OMB #1545-1432
Attachments
Taxpayer Experience Survey—This survey draft is based on a prior year administration and will be refined as a result of the pretest.
W&I Taxpayer Experience Survey 2012
CONSENT [DISPLAY]
In an effort to improve its services, The Internal Revenue Service (IRS) is asking customers about their experiences and opinions. Your responses assist the IRS to reduce the burden on the average taxpayer in preparing and filing taxes and to identify ways to improve the level of service IRS provides to taxpayers.
The survey takes about 20 minutes to complete. This is an opinion survey about YOUR experiences in preparing and filing your taxes. Please complete the questions even if you used a tax professional to help prepare your return(s). We need input from a cross-section of individual taxpayers to get a true picture of what Americans think, not just what "experts" say.
This survey is conducted for the IRS by an independent national research organization, Knowledge Networks. Your answers are anonymous and no personal identifying information will be released to the IRS. If you have any questions about this survey, please contact Knowledge Networks Panel Relations at (800) 782-6899.
The OMB Control Number for this study is 1545-1432. Also, if you have any comments regarding the time estimates associated with this study or suggestions on making this process simpler, please contact the Internal Revenue Service, Tax Products Coordinating Committee, SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave. NW, Washington, DC 20224.
Thank you in advance for your participation!
[show if xlang=7 (missing value for xlang)]
S1-intro: First, we would like to ask you a question about the language or languages you speak.
[sp]
[if xlang=7]
S1: What language do you usually speak at home?
1 Only Spanish
2 More Spanish than English
3 Both Spanish and English equally
4 More English than Spanish
5 Only English
6 Neither Spanish nor English
Data Only [single punch]
DOV_S1 – Language usually spoken at home - aggregate of XLANG and S1
[INSTRUCTIONS: If XLANG=1-6 then DOV_S1=XLANG. If XLANG=7 then DOV_S1=S1. If XLANG=8 then DOV_S1=8]
1 Only Spanish
2 More Spanish than English
3 Both Spanish and English equally
4 More English than Spanish
5 Only English
6 Neither Spanish nor English
7 Hispanics who have not taken Hispanic profile; re-ask in field
8 Non-Hispanic
[PROGRAMMING: ENSURE CORRECT LANGUAGE OFFERED TO RESPONDENTS BASED ON PANEL DATA]
1 English
2 Spanish
[SC,IF XSPANISH=2]
S1e. Would you say you can carry on a conversation in English, both understanding and speaking, very well, well, not well, or not at all?
Very well
Well
Not well
Not at all
[SC,IF XSPANISH=2]
S1f. Would you say you can read a newspaper or book in English-- very well, well, not well, or not at all?
Very well
Well
Not well
Not at all
[PROGRAMMING: If S1e=3 or 4, or S1f=3 or 4 CONTINUE. OTHERWISE, TERMINATE]
[SC, PROMPT, TERMINATE IF SKIPPED]
S1a. Did you or your spouse file a Federal Income Tax Return in 2012 for income earned in 2011?
1 Yes, I or my spouse filed federal tax return
2 No federal income tax return filed for 2011 taxes
3 Not sure/Refused
[SC, IF S1A = 2, 3, PROMPT, TERMINATE IF SKIPPED]
S1c. Did you not file a federal income tax return in 2012 for 2011 taxes because you….
1 Got an extension
2 Were under the income limit for filing
3 Were a dependent of someone outside the household
4 Something else (Specify)____________________
5 Not sure
6 Did file federal tax return
[IF S1C IN 1-5, TERMINATE]
[SC, PROMPT, TERMINATE IF SKIPPED]
S2. Would you say that you are the adult in your household who is most familiar with the preparation and filing of your 2011 federal income tax return [IF XSPANISH = 2 ‘and your preferred language is Spanish’]?
1 Yes, most familiar
2 Equally familiar
3 Not most/equally familiar [TERMINATE]
[PROMPT, TERMINATE IF SKIPPED]
S3. Who prepared your taxes?
I (myself)
A friend or family member (relative)
The IRS
A volunteer preparer from a community organization (do not count tax software company promotional events)
An independent accountant/CPA
H&R Block
Jackson Hewitt
Other paid professional [IF XSPANISH = 2, SHOW ‘Notario’]
Someone else
Don’t Know [TERMINATE]
[SC, PROMPT, TERMINATE IF SKIPPED]
S4. Which of the following is the filing status you used on your 2011 tax return?
1 Single
2 Married, filing jointly
3 Married, filing separately
4 Head of Household (single with dependent parent or child)
5 Qualifying widow(er) with dependent child
6 Don’t Know [TERMINATE]
[SC]
S6. Which of the following forms were used to file your 2011 tax return (tax return filed in 2012 for income earned in year 2011)?
1 Short form 1040EZ - did not itemize deductions [skip to q1a]
2 Short form 1040A - did not itemize deductions [skip to q1a]
3 Long form 1040 WITHOUT other forms or schedules - did not itemize deductions [skip to q1a]
4 Long form 1040 WITH other forms or schedules
Long form - don’t remember if had other forms/schedules
6 Short form - don’t remember which one [skip to q1a]
7 Don’t know - someone else prepared or filed it
[SC, GRID, IF S6 IS 4 or 5]
S6a. Which of the following form and schedules were filed with your 2011 return? Did you file a:
1—Yes 2—No 3—Don’t Know
Schedule A for itemized deductions including home mortgage deductions, charitable contributions, and other types of deductions
Schedule B for interest and dividend income
Schedule C for small business income
Schedule D for capital gains or losses
Schedule E for supplemental income, such as rental income, royalties, and trusts
Schedule F for farm income
Form 2106 employee business expenses
Forms related to partnerships or S Corp [TERMINATE IF SELECTED]
I. AWARENESS AND IRS INTERACTIONS IN PAST 12 MONTHS
AWARENESS
[SC, GRID]
Q1a. The following questions are about your awareness of different ways to contact the IRS.
Are you aware that you can get information or help such as obtaining forms or tax law information, checking refund status or getting help to resolve a notice from the IRS in the following ways . . .
1—Yes 2—No
Calling an IRS Toll-Free line?
Visiting a local IRS office (Taxpayer Assistance Center, walk-in center)?
Visiting the IRS website (www.irs.gov)?
Sending regular mail to the IRS?
E-mailing the IRS?
Getting help from a volunteer tax preparer from a community organization?
Q1a.1 [IF Q1A_3=YES, AWARE OF IRS.GOV] Which of the following irs.gov (online) services/tools are you aware of?
Yes
No
[PROGRAMMER: Rotate list...]
Electronic Federal Tax Payment System (EFTPS)
Electronic Filing PIN Request
Interactive Tax Assistant (ITA)
IRS Withholding Calculator
Online Employer Identification Number (EIN)
Online Payment Agreement (OPA)
Tax Exempt Charity Search
Tax Trails
Where's My Refund
I am not aware of any of these tools [PROGRAMMER: KEEP THIS OPTION AT THE END OF THE LIST]
[IF XSPANISH = 2, SC, GRID]
Q1b. Are you aware that you can get information or help such as finding forms or tax law information, checking refund status or getting help resolve a notice from the IRS in the following ways in Spanish?
1—Yes 2—No
1 Calling an IRS Toll-Free line and getting assistance in Spanish?
2 Visiting a local IRS office (Taxpayer Assistance Center, walk-in center) and getting assistance in Spanish?
3 Visiting the Español section of the IRS website?
4 Sending regular mail to the IRS in Spanish?
5 Spanish speaking volunteer preparers from a community organization?
[SC, IF XSPANISH = 2]
Q5s1. Were you aware there is a “Where’s My Refund” section in Spanish on the IRS website?
Yes
No
[SC, IF XSPANISH = 2]
Q5s2. Are you aware that you can get basic tax information, tax forms, instructions, and publications in Spanish from the Español section of the IRS website?
1 Yes
2 No
INTRO1 [IF A “YES” RESPONSE TO Q1a_a thru Q1a_e or YES to Q1b_a thru Q1b_d, DISPLAY]
The next questions are about any contact you may have had with the Internal Revenue Service (IRS) in the past 12 months, including actively using the IRS website to obtain information. [IF XSPANISH = 2: ‘Please include all contacts regardless of whether they were in Spanish or English’]
[IF A “YES” RESPONSE TO Q1a_a thru Q1a_e or YES to Q1b_a thru Q1b_d, SC, GRID]
Q2. In the past 12 months, did you contact the IRS for any reason, using any of the following methods:
Select one answer from each row in the grid
1—Yes 2—No
2a [ASK IF Q1a_a=Yes or Q1b_a=Yes] Call an IRS Toll-Free line
2b [ASK IF Q1a_b=Yes or Q1b_b=Yes] Visit a local IRS office (Taxpayer Assistance Center, walk-in center)
2c [ASK IF Q1a_c=Yes or Q1b_c=Yes] Actively visit the IRS website to obtain information. Please do not count casual browsing.
2d [ASK IF Q1a_d=Yes or Q1b_d=Yes] Contact the IRS through regular mail
2e [ASK IF Q1a_e=Yes] Email the IRS
CHANNEL EXPERIENCE
[IF Q2A = YES; MC/NUM, GRID, RANGE 01-99]
[PUT WORDS HIGHLIGHTED BELOW IN BOLD YELLOW TEXT IN SURVEY]
Q3a/3b. For which of the following reasons did you call the Toll-Free line in the past 12 months, and for each issue mentioned, how many times did you call Toll-Free for this issue?
Issue |
|
# Times |
|
|
_____ _____
_____
_____
_____ _____ _____ _____
_____ _____
|
[SC, IF XSPANISH = 2]
3s1. Have you called the IRS Espanol Toll-Free Line?
Yes (Continue)
No
[DISPLAY IF Q2A=YES]
For the following questions, please focus on your most recent experience with calling an IRS Toll-Free line.
[IF Q2A = YES , SC]
[Should appear only when Q2A=YES. Currently appears even when respondent said didn’t contact TF]
Q3e. Did you hang up before speaking with an IRS representative?
1 Yes
2 No
[IF Q3E = 1, MC]
Q3g. What were your reasons for hanging up?
1 Kept getting a busy signal
2 Placed on hold too long
3 Kept getting transferred
4 Couldn’t understand the menu system
5 Too many choices to listen to on the menu system
6 Other
[IF Q2A = YES , SC]
Q3h. Were you transferred more than once when you called?
1 Yes
2 No
[IF Q2A = YES , SC]
Q3i. Did you understand the information that was provided to you?
Yes
No
[SP]
[IF Q2A = YES , SC]
[IF Q3i=YES]
Q3j. How confident were you in your ability to apply the information you received?
Not at all confident
Not very confident
Somewhat confident
Very confident
[IF Q2A = YES, SC]
Q3l. Please rate your overall satisfaction with calling an IRS Toll-Free line.
Very dissatisfied
Dissatisfied
Neither satisfied nor dissatisfied (neutral)
Satisfied
Very satisfied
[IF LOCAL = 2, GO TO Q5A, ELSE CONTINUE WITH Q4A]
[PUT WORDS HIGHLIGHTED BELOW IN BOLD YELLOW TEXT IN SURVEY]
[MC/NUM, GRID, RANGE 01-99]
Q4a/4b. For which of the following reasons did you visit a local IRS office (Taxpayer Assistance Center, walk-in center), in the past 12 months, and for each issue mentioned, how many times did you use a local IRS office for this issue?
Issue |
# Times |
|
_____ _____
_____ _____ _____
_____ _____
_____ _____ _____
_____ _____
|
[DISPLAY]
For the following questions, please focus on your most recent experience with visiting a local IRS office.
[SC]
Q4c1. Did you understand the information that was provided to you?
Yes
No
[SC]
[IF Q4c1=YES]
Q4c2. How confident were you in your ability to apply the information you received?
Not at all confident
Not very confident
Somewhat confident
Very confident
[IF XSPANISH = 2, SC]
Q4s1 Did you need assistance in Spanish when you visited a local IRS office (Taxpayer Assistance Center, walk-in center)?
1 Yes
2 No
[IF Q4S1 = 1, SC]
Q4s2 Did you receive assistance in Spanish?
1 Yes
2 No
[IF Q4S2 = 1, SP]
Q4s3 Did you receive assistance from a bilingual assistor, or did you use the over the phone interpreter service?
1 Bilingual assistor
2 Over the Phone interpreter service
[IF Q4S3 = 1, SC]
Q4s4 Please rate your satisfaction with using a bilingual assistor?
Very dissatisfied
Dissatisfied
Neither satisfied nor dissatisfied
Satisfied
Very satisfied
[IF Q4S3 = 2, SC]
Q4s5 Please rate your satisfaction with using the over-the-phone interpreter service?
Very dissatisfied
Dissatisfied
Neither satisfied nor dissatisfied
Satisfied
Very satisfied
[SC]
4d. Please rate your overall satisfaction with visiting a local IRS office (Taxpayer Assistance Center, walk-in center).
Very dissatisfied
Dissatisfied
Neither satisfied nor dissatisfied (neutral)
Satisfied
Very satisfied
IRS website [PROGRAMMING: If Q2c=YES, continue with this section]
[IF Q2C NE 1, GO TO Q6A, ELSE CONTINUE WITH Q5A]
[PUT WORDS HIGHLIGHTED BELOW IN BOLD YELLOW TEXT IN SURVEY]
[MC/NUM, GRID, RANGE 01-99]
5a/5b. For which of the following reasons did you actively use the IRS website in the past 12 months? Please do not count casual browsing, and for each issue mentioned, how many times did you use the IRS website for this issue?
Issue |
# Times |
|
_____ _____
_____
_____
_____ _____
_____ _____ _____
_____ _____
|
[SC,GRID]
[SHOW and ASK categories if YES in Q1a.1]
Q5c In the past 12 months, did you use any of the following services/tools on the IRS website?
Yes
No
Electronic Federal Tax Payment System (EFTPS)
Electronic Filing PIN Request
Interactive Tax Assistant (ITA)
IRS Withholding Calculator
Online Employer Identification Number (EIN)
Online Payment Agreement (OPA)
Tax Exempt Charity Search
Tax Trails
Where's My Refund?
[IF XSPANISH = 2, SC]
Q5s1A. When you used the IRS website to get information, did you use the Español section of the IRS website, the English section of the IRS website, or both?
1 Español only
2 English only
3 Both Español and English
[IF XSPANISH=2 AND Q5S1 = 3, SC]
Q5s2A. Which language section of the IRS website did you use more?
Español
English
About the same
[IF XSPANISH=2 AND IF Q5a_9 = 1, SC]
Q5s5. How satisfied were you with the “Where’s My Refund” tool on the IRS Español website?
Very dissatisfied
Dissatisfied
Neither satisfied nor dissatisfied (neutral)
Satisfied
Very satisfied
[IF XSPANISH=2 AND Q5S1 = 2 MC]
Q5s7 What were the reasons you have not used the Español section of the IRS website?
1 I’m not aware of the Español section of website
2 I’m not aware that tax info is available in Spanish
3 Other (specify)____________________________
[SHOW ONLY THOSE OPTIONS WHERE in Q1a.2=YES, GRID, SC]
For the following questions, please focus on your most recent experience using the IRS website.
Q5e. Did you find the information you were looking for?
Yes (skip to Q5f)
No (ask Q5e1 then skip Q5f1 and Q5f2)
Partially
[TEXT BOX]
Q5e1. If you didn't find what you were looking for, what specific type of information were you trying to find?
Please specify
[SC]
Q5f1. Did you understand the information?
Yes
No
[SC, IF Q5f1=YES]
Q5f2. How confident were you in your ability to apply the information?
Not at all confident
Not very confident
Somewhat confident
Very confident
[SC]
Q5h. Please rate your overall satisfaction with using the IRS website
Very dissatisfied
Dissatisfied
Neither satisfied nor dissatisfied (neutral)
Satisfied
Very satisfied
[MC]
[ASKED OF ALL RESPONDENTS]
Q14. Which tax-related activities would you perform in the future using the IRS website (www.irs.gov)?
Get an IRS form or publication
Get information about completing a tax form
Find an answer to a tax law question
Determine my eligibility for a tax benefit or whether certain requirements apply to me
Get help making tax-related calculations
Get help preparing a tax return or form
File a tax return or form
Set up a payment plan
Make a payment
Get information about a refund
Respond to a notice of letter received from the IRS
Something else (specify)_____________________
None – I would not complete any of these activities using the IRS website
Q15. If you were able to review your prior year federal tax return (e.g. transcripts) online through a secure link on the IRS website, how likely would you be to use this service? Would you be . . .
Very unlikely
Somewhat unlikely
Somewhat likely
Very likely
[MC, IF Q2C = NO AND (Q2B = YES OR Q2A = YES)]
Q13. What are the main reasons you visited a local office or used an Toll-Free line instead of visiting the IRS website to get information from the IRS?
I don’t have Internet access
I used local IRS offices before
I called the Toll-Free line before
I don’t believe I can get my questions answered by using the IRS website
I did try to use the IRS website
I wasn’t aware of the IRS website
The letter I received from the IRS said to call a telephone number
The letter I received from the IRS said to go to a local office
Something else (specify)
Regular Mail [PROGRAMMING: If Q2d=YES, continue with this section]
[IF Q2D NE 1, GO TO Q7A, ELSE CONTINUE WITH Q6A]
[PUT WORDS HIGHLIGHTED BELOW IN BOLD YELLOW TEXT IN SURVEY]
[MC/NUM, GRID, RANGE 01-99]
Q6a/6b. For which of the following reasons did you use regular mail to contact the IRS in the past 12 months, and for each issue mentioned, how many times did you use regular mail for this issue?
a. Issue |
# Times |
|
_____ _____
_____ _____ _____
_____ _____
_____ _____ _____
_____ _____
|
[DISPLAY]
For the next two questions, please focus on the information you received through mail in response to your most recent mail contact with the IRS.
[SC]
Q6n1. Did you understand the information that was provided to you by mail from the IRS?
Yes
No
Have not received a response from the IRS
[SC, IF Q6n1=YES]
Q6n2. How confident were you in your ability to apply the information you received?
Not at all confident
Not very confident
Somewhat confident
Very confident
[MC, IF Q2D = YES AND Q2A=NO, AND Q2C = NO]
Q6c. What are the reasons that you contacted the IRS using regular mail instead of other channels such as the IRS website or an IRS Toll-Free line?
IRS required information be mailed to the agency.
Am not aware that I could contact the IRS any other way
Never thought about contacting the IRS any other way
I don’t have Internet access
Don’t believe I can get information needed from IRS website
Don’t believe I can get information needed from the IRS Toll-Free line
Don’t believe I can get information from other IRS sources
Other (specify)____________________
[SC]
Q6e. Please rate your overall satisfaction with contacting the IRS by regular mail.
Very dissatisfied
Dissatisfied
Neither satisfied nor dissatisfied (neutral)
Satisfied
Very satisfied
Email [PROGRAMMING: IF Q2e=YES, continue with this section]
[IF Q2E NE 1, GO TO Q8 ELSE CONTINUE WITH Q7A]
[PUT WORDS HIGHLIGHTED BELOW IN BOLD YELLOW TEXT IN SURVEY]
[MC/NUM, GRID, RANGE 01-99]
Q7a/7b. For which of the following reasons did you send email to the IRS in the past 12 months, and for each issue mentioned, how many times did you use email for this issue?
a. Issue |
# Times |
|
_____
_____
|
[SC, If yes to 2a, b, c, d, OR e]
Q8. Did you contact the IRS for any other reasons you have not mentioned?
Yes
No
[TXT, IF Q8 = 1]
Q8A What other reasons?________________________________________
VITA
[PROGRAMMING: ASK Q10a IF Q1a_f=Yes OR Q1b_e=Yes, ELSE SKIP TO Q11]
[IF Q1a_f=Yes OR Q1b_e=Yes CONTINUE WITH Q10A, ELSE SKIP TO Q11]
[SC]
Q10a. In the past 12 months, did you get help with return preparation from a volunteer preparer from a community organization?
Yes
No [SKIP TO Q11]
[IF XSPANISH = 2, SC]
Q10s1. Some volunteer return preparers from community organizations speak Spanish. Did you need assistance in Spanish?
1 Yes
2 No
[IF XSPANISH = 2, Q10S1 = 1, SC]
Q10s2 Did you receive assistance in Spanish?
1 Yes
2 No
[IF Q10A = 1, SC]
Q10d. How satisfied are you with return preparation assistance from a volunteer preparer from a community organization?
Very dissatisfied
Dissatisfied
Neither satisfied nor dissatisfied (neutral)
Satisfied
Very satisfied
[IF XSPANISH = 2, MC]
Q11. What Spanish Language tax products or services would be helpful to you? Please select all that apply.
Offer tax preparation assistance in Spanish
Make the 1040 Forms/Instructions available in Spanish
Offer education to about how to fill out tax forms/prepare taxes myself
Make other tax forms available in Spanish
Other (Please specify)_____________________________________________________
Cross-Channel Interactions
[ALL RESPONDENTS]
[SC]
Q12. Assume you are visiting a local IRS office (Taxpayer Assistance Center, walk-in center) and you had a wait that was longer than you anticipated, if you could get the same information or service you needed by using a computer instead of talking to a representative in-person how likely would you be to use a computer at a local IRS office? A representative would still be available if you had questions. Would you be . . .
Very unlikely
Somewhat unlikely
Somewhat likely
Very likely
[TEXT]
[FOR PRETEST ONLY]
Q12A. Was there anything confusing or difficult to answer?
SECTION II. EFFECTIVE CONTACT RESOLUTION
[PROGRAMMING: SKIP TO SECTION III IF Q2a thru Q2e is not yes]
[IF all q2a through q2e ne yes skip to NEXT SECTION. ELSE continue with q16]
Q16 You mentioned that you have contacted the IRS in the past 12 months. Contacting the IRS includes calling an IRS Toll-Free line, visiting a local IRS office (Taxpayer Assistance Center, walk-in center), actively visiting the IRS website (not casual browsing), contacting the IRS through regular mail, or emailing the IRS.
What was the most recent reason that you contacted the IRS in the past 12 months?
A form or publication
Tax return preparation assistance (includes getting information on which forms to file, record keeping, completing or filing income taxes, and how to get help with taxes)
Make a payment
Payment information
A balance due
Levy/Lien
Information or assistance about a notice, other than balance due or levy/lien (A notice is a letter from the IRS)
Tax law question(s), besides notice (Tax law examples include finding out which deductions to take, finding out how to file estate taxes, and etc.)
A prior year’s tax return information (e.g. transcripts)
Information about the new Economic Recovery credits and deductions
Refund information
Individual or Employer Tax ID
Information about the Affordable Care Act
Other, specify ___________
[IF NO RESPONSE SELECTED IN Q16, SKIP TO NEXT SECTION]
[PROGRAM different color for the issue selected in Q16 for Q17 thru Q22]
[SC]
Q17. Did you contact the IRS more than once in the past 12 months to get help resolving your most recent issue?
[Insert response from Q16]?
Yes
No
[IF Q17 IS SKIPPED, SKIP TO Q23]
[SC]
Q18. Thinking back to the [IF Q17 = 1 INSERT: ‘very first’] time you contacted the IRS in the past 12 months for [Insert response from Q16] what method did you use for contact?
IRS website
Toll-Free (telephone)
IRS office (Taxpayer Assistance Center, walk-in center)
[IF Q18 IS SKIPPED, SKIP TO NEXT SECTION]
[MC, IF Q17 = 1] programmer; only show option not selected in Q18
Q19. Besides[Insert response from Q18], what other methods did you use to contact the IRS in the past 12 months to get help with your most recent issue? [Insert response from Q16]
IRS website
Toll-Free (Telephone)
IRS office (TAC, walk-in center)
None [SC]
[IF Q17 = 2, AUTOFILL WITH 1 AND SKIP TO Q20B. NUM 1-99]
Q20a. Approximately, how many times did you contact the IRS to get the information you needed to resolve this issue?
_________ times
98 Still ongoing
99 Don’t remember
20b. When you contacted the IRS [If yes to Q17: the very first time] using [Insert response to Q18] for [Insert response to Q16], did you expect to resolve this issue with just one contact to the IRS?
Yes
No
Don’t Know
[SC]
Q20c. You said that you made [Insert number of times from Q20a] contacts to the IRS in order to resolve your issue. After your last attempt, was your issue:
Completely resolved
Partially resolved
Not at all resolved
Still pending in the process
[GRID – SC]
Q20d. Did you contact any of the following non-IRS sources to try to resolve your issue?
Contacted a tax practitioner or attorney Yes/No
Contacted a friend or colleague for advice Yes/No
Contacted Taxpayer Advocate Service Yes/No
Went to a Non-IRS information source (e.g. book, web, tax software, etc.) Yes/No
[SC]
Q23 How would you rate the overall effectiveness with which the IRS resolved your most recent reason for contacting the IRS, [Insert response from Q16]? Was the issue resolution process:
Not at all effective
Not very effective
Neutral
Somewhat effective
Very effective
[TEXT]
[FOR PRETEST ONLY]
Q23A. Was there anything confusing or difficult to answer?
[MC]
The next questions are about completing and filing your 2011 taxes.
Tax Prep
[MC]
Q23a In 2012, when you prepared your 2011 federal tax return, where did you get general tax information, including information about changes in tax laws?
[USE LIST FROM Q23B BELOW]
[MC]
Q23b. In the future, where would you prefer to get general tax information, including information about changes in tax laws?
IRS direct mailings
IRS website in English
IRS website in Spanish
IRS telephone contact
IRS in-person/local IRS office (Taxpayer Assistance Center, walk-in center)
IRS sponsored tax class or seminar
IRS (unspecified)
Accountant/tax preparer (H&R Block, Jackson Hewitt)
Employer/Union/Trade Organization
Family/Friend
Library
Media such as radio, television, or newspapers
[IF XSPANISH = 2] Notario
Non-IRS Books and Publications
Non-IRS website
Post Office
Social/Community Organization (Church/religious group, theaters, community centers/outreach groups, schools)
Tax preparation software (TurboTax, TaxAct, etc)
Other [specify]
[MC]
Q24. Where did you get forms and publications for your 2011 federal tax return?
IRS direct mailings
IRS website in English
IRS website in Spanish
IRS telephone contact
IRS in-person
IRS sponsored tax class or seminar
IRS (unspecified)
Accountant/tax preparer (H&R Block, Jackson Hewitt)
Volunteer preparer from a community organization
Employer/Union/Trade Organization
Family/Friend
Library
Notario [PROGRAMMING: Spanish-only]
Non-IRS Books and Publications
Non-IRS website
Post Office
Social/Community Organization (Church/religious group, theaters, community centers/outreach groups, schools)
Tax preparation software (TurboTax, TaxAct, etc)
Other [specify]
[PROGRAMMING: IF accountant or notario in both Q23a , skip Q25]
[PROGRAMMING: IF only 8 or 13 for both Q23a AND Q24, SKIP TO CONDITIONAL BEFORE N3a]
[IF (Q23a= 1 thru 7) OR (Q24 = 1 thru 7), SC]
Q25. Considering all IRS sources you used, please rate your satisfaction with the ease of getting general tax information, including forms or publications.
Very dissatisfied
Dissatisfied
Neither satisfied nor dissatisfied (neutral)
Satisfied
Very satisfied
.
[DISPLAY]
The next few questions are about record keeping.
[ASSIGN N3A AND N3B TO HALF OF RESPONDENTS; ASSIGN N3C N3D TO OTHER HALF]
[MP]
N3a. If you had a question about rules for keeping records, from which of the following sources would you get that information? (Select all that apply)
The IRS website (IRS.gov)
An IRS telephone line
Other IRS sources, specify
Your tax professional/preparer/accountant/CPA
Tax software (e.g. TurboTax, TaxCut, TaxAct)
Other financial websites
A friend or relative
Other non-IRS sources, specify
None
Not sure
(ASK IF N3a=4; ELSE SKIP TO Q28a)
N3b. How confident were you in the advice that your tax professional/preparer gives you about rules for record keeping?
Extremely confident
Somewhat confident
Not very confident
Not sure
My tax preparer did not give me advice about record keeping
[Programmer: Ask the following questions to another half of the respondents]
[MP]
N3c.Now, if you had a question about correctly reporting income and allowable deductions, from which of the following sources would you get that information?
The IRS website (IRS.gov)
An IRS telephone line
Other IRS sources, specify
Your tax professional/preparer/accountant/CPA
Tax software (e.g. TurboTax, TaxCut, TaxAct)
Other financial websites
A friend or relative
Other non-IRS sources, specify
None
Not sure
[ASK IF N3c=4; ELSE SKIP TO Q28a]
N3d. How confident were you in the advice that your tax professional gives you about correctly reporting income and allowable deductions?
Extremely confident
Somewhat confident
Not very confident
Not sure
My tax preparer did not give me advice about correctly reporting income and allowable deductions
[SC]
Q28a Are you aware of the Earned Income Tax Credit (EITC/EIC)?
1 Yes
2 No [Skip to Q29]
[SC]
Q28b [If Q28a=Yes] How did you learn about Earned Income Tax Credit (EITC/EIC)?
Tax preparer
TV/Radio
Friend/Family/Co-worker
IRS.gov or IRS publication
Tax software (e.g. TurboTax, TaxCut, TaxAct)
Social Media (e.g. Facebook, Twitter, YouTube, etc.)
Other (specify)______________________________
[SC]
Q29. During the past year the IRS’ Earned Income Tax Credit (EITC/EIC) advertising campaign was, “Life’s easier with EITC”. Have you seen or heard this advertisement?
Yes
No
[SP]
Q26. Which of the following described how your 2011 federal taxes was prepared? By this, we mean filling out the forms and NOT the actual filing task.
By hand, using IRS tax forms
On a computer, using purchased tax software (for example, TurboTax or TaxACT)
Went to IRS.gov, found a Free File company and used their tax software (Traditional Free File)
Went to IRS.gov and used Free File Fillable Forms - filled in blank tax forms online without using tax software
Went to IRS.gov Espanol, found a Free File company and used their tax software in Spanish (Traditional Free File)
Both by hand and using purchased tax software (for example, TurboTax or TaxACT)
Other, specify
Don’t know/Someone else prepared my return
[IF S3 = 1, SC]
Q27. Did you have your 2008 federal tax return available to you when you prepared your 2011 return?
Yes
No
First time filer/Not applicable
[SP]
Q29a. Did you use EITC Assistant tool on irs.gov to help determine your Earned Income Tax Credit (EITC/EIC) eligibility?
Yes
No
[SP]
Q29b. [If Q29a=Yes] Was the tool helpful in helping you determine your Earned Income Tax Credit (EITC/EIC) eligibility?
Yes
No
[SP]
Q28. [If Q28a=Yes] Did you apply for the Earned Income Tax Credit (EITC/EIC) when you filed your 2011 federal tax return in 2012?
Yes [skip to Q28c]
No
SC]
Q28c. [If Q28a=Yes] Did you qualify for Earned Income Tax Credit (EITC)/EIC for the 2011 tax year?
Yes
No
Don’t know
[ SC]
[IF XSPANISH=2]
Q30S1. In the past 12 months, did you use any of the following Spanish forms or publications?
Did Not Use
Used
Not
Sure
Pub 17 SP
Pub 596 SP
Form 2848 SP
Form W-7 SP
Pub 179
Form 2290 SP
Form W-9 SP
Form W-11 SP
Form
9465 SP
[TEXT]
[FOR PRETEST ONLY]
Q30S1A. Was there anything confusing or difficult to answer?
Tax Filing
[ SC]
Q33. Are you aware that you can file your federal tax return electronically?
1 Yes
2 No
[ SC] [SKIP if Q26=3]
Q35. Are you aware that “Free File” options are available on irs.gov, where taxpayers who qualify can prepare their federal return online (electronically) at no cost?
1 Yes
2 No
[SC, IF XSPANISH = 2 and Q35=yes][SKIP if Q26=5]
Q35s1. Are you aware that IRS Free-File is also available in Spanish from the Espanol section of irs.gov.?
1 Yes
2 No
[SC, Q35 = 1 or 35s1=1 or q26=3,4,5]
Q36 How did you first learn about Free File?
[Programmer: Please move option 1 “Don’t remember” to the end of the list but don’t change the value labels.]
Don’t remember
Cinema, movie theater
Friend, family, colleague
IRS website
Social media (Facebook, YouTube, Twitter, etc)
Other non-IRS website
Newspaper/Magazine
Radio/Television
IRS Federal Income Tax Return package
Other IRS materials - Poster, brochure, flyer
Other
[ SC]
Q30a. How was your 2011 federal tax return filed in 2012? Did you:
Send your tax return by U.S. mail or commercial delivery service
File electronically (e-file) (including Free File)
Deliver in person
Not sure, filed by someone else
[ SC, IF Q30A NOT =4 OR MISSING]
Q31a. Did you Insert response from Q30A] in the previous year?
Yes
No
[ SC, IF Q31A = 2]
Q31b. What is the main reason you changed the way you filed your tax return in 2012?
New computer access/computer programs
IRS Free File options
Commercial software free filing option
Advertising
Different/new tax preparer
Tax preparer influenced change
Word of mouth
Quicker/faster Refund
Easier/more Convenient
Owed money
Change in filing status
Wanted to try different method
Security issues
Cost
First time filer/haven't filed for previous years
Filed for an extension/meeting deadline
Other (specify)
[ SC, IF Q33 = 1 AND Q30A = 1 0R 3]
Q31c. What is the primary reason that your return was not filed electronically?
Like paper filing
Cost
Don’t have trust that filing tax returns electronically (e-filing) works
[IF S3 NE 1] The option was not offered to me
[IF S3 = 1] No access to Internet/computer
Did not know about it/never thought about it
Too hard/complex
Don’t trust security with sending my personal information online
Owed money to the IRS
No need/prefer not to
Other (specify)__________________
[MC if ((Q35=YES OR Q35S1=YES (AWARE OF FREE FILE)) AND (Q26 NOT = 3 or 5(DID NOT USE TRADITIONAL FREE FILE )]
Q37. What were the reasons that you did not use Free File for your 2011 tax return?
