Form 1114 2014 869 PSC Email

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Overview

Guidelines
Welcome and Thank You Text
Current Model Qsts
Model Qsts (8-16-12)
Current CQs
CQs (7-2-14)
CQs (6-17-14)
CQs (6-12-14)
CQs (5-6-14)
CQs (4-30-14)
CQs (4-25-14)
CQs (4-16-14)
CQs (8-21-13)
CQs (8-28-12)
CQs (8-16-12)
PRE DL v2 CQs

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Sheet 1: Guidelines

Questionnaire Management Guidelines

Goals:

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One consolidated document to track all model and CQ changes throughout the life of the project

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Questionnaire always matches the live survey

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Easy and error-free way to submit CQ changes

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All changes tracked and reflected in one document (DOT will help)

Questionnaire Resources:

1

Questionnaire Design and Approval Process

2

Question Grouping Rules

3

OPS vs. Skip Logic Decision for "Other, Please Specify"

4

Foreign Language Survey Instructions

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Sheet 2: Welcome and Thank You Text

Model Instance Name:
DHHS-PSC Offline Support Services v2
MID:	4AFVdB88Aw1dk0QocxcEtw==
Date:	8/6/2012
Welcome and Thank You Text
	Directions:
	This welcome text is shown at the top of the questionnaire window and the thank you text at the bottom. This is a good place to mention the site/company/agency name so the visitor knows whom they are taking the survey for. Feel free to modify the standard Welcome and Thank you text shown in the boxes below. Please read comments before using any of the text.
					Examples
					Welcome Text Example
	Welcome Text
	Based upon your most recent experience with PSC we ask that you please complete this brief survey to let us know what we're doing well and where we can improve.
					Thank You Text Example
	DEFAULT Thank You Text
	“Thank you for taking our survey - and for helping us serve you better. We appreciate your input!”

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Sheet 3: Current Model Qsts

Model Instance Name:
DHHS-PSC Offline Support Services v2
MID:		4AFVdB88Aw1dk0QocxcEtw==
Partitioned (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:		8/6/2012
DHHS-PSC Offline Support Services v2
Model questions utilize the ACSI methodology to determine scores and impacts
		ELEMENTS (drivers of satisfaction)			CUSTOMER SATISFACTION		FUTURE BEHAVIORS
	MQ Label			MQ Label		MQ Label
		Representative (1=Poor, 10=Excellent, Don't Know)			Satisfaction		Use Again (1=Very Unlikely, 10=Very Likely)
	Representative - Professionalism	Thinking about the representative who worked with you, please rate the following: Please rate the professionalism of the representative.		Satisfaction - Overall	What is your overall satisfaction with this service experience? (1=Very Dissatisfied, 10=Very Satisfied)	Use Again	How likely are you to use these services in the future?
	Representative - Knowledge	Please rate the knowledge of the representative.		Satisfaction - Expectations	How well did this service experience meet your expectations? (1=Falls Short, 10=Exceeds)		Recommend (1=Very Unlikely, 10=Very Likely)
	Representative - Courtesy	Please rate the courtesy of the representative.		Satisfaction - Ideal	How does this experience compare to your idea of an ideal service experience? (1=Not Very Close, 10=Very Close)	Recommend	How likely are you to recommend this service provider to someone else?
		Response Speed (1=Poor, 10=Excellent, Don't Know)
	Reponses -Time	Thinking about the responsiveness of service delivery, please rate the following: Length of time it took to get the service delivered.
	Response - Speed	The speed with which the service was completed.
	Response - Timeliness	The overall timeliness of the service delivery process.
		Service Quality (1=Poor, 10=Excellent, Don't Know)
	Service - Completeness	Thinking about the services received, please rate the following aspects of those services: The completeness of the services you received.
	Service - reliability	The reliability of the service delivery you received.
	Service - Quality	The quality of the services you received.

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Sheet 4: Model Qsts (8-16-12)

Model Instance Name:
DHHS-PSC Offline Support Services v2
MID:		4AFVdB88Aw1dk0QocxcEtw==
Partitioned (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:		8/6/2012
DHHS-PSC Offline Support Services v2
Model questions utilize the ACSI methodology to determine scores and impacts
		ELEMENTS (drivers of satisfaction)			CUSTOMER SATISFACTION		FUTURE BEHAVIORS
	MQ Label			MQ Label		MQ Label
		Representative (1=Poor, 10=Excellent, Don't Know)			Satisfaction		Use Again (1=Very Unlikely, 10=Very Likely)
	Representative - Professionalism	Thinking about the representative you who worked with you, please rate the following: Please rate the professionalism of the representative.		Satisfaction - Overall	What is your overall satisfaction with this service experience? (1=Very Dissatisfied, 10=Very Satisfied)	Use Again	How likely are you to use these services in the future?
	Representative - Knowledge	Please rate the knowledge of the representative.		Satisfaction - Expectations	How well did this service experience meet your expectations? (1=Falls Short, 10=Exceeds)		Recommend (1=Very Unlikely, 10=Very Likely)
	Representative - Courtesy	Please rate the courtesy of the representative.		Satisfaction - Ideal	How does this experience compare to your idea of an ideal service experience? (1=Not Very Close, 10=Very Close)	Recommend	How likely are you to recommend this service provider to someone else?
		Response Speed (1=Poor, 10=Excellent, Don't Know)
	Reponses -Time	Thinking about the responsiveness of service delivery, please rate the following: Length of time it took to get the service delivered.
	Response - Speed	The speed with which the service was completed.
	Response - Timeliness	The overall timeliness of the service delivery process.
		Service Quality (1=Poor, 10=Excellent, Don't Know)
	Service - Completeness	Thinking about the services received, please rate the following aspects of those services: The completeness of the services you received.
	Service - reliability	The reliability of the service delivery you received.
	Service - Quality	The quality of the services you received.

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Sheet 5: Current CQs

Model Instance Name:			red & strike-through: DELETE
DHHS-PSC Offline Support Services v2			underlined & italicized: RE-ORDER
MID: 4AFVdB88Aw1dk0QocxcEtw==			pink: ADDITION
Date:	3/1/2008		blue + -->: REWORDING
DHHS-PSC Offline Support Services v2 CUSTOM QUESTION LIST
QID	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
CAS0056633		Please select the service for which you would like to provide feedback today. Select from the below list to reveal the individual services.	Administrative	A	Radio button, one-up vertical	Single	Y	Skip Logic Group*	Service Type
			Finance	B
			Occupational Health	C
			Acquisition	D
			Real Estate and Logistics	E
			Other, please specify	Z
CAS0056641	A	Select the administrative service you are providing feedback on:	Customer Contact Center		Radio button, one-up vertical	single	Y		Administration Service
			Departmental Forms Management
			Digital Conversion and Archiving of Documents
			Driver Services
			Freedom of Information Act (FOIA)
			Graphic Arts
			Mail Operations
			Mail Screening
			Payroll Liaison
			Printing
			Section 508 Compliance Testing and Remediation
			Transit Subsidy Program Management
			Travel Charge Card Services
			Travel Management Company Services
			Travel Program Management
			Vehicle Leasing Services
			Vehicle Rental Services
CAS0056643	B	Select the financial service you are providing feedback on:	Accounting		Radio button, one-up vertical	single	Y		Financial Service
			Debt Collection
			Financial Reporting
			Grant Payments
			Indirect Cost Negotiations
CAS0056647	C	Select the occupational service you are providing feedback on:	Automated External Defibrillator		Radio button, one-up vertical	single	Y		Occupational Service
			Employee Assistance Program
			Environmental Health
			Health Clinics
			Organizational Development and Leadership
			Wellness and Fitness
			Work/Life Programs
			Workers Compensation Management
CAS0056636	D	Select the acquisition service you are providing feedback on:	Negotiated Contracts and Simplified Acquisitions		Radio button, one-up vertical	single	Y		Acquisition Service
			Purchase Card Management
CAS0056646	E	Select the logistics service you are providing feedback on:	Child Care Subsidy Program		Radio button, one-up vertical	single	Y		Logistics Service
			Employee Child Care Centers
			Facilities Operations and Management
			Federal Real Property Assistance Program
			Labor and Moving
			Medical Supply
			Parking Services
			Personal Property Services
			Product Distribution
			Property Disposal
			Real Property Management
			Real Property Strategy
			Regional Services
			Shredding
			Storage
CAS0056604	Z	What product or service would you like to provide feedback on:			Text area, no char limit		N		OPS_Product/Service Type
CJI3627		Please specify the customer service representative who assisted you.			Text area, no char limit		Y		Service Provided by
CJI3628		How often do you transact with this organization or division?	This is my first experience with this organization.		Radio button, one-up vertical	Single	Y		Frequency
			A few times per year
			A few times per month
			A few times per week
			Everyday
			Multiple times per day
			Not sure/NA
CAS0056148		Thinking about the entire service you have received, what changes can we make to improve your customer experience?			Text area, no char limit		Y		OE_Improvement

