| Model Instance Name: | ||||||||||
| SSA iClaim v3 | underlined & italicized: RE-ORDER | |||||||||
| MID: xZAAEQw81gIo1Vo4Noc1Rw4C | pink: ADDITION | |||||||||
| Date: | 7/15/2011 | blue + -->: REWORDING | ||||||||
| violet (bold): SKIP-LOGIC | ||||||||||
| SSA iClaim v3 CUSTOM QUESTION LIST | ||||||||||
| QID | Skip Logic Label | Question Text | Answer Choices (limited to 50 characters) |
Skip To | Type (select from list) | Single or Multi | Required Y/N |
Special Instructions | CQ Label | |
| BJL2231 | What type of benefits were you applying for? | Retirement | Dropdown (Select-one) | Single | Y | Type of Benefits | ||||
| Medicare only | ||||||||||
| Disability | ||||||||||
| Both Retirement and Disability | ||||||||||
| Spouse's | ||||||||||
| Other | ||||||||||
| CAS0045242 | Are you applying online for yourself or are you helping someone else? | Myself | Dropdown (Select-one) | Single | Y | Applying for | ||||
| Helping a Spouse/Relative/Friend | ||||||||||
| Professional Helping a Client | ||||||||||
| Other | ||||||||||
| CAS0045243 | How did you learn about this online application? (Select all that apply.) | Official Social Security website | check box one up vertical | Multi | Y | Skip Logic Group | Learn about App | |||
| A general web search (e.g. Google, Bing, etc.) | ||||||||||
| The radio | ||||||||||
| The television | ||||||||||
| An email from Social Security | ||||||||||
| A newspaper or magazine article | ||||||||||
| An online ad (Banner/Image) | ||||||||||
| An online video | ||||||||||
| A newspaper or magazine ad | ||||||||||
| A billboard or other printed ad | ||||||||||
| Social Media (Blog, Facebook, Twitter, etc.) | ||||||||||
| Friend, spouse, relative, neighbor or acquaintance | ||||||||||
| Social Security statement | ||||||||||
| Social Security employee | A | |||||||||
| Community Group or Association | ||||||||||
| Other, please specify | B | |||||||||
| CAS0045244 | A | How did you make contact with a Social Security employee? | Visited a local Social Security office | check box one up vertical | Multi | Y | Skip Logic | SSA Emplyee Contact | ||
| Called a local Social Security office | ||||||||||
| Called the national 800 number | ||||||||||
| Other, please specify | AA | |||||||||
| CAS0045245 | AA | Please describe how you made contact with a Social Security employee. | Text box, no char limit | N | Skip Logic | OPS SSA Employe Contact | ||||
| CAS0045246 | B | Please specify how you learned about this online application. | Text box, no char limit | N | Skip Logic | OPS Learn about App | ||||
| CAS0045262 | Did you use any of the following to prepare to apply online? (Select all that apply.) | Reviewed my online Social Security Statement | A | check box one up vertical | Multi | Y | Skip Logic | Prepare for App | ||
| I used the Retirement Estimator or other tools on the Social Security website | B | |||||||||
| I watched the instructional video | C | |||||||||
| I used other information on the Social Security website to prepare | D | |||||||||
| I used another resource to prepare to apply online | E | |||||||||
| I did not use any resources to prepare to apply online | ||||||||||
| CAS0045263 | A | How helpful did you find the online Social Security Statement? | Very helpful | Drop down select one | Single | Y | Skip Logic | Rate Statement | ||
| Somewhat helpful | ||||||||||
| Not at all helpful | ||||||||||
| CAS0045264 | B | How helpful did you find the estimator tools on the website? | Very helpful | Drop down select one | Single | Y | Skip Logic | Rate RE Tools | ||
| Somewhat helpful | ||||||||||
| Not at all helpful | ||||||||||
| CAS0045265 | C | How helpful did you find the instructional video? | Very helpful | Drop down select one | Single | Y | Skip Logic | Rate Video | ||
| Somewhat helpful | ||||||||||
| Not at all helpful | ||||||||||
| CAS0045266 | D | How helpful did you find the other information on the Social Security website? | Very helpful | Drop down select one | Single | Y | Skip Logic | Rate Other Info on Website | ||
| Somewhat helpful | ||||||||||
| Not at all helpful | ||||||||||
| CAS0045267 | E | Please describe what other resource(s) you used to prepare to apply online? | Text field, no char limit | N | Skip Logic | OPS Prepare for App | ||||
| CAS0045247 | Did you start a new online application today or did you return to a saved application? | Started a new application | Drop down select one | Single | Y | App Status | ||||
| Returned to work on a saved application | ||||||||||
| CAS0045282 | Did you complete and submit this online application today? | Yes | Drop down select one | Single | Y | Skip Logic | Complete App | |||
| No, I plan to complete and submit later | A | |||||||||
| No, I do not plan to complete and submit the online application | A | |||||||||
| CAS0045283 | A | If you did not complete and submit this online application today, please tell us why. | Too many questions | check box one up vertical | Multi | Y | Skip Logic | Not Complete App | ||
| Takes too long to fill out | ||||||||||
| Too complicated to use without help | ||||||||||
| Didn't have information I needed like names, addresses, or dates | ||||||||||
| Didn't understand what questions meant/how to answer | ||||||||||
| I wanted to use the Retirement Estimator to reconsider my retirement options | ||||||||||
| I needed to view my Social Security Statement and/or verify that my earnings record is correct | ||||||||||
| My disabling condition prevents me from working with a computer for long periods | ||||||||||
| I had a limited amount of time/family demands that kept me from working on it for very long | ||||||||||
| I had technical problems like an error message or a mistake I couldn't fix | ||||||||||
| Other, please specify | AA | |||||||||
| CAS0045284 | AA | Please tell us why you did not complete and submit this application today. | Text field, no char limit | N | Skip Logic | OPS Why Not Complete today | ||||
| CAS0045248 | So far, how long have you worked on this online application? | Up to 15 minutes | Drop down select one | Single | Y | Time Spent | ||||
| 16 minutes - 30 minutes | ||||||||||
| 31 minutes - 1 hour | ||||||||||
| More than 1 hour up to 2 hours | ||||||||||
| More than 2 hours | ||||||||||
| CAS0045249 | How easy was it for you to find this online application? | Very easy | Find App | |||||||
| Somewhat easy | ||||||||||
| Somewhat hard | A | |||||||||
| Very hard | A | |||||||||
| CAS0045250 | A | Please tell us why it was hard to find the online application. (Select all that apply.) | Could not find where to start a new online application | check box one up vertical | Multi | Y | Skip Logic | Why hard to find | ||
| Not clear where to go to return to a previously saved application | ||||||||||
| It was not clear to me where the links would lead | ||||||||||
| Difficulty using a link on the Social Security website | ||||||||||
| The information did not seem to be organized in a logical manner | ||||||||||
| I used the search feature but the results didn’t seem to apply. | ||||||||||
| I tried to use the FAQ's, but couldn't find the online application | ||||||||||
| Other reason (please describe) | AA | |||||||||
| CAS0045285 | AA | Please explain the reason why it was hard for you to find the online application. | N | N | Skip Logic | OPS Hard to Find | ||||
| CAS0045286 | How did you arrive at this online application today? | Used the Online Services link on the Social Security homepage | Radio Button | Single | Y | Skip Logic | Arrive at App | |||
| Followed a link from somewhere else on the Social Security website | ||||||||||
| Used the search feature on the Social Security website | ||||||||||
| Used an outside search engine (i.e. Google, Bing, yahoo etc.) | ||||||||||
| Followed a link from medicare.gov | ||||||||||
| Followed a link from another website | ||||||||||
| Site was bookmarked | ||||||||||
| Other, please specify | A | |||||||||
| CAS0045251 | A | Please describe how you arrived at this online application today | Text field, no char limit | N | OPS Arrive at app | |||||
| CAS0045252 | Why did you choose to apply online? (Select all that apply.) | I did not want to go to a local Social Security office | check box one up vertical | Multi | Y | Skip Logic | Why Online | |||
| I did not want to apply over the phone | ||||||||||
| I prefer to use online services as much as possible | ||||||||||
| I learned about applying online while visiting Social Security's website | ||||||||||
| A Social Security employee recommended that I apply online | ||||||||||
| A friend or relative recommended that I apply online | ||||||||||
| I knew that if I had a question or problem applying online, I could still get help from Social Security | ||||||||||
| I am filing on behalf of another person | ||||||||||
| Other, please specify | A | |||||||||
| CAS0045287 | A | Please specify why you choose to apply online | Text field, no char limit | N | OPS Why Online | |||||
| CAS0045289 | What is your current marital status? | Married | Radio button, one-up vertical | Single | N | OPS Group | Marital Status | |||
| Separated | ||||||||||
| Divorced | ||||||||||
| Widowed | ||||||||||
| Never married | ||||||||||
| Prefer not to answer | ||||||||||
| Other, please specify | A | |||||||||
| CAS0045290 | A | Other marital status | Text field, <100 char | N | OPS Group | OPS Marital Status | ||||
| STE0059662 | Have you registered for a my Social Security account? | Yes | Radio button, one-up vertical | Single | Y | Skip Logic | Have mySSA Account | |||
| No | A | |||||||||
| STE0061423 | A | What is the main reason you have not registered for a my Social Security account? | I am unaware of what a my Social Security account is. | Radio button, one-up vertical | Single | Y | Skip Logic | Why Not Have mySSA Account | ||
| I tried to register for a my Social Security account, but was unsuccessful. | ||||||||||
| I am currently trying to register for a my Social Security account. | ||||||||||
| I do not want a my Social Security account. | ||||||||||
| Other (please specify): | AA | |||||||||
| STE0061395 | AA | Please tell us why you have not registered for a my Social Security account. | Text field, no char limit | Single | N | Skip Logic | OPS_Why Not Have mySSA Account | |||
| CAS0045291 | Do you have any suggestions for improving Social Security's online application. | Text field, no char limit | N | OE_Improvement | ||||||
| Model Instance Name: | ||||||||||
| SSA iClaim v3 | underlined & italicized: RE-ORDER | |||||||||
| MID: VgpBBYx9l8JxIFgJlY1Ikg4C | pink: ADDITION | |||||||||
| Date: | 7/15/2011 | blue + -->: REWORDING | ||||||||
| violet (bold): SKIP-LOGIC | ||||||||||
| SSA iClaim v3 CUSTOM QUESTION LIST | ||||||||||
| QID | Skip Logic Label | Question Text | Answer Choices (limited to 50 characters) |
Skip To | Type (select from list) | Single or Multi | Required Y/N |
Special Instructions | CQ Label | |
| ENBJL2231 | What type of benefits were you applying for? | Retirement | Dropdown (Select-one) | Single | Y | Type of Benefits | ||||
| Medicare only | ||||||||||
| Disability | ||||||||||
| Both Retirement and Disability | ||||||||||
| Spouse's | ||||||||||
| Other | ||||||||||
| ENCAS0045242 | Are you applying online for yourself or are you helping someone else? | Myself | Dropdown (Select-one) | Single | Y | Applying for | ||||
| Helping a Spouse/Relative/Friend | ||||||||||
| Professional Helping a Client | ||||||||||
| Other | ||||||||||
| ENCAS0045243 | How did you learn about this online application? (Select all that apply.) | Official Social Security website | check box one up vertical | Multi | Y | Skip Logic Group | Learn about App | |||
| A general web search (e.g. Google, Bing, etc.) | ||||||||||
| The radio | ||||||||||
| The television | ||||||||||
| An email from Social Security | ||||||||||
| A newspaper or magazine article | ||||||||||
| An online ad (Banner/Image) | ||||||||||
| An online video | ||||||||||
| A newspaper or magazine ad | ||||||||||
| A billboard or other printed ad | ||||||||||
| Social Media (Blog, Facebook, Twitter, etc.) | ||||||||||
| Friend, spouse, relative, neighbor or acquaintance | ||||||||||
| Social Security statement | ||||||||||
| Social Security employee | A | |||||||||
| Community Group or Association | ||||||||||
| Other, please specify | B | |||||||||
| ENCAS0045244 | A | How did you make contact with a Social Security employee? | Visited a local Social Security office | check box one up vertical | Multi | Y | Skip Logic | SSA Emplyee Contact | ||
| Called a local Social Security office | ||||||||||
| Called the national 800 number | ||||||||||
| Other, please specify | AA | |||||||||
| ENCAS0045245 | AA | Please describe how you made contact with a Social Security employee. | Text box, no char limit | N | Skip Logic | OPS SSA Employe Contact | ||||
| ENCAS0045246 | B | Please specify how you learned about this online application. | Text box, no char limit | N | Skip Logic | OPS Learn about App | ||||
| ENCAS0045262 | Did you use any of the following to prepare to apply online? (Select all that apply.) | Reviewed my online Social Security Statement | A | check box one up vertical | Multi | Y | Skip Logic | Prepare for App | ||
| I used the Retirement Estimator or other tools on the Social Security website | B | |||||||||
| I watched the instructional video | C | |||||||||
| I used other information on the Social Security website to prepare | D | |||||||||
| I used another resource to prepare to apply online | E | |||||||||
| I did not use any resources to prepare to apply online | ||||||||||
| ENCAS0045263 | A | How helpful did you find the online Social Security Statement? | Very helpful | Drop down select one | Single | Y | Skip Logic | Rate Statement | ||
| Somewhat helpful | ||||||||||
| Not at all helpful | ||||||||||
| ENCAS0045264 | B | How helpful did you find the estimator tools on the website? | Very helpful | Drop down select one | Single | Y | Skip Logic | Rate RE Tools | ||
| Somewhat helpful | ||||||||||
| Not at all helpful | ||||||||||
| ENCAS0045265 | C | How helpful did you find the instructional video? | Very helpful | Drop down select one | Single | Y | Skip Logic | Rate Video | ||
| Somewhat helpful | ||||||||||
| Not at all helpful | ||||||||||
| ENCAS0045266 | D | How helpful did you find the other information on the Social Security website? | Very helpful | Drop down select one | Single | Y | Skip Logic | Rate Other Info on Website | ||
| Somewhat helpful | ||||||||||
| Not at all helpful | ||||||||||
| ENCAS0045267 | E | Please describe what other resource(s) you used to prepare to apply online? | Text field, no char limit | N | Skip Logic | OPS Prepare for App | ||||
| ENCAS0045247 | Did you start a new online application today or did you return to a saved application? | Started a new application | Drop down select one | Single | Y | App Status | ||||
| Returned to work on a saved application | ||||||||||
| ENCAS0045282 | Did you complete and submit this online application today? | Yes | Drop down select one | Single | Y | Skip Logic | Complete App | |||
| No, I plan to complete and submit later | A | |||||||||
| No, I do not plan to complete and submit the online application | A | |||||||||
| ENCAS0045283 | A | If you did not complete and submit this online application today, please tell us why. | Too many questions | check box one up vertical | Multi | Y | Skip Logic | Not Complete App | ||
| Takes too long to fill out | ||||||||||
| Too complicated to use without help | ||||||||||
| Didn't have information I needed like names, addresses, or dates | ||||||||||
| Didn't understand what questions meant/how to answer | ||||||||||
| I wanted to use the Retirement Estimator to reconsider my retirement options | ||||||||||
| I needed to view my Social Security Statement and/or verify that my earnings record is correct | ||||||||||
| My disabling condition prevents me from working with a computer for long periods | ||||||||||
| I had a limited amount of time/family demands that kept me from working on it for very long | ||||||||||
| I had technical problems like an error message or a mistake I couldn't fix | ||||||||||
| Other, please specify | AA | |||||||||
| ENCAS0045284 | AA | Please tell us why you did not complete and submit this application today. | Text field, no char limit | N | Skip Logic | OPS Why Not Complete today | ||||
| ENCAS0045248 | So far, how long have you worked on this online application? | Up to 15 minutes | Drop down select one | Single | Y | Time Spent | ||||
| 16 minutes - 30 minutes | ||||||||||
| 31 minutes - 1 hour | ||||||||||
| More than 1 hour up to 2 hours | ||||||||||
| More than 2 hours | ||||||||||
| ENCAS0045249 | How easy was it for you to find this online application? | Very easy | Find App | |||||||
| Somewhat easy | ||||||||||
| Somewhat hard | A | |||||||||
| Very hard | A | |||||||||
| ENCAS0045250 | A | Please tell us why it was hard to find the online application. (Select all that apply.) | Could not find where to start a new online application | check box one up vertical | Multi | Y | Skip Logic | Why hard to find | ||
| Not clear where to go to return to a previously saved application | ||||||||||
| It was not clear to me where the links would lead | ||||||||||
| Difficulty using a link on the Social Security website | ||||||||||
| The information did not seem to be organized in a logical manner | ||||||||||
| I used the search feature but the results didn’t seem to apply. | ||||||||||
| I tried to use the FAQ's, but couldn't find the online application | ||||||||||
| Other reason (please describe) | AA | |||||||||
| ENCAS0045285 | AA | Please explain the reason why it was hard for you to find the online application. | N | N | Skip Logic | OPS Hard to Find | ||||
| ENCAS0045286 | How did you arrive at this online application today? | Used the Online Services link on the Social Security homepage | Radio Button | Single | Y | Skip Logic | Arrive at App | |||
| Followed a link from somewhere else on the Social Security website | ||||||||||
| Used the search feature on the Social Security website | ||||||||||
| Used an outside search engine (i.e. Google, Bing, yahoo etc.) | ||||||||||
| Followed a link from medicare.gov | ||||||||||
| Followed a link from another website | ||||||||||
| Site was bookmarked | ||||||||||
| Other, please specify | A | |||||||||
| ENCAS0045251 | A | Please describe how you arrived at this online application today | Text field, no char limit | N | OPS Arrive at app | |||||
| ENCAS0045252 | Why did you choose to apply online? (Select all that apply.) | I did not want to go to a local Social Security office | check box one up vertical | Multi | Y | Skip Logic | Why Online | |||
| I did not want to apply over the phone | ||||||||||
| I prefer to use online services as much as possible | ||||||||||
| I learned about applying online while visiting Social Security's website | ||||||||||
| A Social Security employee recommended that I apply online | ||||||||||
| A friend or relative recommended that I apply online | ||||||||||
| I knew that if I had a question or problem applying online, I could still get help from Social Security | ||||||||||
| I am filing on behalf of another person | ||||||||||
| Other, please specify | A | |||||||||
| ENCAS0045287 | A | Please specify why you choose to apply online | Text field, no char limit | N | OPS Why Online | |||||
| ENCAS0045289 | What is your current marital status? | Married | Radio button, one-up vertical | Single | N | OPS Group | Marital Status | |||
| Separated | ||||||||||
| Divorced | ||||||||||
| Widowed | ||||||||||
| Never married | ||||||||||
| Prefer not to answer | ||||||||||
| Other, please specify | A | |||||||||
| ENCAS0045290 | A | Other marital status | Text field, <100 char | N | OPS Group | OPS Marital Status | ||||
| ENSTE0059662 | Have you registered for a my Social Security account? | Yes | Radio button, one-up vertical | Single | Y | Skip Logic | Have mySSA Account | |||
| No | A | |||||||||
| ENSTE0061423 | A | What is the main reason you have not registered for a my Social Security account? | I am unaware of what a my Social Security account is. | Radio button, one-up vertical | Single | Y | Skip Logic | Why Not Have mySSA Account | ||
