30628 Q_CGSJ15_Web_Browse_20180907_DOT

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Overview

Welcome and Thank You Text
Model Qsts
Current CQs
CQs (9-7-18)
CQs(2-7-18)
CQs (1-5-17)
Model Qsts (11-17-16)
CQs (11-17-16)

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Sheet 1: Welcome and Thank You Text

Welcome and Thank You Text
	Welcome Text			Thank You Text
	Customer Satisfaction Survey Thank you for visiting CGS. You have been randomly selected to take part in this survey that is being conducted by ForeSee Results on behalf of CGS. Please take a minute or two to give us your opinions. The feedback you provide will help CGS enhance its site and serve you better in the future. All results are strictly confidential.			Thank you for your time in completing this survey. Your input is very valuable and will be taken into consideration.
	Welcome Text - Alternate			Thank You Text - Alternate
	Thank you for visiting [Company/Site/Agency]. You have been randomly selected to take part in this survey that is being conducted by ForeSee on behalf of the [Company/Site/Agency]. Please take a few minutes to give us your feedback. All results are strictly confidential.			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 web site.

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Sheet 2: Model Qsts

Model Name		CMS - CGS J15 V2					Red & Strike-Through: Delete
Model ID		AZol5A5wt1llpYE8Fk4gdw4C					Underlined & Italicized: Re-order
Partitioned		2MQ					Pink: Addition
Date		10/31/2016					Blue: Reword
	Label	Element Questions		Label	Satisfaction Questions		Label	Future Behaviors
		Look and Feel (1=Poor, 10=Excellent, Don't Know)			Satisfaction			Primary Resource (1=Not Very Likely, 10=Very Likely)
	Look and Feel - Appeal	Please rate the visual appeal of this site.		Satisfaction - Overall	What is your overall satisfaction with this site? (1=Very Dissatisfied, 10=Very Satisfied)		Primary Resource	How likely are you to use this site as your primary resource for getting information on Medicare?
	Look and Feel - Balance	Please rate the balance of graphics and text on this site.		Satisfaction - Expectations	How well does this site meet your expectations? (1=Falls Short, 10=Exceeds)			Recommend Site (1=Not Very Likely, 10=Very Likely)
	Look and Feel - Legibility	Please rate the legibility of the pages on this site.		Satisfaction - Ideal	How does this site compare to your idea of an ideal site? (1=Not Very Close, 10=Very Close)		Recommend Site	How likely are you to recommend this site to someone else?
		Site Performance (1=Poor, 10=Excellent, Don't Know)						Likelihood to Return (1=Not Very Likely, 10=Very Likely)
	Site Performance - Loading	Please rate how quickly pages load on this site.					Return	How likely are you to return to this site?
	Site Performance - Consistency	Please rate the consistency of speed from page to page on this site.
	Site Performance - Completeness	Please rate how completely the page content loads on this site.
		Navigation (1=Poor, 10=Excellent, Don't Know)
	Navigation - Organized	Please rate how well this site is organized.
	Navigation - Options	Please rate the options available for navigating this site.
	Navigation - Layout	Please rate how well the site layout helps you find what you need.
		Information Browsing (1=Poor, 10=Excellent, Don't Know)
	Information Browsing - Sort	Please rate the ability to sort information by criteria that are important to you on this site.
	Information Browsing - Narrow	Please rate the ability to narrow choices to find the information you are looking for on this site.
	Information Browsing - Features	Please rate how well the features on the site help you find the information you need.
		Site Information (1=Poor, 10=Excellent, Don't Know)
	Site Information - Thoroughness	Please rate the thoroughness of information provided on this site.
	Site Information - Relevant	Please rate how relevant this site’s information is.
	Site Information - Answers	Please rate how well the site’s information provides answers to your questions.

