Form 977 2015 977 CQs for OMB - 6-9-16

Measures Name/Client name (CQs and Answer choices)
SBA Learning Center Feedback/Small Business Administration	What topic were you looking to learn more about? (check all that apply)	Starting a Business
		Managing a Business
		Financing
		Marketing
		Government Contracting
		Other topic
		Just browsing
	Did you download a worksheet or checklist?	Yes
		No
		Course did not include a worksheet/checklist
	Please tell us why you did not download the course worksheet/checklist.
	With which SBA funded program are you affiliated?	SBDC
		WBC
		SCORE
		VBOC
		SBA
		Other
		None of the above
	Other organization (please list)
	What is your primary role within your organization?	Business Counselor, Mentor, or Advisor
		District, Center, or Chapter Director or other leadership position
		SBA Business Development Specialist or equivalent position
		Other
	Other primary role (please list)
	What topic were you looking to learn more about? (check all that apply)	Capital
		Contracting
		Counseling
		Disaster
		Other topic
		Just browsing
Research.gov Satisfaction Survey V2/NSF Research	What is your purpose in visiting Research.gov today? (Please check all that apply)	Create, edit and submit project reports for my NSF awards
		Deposit or manage publications (NSF Public Access Repository (NSF-PAR))
		Perform cash management and financial functions for my NSF awards
		Create and submit notifications and requests
		Check proposal status
		Add users and/or manage roles
		Find information about federally funded research
		Submit images or videos
		Other
	Which Research.gov services did you access today? (Please check all that apply)	Project Reports
		Deposit or Manage Publications (NSF Public Access Repository (NSF-PAR))
		Award Cash Management $ervice
		Research Spending & Results
		Application Submission Web Services
		Proposal Status
		Notification & Requests
		User Management
		Submit Image/Video
		Other
	Were you able to accomplish what you came to the site to do?	Yes
		Partially
		Just browsing
		No
	What were you unable to accomplish?
	Since you were not able to accomplish everything you came to the site for, what will you do next?	Nothing, although I did not find/complete what I wanted
		Call NSF
		Email Research.gov
		Use Research.gov's Live Chat
		Return to Research.gov web site later and try again
		Ask a colleague
		Other
	Please briefly describe, 1) where on the site you experienced technical difficulties and, 2) what type of technical difficulties you experienced.
	Since you did not find everything you were looking for, what will you do next?	Nothing, although I did not find/complete what I wanted
		Call NSF
		Email Research.gov
		Use Research.gov's Live Chat
		Return to Research.gov web site later and try again
		Ask a colleague
		Other
	What else will you do next?
CMS - Palmetto GBA JM MAC/CMS	We recently redesigned our website. How does the new website compare to the previous design?	Better than the previous website
		Same as the previous website
		Worse than the previous website
		Didn't notice the change
	Please tell us why you feel the new design is better than the previous website.
	Please tell us why you feel the new design is worse than the previous website.
IRS ACA AIR Survey/U.S. Department of Treasury - Internal Revenue Service	Which category best describes you? Are you a(n)…?	Applicable Large Employer “ALE” with 50 or more "full-time employees" (Non-Governmental)
		Applicable Large Employer "ALE" (Governmental-federal, state, local, Indian tribal)
		Health Insurance Provider (Non-Profit or For-Profit)
		Government Sponsored Insurance (e.g., Medicaid/CHIP, Medicare, Tricare, veterans' health coverage)
		Software developer
		Transmitter
		Other
ABMC v2/American Battle Monuments Commission	Did you complete any of the following actions while using the database today? (Select all that apply)	I downloaded search results to an Excel file
		I printed a certificate
		I shared information via social media or email about a person in the database
		None of the above
	What search terms did you initially use? (Select all that apply)	First name
		Last name
		Service #
		Unit
		Entered Service From
		Cemetery/Memorial
		Branch of Service
		Keyword
		War/Conflict
		Date of Death
		Medal of Honor Recipient
		Missing in Action (MIA)
		Other
myUSCIS/US Dept of Homeland Security - myUSCIS	Please complete this sentence: I am visiting this site as a …	U.S. citizen by birth
		Naturalized U.S. citizen
		Permanent resident (Green Card holder)
		Conditional resident
		Temporary worker/nonimmigrant
		Student or exchange visitor
		Visitor to the USA
		Other
	Did the names of the tools you used today help you understand the tools?	Very helpful
		Helpful
		Somewhat helpful
		Not at all helpful
	Which of the following tools on this site did you use today? Please check all that apply.	Ask a Question, Get a Trusted Answer (search tool)
		Find immigration options/explore my options
		Check your case status online
		Find a doctor
		Emma (chat feature)
		Online change of address
		Civics practice test
		Find an English or citizenship preparation class
		Other
VA eBenefits/U.S. Department of Veterans Affairs	How did you look for information on the site today? (Check all that apply)	Search feature
		Top navigation bar
		Left navigation bar
		Links in the main body of the page
		National Resource Directory section
		Other
	Other way you looked for information:
	Which of these method(s) led you to the information you were looking for?	Search feature
		Top navigation bar
		Left navigation bar
		Links in the main body of the page
		National Resource Directory section
		Other
		None of these
		Don't recall
	Other method(s) that led you to your information:
	How would you describe your navigation experience on this site today? (Check all that apply)	I had no difficulty navigating this site
		Links often did not take me where I expected
		Had difficulty finding relevant information
		Links/labels are difficult to understand
		Too many links/navigational options to choose from
		Had technical difficulties (error messages, broken links, etc.)
