Form 234 2019 234 Q_SSA-mySSA_Web_AccountManagement_JULY 2019
E-Government Website Customer Satisfaction Surveys
2019 234 Q_SSA-mySSA_Web_AccountManagement_JULY 2019.xlsx
2019 234 Q_SSA-mySSA_Web_AccountManagement_JULY 2019
OMB: 1090-0008
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1090-0008 can be found here:
Document [xlsx]
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Welcome and Thank You Text
Current CQs
v2 Model Qsts
Overview
GuidelinesWelcome and Thank You Text
Current CQs
v2 Model Qsts
Sheet 1: Guidelines
| SSA My Social Security v2 | |||||||||||||||||||||
| Partitioned Yes | Questionnaire Management Guidelines | ||||||||||||||||||||
| Goals: | |||||||||||||||||||||
| � | One consolidated document to track all model and CQ changes throughout the life of the project | ||||||||||||||||||||
| � | Questionnaire always matches the live survey | ||||||||||||||||||||
| � | Easy and error-free way to submit CQ changes | ||||||||||||||||||||
| � | All changes tracked and reflected in one document (DOT will help) | ||||||||||||||||||||
| Questionnaire Resources: | |||||||||||||||||||||
| 1 | Questionnaire Design and Approval Process | ||||||||||||||||||||
| 2 | Question Grouping Rules | ||||||||||||||||||||
| 3 | OPS vs. Skip Logic Decision for "Other, Please Specify" | ||||||||||||||||||||
| 4 | Model and Custom Question Checks_ SRA | ||||||||||||||||||||
| 5 | Model and Custom Question Checks_ Team LeadManager | ||||||||||||||||||||
| 6 | Model and Custom Question Checks_ DOT | ||||||||||||||||||||
| 7 | Foreign Language Survey Instructions | ||||||||||||||||||||
Sheet 2: Welcome and Thank You Text
| Model Instance Name: | 
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| SSA My Social Security v2 | |||||||||||||
| MID: | Z5w0N58sJ5AkRkYUg4pVFg== | ||||||||||||
| Partitioned Yes | 2/8/2012 | ||||||||||||
| Welcome and Thank You Text | |||||||||||||
| Directions: | |||||||||||||
| This welcome text is shown at the top of the questionnaire window and the thank you text at the bottom. This is a good place to mention the site/company/agency name so the visitor knows whom they are taking the survey for. Feel free to modify the standard Welcome text shown in the box below. | |||||||||||||
| Examples | |||||||||||||
| Welcome Text Example | |||||||||||||
| Welcome Text | |||||||||||||
| Thank you for visiting our site. You've been randomly chosen to take part in a brief survey to let us know what we're doing well and where we can improve. Please take a few minutes to share your opinions, which are essential in helping us provide the best online experience possible. |
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| Thank You Text Example | |||||||||||||
| Thank You Text | 
|
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| Thank you for taking our survey and for helping us serve you better. Please note you will not receive a response from us based on your survey comments. If you would like us to contact you about your feedback, please visit the Contact Us section of our website. |
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| us | |||||||||||||
Sheet 3: Current CQs
| Model Instance Name: | |||||||||
| SSA My Social Security v2 | underlined & italicized: RE-ORDER | ||||||||
| MID: | R9JQtMNl09w1VJAZFxsVYQ4C | pink: ADDITION | |||||||
| Partitioned Yes | 1/11/2018 | blue + -->: REWORDING | |||||||
| SSA My Social Security v2 CUSTOM QUESTION LIST | |||||||||
| QID | Skip Logic Label | Question Text | AnswerIDs (DOT) | Answer Choices (limited to 50 characters) |
Skip to | Type (select from list) | Required Y/N |
Special Instructions | CQ Label |
| HAR0069569 | How often do you access (or plan to access) your my Social Security account? | Once a year | Radio button, one up vertical | Y | Access Frequency - NEW | ||||
