30688 Q_SSAiAppeals_Web_AccountManagement_20180803_DOT

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Overview

Foreign Language Translation
Welcome and Thank You Text
Model Qsts
Current CQs
CQs (8-3-18)

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Sheet 1: Foreign Language Translation

Measure Name	SSA iAppeals v2		(Remove this tab for non-international surveys)
Custom Qualifier Page	Yes
Custom Invitation Text
Custom Tracker Text
MID	Language	Target Country	Target Audience	Website URL	Notes

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Sheet 2: Welcome and Thank You Text

Welcome and Thank You Text
	Welcome Text			Thank You Text
	Thanks for using the Social Security Administration’s online disability appeal. 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. Please take a few minutes to share your opinions, which are essential in helping us provide the best online experience possible.
	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 3: Model Qsts

Model Name		SSA iAppeals v2					Red & Strike-Through: Delete
Model ID		tEtMY0Q8EMsQlUkRVwUM4w4C					Underlined & Italicized: Re-order
Partitioned		Yes					Pink: Addition
Date		1/27/2017					Blue: Reword
	Label	Element Questions		Label	Satisfaction Questions		Label	Future Behaviors
		Look and Feel (1=Poor, 10=Excellent, Don't Know)			Satisfaction			Use other online applications (1=Very Unlikely, 10=Very Likely)
1	Look and Feel - Appeal	Please rate the visual appeal of the online disability appeal.	10	Satisfaction - Overall	What is your overall satisfaction with the online disability appeal? (1=Very Dissatisfied, 10=Very Satisfied)	13	Use other online applications	How likely are you to use other on-line applications/forms on the Social Security web site?
2	Look and Feel - Balance	Please rate the balance of graphics and text on the online disability appeal.	11	Satisfaction - Expectations	How well does the online disability appeal meet your expectations? (1=Falls Short, 10=Exceeds)
3	Look and Feel - Readability	Please rate the readability of the pages on the online disability appeal.	12	Satisfaction - Ideal	How does the online disability appeal compare to your idea of an ideal online form? (1=Not Very Close, 10=Very Close)
		Site Performance (1=Poor, 10=Excellent, Don't Know)
4	Site Performance - Loading	Please rate how quickly pages load on the online disability appeal.
5	Site Performance - Consistency	Please rate the consistency of speed from page to page of the online disability appeal.
6	Site Performance - Completeness	Please rate the ability to load pages without getting error messages on the online disability appeal.
		Online Application Process (1=Poor, 10=Excellent, Don't Know)
7	Online Application Process - Clarity	Please rate the clarity of the instructions to complete the online disability appeal.
8	Online Application Process - Simplicity	Please rate the simplicity of completing the online disability appeal.
9	Online Application Process - Steps	Please rate the number of steps for entering the information into the online disability appeal.