		Could not navigate back to previous information
		I had a navigation difficulty not listed above:
	Other navigation difficulty:
	Please describe the way one or more links took you somewhere unexpected. (Check all that apply)	Link(s) unexpectedly took me outside the eBenefits site
		Link(s) unexpectedly took me outside the VA altogether
		Link(s) took me to a page within eBenefits I was not expecting (e.g., I expected the link would take me somewhere other than where it did)
		Other
	Other way one or more links took you somewhere unexpected:
VA - My HealtheVet V2/U.S. Department of Veterans Affairs	Please tell us more about your experience logging in. (Please select all that apply)	My login information wasn't recognized/site would not accept my login information
		I was unable to register
		I forgot my username and was unable to retrieve it (e.g., retrieval process did not work, I was not aware there was a retrieval process)
		I forgot my password and was unable to retrieve it (e.g., retrieval process did not work, I was not aware there was a retrieval process)
		I entered my username and/or password incorrectly
	What types of medical care do you receive from VA? (Please select all that apply)	Primary care
		Specialty care (e.g., cardiology, orthopedics, etc.)
		Emergency care
		Behavioral health care (e.g., mental health, drug or alcohol treatment, PTSD, brain injury)
		Home health care (e.g., visiting nurse, home health aide)
		Hospital-based care
		Prefer not to answer
		Other
	What other type of care do you receive from VA?
	How much time does it take for you to travel to the VA location where you receive care?	Less than 30 minutes
		30-60 minutes
		61-90 minutes
		91 minutes to 2 hours
		Over 2 hours
	Do you get care from any health care providers in the community who are not part of VA (community non-VA providers)?	Yes
		No
		Not sure
	What types of medical care do you receive from community non-VA providers? (Please select all that apply)	Primary care
		Specialty care (e.g., cardiology, orthopedics, etc.)
		Emergency care
		Behavioral health care (e.g., mental health, drug or alcohol treatment, PTSD, brain injury)
		Home health care (e.g., visiting nurse, home health aide)
		Hospital-based care
		Prefer not to answer
		Other
	What other type of care do you receive from community non-VA providers?
	Does VA pay for the care you receive from community non-VA providers?	Yes, VA pays for ALL of the care I receive from my community non-VA providers.
		Yes, VA pays for SOME of the care I receive from community non-VA providers.
		No, VA does NOT pay for any of the care I receive from community non-VA providers.