| I tried to register for a my Social Security account, but was unsuccessful. | ||||||||||
| I am currently trying to register for a my Social Security account. | ||||||||||
| I do not want a my Social Security account. | ||||||||||
| Other (please specify): | AA | |||||||||
| ENSTE0061395 | AA | Please tell us why you have not registered for a my Social Security account. | Text field, no char limit | Single | N | Skip Logic | OPS_Why Not Have mySSA Account | |||
| ENCAS0045291 | Do you have any suggestions for improving Social Security's online application. | Text field, no char limit | N | OE_Improvement | ||||||
| Model Instance Name: | ||||||||||
| SSA iClaim v3 (Spanish) | underlined & italicized: RE-ORDER | |||||||||
| MID: | Q0ExM1xNQRl9JJUR0M0JlA4C | pink: ADDITION | ||||||||
| Date: | 7/15/2011 | blue + -->: REWORDING | ||||||||
| violet (bold): SKIP-LOGIC | ||||||||||
| SSA iClaim v3 (Spanish) CUSTOM QUESTION LIST | ||||||||||
| QID | Skip Logic Label | Question Text | Answer Choices (limited to 50 characters) |
Skip To | Type (select from list) | Single or Multi | Required Y/N |
Special Instructions | CQ Label | |
| SPBJL2231 | ¿Qué tipo de beneficios estaba solicitando? | Por jubilación | Dropdown (Select-one) | Single | Y | Type of Benefits | ||||
| Solo Medicare | ||||||||||
| Por incapacidad | ||||||||||
| Tanto Jubilación y Discapacidad | ||||||||||
| Coomo cónyuge | ||||||||||
| Otro | ||||||||||
| SPCAS0045242 | ¿Es esta solicitud en línea para sí mismo o estás ayudando a alguien más? | Yo mismo | Dropdown (Select-one) | Single | Y | Applying for | ||||
| Cómo ayudar a un cónyuge / pariente / amigo | ||||||||||
| Profesional Ayudar a un cliente | ||||||||||
| Otro | ||||||||||
| SPCAS0045243 | ¿Cómo se enteró acerca de esta solicitud en línea? (Seleccione todas las que apliquen.) | Sitio web oficial de la Seguridad Social | check box one up vertical | Multi | Y | Skip Logic Group | Learn about App | |||
| Una búsqueda web general (por ejemplo, Google, Bing, etc) | ||||||||||
| La radio | ||||||||||
| La televisión | ||||||||||
| Un correo electrónico de la Seguridad Social | ||||||||||
| Un periódico o la revista | ||||||||||
| Un anuncio en línea (Banner / Imagen) | ||||||||||
| Un video en línea | ||||||||||
| Un periódico o una revista de anuncios | ||||||||||
| Un anuncio impreso cartelera u otro | ||||||||||
| Medios de Comunicación Social (Blog, Facebook, Twitter, etc) | ||||||||||
| Amigo, cónyuge, pariente, vecino o conocido | ||||||||||
| Declaración del Seguro Social | ||||||||||
| Empleado del Seguro Social | A | |||||||||
| Grupo de la comunidad o de la Asociación | ||||||||||
| Otro, especificar | B | |||||||||
| SPCAS0045244 | A | ¿Cómo se hace el contacto con un empleado del Seguro Social? | Visitado una oficina local del Seguro Social | check box one up vertical | Multi | Y | Skip Logic | SSA Emplyee Contact | ||
| Llamado a la oficina local del Seguro Social | ||||||||||
| Llamado el número nacional 800 | ||||||||||
| Otro, especificar | AA | |||||||||
| SPCAS0045245 | AA | Por favor describa cómo se hizo contacto con un empleado del Seguro Social. | Text box, no char limit | N | Skip Logic | OPS SSA Employe Contact | ||||
| SPCAS0045246 | B | Por favor, especifique cómo se enteró de esta aplicación en línea. | Text box, no char limit | N | Skip Logic | OPS Learn about App | ||||
| SPCAS0045262 | ¿Ha usado alguna de las siguientes acciones para prepararse para aplicar en línea? (Seleccione todas las que apliquen.) | Comentado mi Declaración del Seguro Social en línea | A | check box one up vertical | Multi | Y | Skip Logic | Prepare for App | ||
| He utilizado el Retirement Estimator u otras herramientas en el sitio web de la Seguridad Social | B | |||||||||
| Vi el video de instrucciones | C | |||||||||
| Usé otra información en la página web de la Seguridad Social para preparar | D | |||||||||
| Utilicé otro recurso que se preparen para aplicar en línea | E | |||||||||
| No hice uso de los recursos para prepararse para aplicar en línea | ||||||||||
| SPCAS0045263 | A | ¿Qué tan útil ha encontrado el Declaración del Seguro Social en línea? | Muy útil | Drop down select one | Single | Y | Skip Logic | Rate Statement | ||
| algo útil | ||||||||||
| Para nada útil | ||||||||||
| SPCAS0045264 | B | ¿Qué tan útil encontraste las herramientas estimador en el sitio web? | Muy útil | Drop down select one | Single | Y | Skip Logic | Rate RE Tools | ||
| algo útil | ||||||||||
| Para nada útil | ||||||||||
| SPCAS0045265 | C | ¿Qué tan útil le parecen la video instructivo? | Muy útil | Drop down select one | Single | Y | Skip Logic | Rate Video | ||
| algo útil | ||||||||||
| Para nada útil | ||||||||||
| SPCAS0045266 | D | ¿Qué tan útil le parecen la otra información en el sitio web de la Seguridad Social? | Muy útil | Drop down select one | Single | Y | Skip Logic | Rate Other Info on Website | ||
| algo útil | ||||||||||
| Para nada útil | ||||||||||
| SPCAS0045267 | E | Por favor describa lo otro recurso (s) que utilizó para prepararse para aplicar en línea. | Text field, no char limit | N | Skip Logic | OPS Prepare for App | ||||
| SPCAS0045247 | ¿Comenzó una nueva aplicación en línea hoy mismo o que te vuelva a una solicitud guardada? | Comenzó una nueva aplicación | Drop down select one | Single | Y | App Status | ||||
| Volvió a trabajar en una solicitud guardada | ||||||||||
| SPCAS0045282 | ¿Sabía usted completar y presentar esta solicitud en línea hoy en día? | Sí | Drop down select one | Single | Y | Skip Logic | Complete App | |||
| No, tengo la intención de completar y enviar más tarde | A | |||||||||
| No, no tengo planes para completar y enviar la solicitud en línea | A | |||||||||
| SPCAS0045283 | A | Si no logró completar y presentar esta solicitud en línea hoy, por favor díganos por qué. | Demasiadas preguntas | check box one up vertical | Multi | Y | Skip Logic | Not Complete App | ||
| Toma demasiado tiempo para llenar | ||||||||||
| Demasiado complicado de usar sin ayuda | ||||||||||
| No tenía la información que necesitaba como nombres, direcciones o fechas | ||||||||||
| No entendía lo que significaba preguntas / cómo responder | ||||||||||
| Que quería utilizar el estimador de jubilación reconsiderar mis opciones | ||||||||||
| Que tenía que ver mi Declaración del Seguro Social y / o comprobar que mi registro de ganancias es el correcto | ||||||||||
| Mi condición de discapacidad me impide trabajar con una computadora por largos periodos | ||||||||||
| Yo tenía una cantidad limitada de demandas de tiempo / de la familia que me impedía trabajar en ella por mucho tiempo | ||||||||||
| Tuve problemas técnicos, como un mensaje de error o un error que no podía fijar | ||||||||||
| Otro, especificar | AA | |||||||||
| SPCAS0045284 | AA | Haznos saber por qué no se ha completado y se somete esta solicitud hoy. | Text field, no char limit | N | Skip Logic | OPS Why Not Complete today | ||||
| SPCAS0045248 | Hasta el momento, ¿cuánto tiempo ha trabajado en esta solicitud en línea? | Hasta 15 minutos | Drop down select one | Single | Y | Time Spent | ||||
| 16 minutos - 30 minutos | ||||||||||
| 31 minutos - 1 hora | ||||||||||
| Más de 1 hora hasta 2 horas | ||||||||||
| Más de 2 horas | ||||||||||
| SPCAS0045249 | ¿Fue fácil para usted para encontrar esta aplicación en línea? | Muy fácil | Find App | |||||||
| algo fácil | ||||||||||
| algo duro | A | |||||||||
| Muy difícil | A | |||||||||
| SPCAS0045250 | A | Haznos saber por qué era difícil encontrar la aplicación en línea. (Seleccione todas las que apliquen.) | No se pudo encontrar por dónde empezar una nueva aplicación en línea | check box one up vertical | Multi | Y | Skip Logic | Why hard to find | ||
| Donde no está claro que vaya a volver a una solicitud previamente guardada | ||||||||||
| No estaba claro para mí cuando los vínculos conducirían | ||||||||||
| Dificultad para utilizar un enlace en la página web de la Seguridad Social | ||||||||||
| La información no parecía estar organizados de una manera lógica | ||||||||||
| Usé la función de búsqueda, pero los resultados no parecen aplicarse. | ||||||||||
| Traté de usar el FAQ, pero no pude encontrar la solicitud en línea | ||||||||||
| Otro, especificar | AA | |||||||||
| SPCAS0045285 | AA | Por favor, explique la razón por la que era difícil para usted para encontrar la solicitud en línea. | N | N | Skip Logic | OPS Hard to Find | ||||
| SPCAS0045286 | ¿Cómo llegaste a esta solicitud en línea hoy en día? | Se utiliza el enlace de los servicios en línea en la página web de la Seguridad Social | Radio Button | Single | Y | Skip Logic | Arrive at App | |||
| Seguido de un enlace de algún otro lugar en el sitio web de la Seguridad Social | ||||||||||
| Se utiliza la función de búsqueda en la página web de la Seguridad Social | ||||||||||
| Se utiliza un motor de búsqueda fuera (es decir, Google, Bing, Yahoo, etc) | ||||||||||
| Seguido de un enlace desde medicare.gov | ||||||||||
| Seguido un enlace desde otro sitio web | ||||||||||
| Este sitio fue bookmarked | ||||||||||
| Otro, especificar | A | |||||||||
| SPCAS0045251 | A | Por favor describa cómo llegó a esta solicitud en línea hoy | Text field, no char limit | N | OPS Arrive at app | |||||
| SPCAS0045252 | ¿Por qué eligió para aplicar en línea? (Seleccione todas las que apliquen.) | Yo no quería ir a una oficina local del Seguro Social | check box one up vertical | Multi | Y | Skip Logic | Why Online | |||
| Yo no quería que la solicitud por teléfono | ||||||||||
| Yo prefiero usar los servicios en línea tanto como sea posible | ||||||||||
| Aprendí acerca de la aplicación en línea durante su visita a la página web de la Seguridad Social | ||||||||||
| Un empleado del Seguro Social recomienda que aplico en línea | ||||||||||
| Un amigo o familiar recomendaron que aplico en línea | ||||||||||
| Yo sabía que si tenía alguna pregunta o problema la aplicación en línea, todavía podía recibir ayuda de la Seguridad Social | ||||||||||
| Estoy presentando en nombre de otra persona | ||||||||||
| Otro, especificar | A | |||||||||
| SPCAS0045287 | A | Por favor, especifique qué decide aplicar en línea | Text field, no char limit | N | OPS Why Online | |||||
| SPCAS0045289 | ¿Cuál es su estado civil actual? | casado | Radio button, one-up vertical | Single | N | OPS Group | Marital Status | |||
| apartado | ||||||||||
| divorciado | ||||||||||
| viudo | ||||||||||
| ` | Nunca se ha casado | |||||||||
| Prefiero no responder | ||||||||||
| Otro, especificar | A | |||||||||
| SPCAS0045290 | A | Otro estado civil | Text field, <100 char | N | OPS Group | OPS Marital Status | ||||
| ENSTE0059662 | ¿Ya se registró para una cuenta de mi Seguro Social? | Sí | Radio button, one-up vertical | Single | Y | Skip Logic | Have mySSA Account | |||
| No | A | |||||||||
| SPSTE0061423 | A | ¿Cuál es la razón principal por la que no se haya registrado para una cuenta de mi Seguro Social? | No tengo conocimiento de lo que una cuenta de mi Seguro Social es. | Radio button, one-up vertical | Single | Y | Skip Logic | Why Not Have mySSA Account | ||
| Traté de registrar una cuenta de mi Seguro Social, pero no tuvo éxito. | ||||||||||
| Actualmente estoy tratando de registrar una cuenta de mi Seguro Social. | ||||||||||
| Yo no quiero una cuenta de mi Seguro Social. | ||||||||||
| Otro (especificar): | AA | |||||||||
| SPSTE0061395 | AA | Por favor, díganos por qué usted no está registrado para obtener una cuenta de mi Seguridad Social. | Text field, no char limit | Single | N | Skip Logic | OPS_Why Not Have mySSA Account | |||
| SPCAS0045291 | ¿Tiene alguna sugerencia para mejorar la aplicación en línea de la Seguridad Social? | Text field, no char limit | N | OE_Improvement | ||||||
| Model Instance Name: | ||||||||||
| SSA iClaim v3 | underlined & italicized: RE-ORDER | |||||||||
| MID: xZAAEQw81gIo1Vo4Noc1Rw4C | pink: ADDITION | |||||||||
| Date: | 7/15/2011 | blue + -->: REWORDING | ||||||||
| violet (bold): SKIP-LOGIC | ||||||||||
| SSA iClaim v3 CUSTOM QUESTION LIST | ||||||||||
| QID | Skip Logic Label | Question Text | Answer Choices (limited to 50 characters) |
Skip To | Type (select from list) | Single or Multi | Required Y/N |
Special Instructions | CQ Label | |
| BJL2231 | What type of benefits were you applying for? | Retirement | Dropdown (Select-one) | Single | Y | Type of Benefits | ||||
| Medicare only | ||||||||||
| Disability | ||||||||||
| Both Retirement and Disability | ||||||||||
| Spouse's | ||||||||||
| Other | ||||||||||
| CAS0045242 | Are you applying online for yourself or are you helping someone else? | Myself | Dropdown (Select-one) | Single | Y | Applying for | ||||
| Helping a Spouse/Relative/Friend | ||||||||||
| Professional Helping a Client | ||||||||||
| Other | ||||||||||
| CAS0045243 | How did you learn about this online application? (Select all that apply.) | Official Social Security website | check box one up vertical | Multi | Y | Skip Logic Group | Learn about App | |||
| A general web search (e.g. Google, Bing, etc.) | ||||||||||
| The radio | ||||||||||
| The television | ||||||||||
| An email from Social Security | ||||||||||
| A newspaper or magazine article | ||||||||||
| An online ad (Banner/Image) | ||||||||||
| An online video | ||||||||||
| A newspaper or magazine ad | ||||||||||
| A billboard or other printed ad | ||||||||||
| Social Media (Blog, Facebook, Twitter, etc.) | ||||||||||
| Friend, spouse, relative, neighbor or acquaintance | ||||||||||
| Social Security statement | ||||||||||
| Social Security employee | A | |||||||||
| Community Group or Association | ||||||||||
| Other, please specify | B | |||||||||
| CAS0045244 | A | How did you make contact with a Social Security employee? | Visited a local Social Security office | check box one up vertical | Multi | Y | Skip Logic | SSA Emplyee Contact | ||
| Called a local Social Security office | ||||||||||
| Called the national 800 number | ||||||||||
| Other, please specify | AA | |||||||||
| CAS0045245 | AA | Please describe how you made contact with a Social Security employee. | Text box, no char limit | N | Skip Logic | OPS SSA Employe Contact | ||||
| CAS0045246 | B | Please specify how you learned about this online application. | Text box, no char limit | N | Skip Logic | OPS Learn about App | ||||
| CAS0045262 | Did you use any of the following to prepare to apply online? (Select all that apply.) | Reviewed my online Social Security Statement | A | check box one up vertical | Multi | Y | Skip Logic | Prepare for App | ||
| I used the Retirement Estimator or other tools on the Social Security website | B | |||||||||
| I watched the instructional video | C | |||||||||
| I used other information on the Social Security website to prepare | D | |||||||||
| I used another resource to prepare to apply online | E | |||||||||
| I did not use any resources to prepare to apply online | ||||||||||
| CAS0045263 | A | How helpful did you find the online Social Security Statement? | Very helpful | Drop down select one | Single | Y | Skip Logic | Rate Statement | ||
| Somewhat helpful | ||||||||||
| Not at all helpful | ||||||||||
| CAS0045264 | B | How helpful did you find the estimator tools on the website? | Very helpful | Drop down select one | Single | Y | Skip Logic | Rate RE Tools | ||
| Somewhat helpful | ||||||||||
| Not at all helpful | ||||||||||
| CAS0045265 | C | How helpful did you find the instructional video? | Very helpful | Drop down select one | Single | Y | Skip Logic | Rate Video | ||
| Somewhat helpful | ||||||||||
| Not at all helpful | ||||||||||
| CAS0045266 | D | How helpful did you find the other information on the Social Security website? | Very helpful | Drop down select one | Single | Y | Skip Logic | Rate Other Info on Website | ||
| Somewhat helpful | ||||||||||
| Not at all helpful | ||||||||||
| CAS0045267 | E | Please describe what other resource(s) you used to prepare to apply online? | Text field, no char limit | N | Skip Logic | OPS Prepare for App | ||||
| CAS0045247 | Did you start a new online application today or did you return to a saved application? | Started a new application | Drop down select one | Single | Y | App Status | ||||
| Returned to work on a saved application | ||||||||||
| CAS0045282 | Did you complete and submit this online application today? | Yes | Drop down select one | Single | Y | Skip Logic | Complete App | |||
| No, I plan to complete and submit later | A | |||||||||
| No, I do not plan to complete and submit the online application | A | |||||||||
| CAS0045283 | A | If you did not complete and submit this online application today, please tell us why. | Too many questions | check box one up vertical | Multi | Y | Skip Logic | Not Complete App | ||
| Takes too long to fill out | ||||||||||
| Too complicated to use without help | ||||||||||
| Didn't have information I needed like names, addresses, or dates | ||||||||||
| Didn't understand what questions meant/how to answer | ||||||||||
| I wanted to use the Retirement Estimator to reconsider my retirement options | ||||||||||
| I needed to view my Social Security Statement and/or verify that my earnings record is correct | ||||||||||
| My disabling condition prevents me from working with a computer for long periods | ||||||||||
| I had a limited amount of time/family demands that kept me from working on it for very long | ||||||||||
| I had technical problems like an error message or a mistake I couldn't fix | ||||||||||
| Other, please specify | AA | |||||||||
| CAS0045284 | AA | Please tell us why you did not complete and submit this application today. | Text field, no char limit | N | Skip Logic | OPS Why Not Complete today | ||||
| CAS0045248 | So far, how long have you worked on this online application? | Up to 15 minutes | Drop down select one | Single | Y | Time Spent | ||||
| 16 minutes - 30 minutes | ||||||||||
| 31 minutes - 1 hour | ||||||||||
| More than 1 hour up to 2 hours | ||||||||||
| More than 2 hours | ||||||||||
| CAS0045249 | How easy was it for you to find this online application? | Very easy | Find App | |||||||
| Somewhat easy | ||||||||||
| Somewhat hard | A | |||||||||
| Very hard | A | |||||||||
| CAS0045250 | A | Please tell us why it was hard to find the online application. (Select all that apply.) | Could not find where to start a new online application | check box one up vertical | Multi | Y | Skip Logic | Why hard to find | ||
| Not clear where to go to return to a previously saved application | ||||||||||
| It was not clear to me where the links would lead | ||||||||||
| Difficulty using a link on the Social Security website | ||||||||||
| The information did not seem to be organized in a logical manner | ||||||||||
| I used the search feature but the results didn’t seem to apply. | ||||||||||
| I tried to use the FAQ's, but couldn't find the online application | ||||||||||
| Other reason (please describe) | AA | |||||||||
| CAS0045285 | AA | Please explain the reason why it was hard for you to find the online application. | N | N | Skip Logic | OPS Hard to Find | ||||
| CAS0045286 | How did you arrive at this online application today? | Used the Online Services link on the Social Security homepage | Radio Button | Single | Y | Skip Logic | Arrive at App | |||
| Followed a link from somewhere else on the Social Security website | ||||||||||
| Used the search feature on the Social Security website | ||||||||||
| Used an outside search engine (i.e. Google, Bing, yahoo etc.) | ||||||||||
| Followed a link from medicare.gov | ||||||||||
| Followed a link from another website | ||||||||||
| Site was bookmarked | ||||||||||
| Other, please specify | A | |||||||||
| CAS0045251 | A | Please describe how you arrived at this online application today | Text field, no char limit | N | OPS Arrive at app | |||||
| CAS0045252 | Why did you choose to apply online? (Select all that apply.) | I did not want to go to a local Social Security office | check box one up vertical | Multi | Y | Skip Logic | Why Online | |||
| I did not want to apply over the phone | ||||||||||
| I prefer to use online services as much as possible | ||||||||||
| I learned about applying online while visiting Social Security's website | ||||||||||
