| Model Instance Name: |
|
|
|
|
|
|
|
|
|
| SSA Main v3 |
|
|
|
|
|
|
|
|
|
| MID: |
|
V1wUw0sAYNUA1pUkAswd1g4C |
|
|
|
|
|
|
| Partitioned (Y/N)? |
|
|
|
|
|
|
|
|
| FPI Included(Y/N)? |
|
|
|
|
|
|
|
|
| NOTE: All non-partitioned surveys will NOT be imputed and the elements will be rotated as a default unless otherwise specified and approved by Research. |
|
|
|
|
|
| Date: |
|
6/12/2013 |
|
|
|
|
|
|
| SSA Main v3 |
| Model questions utilize the ACSI methodology to determine scores and impacts |
|
|
ELEMENTS (drivers of satisfaction) |
|
|
CUSTOMER SATISFACTION |
|
|
FUTURE BEHAVIORS |
FPI |
|
MQ Label |
|
|
MQ Label |
|
|
MQ Label |
|
Y? |
|
|
Look and Feel (1=Poor, 10=Excellent, Don't Know) |
|
|
Satisfaction |
|
|
Recommend (1=Very Unlikely, 10=Very Likely) |
|
| 1 |
Look and Feel - Appeal |
Please rate the visual appeal of this site. |
16 |
Satisfaction - Overall |
What is your overall satisfaction with this site?
(1=Very Dissatisfied, 10=Very Satisfied) |
19 |
Recommend |
How likely are you to recommend this site to someone else? |
|
| 2 |
Look and Feel - Balance |
Please rate the balance of graphics and text on this site. |
17 |
Satisfaction - Expectations |
How well does this site meet your expectations?
(1=Falls Short, 10=Exceeds) |
|
|
Return (1=Very Unlikely, 10=Very Likely) |
|
| 3 |
Look and Feel - Readability |
Please rate the readability of the pages on this site. |
18 |
Satisfaction - Ideal |
How does this site compare to your idea of an ideal website?
(1=Not Very Close, 10=Very Close) |
20 |
Return |
How likely are you to return to this site? |
|
|
|
Navigation (1=Poor, 10=Excellent, Don't Know) |
|
|
|
|
|
|
|
| 4 |
Navigation - Organized |
Please rate how well the site is organized. |
|
|
|
| 5 |
Navigation - Options |
Please rate the options available for navigating this site. |
|
| 6 |
Navigation - Layout |
Please rate how well the site layout helps you find what you are looking for. |
|
|
|
SSA Information(1=Poor, 10=Excellent, Don't Know) |
|
| 7 |
SSA Information - Thoroughness |
Please rate the thoroughness of information you viewed on this site today. |
|
|
|
|
|
|
|
| 8 |
SSA Information - Quality |
Please rate the quality of information you viewed today. |
|
|
|
|
|
|
|
| 9 |
SSA Information - Provided Answers |
Please rate how well the information viewed today provided answers to your questions. |
|
|
|
|
|
|
|
|
|
Site Performance (1=Poor, 10=Excellent, Don't Know) |
|
|
|
|
|
|
|
| 10 |
Site Performance - Loading |
Please rate how quickly pages load on this site. |
|
|
|
|
|
|
|
| 11 |
Site Performance - Consistency |
Please rate the consistency of speed from page to page on this site. |
|
|
|
|
|
|
|
| 12 |
Site Performance - Errors |
Please rate the ability to load pages without getting error messages on this site. |
|
|
|
|
|
|
|
|
|
Plain Language (1=Poor, 10=Excellent, Don't Know) |
|
|
|
|
|
|
|
| 13 |
Plain Language - Clear |
Please rate the clarity of the wording on this site. |
|
|
|
|
|
|
|
| 14 |
Plain Language - Understandable |
Please rate how well you understand the wording on this site. |
|
|
|
|
|
|
|
| 15 |
Plain Language - Concise |
Please rate this site on its use of short, clear sentences. |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| Model Instance Name: |
|
|
red & strike-through: DELETE |
|
|
|
|
|
|
| SSA Main v3 |
|
|
underlined & italicized: RE-ORDER |
|
|
|
|
|
|
| MID: |
V1wUw0sAYNUA1pUkAswd1g4C |
|
pink: ADDITION |
|
|
|
|
|
|
| Date: |
6/14/2011 |
blue + -->: REWORDING |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| SSA Main v3 CUSTOM QUESTION LIST |
|
QID
(Group ID) |
Skip Logic Label |
Question Text |
Answer Choices
(limited to 50 characters) |
Skip to |
Type (select from list) |
Single or Multi |
Required
Y/N |
Special Instructions |
CQ Label |
| LNH4733 |
|
Which of the following best describes you? |
I am entitled to or receive Social Security benefits (i.e. retirement, survivor’s, disability, spouses, Medicare and/or Supplemental Security Income) |
|
Radio Button One Up Vertical |
Single |
Y |
OPS Group |
Best Describes |
|
I do not receive Social Security, Medicare or Supplemental Security Income benefits |
|
|
|
|
I am applying for Social Security, Supplemental Security Income (SSI) benefits or Medicare benefits. |
|
|
|
|
I am an employer looking for Social Security information and services |
|
|
|
|
I am a professional helping someone else with a Social Security matter |
|
|
|
|
Other (please specify) |
A |
|
|
| LNH4734 |
A |
Other Role |
|
|
Text Field – limited to 100 characters |
|
N |
OPS Group |
OE - Best Describes |
| LNH4735 |
|
What was the main reason for your visit today? |
To learn about Social Security benefits |
|
Radio Button One Up Vertical |
Single |
Y |
OPS Group
|
Main Reason |
|
|
|
To plan for my future benefits (e.g., view my Social Security Statement, estimate my benefit amount, determine when to file and what information will be needed, etc.) |
|
|
|
|
|
|
|
|
To apply for Social Security, Supplemental Security Income (SSI) or Medicare benefits |
|
|
|
|
|
|
|
|
To manage the benefits I currently receive |
|
|
|
|
|
|
|
|
To find out how to get or replace a Social Security card |
|
|
|
|
|
|
|
|
To get an SSA form or publication |
|
|
|
|
|
|
|
|
To get SSA contact information (e.g., locate an office, phone number or email) |
|
|
|
|
|
|
|
|
To get information or conduct business as an employer or government official |
|
|
|
|
|
|
|
|
To help someone else with Social Security business |
|
|
|
|
|
|
|
|
To conduct research about Social Security history, policies, regulations, etc. |
|
|
|
|
|
|
|
|
Other (please specify) |
A |
|
|
|
|
|
| LNH4736 |
A |
What is the reason you are visiting SSA today? |
|
|
Text Area – no character limit |
|
|
OPS Group |
OE - Main Reason |
| CAS0049643 |
|
How did you arrive at the Social Security website today? |
I searched for it using Google, Yahoo, Bing, etc. |
|
Radio Button One Up Vertical |
Single |
Yes |
|
Arrived at Site |
|
|
|
I typed in the web address of a Social Security page. |
|
|
|
|
|
|
|
|
|
I arrived here from another website. |
|
|
|
|
|
|
|
|
|
I had the Social Security website bookmarked. |
|
|
|
|
|
|
|
|
|
Other (please specfiy) |
A |
|
|
|
|
|
| CAS0049644 |
A |
Please explain how you arrived at the Social Security website today. |
|
|
Text Area – no character limit |
|
|
|
OPS_Arrived at Site |
| LNH4737 |
|
Did the Social Security home page help you find what you were looking for? |
Yes |
|
Radio Button One Up Vertical |
Single |
Y |
Skip Logic |
Site Clarity |
|
|
No |
A |
|
|
| LNH4738 |
A |
Please tell us why the home page was not helpful. |
|
|
Text Area – no character limit |
|
N |
Skip Logic |
OE - Homepage |
| LNH4741 |
|
Did you find the information you were looking for or did you successfully complete your online transaction? |
Yes |
|
Dropdown (Select-one) |
Single |
Y |
Skip Logic |
Find Info |
|
No |
A |
|
|
|
Not yet, I am still looking |
A |
|
|
|
Not looking for anything specific |
|
|
|
| LNH4742 |
A |
Please tell us what you were trying to find or do on the SSA website today. |
|
|
Text Area – no character limit |
|
N |
Skip Logic |
Trying to Do |
| CAS0049645 |
|
Did you use the Frequently Asked Questions (“FAQs”) to find information? |
Yes |
A |
Dropdown (Select-one) |
Single |
Yes |
Skip Logic |
Use FAQ |
|
|
|
No |
|
|
|
|
|
|
|
|
|
Not sure |
|
|
|
|
|
|
| CAS0049623 |
A |
Did the Frequently Asked Questions give you the information you needed? |
Yes |
|
Dropdown (Select-one) |
Single |
Yes |
Skip Logic |
FAQ Answers |
|
|
|
No |
AA |
|
|
|
|
|
| CAS0049624 |
AA |
Please tell us about your concerns or problems when using the Frequently Asked Questions. |
|
|
Text Area – no character limit |
|
N |
Skip Logic |
OE_FAQ Concerns |
| CAS0049625 |
|
Now that you have visited the website, do you plan to contact Social Security? |
No, I found the information or service I wanted. |
|
Radio Button One Up Vertical |
Single |
Y |
|
Do Next |
|
|
|
Yes, I plan to call on the phone. |
|
|
|
|
|
|
|
|
|
Yes, I plan to visit an office. |
|
|
|
|
|
|
|
|
|
Yes, I plan to send an email or letter. |
|
|
|
|
|
|
| LNH4732 |
|
How often do you visit this site? |
First time |
|
Dropdown (Select-one) |
Single |
Y |
|
Freq of Visit |
|
More than once a day |
|
|
|
|
Daily |
|
|
|
|
Once a week |
|
|
|
|
Once a month |
|
|
|
|
Every 6 months or less frequently |
|
|
|
| LNH4751 |
|
If there was one thing you could change about the Social Security web site, please tell us what it would be. |
|
|
Text Area – no character limit |
|
N |
|
Change One Thing |
| Model Instance Name: |
|
|
red & strike-through: DELETE |
|
|
|
|
|
|
|
|
|
|
|
| SSA Main v3 |
|
|
underlined & italicized: RE-ORDER |
|
|
|
|
|
|
|
|
|
|
|
| MID: |
V1wUw0sAYNUA1pUkAswd1g4C |
|
pink: ADDITION |
|
|
|
|
|
|
|
|
|
|
|
| Date: |
6/14/2011 |
blue + -->: REWORDING |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| SSA Main v3 CUSTOM QUESTION LIST |
|
|
|
|
|
|
QID
(Group ID) |
Skip Logic Label |
Question Text |
Answer Choices
(limited to 50 characters) |
Skip to |
Type (select from list) |
Single or Multi |
Required
Y/N |
Special Instructions |
CQ Label |
|
|
|
|
|
LNH4729 |
|
Prior to receiving this survey today, did you experience any difficulties logging in, applying for benefits or using another service online? |
Yes |
A,B |
Radio Button One up |
Single |
Y |
Skip Logic Group |
Prior Difficulty |
|
|
|
|
|
|
|
|
No |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Don't remember |
|
|
|
|
|
|
|
|
|
|
|
LNH4730 |
A |
Which of the following did you experience difficulties with today? |
Creating a new My Social Security account |
|
Check box one up vertical |
Multi |
Y |
Skip Logic Group |
Difficulty |
|
|
|
|
Types |
|
|
|
Problems using a previously created My Social Security account |
|
|
|
|
|
|
|
|
|
|
Open-ended |
|
|
|
Viewing my Social Security Statement |
|
|
|
|
|
|
|
|
|
|
Text Field – limited to 100 characters |
|
|
|
Checking the status of my application |
|
|
|
|
|
|
|
|
|
|
Text Area – no character limit |
|
|
|
Applying for Help with Medicare Prescription Drug Plan Costs |
|
|
|
|
|
|
|
|
|
|
Dropdown (Select-one) |
|
|
|
Using the Retirement Estimator |
|
|
|
|
|
|
|
|
|
|
Radio Button One Up Vertical |
|
|
|
Applying for Disability benefits |
|
|
|
|
|
|
|
|
|
|
Radio Button Two Up Vertical |
|
|
|
Applying for Medicare benefits |
|
|
|
|
|
|
|
|
|
|
Radio Button Three Up Vertical |
|
|
|
Applying for Retirement benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Applying for Spousal benefits |
|
|
|
|
|
|
|
|
|
|
Radio Button Scale Has Don’t Know |
|
|
|
Filing a Representative Payee Accounting Report |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Appealing a benefits decision |
|
|
|
|
|
|
|
|
|
|
Radio Button Scale No Don’t Know |
|
|
|
Finding an answer to my question using the Frequently Asked Questions (FAQs) |
|
|
|
|
|
|
|
|
|
|
Checkbox One Up Vertical |
|
|
|
None of the above |
|
|
|
|
|
|
|
|
|
|
Checkbox Two Up Vertical |
