30688 Q_SSA-mySSA_Web_AccountManagement_11_20_18_DOT

E-Government Website Customer Satisfaction Surveys

Q_SSA-mySSA_Web_AccountManagement_11_20_18_DOT.xlsx

Mapping and Questionnaire Documents IA 30688 A4 (SSA)

OMB: 1090-0008

Document [xlsx]
Download: xlsx | pdf

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


Sheet 1: Guidelines

SSA My Social Security v2










































Partitioned Yes
Questionnaire Management Guidelines










































Goals:




















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



















Questionnaire always matches the live survey



















Easy and error-free way to submit CQ changes



















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



































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


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

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.








































































































































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