Form 235 2019 235 Q_SSADisability_Web_AccountManagement_2019_8_19

---

Overview

Disability v2 Model Qsts
Current CQs

---

Sheet 1: Disability v2 Model Qsts

Model Name		Disability V3					Red & Strike-Through: Delete
Model ID							Underlined & Italicized: Re-order
Partitioned		Yes - 2 MQ					Pink: Addition
Date		8/19/2019					Blue: Reword
	Label	Element Questions		Label	CUSTOMER SATISFACTION		Label	FUTURE BEHAVIORS
		Site Performance (1=Poor, 10=Excellent, Don't Know)			Satisfaction			Recommend (1=Very Unlikely, 10=Very Likely)
1	Site Performance - Speed	Please rate the speed that pages and content loaded for you.	16	Satisfaction - Overall	What is your overall satisfaction with this application? (1=Very Dissatisfied, 10=Very Satisfied)	19	Recommend	How likely are you to recommend this application to someone else?
2	Site Performance - Completeness	Please rate the consistency of complete loading of pages and content.	17	Satisfaction - Expectations	How well does this application meet your expectations? (1=Falls Short, 10=Exceeds)			Use Other Online Services (1=Very Unlikely, 10=Very Likely)
3	Site Performance -Responsiveness	Please rate the responsiveness of the pages to your actions.	18	Satisfaction - Ideal	How does this application compare to your idea of an ideal application? (1=Not Very Close, 10=Very Close)	20	Use Other Online Services	How likely are you to use other Social Security online services?
		Look and Feel (1=Poor, 10=Excellent, Don't Know)
4	Look and Feel - Appeal	Please rate the visual appeal of the pages that you visited.
5	Look and Feel - Spacing	Please rate the spacing between items on the pages that you visited.
6	Look and Feel - Readability	Please rate the legibility of the pages that you visited.
		Navigation (1=Poor, 10=Excellent, Don't Know)
7	Navigation - Ease	Please rate the ease of finding what you were looking for.
8	Navigation - Layout	Please rate the page layout on displaying content and links where you could find them.
9	Navigation - Links	Please rate the links on taking you where you needed to go.
		Site Information (1=Poor, 10=Excellent, Don't Know)
10	Site Information - Relevance	Please rate the relevance to your interests of the information that you found.
11	Site Information - Thoroughness	Please rate the thoroughness of the information that you found.
12	Site Information - Readability	Please rate the readability of the information that you found.
		Account Management (1=Poor, 10=Excellent, Don't Know)
13	Account Management - Simplicity	Please rate the simplicity of account management on this site.
14	Account Management - Efficiency	Please rate the efficiency of account management on this site.
15	Account Management - Essential Information	Please rate the presentation of essential account information.