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Sheet 6: CQs (7-2-14)

Model Instance Name:			red & strike-through: DELETE
DHHS-PSC Offline Support Services v2			underlined & italicized: RE-ORDER
MID: 4AFVdB88Aw1dk0QocxcEtw==			pink: ADDITION
Date:	3/1/2008		blue + -->: REWORDING
DHHS-PSC Offline Support Services v2 CUSTOM QUESTION LIST
QID	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
CAS0056633		Please select the service for which you would like to provide feedback today. Select from the below list to reveal the individual services.	Administrative	A	Radio button, one-up vertical	Single	Y	Skip Logic Group*	Service Type
			Finance	B
			Occupational Health	C
			Acquisition	D
			--> Real Estate and Logistics	E
			Other, please specify	Z
CAS0056641	A	Select the administrative service you are providing feedback on:	Customer Contact Center		Radio button, one-up vertical	single	Y		Administration Service
			Departmental Forms Management
			Digital Conversion and Archiving of Documents
			Driver Services
			Freedom of Information Act (FOIA)
			Graphic Arts
			Mail Operations
			Mail Screening
			Payroll Liaison
			Printing
			Section 508 Compliance Testing and Remediation
			Transit Subsidy Program Management
			Travel Charge Card Services
			Travel Management Company Services
			Travel Program Management
			Vehicle Leasing Services
			Vehicle Rental Services
CAS0056643	B	Select the financial service you are providing feedback on:	Accounting		Radio button, one-up vertical	single	Y		Financial Service
			Debt Collection
			Financial Reporting
			Grant Payments
			Indirect Cost Negotiations
CAS0056647	C	Select the occupational service you are providing feedback on:	Automated External Defibrillator		Radio button, one-up vertical	single	Y		Occupational Service
			Employee Assistance Program
			Environmental Health
			Health Clinics
			Organizational Development and Leadership
			Wellness and Fitness
			Work/Life Programs
			Workers Compensation Management
CAS0056636	D	Select the acquisition service you are providing feedback on:	Negotiated Contracts and Simplified Acquisitions		Radio button, one-up vertical	single	Y		Acquisition Service
			Purchase Card Management
CAS0056646	E	Select the logistics service you are providing feedback on:	Child Care Subsidy Program		Radio button, one-up vertical	single	Y		Logistics Service
			Employee Child Care Centers
			Facilities Operations and Management
			Federal Real Property Assistance Program
			Labor and Moving
			Medical Supply
			Parking Services
			Personal Property Services
			Product Distribution
			Property Disposal
			Real Property Management
			Real Property Strategy
			Regional Services
			Shredding
			Storage
CAS0056604	Z	What product or service would you like to provide feedback on:			Text area, no char limit		N		OPS_Product/Service Type
CJI3627		Please specify the customer service representative who assisted you.			Text area, no char limit		Y		Service Provided by
CJI3628		How often do you transact with this organization or division?	This is my first experience with this organization.		Radio button, one-up vertical	Single	Y		Frequency
			A few times per year
			A few times per month
			A few times per week
			Everyday
			Multiple times per day
			Not sure/NA
CAS0056148		Thinking about the entire service you have received, what changes can we make to improve your customer experience?			Text area, no char limit		Y		OE_Improvement

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Sheet 7: CQs (6-17-14)

Model Instance Name:			red & strike-through: DELETE
DHHS-PSC Offline Support Services v2			underlined & italicized: RE-ORDER
MID: 4AFVdB88Aw1dk0QocxcEtw==			pink: ADDITION
Date:	3/1/2008		blue + -->: REWORDING
DHHS-PSC Offline Support Services v2 CUSTOM QUESTION LIST
QID	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
CAS0056633		Please select the service for which you would like to provide feedback today. Select from the below list to reveal the individual services.	Administrative	A	Radio button, one-up vertical	Single	Y	Skip Logic Group*	Service Type
			Finance	B
			Occupational Health	C
			Acquisition	D
			Logistics	E
			Other, please specify	Z
CAS0056641	A	Select the administrative service you are providing feedback on:	Customer Contact Center		Radio button, one-up vertical	single	Y		Administration Service
			Departmental Forms Management
			Digital Conversion and Archiving of Documents
			Driver Services
			Freedom of Information Act (FOIA)
			Graphic Arts
			Mail Operations
			Mail Screening
			Payroll Liaison
			Printing
			Section 508 Compliance Testing and Remediation
			Transit Subsidy Program Management
			Travel Charge Card Services
			Travel Management Company Services
			Travel Program Management
			Vehicle Leasing Services
			Vehicle Rental Services
CAS0056643	B	Select the financial service you are providing feedback on:	Accounting		Radio button, one-up vertical	single	Y		Financial Service
			Debt Collection
			Financial Reporting
			Grant Payments
			Indirect Cost Negotiations
CAS0056647	C	Select the occupational service you are providing feedback on:	Automated External Defibrillator		Radio button, one-up vertical	single	Y		Occupational Service
			Employee Assistance Program
			Environmental Health
			Health Clinics
			Organizational Development and Leadership
			Wellness and Fitness
			Work/Life Programs
			Workers Compensation Management
CAS0056636	D	Select the acquisition service you are providing feedback on:	Negotiated Contracts and Simplified Acquisitions		Radio button, one-up vertical	single	Y		Acquisition Service
			Purchase Card Management
CAS0056646	E	Select the logistics service you are providing feedback on:	Child Care Subsidy Program		Radio button, one-up vertical	single	Y		Logistics Service
			Employee Child Care Centers
			Facilities Operations and Management
			Federal Real Property Assistance Program
			Labor and Moving
			Medical Supply
			Parking Services
			Personal Property Services
			Product Distribution
			Property Disposal
			Real Property Management
			Real Property Strategy
			Regional Services
			Shredding
			Storage
CAS0056604	Z	What product or service would you like to provide feedback on:			Text area, no char limit		N		OPS_Product/Service Type
CJI3627		Please specify the customer service representative who assisted you.			Text area, no char limit		Y		Service Provided by
CJI3628		How often do you transact with this organization or division?	This is my first experience with this organization.		Radio button, one-up vertical	Single	Y		Frequency
			A few times per year
			A few times per month
			A few times per week
			Everyday
			Multiple times per day
			Not sure/NA
CAS0056148		Thinking about the entire service you have received, what changes can we make to improve your customer experience?			Text area, no char limit		Y		OE_Improvement
CJI3632		If we may contact you regarding your experience with this product or service, please provide your name, email address, and agency affiliation.			Text area, no char limit		N		OE_Contact Yes

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Sheet 8: CQs (6-12-14)

