940 2015 940 ACA Employer
E-Government Website Customer Satisfaction Surveys
2015 940 ACA Employer.xlsx
2015 939 ACA AIR Readiness - 2015 942 NIJ v3
OMB: 1090-0008
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1090-0008 can be found here:
Document [xlsx]
Download: xlsx | pdf
Model Qsts
Current CQs
Overview
Welcome and Thank You TextModel Qsts
Current CQs
Sheet 1: Welcome and Thank You Text
|
||||||
| Welcome and Thank You Text | ||||||
| Welcome Text | Thank You Text | |||||
| Thank you for visiting the Affordable Care Act (ACA) Tax Provisions section of the IRS.gov website. You have been selected at random to take part in a survey conducted by ForeSee on behalf of the Internal Revenue Service. Your opinions will help the IRS provide the types of information and services that you need and want. Your participation is voluntary and your responses to the survey are strictly private and will remain anonymous, therefore we do not collect any information which would enable us to respond to any inquiries. The IRS receives only compiled data, which does not allow for the identification of any individual. The IRS is committed to protecting your privacy as you take this survey, and whenever you visit the IRS website. Please do NOT provide any personal identification information such as your Name, Social Security Number, Taxpayer Identification Number, Telephone Number, E-Mail Address, or Street Address in the "comments" sections of this questionnaire. The IRS is NOT able to respond to tax or personal related inquiries that are submitted through this survey. |
Thank you very much for completing this survey. All answers and comments will be used by the IRS to help serve you better. |
|||||
| Welcome Text - Alternate | Thank You Text - Alternate | |||||
Please note you will not receive a response from us based on your survey comments. If you would like us to contact you about your feedback, please visit the Contact Us section of our web site. |
||||||
|
|
|||||
Sheet 2: Model Qsts
| Model Name ACA Employer Survey |
|
|||||||
| Model ID | Underlined & Italicized: Re-order | |||||||
| Partitioned No | Pink: Addition | |||||||
| Date (9/2/2015) | Blue: Reword | |||||||
| Label | Satisfaction Questions | Label | Future Behaviors | |||||
| Satisfaction | Return (1=Very Unlikely, 10=Very Likely) | |||||||
| Satisfaction - Overall | What is your overall satisfaction with the Employer-Related ACA section of the IRS.gov website? (1=Very Dissatisfied, 10=Very Satisfied) |
Return | How likely are you to return to the Employer-Related ACA section of the IRS.gov website? | |||||
| Satisfaction - Expectations | How well does the Employer-Related ACA section of the IRS.gov website meet your expectations? (1=Falls Short, 10=Exceeds) |
Recommend (1=Very Unlikely, 10=Very Likely) | ||||||
| Satisfaction - Ideal | How does the Employer-Related ACA section of the IRS.gov compare to your idea of an ideal website? (1=Not Very Close, 10=Very Close) |
Recommend Site | How likely are you to recommend the Employer-Related ACA section of the IRS.gov website to someone else? | |||||
| Primary Resource (1=Very Unlikely, 10=Very Likely) | ||||||||
| Primary Resource | How likely are you to use the IRS.gov website as your primary resource for all Employer-Related ACA information? | |||||||
Sheet 3: Current CQs
| Model Name ACA Employer Survey |
|
||||||||
| Model ID | Underlined & Italicized: Re-order | ||||||||
| Partitioned No | Pink: Addition | ||||||||
| Date (9/11/2015) | Blue: Reword | ||||||||
| QID | QUESTION META TAG | Skip From | Question Text | Answer Choices | Skip To | Required Y/N |
Type | Special Instructions | CQ Label |
| Role | Which category best describes you? Are you …? | Employer with generally fewer than 50 FTE - includes tax-exempt employer | Y | Radio button, one-up vertical | Skip Logic Group* | Role | |||
| Applicable Large Employer “ALE” (i.e., business/government agency with 50 or more FTE employees) | A,B | ||||||||
| Health Insurance Issuer/Carrier | C | ||||||||
| Government Sponsored Insurance | D | ||||||||
| Tax Return Preparer or Payroll or Other Service Provider | |||||||||
| Software developer or Transmitter | |||||||||
| Other | E | ||||||||
| A | If ALE, are you: | Local/State Government Employer | Y | Radio button, one-up vertical | Skip Logic Group* | ALE | |||
| Indian Tribal Government Employer | |||||||||
| Federal Government Employer | |||||||||
| None of the above | |||||||||
| B | If ALE, are you also: | Self-insured (i.e. sponsors self-insured group health plans) | Y | Radio button, one-up vertical | Skip Logic Group* | ALE insured | |||
| Not self-insured | |||||||||
| C | If Health Care Insurance Issuer/Carrier, are you: | Non-Profit | Y | Radio button, one-up vertical | Skip Logic Group* | Health care | |||
