic OE_Info Needed



D Could we have provided any additional information or assistance to help you be more prepared?

Text Field, 1,000 char limit
N Skip Logic OE_Improve Info Needed


MAC0716
How can we improve the online disability appeal? Please be as specific as possible. (Examples: What information we could have provided upfront? Do you have any suggested changes or updates?)

Text Field, 1,000 char limit
N
Improvement















Sheet 8: Custom Qsts (12-17-13)



red & strike-through: DELETE








SSA - iAppeals

underlined & italicized: RE-ORDER








MID: ZpNoNJE50NYgMZApls95Eg==
pink: ADDITION








Date: 3/1/2013 blue + -->: REWORDING





















SSA - iAppeals 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 25 character limit. CQ Label


MAC0707
Which of the following best describes your role in using the online disability appeal today? Self
Radio Button One Up Vertical Single Y Skip Logic Role



Attorney or Attorney's Staff









Non-Attorney Representative or Non-Attorney Representative's Staff









Other Third Party Representative (e.g. Family Member, Social Service Agency Worker, Case Manager)








MAC0708
Did you start a new online disability appeal today or did you return to work on an appeal you previously started? I started a new appeal
Radio Button One Up Vertical Single Y
New or Repeat?





I returned to work on an appeal previously started








MAC0709
Did you complete your online disability appeal today? Yes, I completed my online appeal today
Radio Button One Up Vertical Single Y
Complete today





No, I plan to complete it later











No, I do not plan to complete it








MAC0710
How much time have you spent on your online disability appeal? Less than 20 minutes
Radio Button One Up Vertical Single Y
Time





20 – 40 minutes










40 minutes - 1 hour











1 - 2 hours











2 or more hours











Not sure








MAC0711
Did you experience any of the following while completing the online disability appeal? Check all that apply. The questions did not seem to be organized in a logical manner
Checkbox, one-up vertical Multi N Skip Logic Form Experience





I had difficulty understanding the questions because they were not clearly written










I did not have the information necessary to answer the questions









I had difficulty editing the medical information (e.g. doctors, medication, etc.)









I had difficulty editing other information










I was unable to print










I did not have enough time to complete










I received an error message or was “kicked out” of the appeal










The text box blanks did not allow enough characters for my answers










Other











Matthew Castillo: I made this mutually exclusive. Let me know if you want it removed please. I did not have any difficulties








MAC0712
So that we can better identify the difficulties you indicated above, please provide specific information if possible. (i.e. Which questions or sections were difficult? Where did you receive an error message? etc.)

Text Field, 1,000 char limit
N
Difficult


MAC0714
How helpful was the information on the online disability appeal Welcome Page? Very helpful
Drop Down, Select one Single Y
Welcome Page Angie Kiger: DOT - Please note the reordering of questions. Previously, the Ease of Navigating was first, now we want the Welcome Page first, then the new Pop ups question, then Ease of Navigating.





Somewhat helpful











Not helpful at all











Did not read the Welcome Page











Don't remember










How helpful were the links to pop-up help pages (as indicated by a blue question mark) throughout the online disability appeal application? Very helpful
Drop Down, Select one Single Y
Pop-up Help Links





Somewhat helpful











Not helpful at all











Did not read the help links











Don't remember








MAC0713
Please rate the ease of navigating through the online disability appeal. Very easy
Drop Down, Select one Single Y
Ease of Navigating





Somewhat easy











Somewhat difficult











Very difficult








MAC0715
Did you have ALL of your personal and medical information ready when you started? Yes
Radio Button One Up Vertical Single Y
Necessary Documents





No








MAC0716
How can we improve the online disability appeal? Please be as specific as possible. (Examples: What information we could have provided upfront? Do you have any suggested changes or updates?)

Text Field, 1,000 char limit
N
Improvement


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
File Typeapplication/vnd.openxmlformats-officedocument.spreadsheetml.sheet
File Modified0000-00-00
File Created0000-00-00
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