Model Instance Name:			red & strike-through: DELETE
DHHS-PSC Offline Support Services v2			underlined & italicized: RE-ORDER
MID: 4AFVdB88Aw1dk0QocxcEtw==			pink: ADDITION
Date:	3/1/2008		blue + -->: REWORDING
DHHS-PSC Offline Support Services v2 CUSTOM QUESTION LIST
QID	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
CAS0056633		Please select the service for which you would like to provide feedback today. Select from the below list to reveal the individual services.	Administrative	A	Radio button, one-up vertical	Single	Y	Skip Logic Group*	Service Type
			Finance	B
			Occupational Health	C
			Acquisition	D
			Logistics	E
			Other, please specify	Z
CAS0056641	A	Select the administrative service you are providing feedback on:	Customer Contact Center		Radio button, one-up vertical	single	Y		Administration Service
			Departmental Forms Management
			Digital Conversion and Archiving of Documents
			Driver Services
			Freedom of Information Act (FOIA)
			Graphic Arts
			Mail Operations
			Mail Screening
			Payroll Liaison
			Printing
			Section 508 Compliance Testing and Remediation
			Transit Subsidy Program Management
			Travel Charge Card Services
			Travel Management Company Services
			Travel Program Management
			Vehicle Leasing Services
			Vehicle Rental Services
CAS0056643	B	Select the financial service you are providing feedback on:	Accounting		Radio button, one-up vertical	single	Y		Financial Service
			Debt Collection
			Financial Reporting
			Grant Payments
			Indirect Cost Negotiations
CAS0056647	C	Select the occupational service you are providing feedback on:	Automated External Defibrillator		Radio button, one-up vertical	single	Y		Occupational Service
			Employee Assistance Program
			Environmental Health
			Health Clinics
			Organizational Development and Leadership
			Wellness and Fitness
			Work/Life Programs
			Workers Compensation Management
CAS0056636	D	Select the acquisition service you are providing feedback on:	Negotiated Contracts and Simplified Acquisitions		Radio button, one-up vertical	single	Y		Acquisition Service
			Purchase Card Management
CAS0056646	E	Select the logistics service you are providing feedback on:	Child Care Subsidy Program		Radio button, one-up vertical	single	Y		Logistics Service
			Employee Child Care Centers
			Facilities Operations and Management
			Federal Real Property Assistance Program
			Labor and Moving
			Medical Supply
			Parking Services
			Personal Property Services
			Product Distribution
			Property Disposal
			Real Property Management
			Real Property Strategy
			Regional Services
			Shredding
			Storage
CAS0056604	Z	What product or service would you like to provide feedback on:			Text area, no char limit		N		OPS_Product/Service Type
CJI3627		Please specify the customer service representative who assisted you.			Text area, no char limit		Y		Service Provided by
CJI3628		How often do you transact with this organization or division?	This is my first experience with this organization.		Radio button, one-up vertical	Single	Y		Frequency
			A few times per year
			A few times per month
			A few times per week
			Everyday
			Multiple times per day
			Not sure/NA
CAS0056148		Thinking about the entire service you have received, what changes can we make to improve your customer experience?			Text area, no char limit		Y		OE_Improvement
ACQinh0014765		Are you a Health & Human Services Employee?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group*	HHS Employee
			No	A
CJI3630	A	What Agency do you work for? (If not part of a Federal Agency please select Other)	Agency for International Development		Radio button, one-up vertical	Single	Y	Skip Logic Group*	Fed_Agency
			Department of Agriculture
			Department of Commerce
			Department of Defense
			Department of Education
			Department of Homeland Security
			Department of Housing and Urban Development
			Department of the Interior
			Department of Justice
			Department of Labor
			Department of State
			Department of the Interior
			Department of the Treasury
			Department of Transportation
			Department of Veterans Affairs
			Executive Office of the President
			Federal Legislative Branch
			General Accounting Office
			General Services Administration
			Independent Agencies
			Judicial Branch
			National Aeronautics and Space Administration
			Office of Personnel Management
			Peace Corps
			Postal Service
			Private Vendor
			Quasi Official INTNL & Non Govt
			Railroad Retirement Board
			Securities and Exchange Commission
			Other (please specify)	A
CJI3631	A	Other agency:			Text area, no char limit		N		OE_Other Agency
CJI3632		If we may contact you regarding your experience with this product or service, please provide your name, email address, and agency affiliation.			Text area, no char limit		N		OE_Contact Yes

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Sheet 9: CQs (5-6-14)

Model Instance Name:			red & strike-through: DELETE
DHHS-PSC Offline Support Services v2			underlined & italicized: RE-ORDER
MID: 4AFVdB88Aw1dk0QocxcEtw==			pink: ADDITION
Date:	3/1/2008		blue + -->: REWORDING
DHHS-PSC Offline Support Services v2 CUSTOM QUESTION LIST
QID	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
CAS0056633		Please select the service for which you would like to provide feedback today. Select from the below list to reveal the individual services.	Administrative	A	Radio button, one-up vertical	Single	Y	Skip Logic Group*	Service Type
			Finance	B
			Occupational Health	C
			Acquisition	D
			Logistics	E
			Other, please specify	Z
CAS0056641	A	Select the administrative service you are providing feedback on:	Customer Contact Center		Radio button, one-up vertical	single	Y		Administration Service
			Departmental Forms Management
			Digital Conversion and Archiving of Documents
			Driver Services
			Freedom of Information Act (FOIA)
			Graphic Arts
			Mail Operations
			Mail Screening
			Payroll Liaison
			Printing
			Section 508 Compliance Testing and Remediation
			Transit Subsidy Program Management
			Travel Charge Card Services
			Travel Management Company Services
			Travel Program Management
			Vehicle Leasing Services
			Vehicle Rental Services
CAS0056643	B	Select the financial service you are providing feedback on:	Accounting		Radio button, one-up vertical	single	Y		Financial Service
			Debt Collection
			Financial Reporting
			Grant Payments
			Indirect Cost Negotiations
CAS0056647	C	Select the occupational service you are providing feedback on:	Automated External Defibrillator		Radio button, one-up vertical	single	Y		Occupational Service
			Employee Assistance Program
			Environmental Health
			Health Clinics
			Organizational Development and Leadership
			Wellness and Fitness
			Work/Life Programs
			Workers Compensation Management
CAS0056636	D	Select the acquisition service you are providing feedback on:	Negotiated Contracts and Simplified Acquisitions		Radio button, one-up vertical	single	Y		Acquisition Service
			Purchase Card Management
CAS0056646	E	Select the logistics service you are providing feedback on:	Child Care Subsidy Program		Radio button, one-up vertical	single	Y		Logistics Service
			Employee Child Care Centers
			Facilities Operations and Management
			Federal Real Property Assistance Program
			Labor and Moving
			Medical Supply
			Parking Services
			Personal Property Services
			Product Distribution
			Property Disposal
			Real Property Management
			Real Property Strategy
			Regional Services
			Shredding
			Storage
CAS0056604	Z	What product or service would you like to provide feedback on:			Text area, no char limit		N		OPS_Product/Service Type
CJI3627		Please specify the customer service representative who assisted you.			Text area, no char limit		Y		Service Provided by
CJI3628		How often do you transact with this organization or division?	This is my first experience with this organization.		Radio button, one-up vertical	Single	Y		Frequency
			Once a year or less
			A few times per year
			A few times per month
			A few times per week
			Everyday
			Multiple times per day
			Monthly
			Weekly
			Daily or more often
			Not sure/NA
CAS0056148		Thinking about the entire service you have received, what changes can we make to improve your customer experience?			Text area, no char limit		Y		OE_Improvement
ACQinh0014765		Are you a Health & Human Services Employee?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group*	HHS Employee
			No	A
CJI3630	A	What Agency do you work for? (If not part of a Federal Agency please select Other)	Agency for International Development		Radio button, one-up vertical	Single	Y	Skip Logic Group*	Fed_Agency
			Department of Agriculture
			Department of Commerce
			Department of Defense
			Department of Education
			Department of Homeland Security
			Department of Housing and Urban Development
			Department of the Interior
			Department of Justice
			Department of Labor
			Department of State
			Department of the Interior
			Department of the Treasury
			Department of Transportation
			Department of Veterans Affairs
			Executive Office of the President
			Federal Legislative Branch
			General Accounting Office
			General Services Administration
			Independent Agencies
			Judicial Branch
			National Aeronautics and Space Administration
			Office of Personnel Management
			Peace Corps
			Postal Service
			Private Vendor
			Quasi Official INTNL & Non Govt
			Railroad Retirement Board
			Securities and Exchange Commission
			Other (please specify)	A
CJI3631	A	Other agency:			Text area, no char limit		N		OE_Other Agency
CJI3632		If we may contact you regarding your experience with this product or service, please provide your name, email address, and agency affiliation.			Text area, no char limit		N		OE_Contact Yes

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Sheet 10: CQs (4-30-14)

