Form 30731 Q_PbgcCsat_Web_Browse_2018040610_DOT

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Overview

Welcome and Thank You Text
Current Model Qsts
Current CQs
CQs (4-10-18)
CQs (12-7-17)
CQs (4-24-17)
CQs (10-20-15x2)
CQs (10-20-15)
CQ 10.02.15 edits for DOT
CQ 1.28.15 edits for DOT (2-5)
CQs 8.18.14 edits for DOT
CQs 10-17-13
Custom Qsts (10-17-13)
Custom Qsts (8-2-13)

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Sheet 1: Welcome and Thank You Text

Model Instance Name:
PBGC - Customer Satisfaction v2
MID:	lUx1IFIhgp5YEpxx5JlVIw==
Date:	4/19/2013
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
	The U.S. Pension Benefit Guaranty Corporation has three overarching goals to: • Preserve plans and protect pensioners, • Pay pension benefits on time and accurately, and • Maintain high standards of stewardship and accountability. We want your feedback to help us determine how we are meeting our goals as an agency.
					Thank You Text Example
	Thank You Text
	Thank you for taking our survey - and for helping us serve you better. Pursuant to 29 U.S.C. § 1302(b)(4), PBGC is authorized to collect the following personally identifiable information: name, telephone, number, and email address. PBGC is collecting this information for the sole purpose of contacting you to follow up on your responses to the survey questions, as you are requesting. This information will be used by PBGC personnel. Furnishing this information is voluntary and will not impact other business you may have with PBGC. The data will be maintained on our secure server.

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Sheet 2: Current Model Qsts

Model Instance Name:
PBGC - Customer Satisfaction V2
MID:		lohcdxZpY48xEgEE58c8pA==
Partitioned (Y/N)?		NO
Date:		4/19/2013
\
Model questions utilize the ACSI methodology to determine scores and impacts
		ELEMENTS (drivers of satisfaction)			CUSTOMER SATISFACTION			FUTURE BEHAVIORS
	MQ Label			MQ Label			MQ Label
		Agency Information (1=Poor, 10=Excellent, Don't Know)			Satisfaction			Goal Accomplishment Index (1=Strongly Disagree, 10=Strongly Agree)
1	Agency Information - Thoroughness	Thinking about the agency as a whole, please rate your perception of the thoroughness of the information that the PBGC provides.	6	Satisfaction - Overall	What is your overall satisfaction with the PBGC agency? (1=Very Dissatisfied, 10=Very Satisfied)	9	Goal Accomplishment - Mission	Please indicate how much you agree or disagree with the following statements. The PBGC carries out its mission to protect pensions.
2	Agency Information - Understandable	Please rate how understandable you find the information that the PBGC provides.	7	Satisfaction - Expectations	How well does the PBGC meet your expectations? (1=Falls Short, 10=Exceeds)	10	Goal Accomplishment - Responsibility	The PBGC shows that it takes responsibility for preserving pension plans.
3	Agency Information - Answers	Please rate how well the agency's information provides answers to your questions.	8	Satisfaction - Ideal	How does the PBGC compare to your idea of an ideal federal agency? (1=Not Very Close, 10=Very Close)	11	Goal Accomplishment - Preserve	The PBGC efficiently preserves pension plans.
		Agency Services (1=Poor, 10=Excellent, Don't Know)				12	Goal Accomplishment - Protect	The PBGC protects pensioners effectively.
4	Agency Services - Provision	Thinking about the agency's services as a whole, please rate the extent to which the PBGC provides needed services.						Trust (1=Strongly Disagree, 10=Strongly Agree)
5	Agency Services - Range	Please rate your perception of the range of services offered by the PBGC.				13	Trust - Best Interests	I can count on this agency to act in my best interests.
						14	Trust - Trustworthy	I consider this agency to be trustworthy.
							15	Trust - Do Right	This agency can be trusted to do what is right.
									Brand Confidence (1=Not At All Confident, 10=Very Confident)
							17	Brand Confidence	How confident are you that your future interactions with the PBGC will meet your needs?

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Sheet 3: Current CQs

Model Instance Name:			red & strike-through: DELETE
PBGC - Customer Satisfaction V2			underlined & italicized: RE-ORDER
MID: lohcdxZpY48xEgEE58c8pA==			pink: ADDITION
Date:	10.19.2015		blue + -->: REWORDING
PBGC - Customer Satisfaction V2 CUSTOM QUESTION LIST
QID	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
LON0035494		About how often do you interact with the PBGC?	This is my first interaction		Radio button, one-up vertical	S	Y		Frequency
			At least monthly
			A few times a year
			Once a year or less
LNH4533		Which best describes you?	Worker		Radio button, one-up vertical	S	Y	Skip Logic Group	Best Describes
			Retiree
			Disabled Worker or Retiree
			Widow(er) or spouse or beneficiary
			Other family member, friend, or power of attorney
			Practitioner or pension professional
			Media or press representative
			Congressional or regulatory researcher
			Trade association or business organization
			Job seeker
			Student
			Other (please specify)	A
LNH4534	A	Other - best describes you:			Text area, no char limit	S	N		Other Best Describes
LNH4535		What is your primary interest in PBGC?	To learn if my pension plan is insured or covered by the PBGC		Radio button, one-up vertical	S	Y	Skip Logic Group	Primary Interest
			To learn what to expect if PBGC takes over my pension plan
			To better understand the extent to which my benefits (pension, health care, etc.) are insured
			To find out if I am entitled to a benefit (unclaimed pension, not listed in a plan, etc.)
			To learn more about the Annual Funding Notice I received
			To check or update my personal information
			To get an estimate of my benefit
			To file a premium
			To submit a standard termination
			To submit a distress termination
			To submit a reportable event
			To obtain interest rates
			To look for a job
			To learn more about PBGC's mission to protect pensions
			Other (please specify)	A
LNH4536	A	Please specify your primary interest in PBGC.			Text area, no char limit	S	N	Skip Logic Group	OE_Primary Interest
HAR0040602		Did you get the information you were looking for from PBGC?	Yes		Radio button, one-up vertical	S	Y	Skip Logic Group	Did You Find
			No	A
HAR0040526	A	What information were you looking for?			Text area, no char limit	S	N	Skip Logic Group	OE_What Looking For
LON0035495		Is the wording used by this agency easy to understand?	Yes		Radio button, one-up vertical	S	Y		Agency Wording
			No
LNH4537		As an agency, what could PBGC do differently to better meet your needs?			Text area, no char limit	S	N		Better Meet Needs
LNH4538		PBGC wants to ensure we are providing you with excellent customer service. If you have a particular issue you need help with we want to hear from you. Please indicate that you would like to be contacted and provide us with the best way to reach you. Please note: This survey is anonymous unless you provide contact information.	Yes, please contact me by phone	A, C, D, E	Radio button, one-up vertical	S	Y	Skip Logic Group	Contact
			Yes, please contact me by email	A, B, F
			Yes, you can contact me by either phone or email	A, B, C, D, E
			No, no contact is needed
LNH4539	A	This survey is anonymous unless you provide contact information. If you would like a PBGC representative to contact you, please provide the following: Name: (First/Last Name)			Text field, <100 char	S	Y		Name
LNH4540	B	Email: (e.g. ,[email protected])			Text field, <100 char	S	Y		Email
LNH4541	C	Telephone: (e.g. ,555-555-5555)			Text field, <100 char	S	Y		Telephone
RUS0222725	D	Best weekday(s) to be reached:	Monday		Checkbox, one-up vertical	Multi	Y		Best Day to Reach
			Tuesday
			Wednesday
			Thursday
			Friday
RUS0222726	E	Best time(s) to be reached:	9 - 10 AM (ET)		Checkbox, one-up vertical	Multi	Y		Best hour to Reach
			10 - 11 AM (ET)
			11 - 12 PM (ET)
			12 - 1 PM (ET)
			1 - 2 PM (ET)
			2 - 3 PM (ET)
			3 - 4 PM (ET)
			4 - 5 PM (ET)
			5 - 6 PM (ET)
LNH4544	A,B,C	Please describe what you would like PBGC to contact you about:			Text area, no char limit	S	Y		Assistance requested