---

Sheet 2: Current CQs

Model Instance Name:		SSA Disability v2
MID:		451pZNUxEwhdwdY1JBg4EA4C
Partitioned No
Date:		6/12/2013
QID	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip To	Required Y/N	Type (select from list)	Special Instructions	Labels
CAS0045268		Are you applying online for yourself or are you helping someone else?	Myself	A	Y	Drop down select one		Applying for
			Helping a Spouse/Relative/Friend
			Professional Helping a Client
			Other
BUC0266068	A	Were you able to create or log in to your mySSA account?	Yes		Y	Radio button, one-up vertical	Skip Logic Group	Create or log into mySSA
			No	B
			Don't know
BUC0266088	B	Why were you not able to create or log in to your mySSA account?	Did not have required information to create account		Y	Radio button, one-up vertical	Skip Logic Group	Why not log in mySSA
			Could not remember my password
			Other	BB
			Don't know
BUC0266069	BB	Please describe why you were not able to create or log in to your mySSA account.			N	Text area, no char limit	Skip Logic Group	OE_Why not log in mySSA
CAS0045269		How did you learn about the Social Security online disability application? (Select all that apply)	Official Social Security website (www.ssa.gov)		Y	Check box vertical one up	Skip Logic	Learn about App
			Online social media (Facebook, Twitter, etc.)
			A general web search (e.g., Google, Bing, etc.)
			Traditional media (TV, radio, newspaper, etc.)
			Social Security Statement
			Social Security publication
			Social Security employee	A
			Relative or friend
			Doctor, social worker, attorney, or other professional
			I saw the link while I was checking my online statements
			Other, please specify	B
CAS0045272	B	Please specify how you learned about this online disability application.			N	Text box, no char limit	Skip Logic	OPS_learned of app
RUS0250217		Before visiting SSA.gov did you first try to accomplish your task in any of the following ways?	Calling Social Security's 1-800 number		Y	Checkbox, one up vertical		First try
			Visiting my local Social Security office
			Calling my local Social Security office
			No, I visited SSA.gov first
			Not sure
CAS0045273		Did you use any of the following to prepare to apply online? (Select all that apply.)	I used the Disability Benefits Checklist	A	Y	check box one up vertical	Skip Logic	Prepare for App
			I watched the instructional video	C
			I used other information on the Social Security website to prepare	D
			I used another resource to prepare to apply online	E
			I did not use any resources to prepare to apply online				Mutually Exclusive
CAS0045274	A	How helpful did you find the Disability Benefits Checklist?	Very helpful		Y	Drop down select one	Skip Logic	Rate Statement
			Somewhat helpful
			Not at all helpful
CAS0045276	C	How helpful did you find the instructional video?	Very helpful		Y	Drop down select one	Skip Logic	Rate Video
			Somewhat helpful
			Not at all helpful
CAS0045277	D	How helpful did you find the other information on the Social Security website?	Very helpful		Y	Drop down select one	Skip Logic	Rate Other Info on Website
			Somewhat helpful
			Not at all helpful
CAS0045278	E	Please describe what other resource(s) you used to prepare to apply online?			N	Text field, no char limit	Skip Logic	OPS Prepare for App
RUS0199339		Did you apply for SSI (Supplemental Security Income) today along with disability?	Yes	A	Y	Radio button, one-up vertical	Skip Logic	SSI Apply Today
			No, I applied only for disability	B
			Not sure
RUS0199341	A	Are you aware that additional information may be required to determine your eligibility for SSI (Supplemental Security Income)?	Yes		Y	Radio button, one-up vertical	Skip logic	SSI Criteria Aware
			No
RUS0199342	B	Do you intend to apply for SSI (Supplemental Security Income) in the future?	Yes		Y	Radio button, one-up vertical	Skip logic	SSI Apply Future
			No
			Not sure
RUS0199364		Did the site clearly describe what you wanted to know about SSI (Supplemental Security Income)?	Yes		Y	Radio button, one-up vertical	Skip Logic	Clearly describe SSI
			No	C
			Not sure/Was not looking for SSI information
RUS0199365	C	Please describe what was not clear.				Text field, no char limit		OE_Not clear about SSI
CAS0047708		Did you start a new online disability application today or did you return to a saved application?	Started a new application		Y	Radio button, one-up vertical	Skip Logic	App Status
			Returned to work on a saved application	R1
STE0123750	R1	Were you able to access your previously saved online application with your Reentry number?	Yes, I was able to use the Reentry number that was provided to me	R0	Y	Radio button, one-up vertical	Skip Logic	Access Saved App
			No, I was not able to use the Reentry number that was provided to me	R2
			No, I did not have my Reentry number	R2,R3
BUC0266089	R0	Were you aware you could find your re-entry number in mySSA "Your Benefit Applications"?	Yes		Y	Radio button, one-up vertical	Skip logic	Reentry number aware
			No
BUC0266090	R3	Do you have a mySSA account?	Yes		Y	Radio button, one-up vertical	Skip logic	Have mySSA account
			No
			Don't know
STE0123734	R2	If you were not able to access your saved application, did you create a new application?	Yes		Y	Radio button, one-up vertical	Skip Logic	Create New App
			No
RUS0250218		Do you plan to do any of the following as a next step?	Call Social Security's 1-800 number		Y	Radio button, one up veritical	Skip Logic Group	Do next
			Visit my local Social Security office
			Call my local Social Security office
			Other (please specify)	B
RUS0250219	B	What do you plan to do next?				Text area, no char limit	Skip Logic Group	OE_Do next
CAS0045279		Why did you choose to apply online? (Select all that apply.)	I prefer to use online services as much as possible		Y	check box one up vertical	Skip Logic	Why Online
			I learned about applying online while visiting Social Security's website
			A Social Security employee recommended that I apply online
			I can't get to my local Social Security Office
			A friend or relative recommended that I apply online
			I knew that if I had a question or problem applying online, I could still get help from Social Security
			I am filing on behalf of another person
			I did not want to go to a local Social Security office
			I did not want to apply over the phone
			Other, please specify	A
CAS0045253	A	Please specify why you choose to apply online			N	Text field, no char limit	Skip Logic Group	OPS Why Online
		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		Y	Radio Button, Scale, No don't know		A11-Satisfied
			2=Disagree
			3=Neutral
			4=Agree
			5=Strongly Agree
		This interaction increased my confidence in the Social Security Administration.	1=Strongly Disagree		Y	Radio Button, Scale, No don't know		A11-Trust
			2=Disagree
			3=Neutral
			4=Agree
			5=Strongly Agree
		My need was addressed.	1=Strongly Disagree		Y	Radio Button, Scale, No don't know		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		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		Y	Radio Button, Scale, No don't know		A11-Speed
			2=Disagree
			3=Neutral
			4=Agree
			5=Strongly Agree
RUS0228686		What is your age?	Under 18		Y	Radio Button, One Up Vertical		Age
			18 - 29
			30 - 39
			40 - 49
			50 - 59
			60 - 69
			70 or older
			Prefer not to answer
CAS0047685		Do you have any suggestions for improving Social Security's online disability application?			N	Text Area – no character limit		OE_Improvement