30688 Q_SSAiClaim_Web_AccountManagement_20160614_DOT
E-Government Website Customer Satisfaction Surveys
Q_SSAiClaim_Web_AccountManagement_20160614_DOT.xlsx
Mapping and Questionnaire Documents IA 30688 A4 (SSA)
OMB: 1090-0008
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1090-0008 can be found here:
Document [xlsx]
Download: xlsx | pdf
v3 Model Qsts (SP)
v3 CQs (EE) (11-22-17)
v3 CQs (EE)
v3 CQs (EE) (11-20-17)
Current v3 CQs (SP)
v3 CQs (EE) (7-1-16)
Overview
v3 Model Qsts (EN)v3 Model Qsts (SP)
v3 CQs (EE) (11-22-17)
v3 CQs (EE)
v3 CQs (EE) (11-20-17)
Current v3 CQs (SP)
v3 CQs (EE) (7-1-16)
Sheet 1: v3 Model Qsts (EN)
| Model Instance Name: | ||||||||||
| SSA iClaim v3 | 
|
|||||||||
| MID: | VgpBBYx9l8JxIFgJlY1Ikg4C | |||||||||
| Partitioned No | Element rotation scheme has been added | |||||||||
| FPI Included(Y/N)? | ||||||||||
| Date: | 6/6/2013 | |||||||||
| SSA iClaim v3 | ||||||||||
| Model questions utilize the ACSI methodology to determine scores and impacts | ||||||||||
| ELEMENTS (drivers of satisfaction) | CUSTOMER SATISFACTION | FUTURE BEHAVIORS | FPI | |||||||
| NOTE: All questions under each element are required. Element questions are partitioned among surveys. |
||||||||||
| REQUIRED ELEMENTS (common to all websites) | ||||||||||
| MQ Label | MQ Label | MQ Label | Y? | |||||||
| Site Information (1=Poor, 10=Excellent, Don't Know) | Satisfaction | Recommend (1=Very Unlikely, 10=Very Likely) | ||||||||
| Site Information - Thoroughness | Please rate the thoroughness of information provided in this application. | Satisfaction - Overall | What is your overall satisfaction with this application? (1=Very Dissatisfied, 10=Very Satisfied) |
Recommend | How likely are you to recommend this application to someone else? | |||||
| SiteInformation - Understandable | Please rate how understandable this application’s information is. | 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) | ||||||
| SiteInformation - Answers | Please rate how well the application’s information provides answers to your questions. | Satisfaction - Ideal | How does this application compare to your idea of an ideal application? (1=Not Very Close, 10=Very Close) |
Use Other Online Services | How likely are you to use other Social Security online services? | |||||
| Site Performance (1=Poor, 10=Excellent, Don't Know) | ||||||||||
| Site Performance - Consistency | Please rate how quickly pages load in this application. | |||||||||
| Site Performance - Errors | Please rate the consistency of speed from page to page in this application. | |||||||||
| Site Performance - Loading | Please rate the ability to load pages without getting error messages in this application. | |||||||||
| Navigation (1=Poor, 10=Excellent, Don't Know) | ||||||||||
| Navigation - Organized | Please rate how well the application is organized. | |||||||||
| Navigation - Options | Please rate the options available for navigating this application. | 
|
|
|||||||
| Navigation - Layout | Please rate how well the application layout helps you find what you are looking for. | |||||||||
| 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) | ||||||||||
| Plain Language - Clear | Please rate the clarity of the wording in this application. | |||||||||
| Plain Language - Understandable | Please rate how well you understand the wording in this application. | |||||||||
| Plain Language - Concise | Please rate this application on its use of short, clear sentences. | |||||||||
Sheet 2: v3 Model Qsts (SP)
| Model Instance Name: | ||||||||||
| SSA iClaim v3 |
|
|||||||||
| MID: | Q0ExM1xNQRl9JJUR0M0JlA4C | |||||||||
| Partitioned No | ||||||||||
| 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: | 7/19/2013 | |||||||||
| SSA iClaim v3 | ||||||||||
| Model questions utilize the ACSI methodology to determine scores and impacts | ||||||||||
| ELEMENTS (drivers of satisfaction) | CUSTOMER SATISFACTION | FUTURE BEHAVIORS | FPI | |||||||
| NOTE: All questions under each element are required. Element questions are partitioned among surveys. |
||||||||||
| REQUIRED ELEMENTS (common to all websites) | ||||||||||
| MQ Label | MQ Label | MQ Label | Y? | |||||||
| Información del sitio de Internet (1=Mala, 10=Excelente, No sé) | Satisfacción | Recomendar (1=Muy improbablemente, 10=Muy probablemente) | ||||||||
| Site Information - Thoroughness | Por favor califique lo exhaustivo de la información presentada en este programa de computadora. | Satisfaction - Overall | ¿Cómo calificaría su satisfacción en general de este programa de computadora? (1=Totalmente insatisfecho, 10=Totalmente satisfecho) | Recommend | ¿Cuáles son las posibilidades de que le recomiende a otra persona el que use este programa de computadora ? | |||||
| SiteInformation - Understandable | Por favor califique lo comprensible de la información presentada en este programa de computadora. | Satisfaction - Expectations | ¿Con cuánta exactitud este programa de computadora satisfizo sus expectativas? (1=No llenó mis expectativas, 10=Totalmente satisfecho) | Uso de otros servicios del Seguro Social por Internet (1=Muy improbablemente, 10=Muy probablemente) | ||||||
| SiteInformation - Answers | Por favor califique lo adecuado de las respuestas que presenta este programa de computadora. | Satisfaction - Ideal | ¿Cómo se compara este programa de computadora con lo que se imaginaría que sería su programa de computadora ideal? (1=No se asemeja, 10=Se asemeja) | Use Other Online Services | ¿Cuáles son las posibilidades de que use otros programas del Seguro Social de computadora por Internet ? | |||||
| Rendimiento del sitio de Internet (1=Malo, 10=Excelente, No sé) | ||||||||||
| Site Performance - Consistency | Por favor califique la rapidez con que suben las páginas en este programa de computadora. | |||||||||
| Site Performance - Errors | Por favor califique la consistencia de la rapidez para moverse de una página a la otra en este programa de computadora. | |||||||||
| Por favor califique la capacidad para subir las páginas sin que reciba un error en este programa de computadora. | ||||||||||
| Navegación (1=Mala, 10=Excelente, No sé) | ||||||||||
| Navigation - Organized | Por favor califique la organización de este programa de computadora. | |||||||||
| Navigation - Options | Por favor califique las opciones disponibles para navegar este programa de computadora. | 
|
|
|||||||
| Navigation - Layout | Por favor califique cómo el diseño de este programa de computadora le ayuda a encontrar lo que busca. | |||||||||
| Navigation - Clicks | Por favor califique el número de clics que tuvo que hacer para encontrar lo que buscaba en este programa de computadora. | |||||||||
| Simpleza del vocabulario (1=Malo, 10=Excelente, No sé) | ||||||||||
| Plain Language - Clear | Por favor califique la claridad de las palabras usadas este programa de computadora. | |||||||||