| Once every six months | |||||||||
| Once every three months | |||||||||
| Once a month | |||||||||
| More than once a month | |||||||||
| Not sure | |||||||||
| CAS0045395 | What is your reason for visiting my Social Security today? (Check all that apply) | CAS0045395A001 | To get a Benefit Verification Letter | B | check box one up vertical | Yes | Skip Logic Group | Primary Reason | |
| To access my online notices (e.g., COLA) | C1, C2,C4,N1,N2, N3,N4 | ||||||||
| To view my Benefits and Payment Details | |||||||||
| CAS0045395A002 | To enroll in or update my direct deposit | ||||||||
| CAS0045395A003 | To change my address with SSA | ||||||||
| To print or view my online Social Security Statement | A | ||||||||
| CAS0045395A004 | To make sure my earnings record is correct | ||||||||
| CAS0045395A005 | To replace my Social Security Card or get a new card | M | |||||||
| To check the Status of my recently filed application for benefits | |||||||||
| CAS0045395A006 | To learn about the benefits to which I might be entitled | ||||||||
| CAS0045395A009 | To apply only for Social Security or Medicare Only benefits | ||||||||
| CAS0045395A017 | To report my wages | Q | |||||||
| To request a replacement SSA-1099 (or SSA-10425) for tax purposes | |||||||||
| To add Extra Security to my online account | |||||||||
| CAS0045395A010 | Just curious – wanted to see what information was contained in my Social Security account | ||||||||
| CAS0045395A011 | Other Reason for visiting today | Z | |||||||
| RUS0280247 | C1 | How difficult or easy was it to access your Cost of Living Adjustment (COLA) notice online? | RUS0280247A001 | Very difficult | Radio button, one-up vertical | Y | Skip Logic Group | Ease of access COLA | |
| RUS0280247A002 | Somewhat difficult | ||||||||
| RUS0280247A003 | Neither difficult or easy | ||||||||
| RUS0280247A004 | Somewhat easy | ||||||||
| RUS0280247A005 | Very easy | ||||||||
| RUS0280250 | C4 | Do you have any suggestions for improving our online notices? | text, no char limit | N | Skip Logic Group | Improve Online notices | |||
| N1 | If you owed us money, would you like the option to make a payment on line? | Yes | Radio button, one-up vertical | Y | Skip Logic Group | Pay online option | |||
| No | |||||||||
| Don't know/Not applicable | |||||||||
| N2 | Are you aware that the communication delivery preference gives you the option to get your notices either electronically or by mail? | Yes | A1 | Radio button, one-up vertical | Y | Skip Logic Group | Understand communication delivery preference | ||
| No | |||||||||
| A1 | How easy or difficult was it to change your communication delivery preference? | Very difficult | Radio button, one-up vertical | Y | Skip Logic Group | Ease of changing communication delivery | |||
| Somewhat difficult | |||||||||
| Neither easy or difficult | |||||||||
| Somewhat easy | |||||||||
| Very easy | |||||||||
| Don't know/Not applicable | |||||||||
| N3 | Are you comfortable receiving notices electronically? | Yes | Radio button, one-up vertical | Y | Skip Logic Group | Comfortable receiving notices online | |||
| No | |||||||||
| Don't know | |||||||||
| N4 | Would you recommend accessing notices online to your family and friends? | Yes | Radio button, one-up vertical | Y | Skip Logic Group | Recommend accessing notices online | |||
| No | |||||||||
| Don't know/Not applicable | |||||||||
| CAS0045407 | A | How often do you review your online Social Security Statement? | CAS0045407A001 | This is my first time | AA | check box one up vertical | Y | Skip Logic Group | Freq View Statement |
| CAS0045407A003 | At least once a year | ||||||||
| CAS0045407A004 | Every 6 months | ||||||||
| CAS0045407A005 | Every 3 months or more frequently | ||||||||