LNH4731 |
B |
Please explain your difficulty. |
|
|
Text Area – no character limit |
|
|
Skip Logic Group |
OE_Explain Difficulty |
|
|
|
|
Select-multiple Show Four |
| LNH4733 |
|
Which of the following best describes you? |
I am entitled to or receive Social Security benefits (i.e. retirement, survivor’s, disability, spouses, Medicare and/or Supplemental Security Income) |
|
Radio Button One Up Vertical |
Single |
Y |
OPS Group |
Best Describes |
|
|
|
|
|
|
I do not receive Social Security, Medicare or Supplemental Security Income benefits |
|
|
|
|
|
|
|
|
|
I receive Supplemental Security Income (SSI) |
|
|
|
|
|
|
|
|
|
I am applying for Social Security, Supplemental Security Income (SSI) benefits or Medicare benefits. |
|
|
|
|
|
|
|
|
|
I am applying for Social Security disability, retirement, survivor's, or SSI |
|
|
|
|
|
|
|
|
|
I am an employer looking for Social Security information and services |
|
|
|
|
|
|
|
|
|
I am an employer |
|
|
|
|
|
|
|
|
|
I am a professional helping someone else with a Social Security matter business |
|
|
|
|
|
|
|
|
|
Other (please specify) |
A |
|
|
|
|
|
|
|
| LNH4734 |
A |
Other Role |
|
|
Text Field – limited to 100 characters |
|
N |
OPS Group |
OE - Best Describes |
|
|
|
|
|
| LNH4735 |
|
What was the main reason for your visit today? |
To learn about Social Security benefits |
|
Radio Button One Up Vertical |
Single |
Y |
OPS Group
|
Main Reason |
|
|
|
|
|
|
|
|
To plan for my future benefits (e.g., view my Social Security Statement, estimate my benefit amount, determine when to file and what information will be needed, etc.) |
|
|
|
|
|
|
|
|
|
|
|
|
|
To apply for Social Security, Supplemental Security Income (SSI) or Medicare benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
To manage the benefits I currently receive |
|
|
|
|
|
|
|
|
|
|
|
|
|
To find out how to get or replace a Social Security card |
|
|
|
|
|
|
|
|
|
|
|
|
|
To get an SSA form or publication |
|
|
|
|
|
|
|
|
|
|
|
|
|
To get SSA contact information (e.g., locate an office, phone number or email) |
|
|
|
|
|
|
|
|
|
|
|
|
|
To get information or conduct business as an employer or government official |
|
|
|
|
|
|
|
|
|
|
|
|
|
To help someone else with Social Security business |
|
|
|
|
|
|
|
|
|
|
|
|
|
To conduct research about Social Security history, policies, regulations, etc. |
|
|
|
|
|
|
|
|
|
|
|
|
|
Online check of the status of my application for benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
See if I qualify for benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Get online estimate of my future benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Plan for retirement |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Request a Proof-of-Income letter |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Online request for a Form 1099/1042S -- Social Security Benefit Statement |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Request a Social Security Statement online |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Get information about the disability program |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Learn about the Medicare Prescription Drug Program (Medicare Part D) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Apply online for Help With Medicare Prescription Drug Plan Costs |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Get/replace Social Security card or change my name on my Social Security card |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Online request for a replacement Medicare card |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Get a password for Social Security Online, or change my current password |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Check the contact, direct deposit, Medicare and payment information you have on file for me |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Set up or change Direct Deposit of my check |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Make an online change affecting the benefits I already receive |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Check for popular baby names |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Look for Federal employment |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Find my local office; how to contact Social Security |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Download forms |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Use online services for employers/businesses |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Research Social Security or its financial status |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Other (please specify) |
A |
|
|
|
|
|
|
|
|
|
|
| LNH4736 |
A |
Other ReasonWhat is the reason you are visiting SSA today? |
|
|
Text Area – no character limit |
|
|
OPS Group |
OE - Main Reason |
|
|
|
|
|
|
|
How did you arrive at the Social Security website today? |
I searched for it using Google, Yahoo, Bing, etc. |
|
Radio Button One Up Vertical |
Single |
Yes |
|
Arrived at Site |
|
|
|
|
|
|
|
|
I typed in the web address of a Social Security page. |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
I arrived here from another website. |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
I had the Social Security website bookmarked. |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Other (please specfiy) |
A |
|
|
|
|
|
|
|
|
|
|
|
A |
Please explain how you arrived at the Social Security website today. |
|
|
Text Area – no character limit |
|
|
|
OPS_Arrived at Site |
|
|
|
|
|
| LNH4737 |
|
Thinking about the Social Security web site’s home page (http://www.socialsecurity.gov) please tell us if it made clear to you where you needed to go to accomplish what you wanted. Did the Social Security home page help you find what you were looking for? |
Yes |
|
Radio Button One Up Vertical |
Single |
Y |
Skip Logic |
Site Clarity |
|
|
|
|
|
|
|
No |
A |
|
|
|
|
|
|
|
|
|
Not Sure/ Didn't visit the home page |
|
|
|
|
|
|
|
|
| LNH4738 |
A |
Please explain why it wasn’t clear where you needed to go to accomplish what you wanted. Please tell us why the home page was not helpful. |
|
|
Text Area – no character limit |
|
N |
Skip Logic |
OE - Homepage |
|
|
|
|
|
| LNH4741 |
|
Did you find the information you were looking for or did you successfully complete your online transaction? |
Yes |
|
Dropdown (Select-one) |
Single |
Y |
Skip Logic |
Find Info |
|
|
|
|
|
|
No |
A |
|
|
|
|
|
|
|
|
Not yet, I am still looking |
A |
|
|
|
|
|
|
|
|
Not looking for anything specific |
|
|
|
|
|
|
|
|
| LNH4742 |
A |
Please tell us what you were trying to find or do on the SSA website today. |
|
|
Text Area – no character limit |
|
N |
Skip Logic |
Trying to Do |
|
|
|
|
|
|
|
Did you use the Frequently Asked Questions (“FAQs”) to find information? |
Yes |
A |
Dropdown (Select-one) |
Single |
Yes |
Skip Logic |
Use FAQ |
|
|
|
|
|
|
|
|
No |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Not sure |
|
|
|
|
|
|
|
|
|
|
|
|
A |
Did the Frequently Asked Questions give you the information you needed? |
Yes |
|
Dropdown (Select-one) |
Single |
Yes |
Skip Logic |
FAQ Answers |
|
|
|
|
|
|
|
|
No |
AA |
|
|
|
|
|
|
|
|
|
|
|
AA |
Please tell us about your concerns or problems when using the Frequently Asked Questions. |
|
|
Text Area – no character limit |
|
N |
Skip Logic |
OE_FAQ Concerns |
|
|
|
|
|
|
|
Now that you have visited the website, do you plan to contact Social Security? |
No, I found the information or service I wanted. |
|
Radio Button One Up Vertical |
Single |
Y |
|
Do Next |
|
|
|
|
|
|
|
|
Yes, I plan to call on the phone. |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Yes, I plan to visit an office. |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Yes, I plan to send an email or letter. |
|
|
|
|
|
|
|
|
|
|
|
| LNH4732 |
|
How often do you visit this site? |
First time |
|
Dropdown (Select-one) |
Single |
Y |
|
Freq of Visit |
|
|
|
|
|
|
More than once a day |
|
|
|
|
|
|
|
|
|
Daily |
|
|
|
|
|
|
|
|
|
About o Once a week |
|
|
|
|
|
|
|
|
|
About o Once a month |
|
|
|
|
|
|
|
|
|
Every 6 months or less frequently |
|
|
|
|
|
|
|
|
LNH4743 |
|
Did you use the Social Security web site's Search (located in the upper right-hand corner of every page) during your visit? |
Yes |
A |
Radio Button One Up Vertical |
Single |
Y |
Skip Logic |
Use Search |
|
|
|
|
|
|
No |
|
|
|
|
|
|
|
|
|
Don't know what that is |
|
|
|
|
|
|
|
|
LNH4744 |
A |
Which of the following, if any, did you experience while using the search tool today? (check all that apply) |
I found what I was looking for |
|
Checkbox One Up Vertical |
Multi |
N |
Skip Logic |
Search Experience |
|
|
|
|
|
|
I was not sure what words to use in my search |
C |
|
|
|
|
|
|
|
|
Results were not relevant to my search terms or needs |
C |
|
|
|
|
|
|
|
|
Search returned no results |
C |
|
|
|
|
|
|
|
|
Search returned not enough results |
C |
|
|
|
|
|
|
|
|
Search returned too many results |
C |
|
|
|
|
|
|
|
|
Search required too many refinements to get to what I wanted |
C |
|
|
|
|
|
|
|
|
Search returned results that were too similar/redundant |
C |
|
|
|
|
|
|
|
|
Other (please specify) |
B,C |
|
|
|
|
|
|
|
LNH4745 |
B |
Please tell us what else you experienced while using the search tool today. |
|
|
Text Area – no character limit |
|
N |
Skip Logic |
Other Search Experience |
|
|
|
|
|
LNH4746 |
C |
What word(s) did you enter into the search box? |
|
|
Text Area – no character limit |
|
N |
Skip Logic |
Search Word |
|
|
|
|
|
LNH4750 |
|
After viewing our website, what do you plan to do next? |
Nothing, I found /completed what I wanted |
|
Dropdown (Select-one) |
Single |
Y |
|
Do Next |
|
|
|
|
|
|
Nothing, although I did not find/complete what I wanted |
|
|
|
|
|
|
|
|
|
Send Social Security an e-mail |
|
|
|
|
|
|
|
|
|
Call Social Security's 800 number |
|
|
|
|
|
|
|
|
|
Call my local Social Security office |
|
|
|
|
|
|
|
|
|
Visit my local Social Security office |
|
|
|
|
|
|
|
|
|
Write a letter to Social Security |
|
|
|
|
|
|
|
|
|
Return to the Social Security website later and try again |
|
|
|
|
|
|
|
|
| LNH4751 |
|
If there was one thing you could change about the Social Security web site, please tell us what it would be. |
|
|
Text Area – no character limit |
|
N |
|
Change One Thing |
|
|
|
|
|
| Model Instance Name: |
|
|
red & strike-through: DELETE |
|
|
|
|
|
|
|
|
|
|
|
|
|
| SSA Main v3 |
|
|
underlined & italicized: RE-ORDER |
|
|
|
|
|
|
|
|
|
|
|
|
|
| MID: |
V1wUw0sAYNUA1pUkAswd1g4C |
|
pink: ADDITION |
|
|
|
|
|
|
|
|
|
|
|
|
|
| Date: |
6/14/2011 |
blue + -->: REWORDING |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| SSA Main v3 CUSTOM QUESTION LIST |
|
|
|
|
|
|
|
|
QID
(Group ID) |
Skip Logic Label |
Question Text |
Answer Choices
(limited to 50 characters) |
Skip to |
Type (select from list) |
Single or Multi |
Required
Y/N |
Special Instructions |
25 character limit. Leave blank if you want DOT to fill this part out.
