30688 Q_SSADisability_Web_AccountManagement_20181001_DOT

---

Overview

Disability_v2_Model_Qsts
Current_CQs
CQs_(10-1-18)
CQs_(8-3-18)

---

Sheet 1: Disability_v2_Model_Qsts

Model Instance Name:
SSA Disability v2
MID:		451pZNUxEwhdwdY1JBg4EA4C
Partitioned No					Element rotation scheme has been added
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:		6/12/2013
SSA Disability v2
Model questions utilize the ACSI methodology to determine scores and impacts
		ELEMENTS (drivers of satisfaction)			CUSTOMER SATISFACTION			FUTURE BEHAVIORS	FPI
	MQ Label			MQ Label			MQ Label		Y?
		Site Information (1=Poor, 10=Excellent, Don't Know)			Satisfaction			Recommend (1=Very Unlikely, 10=Very Likely)
1	Site Information - Thoroughness	Please rate the thoroughness of information provided in this application.	14	Satisfaction - Overall	What is your overall satisfaction with this application? (1=Very Dissatisfied, 10=Very Satisfied)	17	Recommend	How likely are you to recommend this application to someone else?
2	SiteInformation - Understandable	Please rate how understandable this application’s information is.	15	Satisfaction - Expectations	How well does this application meet your expectations? (1=Falls Short, 10=Exceeds)			Use Other Online Services (1=Very Unlikely, 10=Very Likely)
3	SiteInformation - Answers	Please rate how well the application’s information provides answers to your questions.	16	Satisfaction - Ideal	How does this application compare to your idea of an ideal application? (1=Not Very Close, 10=Very Close)	18	Use Other Online Services	How likely are you to use other Social Security online services?
		Site Performance (1=Poor, 10=Excellent, Don't Know)
4	Site Performance - Consistency	Please rate how quickly pages load in this application.
5	Site Performance - Errors	Please rate the consistency of speed from page to page in this application.
6	leann.hartka: Need label	Please rate the ability to load pages without getting error messages in this application.
		Navigation (1=Poor, 10=Excellent, Don't Know)
7	Navigation - Organized	Please rate how well the application is organized.
8	Navigation - Options	Please rate the options available for navigating this application.
9	Navigation - Layout	Please rate how well the application layout helps you find what you are looking for.
10	Navigation - Clicks	Please rate the number of clicks to get where you want in this application.
		Plain Language (1=Poor, 10=Excellent, Don't Know)
11	Plain Language - Clear	Please rate the clarity of the wording in this application.
12	Plain Language - Understandable	Please rate how well you understand the wording in this application.
13	Plain Language - Concise	Please rate this application on its use of short, clear sentences.