		Not sure
	Thinking about the past 2 years, when receiving care for a medical problem: In the past 2 years, was there EVER a time when previous test results or your medical records from one organization were not available at the time of your scheduled medical care appointment at another organization?	Yes
		No
		Not sure
	In the past 2 years, was there EVER a time when your health care provider(s) ordered a medical test that you felt was unnecessary because the test was ordered/completed by your other health care provider?	Yes
		No
		Not sure
	In the past 2 years, was there EVER a time when you received information from your VA provider or community non-VA provider that conflicted?	Yes
		No
		Not sure
	To coordinate your care, it is important for health information to be shared between all your healthcare providers. In some locations, VA has connected with non-VA health care organizations to share medical record information electronically for medical treatment. If you had a choice, which of the following options would you most prefer when it comes to permission needed to have your VA health information shared electronically with community non-VA providers for medical care?	Share my VA information automatically unless I say not to share it
		Share my VA information only after I provide my consent
		Share my VA information automatically in case of emergency, but otherwise do not share unless I provide consent
	Please indicate your agreement with the following statements: I am comfortable with my medical records being shared electronically between VA and community non-VA providers for treatment.	Strongly disagree
		Disagree
		Neither agree nor disagree
		Agree
		Strongly agree
	I would like to use a mobile application (‘app’) or device to share my VA health information with community non-VA providers.	Strongly disagree
		Disagree
		Neither agree nor disagree
		Agree
		Strongly agree
	I prefer that my VA providers and community non-VA providers are responsible for sharing my health information with each other (i.e., other than providing consent, I do not need to be involved in sharing my health information).	Strongly disagree
		Disagree
		Neither agree nor disagree
		Agree
		Strongly agree
	There may be parts of my VA medical record that I would not want to share with community non-VA providers (and vice versa).	Strongly disagree
		Disagree
		Neither agree nor disagree
		Agree
		Strongly agree
	What types of information would you not want shared between providers if it was in your medical record? (Please select all that apply)	Lab test results
		List of medical conditions
		Medications
		Mental health information (e.g., PTSD, depression)
		Alcohol or drug use information
		Military service information
		Reproductive health information
		HIV treatment or testing information
		Other
	What other types of information would you not want shared between providers?
	I want to share my VA health information such as my medication list, or notes from medical visits, with family members or other informal care givers.	Strongly disagree
		Disagree
		Neither agree nor disagree
		Agree
		Strongly agree
	I want to review my VA health information when meeting with my community non-VA providers.	Strongly disagree
		Disagree
		Neither agree nor disagree
		Agree
		Strongly agree
	I prefer to be the only one responsible for sharing information between my VA and community non-VA providers.	Strongly disagree
		Disagree
		Neither agree nor disagree
		Agree
		Strongly agree
	I am confident that if my health information is available electronically to others for medical care, it will be secure and protected from being viewed by individuals that should not have access to my health information.	Strongly disagree
		Disagree
		Neither agree nor disagree
		Agree
		Strongly agree
	Are you aware of the “Connect Your Docs” or Virtual Lifetime Electronic Record (VLER) Health Information Exchange program where, with your consent, VA can share your VA medical record information with community non-VA partners?	Yes
		No
		Not sure
	How did you learn about “Connect your Docs”/ Virtual Lifetime Electronic Record (VLER) Health Information Exchange program? (Please select all that apply)	Received information in the mail
		Learned about it from the My HealtheVet website
		Learned about it from the eBenefits website
		VA staff told me about it
		Learned about it from another Veteran
		Received information at a VA patient orientation
		Learned about it when enrolling for benefits
		Other
	How else did you learn about "Connect your Docs"/ Virtual Lifetime Electronic Record (VLER) Health Information Exchange program?
	Are you aware that you can provide your consent/authorization online for the "Connect your Docs"/Virtual Lifetime Electronic Record (VLER) Health Information Exchange program through eBenefits?	Yes
		No
		Not sure
		I have not heard of eBenefits
	Have you ever provided your consent to participate in the “Connect your Docs”/Virtual Lifetime Electronic Record (VLER) Health Exchange program?	Yes
		No
		Not sure
	Please share why you have not provided your consent. (Please select all that apply)	I do not know how to provide my consent for the program.
		I need to learn more about this program first.
		There are some parts of my medical record I do not want shared with others.
		I do not want my VA health information to be part of a health information exchange.
		I am not certain my health information is protected if it is part of a health information exchange.
		Other
	Why else have you not provided your consent?
	My HealtheVet offers VA patients the option to download a VA Health Summary using a feature called Blue Button. The VA Health Summary contains a summary of information from your VA medical record, such as medications, allergies, and recent lab test results. It can then be shared with others involved with your health care. Are you aware of the VA Health Summary?	Yes
		No
		Not sure
	Have you used My HealtheVet to access your VA Health Summary?	Yes
		No
		Not sure
		I tried to access my VA Health Summary, but was unable to view it
	How did you use your VA Health Summary? (Please select all that apply)	I saved it for my records
		I read it
		I printed it
		I shared it (or plan to share it) with my community non-VA health care provider
		I shared it (or plan to share it/review it) with my VA health care provider
		I shared it (or plan to share it) with my spouse, child, or other family member, friend, or informal caregiver
		Other
	How else did you use your VA Health Summary?