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Sheet 3: Current CQs

Model Name	CMS - CGS J15 V2					Red & Strike-Through: Delete
Model ID	AZol5A5wt1llpYE8Fk4gdw4C					Underlined & Italicized: Re-order
Partitioned	2MQ					Pink: Addition
Date	10/31/2016					Blue: Reword
QID	QUESTION META TAG	Skip From	Question Text	Answer Choices	Skip To	Required Y/N	Type	Special Instructions	CQ Label
HDU7039Q001			Which best describes you?	Staff of a provider/supplier working primarily with billing/insurance		Y	Radio button, one-up vertical	Skip Logic Group	Role
				Billing service
				Supplier of medical equipment or supplies
				Administrative staff of a provider/supplier
				Provider of medical services
				Other staff of a provider/supplier
				Consultant or attorney
				Other (please specify)	A
HDU7039Q002		A				N	Text area, no char limit	Skip Logic Group	Other_Role
HDU7039Q003			In the last 30 days, how many times have you visited this website?	This is my first time		Y	Radio button, one-up vertical		Visit Frequency
				Once or twice
				Three or four times
				More than once per week but not every day
				Every day
MAD0210864			Did you log in to the myCGS Web Portal today?	Yes		Y	Radio button, one-up vertical		Log In
				No
HDU7039Q004	Primary Reason: Retail		What is your primary reason for visiting this site today?	Research a general or specific question on Medicare policy or billing	R	Y	Radio button, one-up vertical	Skip Logic Group	Primary Reason
				Read Medicare publications such as newsletters, articles, etc.
				Find out about a Local Coverage Determination (LCD)
				Download forms
				Access claim status and/or beneficiary eligibility
				Find general Medicare program information
				Learn of, or register for, workshops, seminars or other training events
				Find information on fees or fee schedules
				Take an on-line training course
				Find enrollment information
				Find contact information
				Other (please specify)	B
HDU7039Q005		B	Please explain your primary reason for visiting the site.			N	Text area, no char limit	Skip Logic Group	Other_Primary Reason
HDU7039Q006		R	What enhancements (if any) would you like to see added to the myCGS Web Portal?			N	Text area, no char limit	Skip Logic Group	Portal enhancements
HDU7039Q007	Accomplish		Did you accomplish your goal in coming to the site today?	Yes		Y	Radio button, one-up vertical	Skip Logic Group	Accomplish Goal
				No	C
HDU7039Q008	OE_Accomplish	C	Why didn't you accomplish your goal?			N	Text area, no char limit	Skip Logic Group	Why not accomplish
HDU7039Q009			How did you primarily look for information on this site today?	Left navigation bar	N	Y	Radio button, one-up vertical	Skip Logic Group	Look for Info
				Searched using the site search feature	N
				Quick Links on the right side of the page	N
				Other
HDU7039Q010		N	How would you describe your navigation experience on this site today? (Please select all that apply.)	I had no difficulty browsing on this site		Y	Checkbox, one-up vertical	Skip Logic Group	Navigation Experience
				Some links did not take me where I expected or were broken	E
				Too many links/navigational options to choose from
				Other	G
HDU7039Q011		E	What specific links did not take you where they should have?			N	Text area, no char limit	Skip Logic Group	Nav links wrong path
HDU7039Q012		G	The navigation difficulty I experienced was:			N	Text area, no char limit	Skip Logic Group	Other_Nav Experience
HDU7039Q013			If you could identify one improvement to the web site, what would that improvement be?			N	Text area, no char limit		One Improvement
HDU7039Q014			If you are over the age of 18 and would like CGS to respond to your feedback regarding this website, please provide your work email address here:			N	Text field with 100 character limit		Email

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Sheet 4: CQs (9-7-18)