---

Sheet 2: Current_CQs

Model Instance Name:		SSA Disability v2
MID:		451pZNUxEwhdwdY1JBg4EA4C
Partitioned No
Date:		6/12/2013
QID	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip To	Required Y/N	Type (select from list)	Special Instructions	Labels
CAS0045268		Are you applying online for yourself or are you helping someone else?	Myself	A	Y	Drop down select one		Applying for
			Helping a Spouse/Relative/Friend
			Professional Helping a Client
			Other
BUC0266068	A	Were you able to create or log in to your mySSA account?	Yes		Y	Radio button, one-up vertical	Skip Logic Group	Create or log into mySSA
			No	B
			Don't know
BUC0266088	B	Why were you not able to create or log in to your mySSA account?	Did not have required information to create account		Y	Radio button, one-up vertical	Skip Logic Group	Why not log in mySSA
			Could not remember my password
			Other	BB
			Don't know
BUC0266069	BB	Please describe why you were not able to create or log in to your mySSA account.			N	Text area, no char limit	Skip Logic Group	OE_Why not log in mySSA
CAS0045269		How did you learn about the Social Security online disability application? (Select all that apply)	Official Social Security website (www.ssa.gov)		Y	Check box vertical one up	Skip Logic	Learn about App
			Online social media (Facebook, Twitter, etc.)
			A general web search (e.g., Google, Bing, etc.)
			Traditional media (TV, radio, newspaper, etc.)
			Social Security Statement
			Social Security publication
			Social Security employee	A
			Relative or friend
			Doctor, social worker, attorney, or other professional
			I saw the link while I was checking my online statements
			Other, please specify	B
CAS0045272	B	Please specify how you learned about this online disability application.			N	Text box, no char limit	Skip Logic	OPS_learned of app
RUS0250217		Before visiting SSA.gov did you first try to accomplish your task in any of the following ways?	Calling Social Security's 1-800 number		Y	Checkbox, one up vertical		First try
			Visiting my local Social Security office
			Calling my local Social Security office
			No, I visited SSA.gov first
			Not sure
CAS0045273		Did you use any of the following to prepare to apply online? (Select all that apply.)	I used the Disability Benefits Checklist	A	Y	check box one up vertical	Skip Logic	Prepare for App
			I watched the instructional video	C
			I used other information on the Social Security website to prepare	D
			I used another resource to prepare to apply online	E
			I did not use any resources to prepare to apply online				Mutually Exclusive
CAS0045274	A	How helpful did you find the Disability Benefits Checklist?	Very helpful		Y	Drop down select one	Skip Logic	Rate Statement
			Somewhat helpful
			Not at all helpful
CAS0045276	C	How helpful did you find the instructional video?	Very helpful		Y	Drop down select one	Skip Logic	Rate Video
			Somewhat helpful
			Not at all helpful
CAS0045277	D	How helpful did you find the other information on the Social Security website?	Very helpful		Y	Drop down select one	Skip Logic	Rate Other Info on Website
			Somewhat helpful
			Not at all helpful
CAS0045278	E	Please describe what other resource(s) you used to prepare to apply online?			N	Text field, no char limit	Skip Logic	OPS Prepare for App
RUS0199339		Did you apply for SSI (Supplemental Security Income) today along with disability?	Yes	A	Y	Radio button, one-up vertical	Skip Logic	SSI Apply Today
			No, I applied only for disability	B
			Not sure
RUS0199341	A	Are you aware that additional information may be required to determine your eligibility for SSI (Supplemental Security Income)?	Yes		Y	Radio button, one-up vertical	Skip logic	SSI Criteria Aware
			No
RUS0199342	B	Do you intend to apply for SSI (Supplemental Security Income) in the future?	Yes		Y	Radio button, one-up vertical	Skip logic	SSI Apply Future
			No
			Not sure
RUS0199364		Did the site clearly describe what you wanted to know about SSI (Supplemental Security Income)?	Yes		Y	Radio button, one-up vertical	Skip Logic	Clearly describe SSI
			No	C
			Not sure/Was not looking for SSI information
RUS0199365	C	Please describe what was not clear.				Text field, no char limit		OE_Not clear about SSI
CAS0047708		Did you start a new online disability application today or did you return to a saved application?	Started a new application		Y	Radio button, one-up vertical	Skip Logic	App Status
			Returned to work on a saved application	R1
STE0123750	R1	Were you able to access your previously saved online application with your Reentry number?	Yes, I was able to use the Reentry number that was provided to me	R0	Y	Radio button, one-up vertical	Skip Logic	Access Saved App
			No, I was not able to use the Reentry number that was provided to me	R2
			No, I did not have my Reentry number	R2,R3
BUC0266089	R0	Were you aware you could find your re-entry number in mySSA "Your Benefit Applications"?	Yes		Y	Radio button, one-up vertical	Skip logic	Reentry number aware
			No
BUC0266090	R3	Do you have a mySSA account?	Yes		Y	Radio button, one-up vertical	Skip logic	Have mySSA account
			No
			Don't know
STE0123734	R2	If you were not able to access your saved application, did you create a new application?	Yes		Y	Radio button, one-up vertical	Skip Logic	Create New App
			No
CAS0047725		Did you complete and submit your online disability application today?	Yes		Y	Radio button, one-up vertical	Skip Logic	Complete App
			No, I plan to complete and submit later	A
