Form Q_PbgcCsat_Web_Bro Q_PbgcCsat_Web_Browse_2018040610_DOT

E-Government Website Customer Satisfaction Surveys

Q_PbgcCsat_Web_Browse_2018040610_DOT.xlsx

Mapping and Questionnaire Documents IA 30829 A0 (DOJ)

OMB: 1090-0008

Document [xlsx]
Download: xlsx | pdf

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)


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.











































































































































































































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?






























































































































































































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

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

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

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

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


















































































































































































































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

















































































































































































































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