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Sheet 4: CQs (4-10-18)

Model Instance Name:			red & strike-through: DELETE
PBGC - Customer Satisfaction V2			underlined & italicized: RE-ORDER
MID: lohcdxZpY48xEgEE58c8pA==			pink: ADDITION
Date:	10.19.2015		blue + -->: REWORDING
PBGC - Customer Satisfaction V2 CUSTOM QUESTION LIST
QID	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
LON0035494		About how often do you interact with the PBGC?	This is my first interaction		Radio button, one-up vertical	S	Y		Frequency
			At least monthly
			A few times a year
			Once a year or less
LNH4533		Which best describes you?	Worker		Radio button, one-up vertical	S	Y	Skip Logic Group	Best Describes
			Retiree
			Disabled Worker or Retiree
			Widow(er) or spouse or beneficiary
			Other family member, friend, or power of attorney
			Practitioner or pension professional
			Media or press representative
			Congressional or regulatory researcher
			Trade association or business organization
			Job seeker
			Student
			Other (please specify)	A
LNH4534	A	Other - best describes you:			Text area, no char limit	S	N		Other Best Describes
LNH4535		What is your primary interest in PBGC?	To learn if my pension plan is insured or covered by the PBGC		Radio button, one-up vertical	S	Y	Skip Logic Group	Primary Interest
			To learn what to expect if PBGC takes over my pension plan
			To better understand the extent to which my benefits (pension, health care, etc.) are insured
			To find out if I am entitled to a benefit (unclaimed pension, not listed in a plan, etc.)
			To learn more about the Annual Funding Notice I received
			To check or update my personal information
			To get an estimate of my benefit
			To file a premium
			To submit a standard termination
			To submit a distress termination
			To submit a reportable event
			To obtain interest rates
			To look for a job
			To learn more about PBGC's mission to protect pensions
			Other (please specify)	A
LNH4536	A	Please specify your primary interest in PBGC.			Text area, no char limit	S	N	Skip Logic Group	OE_Primary Interest
HAR0040602		Did you get the information you were looking for from PBGC?	Yes		Radio button, one-up vertical	S	Y	Skip Logic Group	Did You Find
			No	A
HAR0040526	A	What information were you looking for?			Text area, no char limit	S	N	Skip Logic Group	OE_What Looking For
LON0035495		Is the wording used by this agency easy to understand?	Yes		Radio button, one-up vertical	S	Y		Agency Wording
			No
LNH4537		As an agency, what could PBGC do differently to better meet your needs?			Text area, no char limit	S	N		Better Meet Needs
LNH4538		PBGC wants to ensure we are providing you with excellent customer service. If you have a particular issue you need help with we want to hear from you. Please indicate that you would like to be contacted and provide us with the best way to reach you. Please note: This survey is anonymous unless you provide contact information.	Yes, please contact me by phone	A, C, D, E	Radio button, one-up vertical	S	Y	Skip Logic Group	Contact
			Yes, please contact me by email	A, B, F
			Yes, you can contact me by either phone or email	A, B, C, D, E
			No, no contact is needed
LNH4539	A	This survey is anonymous unless you provide contact information. If you would like a PBGC representative to contact you, please provide the following: Name: (First/Last Name)			Text field, <100 char	S	Y		Name
LNH4540	B	Email: (e.g. ,[email protected])			Text field, <100 char	S	Y		Email
LNH4541	C	Telephone: (e.g. ,555-555-5555)			Text field, <100 char	S	Y		Telephone
LNH4542	D	Best weekday to be reached:	Monday		Drop down, select one	S	Y		Best Day to Reach
			Tuesday
			Wednesday
			Thursday
			Friday
	D	Best weekday(s) to be reached:	Monday		Checkbox, one-up vertical	Multi	Y		Best Day to Reach
			Tuesday
			Wednesday
			Thursday
			Friday
LNH4543	E	Best time to be reached:	9 - 10 AM (EST)		Drop down, select one	S	Y		Best hour to Reach
			10 - 11 AM (EST)
			11 - 12 PM (EST)
			12 - 1 PM (EST)
			1 - 2 PM (EST)
			2 - 3 PM (EST)
			3 - 4 PM (EST)
			4 - 5 PM (EST)
			5 - 6 PM (EST)
	E	Best time(s) to be reached:	9 - 10 AM (ET)		Checkbox, one-up vertical	Multi	Y		Best hour to Reach
			10 - 11 AM (ET)
			11 - 12 PM (ET)
			12 - 1 PM (ET)
			1 - 2 PM (ET)
			2 - 3 PM (ET)
			3 - 4 PM (ET)
			4 - 5 PM (ET)
			5 - 6 PM (ET)
LNH4544	A,B,C	Please describe what you would like PBGC to contact you about:			Text area, no char limit	S	Y		Assistance requested

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Sheet 5: CQs (12-7-17)

