30688 Q_SSADiagnostic_Web_Browse_20160718

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Overview

Qualifer Page
Welcome and TY Text
Diagnostic Survey Model Qsts
Current CQs
CQs (7-29-16)

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Sheet 1: Qualifer Page

	Trigger Request Form	If you see the Security Warning above, Please go to the options and enable content. Please Mouse Over the Red Triangle->
	Client Name	Social Security Administration
	Site URL	www.ssa.gov www.SocialSecurity.gov	Wiki
	Domains/Subdomains	List the domains and sub-domains.
	SRA Name	Laura Winebarger
	Team Lead / CS Manager	Erica Noble
	Today's Date	Mar-14
	Customer ID (CID)	Please specify if the client is new. TV7AmpuatC8KshccfhpXDQ==
	True Conversion Events	Is the client using true conversion? N/A
	Multi-language	Is this survey a multi-language? N/A
	Language (Locales)	Please list all languages needed. N/A
	Persistent cookie-accept	The number of days the visitor will not receive an invite, after the accept. N/A
	Persistent cookie-decline	The number of days the visitor will not receive an invite, after the decline.
	Logo	Please attach logo to the ticket. The logo should be around 130x60 in size and jpg or gif format. On file other SSA measures
	Pharmaceutical	Is this a pharmaceutical client? n/a
	Current Code	Are there multiple code packages across the same domain? 16.1.3.7
	Session Replay	Is Session Replay currently implemented? N/A
	IE9 Upgrade	Is this a code upgrade? N/A
P
1	Name	SSA Diagnostic Survey
	MID	Model Instance ID TBD
	Loyalty Factor (LF)	Loyalty Factor: Is the number of pages that needs to be met before receiving a invite. Qualifier page only
	Sampling Percentage (SP)	Sampling Percentage: Is the percent of the visitors to sample.
	Invite	Do you want an invite layer to show to the visitor?
	Pop what	What do you want to pop? qualifer page
	Pop when	When do you want to survey to be presented?
	Pin	Is there precedence over which survey is presented?
	Include areas/pages	What urls are we including for this survey definition? ssa.gov| socialsecurity.gov
	Special Instructions
	Notes
P
	Exclude from Invitation
	Do not show a survey invitation on pages where URL contains the following strings:
	Details	Explain what the client wants to exclude here. Please carry over from old/existing code if necessary.
	URLs	List the urls/areas you do not want the invite to show.
	Exclude from running code
	Do not run code at all where the following is true. You may use url, variable or cookie.
	Details	Please carry over from old/existing code if necessary
	Customer Passed Parameters (CPPs)	If you are not sure about CPPs on the site. Please set up a meeting with IS and the client to discuss custom passed parameters.
	Do you need Custom Cpps?
	Name in Portal	Type the name of the cpp that will show in portal. Yes as part of qualifer
	Source	What is the source of the cpp? (Is it coming from a variable? A cookie? A URL parameter?) Qualifer notes below on qualifer page details
	Name from Client	Please type the exact name of the variable that was given from the client. Thinking about your experience today, were you looking for information on SSA’s Main pages or Frequently Asked Questions because you had difficulty using one of Social Security’s online services (e.g., online application, Retirement Estimator, creating or accessing you’re my Social Security account, appealing a decision online, etc.)? Answer: Yes, I had difficulty using one of Social Security's online applications or services.   (triggers the new Diagnostic Survey) qtype:difyes Answer: No, I did not have any difficulty using one of Social Security's online applications or services. (triggers the new SSA Main Pages/FAQ survey)qtype:difno
	Invitation and tracker text
	Invitation (now)	If you press alt + enter, you can put in spaces where needed.
		If you press alt + enter, you can put in spaces where needed.
	Tracker	If you press alt + enter, you can put in spaces where needed.
	Qualifier Text
		Thinking about your visit today, please tell us whether you had any difficulty finding or using any of the online applications or services offered on the Social Security website. Please check one of the following: O I had no difficulty using or finding one of Social Security’s online applications or services. (Triggers Main) O I had difficulty finding or determining which online application or service to use. (Triggers Main) O I had one or more of the following difficulties: (Triggers Diagnostic) • Setting up a my Social Security account • Accessing a previously created my Social Security account • Accessing my Social Security Statement • Changing my address • Starting or changing direct deposit • Requesting a Benefit Verification letter • Applying online for benefits (i.e., retirement, disability, Medicare or spouse’s) • Checking the status of a previously filed online application • Using the online appeal process • Using the online Retirement Estimator • Obtaining a form SSA-1099 for tax purposes • Obtaining a replacement Medicare card • Completing an online Representative Payee Report • Filing a W-2 form as an employer O I had another difficulty not listed above. (Triggers Main)
	Present
	Special instructions
		FM-000023; Rev: 4 (1/11/2012) - Trigger Request Form

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Sheet 2: Welcome and TY Text

Model Instance Name:
SSA Diagnostic Survey
MID:	YkcF1R1BkpwZYBUtdFo4lQ4C
Date:	2/10/2014
Welcome and Thank You Text
	Directions:
	This welcome text is shown at the top of the questionnaire window and the thank you text at the bottom. This is a good place to mention the site/company/agency name so the visitor knows whom they are taking the survey for. Feel free to modify the standard Welcome and Thank you text shown in the boxes below. Please read comments before using any of the text.
					Examples
					Welcome Text Example
	Welcome Text
	Thank you for visiting the Social Security website. 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 SSA provide the best online experience possible.
					Thank You Text Example
	DEFAULT Thank You Text
	Thank you for taking our survey - and for helping SSA serve you better. We appreciate your input!
	ALTERNATE WEB Thank You Text
	Thank you for taking our survey - and for helping us serve you better. Please note you will not receive a response from us based on your survey comments. If you would like us to contact you about your feedback, please visit the Contact Us section of our website.