	How would you like VA to provide more information about your options for health information exchange such as the "Connect the Docs" program or the VA Health Summary in My HealtheVet? (Please select all that apply)	Send information in the mail
		Include information on the My HealtheVet homepage
		Have my provider discuss these programs with me
		Have VA support staff provide me this information by phone
		Have VA support staff provide me this information at my next VA appointment
		Have Veterans educate me through Veteran Service Organizations or other Veteran outreach groups
		Provide information about this through a web link or through YouTube videos
		I am not interested in information about Connect Your Docs or the VA Health Summary
		Other
	How else would you like VA to provide more information about your options for health information exchange?
	Please rate your ability in using the Internet:	Beginner or novice (just starting/don't use Internet much)
		Intermediate (use the Internet for a few things)
		Advanced (frequently use Internet and search for information)
	Do you have a DS Logon Premium account?	Yes
		No
		Not sure
	Which categories best describe you? (Please select all that apply)	White
		Hispanic, Latino(a), or Spanish origin
		Black or African American
		Asian
		American Indian or Alaska Native
		Middle Eastern or North African
		Native Hawaiian or other Pacific Islander
		Other race, ethnicity, or origin
		Prefer not to answer
	Do you have (or have you ever had) any of the following health conditions? (Please select all that apply)	Arthritis of any kind (e.g., rheumatoid, osteoarthritis, degenerative arthritis)
		Cancer of any kind
		Chronic pain
		Diabetes
		Heart problems (e.g., heart attack, coronary artery disease, heart failure)
		High cholesterol
		High blood pressure
		Lung problems (including asthma)
		Mental health/psychiatric condition (e.g., anxiety, depression, PTSD)
		Neurological disorders (e.g., stroke, Parkinson's disease, traumatic brain injury)
		Stomach/gastrointestinal problems
		Other
		Prefer not to answer
	What other health condition do you or have you had?
CIA Careers Mobile/Central Intelligence Agency	Separate from cia.gov/careers, what site do you primarily use for your job/internship search?	USAJOBS.gov
		Indeed
		Monster
		Career Builder
		Dice
		LinkedIn
		Glassdoor
		SimplyHired
		CollegeRecruiter
		Other, please specify:
		None of these
	Other primary career site:
	How does the search process on cia.gov/careers compare to your primary job/internship search site?	Much Worse
		Somewhat Worse
		About the Same
		Somewhat Better
		Much Better
	What is your primary reason for not using the Job Fit Tool?	I couldn't find it
		I did not need to use it during this visit
		I had technical difficulties when I tried to use it
		Other, please specify:
	Please specify why you did not use the Job Fit Tool:
	Did you find the information you were looking for on the site today?	Yes
		No
CIA Careers site V2/Central Intelligence Agency	Separate from cia.gov/careers, what site do you primarily use for your job/internship search?	USAJOBS.gov
		Indeed
		Monster
		Career Builder
		Dice
		LinkedIn
		Glassdoor
		SimplyHired
		CollegeRecruiter
		Other, please specify
		None of these
	Other primary career site:
	How does the search process on cia.gov/careers compare to your primary job/internship search site?	Much Worse
		Somewhat Worse
		About the Same
		Somewhat Better
		Much Better
	What is your primary reason for not using the Job Fit Tool?	I couldn't find it
		I did not need to use it during this visit
		I had technical difficulties when I tried to use it
		Other, please specify:
	Please specify why you did not use the Job Fit Tool:
Smithsonian Enterprise/Smithsonian	What was your primary purpose in coming to the website today?	Plan a museum or zoo visit
		Follow-up after a visit
		Conduct research
		Do my homework For school work
		Education Find information for my students
		Entertainment For general interest and/or entertainment
		Make a donation
		Become a member
		To join or support the Smithsonian
		Find a job or internship
		Shop
		View the Zoo Cams
		Book a vacation (via Smithsonian Journeys)
		Other, (please specify):
	Other purpose for coming to the website:
	Please indicate which parts of the Smithsonian you are interested in. (Select all that apply.)	African American History and Culture Museum
		African Art Museum
		Air and Space Museum
		Air and Space Museum Udvar-Hazy Center (Virginia)
		American Art Museum
		American History Museum
		American Indian Museum (Washington, D.C.)
