Form 1129 2014 884 DoD Tricare
E-Government Website Customer Satisfaction Surveys
2014 884 DoD Tricare.xlsx
2014 884 DoD Tricare
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⚠️ Notice: This form may be outdated.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
Current Custom Qsts
Custom Qsts (5-22-14)
Custom Qsts (5-20-14)
Custom Qsts (7-20-12)
Custom Qsts (6-18-12)
Custom Qsts (2-23-12)
Custom Qsts 10-18-10
Custom Qsts 08-03-09
Current Custom Qsts 11-14-08
Overview
Current Model QstsCurrent Custom Qsts
Custom Qsts (5-22-14)
Custom Qsts (5-20-14)
Custom Qsts (7-20-12)
Custom Qsts (6-18-12)
Custom Qsts (2-23-12)
Custom Qsts 10-18-10
Custom Qsts 08-03-09
Current Custom Qsts 11-14-08
Sheet 1: Current Model Qsts
| Model Instance Name: | |||||
| DOD TRICARE | |||||
| MID: | EkBkYwMF5pUhJZssIpM89w== | ||||
| Date: | 2004 | ||||
| DOD TRICARE MODEL QUESTION LIST | |||||
| Model questions utilize the ACSI methodology to determine scores and impacts | |||||
| ELEMENTS (drivers of satisfaction) | CUSTOMER SATISFACTION | FUTURE BEHAVIORS | |||
| Content (1=Poor, 10=Excellent, Don't Know) | Satisfaction (1=Poor, 10=Excellent) | Likelihood to Return (1=Not Very Likely, 10=Very Likely) | |||
| 1 | Please rate the accuracy of information on this site. | 21 | What is your overall satisfaction with this site? | 24 | How likely are you to return to this site? |
| 2 | Please rate the quality of information on this site. | 22 | How well does this site meet your expectations? | Recommend (1=Not Very Likely, 10=Very Likely) | |
| 3 | Please rate the freshness of content on this site. | 23 | How does this site compare to your idea of an ideal website? | 25 | How likely are you to recommend this site to someone else? |
| Functionality (1=Poor, 10=Excellent, Don't Know) | Primary Resources (1=Not Very Likely, 10=Very Likely) | ||||
| 4 | Please rate the usefulness of the services provided on this site. | 26 | How likely are you to use this site as your primary resource for obtaining information from this organization? | ||
| 5 | Please rate the convenience of the services on this site. | ||||
| 6 | Please rate the ability to accomplish what you wanted to on this site. | ||||
| Look and Feel (1=Poor, 10=Excellent, Don't Know) | |||||
| 7 | Please rate the ease of reading this site. | ||||
| 8 | Please rate the clarity of site organization. | 
|
|||
| 9 | Please rate the clean layout of this site. | ||||
| Navigation (1=Poor, 10=Excellent, Don't Know) | |||||
| 10 | Please rate the degree to which the number of steps it took to get where you want is acceptable. | ||||
| 11 | Please rate the ability to find the information you want on this site. | ||||
| 12 | Please rate the clarity of site map/directory. | ||||
| 13 | Please rate the ease of navigation on this site. | ||||
| Search (1=Poor, 10=Excellent, Don't Know) | |||||
| 14 | Please rate the usefulness of search results on this site. | ||||
| 15 | Please rate how this site provides comprehensive search results. | ||||
| 16 | Please rate the organization of search results for this site. | ||||
| 17 | Please rate how the search feature helps you to narrow the results to find the information you want. | ||||
| Site Performance (1=Poor, 10=Excellent, Don't Know) | |||||
| 18 | Please rate the speed of loading the page on this site. | ||||
| 19 | Please rate the consistency of speed on this site. | ||||
| 20 | Please rate the reliability of site performance on this site. | ||||
Sheet 2: Current Custom Qsts
| Model Instance Name: | |||||||||
| DOD TRICARE | underlined & italicized: RE-ORDER | ||||||||
| MID: EkBkYwMF5pUhJZssIpM89w== | pink: ADDITION | ||||||||
| Date: | May 21, 2014 | blue + -->: REWORDING | |||||||
| DOD TRICARE CUSTOM QUESTION LIST | |||||||||
| CQID | 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 | Short Name |
| 5923 | How frequently do you visit our site? | First time | Drop down, select one | Single | Y | Visit Frequency | |||
| Every 6 months or less | |||||||||
| About once a month | |||||||||
| About once a week | |||||||||
| Daily | |||||||||
| More than once a day | |||||||||
| STE0058266 | Which best describes you? | Active Duty Service Member (includes all Uniformed Services) | N | Radio button, one-up vertical | Single | Yes | Skip Logic Group | Status | |
| Retired Service Member | P | ||||||||
| National Guard or Reserve Member (Active, Reserve or Retired) | Q | ||||||||
| Family of Active Duty Service Member | R | ||||||||
| Family of Retired Service Member | S | ||||||||
| Family of National Guard or Reserve Member | T | ||||||||
| Other (Provider, Staff, Government, Media, etc.) | M | ||||||||
| STE0058267 | M | Please specify. | Provider (Staff included) | Radio button, one-up vertical | Single | Yes | Skip Logic Group | Other Status | |
| Government | |||||||||
| Government Contractor | |||||||||
| Media | |||||||||
| Other | |||||||||
| STE0058268 | N | Which plan are you? | TRICARE Prime | Radio button, one-up vertical | Single | Yes | Skip Logic Group | Active Duty Plan | |
| TRICARE Prime Remote | |||||||||
| TRICARE Prime Overseas | |||||||||
| TRICARE Prime Remote Overseas | |||||||||
| Other/Don’t Know | |||||||||
| STE0058269 | P | Which plan are you? | TRICARE Prime | Radio button, one-up vertical | Single | Yes | Skip Logic Group | Retired Plan | |
| TRICARE Standard and Extra | |||||||||
| TRICARE Standard Overseas | |||||||||
| TRICARE For Life | |||||||||
| US Family Health Plan | |||||||||
| Other/Don’t Know | |||||||||
| STE0058270 | Q | Which plan are you? | TRICARE Prime | Radio button, one-up vertical | Single | Yes | Skip Logic Group | Guard or Reserve Plan | |
| TRICARE Prime Remote | |||||||||
| TRICARE Prime Overseas | |||||||||
| TRICARE Prime Remote Overseas | |||||||||
| TRICARE Standard and Extra | |||||||||
| TRICARE Standard Overseas | |||||||||
| TRICARE For Life | |||||||||
| TRICARE Reserve Select | |||||||||
| TRICARE Retired Reserve | |||||||||
| US Family Health Plan | |||||||||
| Other/Don’t Know | |||||||||
| STE0058302 | R | Which plan are you? | TRICARE Prime | Radio button, one-up vertical | Single | Yes | Skip Logic Group | Family of Active Duty Plan | |
| TRICARE Prime Remote | |||||||||
| TRICARE Prime Overseas | |||||||||
| TRICARE Prime Remote Overseas | |||||||||
| TRICARE Standard and Extra | |||||||||
| TRICARE Standard Overseas | |||||||||
| TRICARE Young Adult | |||||||||
| US Family Health Plan | |||||||||
| Other/Don’t Know | |||||||||
| STE0058303 | S | Which plan are you? | TRICARE Prime | Radio button, one-up vertical | Single | Yes | Skip Logic Group | Family of Retired Plan | |
| TRICARE Standard and Extra | |||||||||
| TRICARE Standard Overseas | |||||||||
| TRICARE For Life | |||||||||
| TRICARE Young Adult | |||||||||
| US Family Health Plan | |||||||||
| Other/Don’t Know | |||||||||
| STE0058304 | T | Which plan are you? | TRICARE Prime | Radio button, one-up vertical | Single | Yes | Skip Logic Group | Family of Guard or Reserve Plan | |
| TRICARE Prime Remote | |||||||||
| TRICARE Prime Overseas | |||||||||
| TRICARE Prime Remote Overseas | |||||||||
| TRICARE Standard and Extra | |||||||||
| TRICARE Standard Overseas | |||||||||
| TRICARE For Life | |||||||||
| TRICARE Reserve Select | |||||||||
| TRICARE Retired Reserve | |||||||||
| TRICARE Young Adult | |||||||||
| US Family Health Plan | |||||||||
| Other/Don’t Know | |||||||||