			No, I do not plan to complete and submit the online application	A
CAS0047730	A	If you did not complete and submit your online disability application today, please tell us why.	I didn't have information I needed like names, addresses, or dates		Y	check box one up vertical	Skip Logic	Not Complete App
			I didn't understand what the questions meant or how to answer
			I needed to view my Social Security Statement and/or verify that my earnings record is correct
			My disabling condition prevents me from working with a computer for long periods
			I had a limited amount of time/family demands that kept me from working on it for very long
			I had technical problems like an error message or a mistake I couldn't fix
			There are too many questions
			It takes too long to fill out
			It's too complicated to complete without help
			None of the above
			Other, please specify	AA
CAS0047731	AA	Please tell us why you did not complete and submit your online disability application today.			N	Text field, no char limit	Skip Logic	OPS Why Not Complete today
RUS0250218		Do you plan to do any of the following as a next step?	Call Social Security's 1-800 number		Y	Radio button, one up veritical	Skip Logic Group	Do next
			Visit my local Social Security office
			Call my local Social Security office
			Other (please specify)	B
RUS0250219	B	What do you plan to do next?				Text area, no char limit	Skip Logic Group	OE_Do next
CAS0047732		So far, how long have you worked on this disability online application?	Up to 30 minutes		Y	Radio button select one		Time Spent
			More than 30 minutes up to 1 hour
			More than 1 hour up to 2 hours
			More than 2 hours up to 3 hours
			More than 3 hours up to 4 hours
			More than 4 hours
CAS0047733		How many times did you work on your online disability application?	One Time		Y	Radio button select one		Number of times
			Two Times
			Three Times
			Four Times
			Five or More Times
CAS0047709		How did you locate the online disability application today?	I used the Online Services link on the Social Security homepage		Y	Radio Button	Skip Logic	Arrive at App
			I followed a link from somewhere else on the Social Security website
			I used Social Security's online search
			I used a search engine (i.e. Google, Bing, etc.) to locate the online application
			I had bookmarked the site
			Other, please specify	A
CAS0047686	A	Please describe how you arrived at this online disability application today.			N	Text field, no char limit	Skip Logic Group	OPS Arrive at app
CAS0047734		How easy was it for you to find the link to apply for Disability online?	Very easy		Y	Radio, one-up	Skip Logic Group	Find App
			Somewhat easy
			Somewhat hard	A
			Very hard	A
CAS0047735	A	Please tell us why it was hard to locate the link to apply for disability online. (Select all that apply.)	I could not find where to start a new online application		Y	check box one up vertical	Skip Logic	Why hard to find
			The "Apply for Benefits" was not clear to me
			Not clear where to go to return to my previously saved application
			I could not find the correct link to select
			The link(s) did not work on the Social Security website
			The information did not seem to be organized in a logical manner
			I used the search feature but the results didn’t seem to apply
			I tried to find the application using the FAQs links
			Other, please specify	AA
CAS0047736	AA	Please explain the reason why it was hard for you to find the online application.			N	Text field, no char limit	Skip Logic	OPS Hard to Find
RUS0199366		Once you found the application, did you have any difficulties completing it? (Select all that apply.)	I did not have any difficulties		Y	check box one up vertical	Skip Logic Mutually Exclusive,	Difficulties
			Forms/questions were difficult to understand
			Needed more room on form to include my information
			Other, please specify	AB
RUS0199367	AB	Please describe your difficulty.			N	Text field, no char limit	Skip Logic	OPS Hard to Find
CAS0045279		Why did you choose to apply online? (Select all that apply.)	I prefer to use online services as much as possible		Y	check box one up vertical	Skip Logic	Why Online
			I learned about applying online while visiting Social Security's website
			A Social Security employee recommended that I apply online
			I can't get to my local Social Security Office
			A friend or relative recommended that I apply online
			I knew that if I had a question or problem applying online, I could still get help from Social Security
			I am filing on behalf of another person
			I did not want to go to a local Social Security office
			I did not want to apply over the phone
			Other, please specify	A
CAS0045253	A	Please specify why you choose to apply online			N	Text field, no char limit	Skip Logic Group	OPS Why Online
CAS0045254		What is your current marital status?	Married		N	Radio button, one-up vertical	OPS Group	Marital Status
			Significant Other/Partner
			Separated
			Divorced
			Widowed
			Never Married/Single
			Prefer not to answer
			Other, please specify	A
CAS0045255	A	Other marital status			N	Text field, <100 char	OPS Group	OPS Marital Status
RUS0228686		What is your age?	Under 18		Y	Radio Button, One Up Vertical		Age
			18 - 29
			30 - 39
			40 - 49
			50 - 59
			60 - 69
			70 or older
			Prefer not to answer
CAS0047685		Do you have any suggestions for improving Social Security's online disability application?			N	Text Area – no character limit		OE_Improvement