		American Indian Museum Heye Center (New York)
		Anacostia Community Museum
		Arts and Industries Building
		Cooper -Hewitt, Smithsonian Design Museum
		Freer Gallery of Art
		Freer | Sackler Galleries of Art
		Hirshhorn Museum and Sculpture Garden
		Natural History Museum
		National Zoo
		Portrait Gallery
		Postal Museum
		Renwick Gallery
		Sackler Gallery
		Smithsonian Institution Building, The (Castle)
		Not sure
	How many museums are you planning to visit?	1
		2-3
		More than 3
	Did you use the search box during your visit today?	Yes
		No
		Not sure/can't recall
	Please tell us about your experience with the site's search box today. (Please select all that apply.)	Search results were helpful
		Results were not relevant/not what I wanted
		Too many results/I needed to refine my search
		Not enough results
		Returned NO results
		Received error message(s)
		Search speed was too slow
		I experienced a different search issue (please explain):
	Other search issue:
	How would you describe your navigation experience on this site today? (Please select all that apply.)	I had no difficulty navigating/browsing on this site
		Links often did not take me where I expected
		Had difficulty finding relevant information/products
		Links/labels are difficult to understand
		Too many links/navigational options to choose from
		Had technical difficulties (error messages, broken links, etc.)
		Could not navigate back to previous information
		I had a navigation difficulty not listed above:
	Other navigation difficulty:
	Today, did you make an online purchase or reserve a tour or ticket from the Smithsonian?	No
		Yes
	What type of purchase or reservation did you make online?	Merchandise
		Event ticket
		IMAX ticket
		Tour reservation
		Buy membership or renewal
		Music download
		Other (please specify)
	Please specify what other type of purchase or reservation you made online.
	What is your overall satisfaction with the online purchase or reservation experience?	1=Not very satisfied
		2
		3
		4
		5
		6
		7
		8
		9
		10=Very satisfied
	Which of the following was most important in bringing you to the site today?	Email from Smithsonian
		Internet blogs or discussion forums
		Search engine results
		Word of mouth recommendation from someone I know
		TV, radio, newspaper, or magazine advertising
		Internet advertising
		Familiarity with Smithsonian
		Not sure/can't recall
		Other (please specify)
	What else was most important in bringing you to the site?
	On this site today, did you see an advertisement or sponsorship message?	Yes
		No
	How did the advertisement or sponsorship message affect your overall satisfaction with the web site?	1=Negatively affected
		2
		3
		4
		5
		6
		7
		8
		9
		10 = Positively affected
	When you were last in a museum, did you use a mobile device to access information for your visit?	Yes
		No
		Not sure/can't recall
	What is your highest education level completed (highest level completed or current level if you are a student)?	K - 8th grade
		High School (or equivalent)
		Some College or Technical Training
		College (Undergraduate)
		Graduate Degree or Professional
		Graduate (Master's)
		Graduate (Doctoral)
		I prefer not to answer
	Are you a male or female?	Male
		Female
		I prefer not to answer
	If you could identify one improvement to the web site, what would that improvement be?
OPM Manager Survey/US Office of Personnel Management	Please indicate what grade the position is that you are hiring for	GS1 or equivalent
		GS2 or equivalent
		GS3 or equivalent
		GS4 or equivalent
		GS5 or equivalent
		GS6 or equivalent
		GS7 or equivalent
		GS8 or equivalent
		GS9 or equivalent
		GS10 or equivalent
		GS11 or equivalent
		GS12 or equivalent
		GS13 or equivalent
		GS14 or equivalent
		GS15 or equivalent
		Special Pay Plan (VN-Nurses, VM-Medical and Dental, TSA, FAA, ST, SL, ND, etc.)
		Senior Executive Service (positions classified above General Schedule (GS) grade 15 or equivalent positions in the Executive Branch)
SAMHSA Store V2/Substance Abuse and Mental Health Services Administration	What best describes your organization type?	Behavioral health treatment facility
		Criminal justice/courts
		Government office
		Health insurer
		Human resources/employee assistance program
		Individual or group private practice
		Managed care/insurance company office
		Military/veterans group
		Nonprofit/community-based organization/coalition
		Non-residential/out-patient facility
		Other health care facility (e.g., primary care)
		Public place/Interacting in community
		Residential/in-patient facility
		School/university
		Other
	Please specify your organization.