| A Social Security employee recommended that I apply online | ||||||||||
| A friend or relative recommended that I apply online | ||||||||||
| I knew that if I had a question or problem applying online, I could still get help from Social Security | ||||||||||
| I am filing on behalf of another person | ||||||||||
| Other, please specify | A | |||||||||
| CAS0045287 | A | Please specify why you choose to apply online | Text field, no char limit | N | OPS Why Online | |||||
| CAS0045289 | What is your current marital status? | Married | Radio button, one-up vertical | Single | N | OPS Group | Marital Status | |||
| Separated | ||||||||||
| Divorced | ||||||||||
| Widowed | ||||||||||
| Never married | ||||||||||
| Prefer not to answer | ||||||||||
| Other, please specify | A | |||||||||
| CAS0045290 | A | Other marital status | Text field, <100 char | N | OPS Group | OPS Marital Status | ||||
| STE0059662 | Have you registered for a my Social Security account? | Yes | Radio button, one-up vertical | Single | Y | Skip Logic | Have mySSA Account | |||
| No | A | |||||||||
| STE0061423 | A | What is the main reason you have not registered for a my Social Security account? | I am unaware of what a my Social Security account is. | Radio button, one-up vertical | Single | Y | Skip Logic | Why Not Have mySSA Account | ||
| I tried to register for a my Social Security account, but was unsuccessful. | ||||||||||
| I am currently trying to register for a my Social Security account. | ||||||||||
| I do not want a my Social Security account. | ||||||||||
| Other (please specify): | AA | |||||||||
| STE0061395 | AA | Please tell us why you have not registered for a my Social Security account. | Text field, no char limit | Single | N | Skip Logic | OPS_Why Not Have mySSA Account | |||
| CAS0045291 | Do you have any suggestions for improving Social Security's online application. | Text field, no char limit | N | OE_Improvement | ||||||
| Model Instance Name: | ||||||||||
| SSA iClaim v3 | underlined & italicized: RE-ORDER | |||||||||
| MID: xZAAEQw81gIo1Vo4Noc1Rw4C | pink: ADDITION | |||||||||
| Date: | 7/15/2011 | blue + -->: REWORDING | ||||||||
| violet (bold): SKIP-LOGIC | ||||||||||
| SSA iClaim v3 CUSTOM QUESTION LIST | ||||||||||
| QID | Skip Logic Label | Question Text | Answer Choices (limited to 50 characters) |
Skip To | Type (select from list) | Single or Multi | Required Y/N |
Special Instructions | CQ Label | |
| BJL2231 | What type of benefits were you applying for? | Retirement | Dropdown (Select-one) | Single | Y | Type of Benefits | ||||
| Medicare only | ||||||||||
| Disability | ||||||||||
| Both Retirement and Disability | ||||||||||
| Spouse's | ||||||||||
| Other | ||||||||||
| CAS0045242 | Are you applying online for yourself or are you helping someone else? | Myself | Dropdown (Select-one) | Single | Y | Applying for | ||||
| Helping a Spouse/Relative/Friend | ||||||||||
| Professional Helping a Client | ||||||||||
| Other | ||||||||||
| CAS0045243 | How did you learn about this online application? (Select all that apply.) | Official Social Security website | check box one up vertical | Multi | Y | Skip Logic Group | Learn about App | |||
| A general web search (e.g. Google, Bing, etc.) | ||||||||||
| The radio | ||||||||||
| The television | ||||||||||
| An email from Social Security | ||||||||||
| A newspaper or magazine article | ||||||||||
| An online ad (Banner/Image) | ||||||||||
| An online video | ||||||||||
| A newspaper or magazine ad | ||||||||||
| A billboard or other printed ad | ||||||||||
| Social Media (Blog, Facebook, Twitter, etc.) | ||||||||||
| Friend, spouse, relative, neighbor or acquaintance | ||||||||||
| Social Security statement | ||||||||||
| Social Security employee | A | |||||||||
| Community Group or Association | ||||||||||
| Other, please specify | B | |||||||||
| CAS0045244 | A | How did you make contact with a Social Security employee? | Visited a local Social Security office | check box one up vertical | Multi | Y | Skip Logic | SSA Emplyee Contact | ||
| Called a local Social Security office | ||||||||||
| Called the national 800 number | ||||||||||
| Other, please specify | AA | |||||||||
| CAS0045245 | AA | Please describe how you made contact with a Social Security employee. | Text box, no char limit | N | Skip Logic | OPS SSA Employe Contact | ||||
| CAS0045246 | B | Please specify how you learned about this online application. | Text box, no char limit | N | Skip Logic | OPS Learn about App | ||||
| CAS0045262 | Did you use any of the following to prepare to apply online? (Select all that apply.) | Reviewed my online Social Security Statement | A | check box one up vertical | Multi | Y | Skip Logic | Prepare for App | ||
| I used the Retirement Estimator or other tools on the Social Security website | B | |||||||||
| I watched the instructional video | C | |||||||||
| I used other information on the Social Security website to prepare | D | |||||||||
| I used another resource to prepare to apply online | E | |||||||||
| I did not use any resources to prepare to apply online | ||||||||||
| CAS0045263 | A | How helpful did you find the online Social Security Statement? | Very helpful | Drop down select one | Single | Y | Skip Logic | Rate Statement | ||
| Somewhat helpful | ||||||||||
| Not at all helpful | ||||||||||
| CAS0045264 | B | How helpful did you find the estimator tools on the website? | Very helpful | Drop down select one | Single | Y | Skip Logic | Rate RE Tools | ||
| Somewhat helpful | ||||||||||
| Not at all helpful | ||||||||||
| CAS0045265 | C | How helpful did you find the instructional video? | Very helpful | Drop down select one | Single | Y | Skip Logic | Rate Video | ||
| Somewhat helpful | ||||||||||
| Not at all helpful | ||||||||||
| CAS0045266 | D | How helpful did you find the other information on the Social Security website? | Very helpful | Drop down select one | Single | Y | Skip Logic | Rate Other Info on Website | ||
| Somewhat helpful | ||||||||||
| Not at all helpful | ||||||||||
| CAS0045267 | E | Please describe what other resource(s) you used to prepare to apply online? | Text field, no char limit | N | Skip Logic | OPS Prepare for App | ||||
| CAS0045247 | Did you start a new online application today or did you return to a saved application? | Started a new application | Drop down select one | Single | Y | App Status | ||||
| Returned to work on a saved application | ||||||||||
| CAS0045282 | Did you complete and submit this online application today? | Yes | Drop down select one | Single | Y | Skip Logic | Complete App | |||
| No, I plan to complete and submit later | A | |||||||||
| No, I do not plan to complete and submit the online application | A | |||||||||
| CAS0045283 | A | If you did not complete and submit this online application today, please tell us why. | Too many questions | check box one up vertical | Multi | Y | Skip Logic | Not Complete App | ||
| Takes too long to fill out | ||||||||||
| Too complicated to use without help | ||||||||||
| Didn't have information I needed like names, addresses, or dates | ||||||||||
| Didn't understand what questions meant/how to answer | ||||||||||
| My disabling condition prevents me from working with a computer for long periods | ||||||||||
| I had a limited amount of time/family demands that kept me from working on it for very long | ||||||||||
| I had technical problems like an error message or a mistake I couldn't fix | ||||||||||
| Other, please specify | AA | |||||||||
| CAS0045284 | AA | Please tell us why you did not complete and submit this application today. | Text field, no char limit | N | Skip Logic | OPS Why Not Complete today | ||||
| CAS0045248 | So far, how long have you worked on this online application? | Up to 15 minutes | Drop down select one | Single | Y | Time Spent | ||||
| 16 minutes - 30 minutes | ||||||||||
| 31 minutes - 1 hour | ||||||||||
| More than 1 hour up to 2 hours | ||||||||||
| More than 2 hours | ||||||||||
| CAS0045249 | How easy was it for you to find this online application? | Very easy | Find App | |||||||
| Somewhat easy | ||||||||||
| Somewhat hard | A | |||||||||
| Very hard | A | |||||||||
| CAS0045250 | A | Please tell us why it was hard to find the online application. (Select all that apply.) | Could not find where to start a new online application | check box one up vertical | Multi | Y | Skip Logic | Why hard to find | ||
| Not clear where to go to return to a previously saved application | ||||||||||
| It was not clear to me where the links would lead | ||||||||||
| Difficulty using a link on the Social Security website | ||||||||||
| The information did not seem to be organized in a logical manner | ||||||||||
| I used the search feature but the results didn’t seem to apply. | ||||||||||
| I tried to use the FAQ's, but couldn't find the online application | ||||||||||
| Other reason (please describe) | AA | |||||||||
| CAS0045285 | AA | Please explain the reason why it was hard for you to find the online application. | N | N | Skip Logic | OPS Hard to Find | ||||
| CAS0045286 | How did you arrive at this online application today? | Used the Online Services link on the Social Security homepage | Radio Button | Single | Y | Skip Logic | Arrive at App | |||
| Followed a link from somewhere else on the Social Security website | ||||||||||
| Used the search feature on the Social Security website | ||||||||||
| Used an outside search engine (i.e. Google, Bing, yahoo etc.) | ||||||||||
| Followed a link from medicare.gov | ||||||||||
| Followed a link from another website | ||||||||||
| Site was bookmarked | ||||||||||
| Other, please specify | A | |||||||||
| CAS0045251 | A | Please describe how you arrived at this online application today | Text field, no char limit | N | OPS Arrive at app | |||||
| CAS0045252 | Why did you choose to apply online? (Select all that apply.) | I did not want to go to a local Social Security office | check box one up vertical | Multi | Y | Skip Logic | Why Online | |||
| I did not want to apply over the phone | ||||||||||
| I prefer to use online services as much as possible | ||||||||||
| I learned about applying online while visiting Social Security's website | ||||||||||
| A Social Security employee recommended that I apply online | ||||||||||
| A friend or relative recommended that I apply online | ||||||||||
| I knew that if I had a question or problem applying online, I could still get help from Social Security | ||||||||||
| I am filing on behalf of another person | ||||||||||
| Other, please specify | A | |||||||||
| CAS0045287 | A | Please specify why you choose to apply online | Text field, no char limit | N | OPS Why Online | |||||
| CAS0045289 | What is your current marital status? | Married | Radio button, one-up vertical | Single | N | OPS Group | Marital Status | |||
| Separated | ||||||||||
| Divorced | ||||||||||
| Widowed | ||||||||||
| Never married | ||||||||||
| Prefer not to answer | ||||||||||
| Other, please specify | A | |||||||||
| CAS0045290 | A | Other marital status | Text field, <100 char | N | OPS Group | OPS Marital Status | ||||
| STE0059662 | Have you registered for a my Social Security account? | Yes | Radio button, one-up vertical | Single | Y | Skip Logic | Have mySSA Account | |||
| No | A | |||||||||
| A | What is the main reason you have not registered for a my Social Security account? | I am unaware of what a my Social Security account is. | Radio button, one-up vertical | Single | Y | Skip Logic | Why Not Have mySSA Account | |||
| I tried to register for a my Social Security account, but was unsuccessful. | ||||||||||
| I am currently trying to register for a my Social Security account. | ||||||||||
| I do not want a my Social Security account. | ||||||||||
| Other (please specify): | AA | |||||||||
| AA | Please tell us why you have not registered for a my Social Security account. | Text field, no char limit | Single | N | Skip Logic | OPS_Why Not Have mySSA Account | ||||
| CAS0045291 | Do you have any suggestions for improving Social Security's online application. | Text field, no char limit | N | OE_Improvement | ||||||
| Model Instance Name: | ||||||||||
| SSA iClaim v3 | underlined & italicized: RE-ORDER | |||||||||
| MID: VgpBBYx9l8JxIFgJlY1Ikg4C | pink: ADDITION | |||||||||
| Date: | 7/15/2011 | blue + -->: REWORDING | ||||||||
| violet (bold): SKIP-LOGIC | ||||||||||
| SSA iClaim v3 CUSTOM QUESTION LIST | ||||||||||
| QID | Skip Logic Label | Question Text | Answer Choices (limited to 50 characters) |
Skip To | Type (select from list) | Single or Multi | Required Y/N |
Special Instructions | CQ Label | |
| ENBJL2231 | What type of benefits were you applying for? | Retirement | Dropdown (Select-one) | Single | Y | Type of Benefits | ||||
| Medicare only | ||||||||||
| Disability | ||||||||||
| Both Retirement and Disability | ||||||||||
| Spouse's | ||||||||||
| Other | ||||||||||
| ENCAS0045242 | Are you applying online for yourself or are you helping someone else? | Myself | Dropdown (Select-one) | Single | Y | Applying for | ||||
| Helping a Spouse/Relative/Friend | ||||||||||
| Professional Helping a Client | ||||||||||
| Other | ||||||||||
| ENCAS0045243 | How did you learn about this online application? (Select all that apply.) | Official Social Security website | check box one up vertical | Multi | Y | Skip Logic Group | Learn about App | |||
| A general web search (e.g. Google, Bing, etc.) | ||||||||||
| The radio | ||||||||||
| The television | ||||||||||
| An email from Social Security | ||||||||||
| A newspaper or magazine article | ||||||||||
| An online ad (Banner/Image) | ||||||||||
| An online video | ||||||||||
| A newspaper or magazine ad | ||||||||||
| A billboard or other printed ad | ||||||||||
| Social Media (Blog, Facebook, Twitter, etc.) | ||||||||||
| Friend, spouse, relative, neighbor or acquaintance | ||||||||||
| Social Security statement | ||||||||||
| Social Security employee | A | |||||||||
| Community Group or Association | ||||||||||
| Other, please specify | B | |||||||||
| ENCAS0045244 | A | How did you make contact with a Social Security employee? | Visited a local Social Security office | check box one up vertical | Multi | Y | Skip Logic | SSA Emplyee Contact | ||
| Called a local Social Security office | ||||||||||
| Called the national 800 number | ||||||||||
| Other, please specify | AA | |||||||||
| ENCAS0045245 | AA | Please describe how you made contact with a Social Security employee. | Text box, no char limit | N | Skip Logic | OPS SSA Employe Contact | ||||
| ENCAS0045246 | B | Please specify how you learned about this online application. | Text box, no char limit | N | Skip Logic | OPS Learn about App | ||||
| ENCAS0045262 | Did you use any of the following to prepare to apply online? (Select all that apply.) | Reviewed my online Social Security Statement | A | check box one up vertical | Multi | Y | Skip Logic | Prepare for App | ||
| I used the Retirement Estimator or other tools on the Social Security website | B | |||||||||
| I watched the instructional video | C | |||||||||
| I used other information on the Social Security website to prepare | D | |||||||||
| I used another resource to prepare to apply online | E | |||||||||
| I did not use any resources to prepare to apply online | ||||||||||
| ENCAS0045263 | A | How helpful did you find the online Social Security Statement? | Very helpful | Drop down select one | Single | Y | Skip Logic | Rate Statement | ||
| Somewhat helpful | ||||||||||
| Not at all helpful | ||||||||||
| ENCAS0045264 | B | How helpful did you find the estimator tools on the website? | Very helpful | Drop down select one | Single | Y | Skip Logic | Rate RE Tools | ||
| Somewhat helpful | ||||||||||
| Not at all helpful | ||||||||||
| ENCAS0045265 | C | How helpful did you find the instructional video? | Very helpful | Drop down select one | Single | Y | Skip Logic | Rate Video | ||
| Somewhat helpful | ||||||||||
| Not at all helpful | ||||||||||
| ENCAS0045266 | D | How helpful did you find the other information on the Social Security website? | Very helpful | Drop down select one | Single | Y | Skip Logic | Rate Other Info on Website | ||
| Somewhat helpful | ||||||||||
| Not at all helpful | ||||||||||
| ENCAS0045267 | E | Please describe what other resource(s) you used to prepare to apply online? | Text field, no char limit | N | Skip Logic | OPS Prepare for App | ||||
| ENCAS0045247 | Did you start a new online application today or did you return to a saved application? | Started a new application | Drop down select one | Single | Y | App Status | ||||
| Returned to work on a saved application | ||||||||||
| ENCAS0045282 | Did you complete and submit this online application today? | Yes | Drop down select one | Single | Y | Skip Logic | Complete App | |||
| No, I plan to complete and submit later | A | |||||||||
| No, I do not plan to complete and submit the online application | A | |||||||||
| ENCAS0045283 | A | If you did not complete and submit this online application today, please tell us why. | Too many questions | check box one up vertical | Multi | Y | Skip Logic | Not Complete App | ||
| Takes too long to fill out | ||||||||||
| Too complicated to use without help | ||||||||||
| Didn't have information I needed like names, addresses, or dates | ||||||||||
| Didn't understand what questions meant/how to answer | ||||||||||
| My disabling condition prevents me from working with a computer for long periods | ||||||||||
| I had a limited amount of time/family demands that kept me from working on it for very long | ||||||||||
| I had technical problems like an error message or a mistake I couldn't fix | ||||||||||
| Other, please specify | AA | |||||||||
| ENCAS0045284 | AA | Please tell us why you did not complete and submit this application today. | Text field, no char limit | N | Skip Logic | OPS Why Not Complete today | ||||
| ENCAS0045248 | So far, how long have you worked on this online application? | Up to 15 minutes | Drop down select one | Single | Y | Time Spent | ||||
| 16 minutes - 30 minutes | ||||||||||
| 31 minutes - 1 hour | ||||||||||
| More than 1 hour up to 2 hours | ||||||||||
| More than 2 hours | ||||||||||
| ENCAS0045249 | How easy was it for you to find this online application? | Very easy | Find App | |||||||
| Somewhat easy | ||||||||||
| Somewhat hard | A | |||||||||
| Very hard | A | |||||||||
| ENCAS0045250 | A | Please tell us why it was hard to find the online application. (Select all that apply.) | Could not find where to start a new online application | check box one up vertical | Multi | Y | Skip Logic | Why hard to find | ||
| Not clear where to go to return to a previously saved application | ||||||||||
| It was not clear to me where the links would lead | ||||||||||
| Difficulty using a link on the Social Security website | ||||||||||
| The information did not seem to be organized in a logical manner | ||||||||||
| I used the search feature but the results didn’t seem to apply. | ||||||||||
| I tried to use the FAQ's, but couldn't find the online application | ||||||||||
| Other reason (please describe) | AA | |||||||||
| ENCAS0045285 | AA | Please explain the reason why it was hard for you to find the online application. | N | N | Skip Logic | OPS Hard to Find | ||||
| ENCAS0045286 | How did you arrive at this online application today? | Used the Online Services link on the Social Security homepage | Radio Button | Single | Y | Skip Logic | Arrive at App | |||
| Followed a link from somewhere else on the Social Security website | ||||||||||
| Used the search feature on the Social Security website | ||||||||||
| Used an outside search engine (i.e. Google, Bing, yahoo etc.) | ||||||||||
| Followed a link from medicare.gov | ||||||||||
| Followed a link from another website | ||||||||||
| Site was bookmarked | ||||||||||
| Other, please specify | A | |||||||||
| ENCAS0045251 | A | Please describe how you arrived at this online application today | Text field, no char limit | N | OPS Arrive at app | |||||
| ENCAS0045252 | Why did you choose to apply online? (Select all that apply.) | I did not want to go to a local Social Security office | check box one up vertical | Multi | Y | Skip Logic | Why Online | |||