| CAS0045409 | B | For which Agency or program do you need a Benefit Verification Letter? (Check all that apply) | CAS0045409A001 | Medicare | check box vertical one up | Y | skip logic group | Agency Need | |
| CAS0045409A002 | Medicaid | ||||||||
| State or Local Department of Social Services | |||||||||
| CAS0045409A003 | HUD - Federal Housing Admin. (FHA) and/or Section 8 Housing | ||||||||
| CAS0045409A004 | USDA - SNAP (Food Stamps) | ||||||||
| CAS0045409A005 | Department of Veterans Affairs | ||||||||
| CAS0045409A006 | IRS | ||||||||
| CAS0045409A007 | Court | ||||||||
| CAS0045409A008 | Want a copy for personal use | ||||||||
| Bank or financial institution | |||||||||
| Education-related | |||||||||
| Medical-related | |||||||||
| Healthcare signup and/or verification | |||||||||
| Requesting a Retirement Visa from another country | |||||||||
| CAS0045409A009 | Other agency or program | BB | |||||||
| CAS0045396 | BB | Which "other" agency or program requested your Benefit Verification information? | Text area, no Char limit | N | Skip Logic Group | OPS_Other Agency | |||
| CAS0045397 | Z | Please tell us what your primary reason was for visiting today: | Text area, no Char limit | N | Skip Logic Group | OPS_Primary Reason | |||
| RUS0172647 | M | For which purpose or program do you need a replacement SSN Card? (Check all that apply) | Proof of identity | checkbox vertical, one up | Y | Skip Logic Group | Purpose for SSN Card | ||
| Tax purposes | |||||||||
| Education-related | |||||||||
| Required for my job | |||||||||
| Passport | |||||||||
| Bank or financial institution | |||||||||
| Income assistance | |||||||||
| Other (Please specify) | MM | ||||||||
| RUS0172648 | MM | Please explain for which purpose or program you need a replacement SSN card. | Text area, no Char limit | N | Skip Logic Group | OPS_Purpose Other | |||
| TAR0201664 | Q | Who are you reporting wages for? | Myself only | Y | Skip Logic Group | Reporting For | |||
| Q2, R | Radio button, one-up vertical | ||||||||
| Myself and my spouse | Q2, R | ||||||||
| Q1,Q2, R | |||||||||
| Q2, R | |||||||||
| Q1,Q2, R | |||||||||
| TAR0201665 | Q1 | What is your relationship to the individual you are reporting wages for? | Text area, no Char limit | N | Skip Logic Group | OE_Report For | |||
| BUC0233611 | R | What type of benefits does the person you are reporting for receive? | Disability | Radio button, one-up vertical | Y | skip logic group | Benefit Type Reporting | ||
| Supplemental Security Income (SSI) | |||||||||
| Both Disability and SSI | |||||||||
| Don't know | |||||||||
| TAR0201666 | Q2 | Was the person you wanted to report wages for listed? | Yes | Radio button, one-up vertical | Y | skip logic group | OE_Relationship | ||
| No | |||||||||
| TAR0201667 | Q | Was the employer listed? | Yes | Radio button, one-up vertical | Y | Skip Logic Group | Employer listed | ||
| No | |||||||||
| TAR0201668 | Q | Are you reporting for more than one employer for the same person? | Yes | Radio button, one-up vertical | Y | Skip Logic Group | Reporting multiple employers | ||
| No | |||||||||
| TAR0202213 | Q | Are you currently working? | Yes | Radio button, one-up vertical | Y | Skip Logic Group | Currently working | ||
| No | |||||||||
| TAR0201669 | Q | How long did it take you to submit your wages? | Radio button, one-up vertical | Y | Skip Logic Group | Time Submit Wage | |||
| 6-10 minutes | |||||||||
| Unsure | |||||||||
| Did not submit wages | |||||||||
| BUC0233612 | Q | Before today's visit, what other methods have you used to report wages? | Field Office | Checkbox, one-up vertical | Y | Skip logic group | Other reporting methods | ||
| Fax | |||||||||
| Phone | |||||||||
| Other | |||||||||