Model Name	CMS - CGS J15 V2					Red & Strike-Through: Delete
Model ID	AZol5A5wt1llpYE8Fk4gdw4C					Underlined & Italicized: Re-order
Partitioned	2MQ					Pink: Addition
Date	10/31/2016					Blue: Reword
QID	QUESTION META TAG	Skip From	Question Text	Answer Choices	Skip To	Required Y/N	Type	Special Instructions	CQ Label
HDU7039Q001			Which best describes you?	Staff of a provider/supplier working primarily with billing/insurance		Y	Radio button, one-up vertical	Skip Logic Group	Role
				Billing service
				Supplier of medical equipment or supplies
				Administrative staff of a provider/supplier
				Provider of medical services
				Other staff of a provider/supplier
				Consultant or attorney
				Other (please specify)	A
HDU7039Q002		A				N	Text area, no char limit	Skip Logic Group	Other_Role
HDU7039Q003			In the last 30 days, how many times have you visited this website?	This is my first time		Y	Radio button, one-up vertical		Visit Frequency
				Once or twice
				Three or four times
				More than once per week but not every day
				Every day
MAD0210864			Did you log in to the myCGS Web Portal today?	Yes		Y	Radio button, one-up vertical		Log In
				No
HDU7039Q004	Primary Reason: Retail		What is your primary reason for visiting this site today?	Research a general or specific question on Medicare policy or billing	R	Y	Radio button, one-up vertical	Skip Logic Group	Primary Reason
				Read Medicare publications such as newsletters, articles, etc.
				Find out about a Local Coverage Determination (LCD)
				Download forms
				Access claim status and/or beneficiary eligibility
				Find general Medicare program information
				Learn of, or register for, workshops, seminars or other training events
				Find information on fees or fee schedules
				Take an on-line training course
				Find enrollment information
				Find contact information
				Other (please specify)	B
HDU7039Q005		B	Please explain your primary reason for visiting the site.			N	Text area, no char limit	Skip Logic Group	Other_Primary Reason
HDU7039Q006		R	What enhancements (if any) would you like to see added to the myCGS Web Portal?			N	Text area, no char limit	Skip Logic Group	Portal enhancements
HDU7039Q007	Accomplish		Did you accomplish your goal in coming to the site today?	Yes		Y	Radio button, one-up vertical	Skip Logic Group	Accomplish Goal
				No	C
HDU7039Q008	OE_Accomplish	C	Why didn't you accomplish your goal?			N	Text area, no char limit	Skip Logic Group	Why not accomplish
HDU7039Q009			How did you primarily look for information on this site today?	Left navigation bar	N	Y	Radio button, one-up vertical	Skip Logic Group	Look for Info
				Searched using the site search feature	N
				Quick Links on the right side of the page	N
				Other
HDU7039Q010		N	How would you describe your navigation experience on this site today? (Please select all that apply.)	I had no difficulty browsing on this site		Y	Checkbox, one-up vertical	Skip Logic Group	Navigation Experience
				Some links did not take me where I expected or were broken	E
				Too many links/navigational options to choose from
				Other	G
HDU7039Q011		E	What specific links did not take you where they should have?			N	Text area, no char limit	Skip Logic Group	Nav links wrong path
HDU7039Q012		G	The navigation difficulty I experienced was:			N	Text area, no char limit	Skip Logic Group	Other_Nav Experience
HDU7039Q013			If you could identify one improvement to the web site, what would that improvement be?			N	Text area, no char limit		One Improvement
HDU7039Q014			If you are over the age of 18 and would like CGS to respond to your feedback regarding this website, please provide your work email address here:			N	Text field with 100 character limit		Email

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Sheet 5: CQs(2-7-18)

