30628 Q_NGSJK_Web_Browse_20180618_DOT

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Overview

Model Questions
Current CQs
CQs (6-18-18)
CQs (12-4-17)
CQs (11-2-17)
CQs (10-13-17)
CQs (4-21-17)
CQs (3-7-17)

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Sheet 1: Model Questions

Model Instance Name:
CMS - NGS JK MAC V2
MID:	cJscBVQFAoYYkwtkNAQhcg4C
Partitioned? Yes		2MQ
Date:		2/21/2017
CMS - NGS JK MAC 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 site? (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 2: Current CQs

Model Instance Name:			red & strike-through: DELETE
CMS - NGS JK MAC V2			underlined & italicized: RE-ORDER
MID:	cJscBVQFAoYYkwtkNAQhcg4C		pink: ADDITION
Date:			blue + -->: REWORDING
CMS - NGS JK MAC 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
RUS0196079		We’re here to help. If you would like assistance with your website experience, please leave your email address and/or phone number and we will reach out to you as soon as possible.				N		Email Follow Up
HAJ7213Q001		Which best describes you?	Provider of medical services		Radio button, one-up vertical	Y	OPS Group*	Best Describes You
			Supplier of medical equipment or supplies
			Staff of provider/supplier working primarily with billing/insurance
			Administrative staff of a provider/supplier
			Other staff of a provider/supplier
			Consultant or attorney
			Billing service
			Other (please specify)	A
HAJ7213Q002	A	Other - which best describes you?			Text field, <100 char	N	OPS Group*	Other Role
HAJ7213Q003		In the last 30 days, how many times have you visited this website?	This is my first time		Radio button, one-up vertical	Y		Visit Frequency
			Once or twice
			Three or four times
			More than once per week but not every day
			Every day
HAJ7213Q004		Which website(s) did you visit today? (Select all that apply)	NGSConnex	B, AA, AP, AJ, AK, P	Check box, one-up vertical	Y	Skip Logic Group	Websites
			NGSMedicare as a REGISTERED user	B, AA, AB, AC, AH, AI
			NGSMedicare as a GUEST user	B, AA, AB, AC, AH, AI
HAJ7213Q005	B	What is your primary reason for visiting this site today?	Access claim status and/or beneficiary eligibility		Radio button, one-up vertical	Y	Skip Logic Group*	Visit Reason
			Research a specific question on Medicare policy or billing
			Find information on fees or fee schedules
			Find out about a Local Coverage Determination (LCD)
			Read Medicare publications such as newsletters, articles, etc.
			Find enrollment information
			Download forms
			Learn of, or register for, workshops, seminars or other training events
			Find contact information
			Find general Medicare program information
			Take an on-line training course
			Other (please specify)	BB
HAJ7213Q006	BB	Please specify your other reason for visiting this site today.			Text area, no char limit	N	Skip Logic Group*	Other Reason
HAJ7213Q007	AA	While visiting the site, did you find what you were looking for?	Yes		Dropdown, Select One	Y	Skip Logic Group	Find
			No	E
			Not yet	E
RUS0200424	E	What specific task were you trying to accomplish today?	Create an NGSConnex account		Radio button, one-up vertical	Y	Skip Logic Group*	Specific Task
			Submit a claim				Randomize
			View/print beneficiary eligibility information
			Submit reopening or redetermination
			View/print remittances
			Respond to an ADR
			View claim status and/or claim overlap information
			View status of a check/EFT
			Something Else	EA			Anchor Answer Choice
HAJ7213Q008	EA	What were you trying to accomplish? (Please be specific)			Text area, no char limit	N	Skip Logic Group	OE_Find
HAJ7213Q009	AB	How did you navigate the website(s) today? (Select all that apply)	Top navigation menu		Checkbox, one-up vertical	Y	Skip Logic Group	Navigate
			Left navigation menu
			Quick links on the right side of the page
			Searched using the site search feature	AD
			Bookmarks
			Other	Z
HAJ7213Q010	AD	How would you rate the helpfulness of the search results?	Not helpful at all		Dropdown, Select One	Y	Skip Logic Group	Search Useful
			Somewhat helpful
			Very helpful
HAJ7213Q011	Z	Please specify how you navigated the website(s) today.			Text area, no char limit	N	Skip Logic Group	OE_Navigate
HAJ7213Q012	AC	What features did you use during your visit today? (Select all that apply)	Self-Service Tools (calculators, education, forms, IVR, transactions, etc.)	AE, AG	Checkbox, one-up vertical	Y	Skip Logic Group	Features/tools
			Educational Content (Medicare University, policy education, training events, calendar and summaries, New Supplier Center, etc.)	AF
			None of the above				Mutually Exclusive
HAJ7213Q013	AE	How would you rate the helpfulness of the Self-Service tools you used today?	Not helpful at all		Dropdown, Select One	Y	Skip Logic Group	Rate Tools
			Somewhat helpful
			Very helpful
HAJ7213Q014	AG	What one thing would you improve or add to the Self-Service tools?			Text area, no char limit	N	Skip Logic Group	OE_improve tools
HAJ7213Q015	AF	How would you rate the helpfulness of the educational content on NGSMedicare.com?	Not helpful at all		Dropdown, Select One	Y	Skip Logic Group	Rate Edu Content
			Somewhat helpful
			Very helpful
HAJ7213Q016	AH	What one improvement would you like to see made to NGSMedicare?			Text area, no char limit	N	Skip Logic Group	OE_Medicare_Improvement
HAJ7213Q017	AI	What do you like most about NGSMedicare?			Text area, no char limit	N	Skip Logic Group	OE_Medicare_Like Most
HAJ7213Q018	AP	As a National Government Services Connex user, did you try using any of the following tools today in order to accomplish your task? (Select all that apply)	Entitlement inquiries		Checkbox, one-up vertical	Y	Skip Logic Group	Tools Used
			Same/similar inquiries
			Reopenings
			Redeterminations
			Responding to additional documentation requests (ADRs)
			Other
			None of the above				Mutually Exclusive
HAJ7213Q019	P	How would you rate the helpfulness of the NGSConnex portal in your visit today?	Not helpful at all		Dropdown, Select One	Y	Skip Logic Group	Rate Portal
			Somewhat helpful
			Very helpful
HAJ7213Q020	AJ	What one improvement would you like to see made to NGSConnex?			Text area, no char limit	N	Skip Logic Group	OE_Connex_Improvement
HAJ7213Q021	AK	What do you like most about NGSConnex?			Text area, no char limit	N	Skip Logic Group	OE_Connex_Like Most