CQ Label |
|
|
|
|
|
|
|
| LNH4729 |
|
Prior to receiving this survey today, did you experience any difficulties logging in, applying for benefits or using another service online? |
Yes |
A,B |
Radio Button One up |
Single |
Y |
Skip Logic Group |
Prior Difficulty |
|
|
|
|
|
|
|
|
|
|
No |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Don't remember |
|
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4730 |
A |
Which of the following did you experience difficulties with today? |
Creating a new My Social Security account |
|
Check box one up vertical |
Multi |
Y |
Skip Logic Group |
Difficulty |
|
|
|
|
|
|
|
|
|
|
Problems using a previously created My Social Security account |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Viewing my Social Security Statement |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Checking the status of my application |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Applying for Help with Medicare Prescription Drug Plan Costs |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Using the Retirement Estimator |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Applying for Disability benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Applying for Medicare benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Applying for Retirement benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Applying for Spousal benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Filing a Representative Payee Accounting Report |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Appealing a benefits decision |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Finding an answer to my question using the Frequently Asked Questions (FAQs) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
None of the above |
|
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4731 |
B |
Please explain your difficulty. |
|
|
Text Area – no character limit |
|
|
Skip Logic Group |
OE_Explain Difficulty |
|
|
|
|
|
|
|
| LNH4732 |
|
How often do you visit this site? |
First time |
|
Dropdown (Select-one) |
Single |
Y |
|
Freq of Visit |
|
|
|
|
Types |
|
|
|
More than once a day |
|
|
|
|
|
|
|
Open-ended |
|
|
|
Daily |
|
|
|
|
|
|
|
Text Field – limited to 100 characters |
|
|
|
About once a week |
|
|
|
|
|
|
|
Text Area – no character limit |
|
|
|
About once a month |
|
|
|
|
|
|
|
Dropdown (Select-one) |
|
|
|
Every 6 months or less frequently |
|
|
|
|
|
|
|
Radio Button One Up Vertical |
|
|
| LNH4733 |
|
Which of the following best describes you? |
I receive Social Security Disability, Retirement, or Survivor's benefits |
|
Radio Button One Up Vertical |
Single |
Y |
OPS Group |
Best Describes |
|
|
|
|
Radio Button Two Up Vertical |
|
|
|
I receive SSI |
|
|
|
|
|
|
|
Radio Button Three Up Vertical |
|
|
|
I am applying for Social Security disability, retirement, survivor's, or SSI |
|
|
|
|
|
|
|
Radio Button Scale Has Don’t Know |
|
|
|
I do not receive Social Security benefits |
|
|
|
|
|
|
|
Radio Button Scale No Don’t Know |
|
|
|
I am an employer |
|
|
|
|
|
|
|
Checkbox One Up Vertical |
|
|
|
I am a professional helping someone else with Social Security business |
|
|
|
|
|
|
|
Checkbox Two Up Vertical |
|
|
|
Other (please specify) |
A |
|
|
|
|
|
|
Select-multiple Show Four |
|
|
| LNH4734 |
A |
Other Role |
|
|
Text Field – limited to 100 characters |
|
N |
OPS Group |
OE - Best Describes |
|
|
|
|
|
|
|
| LNH4735 |
|
What was the main reason for your visit today? |
Apply for benefits online |
|
Radio Button One Up Vertical |
Single |
Y |
OPS Group
|
Main Reason |
|
|
|
|
|
|
|
|
|
|
Online check of the status of my application for benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
See if I qualify for benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Get online estimate of my future benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Plan for retirement |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Request a Proof-of-Income letter |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Online request for a Form 1099/1042S -- Social Security Benefit Statement |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Request a Social Security Statement online |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Get information about the disability program |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Learn about the Medicare Prescription Drug Program (Medicare Part D) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Apply online for Help With Medicare Prescription Drug Plan Costs |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Get/replace Social Security card or change my name on my Social Security card |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Online request for a replacement Medicare card |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Get a password for Social Security Online, or change my current password |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Check the contact, direct deposit, Medicare and payment information you have on file for me |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Set up or change Direct Deposit of my check |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Make an online change affecting the benefits I already receive |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Check for popular baby names |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Look for Federal employment |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Find my local office; how to contact Social Security |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Download forms |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Use online services for employers/businesses |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Research Social Security or its financial status |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Other (please specify) |
A |
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4736 |
A |
Other Reason |
|
|
Text Field – limited to 100 characters |
|
|
OPS Group |
OE - Main Reason |
|
|
|
|
|
|
|
| LNH4737 |
|
Thinking about the Social Security web site’s home page (http://www.socialsecurity.gov) please tell us if it made clear to you where you needed to go to accomplish what you wanted. |
Yes |
|
Radio Button One Up Vertical |
Single |
Y |
Skip Logic |
Site Clarity |
|
|
|
|
|
|
|
|
No |
H |
|
|
|
|
|
|
|
|
|
|
Not Sure/Didn't visit the home page |
|
|
|
|
|
|
|
|
|
|
| LNH4738 |
H |
Please explain why it wasn’t clear where you needed to go to accomplish what you wanted. |
|
|
Text Field – limited to 100 characters |
|
N |
Skip Logic |
OE - Homepage |
|
|
|
|
|
|
|
| LNH4741 |
|
Did you find the information you were looking for or did you successfully complete your online transaction? |
Yes |
|
Dropdown (Select-one) |
Single |
Y |
Skip Logic |
Find Info |
|
|
|
|
|
|
|
|
No |
A |
|
|
|
|
|
|
|
|
|
|
Not yet, I am still looking |
A |
|
|
|
|
|
|
|
|
|
|
Not looking for anything specific |
|
|
|
|
|
|
|
|
|
|
| LNH4742 |
A |
Please tell us what you were trying to find or do on the SSA website today. |
|
|
Text Area – no character limit |
|
N |
Skip Logic |
Trying to Do |
|
|
|
|
|
|
|
| LNH4743 |
|
Did you use the Social Security web site's Search (located in the upper right-hand corner of every page) during your visit? |
Yes |
A |
Radio Button One Up Vertical |
Single |
Y |
Skip Logic |
Use Search |
|
|
|
|
|
|
|
|
No |
|
|
|
|
|
|
|
|
|
|
|
Don't know what that is |
|
|
|
|
|
|
|
|
|
|
| LNH4744 |
A |
Which of the following, if any, did you experience while using the search tool today? (check all that apply) |
I found what I was looking for |
|
Checkbox One Up Vertical |
Multi |
N |
Skip Logic |
Search Experience |
|
|
|
|
|
|
|
|
I was not sure what words to use in my search |
C |
|
|
|
|
|
|
|
|
|
|
Results were not relevant to my search terms or needs |
C |
|
|
|
|
|
|
|
|
|
|
Search returned no results |
C |
|
|
|
|
|
|
|
|
|
|
Search returned not enough results |
C |
|
|
|
|
|
|
|
|
|
|
Search returned too many results |
C |
|
|
|
|
|
|
|
|
|
|
Search required too many refinements to get to what I wanted |
C |
|
|
|
|
|
|
|
|
|
|
Search returned results that were too similar/redundant |
C |
|
|
|
|
|
|
|
|
|
|
Other (please specify) |
B,C |
|
|
|
|
|
|
|
|
|
| LNH4745 |
B |
Please tell us what else you experienced while using the search tool today. |
|
|
Text Area – no character limit |
|
N |
Skip Logic |
Other Search Experience |
|
|
|
|
|
|
|
| LNH4746 |
C |
What word(s) did you enter into the search box? |
|
|
Text Area – no character limit |
|
N |
Skip Logic |
Search Word |
|
|
|
|
|
|
|
| LNH4750 |
|
After viewing our website, what do you plan to do next? |
Nothing, I found /completed what I wanted |
|
Dropdown (Select-one) |
Single |
Y |
|
Do Next |
|
|
|
|
|
|
|
|
Nothing, although I did not find/complete what I wanted |
|
|
|
|
|
|
|
|
|
|
|
Send Social Security an e-mail |
|
|
|
|
|
|
|
|
|
|
|
Call Social Security's 800 number |
|
|
|
|
|
|
|
|
|
|
|
Call my local Social Security office |
|
|
|
|
|
|
|
|
|
|
|
Visit my local Social Security office |
|
|
|
|
|
|
|
|
|
|
|
Write a letter to Social Security |
|
|
|
|
|
|
|
|
|
|
|
Return to the Social Security website later and try again |
|
|
|
|
|
|
|
|
|
|
| LNH4751 |
|
If there was one thing you could change about the Social Security web site, please tell us what it would be. |
|
|
Text Area – no character limit |
|
N |
|
Change One Thing |
|
|
|
|
|
|
|
LNH4752 |
|
Do you ever access the Internet using a mobile phone or tablet? |
Yes |
A, B |
Radio button, one-up vertical |
Single |
Y |
Skip Logic Group |
Access Mobile Internet |
|
|
|
|
|
|
|
|
|
|
No |
|
|
|
|
|
|
|
|
|
|
|
|
|
LNH4753 |
A |
Which of the following devices do you have? |
A SmartPhone |
W |
Checkbox, one-up vertical |
Multi |
Y |
Skip Logic Group |
Phone or Tablet |
|
|
|
|
|
|
|
|
|
|
A tablet |
X |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
None of these |
|
|
|
|
|
|
|
|
|
|
|
|
|
LNH4754 |
W |
Specifically, which type of mobile phone do you have? |
iPhone |
|
Radio button, one-up vertical |
Single |
Y |
Skip Logic Group |
Phone Type |
|
|
|
|
|
|
|
|
|
|
Android |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Blackberry |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Another phone |
|
|
|
|
|
|
|
|
|
|
|
|
|
LNH4755 |
X |
Specifically, which type of tablet do you have? |
iPad |
|
Radio button, one-up vertical |
Single |
Y |
Skip Logic Group |
Tablet Type |
|
|
|
|
|
|
|
|
|
|
Kindle |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Android |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Blackberry |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Another tablet |
|
|
|
|
|
|
|
|
|
|
|
|
|
LNH4756 |
B |
Have you ever accessed ANY federal website using a mobile phone or tablet? |
Yes |
C |
Radio button, one-up vertical |
Single |
Y |
Skip Logic Group |
Federal Mobile Site Usage |
|
|
|
|
|
|
|
|
|
|
No, but I plan to do so |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
No, but I might in the future |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
No, and I don't plan to do so |
|
|
|
|
|
|
|
|
|
|
|
|
|
LNH4757 |
C |
Have you ever accessed the Social Security website using a mobile phone or tablet? |
Yes |
Y, Z |
Radio button, one-up vertical |
Single |
Y |
Skip Logic Group |
Mobile Site Usage |
|
|
|
|
|
|
|
|
|
|
No, but I plan to do so |
Z |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
No, but I might in the future |
Z |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
No, and I don't plan to do so |
|
|
|
|
|
|
|
|
|
|
|
|
|
LNH4758 |
Y |
What was the main reason you last visited the Social Security website using a mobile phone or tablet? |
|
|
Text area, no char limit |
Single |
N |
Skip Logic Group |
Mobile Primary Reason |
|
|
|
|
|
|
|
LNH4759 |
Z |
What additional resources might you want to access from the Social Security website using a mobile phone or tablet? |
|
|
Text area, no char limit |
Single |
N |
Skip Logic Group |
MobileDesired Resources |
|
|
|
|
|
|
|
| Model Instance Name: |
|
|
red & strike-through: DELETE |
|
|
|
|
|
|
|
|
|
|
|
|
|
| SSA Main v3 |
|
|
underlined & italicized: RE-ORDER |
|
|
|
|
|
|
|
|
|
|
|
|
|
| MID: |
V1wUw0sAYNUA1pUkAswd1g4C |
|
pink: ADDITION |
|
|
|
|
|
|
|
|
|
|
|
|
|
| Date: |
6/14/2011 |
blue + -->: REWORDING |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| SSA Main v3 CUSTOM QUESTION LIST |
|
|
|
|
|
|
|
|
QID
(Group ID) |
Skip Logic Label |
Question Text |
Answer Choices
(limited to 50 characters) |
Skip to |
Type (select from list) |
Single or Multi |
Required
Y/N |
Special Instructions |
25 character limit. Leave blank if you want DOT to fill this part out.
