30688 SSA Mobile Innovation Questionnaire Update 10.16.14_DOT

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Overview

Welcome and Thank You Text
Model Qsts
Current CQs
CQs (10-20-14)
CQs (9-25-14)

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Sheet 1: Welcome and Thank You Text

Welcome and Thank You Text
	Welcome Text			Thank You Text
	Thank you for visiting SSA.gov. You've been randomly chosen to take part in a brief survey to let us know what we're doing well and where we can improve. Please take a few minutes to share your opinions, which are essential in helping us provide the best online experience possible.			Thank you for taking our survey - and for helping us serve you better. We appreciate your input!
	Welcome Text - Alternate			Thank You Text - Alternate
	Thank you for visiting SSA.gov. You have been randomly selected to take part in this survey that is being conducted by ForeSee on behalf of the Social Security Administration. Please take a few minutes to give us your feedback. All results are strictly confidential.			Thank you for taking our survey - and for helping us serve you better. Please note you will not receive a response from us based on your survey comments. If you would like us to contact you about your feedback, please visit the Contact Us section of our web site.

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Sheet 2: Model Qsts

Model Name		SSA Main-Mobile					Red & Strike-Through: Delete
Model ID		BkUZRJUBJdFw8Zdxl9gZ1Q4C					Underlined & Italicized: Re-order
Partitioned		No					Pink: Addition
Date		7/22/2014					Blue: Reword
	Label	Element Questions		Label	Satisfaction Questions		Label	Future Behaviors
		Look and Feel (1=Poor, 10=Excellent, Don't Know)			Satisfaction			Recommend (1=Very Unlikely, 10=Very Likely)
1	Look and Feel - Appeal	Please rate the visual appeal of this mobile site.	9	Satisfaction - Overall	What is your overall satisfaction with this mobile site? (1=Very Dissatisfied, 10=Very Satisfied)	12	Recommend	How likely are you to recommend this mobile site to someone else?
2	Look and Feel - Readability	Please rate the readability of the pages on this mobile site.	10	Satisfaction - Expectations	How well does this mobile site meet your expectations? (1=Falls Short, 10=Exceeds)			Return (1=Very Unlikely, 10=Very Likely)
		Navigation (1=Poor, 10=Excellent, Don't Know)	11	Satisfaction - Ideal	How does this site compare to your idea of an mobile website? (1=Not Very Close, 10=Very Close)	13	Return	How likely are you to return to this mobile site?
3	Navigation - Organized	Please rate how well this mobile site is organized.
4	Navigation - Options	Please rate the options available for navigating this mobile site.
		SSA Information(1=Poor, 10=Excellent, Don't Know)
5	Site Information - Thoroughness	Please rate the thoroughness of information provided on this mobile site.
6	Site Information - Answers	Please rate how well this mobile site’s information provides answers to your questions.
		Site Performance (1=Poor, 10=Excellent, Don't Know)
7	Site Performance - Loading	Please rate how quickly pages load on this mobile site.
8	Site Performance - Completeness	Please rate how completely the page content loads on this mobile site.