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Sheet 3: Diagnostic Survey Model Qsts

Model Instance Name:
SSA Diagnostic Survey
MID:		YkcF1R1BkpwZYBUtdFo4lQ4C
Partitioned (Y/N)?
FPI Included(Y/N)?
NOTE: All non-partitioned surveys will NOT be imputed and the elements will be rotated as a default unless otherwise specified and approved by Research.
Date:		2/10/2014
SSA Diagnostic Survey
Model questions utilize the ForeSee CXA methodology to determine scores and impacts
		ELEMENTS (drivers of satisfaction)			CUSTOMER SATISFACTION			FUTURE BEHAVIORS	FPI
	MQ Label			MQ Label			MQ Label		Y?
		Plain Language (1=Poor, 10=Excellent, Don't Know)			Satisfaction			Return (1=Very Unlikely, 10=Very Likely)
1	Plain Language - Clear	Please rate the clarity of the wording on this site.	17	Satisfaction - Overall	What is your overall satisfaction with this site? (1=Very Dissatisfied, 10=Very Satisfied)	20	Return	How likely are you to return to this website?
2	Plain Language - Understandable	Please rate how well you understand the wording on this site.	18	Satisfaction - Expectations	How well does this site meet your expectations? (1=Falls Short, 10=Exceeds)			Use Web Channel Over Others
3	Plain Language - Concise	Please rate this site on its use of short, clear sentences.	19	Satisfaction - Ideal	How does this site compare to your idea of an ideal website? (1=Not Very Close, 10=Very Close)	21	Use Web Channel Over Others	How likely are you to use this site rather than seek information from other channels (i.e. local field office, call center)?
		Navigation (1=Poor, 10=Excellent, Don't Know)
4	Navigation - Organized	Please rate how well the site is organized.
5	Navigation - Options	Please rate the options available for navigating this site.
6	Navigation - Layout	Please rate how well the site layout helps you find what you need.
7	Navigation - Clicks	Please rate the number of clicks to get where you want on this site.
		SSA Information (1=Poor, 10=Excellent, Don't Know)
8	Site Information - Thoroughness	Please rate the thoroughness of information you viewed on this site today.
9	Site Information - Understandable	Please rate the quality of information you viewed today.
10	Site Information - Answers	Please rate how well the information viewed today provided answers to your questions.
		Site Performance (1=Poor, 10=Excellent, Don't Know)
11	Site Performance - Loading	Please rate how quickly pages load on this site.
12	Site Performance - Consistency	Please rate the consistency of speed from page to page on this site.
13	Site Performance - Completeness	Please rate how completely the page content loads on this site.
		Functionality (1=Poor, 10=Excellent, Don't Know)
14	Functionality - Usefulness	Please rate the usefulness of the features provided on this site.
15	Functionality - Convenient	Please rate the convenient placement of the features on this site.
16	Functionality - Variety	Please rate the variety of features on this site.

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Sheet 4: Current CQs

			red & strike-through: DELETE
SSA Diagnostic Survey			underlined & italicized: RE-ORDER
MID: YkcF1R1BkpwZYBUtdFo4lQ4C			pink: ADDITION
Date:	2/10/2014		blue + -->: REWORDING
SSA Diagnostic Survey 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
MAD0061911		You indicated that you had difficulty today using one of Social Security’s online services or applications. Which of the following online services or applications did you primarily have difficulty with?	my Social Security account (e.g., creating, accessing/re-entering, or using any of the services contained in my Social Security account)	1.A,A	Radio button, one-up vertical	Yes	Skip Logic Group*	Difficulty_Single Select
			Applying online for benefits(e.g., applying for Social Security retirement, disability, spouse, or Medicare only benefits; returning to a saved application for benefits, etc.)	B
			Checking the status of my recently filed/completed online application for benefits	C, C1
			Using the Retirement Estimator	D, D-1
			Appealing an unfavorable disability decision	E
			Using Business Services Online (e.g., employer services, appointed representative payee services, etc.)	F, F1, F2
			I had another difficulty using one of Social Security's online services or applications	G, G1
KAU0126756	1.A	Did you enter your cell phone number when creating your my Social Security account?	Yes		Radio button, one-up vertical	Y	Skip Logic Group*	Enter Cell Number
			No	2.A
KAU0126757	2.A	Why did you not enter your cell phone number when you created your account?			Text field, <100 char	N	Skip Logic Group*	OE_Enter Cell Number
STE0075282	A	Please describe the difficulty you had trying to use your my Social Security account:	Creating a my Social Security account	A1, A1-1, A1-2, A1-3	Radio button, one-up vertical	Y	Skip Logic Group*	Describe mySSA Difficulty
			Accessing or re-entering your previously established my Social Security account	A2, A2-1, A2-2, A2-3
			I am not certain if my problem is with creating a my Social Security account or re-entering my previously established my Social Security account	A4
			Using the services and information contained in your my Social Security account	A3, A3-1
MAD0056720	A1	Please describe the difficulty you had with creating your my Social Security account:			Text area, no char limit	N	Skip Logic Group*	OE_New mySSA Difficulty
MAD0061984	A1-1	How many times have you attempted to create your my Social Security account?	1-2 times		Radio button, two-up vertical	Y	Skip Logic Group*	How Many Times - New mySSA
			3-4 times
			5-6 times
			More than 6 times
MAD0061983	A1-2	While attempting to create your my Social Security account, did you seek assistance from SSA?	Yes	AA	Radio button, one-up vertical	Y	Skip Logic Group*	Seek assistance - New mySSA
			No	AAA