Model Instance Name:			red & strike-through: DELETE
DHHS-PSC Offline Support Services v2			underlined & italicized: RE-ORDER
MID: 4AFVdB88Aw1dk0QocxcEtw==			pink: ADDITION
Date:	3/1/2008		blue + -->: REWORDING
DHHS-PSC Offline Support Services v2 CUSTOM QUESTION LIST
QID	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
CAS0056633		Please select the service for which you would like to provide feedback today. Select from the below list to reveal the individual services.	Administrative	A	Radio button, one-up vertical	Single	Y	Skip Logic Group*	Service Type
			Finance	B
			Occupational Health	C
			Acquisition	D
			Logistics	E
			Other, please specify	Z
CAS0056641	A	Select the administrative service you are providing feedback on:	Customer Contact Center		Radio button, one-up vertical	single	Y		Administration Service
			Departmental Forms Management
			Digital Conversion and Archiving of Documents
			Driver Services
			Freedom of Information Act (FOIA)
			Graphic Arts
			Mail Operations
			Mail Screening
			Payroll Liaison
			Printing
			Section 508 Compliance Testing and Remediation
			Transit Subsidy Program Management
			Travel Charge Card Services
			Travel Management Company Services
			Travel Program Management
			Vehicle Leasing Services
			Vehicle Rental Services
CAS0056643	B	Select the financial service you are providing feedback on:	Accounting		Radio button, one-up vertical	single	Y		Financial Service
			Debt Collection
			Financial Reporting
			Grant Payments
			Indirect Cost Negotiations
CAS0056647	C	Select the occupational service you are providing feedback on:	Automated External Defibrillator		Radio button, one-up vertical	single	Y		Occupational Service
			Employee Assistance Program
			Environmental Health
			Health Clinics
			Organizational Development and Leadership
			Wellness and Fitness
			Work/Life Programs
			Workers Compensation Management
CAS0056636	D	Select the acquisition service you are providing feedback on:	Negotiated Contracts and Simplified Acquisitions		Radio button, one-up vertical	single	Y		Acquisition Service
			Purchase Card Management
CAS0056646	E	Select the logistics service you are providing feedback on:	Child Care Subsidy Program		Radio button, one-up vertical	single	Y		Logistics Service
			Employee Child Care Centers
			Facilities Operations and Management
			Federal Real Property Assistance Program
			Labor and Moving
			Medical Supply
			Parking Services
			Personal Property Services
			Product Distribution
			Property Disposal
			Real Property Management
			Real Property Strategy
			Regional Services
			Shredding
			Storage
CAS0056604	Z	What product or service would you like to provide feedback on:			Text area, no char limit		N		OPS_Product/Service Type
CJI3627		Please specify the customer service representative who assisted you.			Text area, no char limit		Y		Service Provided by
CJI3628		How often do you transact with this organization or division?	This is my first experience with this organization.		Radio button, one-up vertical	Single	Y		Frequency
			Once a year or less
			A few times per year
			Monthly
			Weekly
			About once a month
			A few times per month
			About once a week
			A few times per week
			Daily or more often
			Not sure/NA
CAS0056148		Thinking about the entire service you have received, what changes can we make to improve your customer experience?			Text area, no char limit		Y		OE_Improvement
ACQinh0014765		Are you a Health & Human Services Employee?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group*	HHS Employee
			No	A
CJI3630	A	What Agency do you work for? (If not part of a Federal Agency please select Other)	Agency for International Development		Radio button, one-up vertical	Single	Y	Skip Logic Group*	Fed_Agency
			Department of Agriculture
			Department of Commerce
			Department of Defense
			Department of Education
			Department of Homeland Security
			Department of Housing and Urban Development
			Department of the Interior
			Department of Justice
			Department of Labor
			Department of State
			Department of the Interior
			Department of the Treasury
			Department of Transportation
			Department of Veterans Affairs
			Executive Office of the President
			Federal Legislative Branch
			General Accounting Office
			General Services Administration
			Independent Agencies
			Judicial Branch
			National Aeronautics and Space Administration
			Office of Personnel Management
			Peace Corps
			Postal Service
			Private Vendor
			Quasi Official INTNL & Non Govt
			Railroad Retirement Board
			Securities and Exchange Commission
			Other (please specify)	A
CJI3631	A	Other agency:			Text area, no char limit		N		OE_Other Agency
CJI3632		If we may contact you regarding your experience with this product or service, please provide your name, email address, and agency affiliation.			Text area, no char limit		N		OE_Contact Yes

---

Sheet 11: CQs (4-25-14)

Model Instance Name:			red & strike-through: DELETE
DHHS-PSC Offline Support Services v2			underlined & italicized: RE-ORDER
MID: 4AFVdB88Aw1dk0QocxcEtw==			pink: ADDITION
Date:	3/1/2008		blue + -->: REWORDING
DHHS-PSC Offline Support Services v2 CUSTOM QUESTION LIST
QID	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
		Please select the service for which you would like to provide feedback today. Select from the below list to reveal the individual services.	Acquisition	A	Radio button, one-up vertical	Single	Y	Skip Logic Group*	Service Type
			Administrative	B
			Finance	C
			Logistics	D
			Occupational Health	E
			Other, please specify	Z
	A	Select the acquisition service you are providing feedback on:	Negotiated Contracts and Simplified Acquisitions		Radio button, one-up vertical	single	Y		Acquisition Service
			Purchase Card Management
	B	Select the administrative service you are providing feedback on:	Driver Services		Radio button, one-up vertical	single	Y		Administration Service
			Transit Subsidy Program Management
			Travel Charge Card Services
			Travel Management Company Services
			Travel Program Management
			Vehicle Leasing Services
			Vehicle Rental Services
			Departmental Forms Management
			Digital Conversion and Archiving of Documents
			Graphic Arts
			Printing
			Section 508 Compliance Testing and Remediation
			Mail Operations
			Mail Screening
			Customer Contact Center
			Payroll Liaison
			Freedom of Information Act (FOIA)
	C	Select the financial service you are providing feedback on:	Indirect Cost Negotiations		Radio button, one-up vertical	single	Y		Financial Service
			Financial Reporting
			Grant Payments
			Accounting
			Debt Collection
	D	Select the occupational service you are providing feedback on:	Employee Assistance Program		Radio button, one-up vertical	single	Y		Occupational Service
			Organizational Development and Leadership
			Work/Life Programs
			Automated External Defibrillator
			Health Clinics
			Workers Compensation Management
			Environmental Health
			Wellness and Fitness
	E	Select the logistics service you are providing feedback on:	Facilities Operations and Management		Radio button, one-up vertical	single	Y		Logistics Service
			Parking Services
			Real Property Strategy
			Regional Services
			Shredding
			Labor and Moving
			Medical Supply
			Product Distribution
			Property Disposal
			Storage
			Personal Property Services
			Child Care Subsidy Program
			Employee Child Care Centers
			Federal Real Property Assistance Program
			Real Property Management
	Z	What product or service would you like to provide feedback on:			Text area, no char limit		N		OPS_Product/Service Type
CAS0056041		Please select the product or service for which you would like to provide feedback today.	Accounting Services	A	Radio button, one-up vertical	Single	Y	Skip Logic Group*	Product/Service Type
			Acquisition Management Services	B
			Behavioral Health Services	C
			Clinical Health Services	D
			Cost Allocation Services
			Customer Care Services	E
			Enterprise Support Services	F
			Environmental, Health and Safety Services	G
			Facilities Management Services	H
			Financial Reporting Services
			Freedom of Information Act Services
			Grant Payment Services
			Mail Services	I
			Publishing Services	J
			Real Property Management Services	K
			Transportation Services	L
			Warehouse and Logistics Services	M
			Wellness and Health Promotion Services
			Other, please specfiy	Z
CAS0056104	Z	What product or service would you like to provide feedback on:			Text area, no char limit		N		OPS_Product/Service Type
CAS0056105	A	Select the accounting service you are providing feedback on:	Debt Collection		Radio button, one-up vertical	Single	Y		Accounting service
			Accounting
CAS0056106	B	Select the acquisition management service you are providing feedback on:	Negotiated Contracts and Simplified Acquisitions		Radio button, one-up vertical	single	Y		Acquistion Mgt Systems
			Purchase Card Management
CAS0056107	C	Select the behavioral health service you are providing feedback on:	Employee Assistance Program		Radio button, one-up vertical	single	Y		Behavorial Health Services
			Organizational Development and Leadership
			Work/Life Programs
CAS0056124	D	Select the clinical health service you are providing feedback on:	Automated External Defibrillator		Radio button, one-up vertical	single	Y		Clinical Health Services
			Health Clinics
			Workers Compensation Management
CAS0056125	E	Select the customer care service you are providing feedback on:	Payroll Liaison		Radio button, one-up vertical	single	Y		Customer Care Services
			Customer Contact Center
CAS0056126	F	Select the enterprise support service you are providing feedback on:	Child Care Subsidy Program		Radio button, one-up vertical	single	Y		Enterprise Support Services
			Employee Child Care Centers
			Personal Property
			OSHA/Safety
			Sustainability Program
			Fleet
			Personal Property Services
			Federal Real Property Assistance Program
CAS0056127	G	Select the environmental, health and safety service you are providing feedback on:	Environmental Programs		Radio button, one-up vertical	single	Y		Environmental Health
			Environmental Health
CAS0056142	H	Select the facilities management service you are providing feedback on:	Real Property Strategy		Radio button, one-up vertical	single	Y		Facilities Management
			Facilities Operations and Management
			Shredding
			Parking Services
			Regional Services
CAS0056143	I	Select the mail Service you are providing feedback on:	Mail		Radio button, one-up vertical	single	Y		Mail Services
			Mail Operations
			Mail Screening
CAS0056144	J	Select the publishing service you are providing feedback on:	Printing		Radio button, one-up vertical	single	Y		Publishing Services
			Digital Conversion and Archiving of Documents
			Graphic Arts
			Section 508 Compliance Testing and Remediation
			Departmental Forms Management
			Printing
CAS0056145	K	Select the real property management service you are providing feedback on:	Real Property		Radio button, one-up vertical	single	Y		Real Property Mgt Services
			Real Property Management
CAS0056146	L	Select the transportation service you are providing feedback on:	Travel Charge Card Services		Radio button, one-up vertical	single	Y		Transportation Services
			Travel Management Company Services
			Travel Program Management
			Travel
			Transit Subsidy Program Management
			Driver Services
			Vehicle Leasing Services
			Vehicle Rental Services
CAS0056147	M	Select the warehouse and logistics service you are providing feedback on:	Labor and Moving		Radio button, one-up vertical	single	Y		Warehouse and Logistic Services
			Product Distribution
			Property Disposal
			Storage
			Medical Supply
CJI3627		Please specify the customer service representative who assisted you. provided you with this product or service.			Text area, no char limit		Y		Service Provided by
CJI3628		How often do you transact with this organization or division?	This is my first experience with this organization.		Radio button, one-up vertical	Single	Y		Frequency
			Once a year or less
			A few times per year
			About once a month
			A few times per month
			About once a week
			A few times per week
			Daily or more often
			Not sure/NA
CAS0056148		Thinking about the entire service you have received, what changes can we make to improve your customer experience?			Text area, no char limit		Y		OE_Improvement
ACQinh0014765		Are you a Health & Human Services Employee?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group*	HHS Employee
			No	A
CJI3630	A	What Agency do you work for? (If not part of a Federal Agency please select Other)	Agency for International Development		Radio button, one-up vertical	Single	Y	Skip Logic Group*	Fed_Agency
			Department of Agriculture
			Department of Commerce
			Department of Defense
			Department of Education
			Department of Homeland Security
			Department of Housing and Urban Development
			Department of the Interior
			Department of Justice
			Department of Labor
			Department of State
			Department of the Interior
			Department of the Treasury
			Department of Transportation
			Department of Veterans Affairs
			Executive Office of the President
			Federal Legislative Branch
			General Accounting Office
			General Services Administration
			Independent Agencies
			Judicial Branch
			National Aeronautics and Space Administration
			Office of Personnel Management
			Peace Corps
			Postal Service
			Private Vendor
			Quasi Official INTNL & Non Govt
			Railroad Retirement Board
			Securities and Exchange Commission
			Other (please specify)	A
CJI3631	A	Other agency:			Text area, no char limit		N		OE_Other Agency
CJI3632		If we may contact you regarding your experience with this product or service, please provide your email address.			Text area, no char limit		N		OE_Contact Yes