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Sheet 4: Current CQs

Model Name	SSA iAppeals v2					Red & Strike-Through: Delete
Model ID	tEtMY0Q8EMsQlUkRVwUM4w4C					Underlined & Italicized: Re-order
Partitioned	Yes					Pink: Addition
Date	7/30/2018					Blue: Reword
QID	QUESTION META TAG	Skip From	Question Text	Answer Choices	Skip To	Required Y/N	Type	Special Instructions	CQ Label
BUC0250330			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				Mutually exclusive
KMJ4615Q044			Which type of appeal did you work on today?	Medical Disability Appeal	A,D,E,G,J,K,M,P	Y	Radio button, one-up vertical	Skip Logic Group*	Appeal Category
				Other Non-Medical Appeal	1,2,3,5,8,10
KMJ4615Q045		A	Which of the following best describes your role in using the online appeal today?	Self		Y	Radio button, one-up vertical	Skip Logic Group*	Medical Role
				Attorney or attorney's staff	B
				Non-attorney representative or non-attorney representative's staff	B
				Other third party representative (e.g., family member, social service agency worker, case manager)
KMJ4615Q046		B	Did you complete an appeal for more than one client during this session?	Yes	C	Y	Radio button, one-up vertical	Skip Logic Group*	Medical Attorney Appeal
				No
KMJ4615Q047		C	During this visit, how many clients did you file an appeal for?	2		Y	Radio button, one-up vertical	Skip Logic Group*	Medical Num of Clients
				3
				4 or more clients
KMJ4615Q048		D	How often do you use the online appeal?	This was the first time		Y	Radio button, one-up vertical	Skip Logic Group*	Medical Frequency
				Less than five times a week
				5-10 times per week
				11-25 times per week
				More than 25 times per week
KMJ4615Q049		E	Did you start a new online appeal today or return to a previously saved appeal?	I started a new appeal		Y	Radio button, one-up vertical	Skip Logic Group*	Medical Start or Return
				I returned to a previously saved appeal	F
KMJ4615Q050		F	Please tell us why you did not complete your appeal during your initial session.			N	Text field, <100 char	Skip Logic Group*	Medical Why Return
KMJ4615Q051		G	Did you complete and submit your online appeal today?	Yes, I completed and submitted my online appeal today	AA	Y	Radio button, one-up vertical	Skip Logic Group*	Medical Submit
				No	H,Q
BUC0250371		AA	How many attempts did you need to accomplish your task?	1		Y	Radio button, one-up vertical	Skip Logic Group*	Number of attempts
				2
				3
				4
				5 or more
KMJ4615Q052		H	Please tell us why you did not complete your appeals application today. Check all that apply.	I didn't have information I needed to complete the application, such as names, addresses, or dates		Y	Checkbox, one-up vertical	Skip Logic Group*	Medical Not Submit
				I didn't understand what the questions meant or how to answer
				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, i.e., an error message or a mistake I couldn't fix
				It takes too long to fill out
				It's too complicated to complete without help
				Other, please specify	I
KMJ4615Q053		I	What is your other reason?			N	Text field, <100 char	Skip Logic Group*	OE_Medical Not Submit
KMJ4615Q054		Q	What do you plan to do next?	I will complete my appeal at a later time		Y	Radio button, one-up vertical	Skip Logic Group*	Medical Do Next
				Browse the SSA website
				I will visit my local Social Security Office
				I do not know what I will do next at this time
				I do not plan to complete my appeal
KMJ4615Q055		J	How much time have you spent on your online disability appeal?	Less than 20 minutes		Y	Radio button, one-up vertical	Skip Logic Group*	Medical Time
				20 - 40 minutes
				41 minutes - 1 hour
				More than 1 hour but less than 2 hours
