30628 Q_NordJf_Web_Browse_20161227
E-Government Website Customer Satisfaction Surveys
Q_NordJf_Web_Browse_20161227.xlsx
Mapping and Questionnaire Documents IA 30628 A4 (CMS)
OMB: 1090-0008
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1090-0008 can be found here:
Document [xlsx]
Download: xlsx | pdf
Model Qsts
Current CQs
CQs (1-3-17)
Overview
Welcome and Thank You TextModel Qsts
Current CQs
CQs (1-3-17)
Sheet 1: Welcome and Thank You Text
| Please use current Welcome and Thank you texts. | 
|
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| Welcome and Thank You Text | ||||||
| Welcome Text | Thank You Text | |||||
| Thank you for visiting [Company/Site/Agency]. 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 for taking our survey - and for helping us serve you better. We appreciate your input! |
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| 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 Noridian JF V2 |
|
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| Model ID | xJNVdskEg8oJ19VsNM4QQg4C | Underlined & Italicized: Re-order | ||||||
| Partitioned | Yes - 2MQ | Pink: Addition | ||||||
| Date | 11/10/2016 | 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=Very Unlikely, 10=Very Likely) |
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| 1 | Look and Feel - Appeal | Please rate the visual appeal of this site. | 16 | Satisfaction - Overall | What is your overall satisfaction with this site? (1=Very Dissatisfied, 10=Very Satisfied) |
19 | 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. | 17 | Satisfaction - Expectations | How well does this site meet your expectations? (1=Falls Short, 10=Exceeds) |
Recommend Site (1=Very Unlikely, 10=Very Likely) |
||
| 3 | Look and Feel - Legibility | Please rate the legibility of the pages on this site. | 18 | Satisfaction - Ideal | How does this site compare to your idea of an ideal site? (1=Not Very Close, 10=Very Close) |
20 | 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=Very Unlikely, 10=Very Likely) |
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| 4 | Site Performance - Loading | Please rate how quickly pages load on this site. | 21 | 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. | ||||||
Sheet 3: Current CQs
| Model Name | CMS Noridian JF V2 | 
|
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| Model ID | xJNVdskEg8oJ19VsNM4QQg4C | Underlined & Italicized: Re-order | |||||||
| Partitioned | Yes - 2MQ | Pink: Addition | |||||||
| Date | 11/10/2016 | Blue: Reword | |||||||
| QID | QUESTION META TAG | Skip From | Question Text | Answer Choices | Skip To | Required Y/N |
Type | Special Instructions | CQ Label |
| HAJ7090Q001 | Which best describes you? | Provider of medical services | Y | Radio button, one-up vertical | 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 | ||||||||
| HAJ7090Q002 | A | Other - which best describes you? | N | Text field, <100 char | OPS Group | Other-Best Describes You | |||
| HAJ7090Q003 | What is your primary reason for visiting this site today? | Access claim status and/or beneficiary eligibility | Y | Radio button, one-up vertical | Skip Logic Group | Visit Reason non-CMS | |||
| Download forms | |||||||||
| Learn of, or register for, workshops, seminars or other training events | |||||||||
| Find contact information | B | ||||||||
| Find general Medicare program information | C | ||||||||
| Research a specific question on Medicare policy or billing | E | ||||||||
| Find information on fees or fee schedules | D | ||||||||
| Find out about a Local Coverage Determination (LCD) | |||||||||
| Read Medicare publications such as newsletters, articles, etc. | |||||||||
| Find enrollment information | |||||||||
| Take an on-line training course | |||||||||
| Other (please specify) | A | ||||||||
| HAJ7090Q004 | A | Other - primary reason? | N | Text field, <100 char | Skip Logic Group | OE_Visit Reason non-CMS | |||
| HAJ7090Q005 | B | Who were you trying to contact? | N | Text area, no char limit | Skip Logic Group | OE_Who Contact | |||
| HAJ7090Q006 | C | What was the topic of program information you were looking for? | N | Text area, no char limit | Skip Logic Group | OE_Topic Program Info | |||
| HAJ7090Q007 | D | What code or type of fee schedule were you looking for? | N | Text area, no char limit | Skip Logic Group | OE_Code Fee Sched | |||
| HAJ7090Q008 | E | What specific question were you researching? | N | Text area, no char limit | Skip Logic Group | OE_Reearch Q | |||
| HAJ7090Q009 | 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 | |||||||||
| HAJ7090Q010 | Please select the contract that best describes what you are looking for. | Medicare Part A | Y | Drop down, select one | Medicare Contract | ||||
| Medicare Part B | |||||||||
| Durable Medical Equipment (DME) | |||||||||
| Other | |||||||||
| HAJ7090Q011 | How did you primarily look for information on this site today? | Browsed pages by clicking links | Y | Drop down, select one | Skip Logic Group | Look for Info | |||