MAD0056762	AAA	Please describe your experience seeking assistance.			Text area, no char limit	N	Skip Logic Group*	OE_Describe Assistance - New mySSA
MAD0056721	AAA	Were you aware that Social Security provides assistance to visitors trying to establish their my Social Security account?	Yes		Radio button, one-up vertical	Y	Skip Logic Group*	Aware of Assistance - New mySSA
			No
MAD0061982	A1-3	Being mindful of Social Security’s commitment to protecting your personal information, do you have any suggestions for making the process of creating a my Social Security account better?			Text area, no char limit	N	Skip Logic Group*	OE_Improvements for New mySSA
MAD0061990	A2	Please describe the difficulty you had with accessing your previously created my Social Security account:			Text area, no char limit	N		OE_Established mySSA Difficulty
MAD0061989	A2-1	How many times have you attempted to access or re-enter your my Social Security account?	1-2 times		Radio button, one-up vertical	Y	Skip Logic Group*	How Many Times - Established mySSA
			3-4 times
			5-6 times
			More than 6 times
MAD0061988	A2-2	While attempting to access or re-enter your my Social Security account, did you seek assistance from SSA?	Yes	A2-2.1	Radio button, one-up vertical	Y	Skip Logic Group*	Seek assistance - Established mySSA
			No	A2-2.2
MAD0061992	A2-2.1	Please describe your experience seeking assistance.			Text area, no char limit	N	Skip Logic Group*	OE_Describe Assistance - Established mySSA
MAD0061991	A2-2.2	Were you aware that Social Security provides assistance to visitors trying to access their my Social Security account?	Yes		Radio button, one-up vertical	Y	Skip Logic Group*	Aware of Assistance - Established mySSA
			No
MAD0061987	A2-3	Being mindful of Social Security’s commitment to protecting your personal information, do you have any suggestions for making the process of accessing or re-entering a my Social Security account better?			Text area, no char limit	N	Skip Logic Group*	OE_Improvements-Established mySSA
MAD0061986	A3	Please describe the difficulty you had with using the services and information contained in my Social Security:			Text area, no char limit	N	Skip Logic Group*	OE_Difficulty with mySSA Services/Info
MAD0061985	A3-1	Which my Social Security services or information were you trying to use? (Select all that apply)	View my Social Security Earnings history		Checkbox, one-up vertical	Y	Skip Logic Group*	mySSA Services/Info Trying to Use
			View my Social Security Statement	A-3.3
			"Check Your Benefits"
			Print out a Benefit Verification Letter
			Use SSA's Retirement Estimator
			Use SSA's other online benefit calculators
			Change my address
			Enroll in or change my Direct Deposit information
			Could NOT find the information or services I was looking for	A-3.1
			I had another difficulty using my Social Security account	A-3.2
CAS0073022	A-3.3	Did you use the Retirement Estimator before visiting your my Social Security account today?	Yes	A3.3-1	Radio button, one-up vertical	Y	Skip Logic Group*	Use RE
			No	A3.3-2
CAS0073023	A3.3-1	Did you have difficulty navigating between my Social Security and the Retirement Estimator?	Yes	A3.3-3	Radio button, one-up vertical	Y	Skip Logic Group*	Difficulty Navigating Between RE and mySSA
			No
CAS0073024	A3.3-3	Please describe the difficulty you had navigating between my Social Security and the Retirement Estimator.			Text area, no char limit	N	Skip Logic Group*	OE_Difficulty Navigating Between RE and mySSA
CAS0073025	A3.3-2	Do you plan to use the Retirement Estimator after you are finished with your my Social Security account?	Yes		Radio button, one-up vertical	Y	Skip Logic Group*	Plan to Use RE
			No
MAD0061994	A-3.1	Please tell us what you were looking for:			Text area, no char limit	N	Skip Logic Group*	OE_mySSA Services Looking For
MAD0061993	A-3.2	Please describe the difficulty you had using my Social Security:			Text area, no char limit	N	Skip Logic Group*	OPS_Other mySSA Service Difficulty
STE0075283	A4	Please describe the problem you had.			Text area, no char limit	N	Skip Logic Group*	OE_Describe Uncertain mySSA Problem
MAD0061920	B	Please describe the difficulty you had trying to apply for benefits (Select all that apply):	I could not find the online application page.	B1, B1-1	Checkbox, one-up vertical	Y	Skip Logic Group*	Difficulty with App
			I was not certain if I was completing the correct online application form.	B2
			I was unable to complete my benefit application.	B3
			I tried unsuccessfully to obtain the assistance needed from Social Security to help me complete my online application.	B4, B4-1
			I had another difficulty applying online for benefits.	B5
MAD0062001	B1	Which application were you trying to find?	Retirement		Radio button, one-up vertical	Y	Skip Logic Group*	App Trying to Find
			Disability
			Medicare Only
			Extra Help with Medicare Prescription Costs
			Spouse's Benefits
			Child's Benefits
			I was looking for another application.	BB
MAD0062002	BB	Please tell us which application you were trying to find:			Text area, no char limit	N	Skip Logic Group*	OPS- App Trying to Find
MAD0062000	B1-1	Where were you looking for this application?			Text area, no char limit	N	Skip Logic Group*	OE_Where Looking for App
MAD0061999	B2	Please explain why you were not certain if you were completing the correct online application form.			Text area, no char limit	N	Skip Logic Group*	OE_Why Not Sure Correct Form
MAD0061998	B3	Please tell us why you could not complete your application (Select al that apply(:	I had to save and exit my application to find information needed to continue.	B3.1	Checkbox, one-up vertical	Y	Skip Logic Group*	Why Not Complete App
			I had to save and exit my application to verify my Social Security earnings record.
			I saved and exited my application because I wanted to use the online Retirement Estimator to reconsider my retirement options.
