Attribute | Value |
Channel | Web |
Touchpoint Name | Informational |
Hierarchy | No |
Model Type | PredCSAT Desktop Info |
Journey Phase | Awareness |
Touchpoint Type | Standard |
Partner Involved | No |
Replay | No |
Version Number of Model Template | 17.3.Y |
Survey Type | PREDCSAT |
Look and Feel | Single Page |
Theme Color | #009fea |
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The text you see here will appear at the top and bottom of your survey, examples below. | |||
Default text is included and you may modify this text as needed. | ||||
Welcome and Thank You Text | ||||
Welcome Text | ||||
Thank you for visiting insurekidsnow.gov. You've been randomly chosen to take part in a brief survey to let us know what we're doing well and where we can improve. Please take a few minutes to share your opinions, which are essential in helping us provide the best online experience possible. |
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Thank You Text | ||||
Thank you for taking our survey - and for helping us serve you better. Please note you will not receive a response from us based on your survey comments. If you would like us to contact you about your feedback, please visit the Contact Us section of our website. |
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Example Desktop | ||||
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Model Name | CMS - InsureKidsNow | ![]() |
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Model ID | NEW MEASURE | Underlined & Italicized: Re-order | ||||||
Partitioned | Yes - 2MQ | Pink: Addition | ||||||
Date | 7/24/2018 | Blue: Reword | ||||||
Model Version | 17.3.Y | |||||||
Label | Element Questions | Label | Satisfaction Questions | Label | Future Behaviors | |||
Site Performance (1=Poor, 10=Excellent, Don't Know) | Satisfaction | Return (1=Very Unlikely, 10=Very Likely) |
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Site Performance - Speed | Please rate the speed that pages and content loaded for you. | Satisfaction - Overall | What is your overall satisfaction with this site? (1=Very Dissatisfied, 10=Very Satisfied) |
Return | How likely are you to return to insurekidsnow.gov in the future? | |||
Site Performance - Completeness | Please rate the consistency of complete loading of pages and content. | Satisfaction - Expectations | How well does this site meet your expectations? (1=Falls Short, 10=Exceeds) |
Recommend Company (1=Very Unlikely, 10=Very Likely) |
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Site Performance -Responsiveness | Please rate the responsiveness of the pages to your actions. | Satisfaction - Ideal | How does this site compare to an ideal website? (1=Not Very Close, 10=Very Close) |
Recommend Company | How likely are you to recommend insurekidsnow.gov to someone else? | |||
Look and Feel (1=Poor, 10=Excellent, Don't Know) | Primary Resource (1=Very Unlikely, 10=Very Likely) |
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Look and Feel - Appeal | Please rate the visual appeal of the pages that you visited. | Primary Resource | How likely are you to use insurekidsnow.gov as your primary resource for information about healthcare for children? | |||||
Look and Feel - Spacing | Please rate the spacing between items on the pages that you visited. | |||||||
Look and Feel - Readability | Please rate the legibility of the pages that you visited. | |||||||
Navigation (1=Poor, 10=Excellent, Don't Know) | ||||||||
Navigation - Ease | Please rate the ease of finding what you were looking for. | |||||||
Navigation - Layout | Please rate the page layout on displaying content and links where you could find them. | |||||||
Navigation - Links | Please rate the links on taking you where you needed to go. | |||||||
Site Information (1=Poor, 10=Excellent, Don't Know) | ||||||||
Site Information - Relevance | Please rate the relevance to your interests of the information that you found. | |||||||
Site Information - Thoroughness | Please rate the thoroughness of the information that you found. | |||||||