---

Sheet 3: CQs_(10-1-18)

Model Instance Name:		SSA Disability v2
MID:		451pZNUxEwhdwdY1JBg4EA4C
Partitioned No
Date:		6/12/2013
QID	Skip Logic Label	Question Text	Answer IDs (DOT ONLY)	Answer Choices (limited to 50 characters)	Skip To	Type (select from list)	Required Y/N	Special Instructions	Labels
CAS0045268		Are you applying online for yourself or are you helping someone else?		Myself	A	Drop down select one	Y		Applying for
				Helping a Spouse/Relative/Friend
				Professional Helping a Client
				Other
	A	Were you able to create or log in to your mySSA account?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Create or log into mySSA
				No	B
				Don't know
	B	Why were you not able to create or log in to your mySSA account?		Did not have required information to create account		Radio button, one-up vertical	Y	Skip Logic Group
				Could not remember my password					Why not log in mySSA
				Other	BB
				Don't know
	BB	Please describe why you were not able to create or log in to your mySSA account.				Text area, no char limit	N	Skip Logic Group	OE_Why not log in mySSA
CAS0045269		How did you learn about the Social Security online disability application? (Select all that apply)		Official Social Security website (www.ssa.gov)		Check box vertical one up	Y	Skip Logic	Learn about App
				Online social media (Facebook, Twitter, etc.)
				A general web search (e.g., Google, Bing, etc.)
				Traditional media (TV, radio, newspaper, etc.)
				Social Security Statement
				Social Security publication
				Social Security employee	A
				Relative or friend
				Doctor, social worker, attorney, or other professional
				I saw the link while I was checking my online statements
				Other, please specify	B
CAS0045272	B	Please specify how you learned about this online disability application.				Text box, no char limit	N	Skip Logic	OPS_learned of app
RUS0250217		Before visiting SSA.gov did you first try to accomplish your task in any of the following ways?		Calling Social Security's 1-800 number		Checkbox, one up vertical	Y		First try
				Visiting my local Social Security office
				Calling my local Social Security office
				No, I visited SSA.gov first
				Not sure
CAS0045273		Did you use any of the following to prepare to apply online? (Select all that apply.)		I used the Disability Benefits Checklist	A	check box one up vertical	Y	Skip Logic	Prepare for App
				I used the Disability Starter Kit	B
				I watched the instructional video	C
				I used other information on the Social Security website to prepare	D
				I used another resource to prepare to apply online	E
				I did not use any resources to prepare to apply online				Mutually Exclusive
CAS0045274	A	How helpful did you find the Disability Benefits Checklist?		Very helpful		Drop down select one	Y	Skip Logic	Rate Statement
				Somewhat helpful
				Not at all helpful
CAS0045275	B	How helpful did you find the Disability Starter Kit?		Very helpful		Drop down select one	Y	Skip Logic	Rate RE Tools
				Somewhat helpful
				Not at all helpful
CAS0045276	C	How helpful did you find the instructional video?		Very helpful		Drop down select one	Y	Skip Logic	Rate Video
				Somewhat helpful
				Not at all helpful
CAS0045277	D	How helpful did you find the other information on the Social Security website?		Very helpful		Drop down select one	Y	Skip Logic	Rate Other Info on Website
				Somewhat helpful
				Not at all helpful
CAS0045278	E	Please describe what other resource(s) you used to prepare to apply online?				Text field, no char limit	N	Skip Logic	OPS Prepare for App
RUS0199339		Did you apply for SSI (Supplemental Security Income) today along with disability?		Yes	A	Radio button, one-up vertical	Y	Skip Logic	SSI Apply Today
				No, I applied only for disability	B
				Not sure