				More than 2 hours but less than 3 hours
				More than 3 hours
				Not sure
KMJ4615Q056		K	Did you experience any of the following while completing the online appeal? Check all that apply.	The questions did not seem to be organized in a logical manner		Y	Checkbox, one-up vertical	Skip Logic Group*	Medical Form Experience
				I had difficulty understanding the questions because they were not clearly written
				I did not have the information necessary to answer the questions
				I had difficulty editing the medical information (e.g., doctors, medication, etc.)
				I had difficulty editing other information
				I was unable to print the application
				I did not have enough time to complete the application
				I received an error message or was “kicked out” of the appeal
				The text box blanks did not allow enough characters for my answers
				Other	L
				I did not have any difficulties				Mutually Exclusive
KMJ4615Q057		L	So that we can better identify the difficulties you indicated above, please provide specific information if possible. (e.g., Which questions or sections were difficult? Where did you receive an error message? etc.)			N	Text field, <100 char	Skip Logic Group*	OE_Medical Form Experience
KMJ4615Q058		M	Did you have ALL of your personal and medical information ready when you started?	Yes		Y	Radio button, one-up vertical	Skip Logic Group*	Medical Info
				No	N,O
KMJ4615Q059		N	What personal and/or medical information did you not have ready when you started?			N	Text field, <100 char	Skip Logic Group*	OE_Medical Info
KMJ4615Q060		O	Could we have provided any additional information or assistance to help you be more prepared?			N	Text field, <100 char	Skip Logic Group*	Medical Info Help
KMJ4615Q061		P	How can we improve the online disability appeal? Please be as specific as possible. (Examples: What information could we have provided upfront? Do you have any suggested changes or updates?)			N	Text field, <100 char	Skip Logic Group*	Medical Improvement
KMJ4615Q062		1	Which of the following best describes your role in using the online appeal today?	Self		Y	Radio button, one-up vertical	Skip Logic Group*	Other Role
				Attorney or attorney's staff
				Non-attorney representative or non-attorney representative's staff
				Other third party representative (e.g., family member, social service agency worker, case manager)
KMJ4615Q063		2	How much time have you spent on your online appeal?	Less than 10 minutes		Y	Radio button, one-up vertical	Skip Logic Group*	Other Time
				10 - 20 minutes
				21 - 40 minutes
				41 minutes - 1 hour
				More than 1 hour but less than 2 hours
				More than 2 hours
				Not sure
KMJ4615Q064		3	Did you experience any of the following while completing the online appeal? Check all that apply.	The questions did not seem to be organized in a logical manner		Y	Checkbox, one-up vertical	Skip Logic Group*	Other Form Experience
				I had difficulty understanding the questions because they were not clearly written
				I did not have the information necessary to answer the questions
				I had difficulty editing the required information
				I had difficulty editing other information
				I was unable to print the application
				I did not have enough time to complete the application
				I received an error message or was “kicked out” of the appeal
				The text box blanks did not allow enough characters for my answers
				Other	4
				I did not have any difficulties				Mutually Exclusive
KMJ4615Q065		4	Please provide specific information as to your difficulty. (Which questions or sections were difficult? Where did you receive an error message? etc.)			N	Text field, <100 char	Skip Logic Group*	OE_Other Form Experience
KMJ4615Q066		5	Did you have ALL of your information ready when you started?	Yes		Y	Radio button, one-up vertical	Skip Logic Group*	Other Info
				No	6,7
KMJ4615Q067		6	What information did you not have ready when you started?			N	Text field, <100 char	Skip Logic Group*	OE_Other Info
KMJ4615Q068		7	Could we have provided any additional information or assistance to help you be more prepared?			N	Text field, <100 char	Skip Logic Group*	Other Info Help
KMJ4615Q069		8	Did you submit your appeals application today?	Yes		Y	Radio button, one-up vertical	Skip Logic Group*	Other Submit
				No	9
KMJ4615Q070		9	What do you plan to do next?	I will complete my appeal at a later time		Y	Radio button, one-up vertical	Skip Logic Group*	Other Do Next
				Browse the SSA website
				I will visit my local Social Security Office
				Call the SSA 1-800 number
				I do not know what I will do next at this time
				Other (please specify)	OT
BUC0250387		OT	What do you plan to do next?			Y	Text area no limit		OE_Do next
KMJ4615Q071		10	How can we improve the online appeal? Please be as specific as possible. (Examples: What information could we have provided upfront? Do you have any suggested changes or updates?)			N	Text field, <100 char	Skip Logic Group*	Other Improvement
UNG0123786			Did you have any documents to upload?	Yes	A	Y	Radio button, one-up vertical	Skip Logic Group*	Upload Docs
				No
UNG0123810		A	Did you use the attachment feature to upload your documents?	Yes	C	Y	Drop down, select one	Skip Logic Group*	Use Attachment Feature
				No	D
UNG0123811		C	Please tell us how easy it was to upload your attachments.	I had little or no difficulty uploading my attachment(s)		Y	Radio button, one-up vertical	Skip Logic Group*	Ease of Upload
				I found it somewhat difficult to upload my attachment(s)	E
UNG0123787		E	Please describe the difficulty you experienced.			N	Text field, <100 char	Skip Logic Group*	OE_UploadDifficulty
UNG0123840		D	Why didn't you use the attachment feature?	I will upload them later because I am not finished yet		Y	Radio button, one-up vertical	Skip Logic Group*	Did Not Attach
				I do not have electronic copies of my document(s) to upload
				I was not clear on how to upload my document(s)
				I did not see the attachment feature
				I forgot to upload my document(s)
				My documents were too big to upload
				Received an error message
				Other, please specify	F
UNG0123841		F	Please specify your other reason.			N	Text field, <100 char	Skip Logic Group*	OE_Did Not Attach
MAC0714			How helpful was the information on the online appeal Welcome Page?	Very helpful		Y	Drop down, select one		Welcome Page
				Somewhat helpful
				Not helpful at all
				Did not read the Welcome Page
CAS0045693			How helpful were the links to pop-up help pages (as indicated by a blue question mark) throughout the online appeal application?	Very helpful		Y	Drop down, select one		Pop-up Help Links
				Somewhat helpful
				Not helpful at all
				Did not read the help links
				Did not see the blue question marks
STE0078190			How helpful was the “Information You Will Need” checklist that was provided on the disability appeal Welcome Page?	Very helpful		Y	Drop down, select one		Checklist Helpful
				Somewhat helpful
				Not helpful at all
				Did not review the checklist
				Don't remember seeing the link to the checklist
MAC0713			Please rate the ease of navigating through the online appeal.	Very easy		Y	Drop down, select one		Ease of Navigating
				Somewhat easy
				Somewhat difficult
				Very difficult
STE0078182			What is your permanent residence?	United States or one of its territories / commonwealths		Y	Radio button, one-up vertical		Residence
				Foreign country
				I prefer not to answer

