Form 016 2018 016 CMS - InsureKidsNow_20180810

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Overview

Attributes
Welcome and Thank You Text
Model Questions
Custom Questions

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Sheet 1: Attributes

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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Sheet 2: Welcome and Thank You Text

	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.
		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.
		Example Desktop

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Sheet 3: Model Questions

Model Name		CMS - InsureKidsNow					Red & Strike-Through: Delete
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)
	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)
	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)
	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.

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Sheet 4: Custom Questions

Model Name		CMS - InsureKidsNow					Red & Strike-Through: Delete
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