RUS0199341	A	Are you aware that additional information may be required to determine your eligibility for SSI (Supplemental Security Income)?		Yes		Radio button, one-up vertical	Y	Skip logic	SSI Criteria Aware
				No
RUS0199342	B	Do you intend to apply for SSI (Supplemental Security Income) in the future?		Yes		Radio button, one-up vertical	Y	Skip logic	SSI Apply Future
				No
				Not sure
RUS0199364		Did the site clearly describe what you wanted to know about SSI (Supplemental Security Income)?		Yes		Radio button, one-up vertical	Y	Skip Logic	Clearly describe SSI
				No	C
				Not sure/Was not looking for SSI information
RUS0199365	C	Please describe what was not clear.				Text field, no char limit			OE_Not clear about SSI
CAS0047708		Did you start a new online disability application today or did you return to a saved application?		Started a new application		Radio button, one-up vertical	Y	Skip Logic	App Status
				Returned to work on a saved application	R1
STE0123750	R1	Were you able to access your previously saved online application with your Reentry number?		Yes, I was able to use the Reentry number that was provided to me	R0	Radio button, one-up vertical	Y	Skip Logic	Access Saved App
				No, I was not able to use the Reentry number that was provided to me	R2
				No, I did not have my Reentry number	R2,R3
	R0	Were you aware you could find your re-entry number in mySSA "Your Benefit Applications"?		Yes		Radio button, one-up vertical	Y	Skip logic	Reentry number aware
				No
	R3	Do you have a mySSA account?		Yes		Radio button, one-up vertical	Y	Skip logic	Have mySSA account
				No
				Don't know
STE0123734	R2	If you were not able to access your saved application, did you create a new application?		Yes		Radio button, one-up vertical	Y	Skip Logic	Create New App
				No
CAS0047725		Did you complete and submit your online disability application today?		Yes		Radio button, one-up vertical	Y	Skip Logic	Complete App
				No, I plan to complete and submit later	A
				No, I do not plan to complete and submit the online application	A
CAS0047730	A	If you did not complete and submit your online disability application today, please tell us why.		I didn't have information I needed like names, addresses, or dates		check box one up vertical	Y	Skip Logic	Not Complete App
				I didn't understand what the questions meant or how to answer
				I needed to view my Social Security Statement and/or verify that my earnings record is correct
				My disabling condition prevents me from working with a computer for long periods
				I had a limited amount of time/family demands that kept me from working on it for very long
				I had technical problems like an error message or a mistake I couldn't fix
				There are too many questions
				It takes too long to fill out
				It's too complicated to complete without help
				None of the above
				Other, please specify	AA
CAS0047731	AA	Please tell us why you did not complete and submit your online disability application today.				Text field, no char limit	N	Skip Logic	OPS Why Not Complete today
RUS0250218		Do you plan to do any of the following as a next step?		Call Social Security's 1-800 number		Radio button, one up veritical	Y	Skip Logic Group	Do next
				Visit my local Social Security office
				Call my local Social Security office
				Other (please specify)	B
RUS0250219	B	What do you plan to do next?				Text area, no char limit		Skip Logic Group	OE_Do next
CAS0047732		So far, how long have you worked on this disability online application?		Up to 30 minutes		Radio button select one	Y		Time Spent
				More than 30 minutes up to 1 hour
				More than 1 hour up to 2 hours
				More than 2 hours up to 3 hours
				More than 3 hours up to 4 hours
				More than 4 hours
CAS0047733		How many times did you work on your online disability application?		One Time		Radio button select one	Y		Number of times
				Two Times
				Three Times
				Four Times
				Five or More Times
CAS0047709		How did you locate the online disability application today?		I used the Online Services link on the Social Security homepage		Radio Button	Y	Skip Logic	Arrive at App
				I followed a link from somewhere else on the Social Security website
				I used Social Security's online search
				I used a search engine (i.e. Google, Bing, etc.) to locate the online application
				I had bookmarked the site
				Other, please specify	A
CAS0047686	A	Please describe how you arrived at this online disability application today.				Text field, no char limit	N	Skip Logic Group	OPS Arrive at app
CAS0047734		How easy was it for you to find the link to apply for Disability online?		Very easy		Radio, one-up	Y	Skip Logic Group	Find App
				Somewhat easy
				Somewhat hard	A
				Very hard	A
CAS0047735	A	Please tell us why it was hard to locate the link to apply for disability online. (Select all that apply.)		I could not find where to start a new online application		check box one up vertical	Y	Skip Logic	Why hard to find
				The "Apply for Benefits" was not clear to me
				Not clear where to go to return to my previously saved application
				I could not find the correct link to select
				The link(s) did not work on the Social Security website
				The information did not seem to be organized in a logical manner
				I used the search feature but the results didn’t seem to apply
				I tried to find the application using the FAQs links
				Other, please specify	AA
CAS0047736	AA	Please explain the reason why it was hard for you to find the online application.				Text field, no char limit	N	Skip Logic	OPS Hard to Find
RUS0199366		Once you found the application, did you have any difficulties completing it? (Select all that apply.)		I did not have any difficulties		check box one up vertical	Y	Skip Logic Mutually Exclusive,	Difficulties
				Forms/questions were difficult to understand
				Needed more room on form to include my information
				Other, please specify	AB
RUS0199367	AB	Please describe your difficulty.				Text field, no char limit	N	Skip Logic	OPS Hard to Find
CAS0045279		Why did you choose to apply online? (Select all that apply.)		I prefer to use online services as much as possible		check box one up vertical	Y	Skip Logic	Why Online
				I learned about applying online while visiting Social Security's website
				A Social Security employee recommended that I apply online
				I can't get to my local Social Security Office
				A friend or relative recommended that I apply online
				I knew that if I had a question or problem applying online, I could still get help from Social Security
				I am filing on behalf of another person
				I did not want to go to a local Social Security office
				I did not want to apply over the phone
				Other, please specify	A
CAS0045253	A	Please specify why you choose to apply online				Text field, no char limit	N	Skip Logic Group	OPS Why Online
CAS0045254		What is your current marital status?		Married		Radio button, one-up vertical	N	OPS Group	Marital Status
				Significant Other/Partner
				Separated
				Divorced
				Widowed
				Never Married/Single
				Prefer not to answer
				Other, please specify	A
CAS0045255	A	Other marital status				Text field, <100 char	N	OPS Group	OPS Marital Status
RUS0228686		What is your age?		Under 18		Radio Button, One Up Vertical	Y		Age
				18 - 29
				30 - 39
				40 - 49
				50 - 59
				60 - 69
				70 or older
				Prefer not to answer
CAS0047685		Do you have any suggestions for improving Social Security's online disability application?				Text Area – no character limit	N		OE_Improvement

---

Sheet 4: CQs_(8-3-18)

QID	Skip Logic Label	Question Text	Answer IDs (DOT ONLY)	Answer Choices (limited to 50 characters)	Skip To	Type (select from list)	Required Y/N	Special Instructions	Labels
CAS0045268		Are you applying online for yourself or are you helping someone else?		Myself		Drop down select one	Y		Applying for
				Helping a Spouse/Relative/Friend
				Professional Helping a Client
				Other
CAS0045269		How did you learn about the Social Security online disability application? (Select all that apply)		Official Social Security website (www.ssa.gov)		Check box vertical one up	Y	Skip Logic	Learn about App
				Online social media (Facebook, Twitter, etc.)
				A general web search (e.g., Google, Bing, etc.)
				Traditional media (TV, radio, newspaper, etc.)
				Social Security Statement
				Social Security publication
				Social Security employee	A
				Relative or friend
				Doctor, social worker, attorney, or other professional
				Other, please specify	B
CAS0045270	A	How did you make contact with a Social Security employee?		Called the national 800 number		Drop down select one	Y	Skip Logic	How Contact SSA employee
				Called a local Social Security office
				Visited a local Social Security office
				At a Social Security sponsored event
				Other, please specify	AA
CAS0045271	AA	Please describe how you made contact with a Social Security employee.						Skip Logic	OPS how Contact SSA Employee
CAS0045272	B	Please specify how you learned about this online disability application.				Text box, no char limit	N	Skip Logic	OPS_learned of app
		Before visiting SSA.gov did you first try to accomplish your task in any of the following ways?		Calling Social Security's 1-800 number		Checkbox, one up vertical	Y		First try
				Visiting my local Social Security office
				Calling my local Social Security office
				No, I visited SSA.gov first
				Not sure
CAS0045273		Did you use any of the following to prepare to apply online? (Select all that apply.)		I used the Disability Benefits Checklist	A	check box one up vertical	Y	Skip Logic	Prepare for App
				I used the Disability Starter Kit	B
				I watched the instructional video	C
				I used other information on the Social Security website to prepare	D
				I used another resource to prepare to apply online	E
				I did not use any resources to prepare to apply online				Mutually Exclusive
CAS0045274	A	How helpful did you find the Disability Benefits Checklist?		Very helpful		Drop down select one	Y	Skip Logic	Rate Statement
				Somewhat helpful
				Not at all helpful
CAS0045275	B	How helpful did you find the Disability Starter Kit?		Very helpful		Drop down select one	Y	Skip Logic	Rate RE Tools
				Somewhat helpful
				Not at all helpful
CAS0045276	C	How helpful did you find the instructional video?		Very helpful		Drop down select one	Y	Skip Logic	Rate Video
				Somewhat helpful
				Not at all helpful
CAS0045277	D	How helpful did you find the other information on the Social Security website?		Very helpful		Drop down select one	Y	Skip Logic	Rate Other Info on Website
				Somewhat helpful
				Not at all helpful
CAS0045278	E	Please describe what other resource(s) you used to prepare to apply online?				Text field, no char limit	N	Skip Logic	OPS Prepare for App
RUS0199339		Did you apply for SSI (Supplemental Security Income) today along with disability?		Yes	A	Radio button, one-up vertical	Y	Skip Logic	SSI Apply Today
				No, I applied only for disability	B
				Not sure
RUS0199341	A	Are you aware that additional information may be required to determine your eligibility for SSI (Supplemental Security Income)?		Yes		Radio button, one-up vertical	Y	Skip logic	SSI Criteria Aware
				No
RUS0199342	B	Do you intend to apply for SSI (Supplemental Security Income) in the future?		Yes		Radio button, one-up vertical	Y	Skip logic	SSI Apply Future
				No
				Not sure
RUS0199364		Did the site clearly describe what you wanted to know about SSI (Supplemental Security Income)?		Yes		Radio button, one-up vertical	Y	Skip Logic	Clearly describe SSI
				No	C
				Not sure/Was not looking for SSI information
RUS0199365	C	Please describe what was not clear.				Text field, no char limit			OE_Not clear about SSI
CAS0047708		Did you start a new online disability application today or did you return to a saved application?		Started a new application		Radio button, one-up vertical	Y	Skip Logic	App Status
				Returned to work on a saved application	R1
STE0123750	R1	Were you able to access your previously saved online application with your Reentry number?		Yes, I was able to use the Reentry number that was provided to me		Radio button, one-up vertical	Y	Skip Logic	Access Saved App
				No, I was not able to use the Reentry number that was provided to me	R2
				No, I did not have my Reentry number	R2
STE0123734	R2	If you were not able to access your saved application, did you create a new application?		Yes		Radio button, one-up vertical	Y	Skip Logic	Create New App
				No
CAS0047725		Did you complete and submit your online disability application today?		Yes		Radio button, one-up vertical	Y	Skip Logic	Complete App
				No, I plan to complete and submit later	A
				No, I do not plan to complete and submit the online application	A
CAS0047730	A	If you did not complete and submit your online disability application today, please tell us why.		I didn't have information I needed like names, addresses, or dates		check box one up vertical	Y	Skip Logic	Not Complete App
				I didn't understand what the questions meant or how to answer