| Searched using the site search feature | B, D | ||||||||
| Used the site map | C | ||||||||
| Used the Noridian Portal | |||||||||
| HAJ7090Q012 | B | What keywords did you use? | N | Text area, no char limit | Skip Logic Group | Keywords | |||
| HAJ7090Q013 | D | Please tell us about your experience with the site's search feature today. (Please select all that apply.) | Search results were helpful | Y | Checkbox, one-up vertical | Skip Logic Group | Search Experience | ||
| Results were not relevant/not what I wanted | |||||||||
| Too many results/I needed to refine my search | |||||||||
| Not enough results | |||||||||
| Returned NO results | |||||||||
| Had technical difficulty | |||||||||
| I experienced a different search issue (please explain): | G | ||||||||
| HAJ7090Q014 | G | Other search issue: | N | Text area, no char limit | Skip Logic Group | OE_Search Experience | |||
| HAJ7090Q015 | C | Please tell us about your experience using the site map. | N | Text area, no char limit | Skip Logic Group | Site Map Experience | |||
| HAJ7090Q016 | Did you find what you were looking for? | Yes | Y | Radio button, one-up vertical | Skip Logic Group | Did You Find | |||
| No | A | ||||||||
| I'm still searching | A | ||||||||
| HAJ7090Q017 | A | What were you looking for that you were unable to find? | N | Text area, no char limit | Skip Logic Group | OE_Unabe to find | |||
| HAJ7090Q018 | If you could identify one improvement to the website, what would that improvement be? | N | Text area, no char limit | Open-Improvement | |||||
| HAJ7090Q019 | If you are over the age of 18 and would like Noridian to respond to your feedback regarding this website, please provide your email address here. | N | Text field, <100 char | Feedback email | |||||
| HAJ7090Q020 | Did you experience technical difficulties when using our website or portal? | Yes | B | Y | Drop down, select one | Skip Logic Group | Tech Difficulties | ||
| No | |||||||||
| HAJ7090Q021 | B | What technical difficulties did you encounter? | Broken links | N | Drop down, select one | Skip Logic Group | Technical Difficulties - what | ||
| Error loading pages | |||||||||
| Unable to login to my account | |||||||||
| The site was down | |||||||||
| Pages took too long to load | |||||||||
| Other | B1 | ||||||||
| HAJ7090Q022 | B1 | Please specify the technical difficulty you had. | N | Text area, no char limit | Skip Logic Group | OE_Technical Difficulties - what | |||
| HAJ7090Q023 | How would you describe your navigation experience on this site today? (Please select all that apply.) | I had no difficulty navigating/browsing on this site | Y | Checkbox, one-up vertical | Skip Logic Group | Navigation Experience | |||
| Links often did not take me where I expected | B | ||||||||
| Had difficulty finding relevant information/products | |||||||||
| Links/labels are difficult to understand | C | ||||||||
| Too many links/navigational options to choose from | |||||||||
| Had technical difficulties (error messages, broken links, etc.) | |||||||||
| Could not navigate back to previous information | |||||||||
| I had a navigation difficulty not listed above | A | ||||||||
| HAJ7090Q024 | A | Other navigation difficulty: | N | Text area, no char limit | Skip Logic Group | OE_Navigation Experience | |||
| HAJ7090Q025 | B | 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 | OE_Links/Paths | |||
| HAJ7090Q026 | C | What specific links/labels were difficult to understand? | N | Text area, no char limit | Skip Logic Group | OE_links/labels | |||
Sheet 4: CQs (1-3-17)
| Model Name | CMS Noridian JF V2 |
|
|||||||
| Model ID | xJNVdskEg8oJ19VsNM4QQg4C | Underlined & Italicized: Re-order | |||||||
| Partitioned | Yes - 2MQ | Pink: Addition | |||||||
| Date | 11/10/2016 | Blue: Reword | |||||||
| QID | QUESTION META TAG | Skip From | Question Text | Answer Choices | Skip To | Required Y/N |
Type | Special Instructions | CQ Label |
| HAJ7090Q001 | Which best describes you? | Provider of medical services | Y | Radio button, one-up vertical | 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 | ||||||||
| HAJ7090Q002 | A | Other - which best describes you? | N | Text field, <100 char | OPS Group | Other-Best Describes You | |||
| HAJ7090Q003 | What is your primary reason for visiting this site today? | Access claim status and/or beneficiary eligibility | Y | Radio button, one-up vertical | Skip Logic Group | Visit Reason non-CMS | |||
| Download forms | |||||||||
| Learn of, or register for, workshops, seminars or other training events | |||||||||
| Find contact information | B | ||||||||
| Find general Medicare program information | C | ||||||||
| Research a specific question on Medicare policy or billing | E | ||||||||
| Find information on fees or fee schedules | D | ||||||||
| Find out about a Local Coverage Determination (LCD) | |||||||||
| Read Medicare publications such as newsletters, articles, etc. | |||||||||