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Sheet 3: CQs (6-18-18)

Model Instance Name:			red & strike-through: DELETE
CMS - NGS JK MAC V2			underlined & italicized: RE-ORDER
MID:	cJscBVQFAoYYkwtkNAQhcg4C		pink: ADDITION
Date:			blue + -->: REWORDING
CMS - NGS JK MAC 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
RUS0196079		We’re here to help. If you would like assistance with your website experience, please leave your email address and/or phone number and we will reach out to you as soon as possible.				N		Email Follow Up
HAJ7213Q001		Which best describes you?	Provider of medical services		Radio button, one-up vertical	Y	OPS Group*	Best Describes You
			Supplier of medical equipment or supplies
			Staff of provider/supplier working primarily with billing/insurance
			Administrative staff of a provider/supplier
			Other staff of a provider/supplier
			Consultant or attorney
			Billing service
			Other (please specify)	A
HAJ7213Q002	A	Other - which best describes you?			Text field, <100 char	N	OPS Group*	Other Role
HAJ7213Q003		In the last 30 days, how many times have you visited this website?	This is my first time		Radio button, one-up vertical	Y		Visit Frequency
			Once or twice
			Three or four times
			More than once per week but not every day
			Every day
HAJ7213Q004		Which website(s) did you visit today? (Select all that apply)	NGSConnex	B, AA, AP, AJ, AK, P	Check box, one-up vertical	Y	Skip Logic Group	Websites
			NGSMedicare as a REGISTERED user	B, AA, AB, AC, AH, AI
			NGSMedicare as a GUEST user	B, AA, AB, AC, AH, AI
HAJ7213Q005	B	What is your primary reason for visiting this site today?	Access claim status and/or beneficiary eligibility		Radio button, one-up vertical	Y	Skip Logic Group*	Visit Reason
			Research a specific question on Medicare policy or billing
			Find information on fees or fee schedules
			Find out about a Local Coverage Determination (LCD)
			Read Medicare publications such as newsletters, articles, etc.
			Find enrollment information
			Download forms
			Learn of, or register for, workshops, seminars or other training events
			Find contact information
			Find general Medicare program information
			Take an on-line training course
			Other (please specify)	BB
HAJ7213Q006	BB	Please specify your other reason for visiting this site today.			Text area, no char limit	N	Skip Logic Group*	Other Reason
HAJ7213Q007	AA	While visiting the site, did you find what you were looking for?	Yes		Dropdown, Select One	Y	Skip Logic Group	Find
			No	E
			Not yet	E
RUS0200424	E	What specific task were you trying to accomplish today?	Create an NGSConnex account		Radio button, one-up vertical	Y	Skip Logic Group*	Specific Task
			Submit a claim				Randomize
			View/print beneficiary eligibility information
			Submit reopening or redetermination
			View/print remittances
			Respond to an ADR
			View claim status and/or claim overlap information
			View status of a check/EFT
			Something Else	EA			Anchor Answer Choice
HAJ7213Q008	EA	What were you trying to accomplish? (Please be specific)			Text area, no char limit	N	Skip Logic Group	OE_Find
HAJ7213Q009	AB	How did you navigate the website(s) today? (Select all that apply)	Top navigation menu		Checkbox, one-up vertical	Y	Skip Logic Group	Navigate
			Left navigation menu
			Quick links on the right side of the page
			Searched using the site search feature	AD
			Bookmarks
			Other	Z
HAJ7213Q010	AD	How would you rate the helpfulness of the search results?	Not helpful at all		Dropdown, Select One	Y	Skip Logic Group	Search Useful
			Somewhat helpful
			Very helpful
HAJ7213Q011	Z	Please specify how you navigated the website(s) today.			Text area, no char limit	N	Skip Logic Group	OE_Navigate
HAJ7213Q012	AC	What features did you use during your visit today? (Select all that apply)	Self-Service Tools (calculators, education, forms, IVR, transactions, etc.)	AE, AG	Checkbox, one-up vertical	Y	Skip Logic Group	Features/tools
			Educational Content (Medicare University, policy education, training events, calendar and summaries, New Supplier Center, etc.)	AF
			None of the above				Mutually Exclusive
HAJ7213Q013	AE	How would you rate the helpfulness of the Self-Service tools you used today?	Not helpful at all		Dropdown, Select One	Y	Skip Logic Group	Rate Tools
			Somewhat helpful
			Very helpful
HAJ7213Q014	AG	What one thing would you improve or add to the Self-Service tools?			Text area, no char limit	N	Skip Logic Group	OE_improve tools
HAJ7213Q015	AF	How would you rate the helpfulness of the educational content on NGSMedicare.com?	Not helpful at all		Dropdown, Select One	Y	Skip Logic Group	Rate Edu Content
			Somewhat helpful
			Very helpful
HAJ7213Q016	AH	What one improvement would you like to see made to NGSMedicare?			Text area, no char limit	N	Skip Logic Group	OE_Medicare_Improvement
HAJ7213Q017	AI	What do you like most about NGSMedicare?			Text area, no char limit	N	Skip Logic Group	OE_Medicare_Like Most
HAJ7213Q018	AP	As a National Government Services Connex user, did you try using any of the following tools today in order to accomplish your task? (Select all that apply)	Entitlement inquiries		Checkbox, one-up vertical	Y	Skip Logic Group	Tools Used
			Same/similar inquiries
			Reopenings
			Redeterminations
			Responding to additional documentation requests (ADRs)
			Other
			None of the above				Mutually Exclusive
HAJ7213Q019	P	How would you rate the helpfulness of the NGSConnex portal in your visit today?	Not helpful at all		Dropdown, Select One	Y	Skip Logic Group	Rate Portal
			Somewhat helpful
			Very helpful
HAJ7213Q020	AJ	What one improvement would you like to see made to NGSConnex?			Text area, no char limit	N	Skip Logic Group	OE_Connex_Improvement
HAJ7213Q021	AK	What do you like most about NGSConnex?			Text area, no char limit	N	Skip Logic Group	OE_Connex_Like Most