| MMM00389 | Did you create a profile based on your beneficiary category, where you live and which TRICARE plan you’re in? | Yes | Radio button, one-up vertical | Single | Yes | Create Profile | |||
| No | |||||||||
| STE0058306 | What were you looking for on our web site today? | Text area, no char limit | Yes | Looking For | |||||
| STE0058305 | Did you find it? | Yes | Radio button, one-up vertical | Single | Yes | Did You Find | |||
| No | |||||||||
Sheet 3: Custom Qsts (5-22-14)
| Model Instance Name: | |||||||||
| DOD TRICARE | underlined & italicized: RE-ORDER | ||||||||
| MID: EkBkYwMF5pUhJZssIpM89w== | pink: ADDITION | ||||||||
| Date: | May 21, 2014 | blue + -->: REWORDING | |||||||
| DOD TRICARE CUSTOM QUESTION LIST | |||||||||
| CQID | 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 | Short Name |
| 5923 | How frequently do you visit our site? | First time | Drop down, select one | Single | Y | Visit Frequency | |||
| Every 6 months or less | |||||||||
| About once a month | |||||||||
| About once a week | |||||||||
| Daily | |||||||||
| More than once a day | |||||||||
| STE0058266 | Which best describes you? | Active Duty Service Member (includes all Uniformed Services) | N | Radio button, one-up vertical | Single | Yes | Skip Logic Group | Status | |
| Retired Service Member | P | ||||||||
| National Guard or Reserve Member (Active, Reserve or Retired) | Q | ||||||||
| Family of Active Duty Service Member | R | ||||||||
| Family of Retired Service Member | S | ||||||||
| Family of National Guard or Reserve Member | T | ||||||||
| Other (Provider, Staff, Government, Media, etc.) | M | ||||||||
| STE0058267 | M | Please specify. | Provider (Staff included) | Radio button, one-up vertical | Single | Yes | Skip Logic Group | Other Status | |
| Government | |||||||||
| Government Contractor | |||||||||
| Media | |||||||||
| Other | |||||||||
| STE0058268 | N | Which plan are you? | TRICARE Prime | Radio button, one-up vertical | Single | Yes | Skip Logic Group | Active Duty Plan | |
| TRICARE Prime Remote | |||||||||
| TRICARE Prime Overseas | |||||||||
| TRICARE Prime Remote Overseas | |||||||||
| Other/Don’t Know | |||||||||
| STE0058269 | P | Which plan are you? | TRICARE Prime | Radio button, one-up vertical | Single | Yes | Skip Logic Group | Retired Plan | |
| TRICARE Standard and Extra | |||||||||
| TRICARE Standard Overseas | |||||||||
| TRICARE For Life | |||||||||
| US Family Health Plan | |||||||||
| Other/Don’t Know | |||||||||
| STE0058270 | Q | Which plan are you? | TRICARE Prime | Radio button, one-up vertical | Single | Yes | Skip Logic Group | Guard or Reserve Plan | |
| TRICARE Prime Remote | |||||||||
| TRICARE Prime Overseas | |||||||||
| TRICARE Prime Remote Overseas | |||||||||
| TRICARE Standard and Extra | |||||||||
| TRICARE Standard Overseas | |||||||||
| TRICARE For Life | |||||||||
| TRICARE Reserve Select | |||||||||
| TRICARE Retired Reserve | |||||||||
| US Family Health Plan | |||||||||
| Other/Don’t Know | |||||||||
| STE0058302 | R | Which plan are you? | TRICARE Prime | Radio button, one-up vertical | Single | Yes | Skip Logic Group | Family of Active Duty Plan | |
| TRICARE Prime Remote | |||||||||
| TRICARE Prime Overseas | |||||||||
| TRICARE Prime Remote Overseas | |||||||||
| TRICARE Standard and Extra | |||||||||
| TRICARE Standard Overseas | |||||||||
| TRICARE Young Adult | |||||||||
| US Family Health Plan | |||||||||
| Other/Don’t Know | |||||||||
| STE0058303 | S | Which plan are you? | TRICARE Prime | Radio button, one-up vertical | Single | Yes | Skip Logic Group | Family of Retired Plan | |
| TRICARE Standard and Extra | |||||||||
| TRICARE Standard Overseas | |||||||||
| TRICARE For Life | |||||||||
| TRICARE Young Adult | |||||||||
| US Family Health Plan | |||||||||
| Other/Don’t Know | |||||||||
| STE0058304 | T | Which plan are you? | TRICARE Prime | Radio button, one-up vertical | Single | Yes | Skip Logic Group | Family of Guard or Reserve Plan | |
| TRICARE Prime Remote | |||||||||
| TRICARE Prime Overseas | |||||||||
| TRICARE Prime Remote Overseas | |||||||||
| TRICARE Standard and Extra | |||||||||
| TRICARE Standard Overseas | |||||||||
| TRICARE For Life | |||||||||
| TRICARE Reserve Select | |||||||||
| TRICARE Retired Reserve | |||||||||
| TRICARE Young Adult | |||||||||
| US Family Health Plan | |||||||||
| Other/Don’t Know | |||||||||
| MMM00389 | Did you create a profile based on your beneficiary category, where you live and which TRICARE plan you’re in? | Yes | Radio button, one-up vertical | Single | Yes | Create Profile | |||
| No | |||||||||
| STE0058306 | What were you looking for on our web site today? | Text area, no char limit | YES | Looking For | |||||
| STE0058305 | Did you find it? | Yes | Radio button, one-up vertical | Single | Yes | Did You Find | |||
| No | |||||||||
Sheet 4: Custom Qsts (5-20-14)
| Model Instance Name: | |||||||||
| DOD TRICARE | underlined & italicized: RE-ORDER | ||||||||
| MID: EkBkYwMF5pUhJZssIpM89w== | pink: ADDITION | ||||||||
| Date: | May 15, 2014 | blue + -->: REWORDING | |||||||
| DOD TRICARE CUSTOM QUESTION LIST | |||||||||
| CQID | 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 | Short Name |
| 5923 | How frequently do you visit our site? | First time | Drop down, select one | Single | Y | Visit Frequency | |||
| Every 6 months or less | |||||||||
| About once a month | |||||||||
| About once a week | |||||||||
| Daily | |||||||||
| More than once a day | |||||||||
| NEW | Which best describes you? | Active Duty Service Member (includes all Uniformed Services) | N | Radio button, one-up vertical | Single | Yes | Skip Logic Group | Status | |
| Retired Service Member | P | ||||||||
| National Guard or Reserve Member (Active, Reserve or Retired) | Q | ||||||||
| Family of Active Duty Service Member | R | ||||||||
| Family of Retired Service Member | S | ||||||||
| Family of National Guard or Reserve Member | T | ||||||||
| Other (Provider, Staff, Government, Media, etc.) | M | ||||||||
| NEW | M | Please specify. | Provider (Staff included) | Radio button, one-up vertical | Single | Yes | Skip Logic Group | Other Status | |
| Government | |||||||||
| Government Contractor | |||||||||
| Media | |||||||||
| Other | |||||||||
| NEW | N | Which plan are you? | TRICARE Prime | Radio button, one-up vertical | Single | Yes | Skip Logic Group | Active Duty Plan | |
| TRICARE Prime Remote | |||||||||
| TRICARE Prime Overseas | |||||||||
| TRICARE Prime Remote Overseas | |||||||||
| Other/Don’t Know | |||||||||
| NEW | P | Which plan are you? | TRICARE Prime | Radio button, one-up vertical | Single | Yes | Skip Logic Group | Retired Plan | |
| TRICARE Standard and Extra | |||||||||
| TRICARE Standard Overseas | |||||||||
| TRICARE For Life | |||||||||
| US Family Health Plan | |||||||||
| Other/Don’t Know | |||||||||
| NEW | Q | Which plan are you? | TRICARE Prime | Radio button, one-up vertical | Single | Yes | Skip Logic Group | Guard or Reserve Plan | |
| TRICARE Prime Remote | |||||||||
| TRICARE Prime Overseas | |||||||||
| TRICARE Prime Remote Overseas | |||||||||
| TRICARE Standard and Extra | |||||||||
| TRICARE Standard Overseas | |||||||||
| TRICARE For Life | |||||||||
| TRICARE Reserve Select | |||||||||
| TRICARE Retired Reserve | |||||||||
| US Family Health Plan | |||||||||
| Other/Don’t Know | |||||||||