Small Business Administration v2/Small Business Administration	Were you able to complete the task you came to do today on SBA.gov?	Yes
		Partially
		No
	Please tell us why you were unable to complete your task today on SBA.gov.
	Since you were unable to accomplish what you wanted to do, what do you plan to do next?	Return to SBA.gov and try again
		Try another web site
		Contact a local SBA Resource Partner Office
		Take no action
		Other
	Please tell us what other action you plan to take next.
	Please tell us which website you plan to visit next for more information.
	Have you visited SBA.gov using a mobile phone or tablet in the past?	Yes
		No
		Unsure
	What was the reason you last visited SBA.gov by mobile phone or tablet?
	What, if any, SBA.gov resources would you have liked to access via mobile phone or tablet but were unable to?
	Are you interested in providing additional feedback to SBA in the future?  We respect your privacy and will not share your information.	Yes
		No
	Please provide your e-mail address.  We may contact you in the future:
IC Careers Desktop Browse/NSA - National Security Agency	Have  you visited this site using a mobile phone in the past?	Yes
		No
		Unsure
NASS Satisfaction Survey/NASS	What is your primary role in visiting the site today?	Agri-business representative
		Commodities exchange person
		Farmer, Rancher, or other Agricultural Producer
		General Public Individual
		Federal Government Individual
		Local/State Government Individual
		Researcher
		Educator
		Student
		Media individual
		NASS/AG Census Employee
		Other:
	Which of the following sources primarily drove you to visit the site today?	Familiarity with NASS
		External search (Google, Bing, etc.)
		Email from NASS
		Link from another website
		Bookmark or favorite
		Referred by someone I know
		Social media
		Don't know
		Other:
	What other source drove you to visit the site today?
	How would you describe your navigation experience on this site? (Please select all that apply).	I had no difficulty navigating this site
		Links often did not take where I expected
		Had difficulty finding relevant information
		Labels are difficult to understand
		Too many navigational options to choose from
		Had technical difficulties (error messages, broken links, etc.)
		Could not navigate back to previous information
		I had a navigation difficulty not listed above.
	Please describe the issue(s) you experienced while navigating this site.
	Have you ever visited the NASS.USDA.gov site using a mobile device?	Yes
		I have never visited this site on a mobile device
		I don't know
	Thinking about your most recent visit on your mobile device, what content did you access?	Publications or reports
		Charts & Maps
		Agriculture Census Info
		Statistical Information
		Quick Stats Database
		NASS State Office Websites
		NASS Products and Services
		Agency News/Upcoming events
		General Agency Information
		Contact Customer Service
		Career Opportunities
		Other:
	What other content did you access via your mobile device?
	From what location did you access NASS.USDA.gov?	From home
		From work
		From school
		In Transit
		Other:
	From what other location did you access NASS.USDA.gov from your mobile device?