| I did not want to apply over the phone | ||||||||||
| I prefer to use online services as much as possible | ||||||||||
| I learned about applying online while visiting Social Security's website | ||||||||||
| A Social Security employee recommended that I apply online | ||||||||||
| A friend or relative recommended that I apply online | ||||||||||
| I knew that if I had a question or problem applying online, I could still get help from Social Security | ||||||||||
| I am filing on behalf of another person | ||||||||||
| Other, please specify | A | |||||||||
| ENCAS0045287 | A | Please specify why you choose to apply online | Text field, no char limit | N | OPS Why Online | |||||
| ENCAS0045289 | What is your current marital status? | Married | Radio button, one-up vertical | Single | N | OPS Group | Marital Status | |||
| Separated | ||||||||||
| Divorced | ||||||||||
| Widowed | ||||||||||
| Never married | ||||||||||
| Prefer not to answer | ||||||||||
| Other, please specify | A | |||||||||
| ENCAS0045290 | A | Other marital status | Text field, <100 char | N | OPS Group | OPS Marital Status | ||||
| ENSTE0059662 | Have you registered for a my Social Security account? | Yes | Radio button, one-up vertical | Single | Y | Skip Logic | Have mySSA Account | |||
| No | A | |||||||||
| A | What is the main reason you have not registered for a my Social Security account? | I am unaware of what a my Social Security account is. | Radio button, one-up vertical | Single | Y | Skip Logic | Why Not Have mySSA Account | |||
| I tried to register for a my Social Security account, but was unsuccessful. | ||||||||||
| I am currently trying to register for a my Social Security account. | ||||||||||
| I do not want a my Social Security account. | ||||||||||
| Other (please specify): | AA | |||||||||
| AA | Please tell us why you have not registered for a my Social Security account. | Text field, no char limit | Single | N | Skip Logic | OPS_Why Not Have mySSA Account | ||||
| ENCAS0045291 | Do you have any suggestions for improving Social Security's online application. | Text field, no char limit | N | OE_Improvement | ||||||
| Model Instance Name: | ||||||||||
| SSA iClaim v3 (Spanish) | underlined & italicized: RE-ORDER | |||||||||
| MID: | Q0ExM1xNQRl9JJUR0M0JlA4C | pink: ADDITION | ||||||||
| Date: | 7/15/2011 | blue + -->: REWORDING | ||||||||
| violet (bold): SKIP-LOGIC | ||||||||||
| SSA iClaim v3 (Spanish) CUSTOM QUESTION LIST | ||||||||||
| QID | Skip Logic Label | Question Text | Answer Choices (limited to 50 characters) |
Skip To | Type (select from list) | Single or Multi | Required Y/N |
Special Instructions | CQ Label | |
| SPBJL2231 | ¿Qué tipo de beneficios estaba solicitando? | Por jubilación | Dropdown (Select-one) | Single | Y | Type of Benefits | ||||
| Solo Medicare | ||||||||||
| Por incapacidad | ||||||||||
| Tanto Jubilación y Discapacidad | ||||||||||
| Coomo cónyuge | ||||||||||
| Otro | ||||||||||
| SPCAS0045242 | ¿Es esta solicitud en línea para sí mismo o estás ayudando a alguien más? | Yo mismo | Dropdown (Select-one) | Single | Y | Applying for | ||||
| Cómo ayudar a un cónyuge / pariente / amigo | ||||||||||
| Profesional Ayudar a un cliente | ||||||||||
| Otro | ||||||||||
| SPCAS0045243 | ¿Cómo se enteró acerca de esta solicitud en línea? (Seleccione todas las que apliquen.) | Sitio web oficial de la Seguridad Social | check box one up vertical | Multi | Y | Skip Logic Group | Learn about App | |||
| Una búsqueda web general (por ejemplo, Google, Bing, etc) | ||||||||||
| La radio | ||||||||||
| La televisión | ||||||||||
| Un correo electrónico de la Seguridad Social | ||||||||||
| Un periódico o la revista | ||||||||||
| Un anuncio en línea (Banner / Imagen) | ||||||||||
| Un video en línea | ||||||||||
| Un periódico o una revista de anuncios | ||||||||||
| Un anuncio impreso cartelera u otro | ||||||||||
| Medios de Comunicación Social (Blog, Facebook, Twitter, etc) | ||||||||||
| Amigo, cónyuge, pariente, vecino o conocido | ||||||||||
| Declaración del Seguro Social | ||||||||||
| Empleado del Seguro Social | A | |||||||||
| Grupo de la comunidad o de la Asociación | ||||||||||
| Otro, especificar | B | |||||||||
| SPCAS0045244 | A | ¿Cómo se hace el contacto con un empleado del Seguro Social? | Visitado una oficina local del Seguro Social | check box one up vertical | Multi | Y | Skip Logic | SSA Emplyee Contact | ||
| Llamado a la oficina local del Seguro Social | ||||||||||
| Llamado el número nacional 800 | ||||||||||
| Otro, especificar | AA | |||||||||
| SPCAS0045245 | AA | Por favor describa cómo se hizo contacto con un empleado del Seguro Social. | Text box, no char limit | N | Skip Logic | OPS SSA Employe Contact | ||||
| SPCAS0045246 | B | Por favor, especifique cómo se enteró de esta aplicación en línea. | Text box, no char limit | N | Skip Logic | OPS Learn about App | ||||
| SPCAS0045262 | ¿Ha usado alguna de las siguientes acciones para prepararse para aplicar en línea? (Seleccione todas las que apliquen.) | Comentado mi Declaración del Seguro Social en línea | A | check box one up vertical | Multi | Y | Skip Logic | Prepare for App | ||
| He utilizado el Retirement Estimator u otras herramientas en el sitio web de la Seguridad Social | B | |||||||||
| Vi el video de instrucciones | C | |||||||||
| Usé otra información en la página web de la Seguridad Social para preparar | D | |||||||||
| Utilicé otro recurso que se preparen para aplicar en línea | E | |||||||||
| No hice uso de los recursos para prepararse para aplicar en línea | ||||||||||
| SPCAS0045263 | A | ¿Qué tan útil ha encontrado el Declaración del Seguro Social en línea? | Muy útil | Drop down select one | Single | Y | Skip Logic | Rate Statement | ||
| algo útil | ||||||||||
| Para nada útil | ||||||||||
| SPCAS0045264 | B | ¿Qué tan útil encontraste las herramientas estimador en el sitio web? | Muy útil | Drop down select one | Single | Y | Skip Logic | Rate RE Tools | ||
| algo útil | ||||||||||
| Para nada útil | ||||||||||
| SPCAS0045265 | C | ¿Qué tan útil le parecen la video instructivo? | Muy útil | Drop down select one | Single | Y | Skip Logic | Rate Video | ||
| algo útil | ||||||||||
| Para nada útil | ||||||||||
| SPCAS0045266 | D | ¿Qué tan útil le parecen la otra información en el sitio web de la Seguridad Social? | Muy útil | Drop down select one | Single | Y | Skip Logic | Rate Other Info on Website | ||
| algo útil | ||||||||||
| Para nada útil | ||||||||||
| SPCAS0045267 | E | Por favor describa lo otro recurso (s) que utilizó para prepararse para aplicar en línea. | Text field, no char limit | N | Skip Logic | OPS Prepare for App | ||||
| SPCAS0045247 | ¿Comenzó una nueva aplicación en línea hoy mismo o que te vuelva a una solicitud guardada? | Comenzó una nueva aplicación | Drop down select one | Single | Y | App Status | ||||
| Volvió a trabajar en una solicitud guardada | ||||||||||
| SPCAS0045282 | ¿Sabía usted completar y presentar esta solicitud en línea hoy en día? | Sí | Drop down select one | Single | Y | Skip Logic | Complete App | |||
| No, tengo la intención de completar y enviar más tarde | A | |||||||||
| No, no tengo planes para completar y enviar la solicitud en línea | A | |||||||||
| SPCAS0045283 | A | Si no logró completar y presentar esta solicitud en línea hoy, por favor díganos por qué. | Demasiadas preguntas | check box one up vertical | Multi | Y | Skip Logic | Not Complete App | ||
| Toma demasiado tiempo para llenar | ||||||||||
| Demasiado complicado de usar sin ayuda | ||||||||||
| No tenía la información que necesitaba como nombres, direcciones o fechas | ||||||||||
| No entendía lo que significaba preguntas / cómo responder | ||||||||||
| Mi condición de discapacidad me impide trabajar con una computadora por largos periodos | ||||||||||
| Yo tenía una cantidad limitada de demandas de tiempo / de la familia que me impedía trabajar en ella por mucho tiempo | ||||||||||
| Tuve problemas técnicos, como un mensaje de error o un error que no podía fijar | ||||||||||
| Otro, especificar | AA | |||||||||
| SPCAS0045284 | AA | Haznos saber por qué no se ha completado y se somete esta solicitud hoy. | Text field, no char limit | N | Skip Logic | OPS Why Not Complete today | ||||
| SPCAS0045248 | Hasta el momento, ¿cuánto tiempo ha trabajado en esta solicitud en línea? | Hasta 15 minutos | Drop down select one | Single | Y | Time Spent | ||||
| 16 minutos - 30 minutos | ||||||||||
| 31 minutos - 1 hora | ||||||||||
| Más de 1 hora hasta 2 horas | ||||||||||
| Más de 2 horas | ||||||||||
| SPCAS0045249 | ¿Fue fácil para usted para encontrar esta aplicación en línea? | Muy fácil | Find App | |||||||
| algo fácil | ||||||||||
| algo duro | A | |||||||||
| Muy difícil | A | |||||||||
| SPCAS0045250 | A | Haznos saber por qué era difícil encontrar la aplicación en línea. (Seleccione todas las que apliquen.) | No se pudo encontrar por dónde empezar una nueva aplicación en línea | check box one up vertical | Multi | Y | Skip Logic | Why hard to find | ||
| Donde no está claro que vaya a volver a una solicitud previamente guardada | ||||||||||
| No estaba claro para mí cuando los vínculos conducirían | ||||||||||
| Dificultad para utilizar un enlace en la página web de la Seguridad Social | ||||||||||
| La información no parecía estar organizados de una manera lógica | ||||||||||
| Usé la función de búsqueda, pero los resultados no parecen aplicarse. | ||||||||||
| Traté de usar el FAQ, pero no pude encontrar la solicitud en línea | ||||||||||
| Otro, especificar | AA | |||||||||
| SPCAS0045285 | AA | Por favor, explique la razón por la que era difícil para usted para encontrar la solicitud en línea. | N | N | Skip Logic | OPS Hard to Find | ||||
| SPCAS0045286 | ¿Cómo llegaste a esta solicitud en línea hoy en día? | Se utiliza el enlace de los servicios en línea en la página web de la Seguridad Social | Radio Button | Single | Y | Skip Logic | Arrive at App | |||
| Seguido de un enlace de algún otro lugar en el sitio web de la Seguridad Social | ||||||||||
| Se utiliza la función de búsqueda en la página web de la Seguridad Social | ||||||||||
| Se utiliza un motor de búsqueda fuera (es decir, Google, Bing, Yahoo, etc) | ||||||||||
| Seguido de un enlace desde medicare.gov | ||||||||||
| Seguido un enlace desde otro sitio web | ||||||||||
| Este sitio fue bookmarked | ||||||||||
| Otro, especificar | A | |||||||||
| SPCAS0045251 | A | Por favor describa cómo llegó a esta solicitud en línea hoy | Text field, no char limit | N | OPS Arrive at app | |||||
| SPCAS0045252 | ¿Por qué eligió para aplicar en línea? (Seleccione todas las que apliquen.) | Yo no quería ir a una oficina local del Seguro Social | check box one up vertical | Multi | Y | Skip Logic | Why Online | |||
| Yo no quería que la solicitud por teléfono | ||||||||||
| Yo prefiero usar los servicios en línea tanto como sea posible | ||||||||||
| Aprendí acerca de la aplicación en línea durante su visita a la página web de la Seguridad Social | ||||||||||
| Un empleado del Seguro Social recomienda que aplico en línea | ||||||||||
| Un amigo o familiar recomendaron que aplico en línea | ||||||||||
| Yo sabía que si tenía alguna pregunta o problema la aplicación en línea, todavía podía recibir ayuda de la Seguridad Social | ||||||||||
| Estoy presentando en nombre de otra persona | ||||||||||
| Otro, especificar | A | |||||||||
| SPCAS0045287 | A | Por favor, especifique qué decide aplicar en línea | Text field, no char limit | N | OPS Why Online | |||||
| SPCAS0045289 | ¿Cuál es su estado civil actual? | casado | Radio button, one-up vertical | Single | N | OPS Group | Marital Status | |||
| apartado | ||||||||||
| divorciado | ||||||||||
| viudo | ||||||||||
| ` | Nunca se ha casado | |||||||||
| Prefiero no responder | ||||||||||
| Otro, especificar | A | |||||||||
| SPCAS0045290 | A | Otro estado civil | Text field, <100 char | N | OPS Group | OPS Marital Status | ||||
| ENSTE0059662 | ¿Ya se registró para una cuenta de mi Seguro Social? | Sí | Radio button, one-up vertical | Single | Y | Skip Logic | Have mySSA Account | |||
| No | A | |||||||||
| A | ¿Cuál es la razón principal por la que no se haya registrado para una cuenta de mi Seguro Social? | No tengo conocimiento de lo que una cuenta de mi Seguro Social es. | Radio button, one-up vertical | Single | Y | Skip Logic | Why Not Have mySSA Account | |||
| Traté de registrar una cuenta de mi Seguro Social, pero no tuvo éxito. | ||||||||||
| Actualmente estoy tratando de registrar una cuenta de mi Seguro Social. | ||||||||||
| Yo no quiero una cuenta de mi Seguro Social. | ||||||||||
| Otro (especificar): | AA | |||||||||
| AA | Por favor, díganos por qué usted no está registrado para obtener una cuenta de mi Seguridad Social. | Text field, no char limit | Single | N | Skip Logic | OPS_Why Not Have mySSA Account | ||||
| SPCAS0045291 | ¿Tiene alguna sugerencia para mejorar la aplicación en línea de la Seguridad Social? | Text field, no char limit | N | OE_Improvement | ||||||
| Model Instance Name: | ||||||||||
| SSA iClaim v3 | underlined & italicized: RE-ORDER | |||||||||
| MID: xZAAEQw81gIo1Vo4Noc1Rw4C | pink: ADDITION | |||||||||
| Date: | 7/15/2011 | blue + -->: REWORDING | ||||||||
| violet (bold): SKIP-LOGIC | ||||||||||
| SSA iClaim v3 CUSTOM QUESTION LIST | ||||||||||
| QID | Skip Logic Label | Question Text | Answer Choices (limited to 50 characters) |
Skip To | Type (select from list) | Single or Multi | Required Y/N |
Special Instructions | CQ Label | |
| BJL2231 | What type of benefits were you applying for? | Retirement | Dropdown (Select-one) | Single | Y | Skip Logic Group | Type of Benefits | |||
| Medicare only | ||||||||||
| Disability | ||||||||||
| Both Retirement and Disability | ||||||||||
| Spouse's | ||||||||||
| Other | ||||||||||
| CAS0045242 | Are you applying online for yourself or are you helping someone else? | Myself | Dropdown (Select-one) | Single | Y | Applying for | ||||
| Helping a Spouse/Relative/Friend | ||||||||||
| Professional Helping a Client | ||||||||||
| Other | ||||||||||
| CAS0045243 | How did you learn about this online application? (Select all that apply.) | Official Social Security website | check box one up vertical | Multi | Y | Skip Logic Group | Learn about App | |||
| A general web search (e.g. Google, Bing, etc.) | ||||||||||
| The radio | ||||||||||
| The television | ||||||||||
| An email from Social Security | ||||||||||
| A newspaper or magazine article | ||||||||||
| An online ad (Banner/Image) | ||||||||||
| An online video | ||||||||||
| A newspaper or magazine ad | ||||||||||
| A billboard or other printed ad | ||||||||||
| Social Media (Blog, Facebook, Twitter, etc.) | ||||||||||
| Friend, spouse, relative, neighbor or acquaintance | ||||||||||
| Social Security statement | ||||||||||
| Social Security employee | A | |||||||||
| Community Group or Association | ||||||||||
| Other, please specify | B | |||||||||
| CAS0045244 | A | How did you make contact with a Social Security employee? | Visited a local Social Security office | check box one up vertical | Multi | Y | Skip Logic | SSA Emplyee Contact | ||
| Called a local Social Security office | ||||||||||
| Called the national 800 number | ||||||||||
| Other, please specify | AA | |||||||||
| CAS0045245 | AA | Please describe how you made contact with a Social Security employee. | Text box, no char limit | N | Skip Logic | OPS SSA Employe Contact | ||||
| CAS0045246 | B | Please specify how you learned about this online application. | Text box, no char limit | N | Skip Logic | OPS Learn about App | ||||
| CAS0045262 | Did you use any of the following to prepare to apply online? (Select all that apply.) | Reviewed my online Social Security Statement | A | check box one up vertical | Multi | Y | Skip Logic | Prepare for App | ||
| I used the Retirement Estimator or other tools on the Social Security website | B | |||||||||
| I watched the instructional video | C | |||||||||
| I used other information on the Social Security website to prepare | D | |||||||||
| I used another resource to prepare to apply online | E | |||||||||
| I did not use any resources to prepare to apply online | ||||||||||
| CAS0045263 | A | How helpful did you find the online Social Security Statement? | Very helpful | Drop down select one | Single | Y | Skip Logic | Rate Statement | ||
| Somewhat helpful | ||||||||||
| Not at all helpful | ||||||||||
| CAS0045264 | B | How helpful did you find the estimator tools on the website? | Very helpful | Drop down select one | Single | Y | Skip Logic | Rate RE Tools | ||
| Somewhat helpful | ||||||||||
| Not at all helpful | ||||||||||
| CAS0045265 | C | How helpful did you find the instructional video? | Very helpful | Drop down select one | Single | Y | Skip Logic | Rate Video | ||
| Somewhat helpful | ||||||||||
| Not at all helpful | ||||||||||
| CAS0045266 | D | How helpful did you find the other information on the Social Security website? | Very helpful | Drop down select one | Single | Y | Skip Logic | Rate Other Info on Website | ||
| Somewhat helpful | ||||||||||
| Not at all helpful | ||||||||||
| CAS0045267 | E | Please describe what other resource(s) you used to prepare to apply online? | Text field, no char limit | N | Skip Logic | OPS Prepare for App | ||||
| CAS0045247 | Did you start a new online application today or did you return to a saved application? | Started a new application | Drop down select one | Single | Y | App Status | ||||
| Returned to work on a saved application | ||||||||||
| CAS0045282 | Did you complete and submit this online application today? | Yes | Drop down select one | Single | Y | Skip Logic | Complete App | |||
| No, I plan to complete and submit later | A | |||||||||
| No, I do not plan to complete and submit the online application | A | |||||||||
| CAS0045283 | A | If you did not complete and submit this online application today, please tell us why. | Too many questions | check box one up vertical | Multi | Y | Skip Logic | Not Complete App | ||
| Takes too long to fill out | ||||||||||
| Too complicated to use without help | ||||||||||
| Didn't have information I needed like names, addresses, or dates | ||||||||||
| Didn't understand what questions meant/how to answer | ||||||||||
| My disabling condition prevents me from working with a computer for long periods | ||||||||||
| I had a limited amount of time/family demands that kept me from working on it for very long | ||||||||||
| I had technical problems like an error message or a mistake I couldn't fix | ||||||||||
| Other, please specify | AA | |||||||||
| CAS0045284 | AA | Please tell us why you did not complete and submit this application today. | Text field, no char limit | N | Skip Logic | OPS Why Not Complete today | ||||
| CAS0045248 | So far, how long have you worked on this online application? | Up to 15 minutes | Drop down select one | Single | Y | Time Spent | ||||
| 16 minutes - 30 minutes | ||||||||||
| 31 minutes - 1 hour | ||||||||||
| More than 1 hour up to 2 hours | ||||||||||
| More than 2 hours | ||||||||||
| CAS0045249 | How easy was it for you to find this online application? | Very easy | Find App | |||||||
| Somewhat easy | ||||||||||
| Somewhat hard | A | |||||||||
| Very hard | A | |||||||||
| CAS0045250 | A | Please tell us why it was hard to find the online application. (Select all that apply.) | Could not find where to start a new online application | check box one up vertical | Multi | Y | Skip Logic | Why hard to find | ||
| Not clear where to go to return to a previously saved application | ||||||||||
| It was not clear to me where the links would lead | ||||||||||
| Difficulty using a link on the Social Security website | ||||||||||
| The information did not seem to be organized in a logical manner | ||||||||||
| I used the search feature but the results didn’t seem to apply. | ||||||||||
| I tried to use the FAQ's, but couldn't find the online application | ||||||||||
| Other reason (please describe) | AA | |||||||||
| CAS0045285 | AA | Please explain the reason why it was hard for you to find the online application. | N | N | Skip Logic | OPS Hard to Find | ||||