CQ Label |
|
|
|
|
|
|
|
| LNH4729 |
|
Prior to receiving this survey today, did you experience any difficulties logging in, applying for benefits or using another service online? |
Yes |
A,B |
Radio Button One up |
Single |
Y |
Skip Logic Group |
Prior Difficulty |
|
|
|
|
|
|
|
|
|
|
No |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Don't remember |
|
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4730 |
A |
Which of the following did you experience difficulties with today? |
Creating a new My Social Security account |
|
Check box one up vertical |
Multi |
Y |
Skip Logic Group |
Difficulty |
|
|
|
|
|
|
|
|
|
|
Problems using a previously created My Social Security account |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Viewing my Social Security Statement |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Checking the status of my application |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Applying for Help with Medicare Prescription Drug Plan Costs |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Using the Retirement Estimator |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Applying for Disability benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Applying for Medicare benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Applying for Retirement benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Applying for Spousal benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Filing a Representative Payee Accounting Report |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Appealing a benefits decision |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Finding an answer to my question using the Frequently Asked Questions (FAQs) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
None of the above |
|
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4731 |
B |
Please explain your difficulty. |
|
|
Text Area – no character limit |
|
|
Skip Logic Group |
OE_Explain Difficulty |
|
|
|
|
|
|
|
| LNH4732 |
|
How often do you visit this site? |
First time |
|
Dropdown (Select-one) |
Single |
Y |
|
Freq of Visit |
|
|
|
|
Types |
|
|
|
More than once a day |
|
|
|
|
|
|
|
Open-ended |
|
|
|
Daily |
|
|
|
|
|
|
|
Text Field – limited to 100 characters |
|
|
|
About once a week |
|
|
|
|
|
|
|
Text Area – no character limit |
|
|
|
About once a month |
|
|
|
|
|
|
|
Dropdown (Select-one) |
|
|
|
Every 6 months or less frequently |
|
|
|
|
|
|
|
Radio Button One Up Vertical |
|
|
| LNH4733 |
|
Which of the following best describes you? |
I receive Social Security Disability, Retirement, or Survivor's benefits |
|
Radio Button One Up Vertical |
Single |
Y |
OPS Group |
Best Describes |
|
|
|
|
Radio Button Two Up Vertical |
|
|
|
I receive SSI |
|
|
|
|
|
|
|
Radio Button Three Up Vertical |
|
|
|
I am applying for Social Security disability, retirement, survivor's, or SSI |
|
|
|
|
|
|
|
Radio Button Scale Has Don’t Know |
|
|
|
I do not receive Social Security benefits |
|
|
|
|
|
|
|
Radio Button Scale No Don’t Know |
|
|
|
I am an employer |
|
|
|
|
|
|
|
Checkbox One Up Vertical |
|
|
|
I am a professional helping someone else with Social Security business |
|
|
|
|
|
|
|
Checkbox Two Up Vertical |
|
|
|
Other (please specify) |
A |
|
|
|
|
|
|
Select-multiple Show Four |
|
|
| LNH4734 |
A |
Other Role |
|
|
Text Field – limited to 100 characters |
|
N |
OPS Group |
OE - Best Describes |
|
|
|
|
|
|
|
| LNH4735 |
|
What was the main reason for your visit today? |
Apply for benefits online |
|
Radio Button One Up Vertical |
Single |
Y |
OPS Group
|
Main Reason |
|
|
|
|
|
|
|
|
|
|
Online check of the status of my application for benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
See if I qualify for benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Get online estimate of my future benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Plan for retirement |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Request a Proof-of-Income letter |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Online request for a Form 1099/1042S -- Social Security Benefit Statement |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Request a Social Security Statement online |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Get information about the disability program |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Learn about the Medicare Prescription Drug Program (Medicare Part D) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Apply online for Help With Medicare Prescription Drug Plan Costs |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Get/replace Social Security card or change my name on my Social Security card |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Online request for a replacement Medicare card |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Get a password for Social Security Online, or change my current password |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Check the contact, direct deposit, Medicare and payment information you have on file for me |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Set up or change Direct Deposit of my check |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Make an online change affecting the benefits I already receive |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Check for popular baby names |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Look for Federal employment |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Find my local office; how to contact Social Security |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Download forms |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Use online services for employers/businesses |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Research Social Security or its financial status |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Other (please specify) |
A |
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4736 |
A |
Other Reason |
|
|
Text Field – limited to 100 characters |
|
|
OPS Group |
OE - Main Reason |
|
|
|
|
|
|
|
| LNH4737 |
|
Thinking about the Social Security web site’s home page (http://www.socialsecurity.gov) please tell us if it made clear to you where you needed to go to accomplish what you wanted. |
Yes |
|
Radio Button One Up Vertical |
Single |
Y |
Skip Logic |
Site Clarity |
|
|
|
|
|
|
|
|
No |
H |
|
|
|
|
|
|
|
|
|
|
Not Sure/Didn't visit the home page |
|
|
|
|
|
|
|
|
|
|
| LNH4738 |
H |
Please explain why it wasn’t clear where you needed to go to accomplish what you wanted. |
|
|
Text Field – limited to 100 characters |
|
N |
Skip Logic |
OE - Homepage |
|
|
|
|
|
|
|
| LNH4741 |
|
Did you find the information you were looking for or did you successfully complete your online transaction? |
Yes |
|
Dropdown (Select-one) |
Single |
Y |
Skip Logic |
Find Info |
|
|
|
|
|
|
|
|
No |
A |
|
|
|
|
|
|
|
|
|
|
Not yet, I am still looking |
A |
|
|
|
|
|
|
|
|
|
|
Not looking for anything specific |
|
|
|
|
|
|
|
|
|
|
| LNH4742 |
A |
Please tell us what you were trying to find or do on the SSA website today. |
|
|
Text Area – no character limit |
|
N |
Skip Logic |
Trying to Do |
|
|
|
|
|
|
|
| LNH4743 |
|
Did you use the Social Security web site's Search (located in the upper right-hand corner of every page) during your visit? |
Yes |
A |
Radio Button One Up Vertical |
Single |
Y |
Skip Logic |
Use Search |
|
|
|
|
|
|
|
|
No |
|
|
|
|
|
|
|
|
|
|
|
Don't know what that is |
|
|
|
|
|
|
|
|
|
|
| LNH4744 |
A |
Which of the following, if any, did you experience while using the search tool today? (check all that apply) |
I found what I was looking for |
|
Checkbox One Up Vertical |
Multi |
N |
Skip Logic |
Search Experience |
|
|
|
|
|
|
|
|
I was not sure what words to use in my search |
C |
|
|
|
|
|
|
|
|
|
|
Results were not relevant to my search terms or needs |
C |
|
|
|
|
|
|
|
|
|
|
Search returned no results |
C |
|
|
|
|
|
|
|
|
|
|
Search returned not enough results |
C |
|
|
|
|
|
|
|
|
|
|
Search returned too many results |
C |
|
|
|
|
|
|
|
|
|
|
Search required too many refinements to get to what I wanted |
C |
|
|
|
|
|
|
|
|
|
|
Search returned results that were too similar/redundant |
C |
|
|
|
|
|
|
|
|
|
|
Other (please specify) |
B,C |
|
|
|
|
|
|
|
|
|
| LNH4745 |
B |
Please tell us what else you experienced while using the search tool today. |
|
|
Text Area – no character limit |
|
N |
Skip Logic |
Other Search Experience |
|
|
|
|
|
|
|
| LNH4746 |
C |
What word(s) did you enter into the search box? |
|
|
Text Area – no character limit |
|
N |
Skip Logic |
Search Word |
|
|
|
|
|
|
|
| LNH4750 |
|
After viewing our website, what do you plan to do next? |
Nothing, I found /completed what I wanted |
|
Dropdown (Select-one) |
Single |
Y |
|
Do Next |
|
|
|
|
|
|
|
|
Nothing, although I did not find/complete what I wanted |
|
|
|
|
|
|
|
|
|
|
|
Send Social Security an e-mail |
|
|
|
|
|
|
|
|
|
|
|
Call Social Security's 800 number |
|
|
|
|
|
|
|
|
|
|
|
Call my local Social Security office |
|
|
|
|
|
|
|
|
|
|
|
Visit my local Social Security office |
|
|
|
|
|
|
|
|
|
|
|
Write a letter to Social Security |
|
|
|
|
|
|
|
|
|
|
|
Return to the Social Security website later and try again |
|
|
|
|
|
|
|
|
|
|
| LNH4751 |
|
If there was one thing you could change about the Social Security web site, please tell us what it would be. |
|
|
Text Area – no character limit |
|
N |
|
Change One Thing |
|
|
|
|
|
|
|
| LNH4752 |
|
Do you ever access the Internet using a mobile phone or tablet? |
Yes |
A, B |
Radio button, one-up vertical |
Single |
Y |
Skip Logic Group |
Access Mobile Internet |
|
|
|
|
|
|
|
|
|
|
No |
|
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4753 |
A |
Which of the following devices do you have? |
A SmartPhone |
W |
Checkbox, one-up vertical |
Multi |
Y |
Skip Logic Group |
Phone or Tablet |
|
|
|
|
|
|
|
|
|
|
A tablet |
X |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
None of these |
|
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4754 |
W |
Specifically, which type of mobile phone do you have? |
iPhone |
|
Radio button, one-up vertical |
Single |
Y |
Skip Logic Group |
Phone Type |
|
|
|
|
|
|
|
|
|
|
Android |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Blackberry |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Another phone |
|
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4755 |
X |
Specifically, which type of tablet do you have? |
iPad |
|
Radio button, one-up vertical |
Single |
Y |
Skip Logic Group |
Tablet Type |
|
|
|
|
|
|
|
|
|
|
Kindle |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Android |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Blackberry |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Another tablet |
|
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4756 |
B |
Have you ever accessed ANY federal website using a mobile phone or tablet? |
Yes |
C |
Radio button, one-up vertical |
Single |
Y |
Skip Logic Group |
Federal Mobile Site Usage |
|
|
|
|
|
|
|
|
|
|
No, but I plan to do so |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
No, but I might in the future |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
No, and I don't plan to do so |
|
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4757 |
C |
Have you ever accessed the Social Security website using a mobile phone or tablet? |
Yes |
Y, Z |
Radio button, one-up vertical |
Single |
Y |
Skip Logic Group |
Mobile Site Usage |
|
|
|
|
|
|
|
|
|
|
No, but I plan to do so |
Z |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
No, but I might in the future |
Z |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
No, and I don't plan to do so |
|
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4758 |
Y |