| BUC0233613 | Q | Do you plan to electronically report additional wages in the future? | Yes | Q3 | Radio button, one-up vertical | Y | Skip logic group | Plan report electronically | |
| No | Q5 | ||||||||
| Don't know | |||||||||
| TAR0201672 | Q3 | How do you plan to report future wages? | Radio button, one-up vertical | Y | Skip Logic Group | How Report Again | |||
| Don't know | |||||||||
| BUC0233614 | Q5 | What method do you prefer to use to report your wages? | Field Office | Radio button, one-up vertical | Y | Skip Logic Group | Preferred method reporting | ||
| Fax | |||||||||
| Phone | |||||||||
| Other | |||||||||
| TAR0201673 | Q | Were the instructions you received helpful? | Yes | Y | Skip Logic Group | Instructions Helpful | |||
| No | Q4 | ||||||||
| TAR0201674 | Q4 | How can we improve the wage reporting application? | Text area, no Char limit | N | Skip Logic Group | OE_Improve Instructions | |||
| CAS0045398 | Did you register for your my Social Security online or in person? | CAS0045398A001 | Registered online on my first attempt | A | Radio button, one-up vertical | Y | Skip Logic Group | How Registered | |
| CAS0045398A002 | Registered online after prior unsuccessful attempts | A | |||||||
| CAS0045398A003 | Registered with in-person assistance from my local SSA office | A,C | |||||||
| Registered using the SSA Express | |||||||||
| CAS0045398A004 | Not sure or don't remember | ||||||||
| CAS0045399 | A | Please select the approximate length of time it took for you complete your registration | CAS0045399A001 | Less than 15 minutes | Radio button, one-up vertical | Y | Skip Logic Group | Reg Time | |
| CAS0045399A002 | More than 15 but less than 30 minutes | ||||||||
| CAS0045399A003 | 30 minutes or more | ||||||||
| CAS0045410 | C | Why did you decide to register in-person? | I was unsuccessful registering online and was required to do so in-person | CC | Radio button, one-up vertical | Y | Skip Logic Group | Reg In person | |
| I preferred registering for a my Social Security account in-person at my SSA office | CC | ||||||||
| Employee offered the option for me to register for a my Social Security account | CC | ||||||||
| CAS0045401 | CC | Please describe your in-person registration experience. | Text area, no char limit | N | Skip Logic Group | OE_In-person Experience | |||
| CAS0045413 | Did you find the instructions for creating a username, password and registering a second factor to be clear? | CAS0045413A001 | Yes | Radio button, one-up vertical | Y | Skip Logic Group | Instructions Understand | ||
| CAS0045413A002 | Partially | A | |||||||
| CAS0045413A003 | No | A | |||||||
| CAS0045414 | A | Please explain what was not clear about any of the instructions. |
Text area, no char limit | N | Skip Logic Group | OE_Instructions | |||
| CAS0045424 | Do you have any concerns about the security of the personal information contained in your my Social Security account? | CAS0045424A001 | No | Radio Button, One-up | Y | Skip Logic Group | Security Concerns | ||
| CAS0045424A002 | Yes | A | |||||||
| CAS0045425 | A | Please describe your security concerns. | Text area, no char limit | N | Skip Logic Group | OE_Security Concern | |||
| Please indicate your level of agreement with the following statements about your interaction today: I am satisfied with the service I received from the Social Security Administration. | 1=Strongly Disagree | Radio Button, Scale, No don't know | Y | A11-Satisfied | |||||
| 2=Disagree | |||||||||
| 3=Neutral | |||||||||
| 4=Agree | |||||||||
| 5=Strongly Agree | |||||||||
| This interaction increased my confidence in the Social Security Administration. |
1=Strongly Disagree | Radio Button, Scale, No don't know | Y | A11-Trust | |||||
| 2=Disagree | |||||||||
| 3=Neutral | |||||||||
| 4=Agree | |||||||||
| 5=Strongly Agree | |||||||||