| Find enrollment information | |||||||||
| Take an on-line training course | |||||||||
| Other (please specify) | A | ||||||||
| HAJ7090Q004 | A | Other - primary reason? | N | Text field, <100 char | Skip Logic Group | OE_Visit Reason non-CMS | |||
| HAJ7090Q005 | B | Who were you trying to contact? | N | Text area, no char limit | Skip Logic Group | OE_Who Contact | |||
| HAJ7090Q006 | C | What was the topic of program information you were looking for? | N | Text area, no char limit | Skip Logic Group | OE_Topic Program Info | |||
| HAJ7090Q007 | D | What code or type of fee schedule were you looking for? | N | Text area, no char limit | Skip Logic Group | OE_Code Fee Sched | |||
| HAJ7090Q008 | E | What specific question were you researching? | N | Text area, no char limit | Skip Logic Group | OE_Reearch Q | |||
| HAJ7090Q009 | 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 | |||||||||
| HAJ7090Q010 | Please select the contract that best describes what you are looking for. | Medicare Part A | Y | Drop down, select one | Medicare Contract | ||||
| Medicare Part B | |||||||||
| Durable Medical Equipment (DME) | |||||||||
| Other | |||||||||
| HAJ7090Q011 | How did you primarily look for information on this site today? | Browsed pages by clicking links | Y | Drop down, select one | Skip Logic Group | Look for Info | |||
| Searched using the site search feature | B, D | ||||||||
| Used the site map | C | ||||||||
| Used the Noridian Portal | |||||||||
| HAJ7090Q012 | B | What keywords did you use? | N | Text area, no char limit | Skip Logic Group | Keywords | |||
| HAJ7090Q013 | D | Please tell us about your experience with the site's search feature today. (Please select all that apply.) | Search results were helpful | Y | Checkbox, one-up vertical | Skip Logic Group | Search Experience | ||
| Results were not relevant/not what I wanted | |||||||||
| Too many results/I needed to refine my search | |||||||||
| Not enough results | |||||||||
| Returned NO results | |||||||||
| Had technical difficulty | |||||||||
| I experienced a different search issue (please explain): | G | ||||||||
| HAJ7090Q014 | G | Other search issue: | N | Text area, no char limit | Skip Logic Group | OE_Search Experience | |||
| HAJ7090Q015 | C | Please tell us about your experience using the site map. | N | Text area, no char limit | Skip Logic Group | Site Map Experience | |||
| HAJ7090Q016 | Did you find what you were looking for? | Yes | Y | Radio button, one-up vertical | Skip Logic Group | Did You Find | |||
| No | A | ||||||||
| I'm still searching | A | ||||||||
| HAJ7090Q017 | A | What were you looking for that you were unable to find? | N | Text area, no char limit | Skip Logic Group | OE_Unabe to find | |||
| HAJ7090Q018 | If you could identify one improvement to the website, what would that improvement be? | N | Text area, no char limit | Open-Improvement | |||||
| HAJ7090Q019 | If you are over the age of 18 and would like Noridian to respond to your feedback regarding this website, please provide your email address here. | N | Text field, <100 char | Feedback email | |||||
| HAJ7090Q020 | Did you experience technical difficulties when using our website or portal? | Yes | B | Y | Drop down, select one | Skip Logic Group | Tech Difficulties | ||
| No | |||||||||
| HAJ7090Q021 | B | What technical difficulties did you encounter? | Broken links | N | Drop down, select one | Skip Logic Group | Technical Difficulties - what | ||
| Error loading pages | |||||||||
| Unable to login to my account | |||||||||
| The site was down | |||||||||
| Pages took too long to load | |||||||||
| Other | B1 | ||||||||
| HAJ7090Q022 | B1 | Please specify the technical difficulty you had. | N | Text area, no char limit | Skip Logic Group | OE_Technical Difficulties - what | |||
| HAJ7090Q023 | How would you describe your navigation experience on this site today? (Please select all that apply.) | I had no difficulty navigating/browsing on this site | Y | Checkbox, one-up vertical | Skip Logic Group | Navigation Experience | |||
| Links often did not take me where I expected | B | ||||||||
| Had difficulty finding relevant information/products | |||||||||
| Links/labels are difficult to understand | C | ||||||||
| Too many links/navigational options to choose from | |||||||||
| Had technical difficulties (error messages, broken links, etc.) | |||||||||
| Could not navigate back to previous information | |||||||||
| I had a navigation difficulty not listed above | A | ||||||||
| HAJ7090Q024 | A | Other navigation difficulty: | N | Text area, no char limit | Skip Logic Group | OE_Navigation Experience | |||
| HAJ7090Q025 | B | 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 | OE_Links/Paths | |||
| HAJ7090Q026 | C | What specific links/labels were difficult to understand? | N | Text area, no char limit | Skip Logic Group | OE_links/labels | |||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |
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