Model Instance Name:			red & strike-through: DELETE
PBGC - Customer Satisfaction V2			underlined & italicized: RE-ORDER
MID: lohcdxZpY48xEgEE58c8pA==			pink: ADDITION
Date:	10.19.2015		blue + -->: REWORDING
PBGC - Customer Satisfaction V2 CUSTOM QUESTION LIST
QID	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
LON0035494		About how often do you interact with the PBGC?	This is my first interaction		Radio button, one-up vertical	S	Y		Frequency
			At least monthly
			A few times a year
			Once a year or less
LNH4533		Which best describes you?	Worker		Radio button, one-up vertical	S	Y	Skip Logic Group	Best Describes
			Retiree
			Disabled Worker or Retiree
			Widow(er) or spouse or beneficiary
			Other family member, friend, or power of attorney
			Practitioner or pension professional
			Media or press representative
			Congressional or regulatory researcher
			Trade association or business organization
			Job seeker
			Student
			Other (please specify)	A
LNH4534	A	Other - best describes you:			Text area, no char limit	S	N		Other Best Describes
LNH4535		What is your primary interest in PBGC?	To learn if my pension plan is insured or covered by the PBGC		Radio button, one-up vertical	S	Y	Skip Logic Group	Primary Interest
			To learn what to expect if PBGC takes over my pension plan
			To better understand the extent to which my benefits (pension, health care, etc.) are insured
			To find out if I am entitled to a benefit (unclaimed pension, not listed in a plan, etc.)
			To learn more about the Annual Funding Notice I received
			To check or update my personal information
			To get an estimate of my benefit
			To file a premium
			To submit a standard termination
			To submit a distress termination
			To submit a reportable event
			To obtain interest rates
			To look for a job
			To learn more about PBGC's mission to protect pensions
			Other (please specify)	A
LNH4536	A	Please specify your primary interest in PBGC.			Text area, no char limit	S	N	Skip Logic Group	OE_Primary Interest
HAR0040602		Did you get the information you were looking for from PBGC?	Yes		Radio button, one-up vertical	S	Y	Skip Logic Group	Did You Find
			No	A
HAR0040526	A	What information were you looking for?			Text area, no char limit	S	N	Skip Logic Group	OE_What Looking For
LON0035495		Is the wording used by this agency easy to understand?	Yes		Radio button, one-up vertical	S	Y		Agency Wording
			No
LNH4537		As an agency, what could PBGC do differently to better meet your needs?			Text area, no char limit	S	N		Better Meet Needs
KAU0158933		PBGC recently redesigned its website to improve service to you. We would like to hear your thoughts and opinions on the new look.	I have feedback on the new look	Z	Radio button, one-up vertical	S	Y	Skip Logic Group	Noticed Changes
			I did not notice changes to the site
KAU0158934	Z	Please share your feedback on the new look of PBGC’s website.			Text area, no char limit		N	Skip Logic Group	Feedback on change
LNH4538		PBGC wants to ensure we are providing you with excellent customer service. If you have a particular issue you need help with we want to hear from you. Please indicate that you would like to be contacted and provide us with the best way to reach you. Please note: This survey is anonymous unless you provide contact information.	Yes, please contact me by phone	A, C, D, E	Radio button, one-up vertical	S	Y	Skip Logic Group	Contact
			Yes, please contact me by email	A, B, F
			Yes, you can contact me by either phone or email	A, B, C, D, E
			No, no contact is needed
LNH4539	A	This survey is anonymous unless you provide contact information. If you would like a PBGC representative to contact you, please provide the following: Name: (First/Last Name)			Text field, <100 char	S	Y		Name
LNH4540	B	Email: (e.g. ,[email protected])			Text field, <100 char	S	Y		Email
LNH4541	C	Telephone: (e.g. ,555-555-5555)			Text field, <100 char	S	Y		Telephone
LNH4542	D	Best weekday to be reached:	Monday		Drop down, select one	S	Y		Best Day to Reach
			Tuesday
			Wednesday
			Thursday
			Friday
LNH4543	E	Best time to be reached:	9 - 10 AM (EST)		Drop down, select one	S	Y		Best hour to Reach
			10 - 11 AM (EST)
			11 - 12 PM (EST)
			12 - 1 PM (EST)
			1 - 2 PM (EST)
			2 - 3 PM (EST)
			3 - 4 PM (EST)
			4 - 5 PM (EST)
			5 - 6 PM (EST)
LNH4544	A,B,C	Please describe what you would like PBGC to contact you about:			Text area, no char limit	S	Y		Assistance requested

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Sheet 6: CQs (4-24-17)

Model Instance Name:			red & strike-through: DELETE
PBGC - Customer Satisfaction V2			underlined & italicized: RE-ORDER
MID: lohcdxZpY48xEgEE58c8pA==			pink: ADDITION
Date:	10.19.2015		blue + -->: REWORDING
PBGC - Customer Satisfaction V2 CUSTOM QUESTION LIST
QID	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
LON0035494		About how often do you interact with the PBGC?	This is my first interaction		Radio button, one-up vertical	S	Y		Frequency
			At least monthly
			A few times a year
			Once a year or less
LNH4533		Which best describes you?	Worker		Radio button, one-up vertical	S	Y	Skip Logic Group	Best Describes
			Retiree
			Disabled Worker or Retiree
			Widow(er) or spouse or beneficiary
			Other family member, friend, or power of attorney
			Practitioner or pension professional
			Media or press representative
			Congressional or regulatory researcher
			Trade association or business organization
			Job seeker
			Student
			Other (please specify)	A
LNH4534	A	Other - best describes you:			Text area, no char limit	S	N		Other Best Describes
LNH4535		What is your primary interest in PBGC?	To learn if my pension plan is insured or covered by the PBGC		Radio button, one-up vertical	S	Y	Skip Logic Group	Primary Interest
			To learn what to expect if PBGC takes over my pension plan
			To better understand the extent to which my benefits (pension, health care, etc.) are insured
			To find out if I am entitled to a benefit (unclaimed pension, not listed in a plan, etc.)
			To learn more about the Annual Funding Notice I received
			To check or update my personal information
			To get an estimate of my benefit
			To file a premium
			To submit a standard termination
			To submit a distress termination
			To submit a reportable event
			To obtain interest rates
			To look for a job
			To learn more about PBGC's mission to protect pensions
			Other (please specify)	A
LNH4536	A	Please specify your primary interest in PBGC.			Text area, no char limit	S	N	Skip Logic Group	OE_Primary Interest
HAR0040602		Did you get the information you were looking for from PBGC?	Yes		Radio button, one-up vertical	S	Y	Skip Logic Group	Did You Find
			No	A
HAR0040526	A	What information were you looking for?			Text area, no char limit	S	N	Skip Logic Group	OE_What Looking For
LON0035495		Is the wording used by this agency easy to understand?	Yes		Radio button, one-up vertical	S	Y		Agency Wording
			No
LNH4537		As an agency, what could PBGC do differently to better meet your needs?			Text area, no char limit	S	N		Better Meet Needs
		PBGC recently redesigned its website to improve service to you. We would like to hear your thoughts and opinions on the new look.	I have feedback on the new look	Z	Radio button, one-up vertical	S	Y	Skip Logic Group	Noticed Changes
			I did not notice changes to the site
	Z	Please share your feedback on the new look of PBGC’s website.			Text area, no char limit		N	Skip Logic Group	Feedback on change
LNH4538		PBGC wants to ensure we are providing you with excellent customer service. If you have a particular issue you need help with we want to hear from you. Please indicate that you would like to be contacted and provide us with the best way to reach you. Please note: This survey is anonymous unless you provide contact information.	Yes, please contact me by phone	A, C, D, E	Radio button, one-up vertical	S	Y	Skip Logic Group	Contact
			Yes, please contact me by email	A, B, F
			Yes, you can contact me by either phone or email	A, B, C, D, E
			No, no contact is needed
LNH4539	A	This survey is anonymous unless you provide contact information. If you would like a PBGC representative to contact you, please provide the following: Name: (First/Last Name)			Text field, <100 char	S	Y		Name
LNH4540	B	Email: (e.g. ,[email protected])			Text field, <100 char	S	Y		Email
LNH4541	C	Telephone: (e.g. ,555-555-5555)			Text field, <100 char	S	Y		Telephone
LNH4542	D	Best weekday to be reached:	Monday		Drop down, select one	S	Y		Best Day to Reach
			Tuesday
			Wednesday
			Thursday
			Friday
LNH4543	E	Best time to be reached:	9 - 10 AM (EST)		Drop down, select one	S	Y		Best hour to Reach
			10 - 11 AM (EST)
			11 - 12 PM (EST)
			12 - 1 PM (EST)
			1 - 2 PM (EST)
			2 - 3 PM (EST)
			3 - 4 PM (EST)
			4 - 5 PM (EST)
			5 - 6 PM (EST)
LNH4544	A,B,C	Please describe what you would like PBGC to contact you about:			Text area, no char limit	S	Y		Assistance requested

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Sheet 7: CQs (10-20-15x2)

Model Instance Name:			red & strike-through: DELETE
PBGC - Customer Satisfaction V2			underlined & italicized: RE-ORDER
MID: lohcdxZpY48xEgEE58c8pA==			pink: ADDITION
Date:	10.19.2015		blue + -->: REWORDING
PBGC - Customer Satisfaction V2 CUSTOM QUESTION LIST
QID	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
STE0095513		Did you successfully log in to your MyPBA account today?	Yes		Radio button, one-up vertical	S	Y		Login
			No, I did not try to log in
			No, I tried to log in but could not
			Don’t know
LON0035494		About how often do you interact with the PBGC?	This is my first interaction		Radio button, one-up vertical	S	Y		Frequency
			At least monthly
			A few times a year
			Once a year or less
LNH4533		Which best describes you?	Worker		Radio button, one-up vertical	S	Y	Skip Logic Group	Best Describes
			Retiree
			Disabled Worker or Retiree
			Widow(er) or spouse or beneficiary
			Other family member, friend, or power of attorney
			Practitioner or pension professional
			Media or press representative
			Congressional or regulatory researcher
			Trade association or business organization
			Job seeker
			Student
			Other (please specify)	A
LNH4534	A	Other - best describes you:			Text area, no char limit	S	N		Other Best Describes
LNH4535		What is your primary interest in PBGC?	To learn if my pension plan is insured or covered by the PBGC		Radio button, one-up vertical	S	Y	Skip Logic Group	Primary Interest
			To learn what to expect if PBGC takes over my pension plan
			To better understand the extent to which my benefits (pension, health care, etc.) are insured
			To find out if I am entitled to a benefit (unclaimed pension, not listed in a plan, etc.)
			To learn more about the Annual Funding Notice I received
			To check or update my personal information
			To get an estimate of my benefit
			To file a premium
			To submit a standard termination
			To submit a distress termination
			To submit a reportable event
			To obtain interest rates
			To look for a job
			To learn more about PBGC's mission to protect pensions
			Other (please specify)	A
LNH4536	A	Please specify your primary interest in PBGC.			Text area, no char limit	S	N	Skip Logic Group	OE_Primary Interest
HAR0040602		Did you get the information you were looking for from PBGC?	Yes		Radio button, one-up vertical	S	Y	Skip Logic Group	Did You Find
			No	A
HAR0040526	A	What information were you looking for?			Text area, no char limit	S	N	Skip Logic Group	OE_What Looking For
LON0035495		Is the wording used by this agency easy to understand?	Yes		Radio button, one-up vertical	S	Y		Agency Wording
			No
LNH4537		As an agency, what could PBGC do differently to better meet your needs?			Text area, no char limit	S	N		Better Meet Needs
LNH4538		PBGC wants to ensure we are providing you with excellent customer service. If you have a particular issue you need help with we want to hear from you. Please indicate that you would like to be contacted and provide us with the best way to reach you. Please note: This survey is anonymous unless you provide contact information.	Yes, please contact me by phone	A, C, D, E	Radio button, one-up vertical	S	Y	Skip Logic Group	Contact
			Yes, please contact me by email	A, B, F
			Yes, you can contact me by either phone or email	A, B, C, D, E
			No, no contact is needed
LNH4539	A	This survey is anonymous unless you provide contact information. If you would like a PBGC representative to contact you, please provide the following: Name: (First/Last Name)			Text field, <100 char	S	Y		Name
LNH4540	B	Email: (e.g. ,[email protected])			Text field, <100 char	S	Y		Email
LNH4541	C	Telephone: (e.g. ,555-555-5555)			Text field, <100 char	S	Y		Telephone
LNH4542	D	Best weekday to be reached:	Monday		Drop down, select one	S	Y		Best Day to Reach
			Tuesday
			Wednesday
			Thursday
			Friday
LNH4543	E	Best time to be reached:	9 - 10 AM (EST)		Drop down, select one	S	Y		Best hour to Reach
			10 - 11 AM (EST)
			11 - 12 PM (EST)
			12 - 1 PM (EST)
			1 - 2 PM (EST)
			2 - 3 PM (EST)

---

Sheet 8: CQs (10-20-15)