| CAS0045286 | How did you arrive at this online application today? | Used the Online Services link on the Social Security homepage | Radio Button | Single | Y | Skip Logic | Arrive at App | |||
| Followed a link from somewhere else on the Social Security website | ||||||||||
| Used the search feature on the Social Security website | ||||||||||
| Used an outside search engine (i.e. Google, Bing, yahoo etc.) | ||||||||||
| Followed a link from medicare.gov | ||||||||||
| Followed a link from another website | ||||||||||
| Site was bookmarked | ||||||||||
| Other, please specify | A | |||||||||
| CAS0045251 | A | Please describe how you arrived at this online application today | Text field, no char limit | N | OPS Arrive at app | |||||
| CAS0045252 | Why did you choose to apply online? (Select all that apply.) | I did not want to go to a local Social Security office | check box one up vertical | Multi | Y | Skip Logic | Why Online | |||
| I did not want to apply over the phone | ||||||||||
| I prefer to use online services as much as possible | ||||||||||
| I learned about applying online while visiting Social Security's website | ||||||||||
| A Social Security employee recommended that I apply online | ||||||||||
| A friend or relative recommended that I apply online | ||||||||||
| I knew that if I had a question or problem applying online, I could still get help from Social Security | ||||||||||
| I am filing on behalf of another person | ||||||||||
| Other, please specify | A | |||||||||
| CAS0045287 | A | Please specify why you choose to apply online | Text field, no char limit | N | OPS Why Online | |||||
| CAS0045289 | What is your current marital status? | Married | Radio button, one-up vertical | Single | N | OPS Group | Marital Status | |||
| Separated | ||||||||||
| Divorced | ||||||||||
| Widowed | ||||||||||
| Never married | ||||||||||
| Prefer not to answer | ||||||||||
| Other, please specify | A | |||||||||
| CAS0045290 | A | Other marital status | Text field, <100 char | N | OPS Group | OPS Marital Status | ||||
| Do you presently have an active my Social Security account established? | Yes | Radio button, one-up vertical | Single | Y | Have mySSA Account | |||||
| No | ||||||||||
| CAS0045291 | Do you have any suggestions for improving Social Security's online application. | Text field, no char limit | N | OE_Improvement | ||||||
| Model Instance Name: | ||||||||||
| SSA iClaim v3 | underlined & italicized: RE-ORDER | |||||||||
| MID: VgpBBYx9l8JxIFgJlY1Ikg4C | pink: ADDITION | |||||||||
| Date: | 7/15/2011 | blue + -->: REWORDING | ||||||||
| violet (bold): SKIP-LOGIC | ||||||||||
| SSA iClaim v3 CUSTOM QUESTION LIST | ||||||||||
| QID | Skip Logic Label | Question Text | Answer Choices (limited to 50 characters) |
Skip To | Type (select from list) | Single or Multi | Required Y/N |
Special Instructions | CQ Label | |
| ENBJL2231 | What type of benefits were you applying for? | Retirement | Dropdown (Select-one) | Single | Y | Type of Benefits | ||||
| Medicare only | ||||||||||
| Disability | ||||||||||
| Both Retirement and Disability | ||||||||||
| Spouse's | ||||||||||
| Other | ||||||||||
| ENCAS0045242 | Are you applying online for yourself or are you helping someone else? | Myself | Dropdown (Select-one) | Single | Y | Applying for | ||||
| Helping a Spouse/Relative/Friend | ||||||||||
| Professional Helping a Client | ||||||||||
| Other | ||||||||||
| ENCAS0045243 | How did you learn about this online application? (Select all that apply.) | Official Social Security website | check box one up vertical | Multi | Y | Skip Logic Group | Learn about App | |||
| A general web search (e.g. Google, Bing, etc.) | ||||||||||
| The radio | ||||||||||
| The television | ||||||||||
| An email from Social Security | ||||||||||
| A newspaper or magazine article | ||||||||||
| An online ad (Banner/Image) | ||||||||||
| An online video | ||||||||||
| A newspaper or magazine ad | ||||||||||
| A billboard or other printed ad | ||||||||||
| Social Media (Blog, Facebook, Twitter, etc.) | ||||||||||
| Friend, spouse, relative, neighbor or acquaintance | ||||||||||
| Social Security statement | ||||||||||
| Social Security employee | A | |||||||||
| Community Group or Association | ||||||||||
| Other, please specify | B | |||||||||
| ENCAS0045244 | A | How did you make contact with a Social Security employee? | Visited a local Social Security office | check box one up vertical | Multi | Y | Skip Logic | SSA Emplyee Contact | ||
| Called a local Social Security office | ||||||||||
| Called the national 800 number | ||||||||||
| Other, please specify | AA | |||||||||
| ENCAS0045245 | AA | Please describe how you made contact with a Social Security employee. | Text box, no char limit | N | Skip Logic | OPS SSA Employe Contact | ||||
| ENCAS0045246 | B | Please specify how you learned about this online application. | Text box, no char limit | N | Skip Logic | OPS Learn about App | ||||
| ENCAS0045262 | Did you use any of the following to prepare to apply online? (Select all that apply.) | Reviewed my online Social Security Statement | A | check box one up vertical | Multi | Y | Skip Logic | Prepare for App | ||
| I used the Retirement Estimator or other tools on the Social Security website | B | |||||||||
| I watched the instructional video | C | |||||||||
| I used other information on the Social Security website to prepare | D | |||||||||
| I used another resource to prepare to apply online | E | |||||||||
| I did not use any resources to prepare to apply online | ||||||||||
| ENCAS0045263 | A | How helpful did you find the online Social Security Statement? | Very helpful | Drop down select one | Single | Y | Skip Logic | Rate Statement | ||
| Somewhat helpful | ||||||||||
| Not at all helpful | ||||||||||
| ENCAS0045264 | B | How helpful did you find the estimator tools on the website? | Very helpful | Drop down select one | Single | Y | Skip Logic | Rate RE Tools | ||
| Somewhat helpful | ||||||||||
| Not at all helpful | ||||||||||
| ENCAS0045265 | C | How helpful did you find the instructional video? | Very helpful | Drop down select one | Single | Y | Skip Logic | Rate Video | ||
| Somewhat helpful | ||||||||||
| Not at all helpful | ||||||||||
| ENCAS0045266 | D | How helpful did you find the other information on the Social Security website? | Very helpful | Drop down select one | Single | Y | Skip Logic | Rate Other Info on Website | ||
| Somewhat helpful | ||||||||||
| Not at all helpful | ||||||||||
| ENCAS0045267 | E | Please describe what other resource(s) you used to prepare to apply online? | Text field, no char limit | N | Skip Logic | OPS Prepare for App | ||||
| ENCAS0045247 | Did you start a new online application today or did you return to a saved application? | Started a new application | Drop down select one | Single | Y | App Status | ||||
| Returned to work on a saved application | ||||||||||
| ENCAS0045282 | Did you complete and submit this online application today? | Yes | Drop down select one | Single | Y | Skip Logic | Complete App | |||
| No, I plan to complete and submit later | A | |||||||||
| No, I do not plan to complete and submit the online application | A | |||||||||
| ENCAS0045283 | A | If you did not complete and submit this online application today, please tell us why. | Too many questions | check box one up vertical | Multi | Y | Skip Logic | Not Complete App | ||
| Takes too long to fill out | ||||||||||
| Too complicated to use without help | ||||||||||
| Didn't have information I needed like names, addresses, or dates | ||||||||||
| Didn't understand what questions meant/how to answer | ||||||||||
| My disabling condition prevents me from working with a computer for long periods | ||||||||||
| I had a limited amount of time/family demands that kept me from working on it for very long | ||||||||||
| I had technical problems like an error message or a mistake I couldn't fix | ||||||||||
| Other, please specify | AA | |||||||||
| ENCAS0045284 | AA | Please tell us why you did not complete and submit this application today. | Text field, no char limit | N | Skip Logic | OPS Why Not Complete today | ||||
| ENCAS0045248 | So far, how long have you worked on this online application? | Up to 15 minutes | Drop down select one | Single | Y | Time Spent | ||||
| 16 minutes - 30 minutes | ||||||||||
| 31 minutes - 1 hour | ||||||||||
| More than 1 hour up to 2 hours | ||||||||||
| More than 2 hours | ||||||||||
| ENCAS0045249 | How easy was it for you to find this online application? | Very easy | Find App | |||||||
| Somewhat easy | ||||||||||
| Somewhat hard | A | |||||||||
| Very hard | A | |||||||||
| ENCAS0045250 | A | Please tell us why it was hard to find the online application. (Select all that apply.) | Could not find where to start a new online application | check box one up vertical | Multi | Y | Skip Logic | Why hard to find | ||
| Not clear where to go to return to a previously saved application | ||||||||||
| It was not clear to me where the links would lead | ||||||||||
| Difficulty using a link on the Social Security website | ||||||||||
| The information did not seem to be organized in a logical manner | ||||||||||
| I used the search feature but the results didn’t seem to apply. | ||||||||||
| I tried to use the FAQ's, but couldn't find the online application | ||||||||||
| Other reason (please describe) | AA | |||||||||
| ENCAS0045285 | AA | Please explain the reason why it was hard for you to find the online application. | N | N | Skip Logic | OPS Hard to Find | ||||
| ENCAS0045286 | How did you arrive at this online application today? | Used the Online Services link on the Social Security homepage | Radio Button | Single | Y | Skip Logic | Arrive at App | |||
| Followed a link from somewhere else on the Social Security website | ||||||||||
| Used the search feature on the Social Security website | ||||||||||
| Used an outside search engine (i.e. Google, Bing, yahoo etc.) | ||||||||||
| Followed a link from medicare.gov | ||||||||||
| Followed a link from another website | ||||||||||
| Site was bookmarked | ||||||||||
| Other, please specify | A | |||||||||
| ENCAS0045251 | A | Please describe how you arrived at this online application today | Text field, no char limit | N | OPS Arrive at app | |||||
| ENCAS0045252 | Why did you choose to apply online? (Select all that apply.) | I did not want to go to a local Social Security office | check box one up vertical | Multi | Y | Skip Logic | Why Online | |||
| I did not want to apply over the phone | ||||||||||
| I prefer to use online services as much as possible | ||||||||||
| I learned about applying online while visiting Social Security's website | ||||||||||
| A Social Security employee recommended that I apply online | ||||||||||
| A friend or relative recommended that I apply online | ||||||||||
| I knew that if I had a question or problem applying online, I could still get help from Social Security | ||||||||||
| I am filing on behalf of another person | ||||||||||
| Other, please specify | A | |||||||||
| ENCAS0045287 | A | Please specify why you choose to apply online | Text field, no char limit | N | OPS Why Online | |||||
| ENCAS0045289 | What is your current marital status? | Married | Radio button, one-up vertical | Single | N | OPS Group | Marital Status | |||
| Separated | ||||||||||
| Divorced | ||||||||||
| Widowed | ||||||||||
| Never married | ||||||||||
| Prefer not to answer | ||||||||||
| Other, please specify | A | |||||||||
| ENCAS0045290 | A | Other marital status | Text field, <100 char | N | OPS Group | OPS Marital Status | ||||
| Do you presently have an active my Social Security account established? | Yes | Radio button, one-up vertical | Single | Y | Have mySSA Account | |||||
| No | ||||||||||
| ENCAS0045291 | Do you have any suggestions for improving Social Security's online application. | Text field, no char limit | N | OE_Improvement | ||||||
| Model Instance Name: | |||||||||||
| SSA iClaim v3 (Spanish) | underlined & italicized: RE-ORDER | ||||||||||
| MID: | Q0ExM1xNQRl9JJUR0M0JlA4C | pink: ADDITION | |||||||||
| Date: | 7/15/2011 | blue + -->: REWORDING | |||||||||
| violet (bold): SKIP-LOGIC | |||||||||||
| SSA iClaim v3 (Spanish) CUSTOM QUESTION LIST | |||||||||||
| QID | Skip Logic Label | Question Text | Answer Choices (limited to 50 characters) |
Skip To | Type (select from list) | Single or Multi | Required Y/N |
Special Instructions | CQ Label | ||
| SPBJL2231 | ¿Qué tipo de beneficios estaba solicitando? | Por jubilación | Dropdown (Select-one) | Single | Y | Skip Logic Group | Type of Benefits | ||||
| Solo Medicare | |||||||||||
| Por incapacidad | |||||||||||
| Tanto Jubilación y Discapacidad | |||||||||||
| Coomo cónyuge | |||||||||||
| Otro | |||||||||||
| SPCAS0045242 | ¿Es esta solicitud en línea para sí mismo o estás ayudando a alguien más? | Yo mismo | Dropdown (Select-one) | Single | Y | Applying for | |||||
| Cómo ayudar a un cónyuge / pariente / amigo | |||||||||||
| Profesional Ayudar a un cliente | |||||||||||
| Otro | |||||||||||
| SPCAS0045243 | ¿Cómo se enteró acerca de esta solicitud en línea? (Seleccione todas las que apliquen.) | Sitio web oficial de la Seguridad Social | check box one up vertical | Multi | Y | Skip Logic Group | Learn about App | ||||
| Una búsqueda web general (por ejemplo, Google, Bing, etc) | |||||||||||
| La radio | |||||||||||
| La televisión | |||||||||||
| Un correo electrónico de la Seguridad Social | |||||||||||
| Un periódico o la revista | |||||||||||
| Un anuncio en línea (Banner / Imagen) | |||||||||||
| Un video en línea | |||||||||||
| Un periódico o una revista de anuncios | |||||||||||
| Un anuncio impreso cartelera u otro | |||||||||||
| Medios de Comunicación Social (Blog, Facebook, Twitter, etc) | |||||||||||
| Amigo, cónyuge, pariente, vecino o conocido | |||||||||||
| Declaración del Seguro Social | |||||||||||
| Empleado del Seguro Social | A | ||||||||||
| Grupo de la comunidad o de la Asociación | |||||||||||
| Otro, especificar | B | ||||||||||
| SPCAS0045244 | A | ¿Cómo se hace el contacto con un empleado del Seguro Social? | Visitado una oficina local del Seguro Social | check box one up vertical | Multi | Y | Skip Logic | SSA Emplyee Contact | |||
| Llamado a la oficina local del Seguro Social | |||||||||||
| Llamado el número nacional 800 | |||||||||||
| Otro, especificar | AA | ||||||||||
| SPCAS0045245 | AA | Por favor describa cómo se hizo contacto con un empleado del Seguro Social. | Text box, no char limit | N | Skip Logic | OPS SSA Employe Contact | |||||
| SPCAS0045246 | B | Por favor, especifique cómo se enteró de esta aplicación en línea. | Text box, no char limit | N | Skip Logic | OPS Learn about App | |||||
| SPCAS0045262 | ¿Ha usado alguna de las siguientes acciones para prepararse para aplicar en línea? (Seleccione todas las que apliquen.) | Comentado mi Declaración del Seguro Social en línea | A | check box one up vertical | Multi | Y | Skip Logic | Prepare for App | |||
| He utilizado el Retirement Estimator u otras herramientas en el sitio web de la Seguridad Social | B | ||||||||||
| Vi el video de instrucciones | C | ||||||||||
| Usé otra información en la página web de la Seguridad Social para preparar | D | ||||||||||
| Utilicé otro recurso que se preparen para aplicar en línea | E | ||||||||||
| No hice uso de los recursos para prepararse para aplicar en línea | |||||||||||
| SPCAS0045263 | A | ¿Qué tan útil ha encontrado el Declaración del Seguro Social en línea? | Muy útil | Drop down select one | Single | Y | Skip Logic | Rate Statement | |||
| algo útil | |||||||||||
| Para nada útil | |||||||||||
| SPCAS0045264 | B | ¿Qué tan útil encontraste las herramientas estimador en el sitio web? | Muy útil | Drop down select one | Single | Y | Skip Logic | Rate RE Tools | |||
| algo útil | |||||||||||
| Para nada útil | |||||||||||
| SPCAS0045265 | C | ¿Qué tan útil le parecen la video instructivo? | Muy útil | Drop down select one | Single | Y | Skip Logic | Rate Video | |||
| algo útil | |||||||||||
| Para nada útil | |||||||||||
| SPCAS0045266 | D | ¿Qué tan útil le parecen la otra información en el sitio web de la Seguridad Social? | Muy útil | Drop down select one | Single | Y | Skip Logic | Rate Other Info on Website | |||
| algo útil | |||||||||||
| Para nada útil | |||||||||||
| SPCAS0045267 | E | Por favor describa lo otro recurso (s) que utilizó para prepararse para aplicar en línea. | Text field, no char limit | N | Skip Logic | OPS Prepare for App | |||||
| SPCAS0045247 | ¿Comenzó una nueva aplicación en línea hoy mismo o que te vuelva a una solicitud guardada? | Comenzó una nueva aplicación | Drop down select one | Single | Y | App Status | |||||
| Volvió a trabajar en una solicitud guardada | |||||||||||
| SPCAS0045282 | ¿Sabía usted completar y presentar esta solicitud en línea hoy en día? | Sí | Drop down select one | Single | Y | Skip Logic | Complete App | ||||
| No, tengo la intención de completar y enviar más tarde | A | ||||||||||
| No, no tengo planes para completar y enviar la solicitud en línea | A | ||||||||||
| SPCAS0045283 | A | Si no logró completar y presentar esta solicitud en línea hoy, por favor díganos por qué. | Demasiadas preguntas | check box one up vertical | Multi | Y | Skip Logic | Not Complete App | |||
| Toma demasiado tiempo para llenar | |||||||||||
| Demasiado complicado de usar sin ayuda | |||||||||||
| No tenía la información que necesitaba como nombres, direcciones o fechas | |||||||||||
| No entendía lo que significaba preguntas / cómo responder | |||||||||||
| Mi condición de discapacidad me impide trabajar con una computadora por largos periodos | |||||||||||
| Yo tenía una cantidad limitada de demandas de tiempo / de la familia que me impedía trabajar en ella por mucho tiempo | |||||||||||
| Tuve problemas técnicos, como un mensaje de error o un error que no podía fijar | |||||||||||
| Otro, especificar | AA | ||||||||||
| SPCAS0045284 | AA | Haznos saber por qué no se ha completado y se somete esta solicitud hoy. | Text field, no char limit | N | Skip Logic | OPS Why Not Complete today | |||||
| SPCAS0045248 | Hasta el momento, ¿cuánto tiempo ha trabajado en esta solicitud en línea? | Hasta 15 minutos | Drop down select one | Single | Y | Time Spent | |||||
| 16 minutos - 30 minutos | |||||||||||
| 31 minutos - 1 hora | |||||||||||
| Más de 1 hora hasta 2 horas | |||||||||||
| Más de 2 horas | |||||||||||
| SPCAS0045249 | ¿Fue fácil para usted para encontrar esta aplicación en línea? | Muy fácil | Find App | ||||||||
| algo fácil | |||||||||||
| algo duro | A | ||||||||||
| Muy difícil | A | ||||||||||
| SPCAS0045250 | A | Haznos saber por qué era difícil encontrar la aplicación en línea. (Seleccione todas las que apliquen.) | No se pudo encontrar por dónde empezar una nueva aplicación en línea | check box one up vertical | Multi | Y | Skip Logic | Why hard to find | |||
| Donde no está claro que vaya a volver a una solicitud previamente guardada | |||||||||||
| No estaba claro para mí cuando los vínculos conducirían | |||||||||||
| Dificultad para utilizar un enlace en la página web de la Seguridad Social | |||||||||||
| La información no parecía estar organizados de una manera lógica | |||||||||||
| Usé la función de búsqueda, pero los resultados no parecen aplicarse. | |||||||||||
| Traté de usar el FAQ, pero no pude encontrar la solicitud en línea | |||||||||||
| Otro, especificar | AA | ||||||||||
| SPCAS0045285 | AA | Por favor, explique la razón por la que era difícil para usted para encontrar la solicitud en línea. | N | N | Skip Logic | OPS Hard to Find | |||||
| SPCAS0045286 | ¿Cómo llegaste a esta solicitud en línea hoy en día? | Se utiliza el enlace de los servicios en línea en la página web de la Seguridad Social | Radio Button | Single | Y | Skip Logic | Arrive at App | ||||
| Seguido de un enlace de algún otro lugar en el sitio web de la Seguridad Social | |||||||||||
| Se utiliza la función de búsqueda en la página web de la Seguridad Social | |||||||||||
| Se utiliza un motor de búsqueda fuera (es decir, Google, Bing, Yahoo, etc) | |||||||||||
| Seguido de un enlace desde medicare.gov | |||||||||||
| Seguido un enlace desde otro sitio web | |||||||||||
| Este sitio fue bookmarked | |||||||||||
| Otro, especificar | A | ||||||||||