| NEW | R | Which plan are you? | TRICARE Prime | Radio button, one-up vertical | Single | Yes | Skip Logic Group | Family of Active Duty Plan | |
| TRICARE Prime Remote | |||||||||
| TRICARE Prime Overseas | |||||||||
| TRICARE Prime Remote Overseas | |||||||||
| TRICARE Standard and Extra | |||||||||
| TRICARE Standard Overseas | |||||||||
| TRICARE Young Adult | |||||||||
| US Family Health Plan | |||||||||
| Other/Don’t Know | |||||||||
| NEW | S | Which plan are you? | TRICARE Prime | Radio button, one-up vertical | Single | Yes | Skip Logic Group | Family of Retired Plan | |
| TRICARE Standard and Extra | |||||||||
| TRICARE Standard Overseas | |||||||||
| TRICARE For Life | |||||||||
| TRICARE Young Adult | |||||||||
| US Family Health Plan | |||||||||
| Other/Don’t Know | |||||||||
| NEW | T | Which plan are you? | TRICARE Prime | Radio button, one-up vertical | Single | Yes | Skip Logic Group | Family of Guard or Reserve Plan | |
| TRICARE Prime Remote | |||||||||
| TRICARE Prime Overseas | |||||||||
| TRICARE Prime Remote Overseas | |||||||||
| TRICARE Standard and Extra | |||||||||
| TRICARE Standard Overseas | |||||||||
| TRICARE For Life | |||||||||
| TRICARE Reserve Select | |||||||||
| TRICARE Retired Reserve | |||||||||
| TRICARE Young Adult | |||||||||
| US Family Health Plan | |||||||||
| Other/Don’t Know | |||||||||
| MMM00389 | Did you create a profile based on your beneficiary category, where you live and which TRICARE plan you’re in? | Yes | Radio button, one-up vertical | Single | Yes | Create Profile | |||
| No | |||||||||
| NEW | What were you looking for on our web site today? | Text area, no char limit | No | Looking For | |||||
| NEW | Did you find it? | Yes | Radio button, one-up vertical | Single | Yes | Did You Find | |||
| No | |||||||||
Sheet 5: Custom Qsts (7-20-12)
| Model Instance Name: | |||||||||
| DOD TRICARE | underlined & italicized: RE-ORDER | ||||||||
| MID: EkBkYwMF5pUhJZssIpM89w== | pink: ADDITION | ||||||||
| Date: | 7/16/2012 | blue + -->: REWORDING | |||||||
| DOD TRICARE CUSTOM QUESTION LIST | |||||||||
| CQID | 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 | |
| 5923 | How frequently do you visit our site? | First time | Drop down, select one | Single | Y | ||||
| Every 6 months or less | |||||||||
| About once a month | |||||||||
| About once a week | |||||||||
| Daily | |||||||||
| More than once a day | |||||||||
| MMM00067 | Which of the following best describes your role in visiting our site today? | TRICARE beneficiary | E, F, G, 2A | Radio button, one-up vertical | Single | Y | |||
| Family, friend or caregiver of TRICARE beneficiary | |||||||||
| Future TRICARE beneficiary | |||||||||
| TRICARE Network Provider or Provider Staff | |||||||||
| TRICARE Non-Network Provider or Provider Staff | |||||||||
| Prospective TRICARE Provider or Provider Staff | |||||||||
| Military Treatment Facility Clinical Staff | |||||||||
| TRICARE Beneficiary Advisors and Customer Service Staff | |||||||||
| All other Military Health System/TRICARE staff (Including government and supporting contractors) | |||||||||
| Media/Researcher | |||||||||
| Other | |||||||||
| 5929 | E | For TRICARE beneficiaries only- Which best describes your status? | Active Duty Service Member | Radio button, one-up vertical | Single | N | |||
| Family of Active Duty Service Member | |||||||||
| Family of Deceased Active Duty Service Member | |||||||||
| National Guard or Reserve Member (Activated) | |||||||||
| Family of National Guard or Reserve Member (Activated) | |||||||||
| National Guard or Reserve member (Non-Activated) | |||||||||
| Family of National Guard or Reserve Member (Non-Activated) | |||||||||
| Retired Service Member | |||||||||
| Family of Retired Service Member | |||||||||
| Family of Deceased Retired Service Member | |||||||||
| Other Beneficiary | |||||||||
| Not Applicable | |||||||||
| MMM00068 | F | For TRICARE beneficiaries only: Which of the following best describes your TRICARE enrollment option? | Sponsor is active duty (no premium paid) | Radio button, one-up vertical | |||||
| Sponsor is active duty and family member has disenrolled from Prime to use TRICARE Standard | Single | N | |||||||
| Sponsor is retired and we pay either $260/individual or $520/family per year | |||||||||
| Sponsor is retired and we pay the Medicare Part B premium; TRICARE for Life | |||||||||
| Sponsor is retired (and we do NOT pay either a TRICARE or Medicare Part B premium; TRICARE Standard) | |||||||||
| Not applicable | |||||||||
| MMM00389 | 2A | Did you create a profile based on your beneficiary category, where you live and which TRICARE plan you’re in? | Yes | Radio button, one-up vertical | Single | ||||
| No | |||||||||
| MMM00061 | Which of the following best describes your main reason for visiting our Web site today? | Find out what’s covered | Radio button, one-up vertical | Single | Y | Randomize | |||
| Look up costs | |||||||||
| Find a military or civilian doctor | |||||||||
| Make an appointment | |||||||||
| Referral | |||||||||
| Find contact information | |||||||||
| Find claims information | |||||||||
| Find enrollment information | |||||||||
| Pharmacy | |||||||||
| Check eligibility | |||||||||
| Update personal information | |||||||||
| Learn about the plans / options | |||||||||
| Look for health/wellness information | |||||||||
| Other (please explain) | A | ||||||||
| MMM00062 | A | Other | Text field, <100 char | ||||||
| AED05079 | Did you find what you were looking for on our Web site today? | Yes | |||||||
| No | K, L | ||||||||
| MMM00065 | K | If you did not find what you were looking for, what will you do now? | Try a different Web site | Radio button, one-up vertical | Single | N | |||
| Call a toll-free number | |||||||||
| Read a TRICARE brochure or handbook | |||||||||
| Visit a TRICARE Service Center | |||||||||
| Visit a Military Treatment Facility | |||||||||
| Other | C | ||||||||
| Not applicable | |||||||||
| MMM00066 | C | Please explain what you will do now. | Text field, <100 char | ||||||
| 5926 | L | If you did not find what you were looking for on our Web site, what was it? | Text area, no char limit | N | |||||
| 51492 | What method are you primarily using to locate the information you are looking for? | Search Bar | H, 2A | Drop down, select one | Single | Y | SKIP LOGIC GROUP | ||
| Clicking tabs or links | |||||||||
| Site Map | |||||||||
| Other | 1A | ||||||||
| ACQwil0013622 | 1A | What other method are you using? | Text area, no char limit | ||||||
| NEW | 2A | Please describe your experience with the site's search feature. | Very helpful | Radio button, one-up vertical | Single | No | |||
| Somewhat helpful | 3A, 3B | ||||||||
| Not at all helpful | 3A, 3B | ||||||||
| ACQOsl0002177 | H, 3A, 3B | What key word(s) did you use to search? | Text area, no char limit | No | SKIP LOGIC GROUP | ||||
| NEW | 3A, 3B | What information were you searching for on the site? | Text area, no char limit | ||||||
| MMM00056 | How did you get to our Web site today? | Referred by TRICARE brochure or handbook | Drop down, select one | Single | Y | ||||
| Referred by TRICARE customer service representative | |||||||||
| Typed in the address | |||||||||
| Search engine (such as Google or Yahoo) | |||||||||
| Bookmarks or Favorites | |||||||||
| Link from another Web site | |||||||||
| Other | |||||||||
Sheet 6: Custom Qsts (6-18-12)