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Sheet 4: CQs (12-4-17)

Model Instance Name:			red & strike-through: DELETE
CMS - NGS JK MAC V2			underlined & italicized: RE-ORDER
MID:	cJscBVQFAoYYkwtkNAQhcg4C		pink: ADDITION
Date:			blue + -->: REWORDING
CMS - NGS JK MAC 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
HAJ7213Q001		Which best describes you?	Provider of medical services		Radio button, one-up vertical	Y	OPS Group*	Best Describes You
			Supplier of medical equipment or supplies
			Staff of provider/supplier working primarily with billing/insurance
			Administrative staff of a provider/supplier
			Other staff of a provider/supplier
			Consultant or attorney
			Billing service
			Other (please specify)	A
HAJ7213Q002	A	Other - which best describes you?			Text field, <100 char	N	OPS Group*	Other Role
HAJ7213Q003		In the last 30 days, how many times have you visited this website?	This is my first time		Radio button, one-up vertical	Y		Visit Frequency
			Once or twice
			Three or four times
			More than once per week but not every day
			Every day
HAJ7213Q004		Which website(s) did you visit today? (Select all that apply)	NGSConnex	B, AA, AP, AJ, AK, P	Check box, one-up vertical	Y	Skip Logic Group	Websites
			NGSMedicare as a REGISTERED user	B, AA, AB, AC, AH, AI
			NGSMedicare as a GUEST user	B, AA, AB, AC, AH, AI
HAJ7213Q005	B	What is your primary reason for visiting this site today?	Access claim status and/or beneficiary eligibility		Radio button, one-up vertical	Y	Skip Logic Group*	Visit Reason
			Research a specific question on Medicare policy or billing
			Find information on fees or fee schedules
			Find out about a Local Coverage Determination (LCD)
			Read Medicare publications such as newsletters, articles, etc.
			Find enrollment information
			Download forms
			Learn of, or register for, workshops, seminars or other training events
			Find contact information
			Find general Medicare program information
			Take an on-line training course
			Other (please specify)	BB
HAJ7213Q006	BB	Please specify your other reason for visiting this site today.			Text area, no char limit	N	Skip Logic Group*	Other Reason
HAJ7213Q007	AA	While visiting the site, did you find what you were looking for?	Yes		Dropdown, Select One	Y	Skip Logic Group	Find
			No	E
			Not yet	E
	E	What specific task were you trying to accomplish today?	Create an NGSConnex account		Radio button, one-up vertical	Y	Skip Logic Group*	Specific Task
			Submit a claim				Randomize
			View/print beneficiary eligibility information
			Submit reopening or redetermination
			View/print remittances
			Respond to an ADR
			View claim status and/or claim overlap information
			View status of a check/EFT
			Something Else	EA			Anchor Answer Choice
HAJ7213Q008	EA	What were you trying to accomplish? (Please be specific)			Text area, no char limit	N	Skip Logic Group	OE_Find
HAJ7213Q009	AB	How did you navigate the website(s) today? (Select all that apply)	Top navigation menu		Checkbox, one-up vertical	Y	Skip Logic Group	Navigate
			Left navigation menu
			Quick links on the right side of the page
			Searched using the site search feature	AD
			Bookmarks
			Other	Z
HAJ7213Q010	AD	How would you rate the helpfulness of the search results?	Not helpful at all		Dropdown, Select One	Y	Skip Logic Group	Search Useful
			Somewhat helpful
			Very helpful
HAJ7213Q011	Z	Please specify how you navigated the website(s) today.			Text area, no char limit	N	Skip Logic Group	OE_Navigate
HAJ7213Q012	AC	What features did you use during your visit today? (Select all that apply)	Self-Service Tools (calculators, education, forms, IVR, transactions, etc.)	AE, AG	Checkbox, one-up vertical	Y	Skip Logic Group	Features/tools
			Educational Content (Medicare University, policy education, training events, calendar and summaries, New Supplier Center, etc.)	AF
			None of the above				Mutually Exclusive
HAJ7213Q013	AE	How would you rate the helpfulness of the Self-Service tools you used today?	Not helpful at all		Dropdown, Select One	Y	Skip Logic Group	Rate Tools
			Somewhat helpful
			Very helpful
HAJ7213Q014	AG	What one thing would you improve or add to the Self-Service tools?			Text area, no char limit	N	Skip Logic Group	OE_improve tools
HAJ7213Q015	AF	How would you rate the helpfulness of the educational content on NGSMedicare.com?	Not helpful at all		Dropdown, Select One	Y	Skip Logic Group	Rate Edu Content
			Somewhat helpful
			Very helpful
HAJ7213Q016	AH	What one improvement would you like to see made to NGSMedicare?			Text area, no char limit	N	Skip Logic Group	OE_Medicare_Improvement
HAJ7213Q017	AI	What do you like most about NGSMedicare?			Text area, no char limit	N	Skip Logic Group	OE_Medicare_Like Most
HAJ7213Q018	AP	As a National Government Services Connex user, did you try using any of the following tools today in order to accomplish your task? (Select all that apply)	Entitlement inquiries		Checkbox, one-up vertical	Y	Skip Logic Group	Tools Used
			Same/similar inquiries
			Reopenings
			Redeterminations
			Responding to additional documentation requests (ADRs)
			Other
			None of the above				Mutually Exclusive
HAJ7213Q019	P	How would you rate the helpfulness of the NGSConnex portal in your visit today?	Not helpful at all		Dropdown, Select One	Y	Skip Logic Group	Rate Portal
			Somewhat helpful
			Very helpful
HAJ7213Q020	AJ	What one improvement would you like to see made to NGSConnex?			Text area, no char limit	N	Skip Logic Group	OE_Connex_Improvement
HAJ7213Q021	AK	What do you like most about NGSConnex?			Text area, no char limit	N	Skip Logic Group	OE_Connex_Like Most
		We’re here to help. If you would like assistance with your website experience, please leave your email address and/or phone number and we will reach out to you as soon as possible.				N		Email Follow Up