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Sheet 3: Current CQs

Model Name	SSA Main-Mobile				Red & Strike-Through: Delete
Model ID	BkUZRJUBJdFw8Zdxl9gZ1Q4C				Underlined & Italicized: Re-order
Partitioned	No				Pink: Addition
Date	8/13/2014				Blue: Reword
QID	Skip From	Question Text	Answer Choices	Skip To	Required Y/N	Type	Special Instructions	CQ Label
STE0068146		What is your preferred method of contact when conducting business with SSA (including personal transactions)?	Mobile device (e.g., smartphone, iPhone, Android, Blackberry, etc.)		Y	Radio button, one-up vertical	Skip Logic Group*	Preferred Channel
			Tablet
			Desktop computer
			No preferences (i.e., I use multiple devices; e.g., handheld, tablet, desktop, etc.)
			For a transaction involving my personal information, I prefer to (or often) begin with a mobile device and then complete it on my desktop
			Other (please explain)	A
STE0068147	A	What is your preferred method of contact?			N	Text area, no char limit	Skip Logic Group*	OPS_Preferred Channel
LNH5416Q002		Which role best describes you?	I am currently entitled to or receiving benefits (e.g., Social Security retirement, survivor, spouse, disability, or Supplemental Security Income benefits).		Y	Radio button, one-up vertical	OPS Group*	Role
			I am not currently entitled to or receiving benefits (e.g., Social Security retirement, survivor, spouse, disability, Medicare, or Supplemental Security Income benefits)
			I am currently applying for benefits (e.g., Social Security retirement, survivor, spouse, disability, Medicare, or Supplemental Security Income benefits)
			I am helping a relative, neighbor, friend, or other acquaintance with a Social Security matter.
			Other (please specify)	A
LNH5416Q003	A	What other role best describes you?			N	Text field, <100 char	OPS Group*	OPS_Role
LNH5416Q004		What was the primary reason for your visit today?	To obtain general information about Social Security programs and benefits		Y	Radio button, one-up vertical	OPS Group*	Primary Reason
			To plan and prepare for my future benefits (e.g., view my Online Social Security Statement, estimate my benefits, determine when to file, learn what information will be needed, etc.)
			To apply for benefits ( i.e., Social Security retirement, survivor, spouse, disability, Medicare, or Supplemental Security Income [SSI] benefits)
			To appeal an unfavorable decision I received from Social Security
			To request a benefit verification letter
			To check the status of my recently filed Social Security application
			To change my address or sign up for/update my direct deposit information
			To create a my Social Security account
			To access a my Social Security account
			To apply for, replace, or make a change to a Social Security card (e.g., request a new card, replace a lost card, change a name due to marriage, divorce or adoption, etc.)
			To obtain SSA contact information (i.e., 1-800 number, address for local SSA office, etc.)
			To request a form or publication
			Other (please specify)	A
LNH5416Q005	A	What was the other primary reason for your visit today?			N	Text field, <100 char	OPS Group*	OPS_Primary Reason
	1	Did you enter your cell phone number when creating your my Social Security account?	Yes		N	Radio button, one-up vertical	Skip Logic Group*	Enter Cell Number
			No	2
	2	Why did you not enter your cell phone number when you created your account?			N	Text field, <100 char	Skip Logic Group*	OE_Enter Cell Number
LNH5416Q006		Did you find what you were looking for or successfully complete your online transaction today?	Yes		Y	Radio button, one-up vertical	Skip Logic Group*	Accomplish Task
			Not yet, still looking	A
STE0068145	A	Please explain what prevented you from accomplishing your goal.			N	Text area, no char limit	Skip Logic Group*	OE_Why Not Accomplish
LNH5416Q009		Have you registered for a my Social Security account?	Yes	B	Y	Radio button, one-up vertical	Skip Logic Group*	Have mySSA Account
			No	A
LNH5416Q010	A	What is the main reason you have not registered for a my Social Security account?	I don’t know enough about my Social Security to make a decision.		Y	Radio button, one-up vertical	Skip Logic Group*	Why Not Have mySSA Account
			I tried to register for a my Social Security account, but was unsuccessful.
			I just learned about my Social Security and plan to register.
			I am currently trying to register
			I thought I was to register when I begin receiving benefits.
			I thought I was to register when I apply for my benefits.
			I prefer not to register for a my Social Security account.	C
			Other (please specify):	AA
LNH5416Q011	AA	Please tell us why you have not registered for a my Social Security account.			N	Text area, no char limit	Skip Logic Group*	OPS_Why Not Have mySSA Account
STE0068143	C	Why do you prefer not to register for a my Social Security account?			N	Text area, no char limit	Skip Logic Group*	OE_Why Prefer Not to Have mySSA Account
STE0068142	B	What was the primary influence in your decision to register for a my Social Security account?	The my Social Security link on the SSA Home Page		Y	Radio button, one-up vertical	Skip Logic Group*	Why Registered for mySSA
			An email from SSA
			The Social Security Statement that I received in the mail
			SSA’s Frequently Asked Questions (FAQs)
			Applying for Social Security benefits
			An SSA employee
			Other (please specify)	D
STE0068144	D	What was the primary influence in your decision to register?						OPS_Why Registered for mySSA
LNH5416Q013		What is your age?	Under 30		Y	Radio button, one-up vertical		Age
			30 to 39
			40 to 49
			50 to 54
			55 to 59
			60 to 61
			62 to 63
			64 to 65
			66 or older
			Prefer not to answer
STE0068124		Do you have any suggestions for improving the SSA mobile site or recommendations for SSA services or applications you would like to be able to access via your mobile device?			N	Text area, no char limit		OE_Improvement - New

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Sheet 4: CQs (10-20-14)

Model Name	SSA Main-Mobile				Red & Strike-Through: Delete
Model ID	BkUZRJUBJdFw8Zdxl9gZ1Q4C				Underlined & Italicized: Re-order
Partitioned	No				Pink: Addition
Date	8/13/2014				Blue: Reword
QID	Skip From	Question Text	Answer Choices	Skip To	Required Y/N	Type	Special Instructions	CQ Label
LNH5416Q001		Have you visited this mobile site before?	This is my first visit.		Y	Checkbox, one-up vertical	Mutually Exclusive	Visit Frequency
			I have visited before from a smartphone.
			I have visited before from a desktop computer.
			I have visited before from a tablet.
			I am not sure.				Mutually Exclusive
		What is your preferred method of contact when conducting business with SSA (including personal transactions)?	Mobile device (e.g., smartphone, iPhone, Android, Blackberry, etc.)		Y	Radio button, one-up vertical	Skip Logic Group*	Preferred Channel
			Tablet
			Desktop computer
			No preferences (i.e., I use multiple devices; e.g., handheld, tablet, desktop, etc.)
			For a transaction involving my personal information, I prefer to (or often) begin with a mobile device and then complete it on my desktop
			Other (please explain)	A
	A	What is your preferred method of contact?			N	Text area, no char limit	Skip Logic Group*	OPS_Preferred Channel
LNH5416Q002		Which role best describes you?	I am currently entitled to or receiving monthly Social Security benefits (e.g., Social Security retirement, survivor, spouse, disability, or Supplemental Security Income benefits).		Y	Radio button, one-up vertical	OPS Group*	Role
			I am currently entitled to or receive Medicare Only benefits.
			I am not currently entitled to or receiving Social Security benefits (e.g., Social Security retirement, survivor, spouse, disability, Medicare, or Supplemental Security Income benefits)
			I am currently in the process of applying for monthly Social Security benefits (e.g., Social Security retirement, survivor, spouse, disability, Medicare, or Supplemental Security Income benefits)
			I am helping a relative, neighbor, friend, or other acquaintance with a Social Security matter.
			I am a professional helping someone else with a Social Security matter.
			I am an employer looking for Social Security information and/or services.
			Other (please specify)	A
LNH5416Q003	A	What other role best describes you?			N	Text field, <100 char	OPS Group*	OPS_Role
LNH5416Q004		What was the primary reason for your visit today?	To learn about Social Security benefits		Y	Radio button, one-up vertical	OPS Group*	Primary Reason
			To help someone else with a Social Security matter
			To obtain general information about Social Security programs and benefits
			To plan and prepare for my future benefits (e.g., view my Online Social Security Statement, estimate my benefits, determine when to file, learn what information will be needed, etc.)
			To apply for Social Security benefits (including i.e., Social Security retirement, survivor, spouse, disability, Medicare, and or Supplemental Security Income [SSI] benefits)
			To manage the benefits I currently receive from Social Security
			To appeal an unfavorable decision I received from Social Security
			To request a benefit verification letter
			To check the status of my recently filed Social Security application
			To change my address or sign up for/update my direct deposit information
			To create a my Social Security account
			To access a my Social Security account
			To apply for, replace, or make a change to a Social Security card (e.g., request a new card, replace a lost card, change a name due to marriage, divorce or adoption, etc.)
			To find out how to apply for or replace a Social Security number or card
			To sign up for bank direct deposit or change my bank direct deposit information
			To obtain SSA contact information (i.e., 1-800 number, address for local SSA office, etc.)
			To request a form or publication
			Other (please specify)	A
LNH5416Q005	A	What was the other primary reason for your visit today?			N	Text field, <100 char	OPS Group*	OPS_Primary Reason
LNH5416Q006		Did you find what you were looking for or successfully complete your online transaction today?	Yes		Y	Radio button, one-up vertical	Skip Logic Group*	Accomplish Task
			Not yet, still looking	A
			Not looking for anything specific	A
	A	Please explain what prevented you from accomplishing your goal.			N	Text area, no char limit	Skip Logic Group*	OE_Why Not Accomplish
LNH5416Q007	A	Please select the online transaction you were attempting to complete on your mobile device or tablet (Select all that apply):	Create a my Social Security account		Y	Checkbox, one-up vertical	Skip Logic Group*	Why Not Accomplish
			Access a previously established my Social Security account
			Appeal a Social Security decision
			Apply for benefits
			Manage the benefits I currently receive (e.g. change my address or direct deposit information)
			Request a benefit verification letter
			Check my benefit and payment information
			View or download my Social Security statement
			Check the status of my pending application for Social Security benefits
			Seeking Social Security contact information (e.g., 1-800 number, address of my local Social Security office, special help desk, how to email Social Security, chat with a Social Security agent, etc.)
			Use the Retirement Estimator
			Replace a lost Social Security card
			Change a name on a Social Security card (e.g., due to marriage or divorce)
			Make an appointment with a local Social Security office
			Use one of the services provided in Business Services Online
			Other (please specify)	B
LNH5416Q008	B	Please describe the online transaction you were attempting to complete on your mobile device or tablet:			N	Text area, no char limit	Skip Logic Group*	OPS_Why Not Accomplish
LNH5416Q009		Have you registered for a my Social Security account?	Yes	B	Y	Radio button, one-up vertical	Skip Logic Group*	Have mySSA Account
			No	A
LNH5416Q010	A	What is the main reason you have not registered for a my Social Security account?	I don’t know enough about my Social Security to make a decision.		Y	Radio button, one-up vertical	Skip Logic Group*	Why Not Have mySSA Account
			I am unaware of what a my Social Security account is.
			I tried to register for a my Social Security account, but was unsuccessful.
			I just learned about my Social Security and plan to register.
			I am currently trying to register for a my Social Security account.
			I thought I was to register when I begin receiving benefits.
			I thought I was to register when I apply for my benefits.
			I prefer not to register for a my Social Security account.	C
			I do not want a my Social Security account.
			Other (please specify):	AA
LNH5416Q011	AA	Please tell us why you have not registered for a my Social Security account.			N	Text area, no char limit	Skip Logic Group*	OPS_Why Not Have mySSA Account
	C	Why do you prefer not to register for a my Social Security account?			N	Text area, no char limit	Skip Logic Group*	OE_Why Prefer Not to Have mySSA Account
	B	What was the primary influence in your decision to register for a my Social Security account?	The my Social Security link on the SSA Home Page		Y	Radio button, one-up vertical	Skip Logic Group*	Why Registered for mySSA
			An email from SSA
			The Social Security Statement that I received in the mail
			SSA’s Frequently Asked Questions (FAQs)
			Applying for Social Security benefits
			An SSA employee
			Other (please specify)	D
	D	What was the primary influence in your decision to register?						OPS_Why Registered for mySSA
LNH5416Q012		Do you have any suggestions regarding online services or applications you would like to see SSA make available on a mobile device or tablet?			N	Text area, no char limit		Services Want to Access
LNH5416Q013		What is your age?	Under 30		Y	Radio button, one-up vertical		Age
			30 to 39
			40 to 49
			50 to 54
			55 to 59
			60 to 61
			62 to 63
			64 to 65
			66 or older
			Under 25
			25-39
			40-59
			60-63
			64-65
			66-67
			68 or older
			Prefer not to answer
LNH5416Q014		Do you have any suggestions for improving the services SSA offers via a mobile device?			N	Text area, no char limit		OE_Improvement
		Do you have any suggestions for improving the SSA mobile site or recommendations for SSA services or applications you would like to be able to access via your mobile device?			N	Text area, no char limit		OE_Improvement - New

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Sheet 5: CQs (9-25-14)

Model Name	SSA Main-Mobile				Red & Strike-Through: Delete
Model ID	BkUZRJUBJdFw8Zdxl9gZ1Q4C				Underlined & Italicized: Re-order
Partitioned	No				Pink: Addition
Date	8/13/2014				Blue: Reword
QID	Skip From	Question Text	Answer Choices	Skip To	Required Y/N	Type	Special Instructions	CQ Label
LNH5416Q001		Have you visited this mobile site before?	This is my first visit.		Y	Checkbox, one-up vertical	Mutually Exclusive	Visit Frequency
			I have visited before from a smartphone.
			I have visited before from a desktop computer.
			I have visited before from a tablet.
			I am not sure.				Mutually Exclusive
LNH5416Q002		Which role best describes you?	I am currently entitled to or receive monthly Social Security benefits (e.g., retirement, survivor, spouse, disability, or Supplemental Security Income benefits).		Y	Radio button, one-up vertical	OPS Group*	Role
			I am currently entitled to or receive Medicare Only benefits.
			I do not currently receive Social Security benefits (e.g. retirement, survivor, spouse, disability, Medicare, or Supplemental Security Income benefits)
			I am currently in the process of applying for monthly Social Security benefits (e.g. retirement, survivor, spouse, disability, Medicare, or Supplemental Security Income benefits)
			I am a professional helping someone else with a Social Security matter.
			I am an employer looking for Social Security information and/or services.
			Other (please specify)	A
LNH5416Q003	A	What other role best describes you?			N	Text field, <100 char	OPS Group*	OPS_Role
LNH5416Q004		What was the primary reason for your visit today?	To learn about Social Security benefits		Y	Radio button, one-up vertical	OPS Group*	Primary Reason
			To help someone else with a Social Security matter
			To plan for my future benefits (e.g., view my Social Security Statement, estimate my benefits, determine when to file, learn what information will be needed, etc.)
			To apply for Social Security benefits (including retirement, survivor, spouse, disability, Medicare, and Supplemental Security Income [SSI] benefits)
			To manage the benefits I currently receive from Social Security
			To check the status of my recently filed Social Security application
			To find out how to apply for or replace a Social Security number or card
			To change my address
			To sign up for bank direct deposit or change my bank direct deposit information
			To obtain SSA contact information (i.e., 1-800 number, address for local SSA office, etc.)
			To request a form or publication
			Other (please specify)	A
LNH5416Q005	A	What was the other primary reason for your visit today?			N	Text field, <100 char	OPS Group*	OPS_Primary Reason
LNH5416Q006		Did you find what you were looking for or successfully complete your online transaction today?	Yes		Y	Radio button, one-up vertical	Skip Logic Group*	Accomplish Task
			Not yet, still looking	A
			Not looking for anything specific
LNH5416Q007	A	Please select the online transaction you were attempting to complete on your mobile device or tablet (Select all that apply):	Create a my Social Security account		Y	Checkbox, one-up vertical	Skip Logic Group*	Why Not Accomplsih
			Access a previously established my Social Security account
			Appeal a Social Security descision
			Apply for benefits
			Manage the benefits I currently receive (e.g. change my address or direct deposit information)
			Request a benefit verfication letter
			Check my benefit and payment information
			View or download my Social Security statement
			Check the status of my pending application for Social Security benefits
			Seeking Social Security contact informaiton (e.g., 1-800 number, address of my local Social Security office, special help desk, how to email Social Security, chat with a Social Security agent, etc.)
			Use the Retirement Estimator
			Replace a lost Social Security card
			Change a name on a Social Security card (e.g., due to marriage or divorce)
			Make an appointment with a local Social Security office
			Use one of the services provided in Business Services Online
			Other (please specify)	B
LNH5416Q008	B	Please describe the online transaction you were attempting to complete on your mobile device or tablet:			N	Text area, no char limit	Skip Logic Group*	OPS_Why Not Accomplish
LNH5416Q009		Have you registered for a my Social Security account?	Yes		Y	Radio button, one-up vertical	Skip Logic Group*	Have mySSA Account
			No	A
LNH5416Q010	A	What is the main reason you have not registered for a my Social Security account?	I am unaware of what a my Social Security account is.		Y	Radio button, one-up vertical	Skip Logic Group*	Why Not Have mySSA Account
			I tried to register for a my Social Security account, but was unsuccessful.
			I am currently trying to register for a my Social Security account.
			I do not want a my Social Security account.
			Other (please specify):	AA
LNH5416Q011	AA	Please tell us why you have not registered for a my Social Security account.			N	Text area, no char limit	Skip Logic Group*	OPS_Why Not Have mySSA Account
LNH5416Q012		Do you have any suggestions regarding online services or applications you would like to see SSA make available on a mobile device or tablet?			N	Text area, no char limit		Services Want to Access
LNH5416Q013		What is your age?	Under 25		Y	Radio button, one-up vertical		Age
			25-39
			40-59
			60-63
			64-65
			66-67
			68 or older
			Prefer not to answer
LNH5416Q014		Do you have any suggestions for improving the services SSA offers via a mobile device?			N	Text area, no char limit		OE_Improvement