			I tried to return to my saved application, but could not access or log back into my application.	B3.2
MAD0062004	B3.1	Please tell us what information or documents you needed to complete your application:			Text area, no char limit	N	Skip Logic Group*	OE_What Info Needed for App
	B3.2	Please explain your difficulty with accessing or logging back into your application:			Text area, no char limit	N	Skip Logic Group*	OE_Difficulty with Returning to App
MAD0061997	B4	Please tell us how you tried to obtain assistance.			Text area, no char limit	N	Skip Logic Group*	OE_Assistance Return App
MAD0061996	B4.1	What assistance or help could Social Security have provided to enable you to successfully complete your online application?			Text area, no char limit	N	Skip Logic Group*	OE_Assistance Needed to Complete App
MAD0061995	B5	Please describe the difficulty you had applying online for benefits:			Text area, no char limit	N	Skip Logic Group*	OPS_ App Difficulty
MAD0061919	C	Please describe the difficulty you had trying to check the status of your recently filed/completed application for Social Security benefits (Select all that apply):	I could not find where to check the status of my application on the SSA website.	C1.1	Checkbox, one-up vertical	Y	Skip Logic Group*	Check Status Difficulty
			I could not access the “Application Status Information” page.	C1.2
			I thought I had completed/submitted my benefit application, but later learned that I had not.	C1.3
			I had another difficulty checking the status of my recently filed/completed application.	C1.4
MAD0062008	C1.1	Please tell us where on the SSA website you looked to check your application status.			Text area, no char limit	N	Skip Logic Group*	OE_Where Looked - Check Status
MAD0062007	C1.2	Please explain why you were unable to access the "Application Status Information" page.			Text area, no char limit	N	Skip Logic Group*	OE_Unable to Access Check Status
MAD0062006	C1.3	Please explain what you learned and how you found out.			Text area, no char limit	N	Skip Logic Group*	OE_What Learned - Check Status
MAD0062005	C1.4	Please describe the difficulty you had checking the status of your recently filed/completed application.			Text area, no char limit	N	Skip Logic Group*	OPS_Check Status Difficulty
MAD0061918	C1	Did you try to obtain assistance from Social Security?	Yes	CC	Radio button, one-up vertical	Y	Skip Logic Group*	Obtain Assistance - Check Status
			No
MAD0062009	CC	Please describe your experience obtaining assistance from SSA:			Text area, no char limit	N	Skip Logic Group*	OE_Assistance -Check Status
MAD0061917	D	Please describe the difficulty you had using the Retirement Estimator: (Select all that apply):	I could not find the Retirement Estimator webpage.	D1	Checkbox, one-up vertical	Y	Skip Logic Group*	RE Difficulty
			I was unable to access or log in to the Retirement Estimator.	D2
			I was unsuccessful in using the Retirement Estimator.	D3
			The Retirement Estimator did not give me all the estimates I was seeking.	D4
			I am not certain the retirement estimates I received were based on my entire social security work (earnings) record.	D5
			I thought the Retirement Estimator would provide an estimate of benefits I would receive as a spouse.
			I had another difficulty using the Retirement Estimator	D6
CAS0073026	D-1	Did you review your Social Security Statement before using the Retirement Estimator?	Yes, I reviewed my paper Social Security Statement.		Radio button, one-up vertical	Y	Skip Logic Group*	View Statement
			Yes, I reviewed my online Social Security Statement (located in your my Social Security account).	D-1.1
			No	D-1.2
CAS0073027	D-1.1	Did you have difficulty navigating between your online Social Security Statement and the Retirement Estimator?	Yes	D-1.3	Radio button, one-up vertical	Y	Skip Logic Group*	Difficulty Navigating Between Statement and RE
			No
CAS0073028	D-1.3	Please describe the difficulty you had navigating between your online Social Security Statement and the Retirement Estimator.			Text area, no char limit	N	Skip Logic Group*	OE_Difficulty Navigating Between Statement and RE
CAS0073029	D-1.2	Do you plan to review your online Social Security Statement next?	Yes		Radio button, one-up vertical	Y	Skip Logic Group*	Plan to Review Statement
			No
MAD0062015	D1	Where on the SSA website did you look for the Retirement Estimator?			Text area, no char limit	N	Skip Logic Group*	OE_Where Look for RE
MAD0062014	D2	What message did you receive to tell you that you could not use the Retirement Estimator?			Text area, no char limit	N	Skip Logic Group*	OE_Message Received- RE
MAD0062013	D3	Please tell us why you were unsuccessful in using the Retirement Estimator:			Text area, no char limit	N	Skip Logic Group*	OE_Why Unsuccessful - RE
MAD0062012	D4	What estimates were you seeking that the Retirement Estimator did not provide?			Text area, no char limit	N	Skip Logic Group*	OE_RE Estimates Not Provided
MAD0062011	D5	Please tell us why you are uncertain about the estimates:			Text area, no char limit	N	Skip Logic Group*	OE_Why Uncertain of RE Estimates
MAD0062010	D6	Please describe the difficulty you had with using the Retirement Estimator.			Text area, no char limit	N	Skip Logic Group*	OPS_RE Difficulty
MAD0061916	E	Please describe the difficulty you had appealing an unfavorable disability decision: (Select all that apply):	I could not find where to appeal a disability decision on the SSA website.	E1	Checkbox, one-up vertical	Y	Skip Logic Group*	iAppeals Difficulty
			I was unable to access the online appeal form to appeal my decision.	E2
			I could not complete the online appeal form because I did not have all the information I needed.	E3
			I had another difficulty using the online appeal form.	E4
MAD0062019	E1	Please tell us where on the SSA website you were looking for the online appeal form.			Text area, no char limit	N	Skip Logic Group*	OE_Where Looked - iAppeals
MAD0062018	E2	Please describe the difficulty you had when trying to access the online appeal form.			Text area, no char limit	N	Skip Logic Group*	OE_Difficulty Accessing iAppeals Form
MAD0062017	E3	Please tell us which what documents or information you did not have.			Text area, no char limit	N	Skip Logic Group*	OE_Documents Needed-iAppeals
MAD0062016	E4	Please describe the difficulty you had with appealing an unfavorable disability decision:			Text area, no char limit	N	Skip Logic Group*	OPS_iAppeals Difficulty
MAD0061915	F	Please tell us which BSO service or application you were trying to use. (Select all that apply)	W-2 Online		Checkbox, one-up vertical	Y	Skip Logic Group*	Which BSO Service
			W-2c Online
			View Submission Status
			View Employer Report Status
			View Errors
			View Notices
			SSN Verification
			Registration Services
			Resubmission Services
			Consent-Based Services
			Appointed Representative Services
			Representative Payee Accounting Report
MAD0061914	F1	Please describe the difficulty you encountered trying to use one of the BSO services.			Text area, no char limit	N	Skip Logic Group*	OE_BSO Difficulty
MAD0061913	F2	What type of assistance could SSA have provided to enable you to successfully use the BSO services?			Text area, no char limit	N	Skip Logic Group*	OE_Assistance BSO
LNH5061Q002	G	Please describe the difficulty you encountered with one of Social Security's online applications or services:			Text area, no char limit	N	Skip Logic Group*	OPS_Difficulty
MAD0061912	G1	Please tell us why you were unable to successfully use or complete the SSA online service or application:			Text area, no char limit	N	Skip Logic Group*	OE_Other Difficulty -Why Unsuccessful
JAC0076482		Please tell us how and from where you connected with SSA during your visit today?	Desktop computer/laptop from my home		Radio button, one-up vertical	Y	Skip Logic Group	How Connected with SSA
			Desktop computer/laptop from a friend or relative's home				Randomize
			Desktop computer/laptop from my place of employment
			Public computer workstation in a library	A
			Public computer workstation in some other agency/social organization (e.g., social services, Motor Vehicle Administration, housing agency, hospital, etc.)