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Sheet 5: CQs (11-2-17)

Model Instance Name:			red & strike-through: DELETE
CMS - NGS JK MAC V2			underlined & italicized: RE-ORDER
MID:	cJscBVQFAoYYkwtkNAQhcg4C		pink: ADDITION
Date:			blue + -->: REWORDING
CMS - NGS JK MAC 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
HAJ7213Q001		Which best describes you?	Provider of medical services		Radio button, one-up vertical	Y	OPS Group*	Best Describes You
			Supplier of medical equipment or supplies
			Staff of provider/supplier working primarily with billing/insurance
			Administrative staff of a provider/supplier
			Other staff of a provider/supplier
			Consultant or attorney
			Billing service
			Other (please specify)	A
HAJ7213Q002	A	Other - which best describes you?			Text field, <100 char	N	OPS Group*	Other Role
HAJ7213Q003		In the last 30 days, how many times have you visited this website?	This is my first time		Radio button, one-up vertical	Y		Visit Frequency
			Once or twice
			Three or four times
			More than once per week but not every day
			Every day
HAJ7213Q004		Which website(s) did you visit today? (Select all that apply)	NGSConnex	B, AA, AP, AJ, AK, P	Check box, one-up vertical	Y	Skip Logic Group	Websites
			NGSMedicare as a REGISTERED user	B, AA, AB, AC, AH, AI
			NGSMedicare as a GUEST user	B, AA, AB, AC, AH, AI
HAJ7213Q005	B	What is your primary reason for visiting this site today?	Access claim status and/or beneficiary eligibility		Radio button, one-up vertical	Y	Skip Logic Group*	Visit Reason
			Research a specific question on Medicare policy or billing
			Find information on fees or fee schedules
			Find out about a Local Coverage Determination (LCD)
			Read Medicare publications such as newsletters, articles, etc.
			Find enrollment information
			Download forms
			Learn of, or register for, workshops, seminars or other training events
			Find contact information
			Find general Medicare program information
			Take an on-line training course
			Other (please specify)	BB
HAJ7213Q006	BB	Please specify your other reason for visiting this site today.			Text area, no char limit	N	Skip Logic Group*	Other Reason
HAJ7213Q007	AA	While visiting the site, did you find what you were looking for?	Yes		Dropdown, Select One	Y	Skip Logic Group	Find
			No	E
			Not yet	E
HAJ7213Q008	E	What were you trying to locate? (Please be specific)			Text area, no char limit	N	Skip Logic Group	OE_Find
HAJ7213Q009	AB	How did you navigate the website(s) today? (Select all that apply)	Top navigation menu		Checkbox, one-up vertical	Y	Skip Logic Group	Navigate
			Left navigation menu
			Quick links on the right side of the page
			Searched using the site search feature	AD
			Bookmarks
			Other	Z
HAJ7213Q010	AD	How would you rate the helpfulness of the search results?	Not helpful at all		Dropdown, Select One	Y	Skip Logic Group	Search Useful
			Somewhat helpful
			Very helpful
HAJ7213Q011	Z	Please specify how you navigated the website(s) today.			Text area, no char limit	N	Skip Logic Group	OE_Navigate
HAJ7213Q012	AC	What features did you use during your visit today? (Select all that apply)	Self-Service Tools (calculators, education, forms, IVR, transactions, etc.)	AE, AG	Checkbox, one-up vertical	Y	Skip Logic Group	Features/tools
			Educational Content (Medicare University, policy education, training events, calendar and summaries, New Supplier Center, etc.)	AF
			None of the above				Mutually Exclusive
HAJ7213Q013	AE	How would you rate the helpfulness of the Self-Service tools you used today?	Not helpful at all		Dropdown, Select One	Y	Skip Logic Group	Rate Tools
			Somewhat helpful
			Very helpful
HAJ7213Q014	AG	What one thing would you improve or add to the Self-Service tools?			Text area, no char limit	N	Skip Logic Group	OE_improve tools
HAJ7213Q015	AF	How would you rate the helpfulness of the educational content on NGSMedicare.com?	Not helpful at all		Dropdown, Select One	Y	Skip Logic Group	Rate Edu Content
			Somewhat helpful
			Very helpful
HAJ7213Q016	AH	What one improvement would you like to see made to NGSMedicare?			Text area, no char limit	N	Skip Logic Group	OE_Medicare_Improvement
HAJ7213Q017	AI	What do you like most about NGSMedicare?			Text area, no char limit	N	Skip Logic Group	OE_Medicare_Like Most
HAJ7213Q018	AP	As a National Government Services Connex user, did you try using any of the following tools today in order to accomplish your task? (Select all that apply)	Entitlement inquiries		Checkbox, one-up vertical	Y	Skip Logic Group	Tools Used
			Same/similar inquiries
			Reopenings
			Redeterminations
			Responding to additional documentation requests (ADRs)
			Other
			None of the above				Mutually Exclusive
HAJ7213Q019	P	How would you rate the helpfulness of the NGSConnex portal in your visit today?	Not helpful at all		Dropdown, Select One	Y	Skip Logic Group	Rate Portal
			Somewhat helpful
			Very helpful
HAJ7213Q020	AJ	What one improvement would you like to see made to NGSConnex?			Text area, no char limit	N	Skip Logic Group	OE_Connex_Improvement
HAJ7213Q021	AK	What do you like most about NGSConnex?			Text area, no char limit	N	Skip Logic Group	OE_Connex_Like Most
HAJ7213Q022		From time to time, National Government Services likes to reach out to website visitors to learn more about their experiences using the website. If you are over the age of 18 and would be willing to be contacted in the future, please provide your phone number and or email address.			Text area, no char limit	N		Email Address
		We’re here to help. If you would like assistance with your website experience, please leave your email address and/or phone number and we will reach out to you as soon as possible.				N		Email Follow Up