| Plain Language - Understandable | Por favor califique su comprensión de las palabras usadas este programa de computadora. | |||||||||
| Plain Language - Concise | Por favor califique este programa de computadora basado en el uso de oraciones cortas y claras de este programa de computadora. | |||||||||
Sheet 3: v3 CQs (EE) (11-22-17)
| Model Instance Name: | |||||||||
| SSA iClaim v3 | underlined & italicized: RE-ORDER | ||||||||
| MID: xZAAEQw81gIo1Vo4Noc1Rw4C | pink: ADDITION | ||||||||
| Date: | 7/15/2011 | blue + -->: REWORDING | |||||||
| violet (bold): SKIP-LOGIC | |||||||||
| SSA iClaim v3 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 | |
| BJL2231 | What type of benefits were you applying for? | Retirement | Radio button, one up vertical | Y | Type of Benefits | ||||
| Medicare only | |||||||||
| Disability | |||||||||
| Both Retirement and Disability | |||||||||
| Spouse's | |||||||||
| Other | |||||||||
| CAS0045242 | Are you applying online for yourself or are you helping someone else? | Myself | Radio button, one up vertical | Y | Applying for | ||||
| Helping a Spouse/Relative/Friend | |||||||||
| Professional Helping a Client | |||||||||
| Other | |||||||||
| CAS0045243 | How did you learn about applying for Retirement, Disability or Medicare online? (Select all that apply.) | Official Social Security website (www.ssa.gov) | check box one up vertical | Y | Skip Logic Group | Learn about App | |||
| Social Media (Blog, Facebook, Twitter, etc.) | |||||||||
| A general web search (e.g. Google, Bing, etc.) | |||||||||
| An online ad (Banner/Image) | |||||||||
| An online video | |||||||||
| Radio | |||||||||
| Television | |||||||||
| A newspaper or magazine article | |||||||||
| A newspaper or magazine ad | |||||||||
| An email from Social Security | |||||||||
| My Social Security statement | |||||||||
| A Social Security employee | A | ||||||||
| A relative or friend | |||||||||
| A community group or association | |||||||||
| A billboard or other printed ad | |||||||||
| Other, please specify | B | ||||||||
| CAS0045244 | A | How did you make contact with a Social Security employee? | Called the national 800 number | check box one up vertical | Y | Skip Logic | SSA Employee Contact | ||
| Called a local Social Security office | |||||||||
| Visited a local Social Security office | |||||||||
| At a Social Security sponsored event | |||||||||
| Other, please specify | AA | ||||||||
| CAS0045245 | AA | Please describe how you made contact with a Social Security employee. | Text box, no char limit | N | Skip Logic | OPS SSA Employee Contact | |||
| CAS0045246 | B | Please specify how you learned about this online application. | Text box, no char limit | N | Skip Logic | OPS Learn about App | |||
| CAS0045262 | Did you use any of the following to prepare to apply online? (Select all that apply.) | Reviewed my online Social Security Statement | A | check box one up vertical | Y | Skip Logic | Prepare for App | ||
| Reviewed the Social Security statement that was mailed to me | |||||||||
| I used the Retirement Estimator or other tools on the Social Security website | 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 | ||||||||
| CAS0045263 | A | How helpful did you find the online Social Security Statement? | Very helpful | Radio button, one up vertical | Y | Skip Logic | Rate Statement | ||
| Somewhat helpful | |||||||||
| Not at all helpful | |||||||||
| CAS0045264 | B | How helpful did you find the estimator tools on the website? | Very helpful | Radio button, one up vertical | Y | Skip Logic | Rate RE Tools | ||
| Somewhat helpful | |||||||||
| Not at all helpful | |||||||||
| CAS0045265 | C | How helpful did you find the instructional video? | Very helpful | Radio button, one up vertical | Y | Skip Logic | Rate Video | ||
| Somewhat helpful | |||||||||
| Not at all helpful | |||||||||
| CAS0045266 | D | How helpful did you find the other information on the Social Security website? | Very helpful | Radio button, one up vertical | Y | Skip Logic | Rate Other Info on Website | ||
| Somewhat helpful | |||||||||
| Not at all helpful | |||||||||
| CAS0045267 | 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 | |||
| CAS0045247 | Did you start a new online application today or did you return to a previously saved application? | Started a new application | Radio button, one up vertical | Y | Skip Logic | App Status | |||
| Returned to work on a saved application | R1 | ||||||||
| STE0123836 | 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 | ||||||||
| STE0123837 | 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 | |||||||||
| CAS0045282 | Did you complete and submit your online application today? | Yes | B | Radio button, one up vertical | Y | Skip Logic | Complete App | ||
| No, I plan to complete and submit it later | A | ||||||||
| No, I do not plan to complete and submit my online application | A | ||||||||
| RUS0199384 | B | During your visit today did you look for any additional information for any of the following? (Select all that apply.) | Medicare coverage | D | check box one up vertical | Y | Skip Logic | Other Benefit Info | |
| Other health insurance coverage | D | ||||||||
| None of the above | Mutually exclusive | ||||||||
| RUS0199385 | D | Was the information clear? | Yes | Radio button, one up vertical | Y | Skip Logic | Benefit info clear | ||
| No | E | ||||||||
| Did not find needed information | |||||||||
| RUS0199386 | E | Please describe what was not clear. | Text box, no character limit | N | Skip Logic | How improve benefit info | |||
| CAS0045283 | A | If you did not complete and submit your online 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 wanted to use the Retirement Estimator to reconsider my retirement options | |||||||||
| 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, e.g.,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 | |||||||||
| Other, please specify | AA | ||||||||
| CAS0045284 | AA | What is your other reason? | Text field, no char limit | N | Skip Logic | OPS Why Not Complete today | |||
| CAS0045248 | So far, how long have you worked on this online application? | Up to 15 minutes | Drop down select one | Y | Time Spent | ||||
| 16 minutes - 30 minutes | |||||||||
| 31 minutes - 1 hour | |||||||||
| More than 1 hour up to 2 hours | |||||||||
| More than 2 hours | |||||||||
| CAS0045286 | How did you find where to create an application for Retirement, Medicare or Disability? | Used the Online Services link on the Social Security homepage | Radio Button | Y | Skip Logic | Arrive at App | |||
| Followed a link from somewhere else on the Social Security website | |||||||||
| Used Social Security's online search feature | |||||||||
| Used a search engine (e.g., Google, Bing, etc.) | |||||||||