| SPCAS0045251 | A | Por favor describa cómo llegó a esta solicitud en línea hoy | Text field, no char limit | N | OPS Arrive at app | ||||||
| SPCAS0045252 | ¿Por qué eligió para aplicar en línea? (Seleccione todas las que apliquen.) | Yo no quería ir a una oficina local del Seguro Social | check box one up vertical | Multi | Y | Skip Logic | Why Online | ||||
| Yo no quería que la solicitud por teléfono | |||||||||||
| Yo prefiero usar los servicios en línea tanto como sea posible | |||||||||||
| Aprendí acerca de la aplicación en línea durante su visita a la página web de la Seguridad Social | |||||||||||
| Un empleado del Seguro Social recomienda que aplico en línea | |||||||||||
| Un amigo o familiar recomendaron que aplico en línea | |||||||||||
| Yo sabía que si tenía alguna pregunta o problema la aplicación en línea, todavía podía recibir ayuda de la Seguridad Social | |||||||||||
| Estoy presentando en nombre de otra persona | |||||||||||
| Otro, especificar | A | ||||||||||
| SPCAS0045287 | A | Por favor, especifique qué decide aplicar en línea | Text field, no char limit | N | OPS Why Online | ||||||
| SPCAS0045289 | ¿Cuál es su estado civil actual? | casado | Radio button, one-up vertical | Single | N | OPS Group | Marital Status | ||||
| apartado | |||||||||||
| divorciado | |||||||||||
| viudo | |||||||||||
| ` | Nunca se ha casado | ||||||||||
| Prefiero no responder | |||||||||||
| Otro, especificar | A | ||||||||||
| SPCAS0045290 | A | Otro estado civil | Text field, <100 char | N | OPS Group | OPS Marital Status | |||||
| ¿Tiene actualmente una cuenta activa de my Social Security establecido? | Sí | Radio button, one-up vertical | Single | Y | Have mySSA Account | ||||||
| No | |||||||||||
| SPCAS0045291 | ¿Tiene alguna sugerencia para mejorar la aplicación en línea de la Seguridad Social? | Text field, no char limit | N | OE_Improvement | |||||||
| Model Instance Name: | |||||||||||||||
| SSA iClaim v3 | underlined & italicized: RE-ORDER | ||||||||||||||
| MID: xZAAEQw81gIo1Vo4Noc1Rw4C | pink: ADDITION | ||||||||||||||
| Date: | 7/15/2011 | blue + -->: REWORDING | |||||||||||||
| violet (bold): SKIP-LOGIC | |||||||||||||||
| SSA iClaim v3 CUSTOM QUESTION LIST | |||||||||||||||
| QID | Skip Logic Label | Question Text | Answer Choices (limited to 50 characters) |
Skip To | Type (select from list) | Single or Multi | Required Y/N |
Special Instructions | CQ Label | ||||||
| BJL2231 | What type of benefits were you applying for? | Retirement | Dropdown (Select-one) | Single | Y | Skip Logic Group | Type of Benefits | ||||||||
| Medicare only | |||||||||||||||
| Disability | |||||||||||||||
| Both Retirement and Disability | |||||||||||||||
| Spouse's | |||||||||||||||
| Other | |||||||||||||||
| Are you applying online for yourself or are you helping someone else? | Myself | Dropdown (Select-one) | Single | Y | Applying for | ||||||||||
| Helping a Spouse/Relative/Friend | |||||||||||||||
| Professional Helping a Client | |||||||||||||||
| Other | |||||||||||||||
| How did you learn about this online application? (Select all that apply.) | Official Social Security website | check box one up vertical | Multi | Y | Skip Logic Group | Learn about App | |||||||||
| A general web search (e.g. Google, Bing, etc.) | |||||||||||||||
| The radio | |||||||||||||||
| The television | |||||||||||||||
| An email from Social Security | |||||||||||||||
| A newspaper or magazine article | |||||||||||||||
| An online ad (Banner/Image) | |||||||||||||||
| An online video | |||||||||||||||
| A newspaper or magazine ad | |||||||||||||||
| A billboard or other printed ad | |||||||||||||||
| Social Media (Blog, Facebook, Twitter, etc.) | |||||||||||||||
| Friend, spouse, relative, neighbor or acquaintance | |||||||||||||||
| Social Security statement | |||||||||||||||
| Social Security employee | A | ||||||||||||||
| Community Group or Association | |||||||||||||||
| Other, please specify | B | ||||||||||||||
| A | How did you make contact with a Social Security employee? | Visited a local Social Security office | check box one up vertical | Multi | Y | Skip Logic | SSA Emplyee Contact | ||||||||
| Called a local Social Security office | |||||||||||||||
| Called the national 800 number | |||||||||||||||
| Other, please specify | AA | ||||||||||||||
| AA | Please describe how you made contact with a Social Security employee. | Text box, no char limit | N | Skip Logic | OPS SSA Employe Contact | ||||||||||
| B | Please specify how you learned about this online application. | Text box, no char limit | N | Skip Logic | OPS Learn about App | ||||||||||
| Did you use any of the following to prepare to apply online? (Select all that apply.) | Reviewed my online Social Security Statement | A | check box one up vertical | Multi | Y | Skip Logic | Prepare for App | ||||||||
| I used the Retirement Estimator or other tools on the Social Security website | B | ||||||||||||||
| I watched the instructional video | C | ||||||||||||||
| I used other information on the Social Security website to prepare | D | ||||||||||||||
| I used another resource to prepare to apply online | E | ||||||||||||||
| I did not use any resources to prepare to apply online | |||||||||||||||
| A | How helpful did you find the online Social Security Statement? | Very helpful | Drop down select one | Single | Y | Skip Logic | Rate Statement | ||||||||
| Somewhat helpful | |||||||||||||||
| Not at all helpful | |||||||||||||||
| B | How helpful did you find the estimator tools on the website? | Very helpful | Drop down select one | Single | Y | Skip Logic | Rate RE Tools | ||||||||
| Somewhat helpful | |||||||||||||||
| Not at all helpful | |||||||||||||||
| C | How helpful did you find the instructional video? | Very helpful | Drop down select one | Single | Y | Skip Logic | Rate Video | ||||||||
| Somewhat helpful | |||||||||||||||
| Not at all helpful | |||||||||||||||
| D | How helpful did you find the other information on the Social Security website? | Very helpful | Drop down select one | Single | Y | Skip Logic | Rate Other Info on Website | ||||||||
| Somewhat helpful | |||||||||||||||
| Not at all helpful | |||||||||||||||
| E | Please describe what other resource(s) you used to prepare to apply online? | Text field, no char limit | N | Skip Logic | OPS Prepare for App | ||||||||||
| Did you start a new online application today or did you return to a saved application? | Started a new application | Drop down select one | Single | Y | App Status | ||||||||||
| Returned to work on a saved application | |||||||||||||||
| Did you complete and submit this online application today? | Yes | Drop down select one | Single | Y | Skip Logic | Complete App | |||||||||
| No, I plan to complete and submit later | A | ||||||||||||||
| No, I do not plan to complete and submit the online application | A | ||||||||||||||
| A | If you did not complete and submit this online application today, please tell us why. | Too many questions | check box one up vertical | Multi | Y | Skip Logic | Not Complete App | ||||||||
| Takes too long to fill out | |||||||||||||||
| Too complicated to use without help | |||||||||||||||
| Didn't have information I needed like names, addresses, or dates | |||||||||||||||
| Didn't understand what questions meant/how to answer | |||||||||||||||
| My disabling condition prevents me from working with a computer for long periods | |||||||||||||||
| I had a limited amount of time/family demands that kept me from working on it for very long | |||||||||||||||
| I had technical problems like an error message or a mistake I couldn't fix | |||||||||||||||
| Other, please specify | AA | ||||||||||||||
| AA | Please tell us why you did not complete and submit this application today. | Text field, no char limit | N | Skip Logic | OPS Why Not Complete today | ||||||||||
| So far, how long have you worked on this online application? | Up to 15 minutes | Drop down select one | Single | Y | Time Spent | ||||||||||
| 16 minutes - 30 minutes | |||||||||||||||
| 31 minutes - 1 hour | |||||||||||||||
| More than 1 hour up to 2 hours | |||||||||||||||
| More than 2 hours | |||||||||||||||
| How easy was it for you to find this online application? | Very easy | Find App | |||||||||||||
| Somewhat easy | |||||||||||||||
| Somewhat hard | A | ||||||||||||||
| Very hard | A | ||||||||||||||
| A | Please tell us why it was hard to find the online application. (Select all that apply.) | Could not find where to start a new online application | check box one up vertical | Multi | Y | Skip Logic | Why hard to find | ||||||||
| Not clear where to go to return to a previously saved application | |||||||||||||||
| It was not clear to me where the links would lead | |||||||||||||||
| Difficulty using a link on the Social Security website | |||||||||||||||
| The information did not seem to be organized in a logical manner | |||||||||||||||
| I used the search feature but the results didn’t seem to apply. | |||||||||||||||
| I tried to use the FAQ's, but couldn't find the online application | |||||||||||||||
| Other reason (please describe) | AA | ||||||||||||||
| AA | Please explain the reason why it was hard for you to find the online application. | N | N | Skip Logic | OPS Hard to Find | ||||||||||
| How did you arrive at this online application today? | Used the Online Services link on the Social Security homepage | Radio Button | Single | Y | Skip Logic | Arrive at App | |||||||||
| Followed a link from somewhere else on the Social Security website | |||||||||||||||
| Used the search feature on the Social Security website | |||||||||||||||
| Used an outside search engine (i.e. Google, Bing, yahoo etc.) | |||||||||||||||
| Followed a link from medicare.gov | |||||||||||||||
| Followed a link from another website | |||||||||||||||
| Site was bookmarked | |||||||||||||||
| Other, please specify | A | ||||||||||||||
| A | Please describe how you arrived at this online application today | Text field, no char limit | N | OPS Arrive at app | |||||||||||
| Why did you choose to apply online? (Select all that apply.) | I did not want to go to a local Social Security office | check box one up vertical | Multi | Y | Skip Logic | Why Online | |||||||||
| I did not want to apply over the phone | |||||||||||||||
| I prefer to use online services as much as possible | |||||||||||||||
| I learned about applying online while visiting Social Security's website | |||||||||||||||
| A Social Security employee recommended that I apply online | |||||||||||||||
| A friend or relative recommended that I apply online | |||||||||||||||
| I knew that if I had a question or problem applying online, I could still get help from Social Security | |||||||||||||||
| I am filing on behalf of another person | |||||||||||||||
| Other, please specify | A | ||||||||||||||
| A | Please specify why you choose to apply online | Text field, no char limit | N | OPS Why Online | |||||||||||
| What is your current marital status? | Married | Radio button, one-up vertical | Single | N | OPS Group | Marital Status | |||||||||
| Separated | |||||||||||||||
| Divorced | |||||||||||||||
| Widowed | |||||||||||||||
| Never married | |||||||||||||||
| Prefer not to answer | |||||||||||||||
| Other, please specify | A | ||||||||||||||
| A | Other marital status | Text field, <100 char | N | OPS Group | OPS Marital Status | ||||||||||
| Do you have any suggestions for improving Social Security's online application. | Text field, no char limit | N | OE_Improvement | ||||||||||||
| Types | |||||||||||||||
| Model Instance Name: | |||||||||||||||
| SSA iClaim v3 | underlined & italicized: RE-ORDER | ||||||||||||||
| MID: VgpBBYx9l8JxIFgJlY1Ikg4C | pink: ADDITION | ||||||||||||||
| Date: | 7/15/2011 | blue + -->: REWORDING | |||||||||||||
| violet (bold): SKIP-LOGIC | |||||||||||||||
| SSA iClaim v3 CUSTOM QUESTION LIST | |||||||||||||||
| QID | Skip Logic Label | Question Text | Answer Choices (limited to 50 characters) |
Skip To | Type (select from list) | Single or Multi | Required Y/N |
Special Instructions | CQ Label | ||||||
| ENBJL2231 | What type of benefits were you applying for? | Retirement | Dropdown (Select-one) | Single | Y | Type of Benefits | |||||||||
| Medicare only | |||||||||||||||
| Disability | |||||||||||||||
| Both Retirement and Disability | |||||||||||||||
| Spouse's | |||||||||||||||
| Other | |||||||||||||||
| Are you applying online for yourself or are you helping someone else? | Myself | Dropdown (Select-one) | Single | Y | Applying for | ||||||||||
| Helping a Spouse/Relative/Friend | |||||||||||||||
| Professional Helping a Client | |||||||||||||||
| Other | |||||||||||||||
| How did you learn about this online application? (Select all that apply.) | Official Social Security website | check box one up vertical | Multi | Y | Skip Logic Group | Learn about App | |||||||||
| A general web search (e.g. Google, Bing, etc.) | |||||||||||||||
| The radio | |||||||||||||||
| The television | |||||||||||||||
| An email from Social Security | |||||||||||||||
| A newspaper or magazine article | |||||||||||||||
| An online ad (Banner/Image) | |||||||||||||||
| An online video | |||||||||||||||
| A newspaper or magazine ad | |||||||||||||||
| A billboard or other printed ad | |||||||||||||||
| Social Media (Blog, Facebook, Twitter, etc.) | |||||||||||||||
| Friend, spouse, relative, neighbor or acquaintance | |||||||||||||||
| Social Security statement | |||||||||||||||
| Social Security employee | A | ||||||||||||||
| Community Group or Association | |||||||||||||||
| Other, please specify | B | ||||||||||||||
| A | How did you make contact with a Social Security employee? | Visited a local Social Security office | check box one up vertical | Multi | Y | Skip Logic | SSA Emplyee Contact | ||||||||
| Called a local Social Security office | |||||||||||||||
| Called the national 800 number | |||||||||||||||
| Other, please specify | AA | ||||||||||||||
| AA | Please describe how you made contact with a Social Security employee. | Text box, no char limit | N | Skip Logic | OPS SSA Employe Contact | ||||||||||
| B | Please specify how you learned about this online application. | Text box, no char limit | N | Skip Logic | OPS Learn about App | ||||||||||
| Did you use any of the following to prepare to apply online? (Select all that apply.) | Reviewed my online Social Security Statement | A | check box one up vertical | Multi | Y | Skip Logic | Prepare for App | ||||||||
| I used the Retirement Estimator or other tools on the Social Security website | B | ||||||||||||||
| I watched the instructional video | C | ||||||||||||||
| I used other information on the Social Security website to prepare | D | ||||||||||||||
| I used another resource to prepare to apply online | E | ||||||||||||||
| I did not use any resources to prepare to apply online | |||||||||||||||
| A | How helpful did you find the online Social Security Statement? | Very helpful | Drop down select one | Single | Y | Skip Logic | Rate Statement | ||||||||
| Somewhat helpful | |||||||||||||||
| Not at all helpful | |||||||||||||||
| B | How helpful did you find the estimator tools on the website? | Very helpful | Drop down select one | Single | Y | Skip Logic | Rate RE Tools | ||||||||
| Somewhat helpful | |||||||||||||||
| Not at all helpful | |||||||||||||||
| C | How helpful did you find the instructional video? | Very helpful | Drop down select one | Single | Y | Skip Logic | Rate Video | ||||||||
| Somewhat helpful | |||||||||||||||
| Not at all helpful | |||||||||||||||
| D | How helpful did you find the other information on the Social Security website? | Very helpful | Drop down select one | Single | Y | Skip Logic | Rate Other Info on Website | ||||||||
| Somewhat helpful | |||||||||||||||
| Not at all helpful | |||||||||||||||
| E | Please describe what other resource(s) you used to prepare to apply online? | Text field, no char limit | N | Skip Logic | OPS Prepare for App | ||||||||||
| Did you start a new online application today or did you return to a saved application? | Started a new application | Drop down select one | Single | Y | App Status | ||||||||||
| Returned to work on a saved application | |||||||||||||||
| Did you complete and submit this online application today? | Yes | Drop down select one | Single | Y | Skip Logic | Complete App | |||||||||
| No, I plan to complete and submit later | A | ||||||||||||||
| No, I do not plan to complete and submit the online application | A | ||||||||||||||
| A | If you did not complete and submit this online application today, please tell us why. | Too many questions | check box one up vertical | Multi | Y | Skip Logic | Not Complete App | ||||||||
| Takes too long to fill out | |||||||||||||||
| Too complicated to use without help | |||||||||||||||
| Didn't have information I needed like names, addresses, or dates | |||||||||||||||
| Didn't understand what questions meant/how to answer | |||||||||||||||
| My disabling condition prevents me from working with a computer for long periods | |||||||||||||||
| I had a limited amount of time/family demands that kept me from working on it for very long | |||||||||||||||
| I had technical problems like an error message or a mistake I couldn't fix | |||||||||||||||
| Other, please specify | AA | ||||||||||||||
| AA | Please tell us why you did not complete and submit this application today. | Text field, no char limit | N | Skip Logic | OPS Why Not Complete today | ||||||||||
| So far, how long have you worked on this online application? | Up to 15 minutes | Drop down select one | Single | Y | Time Spent | ||||||||||
| 16 minutes - 30 minutes | |||||||||||||||
| 31 minutes - 1 hour | |||||||||||||||
| More than 1 hour up to 2 hours | |||||||||||||||
| More than 2 hours | |||||||||||||||
| How easy was it for you to find this online application? | Very easy | Find App | |||||||||||||
| Somewhat easy | |||||||||||||||
| Somewhat hard | A | ||||||||||||||
| Very hard | A | ||||||||||||||
| A | Please tell us why it was hard to find the online application. (Select all that apply.) | Could not find where to start a new online application | check box one up vertical | Multi | Y | Skip Logic | Why hard to find | ||||||||
| Not clear where to go to return to a previously saved application | |||||||||||||||
| It was not clear to me where the links would lead | |||||||||||||||
| Difficulty using a link on the Social Security website | |||||||||||||||
| The information did not seem to be organized in a logical manner | |||||||||||||||
| I used the search feature but the results didn’t seem to apply. | |||||||||||||||
| I tried to use the FAQ's, but couldn't find the online application | |||||||||||||||
| Other reason (please describe) | AA | ||||||||||||||
| AA | Please explain the reason why it was hard for you to find the online application. | N | N | Skip Logic | OPS Hard to Find | ||||||||||
| How did you arrive at this online application today? | Used the Online Services link on the Social Security homepage | Radio Button | Single | Y | Skip Logic | Arrive at App | |||||||||
| Followed a link from somewhere else on the Social Security website | |||||||||||||||
| Used the search feature on the Social Security website | |||||||||||||||
| Used an outside search engine (i.e. Google, Bing, yahoo etc.) | |||||||||||||||
| Followed a link from medicare.gov | |||||||||||||||
| Followed a link from another website | |||||||||||||||
| Site was bookmarked | |||||||||||||||
| Other, please specify | A | ||||||||||||||
| A | Please describe how you arrived at this online application today | Text field, no char limit | N | OPS Arrive at app | |||||||||||
| Why did you choose to apply online? (Select all that apply.) | I did not want to go to a local Social Security office | check box one up vertical | Multi | Y | Skip Logic | Why Online | |||||||||
| I did not want to apply over the phone | |||||||||||||||
| I prefer to use online services as much as possible | |||||||||||||||
| I learned about applying online while visiting Social Security's website | |||||||||||||||
| A Social Security employee recommended that I apply online | |||||||||||||||
| A friend or relative recommended that I apply online | |||||||||||||||