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Sheet 5: CQs (8-3-18)

Model Name	SSA iAppeals v2					Red & Strike-Through: Delete
Model ID	tEtMY0Q8EMsQlUkRVwUM4w4C					Underlined & Italicized: Re-order
Partitioned	Yes					Pink: Addition
Date	7/30/2018					Blue: Reword
QID	QUESTION META TAG	Skip From	Question Text	Answer Choices	Skip To	Required Y/N	Type	Special Instructions	CQ Label
			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			Mutually exclusive
KMJ4615Q044			Which type of appeal did you work on today?	Medical Disability Appeal	A,D,E,G,J,K,M,P	Y	Radio button, one-up vertical	Skip Logic Group*	Appeal Category
				Other Non-Medical Appeal	1,2,3,5,8,10
KMJ4615Q045		A	Which of the following best describes your role in using the online appeal today?	Self		Y	Radio button, one-up vertical	Skip Logic Group*	Medical Role
				Attorney or attorney's staff	B
				Non-attorney representative or non-attorney representative's staff	B
				Other third party representative (e.g., family member, social service agency worker, case manager)
KMJ4615Q046		B	Did you complete an appeal for more than one client during this session?	Yes	C	Y	Radio button, one-up vertical	Skip Logic Group*	Medical Attorney Appeal
				No
KMJ4615Q047		C	During this visit, how many clients did you file an appeal for?	2		Y	Radio button, one-up vertical	Skip Logic Group*	Medical Num of Clients
				3
				4 or more clients
KMJ4615Q048		D	How often do you use the online appeal?	This was the first time		Y	Radio button, one-up vertical	Skip Logic Group*	Medical Frequency
				Less than five times a week
				5-10 times per week
				11-25 times per week
				More than 25 times per week
KMJ4615Q049		E	Did you start a new online appeal today or return to a previously saved appeal?	I started a new appeal		Y	Radio button, one-up vertical	Skip Logic Group*	Medical Start or Return
				I returned to a previously saved appeal	F
KMJ4615Q050		F	Please tell us why you did not complete your appeal during your initial session.			N	Text field, <100 char	Skip Logic Group*	Medical Why Return
KMJ4615Q051		G	Did you complete and submit your online appeal today?	Yes, I completed and submitted my online appeal today	AA	Y	Radio button, one-up vertical	Skip Logic Group*	Medical Submit
				No	H,Q
		AA	How many attempts did you need to accomplish your task?	1		Y	Radio button, one-up vertical	Skip Logic Group*	Number of attempts
				2
				3
				4
				5 or more
KMJ4615Q052		H	Please tell us why you did not complete your appeals application today. Check all that apply.	I didn't have information I needed to complete the application, such as names, addresses, or dates		Y	Checkbox, one-up vertical	Skip Logic Group*	Medical Not Submit
				I didn't understand what the questions meant or how to answer
				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, i.e., an error message or a mistake I couldn't fix
				It takes too long to fill out
				It's too complicated to complete without help
				Other, please specify	I
KMJ4615Q053		I	What is your other reason?			N	Text field, <100 char	Skip Logic Group*	OE_Medical Not Submit
KMJ4615Q054		Q	What do you plan to do next?	I will complete my appeal at a later time		Y	Radio button, one-up vertical	Skip Logic Group*	Medical Do Next
				Browse the SSA website
				I will visit my local Social Security Office
				I do not know what I will do next at this time
				I do not plan to complete my appeal
KMJ4615Q055		J	How much time have you spent on your online disability appeal?	Less than 20 minutes		Y	Radio button, one-up vertical	Skip Logic Group*	Medical Time
				20 - 40 minutes
				41 minutes - 1 hour
				More than 1 hour but less than 2 hours
				More than 2 hours but less than 3 hours
				More than 3 hours
				Not sure
KMJ4615Q056		K	Did you experience any of the following while completing the online appeal? Check all that apply.	The questions did not seem to be organized in a logical manner		Y	Checkbox, one-up vertical	Skip Logic Group*	Medical Form Experience
				I had difficulty understanding the questions because they were not clearly written
				I did not have the information necessary to answer the questions
				I had difficulty editing the medical information (e.g., doctors, medication, etc.)
				I had difficulty editing other information
				I was unable to print the application
				I did not have enough time to complete the application
				I received an error message or was “kicked out” of the appeal
				The text box blanks did not allow enough characters for my answers
				Other	L
				I did not have any difficulties				Mutually Exclusive
KMJ4615Q057		L	So that we can better identify the difficulties you indicated above, please provide specific information if possible. (e.g., Which questions or sections were difficult? Where did you receive an error message? etc.)			N	Text field, <100 char	Skip Logic Group*	OE_Medical Form Experience
KMJ4615Q058		M	Did you have ALL of your personal and medical information ready when you started?	Yes		Y	Radio button, one-up vertical	Skip Logic Group*	Medical Info
				No	N,O
KMJ4615Q059		N	What personal and/or medical information did you not have ready when you started?			N	Text field, <100 char	Skip Logic Group*	OE_Medical Info
KMJ4615Q060		O	Could we have provided any additional information or assistance to help you be more prepared?			N	Text field, <100 char	Skip Logic Group*	Medical Info Help
KMJ4615Q061		P	How can we improve the online disability appeal? Please be as specific as possible. (Examples: What information could we have provided upfront? Do you have any suggested changes or updates?)			N	Text field, <100 char	Skip Logic Group*	Medical Improvement