	Which category includes your age?	Under 18
		18-24
		25-34
		35-44
		45-54
		55-64
		65 or older
		Prefer not to respond
	What is your gender?	Male
		Female
		Prefer not to respond
	In which state are you located?	Alabama
		Alaska
		Arizona
		Arkansas
		California
		Colorado
		Connecticut
		Delaware
		District of Columbia
		Florida
		Georgia
		Hawaii
		Idaho
		Illinois
		Indiana
		Iowa
		Kansas
		Kentucky
		Louisiana
		Maine
		Maryland
		Massachusetts
		Michigan
		Minnesota
		Mississippi
		Missouri
		Montana
		Nebraska
		Nevada
		New Hampshire
		New Jersey
		New Mexico
		New York
		North Carolina
		North Dakota
		Ohio
		Oklahoma
		Oregon
		Pennsylvania
		Rhode Island
		South Carolina
		South Dakota
		Tennessee
		Texas
		Utah
		Vermont
		Virginia
		Washington
		West Virginia
		Wisconsin
		Wyoming
	What is your primary reason for visiting this site today?	Publications or reports
		Charts & Maps
		Agriculture Census Info
		Statistical Information
		Quick Stats Database
		NASS State Office Websites
		NASS Products and Services
		Agency News/Upcoming events
		General Agency Information
		Contact Customer Service
		Career Opportunities
		Respond to a Survey
		Other:
NIH Grants/NIH Grants	Did you notice any changes to our website today?	Yes, I noticed changes
		No, I did not notice changes
		Don't know/Not sure
	How would you describe the redesigned website?	Better than the previous website
		Same as the previous website
		Worse than the previous website
		Don't know/Not sure
	Please share with us any thoughts or opinions that you have about the redesigned website:
FDA Web V3/FDA	Which of the following best describes the primary reason for visiting the FDA site today:
		Get recall or outbreak information
		Look up warning letters or enforcement actions
		Get consumer advice on a product
		Report a problem (adverse event) with a product
		Check a regulation, rule, or guidance Look up a regulation, rule, or industry guidance document
		Get labeling information for a product
		Check side effects of a product
		Look up product approvals
		Get news or updates
		Import or export a product (including Prior Notice)
		Comment on a proposed guidance or rule
		Get a form
		Get training
		Complete or check registration for a product or facility
		Dispose of drugs or sharps
		Get FDA organizational information
		Contact an FDA office or staff member
		Get a job with FDA
		Other
	Please specify what kind of consumer advice you are seeking:
FDA Mobile V3/FDA	Which of the following best describes the primary reason for visiting the FDA site today:	Get recall or outbreak information
		Look up warning letters or enforcement actions
		Get consumer advice on a product
		Report a problem (adverse event) with a product
		Check a regulation, rule, or guidance Look up a regulation, rule, or industry guidance document
		Get labeling information for a product
		Check side effects of a product
		Look up product approvals
		Get news or updates
		Import or export a product (including Prior Notice)
		Comment on a proposed guidance or rule
		Get a form
		Get training
		Complete or check registration for a product or facility
		Dispose of drugs or sharps
		Get FDA organizational information
		Contact an FDA office or staff member
		Get a job with FDA
		Other
	Please specify what kind of consumer advice you are seeking:
IC Careers Mobile Browse/NSA - National Security Agency	What is your age?	Under 18
		18 - 24
		25 - 34
		35 - 44
		45 - 54
		55 - 64
		65 or older
		Prefer not to respond
FBI V3/FBI	How confident are you that your future interactions with the FBI will meet your needs? (10=Confident - 1=Not at all Confident)	1=Not at all Confident
		2
		3
		4
		5
		6
		7
		8
		9
		10=Confident
		Don't Know
	What is your overall impression of the FBI?  (10= Very Favorable - 1= Not at all Favorable)	1=Not at all Favorable
		2
		3
		4
		5
		6
		7
		8
		9
		10=Very Favorable
		Don't Know
	Compared to a few years ago, is the FBI doing a better or a worse job at protecting the nation from threats and bringing justice to those who violate the laws?	Better job than a year ago
		Worse job than a year ago
		About the same
		I don't know
	How would you categorize the age of the information you were looking for:	New Information - Updated this month
		Old information - Updated more than a month ago but less than a year ago
		Historical Information - Updated more than a year ago
		Not Sure
	Did you submit a tip electronically on the website?	Yes
		No
	Why did you not submit a tip electronically?
	Which of the following influenced your visit to the FBI site today: (Select all that apply)	News story
		FBI Social Media (Facebook, Twitter, etc.)
		Ad on another website or social media
		Email from the FBI
		Research for school/academic project
		Interest in FBI in general
		Interest in Most Wanted Information
		Other, please specify:
		None of the Above
	What influenced you to visit FBI.gov today?
	Which of the following ways will you obtain information about the FBI in the future: (Select all that apply)	FBI Facebook page
		FBI Flickr page
		FBI Twitter feed
		FBI Website (via desktop or mobile device)
		FBI Emails
		FBI YouTube Channel
		Other
		None of the Above
USTTB V3/Alcohol and Tobacco Tax and Trade Bureau	Did you encounter any difficulties using COLAs Online?	Yes
		No
	Please tell us about any difficulties you encountered using COLAs Online:
	Did you encounter any difficulties using Formulas Online?	Yes
		No
	Please tell us about any difficulties you encountered using Formulas Online:
	Did you encounter any difficulties using Permits Online?	Yes
		No
	Please tell us about any difficulties you encountered using Permits Online: