30688 Q_SSA-mySSA_Web_AccountManagement_11_20_18_DOT

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Overview

Guidelines
Welcome and Thank You Text
Current CQs
CQs (11-20-18)
CQs (7-30-18)
Current CQs (6-25-18)
v2 Model Qsts

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Sheet 1: Guidelines

SSA My Social Security v2

Partitioned Yes

Questionnaire Management Guidelines

Goals:

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One consolidated document to track all model and CQ changes throughout the life of the project

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Questionnaire always matches the live survey

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Easy and error-free way to submit CQ changes

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All changes tracked and reflected in one document (DOT will help)

Questionnaire Resources:

1

Questionnaire Design and Approval Process

2

Question Grouping Rules

3

OPS vs. Skip Logic Decision for "Other, Please Specify"

4

Model and Custom Question Checks_ SRA

5

Model and Custom Question Checks_ Team LeadManager

6

Model and Custom Question Checks_ DOT

7

Foreign Language Survey Instructions

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Sheet 2: Welcome and Thank You Text

Model Instance Name:

SSA My Social Security v2

MID:

Z5w0N58sJ5AkRkYUg4pVFg==

Partitioned Yes

2/8/2012

Welcome and Thank You Text

Directions:

This welcome text is shown at the top of the questionnaire window and the thank you text at the bottom. This is a good place to mention the site/company/agency name so the visitor knows whom they are taking the survey for. Feel free to modify the standard Welcome text shown in the box below.

Examples

Welcome Text Example

Welcome Text

Thank you for visiting our site. You've been randomly chosen to take part in a brief survey to let us know what we're doing well and where we can improve. Please take a few minutes to share your opinions, which are essential in helping us provide the best online experience possible.

Thank You Text Example

Thank You Text

Thank you for taking our survey and for helping us serve you better. Please note you will not receive a response from us based on your survey comments. If you would like us to contact you about your feedback, please visit the Contact Us section of our website.

us

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Sheet 3: Current CQs

Model Instance Name:				red & strike-through: DELETE
SSA My Social Security v2				underlined & italicized: RE-ORDER
MID:	R9JQtMNl09w1VJAZFxsVYQ4C			pink: ADDITION
Partitioned Yes	1/11/2018			blue + -->: REWORDING
SSA My Social Security v2 CUSTOM QUESTION LIST
QID	Skip Logic Label	Question Text	AnswerIDs (DOT)	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Required Y/N	Special Instructions	CQ Label
STE0123737		From where did you connect to SSA today?		At home		Radio button, one-up vertical	Y		From Where Connected with SSA
				In office / place of employment
				At a Friend or Relative's place
				Public Library
				Social Security Office
				Social Security Kiosk
				Other Agency
				Other
CAS0045388		How did you learn about my Social Security? (Check all that apply.)	CAS0045388A022	Official Social Security website (www.ssa.gov)		check box, one up	Y	Skip Logic Group	Learn about
			CAS0045388A023	Browsing SSA.gov's informational webpages				Randomize
				Social Security's Frequently Asked Questions (FAQs)
			CAS0045388A024	The "Manage Your Benefits with a my Social Security account" page
			CAS0045388A009	An email reminder from Social Security
			CAS0045388A017	Social Security Statement that I received in the mail
			CAS0045388A006	A general web search (e.g., Google, Bing, etc.)
			CAS0045388A015	Social media (e.g., Facebook, Twitter, blog, etc.)
			CAS0045388A016	Friend, spouse, relative, neighbor, or acquaintance
			CAS0045388A019	Social Security employee
			CAS0045388A020	Community group or association
			CAS0045388A021	Government agency other than Social Security (e.g., State, Federal)
			CAS0045388A004	Other, please explain	B			Anchor answer choice
CAS0045390	B	How did you learn about my Social Security?				Text area, no char limit	N	Skip Logic Group	OPS_Learn about
HAR0069569		How often do you access (or plan to access) your my Social Security account?		Once a year		Radio button, one up vertical	Y		Access Frequency - NEW
				Once every six months
				Once every three months
				Once a month
				More than once a month
				Not sure
BJL1506		Are you currently receiving cash benefits?	BJL1506A01	Yes, I recently applied	A	Radio button, one-up vertical	Y	Skip Logic Group	Cash Benefits
				No, I am taking Medicare Only
				No, I am not receiving cash benefits
			BJL1506A06	I don't know or prefer not to answer
RUS0166831	A	What type of benefits are you receiving? (Check all that apply)		Retirement		Check box, one up vertical	N	Skip Logic Group	Benefit Type
				Disability
				Spouses
				Survivors
				Supplemental Security Insurance (SSI)
CAS0045395		What is your reason for visiting my Social Security today? (Check all that apply)	CAS0045395A001	To get a Benefit Verification Letter	B	check box one up vertical	Yes	Skip Logic Group	Primary Reason
				To access my online notices (e.g., COLA)	C1, C2,C3,C4
				To view my Benefits and Payment Details
			CAS0045395A002	To enroll in or update my direct deposit
			CAS0045395A003	To change my address with SSA
				To print or view my online Social Security Statement	A
			CAS0045395A004	To make sure my earnings record is correct
			CAS0045395A005	To replace my Social Security Card or get a new card	X,M,N
				To check the Status of my recently filed application for benefits
			CAS0045395A006	To learn about the benefits to which I might be entitled
			CAS0045395A009	To apply only for Social Security or Medicare Only benefits
			CAS0045395A017	To report my wages	Q
				To request a replacement SSA-1099 (or SSA-10425) for tax purposes	K
				To add Extra Security to my online account
			CAS0045395A010	Just curious – wanted to see what information was contained in my Social Security account
			CAS0045395A011	Other Reason for visiting today	Z
RUS0280247	C1	How difficult or easy was it to access your Cost of Living Adjustment (COLA) notice online?	RUS0280247A001	Very difficult		Radio button, one-up vertical	Y	Skip Logic Group	Ease of access COLA
			RUS0280247A002	Somewhat difficult
			RUS0280247A003	Neither difficult or easy
			RUS0280247A004	Somewhat easy
			RUS0280247A005	Very easy
RUS0280248	C2	How much do you agree or disagree with the following statement? I am comfortable receiving notices only online.	RUS0280248A001	Strongly disagree		Radio button, one-up vertical	Y	Skip Logic Group	Comfortable COLA online
			RUS0280248A002	Somewhat disagree
			RUS0280248A003	Neither agree or disagree
			RUS0280248A004	Somewhat agree
			RUS0280248A005	Strongly agree
RUS0280249	C3	Would you recommend accessing the COLA notice online to your family and friends?	RUS0280249A001	Yes		Radio button, one-up vertical	Y	Skip Logic Group	Recommend COLA online
			RUS0280249A002	No
			RUS0280249A003	Don't know
RUS0280250	C4	Do you have any suggestions for improving our online notices?				text, no char limit	N	Skip Logic Group	Improve Online notices
CAS0045407	A	How often do you review your online Social Security Statement?	CAS0045407A001	This is my first time	AA	check box one up vertical	Y	Skip Logic Group	Freq View Statement
			CAS0045407A003	At least once a year
			CAS0045407A004	Every 6 months
			CAS0045407A005	Every 3 months or more frequently
CAS0045409	B	For which Agency or program do you need a Benefit Verification Letter? (Check all that apply)	CAS0045409A001	Medicare		check box vertical one up	Y	skip logic group	Agency Need
			CAS0045409A002	Medicaid
				State or Local Department of Social Services
			CAS0045409A003	HUD - Federal Housing Admin. (FHA) and/or Section 8 Housing
			CAS0045409A004	USDA - SNAP (Food Stamps)
			CAS0045409A005	Department of Veterans Affairs
			CAS0045409A006	IRS
			CAS0045409A007	Court
			CAS0045409A008	Want a copy for personal use
				Bank or financial institution
				Education-related
				Medical-related
				Healthcare signup and/or verification
				Requesting a Retirement Visa from another country
			CAS0045409A009	Other agency or program	BB
CAS0045396	BB	Which "other" agency or program requested your Benefit Verification information?				Text area, no Char limit	N	Skip Logic Group	OPS_Other Agency
CAS0045397	Z	Please tell us what your primary reason was for visiting today:				Text area, no Char limit	N	Skip Logic Group	OPS_Primary Reason
CAS0076487	K	Please select the response that best reflects the action you took:		Viewed my SSA 1099 (or 1042S)		Radio button, one-up vertical	Y	Skip Logic Group	SSA 1099 Action
				Viewed and printed my SSA 1099 (or SSA 1042S)
				Viewed my SSA 1099 (or SSA 1042s) and requested a replacement to be mailed	L
				Other	KK
CAS0076488	L	Please explain why you requested a copy to be mailed since it was available for viewing and printing online.				Text area, no Char limit	N	Skip Logic Group	Why Request 1099
CAS0076467	KK	What action did you take?				Text area, no Char limit	N	Skip Logic Group	OPS_SSA 1099 Action
RUS0172646	X	Do you plan to replace your SSN card online through iSSNRC (Internet Social Security Number Replacement Card)?		Yes		Radio button, one up vertical	Y	Skip Logic Group	Plan to Replace
				No, this service is not yet available in my state
				No, I prefer to go to a field office
				I am not aware of this service
				Don't know
RUS0172647	M	For which purpose or program do you need a replacement SSN Card? (Check all that apply)		Proof of identity		checkbox vertical, one up	Y	Skip Logic Group	Purpose for SSN Card
				Tax purposes
				Education-related
				Required for my job
				Passport
				Bank or financial institution
				Income assistance
				Other (Please specify)	MM
RUS0172648	MM	Please explain for which purpose or program you need a replacement SSN card.				Text area, no Char limit	N	Skip Logic Group	OPS_Purpose Other
RUS0172649	N	Which best describes why you are applying for a replacement SSN card?		My original card was lost or stolen		Radio button, one up vertical	Y	Skip Logic Group	Why Applying for SSN Card
				My original card was not lost or stolen but someone else (e.g., family member) is holding it
				Never had an SSN card
				Other (Please specify)	NN
RUS0172650	NN	Please explain why you are applying for a replacement SSN card.				Text area, no Char limit	N	Skip Logic Group	OPS_Why Applying
TAR0201664	Q	Who are you reporting wages for?		Myself only			Y	Skip Logic Group	Reporting For
				My spouse only	Q2, R	Radio button, one-up vertical
				Myself and my spouse	Q2, R
				Myself and another individual (not spouse)	Q1,Q2, R
				Other relative only	Q2, R
				Other	Q1,Q2, R
TAR0201665	Q1	What is your relationship to the individual you are reporting wages for?				Text area, no Char limit	N	Skip Logic Group	OE_Report For
BUC0233611	R	What type of benefits does the person you are reporting for receive?		Disability		Radio button, one-up vertical	Y	skip logic group	Benefit Type Reporting
				Supplemental Security Income (SSI)
				Both Disability and SSI
				Don't know
TAR0201666	Q2	Was the person you wanted to report wages for listed?		Yes		Radio button, one-up vertical	Y	skip logic group	OE_Relationship
				No
