Form CMS-10494 Training Quality Questionnaire

Expiration Date: XX/XXXX

MLMS Assister Training Feedback

Training Content	N/A (1)	Strongly Disagree (2)	Disagree (3)	Neutral (4)	Agree (5)	Strongly Agree (6)
1. The scope of the material is appropriate to my needs.	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐	6 ☐
2. The content will help me use HealthCare.gov to assist consumers with the eligibility and enrollment process.	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐	6 ☐
3. The content has given me sufficient information to perform the following tasks on the job: a. Adequately explain health insurance concepts and educate consumers about the different types of plans available to them	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐	6 ☐
b. Assist consumers with creating an online Marketplace account	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐	6 ☐
c. Use the Plan Compare Tool to help consumers learn about and compare coverage options	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐	6 ☐
d. Conduct effective outreach in the communities I serve and build community partnerships	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐	6 ☐
e. Help consumers understand SHOP Marketplace policy (e.g., employer and employee eligibility, application requirements, the appeals process)	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐	6 ☐
4. The content has given me sufficient information to assist consumers with these more complex scenarios: a. Assist consumers in multi-tax households	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐	6 ☐

Training Content	N/A (1)	Strongly Disagree (2)	Disagree (3)	Neutral (4)	Agree (5)	Strongly Agree (6)
b. Assist consumers applying for exemptions	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐	6 ☐
c. Assist consumers in households with mixed immigration statuses	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐	6 ☐
d. Assist small employers understand the Small Business Health Care Tax Credit	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐	6 ☐
e. Assist employees understand how to obtain coverage through the SHOP Marketplace	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐	6 ☐
5. The content has given me sufficient information to assist consumers with multi-tax households.	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐	6 ☐
6. The content has given me sufficient information to assist consumers with applying for exemptions.	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐	6 ☐
7. The content has given me sufficient information to assist consumers within households with mixed immigration statuses.	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐	6 ☐
8. The content has given me sufficient information to assist consumers with help small employers understand the Small Business Health Care Tax Credit.	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐	6 ☐
9. The content has given me sufficient information to assist consumers with helping employees understand how to obtain coverage through the SHOP Marketplace.	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐	6 ☐
10. The content has given me sufficient information to work with the following population: consumers with disabilities.	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐	6 ☐

Training Content	N/A (1)	Strongly Disagree (2)	Disagree (3)	Neutral (4)	Agree (5)	Strongly Agree (6)
11. The content has given me sufficient information to work with the following population: immigrants.	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐	6 ☐
12. The content has given me sufficient information to work with the following populations: consumers with limited English proficiency.	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐	6 ☐
13. The content has given me sufficient information to work with the following populations: American Indians/Alaskan Natives.	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐	6 ☐
14. The content has given me sufficient information to work with the following populations: Medicare-eligible consumers.	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐	6 ☐
15. The content has given me sufficient information to work with the following populations: Medicaid/CHIP-eligible consumers.	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐	6 ☐
16. The content has given me sufficient information to work with the following populations: Tri-Care eligible consumers.	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐	6 ☐
17. The content has given me sufficient information to work with the following populations: consumers under age 26.	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐	6 ☐
Training Structure	1 - 1st	2 - Second	3 - Third	4 - Fourth	5 - Fifth	6 - Sixth
18. Please rank in order of importance the following training features by how useful they are in helping you understand the material during the training: a. Screenshots of HealthCare.gov.	a.☐ b.☐ c.☐ d.☐	a.☐ b.☐ c.☐ d.☐	a.☐ b.☐ c.☐ d.☐	a.☐ b.☐ c.☐ d.☐	n/a	n/a
Training Content	N/A (1)	Strongly Disagree (2)	Disagree (3)	Neutral (4)	Agree (5)	Strongly Agree (6)
Detailed scenarios/narratives of enrollment situations. The ability to print and read materials during the training. Hands-on, interactive exercises or content.
19. Please rank in order of importance the following training features by how useful they are in helping you understand the material after the training: Real-time help with complex consumer scenarios Specific examples of how to assist consumers with complex scenarios and/or Continuing education webinars Fact sheets, FAQs, and other printed materials Standard operating procedures Examples of best practices from other assisters More in-depth assister certification training	a.☐ b.☐ c.☐ d.☐ e.☐ f.☐	a.☐ b.☐ c.☐ d.☐ e.☐ f.☐	a.☐ b.☐ c.☐ d.☐ e.☐ f.☐	a.☐ b.☐ c.☐ d.☐ e.☐ f.☐	a.☐ b.☐ c.☐ d.☐ e.☐ f.☐	a.☐ b.☐ c.☐ d.☐ e.☐ f.☐
Tell Us What You Think?
Please use the space below to answer the following question: What other information would you have liked to see included in the training?”
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