| Model Instance Name: | |||||||||
| DOD TRICARE | underlined & italicized: RE-ORDER | ||||||||
| MID: EkBkYwMF5pUhJZssIpM89w== | pink: ADDITION | ||||||||
| Date: | 6/18/2012 | blue + -->: REWORDING | |||||||
| DOD TRICARE CUSTOM QUESTION LIST | |||||||||
| CQID | 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 | |
| 5923 | How frequently do you visit our site? | First time | Drop down, select one | Single | Y | ||||
| Every 6 months or less | |||||||||
| About once a month | |||||||||
| About once a week | |||||||||
| Daily | |||||||||
| More than once a day | |||||||||
| MMM00067 | Which of the following best describes your role in visiting our site today? | TRICARE beneficiary | E, F, G | Radio button, one-up vertical | Single | Y | |||
| Family, friend or caregiver of TRICARE beneficiary | |||||||||
| Future TRICARE beneficiary | |||||||||
| TRICARE Network Provider or Provider Staff | |||||||||
| TRICARE Non-Network Provider or Provider Staff | |||||||||
| Prospective TRICARE Provider or Provider Staff | |||||||||
| Military Treatment Facility Clinical Staff | |||||||||
| TRICARE Beneficiary Advisors and Customer Service Staff | |||||||||
| All other Military Health System/TRICARE staff (Including government and supporting contractors) | |||||||||
| Media/Researcher | |||||||||
| Other | |||||||||
| 5929 | E | For TRICARE beneficiaries only- which best describes your status? | Active Duty Service Member | Radio button, one-up vertical | Single | N | |||
| Family of Active Duty Service Member | |||||||||
| Family of Deceased Active Duty Service Member | |||||||||
| National Guard or Reserve Member (Activated) | |||||||||
| Family of National Guard or Reserve Member (Activated) | |||||||||
| National Guard or Reserve member (Non-Activated) | |||||||||
| Family of National Guard or Reserve Member (Non-Activated) | |||||||||
| Retired Service Member | |||||||||
| Family of Retired Service Member | |||||||||
| Family of Deceased Retired Service Member | |||||||||
| Other Beneficiary | |||||||||
| Not Applicable | |||||||||
| MMM00068 | F | For TRICARE beneficiaries only: which of the following best describes your TRICARE enrollment option? | Sponsor is active duty (no premium paid) | Radio button, one-up vertical | |||||
| Sponsor is active duty and family member has disenrolled from Prime to use TRICARE Standard | Single | N | |||||||
| Sponsor is retired and we pay either $260/individual or $520/family per year | |||||||||
| Sponsor is retired and we pay the Medicare Part B premium; TRICARE for Life | |||||||||
| Sponsor is retired (and we do NOT pay either a TRICARE or Medicare Part B premium; TRICARE Standard) | |||||||||
| Not applicable | |||||||||
| 5928 | G | For TRICARE beneficiaries only- do you receive most of your care from: | A military clinic or hospital | Radio button, one-up vertical | Single | N | |||
| A civilian clinic or hospital | |||||||||
| Not applicable | |||||||||
| MMM00061 | Which of the following best describes your main reason for visiting our Web site today? | Find out what’s covered | Radio button, one-up vertical | Single | Y | Randomize | |||
| Look up costs | |||||||||
| Find a civilian/network provider | |||||||||
| Find a military provider | |||||||||
| Make an appointment | |||||||||
| Referral | |||||||||
| Look up a toll free phone number | |||||||||
| File a claim | |||||||||
| Check the status of a claim | |||||||||
| Problem with a claim | |||||||||
| Enroll | |||||||||
| Pay Enrollment Fees | |||||||||
| Pharmacy | |||||||||
| Check eligibility | |||||||||
| Update personal information | |||||||||
| Learn about the plans / options | |||||||||
| Look up health information / medical advice | |||||||||
| Other (please explain) | A | ||||||||
| MMM00062 | A | Other | Text field, <100 char | ||||||
| MMM00063 | Where did you first go to find this information? | This web site was the first place I went | Radio button, one-up vertical | Single | Y | ||||
| I went to a different Web site | |||||||||
| I called a toll-free number | |||||||||
| I read a TRICARE brochure or handbook | |||||||||
| I visited a TRICARE Service Center | |||||||||
| I visited a Military Treatment Facility | |||||||||
| Other (please explain) | B | ||||||||
| MMM00064 | B | Other | Text field, <100 char | ||||||
| MMM00389 | Did you create a profile based on your beneficiary category, where you live and which TRICARE plan you’re in? | Yes | Radio button, one-up vertical | Single | |||||
| No | |||||||||
| AED05079 | Did you find what you were looking for on our Web site today? | Yes | |||||||
| No | K, L | ||||||||
| MMM00065 | K | If you did not find what you were looking for, what will you do now? | Try a different Web site | Radio button, one-up vertical | Single | N | |||
| Call a toll-free number | |||||||||
| Read a TRICARE brochure or handbook | |||||||||
| Visit a TRICARE Service Center | |||||||||
| Visit a Military Treatment Facility | |||||||||
| Other | C | ||||||||
| Not applicable | |||||||||
| MMM00066 | C | Please explain what you will do now. | Text field, <100 char | ||||||
| 5926 | L | If you did not find what you were looking for on our Web site, what was it? | Text area, no char limit | N | |||||
| 51492 | What method are you primarily using to locate the information you are looking for? | Search Bar | H | Drop down, select one | Single | Y | SKIP LOGIC GROUP | ||
| Clicking tabs or links | |||||||||
| Site Map | |||||||||
| Other | 1A | ||||||||
| NEW | 1A | What other method are you using? | Text area, no char limit | ||||||
| ACQOsl0002176 | H | Please describe your experience with the site's search feature? | I had no difficulty using the search feature on this site | Radio button, one-up vertical | Single | No | SKIP LOGIC GROUP | ||
| The search feature was difficult to find | |||||||||
| The search feature was difficult to use | |||||||||
| Returned no results/received an error message | |||||||||
| Could not tell where the search results would take me | |||||||||
| Too many results | |||||||||
| Too few results | |||||||||
| Results were not related to what I was looking for | |||||||||
| Could not sort the results | |||||||||
| Could not refine the results | |||||||||
| Other | 1B | ||||||||
| NEW | 1B | What other experience did you have with the site's search feature? | Text area, no char limit | ||||||
| ACQOsl0002177 | H | What key word(s) did you use to search? | Text area, no char limit | No | SKIP LOGIC GROUP | ||||
| ACQOsl0002178 | H | Please indicate how helpful you feel the search feature was in finding the information you wanted/needed? | Very helpful | Radio button, one-up vertical | Single | No | SKIP LOGIC GROUP | ||
| Somewhat helpful | I | ||||||||
| Not at all helpful | I, J | ||||||||
| ACQOsl0002179 | J | Why do you feel the search feature was not at all helpful? | Text area, no char limit | No | SKIP LOGIC GROUP | ||||
| ACQOsl0002180 | I | What would make the search feature more helpful? | Text area, no char limit | No | SKIP LOGIC GROUP | ||||
| MMM00056 | How did you get to our Web site today? | Referred by TRICARE brochure or handbook | Drop down, select one | Single | Y | ||||
| Referred by TRICARE customer service representative | |||||||||
| Typed in the address | |||||||||
| Search engine (such as Google or Yahoo) | |||||||||
| Bookmarks or Favorites | |||||||||