---

Sheet 6: CQs (10-13-17)

Model Instance Name:			red & strike-through: DELETE
CMS - NGS JK MAC V2			underlined & italicized: RE-ORDER
MID:	cJscBVQFAoYYkwtkNAQhcg4C		pink: ADDITION
Date:			blue + -->: REWORDING
CMS - NGS JK MAC 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
HAJ7213Q001		Which best describes you?	Provider of medical services		Radio button, one-up vertical	Y	OPS Group*	Best Describes You
			Supplier of medical equipment or supplies
			Staff of provider/supplier working primarily with billing/insurance
			Administrative staff of a provider/supplier
			Other staff of a provider/supplier
			Consultant or attorney
			Billing service
			Other (please specify)	A
HAJ7213Q002	A	Other - which best describes you?			Text field, <100 char	N	OPS Group*	Other Role
HAJ7213Q003		In the last 30 days, how many times have you visited this website?	This is my first time		Radio button, one-up vertical	Y		Visit Frequency
			Once or twice
			Three or four times
			More than once per week but not every day
			Every day
HAJ7213Q004		Which website(s) did you visit today? (Select all that apply)	NGSConnex	B, AA, AP, AJ, AK, P, X	Check box, one-up vertical	Y	Skip Logic Group	Websites
			NGSMedicare as a REGISTERED user	B, AA, AB, AC, AH, AI
			NGSMedicare as a GUEST user	B, AA, AB, AC, AH, AI
JIB0151806	X	During your visit today, did you notice the redesign of the NGS site?	Yes	Y, Z	Radio button, one-up vertical	Y	Skip Logic Group	New Site_Notice Redesign
			No
JIB0151808	Y	How does the new site compare to the previous design?	New site is an improvement		Radio button, one-up vertical	Y	Skip Logic Group	New Site_Compare
			New site is comparable
			New site is inferior	Y1
JIB0151809	Y1	Please tell us why you feel the new site is inferior to the previous site.			Text area, no char limit	N	Skip Logic Group	OE_New Site_Compare
JIB0151807	Z	Please tell us whether you agree or disagree with the following statement: The new site makes it easier to complete my task.	Strongly Disagree		Radio button, one-up vertical	Y	Skip Logic Group	New Site_Task
			Disagree
			Neutral
			Agree
			Strongly Agree
			Don't know
HAJ7213Q005	B	What is your primary reason for visiting this site today?	Access claim status and/or beneficiary eligibility		Radio button, one-up vertical	Y	Skip Logic Group*	Visit Reason
			Research a specific question on Medicare policy or billing
			Find information on fees or fee schedules
			Find out about a Local Coverage Determination (LCD)
			Read Medicare publications such as newsletters, articles, etc.
			Find enrollment information
			Download forms
			Learn of, or register for, workshops, seminars or other training events
			Find contact information
			Find general Medicare program information
			Take an on-line training course
			Other (please specify)	BB
HAJ7213Q006	BB	Please specify your other reason for visiting this site today.			Text area, no char limit	N	Skip Logic Group*	Other Reason
HAJ7213Q007	AA	While visiting the site, did you find what you were looking for?	Yes		Dropdown, Select One	Y	Skip Logic Group	Find
			No	E
			Not yet	E
HAJ7213Q008	E	What were you trying to locate? (Please be specific)			Text area, no char limit	N	Skip Logic Group	OE_Find
HAJ7213Q009	AB	How did you navigate the website(s) today? (Select all that apply)	Top navigation menu		Checkbox, one-up vertical	Y	Skip Logic Group	Navigate
			Left navigation menu
			Quick links on the right side of the page
			Searched using the site search feature	AD
			Bookmarks
			Other	Z
HAJ7213Q010	AD	How would you rate the helpfulness of the search results?	Not helpful at all		Dropdown, Select One	Y	Skip Logic Group	Search Useful
			Somewhat helpful
			Very helpful
HAJ7213Q011	Z	Please specify how you navigated the website(s) today.			Text area, no char limit	N	Skip Logic Group	OE_Navigate
HAJ7213Q012	AC	What features did you use during your visit today? (Select all that apply)	Self-Service Tools (calculators, education, forms, IVR, transactions, etc.)	AE, AG	Checkbox, one-up vertical	Y	Skip Logic Group	Features/tools
			Educational Content (Medicare University, policy education, training events, calendar and summaries, New Supplier Center, etc.)	AF
			None of the above				Mutually Exclusive
HAJ7213Q013	AE	How would you rate the helpfulness of the Self-Service tools you used today?	Not helpful at all		Dropdown, Select One	Y	Skip Logic Group	Rate Tools
			Somewhat helpful
			Very helpful
HAJ7213Q014	AG	What one thing would you improve or add to the Self-Service tools?			Text area, no char limit	N	Skip Logic Group	OE_improve tools
HAJ7213Q015	AF	How would you rate the helpfulness of the educational content on NGSMedicare.com?	Not helpful at all		Dropdown, Select One	Y	Skip Logic Group	Rate Edu Content
			Somewhat helpful
			Very helpful
HAJ7213Q016	AH	What one improvement would you like to see made to NGSMedicare?			Text area, no char limit	N	Skip Logic Group	OE_Medicare_Improvement
HAJ7213Q017	AI	What do you like most about NGSMedicare?			Text area, no char limit	N	Skip Logic Group	OE_Medicare_Like Most
HAJ7213Q018	AP	As a National Government Services Connex user, did you try using any of the following tools today in order to accomplish your task? (Select all that apply)	Entitlement inquiries		Checkbox, one-up vertical	Y	Skip Logic Group	Tools Used
			Same/similar inquiries
			Reopenings
			Redeterminations
			Responding to additional documentation requests (ADRs)
			Other
			None of the above				Mutually Exclusive
HAJ7213Q019	P	How would you rate the helpfulness of the NGSConnex portal in your visit today?	Not helpful at all		Dropdown, Select One	Y	Skip Logic Group	Rate Portal
			Somewhat helpful
			Very helpful
HAJ7213Q020	AJ	What one improvement would you like to see made to NGSConnex?			Text area, no char limit	N	Skip Logic Group	OE_Connex_Improvement
HAJ7213Q021	AK	What do you like most about NGSConnex?			Text area, no char limit	N	Skip Logic Group	OE_Connex_Like Most
HAJ7213Q022		From time to time, National Government Services likes to reach out to website visitors to learn more about their experiences using the website. If you are over the age of 18 and would be willing to be contacted in the future, please provide your phone number or email address.			Text area, no char limit	N		Email Address

---

Sheet 7: CQs (4-21-17)