			Public computer workstation made available at my local Social Security office
			SSA Express kiosk located in a public space or governmental office	B
			Other (please specify)	C			Anchor Answer Choice
JAC0076483	A	Did you connect through a unique Social Security icon featured on the computer's desktop?	Yes		Radio button, one-up vertical	Y	Skip Logic Group	Use SSA Icon
			No	AA
JAC0076486	AA	How did you link to the SSA website?			Text area, no char limit	N	Skip Logic Group	OE_How Linked to SSA (library)
JAC0076484	B	Please describe the location.			Text area, no char limit	N	Skip Logic Group	OE_Location of Kiosk
JAC0076485	C	Please tell us how and from where you connected with SSA during your visit today?			Text area, no char limit	N	Skip Logic Group	OPS_How Connected with SSA
STE0074163		Did you use the Frequently Asked Questions (“FAQs”) to find information?	Yes	A	Dropdown (Select-one)	Yes	Skip Logic	Use FAQ
			No
			Not sure
STE0074164	A	Did the Frequently Asked Questions give you the information you needed?	Yes		Dropdown (Select-one)	Yes	Skip Logic	FAQ Answers
			No	AA
STE0074165	AA	Please tell us about your concerns or problems when using the Frequently Asked Questions.			Text Area – no character limit	N	Skip Logic	OE_FAQ Concerns
MAD0062020		Thinking about the difficulty you just encountered, what kind of assistance could Social Security have provided to help you accomplish your goal on the SSA website?			Text area, no char limit	N		OE_Overall Improvements
STE0074166		With respect to resolving your online difficulty, what do you PREFER to do next?	I prefer calling the SSA 1-800 Number		Radio Button One Up Vertical	Y	Skip Logic	Prefer to Do Next
			I prefer calling my local Social Security office				Randomize
			I prefer visiting my local Social Security office
			I prefer having an online solution (e.g., click-to-chat, "Before You Start" checklist, instructional video, email SSA feature, etc.)	A
			I prefer sending a letter to Social Security
			Other (please specify)	AA			Anchor Answer Choice
			Not sure				Anchor Answer Choice
STE0074167	AA	What do you plan to do next?			Text Area – no character limit	N	Skip Logic	OPS_Prefer to Do Next
STE0074168	A	Which type of online solution would you prefer to use?	Click-to-chat		Radio Button One Up Vertical	Y	Skip Logic	Online Solution
			Email				Randomize
			"Before You Start" checklist
			Instructional video
			Other (please specify)	B			Anchor Answer Choice
STE0074169	B	What other type of online solution would you prefer to use?			Text Area – no character limit	N	Skip Logic	OPS_Online Solution

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Sheet 5: CQs (7-29-16)

			red & strike-through: DELETE
SSA Diagnostic Survey			underlined & italicized: RE-ORDER
MID: YkcF1R1BkpwZYBUtdFo4lQ4C			pink: ADDITION
Date:	2/10/2014		blue + -->: REWORDING
SSA Diagnostic Survey 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
MAD0061911		You indicated that you had difficulty today using one of Social Security’s online services or applications. Which of the following online services or applications did you primarily have difficulty with?	my Social Security account (e.g., creating, accessing/re-entering, or using any of the services contained in my Social Security account)	1.A,A	Radio button, one-up vertical	Yes	Skip Logic Group*	Difficulty_Single Select
			Applying online for benefits(e.g., applying for Social Security retirement, disability, spouse, or Medicare only benefits; returning to a saved application for benefits, etc.)	B
			Checking the status of my recently filed/completed online application for benefits	C, C1
			Using the Retirement Estimator	D, D-1
			Appealing an unfavorable disability decision	E
			Using Business Services Online (e.g., employer services, appointed representative payee services, etc.)	F, F1, F2
			I had another difficulty using one of Social Security's online services or applications	G, G1
	1.A	Did you enter your cell phone number when creating your my Social Security account?	Yes		Radio button, one-up vertical	Y	Skip Logic Group*	Enter Cell Number
			No	2.A
	2.A	Why did you not enter your cell phone number when you created your account?			Text field, <100 char	N	Skip Logic Group*	OE_Enter Cell Number
STE0075282	A	Please describe the difficulty you had trying to use your my Social Security account:	Creating a my Social Security account	A1, A1-1, A1-2, A1-3	Radio button, one-up vertical	Y	Skip Logic Group*	Describe mySSA Difficulty
			Accessing or re-entering your previously established my Social Security account	A2, A2-1, A2-2, A2-3
			I am not certain if my problem is with creating a my Social Security account or re-entering my previously established my Social Security account	A4
			Using the services and information contained in your my Social Security account	A3, A3-1
MAD0056720	A1	Please describe the difficulty you had with creating your my Social Security account:			Text area, no char limit	N	Skip Logic Group*	OE_New mySSA Difficulty
MAD0061984	A1-1	How many times have you attempted to create your my Social Security account?	1-2 times		Radio button, two-up vertical	Y	Skip Logic Group*	How Many Times - New mySSA
			3-4 times
			5-6 times
			More than 6 times
MAD0061983	A1-2	While attempting to create your my Social Security account, did you seek assistance from SSA?	Yes	AA	Radio button, one-up vertical	Y	Skip Logic Group*	Seek assistance - New mySSA
			No	AAA
MAD0056762	AAA	Please describe your experience seeking assistance.			Text area, no char limit	N	Skip Logic Group*	OE_Describe Assistance - New mySSA