| Link from another Web site | |||||||||
| Other | |||||||||
| 5934 | If you could make one improvement to the site what would that be? | Text area, no char limit | N | ||||||
| MMM00059 | Where are you located? | US (Continental) | Drop down, select one | Single | Y | ||||
| Alaska | |||||||||
| Hawaii | |||||||||
| Pacific | |||||||||
| Latin America | |||||||||
| Canada | |||||||||
| Europe | |||||||||
| Puerto Rico/Virgin Islands | |||||||||
| Other Overseas | |||||||||
Sheet 7: Custom Qsts (2-23-12)
| Model Instance Name: | |||||||||
| DOD TRICARE | underlined & italicized: RE-ORDER | ||||||||
| MID: EkBkYwMF5pUhJZssIpM89w== | pink: ADDITION | ||||||||
| Date: | 2/22/2012 | blue + -->: REWORDING | |||||||
| DOD TRICARE CUSTOM QUESTION LIST | |||||||||
| CQID | 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 | |
| 5923 | How frequently do you visit our site? | First time | Drop down, select one | Single | Y | ||||
| Every 6 months or less | |||||||||
| About once a month | |||||||||
| About once a week | |||||||||
| Daily | |||||||||
| More than once a day | |||||||||
| MMM00067 | Which of the following best describes your role in visiting our site today? | TRICARE beneficiary | E, F, G | Radio button, one-up vertical | Single | Y | |||
| Family, friend or caregiver of TRICARE beneficiary | |||||||||
| Future TRICARE beneficiary | |||||||||
| TRICARE Network Provider or Provider Staff | |||||||||
| TRICARE Non-Network Provider or Provider Staff | |||||||||
| Prospective TRICARE Provider or Provider Staff | |||||||||
| Military Treatment Facility Clinical Staff | |||||||||
| TRICARE Beneficiary Advisors and Customer Service Staff | |||||||||
| All other Military Health System/TRICARE staff (Including government and supporting contractors) | |||||||||
| Media/Researcher | |||||||||
| Other | |||||||||
| 5929 | E | For TRICARE beneficiaries only- which best describes your status? | Active Duty Service Member | Radio button, one-up vertical | Single | N | |||
| Family of Active Duty Service Member | |||||||||
| Family of Deceased Active Duty Service Member | |||||||||
| National Guard or Reserve Member (Activated) | |||||||||
| Family of National Guard or Reserve Member (Activated) | |||||||||
| National Guard or Reserve member (Non-Activated) | |||||||||
| Family of National Guard or Reserve Member (Non-Activated) | |||||||||
| Retired Service Member | |||||||||
| Family of Retired Service Member | |||||||||
| Family of Deceased Retired Service Member | |||||||||
| Other Beneficiary | |||||||||
| Not Applicable | |||||||||
| MMM00068 | F | For TRICARE beneficiaries only: which of the following best describes your TRICARE enrollment option? | Sponsor is active duty (no premium paid) | Radio button, one-up vertical | |||||
| Sponsor is active duty and family member has disenrolled from Prime to use TRICARE Standard | Single | N | |||||||
| Sponsor is retired and we pay either $230/individual or $460/family per year Sponsor is retired and we pay either $260/individual or $520/family per year |
|||||||||
| Sponsor is retired and we pay the Medicare Part B premium; TRICARE for Life | |||||||||
| Sponsor is retired (and we do NOT pay either a TRICARE or Medicare Part B premium; TRICARE Standard) | |||||||||
| Not applicable | |||||||||
| 5928 | G | For TRICARE beneficiaries only- do you receive most of your care from: | A military clinic or hospital | Radio button, one-up vertical | Single | N | |||
| A civilian clinic or hospital | |||||||||
| Not applicable | |||||||||
| MMM00061 | Which of the following best describes your main reason for visiting our Web site today? | Find out what’s covered | Radio button, one-up vertical | Single | Y | Randomize | |||
| Look up costs | |||||||||
| Find a civilian/network provider | |||||||||
| Find a military provider | |||||||||
| Make an appointment | |||||||||
| Look up a toll free phone number | |||||||||
| File a claim | |||||||||
| Check the status of a claim | |||||||||
| Problem with a claim | |||||||||
| Enroll | |||||||||
| Pay Enrollment Fees | |||||||||
| Pharmacy | |||||||||
| Check eligibility | |||||||||
| Update personal information | |||||||||
| Learn about the plans / options | |||||||||
| Look up health information / medical advice | |||||||||
| Other (please explain) | A | ||||||||
| MMM00062 | A | Other | Text field, <100 char | ||||||
| MMM00063 | Where did you first go to find this information? | This web site was the first place I went | Radio button, one-up vertical | Single | Y | ||||
| I went to a different Web site | |||||||||
| I called a toll-free number | |||||||||
| I read a TRICARE brochure or handbook | |||||||||
| I visited a TRICARE Service Center | |||||||||
| I visited a Military Treatment Facility | |||||||||
| Other (please explain) | B | ||||||||
| MMM00064 | B | Other | Text field, <100 char | ||||||
| MMM00389 | Did you create a profile based on your beneficiary category, where you live and which TRICARE plan you’re in? | Yes | Radio button, one-up vertical | Single | |||||
| No | |||||||||
| AED05079 | Did you find what you were looking for on our Web site today? | Yes | |||||||
| No | K, L | ||||||||
| MMM00065 | K | If you did not find what you were looking for, what will you do now? | Try a different Web site | Radio button, one-up vertical | Single | N | |||
| Call a toll-free number | |||||||||
| Read a TRICARE brochure or handbook | |||||||||
| Visit a TRICARE Service Center | |||||||||
| Visit a Military Treatment Facility | |||||||||
| Other | C | ||||||||
| Not applicable | |||||||||
| MMM00066 | C | Please explain what you will do now. | Text field, <100 char | ||||||
| 5926 | L | If you did not find what you were looking for on our Web site, what was it? | Text area, no char limit | N | |||||
| 51492 | What method are you primarily using to locate the information you are looking for? | Search Bar | H | Drop down, select one | Single | Y | SKIP LOGIC GROUP | ||
| Clicking tabs or links | |||||||||
| Site Map | |||||||||
| Other | |||||||||
| ACQOsl0002176 | H | Please describe your experience with the site's search feature? | I had no difficulty using the search feature on this site | Radio button, one-up vertical | Single | No | SKIP LOGIC GROUP | ||
| The search feature was difficult to find | |||||||||
| The search feature was difficult to use | |||||||||
| Returned no results/received an error message | |||||||||
| Could not tell where the search results would take me | |||||||||
| Too many results | |||||||||
| Too few results | |||||||||
| Results were not related to what I was looking for | |||||||||
| Could not sort the results | |||||||||
| Could not refine the results | |||||||||
| Other | |||||||||
| ACQOsl0002177 | H | What key word(s) did you use to search? | Text area, no char limit | No | SKIP LOGIC GROUP | ||||
| ACQOsl0002178 | H | Please indicate how helpful you feel the search feature was in finding the information you wanted/needed? | Very helpful | Radio button, one-up vertical | Single | No | SKIP LOGIC GROUP | ||
| Somewhat helpful | I | ||||||||
| Not at all helpful | I, J | ||||||||
| ACQOsl0002179 | J | Why do you feel the search feature was not at all helpful? | Text area, no char limit | No | SKIP LOGIC GROUP | ||||
| ACQOsl0002180 | I | What would make the search feature more helpful? | Text area, no char limit | No | SKIP LOGIC GROUP | ||||
| MMM00056 | How did you get to our Web site today? | Referred by TRICARE brochure or handbook | Drop down, select one | Single | Y | ||||
| Referred by TRICARE customer service representative | |||||||||
| Typed in the address | |||||||||
| Search engine (such as Google or Yahoo) | |||||||||
| Bookmarks or Favorites | |||||||||
| Link from another Web site | |||||||||
| Other | |||||||||
| 5934 | If you could make one improvement to the site what would that be? | Text area, no char limit | N | ||||||
| MMM00059 | Where are you located? | US (Continental) | Drop down, select one | Single | Y | ||||
| Alaska | |||||||||
| Hawaii | |||||||||
| Pacific | |||||||||
| Latin America | |||||||||
| Canada | |||||||||
| Europe | |||||||||
| Puerto Rico/Virgin Islands | |||||||||
| Other Overseas | |||||||||
Sheet 8: Custom Qsts 10-18-10
| Model Instance Name: | |||||||||
| DOD TRICARE | underlined & italicized: RE-ORDER | ||||||||
| MID: EkBkYwMF5pUhJZssIpM89w== | pink: ADDITION | ||||||||
| Date: | 10/15/2010 | blue + -->: REWORDING | |||||||
| DOD TRICARE 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 | |
| 5923 | How frequently do you visit our site? | First time | Drop down, select one | Single | Y | ||||
| Every 6 months or less | |||||||||
| About once a month | |||||||||
| About once a week | |||||||||
| Daily | |||||||||
| More than once a day | |||||||||
| MMM00067 | Which of the following best describes your role in visiting our site today? | TRICARE beneficiary | E, F, G | Radio button, one-up vertical | Single | Y | |||
| Family, friend or caregiver of TRICARE beneficiary | |||||||||
| Future TRICARE beneficiary | |||||||||
| TRICARE Network Provider or Provider Staff | |||||||||
| TRICARE Non-Network Provider or Provider Staff | |||||||||
| Prospective TRICARE Provider or Provider Staff | |||||||||
| Military Treatment Facility Clinical Staff | |||||||||
| TRICARE Beneficiary Advisors and Customer Service Staff | |||||||||
| All other Military Health System/TRICARE staff (Including government and supporting contractors) | |||||||||
| Media/Researcher | |||||||||
| Other | |||||||||
| 5929 | SKIP E | For TRICARE beneficiaries only- which best describes your status? | Active Duty Service Member | Radio button, one-up vertical | Single | N | |||
| Family of Active Duty Service Member | |||||||||
| Family of Deceased Active Duty Service Member | |||||||||
| National Guard or Reserve Member (Activated) | |||||||||
| Family of National Guard or Reserve Member (Activated) | |||||||||
| National Guard or Reserve member (Non-Activated) | |||||||||
| Family of National Guard or Reserve Member (Non-Activated) | |||||||||
| Retired Service Member | |||||||||
| Family of Retired Service Member | |||||||||
| Family of Deceased Retired Service Member | |||||||||
| Other Beneficiary | |||||||||
| Not Applicable | |||||||||
| MMM00068 | SKIP F | For TRICARE beneficiaries only: which of the following best describes your TRICARE enrollment option? | Sponsor is active duty (no premium paid) | Radio button, one-up vertical | |||||
| Sponsor is active duty and family member has disenrolled from Prime to use TRICARE Standard | Single | N | |||||||
| Sponsor is retired and we pay either $230/individual or $460/family per year | |||||||||
| Sponsor is retired and we pay the Medicare Part B premium; TRICARE for Life | |||||||||
| Sponsor is retired (and we do NOT pay either a TRICARE or Medicare Part B premium; TRICARE Standard) | |||||||||
| Not applicable | |||||||||
| 5928 | SKIP G | For TRICARE beneficiaries only- do you receive most of your care from: | A military clinic or hospital | Radio button, one-up vertical | Single | N | |||
| A civilian clinic or hospital | |||||||||
| Not applicable | |||||||||
| MMM00061 | Which of the following best describes your main reason for visiting our Web site today? | Find out what’s covered | Radio button, one-up vertical | Single | Y | Randomize | |||
| Look up costs | |||||||||
| Find a civilian/network provider | |||||||||
| Find a military provider | |||||||||
| Make an appointment | |||||||||
| Look up a toll free phone number | |||||||||
| File a claim | |||||||||
| Check the status of a claim | |||||||||
| Problem with a claim | |||||||||
| Enroll | |||||||||
| Pay Enrollment Fees | |||||||||
| Pharmacy | |||||||||
| Check eligibility | |||||||||
| Update personal information | |||||||||
| Learn about the plans / options | |||||||||
| Look up health information / medical advice | |||||||||
| Other (please explain) | A | ||||||||
| MMM00062 | A | Other | Text field, <100 char | ||||||
| MMM00063 | Where did you first go to find this information? | This web site was the first place I went | Radio button, one-up vertical | Single | Y | ||||
| I went to a different Web site | |||||||||
| I called a toll-free number | |||||||||
| I read a TRICARE brochure or handbook | |||||||||
| I visited a TRICARE Service Center | |||||||||
| I visited a Military Treatment Facility | |||||||||
| Other (please explain) | B | ||||||||
| MMM00064 | B | Other | Text field, <100 char | ||||||
| MMM00389 | Did you create a profile based on your beneficiary category, where you live and which TRICARE plan you’re in? | Yes | Radio button, one-up vertical | Single | |||||
| No | |||||||||
| AED05079 | Did you find what you were looking for on our Web site today? | Yes | |||||||
| No | K, L | ||||||||
| MMM00065 | SKIP K | If you did not find what you were looking for, what will you do now? | Try a different Web site | Radio button, one-up vertical | Single | N | |||
| Call a toll-free number | |||||||||
| Read a TRICARE brochure or handbook | |||||||||
| Visit a TRICARE Service Center | |||||||||
| Visit a Military Treatment Facility | |||||||||
| Other | C | ||||||||
| Not applicable | |||||||||
| MMM00066 | C | Please explain what you will do now. | Text field, <100 char | ||||||
| 5926 | SKIP L | If you did not find what you were looking for on our Web site, what was it? | Text area, no char limit | N | |||||
| 51492 | What method are you primarily using to locate the information you are looking for? | Search Bar | H | Drop down, select one | Single | Y | SKIP LOGIC GROUP | ||
| Clicking tabs or links | |||||||||
| Site Map | |||||||||
| Other | |||||||||
| ACQOsl0002176 | H | Please describe your experience with the site's search feature? | I had no difficulty using the search feature on this site | Radio button, one-up vertical | Single | No | SKIP LOGIC GROUP | ||
| The search feature was difficult to find | |||||||||
| The search feature was difficult to use | |||||||||
| Returned no results/received an error message | |||||||||
| Could not tell where the search results would take me | |||||||||
| Too many results | |||||||||
| Too few results | |||||||||
| Results were not related to what I was looking for | |||||||||
| Could not sort the results | |||||||||
| Could not refine the results | |||||||||
| Other | |||||||||
| ACQOsl0002177 | H | What key word(s) did you use to search? | Text area, no char limit | No | SKIP LOGIC GROUP | ||||
| ACQOsl0002178 | H | Please indicate how helpful you feel the search feature was in finding the information you wanted/needed? | Very helpful | Radio button, one-up vertical | Single | No | SKIP LOGIC GROUP | ||
| Somewhat helpful | I | ||||||||
| Not at all helpful | I, J | ||||||||
| ACQOsl0002179 | J | Why do you feel the search feature was not at all helpful? | Text area, no char limit | No | SKIP LOGIC GROUP | ||||
| ACQOsl0002180 | I | What would make the search feature more helpful? | Text area, no char limit | No | SKIP LOGIC GROUP | ||||
| MMM00056 | How did you get to our Web site today? | Referred by TRICARE brochure or handbook | Drop down, select one | Single | Y | ||||
| Referred by TRICARE customer service representative | |||||||||
| Typed in the address | |||||||||
| Search engine (such as Google or Yahoo) | |||||||||
| Bookmarks or Favorites | |||||||||
| Link from another Web site | |||||||||
| Other | |||||||||
| 5934 | If you could make one improvement to the site what would that be? | Text area, no char limit | N | ||||||
| MMM00059 | Where are you located? | US (Continental) | Drop down, select one | Single | Y | ||||
| Alaska | |||||||||
| Hawaii | |||||||||
| Pacific | |||||||||
| Latin America | |||||||||
| Canada | |||||||||
| Europe | |||||||||
| Puerto Rico/Virgin Islands | |||||||||
| Other Overseas | |||||||||
Sheet 9: Custom Qsts 08-03-09
| Model Instance Name: | ||||||||
| DOD TRICARE | underlined & italicized: RE-ORDER | |||||||
| MID: EkBkYwMF5pUhJZssIpM89w== | pink: ADDITION | |||||||
| Date: | 11/10/2008 | blue + -->: REWORDING | ||||||
| DOD TRICARE 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 |
| 5923 | How frequently do you visit our site? | First time | Drop down, select one | Single | Y | |||
| Every 6 months or less | ||||||||
| About once a month | ||||||||
| About once a week | ||||||||
| Daily | ||||||||
| More than once a day | ||||||||
| MMM00067 | Which of the following best describes your role in visiting our site today? | TRICARE beneficiary | E, F, G | Radio button, one-up vertical | Single | Y | ||
| Family, friend or caregiver of TRICARE beneficiary | ||||||||
| Future TRICARE beneficiary | ||||||||
| TRICARE Network Provider or Provider Staff | ||||||||
| TRICARE Non-Network Provider or Provider Staff | ||||||||
| Prospective TRICARE Provider or Provider Staff | ||||||||
| Military Treatment Facility Clinical Staff | ||||||||
| TRICARE Beneficiary Advisors and Customer Service Staff | ||||||||
| All other Military Health System/TRICARE staff (Including government and supporting contractors) | ||||||||
| Media/Researcher | ||||||||
| Other | ||||||||
| 5929 | SKIP E | For TRICARE beneficiaries only- which best describes your status? | Active Duty Service Member | Radio button, one-up vertical | Single | N | ||
| Family of Active Duty Service Member | ||||||||
| Family of Deceased Active Duty Service Member | ||||||||
| National Guard or Reserve Member (Activated) | ||||||||
| Family of National Guard or Reserve Member (Activated) | ||||||||
| National Guard or Reserve member (Non-Activated) | ||||||||
| Family of National Guard or Reserve Member (Non-Activated) | ||||||||
| Retired Service Member | ||||||||
| Family of Retired Service Member | ||||||||
| Family of Deceased Retired Service Member | ||||||||
| Other Beneficiary | ||||||||
| Not Applicable | ||||||||
| MMM00068 | SKIP F | For TRICARE beneficiaries only: which of the following best describes your TRICARE enrollment option? | Sponsor is active duty (no premium paid) | Radio button, one-up vertical | ||||
| Sponsor is active duty and family member has disenrolled from Prime to use TRICARE Standard | Single | N | ||||||
| Sponsor is retired and we pay either $230/individual or $460/family per year | ||||||||
| Sponsor is retired and we pay the Medicare Part B premium; TRICARE for Life | ||||||||
| Sponsor is retired (and we do NOT pay either a TRICARE or Medicare Part B premium; TRICARE Standard) | ||||||||
| Not applicable | ||||||||
| 5928 | SKIP G | For TRICARE beneficiaries only- do you receive most of your care from: | A military clinic or hospital | Radio button, one-up vertical | Single | N | ||
| A civilian clinic or hospital | ||||||||
| Not applicable | ||||||||
| MMM00061 | Which of the following best describes your main reason for visiting our Web site today? | Find out what’s covered | Radio button, one-up vertical | Single | Y | |||
| Look up costs | ||||||||
| Find a civilian/network provider | ||||||||
| Find a military provider | ||||||||
| Make an appointment | ||||||||
| Look up a toll free phone number | ||||||||
| File a claim | ||||||||
| Check the status of a claim | ||||||||
| Problem with a claim | ||||||||
| Enroll | ||||||||
| Pay Enrollment Fees | ||||||||
| Pharmacy | ||||||||
| Check eligibility | ||||||||
| Update personal information | ||||||||
| Learn about the plans / options | ||||||||
| Look up health information / medical advice | ||||||||
| Other (please explain) | A | |||||||
| MMM00062 | A | Other | Text field, <100 char | |||||
| MMM00063 | Where did you first go to find this information? | This web site was the first place I went | Radio button, one-up vertical | Single | Y | |||
| I went to a different Web site | ||||||||
| I called a toll-free number | ||||||||
| I read a TRICARE brochure or handbook | ||||||||
| I visited a TRICARE Service Center | ||||||||
| I visited a Military Treatment Facility | ||||||||
| Other (please explain) | B | |||||||
| MMM00064 | B | Other | Text field, <100 char | |||||
| MMM00389 | Did you create a profile based on your beneficiary category, where you live and which TRICARE plan you’re in? | Yes | Radio button, one-up vertical | Single | ||||
| No | ||||||||
| AED05079 | Did you find what you were looking for on our Web site today? | Yes | ||||||
| No | H, I | |||||||
| MMM00065 | SKIP H | If you did not find what you were looking for, what will you do now? | Try a different Web site | Radio button, one-up vertical | Single | N | ||
| Call a toll-free number | ||||||||
| Read a TRICARE brochure or handbook | ||||||||
| Visit a TRICARE Service Center | ||||||||
| Visit a Military Treatment Facility | ||||||||
| Other | C | |||||||
| Not applicable | ||||||||
| MMM00066 | C | Please explain what you will do now. | Text field, <100 char | |||||
| 5926 | SKIP I | If you did not find what you were looking for on our Web site, what was it? | Text area, no char limit | N | ||||
| 51492 | What method are you primarily using to locate the information you are looking for? | Search Bar | Drop down, select one | Single | Y | |||
| Clicking tabs or links | ||||||||
| Site Map | ||||||||
| Other | ||||||||
| MMM00056 | How did you get to our Web site today? | Referred by TRICARE brochure or handbook | Drop down, select one | Single | Y | |||
| Referred by TRICARE customer service representative | ||||||||
| Typed in the address | ||||||||
| Search engine (such as Google or Yahoo) | ||||||||
| Bookmarks or Favorites | ||||||||
| Link from another Web site | ||||||||
| Other | ||||||||
| 5934 | If you could make one improvement to the site what would that be? | Text area, no char limit | N | |||||
| MMM00059 | Where are you located? | US (Continental) | Drop down, select one | Single | Y | |||
| Alaska | ||||||||
| Hawaii | ||||||||
| Pacific | ||||||||
| Latin America | ||||||||
| Canada | ||||||||
| Europe | ||||||||
| Puerto Rico/Virgin Islands | ||||||||
| Other Overseas | ||||||||
| NOTE: Following questions do not appear on survey. | ||||||||
| MMM00060 | Have you done any of the following activities in the past 90 days? | Applied for a job online | Multi | Y | ||||