Site Information - Readability | Please rate the readability of the information that you found. |
Model Name | CMS - InsureKidsNow | ![]() |
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Model ID | NEW MEASURE | Underlined & Italicized: Re-order | |||||||||
Partitioned | Yes - 2MQ | Pink: Addition | |||||||||
Date | Blue: Reword | ||||||||||
QID | AP Question Tag | Skip From | Question Text | Answer Choices | Skip To | AP Answer Tag | Required Y/N |
Type | Special Instructions | CQ Label | |
primary_reason_healthcare | What is your primary reason for visiting this site today? | Find coverage for my family | Y | Radio button, one-up vertical | Primary Reason | ||||||
Find a dentist | |||||||||||
View initiatives (back-to-school, youth sports, etc.) | |||||||||||
Watch webinars / videos | |||||||||||
Find residency, fellowship or other educational opportunities | |||||||||||
Find general information (e.g. FAQ, phone numbers, etc.) | |||||||||||
Other | |||||||||||
accomplish | Did you accomplish what you wanted to do today on this site? | Yes | yes | Y | Radio button, one-up vertical | Skip Logic Group* | Accomplish | ||||
No | A | no | |||||||||
why_not_accomplish | A | Please tell us why you were unable to accomplish your task today. | N | Text area, no char limit | Skip Logic Group* | Why Not Accomplish | |||||
do_next_insurance | What do you plan to do next? | Call CMS | call | Y | Radio button, one-up vertical | Do Next | |||||
Return to insurekidsnow.gov at a later time | return_to_client | ||||||||||
Visit other provider/insurance sites | visit_other_sites | Choose to display Medicare or insurance where this is noted in blue | |||||||||
Call other providers/insurance | call_other | Choose to display Medicare or insurance where this is noted in blue | |||||||||
Something else | something_else | ||||||||||
Nothing | nothing | ||||||||||
acquisition_source_healthcare | How were you referred to the site today? | An email from CMS | client_email | Y | Radio button, one-up vertical | Skip Logic Group* | Acquisition Source | ||||
CMS social network post, tweet, video, etc. | client_social_media | ||||||||||
Non - CMS social network post, tweet, video, etc. | non_client_social_media | ||||||||||
Internet blogs or discussion forums | blogs_forums | Randomize | |||||||||
Search engine results | search_engine | ||||||||||
Recommendation from friend/family | recommend_friend_family | ||||||||||
Recommendation from a doctor/healthcare professional | recommend_doctor | ||||||||||
TV or radio advertising | tv_radio_ads | ||||||||||
Newspaper or magazine advertising | newspaper_magazine_ads | ||||||||||
Internet advertising | internet_ads | ||||||||||
Advertising on social networks (Facebook, Twitter) | social_network_ads | ||||||||||
Research study conducted by CMS | research_study | ||||||||||
Health insurance company website | insurance_company | ||||||||||
Current or previous experience with CMS | past_experience | ||||||||||
Other (please specify) | A | other_please_specify | Anchor Answer Choice | ||||||||
I was not referred to the site by anything specific | not_referred | Anchor Answer Choice | |||||||||
acquisition_source_healthcare_other | A | Please specify how you were referred to the site. | N | Text field, <100 char | Skip Logic Group* | Acquisition Source - Other | |||||
primary_role_insurance | What is your primary role in visiting the site today? | Parent/Guardian | Y | Radio button, one-up vertical | Role | ||||||
Physician/medical professional/researcher | |||||||||||
Agent/insurance broker | |||||||||||
Shopping/obtaining a quote for insurance coverage | |||||||||||
I am covered by insurance through this organization | |||||||||||
Other | |||||||||||
nav_method | How did you look for information or navigate the site today? (Please select all that apply.) | Top navigation bar | top_navigation_bar | Y | Checkbox, one-up vertical | Skip Logic Group* | Navigation Method | ||||
Left navigation bar | left_navigation_bar | ||||||||||
Search feature | search_feature | ||||||||||
Clicked on links on the page | clicked_links_on_page | ||||||||||