What was the main reason you last visited the Social Security website using a mobile phone or tablet? |
|
|
Text area, no char limit |
Single |
N |
Skip Logic Group |
Mobile Primary Reason |
|
|
|
|
|
|
|
| LNH4759 |
Z |
What additional resources might you want to access from the Social Security website using a mobile phone or tablet? |
|
|
Text area, no char limit |
Single |
N |
Skip Logic Group |
MobileDesired Resources |
|
|
|
|
|
|
|
| Model Instance Name: |
|
|
red & strike-through: DELETE |
|
|
|
|
|
|
|
|
|
|
|
|
|
| SSA Main v3 |
|
|
underlined & italicized: RE-ORDER |
|
|
|
|
|
|
|
|
|
|
|
|
|
| MID: |
V1wUw0sAYNUA1pUkAswd1g4C |
|
pink: ADDITION |
|
|
|
|
|
|
|
|
|
|
|
|
|
| Date: |
6/14/2011 |
blue + -->: REWORDING |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| SSA Main v3 CUSTOM QUESTION LIST |
|
|
|
|
|
|
|
|
QID
(Group ID) |
Skip Logic Label |
Question Text |
Answer Choices
(limited to 50 characters) |
Skip to |
Type (select from list) |
Single or Multi |
Required
Y/N |
Special Instructions |
25 character limit. Leave blank if you want DOT to fill this part out.
CQ Label |
|
|
|
|
|
|
|
| LNH4729 |
|
Prior to receiving this survey today, did you experience any difficulties logging in, applying for benefits or using another service online? |
Yes |
A,B |
Radio Button One up |
Single |
Y |
Skip Logic Group |
Prior Difficulty |
|
|
|
|
|
|
|
|
|
|
No |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Don't remember |
|
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4730 |
A |
Which of the following did you experience difficulties with today? |
Creating a new My Social Security account |
|
Check box one up vertical |
Multi |
Y |
Skip Logic Group |
Difficulty |
|
|
|
|
|
|
|
|
|
|
Problems using a previously created My Social Security account |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Viewing my Social Security Statement |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Checking the status of my application |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Applying for Help with Medicare Prescription Drug Plan Costs |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Using the Retirement Estimator |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Applying for Disability benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Applying for Medicare benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Applying for Retirement benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Filing a Representative Payee Accounting Report |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Appealing a benefits decision |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
None of the above |
|
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4731 |
B |
Please explain your difficulty. |
|
|
Text Area – no character limit |
|
|
Skip Logic Group |
OE_Explain Difficulty |
|
|
|
|
|
|
|
| LNH4732 |
|
How often do you visit this site? |
First time |
|
Dropdown (Select-one) |
Single |
Y |
|
Freq of Visit |
|
|
|
|
Types |
|
|
|
More than once a day |
|
|
|
|
|
|
|
Open-ended |
|
|
|
Daily |
|
|
|
|
|
|
|
Text Field – limited to 100 characters |
|
|
|
About once a week |
|
|
|
|
|
|
|
Text Area – no character limit |
|
|
|
About once a month |
|
|
|
|
|
|
|
Dropdown (Select-one) |
|
|
|
Every 6 months or less frequently |
|
|
|
|
|
|
|
Radio Button One Up Vertical |
|
|
| LNH4733 |
|
Which of the following best describes you? |
I receive Social Security Disability, Retirement, or Survivor's benefits |
|
Radio Button One Up Vertical |
Single |
Y |
OPS Group |
Best Describes |
|
|
|
|
Radio Button Two Up Vertical |
|
|
|
I receive SSI |
|
|
|
|
|
|
|
Radio Button Three Up Vertical |
|
|
|
I am applying for Social Security disability, retirement, survivor's, or SSI |
|
|
|
|
|
|
|
Radio Button Scale Has Don’t Know |
|
|
|
I do not receive Social Security benefits |
|
|
|
|
|
|
|
Radio Button Scale No Don’t Know |
|
|
|
I am an employer |
|
|
|
|
|
|
|
Checkbox One Up Vertical |
|
|
|
I am a professional helping someone else with Social Security business |
|
|
|
|
|
|
|
Checkbox Two Up Vertical |
|
|
|
Other (please specify) |
A |
|
|
|
|
|
|
Select-multiple Show Four |
|
|
| LNH4734 |
A |
Other Role |
|
|
Text Field – limited to 100 characters |
|
N |
OPS Group |
OE - Best Describes |
|
|
|
|
|
|
|
| LNH4735 |
|
What was the main reason for your visit today? |
Apply for benefits online |
|
Radio Button One Up Vertical |
Single |
Y |
OPS Group |
Main Reason |
|
|
|
|
|
|
|
|
|
|
Online check of the status of my application for benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
See if I qualify for benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Get online estimate of my future benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Plan for retirement |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Request a Proof-of-Income letter |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Online request for a Form 1099/1042S -- Social Security Benefit Statement |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Request a Social Security Statement online |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Get information about the disability program |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Learn about the Medicare Prescription Drug Program (Medicare Part D) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Apply online for Help With Medicare Prescription Drug Plan Costs |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Get/replace Social Security card or change my name on my Social Security card |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Online request for a replacement Medicare card |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Get a password for Social Security Online, or change my current password |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Check the contact, direct deposit, Medicare and payment information you have on file for me |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Set up or change Direct Deposit of my check |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Make an online change affecting the benefits I already receive |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Check for popular baby names |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Look for Federal employment |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Find my local office; how to contact Social Security |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Download forms |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Use online services for employers/businesses |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Research Social Security or its financial status |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Other (please specify) |
A |
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4736 |
A |
Other Reason |
|
|
Text Field – limited to 100 characters |
|
|
OPS Group |
OE - Main Reason |
|
|
|
|
|
|
|
| LNH4737 |
|
Thinking about the Social Security web site’s home page (http://www.socialsecurity.gov) please tell us if it made clear to you where you needed to go to accomplish what you wanted. |
Yes |
|
Radio Button One Up Vertical |
Single |
Y |
Skip Logic |
Site Clarity |
|
|
|
|
|
|
|
|
No |
H |
|
|
|
|
|
|
|
|
|
|
Not Sure/Didn't visit the home page |
|
|
|
|
|
|
|
|
|
|
| LNH4738 |
H |
Please explain why it wasn’t clear where you needed to go to accomplish what you wanted. |
|
|
Text Field – limited to 100 characters |
|
N |
Skip Logic |
OE - Homepage |
|
|
|
|
|
|
|
LNH4739 |
|
Which, if any, of the top navigation links did you use today? (Select all that apply) |
Retirement |
|
Checkbox One Up Vertical |
Multi |
Y |
Skip Logic |
Top Navigation |
|
|
|
|
|
|
|
|
Disability |
|
|
|
|
|
|
|
|
|
|
|
Survivors |
|
|
|
|
|
|
|
|
|
|
|
SSI |
|
|
|
|
|
|
|
|
|
|
|
Medicare |
|
|
|
|
|
|
|
|
|
|
|
Business Services |
|
|
|
|
|
|
|
|
|
|
|
Not Sure |
|
|
|
|
|
|
|
|
|
|
|
None of the above |
|
anchor/pin |
|
|
|
|
|
|
|
|
LNH4740 |
|
Did you use any of the Top Services links on the left side of the homepage today? |
Yes |
|
Radio Button One Up Vertical |
Single |
Y |
Skip Logic |
Top Services Links |
|
|
|
|
|
|
|
|
No |
|
|
|
|
|
|
|
|
|
|
|
Not Sure |
|
|
|
|
|
|
|
|
|
|
| LNH4741 |
|
Did you find the information you were looking for or did you successfully complete your online transaction? |
Yes |
|
Dropdown (Select-one) |
Single |
Y |
Skip Logic |
Find Info |
|
|
|
|
|
|
|
|
No |
A |
|
|
|
|
|
|
|
|
|
|
Not yet, I am still looking |
A |
|
|
|
|
|
|
|
|
|
|
Not looking for anything specific |
|
|
|
|
|
|
|
|
|
|
| LNH4742 |
A |
Please tell us what you were trying to find or do on the SSA website today. |
|
|
Text Area – no character limit |
|
N |
Skip Logic |
Trying to Do |
|
|
|
|
|
|
|
| LNH4743 |
|
Did you use the Social Security web site's Search (located in the upper right-hand corner of every page) during your visit? |
Yes |
A |
Radio Button One Up Vertical |
Single |
Y |
Skip Logic |
Use Search |
|
|
|
|
|
|
|
|
No |
|
|
|
|
|
|
|
|
|
|
|
Don't know what that is |
|
|
|
|
|
|
|
|
|
|
| LNH4744 |
A |
Which of the following, if any, did you experience while using the search tool today? (check all that apply) |
I found what I was looking for |
|
Checkbox One Up Vertical |
Multi |
N |
Skip Logic |
Search Experience |
|
|
|
|
|
|
|
|
I was not sure what words to use in my search |
C |
|
|
|
|
|
|
|
|
|
|
Results were not relevant to my search terms or needs |
C |
|
|
|
|
|
|
|
|
|
|
Search returned no results |
C |
|
|
|
|
|
|
|
|
|
|
Search returned not enough results |
C |
|
|
|
|
|
|
|
|
|
|
Search returned too many results |
C |
|
|
|
|
|
|
|
|
|
|
Search required too many refinements to get to what I wanted |
C |
|
|
|
|
|
|
|
|
|
|
Search returned results that were too similar/redundant |
C |
|
|
|
|
|
|
|
|
|
|
Other (please specify) |
B,C |
|
|
|
|
|
|
|
|
|
| LNH4745 |
B |
Please tell us what else you experienced while using the search tool today. |
|
|
Text Area – no character limit |
|
N |
Skip Logic |
Other Search Experience |
|
|
|
|
|
|
|
| LNH4746 |
C |
What word(s) did you enter into the search box? |
|
|
Text Area – no character limit |
|
N |
Skip Logic |
Search Word |
|
|
|
|
|
|
|
| LNH4750 |
|
After viewing our website, what do you plan to do next? |
Nothing, I found /completed what I wanted |
|
Dropdown (Select-one) |
Single |
Y |
|
Do Next |
|
|
|
|
|
|
|
|
Nothing, although I did not find/complete what I wanted |
|
|
|
|
|
|
|
|
|
|
|
Send Social Security an e-mail |
|
|
|
|
|
|
|
|
|
|
|
Call Social Security's 800 number |
|
|
|
|
|
|
|
|
|
|
|
Call my local Social Security office |
|
|
|
|
|
|
|
|
|
|
|
Visit my local Social Security office |
|
|
|
|
|
|
|
|
|
|
|
Write a letter to Social Security |
|
|
|
|
|
|
|
|
|
|
|
Return to the Social Security website later and try again |
|
|
|
|
|
|
|
|
|
|
| LNH4751 |
|
If there was one thing you could change about the Social Security web site, please tell us what it would be. |
|
|
Text Area – no character limit |
|
N |
|
Change One Thing |
|
|
|
|
|
|
|
| LNH4752 |
|
Do you ever access the Internet using a mobile phone or tablet? |
Yes |
A, B |
Radio button, one-up vertical |
Single |
Y |
Skip Logic Group |
Access Mobile Internet |
|
|
|
|
|
|
|
|
|
|
No |
|
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4753 |
A |
Which of the following devices do you have? |
A SmartPhone |
W |
Checkbox, one-up vertical |
Multi |
Y |
Skip Logic Group |
Phone or Tablet |
|
|
|
|
|
|
|
|
|
|
A tablet |
X |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
None of these |
|
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4754 |
W |
Specifically, which type of mobile phone do you have? |
iPhone |
|
Radio button, one-up vertical |
Single |
Y |
Skip Logic Group |
Phone Type |
|
|
|
|
|
|
|
|
|
|
