30688 Q_SSAMain_Web_Browse_20180705_DOT

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Overview

Main v3 Model Qsts
Current CQs
CQs (7-5-18)
CQs (3-1-18)
CQs (9-7-17)
CQs (2-28-17)

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Sheet 1: Main v3 Model Qsts

Model Instance Name:
SSA Main Services Portal v3
MID:		V1wUw0sAYNUA1pUkAswd1g4C
Partitioned (Y/N)?
FPI Included(Y/N)?
NOTE: All non-partitioned surveys will NOT be imputed and the elements will be rotated as a default unless otherwise specified and approved by Research.
Date:		6/12/2013
SSA Main Services Portal v3
Model questions utilize the ACSI methodology to determine scores and impacts
		ELEMENTS (drivers of satisfaction)			CUSTOMER SATISFACTION			FUTURE BEHAVIORS
	MQ Label			MQ Label			MQ Label
		Look and Feel (1=Poor, 10=Excellent, Don't Know)			Satisfaction			Recommend (1=Very Unlikely, 10=Very Likely)
1	Look and Feel - Appeal	Please rate the visual appeal of this site.	16	Satisfaction - Overall	What is your overall satisfaction with this site? (1=Very Dissatisfied, 10=Very Satisfied)	19	Recommend	How likely are you to recommend this site to someone else?
2	Look and Feel - Balance	Please rate the balance of graphics and text on this site.	17	Satisfaction - Expectations	How well does this site meet your expectations? (1=Falls Short, 10=Exceeds)			Return (1=Very Unlikely, 10=Very Likely)
3	Look and Feel - Readability	Please rate the readability of the pages on this site.	18	Satisfaction - Ideal	How does this site compare to your idea of an ideal website? (1=Not Very Close, 10=Very Close)	20	Return	How likely are you to return to this site?
		Navigation (1=Poor, 10=Excellent, Don't Know)
4	Navigation - Organized	Please rate how well the site is organized.
5	Navigation - Options	Please rate the options available for navigating this site.
6	Navigation - Layout	Please rate how well the site layout helps you find what you are looking for.
		SSA Information(1=Poor, 10=Excellent, Don't Know)
7	SSA Information - Thoroughness	Please rate the thoroughness of information you viewed on this site today.
8	SSA Information - Quality	Please rate the quality of information you viewed today.
9	SSA Information - Provided Answers	Please rate how well the information viewed today provided answers to your questions.
		Site Performance (1=Poor, 10=Excellent, Don't Know)
10	Site Performance - Loading	Please rate how quickly pages load on this site.
11	Site Performance - Consistency	Please rate the consistency of speed from page to page on this site.
12	Site Performance - Errors	Please rate the ability to load pages without getting error messages on this site.
		Plain Language (1=Poor, 10=Excellent, Don't Know)
13	Plain Language - Clear	Please rate the clarity of the wording on this site.
14	Plain Language - Understandable	Please rate how well you understand the wording on this site.
15	Plain Language - Concise	Please rate this site on its use of short, clear sentences.

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Sheet 2: Current CQs

Model Instance Name:			red & strike-through: DELETE
SSA Main Services Portal v3			underlined & italicized: RE-ORDER
MID:	V1wUw0sAYNUA1pUkAswd1g4C		pink: ADDITION
Date:	11/24/2015		blue + -->: REWORDING
SSA Main Services Portal v3 CUSTOM QUESTION LIST
QID (Group ID)	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
LNH4733		Which of the following best describes you?	I am entitled to or receive Social Security benefits (i.e. retirement, survivor’s, disability, spouses, Medicare and/or Supplemental Security Income)		Radio Button One Up Vertical	Single	Y	OPS Group	Best Describes
			I am applying for Social Security, Supplemental Security Income (SSI) benefits or Medicare benefits.
			I am an employer looking for Social Security information and services
			I am a professional helping someone else with a Social Security matter
			Other (please specify)	A
LNH4734	A	Other Role			Text Field – limited to 100 characters		N	OPS Group	OE - Best Describes
RUS0242165		Did you attempt to log in to your mySSA account today?	Yes	A	Radio Button One Up Vertical		Y	Skip Logic	Log into mySSA
			No
			Don't know
RUS0242166	A	Was your log in successful?	Yes		Radio Button One Up Vertical		Y	Skip Logic	Successful Log in
			No
			Don't know
STE0074170		What is the reason(s) for your visit today? (Check all that apply)	To get general information about Social Security programs and benefits			Multi	Y	Skip Logic	Reason for Visit
			To review the Benefits Planners (i.e., Retirement Planner, Disability Planner and Survivors Planner)					Randomize
			To view my online Social Security Statement
			To use the Retirement Estimator
			To apply for Social Security Retirement or Disability benefits (including Spouses Benefits)
			To apply for Medicare benefits
			To apply for Extra Help with Medicare Prescription Drug Plans
			To apply for monthly Supplemental Security Income (SSI) payments
			To apply for Social Security Survivor benefits or Lump Sum Death Payment
			To check the status of my online application for benefits
			To manage the benefits I receive (Social Security, SSI or Medicare benefits)
			To appeal an unfavorable decision regarding my application for benefits
			To file W2/W3s
			To complete Representative Payee Accounting form
			To change information on my Social Security card
			To replace a lost or stolen Social Security card
			To obtain a form or publication
			To obtain contact information (e.g., locate a local SSA office, phone number, address, email, etc.)
			To change my address or information for my direct deposit
			To conduct research about Social Security history, policies, regulations, etc.
			Other (please specify)	AA				Anchor Answer Choice
STE0074172	AA	What is the reason you are visiting SSA today?			Text Area – no character limit	Open	N	Skip Logic	OPS_Reason for Visit
		Before visiting SSA.gov did you first try to accomplish your task in any of the following ways?	Calling Social Security's 1-800 number		Checkbox, one up vertical	Multi	Y		Try First
			Visiting my local Social Security office
			Calling my local Social Security office
			No, I visited SSA.gov first					Mutually Exclusive
			Not sure					Mutually Exclusive
TAR0214844		Did you accomplish your goal?	Yes		Radio Button One Up Vertical	Single	Y	Skip Logic	Accomplish
			No	C, BB
			Not yet, I am still looking	C, BB
TAR0214845	C	How can we help you accomplish your goal?			Text Area – no character limit	Open	Y	Skip Logic	OE_Help Accomplish
TAR0214846	BB	What do you plan to do next?	I will apply online for Social Security, SSI or Medicare benefits		Radio Button One Up Vertical	Open		Skip Logic	Do Next
			I will view or open an online my Social Security account				Y
			I will call Social Security’s 1-800 Number
			I will call my local Social Security office
			I will visit my local Social Security office
			I will send a letter to Social Security
			Other (please specify)	D
TAR0214847	D	What do you plan to do next?			Text Area – no character limit		N	Skip Logic	OPS_Other plan next
		Did you accomplish your goal?	Yes	A	Radio Button One Up Vertical	Single	Y	Skip Logic	Accomplish
			Partially	B
			No	B
	A	How many attempts did you need to accomplish your task?	1		Radio button, one up veritical		Y		Attempts
			2
			3
			4
			5 or more
	B	What do you plan to do next?	Try again to complete my task online		Radio button, one up veritical		Y		Do Next
			Call Social Secuirty's 1-800 number
			Visit my local Social Security office
			Call my local Social Security office
			Other (please specify)	BA
	BA	What do you plan to do next?			Text area, no char limit		N	Skip Logic	OE_Do Next
JIB0184627		What is your age?	Under 18		Radio Button One Up Vertical	Single	Y		Age
			18 - 29
			30 - 39
			40 - 49
			50 - 59
			60 - 69
			70 or older
			Prefer not to answer
LNH4751		If there was one thing you could change about the Social Security web site, please tell us what it would be.			Text Area – no character limit		N		Change One Thing

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Sheet 3: CQs (7-5-18)

Model Instance Name:			red & strike-through: DELETE
SSA Main Services Portal v3			underlined & italicized: RE-ORDER
MID:	V1wUw0sAYNUA1pUkAswd1g4C		pink: ADDITION
Date:	11/24/2015		blue + -->: REWORDING
SSA Main Services Portal v3 CUSTOM QUESTION LIST
QID (Group ID)	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
LNH4733		Which of the following best describes you?	I am entitled to or receive Social Security benefits (i.e. retirement, survivor’s, disability, spouses, Medicare and/or Supplemental Security Income)		Radio Button One Up Vertical	Single	Y	OPS Group	Best Describes
			I am applying for Social Security, Supplemental Security Income (SSI) benefits or Medicare benefits.
			I am an employer looking for Social Security information and services
			I am a professional helping someone else with a Social Security matter
			Other (please specify)	A
LNH4734	A	Other Role			Text Field – limited to 100 characters		N	OPS Group	OE - Best Describes
		Did you attempt to log in to your mySSA account today?	Yes	A	Radio Button One Up Vertical		Y	Skip Logic	Log into mySSA
			No
			Don't know
	A	Was your log in successful?	Yes		Radio Button One Up Vertical		Y	Skip Logic	Successful Log in
			No
			Don't know
STE0074170		What is the reason(s) for your visit today? (Check all that apply)	To get general information about Social Security programs and benefits			Multi	Y	Skip Logic	Reason for Visit
			To review the Benefits Planners (i.e., Retirement Planner, Disability Planner and Survivors Planner)					Randomize
			To view my online Social Security Statement
			To use the Retirement Estimator
			To apply for Social Security Retirement or Disability benefits (including Spouses Benefits)
			To apply for Medicare benefits
			To apply for Extra Help with Medicare Prescription Drug Plans
			To apply for monthly Supplemental Security Income (SSI) payments
			To apply for Social Security Survivor benefits or Lump Sum Death Payment
			To check the status of my online application for benefits
			To log in to or open my Social Security account
			To manage the benefits I receive (Social Security, SSI or Medicare benefits)
			To appeal an unfavorable decision regarding my application for benefits
			To file W2/W3s
			To complete Representative Payee Accounting form
			To change information on my Social Security card
			To replace a lost or stolen Social Security card
			To obtain a form or publication
			To obtain contact information (e.g., locate a local SSA office, phone number, address, email, etc.)
			To change my address or information for my direct deposit
			To conduct research about Social Security history, policies, regulations, etc.
			Other (please specify)	AA				Anchor Answer Choice
STE0074172	AA	What is the reason you are visiting SSA today?			Text Area – no character limit	Open	N	Skip Logic	OPS_Reason for Visit
TAR0214844		Did you accomplish your goal?	Yes		Radio Button One Up Vertical	Single	Y	Skip Logic	Accomplish
			No	C, BB
			Not yet, I am still looking	C, BB
TAR0214845	C	How can we help you accomplish your goal?			Text Area – no character limit	Open	Y	Skip Logic	OE_Help Accomplish
TAR0214846	BB	What do you plan to do next?	I will apply online for Social Security, SSI or Medicare benefits		Radio Button One Up Vertical	Open		Skip Logic	Do Next
			I will view or open an online my Social Security account				Y
			I will call Social Security’s 1-800 Number
			I will call my local Social Security office
			I will visit my local Social Security office
			I will send a letter to Social Security
			Other (please specify)	D
TAR0214847	D	What do you plan to do next?			Text Area – no character limit		N	Skip Logic	OPS_Other plan next
JIB0184627		What is your age?	Under 18		Radio Button One Up Vertical	Single	Y		Age
			18 - 29
			30 - 39
			40 - 49
			50 - 59
			60 - 69
			70 or older
			Prefer not to answer
LNH4751		If there was one thing you could change about the Social Security web site, please tell us what it would be.			Text Area – no character limit		N		Change One Thing

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Sheet 4: CQs (3-1-18)

Model Instance Name:			red & strike-through: DELETE
SSA Main Services Portal v3			underlined & italicized: RE-ORDER
MID:	V1wUw0sAYNUA1pUkAswd1g4C		pink: ADDITION
Date:	11/24/2015		blue + -->: REWORDING
SSA Main Services Portal v3 CUSTOM QUESTION LIST
QID (Group ID)	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
CAS0076473		Please tell us how and from where you connected with SSA during your visit today?	Desktop computer/laptop from my home		Radio button, one-up vertical	Single	Y	Skip Logic Group	How Connected with SSA
			Desktop computer/laptop from a friend or relative's home					Randomize
			Desktop computer/laptop from my place of employment
			Public computer workstation in a library	A
			Public computer workstation in some other agency/social organization (e.g., social services, Motor Vehicle Administration, housing agency, hospital, etc.)
			Public computer workstation made available at my local Social Security office
			SSA Express kiosk located in a public space or governmental office	B
			Other (please specify)	C				Anchor Answer Choice
CAS0076474	A	Did you connect through a unique Social Security icon featured on the computer's desktop?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group	Use SSA Icon
			No	AA
CAS0076475	AA	How did you link to the SSA website?			Text area, no char limit	Open	N	Skip Logic Group	OE_How Linked to SSA (library)
CAS0076494	B	Please describe the location.			Text area, no char limit	Open	N	Skip Logic Group	OE_Location of Kiosk
CAS0076495	C	Please tell us how and from where you connected with SSA during your visit today?			Text area, no char limit	Open	N	Skip Logic Group	OPS_How Connected with SSA
CAS0061122		How did you learn about the Social Security website? (Check all that apply.)	A general web search (e.g., Google, Bing, etc.)		check box, one up	Multi	Y	Skip Logic	Learn about
			The radio
			The television
			An email from Social Security
			A newspaper or magazine article
			A newspaper or magazine ad
			A billboard or other printed ad
			An online ad (e.g., banner, image, etc.)
			An online video
			Social media (e.g., Facebook, Twitter, blog, etc.)
			Friend, spouse, relative, neighbor, or acquaintance
			Mailed Social Security Statement
			Other direct mail (e.g., Post Card)
			Social Security employee
			Community group or association
			Government agency other than Social Security (e.g., State, Federal)
			Other, please explain	A
CAS0061123	A	How did you learn about the Social Security website?			Text Area – no character limit	Single	N	Skip Logic	OE_Learn About
LNH4733		Which of the following best describes you?	I am entitled to or receive Social Security benefits (i.e. retirement, survivor’s, disability, spouses, Medicare and/or Supplemental Security Income)		Radio Button One Up Vertical	Single	Y	OPS Group	Best Describes
			I do not receive Social Security, Medicare or Supplemental Security Income benefits
			I am applying for Social Security, Supplemental Security Income (SSI) benefits or Medicare benefits.
			I am an employer looking for Social Security information and services
			I am a professional helping someone else with a Social Security matter
			Other (please specify)	A
LNH4734	A	Other Role			Text Field – limited to 100 characters		N	OPS Group	OE - Best Describes
STE0074170		What is the reason(s) for your visit today? (Check all that apply)	To get general information about Social Security programs and benefits		check box, one up	Multi	Y	Skip Logic	Reason for Visit
			To review the Benefits Planners (i.e., Retirement Planner, Disability Planner and Survivors Planner)					Randomize
			To view my online Social Security Statement
			To use the Retirement Estimator
			To apply for Social Security Retirement or Disability benefits (including Spouses Benefits)
			To apply for Medicare benefits
			To apply for Extra Help with Medicare Prescription Drug Plans
			To apply for monthly Supplemental Security Income (SSI) payments
			To apply for Social Security Survivor benefits or Lump Sum Death Payment
			To check the status of my online application for benefits
			To log in to or open my Social Security account
			To manage the benefits I receive (Social Security, SSI or Medicare benefits)
			To appeal an unfavorable decision regarding my application for benefits
			To file W2/W3s
			To complete Representative Payee Accounting form
			To change information on my Social Security card
			To replace a lost or stolen Social Security card
			To obtain a form or publication	A
			To obtain contact information (e.g., locate a local SSA office, phone number, address, email, etc.)
			To change my address or information for my direct deposit
			To conduct research about Social Security history, policies, regulations, etc.
			Other (please specify)	AA				Anchor Answer Choice
STE0074172	AA	What is the reason you are visiting SSA today?			Text Area – no character limit	Open	N	Skip Logic	OPS_Reason for Visit
STE0074171	A	Please tell us which SSA form or publication you were seeking.			Text Area – no character limit		N	Skip Logic	OE_Type of Form/Publication
		Did you accomplish your goal?	Yes		Radio Button One Up Vertical	Single	Y	Skip Logic	Accomplish
			No	C, BB
			Not yet, I am still looking	C, BB
	C	How can we help you accomplish your goal?			Text Area – no character limit	Open	Y	Skip Logic	OE_Help Accomplish
	BB	What do you plan to do next?	I will apply online for Social Security, SSI or Medicare benefits		Radio Button One Up Vertical	Open		Skip Logic	Do Next
			I will view or open an online my Social Security account				Y
			I will call Social Security’s 1-800 Number
			I will call my local Social Security office
			I will visit my local Social Security office
			I will send a letter to Social Security
			Other (please specify)	D
	D	What do you plan to do next?			Text Area – no character limit		N	Skip Logic	OPS_Other plan next
LNH4737		Did the Social Security home page help you find what you were looking for?	Yes		Radio Button One Up Vertical	Single	Y	Skip Logic	Site Clarity
			No	A
LNH4738	A	Please tell us why the home page was not helpful.			Text Area – no character limit		N	Skip Logic	OE - Homepage
LNH4741		Did you find the information you were looking for or did you successfully complete your online transaction?	Yes		Dropdown (Select-one)	Single	Y	Skip Logic	Find Info
			No	A, B
			Not yet, I am still looking	A, B
			Not looking for anything specific
STE0074173	A	Please explain what prevented you from accomplishing your goal on the site.			Text Area – no character limit	Open	N	Skip Logic	Prevented from Accomplishing
STE0074174	B	Since you were unable to accomplish your goal on the site, what do you PREFER to do next?	I prefer calling the SSA 1-800 Number		Radio Button One Up Vertical	Single	Y	Skip Logic	Prefer to Do Next
			I prefer calling my local Social Security office					Randomize
			I prefer visiting my local Social Security office
			I prefer having an online solution (e.g., click-to-chat, "Before You Start" checklist, instructional video, email SSA feature, etc.)	C
			I prefer sending a letter to Social Security
			Other (please specify)	BB				Anchor Answer Choice
			Not sure					Anchor Answer Choice
STE0074175	BB	What do you plan to do next?			Text Area – no character limit	Open	N	Skip Logic	OPS_Prefer to Do Next
STE0074176	C	Which type of online solution would you prefer to use?	Click-to-chat		Radio Button One Up Vertical		Y	Skip Logic	Online Solution
			Email					Randomize
			"Before You Start" checklist
			Instructional video
			Other (please specify)	D				Anchor Answer Choice
STE0074177	D	What other type of online solution would you prefer to use?			Text Area – no character limit		N	Skip Logic	OPS_Online Solution
CAS0049645		Did you use the Frequently Asked Questions (“FAQs”) to find information?	Yes	A	Dropdown (Select-one)	Single	Yes	Skip Logic	Use FAQ
			No
			Not sure
CAS0049623	A	Did the Frequently Asked Questions give you the information you needed?	Yes		Dropdown (Select-one)	Single	Yes	Skip Logic	FAQ Answers
			No	AA
CAS0049624	AA	Please tell us about your concerns or problems when using the Frequently Asked Questions.			Text Area – no character limit		N	Skip Logic	OE_FAQ Concerns
CAS0078803		How often do you visit this site?	This is my first time		Radio Button One Up Vertical	Single	Y	Skip Logic	Visit Frequency - NEW
			Once in a while	A
			Frequently	A
JIB0151011	A	Did you notice any changes to ssa.gov during your visit today?	Yes	B	Radio Button One Up Vertical	Single	Y	Skip Logic	Notice changes
			No, I did not notice any changes
			Not sure
JIB0151012	B	How does the new ssa.gov compare to the previous one?	Better than the previous website	C	Radio Button One Up Vertical	Single	Y	Skip Logic	How compares
			Same as the previous website
			Worse than the previous website	D
JIB0151014	C	Please tell us why you feel the new ssa.gov is better than the previous one.			Text Area – no character limit		N	Skip Logic	OE_Why Better
JIB0151013	D	Please tell us why you feel the new ssa.gov is worse than the previous one.			Text Area – no character limit		N	Skip Logic	OE_Why Worse
JIB0184627		What is your age?	Under 18		Radio Button One Up Vertical	Single	Y		Age
			18 - 29
			30 - 39
			40 - 49
			50 - 59
			60 - 69
			70 or older
			Prefer not to answer
LNH4751		If there was one thing you could change about the Social Security web site, please tell us what it would be.			Text Area – no character limit		N		Change One Thing

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Sheet 5: CQs (9-7-17)

Model Instance Name:			red & strike-through: DELETE
SSA Main Services Portal v3			underlined & italicized: RE-ORDER
MID:	V1wUw0sAYNUA1pUkAswd1g4C		pink: ADDITION
Date:	11/24/2015		blue + -->: REWORDING
SSA Main Services Portal v3 CUSTOM QUESTION LIST
QID (Group ID)	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
CAS0076473		Please tell us how and from where you connected with SSA during your visit today?	Desktop computer/laptop from my home		Radio button, one-up vertical	Single	Y	Skip Logic Group	How Connected with SSA
			Desktop computer/laptop from a friend or relative's home					Randomize
			Desktop computer/laptop from my place of employment
			Public computer workstation in a library	A
			Public computer workstation in some other agency/social organization (e.g., social services, Motor Vehicle Administration, housing agency, hospital, etc.)
			Public computer workstation made available at my local Social Security office
			SSA Express kiosk located in a public space or governmental office	B
			Other (please specify)	C				Anchor Answer Choice
CAS0076474	A	Did you connect through a unique Social Security icon featured on the computer's desktop?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group	Use SSA Icon
			No	AA
CAS0076475	AA	How did you link to the SSA website?			Text area, no char limit	Open	N	Skip Logic Group	OE_How Linked to SSA (library)
CAS0076494	B	Please describe the location.			Text area, no char limit	Open	N	Skip Logic Group	OE_Location of Kiosk
CAS0076495	C	Please tell us how and from where you connected with SSA during your visit today?			Text area, no char limit	Open	N	Skip Logic Group	OPS_How Connected with SSA
CAS0061122		How did you learn about the Social Security website? (Check all that apply.)	A general web search (e.g., Google, Bing, etc.)		check box, one up	Multi	Y	Skip Logic	Learn about
			The radio
			The television
			An email from Social Security
			A newspaper or magazine article
			A newspaper or magazine ad
			A billboard or other printed ad
			An online ad (e.g., banner, image, etc.)
			An online video
			Social media (e.g., Facebook, Twitter, blog, etc.)
			Friend, spouse, relative, neighbor, or acquaintance
			Mailed Social Security Statement
			Other direct mail (e.g., Post Card)
			Social Security employee
			Community group or association
			Government agency other than Social Security (e.g., State, Federal)
			Other, please explain	A
CAS0061123	A	How did you learn about the Social Security website?			Text Area – no character limit	Single	N	Skip Logic	OE_Learn About
LNH4733		Which of the following best describes you?	I am entitled to or receive Social Security benefits (i.e. retirement, survivor’s, disability, spouses, Medicare and/or Supplemental Security Income)		Radio Button One Up Vertical	Single	Y	OPS Group	Best Describes
			I do not receive Social Security, Medicare or Supplemental Security Income benefits
			I am applying for Social Security, Supplemental Security Income (SSI) benefits or Medicare benefits.
			I am an employer looking for Social Security information and services
			I am a professional helping someone else with a Social Security matter
			Other (please specify)	A
LNH4734	A	Other Role			Text Field – limited to 100 characters		N	OPS Group	OE - Best Describes
STE0074170		What is the reason(s) for your visit today? (Check all that apply)	To obtain general information about Social Security programs and benefits		check box, one up	Multi	Y	Skip Logic	Reason for Visit
			To review SSA’s Benefits Planners (i.e., Retirement Planner, Disability Planner and Survivors Planner)					Randomize
			To view my online Social Security Statement
			To use the Retirement Estimator
			To apply for monthly Social Security Retirement and/or Disability benefits (including Spouses Benefits)
			To apply for Medicare Only benefits
			To apply for Extra Help with Medicare Prescription Drug Plans
			To apply for monthly Supplemental Security Income (SSI) payments
			To apply for Social Security Survivor benefits and/or Lump Sum Death Payment
			To check the status of my recently submitted online application for benefits
			To create (or access) a my Social Security account
			To manage the Social Security, SSI or Medicare benefits that I receive
			To appeal an unfavorable decision regarding my application for benefits
			To file W2/W3s
			To complete Representative Payee Accounting form
			To change information on my Social Security card
			To replace a lost/stolen Social Security card
			To obtain an SSA form or publication	A
			To obtain SSA contact information (e.g., locate a local SSA office, phone number, address, email, etc.)
			To change my address or change my/sign up for direct deposit
			To conduct research about Social Security history, policies, regulations, etc.
			Other (please specify)	AA				Anchor Answer Choice
STE0074172	AA	What is the reason you are visiting SSA today?			Text Area – no character limit	Open	N	Skip Logic	OPS_Reason for Visit
STE0074171	A	Please tell us which SSA form or publication you were seeking.			Text Area – no character limit		N	Skip Logic	OE_Type of Form/Publication
LNH4737		Did the Social Security home page help you find what you were looking for?	Yes		Radio Button One Up Vertical	Single	Y	Skip Logic	Site Clarity
			No	A
LNH4738	A	Please tell us why the home page was not helpful.			Text Area – no character limit		N	Skip Logic	OE - Homepage
LNH4741		Did you find the information you were looking for or did you successfully complete your online transaction?	Yes		Dropdown (Select-one)	Single	Y	Skip Logic	Find Info
			No	A, B
			Not yet, I am still looking	A, B
			Not looking for anything specific
STE0074173	A	Please explain what prevented you from accomplishing your goal on the site.			Text Area – no character limit	Open	N	Skip Logic	Prevented from Accomplishing
STE0074174	B	Since you were unable to accomplish your goal on the site, what do you PREFER to do next?	I prefer calling the SSA 1-800 Number		Radio Button One Up Vertical	Single	Y	Skip Logic	Prefer to Do Next
			I prefer calling my local Social Security office					Randomize
			I prefer visiting my local Social Security office
			I prefer having an online solution (e.g., click-to-chat, "Before You Start" checklist, instructional video, email SSA feature, etc.)	C
			I prefer sending a letter to Social Security
			Other (please specify)	BB				Anchor Answer Choice
			Not sure					Anchor Answer Choice
STE0074175	BB	What do you plan to do next?			Text Area – no character limit	Open	N	Skip Logic	OPS_Prefer to Do Next
STE0074176	C	Which type of online solution would you prefer to use?	Click-to-chat		Radio Button One Up Vertical		Y	Skip Logic	Online Solution
			Email					Randomize
			"Before You Start" checklist
			Instructional video
			Other (please specify)	D				Anchor Answer Choice
STE0074177	D	What other type of online solution would you prefer to use?			Text Area – no character limit		N	Skip Logic	OPS_Online Solution
CAS0049645		Did you use the Frequently Asked Questions (“FAQs”) to find information?	Yes	A	Dropdown (Select-one)	Single	Yes	Skip Logic	Use FAQ
			No
			Not sure
CAS0049623	A	Did the Frequently Asked Questions give you the information you needed?	Yes		Dropdown (Select-one)	Single	Yes	Skip Logic	FAQ Answers
			No	AA
CAS0049624	AA	Please tell us about your concerns or problems when using the Frequently Asked Questions.			Text Area – no character limit		N	Skip Logic	OE_FAQ Concerns