| I knew that if I had a question or problem applying online, I could still get help from Social Security | |||||||||||||||
| I am filing on behalf of another person | |||||||||||||||
| Other, please specify | A | ||||||||||||||
| A | Please specify why you choose to apply online | Text field, no char limit | N | OPS Why Online | |||||||||||
| What is your current marital status? | Married | Radio button, one-up vertical | Single | N | OPS Group | Marital Status | |||||||||
| Separated | |||||||||||||||
| Divorced | |||||||||||||||
| Widowed | |||||||||||||||
| Never married | |||||||||||||||
| Prefer not to answer | |||||||||||||||
| Other, please specify | A | ||||||||||||||
| A | Other marital status | Text field, <100 char | N | OPS Group | OPS Marital Status | ||||||||||
| Do you have any suggestions for improving Social Security's online application. | Text field, no char limit | N | OE_Improvement | ||||||||||||
| Types | |||||||||||||||
| Model Instance Name: | ||||||||||||||||
| SSA iClaim v3 (Spanish) | underlined & italicized: RE-ORDER | |||||||||||||||
| MID: | Q0ExM1xNQRl9JJUR0M0JlA4C | pink: ADDITION | ||||||||||||||
| Date: | 7/15/2011 | blue + -->: REWORDING | ||||||||||||||
| violet (bold): SKIP-LOGIC | ||||||||||||||||
| SSA iClaim v3 (Spanish) CUSTOM QUESTION LIST | ||||||||||||||||
| QID | Skip Logic Label | Question Text | Answer Choices (limited to 50 characters) |
Skip To | Type (select from list) | Single or Multi | Required Y/N |
Special Instructions | CQ Label | |||||||
| SPBJL2231 | ¿Qué tipo de beneficios estaba solicitando? | Por jubilación | Dropdown (Select-one) | Single | Y | Skip Logic Group | Type of Benefits | |||||||||
| Solo Medicare | ||||||||||||||||
| Por incapacidad | ||||||||||||||||
| Tanto Jubilación y Discapacidad | ||||||||||||||||
| Coomo cónyuge | ||||||||||||||||
| Otro | ||||||||||||||||
| ¿Es esta solicitud en línea para sí mismo o estás ayudando a alguien más? | Yo mismo | Dropdown (Select-one) | Single | Y | Applying for | |||||||||||
| Cómo ayudar a un cónyuge / pariente / amigo | ||||||||||||||||
| Profesional Ayudar a un cliente | ||||||||||||||||
| Otro | ||||||||||||||||
| ¿Cómo se enteró acerca de esta solicitud en línea? (Seleccione todas las que apliquen.) | Sitio web oficial de la Seguridad Social | check box one up vertical | Multi | Y | Skip Logic Group | Learn about App | ||||||||||
| Una búsqueda web general (por ejemplo, Google, Bing, etc) | ||||||||||||||||
| La radio | ||||||||||||||||
| La televisión | ||||||||||||||||
| Un correo electrónico de la Seguridad Social | ||||||||||||||||
| Un periódico o la revista | ||||||||||||||||
| Un anuncio en línea (Banner / Imagen) | ||||||||||||||||
| Un video en línea | ||||||||||||||||
| Un periódico o una revista de anuncios | ||||||||||||||||
| Un anuncio impreso cartelera u otro | ||||||||||||||||
| Medios de Comunicación Social (Blog, Facebook, Twitter, etc) | ||||||||||||||||
| Amigo, cónyuge, pariente, vecino o conocido | ||||||||||||||||
| Declaración del Seguro Social | ||||||||||||||||
| Empleado del Seguro Social | A | |||||||||||||||
| Grupo de la comunidad o de la Asociación | ||||||||||||||||
| Otro, especificar | B | |||||||||||||||
| A | ¿Cómo se hace el contacto con un empleado del Seguro Social? | Visitado una oficina local del Seguro Social | check box one up vertical | Multi | Y | Skip Logic | SSA Emplyee Contact | |||||||||
| Llamado a la oficina local del Seguro Social | ||||||||||||||||
| Llamado el número nacional 800 | ||||||||||||||||
| Otro, especificar | AA | |||||||||||||||
| AA | Por favor describa cómo se hizo contacto con un empleado del Seguro Social. | Text box, no char limit | N | Skip Logic | OPS SSA Employe Contact | |||||||||||
| B | Por favor, especifique cómo se enteró de esta aplicación en línea. | Text box, no char limit | N | Skip Logic | OPS Learn about App | |||||||||||
| ¿Ha usado alguna de las siguientes acciones para prepararse para aplicar en línea? (Seleccione todas las que apliquen.) | Comentado mi Declaración del Seguro Social en línea | A | check box one up vertical | Multi | Y | Skip Logic | Prepare for App | |||||||||
| He utilizado el Retirement Estimator u otras herramientas en el sitio web de la Seguridad Social | B | |||||||||||||||
| Vi el video de instrucciones | C | |||||||||||||||
| Usé otra información en la página web de la Seguridad Social para preparar | D | |||||||||||||||
| Utilicé otro recurso que se preparen para aplicar en línea | E | |||||||||||||||
| No hice uso de los recursos para prepararse para aplicar en línea | ||||||||||||||||
| A | ¿Qué tan útil ha encontrado el Declaración del Seguro Social en línea? | Muy útil | Drop down select one | Single | Y | Skip Logic | Rate Statement | |||||||||
| algo útil | ||||||||||||||||
| Para nada útil | ||||||||||||||||
| B | ¿Qué tan útil encontraste las herramientas estimador en el sitio web? | Muy útil | Drop down select one | Single | Y | Skip Logic | Rate RE Tools | |||||||||
| algo útil | ||||||||||||||||
| Para nada útil | ||||||||||||||||
| C | ¿Qué tan útil le parecen la video instructivo? | Muy útil | Drop down select one | Single | Y | Skip Logic | Rate Video | |||||||||
| algo útil | ||||||||||||||||
| Para nada útil | ||||||||||||||||
| D | ¿Qué tan útil le parecen la otra información en el sitio web de la Seguridad Social? | Muy útil | Drop down select one | Single | Y | Skip Logic | Rate Other Info on Website | |||||||||
| algo útil | ||||||||||||||||
| Para nada útil | ||||||||||||||||
| E | Por favor describa lo otro recurso (s) que utilizó para prepararse para aplicar en línea. | Text field, no char limit | N | Skip Logic | OPS Prepare for App | |||||||||||
| ¿Comenzó una nueva aplicación en línea hoy mismo o que te vuelva a una solicitud guardada? | Comenzó una nueva aplicación | Drop down select one | Single | Y | App Status | |||||||||||
| Volvió a trabajar en una solicitud guardada | ||||||||||||||||
| ¿Sabía usted completar y presentar esta solicitud en línea hoy en día? | Sí | Drop down select one | Single | Y | Skip Logic | Complete App | ||||||||||
| No, tengo la intención de completar y enviar más tarde | A | |||||||||||||||
| No, no tengo planes para completar y enviar la solicitud en línea | A | |||||||||||||||
| A | Si no logró completar y presentar esta solicitud en línea hoy, por favor díganos por qué. | Demasiadas preguntas | check box one up vertical | Multi | Y | Skip Logic | Not Complete App | |||||||||
| Toma demasiado tiempo para llenar | ||||||||||||||||
| Demasiado complicado de usar sin ayuda | ||||||||||||||||
| No tenía la información que necesitaba como nombres, direcciones o fechas | ||||||||||||||||
| No entendía lo que significaba preguntas / cómo responder | ||||||||||||||||
| Mi condición de discapacidad me impide trabajar con una computadora por largos periodos | ||||||||||||||||
| Yo tenía una cantidad limitada de demandas de tiempo / de la familia que me impedía trabajar en ella por mucho tiempo | ||||||||||||||||
| Tuve problemas técnicos, como un mensaje de error o un error que no podía fijar | ||||||||||||||||
| Otro, especificar | AA | |||||||||||||||
| AA | Haznos saber por qué no se ha completado y se somete esta solicitud hoy. | Text field, no char limit | N | Skip Logic | OPS Why Not Complete today | |||||||||||
| Hasta el momento, ¿cuánto tiempo ha trabajado en esta solicitud en línea? | Hasta 15 minutos | Drop down select one | Single | Y | Time Spent | |||||||||||
| 16 minutos - 30 minutos | ||||||||||||||||
| 31 minutos - 1 hora | ||||||||||||||||
| Más de 1 hora hasta 2 horas | ||||||||||||||||
| Más de 2 horas | ||||||||||||||||
| ¿Fue fácil para usted para encontrar esta aplicación en línea? | Muy fácil | Find App | ||||||||||||||
| algo fácil | ||||||||||||||||
| algo duro | A | |||||||||||||||
| Muy difícil | A | |||||||||||||||
| A | Haznos saber por qué era difícil encontrar la aplicación en línea. (Seleccione todas las que apliquen.) | No se pudo encontrar por dónde empezar una nueva aplicación en línea | check box one up vertical | Multi | Y | Skip Logic | Why hard to find | |||||||||
| Donde no está claro que vaya a volver a una solicitud previamente guardada | ||||||||||||||||
| No estaba claro para mí cuando los vínculos conducirían | ||||||||||||||||
| Dificultad para utilizar un enlace en la página web de la Seguridad Social | ||||||||||||||||
| La información no parecía estar organizados de una manera lógica | ||||||||||||||||
| Usé la función de búsqueda, pero los resultados no parecen aplicarse. | ||||||||||||||||
| Traté de usar el FAQ, pero no pude encontrar la solicitud en línea | ||||||||||||||||
| Otro, especificar | AA | |||||||||||||||
| AA | Por favor, explique la razón por la que era difícil para usted para encontrar la solicitud en línea. | N | N | Skip Logic | OPS Hard to Find | |||||||||||
| ¿Cómo llegaste a esta solicitud en línea hoy en día? | Se utiliza el enlace de los servicios en línea en la página web de la Seguridad Social | Radio Button | Single | Y | Skip Logic | Arrive at App | ||||||||||
| Seguido de un enlace de algún otro lugar en el sitio web de la Seguridad Social | ||||||||||||||||
| Se utiliza la función de búsqueda en la página web de la Seguridad Social | ||||||||||||||||
| Se utiliza un motor de búsqueda fuera (es decir, Google, Bing, Yahoo, etc) | ||||||||||||||||
| Seguido de un enlace desde medicare.gov | ||||||||||||||||
| Seguido un enlace desde otro sitio web | ||||||||||||||||
| Este sitio fue bookmarked | ||||||||||||||||
| Otro, especificar | A | |||||||||||||||
| A | Por favor describa cómo llegó a esta solicitud en línea hoy | Text field, no char limit | N | OPS Arrive at app | ||||||||||||
| ¿Por qué eligió para aplicar en línea? (Seleccione todas las que apliquen.) | Yo no quería ir a una oficina local del Seguro Social | check box one up vertical | Multi | Y | Skip Logic | Why Online | ||||||||||
| Yo no quería que la solicitud por teléfono | ||||||||||||||||
| Yo prefiero usar los servicios en línea tanto como sea posible | ||||||||||||||||
| Aprendí acerca de la aplicación en línea durante su visita a la página web de la Seguridad Social | ||||||||||||||||
| Un empleado del Seguro Social recomienda que aplico en línea | ||||||||||||||||
| Un amigo o familiar recomendaron que aplico en línea | ||||||||||||||||
| Yo sabía que si tenía alguna pregunta o problema la aplicación en línea, todavía podía recibir ayuda de la Seguridad Social | ||||||||||||||||
| Estoy presentando en nombre de otra persona | ||||||||||||||||
| Otro, especificar | A | |||||||||||||||
| A | Por favor, especifique qué decide aplicar en línea | Text field, no char limit | N | OPS Why Online | ||||||||||||
| ¿Cuál es su estado civil actual? | casado | Radio button, one-up vertical | Single | N | OPS Group | Marital Status | ||||||||||
| apartado | ||||||||||||||||
| divorciado | ||||||||||||||||
| viudo | ||||||||||||||||
| ` | Nunca se ha casado | |||||||||||||||
| Prefiero no responder | ||||||||||||||||
| Otro, especificar | A | |||||||||||||||
| A | Otro estado civil | Text field, <100 char | N | OPS Group | OPS Marital Status | |||||||||||
| ¿Tiene alguna sugerencia para mejorar la aplicación en línea de la Seguridad Social? | Text field, no char limit | N | OE_Improvement | |||||||||||||
| Types | ||||||||||||||||
| Model Instance Name: | |||||||||||||||
| SSA iClaim v3 | underlined & italicized: RE-ORDER | ||||||||||||||
| MID: xZAAEQw81gIo1Vo4Noc1Rw4C | pink: ADDITION | ||||||||||||||
| Date: | 7/15/2011 | blue + -->: REWORDING | |||||||||||||
| violet (bold): SKIP-LOGIC | |||||||||||||||
| SSA iClaim v3 CUSTOM QUESTION LIST | |||||||||||||||
| QID | Skip Logic Label | Question Text | Answer Choices (limited to 50 characters) |
Skip To | Type (select from list) | Single or Multi | Required Y/N |
Special Instructions | CQ Label | ||||||
| BJL2230 | Please rate your impression of the level of security in completing tasks on this application. | 1 = Poor | Radio Button Scale Has Don’t Know | Single | Y | Level of Security | |||||||||
| 2 | |||||||||||||||
| 3 | |||||||||||||||
| 4 | |||||||||||||||
| 5 | |||||||||||||||
| 6 | |||||||||||||||
| 7 | |||||||||||||||
| 8 | |||||||||||||||
| 9 | |||||||||||||||
| 10 = Excellent | |||||||||||||||
| Don't know | |||||||||||||||
| BJL2231 | What type of benefits were you applying for? | Retirement | M, Q, R, X, Y, Z, U, E, W | Dropdown (Select-one) | Single | Y | Skip Logic Group | Type of Benefits | |||||||
| Disability | M, Q, R, X, Y, Z, U, E, G, W | ||||||||||||||
| Spouse's | M, Q, R, X, Y, Z, U, E, W | ||||||||||||||
| Medicare only | M, Q, R, X, Y, Z, U, E, W | ||||||||||||||
| I am not applying today | |||||||||||||||
| BJL2232 | M | How did you learn about the Social Security online application? (Select all that apply.) | +-->Official Social Security website | Checkbox One Up Vertical | Multi | Y | Skip Logic Group | Learn About Online App | Types | ||||||
| A general web search (e.g. Google, Bing, etc.) | |||||||||||||||
| The radio | |||||||||||||||
| The television | |||||||||||||||
| An email from Social Security | |||||||||||||||
| A newspaper or magazine article | |||||||||||||||
| An online ad (Banner/Image) | |||||||||||||||
| An online video | |||||||||||||||
| A newspaper or magazine ad | |||||||||||||||
| A billboard or other printed ad | |||||||||||||||
| Social Media (Blog, Facebook, Twitter, etc.) | B | ||||||||||||||
| Social Security statement | |||||||||||||||
| Social Security employee | |||||||||||||||
| Community Group or Association | |||||||||||||||
| Other, please specify | A | ||||||||||||||
| BJL2233 | A | Please specify how you learned of Social Security online. | Text area, no char limit | N | Skip Logic Group | OE_Learn about online app | |||||||||
| BJL2234 | B | How did you make contact with a Social Security employee? | Visited a local Social Security office | Radio Button One Up Vertical | Single | Y | Skip Logic Group | Contact SSA Employee | |||||||
| Called a local Social Security office | |||||||||||||||
| Called the national 800 number | |||||||||||||||
| Other, please specify | D | ||||||||||||||
| BJL2235 | D | Please describe the way you made contact with a social security employee. | Text field, <100 char | N | Skip Logic Group | OE_Contact SSA Employee | |||||||||
| BJL2236 | Q | Did you complete your application today? | Yes, I completed my new application today | C | Radio Button One Up Vertical | Single | Y | Skip Logic Group | Complete App | ||||||
| Yes, I restarted and completed my earlier application today | C | ||||||||||||||
| No, I did not complete my new application, but I plan to complete it later | C | ||||||||||||||
| No, I did not complete my re-started earlier application, but I plan to complete it later | C | ||||||||||||||
| No, I do not plan to complete my application at all | C | ||||||||||||||
| I'm not applying for benefits today | |||||||||||||||
| BJL2237 | C | For whom are you filing this online application for Social Security benefits? | Myself | Radio Button One Up Vertical | Single | Y | Skip Logic Group | Whose Behalf | |||||||
| My spouse | |||||||||||||||
| My parent | |||||||||||||||
| Another relative | |||||||||||||||
| My friend | |||||||||||||||
| My client | |||||||||||||||
| Other | |||||||||||||||
| BJL2238 | R | If you stopped working on your application, please tell us why. (Select all that apply.) | I finished my application today | Checkbox One Up Vertical | Multi | Y | Skip Logic Group | Why Stopped App | |||||||
| Needed to find documents/other information for my application | |||||||||||||||
| Too many questions | |||||||||||||||
| Takes too long | |||||||||||||||
| Too complicated to use without help | |||||||||||||||
| My medical/physical condition prevents me from working on the computer for long periods | |||||||||||||||
| Application wouldn't accept empty/blank fields | |||||||||||||||
| Received an error message or was "kicked out" of the application | |||||||||||||||
| I had a problem entering dates or other information in some of the pages | |||||||||||||||
| Other Reason | zz | ||||||||||||||
| BJL2239 | zz | Please tell us the other reason you stopped working on your application. | Text area, no char limit | N | Skip Logic Group | OE_Stopped Application | |||||||||
| BJL2240 | X | Did you visit the Social Security home page (www.socialsecurity.gov) today? | Yes | Dropdown (Select-one) | Single | Y | Skip Logic Group | Homepage | |||||||
| No | |||||||||||||||
| BJL2241 | Y | Did you use the SEARCH box on our website to find what you needed? | Yes | Dropdown (Select-one) | Single | Y | Skip Logic Group | Search | |||||||
| No | |||||||||||||||
| BJL2242 | Z | Please tell us how easy it was for you to find the application for benefits. | I had little or no difficulty getting to the application | Radio Button One Up Vertical | Single | Y | Skip Logic Group | Find app | |||||||
| I found it somewhat difficult to find the application | Z1 | ||||||||||||||
| BJL2243 | Z1 | I found it somewhat difficult to find the application because: (Select all that apply.) | I did not know where to begin looking | Checkbox One Up Vertical | Multi | Y | Skip Logic Group | Difficult to Find | |||||||
| It was not clear to me where the links would lead | |||||||||||||||
| The information did not seem to be organized in a logical manner | |||||||||||||||
| I used the search function but the results didn’t seem to apply. | |||||||||||||||
| Other reason (please describe) | Z2 | ||||||||||||||
| BJL2244 | Z2 | Please explain the reason you found it somewhat difficult to find the application. | Text area, no char limit | N | Skip Logic Group | OE_Difficult to Find | |||||||||
| BJL2245 | U | How did you arrive on the Social Security website today? | Typed ssa.gov or socialsecurity.gov into the browser | Dropdown (Select-one) | Single | Y | Skip Logic Group | Arrive | |||||||
| Did a search (i.e. Google, Bing, Yahoo) | |||||||||||||||
| Followed a link from medicare.gov | |||||||||||||||
| Followed a link from another website | |||||||||||||||
| BJL2246 | E | Please rate the clarity of the instructions provided for this Social Security online application. | 1 = Not At All Clear | F | Radio Button Scale Has Don’t Know | Single | Y | Skip Logic Group | Clarity of Instructions | ||||||
| 2 | F | ||||||||||||||
| 3 | F | ||||||||||||||
| 4 | F | ||||||||||||||
| 5 | F | ||||||||||||||
| 6 | |||||||||||||||
| 7 | |||||||||||||||
| 8 | |||||||||||||||
| 9 | |||||||||||||||
| 10 = Very Clear | |||||||||||||||
| Don't know | |||||||||||||||
| BJL2247 | F | What part of the instructions was not clear? | Text area, no char limit | N | Skip Logic Group | OE_Clarity of Instructions | |||||||||
| BJL2248 | G | Did you complete the Online Disability Report today? | Yes | Radio Button One Up Vertical | Single | Y | Skip Logic Group | Disability Report | |||||||
| No | |||||||||||||||
| Don't recall | |||||||||||||||
| BJL2249 | W | Do you have any other problems with this Social Security Online application that weren't covered in earlier questions, or any suggestions on how we can improve it? (Please do not include any personal information in your answer.) | Text area, no char limit | N | Skip Logic Group | Other Problems | |||||||||
| BJL2250 | What influenced your decision to use our online benefit application? (Select all that apply.) | I did not want to go to an SSA field office | Checkbox One Up Vertical | Multi | Y | Skip Logic Group | Influenced Decision Benefits | ||||||||
| I did not want to do business over the phone | |||||||||||||||
| I prefer to use online services as much as possible | |||||||||||||||
| I learned about filing online while visiting socialsecurity.gov | |||||||||||||||
| Someone from SSA recommended filing online | |||||||||||||||
| A friend, relative, or colleague recommended filing online | |||||||||||||||
| I knew that if I had a question, I could then call or visit SSA | |||||||||||||||
| I am filing on behalf of another person | A | ||||||||||||||
| Other, please specify | B | ||||||||||||||
| BJL2251 | B | Please specify what influenced your decision to file for benefits online. | Text area, no char limit | N | Skip Logic Group | OE_Influenced Decision | |||||||||
| BJL2252 | A | Please specify your role. | I am a non-profit professional | Radio button, one-up vertical | Single | Y | Skip Logic Group | Role | |||||||