MAD0056721	AAA	Were you aware that Social Security provides assistance to visitors trying to establish their my Social Security account?	Yes		Radio button, one-up vertical	Y	Skip Logic Group*	Aware of Assistance - New mySSA
			No
MAD0061982	A1-3	Being mindful of Social Security’s commitment to protecting your personal information, do you have any suggestions for making the process of creating a my Social Security account better?			Text area, no char limit	N	Skip Logic Group*	OE_Improvements for New mySSA
MAD0061990	A2	Please describe the difficulty you had with accessing your previously created my Social Security account:			Text area, no char limit	N		OE_Established mySSA Difficulty
MAD0061989	A2-1	How many times have you attempted to access or re-enter your my Social Security account?	1-2 times		Radio button, one-up vertical	Y	Skip Logic Group*	How Many Times - Established mySSA
			3-4 times
			5-6 times
			More than 6 times
MAD0061988	A2-2	While attempting to access or re-enter your my Social Security account, did you seek assistance from SSA?	Yes	A2-2.1	Radio button, one-up vertical	Y	Skip Logic Group*	Seek assistance - Established mySSA
			No	A2-2.2
MAD0061992	A2-2.1	Please describe your experience seeking assistance.			Text area, no char limit	N	Skip Logic Group*	OE_Describe Assistance - Established mySSA
MAD0061991	A2-2.2	Were you aware that Social Security provides assistance to visitors trying to access their my Social Security account?	Yes		Radio button, one-up vertical	Y	Skip Logic Group*	Aware of Assistance - Established mySSA
			No
MAD0061987	A2-3	Being mindful of Social Security’s commitment to protecting your personal information, do you have any suggestions for making the process of accessing or re-entering a my Social Security account better?			Text area, no char limit	N	Skip Logic Group*	OE_Improvements-Established mySSA
MAD0061986	A3	Please describe the difficulty you had with using the services and information contained in my Social Security:			Text area, no char limit	N	Skip Logic Group*	OE_Difficulty with mySSA Services/Info
MAD0061985	A3-1	Which my Social Security services or information were you trying to use? (Select all that apply)	View my Social Security Earnings history		Checkbox, one-up vertical	Y	Skip Logic Group*	mySSA Services/Info Trying to Use
			View my Social Security Statement	A-3.3
			"Check Your Benefits"
			Print out a Benefit Verification Letter
			Use SSA's Retirement Estimator
			Use SSA's other online benefit calculators
			Change my address
			Enroll in or change my Direct Deposit information
			Could NOT find the information or services I was looking for	A-3.1
			I had another difficulty using my Social Security account	A-3.2
CAS0073022	A-3.3	Did you use the Retirement Estimator before visiting your my Social Security account today?	Yes	A3.3-1	Radio button, one-up vertical	Y	Skip Logic Group*	Use RE
			No	A3.3-2
CAS0073023	A3.3-1	Did you have difficulty navigating between my Social Security and the Retirement Estimator?	Yes	A3.3-3	Radio button, one-up vertical	Y	Skip Logic Group*	Difficulty Navigating Between RE and mySSA
			No
CAS0073024	A3.3-3	Please describe the difficulty you had navigating between my Social Security and the Retirement Estimator.			Text area, no char limit	N	Skip Logic Group*	OE_Difficulty Navigating Between RE and mySSA
CAS0073025	A3.3-2	Do you plan to use the Retirement Estimator after you are finished with your my Social Security account?	Yes		Radio button, one-up vertical	Y	Skip Logic Group*	Plan to Use RE
			No
MAD0061994	A-3.1	Please tell us what you were looking for:			Text area, no char limit	N	Skip Logic Group*	OE_mySSA Services Looking For
MAD0061993	A-3.2	Please describe the difficulty you had using my Social Security:			Text area, no char limit	N	Skip Logic Group*	OPS_Other mySSA Service Difficulty
STE0075283	A4	Please describe the problem you had.			Text area, no char limit	N	Skip Logic Group*	OE_Describe Uncertain mySSA Problem
MAD0061920	B	Please describe the difficulty you had trying to apply for benefits (Select all that apply):	I could not find the online application page.	B1, B1-1	Checkbox, one-up vertical	Y	Skip Logic Group*	Difficulty with App
			I was not certain if I was completing the correct online application form.	B2
			I was unable to complete my benefit application.	B3
			I tried unsuccessfully to obtain the assistance needed from Social Security to help me complete my online application.	B4, B4-1
			I had another difficulty applying online for benefits.	B5
MAD0062001	B1	Which application were you trying to find?	Retirement		Radio button, one-up vertical	Y	Skip Logic Group*	App Trying to Find
			Disability
			Medicare Only
			Extra Help with Medicare Prescription Costs
			Spouse's Benefits
			Child's Benefits
			I was looking for another application.	BB
MAD0062002	BB	Please tell us which application you were trying to find:			Text area, no char limit	N	Skip Logic Group*	OPS- App Trying to Find
MAD0062000	B1-1	Where were you looking for this application?			Text area, no char limit	N	Skip Logic Group*	OE_Where Looking for App
MAD0061999	B2	Please explain why you were not certain if you were completing the correct online application form.			Text area, no char limit	N	Skip Logic Group*	OE_Why Not Sure Correct Form
MAD0061998	B3	Please tell us why you could not complete your application (Select al that apply(:	I had to save and exit my application to find information needed to continue.	B3.1	Checkbox, one-up vertical	Y	Skip Logic Group*	Why Not Complete App
			I had to save and exit my application to verify my Social Security earnings record.