---

Sheet 12: CQs (4-16-14)

Model Instance Name:			red & strike-through: DELETE
DHHS-PSC Offline Support Services v2			underlined & italicized: RE-ORDER
MID: 4AFVdB88Aw1dk0QocxcEtw==			pink: ADDITION
Date:	3/1/2008		blue + -->: REWORDING
DHHS-PSC Offline Support Services v2 CUSTOM QUESTION LIST
QID	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
		Please select the product or service for which you would like to provide feedback today.	Accounting Services	A	Radio button, one-up vertical	Single	Y	Skip Logic Group*	Product/Service Type
			Acquisition Management Services	B
			Behavioral Health Services	C
			Clinical Health Services	D
			Cost Allocation Services
			Customer Care Services	E
			Enterprise Support Services	F
			Environmental, Health and Safety Services	G
			Facilities Management Services	H
			Financial Reporting Services
			Freedom of Information Act Services
			Grant Payment Services
			Mail Services	I
			Publishing Services	J
			Real Property Management Services	K
			Transportation Services	L
			Warehouse and Logistics Services	M
			Wellness and Health Promotion Services
			Other, please specfiy	Z
	Z	What product or service would you like to provide feedback on:			Text area, no char limit		N		OPS_Product/Service Type
	A	Select the accounting service you are providing feedback on:	Debt Collection		Radio button, one-up vertical	Single	Y		Accounting service
			Accounting
	B	Select the acquisition management service you are providing feedback on:	Negotiated Contracts and Simplified Acquisitions		Radio button, one-up vertical	single	Y		Acquistion Mgt Systems
			Purchase Card Management
	C	Select the behavioral health service you are providing feedback on:	Employee Assistance Program		Radio button, one-up vertical	single	Y		Behavorial Health Services
			Organizational Development and Leadership
			Work/Life Programs
	D	Select the clinical health service you are providing feedback on:	Automated External Defibrillator		Radio button, one-up vertical	single	Y		Clinical Health Services
			Health Clinics
			Workers Compensation Management
	E	Select the customer care service you are providing feedback on:	Payroll Liaison		Radio button, one-up vertical	single	Y		Customer Care Services
			Customer Contact Center
	F	Select the enterprise support service you are providing feedback on:	Child Care Subsidy Program		Radio button, one-up vertical	single	Y		Enterprise Support Services
			Employee Child Care Centers
			Personal Property
			OSHA/Safety
			Sustainability Program
			Fleet
			Personal Property Services
			Federal Real Property Assistance Program
	G	Select the environmental, health and safety service you are providing feedback on:	Environmental Programs		Radio button, one-up vertical	single	Y		Environmental Health
			Environmental Health
	H	Select the facilities management service you are providing feedback on:	Real Property Strategy		Radio button, one-up vertical	single	Y		Facilities Management
			Facilities Operations and Management
			Shredding
			Parking Services
			Regional Services
	I	Select the mail Service you are providing feedback on:	Mail		Radio button, one-up vertical	single	Y		Mail Services
			Mail Operations
			Mail Screening
	J	Select the publishing service you are providing feedback on:	Printing		Radio button, one-up vertical	single	Y		Publishing Services
			Digital Conversion and Archiving of Documents
			Graphic Arts
			Section 508 Compliance Testing and Remediation
			Departmental Forms Management
			Printing
	K	Select the real property management service you are providing feedback on:	Real Property		Radio button, one-up vertical	single	Y		Real Property Mgt Services
			Real Property Management
	L	Select the transportation service you are providing feedback on:	Travel Charge Card Services		Radio button, one-up vertical	single	Y		Transportation Services
			Travel Management Company Services
			Travel Program Management
			Travel
			Transit Subsidy Program Management
			Driver Services
			Vehicle Leasing Services
			Vehicle Rental Services
	M	Select the warehouse and logistics service you are providing feedback on:	Labor and Moving		Radio button, one-up vertical	single	Y		Warehouse and Logistic Services
			Product Distribution
			Property Disposal
			Storage
			Medical Supply
CJI3615		Please select the product or service for which you would like to provide feedback today.	Acquisition Services	A	Radio button, one-up vertical	Single	Y	Skip Logic Group*	Product/Service Type
			Commissioned Corps Support Services	B
			Customer Contact Centers	C
			Financial Services	D
			Freedom of Information Act Services
			Logistics Services	F
			Occupational Health Services	G
			Property Management Services	H
			Regional Support Services
			Transportation, Travel, and Telework Services	J
			Visual Media Services	K
			Administrative Offices	L
			Other, please specify	Z
CJI3616	Z	What product or service would you like to provide feedback on:			Text area, no char limit		N		OE_Product/Service Type
CJI3617	A	Select the acquisition service you are providing feedback on:	Negotiated Contracts		Radio button, one-up vertical		Y		Acquisition Service Type
			Simplified Acquisitions
			Purchase Card Management
CJI3618	B	Select the Commissioned Corps Support Services you are providing feedback on:	Board for Corrections (CCSS)		Radio button, one-up vertical		Y		Commissioned Corp Support
CJI3619	C	Select the customer contact center you are providing feedback on:	ONE-DHHS Contact Center		Radio button, one-up vertical		Y		Customer Contact Center
			Payroll Services
CJI3620	D	Select the financial services products you are providing feedback on:	Accounting Services		Radio button, one-up vertical		Y		Financial Services
			Business Office
			Business Process Improvement
			Cost Allocation/Indirect Cost Negotiations
			Debt Collection Center Services
			Financial Reporting
			Payment Management (Grant) Services
			Payroll Accounting Services
CJI3621	F	Select the logistics services you are providing feedback on:	Labor and Moving		Radio button, one-up vertical		Y		Logistics Services
			Mail Operations
			Supply Service Center (Medical Supply)
			Product Distribution
			Storage
CJI3622	G	Select the occupational health services you are providing feedback on:	Automated External Defibrillator (AED)		Radio button, one-up vertical		Y		Occupational Health
			Clinical Services
			Employee Assistance Program (EAP)
			Environmental Health Services
			Wellness/Fitness
			Work/Life
CJI3623	H	Select the property management services you are providing feedback on:	Asset Management		Radio button, one-up vertical		Y		Property Mgt
			Building Management
			Employee Child Care Services
			Property Disposal
			Real Property Management
			Shredding Services
			Space Acquisition and Alterations
CJI3624	J	Select the transportation, travel and telework services you are providing feedback on:	Employee Relocation		Radio button, one-up vertical		Y		Trans, Travel & Telework Service
			Travel Services
			Telework Strategy Solutions
			Transhare
			Vehicle Rental
CJI3625	K	Select the visual media services you are providing feedback on:	Graphic Arts		Radio button, one-up vertical		Y		Visual Media
			Departmental Forms Management
			Printing Procurement
CJI3626	L	Select the administrative office you are providing feedback on:	AOS Office of the Director		Radio button, one-up vertical		Y		Administrative Offices
			FMS Office of the Director
			FLS Office of the Director
			SAS Office of the Director
			FOH Office of the Director
			PSC Office of the Director
CJI3627		Please specify who provided you with this product or service.			Text area, no char limit		Y		Service Provided by
CJI3628		How often do you transact with this organization or division?	This is my first experience with this organization.		Radio button, one-up vertical	Single	Y		Frequency
			Once a year or less
			A few times per year
			About once a month
			A few times per month
			About once a week
			A few times per week
			Daily or more often
			Not sure/NA
		Thinking about the entire service you have received, what changes can we make to improve your customer experience?			Text area, no char limit		Y		OE_Improvement
CJI3629		Thinking about the entire service you have received, what did we do well and what changes can we make to improve your customer experience?			Text area, no char limit		Y		Improvement
ACQinh0014765		Are you a Health & Human Services Employee?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group*	HHS Employee
			No	A
CJI3630	A	What Agency do you work for? (If not part of a Federal Agency please select Other)	Agency for International Development		Radio button, one-up vertical	Single	Y	Skip Logic Group*	Fed_Agency
			Department of Agriculture
			Department of Commerce
			Department of Defense
			Department of Education
			Department of Homeland Security
			Department of Housing and Urban Development
			Department of the Interior
			Department of Justice
			Department of Labor
			Department of State
			Department of the Interior
			Department of the Treasury
			Department of Transportation
			Department of Veterans Affairs
			Executive Office of the President
			Federal Legislative Branch
			General Accounting Office
			General Services Administration
			Independent Agencies
			Judicial Branch
			National Aeronautics and Space Administration
			Office of Personnel Management
			Peace Corps
			Postal Service
			Private Vendor
			Quasi Official INTNL & Non Govt
			Railroad Retirement Board
			Securities and Exchange Commission
			Other (please specify)	A
CJI3631	A	Other agency:			Text area, no char limit		N		OE_Other Agency
CJI3632		If we may contact you regarding your experience with this product or service, please provide your email address.			Text area, no char limit		N		OE_Contact Yes