Model Name	CMS - CGS J15 V2					Red & Strike-Through: Delete
Model ID	AZol5A5wt1llpYE8Fk4gdw4C					Underlined & Italicized: Re-order
Partitioned	2MQ					Pink: Addition
Date	10/31/2016					Blue: Reword
QID	QUESTION META TAG	Skip From	Question Text	Answer Choices	Skip To	Required Y/N	Type	Special Instructions	CQ Label
HDU7039Q001			Which best describes you?	Staff of a provider/supplier working primarily with billing/insurance		Y	Radio button, one-up vertical	Skip Logic Group	Role
				Billing service
				Supplier of medical equipment or supplies
				Administrative staff of a provider/supplier
				Provider of medical services
				Other staff of a provider/supplier
				Consultant or attorney
				Other (please specify)	A
HDU7039Q002		A				N	Text area, no char limit	Skip Logic Group	Other_Role
HDU7039Q003			In the last 30 days, how many times have you visited this website?	This is my first time		Y	Radio button, one-up vertical		Visit Frequency
				Once or twice
				Three or four times
				More than once per week but not every day
				Every day
MAD0210864			Did you log in to the myCGS Web Portal today?	Yes		Y	Radio button, one-up vertical		Log In
				No
HDU7039Q004	Primary Reason: Retail		What is your primary reason for visiting this site today?	Research a general or specific question on Medicare policy or billing	R	Y	Radio button, one-up vertical	Skip Logic Group	Primary Reason
				Read Medicare publications such as newsletters, articles, etc.
				Find out about a Local Coverage Determination (LCD)
				Download forms
				Access claim status and/or beneficiary eligibility
				Find general Medicare program information
				Learn of, or register for, workshops, seminars or other training events
				Find information on fees or fee schedules
				Take an on-line training course
				Find enrollment information
				Find contact information
				Other (please specify)
HDU7039Q005		B	Please explain your primary reason for visiting the site.			N	Text area, no char limit	Skip Logic Group	Other_Primary Reason
HDU7039Q006		R	What enhancements (if any) would you like to see added to the myCGS Web Portal?			N	Text area, no char limit	Skip Logic Group	Portal enhancements
HDU7039Q007	Accomplish		Did you accomplish your goal in coming to the site today?	Yes		Y	Radio button, one-up vertical	Skip Logic Group	Accomplish Goal
				No	C
HDU7039Q008	OE_Accomplish	C	Why didn't you accomplish your goal?			N	Text area, no char limit	Skip Logic Group	Why not accomplish
HDU7039Q009			How did you primarily look for information on this site today?	Left navigation bar	N	Y	Radio button, one-up vertical	Skip Logic Group	Look for Info
				Searched using the site search feature	N
				Quick Links on the right side of the page	N
				Other
HDU7039Q010		N	How would you describe your navigation experience on this site today? (Please select all that apply.)	I had no difficulty browsing on this site		Y	Checkbox, one-up vertical	Skip Logic Group	Navigation Experience
				Some links did not take me where I expected or were broken	E
				Too many links/navigational options to choose from
				Other	G
HDU7039Q011		E	What specific links did not take you where they should have?			N	Text area, no char limit	Skip Logic Group	Nav links wrong path
HDU7039Q012		G	The navigation difficulty I experienced was:			N	Text area, no char limit	Skip Logic Group	Other_Nav Experience
HDU7039Q013			If you could identify one improvement to the web site, what would that improvement be?			N	Text area, no char limit		One Improvement
HDU7039Q014			If you are over the age of 18 and would like CGS to respond to your feedback regarding this website, please provide your email address here:			N	Text field with 100 character limit		Email

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Sheet 6: CQs (1-5-17)