Page bookmark or favorite link | favorite_link | ||||||||||
Google or other search engine | search_engine | ||||||||||
Other (please specify) | A | other_please_specify | |||||||||
nav_method_other | A | Please tell us how else you looked for information. | N | Text field, <100 char | Skip Logic Group* | Navigation Method - Other | |||||
nav_experience | How would you describe your browsing experience on the site today? (Please select all that apply.) | I had no difficulty navigating the site | Y | Checkbox, one-up vertical | Mutually Exclusive | Navigation Experience | |||||
Links often did not take me where I expected | L | Skip Logic Group* | |||||||||
I had difficulty finding relevant information | |||||||||||
Links and labels were difficult to understand | U | ||||||||||
There were too many links or navigation options to choose from | |||||||||||
I had technical difficulties (error messages, broken links, etc.) | T | ||||||||||
I could not navigate back to previous information | |||||||||||
I had a different navigation difficulty | A | Anchor Answer Choice | |||||||||
nav_experience_other | A | Please specify your navigation difficulty. | N | Text area, no char limit | Skip Logic Group* | Navigation Experience - Other | |||||
nav_not_expected_oe | L | Please describe any specific navigation links or paths that did not take you where they should have. | N | Text area, no char limit | Skip Logic Group* | Navigation Not Expected OE | |||||
nav_linkes_labels_oe | U | What specific links or labels were difficult to understand? | N | Text area, no char limit | Skip Logic Group* | Nav Links and Labels OE | |||||
nav_tech_issue_oe | T | Please describe the technical difficulty you encountered (include as much detail as possible). | N | Text area, no char limit | Skip Logic Group* | Navigation Technical Issue OE | |||||
tech_problems_nav | Which of the following technical problems, if any, occurred during your visit? (Please select all that apply.) | Site error message | B | site_error_message | Y | Checkbox, one-up vertical | Skip Logic Group* | Technical Problems | |||
Incomplete load of a site page | incomplete_load_of_page | ||||||||||
Inconsistent page loads | inconsistent_page_loads | ||||||||||
Other (please specify) | A | other_please_specify | |||||||||
No technical problems occurred | no_technical_problems_occurred | Mutually Exclusive | |||||||||
tech_problems_nav_other | A | What other type of technical problems did you experience today? | N | Text area, no char limit | Skip Logic Group* | Technical Problems Other | |||||
tech_error_messages | B | Please describe the error message you received. | N | Text area, no char limit | Skip Logic Group* | Technical Error Messages | |||||
info_issues | Which of the following issues, if any, did you experience while reviewing information? (Please select all that apply.) | Information was not up to date | information_not_up_to_date | Y | Checkbox, one-up vertical | Skip Logic Group* | Information Issues | ||||
Information did not answer my questions | information_did_not_answer_questions | ||||||||||
Information was not presented in a concise format | information_not_concise | ||||||||||
Wording was not clear | wording_not_clear | ||||||||||
Text was difficult to read | text_difficult_to_read | ||||||||||
Other (please specify) | A | other_please_specify | |||||||||
No issues reviewing information occurred | no_issues | Mutually Exclusive | |||||||||
other_info_issues | A | Please describe the issue you experienced reviewing information. | N | Text area, no char limit | Skip Logic Group* | Other Information Issues | |||||
visit_frequency | How often do you visit this site? | This is my first visit | first_visit | Y | Drop down, select one | Visit Frequency | |||||
Once every 6 months or less often | six_months | ||||||||||
Once every few months | few_months | ||||||||||
Monthly | monthly | ||||||||||
Weekly | weekly | ||||||||||
Daily or more often | daily | ||||||||||
demos_gender | What is your gender? | Male | male | N | Radio button, one-up vertical | Demos: Gender Fed Govt | |||||