---

Sheet 13: CQs (8-21-13)

Model Instance Name:			red & strike-through: DELETE
DHHS-PSC Offline Support Services v2			underlined & italicized: RE-ORDER
MID: 4AFVdB88Aw1dk0QocxcEtw==			pink: ADDITION
Date:	3/1/2008		blue + -->: REWORDING
DHHS-PSC Offline Support Services v2 CUSTOM QUESTION LIST
QID	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
CJI3615		Please select the product or service for which you would like to provide feedback today.	Acquisition Services	A	Radio button, one-up vertical	Single	Y	Skip Logic Group*	Product/Service Type
			Commissioned Corps Support Services	B
			Customer Contact Centers	C
			Financial Services	D
			Freedom of Information Act Services
			Logistics Services	F
			Occupational Health Services	G
			Property Management Services	H
			Regional Support Services
			Transportation, Travel, and Telework Services	J
			Visual Media Services	K
			Administrative Offices	L
			Other, please specify	Z
CJI3616	Z	What product or service would you like to provide feedback on:			Text area, no char limit		N		OE_Product/Service Type
CJI3617	A	Select the acquisition service you are providing feedback on:	Negotiated Contracts		Radio button, one-up vertical		Y		Acquisition Service Type
			Simplified Acquisitions
			Purchase Card Management
CJI3618	B	Select the Commissioned Corps Support Services you are providing feedback on:	Board for Corrections (CCSS)		Radio button, one-up vertical		Y		Commissioned Corp Support
			Commissioned Corps Systems Branch (CCSS)
			Compensation and Retirement Branch (CCSS)
			Medical Affairs Branch (CCSS)
CJI3619	C	Select the customer contact center you are providing feedback on:	ONE-DHHS Contact Center		Radio button, one-up vertical		Y		Customer Contact Center
			Payroll Services
CJI3620	D	Select the financial services products you are providing feedback on:	Accounting Services		Radio button, one-up vertical		Y		Financial Services
			Business Office
			Business Process Improvement
			Cost Allocation/Indirect Cost Negotiations
			Debt Collection Center Services
			Financial Reporting
			Payment Management (Grant) Services
			Payroll Accounting Services
CJI3621	F	Select the logistics services you are providing feedback on:	Labor and Moving		Radio button, one-up vertical		Y		Logistics Services
			Mail Operations
			Supply Service Center (Medical Supply)
			Product Distribution
			Storage
CJI3622	G	Select the occupational health services you are providing feedback on:	Automated External Defibrillator (AED)		Radio button, one-up vertical		Y		Occupational Health
			Clinical Services
			Employee Assistance Program (EAP)
			Environmental Health Services
			Wellness/Fitness
			Work/Life
CJI3623	H	Select the property management services you are providing feedback on:	Asset Management		Radio button, one-up vertical		Y		Property Mgt
			Building Management
			Employee Child Care Services
			Property Disposal
			Real Property Management
			Shredding Services
			Space Acquisition and Alterations
CJI3624	J	Select the transportation, travel and telework services you are providing feedback on:	Employee Relocation		Radio button, one-up vertical		Y		Trans, Travel & Telework Service
			Travel Services
			Telework Strategy Solutions
			Transhare
			Vehicle Rental
CJI3625	K	Select the visual media services you are providing feedback on:	Graphic Arts		Radio button, one-up vertical		Y		Visual Media
			Departmental Forms Management
			Printing Procurement
CJI3626	L	Select the administrative office you are providing feedback on:	AOS Office of the Director		Radio button, one-up vertical		Y		Administrative Offices
			FMS Office of the Director
			FLS Office of the Director
			SAS Office of the Director
			FOH Office of the Director
			PSC Office of the Director
CJI3627		Please specify who provided you with this product or service.			Text area, no char limit		Y		Service Provided by
CJI3628		How often do you transact with this organization or division?	This is my first experience with this organization.		Radio button, one-up vertical	Single	Y		Frequency
			Once a year or less
			A few times per year
			About once a month
			A few times per month
			About once a week
			A few times per week
			Daily or more often
			Not sure/NA
CJI3629		Thinking about the entire service you have received, what did we do well and what changes can we make to improve your customer experience?			Text area, no char limit		Y		Improvement
ACQinh0014765		Are you a Health & Human Services Employee?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group*	HHS Employee
			No	A
CJI3630	A	What Agency do you work for? (If not part of a Federal Agency please select Other)	Agency for International Development		Radio button, one-up vertical	Single	Y	Skip Logic Group*	Fed_Agency
			Department of Agriculture
			Department of Commerce
			Department of Defense
			Department of Education
			Department of Homeland Security
			Department of Housing and Urban Development
			Department of the Interior
			Department of Justice
			Department of Labor
			Department of State
			Department of the Interior
			Department of the Treasury
			Department of Transportation
			Department of Veterans Affairs
			Executive Office of the President
			Federal Legislative Branch
			General Accounting Office
			General Services Administration
			Independent Agencies
			Judicial Branch
			National Aeronautics and Space Administration
			Office of Personnel Management
			Peace Corps
			Postal Service
			Private Vendor
			Quasi Official INTNL & Non Govt
			Railroad Retirement Board
			Securities and Exchange Commission
			Other (please specify)	A
CJI3631	A	Other agency:			Text area, no char limit		N		OE_Other Agency
CJI3632		If we may contact you regarding your experience with this product or service, please provide your email address.			Text area, no char limit		N		OE_Contact Yes

---

Sheet 14: CQs (8-28-12)