Android |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Blackberry |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Another phone |
|
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4755 |
X |
Specifically, which type of tablet do you have? |
iPad |
|
Radio button, one-up vertical |
Single |
Y |
Skip Logic Group |
Tablet Type |
|
|
|
|
|
|
|
|
|
|
Kindle |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Android |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Blackberry |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Another tablet |
|
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4756 |
B |
Have you ever accessed ANY federal website using a mobile phone or tablet? |
Yes |
C |
Radio button, one-up vertical |
Single |
Y |
Skip Logic Group |
Federal Mobile Site Usage |
|
|
|
|
|
|
|
|
|
|
No, but I plan to do so |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
No, but I might in the future |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
No, and I don't plan to do so |
|
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4757 |
C |
Have you ever accessed the Social Security website using a mobile phone or tablet? |
Yes |
Y, Z |
Radio button, one-up vertical |
Single |
Y |
Skip Logic Group |
Mobile Site Usage |
|
|
|
|
|
|
|
|
|
|
No, but I plan to do so |
Z |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
No, but I might in the future |
Z |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
No, and I don't plan to do so |
|
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4758 |
Y |
What was the main reason you last visited the Social Security website using a mobile phone or tablet? |
|
|
Text area, no char limit |
Single |
N |
Skip Logic Group |
Mobile Primary Reason |
|
|
|
|
|
|
|
| LNH4759 |
Z |
What additional resources might you want to access from the Social Security website using a mobile phone or tablet? |
|
|
Text area, no char limit |
Single |
N |
Skip Logic Group |
MobileDesired Resources |
|
|
|
|
|
|
|
| Model Instance Name: |
|
|
red & strike-through: DELETE |
|
|
|
|
|
|
|
|
|
|
|
|
|
| SSA Main v3 |
|
|
underlined & italicized: RE-ORDER |
|
|
|
|
|
|
|
|
|
|
|
|
|
| MID: |
V1wUw0sAYNUA1pUkAswd1g4C |
|
pink: ADDITION |
|
|
|
|
|
|
|
|
|
|
|
|
|
| Date: |
6/14/2011 |
blue + -->: REWORDING |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| SSA Main v3 CUSTOM QUESTION LIST |
|
|
|
|
|
|
|
|
QID
(Group ID) |
Skip Logic Label |
Question Text |
Answer Choices
(limited to 50 characters) |
Skip to |
Type (select from list) |
Single or Multi |
Required
Y/N |
Special Instructions |
25 character limit. Leave blank if you want DOT to fill this part out.
CQ Label |
|
|
|
|
|
|
|
| LNH4729 |
|
Prior to receiving this survey today, did you experience any difficulties logging in, applying for benefits or using another service online? |
Yes |
A,B |
Radio Button One up |
Single |
Y |
Skip Logic Group |
Prior Difficulty |
|
|
|
|
|
|
|
|
|
|
No |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Don't remember |
|
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4730 |
A |
Which of the following did you experience difficulties with today? |
Creating a new My Social Security account |
|
Check box one up vertical |
Multi |
Y |
Skip Logic Group |
Difficulty |
|
|
|
|
|
|
|
|
|
|
Problems using a previously created My Social Security account |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Viewing my Social Security Statement |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Checking the status of my application |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Applying for Help with Medicare Prescription Drug Plan Costs |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Using the Retirement Estimator |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Applying for Disability benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Applying for Medicare benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Applying for Retirement benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Filing a Representative Payee Accounting Report |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Appealing a benefits decision |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
None of the above |
|
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4731 |
B |
Please explain your difficulty. |
|
|
Text Area – no character limit |
|
|
Skip Logic Group |
OE_Explain Difficulty |
|
|
|
|
|
|
|
| LNH4732 |
|
How often do you visit this site? |
First time |
|
Dropdown (Select-one) |
Single |
Y |
|
Freq of Visit |
|
|
|
|
Types |
|
|
|
More than once a day |
|
|
|
|
|
|
|
Open-ended |
|
|
|
Daily |
|
|
|
|
|
|
|
Text Field – limited to 100 characters |
|
|
|
About once a week |
|
|
|
|
|
|
|
Text Area – no character limit |
|
|
|
About once a month |
|
|
|
|
|
|
|
Dropdown (Select-one) |
|
|
|
Every 6 months or less frequently |
|
|
|
|
|
|
|
Radio Button One Up Vertical |
|
|
| LNH4733 |
|
Which of the following best describes you? |
I receive Social Security Disability, Retirement, or Survivor's benefits |
|
Radio Button One Up Vertical |
Single |
Y |
OPS Group |
Best Describes |
|
|
|
|
Radio Button Two Up Vertical |
|
|
|
I receive SSI |
|
|
|
|
|
|
|
Radio Button Three Up Vertical |
|
|
|
I am applying for Social Security disability, retirement, survivor's, or SSI |
|
|
|
|
|
|
|
Radio Button Scale Has Don’t Know |
|
|
|
I do not receive Social Security benefits |
|
|
|
|
|
|
|
Radio Button Scale No Don’t Know |
|
|
|
I am an employer |
|
|
|
|
|
|
|
Checkbox One Up Vertical |
|
|
|
I am a professional helping someone else with Social Security business |
|
|
|
|
|
|
|
Checkbox Two Up Vertical |
|
|
|
Other (please specify) |
A |
|
|
|
|
|
|
Select-multiple Show Four |
|
|
| LNH4734 |
A |
Other Role |
|
|
Text Field – limited to 100 characters |
|
N |
OPS Group |
OE - Best Describes |
|
|
|
|
|
|
|
| LNH4735 |
|
What was the main reason for your visit today? |
Apply for benefits online |
|
Radio Button One Up Vertical |
Single |
Y |
OPS Group |
Main Reason |
|
|
|
|
|
|
|
|
|
|
Online check of the status of my application for benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
See if I qualify for benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Get online estimate of my future benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Plan for retirement |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Request a Proof-of-Income letter |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Online request for a Form 1099/1042S -- Social Security Benefit Statement |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Request a Social Security Statement online |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Get information about the disability program |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Learn about the Medicare Prescription Drug Program (Medicare Part D) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Apply online for Help With Medicare Prescription Drug Plan Costs |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Get/replace Social Security card or change my name on my Social Security card |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Online request for a replacement Medicare card |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Get a password for Social Security Online, or change my current password |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Check the contact, direct deposit, Medicare and payment information you have on file for me |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Set up or change Direct Deposit of my check |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Make an online change affecting the benefits I already receive |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Check for popular baby names |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Look for Federal employment |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Find my local office; how to contact Social Security |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Download forms |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Use online services for employers/businesses |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Research Social Security or its financial status |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Other (please specify) |
A |
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4736 |
A |
Other Reason |
|
|
Text Field – limited to 100 characters |
|
|
OPS Group |
OE - Main Reason |
|
|
|
|
|
|
|
| LNH4737 |
|
Thinking about the Social Security web site’s home page (http://www.socialsecurity.gov) please tell us if it made clear to you where you needed to go to accomplish what you wanted. |
Yes |
|
Radio Button One Up Vertical |
Single |
Y |
Skip Logic |
Site Clarity |
|
|
|
|
|
|
|
|
No |
H |
|
|
|
|
|
|
|
|
|
|
Not Sure/Didn't visit the home page |
|
|
|
|
|
|
|
|
|
|
| LNH4738 |
H |
Please explain why it wasn’t clear where you needed to go to accomplish what you wanted. |
|
|
Text Field – limited to 100 characters |
|
N |
Skip Logic |
OE - Homepage |
|
|
|
|
|
|
|
| LNH4739 |
|
Which, if any, of the top navigation links did you use today? (Select all that apply) |
Retirement |
|
Checkbox One Up Vertical |
Multi |
Y |
Skip Logic |
Top Navigation |
|
|
|
|
|
|
|
|
Disability |
|
|
|
|
|
|
|
|
|
|
|
Survivors |
|
|
|
|
|
|
|
|
|
|
|
SSI |
|
|
|
|
|
|
|
|
|
|
|
Medicare |
|
|
|
|
|
|
|
|
|
|
|
Business Services |
|
|
|
|
|
|
|
|
|
|
|
Not Sure |
|
|
|
|
|
|
|
|
|
|
|
None of the above |
|
anchor/pin |
|
|
|
|
|
|
|
|
| LNH4740 |
|
Did you use any of the Top Services links on the left side of the homepage today? |
Yes |
|
Radio Button One Up Vertical |
Single |
Y |
Skip Logic |
Top Services Links |
|
|
|
|
|
|
|
|
No |
|
|
|
|
|
|
|
|
|
|
|
Not Sure |
|
|
|
|
|
|
|
|
|
|
| LNH4741 |
|
Did you find the information you were looking for or did you successfully complete your online transaction? |
Yes |
|
Dropdown (Select-one) |
Single |
Y |
Skip Logic |
Find Info |
|
|
|
|
|
|
|
|
No |
A |
|
|
|
|
|
|
|
|
|
|
Not yet, I am still looking |
A |
|
|
|
|
|
|
|
|
|
|
Not looking for anything specific |
|
|
|
|
|
|
|
|
|
|
| LNH4742 |
A |
Please tell us what you were trying to find or do on the SSA website today. |
|
|
Text Area – no character limit |
|
N |
Skip Logic |
Trying to Do |
|
|
|
|
|
|
|
| LNH4743 |
|
Did you use the Social Security web site's Search (located in the upper right-hand corner of every page) during your visit? |
Yes |
A |
Radio Button One Up Vertical |
Single |
Y |
Skip Logic |
Use Search |
|
|
|
|
|
|
|
|
No |
|
|
|
|
|
|
|
|
|
|
|
Don't know what that is |
|
|
|
|
|
|
|
|
|
|
| LNH4744 |
A |
Which of the following, if any, did you experience while using the search tool today? (check all that apply) |
I found what I was looking for |
|
Checkbox One Up Vertical |
Multi |
N |
Skip Logic |
Search Experience |
|
|
|
|
|
|
|
|
I was not sure what words to use in my search |
C |
|
|
|
|
|
|
|
|
|
|
Results were not relevant to my search terms or needs |
C |
|
|
|
|
|
|
|
|
|
|
Search returned no results |
C |
|
|
|
|
|
|
|
|
|
|
Search returned not enough results |
C |
|
|
|
|
|
|
|
|
|
|
Search returned too many results |
C |
|
|
|
|
|
|
|
|
|
|
Search required too many refinements to get to what I wanted |
C |
|
|
|
|
|
|
|
|
|
|
Search returned results that were too similar/redundant |
C |
|
|
|
|
|
|
|
|
|
|
Other (please specify) |
B,C |
|
|
|
|
|
|
|
|
|
| LNH4745 |
B |
Please tell us what else you experienced while using the search tool today. |
|
|
Text Area – no character limit |
|
N |
Skip Logic |
Other Search Experience |
|
|
|
|
|
|
|
| LNH4746 |
C |
What word(s) did you enter into the search box? |
|
|
Text Area – no character limit |
|
N |
Skip Logic |
Search Word |
|
|
|
|
|
|
|
LNH4747 |
|
Please rate the clarity of the wording on this site.
|
1=Poor |
|
Radio button, scale, has don't know |
S |
Y |
|
Clear |
|
|
|
|
|
|
|
|
|
|
2 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
3 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
4 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
5 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
6 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
7 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
8 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
9 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Excellent=10 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Don't know |
|
|
|
|
|
|
|
|
|
|
|
|
|
LNH4748 |
|
Please rate how well you understand the wording on this site.
|
1=Poor |
|
Radio button, scale, has don't know |
S |
Y |
|
Understandable |
|
|
|
|
|
|
|
|
|
|
2 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
3 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
4 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
5 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
6 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
7 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
8 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
9 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Excellent=10 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Don't know |
|
|
|
|
|
|
|
|
|
|
|
|
LNH4749 |
|
Please rate the site on its use of short, clear sentences.
|
1=Poor |
|
Radio button, scale, has don't know |
S |
Y |
|
Concise |
|
|
|
|
|
|
|
|
|
|
2 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
3 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
4 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
5 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
6 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
7 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
8 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
9 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Excellent=10 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Don't know |
|
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4750 |
|
After viewing our website, what do you plan to do next? |
Nothing, I found /completed what I wanted |
|
Dropdown (Select-one) |
Single |
Y |
|
Do Next |
|
|
|
|
|
|
|
|
Nothing, although I did not find/complete what I wanted |
|
|
|
|
|
|
|
|
|
|
|
Send Social Security an e-mail |
|
|
|
|
|
|
|
|
|
|
|
Call Social Security's 800 number |
|
|
|
|
|
|
|
|
|
|
|
Call my local Social Security office |
|
|
|
|
|
|
|
|
|
|
|
Visit my local Social Security office |
|
|
|
|
|
|
|
|
|
|
|
Write a letter to Social Security |
|
|
|
|
|
|
|
|
|
|
|
Return to the Social Security website later and try again |
|
|
|
|
|
|
|
|
|
|
| LNH4751 |
|
If there was one thing you could change about the Social Security web site, please tell us what it would be. |
|
|
Text Area – no character limit |
|
N |
|
Change One Thing |
|
|
|
|
|
|
|
| LNH4752 |
|
Do you ever access the Internet using a mobile phone or tablet? |
Yes |
A, B |
Radio button, one-up vertical |
Single |
Y |
Skip Logic Group |
Access Mobile Internet |
|
|
|
|
|
|
|
|
|
|
No |
|
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4753 |
A |
Which of the following devices do you have? |
A SmartPhone |
W |
Checkbox, one-up vertical |
Multi |
Y |
Skip Logic Group |
Phone or Tablet |
|
|
|
|
|
|
|
|
|
|
A tablet |
X |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
None of these |
|
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4754 |
W |
Specifically, which type of mobile phone do you have? |
iPhone |
|
Radio button, one-up vertical |
Single |
Y |
Skip Logic Group |
Phone Type |
|
|
|
|
|
|
|
|
|
|
Android |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Blackberry |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Another phone |
|
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4755 |
X |
Specifically, which type of tablet do you have? |
iPad |
|
Radio button, one-up vertical |
Single |
Y |
Skip Logic Group |
Tablet Type |
|
|
|
|
|
|
|
|
|
|
Kindle |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Android |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Blackberry |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Another tablet |
|
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4756 |
B |
Have you ever accessed ANY federal website using a mobile phone or tablet? |
Yes |
C |
Radio button, one-up vertical |
Single |
Y |
Skip Logic Group |
Federal Mobile Site Usage |
|
|
|
|
|
|
|
|
|
|
No, but I plan to do so |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
No, but I might in the future |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
No, and I don't plan to do so |
|
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4757 |
C |
Have you ever accessed the Social Security website using a mobile phone or tablet? |
Yes |
Y, Z |
Radio button, one-up vertical |
Single |
Y |
Skip Logic Group |
Mobile Site Usage |
|
|
|
|
|
|
|
|
|
|
No, but I plan to do so |
Z |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
No, but I might in the future |
Z |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
No, and I don't plan to do so |
|
|
|
|
|
|
|
|
|
|
|
|
|
| LNH4758 |
Y |
What was the main reason you last visited the Social Security website using a mobile phone or tablet? |
|
|
Text area, no char limit |
Single |
N |
Skip Logic Group |
Mobile Primary Reason |
|
|
|
|
|
|
|
| LNH4759 |
Z |
What additional resources might you want to access from the Social Security website using a mobile phone or tablet? |
|
|
Text area, no char limit |
Single |
N |
Skip Logic Group |
MobileDesired Resources |
|
|
|
|
|
|
|
| Model Instance Name: |
|
|
red & strike-through: DELETE |
|
|
|
|
|
|
|
|
|
|
|
|
|
| SSA Main v2 |
|
|
underlined & italicized: RE-ORDER |
|
|
|
|
|
|
|
|
|
|
|
|
|
| MID: |
ZgYJFVF51REcEs5x1EpJUg== |
|
pink: ADDITION |
|
|
|
|
|
|
|
|
|
|
|
|
|
| Date: |
6/14/2011 |
blue + -->: REWORDING |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| SSA Main v2 CUSTOM QUESTION LIST |
|
|
|
|
|
|
|
|
QID
(Group ID) |
Skip Logic Label |
Question Text |
Answer Choices
(limited to 50 characters) |
Skip to |
Type (select from list) |
Single or Multi |
Required
Y/N |
Special Instructions |
25 character limit. Leave blank if you want DOT to fill this part out.
