ODPHP: Page-Level Survey Question Bank
OMB Control Number: 0990-0379
Question block, option 1:
1. How helpful was this page?
Very helpful
Somewhat helpful
Not helpful
2. [If Very helpful or Somewhat helpful] This information can help me:
Talk with my doctor
Get a health service (like a screening test or shot)
Make a health decision
Learn about my health
Other: ____________________________
3. What can we do to improve this page?
Question block, option 2:
1. Did [insert feature name] work as you expected?
Yes
No
2. Do you like the design of [insert feature name]?
Yes
No
3a. [If Yes for question 1]
What part of [insert feature name] did you find most valuable?
3b. [If No for question 1]
What did you dislike about [insert feature name]?
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0990-0379. The time required to complete this information collection is estimated to average 1 minute per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336-E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer
Question block, option 3:
1. Was this page helpful?
Yes
No
2. [If Yes for question 1]
I found this page helpful because the content on the page: (Please select all that apply.)
Had the information I needed
Gave me specific ideas I can use
Was easy to understand
Was trustworthy
Was up to date
Was well written
Other: ____________________________
3. [If No for question 1]
I didn’t find this page helpful because the content on the page: (Please select all that apply.)
Had too little information
Had too much information
Was confusing
Was out of date
Was poorly written
Wasn’t what I was looking for
Wasn’t what I expected
Other: ____________________________
Question block, option 4:
1. Did you find what you were looking for?
Yes
Partially
No
2. [If Partially or No for question 1]
I didn’t find everything I was looking for because: (Please select all that apply.)
There were too many links
There wasn’t enough information
Links were hard to understand
Text or graphics were hard to read or see
There were technical issues
This page wasn’t what I was looking for
Other: ____________________________
3. [If Partially or No for question 1]
Tell us more about the problem so we can fix it.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Jennifer Barone |
File Modified | 0000-00-00 |
File Created | 2021-01-25 |