| For-Profit | |||||||||
| D | If Government Sponsored Insurance, are you: | State Medicaid/CHIP Agency | Y | Radio button, one-up vertical | Skip Logic Group* | Gov Insurance | |||
| Medicare | |||||||||
| Tricare | |||||||||
| E | Please specify what best describes you. | N | Text field, <100 char | Skip Logic Group* | Other role | ||||
| Visit Frequency | How frequently do you visit the Employer-Related ACA section of the IRS.gov website? | This is my first time | Y | Drop down, select one | Frequency | ||||
| Daily | |||||||||
| Weekly | |||||||||
| Monthly | |||||||||
| Every couple of months | |||||||||
| How many Full Time or FTE equivalent employees does your business have? | 0-49 | Y | Drop down, select one | # of employees | |||||
| Between 50-499 | |||||||||
| Between 500-1,999 | |||||||||
| Between 2,000-4,999 | |||||||||
| Between 5,000-9,999 | |||||||||
| 10,000 or more | |||||||||
| Please indicate how many states your business operates in? | One | Y | Drop down, select one | # of states | |||||
| Between 2-5 | |||||||||
| Between 6-10 | |||||||||
| Between 11-20 | |||||||||
| Over 20 states | |||||||||
| Primary Reason: Federal Government or Informational Non-Profit | What are the main topics you were looking for on the Employer-Related ACA section of the IRS.gov website today? (Choose all that apply) | Determining ALE status | Y | Checkbox, one-up vertical | Skip Logic Group* | Main topics | |||
| Health care coverage questions (i.e., determining eligibility and affordability) | |||||||||
| Transition relief from Tax Year 2015 filing requirements/penalties | |||||||||
| Filing requirements, instructions, or publications | |||||||||
| ACA Information reporting requirements | |||||||||
| Calculating Full Time Employee status | |||||||||
| Employer Shared Responsibility Payment FAQs | |||||||||
| How to contact the IRS about my Employer Shared Responsibility Payment Assessment (Preliminary Letter) | |||||||||
| Legal guidance, ACA Regulations, and other resources | |||||||||
| Small Business Health Care Tax Credit/Small Business Health Options Program (SHOP) | |||||||||
| Other | |||||||||
| Accomplish | Did you find the information you were looking for? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | Find info | |||
| No | A | ||||||||
| Partially | A | ||||||||
| OE_Accomplish | A | Please tell us in as much detail as possible what specifically were you trying to find today? | No info found | ||||||
| Based on the guidance you have received from the Employer-Related ACA website, please rate how confident you are in knowing what to do for each of the following requirements. Requirements for Information Reporting (1095-B or 1095-C) to the IRS |
1=Not at all confident | Y | Drop down, select one | Multiple Lists Group* | Confidence Reporting | ||||
| 2 | |||||||||
| 3=Somewhat confident | |||||||||
| 4 | |||||||||
| 5=Extremely confident | |||||||||
| Unsure | |||||||||
| The Quality of the employee data you will be reporting to IRS on your 1094/1095 forms | 1=Not at all confident | Y | Drop down, select one | Multiple Lists Group* | Confidence Quality | ||||
| 2 | |||||||||
| 3=Somewhat confident | |||||||||
| 4 | |||||||||
| 5=Extremely confident | |||||||||
| Unsure | |||||||||
| Calculating Full Time Employee status | 1=Not at all confident | Y | Drop down, select one | Multiple Lists Group* | Confidence Calculating | ||||
| 2 | |||||||||
| 3=Somewhat confident | |||||||||
| 4 | |||||||||
| 5=Extremely confident | |||||||||
| Unsure | |||||||||
| Thinking about the planning and preparation needed for the ACA employer requirements, please rate how ready your organization is to fulfill each of the following. Requirements for Information Reporting (1095b or 1095c) to the IRS |
1=Not at all ready | Y | Drop down, select one | Multiple Lists Group* | Readiness Reporting | ||||
| 2= In process, partially ready | |||||||||
| 3=Completely ready | |||||||||
| Don't know | |||||||||
| The Quality of the employee data you will be reporting to IRS on your 1094/1095 forms | 1=Not at all ready | Y | Drop down, select one | Multiple Lists Group* | Readiness Quality | ||||
| 2= In process, partially ready | |||||||||
| 3=Completely ready | |||||||||
| Don't know | |||||||||
| Calculating Full Time Employee status | 1=Not at all ready | Y | Drop down, select one | Multiple Lists Group* | Readiness Calculating | ||||
| 2= In process, partially ready | |||||||||
| 3=Completely ready | |||||||||
| Don't know | |||||||||
| OE_Improve Experience | What could IRS do to improve the Employer-Related ACA section to better meet your needs? | N | Text area, no char limit | Improve Employer ACA | |||||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |
© 2024 OMB.report | Privacy Policy