Model Instance Name:			red & strike-through: DELETE
CMS - NGS JK MAC V2			underlined & italicized: RE-ORDER
MID:	cJscBVQFAoYYkwtkNAQhcg4C		pink: ADDITION
Date:			blue + -->: REWORDING
CMS - NGS JK MAC 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
HAJ7213Q001		Which best describes you?	Provider of medical services		Radio button, one-up vertical	Y	OPS Group*	Best Describes You
			Supplier of medical equipment or supplies
			Staff of provider/supplier working primarily with billing/insurance
			Administrative staff of a provider/supplier
			Other staff of a provider/supplier
			Consultant or attorney
			Billing service
			Other (please specify)	A
HAJ7213Q002	A	Other - which best describes you?			Text field, <100 char	N	OPS Group*	Other Role
HAJ7213Q003		In the last 30 days, how many times have you visited this website?	This is my first time		Radio button, one-up vertical	Y	Skip Logic Group	Visit Frequency
			Once or twice	A
			Three or four times	A
			More than once per week but not every day	A
			Every day	A
HAJ7213Q004		Which website(s) did you visit today? (Select all that apply)	NGSConnex	B, AA, AP, AJ, AK, P, X	Check box, one-up vertical	Y	Skip Logic Group	Websites
			NGSMedicare as a REGISTERED user	B, AA, AB, AC, AH, AI
			NGSMedicare as a GUEST user	B, AA, AB, AC, AH, AI
JIB0151806	A X	During your visit today, did you notice the redesign of the NGS site?	Yes	B,C Y, Z	Radio button, one-up vertical	Y	Skip Logic Group	New Site_Notice Redesign
			No
JIB0151808	B Y	How does the new site compare to the previous design?	New site is an improvement		Radio button, one-up vertical	Y	Skip Logic Group	New Site_Compare
			New site is comparable
			New site is inferior	B1 Y1
JIB0151809	B1 Y1	Please tell us why you feel the new site is inferior to the previous site.			Text area, no char limit	N	Skip Logic Group	OE_New Site_Compare
JIB0151807	C Z	Please tell us whether you agree or disagree with the following statement: The new site makes it easier to complete my task.	Strongly Disagree		Radio button, one-up vertical	Y	Skip Logic Group	New Site_Task
			Disagree
			Neutral
			Agree
			Strongly Agree
			Don't know
HAJ7213Q005	B	What is your primary reason for visiting this site today?	Access claim status and/or beneficiary eligibility		Radio button, one-up vertical	Y	Skip Logic Group*	Visit Reason
			Research a specific question on Medicare policy or billing
			Find information on fees or fee schedules
			Find out about a Local Coverage Determination (LCD)
			Read Medicare publications such as newsletters, articles, etc.
			Find enrollment information
			Download forms
			Learn of, or register for, workshops, seminars or other training events
			Find contact information
			Find general Medicare program information
			Take an on-line training course
			Other (please specify)	BB
HAJ7213Q006	BB	Please specify your other reason for visiting this site today.			Text area, no char limit	N	Skip Logic Group*	Other Reason
HAJ7213Q007	AA	While visiting the site, did you find what you were looking for?	Yes		Dropdown, Select One	Y	Skip Logic Group	Find
			No	E
			Not yet	E