Model Instance Name:			red & strike-through: DELETE
DHHS-PSC Offline Support Services v2			underlined & italicized: RE-ORDER
MID: 4AFVdB88Aw1dk0QocxcEtw==			pink: ADDITION
Date:	3/1/2008		blue + -->: REWORDING
DHHS-PSC Offline Support Services v2 CUSTOM QUESTION LIST
QID	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
CJI3615		Please select the product or service for which you would like to provide feedback today.	Acquisition Services	A	Radio button, one-up vertical	Single	Y	Skip Logic Group*	Product/Service Type
			Commissioned Corps Support Services	B
			Customer Contact Centers	C
			Financial Services	D
			Freedom of Information Act Services
			Logistics Services	F
			Occupational Health Services	G
			Property Management Services	H
			Regional Support Services
			Transportation, Travel, and Telework Services	J
			Visual Media Services	K
			Administrative Offices	L
			Other, please specify	Z
CJI3616	Z	What product or service would you like to provide feedback on:			Text area, no char limit		N		OE_Product/Service Type
CJI3617	A	Select the acquisition service you are providing feedback on:	Negotiated Contracts		Radio button, one-up vertical		Y		Acquisition Service Type
			Simplified Acquisitions
			Purchase Card Management
CJI3618	B	Select the Commissioned Corps Support Services you are providing feedback on:	Board for Corrections (CCSS)		Radio button, one-up vertical		Y		Commissioned Corp Support
			Commissioned Corps Systems Branch (CCSS)
			Compensation and Retirement Branch (CCSS)
			Medical Affairs Branch (CCSS)
CJI3619	C	Select the customer contact center you are providing feedback on:	ONE-DHHS Contact Center		Radio button, one-up vertical		Y		Customer Contact Center
			Payroll Services
CJI3620	D	Select the financial services products you are providing feedback on:	Accounting Services		Radio button, one-up vertical		Y		Financial Services
			Business Office
			Business Process Improvement
			Cost Allocation/Indirect Cost Negotiations
			Debt Collection Center Services
			Financial Reporting
			Payment Management (Grant) Services
			Payroll Accounting Services
CJI3621	F	Select the logistics services you are providing feedback on:	Labor and Moving		Radio button, one-up vertical		Y		Logistics Services
			Mail Operations
			Supply Service Center (Medical Supply)
			Product Distribution
			Storage
CJI3622	G	Select the occupational health services you are providing feedback on:	Automated External Defibrillator (AED)		Radio button, one-up vertical		Y		Occupational Health
			Clinical Services
			Employee Assistance Program (EAP)
			Environmental Health Services
			Wellness/Fitness
			Work/Life
CJI3623	H	Select the property management services you are providing feedback on:	Asset Management		Radio button, one-up vertical		Y		Property Mgt
			Building Management
			Employee Child Care Services
			Property Disposal
			Real Property Management
			Shredding Services
			Space Acquisition and Alterations
CJI3624	J	Select the transportation, travel and telework services you are providing feedback on:	Employee Relocation		Radio button, one-up vertical		Y		Trans, Travel & Telework Service
			Travel Services
			Telework Strategy Solutions
			Transhare
			Vehicle Rental
CJI3625	K	Select the visual media services you are providing feedback on:	Graphic Arts		Radio button, one-up vertical		Y		Visual Media
			Departmental Forms Management
			Printing Procurement
CJI3626	L	Select the administrative office you are providing feedback on:	AOS Office of the Director		Radio button, one-up vertical		Y		Administrative Offices
			FMS Office of the Director
			FLS Office of the Director
			SAS Office of the Director
			FOH Office of the Director
			PSC Office of the Director
CJI3627		Please specify who provided you with this product or service.			Text area, no char limit		Y		Service Provided by
CJI3628		How often do you transact with this organization or division?	This is my first experience with this organization.		Radio button, one-up vertical	Single	Y		Frequency
			Once a year or less
			A few times per year
			About once a month
			A few times per month
			About once a week
			A few times per week
			Daily or more often
			Not sure/NA
CJI3629		Thinking about the entire service you have received, what did we do well and what changes can we make to improve your customer experience?			Text area, no char limit		Y		Improvement
ACQinh0014765		Are you a Health & Human Services Employee?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group*	HHS Employee
			No	A
CJI3630	A	What Agency do you work for? (If not part of a Federal Agency please select Other)	Agency for International Development		Radio button, one-up vertical	Single	Y	Skip Logic Group*	Fed_Agency
			Department of Agriculture
			Department of Commerce
			Department of Defense
			Department of Education
			Department of Homeland Security
			Department of Housing and Urban Development
			Department of the Interior
			Department of Justice
			Department of Labor
			Department of State
			Department of the Interior
			Department of the Treasury
			Department of Transportation
			Department of Veterans Affairs
			Executive Office of the President
			Federal Legislative Branch
			General Accounting Office
			General Services Administration
			Independent Agencies
			Judicial Branch
			National Aeronautics and Space Administration
			Office of Personnel Management
			Peace Corps
			Postal Service
			Private Vendor
			Quasi Official INTNL & Non Govt
			Railroad Retirement Board
			Securities and Exchange Commission
			Other federal agency (please specify)	A
CJI3631	A	Other agency:			Text area, no char limit		N		OE_Other Agency
CJI3632		If we may contact you regarding your experience with this product or service, please provide your email address.			Text area, no char limit		N		OE_Contact Yes

---

Sheet 15: CQs (8-16-12)

Model Instance Name:				red & strike-through: DELETE
DHHS-PSC Offline Support Services v2				underlined & italicized: RE-ORDER
MID: 4AFVdB88Aw1dk0QocxcEtw==				pink: ADDITION
Date:	3/1/2008			blue + -->: REWORDING
DHHS-PSC Offline Support Services v2 CUSTOM QUESTION LIST
QID	Skip Logic Label	Question Text	bharati.hulbanni: Hide (DO NOT DELETE) this column before sending to a client. AnswerIDs (DOT)	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
CJI3615		Please select the product or service for which you would like to provide feedback today.	CJI3615A01	Acquisition Services	A	Radio button, one-up vertical	Single	Y	Skip Logic Group*	Product/Service Type
			CJI3615A02	Commissioned Corps Support Services	B
			CJI3615A03	Customer Contact Centers	C
			CJI3615A04	Financial Services	D
			CJI3615A05	Information Management Services REWORD _ Freedom of Information Act Services
			CJI3615A06	Logistics Services	F
			CJI3615A07	Occupational Health Services	G
			CJI3615A08	Property Management Services	H
			CJI3615A09	Regional Support Services
			CJI3615A10	Transportation, Travel, and Telework Services	J
			CJI3615A11	Visual Media Services	K
			CJI3615A12	Administrative Offices	L
			CJI3615A13	Other, please specify	Z
CJI3616	Z	What product or service would you like to provide feedback on:				Text area, no char limit		N		OE_Product/Service Type
CJI3617	A	Select the acquisition service you are providing feedback on:	CJI3617A01	Negotiated Contracts		Radio button, one-up vertical		Y		Acquisition Service Type
			CJI3617A02	Simplified Acquisitions
			CJI3617A03	Purchase Card Management
CJI3618	B	Select the Commissioned Corps Support Services you are providing feedback on:	CJI3618A01	Board for Corrections (CCSS)		Radio button, one-up vertical		Y		Commissioned Corp Support
			CJI3618A02	Commissioned Corps Systems Branch (CCSS)
			CJI3618A03	Compensation and Retirement Branch (CCSS)
			CJI3618A04	Medical Affairs Branch (CCSS)
CJI3619	C	Select the customer contact center you are providing feedback on:	CJI3619A01	ONE-DHHS Contact Center		Radio button, one-up vertical		Y		Customer Contact Center
			CJI3619A02	Payroll Services
CJI3620	D	Select the financial services products you are providing feedback on:	CJI3620A01	Accounting Services		Radio button, one-up vertical		Y		Financial Services
			CJI3620A02	Business Office
			CJI3620A03	Cost Allocation/Indirect Cost Negotiations
			CJI3620A04	Debt Collection Center Services
			CJI3620A05	Financial Reporting
			CJI3620A06	Payment Management (Grant) Services
			CJI3620A07	Payroll Accounting Services
CJI3621	F	Select the logistics services you are providing feedback on:	CJI3621A01	Labor and Moving		Radio button, one-up vertical		Y		Logistics Services
			CJI3621A02	Mail Operations
			CJI3621A03	Supply Service Center (Medical Supply)
			CJI3621A04	Product Distribution
			CJI3621A05	Storage
CJI3622	G	Select the occupational health services you are providing feedback on:	CJI3622A01	Automated External Defibrillator (AED)		Radio button, one-up vertical		Y		Occupational Health
			CJI3622A02	Clinical Services
			CJI3622A03	Employee Assistance Program (EAP)
			CJI3622A04	Environmental Health Services
			CJI3622A05	Wellness/Fitness
			CJI3622A06	Work/Life
CJI3623	H	Select the property management services you are providing feedback on:	CJI3623A01	Asset Management		Radio button, one-up vertical		Y		Property Mgt
			CJI3623A02	Building Management
			CJI3623A03	Employee Child Care Services
			CJI3623A04	Property Disposal
			CJI3623A05	Real Property Management
			CJI3623A06	Shredding Services
			CJI3623A07	Space Acquisition and Alterations
CJI3624	J	Select the transportation, travel and telework services you are providing feedback on:	CJI3624A01	Employee Relocation		Radio button, one-up vertical		Y		Trans, Travel & Telework Service
			CJI3624A02	Travel Services
			CJI3624A03	Telework Strategy Solutions
			CJI3624A04	Transhare
			CJI3624A05	Vehicle Rental
CJI3625	K	Select the visual media services you are providing feedback on:	CJI3625A01	Graphic Arts		Radio button, one-up vertical		Y		Visual Media
			CJI3625A02	Departmental Forms Management
			CJI3625A03	Printing Procurement
CJI3626	L	Select the administrative office you are providing feedback on:	CJI3626A01	AOS Office of the Director		Radio button, one-up vertical		Y		Administrative Offices
			CJI3626A02	FMS Office of the Director
			CJI3626A03	FLS Office of the Director
			CJI3626A04	SAS Office of the Director
			CJI3626A05	FOH Office of the Director
			CJI3626A06	PSC Office of the Director
CJI3627		Please specify who provided you with this product or service.				Text area, no char limit		Y		Service Provided by
CJI3628		How often do you transact with this organization or division?	CJI3628A01	This is my first experience with this organization.		Radio button, one-up vertical	Single	Y		Frequency
			CJI3628A02	Once a year or less
			CJI3628A03	A few times per year
			CJI3628A04	About once a month
			CJI3628A05	A few times per month
			CJI3628A06	About once a week
			CJI3628A07	A few times per week
			CJI3628A08	Daily or more often
			CJI3628A09	Not sure/NA
CJI3629		Thinking about the entire service you have received, what did we do well and what changes can we make to improve your customer experience?				Text area, no char limit		Y		Improvement
		Are you a Health & Human Services Employee?		Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group*	HHS Employee
				No	A
CJI3630	A	What Agency do you work for? (If not part of a Federal Agency please select Other)	CJI3630A01	Agency for International Development		Radio button, one-up vertical	Single	Y	Skip Logic Group*	Fed_Agency
			CJI3630A02	Department of Agriculture
			CJI3630A03	Department of Commerce
			CJI3630A04	Department of Defense
			CJI3630A05	Department of Education
			CJI3630A06	Department of Homeland Security
			CJI3630A07	Department of Housing and Urban Development
			CJI3630A08	Department of the Interior
			CJI3630A09	Department of Justice
			CJI3630A10	Department of Labor
			CJI3630A11	Department of State
			CJI3630A12	Department of the Interior
			CJI3630A13	Department of the Treasury
			CJI3630A14	Department of Transportation
			CJI3630A15	Department of Veterans Affairs
			CJI3630A16	Executive Office of the President
			CJI3630A17	Federal Legislative Branch
			CJI3630A18	General Accounting Office
			CJI3630A19	General Services Administration
			CJI3630A20	Independent Agencies
			CJI3630A21	Judicial Branch
			CJI3630A22	National Aeronautics and Space Administration
			CJI3630A23	Office of Personnel Management
			CJI3630A24	Peace Corps
			CJI3630A25	Postal Service
			CJI3630A26	Private Vendor
			CJI3630A27	Quasi Official INTNL & Non Govt
			CJI3630A28	Railroad Retirement Board
			CJI3630A29	Securities and Exchange Commission
			CJI3630A30	Other federal agency (please specify)	A
CJI3631	A	Other agency:				Text area, no char limit		N		OE_Other Agency
CJI3632		If we may contact you regarding your experience with this product or service, please provide your email address.				Text area, no char limit		N		OE_Contact Yes