KMJ4615Q062		1	Which of the following best describes your role in using the online appeal today?	Self		Y	Radio button, one-up vertical	Skip Logic Group*	Other Role
				Attorney or attorney's staff
				Non-attorney representative or non-attorney representative's staff
				Other third party representative (e.g., family member, social service agency worker, case manager)
KMJ4615Q063		2	How much time have you spent on your online appeal?	Less than 10 minutes		Y	Radio button, one-up vertical	Skip Logic Group*	Other Time
				10 - 20 minutes
				21 - 40 minutes
				41 minutes - 1 hour
				More than 1 hour but less than 2 hours
				More than 2 hours
				Not sure
KMJ4615Q064		3	Did you experience any of the following while completing the online appeal? Check all that apply.	The questions did not seem to be organized in a logical manner		Y	Checkbox, one-up vertical	Skip Logic Group*	Other Form Experience
				I had difficulty understanding the questions because they were not clearly written
				I did not have the information necessary to answer the questions
				I had difficulty editing the required information
				I had difficulty editing other information
				I was unable to print the application
				I did not have enough time to complete the application
				I received an error message or was “kicked out” of the appeal
				The text box blanks did not allow enough characters for my answers
				Other	4
				I did not have any difficulties				Mutually Exclusive
KMJ4615Q065		4	Please provide specific information as to your difficulty. (Which questions or sections were difficult? Where did you receive an error message? etc.)			N	Text field, <100 char	Skip Logic Group*	OE_Other Form Experience
KMJ4615Q066		5	Did you have ALL of your information ready when you started?	Yes		Y	Radio button, one-up vertical	Skip Logic Group*	Other Info
				No	6,7
KMJ4615Q067		6	What information did you not have ready when you started?			N	Text field, <100 char	Skip Logic Group*	OE_Other Info
KMJ4615Q068		7	Could we have provided any additional information or assistance to help you be more prepared?			N	Text field, <100 char	Skip Logic Group*	Other Info Help
KMJ4615Q069		8	Did you submit your appeals application today?	Yes		Y	Radio button, one-up vertical	Skip Logic Group*	Other Submit
				No	9
KMJ4615Q070		9	What do you plan to do next?	I will complete my appeal at a later time		Y	Radio button, one-up vertical	Skip Logic Group*	Other Do Next
				Browse the SSA website
				I will visit my local Social Security Office
				Call the SSA 1-800 number
				I do not know what I will do next at this time
				Other (please specify)	OT
		OT	What do you plan to do next?			Y	Text area no limit		OE_Do next
KMJ4615Q071		10	How can we improve the online appeal? Please be as specific as possible. (Examples: What information could we have provided upfront? Do you have any suggested changes or updates?)			N	Text field, <100 char	Skip Logic Group*	Other Improvement
UNG0123786			Did you have any documents to upload?	Yes	A	Y	Radio button, one-up vertical	Skip Logic Group*	Upload Docs
				No
UNG0123810		A	Did you use the attachment feature to upload your documents?	Yes	C	Y	Drop down, select one	Skip Logic Group*	Use Attachment Feature
				No	D
UNG0123811		C	Please tell us how easy it was to upload your attachments.	I had little or no difficulty uploading my attachment(s)		Y	Radio button, one-up vertical	Skip Logic Group*	Ease of Upload
				I found it somewhat difficult to upload my attachment(s)	E
UNG0123787		E	Please describe the difficulty you experienced.			N	Text field, <100 char	Skip Logic Group*	OE_UploadDifficulty
UNG0123840		D	Why didn't you use the attachment feature?	I will upload them later because I am not finished yet		Y	Radio button, one-up vertical	Skip Logic Group*	Did Not Attach
				I do not have electronic copies of my document(s) to upload
				I was not clear on how to upload my document(s)
				I did not see the attachment feature
				I forgot to upload my document(s)
				My documents were too big to upload
				Received an error message
				Other, please specify	F
UNG0123841		F	Please specify your other reason.			N	Text field, <100 char	Skip Logic Group*	OE_Did Not Attach
MAC0714			How helpful was the information on the online appeal Welcome Page?	Very helpful		Y	Drop down, select one		Welcome Page
				Somewhat helpful
				Not helpful at all
				Did not read the Welcome Page
CAS0045693			How helpful were the links to pop-up help pages (as indicated by a blue question mark) throughout the online appeal application?	Very helpful		Y	Drop down, select one		Pop-up Help Links
				Somewhat helpful
				Not helpful at all
				Did not read the help links
				Did not see the blue question marks
STE0078190			How helpful was the “Information You Will Need” checklist that was provided on the disability appeal Welcome Page?	Very helpful		Y	Drop down, select one		Checklist Helpful
				Somewhat helpful
				Not helpful at all
				Did not review the checklist
				Don't remember seeing the link to the checklist
MAC0713			Please rate the ease of navigating through the online appeal.	Very easy		Y	Drop down, select one		Ease of Navigating
				Somewhat easy
				Somewhat difficult
				Very difficult
STE0078182			What is your permanent residence?	United States or one of its territories / commonwealths		Y	Radio button, one-up vertical		Residence
				Foreign country
				I prefer not to answer