| I am a for-profit professional | |||||||||||||||
| I am a friend or relative | |||||||||||||||
| Other, please specify | C | ||||||||||||||
| BJL2253 | C | Please describe your role. | Text field, <100 char | N | Skip Logic Group | OE_Role | |||||||||
| Model Instance Name: | |||||||||||||||
| SSA iClaim v3 | underlined & italicized: RE-ORDER | ||||||||||||||
| MID: VgpBBYx9l8JxIFgJlY1Ikg4C | pink: ADDITION | ||||||||||||||
| Date: | 7/15/2011 | blue + -->: REWORDING | |||||||||||||
| violet (bold): SKIP-LOGIC | |||||||||||||||
| SSA iClaim v3 CUSTOM QUESTION LIST | |||||||||||||||
| QID | Skip Logic Label | Question Text | Answer Choices (limited to 50 characters) |
Skip To | Type (select from list) | Single or Multi | Required Y/N |
Special Instructions | CQ Label | ||||||
| ENBJL2230 | Please rate your impression of the level of security in completing tasks on this application. | 1 = Poor | Radio Button Scale Has Don’t Know | Single | Y | Level of Security | |||||||||
| 2 | |||||||||||||||
| 3 | |||||||||||||||
| 4 | |||||||||||||||
| 5 | |||||||||||||||
| 6 | |||||||||||||||
| 7 | |||||||||||||||
| 8 | |||||||||||||||
| 9 | |||||||||||||||
| 10 = Excellent | |||||||||||||||
| Don't know | |||||||||||||||
| ENBJL2231 | What type of benefits were you applying for? | Retirement | M, Q, R, X, Y, Z, U, E, W | Dropdown (Select-one) | Single | Y | Skip Logic Group | Type of Benefits | |||||||
| Disability | M, Q, R, X, Y, Z, U, E, G, W | ||||||||||||||
| Spouse's | M, Q, R, X, Y, Z, U, E, W | ||||||||||||||
| Medicare only | M, Q, R, X, Y, Z, U, E, W | ||||||||||||||
| I am not applying today | |||||||||||||||
| ENBJL2232 | M | How did you learn about the Social Security online application? (Select all that apply.) | +-->Official Social Security website | Checkbox One Up Vertical | Multi | Y | Skip Logic Group | Learn About Online App | Types | ||||||
| A general web search (e.g. Google, Bing, etc.) | |||||||||||||||
| The radio | |||||||||||||||
| The television | |||||||||||||||
| An email from Social Security | |||||||||||||||
| A newspaper or magazine article | |||||||||||||||
| An online ad (Banner/Image) | |||||||||||||||
| An online video | |||||||||||||||
| A newspaper or magazine ad | |||||||||||||||
| A billboard or other printed ad | |||||||||||||||
| Social Media (Blog, Facebook, Twitter, etc.) | |||||||||||||||
| Social Security statement | |||||||||||||||
| Social Security employee | B | ||||||||||||||
| Community Group or Association | |||||||||||||||
| Other, please specify | A | ||||||||||||||
| ENBJL2233 | A | Please specify how you learned of Social Security online. | Text area, no char limit | N | Skip Logic Group | OE_Learn about online app | |||||||||
| ENBJL2234 | B | How did you make contact with a Social Security employee? | Visited a local Social Security office | Radio Button One Up Vertical | Single | Y | Skip Logic Group | Contact SSA Employee | |||||||
| Called a local Social Security office | |||||||||||||||
| Called the national 800 number | |||||||||||||||
| Other, please specify | D | ||||||||||||||
| ENBJL2235 | D | Please describe the way you made contact with a social security employee. | Text field, <100 char | N | Skip Logic Group | OE_Contact SSA Employee | |||||||||
| ENBJL2236 | Q | Did you complete your application today? | Yes, I completed my new application today | C | Radio Button One Up Vertical | Single | Y | Skip Logic Group | Complete App | ||||||
| Yes, I restarted and completed my earlier application today | C | ||||||||||||||
| No, I did not complete my new application, but I plan to complete it later | C | ||||||||||||||
| No, I did not complete my re-started earlier application, but I plan to complete it later | C | ||||||||||||||
| No, I do not plan to complete my application at all | C | ||||||||||||||
| I'm not applying for benefits today | |||||||||||||||
| ENBJL2237 | C | For whom are you filing this online application for Social Security benefits? | Myself | Radio Button One Up Vertical | Single | Y | Skip Logic Group | Whose Behalf | |||||||
| My spouse | |||||||||||||||
| My parent | |||||||||||||||
| Another relative | |||||||||||||||
| My friend | |||||||||||||||
| My client | |||||||||||||||
| Other | |||||||||||||||
| ENBJL2238 | R | If you stopped working on your application, please tell us why. (Select all that apply.) | I finished my application today | Checkbox One Up Vertical | Multi | Y | Skip Logic Group | Why Stopped App | |||||||
| Needed to find documents/other information for my application | |||||||||||||||
| Too many questions | |||||||||||||||
| Takes too long | |||||||||||||||
| Too complicated to use without help | |||||||||||||||
| My medical/physical condition prevents me from working on the computer for long periods | |||||||||||||||
| Application wouldn't accept empty/blank fields | |||||||||||||||
| Received an error message or was "kicked out" of the application | |||||||||||||||
| I had a problem entering dates or other information in some of the pages | |||||||||||||||
| Other Reason | zz | ||||||||||||||
| ENBJL2239 | zz | Please tell us the other reason you stopped working on your application. | Text area, no char limit | N | Skip Logic Group | OE_Stopped Application | |||||||||
| ENBJL2240 | X | Did you visit the Social Security home page (www.socialsecurity.gov) today? | Yes | Dropdown (Select-one) | Single | Y | Skip Logic Group | Homepage | |||||||
| No | |||||||||||||||
| ENBJL2241 | Y | Did you use the SEARCH box on our website to find what you needed? | Yes | Dropdown (Select-one) | Single | Y | Skip Logic Group | Search | |||||||
| No | |||||||||||||||
| ENBJL2242 | Z | Please tell us how easy it was for you to find the application for benefits. | I had little or no difficulty getting to the application | Radio Button One Up Vertical | Single | Y | Skip Logic Group | Find app | |||||||
| I found it somewhat difficult to find the application | Z1 | ||||||||||||||
| ENBJL2243 | Z1 | I found it somewhat difficult to find the application because: (Select all that apply.) | I did not know where to begin looking | Checkbox One Up Vertical | Multi | Y | Skip Logic Group | Difficult to Find | |||||||
| It was not clear to me where the links would lead | |||||||||||||||
| The information did not seem to be organized in a logical manner | |||||||||||||||
| I used the search function but the results didn’t seem to apply. | |||||||||||||||
| Other reason (please describe) | Z2 | ||||||||||||||
| ENBJL2244 | Z2 | Please explain the reason you found it somewhat difficult to find the application. | Text area, no char limit | N | Skip Logic Group | OE_Difficult to Find | |||||||||
| ENBJL2245 | U | How did you arrive on the Social Security website today? | Typed ssa.gov or socialsecurity.gov into the browser | Dropdown (Select-one) | Single | Y | Skip Logic Group | Arrive | |||||||
| Did a search (i.e. Google, Bing, Yahoo) | |||||||||||||||
| Followed a link from medicare.gov | |||||||||||||||
| Followed a link from another website | |||||||||||||||
| ENBJL2246 | E | Please rate the clarity of the instructions provided for this Social Security online application. | 1 = Not At All Clear | F | Radio Button Scale Has Don’t Know | Single | Y | Skip Logic Group | Clarity of Instructions | ||||||
| 2 | F | ||||||||||||||
| 3 | F | ||||||||||||||
| 4 | F | ||||||||||||||
| 5 | F | ||||||||||||||
| 6 | |||||||||||||||
| 7 | |||||||||||||||
| 8 | |||||||||||||||
| 9 | |||||||||||||||
| 10 = Very Clear | |||||||||||||||
| Don't know | |||||||||||||||
| ENBJL2247 | F | What part of the instructions was not clear? | Text area, no char limit | N | Skip Logic Group | OE_Clarity of Instructions | |||||||||
| ENBJL2248 | G | Did you complete the Online Disability Report today? | Yes | Radio Button One Up Vertical | Single | Y | Skip Logic Group | Disability Report | |||||||
| No | |||||||||||||||
| Don't recall | |||||||||||||||
| ENBJL2249 | W | Do you have any other problems with this Social Security Online application that weren't covered in earlier questions, or any suggestions on how we can improve it? (Please do not include any personal information in your answer.) | Text area, no char limit | N | Skip Logic Group | Other Problems | |||||||||
| ENBJL2250 | What influenced your decision to use our online benefit application? (Select all that apply.) | I did not want to go to an SSA field office | Checkbox One Up Vertical | Multi | Y | Skip Logic Group | Influenced Decision Benefits | ||||||||
| I did not want to do business over the phone | |||||||||||||||
| I prefer to use online services as much as possible | |||||||||||||||
| I learned about filing online while visiting socialsecurity.gov | |||||||||||||||
| Someone from SSA recommended filing online | |||||||||||||||
| A friend, relative, or colleague recommended filing online | |||||||||||||||
| I knew that if I had a question, I could then call or visit SSA | |||||||||||||||
| I am filing on behalf of another person | A | ||||||||||||||
| Other, please specify | B | ||||||||||||||
| ENBJL2251 | B | Please specify what influenced your decision to file for benefits online. | Text area, no char limit | N | Skip Logic Group | OE_Influenced Decision | |||||||||
| ENBJL2252 | A | Please specify your role. | I am a non-profit professional | Radio button, one-up vertical | Single | Y | Skip Logic Group | Role | |||||||
| I am a for-profit professional | |||||||||||||||
| I am a friend or relative | |||||||||||||||
| Other, please specify | C | ||||||||||||||
| ENBJL2253 | C | Please describe your role. | Text field, <100 char | N | Skip Logic Group | OE_Role | |||||||||
| Model Instance Name: | ||||||||||||||||
| SSA iClaim v3 (Spanish) | underlined & italicized: RE-ORDER | |||||||||||||||
| MID: | Q0ExM1xNQRl9JJUR0M0JlA4C | pink: ADDITION | ||||||||||||||
| Date: | 7/15/2011 | blue + -->: REWORDING | ||||||||||||||
| violet (bold): SKIP-LOGIC | ||||||||||||||||
| SSA iClaim v3 (Spanish) CUSTOM QUESTION LIST | ||||||||||||||||
| QID | Skip Logic Label | Question Text | Answer Choices (limited to 50 characters) |
Skip To | Type (select from list) | Single or Multi | Required Y/N |
Special Instructions | CQ Label | |||||||
| SPBJL2230 | Por favor califique su impresión del nivel de seguridad al completar las tareas en esta solicitud. | 1 = Decificente | Radio Button Scale Has Don’t Know | Single | Y | Level of Security | ||||||||||
| Excelente = 10 | ||||||||||||||||
| No sé | ||||||||||||||||
| SPBJL2231 | ¿Qué tipo de beneficios estaba solicitando? | Por jubilación | M, Q, R, X, Y, Z, U, E, W | Dropdown (Select-one) | Single | Y | Skip Logic Group | Type of Benefits | ||||||||
| Por incapacidad | M, Q, R, X, Y, Z, U, E, G, W | |||||||||||||||
| Coomo cónyuge | M, Q, R, X, Y, Z, U, E, W | |||||||||||||||
| Solo Medicare | M, Q, R, X, Y, Z, U, E, W | |||||||||||||||
| No estoy solicitando hoy | ||||||||||||||||
| SPBJL2232 | M | ¿Cómo se enteró de la solicitud por Internet del Seguro Social? (Seleccione todo lo que aplique.) | El sitio de Internet del Seguro Social | El sitio de Internet del Seguro Social | Checkbox One Up Vertical | Multi | Y | Skip Logic Group | Learn About Online App | Types | ||||||
| Por un amigo, mi cónyuge, un familiar, un vecino o un conocido | Una búsqueda por Internet (usando Google, Bing, etc.) | |||||||||||||||
| Agente del Seguro Social | Una promoción en la radio | B | ||||||||||||||
| Por medio de otro sitio de Internet o un buscador de internet | Una promoción en la televisión | |||||||||||||||
| Las noticias (TV, radio, diario o Internet) | Un e-mail del Seguro Social | |||||||||||||||
| Promoción | Un artículo en un diario o una revista | |||||||||||||||
| La Declaración del Seguro Social | Una promoción por Internet (anuncio web/imagen) | |||||||||||||||
| Grupo o asociación comunitaria | Un video en la Internet | |||||||||||||||
| Otro modo, por favor especifique | Una promoción en un diario o una revista | A | ||||||||||||||
| Una pancarta u otro tipo de promoción impresa | ||||||||||||||||
| En las redes sociales (un blog, en Facebook, Twitter, etc.) | ||||||||||||||||
| Un amigo, mi cónyuge, un familiar, un vecino o un conocido | ||||||||||||||||
| La Declaración del Seguro Social | ||||||||||||||||
| Un agente del Seguro Social | ||||||||||||||||
| Una asociación o un grupo comunitario | ||||||||||||||||
| Otro modo, por favor especifique el modo | ||||||||||||||||
| SPBJL2233 | A | Por favor especifique cómo se enteró del sitio de Internet del Seguro Social. | Text area, no char limit | N | Skip Logic Group | OE_Learn about online app | ||||||||||
| SPBJL2234 | B | ¿Cómo se comunicó con un empleado del Seguro Social? | Visitando una de las oficinas locales del Seguro Social | Radio Button One Up Vertical | Single | Y | Skip Logic Group | Contact SSA Employee | ||||||||
| Llamando la oficina local del Seguro Social | ||||||||||||||||
| Llamando el número 800 nacional | ||||||||||||||||
| Otro modo, por favor especifique | D | |||||||||||||||
| SPBJL2235 | D | Por favor describa la manera en la que se comunicó con un empleado del Seguro Social. | Text field, <100 char | N | Skip Logic Group | OE_Contact SSA Employee | ||||||||||
| SPBJL2236 | Q | ¿Completó la solicitud hoy? | Sí, llené mi solicitud hoy mismo. | C | Radio Button One Up Vertical | Single | Y | Skip Logic Group | Complete App | |||||||
| Sí, reanudé y llené la solicitud que ya había comenzado. | C | |||||||||||||||
| No, no terminé de llenar la solicitud pero la terminaré más adelante. | C | |||||||||||||||
| No, no terminé de llenar la solicitud que ya había comenzado pero la terminaré más adelante. | C | |||||||||||||||
| No, no tengo intención de terminar la solicitud. | C | |||||||||||||||
| No voy a solicitar los beneficios hoy. | ||||||||||||||||
| SPBJL2237 | C | ¿Para quién está llenando esta solicitud por Internet para beneficios de Seguro Social? | Para mi mismo. | Radio Button One Up Vertical | Single | Y | Skip Logic Group | Whose Behalf | ||||||||
| Para mi cónyuge. | ||||||||||||||||
| Para mis padres. | ||||||||||||||||
| Para un familiar. | ||||||||||||||||
| Para un amigo. | ||||||||||||||||
| Para un cliente. | ||||||||||||||||
| Para otra persona | ||||||||||||||||
| SPBJL2238 | R | Si dejó de llenar su solicitud, por favor díganos por qué. (Seleccione todo lo que aplique) | Terminé de llenar mi solicitud hoy. | Checkbox One Up Vertical | Multi | Y | Skip Logic Group | Why Stopped App | ||||||||
| Necesitaba conseguir algunos documentos u otra información para terminar mi solicitud. | ||||||||||||||||
| Demasiadas preguntas | ||||||||||||||||
| Me demoró mucho. | ||||||||||||||||
| La solicitud es muy compllicada sin la ayuda de alguien. | ||||||||||||||||
| Mi impedimento físico/médico me impide trabajar con una computadora por periodos prolongados. | ||||||||||||||||
| La solicitud no aceptaba que dejara preguntas sin contestar. | ||||||||||||||||
| Recibí un mensage haciendo saber que había sido «expulsado» de la solicitud. | ||||||||||||||||
| Tuve problemas ingresando fechas y otra información en algunas de las páginas. | ||||||||||||||||
| Por otras razones | zz | |||||||||||||||
| SPBJL2239 | zz | Por favor díganos la razón por la que dejó de llenar su solicitud. | Text area, no char limit | N | Skip Logic Group | OE_Stopped Application | ||||||||||
| SPBJL2240 | X | ¿Visitó la página principal del Seguro Social (www.segurosocial.gov) hoy? | Sí | Dropdown (Select-one) | Single | Y | Skip Logic Group | Homepage | ||||||||
| No | ||||||||||||||||
| SPBJL2241 | Y | ¿Usó el encasillado de BUSCAR en nuestro sitio de Internet para encontrar lo que necesitaba? | Sí | Dropdown (Select-one) | Single | Y | Skip Logic Group | Search | ||||||||
| No | ||||||||||||||||
| SPBJL2242 | Z | Por favor díganos que tan fácil fue para que encontrara la solicitud para beneficios. | Tuve un poco de dificultad para ingresar a la solicitud. | Radio Button One Up Vertical | Single | Y | Skip Logic Group | Find app | ||||||||
| Se me hizo un poco dificultoso el encontrar la solicitud. | Z1 | |||||||||||||||
| SPBJL2243 | Z1 | Encontré que fue un poco difícil encontrar la solicitud debido a que: (Seleccione todo lo que aplique.) | No sabía por dónde comenzar a buscar. | Checkbox One Up Vertical | Multi | Y | Skip Logic Group | Difficult to Find | ||||||||
| No estaba claro a dónde me llevarían los enlaces. | ||||||||||||||||
| No me pareción que la información estaba organizada en una manera lógica. | ||||||||||||||||
| Usé la herramienta de búsqueda pero los resultados no parecían ser relevantes. | ||||||||||||||||
| Por otras razones (por favor explique) | Z2 | |||||||||||||||
| SPBJL2244 | Z2 | Por favor explique la razón por la que encontró que la solicitud fue un poco difícil de encontrar. | Text area, no char limit | N | Skip Logic Group | OE_Difficult to Find | ||||||||||
| SPBJL2245 | U | ¿Cómo llegó al sitio de Internet del Seguro Social hoy? | Ingresé la dirección ssa.gov o segurosocial.gov en el navegador de Internet. | Dropdown (Select-one) | Single | Y | Skip Logic Group | Arrive | ||||||||
| Hice una búsqueda (usando Google, Bing, Yahoo) | ||||||||||||||||
| Oprimí en un enlace que encontré en medicare.gov | ||||||||||||||||
| Oprimí en un enlace que encontré en otro sitio de Internet. | ||||||||||||||||
| SPBJL2246 | E | Por favor califique la claridad de las instrucciones provistas para esta solicitud por Internet del Seguro Social. | 1 = No lo entiendo | F | Radio Button Scale Has Don’t Know | Single | Y | Skip Logic Group | Clarity of Instructions | |||||||
| F | ||||||||||||||||
| F | ||||||||||||||||
| F | ||||||||||||||||
| F | ||||||||||||||||
| Muy claro = 10 | ||||||||||||||||
| No sé | ||||||||||||||||
| SPBJL2247 | F | ¿Qué parte de las instrucciones no estaban claras? | Text area, no char limit | N | Skip Logic Group | OE_Clarity of Instructions | ||||||||||
| SPBJL2248 | G | ¿Llenó el informe de incapacidad por Internet hoy? | Sí. | Radio Button One Up Vertical | Single | Y | Skip Logic Group | Disability Report | ||||||||
| No. | ||||||||||||||||
| No me acuerdo. | ||||||||||||||||
| SPBJL2249 | W | ¿Tiene algún otro problema con la solicitud por Internet del Seguro Social que no se cubrió en las preguntas anteriores, o alguna sugerencia sobre cómo podemos mejorarla? (Por favor no incluya ninguna información personal en su respuesta.) | Text area, no char limit | N | Skip Logic Group | Other Problems | ||||||||||
| SPBJL2250 | ¿Qué influyó su decisión para usar nuestra solicitud de beneficios por Internet? (Seleccione todo lo que aplique.) | No quería ir a la oficina del Seguro Social. | Checkbox One Up Vertical | Multi | Y | Skip Logic Group | Influenced Decision Benefits | |||||||||
| No quería transactar mis asuntos por teléfno. | ||||||||||||||||
| Prefiero usar los servicio por Internet lo más posible. | ||||||||||||||||
| Me informé acerca de los servicios por Internet al visitar el sitio de Internet segurosocialove | ||||||||||||||||
| Uno de los agentes del Seguro Social sugirió el que solicitara los beneficios por Internet. | ||||||||||||||||
| Un amigo, familiar o un colega sugirió el que solicitiara los beneficios por Internet. | ||||||||||||||||
| Sabía que si tenía alguna pregunta podría llamar o visitar al Seguro Social. | ||||||||||||||||
| Estoy llenando el formulario a nombre de otra persona. | A | |||||||||||||||
| Otro razón, por favor especifique | B | |||||||||||||||
| SPBJL2251 | B | Por favor especifique que influyó su decisión para solicitar los beneficios por Internet. | Text area, no char limit | N | Skip Logic Group | OE_Influenced Decision | ||||||||||
| SPBJL2252 | A | Por favor especifique el papel que desempeña: | Proveo servicios como profesional sin fines de lucro. | Radio button, one-up vertical | Single | Y | Skip Logic Group | Role | ||||||||
| Proveo servicios como profesional por honorario. | ||||||||||||||||
| Soy un amigo o familiar del reclamante. | ||||||||||||||||
| Otra persona, por favor especifique. | C | |||||||||||||||
| SPBJL2253 | C | Por favor describa qué papel desempeña. | Text field, <100 char | N | Skip Logic Group | OE_Role | ||||||||||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |