Form 1109 2014 864 SSA Main Mobile Survey
E-Government Website Customer Satisfaction Surveys
2014 864 SSA Main Mobile Survey.xlsx
2014 864 SSA Main Mobile Survey
OMB: 1090-0008
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1090-0008 can be found here:
Document [xlsx]
Download: xlsx | pdf
Model Qsts
Current CQs
Current CQs (9-25-14)
Overview
Welcome and Thank You TextModel Qsts
Current CQs
Current CQs (9-25-14)
Sheet 1: Welcome and Thank You Text
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| Welcome and Thank You Text | |||||||
| Welcome Text | Thank You Text | ||||||
| Thank you for visiting SSA.gov. You've been randomly chosen to take part in a brief survey to let us know what we're doing well and where we can improve. Please take a few minutes to share your opinions, which are essential in helping us provide the best online experience possible. |
Thank you for taking our survey - and for helping us serve you better. We appreciate your input! |
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| Welcome Text - Alternate | Thank You Text - Alternate | ||||||
| Thank you for visiting SSA.gov. You have been randomly selected to take part in this survey that is being conducted by ForeSee on behalf of the Social Security Administration. Please take a few minutes to give us your feedback. All results are strictly confidential. | Thank you for taking our survey - and for helping us serve you better. Please note you will not receive a response from us based on your survey comments. If you would like us to contact you about your feedback, please visit the Contact Us section of our web site. |
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Sheet 2: Model Qsts
| Model Name | SSA Main-Mobile | 
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| Model ID | BkUZRJUBJdFw8Zdxl9gZ1Q4C | Underlined & Italicized: Re-order | ||||||
| Partitioned | No | Pink: Addition | ||||||
| Date | 7/22/2014 | Blue: Reword | ||||||
| Label | Element Questions | Label | Satisfaction Questions | Label | Future Behaviors | |||
| 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 mobile site. | 9 | Satisfaction - Overall | What is your overall satisfaction with this mobile site? (1=Very Dissatisfied, 10=Very Satisfied) |
12 | Recommend | How likely are you to recommend this mobile site to someone else? |
| 2 | Look and Feel - Readability | Please rate the readability of the pages on this mobile site. | 10 | Satisfaction - Expectations | How well does this mobile site meet your expectations? (1=Falls Short, 10=Exceeds) |
Return (1=Very Unlikely, 10=Very Likely) | ||
| Navigation (1=Poor, 10=Excellent, Don't Know) | 11 | Satisfaction - Ideal | How does this site compare to your idea of an mobile website? (1=Not Very Close, 10=Very Close) |
13 | Return | How likely are you to return to this mobile site? | ||
| 3 | Navigation - Organized | Please rate how well this mobile site is organized. | ||||||
| 4 | Navigation - Options | Please rate the options available for navigating this mobile site. | ||||||
| SSA Information(1=Poor, 10=Excellent, Don't Know) | ||||||||
| 5 | Site Information - Thoroughness | Please rate the thoroughness of information provided on this mobile site. | ||||||
| 6 | Site Information - Answers | Please rate how well this mobile site’s information provides answers to your questions. | ||||||
| Site Performance (1=Poor, 10=Excellent, Don't Know) | ||||||||
| 7 | Site Performance - Loading | Please rate how quickly pages load on this mobile site. | ||||||
| 8 | Site Performance - Completeness | Please rate how completely the page content loads on this mobile site. | ||||||
Sheet 3: Current CQs
| Model Name | SSA Main-Mobile |
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| Model ID | BkUZRJUBJdFw8Zdxl9gZ1Q4C | Underlined & Italicized: Re-order | |||||||
| Partitioned | No | Pink: Addition | |||||||
| Date | 8/13/2014 | Blue: Reword | |||||||
| QID | Skip From | Question Text | Answer Choices | Skip To | Required Y/N |
Type | Special Instructions | CQ Label | |
| LNH5416Q001 | Have you visited this mobile site before? | This is my first visit. | Y | Checkbox, one-up vertical | Mutually Exclusive | Visit Frequency | |||
| I have visited before from a smartphone. | |||||||||
| I have visited before from a desktop computer. | |||||||||
| I have visited before from a tablet. | |||||||||
| I am not sure. | Mutually Exclusive | ||||||||
| LNH5416Q002 | Which role best describes you? | I am currently entitled to or receive monthly Social Security benefits (e.g., retirement, survivor, spouse, disability, or Supplemental Security Income benefits). | Y | Radio button, one-up vertical | OPS Group* | Role | |||
| I am currently entitled to or receive Medicare Only benefits. | |||||||||
| I do not currently receive Social Security benefits (e.g. retirement, survivor, spouse, disability, Medicare, or Supplemental Security Income benefits) | |||||||||
| I am currently in the process of applying for monthly Social Security benefits (e.g. retirement, survivor, spouse, disability, Medicare, or Supplemental Security Income benefits) | |||||||||
| I am a professional helping someone else with a Social Security matter. | |||||||||
| I am an employer looking for Social Security information and/or services. | |||||||||
| Other (please specify) | A | ||||||||
| LNH5416Q003 | A | What other role best describes you? | N | Text field, <100 char | OPS Group* | OPS_Role | |||
| LNH5416Q004 | What was the primary reason for your visit today? | To learn about Social Security benefits | Y | Radio button, one-up vertical | OPS Group* | Primary Reason | |||
| To help someone else with a Social Security matter | |||||||||
| To plan for my future benefits (e.g., view my Social Security Statement, estimate my benefits, determine when to file, learn what information will be needed, etc.) | |||||||||
| To apply for Social Security benefits (including retirement, survivor, spouse, disability, Medicare, and Supplemental Security Income [SSI] benefits) | |||||||||
| To manage the benefits I currently receive from Social Security | |||||||||
| To check the status of my recently filed Social Security application | |||||||||
| To find out how to apply for or replace a Social Security number or card | |||||||||
| To change my address | |||||||||
| To sign up for bank direct deposit or change my bank direct deposit information | |||||||||
| To obtain SSA contact information (i.e., 1-800 number, address for local SSA office, etc.) | |||||||||
| To request a form or publication | |||||||||
| Other (please specify) | A | ||||||||
| LNH5416Q005 | A | What was the other primary reason for your visit today? | N | Text field, <100 char | OPS Group* | OPS_Primary Reason | |||
| LNH5416Q006 | Did you find what you were looking for or successfully complete your online transaction today? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | Accomplish Task | |||
| Not yet, still looking | A | ||||||||
| Not looking for anything specific | |||||||||
| LNH5416Q007 | A | Please select the online transaction you were attempting to complete on your mobile device or tablet (Select all that apply): | Create a my Social Security account | Y | Checkbox, one-up vertical | Skip Logic Group* | Why Not Accomplsih | ||
| Access a previously established my Social Security account | |||||||||
| Appeal a Social Security descision | |||||||||
| Apply for benefits | |||||||||
| Manage the benefits I currently receive (e.g. change my address or direct deposit information) | |||||||||
| Request a benefit verfication letter | |||||||||
| Check my benefit and payment information | |||||||||
| View or download my Social Security statement | |||||||||
| Check the status of my pending application for Social Security benefits | |||||||||
| Seeking Social Security contact informaiton (e.g., 1-800 number, address of my local Social Security office, special help desk, how to email Social Security, chat with a Social Security agent, etc.) | |||||||||
| Use the Retirement Estimator | |||||||||
| Replace a lost Social Security card | |||||||||
| Change a name on a Social Security card (e.g., due to marriage or divorce) | |||||||||
| Make an appointment with a local Social Security office | |||||||||
| Use one of the services provided in Business Services Online | |||||||||
| Other (please specify) | B | ||||||||
| LNH5416Q008 | B | Please describe the online transaction you were attempting to complete on your mobile device or tablet: | N | Text area, no char limit | Skip Logic Group* | OPS_Why Not Accomplish | |||
| LNH5416Q009 | Have you registered for a my Social Security account? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | Have mySSA Account | |||
| No | A | ||||||||
| LNH5416Q010 | 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. | Y | Radio button, one-up vertical | Skip Logic Group* | 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 | ||||||||
| LNH5416Q011 | AA | Please tell us why you have not registered for a my Social Security account. | N | Text area, no char limit | Skip Logic Group* | OPS_Why Not Have mySSA Account | |||
| LNH5416Q012 | Do you have any suggestions regarding online services or applications you would like to see SSA make available on a mobile device or tablet? | N | Text area, no char limit | Services Want to Access | |||||
| LNH5416Q013 | What is your age? | Under 25 | Y | Radio button, one-up vertical | Age | ||||
| 25-39 | |||||||||
| 40-59 | |||||||||
| 60-63 | |||||||||
| 64-65 | |||||||||
| 66-67 | |||||||||
| 68 or older | |||||||||
| Prefer not to answer | |||||||||
| LNH5416Q014 | Do you have any suggestions for improving the services SSA offers via a mobile device? | N | Text area, no char limit | OE_Improvement | |||||
Sheet 4: Current CQs (9-25-14)
| Model Name | SSA Main-Mobile |
|
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| Model ID | BkUZRJUBJdFw8Zdxl9gZ1Q4C | Underlined & Italicized: Re-order | |||||||
| Partitioned | No | Pink: Addition | |||||||
| Date | 8/13/2014 | Blue: Reword | |||||||
| QID | Skip From | Question Text | Answer Choices | Skip To | Required Y/N |
Type | Special Instructions | CQ Label | |
| LNH5416Q001 | Have you visited this mobile site before? | This is my first visit. | Y | Checkbox, one-up vertical | Mutually Exclusive | Visit Frequency | |||
| I have visited before from a smartphone. | |||||||||
| I have visited before from a desktop computer. | |||||||||
| I have visited before from a tablet. | |||||||||
| I am not sure. | Mutually Exclusive | ||||||||
| LNH5416Q002 | Which role best describes you? | I am currently entitled to or receive monthly Social Security benefits (e.g., retirement, survivor, spouse, disability, or Supplemental Security Income benefits). | Y | Radio button, one-up vertical | OPS Group* | Role | |||
| I am currently entitled to or receive Medicare Only benefits. | |||||||||
| I do not currently receive Social Security benefits (e.g. retirement, survivor, spouse, disability, Medicare, or Supplemental Security Income benefits) | |||||||||
| I am currently in the process of applying for monthly Social Security benefits (e.g. retirement, survivor, spouse, disability, Medicare, or Supplemental Security Income benefits) | |||||||||
| I am a professional helping someone else with a Social Security matter. | |||||||||
| I am an employer looking for Social Security information and/or services. | |||||||||
| Other (please specify) | A | ||||||||
| LNH5416Q003 | A | What other role best describes you? | N | Text field, <100 char | OPS Group* | OPS_Role | |||
| LNH5416Q004 | What was the primary reason for your visit today? | To learn about Social Security benefits | Y | Radio button, one-up vertical | OPS Group* | Primary Reason | |||
| To help someone else with a Social Security matter | |||||||||
| To plan for my future benefits (e.g., view my Social Security Statement, estimate my benefits, determine when to file, learn what information will be needed, etc.) | |||||||||
| To apply for Social Security benefits (including retirement, survivor, spouse, disability, Medicare, and Supplemental Security Income [SSI] benefits) | |||||||||
| To manage the benefits I currently receive from Social Security | |||||||||
| To check the status of my recently filed Social Security application | |||||||||
| To find out how to apply for or replace a Social Security number or card | |||||||||
| To change my address | |||||||||
| To sign up for bank direct deposit or change my bank direct deposit information | |||||||||
| To obtain SSA contact information (i.e., 1-800 number, address for local SSA office, etc.) | |||||||||
| To request a form or publication | |||||||||
| Other (please specify) | A | ||||||||
| LNH5416Q005 | A | What was the other primary reason for your visit today? | N | Text field, <100 char | OPS Group* | OPS_Primary Reason | |||
| LNH5416Q006 | Did you find what you were looking for or successfully complete your online transaction today? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | Accomplish Task | |||
| Not yet, still looking | A | ||||||||
| Not looking for anything specific | |||||||||
| LNH5416Q007 | A | Please select the online transaction you were attempting to complete on your mobile device or tablet (Select all that apply): | Create a my Social Security account | Y | Checkbox, one-up vertical | Skip Logic Group* | Why Not Accomplsih | ||
| Access a previously established my Social Security account | |||||||||
| Appeal a Social Security descision | |||||||||
| Apply for benefits | |||||||||
| Manage the benefits I currently receive (e.g. change my address or direct deposit information) | |||||||||
| Request a benefit verfication letter | |||||||||
| Check my benefit and payment information | |||||||||
| View or download my Social Security statement | |||||||||
| Check the status of my pending application for Social Security benefits | |||||||||
| Seeking Social Security contact informaiton (e.g., 1-800 number, address of my local Social Security office, special help desk, how to email Social Security, chat with a Social Security agent, etc.) | |||||||||
| Use the Retirement Estimator | |||||||||
| Replace a lost Social Security card | |||||||||
| Change a name on a Social Security card (e.g., due to marriage or divorce) | |||||||||
| Make an appointment with a local Social Security office | |||||||||
| Use one of the services provided in Business Services Online | |||||||||
| Other (please specify) | B | ||||||||
| LNH5416Q008 | B | Please describe the online transaction you were attempting to complete on your mobile device or tablet: | N | Text area, no char limit | Skip Logic Group* | OPS_Why Not Accomplish | |||
| LNH5416Q009 | Have you registered for a my Social Security account? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | Have mySSA Account | |||
| No | A | ||||||||
| LNH5416Q010 | 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. | Y | Radio button, one-up vertical | Skip Logic Group* | 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 | ||||||||
| LNH5416Q011 | AA | Please tell us why you have not registered for a my Social Security account. | N | Text area, no char limit | Skip Logic Group* | OPS_Why Not Have mySSA Account | |||
| LNH5416Q012 | Do you have any suggestions regarding online services or applications you would like to see SSA make available on a mobile device or tablet? | N | Text area, no char limit | Services Want to Access | |||||
| LNH5416Q013 | What is your age? | Under 25 | Y | Radio button, one-up vertical | Age | ||||
| 25-39 | |||||||||
| 40-59 | |||||||||
| 60-63 | |||||||||
| 64-65 | |||||||||
| 66-67 | |||||||||
| 68 or older | |||||||||
| Prefer not to answer | |||||||||
| LNH5416Q014 | Do you have any suggestions for improving the services SSA offers via a mobile device? | N | Text area, no char limit | OE_Improvement | |||||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |
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