TAR0201667	Q	Was the employer listed?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Employer listed
				No
TAR0201668	Q	Are you reporting for more than one employer for the same person?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Reporting multiple employers
				No
TAR0202213	Q	Are you currently working?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Currently working
				No
TAR0201669	Q	How long did it take you to submit your wages?		5 minutes or less		Radio button, one-up vertical	Y	Skip Logic Group	Time Submit Wage
				6-10 minutes
				11-15 minutes
				More than 15 minutes
				Unsure
				Did not submit wages
BUC0233612	Q	Before today's visit, what other methods have you used to report wages?		Field Office		Checkbox, one-up vertical	Y	Skip logic group	Other reporting methods
				Mail
				Fax
				Phone
				Other
BUC0233613	Q	Do you plan to electronically report additional wages in the future?		Yes	Q3	Radio button, one-up vertical	Y	Skip logic group	Plan report electronically
				No	Q5
				Don't know
TAR0201672	Q3	How do you plan to report future wages?		Desktop/Laptop		Radio button, one-up vertical	Y	Skip Logic Group	How Report Again
				Tablet
				Mobile Device
				Don't know
BUC0233614	Q5	What method do you prefer to use to report your wages?		Field Office		Radio button, one-up vertical	Y	Skip Logic Group	Preferred method reporting
				Mail
				Fax
				Phone
				Other
TAR0201673	Q	Were the instructions you received helpful?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Instructions Helpful
				No	Q4
TAR0201674	Q4	How can we improve the wage reporting application?				Text area, no Char limit	N	Skip Logic Group	OE_Improve Instructions
CAS0045398		Did you register for your my Social Security online or in person?	CAS0045398A001	Registered online on my first attempt	A	Radio button, one-up vertical	Y	Skip Logic Group	How Registered
			CAS0045398A002	Registered online after prior unsuccessful attempts	A,B
			CAS0045398A003	Registered with in-person assistance from my local SSA office	A,C
				Registered using the SSA Express
			CAS0045398A004	Not sure or don't remember
CAS0045399	A	Please select the approximate length of time it took for you complete your registration	CAS0045399A001	Less than 15 minutes		Radio button, one-up vertical	Y	Skip Logic Group	Reg Time
			CAS0045399A002	More than 15 but less than 30 minutes
			CAS0045399A003	30 minutes or more
CAS0045400	B	How many prior unsuccessful online registration attempts did you make?	CAS0045400A001	One		Radio button, one-up vertical	Y	Skip Logic Group	Reg Attempts
			CAS0045400A002	Two
			CAS0045400A003	Three or more
CAS0045410	C	Why did you decide to register in-person?		I was unsuccessful registering online and was required to do so in-person	CC	Radio button, one-up vertical	Y	Skip Logic Group	Reg In person
				I preferred registering for a my Social Security account in-person at my SSA office	CC
				Employee offered the option for me to register for a my Social Security account	CC
CAS0045401	CC	Please describe your in-person registration experience.				Text area, no char limit	N	Skip Logic Group	OE_In-person Experience
CAS0045411		Did you request to add Extra Security to your account?	CAS0045411A001	Yes		Radio button, one-up vertical	Y		Xtra Security Reg
			CAS0045411A002	No
			CAS0045411A003	I tried but was unsuccessful
			CAS0045411A004	I don't know
KAU0126773		Was it easy to create a my Social Security account?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Easy Create Account
				No	A
KAU0126790	A	Please tell us why it was not easy to create a my Social Security account.				Text area, no char limit	N	Skip Logic Group	OE_Easy Create Account
CAS0045413		Did you find the instructions for creating a username, password and registering a second factor to be clear?	CAS0045413A001	Yes		Radio button, one-up vertical	Y	Skip Logic Group	Instructions Understand
			CAS0045413A002	Partially	A
			CAS0045413A003	No	A
CAS0045414	A	Please explain what was not clear about any of the instructions.				Text area, no char limit	N	Skip Logic Group	OE_Instructions
CAS0045415		Did you see any information describing my Social Security's security policies or features?	CAS0045415A001	Yes		Radio button, one-up vertical	Y		Security Policies
			CAS0045415A002	No
CAS0045424		Do you have any concerns about the security of the personal information contained in your my Social Security account?	CAS0045424A001	No		Radio Button, One-up	Y	Skip Logic Group	Security Concerns
			CAS0045424A002	Yes	A
CAS0045425	A	Please describe your security concerns.				Text area, no char limit	N	Skip Logic Group	OE_Security Concern
KAU0126791		Was it easy to sign in to your my Social Security account?		Yes		Radio button, one up	Y	Skip Logic Group	Easy Sign In
				No	A
KAU0126792	A	What did you find difficult about signing in to your my Social Security account?				Text area, no char limit	N	Skip Logic Group	OE_Easy Sign In
CAS0045422		Did the information obtained during your my Social Security account visit enable you to accomplish what you wanted to do?	CAS0045422A001	Yes		Radio button, one up	Yes	Skip Logic Group	Ability to Accomplish
			CAS0045422A002	No	A,B
CAS0045426	A	What specifically were you trying to accomplish?				Text area, no char limit	N	Skip Logic	OE_Trying to accomplish
CAS0045427	B	Since you were not able to accomplish what you wanted to do, what do you plan to do next? (Please select all that apply)	CAS0045427A001	Return online and try again		Check box vertical	Y	Skip Logic	Do Next
			CAS0045427A002	Send an e-mail to Social Security
			CAS0045427A003	Call Social Security's 800 number
			CAS0045427A004	Call a local Social Security office
			CAS0045427A005	Visit a local Social Security office
			CAS0045427A006	Take no action
			CAS0045427A008	Other, please specify	BB
CAS0045428	BB	Please tell us what "other" action you plan to take next.				Text area, no char limit	N		OPS_Do Next
TAR0239304		Did you contact Social Security during your online visit?		Yes	A	Radio button, one-up vertical	Y	Skip Logic Group	Contacted SSA
				No
TAR0239305	A	How did you contact Social Security?		Requested a Call Back		Radio button, one-up vertical	Y	Skip Logic Group	How contacted SSA
				Email
				Chat with an Online representative	B,C,D,E
TAR0239306	B	How long was your wait to Chat with a representative online?		About what I expected		Radio button, one-up vertical	Y	Skip Logic Group	Click to chat wait
				Longer than I expected
TAR0239307	C	Did the Chat representative answer your question?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Click to chat answer
				Partially
				No
TAR0239324	D	Do you still have to call the 1-800 number or go into a field office?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Click to chat Call
				No
TAR0248887	D	How satisfied were you with the Chat Service you received today?		Very Satisfied		Radio button, one-up vertical	Y	Skip Logic Group	Click to chat service
				Satisfied
				Not Satisfied
				Very Dissatisfied
	D	How satisfied were you with the Chat Representative who assisted you today?		Very Satisfied		Radio button, one-up vertical	Y	Skip Logic Group	Click to chat representative
TAR0248888				Satisfied
				Not Satisfied
				Very Dissatisfied
TAR0239325	E	Please share any other feedback with us regarding your Chat experience today.				Text area, no Char limit	N	Skip Logic Group	Chat Feedback
CAS0045373		Was the information in your my Social Security account clear to you?	CAS0045373A001	Yes		radial button, one up vertical	Y	skip logic	AccountClarity
			CAS0045373A002	No	A
CAS0045374	A	Please tell us what information or instructions were not clear				Text area, no Char limit	N	Skip Logic Group	OE_Account Clarity
STE0093222		Did you use the “Get Help” button or "Call Back" button during your visit today?		Yes, I used the "Get Help" button only		Radio button, one up vertical	Y		Get Help Button or Call Back
				Yes, I used the "Call Back" button only
				Yes, I used both the "Get Help" button and "Call Back" button
				No, I used neither
STE0125910		Did you view the "Message Center" section during your visit today?		Yes	A	Radio button, one up	Y	Skip Logic Group	Message Center
				No	B
STE0125911	A	Did you select to receive courtesy notifications from the "Message Center?"		Yes		Radio button, one up	Y	Skip Logic Group	Courtesy Notifications
				No
STE0125912	B	Do you plan to view the "Message Center" in the future?		Yes		Radio button, one up	Y	Skip Logic Group	Use Message Center Future
				No
STE0123762		Please select the category that includes your age:		35 and under		Radio button, one up	N		Age
				36 to 50
				51 to 61
				62
				63
				64
				65
				66
				67
				68 to 70
				71 or older
				Prefer not to answer
JIB0147139		Please enter your 5 digit ZIP Code:				Text area, 100 char limit	N		OE_ZIP
CAS0045416		Do you have any suggestions for improving the my Social Security registration process?				Text area, no char limit	N		OE_Improve Reg
CAS0045417		Do you have any suggestions for improving my Social Security's content and features?				Text area, no char limit	N		OE_Improve Contents