| Followed a link from medicare.gov | |||||||||
| Followed a link from another website (e.g., AARP, an attorney's website, etc.) | |||||||||
| I clicked around until I found it | |||||||||
| I had bookmarked the site | |||||||||
| Other, please specify | A | ||||||||
| CAS0045251 | A | Please describe how you arrived at this online claim application today. | Text field, no char limit | N | Skip Logic Group | OPS Arrive at app | |||
| CAS0045249 | How easy was it for you to find the Social Security online application? | Very easy | Skip Logic Group | Find App | |||||
| Somewhat easy | |||||||||
| Somewhat hard | A | ||||||||
| Very hard | A | ||||||||
| CAS0045250 | A | Please tell us why it was hard to locate the claim application. (Select all that apply.) | 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 | |||||||||
| It was not clear to me where the links would lead | |||||||||
| I had difficulty using a link 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 use the FAQ's, but couldn't find the online application link | |||||||||
| Other, please specify | AA | ||||||||
| CAS0045285 | AA | Please explain the reason why it was hard for you to find the online claim application. | N | N | Skip Logic | OPS Hard to Find | |||
| CAS0045252 | 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 (www.ssa.gov) | |||||||||
| A Social Security employee recommended that I apply online | |||||||||
| I can't get to my local Social Security Office | B | ||||||||
| 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 did not want to go to a local Social Security office | |||||||||
| I did not want to apply over the phone | |||||||||
| Other, please specify | A | ||||||||
| CAS0045287 | A | Please specify why you choose to apply online: | Text field, no char limit | N | Skip Logic Group | OPS Why Online | |||
| STE0123838 | B | What is the reason that you cannot get to your local office? | Text field, no char limit | N | Skip Logic Group | OPS Why Local Office | |||
| STE0123839 | 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 | |||||||||
| CAS0045289 | 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 | ||||||||
| CAS0045290 | A | Other marital status | Text field, <100 char | N | OPS Group | OPS Marital Status | |||
| CAS0045291 | Do you have any suggestions for improving Social Security's online application. | Text field, no char limit | N | OE_Improvement | |||||
Sheet 4: v3 CQs (EE)
| Model Instance Name: | |||||||||
| SSA iClaim v3 | underlined & italicized: RE-ORDER | ||||||||
| MID: xZAAEQw81gIo1Vo4Noc1Rw4C | pink: ADDITION | ||||||||
| Date: | 7/15/2011 | blue + -->: REWORDING | |||||||
| violet (bold): SKIP-LOGIC | |||||||||
| SSA iClaim v3 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 | |
| BJL2231 | What type of benefits were you applying for? | Retirement | Dropdown (Select-one) | Y | Type of Benefits | ||||
| Medicare only | |||||||||
| Disability | |||||||||
| Both Retirement and Disability | |||||||||
| Spouse's | |||||||||
| Other | |||||||||
| CAS0045242 | Are you applying online for yourself or are you helping someone else? | Myself | Dropdown (Select-one) | Y | Applying for | ||||
| Helping a Spouse/Relative/Friend | |||||||||
| Professional Helping a Client | |||||||||
| Other | |||||||||
| STE0123830 | How did you connect to SSA today? | Desktop | Radio button, one-up verticalb | Y | How Connected with SSA | ||||
| Laptop | |||||||||
| Smartphone | |||||||||
| Tablet | |||||||||
| STE0123831 | From where did you connect to SSA today? | At home | Radio button, one-up verticalb | Y | Skip Logic Group | From Where Connected with SSA | |||
| In office/place of employment | |||||||||
| A friend or relative's place | |||||||||
| Public library | A | ||||||||
| Social Security Office | |||||||||
| Social Security Kiosk | B | ||||||||
| Other agency | |||||||||
| Other, please specify | C | ||||||||
| STE0123832 | 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 | ||||||||
| STE0123835 | AA | How did you link to the SSA website? | Text area, no char limit | N | Skip Logic Group | OE_How Linked to SSA (library) | |||
| STE0123833 | B | Please describe the location. | Text area, no char limit | N | Skip Logic Group | OE_Location of Kiosk | |||
| STE0123834 | 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 | |||
| CAS0045243 | How did you learn about applying for Retirement, Disability or Medicare online? (Select all that apply.) | Official Social Security website (www.ssa.gov) | check box one up vertical | Y | Skip Logic Group | Learn about App | |||
| Social Media (Blog, Facebook, Twitter, etc.) | |||||||||
| A general web search (e.g. Google, Bing, etc.) | |||||||||
| An online ad (Banner/Image) | |||||||||
| An online video | |||||||||
| Radio | |||||||||
| Television | |||||||||
| A newspaper or magazine article | |||||||||
| A newspaper or magazine ad | |||||||||
| An email from Social Security | |||||||||
| My Social Security statement | |||||||||
| A Social Security employee | A | ||||||||
| A relative or friend | |||||||||
| A community group or association | |||||||||
| A billboard or other printed ad | |||||||||
| Other, please specify | B | ||||||||
| CAS0045244 | A | How did you make contact with a Social Security employee? | Called the national 800 number | check box one up vertical | Y | Skip Logic | SSA Employee Contact | ||
| Called a local Social Security office | |||||||||
| Visited a local Social Security office | |||||||||
| At a Social Security sponsored event | |||||||||
| Other, please specify | AA | ||||||||
| CAS0045245 | AA | Please describe how you made contact with a Social Security employee. | Text box, no char limit | N | Skip Logic | OPS SSA Employee Contact | |||
| CAS0045246 | B | Please specify how you learned about this online application. | Text box, no char limit | N | Skip Logic | OPS Learn about App | |||
| CAS0045262 | Did you use any of the following to prepare to apply online? (Select all that apply.) | Reviewed my online Social Security Statement | A | check box one up vertical | Y | Skip Logic | Prepare for App | ||
| Reviewed the Social Security statement that was mailed to me | |||||||||
| I used the Retirement Estimator or other tools on the Social Security website | 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 | ||||||||
| CAS0045263 | A | How helpful did you find the online Social Security Statement? | Very helpful | Drop down select one | Y | Skip Logic | Rate Statement | ||
| Somewhat helpful | |||||||||
| Not at all helpful | |||||||||
| CAS0045264 | B | How helpful did you find the estimator tools on the website? | Very helpful | Drop down select one | Y | Skip Logic | Rate RE Tools | ||
| Somewhat helpful | |||||||||
| Not at all helpful | |||||||||
| CAS0045265 | 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 | |||||||||
| CAS0045266 | 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 | |||||||||
| CAS0045267 | 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 | |||
| CAS0045247 | Did you start a new online application today or did you return to a previously saved application? | Started a new application | Drop down select one | Y | Skip Logic | App Status | |||
| Returned to work on a saved application | R1 | ||||||||
| STE0123836 | 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 | Drop down select one | 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 | ||||||||
| STE0123837 | R2 | If you were not able to access your saved application, did you create a new application? | Yes | Drop down select one | Y | Skip Logic | Create New App | ||
| No | |||||||||
| CAS0045282 | Did you complete and submit your online application today? | Yes | Drop down select one | Y | Skip Logic | Complete App | |||
| No, I plan to complete and submit it later | A | ||||||||
| No, I do not plan to complete and submit my online application | A | ||||||||
| CAS0045283 | A | If you did not complete and submit your online 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 wanted to use the Retirement Estimator to reconsider my retirement options | |||||||||
| 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, e.g.,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 | |||||||||
| Other, please specify | AA | ||||||||
| CAS0045284 | AA | What is your other reason? | Text field, no char limit | N | Skip Logic | OPS Why Not Complete today | |||
| CAS0045248 | So far, how long have you worked on this online application? | Up to 15 minutes | Drop down select one | Y | Time Spent | ||||
| 16 minutes - 30 minutes | |||||||||
| 31 minutes - 1 hour | |||||||||
| More than 1 hour up to 2 hours | |||||||||
| More than 2 hours | |||||||||
| CAS0045286 | How did you find where to create an application for Retirement, Medicare or Disability? | Used the Online Services link on the Social Security homepage | Radio Button | Y | Skip Logic | Arrive at App | |||
| Followed a link from somewhere else on the Social Security website | |||||||||
| Used Social Security's online search feature | |||||||||
| Used a search engine (e.g., Google, Bing, etc.) | |||||||||
| Followed a link from medicare.gov | |||||||||
| Followed a link from another website (e.g., AARP, an attorney's website, etc.) | |||||||||
| I clicked around until I found it | |||||||||
| I had bookmarked the site | |||||||||
| Other, please specify | A | ||||||||
| CAS0045251 | A | Please describe how you arrived at this online claim application today. | Text field, no char limit | N | Skip Logic Group | OPS Arrive at app | |||
| CAS0045249 | How easy was it for you to find the Social Security online application? | Very easy | Skip Logic Group | Find App | |||||
| Somewhat easy | |||||||||
| Somewhat hard | A | ||||||||
| Very hard | A | ||||||||
| CAS0045250 | A | Please tell us why it was hard to locate the claim application. (Select all that apply.) | 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 | |||||||||
| It was not clear to me where the links would lead | |||||||||
| I had difficulty using a link 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 use the FAQ's, but couldn't find the online application link | |||||||||
| Other, please specify | AA | ||||||||
| CAS0045285 | AA | Please explain the reason why it was hard for you to find the online claim application. | N | N | Skip Logic | OPS Hard to Find | |||
| CAS0045252 | 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 (www.ssa.gov) | |||||||||
| A Social Security employee recommended that I apply online | |||||||||
| I can't get to my local Social Security Office | B | ||||||||
| 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 did not want to go to a local Social Security office | |||||||||
| I did not want to apply over the phone | |||||||||
| Other, please specify | A | ||||||||
| CAS0045287 | A | Please specify why you choose to apply online: | Text field, no char limit | N | Skip Logic Group | OPS Why Online | |||
| STE0123838 | B | What is the reason that you cannot get to your local office? | Text field, no char limit | N | Skip Logic Group | OPS Why Local Office | |||
| STE0123839 | 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 | |||||||||
| CAS0045289 | 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 | ||||||||
| CAS0045290 | A | Other marital status | Text field, <100 char | N | OPS Group | OPS Marital Status | |||
| CAS0045291 | Do you have any suggestions for improving Social Security's online application. | Text field, no char limit | N | OE_Improvement | |||||
Sheet 5: v3 CQs (EE) (11-20-17)
| Model Instance Name: | |||||||||
| SSA iClaim v3 | underlined & italicized: RE-ORDER | ||||||||
| MID: xZAAEQw81gIo1Vo4Noc1Rw4C | pink: ADDITION | ||||||||
| Date: | 7/15/2011 | blue + -->: REWORDING | |||||||
| violet (bold): SKIP-LOGIC | |||||||||
| SSA iClaim v3 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 | |
| BJL2231 | What type of benefits were you applying for? | Retirement | Radio button, one up vertical | Y | Type of Benefits | ||||
| Medicare only | |||||||||
| Disability | |||||||||
| Both Retirement and Disability | |||||||||
| Spouse's | |||||||||
| Other | |||||||||
| CAS0045242 | Are you applying online for yourself or are you helping someone else? | Myself | Radio button, one up vertical | Y | Applying for | ||||
| Helping a Spouse/Relative/Friend | |||||||||
| Professional Helping a Client | |||||||||
| Other | |||||||||
| CAS0045243 | How did you learn about applying for Retirement, Disability or Medicare online? (Select all that apply.) | Official Social Security website (www.ssa.gov) | check box one up vertical | Y | Skip Logic Group | Learn about App | |||
| Social Media (Blog, Facebook, Twitter, etc.) | |||||||||
| A general web search (e.g. Google, Bing, etc.) | |||||||||
| An online ad (Banner/Image) | |||||||||
| An online video | |||||||||
| Radio | |||||||||
| Television | |||||||||
| A newspaper or magazine article | |||||||||
| A newspaper or magazine ad | |||||||||
| An email from Social Security | |||||||||
| My Social Security statement | |||||||||
| A Social Security employee | A | ||||||||
| A relative or friend | |||||||||
| A community group or association | |||||||||
| A billboard or other printed ad | |||||||||
| Other, please specify | B | ||||||||
| CAS0045244 | A | How did you make contact with a Social Security employee? | Called the national 800 number | check box one up vertical | Y | Skip Logic | SSA Employee Contact | ||
| Called a local Social Security office | |||||||||
| Visited a local Social Security office | |||||||||
| At a Social Security sponsored event | |||||||||
| Other, please specify | AA | ||||||||
| CAS0045245 | AA | Please describe how you made contact with a Social Security employee. | Text box, no char limit | N | Skip Logic | OPS SSA Employee Contact | |||
| CAS0045246 | B | Please specify how you learned about this online application. | Text box, no char limit | N | Skip Logic | OPS Learn about App | |||
| CAS0045262 | Did you use any of the following to prepare to apply online? (Select all that apply.) | Reviewed my online Social Security Statement | A | check box one up vertical | Y | Skip Logic | Prepare for App | ||
| Reviewed the Social Security statement that was mailed to me | |||||||||
| I used the Retirement Estimator or other tools on the Social Security website | 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 | ||||||||
| CAS0045263 | A | How helpful did you find the online Social Security Statement? | Very helpful | Radio button, one up vertical | Y | Skip Logic | Rate Statement | ||
| Somewhat helpful | |||||||||
| Not at all helpful | |||||||||
| CAS0045264 | B | How helpful did you find the estimator tools on the website? | Very helpful | Radio button, one up vertical | Y | Skip Logic | Rate RE Tools | ||
| Somewhat helpful | |||||||||
| Not at all helpful | |||||||||
| CAS0045265 | C | How helpful did you find the instructional video? | Very helpful | Radio button, one up vertical | Y | Skip Logic | Rate Video | ||
| Somewhat helpful | |||||||||
| Not at all helpful | |||||||||
| CAS0045266 | D | How helpful did you find the other information on the Social Security website? | Very helpful | Radio button, one up vertical | Y | Skip Logic | Rate Other Info on Website | ||
| Somewhat helpful | |||||||||
| Not at all helpful | |||||||||
| CAS0045267 | 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 | |||
| CAS0045247 | Did you start a new online application today or did you return to a previously saved application? | Started a new application | Radio button, one up vertical | Y | Skip Logic | App Status | |||
| Returned to work on a saved application | R1 | ||||||||
| STE0123836 | 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 | ||||||||
| STE0123837 | 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 | |||||||||
| CAS0045282 | Did you complete and submit your online application today? | Yes | B | Radio button, one up vertical | Y | Skip Logic | Complete App | ||
| No, I plan to complete and submit it later | A | ||||||||
| No, I do not plan to complete and submit my online application | A | ||||||||
| B | During your visit today did you look for any additional information for any of the following? (Select all that apply.) | Medicare coverage | D | check box one up vertical | Y | Skip Logic | Other Benefit Info | ||
| Other health insurance coverage | D | ||||||||
| None of the above | Mutually exclusive | ||||||||
| D | Was the information clear? | Yes | Radio button, one up vertical | Y | Skip Logic | Benefit info clear | |||
| No | E | ||||||||
| Did not find needed information | |||||||||
| E | Please describe what was not clear. | Text box, no character limit | N | Skip Logic | How improve benefit info | ||||
| CAS0045283 | A | If you did not complete and submit your online 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 wanted to use the Retirement Estimator to reconsider my retirement options | |||||||||
| 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, e.g.,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 | |||||||||
| Other, please specify | AA | ||||||||
| CAS0045284 | AA | What is your other reason? | Text field, no char limit | N | Skip Logic | OPS Why Not Complete today | |||
| CAS0045248 | So far, how long have you worked on this online application? | Up to 15 minutes | Drop down select one | Y | Time Spent | ||||
| 16 minutes - 30 minutes | |||||||||
| 31 minutes - 1 hour | |||||||||
| More than 1 hour up to 2 hours | |||||||||
| More than 2 hours | |||||||||
| CAS0045286 | How did you find where to create an application for Retirement, Medicare or Disability? | Used the Online Services link on the Social Security homepage | Radio Button | Y | Skip Logic | Arrive at App | |||
| Followed a link from somewhere else on the Social Security website | |||||||||
| Used Social Security's online search feature | |||||||||
| Used a search engine (e.g., Google, Bing, etc.) | |||||||||
| Followed a link from medicare.gov | |||||||||
| Followed a link from another website (e.g., AARP, an attorney's website, etc.) | |||||||||
| I clicked around until I found it | |||||||||
| I had bookmarked the site | |||||||||
| Other, please specify | A | ||||||||
| CAS0045251 | A | Please describe how you arrived at this online claim application today. | Text field, no char limit | N | Skip Logic Group | OPS Arrive at app | |||
| CAS0045249 | How easy was it for you to find the Social Security online application? | Very easy | Skip Logic Group | Find App | |||||
| Somewhat easy | |||||||||
| Somewhat hard | A | ||||||||
| Very hard | A | ||||||||
| CAS0045250 | A | Please tell us why it was hard to locate the claim application. (Select all that apply.) | 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 | |||||||||
| It was not clear to me where the links would lead | |||||||||
| I had difficulty using a link 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 use the FAQ's, but couldn't find the online application link | |||||||||
| Other, please specify | AA | ||||||||
| CAS0045285 | AA | Please explain the reason why it was hard for you to find the online claim application. | N | N | Skip Logic | OPS Hard to Find | |||
| CAS0045252 | 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 (www.ssa.gov) | |||||||||
| A Social Security employee recommended that I apply online | |||||||||
| I can't get to my local Social Security Office | B | ||||||||
| 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 did not want to go to a local Social Security office | |||||||||
| I did not want to apply over the phone | |||||||||
| Other, please specify | A | ||||||||
| CAS0045287 | A | Please specify why you choose to apply online: | Text field, no char limit | N | Skip Logic Group | OPS Why Online | |||
| STE0123838 | B | What is the reason that you cannot get to your local office? | Text field, no char limit | N | Skip Logic Group | OPS Why Local Office | |||
| STE0123839 | 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 | |||||||||
| CAS0045289 | 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 | ||||||||
| CAS0045290 | A | Other marital status | Text field, <100 char | N | OPS Group | OPS Marital Status | |||
| CAS0045291 | Do you have any suggestions for improving Social Security's online application. | Text field, no char limit | N | OE_Improvement | |||||
Sheet 6: Current v3 CQs (SP)
| Model Instance Name: | |||||||||
| SSA iClaim v3 (Spanish) | underlined & italicized: RE-ORDER | ||||||||
| MID: | Q0ExM1xNQRl9JJUR0M0JlA4C | pink: ADDITION | |||||||
| Date: | 7/15/2011 | blue + -->: REWORDING | |||||||
| violet (bold): SKIP-LOGIC | |||||||||
| SSA iClaim v3 (Spanish) 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 | |
| BJL2231 | ¿Qué tipo de beneficios estaba solicitando? | Por jubilación | Dropdown (Select-one) | Y | Type of Benefits | ||||
| Solo Medicare | |||||||||
| Por incapacidad | |||||||||
| Tanto Jubilación y Discapacidad | |||||||||
| Coomo cónyuge | |||||||||
| Otro | |||||||||
| CAS0045242 | ¿Es esta solicitud en línea para sí mismo o estás ayudando a alguien más? | Yo mismo | Dropdown (Select-one) | Y | Applying for | ||||
| Cómo ayudar a un cónyuge / pariente / amigo | |||||||||
| Profesional Ayudar a un cliente | |||||||||
| Otro | |||||||||
| CAS0045243 | ¿Cómo se enteró de la existencia de esta aplicación para presentar solicitudes en línea? (Seleccione todas las opciones que correspondan.) | En el sitio web oficial del Seguro Social (www.ssa.gov) | check box one up vertical | Y | Skip Logic Group | Learn about App | |||
| Medios de Comunicación Social (Blog, Facebook, Twitter, etc) | |||||||||
| Una búsqueda web general (por ejemplo, Google, Bing, etc) | |||||||||
| Un anuncio en línea (Banner / Imagen) | |||||||||
| Un video en línea | |||||||||
| Por la radio | |||||||||
| Por la televisión | |||||||||
| Un periódico o la revista | |||||||||
| Un periódico o una revista de anuncios | |||||||||
| Un correo electrónico de la Seguridad Social | |||||||||
| Por mi estado de cuenta del Seguro Social | |||||||||
| A través de un empleado del Seguro Social | |||||||||
| A través de un familiar o un amigo | |||||||||
| En un grupo o asociación comunitaria | A | ||||||||
| Un anuncio impreso cartelera u otro | |||||||||
| Otro, especificar | B | ||||||||
| CAS0045244 | A | ¿Cómo se hace el contacto con un empleado del Seguro Social? | Llamado el número nacional 800 | check box one up vertical | Y | Skip Logic | SSA Emplyee Contact | ||
| Llamado a la oficina local del Seguro Social | |||||||||
| Visitado una oficina local del Seguro Social | |||||||||
| En un evento patrocinado por el Seguro Social | |||||||||
| Otro, especificar | AA | ||||||||
| CAS0045245 | AA | Por favor describa cómo se hizo contacto con un empleado del Seguro Social. | Text box, no char limit | N | Skip Logic | OPS SSA Employe Contact | |||
| CAS0045246 | B | Por favor, especifique cómo se enteró de esta aplicación en línea. | Text box, no char limit | N | Skip Logic | OPS Learn about App | |||
| CAS0045262 | ¿Ha usado alguna de las siguientes acciones para prepararse para aplicar en línea? (Seleccione todas las que apliquen.) | Comentado mi Declaración del Seguro Social en línea | A | check box one up vertical | Y | Skip Logic | Prepare for App | ||
| Revisé el estado de cuenta que me envió el Seguro Social | |||||||||
| He utilizado el Retirement Estimator u otras herramientas en el sitio web de la Seguridad Social | B | ||||||||
| Vi el video de instrucciones | C | ||||||||
| Usé otra información en la página web de la Seguridad Social para preparar | D | ||||||||
| Utilicé otro recurso que se preparen para aplicar en línea | E | ||||||||
| No hice uso de los recursos para prepararse para aplicar en línea | |||||||||
| CAS0045263 | A | ¿Qué tan útil ha encontrado el Declaración del Seguro Social en línea? | Muy útil | Drop down select one | Y | Skip Logic | Rate Statement | ||
| algo útil | |||||||||
| Para nada útil | |||||||||
| CAS0045264 | B | ¿Qué tan útil encontraste las herramientas estimador en el sitio web? | Muy útil | Drop down select one | Y | Skip Logic | Rate RE Tools | ||
| algo útil | |||||||||
| Para nada útil | |||||||||
| CAS0045265 | C | ¿Qué tan útil le parecen la video instructivo? | Muy útil | Drop down select one | Y | Skip Logic | Rate Video | ||
| algo útil | |||||||||
| Para nada útil | |||||||||
| CAS0045266 | D | ¿Qué tan útil le parecen la otra información en el sitio web de la Seguridad Social? | Muy útil | Drop down select one | Y | Skip Logic | Rate Other Info on Website | ||
| algo útil | |||||||||
| Para nada útil | |||||||||
| CAS0045267 | E | Por favor describa lo otro recurso (s) que utilizó para prepararse para aplicar en línea. | Text field, no char limit | N | Skip Logic | OPS Prepare for App | |||
| CAS0045247 | ¿Comenzó a preparar una solicitud en línea o regresó a una solicitud que había guardado anteriormente? | Comenzó una nueva aplicación | Drop down select one | Y | App Status | ||||
| Volvió a trabajar en una solicitud guardada | R1 | ||||||||
| STE0123836 | R1 | ¿Logró acceder a la solicitud que había guardado previamente usando su número de re-ingreso? | Sí, pude usar el número de re-ingreso que me facilitaron | Drop down select one | Y | Skip Logic | Acceso solicitud guardada | ||
| No, no pude usar el número de re-ingreso que me facilitaron | R2 | ||||||||
| No, no tenía mi número de re-ingreso | R2 | ||||||||
| STE0123837 | R2 | Si no pudo acceder a la solicitud guardada, ¿creó una nueva solicitud? | Sí | Drop down select one | Y | Skip Logic | Creó nueva solicitud | ||
| No | |||||||||
| CAS0045282 | ¿Completó y envío su solicitud en línea hoy? | Sí | Drop down select one | Y | Skip Logic | Complete App | |||
| No, planeo completarla y enviarla más tarde | A | ||||||||
| No, no planeo completar y enviar mi solicitud en línea | A | ||||||||
| CAS0045283 | A | Si no completó y envió su solicitud en línea hoy, díganos por qué. | Yo no tenía la información que necesitaba como nombres, direcciones o fechas | check box one up vertical | Y | Skip Logic | Not Complete App | ||
| No entendía el significado de las preguntas ni sabía cómo responder | |||||||||
| Que quería utilizar el estimador de jubilación reconsiderar mis opciones | |||||||||
| Que tenía que ver mi Declaración del Seguro Social y / o comprobar que mi registro de ganancias es el correcto | |||||||||
| Mi condición de discapacidad me impide trabajar con una computadora por largos periodos | |||||||||
| Yo tenía una cantidad limitada de demandas de tiempo / de la familia que me impedía trabajar en ella por mucho tiempo | |||||||||
| Tuve problemas técnicos: por ejemplo, un mensaje de error o un error que no pude solucionar | |||||||||
| Hay demasiadas preguntas | |||||||||
| Toma demasiado tiempo llenarla | |||||||||
| Es demasiado complicada para completarla sin ayuda | |||||||||
| Otro, especificar | AA | ||||||||
| CAS0045284 | AA | Text field, no char limit | N | Skip Logic | OPS Why Not Complete today | ||||
| CAS0045248 | Hasta el momento, ¿cuánto tiempo le ha tomado trabajar en esta solicitud? | Hasta 15 minutos | Drop down select one | Y | Time Spent | ||||
| 16 minutos - 30 minutos | |||||||||
| 31 minutos - 1 hora | |||||||||
| Más de 1 hora hasta 2 horas | |||||||||
| Más de 2 horas | |||||||||
| CAS0045286 | ¿Cómo encontró dónde crear una aplicación para solicitar beneficios por jubilación, Medicare o discapacidad? | Se utiliza el enlace de los servicios en línea en la página web de la Seguridad Social | Radio Button | Y | Skip Logic | Arrive at App | |||
| Seguido de un enlace de algún otro lugar en el sitio web de la Seguridad Social | |||||||||
| Usando el sistema de búsqueda en línea del Seguro Social | |||||||||
| Usando un motor de búsqueda (Google, Bing, etc.) | |||||||||
| Seguido de un enlace desde medicare.gov | |||||||||
| Siguiendo un enlace de otro sitio web (por ejemplo, AARP, el sitio web de un abogado...) | |||||||||
| Saltando de un enlace a otro hasta encontrarla | |||||||||
| Había marcado este sitio web anteriormente | |||||||||
| Otro, especificar | A | ||||||||
| CAS0045251 | A | Describa cómo encontró hoy esta aplicación para presentar solicitudes en línea | Text field, no char limit | N | Skip Logic | OPS Arrive at app | |||
| CAS0045249 | ¿Hasta qué punto le pareció fácil encontrar la aplicación para presentar solicitudes en línea del Seguro Social? | Muy fácil | Radio Button | Y | Skip Logic | Find App | |||
| algo fácil | |||||||||
| algo duro | A | ||||||||
| Muy difícil | A | ||||||||
| CAS0045250 | A | Indíquenos por qué le pareció difícil encontrar esta aplicación para presentar solicitudes. (Seleccione todas las opciones que correspondan.) | No se pudo encontrar por dónde empezar una nueva aplicación en línea | check box one up vertical | Y | Skip Logic | Why hard to find | ||
| El enlace para "Solicitar beneficios" no me pareció claro | |||||||||
| No tenía claro adónde ir para volver al formulario de solicitud que había guardado previamente | |||||||||
| No estaba claro para mí cuando los vínculos conducirían | |||||||||
| Tuve dificultades para usar un enlace en el sitio web del Seguro Social | |||||||||
| La información no parecía estar organizados de una manera lógica | |||||||||
| Usé la función de búsqueda, pero los resultados no parecen aplicarse. | |||||||||
| Intenté usar la sección de Preguntas frecuentes, pero no pude encontrar el enlace a la aplicación para presentar solicitudes en línea | |||||||||
| Otra opción (indique cuál) | AA | ||||||||
| CAS0045285 | AA | Explique por qué motivo le pareció difícil encontrar la aplicación para presentar solicitudes en línea. | Text field, no char limit | N | Skip Logic | OPS Hard to Find | |||
| CAS0045252 | ¿Por qué eligió para aplicar en línea? (Seleccione todas las que apliquen.) | Yo prefiero usar los servicios en línea tanto como sea posible | check box one up vertical | Y | Skip Logic | Why Online | |||
| Me enteré de la posibilidad de presentar solicitudes en línea mientras visitaba el sitio web del Seguro Social (www.ssa.gov) | |||||||||
| Un empleado del Seguro Social recomienda que aplico en línea | |||||||||
No puedo llegar a mi oficina local del Seguro Social |
B | ||||||||
| Un amigo o familiar recomendaron que aplico en línea | |||||||||
| Yo sabía que si tenía alguna pregunta o problema la aplicación en línea, todavía podía recibir ayuda de la Seguridad Social | |||||||||
| Yo no quería ir a una oficina local del Seguro Social | |||||||||
| Yo no quería que la solicitud por teléfono | |||||||||
| Otro, especificar | A | ||||||||
| CAS0045287 | A | Por favor, especifique qué decide aplicar en línea | Text field, no char limit | N | Skip Logic | OPS Why Online | |||
| STE0123838 | B | ¿Por qué motivo no puede ir a la oficina de su zona? | Text field, no char limit | N | Skip Logic | OE No ir a la oficina | |||
| STE0123839 | Cuando finalice su visita de hoy, ¿qué planea hacer a continuación? | Nada, ya envié mi solicitud | Radio button, one-up vertical | Y | Próximo paso S/N | ||||
| Volveré a comprobar el estado de mi solicitud | |||||||||
| Volveré para completar mi solicitud | |||||||||
| Navegaré por el sitio web de la SSA | |||||||||
| Llamaré al 1-800 del Seguro Social | |||||||||
| Visitaré la oficina del Seguro Social de mi zona | |||||||||
| En este momento, no sé lo que haré a continuación | |||||||||
| CAS0045289 | ¿Cuál es su estado civil actual? | Casado | Radio button, one-up vertical | N | OPS Group | Marital Status | |||
| En pareja/ Compañero | |||||||||
| Apartado | |||||||||
| Divorciado | |||||||||
| Viudo | |||||||||
| Nunca contraje matrimonio/ Soltero | |||||||||
| Prefiero no responder | |||||||||
| Otro, especificar | A | ||||||||
| CAS0045290 | A | Otro estado civil | Text field, <100 char | N | OPS Group | OPS Marital Status | |||
| CAS0045291 | ¿Tiene alguna sugerencia para mejorar la aplicación en línea de la Seguridad Social? | Text field, no char limit | N | OE_Improvement | |||||
Sheet 7: v3 CQs (EE) (7-1-16)
| Model Instance Name: | |||||||||
| SSA iClaim v3 | underlined & italicized: RE-ORDER | ||||||||
| MID: xZAAEQw81gIo1Vo4Noc1Rw4C | pink: ADDITION | ||||||||
| Date: | 7/15/2011 | blue + -->: REWORDING | |||||||
| violet (bold): SKIP-LOGIC | |||||||||
| SSA iClaim v3 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 | |
| BJL2231 | What type of benefits were you applying for? | Retirement | Dropdown (Select-one) | Y | Type of Benefits | ||||
| Medicare only | |||||||||
| Disability | |||||||||
| Both Retirement and Disability | |||||||||
| Spouse's | |||||||||
| Other | |||||||||
| CAS0045242 | Are you applying online for yourself or are you helping someone else? | Myself | Dropdown (Select-one) | Y | Applying for | ||||
| Helping a Spouse/Relative/Friend | |||||||||
| Professional Helping a Client | |||||||||
| Other | |||||||||
| How did you connect to SSA today? | Desktop | Radio button, one-up verticalb | Y | How Connected with SSA | |||||
| Laptop | |||||||||
| Smart Phone | |||||||||
| Tablet | |||||||||
| From where did you connect to SSA today? | At home | Radio button, one-up verticalb | Y | Skip Logic Group | From Where Connected with SSA | ||||
| In office / place of employment | |||||||||
| A friend or relative's place | |||||||||
| Public library | A | ||||||||
| Social Security Office | |||||||||
| Social Security Kiosk | B | ||||||||
| Other agency | |||||||||
| Other, please specify | C | ||||||||
| 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 | ||||||||
| AA | How did you link to the SSA website? | Text area, no char limit | N | Skip Logic Group | OE_How Linked to SSA (library) | ||||
| B | Please describe the location. | Text area, no char limit | N | Skip Logic Group | OE_Location of Kiosk | ||||
| 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 | ||||
| CAS0045243 | How did you learn about applying for Retirement, Disability or Medicare online? this online application? (Select all that apply.) | Official Social Security website (www.ssa.gov) | check box one up vertical | Y | Skip Logic Group | Learn about App | |||
| Social Media (Blog, Facebook, Twitter, etc.) | |||||||||
| A general web search (e.g. Google, Bing, etc.) | |||||||||
| An online ad (Banner/Image) | |||||||||
| An online video | |||||||||
| The radio Radio | |||||||||
| The televisionTelevision | |||||||||
| A newspaper or magazine article | |||||||||
| A newspaper or magazine ad | |||||||||
| An email from Social Security | |||||||||
| My Social Security statement | |||||||||
| A Social Security employee | A | ||||||||
| Friend, spouse, relative, neighbor or acquaintance A relative or friend | |||||||||
| A community group or association | |||||||||
| A billboard or other printed ad | |||||||||
| Other, please specify | B | ||||||||
| CAS0045244 | A | How did you make contact with a Social Security employee? | Called the national 800 number | check box one up vertical | Y | Skip Logic | SSA Employee Contact | ||
| Called a local Social Security office | |||||||||
| Visited a local Social Security office | |||||||||
| At a Social Security sponsored event | |||||||||
| Other, please specify | AA | ||||||||
| CAS0045245 | AA | Please describe how you made contact with a Social Security employee. | Text box, no char limit | N | Skip Logic | OPS SSA Employee Contact | |||
| CAS0045246 | B | Please specify how you learned about this online application. | Text box, no char limit | N | Skip Logic | OPS Learn about App | |||
| CAS0045262 | Did you use any of the following to prepare to apply online? (Select all that apply.) | Reviewed my online Social Security Statement | A | check box one up vertical | Y | Skip Logic | Prepare for App | ||
| Reviewed the Social Security statement that was mailed to me | |||||||||
| I used the Retirement Estimator or other tools on the Social Security website | 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 | ||||||||
| CAS0045263 | A | How helpful did you find the online Social Security Statement? | Very helpful | Drop down select one | Y | Skip Logic | Rate Statement | ||
| Somewhat helpful | |||||||||
| Not at all helpful | |||||||||
| CAS0045264 | B | How helpful did you find the estimator tools on the website? | Very helpful | Drop down select one | Y | Skip Logic | Rate RE Tools | ||
| Somewhat helpful | |||||||||
| Not at all helpful | |||||||||
| CAS0045265 | 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 | |||||||||
| CAS0045266 | 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 | |||||||||
| CAS0045267 | 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 | |||
| CAS0045247 | Did you start a new online application today or did you return to a previously saved application? | Started a new application | Drop down select one | Y | Skip Logic | App Status | |||
| Returned to work on a saved application | R1 | ||||||||
| 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 | Drop down select one | 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 | ||||||||
| R2 | If you were not able to access your saved application, did you create a new application? | Yes | Drop down select one | Y | Skip Logic | Create New App | |||
| No | |||||||||
| CAS0045282 | Did you complete and submit this your online application today? | Yes | Drop down select one | Y | Skip Logic | Complete App | |||
| No, I plan to complete and submit it later | A | ||||||||
| No, I do not plan to complete and submit the my online application | A | ||||||||
| CAS0045283 | A | If you did not complete and submit this your online 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 wanted to use the Retirement Estimator to reconsider my retirement options | |||||||||
| 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, e.g.,. 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 use complete without help | |||||||||
| Other, please specify | AA | ||||||||
| CAS0045284 | AA | Text field, no char limit | N | Skip Logic | OPS Why Not Complete today | ||||
| CAS0045248 | So far, how long have you worked on this online application? | Up to 15 minutes | Drop down select one | Y | Time Spent | ||||
| 16 minutes - 30 minutes | |||||||||
| 31 minutes - 1 hour | |||||||||
| More than 1 hour up to 2 hours | |||||||||
| More than 2 hours | |||||||||
| CAS0045286 | Used the Online Services link on the Social Security homepage | Radio Button | Y | Skip Logic | Arrive at App | ||||
| Followed a link from somewhere else on the Social Security website | |||||||||
| Followed a link from medicare.gov | |||||||||
| Followed a link from another website (e.g., AARP, an attorney's website, etc.) | |||||||||
| I clicked around until I found it | |||||||||
| Other, please specify | A | ||||||||
| CAS0045251 | A | Please describe how you arrived at this online claim application today | Text field, no char limit | N | Skip Logic Group | OPS Arrive at app | |||
| CAS0045249 | How easy was it for you to find this the Social Security online application? | Very easy | Skip Logic Group | Find App | |||||
| Somewhat easy | |||||||||
| Somewhat hard | A | ||||||||
| Very hard | A | ||||||||
| CAS0045250 | A | Please tell us why it was hard to find locate the online claim application. (Select all that apply.) | 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 | |||||||||
| It was not clear to me where the links would lead | |||||||||
| I had difficulty using a link 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 use the FAQ's, but couldn't find the online application link | |||||||||
| AA | |||||||||
| CAS0045285 | AA | Please explain the reason why it was hard for you to find the online claim application. | N | N | Skip Logic | OPS Hard to Find | |||
| CAS0045252 | 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 (www.ssa.gov) | |||||||||
| A Social Security employee recommended that I apply online | |||||||||
| I can't get to my local Social Security Office | B | ||||||||
| 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 did not want to go to a local Social Security office | |||||||||
| I did not want to apply over the phone | |||||||||
| Other, please specify | A | ||||||||
| CAS0045287 | A | Please specify why you choose to apply online: | Text field, no char limit | N | Skip Logic Group | OPS Why Online | |||
| B | What is the reason that you cannot get to your local office? | Text field, no char limit | N | Skip Logic Group | OPS Why Local Office | ||||
| 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 | |||||||||
| CAS0045289 | 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 | ||||||||
| CAS0045290 | A | Other marital status | Text field, <100 char | N | OPS Group | OPS Marital Status | |||
| CAS0045291 | Do you have any suggestions for improving Social Security's online application. | Text field, no char limit | N | OE_Improvement | |||||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |
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