			I saved and exited my application because I wanted to use the online Retirement Estimator to reconsider my retirement options.
			I tried to return to my saved application, but could not access or log back into my application.	B3.2
MAD0062004	B3.1	Please tell us what information or documents you needed to complete your application:			Text area, no char limit	N	Skip Logic Group*	OE_What Info Needed for App
	B3.2	Please explain your difficulty with accessing or logging back into your application:			Text area, no char limit	N	Skip Logic Group*	OE_Difficulty with Returning to App
MAD0061997	B4	Please tell us how you tried to obtain assistance.			Text area, no char limit	N	Skip Logic Group*	OE_Assistance Return App
MAD0061996	B4.1	What assistance or help could Social Security have provided to enable you to successfully complete your online application?			Text area, no char limit	N	Skip Logic Group*	OE_Assistance Needed to Complete App
MAD0061995	B5	Please describe the difficulty you had applying online for benefits:			Text area, no char limit	N	Skip Logic Group*	OPS_ App Difficulty
MAD0061919	C	Please describe the difficulty you had trying to check the status of your recently filed/completed application for Social Security benefits (Select all that apply):	I could not find where to check the status of my application on the SSA website.	C1.1	Checkbox, one-up vertical	Y	Skip Logic Group*	Check Status Difficulty
			I could not access the “Application Status Information” page.	C1.2
			I thought I had completed/submitted my benefit application, but later learned that I had not.	C1.3
			I had another difficulty checking the status of my recently filed/completed application.	C1.4
MAD0062008	C1.1	Please tell us where on the SSA website you looked to check your application status.			Text area, no char limit	N	Skip Logic Group*	OE_Where Looked - Check Status
MAD0062007	C1.2	Please explain why you were unable to access the "Application Status Information" page.			Text area, no char limit	N	Skip Logic Group*	OE_Unable to Access Check Status
MAD0062006	C1.3	Please explain what you learned and how you found out.			Text area, no char limit	N	Skip Logic Group*	OE_What Learned - Check Status
MAD0062005	C1.4	Please describe the difficulty you had checking the status of your recently filed/completed application.			Text area, no char limit	N	Skip Logic Group*	OPS_Check Status Difficulty
MAD0061918	C1	Did you try to obtain assistance from Social Security?	Yes	CC	Radio button, one-up vertical	Y	Skip Logic Group*	Obtain Assistance - Check Status
			No
MAD0062009	CC	Please describe your experience obtaining assistance from SSA:			Text area, no char limit	N	Skip Logic Group*	OE_Assistance -Check Status
MAD0061917	D	Please describe the difficulty you had using the Retirement Estimator: (Select all that apply):	I could not find the Retirement Estimator webpage.	D1	Checkbox, one-up vertical	Y	Skip Logic Group*	RE Difficulty
			I was unable to access or log in to the Retirement Estimator.	D2
			I was unsuccessful in using the Retirement Estimator.	D3
			The Retirement Estimator did not give me all the estimates I was seeking.	D4
			I am not certain the retirement estimates I received were based on my entire social security work (earnings) record.	D5
			I thought the Retirement Estimator would provide an estimate of benefits I would receive as a spouse.