Female | female | ||||||||||
Prefer not to respond | prefer_not_to_respond | ||||||||||
demos_income_US | Which category includes your household income? | Under $25,000 | under_25k | N | Drop down, select one | Demos: Income | |||||
$25,000 - $49,999 | 25k_50k | ||||||||||
$50,000 - $74,999 | 50k_75k | ||||||||||
$75,000 - $99,999 | 75k_100k | ||||||||||
$100,000 - $124,999 | 100k_125k | ||||||||||
$125,000 - $149,999 | 125k_150k | ||||||||||
$150,000 or more | $150,000 or_more | ||||||||||
Prefer not to respond | prefer_not_to_respond | ||||||||||
demos_age | Which category includes your age? | Under 18 | under_18 | N | Drop down, select one | Demos: Age | |||||
18 - 24 | 18_24 | ||||||||||
25 - 34 | 25_34 | ||||||||||
35 - 44 | 35_44 | ||||||||||
45 - 54 | 45_54 | ||||||||||
55 - 64 | 55_64 | ||||||||||
65 or older | 65_or_older | ||||||||||
Prefer not to respond | prefer_not_to_respond | ||||||||||
demos_race | What is your race? (Please select all that apply.) |
American Indian or Alaska Native | american_indian_or_alaska_native | N | Checkbox, one-up vertical | Demos: Race Fed Govt | |||||
Asian | asian | ||||||||||
Black or African American | black_or_african_american | ||||||||||
Native Hawaiian or Other Pacific Islander | native_hawaiian | ||||||||||
White | white | ||||||||||
Prefer not to respond | prefer_not_to_respond | Mutually Exclusive | |||||||||
demos_children | What are the age groups of any children that live in your household? (Please select all that apply.) | No children in household | no_children_in_household | N | Checkbox, one-up vertical | Mutually Exclusive | Demos: Children | ||||
Expecting a baby | expecting_a_baby | ||||||||||
0 to 2 years old | 0_2 | ||||||||||
3 to 7 years old | 3_7 | ||||||||||
8 to 12 years old | 8_12 | ||||||||||
13 to 15 years old | 13_15 | ||||||||||
16 to 17 years old | 16_17 | ||||||||||
Adult child(ren) 18 or older living at home | adult_children_18_or_older | ||||||||||
Prefer not to respond | prefer_not_to_respond | Mutually Exclusive | |||||||||
state | In which state do you live? | Alabama | alabama | Y | Drop down, select one | State | |||||
Alaska | alaska | ||||||||||
Arizona | arizona | ||||||||||
Arkansas | arkansas | ||||||||||
California | california | ||||||||||
Colorado | colorado | ||||||||||
Connecticut | connecticut | ||||||||||
Delaware | delaware | ||||||||||
District of Columbia | district_of_columbia | ||||||||||
Florida | florida | ||||||||||
Georgia | georgia | ||||||||||
Hawaii | hawaii | ||||||||||
Idaho | idaho | ||||||||||
Illinois | illinois | ||||||||||
Indiana | indiana | ||||||||||
Iowa | iowa | ||||||||||
Kansas | kansas | ||||||||||
Kentucky | kentucky | ||||||||||
Louisiana | louisiana | ||||||||||
Maine | maine | ||||||||||
Maryland | maryland | ||||||||||
Massachusetts | massachusetts | ||||||||||
Michigan | michigan | ||||||||||
Minnesota | minnesota | ||||||||||
Mississippi | mississippi | ||||||||||
Missouri | missouri | ||||||||||
Montana | montana | ||||||||||
Nebraska | nebraska | ||||||||||
Nevada | nevada | ||||||||||
New Hampshire | new_hampshire | ||||||||||
New Jersey | new_jersey | ||||||||||
New Mexico | new_mexico | ||||||||||
New York | new_york | ||||||||||
North Carolina | north_carolina | ||||||||||
North Dakota | north_dakota | ||||||||||
Ohio | ohio | ||||||||||
Oklahoma | oklahoma | ||||||||||
Oregon | oregon | ||||||||||
Pennsylvania | pennsylvania | ||||||||||
Rhode Island | rhode_island | ||||||||||
South Carolina | south_carolina | ||||||||||
South Dakota | south_dakota | ||||||||||
Tennessee | tennessee | ||||||||||
Texas | texas | ||||||||||
Utah | utah | ||||||||||
Vermont | vermont | ||||||||||
Virginia | virginia | ||||||||||
Washington | washington | ||||||||||
West Virginia | west_virginia | ||||||||||
Wisconsin | wisconsin | ||||||||||
Wyoming | wyoming | ||||||||||
I live outside of the United States | live_outside_usa | ||||||||||
Prefer not to respond | prefer_not_to_respond |
File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
File Modified | 0000-00-00 |
File Created | 0000-00-00 |