CAS0078803		How often do you visit this site?	This is my first time		Radio Button One Up Vertical	Single	Y	Skip Logic	Visit Frequency - NEW
			Once in a while	A
			Frequently	A
JIB0151011	A	Did you notice any changes to ssa.gov during your visit today?	Yes	B	Radio Button One Up Vertical	Single	Y	Skip Logic	Notice changes
			No, I did not notice any changes
			Not sure
JIB0151012	B	How does the new ssa.gov compare to the previous one?	Better than the previous website	C	Radio Button One Up Vertical	Single	Y	Skip Logic	How compares
			Same as the previous website
			Worse than the previous website	D
JIB0151014	C	Please tell us why you feel the new ssa.gov is better than the previous one.			Text Area – no character limit		N	Skip Logic	OE_Why Better
JIB0151013	D	Please tell us why you feel the new ssa.gov is worse than the previous one.			Text Area – no character limit		N	Skip Logic	OE_Why Worse
		What is your age?	Under 18		Radio Button One Up Vertical	Single	Y		Age
			18 - 29
			30 - 39
			40 - 49
			50 - 59
			60 - 69
			70 or older
			Prefer not to answer
LNH4751		If there was one thing you could change about the Social Security web site, please tell us what it would be.			Text Area – no character limit		N		Change One Thing

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Sheet 6: CQs (2-28-17)

Model Instance Name:			red & strike-through: DELETE
SSA Main Services Portal v3			underlined & italicized: RE-ORDER
MID:	V1wUw0sAYNUA1pUkAswd1g4C		pink: ADDITION
Date:	11/24/2015		blue + -->: REWORDING
SSA Main Services Portal v3 CUSTOM QUESTION LIST
QID (Group ID)	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
CAS0076473		Please tell us how and from where you connected with SSA during your visit today?	Desktop computer/laptop from my home		Radio button, one-up vertical	Single	Y	Skip Logic Group	How Connected with SSA
			Desktop computer/laptop from a friend or relative's home					Randomize
			Desktop computer/laptop from my place of employment
			Public computer workstation in a library	A
			Public computer workstation in some other agency/social organization (e.g., social services, Motor Vehicle Administration, housing agency, hospital, etc.)
			Public computer workstation made available at my local Social Security office
			SSA Express kiosk located in a public space or governmental office	B
			Other (please specify)	C				Anchor Answer Choice
CAS0076474	A	Did you connect through a unique Social Security icon featured on the computer's desktop?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group	Use SSA Icon
			No	AA
CAS0076475	AA	How did you link to the SSA website?			Text area, no char limit	Open	N	Skip Logic Group	OE_How Linked to SSA (library)
CAS0076494	B	Please describe the location.			Text area, no char limit	Open	N	Skip Logic Group	OE_Location of Kiosk
CAS0076495	C	Please tell us how and from where you connected with SSA during your visit today?			Text area, no char limit	Open	N	Skip Logic Group	OPS_How Connected with SSA
CAS0061122		How did you learn about the Social Security website? (Check all that apply.)	A general web search (e.g., Google, Bing, etc.)		check box, one up	Multi	Y	Skip Logic	Learn about
			The radio
			The television
			An email from Social Security
			A newspaper or magazine article
			A newspaper or magazine ad
			A billboard or other printed ad
			An online ad (e.g., banner, image, etc.)
			An online video
			Social media (e.g., Facebook, Twitter, blog, etc.)
			Friend, spouse, relative, neighbor, or acquaintance
			Mailed Social Security Statement
			Other direct mail (e.g., Post Card)
			Social Security employee
			Community group or association
			Government agency other than Social Security (e.g., State, Federal)
			Other, please explain	A
CAS0061123	A	How did you learn about the Social Security website?			Text Area – no character limit	Single	N	Skip Logic	OE_Learn About
LNH4733		Which of the following best describes you?	I am entitled to or receive Social Security benefits (i.e. retirement, survivor’s, disability, spouses, Medicare and/or Supplemental Security Income)		Radio Button One Up Vertical	Single	Y	OPS Group	Best Describes
			I do not receive Social Security, Medicare or Supplemental Security Income benefits
			I am applying for Social Security, Supplemental Security Income (SSI) benefits or Medicare benefits.
			I am an employer looking for Social Security information and services
			I am a professional helping someone else with a Social Security matter
			Other (please specify)	A
LNH4734	A	Other Role			Text Field – limited to 100 characters		N	OPS Group	OE - Best Describes
STE0074170		What is the reason(s) for your visit today? (Check all that apply)	To obtain general information about Social Security programs and benefits		check box, one up	Multi	Y	Skip Logic	Reason for Visit
			To review SSA’s Benefits Planners (i.e., Retirement Planner, Disability Planner and Survivors Planner)					Randomize
			To view my online Social Security Statement
			To use the Retirement Estimator
			To apply for monthly Social Security Retirement and/or Disability benefits (including Spouses Benefits)
			To apply for Medicare Only benefits
			To apply for Extra Help with Medicare Prescription Drug Plans
			To apply for monthly Supplemental Security Income (SSI) payments
			To apply for Social Security Survivor benefits and/or Lump Sum Death Payment
			To check the status of my recently submitted online application for benefits
			To create (or access) a my Social Security account
			To manage the Social Security, SSI or Medicare benefits that I receive
			To appeal an unfavorable decision regarding my application for benefits
			To file W2/W3s
			To complete Representative Payee Accounting form
			To change information on my Social Security card
			To replace a lost/stolen Social Security card
			To obtain an SSA form or publication	A
			To obtain SSA contact information (e.g., locate a local SSA office, phone number, address, email, etc.)
			To change my address or change my/sign up for direct deposit
			To conduct research about Social Security history, policies, regulations, etc.
			Other (please specify)	AA				Anchor Answer Choice
STE0074172	AA	What is the reason you are visiting SSA today?			Text Area – no character limit	Open	N	Skip Logic	OPS_Reason for Visit
STE0074171	A	Please tell us which SSA form or publication you were seeking.			Text Area – no character limit		N	Skip Logic	OE_Type of Form/Publication
LNH4737		Did the Social Security home page help you find what you were looking for?	Yes		Radio Button One Up Vertical	Single	Y	Skip Logic	Site Clarity
			No	A
LNH4738	A	Please tell us why the home page was not helpful.			Text Area – no character limit		N	Skip Logic	OE - Homepage
LNH4741		Did you find the information you were looking for or did you successfully complete your online transaction?	Yes		Dropdown (Select-one)	Single	Y	Skip Logic	Find Info
			No	A, B
			Not yet, I am still looking	A, B
			Not looking for anything specific
STE0074173	A	Please explain what prevented you from accomplishing your goal on the site.			Text Area – no character limit	Open	N	Skip Logic	Prevented from Accomplishing
STE0074174	B	Since you were unable to accomplish your goal on the site, what do you PREFER to do next?	I prefer calling the SSA 1-800 Number		Radio Button One Up Vertical	Single	Y	Skip Logic	Prefer to Do Next
			I prefer calling my local Social Security office					Randomize
			I prefer visiting my local Social Security office
			I prefer having an online solution (e.g., click-to-chat, "Before You Start" checklist, instructional video, email SSA feature, etc.)	C
			I prefer sending a letter to Social Security
			Other (please specify)	BB				Anchor Answer Choice
			Not sure					Anchor Answer Choice
STE0074175	BB	What do you plan to do next?			Text Area – no character limit	Open	N	Skip Logic	OPS_Prefer to Do Next
STE0074176	C	Which type of online solution would you prefer to use?	Click-to-chat		Radio Button One Up Vertical		Y	Skip Logic	Online Solution
			Email					Randomize
			"Before You Start" checklist
			Instructional video
			Other (please specify)	D				Anchor Answer Choice
STE0074177	D	What other type of online solution would you prefer to use?			Text Area – no character limit		N	Skip Logic	OPS_Online Solution
CAS0049645		Did you use the Frequently Asked Questions (“FAQs”) to find information?	Yes	A	Dropdown (Select-one)	Single	Yes	Skip Logic	Use FAQ
			No
			Not sure
CAS0049623	A	Did the Frequently Asked Questions give you the information you needed?	Yes		Dropdown (Select-one)	Single	Yes	Skip Logic	FAQ Answers
			No	AA
CAS0049624	AA	Please tell us about your concerns or problems when using the Frequently Asked Questions.			Text Area – no character limit		N	Skip Logic	OE_FAQ Concerns
CAS0078803		How often do you visit this site?	This is my first time		Radio Button One Up Vertical	Single	Y	Skip Logic	Visit Frequency - NEW
			Once in a while	A
			Frequently	A
	A	Did you notice any changes to ssa.gov during your visit today?	Yes	B	Radio Button One Up Vertical	Single	Y	Skip Logic	Notice changes
			No, I did not notice any changes
			Not sure
	B	How does the new ssa.gov compare to the previous one?	Better than the previous website	C	Radio Button One Up Vertical	Single	Y	Skip Logic	How compares
			Same as the previous website
			Worse than the previous website	D
	C	Please tell us why you feel the new ssa.gov is better than the previous one.			Text Area – no character limit		N	Skip Logic	OE_Why Better
	D	Please tell us why you feel the new ssa.gov is worse than the previous one.			Text Area – no character limit		N	Skip Logic	OE_Why Worse
LNH4751		If there was one thing you could change about the Social Security web site, please tell us what it would be.			Text Area – no character limit		N		Change One Thing