| Listed an item to sell in an online auction or online classified ad | ||||||||
| Made a purchase online | ||||||||
| Managed personal finances online | ||||||||
| Researched a major purchase item online | ||||||||
| None of these | ||||||||
| MMM00057 | What is your gender? | Male | Single | Y | ||||
| Female | ||||||||
| MMM00058 | What is your age? | Less than 18 | Single | Y | ||||
| 18 to 24 | ||||||||
| 25 to 34 | ||||||||
| 35 to 44 | ||||||||
| 45 to 64 | ||||||||
| 65 and better | ||||||||
Sheet 10: Current Custom Qsts 11-14-08
| Model Instance Name: | ||||||||
| DOD TRICARE | underlined & italicized: RE-ORDER | |||||||
| MID: EkBkYwMF5pUhJZssIpM89w== | pink: ADDITION | |||||||
| Date: | 11/10/2008 | blue + -->: REWORDING | ||||||
| DOD TRICARE 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 |
| 5923 | How frequently do you visit our site? | First time | Drop down, select one | Single | Y | |||
| Every 6 months or less | ||||||||
| About once a month | ||||||||
| About once a week | ||||||||
| Daily | ||||||||
| More than once a day | ||||||||
| MMM00067 | Which of the following best describes your role in visiting our site today? | TRICARE beneficiary | E, F, G | Radio button, one-up vertical | Single | Y | ||
| Family, friend or caregiver of TRICARE beneficiary | ||||||||
| Future TRICARE beneficiary | ||||||||
| TRICARE Network Provider or Provider Staff | ||||||||
| TRICARE Non-Network Provider or Provider Staff | ||||||||
| Prospective TRICARE Provider or Provider Staff | ||||||||
| Military Treatment Facility Clinical Staff | ||||||||
| TRICARE Beneficiary Advisors and Customer Service Staff | ||||||||
| All other Military Health System/TRICARE staff (Including government and supporting contractors) | ||||||||
| Media/Researcher | ||||||||
| Other | ||||||||
| 5929 | SKIP E | For TRICARE beneficiaries only- which best describes your status? | Active Duty Service Member | Radio button, one-up vertical | Single | N | ||
| Family of Active Duty Service Member | ||||||||
| Family of Deceased Active Duty Service Member | ||||||||
| National Guard or Reserve Member (Activated) | ||||||||
| Family of National Guard or Reserve Member (Activated) | ||||||||
| National Guard or Reserve member (Non-Activated) | ||||||||
| Family of National Guard or Reserve Member (Non-Activated) | ||||||||
| Retired Service Member | ||||||||
| Family of Retired Service Member | ||||||||
| Family of Deceased Retired Service Member | ||||||||
| Other Beneficiary | ||||||||
| Not Applicable | ||||||||
| MMM00068 | SKIP F | For TRICARE beneficiaries only: which of the following best describes your TRICARE enrollment option? | Sponsor is active duty (no premium paid) | Radio button, one-up vertical | ||||
| Sponsor is active duty and family member has disenrolled from Prime to use TRICARE Standard | Single | N | ||||||
| Sponsor is retired and we pay either $230/individual or $460/family per year | ||||||||
| Sponsor is retired and we pay the Medicare Part B premium; TRICARE for Life | ||||||||
| Sponsor is retired (and we do NOT pay either a TRICARE or Medicare Part B premium; TRICARE Standard) | ||||||||
| Not applicable | ||||||||
| 5928 | SKIP G | For TRICARE beneficiaries only- do you receive most of your care from: | A military clinic or hospital | Radio button, one-up vertical | Single | N | ||
| A civilian clinic or hospital | ||||||||
| Not applicable | ||||||||
| MMM00061 | Which of the following best describes your main reason for visiting our Web site today? | Find out what’s covered | Radio button, one-up vertical | Single | Y | |||
| Look up costs | ||||||||
| Find a civilian/network provider | ||||||||
| Find a military provider | ||||||||
| Make an appointment | ||||||||
| Look up a toll free phone number | ||||||||
| File a claim | ||||||||
| Check the status of a claim | ||||||||
| Problem with a claim | ||||||||
| Enroll | ||||||||
| Pay Enrollment Fees | ||||||||
| Check eligibility | ||||||||
| Update personal information | ||||||||
| Learn about the plans / options | ||||||||
| Look up health information / medical advice | ||||||||
| Other (please explain) | A | |||||||
| A | Other | Text field, <100 char | ||||||
| MMM00063 | Where did you first go to find this information? | This web site was the first place I went | Radio button, one-up vertical | Single | Y | |||
| I went to a different Web site | ||||||||
| I called a toll-free number | ||||||||
| I read a TRICARE brochure or handbook | ||||||||
| I visited a TRICARE Service Center | ||||||||
| I visited a Military Treatment Facility | ||||||||
| Other (please explain) | B | |||||||
| MMM00064 | B | Other | Text field, <100 char | |||||
| MMM00389 | Did you create a profile based on your beneficiary category, where you live and which TRICARE plan you’re in? | Yes | Radio button, one-up vertical | Single | ||||
| No | ||||||||
| NEW | Did you find what you were looking for on our Web site today? | Yes | ||||||
| No | H, I | |||||||
| MMM00065 | SKIP H | If you did not find what you were looking for, what will you do now? | Try a different Web site | Radio button, one-up vertical | Single | N | ||
| Call a toll-free number | ||||||||
| Read a TRICARE brochure or handbook | ||||||||
| Visit a TRICARE Service Center | ||||||||
| Visit a Military Treatment Facility | ||||||||
| Other (please explain) | C | |||||||
| Not applicable | ||||||||
| MMM00066 | C | Please explain what you will do now. | Text field, <100 char | |||||
| 5926 | SKIP I | If you did not find what you were looking for on our Web site, what was it? | Text area, no char limit | N | ||||
| 51492 | What method are you primarily using to locate the information you are looking for? | Search Bar | Drop down, select one | Single | Y | |||
| Clicking tabs or links | ||||||||
| Site Map | ||||||||
| Other | ||||||||
| MMM00056 | How did you get to our Web site today? | Referred by TRICARE brochure or handbook | Drop down, select one | Single | Y | |||
| Referred by TRICARE customer service representative | ||||||||
| Typed in the address | ||||||||
| Search engine (such as Google or Yahoo) | ||||||||
| Bookmarks or Favorites | ||||||||
| Link from another Web site | ||||||||
| Other | ||||||||
| 5934 | If you could make one improvement to the site what would that be? | Text area, no char limit | N | |||||
| MMM00059 | Where are you located? | US (Continental) | Drop down, select one | Single | Y | |||
| Alaska | ||||||||
| Hawaii | ||||||||
| Pacific | ||||||||
| Latin America | ||||||||
| Canada | ||||||||
| Europe | ||||||||
| Puerto Rico/Virgin Islands | ||||||||
| Other Overseas | ||||||||
| NOTE: Following questions do not appear on survey. | ||||||||
| MMM00060 | Have you done any of the following activities in the past 90 days? | Applied for a job online | Multi | Y | ||||
| Listed an item to sell in an online auction or online classified ad | ||||||||
| Made a purchase online | ||||||||
| Managed personal finances online | ||||||||
| Researched a major purchase item online | ||||||||
| None of these | ||||||||
| MMM00057 | What is your gender? | Male | Single | Y | ||||
| Female | ||||||||
| MMM00058 | What is your age? | Less than 18 | Single | Y | ||||
| 18 to 24 | ||||||||
| 25 to 34 | ||||||||
| 35 to 44 | ||||||||
| 45 to 64 | ||||||||
| 65 and better | ||||||||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |
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