| My need was addressed. |
1=Strongly Disagree | Radio Button, Scale, No don't know | Y | A11-Quality | |||||
| 2=Disagree | |||||||||
| 3=Neutral | |||||||||
| 4=Agree | |||||||||
| 5=Strongly Agree | |||||||||
| It was easy to complete what I needed to do. |
1=Strongly Disagree | Radio Button, Scale, No don't know | Y | A11-Ease | |||||
| 2=Disagree | |||||||||
| 3=Neutral | |||||||||
| 4=Agree | |||||||||
| 5=Strongly Agree | |||||||||
| It took a reasonable amount of time to do what I needed to do. |
1=Strongly Disagree | Radio Button, Scale, No don't know | Y | A11-Speed | |||||
| 2=Disagree | |||||||||
| 3=Neutral | |||||||||
| 4=Agree | |||||||||
| 5=Strongly Agree | |||||||||
| CAS0045422 | Did the information obtained during your my Social Security account visit enable you to accomplish what you wanted to do? | CAS0045422A001 | Yes | Radio button, one up | Yes | Skip Logic Group | Ability to Accomplish | ||
| CAS0045422A002 | No | ||||||||
| TAR0239304 | Did you contact Social Security during your online visit? | Yes | A | Radio button, one-up vertical | Y | Skip Logic Group | Contacted SSA | ||
| No | |||||||||
| TAR0239305 | A | How did you contact Social Security? | Requested a Call Back | Radio button, one-up vertical | Y | Skip Logic Group | How contacted SSA | ||
| Chat with an Online representative | B,C,D,E | ||||||||
| TAR0239306 | B | How long was your wait to Chat with a representative online? | About what I expected | Radio button, one-up vertical | Y | Skip Logic Group | Click to chat wait | ||
| Longer than I expected | |||||||||
| TAR0239307 | C | Did the Chat representative answer your question? | Yes | Radio button, one-up vertical | Y | Skip Logic Group | Click to chat answer | ||
| Partially | |||||||||
| No | |||||||||
| TAR0239324 | D | Do you still have to call the 1-800 number or go into a field office? | Yes | Radio button, one-up vertical | Y | Skip Logic Group | Click to chat Call | ||
| No | |||||||||
| TAR0248887 | D | How satisfied were you with the Chat Service you received today? | Very Satisfied | Radio button, one-up vertical | Y | Skip Logic Group | Click to chat service | ||
| Satisfied | |||||||||
| Not Satisfied | |||||||||
| Very Dissatisfied | |||||||||
| D | How satisfied were you with the Chat Representative who assisted you today? | Very Satisfied | Radio button, one-up vertical | Y | Skip Logic Group | Click to chat representative | |||
| TAR0248888 | Satisfied | ||||||||
| Not Satisfied | |||||||||
| Very Dissatisfied | |||||||||
| TAR0239325 | E | Please share any other feedback with us regarding your Chat experience today. | Text area, no Char limit | N | Skip Logic Group | Chat Feedback | |||
| STE0093222 | Did you use the “Get Help” button or "Call Back" button during your visit today? | Yes, I used the "Get Help" button only | Radio button, one up vertical | Y | Get Help Button or Call Back | ||||
| Yes, I used the "Call Back" button only | |||||||||
| Yes, I used both the "Get Help" button and "Call Back" button | |||||||||
| No, I used neither | |||||||||
| STE0125910 | Did you view the "Message Center" section during your visit today? | Yes | Radio button, one up | Y | Skip Logic Group | Message Center | |||
| No | B | ||||||||
| STE0125912 | B | Do you plan to view the "Message Center" in the future? | Yes | Radio button, one up | Y | Skip Logic Group | Use Message Center Future | ||
| No | |||||||||
| STE0123762 | Please select the category that includes your age: | 35 and under | Radio button, one up | N | Age | ||||
| 36 to 50 | |||||||||
| 51 to 61 | |||||||||
| 62 | |||||||||
| 63 | |||||||||
| 64 | |||||||||
| 65 | |||||||||
| 66 | |||||||||
| 67 | |||||||||
| 68 to 70 | |||||||||
| 71 or older | |||||||||
| Prefer not to answer | |||||||||