Do not meet the income requirements/my income is too high
Do not understand what Free File is
Instructions too confusing on IRS website
Difficult to use once I am on 3rd party website
Do not have confidence in Free File/trust in Free File
Do not have confidence in security of sending my personal information over the Internet
Feel that refund anticipation loan provides faster refund
Option was not offered
Someone else decided how to file
Not interested/Preferred another method
Free File did not support the forms/schedules I file because my taxes are complicated
Other (specify)______________________________
[SC, GRID – MAKE ALL COLUMNS SAME WIDTH]
Q38. Here are some questions about preparing and filing your return. How satisfied were you with the following:
Very dissatisfied
Dissatisfied
Neither satisfied nor dissatisfied (neutral)
Satisfied
Very satisfied
[IF S3 NE 1 SHOW]
The tax advice provided by the person who prepared your taxes
The accuracy of the person who prepared your taxes
The knowledge of the person who prepared your taxes
The time it took that person to prepare your taxes after you provided all the necessary information
[IF S3 = 1 SHOW]
The time you spent completing your federal tax return
The ease of understanding what materials and documents to include with your federal tax return
The ease of understanding where to send your return
[IF Q26=2, 6] The amount of money you spent to file your federal tax return electronically
[IF Q26=3,4,5] Ease of using Free File through the IRS website
[GRID - SP]
Q38.1 Thinking back to the time you filed your 2011 return, please state your level of confidence regarding the following aspects of your return.
Not at all confident
Not very confident
Somewhat confident
Very confident
Q38.1a The return I filed was accurate.
Q38.1b The income I reported was accurate.
Q38.1c The deductions and/or credits I claimed were accurate.
Q38.1d The amount of tax I paid was accurate.
Q38.1e I paid the right amount of taxes under the law. ( i.e., took full advantage of all tax laws, resulting in the maximum refund check and/or minimum amount of additional tax owed)
[S3 NE 1, SC]
Q39a1. Taking all factors into account, please rate your overall satisfaction with the person who completed your return.
Very dissatisfied
Dissatisfied
Neither satisfied nor dissatisfied (neutral)
Satisfied
Very satisfied
[S3 NE 1, SC]
Q39a2. Taking all factors into account, please rate your overall satisfaction with the filing process (the actual filing task) of your federal return.
Very dissatisfied
Dissatisfied
Neither satisfied nor dissatisfied (neutral)
Satisfied
Very satisfied
Not applicable/someone else filed my tax return
[S3 = 1, SC]
Q39b. Taking all factors into account, please rate your overall satisfaction with preparing and filing your federal return.
Very dissatisfied
Dissatisfied
Neither satisfied nor dissatisfied (neutral)
Satisfied
Very satisfied
[S3 = 1, TXT]
Q40. Please tell us what you believe the IRS could do to improve the process of completing and filing your return.
_______________________________________________________________________
IV. GETTING YOUR REFUND FROM THE IRS
[PROGRAMMING: IF Q3a=9 or Q4a=10 or Q5a=9 or Q6a=10 (Refund Information), ASK Q42b]
[IF Q3a NE 9 and Q4a NE 10 and Q5a NE 9 and Q6a NE 10, SC]
Q42a In the past 12 months, did you contact the IRS about a refund from any tax year?
Yes [GO TO Q42C]
No [GO TO Q43]
[IF Q3a=9 or Q4a=10 or Q5a=9 or Q6a=10; SC]
42b You said earlier that you contacted the IRS about a refund by
[IF Q3A = 9 INSERT ‘calling an IRS Toll-Free line’,
[IF Q4A = 10 INSERT ‘visiting a local IRS office (Taxpayer Assistance Center, walk-in center)’,
[IF Q5A = 9 INSERT ‘going to the IRS website’,
[IF Q6A = 10 INSERT ‘using regular mail to contact the IRS’,
Did you also contact the IRS about a refund from any tax year in the last 12 months through
[IF Q3A NE 9 INSERT ‘calling an IRS Toll-Free line’,
[IF Q4A NE 10 INSERT ‘visiting a local IRS office (Taxpayer Assistance Center, walk-in center)’,
[IF Q5A NE 9 INSERT ‘going to the IRS website’,
[IF Q6A NE 10 INSERT ‘using regular mail to contact the IRS’,
Yes ASK Q42c
No SKIP TO Q43
[IF Q42B = 1, MC/NUM GRID, RANGE 0-99]
Q42c. How did you contact the IRS about the refund and how many times did you contact the IRS about a refund in the past 12 months for each method?
Method CHECKBOX Number of Times in Past 12 Months
1. [IF Q3A = 7 DO NOT DISPLAY OPTION]Call an IRS Toll-Free line __________
2. [IF Q4A = 7 DO NOT DISPLAY OPTION]Visit the local IRS office (Taxpayer Assistance Center, walk-in center) __________
3. [IF Q5A = 7 DO NOT DISPLAY OPTION]Visit the IRS website __________
4. [IF Q6A = 7 DO NOT DISPLAY OPTION]Send regular mail to the IRS __________
__________
[SC]
Following are some questions about getting your refund from the IRS for your 2011 federal tax return.
Q43a. When you filed your 2011 federal tax return, did you think you would get a tax refund or that you owed taxes?
Thought I owed taxes
Expected a refund
Neither
Don’t know
Q43b. In the end, did you get a refund, owe money or neither?
Got refund
Owed money
Neither
Don’t know
=
[SC, IF Q43B = 1]
Q46 Have you received your refund for your 2011 tax return yet? If you were expecting a refund, but it was withheld for any reason, please answer “No”.
1 Yes
2 No
3 Applied to prior year balance/estimated tax
[IF 46 = 1, 2, SC]
Q48. [IF Q46 = 2, SHOW How did you request to receive your refund?
[IF Q46 = 1, SHOW How did you receive your refund?
Direct deposit
Paper check
Refund Anticipation Loan (RAL)
[SP, IF Q48=3]
Q45b. If you knew the IRS could directly deposit your refund into your bank account in three days,would you still have taken the Refund Anticpation Loan (RAL)?
1 Yes
2 No
[SC/GRID, IF Q43B = 1 – MAKE ALL COLUMNS SAME WIDTH]
[ENLARGE FONT SIZE]
Q50. Please rate your satisfaction with the following aspects of getting your refund from the IRS. How satisfied were you with:
Very dissatisfied
Dissatisfied
Neither satisfied nor dissatisfied (neutral)
Satisfied
Very satisfied
Not applicable
The time it took to receive your refund from the IRS
The accuracy of your refund
The IRS’s explanation of any adjustments to your refund
[SC, IF Q43B = 1]
Q51. Taking all factors into account, please rate your satisfaction with getting your refund from the IRS for the 2011 tax season?
Very dissatisfied
Dissatisfied
Neither satisfied nor dissatisfied (neutral)
Satisfied
Very satisfied
The following questions are about notices. A notice is a letter sent in the mail from the IRS regarding an issue such as a balance due, an overpayment, or a request for information. Please do not count letters to taxpayers about the IRS not mailing certain tax packages (forms and instructions) in 2011.