				I needed to view my Social Security Statement and/or verify that my earnings record is correct
				My disabling condition prevents me from working with a computer for long periods
				I had a limited amount of time/family demands that kept me from working on it for very long
				I had technical problems like an error message or a mistake I couldn't fix
				There are too many questions
				It takes too long to fill out
				It's too complicated to complete without help
				None of the above
				Other, please specify	AA
CAS0047731	AA	Please tell us why you did not complete and submit your online disability application today.				Text field, no char limit	N	Skip Logic	OPS Why Not Complete today
		Do you plan to do any of the following as a next step?		Call Social Security's 1-800 number		Radio button, one up veritical	Y	Skip Logic Group	Do next
				Visit my local Social Security office
				Call my local Social Security office
				Other (please specify)	B
	B	What do you plan to do next?				Text area, no char limit		Skip Logic Group	OE_Do next
CAS0047732		So far, how long have you worked on this disability online application?		Up to 30 minutes		Radio button select one	Y		Time Spent
				More than 30 minutes up to 1 hour
				More than 1 hour up to 2 hours
				More than 2 hours up to 3 hours
				More than 3 hours up to 4 hours
				More than 4 hours
CAS0047733		How many times did you work on your online disability application?		One Time		Radio button select one	Y		Number of times
				Two Times
				Three Times
				Four Times
				Five or More Times
CAS0047709		How did you locate the online disability application today?		I used the Online Services link on the Social Security homepage		Radio Button	Y	Skip Logic	Arrive at App
				I followed a link from somewhere else on the Social Security website
				I used Social Security's online search
				I used a search engine (i.e. Google, Bing, etc.) to locate the online application
				I had bookmarked the site
				Other, please specify	A
CAS0047686	A	Please describe how you arrived at this online disability application today.				Text field, no char limit	N	Skip Logic Group	OPS Arrive at app
CAS0047734		How easy was it for you to find the link to apply for Disability online?		Very easy		Radio, one-up	Y	Skip Logic Group	Find App
				Somewhat easy
				Somewhat hard	A
				Very hard	A
CAS0047735	A	Please tell us why it was hard to locate the link to apply for disability online. (Select all that apply.)		I could not find where to start a new online application		check box one up vertical	Y	Skip Logic	Why hard to find
				The "Apply for Benefits" was not clear to me
				Not clear where to go to return to my previously saved application
				I could not find the correct link to select
				The link(s) did not work on the Social Security website
				The information did not seem to be organized in a logical manner
				I used the search feature but the results didn’t seem to apply
				I tried to find the application using the FAQs links
				Other, please specify	AA
CAS0047736	AA	Please explain the reason why it was hard for you to find the online application.				Text field, no char limit	N	Skip Logic	OPS Hard to Find
RUS0199366		Once you found the application, did you have any difficulties completing it? (Select all that apply.)		I did not have any difficulties		check box one up vertical	Y	Skip Logic Mutually Exclusive,	Difficulties
				Forms/questions were difficult to understand
				Needed more room on form to include my information
				Other, please specify	AB
RUS0199367	AB	Please describe your difficulty.				Text field, no char limit	N	Skip Logic	OPS Hard to Find
CAS0045279		Why did you choose to apply online? (Select all that apply.)		I prefer to use online services as much as possible		check box one up vertical	Y	Skip Logic	Why Online
				I learned about applying online while visiting Social Security's website
				A Social Security employee recommended that I apply online
				I can't get to my local Social Security Office
				A friend or relative recommended that I apply online
				I knew that if I had a question or problem applying online, I could still get help from Social Security
				I am filing on behalf of another person
				I did not want to go to a local Social Security office
				I did not want to apply over the phone
				Other, please specify	A
CAS0045253	A	Please specify why you choose to apply online				Text field, no char limit	N	Skip Logic Group	OPS Why Online
STE0123751		After your visit today, what do you plan to do next?		Nothing, I submitted my claim		Radio button, one-up vertical	Y	Skip Logic Group	Do Next Y/N
				I will return to check the status of my application
				I will return to complete my claim
				Browse the SSA website
				I will call Social Security’s 1-800 number
				I will visit my local Social Security Office
				I do not know what I will do next at this time
CAS0045254		What is your current marital status?		Married		Radio button, one-up vertical	N	OPS Group	Marital Status
				Significant Other/Partner
				Separated
				Divorced
				Widowed
				Never Married/Single
				Prefer not to answer
				Other, please specify	A
CAS0045255	A	Other marital status				Text field, <100 char	N	OPS Group	OPS Marital Status
		What is your age?		Under 18		Radio Button, One Up Vertical	Y		Age
				18 - 29
				30 - 39
				40 - 49
				50 - 59
				60 - 69
				70 or older
				Prefer not to answer
CAS0047685		Do you have any suggestions for improving Social Security's online disability application?				Text Area – no character limit	N		OE_Improvement