Model Name	CMS - CGS J15 V2					Red & Strike-Through: Delete
Model ID	AZol5A5wt1llpYE8Fk4gdw4C					Underlined & Italicized: Re-order
Partitioned	2MQ					Pink: Addition
Date	10/31/2016					Blue: Reword
QID	QUESTION META TAG	Skip From	Question Text	Answer Choices	Skip To	Required Y/N	Type	Special Instructions	CQ Label
HDU7039Q001			Which best describes you?	Staff of a provider/supplier working primarily with billing/insurance		Y	Radio button, one-up vertical	Skip Logic Group	Role
				Billing service
				Supplier of medical equipment or supplies
				Administrative staff of a provider/supplier
				Provider of medical services
				Other staff of a provider/supplier
				Consultant or attorney
				Other (please specify)	A
HDU7039Q002		A				N	Text area, no char limit	Skip Logic Group	Other_Role
HDU7039Q003			In the last 30 days, how many times have you visited this website?	1-5 times		Y	Radio button, one-up vertical		Visit Frequency
				6-10 times
				More than 10 times
				This is my first time
				Once or twice
				Three or four times
				More than once per week but not every day
				Every day
HDU7039Q004	Primary Reason: Retail		What is your primary reason for visiting this site today?	Access the myCGS web portal (claim status, eligibility, etc.)	R	Y	Radio button, one-up vertical	Skip Logic Group	Primary Reason
				Research a general or specific question on Medicare policy or billing (LCDs, fee schedules, enrollment, etc.)
				Read Medicare publications (newsletters, articles, etc.) such as newsletters, articles, etc.
				Find out about a Local Coverage Determination (LCD)
				Download forms
				Access claim status and/or beneficiary eligibility
				Find general Medicare program information
				Learn of, or register for, workshops, seminars or other training events
				Find information on fees or fee schedules
				Take an on-line training course
				Find enrollment information
				Find contact information
				Other (please specify)	B
HDU7039Q005		B	Please explain your primary reason for visiting the site.			N	Text area, no char limit	Skip Logic Group	Other_Primary Reason
HDU7039Q006		R	What enhancements (if any) would you like to see added to the myCGS Web Portal?			N	Text area, no char limit	Skip Logic Group	Portal enhancements
HDU7039Q007	Accomplish		Did you accomplish your goal in coming to the site today?	Yes		Y	Radio button, one-up vertical	Skip Logic Group	Accomplish Goal
				No	C
HDU7039Q008	OE_Accomplish	C	Why didn't you accomplish your goal?			N	Text area, no char limit	Skip Logic Group	Why not accomplish
HDU7039Q009			How did you primarily look for information on this site today?	Left navigation bar	N	Y	Radio button, one-up vertical	Skip Logic Group	Look for Info
				Searched using the site search feature	N
				Quick Links on the right side of the page	N
				Other
HDU7039Q010		N	How would you describe your navigation experience on this site today? (Please select all that apply.)	I had no difficulty browsing on this site		Y	Checkbox, one-up vertical	Skip Logic Group	Navigation Experience
				Some links did not take me where I expected or were broken	E
				Too many links/navigational options to choose from
				Other	G
HDU7039Q011		E	What specific links did not take you where they should have?			N	Text area, no char limit	Skip Logic Group	Nav links wrong path
HDU7039Q012		G	The navigation difficulty I experienced was:			N	Text area, no char limit	Skip Logic Group	Other_Nav Experience
HDU7039Q013			If you could identify one improvement to the web site, what would that improvement be?			N	Text area, no char limit		One Improvement
HDU7039Q014			If you are over the age of 18 and would like CGS to respond to your feedback regarding this website, please provide your email address here:			N	Text field with 100 character limit		Email

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Sheet 7: Model Qsts (11-17-16)

Model Instance Name:
CMS - CGS J15 V2
Partitioned? Yes		2MQ
Date:		10/31/2016
CMS - CGS J15 V2
Model questions utilize the ACSI methodology to determine scores and impacts
		ELEMENTS (drivers of satisfaction)			CUSTOMER SATISFACTION			FUTURE BEHAVIORS
	MQ Label			MQ Label			MQ Label
		Look and Feel (1=Poor, 10=Excellent, Don't Know)			Satisfaction			Primary Resource (1=Not Very Likely, 10=Very Likely)
1	Look and Feel - Appeal	Please rate the visual appeal of this site.	21	Satisfaction - Overall	What is your overall satisfaction with this site? (1=Very Dissatisfied, 10=Very Satisfied)	24	Primary Resource	How likely are you to use this site as your primary resource for getting information on Medicare?
2	Look and Feel - Balance	Please rate the balance of graphics and text on this site.	22	Satisfaction - Expectations	How well does this site meet your expectations? (1=Falls Short, 10=Exceeds)			Recommend (1=Not Very Likely, 10=Very Likely)
3	Look and Feel - Legibility	Please rate the legibility of the pages on this site.	23	Satisfaction - Ideal	How does this site compare to your idea of an ideal website? (1=Not Very Close, 10=Very Close)	25	Recommend	How likely are you to recommend this site to someone else?
		Site Performance (1=Poor, 10=Excellent, Don't Know)						Likelihood to Return (1=Not Very Likely, 10=Very Likely)
4	Site Performance - Loading	Please rate how quickly pages load on this site.				26	Return	How likely are you to return to this site?
5	Site Performance - Consistency	Please rate the consistency of speed from page to page on this site.
6	Site Performance - Completeness	Please rate how completely the page content loads on this site.
		Navigation (1=Poor, 10=Excellent, Don't Know)
7	Navigation - Organized	Please rate how well this site is organized.
8	Navigation - Options	Please rate the options available for navigating this site.
9	Navigation - Layout	Please rate how well the site layout helps you find what you need.
		Information Browsing (1=Poor, 10=Excellent, Don't Know)
10	Information Browsing - Sort	Please rate the ability to sort information by criteria that are important to you on this site.
11	Information Browsing - Narrow	Please rate the ability to narrow choices to find the information you are looking for on this site.
12	Information Browsing - Features	Please rate how well the features on the site help you find the information you need.
13		Site Information (1=Poor, 10=Excellent, Don't Know)
	Site Information - Thoroughness	Please rate the thoroughness of information provided on this site.
14	Site Information - Relevant	Please rate how relevant this site’s information is.
15	Site Information - Answers	Please rate how well the site’s information provides answers to your questions.