Notice Receipt and Topic
[SC]
52. In the past 12 months, have you received a notice from the IRS?
1 Yes
2 No [
[IF Q52 = NO AND Q3A NE 6 AND Q4A NE 6 AND Q6A NE 6, SKIP TO NEXT SECTION]
[DISPLAY IF Q3A = 6 OR Q4A = 6 OR Q6A = 6]
Next are some questions about your contact in the past 12 months about any notices you’ve received.
[DISPLAY IF Q3A = 6 OR Q4A = 6 OR Q6A = 6]
[REMOVE YES/NO ANSWER CHOICES]
You mentioned that you have contacted the IRS about a notice by [Insert “Calling an IRS Toll-Free line” if Q3a=4], [Insert “Visiting a local IRS office” if Q4a=4], [Insert “Sending regular mail to the IRS” if Q6a=4].
[MC/NUM GRID, RANGE 0-99]
Q56a/56b. Did you contact the IRS about the notice by the following methods? If so, how many times did you contact the IRS about a notice in the past 12 months for each method?
Method Number of Times in Past 12 Months
1. [IF Q3A = 4 DO NOT DISPLAY OPTION]Call an IRS Toll-Free line __________
2. [IF Q4A = 4 DO NOT DISPLAY OPTION]Visit a local IRS office (Taxpayer Assistance Center, walk-in center) __________
3. [IF Q6A = 4 DO NOT DISPLAY OPTION]Send regular mail to the IRS __________
The following questions are about your most recent notice from the IRS:
[SC]
Q57. What was your most recent notice about?
Credits you might be eligible for but did not claim
Error on return: Under-reported income
Error on return: Inadequate withholdings
Error on return: Other
Failure to file a return
Failure to make payment
Failure to sign return or form
Overpayment
Refund issue
Balance due issue
Resubmitting/missing forms
Penalty for late filing
Request for information/proof for items on my tax return (correspondence exam)
Other (specify)
The purpose of the notice was not clear
Do not recall_______________________
Notice Inserts
[IF Q52 = YES, SC]
58. Were additional paper inserts included with this most recent notice?
Yes
No [Skip to Q60]
Don’t remember
[ASK IF Q58=1]
[MC]
[
Q59. Did you find the insert(s) included with the notice useful?
Yes
No
Some were useful, others were not
[SP]
Q60. If you are to receive communications from IRS in the future about your tax account, would you prefer to receive such communications through email or through the postal mail service?
Postal mail service
Neither email nor postal mail service (Specify)
Notice Resolution
[ SC]
Q61. How did you first choose to respond to the most recent notice?
Called an IRS Toll-Free line
Visited a local IRS office (Taxpayer Assistance Center, walk-in center)
Sent regular mail to the IRS
Had someone else respond: tax preparer, accountant, attorney
Had someone else respond: spouse, friend
Did nothing
Other _____________
Don’t remember
Not applicable
[IF Q61=1, SC]Q56c. Were you able to resolve the issue in your notice when you called?
1 Yes
2 No
[IF Q61=2, SC]Q56d. Were you able to resolve the issue in your notice when you visited the local IRS office (Taxpayer Assistance Center, walk-in center)?
1 Yes
2 No
[IF 61=3, SC]
Q56e. Were you able to resolve the issue in your notice when you sent mail to the IRS?
1 Yes
2 No
[IF 61 = 6, SC]
Q63. What was the primary reason that you did nothing about the notice?
It wasn’t clear what I was supposed to do
The notice said no action was needed
The issue was already resolved
Other (specify) ____________________
Interim Letter Questions
[IF Q61=1-5, 7,SC]
Q66. After your initial response to the notice, did you receive correspondence from the IRS indicating your “case” was under review and that the IRS would be getting back to you (i.e., an "interim” letter regarding the status of your correspondence)?
Yes
No [Skip to Q64]
Do not remember
Do not know
[IF Q66 = YES, SC]
Q67. Was the “interim” letter useful in providing an adequate update on the status of your most recent notice?
Yes
No
[IF Q66 = YES, SC]
Q68. Was it clear that this “interim” letter required no action from you until the IRS contacted you again (except to continue making payments that are due)?
Yes
No
[IF Q66 = YES, SC]
Q69. About how many months went by between the time you responded to the initial notice and the time you received the “interim” letter?
Less than 1 month
Between 1 to 3 months
Between 3 and 6 months
More than 6 months
Don’t remember/don’t know
[IF NEW Q66 = YES, SC]
Q70a. Please rate your satisfaction with the timeliness of receiving this “interim” letter.
Very dissatisfied
Dissatisfied
Neither satisfied nor dissatisfied (neutral)
Satisfied
Very satisfied
[IF 61 = 1-5, 7, SC]
Q64. From the time you received your most recent notice, about how long did it take to resolve the issue?
Less than 1 day
1 day or longer, but less than 1 week
Between 1 and 2 weeks
More than 2 weeks, but less than 1 month
Between 1 and 3 months
Between 3 and 6 months
More than 6 months
Notice issue still unresolved
Don’t remember/don’t know
[IF Q61=1-5, 7, GRID]
[DO NOT SPLIT INTO TWO GROUPS]
[INCREASE SIZE OF LABELS]
Q65. Recalling your experience with the notice, please indicate the level to which you agree or disagree with the following statements:
1 Strongly disagree
2 Disagree
3 Neither agree or disagree
4 Agree
5 Strongly agree
a. The language was easy to understand
b. The layout was easy to follow
c. The section headings (if any) were helpful
d. The notice contained too much information
e. The notice contained the information I needed
f. The notice was clear on how to use IRS services to resolve the issue
g. The contact information was easy to locate
[ SC]
Q70b. Thinking about all aspects of your experience with your most recent IRS notice, please rate your satisfaction with the overall notice process.
Very dissatisfied
Dissatisfied
Neither satisfied nor dissatisfied (neutral)
Satisfied
Very satisfied
[ MC, UP TO 2 CHOICES]
Q62. What should the IRS do to improve the notice process? OPEN END
VI. OVERALL SATISFACTION: ALL RESPONDENTS
[PROMPT]
[SC, IF XSPANISH = 2]
Q71a. Please rate your overall satisfaction with the Spanish-language assistance you received from the IRS for your 2011 federal taxes.
Very dissatisfied
Dissatisfied
Neither satisfied nor dissatisfied (neutral)
Satisfied
Very Satisfied
[PROMPT]
[SC]
Q71b. Considering all factors concerning your 2011 federal tax return (including getting information, preparation and filing, and refund or notice issues), please rate your overall satisfaction with the entire 2011 tax filing process.
Very dissatisfied
Dissatisfied
Neither satisfied nor dissatisfied (neutral)
Satisfied
Very Satisfied
[TXT]
Q72. What could the IRS have done to improve your experience with your 2011 taxes? If you have no suggestions, please enter “None.”
_________________________________________________________________________________
VII. PSYCHOGRAPHIC QUESTIONS
[SC, GRID]
Q73. The next set of questions are opinion questions that give us an indication of taxpayer views on finance and Internet-related issues. Please indicate the extent to which you agree or disagree with each of the following statements. [Rotate list of items]
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
I enjoy doing research on the Internet
I enjoy managing my household finances
I wish I had a better understanding of my finances
I believe that the IRS is concerned about how to provide tax information that helps taxpayers deal with economic hardships
I perform financial activities (i.e., pay bills,credit cards, insurance, mortgages, etc) on the Internet
I make purchases on the Internet
I feel secure sharing personal financial information over the Internet
I do not mind paying my fair share of taxes
I think preparing tax returns should be made easier
I think electronic filing should be free to everyone
I think there should be an alternative tax system to replace the income tax system
I regularly save money
Another person has control of my finances
I have an emergency fund/financial safety net
I’m confident in my ability to solve financial problems that come up in my everyday life
VIII. AFFORDABLE CARE ACT OF 2012 Questions
The following questions are about the Affordable Care Act of 2012. As you may know, a federal law was passed earlier in 2012 that makes changes to the country’s health care insurance system.
[SP]
H1. Overall, how much would you say you know about the Affordable Care Act of 2012?
1 Nothing at all
2 Some
3 A lot
4 Everything
[GRID – SP]
H2. How much do you know about each of the following specific changes made by the Affordable Care Act of 2012?
|
Nothing at all |
Some |
A lot |
Everything |
|
1 |
2 |
3 |
4 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
H3. How would you prefer to get information about the new Affordable Care Act and fees? (Please rank top three. Type 1 for your 1st choice, 2 for 2nd and 3 for 3rd) [Programmer: Rotate the list except keep other at the bottom, allow ranking of up to three]
TV
Radio
Newspaper
Internet
Friends, Colleagues, Family Members
Employer
Tax preparer
Health care provider
Other, Specify _______________________________________________
[IF H3=Internet]
[ALLOW RANKING OF UP TO THREE]]
H3.1 Which of the following ways on the Internet would you prefer to get information about the Affordable Care Act and fees? (Please rank up to 3)
YouTube
Social Networks (e.g. Facebook, Twitter, etc.)
Internet news site (e.g. CNN.com, etc)
Healthcare.gov
Other
[IF H3=Mail][SC][Rotate list, keep other and none at the bottom]
H3.2 From which of the following organizations would you prefer to receive mail about the Affordable Care Act and fees?
Health insurance company
Car or home insurance company
State Health Department
County Health Department
Department of Health and Human Services (HHS)
Centers for Disease Control and Prevention (CDC)
My doctor
My pharmacist
Red Cross
Community center or volunteer organization (e.g. senior citizens center)
Internal Revenue Service (IRS)
Tax professional
Other, specify______________
None,
[SC]
H4. Which of the following best describes your current primary health insurance coverage?
Health insurance through a job (current or past employer or union)
Buy health insurance privately (not related to current or past employment)
Medicare (health insurance for persons 65 years or over, or with disabilities)
Medicaid (government assistance program pays for health care)
TRICARE, CHAMPUS, CHAMPVA, VA, military health care, or Indian Health Service
I do not have health insurance
Don’t know
[Programmer: rotate the list]
[SC]
H5. Where is the first place you would contact if you had a question related to the new Affordable Care Act?
Health insurance company
Car or home insurance company
State Health Department
County Health Department
Red Cross
Community center or volunteer organization (e.g., Senior Citizens Center)
Department of Health and Human Services (HHS)
Centers for Disease Control and Prevention (CDC)
Internal Revenue Service (IRS)
Tax professional
My doctor
My pharmacist
None, I would not contact any government office, agency or community group
Other, specify__________________
[SC]
H6. What is your preferred contact method to get more information/get questions answered about the new law? (Select up to three)
Internet
Phone
Text or SMS
Face-to-face /In person
VIII. DEMOGRAPHICS: ALL RESPONDENTS
Here are a few questions for classification purposes only.
[SC]
D1. Do you have a computer at home?
1 Yes
2 No
[SC]
D2.1. Do you access the Internet apart from taking surveys via Knowledge Networks?
Yes
No
[MC]
D2. Where do you access the Internet?
From home
From work
From public library or other place (e.g. school, internet café, etc)
From hotels
At an IRS office (Taxpayer Assistance Center, walk-in center)
I do not access the Internet
Cell phone\BlackBerry\PDA
[IF Q2C = 1 AND D2 = 6, MC]
D2chk Earlier you indicated you visited the IRS website to obtain information and you just now indicated you do not access the Internet. Where did you access the IRS website?
From home
From work
From public library or other place (e.g. school, internet café, etc)
At a local IRS office (Taxpayer Assistance Center, walk-in center)
I do not access the Internet
Cell phone\BlackBerry\PDA
Other explanation (specify)
[SC]
D5. What is the highest level of education you have completed?
1 Less than 9th grade
2 9th grade to 12th grade, no diploma
3 High school graduate/GED
4 Some technical/vocational school
5 Technical or vocational school graduate
6 Some college, no degree
7 Associate Degree
8 Bachelor’s Degree
9 Master’s Degree
10 Post-Master’s Degree
[MC]
D6. Do you have any of the following long-term conditions (lasting 6 months or more)? Please select all that apply.
1 Deafness
2 Severe Vision Impairment
3 Severe Hearing Impairment
4 Severe Speech Impairment
5 A condition that substantially limits your physical abilities (such as standing or walking)
6 A condition that limits learning or remembering
7 Some other condition
8 Do not have a long-term condition [SC]
[IF D6 = 1-7, SC]
D6a. Does your disability prevent you from going outside of your home?
1 Yes
2 No
[SC]
D7. What is your employment status?
1 Work full-time
Work part-time
Retired
Full-time student
Unemployed, looking for work
Employed in the home/homemaker (for example, a stay at home parent)
Other
[IF D7 = 5, NUM ENTER DIGITS 0-99]
D7.1 For how many months have you been unemployed and looking for work?
___________ months
[SC]
D8. Did you report having any dependents on your 2011 tax return?
1 Yes
2 No
[SC]
D9. Which of the following categories best describes your household income before taxes for 2011?
Less than $10,000
$10,000 to less than $15,000
$15,000 to less than $25,000
$25,000 to less than $35,000
$35,000 to less than $50,000
$50,000 to less than $75,000
$75,000 to less than $100,000
$100,000 to less than $150,000
$150,000 to less than $200,000
$200,000 to less than $1 million
$1 million or more
[SC]
D10. Do you speak a language other than English at home?
Yes
No
[IF XSPANISH = 2, SC]
D11A. Are you of Hispanic or Latino origin (ethnicity)?
Yes
No
[IF XSPANISH = 2, SC]
D11B. What is your country of origin?
Argentina
Colombia
Cuba
Dominican Republic
Ecuador
El Salvador
Guatemala
Honduras
Mexico
Nicaragua
Peru
Puerto Rico
Spain
United States
Venezuela
Other (Please specify)
File Type | application/msword |
File Title | OMB SUPPORTING STATEMENT |
Author | sherri.a.settle |
Last Modified By | qhrfb |
File Modified | 2011-11-09 |
File Created | 2011-11-01 |