Model Instance Name:			red & strike-through: DELETE
PBGC - Customer Satisfaction V2			underlined & italicized: RE-ORDER
MID: lohcdxZpY48xEgEE58c8pA==			pink: ADDITION
Date:	10.19.2015		blue + -->: REWORDING
PBGC - Customer Satisfaction V2 CUSTOM QUESTION LIST
QID	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
		Did you successfully log in to your MyPBA account today?	Yes		Radio button, one-up vertical	S	Y		Login
			No, I did not try to log in
			No, I tried to log in but could not
			Don’t know
LON0035494		About how often do you interact with the PBGC?	This is my first interaction		Radio button, one-up vertical	S	Y		Frequency
			At least monthly
			A few times a year
			Once a year or less
LNH4533		Which best describes you?	Worker		Radio button, one-up vertical	S	Y	Skip Logic Group	Best Describes
			Retiree
			Disabled Worker or Retiree
			Widow(er) or spouse or beneficiary
			Other family member, friend, or power of attorney
			Practitioner or pension professional
			Media or press representative
			Congressional or regulatory researcher
			Trade association or business organization
			Job seeker
			Student
			Other (please specify)	A
LNH4534	A	Other - best describes you:			Text area, no char limit	S	N		Other Best Describes
LNH4535		What is your primary interest in PBGC?	To learn if my pension plan is insured or covered by the PBGC		Radio button, one-up vertical	S	Y	Skip Logic Group	Primary Interest
			To learn what to expect if PBGC takes over my pension plan
			To better understand the extent to which my benefits (pension, health care, etc.) are insured
			To find out if I am entitled to a benefit (unclaimed pension, not listed in a plan, etc.)
			To learn more about the Annual Funding Notice I received
			To check or update my personal information
			To get an estimate of my benefit
			To file a premium
			To submit a standard termination
			To submit a distress termination
			To submit a reportable event
			To obtain interest rates
			To look for a job
			To learn more about PBGC's mission to protect pensions
			Other (please specify)	A
LNH4536	A	Please specify your primary interest in PBGC.			Text area, no char limit	S	N	Skip Logic Group	OE_Primary Interest
HAR0040602		Did you get the information you were looking for from PBGC?	Yes		Radio button, one-up vertical	S	Y	Skip Logic Group	Did You Find
			No	A
HAR0040526	A	What information were you looking for?			Text area, no char limit	S	N	Skip Logic Group	OE_What Looking For
LON0035495		Is the wording used by this agency easy to understand?	Yes		Radio button, one-up vertical	S	Y		Agency Wording
			No
LNH4537		As an agency, what could PBGC do differently to better meet your needs?			Text area, no char limit	S	N		Better Meet Needs
LNH4538		PBGC wants to ensure we are providing you with excellent customer service. If you have a particular issue you need help with we want to hear from you. Please indicate that you would like to be contacted and provide us with the best way to reach you. Please note: This survey is anonymous unless you provide contact information.	Yes, please contact me by phone	A, C, D, E	Radio button, one-up vertical	S	Y	Skip Logic Group	Contact
			Yes, please contact me by email	A, B, F
			Yes, you can contact me by either phone or email	A, B, C, D, E
			No, no contact is needed
LNH4539	A	This survey is anonymous unless you provide contact information. If you would like a PBGC representative to contact you, please provide the following: Name: (First/Last Name)			Text field, <100 char	S	Y		Name
LNH4540	B	Email: (e.g. ,[email protected])			Text field, <100 char	S	Y		Email
LNH4541	C	Telephone: (e.g. ,555-555-5555)			Text field, <100 char	S	Y		Telephone
LNH4542	D	Best weekday to be reached:	Monday		Drop down, select one	S	Y		Best Day to Reach
			Tuesday
			Wednesday
			Thursday
			Friday
LNH4543	E	Best time to be reached:	9 - 10 AM (EST)		Drop down, select one	S	Y		Best hour to Reach
			10 - 11 AM (EST)
			11 - 12 PM (EST)
			12 - 1 PM (EST)
			1 - 2 PM (EST)
			2 - 3 PM (EST)

---

Sheet 9: CQ 10.02.15 edits for DOT

Model Instance Name:			red & strike-through: DELETE
PBGC - Customer Satisfaction V2			underlined & italicized: RE-ORDER
MID: lohcdxZpY48xEgEE58c8pA==			pink: ADDITION
Date:	9.28.15		blue + -->: REWORDING
PBGC - Customer Satisfaction V2 CUSTOM QUESTION LIST
QID	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
LON0035494		About how often do you interact with the PBGC?	This is my first interaction		Radio button, one-up vertical	S	Y		Frequency
			At least monthly
			A few times a year
			Once a year or less
LNH4533		Which best describes you?	Worker		Radio button, one-up vertical	S	Y	Skip Logic Group	Best Describes
			Retiree
			Disabled Worker or Retiree
			Widow(er) or spouse or beneficiary
			Other family member, friend, or power of attorney
			Practitioner or pension professional
			Media or press representative
			Congressional or regulatory researcher
			Trade association or business organization
			Job seeker
			Student
			Other (please specify)	A
LNH4534	A	Other - best describes you:			Text area, no char limit	S	N		Other Best Describes
LNH4535		What is your primary interest in PBGC?	To learn if my pension plan is insured or covered by the PBGC		Radio button, one-up vertical	S	Y	Skip Logic Group	Primary Interest
			To learn what to expect if PBGC takes over my pension plan
			To better understand the extent to which my benefits (pension, health care, etc.) are insured
			To find out if I am entitled to a benefit (unclaimed pension, not listed in a plan, etc.)
			To learn more about the Annual Funding Notice I received
			To check or update my personal information
			To get an estimate of my benefit
			To file a premium
			To submit a standard termination
			To submit a distress termination
			To submit a reportable event
			To obtain interest rates
			To look for a job
			To learn more about PBGC's mission to protect pensions
			Other (please specify)	A
LNH4536	A	Please specify your primary interest in PBGC.			Text area, no char limit	S	N	Skip Logic Group	OE_Primary Interest
HAR0040602		Did you get the information you were looking for from PBGC?	Yes		Radio button, one-up vertical	S	Y	Skip Logic Group	Did You Find
			No	A
HAR0040526	A	What information were you looking for?			Text area, no char limit	S	N	Skip Logic Group	OE_What Looking For
LON0035495		Is the wording used by this agency easy to understand?	Yes		Radio button, one-up vertical	S	Y		Agency Wording
			No
LNH4537		As an agency, what could PBGC do differently to better meet your needs?			Text area, no char limit	S	N		Better Meet Needs
LNH4538		PBGC wants to ensure we are providing you with excellent customer service. If you have a particular issue you need help with we want to hear from you. Please indicate that you would like to be contacted and provide us with the best way to reach you. Please note: This survey is anonymous unless you provide contact information.	Yes, please contact me.		Radio button, one-up vertical	S	Y	Skip Logic Group	Contact
			Yes, please contact me by phone	A
			Yes, please contact me by email	B
			Yes, you can contact me by either phone or email	C
			No, no contact is needed.
LNH4539	A,B,C	This survey is anonymous unless you provide contact information. If you would like a PBGC representative to contact you, please provide the following: Name: (First/Last Name)			Text field, <100 char	S	Y		Name
LNH4540	B,C	Email: (e.g. [email protected])			Text field, <100 char	S	Y		Email
LNH4541	A,C	Telephone: (e.g. 555-555-5555)			Text field, <100 char	S	Y		Telephone
LNH4542	A,C	Best weekday to be reached:	Monday		Drop down, select one	S	Y		Best Day to Reach
			Tuesday
			Wednesday
			Thursday
			Friday
LNH4543	A,C	Best time to be reached:	9 - 10 AM (EST)		Drop down, select one	S	Y		Best hour to Reach
			10 - 11 AM (EST)
			11 - 12 PM (EST)
			12 - 1 PM (EST)
			1 - 2 PM (EST)
			2 - 3 PM (EST)
			3 - 4 PM (EST)
			4 - 5 PM (EST)
			5 - 6 PM (EST)
LNH4544	A,B,C	Please describe what you would like PBGC to contact you about:			Text area, no char limit	S	Y		Assistance requested

