Form 1124 2014 879 SAMHSA

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Overview

Model Qsts
Current Custom Qsts

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Sheet 1: Model Qsts

Model Instance Name:			red & strike-through: DELETE
SAMHSA Main Site v2			underlined & italicized: RE-ORDER
MID: will need new mid for the v2 measure			pink: ADDITION
Date:	7/30/2013		blue + -->: REWORDING
SAMHSA Main Site v2
Model questions utilize the ACSI methodology to determine scores and impacts
	ELEMENTS (drivers of satisfaction)		CUSTOMER SATISFACTION		FUTURE BEHAVIORS
	Navigation (1=Poor, 10=Excellent, Don't Know)		Satisfaction		Return (1=Very Unlikely, 10=Very Likely)
1	Please rate how well the site is organized.	19	What is your overall satisfaction with this site? (1=Very Dissatisfied, 10=Very Satisfied)	22	How likely are you to return to this site?
2	Please rate the options available for navigating this site.	20	How well does this site meet your expectations? (1=Falls Short, 10=Exceeds)		Recommend (1=Very Unlikely, 10=Very Likely)
3	Please rate how well the site layout helps you find what you are looking for.	21	How does this site compare to your idea of an ideal website? (1=Not Very Close, 10=Very Close)	23	How likely are you to recommend this site to someone else?
	Site Performance (1=Poor, 10=Excellent, Don't Know)				Primary Resource (1=Very Unlikely, 10=Very Likely)
4	Please rate how quickly pages load on this site.			24	How likely are you to use this site as your primary resource for obtaining information from this agency?
5	Please rate the consistency of speed from page to page on this site.				Trust (1=Strongly Disagree, 10=Strongly Agree)
6	Please rate the ability to load pages without getting error messages on this site.			25	I can count on this agency to act in my best interests.
	Site Information (1=Poor, 10=Excellent, Don't Know)			26	I consider this agency to be trustworthy.
7	Please rate the thoroughness of information provided on this site.			27	This agency can be trusted to do what is right.
8	Please rate how understandable this site’s information is.
9	Please rate how well the site’s information provides answers to your questions.
	Look and Feel (1=Poor, 10=Excellent, Don't Know)
10	Please rate the visual appeal of this site.
11	Please rate the balance of graphics and text on this site.
12	Please rate the readability of the pages on this site.
	Information Browsing (1=Poor, 10=Excellent, Don't Know)
13	Please rate the ability to sort information by criteria that are important to you on this site.
14	Please rate the ability to narrow choices to find the information you are looking for on this site.
15	Please rate how well the features on the site help you find the information you are looking for.
	Online Transparency (1=Poor, 10=Excellent)
16	Please rate how thoroughly this website discloses information about what this agency is doing.
17	Please rate how quickly agency information is made available on this website.
18	Please rate how well information about this agency's actions can be accessed by the public on this website.

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Sheet 2: Current Custom Qsts

Model Instance Name:				red & strike-through: DELETE
SAMHSA Main Site v2				underlined & italicized: RE-ORDER
MID: will need new mid for the v2 measure				pink: ADDITION
Date: 7/30/2013				blue + -->: REWORDING
SAMHSA Main Site v2 CUSTOM QUESTION LIST
QID (Group ID)	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
		What is your primary interest in Substance Abuse and Mental Health today:	Personal		Radio button, one-up vertical	S	Y		Primary interest
			Professional
		What area(s) of the site did you visit today?	Grants		Checkbox, one-up vertical	M	Y		Area Visited
			Publications
			Data
			Newsroom
			Topics
			About Us
			Contact Us
			Strategic Initiative Pages
			Other
		Which of the following is the reason for your current visit to the website?	Find Grant Information		Checkbox, one-up vertical	M	Y		Reason
			Research information by issues/topics
			Order publications
			Get latest news/press releases
			Get Survey or Statistical Data
			Learn about SAMHSA
			Information on the Prevention of Substance Abuse and Mental Illness
			Learn about SAMHSA's Policies and Priorities
			Find information related to Health Reform
			Get help for mental health problems
			Get help for substance use issues
			Find a treatment program/facility
			Look up events & exhibits
			Find phone/email contact information
			Other, please specify:	A
	A	Other reason			Text area, no char limit		N		Other reason
		What method did you primarily use today to find your information?	Site's search feature		Radio button, one-up vertical	S	Y		Method
			Advanced search
			Top navigation bar
			Quick link in the pages
			Site map
			Just browsed the pages
			Other, please specify:	A
	A	Other method			Text area, no char limit		N		Other method
		Did you find what you were looking for?	Yes		Radio button, one-up vertical	S	Y		Find info
			No	A
			Partially	A
			Still looking	A
	A	If you could not fully find what you were looking for, what was it?			Text area, no char limit		N		No info found
		How do you mostly interact with this site?	Bookmark or tag pages		Radio button, one-up vertical	S	Y		Interaction with site
			Adding a widget or gadget to my personalized page
			By adding comments, ratings, or reviews
			Contributing to wikis
			Following a microblog
			In social networks
			In virtual worlds
			Listening to Podcasts or audio
			None
			Reading blogs
			Receiving newsletters/email updates
			Subscribing to RSS feeds
			Watching Vodcasts or video
			Other, please specify:	A
	A	Other interaction			Text area, no char limit		N		Other site interaction
		How frequently do you visit this site?	First time		Drop down, select one	S	Y		Frequency of visits
			Daily
			About once a week
			About once a month
			Every few months or less often
		What best describes your role:	General public		Drop down, select one	S	Y		Role
			Clinician/medical professional
			Consultant
			Educator/school teacher
			Program or service provider/worker
			Researcher
			Social Worker/counselor
			Student
			Other, please specify:	A
	A	Please specify your other role.			Text area, no char limit		N		Other role
		What best describes your current workplace:	Church/faith-based organization		Drop down, select one	S	Y		Workplace
			Client/patient homes
			Government office
			Individual or group private practice
			Managed care/insurance company office
			Non-Profit/Community-Based Org/Coalition
			Non-residential/out-patient facility
			Other corporate office
			Public place/Interacting in community
			Residential/in-patient facility
			School/university
			Other, please specify:	A
	A	Please specify your other workplace.			Text area, no char limit		N		Other workplace
		What services could this agency provide to better serve you?			Text area, no char limit		N		Other services wanted
		If you could improve one thing about this site, what would it be?			Text area, no char limit		N		Improvement
		What is your gender?	Female		Drop down, select one	S	N		Gender
			Male
			I prefer not to respond
		Please select the category that includes your age.	17 and under		Drop down, select one	S	N		Age
			18 - 24
			25 - 34
			35 - 44
			45 - 54
			55 - 64
			65 and over
			I prefer not to respond
		Which of the following best describes the highest level of education you have completed?	Current middle or high school student		Drop down, select one	S	N		Education
			Did not complete high school
			High school graduate
			Some college/vocational school
			College graduate
			Some postgraduate school
			Graduate/professional degree
			MD/PhD
			Prefer not to respond
		How do you describe your ethnicity?	Hispanic		Drop down, select one	S	N		Ethnicity
			Non-Hispanic
			I prefer not to respond
		How do you describe your race?	American Indian or Alaska Native		Drop down, select one	S	N		Race
			Asian or Pacific Islander
			African American or Black
			White
			Other
			I prefer not to respond