CQ Label |
|
|
|
|
|
|
|
| ACQinh0023740 |
|
Prior to receiving this survey today, did you experience any difficulties logging in, applying for benefits or using another service online? |
Yes |
A,B |
Radio Button One up |
Single |
Y |
|
Prior Difficulty |
|
|
|
|
|
|
|
|
|
|
No |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Don't remember |
|
|
|
|
|
|
|
|
|
|
|
|
|
| ACQinh0023741 |
A |
Which of the following did you experience difficulties with today? |
Creating a new My Social Security account |
|
Check box one up vertical |
Multi |
Y |
|
Difficulty |
|
|
|
|
|
|
|
|
|
|
Problems using a previously created My Social Security account |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Viewing my Social Security Statement |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Checking the status of my application |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Applying for Help with Medicare Prescription Drug Plan Costs |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Using the Retirement Estimator |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Applying for Disability benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Applying for Medicare benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Applying for Retirement benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Filing a Representative Payee Accounting Report |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Appealing a benefits decision |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
None of the above |
|
|
|
|
|
|
|
|
|
|
|
|
|
| ACQinh0023742 |
B |
Please explain your difficulty. |
|
|
Text Area – no character limit |
|
|
|
OE_Explain Difficulty |
|
|
|
|
|
|
|
| SAC2649 |
|
How often do you visit this site? |
First time |
|
Dropdown (Select-one) |
Single |
Y |
|
Freq of Visit |
|
|
|
|
Types |
|
|
|
More than once a day |
|
|
|
|
|
|
|
Open-ended |
|
|
|
Daily |
|
|
|
|
|
|
|
Text Field – limited to 100 characters |
|
|
|
About once a week |
|
|
|
|
|
|
|
Text Area – no character limit |
|
|
|
About once a month |
|
|
|
|
|
|
|
Dropdown (Select-one) |
|
|
|
Every 6 months or less frequently |
|
|
|
|
|
|
|
Radio Button One Up Vertical |
|
|
| ACQCol0005956 |
|
Which of the following best describes you? |
I receive Social Security Disability, Retirement, or Survivor's benefits |
|
Radio Button One Up Vertical |
Single |
Y |
OPS Group |
Best Describes |
|
|
|
|
Radio Button Two Up Vertical |
|
|
| I receive SSI |
|
|
|
|
|
|
|
Radio Button Three Up Vertical |
|
|
| I am applying for Social Security disability, retirement, survivor's, or SSI |
|
|
|
|
|
|
|
Radio Button Scale Has Don’t Know |
|
|
| I do not receive Social Security benefits |
|
|
|
|
|
|
|
Radio Button Scale No Don’t Know |
|
|
| I am an employer |
|
|
|
|
|
|
|
Checkbox One Up Vertical |
|
|
| I am a professional helping someone else with Social Security business |
|
|
|
|
|
|
|
Checkbox Two Up Vertical |
|
|
| Other (please specify) |
A |
|
|
|
|
|
|
Select-multiple Show Four |
|
|
| ACQCol0005957 |
A |
Other Role |
|
|
Text Field – limited to 100 characters |
|
N |
OPS Group |
OE - Best Describes |
|
|
|
|
|
|
|
| SAC2652 |
|
What was the main reason for your visit today? |
Apply for benefits online |
|
Radio Button One Up Vertical |
Single |
Y |
OPS Group |
Main Reason |
|
|
|
|
|
|
|
|
|
|
Online check of the status of my application for benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
See if I qualify for benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Get online estimate of my future benefits |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Plan for retirement |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Request a Proof-of-Income letter |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Online request for a Form 1099/1042S -- Social Security Benefit Statement |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Request a Social Security Statement online |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Get information about the disability program |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Learn about the Medicare Prescription Drug Program (Medicare Part D) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Apply online for Help With Medicare Prescription Drug Plan Costs |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Get/replace Social Security card or change my name on my Social Security card |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Online request for a replacement Medicare card |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Get a password for Social Security Online, or change my current password |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Check the contact, direct deposit, Medicare and payment information you have on file for me |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Set up or change Direct Deposit of my check |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Make an online change affecting the benefits I already receive |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Check for popular baby names |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Look for Federal employment |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Find my local office; how to contact Social Security |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Download forms |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Use online services for employers/businesses |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Research Social Security or its financial status |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Other (please specify) |
A |
|
|
|
|
|
|
|
|
|
|
|
|
| SAC2653 |
A |
Other Reason |
|
|
Text Field – limited to 100 characters |
|
|
OPS Group |
OE - Main Reason |
|
|
|
|
|
|
|
| SAC2654 |
|
Thinking about the Social Security web site’s home page (http://www.socialsecurity.gov) please tell us if it made clear to you where you needed to go to accomplish what you wanted. |
Yes |
|
Radio Button One Up Vertical |
Single |
Y |
Skip Logic |
Site Clarity |
|
|
|
|
|
|
|
| No |
H |
|
|
|
|
|
|
|
|
|
| Not Sure/Didn't visit the home page |
|
|
|
|
|
|
|
|
|
|
| SAC2655 |
H |
Please explain why it wasn’t clear where you needed to go to accomplish what you wanted. |
|
|
Text Field – limited to 100 characters |
|
N |
Skip Logic |
OE - Homepage |
|
|
|
|
|
|
|
| SAC2656 |
|
Which, if any, of the top navigation links did you use today? (Select all that apply) |
Retirement |
|
Checkbox One Up Vertical |
Multi |
Y |
Skip Logic |
Top Navigation |
|
|
|
|
|
|
|
| Disability |
|
|
|
|
|
|
|
|
|
|
| Survivors |
|
|
|
|
|
|
|
|
|
|
| SSI |
|
|
|
|
|
|
|
|
|
|
| Medicare |
|
|
|
|
|
|
|
|
|
|
| Business Services |
|
|
|
|
|
|
|
|
|
|
| Not Sure |
|
|
|
|
|
|
|
|
|
|
| None of the above |
|
anchor/pin |
|
|
|
|
|
|
|
|
| SAC2657 |
|
Did you use any of the Top Services links on the left side of the homepage today? |
Yes |
|
Radio Button One Up Vertical |
Single |
Y |
Skip Logic |
Top Services Links |
|
|
|
|
|
|
|
| No |
|
|
|
|
|
|
|
|
|
|
| Not Sure |
|
|
|
|
|
|
|
|
|
|
| SAC2658 |
|
Did you find the information you were looking for or did you successfully complete your online transaction? |
Yes |
|
Dropdown (Select-one) |
Single |
Y |
Skip Logic |
Find Info |
|
|
|
|
|
|
|
|
No |
A |
|
|
|
|
|
|
|
|
|
|
Not yet, I am still looking |
A |
|
|
|
|
|
|
|
|
|
|
Not looking for anything specific |
|
|
|
|
|
|
|
|
|
|
| SAC2659 |
A |
Please tell us what you were trying to find or do on the SSA website today. |
|
|
Text Area – no character limit |
|
N |
Skip Logic |
Trying to Do |
|
|
|
|
|
|
|
| SAC2660 |
|
Did you use the Social Security web site's Search (located in the upper right-hand corner of every page) during your visit? |
Yes |
A |
Radio Button One Up Vertical |
Single |
Y |
Skip Logic |
Use Search |
|
|
|
|
|
|
|
| No |
|
|
|
|
|
|
|
|
|
|
| Don't know what that is |
|
|
|
|
|
|
|
|
|
|
| SAC2661 |
A |
Which of the following, if any, did you experience while using the search tool today? (check all that apply) |
I found what I was looking for |
|
Checkbox One Up Vertical |
Multi |
N |
Skip Logic |
Search Experience |
|
|
|
|
|
|
|
| I was not sure what words to use in my search |
C |
|
|
|
|
|
|
|
|
|
| Results were not relevant to my search terms or needs |
C |
|
|
|
|
|
|
|
|
|
| Search returned no results |
C |
|
|
|
|
|
|
|
|
|
| Search returned not enough results |
C |
|
|
|
|
|
|
|
|
|
| Search returned too many results |
C |
|
|
|
|
|
|
|
|
|
| Search required too many refinements to get to what I wanted |
C |
|
|
|
|
|
|
|
|
|
| Search returned results that were too similar/redundant |
C |
|
|
|
|
|
|
|
|
|
| Other (please specify) |
B,C |
|
|
|
|
|
|
|
|
|
| SAC2662 |
B |
Please tell us what else you experienced while using the search tool today. |
|
|
Text Area – no character limit |
|
N |
Skip Logic |
Other Search Experience |
|
|
|
|
|
|
|
| ACQCol0006071 |
C |
What word(s) did you enter into the search box? |
|
|
Text Area – no character limit |
|
N |
Skip Logic |
Search Word |
|
|
|
|
|
|
|
| ACQhar0021338 |
|
Please rate the clarity of the wording on this site.
|
1=Poor |
|
Radio button, scale, has don't know |
S |
Y |
|
Clear |
|
|
|
|
|
|
|
|
|
|
2 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
3 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
4 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
5 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
6 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
7 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
8 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
9 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Excellent=10 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Don't know |
|
|
|
|
|
|
|
|
|
|
|
|
|
| ACQhar0021339 |
|
Please rate how well you understand the wording on this site.
|
1=Poor |
|
Radio button, scale, has don't know |
S |
Y |
|
Understandable |
|
|
|
|
|
|
|
|
|
|
2 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
3 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
4 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
5 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
6 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
7 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
8 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
9 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Excellent=10 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Don't know |
|
|
|
|
|
|
|
|
|
|
|
|
| ACQhar0021340 |
|
Please rate the site on its use of short, clear sentences.
|
1=Poor |
|
Radio button, scale, has don't know |
S |
Y |
|
Concise |
|
|
|
|
|
|
|
|
|
|
2 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
3 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
4 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
5 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
6 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
7 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
8 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
9 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Excellent=10 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Don't know |
|
|
|
|
|
|
|
|
|
|
|
|
|
| SAC2663 |
|
After viewing our website, what do you plan to do next? |
Nothing, I found /completed what I wanted |
|
Dropdown (Select-one) |
Single |
Y |
|
Do Next |
|
|
|
|
|
|
|
| Nothing, although I did not find/complete what I wanted |
|
|
|
|
|
|
|
|
|
|
| Send Social Security an e-mail |
|
|
|
|
|
|
|
|
|
|
| Call Social Security's 800 number |
|
|
|
|
|
|
|
|
|
|
| Call my local Social Security office |
|
|
|
|
|
|
|
|
|
|
| Visit my local Social Security office |
|
|
|
|
|
|
|
|
|
|
| Write a letter to Social Security |
|
|
|
|
|
|
|
|
|
|
| Return to the Social Security website later and try again |
|
|
|
|
|
|
|
|
|
|
| SAC2664 |
|
If there was one thing you could change about the Social Security web site, please tell us what it would be. |
|
|
Text Area – no character limit |
|
N |
|
Change One Thing |
|
|
|
|
|
|
|
| ACQinh0018616 |
|
Do you ever access the Internet using a mobile phone or tablet? |
Yes |
A, B |
Radio button, one-up vertical |
Single |
Y |
|
Access Mobile Internet |
|
|
|
|
|
|
|
|
|
|
No |
|
|
|
|
|
|
|
|
|
|
|
|
|
| ACQinh0018617 |
A |
Which of the following devices do you have? |
A SmartPhone |
W |
Checkbox, one-up vertical |
Multi |
Y |
|
Phone or Tablet |
|
|
|
|
|
|
|
|
|
|
A tablet |
X |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
None of these |
|
|
|
|
|
|
|
|
|
|
|
|
|
| ACQinh0018618 |
W |
Specifically, which type of mobile phone do you have? |
iPhone |
|
Radio button, one-up vertical |
Single |
Y |
|
Phone Type |
|
|
|
|
|
|
|
|
|
|
Android |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Blackberry |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Another phone |
|
|
|
|
|
|
|
|
|
|
|
|
|
| ACQinh0018619 |
X |
Specifically, which type of tablet do you have? |
iPad |
|
Radio button, one-up vertical |
Single |
Y |
|
Tablet Type |
|
|
|
|
|
|
|
|
|
|
Kindle |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Android |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Blackberry |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Another tablet |
|
|
|
|
|
|
|
|
|
|
|
|
|
| ACQinh0018620 |
B |
Have you ever accessed ANY federal website using a mobile phone or tablet? |
Yes |
C |
Radio button, one-up vertical |
Single |
Y |
|
Federal Mobile Site Usage |
|
|
|
|
|
|
|
|
|
|
No, but I plan to do so |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
No, but I might in the future |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
No, and I don't plan to do so |
|
|
|
|
|
|
|
|
|
|
|
|
|
| ACQinh0018621 |
C |
Have you ever accessed the Social Security website using a mobile phone or tablet? |
Yes |
Y, Z |
Radio button, one-up vertical |
Single |
Y |
|
Mobile Site Usage |
|
|
|
|
|
|
|
|
|
|
No, but I plan to do so |
Z |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
No, but I might in the future |
Z |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
No, and I don't plan to do so |
|
|
|
|
|
|
|
|
|
|
|
|
|
| ACQinh0018622 |
Y |
What was the main reason you last visited the Social Security website using a mobile phone or tablet? |
|
|
Text area, no char limit |
Single |
N |
|
Mobile Primary Reason |
|
|
|
|
|
|
|
| ACQinh0018623 |
Z |
What additional resources might you want to access from the Social Security website using a mobile phone or tablet? |
|
|
Text area, no char limit |
Single |
N |
|
MobileDesired Resources |
|
|
|
|
|
|
|