---

Sheet 10: CQ 1.28.15 edits for DOT (2-5)

Model Instance Name:			red & strike-through: DELETE
PBGC - Customer Satisfaction V2			underlined & italicized: RE-ORDER
MID: lohcdxZpY48xEgEE58c8pA==			pink: ADDITION
Date:	1.28.15		blue + -->: REWORDING
PBGC - Customer Satisfaction V2 CUSTOM QUESTION LIST
QID	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
LON0035494		About how often do you interact with the PBGC?	This is my first interaction		Radio button, one-up vertical	S	Y		Frequency
			At least monthly
			A few times a year
			Once a year or less
LNH4533		Which best describes you?	Worker		Radio button, one-up vertical	S	Y	Skip Logic Group	Best Describes
			Retiree
			Disabled Worker or Retiree
			Widow(er) or spouse or beneficiary
			Other family member, friend, or power of attorney
			Practitioner or pension professional
			Media or press representative
			Congressional or regulatory researcher
			Trade association or business organization
			Job seeker
			Student
			Other (please specify)	A
LNH4534	A	Other - best describes you:			Text area, no char limit	S	N		Other Best Describes
LNH4535		What is your primary interest in PBGC?	To learn if my pension plan is insured or covered by the PBGC		Radio button, one-up vertical	S	Y	Skip Logic Group	Primary Interest
			To learn what to expect if PBGC takes over my pension plan
			To better understand the extent to which my benefits (pension, health care, etc.) are insured
			To find out if I am entitled to a benefit (unclaimed pension, not listed in a plan, etc.)
			To learn more about the Annual Funding Notice I received
			To check or update my personal information
			To get an estimate of my benefit
			To file a premium
			To submit a standard termination
			To submit a distress termination
			To submit a reportable event
			To obtain interest rates
			To look for a job
			To learn more about PBGC's mission to protect pensions
			Other (please specify)	A
LNH4536	A	Please specify your primary interest in PBGC.			Text area, no char limit	S	N	Skip Logic Group	OE_Primary Interest
HAR0040602		Did you get the information you were looking for from PBGC?	Yes		Radio button, one-up vertical	S	Y	Skip Logic Group	Did You Find
			No	A
HAR0040526	A	What information were you looking for?			Text area, no char limit	S	N	Skip Logic Group	OE_What Looking For
LON0035495		Is the wording used by this agency easy to understand?	Yes		Radio button, one-up vertical	S	Y		Agency Wording
			No
LNH4537		As an agency, what could PBGC do differently to better meet your needs?			Text area, no char limit	S	N		Better Meet Needs
LNH4538		Would you like PBGC to contact you about your experience today?	Yes, please contact me.	A	Radio button, one-up vertical	S	Y	Skip Logic Group	Contact
			No, no contact is needed.
LNH4539	A	This survey is anonymous unless you provide contact information. If you would like a PBGC representative to contact you, please provide the following: Name: (First/Last Name)			Text field, <100 char	S	N		Name
LNH4540	A	Email: (e.g. [email protected])			Text field, <100 char	S	N		Email
LNH4541	A	Telephone: (e.g. 555-555-5555)			Text field, <100 char	S	N		Telephone
LNH4542	A	Best weekday to be reached:	Monday		Drop down, select one	S	N		Best Day to Reach
			Tuesday
			Wednesday
			Thursday
			Friday
LNH4543	A	Best time to be reached:	9 - 10 AM (EST)		Drop down, select one	S	N		Best hour to Reach
			10 - 11 AM (EST)
			11 - 12 PM (EST)
			12 - 1 PM (EST)
			1 - 2 PM (EST)
			2 - 3 PM (EST)
			3 - 4 PM (EST)
			4 - 5 PM (EST)
			5 - 6 PM (EST)
LNH4544	A	Please describe what you would like PBGC to contact you about:			Text area, no char limit	S	Y		Assistance requested

---

Sheet 11: CQs 8.18.14 edits for DOT

Model Instance Name:			red & strike-through: DELETE
PBGC - Customer Satisfaction V2			underlined & italicized: RE-ORDER
MID: lohcdxZpY48xEgEE58c8pA==			pink: ADDITION
Date:	8.18.14		blue + -->: REWORDING
PBGC - Customer Satisfaction V2 CUSTOM QUESTION LIST
QID	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
LON0035494		About how often do you interact with the PBGC?	This is my first interaction		Radio button, one-up vertical	S	Y		Frequency
			At least monthly
			A few times a year
			Once a year or less
LNH4533		Which best describes you?	Worker		Radio button, one-up vertical	S	Y	Skip Logic Group	Best Describes
			Retiree
			Disabled Worker or Retiree
			Widow(er) or spouse or beneficiary
			Other family member, friend, or power of attorney
			Practitioner or pension professional
			Media or press representative
			Congressional or regulatory researcher
			Trade association or business organization
			Job seeker
			Student
			Other (please specify)	A
LNH4534	A	Other - best describes you:			Text area, no char limit	S	N		Other Best Describes
LNH4535		What is your primary interest in PBGC?	To learn if my pension plan is insured or covered by the PBGC		Radio button, one-up vertical	S	Y	Skip Logic Group	Primary Interest
			To learn what to expect if PBGC takes over my pension plan
			To better understand the extent to which my benefits (pension, health care, etc.) are insured
			To find out if I am entitled to a benefit (unclaimed pension, not listed in a plan, etc.)
			To learn more about the Annual Funding Notice I received
			To check or update my personal information
			To get an estimate of my benefit
			To file a premium
			To submit a standard termination
			To submit a distress termination
			To submit a reportable event
			To obtain interest rates
			To look for a job
			To learn more about PBGC's mission to protect pensions
			Other (please specify)	A
LNH4536	A	Please specify your primary interest in PBGC.			Text area, no char limit	S	N	Skip Logic Group	OE_Primary Interest
HAR0040602		Did you get the information you were looking for from PBGC?	Yes		Radio button, one-up vertical	S	Y	Skip Logic Group	Did You Find
			No	A
HAR0040526	A	What information were you looking for?			Text area, no char limit	S	N	Skip Logic Group	OE_What Looking For
LON0035495		Is the wording used by this agency easy to understand?	Yes		Radio button, one-up vertical	S	Y		Agency Wording
			No
LNH4537		As an agency, what could PBGC do differently to better meet your needs?			Text area, no char limit	S	N		Better Meet Needs
LNH4538		Would you like PBGC to contact you about your experience today?	Yes, please contact me.	A	Radio button, one-up vertical	S	Y	Skip Logic Group	Contact
			No, no contact is needed.
LNH4539	A	Please provide the following information, and a PBGC representative will contact you. Name: (First/Last Name)			Text field, <100 char	S	N		Name
LNH4540	A	Email: (e.g. [email protected])			Text field, <100 char	S	N		Email
LNH4541	A	Telephone: (e.g. 555-555-5555)			Text field, <100 char	S	N		Telephone
LNH4542	A	Best weekday to be reached:	Monday		Drop down, select one	S	N		Best Day to Reach
			Tuesday
			Wednesday
			Thursday
			Friday
LNH4543	A	Best time to be reached:	9 - 10 AM (EST)		Drop down, select one	S	N		Best hour to Reach
			10 - 11 AM (EST)
			11 - 12 PM (EST)
			12 - 1 PM (EST)
			1 - 2 PM (EST)
			2 - 3 PM (EST)
			3 - 4 PM (EST)
			4 - 5 PM (EST)
			5 - 6 PM (EST)
LNH4544	A	Please describe what you would like PBGC to contact you about:			Text area, no char limit	S	Y		Assistance requested

---

Sheet 12: CQs 10-17-13

Model Instance Name:			red & strike-through: DELETE
PBGC - Customer Satisfaction V2			underlined & italicized: RE-ORDER
MID: lohcdxZpY48xEgEE58c8pA==			pink: ADDITION
Date:	9/21/2012		blue + -->: REWORDING
PBGC - Customer Satisfaction V2 CUSTOM QUESTION LIST
QID	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
LON0035494		About how often do you interact with the PBGC?	This is my first interaction		Radio button, one-up vertical	S	Y		Frequency
			At least monthly
			A few times a year
			Once a year or less
LNH4533		Which best describes you?	Worker		Radio button, one-up vertical	S	Y	Skip Logic Group	Best Describes
			Retiree
			Disabled Worker or Retiree
			Widow(er) or spouse or beneficiary
			Other family member, friend, or power of attorney
			Practitioner or pension professional
			Media or press representative
			Congressional or regulatory researcher
			Trade association or business organization
			Job seeker
			Student
			Other (please specify)	A
LNH4534	A	Other - best describes you:			Text area, no char limit	S	N		Other Best Describes
LNH4535		What is your primary interest in PBGC?	To learn if my pension plan is insured or covered by the PBGC		Radio button, one-up vertical	S	Y	Skip Logic Group	Primary Interest
			To learn what to expect if PBGC takes over my pension plan
			To better understand the extent to which my benefits (pension, health care, etc.) are insured
			To find out if I am entitled to a benefit (unclaimed pension, not listed in a plan, etc.)
			To learn more about the Annual Funding Notice I received
			To check or update my personal information
			To get an estimate of my benefit
			To file a premium
			To submit a standard termination
			To submit a distress termination
			To submit a reportable event
			To obtain interest rates
			To look for a job
			To learn more about PBGC's mission to protect pensions
			Other (please specify)	A
LNH4536	A	Please specify your primary interest in PBGC.			Text area, no char limit	S	N	Skip Logic Group	OE_Primary Interest
HAR0040602		Did you get the information you were looking for from PBGC?	Yes		Radio button, one-up vertical	S	Y	Skip Logic Group	Did You Find
			No	A
HAR0040526	A	What information were you looking for?			Text area, no char limit	S	N	Skip Logic Group	OE_What Looking For
LON0035495		Is the wording used by this agency easy to understand?	Yes		Radio button, one-up vertical	S	Y		Agency Wording
			No
LNH4537		As an agency, what could PBGC do differently to better meet your needs?			Text area, no char limit	S	N		Better Meet Needs
LNH4538		Would you like PBGC to contact you regarding your response?	Yes	A	Radio button, one-up vertical	S	Y	Skip Logic Group	Contact
			No
LNH4539	A	Please provide the following information, and a PBGC representative will contact you. Name: (First/Last Name)			Text field, <100 char	S	N		Name
LNH4540	A	Email: (e.g. [email protected])			Text field, <100 char	S	N		Email
LNH4541	A	Telephone: (e.g. 555-555-5555)			Text field, <100 char	S	N		Telephone
LNH4542	A	Best weekday to be reached:	Monday		Drop down, select one	S	N		Best Day to Reach
			Tuesday
			Wednesday
			Thursday
			Friday
LNH4543	A	Best time to be reached:	9 - 10 AM (EST)		Drop down, select one	S	N		Best hour to Reach
			10 - 11 AM (EST)
			11 - 12 PM (EST)
			12 - 1 PM (EST)
			1 - 2 PM (EST)
			2 - 3 PM (EST)
			3 - 4 PM (EST)
			4 - 5 PM (EST)
			5 - 6 PM (EST)
LNH4544	A	What type of assistance do you need from PBGC?			Text area, no char limit	S	Y		Assistance requested

---

Sheet 13: Custom Qsts (10-17-13)

Model Instance Name:			red & strike-through: DELETE
PBGC - Customer Satisfaction V2			underlined & italicized: RE-ORDER
MID: lohcdxZpY48xEgEE58c8pA==			pink: ADDITION
Date:	9/21/2012		blue + -->: REWORDING
PBGC - Customer Satisfaction V2 CUSTOM QUESTION LIST
QID	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
LON0035494		About how often do you interact with the PBGC?	This is my first interaction		Radio button, one-up vertical	S	Y		Frequency
			At least monthly
			A few times a year
			Once a year or less
LNH4533		Which best describes you?	Worker		Radio button, one-up vertical	S	Y	Skip Logic Group	Best Describes
			Retiree
			Disabled Worker or Retiree
			Widow(er) or spouse or beneficiary
			Other family member, friend, or power of attorney
			Practitioner or pension professional
			Media or press representative
			Congressional or regulatory researcher
			Trade association or business organization
			Job seeker
			Student
			Other (please specify)	A
LNH4534	A	Other - best describes you:			Text area, no char limit	S	N		Other Best Describes
LNH4535		What is your primary interest in PBGC?	To learn if my pension plan is insured or covered by the PBGC		Radio button, one-up vertical	S	Y	Skip Logic Group	Primary Interest
			To learn what to expect if PBGC takes over my pension plan
			To better understand the extent to which my benefits (pension, health care, etc.) are insured
			To find out if I am entitled to a benefit (unclaimed pension, not listed in a plan, etc.)
			To learn more about the Annual Funding Notice I received
			To check or update my personal information
			To get an estimate of my benefit
			To file a premium
			To submit a standard termination
			To submit a distress termination
			To submit a reportable event
			To obtain interest rates
			To look for a job
			To learn more about PBGC's mission to protect pensions
			Other (please specify)	A
LNH4536	A	Please specify your primary interest in PBGC.			Text area, no char limit	S	N	Skip Logic Group	OE_Primary Interest
NEW		Did you get the information you were looking for from PBGC?	Yes		Radio button, one-up vertical	S	Y	Skip Logic Group	Did You Find
			No	A
NEW	A	What information were you looking for?			Text area, no char limit	S	N	Skip Logic Group	OE_What Looking For
LON0035495		Is the wording used by this agency easy to understand?	Yes		Radio button, one-up vertical	S	Y		Agency Wording
			No
LNH4537		As an agency, what could PBGC do differently to better meet your needs?			Text area, no char limit	S	N		Better Meet Needs
LNH4538		Would you like PBGC to contact you regarding your response?	Yes	A	Radio button, one-up vertical	S	Y	Skip Logic Group	Contact
			No
LNH4539	A	Please provide the following information, and a PBGC representative will contact you. Name: (First/Last Name)			Text field, <100 char	S	N		Name
LNH4540	A	Email: (e.g. [email protected])			Text field, <100 char	S	N		Email
LNH4541	A	Telephone: (e.g. 555-555-5555)			Text field, <100 char	S	N		Telephone
LNH4542	A	Best weekday to be reached:	Monday		Drop down, select one	S	N		Best Day to Reach
			Tuesday
			Wednesday
			Thursday
			Friday
LNH4543	A	Best time to be reached:	9 - 10 AM (EST)		Drop down, select one	S	N		Best hour to Reach
			10 - 11 AM (EST)
			11 - 12 PM (EST)
			12 - 1 PM (EST)
			1 - 2 PM (EST)
			2 - 3 PM (EST)
			3 - 4 PM (EST)
			4 - 5 PM (EST)
			5 - 6 PM (EST)
LNH4544	A	What type of assistance do you need from PBGC?			Text area, no char limit	S	Y		Assistance requested

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Sheet 14: Custom Qsts (8-2-13)

Model Instance Name:			red & strike-through: DELETE
PBGC - Customer Satisfaction V2			underlined & italicized: RE-ORDER
MID: lohcdxZpY48xEgEE58c8pA==	lUx1IFIhgp5YEpxx5JlVIw==		pink: ADDITION
Date:	9/21/2012		blue + -->: REWORDING
PBGC - Customer Satisfaction V2 CUSTOM QUESTION LIST
QID	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
NEW		About how often do you interact with the PBGC?	This is my first interaction		Radio button, one-up vertical	S	Y		Frequency
			At least monthly
			A few times a year
			Once a year or less
LNH4533		Which best describes you?	Worker		Radio button, one-up vertical	S	Y	Skip Logic Group	Best Describes
			Retiree
			Disabled Worker or Retiree
			Widow(er) or spouse or beneficiary
			Other family member, friend, or power of attorney
			Practitioner or pension professional
			Media or press representative
			Congressional or regulatory researcher
			Trade association or business organization
			Job seeker
			Student
			Other (please specify)	A
LNH4534	A	Other - best describes you:			Text area, no char limit	S	N		Other Best Describes
LNH4535		What is your primary interest in PBGC?	To learn if my pension plan is insured or covered by the PBGC		Radio button, one-up vertical	S	Y	Skip Logic Group	Primary Interest
			To learn what to expect if PBGC takes over my pension plan
			To better understand the extent to which my benefits (pension, health care, etc.) are insured
			To find out if I am entitled to a benefit (unclaimed pension, not listed in a plan, etc.)
			To learn more about the Annual Funding Notice I received
			To check or update my personal information
			To get an estimate of my benefit
			To file a premium
			To submit a standard termination
			To submit a distress termination
			To submit a reportable event
			To obtain interest rates
			To look for a job
			To learn more about PBGC's mission to protect pensions
			Other (please specify)	A
LNH4536	A	Please specify your primary interest in PBGC.			Text area, no char limit	S	N	Skip Logic Group	OE_Primary Interest
NEW		Is the wording used by this agency easy to understand?	Yes		Radio button, one-up vertical	S	Y		Agency Wording
			No
LNH4537		As an agency, what could PBGC do differently to better meet your needs?			Text area, no char limit	S	N		Better Meet Needs
LNH4538		Would you like PBGC to contact you regarding your response?	Yes	A	Radio button, one-up vertical	S	Y	Skip Logic Group	Contact
			No
LNH4539	A	Please provide the following information, and a PBGC representative will contact you. Name: (First/Last Name)			Text field, <100 char	S	N		Name
LNH4540	A	Email: (e.g. [email protected])			Text field, <100 char	S	N		Email
LNH4541	A	Telephone: (e.g. 555-555-5555)			Text field, <100 char	S	N		Telephone
LNH4542	A	Best weekday to be reached:	Monday		Drop down, select one	S	N		Best Day to Reach
			Tuesday
			Wednesday
			Thursday
			Friday
LNH4543	A	Best time to be reached:	9 - 10 AM (EST)		Drop down, select one	S	N		Best hour to Reach
			10 - 11 AM (EST)
			11 - 12 PM (EST)
			12 - 1 PM (EST)
			1 - 2 PM (EST)
			2 - 3 PM (EST)
			3 - 4 PM (EST)
			4 - 5 PM (EST)
			5 - 6 PM (EST)
LNH4544	A	What type of assistance do you need from PBGC?			Text area, no char limit	S	Y		Assistance requested