HAJ7213Q008	E	What were you trying to locate? (Please be specific)			Text area, no char limit	N	Skip Logic Group	OE_Find
HAJ7213Q009	AB	How did you navigate the website(s) today? (Select all that apply)	Top navigation menu		Checkbox, one-up vertical	Y	Skip Logic Group	Navigate
			Left navigation menu
			Quick links on the right side of the page
			Searched using the site search feature	AD
			Bookmarks
			Other	Z
HAJ7213Q010	AD	How would you rate the helpfulness of the search results?	Not helpful at all		Dropdown, Select One	Y	Skip Logic Group	Search Useful
			Somewhat helpful
			Very helpful
HAJ7213Q011	Z	Please specify how you navigated the website(s) today.			Text area, no char limit	N	Skip Logic Group	OE_Navigate
HAJ7213Q012	AC	What features did you use during your visit today? (Select all that apply)	Self-Service Tools (calculators, education, forms, IVR, transactions, etc.)	AE, AG	Checkbox, one-up vertical	Y	Skip Logic Group	Features/tools
			Educational Content (Medicare University, policy education, training events, calendar and summaries, New Supplier Center, etc.)	AF
			None of the above				Mutually Exclusive
HAJ7213Q013	AE	How would you rate the helpfulness of the Self-Service tools you used today?	Not helpful at all		Dropdown, Select One	Y	Skip Logic Group	Rate Tools
			Somewhat helpful
			Very helpful
HAJ7213Q014	AG	What one thing would you improve or add to the Self-Service tools?			Text area, no char limit	N	Skip Logic Group	OE_improve tools
HAJ7213Q015	AF	How would you rate the helpfulness of the educational content on NGSMedicare.com?	Not helpful at all		Dropdown, Select One	Y	Skip Logic Group	Rate Edu Content
			Somewhat helpful
			Very helpful
HAJ7213Q016	AH	What one improvement would you like to see made to NGSMedicare?			Text area, no char limit	N	Skip Logic Group	OE_Medicare_Improvement
HAJ7213Q017	AI	What do you like most about NGSMedicare?			Text area, no char limit	N	Skip Logic Group	OE_Medicare_Like Most
HAJ7213Q018	AP	As a National Government Services Connex user, did you try using any of the following tools today in order to accomplish your task? (Select all that apply)	Entitlement inquiries		Checkbox, one-up vertical	Y	Skip Logic Group	Tools Used
			Same/similar inquiries
			Reopenings
			Redeterminations
			Responding to additional documentation requests (ADRs)
			Other
			None of the above				Mutually Exclusive
HAJ7213Q019	P	How would you rate the helpfulness of the NGSConnex portal in your visit today?	Not helpful at all		Dropdown, Select One	Y	Skip Logic Group	Rate Portal
			Somewhat helpful
			Very helpful
HAJ7213Q020	AJ	What one improvement would you like to see made to NGSConnex?			Text area, no char limit	N	Skip Logic Group	OE_Connex_Improvement
HAJ7213Q021	AK	What do you like most about NGSConnex?			Text area, no char limit	N	Skip Logic Group	OE_Connex_Like Most
HAJ7213Q022		From time to time, National Government Services likes to reach out to website visitors to learn more about their experiences using the website. If you are over the age of 18 and would be willing to be contacted in the future, please provide your phone number or email address.			Text area, no char limit	N		Email Address

---

Sheet 8: CQs (3-7-17)