			I had another difficulty using the Retirement Estimator	D6
CAS0073026	D-1	Did you review your Social Security Statement before using the Retirement Estimator?	Yes, I reviewed my paper Social Security Statement.		Radio button, one-up vertical	Y	Skip Logic Group*	View Statement
			Yes, I reviewed my online Social Security Statement (located in your my Social Security account).	D-1.1
			No	D-1.2
CAS0073027	D-1.1	Did you have difficulty navigating between your online Social Security Statement and the Retirement Estimator?	Yes	D-1.3	Radio button, one-up vertical	Y	Skip Logic Group*	Difficulty Navigating Between Statement and RE
			No
CAS0073028	D-1.3	Please describe the difficulty you had navigating between your online Social Security Statement and the Retirement Estimator.			Text area, no char limit	N	Skip Logic Group*	OE_Difficulty Navigating Between Statement and RE
CAS0073029	D-1.2	Do you plan to review your online Social Security Statement next?	Yes		Radio button, one-up vertical	Y	Skip Logic Group*	Plan to Review Statement
			No
MAD0062015	D1	Where on the SSA website did you look for the Retirement Estimator?			Text area, no char limit	N	Skip Logic Group*	OE_Where Look for RE
MAD0062014	D2	What message did you receive to tell you that you could not use the Retirement Estimator?			Text area, no char limit	N	Skip Logic Group*	OE_Message Received- RE
MAD0062013	D3	Please tell us why you were unsuccessful in using the Retirement Estimator:			Text area, no char limit	N	Skip Logic Group*	OE_Why Unsuccessful - RE
MAD0062012	D4	What estimates were you seeking that the Retirement Estimator did not provide?			Text area, no char limit	N	Skip Logic Group*	OE_RE Estimates Not Provided
MAD0062011	D5	Please tell us why you are uncertain about the estimates:			Text area, no char limit	N	Skip Logic Group*	OE_Why Uncertain of RE Estimates
MAD0062010	D6	Please describe the difficulty you had with using the Retirement Estimator.			Text area, no char limit	N	Skip Logic Group*	OPS_RE Difficulty
MAD0061916	E	Please describe the difficulty you had appealing an unfavorable disability decision: (Select all that apply):	I could not find where to appeal a disability decision on the SSA website.	E1	Checkbox, one-up vertical	Y	Skip Logic Group*	iAppeals Difficulty
			I was unable to access the online appeal form to appeal my decision.	E2
			I could not complete the online appeal form because I did not have all the information I needed.	E3
			I had another difficulty using the online appeal form.	E4
MAD0062019	E1	Please tell us where on the SSA website you were looking for the online appeal form.			Text area, no char limit	N	Skip Logic Group*	OE_Where Looked - iAppeals
MAD0062018	E2	Please describe the difficulty you had when trying to access the online appeal form.			Text area, no char limit	N	Skip Logic Group*	OE_Difficulty Accessing iAppeals Form
MAD0062017	E3	Please tell us which what documents or information you did not have.			Text area, no char limit	N	Skip Logic Group*	OE_Documents Needed-iAppeals
MAD0062016	E4	Please describe the difficulty you had with appealing an unfavorable disability decision:			Text area, no char limit	N	Skip Logic Group*	OPS_iAppeals Difficulty
MAD0061915	F	Please tell us which BSO service or application you were trying to use. (Select all that apply)	W-2 Online		Checkbox, one-up vertical	Y	Skip Logic Group*	Which BSO Service
			W-2c Online
			View Submission Status
			View Employer Report Status
			View Errors
			View Notices
			SSN Verification
			Registration Services
			Resubmission Services
			Consent-Based Services
			Appointed Representative Services
			Representative Payee Accounting Report
MAD0061914	F1	Please describe the difficulty you encountered trying to use one of the BSO services.			Text area, no char limit	N	Skip Logic Group*	OE_BSO Difficulty
MAD0061913	F2	What type of assistance could SSA have provided to enable you to successfully use the BSO services?			Text area, no char limit	N	Skip Logic Group*	OE_Assistance BSO
LNH5061Q002	G	Please describe the difficulty you encountered with one of Social Security's online applications or services:			Text area, no char limit	N	Skip Logic Group*	OPS_Difficulty
MAD0061912	G1	Please tell us why you were unable to successfully use or complete the SSA online service or application:			Text area, no char limit	N	Skip Logic Group*	OE_Other Difficulty -Why Unsuccessful
JAC0076482		Please tell us how and from where you connected with SSA during your visit today?	Desktop computer/laptop from my home		Radio button, one-up vertical	Y	Skip Logic Group	How Connected with SSA
			Desktop computer/laptop from a friend or relative's home				Randomize
			Desktop computer/laptop from my place of employment
			Public computer workstation in a library	A
			Public computer workstation in some other agency/social organization (e.g., social services, Motor Vehicle Administration, housing agency, hospital, etc.)
			Public computer workstation made available at my local Social Security office
			SSA Express kiosk located in a public space or governmental office	B
			Other (please specify)	C			Anchor Answer Choice
JAC0076483	A	Did you connect through a unique Social Security icon featured on the computer's desktop?	Yes		Radio button, one-up vertical	Y	Skip Logic Group	Use SSA Icon
			No	AA
JAC0076486	AA	How did you link to the SSA website?			Text area, no char limit	N	Skip Logic Group	OE_How Linked to SSA (library)
JAC0076484	B	Please describe the location.			Text area, no char limit	N	Skip Logic Group	OE_Location of Kiosk
JAC0076485	C	Please tell us how and from where you connected with SSA during your visit today?			Text area, no char limit	N	Skip Logic Group	OPS_How Connected with SSA
STE0074163		Did you use the Frequently Asked Questions (“FAQs”) to find information?	Yes	A	Dropdown (Select-one)	Yes	Skip Logic	Use FAQ
			No
			Not sure
STE0074164	A	Did the Frequently Asked Questions give you the information you needed?	Yes		Dropdown (Select-one)	Yes	Skip Logic	FAQ Answers
			No	AA
STE0074165	AA	Please tell us about your concerns or problems when using the Frequently Asked Questions.			Text Area – no character limit	N	Skip Logic	OE_FAQ Concerns
MAD0062020		Thinking about the difficulty you just encountered, what kind of assistance could Social Security have provided to help you accomplish your goal on the SSA website?			Text area, no char limit	N		OE_Overall Improvements
STE0074166		With respect to resolving your online difficulty, what do you PREFER to do next?	I prefer calling the SSA 1-800 Number		Radio Button One Up Vertical	Y	Skip Logic	Prefer to Do Next
			I prefer calling my local Social Security office				Randomize
			I prefer visiting my local Social Security office
			I prefer having an online solution (e.g., click-to-chat, "Before You Start" checklist, instructional video, email SSA feature, etc.)	A
			I prefer sending a letter to Social Security
			Other (please specify)	AA			Anchor Answer Choice
			Not sure				Anchor Answer Choice
STE0074167	AA	What do you plan to do next?			Text Area – no character limit	N	Skip Logic	OPS_Prefer to Do Next
STE0074168	A	Which type of online solution would you prefer to use?	Click-to-chat		Radio Button One Up Vertical	Y	Skip Logic	Online Solution
			Email				Randomize
			"Before You Start" checklist
			Instructional video
			Other (please specify)	B			Anchor Answer Choice
STE0074169	B	What other type of online solution would you prefer to use?			Text Area – no character limit	N	Skip Logic	OPS_Online Solution