---

Sheet 16: PRE DL v2 CQs

Model Instance Name:

red & strike-through: DELETE

DHHS-PSC Offline Support Services v2

underlined & italicized: RE-ORDER

MID: 4AFVdB88Aw1dk0QocxcEtw==

pink: ADDITION

Date:

3/1/2008

blue + -->: REWORDING

DHHS-PSC Offline Support Services v2 CUSTOM QUESTION LIST

QID

Skip Logic Label

Question Text

bharati.hulbanni: Hide (DO NOT DELETE) this column before sending to a client. AnswerIDs (DOT)

Answer Choices (limited to 50 characters)

Skip to

Type (select from list)

Single or Multi

Required Y/N

Special Instructions

CQ Label

Please select the product or service for which you would like to provide feedback today.

Acquisition Services

A

Radio button, one-up vertical

Single

Y

Skip Logic Group*

Product/Service Type

Commissioned Corps Support Services

B

Customer Contact Centers

C

Financial Services

D

Information Management Services

E

Logistics Services

F

Occupational Health Services

G

Property Management Services

H

Regional Support Services

I

Transportation, Travel, and Telework Services

J

Visual Media Services

K

Administrative Offices

L

Other, please specify

Z

Z

What product or service would you like to provide feedback on:

Text area, no char limit

N

OE_Product/Service Type

A

Select the acquisition service you are providing feedback on:

Negotiated Contracts

Radio button, one-up vertical

Acquisition Service Type

Simplified Acquisitions

Purchase Card Management

B

Select the Commissioned Corps Support Services you are providing feedback on:

Board for Corrections (CCSS)

Radio button, one-up vertical

Commissioned Corp Support

Commissioned Corps Systems Branch (CCSS)

Compensation and Retirement Branch (CCSS)

Medical Affairs Branch (CCSS)

C

Select the customer contact center you are providing feedback on:

ONE-DHHS Contact Center

Radio button, one-up vertical

Customer Contact Center

Payroll Services

D

Select the financial services products you are providing feedback on:

Accounting Services

Radio button, one-up vertical

Financial Services

Business Office

Cost Allocation/Indirect Cost Negotiations

Debt Collection Center Services

Financial Reporting

Payment Management (Grant) Services

Payroll Accounting Services

E

Select the information management services you are providing feedback on:

FOIA & Records Management

Radio button, one-up vertical

Information Mgt Services

F

Select the logistics services you are providing feedback on:

Labor and Moving

Radio button, one-up vertical

Logistics Services

Mail Operations

Supply Service Center (Medical Supply)

Product Distribution

Storage

G

Select the occupational health services you are providing feedback on:

Automated External Defibrillator (AED)

Radio button, one-up vertical

Occupational Health

Clinical Services

Employee Assistance Program (EAP)

Environmental Health Services

Wellness/Fitness

Work/Life

H

Select the property management services you are providing feedback on:

Asset Management

Radio button, one-up vertical

Property Mgt

Building Management

Employee Child Care Services

Property Disposal

Real Property Management

Shredding Services

Space Acquisition and Alterations

I

Select the regional support service you are providing feedback on:

Regional Support

Radio button, one-up vertical

Regional Support

J

Select the transportation, travel and telework services you are providing feedback on:

Employee Relocation

Radio button, one-up vertical

Trans, Travel & Telework Service

Travel Services

Telework Strategy Solutions

Transhare

Vehicle Rental

K

Select the visual media services you are providing feedback on:

Graphic Arts

Radio button, one-up vertical

Visual Media

Departmental Forms Management

Printing Procurement

L

Select the administrative office you are providing feedback on:

AOS Office of the Director

Radio button, one-up vertical

Administrative Offices

FMS Office of the Director

FLS Office of the Director

SAS Office of the Director

FOH Office of the Director

PSC Office of the Director

Please specify who provided you with this product or service.

Text area, no char limit

Y

Service Provided by

How often do you transact with this organization or division?

This is my first experience with this organization.

Radio button, one-up vertical

Single

Y

Frequency

Once a year or less

A few times per year

About once a month

A few times per month

About once a week

A few times per week

Daily or more often

Not sure/NA

Thinking about the entire service you have received, what did we do well and what changes can we make to improve your customer experience?

Text area, no char limit

Y

Improvement

What Agency do you work for? (If not part of a Federal Agency please select Other)

Agency for International Development

Single

Y

Skip Logic Group*

Agency

Department of Agriculture

Department of Commerce

Department of Defense

Department of Education

Department of Homeland Security

Department of Housing and Urban Development

Department of the Interior

Department of Justice

Department of Labor

Department of State

Department of the Interior

Department of the Treasury

Department of Transportation

Department of Veterans Affairs

Executive Office of the President

Federal Legislative Branch

General Accounting Office

General Services Administration

Independent Agencies

Judicial Branch

National Aeronautics and Space Administration

Office of Personnel Management

Peace Corps

Postal Service

Private Vendor

Quasi Official INTNL & Non Govt

Railroad Retirement Board

Securities and Exchange Commission

Other federal agency (please specify)

A

A

Other agency:

Text area, no char limit

N

OE_Other Agency

If we may contact you regarding your experience with this product or service, please provide your email address.

Text area, no char limit

N

OE_Contact Yes