Form 1078 2014 833 SSA iAppeals 2012

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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

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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.

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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

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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

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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

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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.

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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

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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

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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