| JIB0147139 | Please enter your 5 digit ZIP Code: | Text area, 100 char limit | N | OE_ZIP | |||||
| CAS0045416 | Do you have any suggestions for improving the my Social Security registration process? | Text area, no char limit | N | OE_Improve Reg | |||||
| CAS0045417 | Do you have any suggestions for improving my Social Security's content and features? | Text area, no char limit | N | OE_Improve Contents | |||||
Sheet 4: v2 Model Qsts
| Model Instance Name: | ||||||||||
| SSA My Social Security v2 | 
|
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| MID: | R9JQtMNl09w1VJAZFxsVYQ4C | |||||||||
| Partitioned Yes | ||||||||||
| FPI Included(Y/N)? | ||||||||||
| Date: | 6/12/2013 | |||||||||
| SSA My Social Security v2 | ||||||||||
| Model questions utilize the ACSI methodology to determine scores and impacts | ||||||||||
| ELEMENTS (drivers of satisfaction) | CUSTOMER SATISFACTION | FUTURE BEHAVIORS | FPI | |||||||
| MQ Label | MQ Label | MQ Label | Y? | |||||||
| Look and Feel (1=Poor, 10=Excellent, Don't Know) | Satisfaction | Recommend (1=Very Unlikely, 10=Very Likely) | ||||||||
| Look and Feel - Appeal | Please rate the visual appeal of this site. | Satisfaction - Overall | What is your overall satisfaction with this site? (1=Very Dissatisfied, 10=Very Satisfied) |
Recommend | How likely are you to recommend this site to someone else? | |||||
| Look and Feel - Balance | Please rate the balance of graphics and text on this site. | Satisfaction - Expectations | How well does this site meet your expectations? (1=Falls Short, 10=Exceeds) |
Return (1=Very Unlikely, 10=Very Likely) | ||||||
| Look and Feel - Readability | Please rate the readability of the pages on this site. | Satisfaction - Ideal | How does this site compare to your idea of an ideal website? (1=Not Very Close, 10=Very Close) |
Return | How likely are you to return to this site? | |||||
| Navigation (1=Poor, 10=Excellent, Don't Know) | Use Web Channel Over Others (1=Very Unlikely, 10=Very Likely) | |||||||||
| Navigation - Organized | Please rate how well the site is organized. | Use Web Channel Over Others | How likely are you to use this site rather than seek information from other channels (i.e. local field office, call center)? | |||||||
| Navigation - Options | Please rate the options available for navigating this site. | |||||||||
| Navigation - Layout | Please rate how well the site layout helps you find what you are looking for. | 
|
|
|||||||
| Site Performance (1=Poor, 10=Excellent, Don't Know) | ||||||||||
| Site Performance - Loading | Please rate how quickly pages load on this site. | |||||||||
| Site Performance - Consistency | Please rate the consistency of speed from page to page on this site. | |||||||||
| Site Performance - Errors | Please rate the ability to load pages without getting error messages on this site. | |||||||||
| My Social Security Information (1=Poor, 10=Excellent, Don't Know) | ||||||||||
| My Social Security Information - Thoroughness | Please rate the thoroughness of information you viewed on this site today. | |||||||||
| My Social Security Information - Quality | Please rate the quality of information you viewed today. | |||||||||
| My Social Security Information - Provided Answers | Please rate how well the information viewed today provided answers to your questions. | |||||||||
| Plain Language (1=Poor, 10=Excellent, Don't Know) | ||||||||||
| Plain Language - Clear | Please rate the clarity of the wording on this site. | |||||||||
| Plain Language - Understandable | Please rate how well you understand the wording on this site. | |||||||||
| Plain Language - Concise | Please rate this site on its use of short, clear sentences. | |||||||||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |
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