Model Instance Name:			red & strike-through: DELETE
CMS - NGS JK MAC V2			underlined & italicized: RE-ORDER
MID:	cJscBVQFAoYYkwtkNAQhcg4C		pink: ADDITION
Date:			blue + -->: REWORDING
CMS - NGS JK MAC 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
HAJ7213Q001		Which best describes you?	Provider of medical services		Radio button, one-up vertical	Y	OPS Group*	Best Describes You
			Supplier of medical equipment or supplies
			Staff of provider/supplier working primarily with billing/insurance
			Administrative staff of a provider/supplier
			Other staff of a provider/supplier
			Consultant or attorney
			Billing service
			Other (please specify)	A
HAJ7213Q002	A	Other - which best describes you?			Text field, <100 char	N	OPS Group*	Other Role
HAJ7213Q003		In the last 30 days, how many times have you visited this website?	This is my first time		Radio button, one-up vertical	Y	Skip Logic Group	Visit Frequency
			Once or twice	A
			Three or four times	A
			More than once per week but not every day	A
			Every day	A
	A	During your visit today, did you notice the redesign of the NGS site?	Yes	B,C	Radio button, one-up vertical	Y	Skip Logic Group	New Site_Notice Redesign
			No
	B	How does the new site compare to the previous design?	New site is an improvement		Radio button, one-up vertical	Y	Skip Logic Group	New Site_Compare
			New site is comparable
			New site is inferior	B1
	B1	Please tell us why you feel the new site is inferior to the previous site.			Text area, no char limit	N	Skip Logic Group	OE_New Site_Compare
	C	Please tell us whether you agree or disagree with the following statement: The new site makes it easier to complete my task.	Strongly Disagree		Radio button, one-up vertical	Y	Skip Logic Group	New Site_Task
			Disagree
			Neutral
			Agree
			Strongly Agree
			Don't know
HAJ7213Q004		Which website(s) did you visit today? (Select all that apply)	NGSConnex	B, AA, AP, AJ, AK, P	Check box, one-up vertical	Y	Skip Logic Group	Websites
			NGSMedicare as a REGISTERED user	B, AA, AB, AC, AH, AI
			NGSMedicare as a GUEST user	B, AA, AB, AC, AH, AI
HAJ7213Q005	B	What is your primary reason for visiting this site today?	Access claim status and/or beneficiary eligibility		Radio button, one-up vertical	Y	Skip Logic Group*	Visit Reason
			Research a specific question on Medicare policy or billing
			Find information on fees or fee schedules
			Find out about a Local Coverage Determination (LCD)
			Read Medicare publications such as newsletters, articles, etc.
			Find enrollment information
			Download forms
			Learn of, or register for, workshops, seminars or other training events
			Find contact information
			Find general Medicare program information
			Take an on-line training course
			Other (please specify)	BB
HAJ7213Q006	BB	Please specify your other reason for visiting this site today.			Text area, no char limit	N	Skip Logic Group*	Other Reason
HAJ7213Q007	AA	While visiting the site, did you find what you were looking for?	Yes		Dropdown, Select One	Y	Skip Logic Group	Find
			No	E
			Not yet	E
HAJ7213Q008	E	What were you trying to locate? (Please be specific)			Text area, no char limit	N	Skip Logic Group	OE_Find
HAJ7213Q009	AB	How did you navigate the website(s) today? (Select all that apply)	Top navigation menu		Checkbox, one-up vertical	Y	Skip Logic Group	Navigate
			Left navigation menu
			Quick links on the right side of the page
			Searched using the site search feature	AD
			Bookmarks
			Other	Z
HAJ7213Q010	AD	How would you rate the helpfulness of the search results?	Not helpful at all		Dropdown, Select One	Y	Skip Logic Group	Search Useful
			Somewhat helpful
			Very helpful
HAJ7213Q011	Z	Please specify how you navigated the website(s) today.			Text area, no char limit	N	Skip Logic Group	OE_Navigate
HAJ7213Q012	AC	What features did you use during your visit today? (Select all that apply)	Self-Service Tools (calculators, education, forms, IVR, transactions, etc.)	AE, AG	Checkbox, one-up vertical	Y	Skip Logic Group	Features/tools
			Educational Content (Medicare University, policy education, training events, calendar and summaries, New Supplier Center, etc.)	AF
			None of the above				Mutually Exclusive
HAJ7213Q013	AE	How would you rate the helpfulness of the Self-Service tools you used today?	Not helpful at all		Dropdown, Select One	Y	Skip Logic Group	Rate Tools
			Somewhat helpful
			Very helpful
HAJ7213Q014	AG	What one thing would you improve or add to the Self-Service tools?			Text area, no char limit	N	Skip Logic Group	OE_improve tools
HAJ7213Q015	AF	How would you rate the helpfulness of the educational content on NGSMedicare.com?	Not helpful at all		Dropdown, Select One	Y	Skip Logic Group	Rate Edu Content
			Somewhat helpful
			Very helpful
HAJ7213Q016	AH	What one improvement would you like to see made to NGSMedicare?			Text area, no char limit	N	Skip Logic Group	OE_Medicare_Improvement
HAJ7213Q017	AI	What do you like most about NGSMedicare?			Text area, no char limit	N	Skip Logic Group	OE_Medicare_Like Most
HAJ7213Q018	AP	As a National Government Services Connex user, did you try using any of the following tools today in order to accomplish your task? (Select all that apply)	Entitlement inquiries		Checkbox, one-up vertical	Y	Skip Logic Group	Tools Used
			Same/similar inquiries
			Reopenings
			Redeterminations
			Responding to additional documentation requests (ADRs)
			Other
			None of the above				Mutually Exclusive
HAJ7213Q019	P	How would you rate the helpfulness of the NGSConnex portal in your visit today?	Not helpful at all		Dropdown, Select One	Y	Skip Logic Group	Rate Portal
			Somewhat helpful
			Very helpful
HAJ7213Q020	AJ	What one improvement would you like to see made to NGSConnex?			Text area, no char limit	N	Skip Logic Group	OE_Connex_Improvement
HAJ7213Q021	AK	What do you like most about NGSConnex?			Text area, no char limit	N	Skip Logic Group	OE_Connex_Like Most
HAJ7213Q022		From time to time, National Government Services likes to reach out to website visitors to learn more about their experiences using the website. If you are over the age of 18 and would be willing to be contacted in the future, please provide your phone number or email address.			Text area, no char limit	N		Email Address