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Sheet 4: CQs (11-20-18)

Model Instance Name:				red & strike-through: DELETE
SSA My Social Security v2				underlined & italicized: RE-ORDER
MID:	R9JQtMNl09w1VJAZFxsVYQ4C			pink: ADDITION
Partitioned Yes	1/11/2018			blue + -->: REWORDING
SSA My Social Security v2 CUSTOM QUESTION LIST
QID	Skip Logic Label	Question Text	AnswerIDs (DOT)	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Required Y/N	Special Instructions	CQ Label
STE0123737		From where did you connect to SSA today?		At home		Radio button, one-up vertical	Y		From Where Connected with SSA
				In office / place of employment
				At a Friend or Relative's place
				Public Library
				Social Security Office
				Social Security Kiosk
				Other Agency
				Other
CAS0045388		How did you learn about my Social Security? (Check all that apply.)	CAS0045388A022	Official Social Security website (www.ssa.gov)		check box, one up	Y	Skip Logic Group	Learn about
			CAS0045388A023	Browsing SSA.gov's informational webpages				Randomize
				Social Security's Frequently Asked Questions (FAQs)
			CAS0045388A024	The "Manage Your Benefits with a my Social Security account" page
			CAS0045388A009	An email reminder from Social Security
			CAS0045388A017	Social Security Statement that I received in the mail
			CAS0045388A006	A general web search (e.g., Google, Bing, etc.)
			CAS0045388A015	Social media (e.g., Facebook, Twitter, blog, etc.)
			CAS0045388A016	Friend, spouse, relative, neighbor, or acquaintance
			CAS0045388A019	Social Security employee
			CAS0045388A020	Community group or association
			CAS0045388A021	Government agency other than Social Security (e.g., State, Federal)
			CAS0045388A004	Other, please explain	B			Anchor answer choice
CAS0045390	B	How did you learn about my Social Security?				Text area, no char limit	N	Skip Logic Group	OPS_Learn about
HAR0069569		How often do you access (or plan to access) your my Social Security account?		Once a year		Radio button, one up vertical	Y		Access Frequency - NEW
				Once every six months
				Once every three months
				Once a month
				More than once a month
				Not sure
BJL1506		Are you currently receiving cash benefits?	BJL1506A01	Yes, I recently applied	A	Radio button, one-up vertical	Y	Skip Logic Group	Cash Benefits
				No, I am taking Medicare Only
				No, I am not receiving cash benefits
			BJL1506A06	I don't know or prefer not to answer
RUS0166831	A	What type of benefits are you receiving? (Check all that apply)		Retirement		Check box, one up vertical	N	Skip Logic Group	Benefit Type
				Disability
				Spouses
				Survivors
				Supplemental Security Insurance (SSI)
CAS0045395		What is your reason for visiting my Social Security today? (Check all that apply)	CAS0045395A001	To get a Benefit Verification Letter	B	check box one up vertical	Yes	Skip Logic Group	Primary Reason
				To access my online notices (e.g., COLA)	C1, C2,C3,C4
				To view my Benefits and Payment Details
			CAS0045395A002	To enroll in or update my direct deposit
			CAS0045395A003	To change my address with SSA
				To print or view my online Social Security Statement	A
			CAS0045395A004	To make sure my earnings record is correct
			CAS0045395A005	To replace my Social Security Card or get a new card	X,M,N
				To check the Status of my recently filed application for benefits
			CAS0045395A006	To learn about the benefits to which I might be entitled
			CAS0045395A009	To apply only for Social Security or Medicare Only benefits
			CAS0045395A017	To report my wages	Q
				To request a replacement SSA-1099 (or SSA-10425) for tax purposes	K
				To add Extra Security to my online account
			CAS0045395A010	Just curious – wanted to see what information was contained in my Social Security account
			CAS0045395A011	Other Reason for visiting today	Z
	C1	How difficult or easy was it to access your Cost of Living Adjustment (COLA) notice online?		Very difficult		Radio button, one-up vertical	Y	Skip Logic Group	Ease of access COLA
				Somewhat difficult
				Neither difficult or easy
				Somewhat easy
				Very easy
	C2	How much do you agree or disagree with the following statement? I am comfortable receiving notices only online.		Strongly disagree		Radio button, one-up vertical	Y	Skip Logic Group	Comfortable COLA online
				Somewhat disagree
				Neither agree or disagree
				Somewhat agree
				Strongly agree
	C3	Would you recommend accessing the COLA notice online to your family and friends?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Recommend COLA online
				No
				Don't know
	C4	Do you have any suggestions for improving our online notices?				text, no char limit	N	Skip Logic Group	Improve Online notices
CAS0045407	A	How often do you review your online Social Security Statement?	CAS0045407A001	This is my first time	AA	check box one up vertical	Y	Skip Logic Group	Freq View Statement
			CAS0045407A003	At least once a year
			CAS0045407A004	Every 6 months
			CAS0045407A005	Every 3 months or more frequently
CAS0045409	B	For which Agency or program do you need a Benefit Verification Letter? (Check all that apply)	CAS0045409A001	Medicare		check box vertical one up	Y	skip logic group	Agency Need
			CAS0045409A002	Medicaid
				State or Local Department of Social Services
			CAS0045409A003	HUD - Federal Housing Admin. (FHA) and/or Section 8 Housing
			CAS0045409A004	USDA - SNAP (Food Stamps)
			CAS0045409A005	Department of Veterans Affairs
			CAS0045409A006	IRS
			CAS0045409A007	Court
			CAS0045409A008	Want a copy for personal use
				Bank or financial institution
				Education-related
				Medical-related
				Healthcare signup and/or verification
				Requesting a Retirement Visa from another country
			CAS0045409A009	Other agency or program	BB
CAS0045396	BB	Which "other" agency or program requested your Benefit Verification information?				Text area, no Char limit	N	Skip Logic Group	OPS_Other Agency
CAS0045397	Z	Please tell us what your primary reason was for visiting today:				Text area, no Char limit	N	Skip Logic Group	OPS_Primary Reason
CAS0076487	K	Please select the response that best reflects the action you took:		Viewed my SSA 1099 (or 1042S)		Radio button, one-up vertical	Y	Skip Logic Group	SSA 1099 Action
				Viewed and printed my SSA 1099 (or SSA 1042S)
				Viewed my SSA 1099 (or SSA 1042s) and requested a replacement to be mailed	L
				Other	KK
CAS0076488	L	Please explain why you requested a copy to be mailed since it was available for viewing and printing online.				Text area, no Char limit	N	Skip Logic Group	Why Request 1099
CAS0076467	KK	What action did you take?				Text area, no Char limit	N	Skip Logic Group	OPS_SSA 1099 Action
RUS0172646	X	Do you plan to replace your SSN card online through iSSNRC (Internet Social Security Number Replacement Card)?		Yes		Radio button, one up vertical	Y	Skip Logic Group	Plan to Replace
				No, this service is not yet available in my state
				No, I prefer to go to a field office
				I am not aware of this service
				Don't know
RUS0172647	M	For which purpose or program do you need a replacement SSN Card? (Check all that apply)		Proof of identity		checkbox vertical, one up	Y	Skip Logic Group	Purpose for SSN Card
				Tax purposes
				Education-related
				Required for my job
				Passport
				Bank or financial institution
				Income assistance
				Other (Please specify)	MM
RUS0172648	MM	Please explain for which purpose or program you need a replacement SSN card.				Text area, no Char limit	N	Skip Logic Group	OPS_Purpose Other
RUS0172649	N	Which best describes why you are applying for a replacement SSN card?		My original card was lost or stolen		Radio button, one up vertical	Y	Skip Logic Group	Why Applying for SSN Card
				My original card was not lost or stolen but someone else (e.g., family member) is holding it
				Never had an SSN card
				Other (Please specify)	NN
RUS0172650	NN	Please explain why you are applying for a replacement SSN card.				Text area, no Char limit	N	Skip Logic Group	OPS_Why Applying
TAR0201664	Q	Who are you reporting wages for?		Myself only			Y	Skip Logic Group	Reporting For
				My spouse only	Q2, R	Radio button, one-up vertical
				Myself and my spouse	Q2, R
				Myself and another individual (not spouse)	Q1,Q2, R
				Other relative only	Q2, R
				Other	Q1,Q2, R
TAR0201665	Q1	What is your relationship to the individual you are reporting wages for?				Text area, no Char limit	N	Skip Logic Group	OE_Report For
BUC0233611	R	What type of benefits does the person you are reporting for receive?		Disability		Radio button, one-up vertical	Y	skip logic group	Benefit Type Reporting
				Supplemental Security Income (SSI)
				Both Disability and SSI
				Don't know
TAR0201666	Q2	Was the person you wanted to report wages for listed?		Yes		Radio button, one-up vertical	Y	skip logic group	OE_Relationship
				No
TAR0201667	Q	Was the employer listed?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Employer listed
				No
TAR0201668	Q	Are you reporting for more than one employer for the same person?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Reporting multiple employers
				No
TAR0202213	Q	Are you currently working?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Currently working
				No
TAR0201669	Q	How long did it take you to submit your wages?		5 minutes or less		Radio button, one-up vertical	Y	Skip Logic Group	Time Submit Wage
				6-10 minutes
				11-15 minutes
				More than 15 minutes
				Unsure
				Did not submit wages
BUC0233612	Q	Before today's visit, what other methods have you used to report wages?		Field Office		Checkbox, one-up vertical	Y	Skip logic group	Other reporting methods
				Mail
				Fax
				Phone
				Other
BUC0233613	Q	Do you plan to electronically report additional wages in the future?		Yes	Q3	Radio button, one-up vertical	Y	Skip logic group	Plan report electronically
				No	Q5
				Don't know
TAR0201672	Q3	How do you plan to report future wages?		Desktop/Laptop		Radio button, one-up vertical	Y	Skip Logic Group	How Report Again
				Tablet
				Mobile Device
				Don't know
BUC0233614	Q5	What method do you prefer to use to report your wages?		Field Office		Radio button, one-up vertical	Y	Skip Logic Group	Preferred method reporting
				Mail
				Fax
				Phone
				Other
TAR0201673	Q	Were the instructions you received helpful?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Instructions Helpful
				No	Q4
TAR0201674	Q4	How can we improve the wage reporting application?				Text area, no Char limit	N	Skip Logic Group	OE_Improve Instructions
CAS0045398		Did you register for your my Social Security online or in person?	CAS0045398A001	Registered online on my first attempt	A	Radio button, one-up vertical	Y	Skip Logic Group	How Registered
			CAS0045398A002	Registered online after prior unsuccessful attempts	A,B
			CAS0045398A003	Registered with in-person assistance from my local SSA office	A,C
				Registered using the SSA Express
			CAS0045398A004	Not sure or don't remember
CAS0045399	A	Please select the approximate length of time it took for you complete your registration	CAS0045399A001	Less than 15 minutes		Radio button, one-up vertical	Y	Skip Logic Group	Reg Time
			CAS0045399A002	More than 15 but less than 30 minutes
			CAS0045399A003	30 minutes or more
CAS0045400	B	How many prior unsuccessful online registration attempts did you make?	CAS0045400A001	One		Radio button, one-up vertical	Y	Skip Logic Group	Reg Attempts
			CAS0045400A002	Two
			CAS0045400A003	Three or more
CAS0045410	C	Why did you decide to register in-person?		I was unsuccessful registering online and was required to do so in-person	CC	Radio button, one-up vertical	Y	Skip Logic Group	Reg In person
				I preferred registering for a my Social Security account in-person at my SSA office	CC
				Employee offered the option for me to register for a my Social Security account	CC
CAS0045401	CC	Please describe your in-person registration experience.				Text area, no char limit	N	Skip Logic Group	OE_In-person Experience
CAS0045411		Did you request to add Extra Security to your account?	CAS0045411A001	Yes		Radio button, one-up vertical	Y		Xtra Security Reg
			CAS0045411A002	No
			CAS0045411A003	I tried but was unsuccessful
			CAS0045411A004	I don't know
KAU0126773		Was it easy to create a my Social Security account?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Easy Create Account
				No	A
KAU0126790	A	Please tell us why it was not easy to create a my Social Security account.				Text area, no char limit	N	Skip Logic Group	OE_Easy Create Account
CAS0045413		Did you find the instructions for creating a username, password and registering a second factor to be clear?	CAS0045413A001	Yes		Radio button, one-up vertical	Y	Skip Logic Group	Instructions Understand
			CAS0045413A002	Partially	A
			CAS0045413A003	No	A
CAS0045414	A	Please explain what was not clear about any of the instructions.				Text area, no char limit	N	Skip Logic Group	OE_Instructions
CAS0045415		Did you see any information describing my Social Security's security policies or features?	CAS0045415A001	Yes		Radio button, one-up vertical	Y		Security Policies
			CAS0045415A002	No
CAS0045424		Do you have any concerns about the security of the personal information contained in your my Social Security account?	CAS0045424A001	No		Radio Button, One-up	Y	Skip Logic Group	Security Concerns
			CAS0045424A002	Yes	A
CAS0045425	A	Please describe your security concerns.				Text area, no char limit	N	Skip Logic Group	OE_Security Concern
KAU0126791		Was it easy to sign in to your my Social Security account?		Yes		Radio button, one up	Y	Skip Logic Group	Easy Sign In
				No	A
KAU0126792	A	What did you find difficult about signing in to your my Social Security account?				Text area, no char limit	N	Skip Logic Group	OE_Easy Sign In
CAS0045422		Did the information obtained during your my Social Security account visit enable you to accomplish what you wanted to do?	CAS0045422A001	Yes		Radio button, one up	Yes	Skip Logic Group	Ability to Accomplish
			CAS0045422A002	No	A,B
CAS0045426	A	What specifically were you trying to accomplish?				Text area, no char limit	N	Skip Logic	OE_Trying to accomplish
CAS0045427	B	Since you were not able to accomplish what you wanted to do, what do you plan to do next? (Please select all that apply)	CAS0045427A001	Return online and try again		Check box vertical	Y	Skip Logic	Do Next
			CAS0045427A002	Send an e-mail to Social Security
			CAS0045427A003	Call Social Security's 800 number
			CAS0045427A004	Call a local Social Security office
			CAS0045427A005	Visit a local Social Security office
			CAS0045427A006	Take no action
			CAS0045427A008	Other, please specify	BB
CAS0045428	BB	Please tell us what "other" action you plan to take next.				Text area, no char limit	N		OPS_Do Next
TAR0239304		Did you contact Social Security during your online visit?		Yes	A	Radio button, one-up vertical	Y	Skip Logic Group	Contacted SSA
				No
TAR0239305	A	How did you contact Social Security?		Requested a Call Back		Radio button, one-up vertical	Y	Skip Logic Group	How contacted SSA
				Email
				Chat with an Online representative	B,C,D,E
TAR0239306	B	How long was your wait to Chat with a representative online?		About what I expected		Radio button, one-up vertical	Y	Skip Logic Group	Click to chat wait
				Longer than I expected
TAR0239307	C	Did the Chat representative answer your question?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Click to chat answer
				Partially
				No
TAR0239324	D	Do you still have to call the 1-800 number or go into a field office?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Click to chat Call
				No
TAR0248887	D	How satisfied were you with the Chat Service you received today?		Very Satisfied		Radio button, one-up vertical	Y	Skip Logic Group	Click to chat service
				Satisfied
				Not Satisfied
				Very Dissatisfied
	D	How satisfied were you with the Chat Representative who assisted you today?		Very Satisfied		Radio button, one-up vertical	Y	Skip Logic Group	Click to chat representative
TAR0248888				Satisfied
				Not Satisfied
				Very Dissatisfied
TAR0239325	E	Please share any other feedback with us regarding your Chat experience today.				Text area, no Char limit	N	Skip Logic Group	Chat Feedback
CAS0045373		Was the information in your my Social Security account clear to you?	CAS0045373A001	Yes		radial button, one up vertical	Y	skip logic	AccountClarity
			CAS0045373A002	No	A
CAS0045374	A	Please tell us what information or instructions were not clear				Text area, no Char limit	N	Skip Logic Group	OE_Account Clarity
STE0093222		Did you use the “Get Help” button or "Call Back" button during your visit today?		Yes, I used the "Get Help" button only		Radio button, one up vertical	Y		Get Help Button or Call Back
				Yes, I used the "Call Back" button only
				Yes, I used both the "Get Help" button and "Call Back" button
				No, I used neither
STE0125910		Did you view the "Message Center" section during your visit today?		Yes	A	Radio button, one up	Y	Skip Logic Group	Message Center
				No	B
STE0125911	A	Did you select to receive courtesy notifications from the "Message Center?"		Yes		Radio button, one up	Y	Skip Logic Group	Courtesy Notifications
				No
STE0125912	B	Do you plan to view the "Message Center" in the future?		Yes		Radio button, one up	Y	Skip Logic Group	Use Message Center Future
				No
STE0123762		Please select the category that includes your age:		35 and under		Radio button, one up	N		Age
				36 to 50
				51 to 61
				62
				63
				64
				65
				66
				67
				68 to 70
				71 or older
				Prefer not to answer
JIB0147139		Please enter your 5 digit ZIP Code:				Text area, 100 char limit	N		OE_ZIP
CAS0045416		Do you have any suggestions for improving the my Social Security registration process?				Text area, no char limit	N		OE_Improve Reg
CAS0045417		Do you have any suggestions for improving my Social Security's content and features?				Text area, no char limit	N		OE_Improve Contents

---

Sheet 5: CQs (7-30-18)

Model Instance Name:				red & strike-through: DELETE
SSA My Social Security v2				underlined & italicized: RE-ORDER
MID:	R9JQtMNl09w1VJAZFxsVYQ4C			pink: ADDITION
Partitioned Yes	1/11/2018			blue + -->: REWORDING
SSA My Social Security v2 CUSTOM QUESTION LIST
QID	Skip Logic Label	Question Text	AnswerIDs (DOT)	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Required Y/N	Special Instructions	CQ Label
STE0123737		From where did you connect to SSA today?		At home		Radio button, one-up vertical	Y		From Where Connected with SSA
				In office / place of employment
				At a Friend or Relative's place
				Public Library
				Social Security Office
				Social Security Kiosk
				Other Agency
				Other
CAS0045388		How did you learn about my Social Security? (Check all that apply.)	CAS0045388A022	Official Social Security website (www.ssa.gov)		check box, one up	Y	Skip Logic Group	Learn about
			CAS0045388A023	Browsing SSA.gov's informational webpages				Randomize
				Social Security's Frequently Asked Questions (FAQs)
			CAS0045388A024	The "Manage Your Benefits with a my Social Security account" page
			CAS0045388A009	An email reminder from Social Security
			CAS0045388A017	Social Security Statement that I received in the mail
			CAS0045388A006	A general web search (e.g., Google, Bing, etc.)
			CAS0045388A015	Social media (e.g., Facebook, Twitter, blog, etc.)
			CAS0045388A016	Friend, spouse, relative, neighbor, or acquaintance
			CAS0045388A019	Social Security employee
			CAS0045388A020	Community group or association
			CAS0045388A021	Government agency other than Social Security (e.g., State, Federal)
			CAS0045388A004	Other, please explain	B			Anchor answer choice
CAS0045390	B	How did you learn about my Social Security?				Text area, no char limit	N	Skip Logic Group	OPS_Learn about
HAR0069569		How often do you access (or plan to access) your my Social Security account?		Once a year		Radio button, one up vertical	Y		Access Frequency - NEW
				Once every six months
				Once every three months
				Once a month
				More than once a month
				Not sure
BJL1506		Are you currently receiving cash benefits?	BJL1506A01	Yes, I recently applied	A	Radio button, one-up vertical	Y	Skip Logic Group	Cash Benefits
				No, I am taking Medicare Only
				No, I am not receiving cash benefits
			BJL1506A06	I don't know or prefer not to answer
RUS0166831	A	What type of benefits are you receiving? (Check all that apply)		Retirement		Check box, one up vertical	N	Skip Logic Group	Benefit Type
				Disability
				Spouses
				Survivors
				Supplemental Security Insurance (SSI)
CAS0045395		What is your reason for visiting my Social Security today? (Check all that apply)	CAS0045395A001	To get a Benefit Verification Letter	B	check box one up vertical	Yes	Skip Logic Group	Primary Reason
				To view my Benefits and Payment Details
			CAS0045395A002	To enroll in or update my direct deposit
			CAS0045395A003	To change my address with SSA
				To print or view my online Social Security Statement	A
			CAS0045395A004	To make sure my earnings record is correct
			CAS0045395A005	To replace my Social Security Card or get a new card	X,M,N
				To check the Status of my recently filed application for benefits
			CAS0045395A006	To learn about the benefits to which I might be entitled
			CAS0045395A009	To apply only for Social Security or Medicare Only benefits
			CAS0045395A017	To report my wages	Q
				To request a replacement SSA-1099 (or SSA-10425) for tax purposes	K
				To add Extra Security to my online account
			CAS0045395A010	Just curious – wanted to see what information was contained in my Social Security account
			CAS0045395A011	Other Reason for visiting today	Z
CAS0045407	A	How often do you review your online Social Security Statement?	CAS0045407A001	This is my first time	AA	check box one up vertical	Y	Skip Logic Group	Freq View Statement
			CAS0045407A003	At least once a year
			CAS0045407A004	Every 6 months
			CAS0045407A005	Every 3 months or more frequently
CAS0045409	B	For which Agency or program do you need a Benefit Verification Letter? (Check all that apply)	CAS0045409A001	Medicare		check box vertical one up	Y	skip logic group	Agency Need
			CAS0045409A002	Medicaid
				State or Local Department of Social Services
			CAS0045409A003	HUD - Federal Housing Admin. (FHA) and/or Section 8 Housing
			CAS0045409A004	USDA - SNAP (Food Stamps)
			CAS0045409A005	Department of Veterans Affairs
			CAS0045409A006	IRS
			CAS0045409A007	Court
			CAS0045409A008	Want a copy for personal use
				Bank or financial institution
				Education-related
				Medical-related
				Healthcare signup and/or verification
				Requesting a Retirement Visa from another country
			CAS0045409A009	Other agency or program	BB
CAS0045396	BB	Which "other" agency or program requested your Benefit Verification information?				Text area, no Char limit	N	Skip Logic Group	OPS_Other Agency
CAS0045397	Z	Please tell us what your primary reason was for visiting today:				Text area, no Char limit	N	Skip Logic Group	OPS_Primary Reason
CAS0076487	K	Please select the response that best reflects the action you took:		Viewed my SSA 1099 (or 1042S)		Radio button, one-up vertical	Y	Skip Logic Group	SSA 1099 Action
				Viewed and printed my SSA 1099 (or SSA 1042S)
				Viewed my SSA 1099 (or SSA 1042s) and requested a replacement to be mailed	L
				Other	KK
CAS0076488	L	Please explain why you requested a copy to be mailed since it was available for viewing and printing online.				Text area, no Char limit	N	Skip Logic Group	Why Request 1099
CAS0076467	KK	What action did you take?				Text area, no Char limit	N	Skip Logic Group	OPS_SSA 1099 Action
RUS0172646	X	Do you plan to replace your SSN card online through iSSNRC (Internet Social Security Number Replacement Card)?		Yes		Radio button, one up vertical	Y	Skip Logic Group	Plan to Replace
				No, this service is not yet available in my state
				No, I prefer to go to a field office
				I am not aware of this service
				Don't know
RUS0172647	M	For which purpose or program do you need a replacement SSN Card? (Check all that apply)		Proof of identity		checkbox vertical, one up	Y	Skip Logic Group	Purpose for SSN Card
				Tax purposes
				Education-related
				Required for my job
				Passport
				Bank or financial institution
				Income assistance
				Other (Please specify)	MM
RUS0172648	MM	Please explain for which purpose or program you need a replacement SSN card.				Text area, no Char limit	N	Skip Logic Group	OPS_Purpose Other
RUS0172649	N	Which best describes why you are applying for a replacement SSN card?		My original card was lost or stolen		Radio button, one up vertical	Y	Skip Logic Group	Why Applying for SSN Card
				My original card was not lost or stolen but someone else (e.g., family member) is holding it
				Never had an SSN card
				Other (Please specify)	NN
RUS0172650	NN	Please explain why you are applying for a replacement SSN card.				Text area, no Char limit	N	Skip Logic Group	OPS_Why Applying
TAR0201664	Q	Who are you reporting wages for?		Myself only			Y	Skip Logic Group	Reporting For
				My spouse only	Q2, R	Radio button, one-up vertical
				Myself and my spouse	Q2, R
				Myself and another individual (not spouse)	Q1,Q2, R
				Other relative only	Q2, R
				Other	Q1,Q2, R
TAR0201665	Q1	What is your relationship to the individual you are reporting wages for?				Text area, no Char limit	N	Skip Logic Group	OE_Report For
BUC0233611	R	What type of benefits does the person you are reporting for receive?		Disability		Radio button, one-up vertical	Y	skip logic group	Benefit Type Reporting
				Supplemental Security Income (SSI)
				Both Disability and SSI
				Don't know
TAR0201666	Q2	Was the person you wanted to report wages for listed?		Yes		Radio button, one-up vertical	Y	skip logic group	OE_Relationship
				No
TAR0201667	Q	Was the employer listed?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Employer listed
				No
TAR0201668	Q	Are you reporting for more than one employer for the same person?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Reporting multiple employers
				No
TAR0202213	Q	Are you currently working?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Currently working
				No
TAR0201669	Q	How long did it take you to submit your wages?		5 minutes or less		Radio button, one-up vertical	Y	Skip Logic Group	Time Submit Wage
				6-10 minutes
				11-15 minutes
				More than 15 minutes
				Unsure
				Did not submit wages
BUC0233612	Q	Before today's visit, what other methods have you used to report wages?		Field Office		Checkbox, one-up vertical	Y	Skip logic group	Other reporting methods
				Mail
				Fax
				Phone
				Other
BUC0233613	Q	Do you plan to electronically report additional wages in the future?		Yes	Q3	Radio button, one-up vertical	Y	Skip logic group	Plan report electronically
				No	Q5
				Don't know
TAR0201672	Q3	How do you plan to report future wages?		Desktop/Laptop		Radio button, one-up vertical	Y	Skip Logic Group	How Report Again
				Tablet
				Mobile Device
				Don't know
BUC0233614	Q5	What method do you prefer to use to report your wages?		Field Office		Radio button, one-up vertical	Y	Skip Logic Group	Preferred method reporting
				Mail
				Fax
				Phone
				Other
TAR0201673	Q	Were the instructions you received helpful?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Instructions Helpful
				No	Q4
TAR0201674	Q4	How can we improve the wage reporting application?				Text area, no Char limit	N	Skip Logic Group	OE_Improve Instructions
CAS0045398		Did you register for your my Social Security online or in person?	CAS0045398A001	Registered online on my first attempt	A	Radio button, one-up vertical	Y	Skip Logic Group	How Registered
			CAS0045398A002	Registered online after prior unsuccessful attempts	A,B
			CAS0045398A003	Registered with in-person assistance from my local SSA office	A,C
				Registered using the SSA Express
			CAS0045398A004	Not sure or don't remember
CAS0045399	A	Please select the approximate length of time it took for you complete your registration	CAS0045399A001	Less than 15 minutes		Radio button, one-up vertical	Y	Skip Logic Group	Reg Time
			CAS0045399A002	More than 15 but less than 30 minutes
			CAS0045399A003	30 minutes or more
CAS0045400	B	How many prior unsuccessful online registration attempts did you make?	CAS0045400A001	One		Radio button, one-up vertical	Y	Skip Logic Group	Reg Attempts
			CAS0045400A002	Two
			CAS0045400A003	Three or more
CAS0045410	C	Why did you decide to register in-person?		I was unsuccessful registering online and was required to do so in-person	CC	Radio button, one-up vertical	Y	Skip Logic Group	Reg In person
				I preferred registering for a my Social Security account in-person at my SSA office	CC
				Employee offered the option for me to register for a my Social Security account	CC
CAS0045401	CC	Please describe your in-person registration experience.				Text area, no char limit	N	Skip Logic Group	OE_In-person Experience
CAS0045411		Did you request to add Extra Security to your account?	CAS0045411A001	Yes		Radio button, one-up vertical	Y		Xtra Security Reg
			CAS0045411A002	No
			CAS0045411A003	I tried but was unsuccessful
			CAS0045411A004	I don't know
KAU0126773		Was it easy to create a my Social Security account?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Easy Create Account
				No	A
KAU0126790	A	Please tell us why it was not easy to create a my Social Security account.				Text area, no char limit	N	Skip Logic Group	OE_Easy Create Account
CAS0045413		Did you find the instructions for creating a username, password and registering a second factor to be clear?	CAS0045413A001	Yes		Radio button, one-up vertical	Y	Skip Logic Group	Instructions Understand
			CAS0045413A002	Partially	A
			CAS0045413A003	No	A
CAS0045414	A	Please explain what was not clear about any of the instructions.				Text area, no char limit	N	Skip Logic Group	OE_Instructions
CAS0045415		Did you see any information describing my Social Security's security policies or features?	CAS0045415A001	Yes		Radio button, one-up vertical	Y		Security Policies
			CAS0045415A002	No
CAS0045424		Do you have any concerns about the security of the personal information contained in your my Social Security account?	CAS0045424A001	No		Radio Button, One-up	Y	Skip Logic Group	Security Concerns
			CAS0045424A002	Yes	A
CAS0045425	A	Please describe your security concerns.				Text area, no char limit	N	Skip Logic Group	OE_Security Concern
KAU0126791		Was it easy to sign in to your my Social Security account?		Yes		Radio button, one up	Y	Skip Logic Group	Easy Sign In
				No	A
KAU0126792	A	What did you find difficult about signing in to your my Social Security account?				Text area, no char limit	N	Skip Logic Group	OE_Easy Sign In
CAS0045422		Did the information obtained during your my Social Security account visit enable you to accomplish what you wanted to do?	CAS0045422A001	Yes		Radio button, one up	Yes	Skip Logic Group	Ability to Accomplish
			CAS0045422A002	No	A,B
CAS0045426	A	What specifically were you trying to accomplish?				Text area, no char limit	N	Skip Logic	OE_Trying to accomplish
CAS0045427	B	Since you were not able to accomplish what you wanted to do, what do you plan to do next? (Please select all that apply)	CAS0045427A001	Return online and try again		Check box vertical	Y	Skip Logic	Do Next
			CAS0045427A002	Send an e-mail to Social Security
			CAS0045427A003	Call Social Security's 800 number
			CAS0045427A004	Call a local Social Security office
			CAS0045427A005	Visit a local Social Security office
			CAS0045427A006	Take no action
			CAS0045427A008	Other, please specify	BB
CAS0045428	BB	Please tell us what "other" action you plan to take next.				Text area, no char limit	N		OPS_Do Next
TAR0239304		Did you contact Social Security during your online visit?		Yes	A	Radio button, one-up vertical	Y	Skip Logic Group	Contacted SSA
				No
TAR0239305	A	How did you contact Social Security?		Requested a Call Back		Radio button, one-up vertical	Y	Skip Logic Group	How contacted SSA
				Email
				Chat with an Online representative	B,C,D,E
TAR0239306	B	How long was your wait to Chat with a representative online?		About what I expected		Radio button, one-up vertical	Y	Skip Logic Group	Click to chat wait
				Longer than I expected
TAR0239307	C	Did the Chat representative answer your question?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Click to chat answer
				Partially
				No
TAR0239324	D	Do you still have to call the 1-800 number or go into a field office?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Click to chat Call
				No
	D	How satisfied were you with the Chat Service you received today?		Very Satisfied		Radio button, one-up vertical	Y	Skip Logic Group	Click to chat service
				Satisfied
				Not Satisfied
				Very Dissatisfied
	D	How satisfied were you with the Chat Representative who assisted you today?		Very Satisfied		Radio button, one-up vertical	Y	Skip Logic Group	Click to chat representative
				Satisfied
				Not Satisfied
				Very Dissatisfied
TAR0239325	E	Please share any other feedback with us regarding your Chat experience today.				Text area, no Char limit	N	Skip Logic Group	Chat Feedback
CAS0045373		Was the information in your my Social Security account clear to you?	CAS0045373A001	Yes		radial button, one up vertical	Y	skip logic	AccountClarity
			CAS0045373A002	No	A
CAS0045374	A	Please tell us what information or instructions were not clear				Text area, no Char limit	N	Skip Logic Group	OE_Account Clarity
STE0093222		Did you use the “Get Help” button or "Call Back" button during your visit today?		Yes, I used the "Get Help" button only		Radio button, one up vertical	Y		Get Help Button or Call Back
				Yes, I used the "Call Back" button only
				Yes, I used both the "Get Help" button and "Call Back" button
				No, I used neither
STE0125910		Did you view the "Message Center" section during your visit today?		Yes	A	Radio button, one up	Y	Skip Logic Group	Message Center
				No	B
STE0125911	A	Did you select to receive courtesy notifications from the "Message Center?"		Yes		Radio button, one up	Y	Skip Logic Group	Courtesy Notifications
				No
STE0125912	B	Do you plan to view the "Message Center" in the future?		Yes		Radio button, one up	Y	Skip Logic Group	Use Message Center Future
				No
STE0123762		Please select the category that includes your age:		35 and under		Radio button, one up	N		Age
				36 to 50
				51 to 61
				62
				63
				64
				65
				66
				67
				68 to 70
				71 or older
				Prefer not to answer
JIB0147139		Please enter your 5 digit ZIP Code:				Text area, 100 char limit	N		OE_ZIP
CAS0045416		Do you have any suggestions for improving the my Social Security registration process?				Text area, no char limit	N		OE_Improve Reg
CAS0045417		Do you have any suggestions for improving my Social Security's content and features?				Text area, no char limit	N		OE_Improve Contents

---

Sheet 6: Current CQs (6-25-18)

Model Instance Name:				red & strike-through: DELETE
SSA My Social Security v2				underlined & italicized: RE-ORDER
MID:	R9JQtMNl09w1VJAZFxsVYQ4C			pink: ADDITION
Partitioned Yes	1/11/2018			blue + -->: REWORDING
SSA My Social Security v2 CUSTOM QUESTION LIST
QID	Skip Logic Label	Question Text	AnswerIDs (DOT)	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Required Y/N	Special Instructions	CQ Label
STE0123737		From where did you connect to SSA today?		At home		Radio button, one-up vertical	Y		From Where Connected with SSA
				In office / place of employment
				At a Friend or Relative's place
				Public Library
				Social Security Office
				Social Security Kiosk
				Other Agency
				Other
CAS0045388		How did you learn about my Social Security? (Check all that apply.)	CAS0045388A022	Official Social Security website (www.ssa.gov)		check box, one up	Y	Skip Logic Group	Learn about
			CAS0045388A023	Browsing SSA.gov's informational webpages				Randomize
				Social Security's Frequently Asked Questions (FAQs)
			CAS0045388A024	The "Manage Your Benefits with a my Social Security account" page
			CAS0045388A009	An email reminder from Social Security
			CAS0045388A017	Social Security Statement that I received in the mail
			CAS0045388A006	A general web search (e.g., Google, Bing, etc.)
			CAS0045388A015	Social media (e.g., Facebook, Twitter, blog, etc.)
			CAS0045388A016	Friend, spouse, relative, neighbor, or acquaintance
			CAS0045388A019	Social Security employee
			CAS0045388A020	Community group or association
			CAS0045388A021	Government agency other than Social Security (e.g., State, Federal)
			CAS0045388A004	Other, please explain	B			Anchor answer choice
CAS0045390	B	How did you learn about my Social Security?				Text area, no char limit	N	Skip Logic Group	OPS_Learn about
HAR0069569		How often do you access (or plan to access) your my Social Security account?		Once a year		Radio button, one up vertical	Y		Access Frequency - NEW
				Once every six months
				Once every three months
				Once a month
				More than once a month
				Not sure
BJL1506		Are you currently receiving cash benefits?	BJL1506A01	Yes, I recently applied	A	Radio button, one-up vertical	Y	Skip Logic Group	Cash Benefits
				No, I am taking Medicare Only
				No, I am not receiving cash benefits
			BJL1506A06	I don't know or prefer not to answer
RUS0166831	A	What type of benefits are you receiving? (Check all that apply)		Retirement		Check box, one up vertical	N	Skip Logic Group	Benefit Type
				Disability
				Spouses
				Survivors
				Supplemental Security Insurance (SSI)
CAS0045395		What is your reason for visiting my Social Security today? (Check all that apply)	CAS0045395A001	To get a Benefit Verification Letter	B	check box one up vertical	Yes	Skip Logic Group	Primary Reason
				To view my Benefits and Payment Details
			CAS0045395A002	To enroll in or update my direct deposit
			CAS0045395A003	To change my address with SSA
				To print or view my online Social Security Statement	A
			CAS0045395A004	To make sure my earnings record is correct
			CAS0045395A005	To replace my Social Security Card or get a new card	X,M,N
				To check the Status of my recently filed application for benefits
			CAS0045395A006	To learn about the benefits to which I might be entitled
			CAS0045395A009	To apply only for Social Security or Medicare Only benefits
			CAS0045395A017	To report my wages	Q
				To request a replacement SSA-1099 (or SSA-10425) for tax purposes	K
				To add Extra Security to my online account
			CAS0045395A010	Just curious – wanted to see what information was contained in my Social Security account
			CAS0045395A011	Other Reason for visiting today	Z
CAS0045407	A	How often do you review your online Social Security Statement?	CAS0045407A001	This is my first time	AA	check box one up vertical	Y	Skip Logic Group	Freq View Statement
			CAS0045407A003	At least once a year
			CAS0045407A004	Every 6 months
			CAS0045407A005	Every 3 months or more frequently
CAS0045409	B	For which Agency or program do you need a Benefit Verification Letter? (Check all that apply)	CAS0045409A001	Medicare		check box vertical one up	Y	skip logic group	Agency Need
			CAS0045409A002	Medicaid
				State or Local Department of Social Services
			CAS0045409A003	HUD - Federal Housing Admin. (FHA) and/or Section 8 Housing
			CAS0045409A004	USDA - SNAP (Food Stamps)
			CAS0045409A005	Department of Veterans Affairs
			CAS0045409A006	IRS
			CAS0045409A007	Court
			CAS0045409A008	Want a copy for personal use
				Bank or financial institution
				Education-related
				Medical-related
				Healthcare signup and/or verification
				Requesting a Retirement Visa from another country
			CAS0045409A009	Other agency or program	BB
CAS0045396	BB	Which "other" agency or program requested your Benefit Verification information?				Text area, no Char limit	N	Skip Logic Group	OPS_Other Agency
CAS0045397	Z	Please tell us what your primary reason was for visiting today:				Text area, no Char limit	N	Skip Logic Group	OPS_Primary Reason
CAS0076487	K	Please select the response that best reflects the action you took:		Viewed my SSA 1099 (or 1042S)		Radio button, one-up vertical	Y	Skip Logic Group	SSA 1099 Action
				Viewed and printed my SSA 1099 (or SSA 1042S)
				Viewed my SSA 1099 (or SSA 1042s) and requested a replacement to be mailed	L
				Other	KK
CAS0076488	L	Please explain why you requested a copy to be mailed since it was available for viewing and printing online.				Text area, no Char limit	N	Skip Logic Group	Why Request 1099
CAS0076467	KK	What action did you take?				Text area, no Char limit	N	Skip Logic Group	OPS_SSA 1099 Action
RUS0172646	X	Do you plan to replace your SSN card online through iSSNRC (Internet Social Security Number Replacement Card)?		Yes		Radio button, one up vertical	Y	Skip Logic Group	Plan to Replace
				No, this service is not yet available in my state
				No, I prefer to go to a field office
				I am not aware of this service
				Don't know
RUS0172647	M	For which purpose or program do you need a replacement SSN Card? (Check all that apply)		Proof of identity		checkbox vertical, one up	Y	Skip Logic Group	Purpose for SSN Card
				Tax purposes
				Education-related
				Required for my job
				Passport
				Bank or financial institution
				Income assistance
				Other (Please specify)	MM
RUS0172648	MM	Please explain for which purpose or program you need a replacement SSN card.				Text area, no Char limit	N	Skip Logic Group	OPS_Purpose Other
RUS0172649	N	Which best describes why you are applying for a replacement SSN card?		My original card was lost or stolen		Radio button, one up vertical	Y	Skip Logic Group	Why Applying for SSN Card
				My original card was not lost or stolen but someone else (e.g., family member) is holding it
				Never had an SSN card
				Other (Please specify)	NN
RUS0172650	NN	Please explain why you are applying for a replacement SSN card.				Text area, no Char limit	N	Skip Logic Group	OPS_Why Applying
TAR0201664	Q	Who are you reporting wages for?		Myself only			Y	Skip Logic Group	Reporting For
				My spouse only	Q2, R	Radio button, one-up vertical
				Myself and my spouse	Q2, R
				Myself and another individual (not spouse)	Q1,Q2, R
				Other relative only	Q2, R
				Other	Q1,Q2, R
TAR0201665	Q1	What is your relationship to the individual you are reporting wages for?				Text area, no Char limit	N	Skip Logic Group	OE_Report For
BUC0233611	R	What type of benefits does the person you are reporting for receive?		Disability		Radio button, one-up vertical	Y	skip logic group	Benefit Type Reporting
				Supplemental Security Income (SSI)
				Both Disability and SSI
				Don't know
TAR0201666	Q2	Was the person you wanted to report wages for listed?		Yes		Radio button, one-up vertical	Y	skip logic group	OE_Relationship
				No
TAR0201667	Q	Was the employer listed?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Employer listed
				No
TAR0201668	Q	Are you reporting for more than one employer for the same person?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Reporting multiple employers
				No
TAR0202213	Q	Are you currently working?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Currently working
				No
TAR0201669	Q	How long did it take you to submit your wages?		5 minutes or less		Radio button, one-up vertical	Y	Skip Logic Group	Time Submit Wage
				6-10 minutes
				11-15 minutes
				More than 15 minutes
				Unsure
				Did not submit wages
BUC0233612	Q	Before today's visit, what other methods have you used to report wages?		Field Office		Checkbox, one-up vertical	Y	Skip logic group	Other reporting methods
				Mail
				Fax
				Phone
				Other
BUC0233613	Q	Do you plan to electronically report additional wages in the future?		Yes	Q3	Radio button, one-up vertical	Y	Skip logic group	Plan report electronically
				No	Q5
				Don't know
TAR0201672	Q3	How do you plan to report future wages?		Desktop/Laptop		Radio button, one-up vertical	Y	Skip Logic Group	How Report Again
				Tablet
				Mobile Device
				Don't know
BUC0233614	Q5	What method do you prefer to use to report your wages?		Field Office		Radio button, one-up vertical	Y	Skip Logic Group	Preferred method reporting
				Mail
				Fax
				Phone
				Other
TAR0201673	Q	Were the instructions you received helpful?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Instructions Helpful
				No	Q4
TAR0201674	Q4	How can we improve the wage reporting application?				Text area, no Char limit	N	Skip Logic Group	OE_Improve Instructions
CAS0045398		Did you register for your my Social Security online or in person?	CAS0045398A001	Registered online on my first attempt	A	Radio button, one-up vertical	Y	Skip Logic Group	How Registered
			CAS0045398A002	Registered online after prior unsuccessful attempts	A,B
			CAS0045398A003	Registered with in-person assistance from my local SSA office	A,C
				Registered using the SSA Express
			CAS0045398A004	Not sure or don't remember
CAS0045399	A	Please select the approximate length of time it took for you complete your registration	CAS0045399A001	Less than 15 minutes		Radio button, one-up vertical	Y	Skip Logic Group	Reg Time
			CAS0045399A002	More than 15 but less than 30 minutes
			CAS0045399A003	30 minutes or more
CAS0045400	B	How many prior unsuccessful online registration attempts did you make?	CAS0045400A001	One		Radio button, one-up vertical	Y	Skip Logic Group	Reg Attempts
			CAS0045400A002	Two
			CAS0045400A003	Three or more
CAS0045410	C	Why did you decide to register in-person?		I was unsuccessful registering online and was required to do so in-person	CC	Radio button, one-up vertical	Y	Skip Logic Group	Reg In person
				I preferred registering for a my Social Security account in-person at my SSA office	CC
				Employee offered the option for me to register for a my Social Security account	CC
CAS0045401	CC	Please describe your in-person registration experience.				Text area, no char limit	N	Skip Logic Group	OE_In-person Experience
CAS0045411		Did you request to add Extra Security to your account?	CAS0045411A001	Yes		Radio button, one-up vertical	Y		Xtra Security Reg
			CAS0045411A002	No
			CAS0045411A003	I tried but was unsuccessful
			CAS0045411A004	I don't know
KAU0126773		Was it easy to create a my Social Security account?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Easy Create Account
				No	A
KAU0126790	A	Please tell us why it was not easy to create a my Social Security account.				Text area, no char limit	N	Skip Logic Group	OE_Easy Create Account
CAS0045413		Did you find the instructions for creating a username, password and registering a second factor to be clear?	CAS0045413A001	Yes		Radio button, one-up vertical	Y	Skip Logic Group	Instructions Understand
			CAS0045413A002	Partially	A
			CAS0045413A003	No	A
CAS0045414	A	Please explain what was not clear about any of the instructions.				Text area, no char limit	N	Skip Logic Group	OE_Instructions
CAS0045415		Did you see any information describing my Social Security's security policies or features?	CAS0045415A001	Yes		Radio button, one-up vertical	Y		Security Policies
			CAS0045415A002	No
CAS0045424		Do you have any concerns about the security of the personal information contained in your my Social Security account?	CAS0045424A001	No		Radio Button, One-up	Y	Skip Logic Group	Security Concerns
			CAS0045424A002	Yes	A
CAS0045425	A	Please describe your security concerns.				Text area, no char limit	N	Skip Logic Group	OE_Security Concern
KAU0126791		Was it easy to sign in to your my Social Security account?		Yes		Radio button, one up	Y	Skip Logic Group	Easy Sign In
				No	A
KAU0126792	A	What did you find difficult about signing in to your my Social Security account?				Text area, no char limit	N	Skip Logic Group	OE_Easy Sign In
CAS0045422		Did the information obtained during your my Social Security account visit enable you to accomplish what you wanted to do?	CAS0045422A001	Yes		Radio button, one up	Yes	Skip Logic Group	Ability to Accomplish
			CAS0045422A002	No	A,B
CAS0045426	A	What specifically were you trying to accomplish?				Text area, no char limit	N	Skip Logic	OE_Trying to accomplish
CAS0045427	B	Since you were not able to accomplish what you wanted to do, what do you plan to do next? (Please select all that apply)	CAS0045427A001	Return online and try again		Check box vertical	Y	Skip Logic	Do Next
			CAS0045427A002	Send an e-mail to Social Security
			CAS0045427A003	Call Social Security's 800 number
			CAS0045427A004	Call a local Social Security office
			CAS0045427A005	Visit a local Social Security office
			CAS0045427A006	Take no action
			CAS0045427A008	Other, please specify	BB
CAS0045428	BB	Please tell us what "other" action you plan to take next.				Text area, no char limit	N		OPS_Do Next
TAR0239304		Did you contact Social Security during your online visit?		Yes	A	Radio button, one-up vertical	Y	Skip Logic Group	Contacted SSA
				No
	A	How did you contact Social Security?		Phone		Radio button, one-up vertical	Y	Skip Logic Group	How contacted SSA
				Email
				Click to Chat	B,C,D,E
	B	How long was your wait to reach a Click to Chat agent?		About what I expected		Radio button, one-up vertical	Y	Skip Logic Group	Click to chat wait
				Longer than I expected
	C	Did the Click to Chat agent answer your question?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Click to chat answer
				Partially
				No
	D	Do you still have to call the 1-800 number or go into a field office?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Click to chat Call
				No
	E	Please share any other feedback with us regarding your chat experience today.				Text area, no Char limit	N	Skip Logic Group	Chat Feedback
CAS0045373		Was the information in your my Social Security account clear to you?	CAS0045373A001	Yes		radial button, one up vertical	Y	skip logic	AccountClarity
			CAS0045373A002	No	A
CAS0045374	A	Please tell us what information or instructions were not clear				Text area, no Char limit	N	Skip Logic Group	OE_Account Clarity
STE0093222		Did you use the “Get Help” button or "Call Back" button during your visit today?		Yes, I used the "Get Help" button only		Radio button, one up vertical	Y		Get Help Button or Call Back
				Yes, I used the "Call Back" button only
				Yes, I used both the "Get Help" button and "Call Back" button
				No, I used neither
STE0125910		Did you view the "Message Center" section during your visit today?		Yes	A	Radio button, one up	Y	Skip Logic Group	Message Center
				No	B
STE0125911	A	Did you select to receive courtesy notifications from the "Message Center?"		Yes		Radio button, one up	Y	Skip Logic Group	Courtesy Notifications
				No
STE0125912	B	Do you plan to view the "Message Center" in the future?		Yes		Radio button, one up	Y	Skip Logic Group	Use Message Center Future
				No
STE0123762		Please select the category that includes your age:		35 and under		Radio button, one up	N		Age
				36 to 50
				51 to 61
				62
				63
				64
				65
				66
				67
				68 to 70
				71 or older
				Prefer not to answer
JIB0147139		Please enter your 5 digit ZIP Code:				Text area, 100 char limit	N		OE_ZIP
CAS0045416		Do you have any suggestions for improving the my Social Security registration process?				Text area, no char limit	N		OE_Improve Reg
CAS0045417		Do you have any suggestions for improving my Social Security's content and features?				Text area, no char limit	N		OE_Improve Contents

---

Sheet 7: v2 Model Qsts

Model Instance Name:
SSA My Social Security v2
MID:	R9JQtMNl09w1VJAZFxsVYQ4C
Partitioned Yes
FPI Included(Y/N)?
Date:		6/12/2013
SSA My Social Security v2
Model questions utilize the ACSI methodology to determine scores and impacts
		ELEMENTS (drivers of satisfaction)			CUSTOMER SATISFACTION			FUTURE BEHAVIORS	FPI
	MQ Label			MQ Label			MQ Label		Y?
		Look and Feel (1=Poor, 10=Excellent, Don't Know)			Satisfaction			Recommend (1=Very Unlikely, 10=Very Likely)
	Look and Feel - Appeal	Please rate the visual appeal of this site.		Satisfaction - Overall	What is your overall satisfaction with this site? (1=Very Dissatisfied, 10=Very Satisfied)		Recommend	How likely are you to recommend this site to someone else?
	Look and Feel - Balance	Please rate the balance of graphics and text on this site.		Satisfaction - Expectations	How well does this site meet your expectations? (1=Falls Short, 10=Exceeds)			Return (1=Very Unlikely, 10=Very Likely)
	Look and Feel - Readability	Please rate the readability of the pages on this site.		Satisfaction - Ideal	How does this site compare to your idea of an ideal website? (1=Not Very Close, 10=Very Close)		Return	How likely are you to return to this site?
		Navigation (1=Poor, 10=Excellent, Don't Know)						Use Web Channel Over Others (1=Very Unlikely, 10=Very Likely)
	Navigation - Organized	Please rate how well the site is organized.					Use Web Channel Over Others	How likely are you to use this site rather than seek information from other channels (i.e. local field office, call center)?
	Navigation - Options	Please rate the options available for navigating this site.
	Navigation - Layout	Please rate how well the site layout helps you find what you are looking for.
		Site Performance (1=Poor, 10=Excellent, Don't Know)
	Site Performance - Loading	Please rate how quickly pages load on this site.
	Site Performance - Consistency	Please rate the consistency of speed from page to page on this site.
	Site Performance - Errors	Please rate the ability to load pages without getting error messages on this site.
		My Social Security Information (1=Poor, 10=Excellent, Don't Know)
	My Social Security Information - Thoroughness	Please rate the thoroughness of information you viewed on this site today.
	My Social Security Information - Quality	Please rate the quality of information you viewed today.
	My Social Security Information - Provided Answers	Please rate how well the information viewed today provided answers to your questions.
		Plain Language (1=Poor, 10=Excellent, Don't Know)
	Plain Language - Clear	Please rate the clarity of the wording on this site.
	Plain Language - Understandable	Please rate how well you understand the wording on this site.
	Plain Language - Concise	Please rate this site on its use of short, clear sentences.