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Sheet 8: CQs (11-17-16)

Model Instance Name:				red & strike-through: DELETE
CMS - CGS J15 V2				underlined & italicized: RE-ORDER
				pink: ADDITION
Date:		11/15/2016		blue + -->: REWORDING
CMS - CGS J15 V2 CUSTOM QUESTION LIST
QID		Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Required Y/N	Special Instructions	CQ Label
			Which best describes you?	Staff of a provider/supplier		Radio button, one-up vertical	Y	Skip Logic Group	Role
				Billing service
				Consultant or attorney
				Other	A
		A				Text area, no char limit	N	Skip Logic Group	Other_Role
			In the last 30 days, how many times have you visited this website?	1-5 times		Radio button, one-up vertical	Y		Visit Frequency
				6-10 times
				More than 10 times
			What is your primary reason for visiting this site today?	Access the myCGS web portal (claim status, eligibility, etc.)	R	Radio button, one-up vertical	Y	Skip Logic Group	Primary Reason
				Research a general or specific question on Medicare policy or billing (LCDs, fee schedules, enrollment, etc.)
				Read Medicare publications (newsletters, articles, etc.)
				Find contact information
				Other	B
		B	Please explain your primary reason for visiting the site.			Text area, no char limit	N	Skip Logic Group	Other_Primary Reason
		R	What enhancements (if any) would you like to see added to the myCGS Web Portal?			Text area, no char limit	N	Skip Logic Group	Portal enhancements
			Did you accomplish your goal in coming to the site today?	Yes		Radio button, one-up vertical	Y	Skip Logic Group	Accomplish Goal
				No	C
		C	Why didn't you accomplish your goal?			Text area, no char limit	N	Skip Logic Group	Why not accomplish
			How did you primarily look for information on this site today?	Left navigation bar	N	Radio button, one-up vertical	Y	Skip Logic Group	Look for Info
				Searched using the site search feature	N
				Quick Links on the right side of the page	N
				Other
		N	How would you describe your navigation experience on this site today? (Please select all that apply.)	I had no difficulty browsing on this site		Checkbox, one-up vertical	Y	Skip Logic Group	Navigation Experience
				Some links did not take me where I expected or were broken	E
				Too many links/navigational options to choose from
				Other	G
		E	What specific links did not take you where they should have?			Text area, no char limit	N	Skip Logic Group	Nav links wrong path
		G	The navigation difficulty I experienced was:			Text area, no char limit	N	Skip Logic Group	Other_Nav Experience
			If you could identify one improvement to the web site, what would that improvement be?			Text area, no char limit	N		One Improvement
			If you are over the age of 18 and would like CGS to respond to your feedback regarding this website, please provide your email address here:			Text field with 100 character limit	N		Email