235 2019 235 Q_SSAiAppeals_Web_AccountManagement_2019_8_19
E-Government Website Customer Satisfaction Surveys
2019 235 Q_SSAiAppeals_Web_AccountManagement_2019_8_19.xlsx
2019 235 Security Administration
OMB: 1090-0008
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1090-0008 can be found here:
Document [xlsx]
Download: xlsx | pdf
Model Qsts
Current CQs
Overview
Welcome and Thank You TextModel Qsts
Current CQs
Sheet 1: Welcome and Thank You Text
| Welcome and Thank You Text | ||||||
| Welcome Text | Thank You Text | |||||
| Thanks for using the Social Security Administration’s online disability appeal. You've been randomly chosen to take part in a brief survey to let us know what we're doing well and where we can improve. Please take a few minutes to share your opinions, which are essential in helping us provide the best online experience possible. | Thank you for taking our survey - and for helping us serve you better. 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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| Welcome Text - Alternate | Thank You Text - Alternate | |||||
| Thank you for visiting [Company/Site/Agency]. You have been randomly selected to take part in this survey that is being conducted by ForeSee on behalf of the [Company/Site/Agency]. Please take a few minutes to give us your feedback. All results are strictly confidential. | Thank you for taking our survey - and for helping us serve you better. Please note you will not receive a response from us based on your survey comments. If you would like us to contact you about your feedback, please visit the Contact Us section of our web site. |
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Sheet 2: Model Qsts
| Model Name | SSA iAppeals V3 | 
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| Model ID | Underlined & Italicized: Re-order | |||||||
| Partitioned | Yes | Pink: Addition | ||||||
| Date | 8/19/2019 | Blue: Reword | ||||||
| Label | Element Questions | Label | Satisfaction Questions | Label | Future Behaviors | |||
| Site Performance (1=Poor, 10=Excellent, Don't Know) | Satisfaction | Use other online applications (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 the online disability appeal? (1=Very Dissatisfied, 10=Very Satisfied) |
19 | Use other online applications | How likely are you to use other on-line applications/forms on the Social Security web site? |
| 2 | Site Performance - Completeness | Please rate the consistency of complete loading of pages and content. | 17 | Satisfaction - Expectations | How well does the online disability appeal meet your expectations? (1=Falls Short, 10=Exceeds) |
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| 3 | Site Performance -Responsiveness | Please rate the responsiveness of the pages to your actions. | 18 | Satisfaction - Ideal | How does the online disability appeal compare to your idea of an ideal online form? (1=Not Very Close, 10=Very Close) |
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| 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 3: Current CQs
| Model Name | SSA iAppeals V3 |
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| Model ID | Underlined & Italicized: Re-order | ||||||||
| Partitioned | Yes | Pink: Addition | |||||||
| Date | 7/30/2018 | Blue: Reword | |||||||
| QID | QUESTION META TAG | Skip From | Question Text | Answer Choices | Skip To | Required Y/N |
Type | Special Instructions | CQ Label |
| BUC0250330 | 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 | Mutually exclusive | ||||||||
| KMJ4615Q044 | Which type of appeal did you work on today? | Medical Disability Appeal | A,D,E,G,J,K,M,P | Y | Radio button, one-up vertical | Skip Logic Group* | Appeal Category | ||
| Other Non-Medical Appeal | 1,2,3,5,8,10 | ||||||||
| KMJ4615Q045 | A | Which of the following best describes your role in using the online appeal today? | Self | Y | Radio button, one-up vertical | Skip Logic Group* | Medical Role | ||
| Attorney or attorney's staff | B | ||||||||
| Non-attorney representative or non-attorney representative's staff | B | ||||||||
| Other third party representative (e.g., family member, social service agency worker, case manager) | |||||||||
| KMJ4615Q046 | B | Did you complete an appeal for more than one client during this session? | Yes | C | Y | Radio button, one-up vertical | Skip Logic Group* | Medical Attorney Appeal | |
| No | |||||||||
| KMJ4615Q047 | C | During this visit, how many clients did you file an appeal for? | 2 | Y | Radio button, one-up vertical | Skip Logic Group* | Medical Num of Clients | ||
| 3 | |||||||||
| 4 or more clients | |||||||||
| KMJ4615Q048 | D | How often do you use the online appeal? | This was the first time | Y | Radio button, one-up vertical | Skip Logic Group* | Medical Frequency | ||
| Less than five times a week | |||||||||
| 5-10 times per week | |||||||||
| 11-25 times per week | |||||||||
| More than 25 times per week | |||||||||
| KMJ4615Q049 | E | Did you start a new online appeal today or return to a previously saved appeal? | I started a new appeal | Y | Radio button, one-up vertical | Skip Logic Group* | Medical Start or Return | ||
| I returned to a previously saved appeal | F | ||||||||
| KMJ4615Q050 | F | Please tell us why you did not complete your appeal during your initial session. | N | Text field, <100 char | Skip Logic Group* | Medical Why Return | |||
| KMJ4615Q051 | G | Did you complete and submit your online appeal today? | Yes, I completed and submitted my online appeal today | AA | Y | Radio button, one-up vertical | Skip Logic Group* | Medical Submit | |
| No | H,Q | ||||||||
| BUC0250371 | AA | How many attempts did you need to accomplish your task? | 1 | Y | Radio button, one-up vertical | Skip Logic Group* | Number of attempts | ||
| 2 | |||||||||
| 3 | |||||||||
| 4 | |||||||||
| 5 or more | |||||||||
| KMJ4615Q052 | H | Please tell us why you did not complete your appeals application today. Check all that apply. | I didn't have information I needed to complete the application, such as names, addresses, or dates | Y | Checkbox, one-up vertical | Skip Logic Group* | Medical Not Submit | ||
| I didn't understand what the questions meant or how to answer | |||||||||
| My disabling condition prevents me from working with a computer for long periods | |||||||||
| I had a limited amount of time/family demands that kept me from working on it for very long | |||||||||
| I had technical problems, i.e., an error message or a mistake I couldn't fix | |||||||||
| It takes too long to fill out | |||||||||
| It's too complicated to complete without help | |||||||||
| Other, please specify | I | ||||||||
| KMJ4615Q053 | I | What is your other reason? | N | Text field, <100 char | Skip Logic Group* | OE_Medical Not Submit | |||
| KMJ4615Q054 | Q | What do you plan to do next? | I will complete my appeal at a later time | Y | Radio button, one-up vertical | Skip Logic Group* | Medical Do Next | ||
| Browse the SSA website | |||||||||
| I will visit my local Social Security Office | |||||||||
| I do not know what I will do next at this time | |||||||||
| I do not plan to complete my appeal | |||||||||
| KMJ4615Q055 | J | How much time have you spent on your online disability appeal? | Less than 20 minutes | Y | Radio button, one-up vertical | Skip Logic Group* | Medical Time | ||
| 20 - 40 minutes | |||||||||
| 41 minutes - 1 hour | |||||||||
| More than 1 hour but less than 2 hours | |||||||||
| More than 2 hours but less than 3 hours | |||||||||
| More than 3 hours | |||||||||
| Not sure | |||||||||
| KMJ4615Q056 | K | Did you experience any of the following while completing the online appeal? Check all that apply. | The questions did not seem to be organized in a logical manner | Y | Checkbox, one-up vertical | Skip Logic Group* | Medical Form Experience | ||
| I had difficulty understanding the questions because they were not clearly written | |||||||||
| I did not have the information necessary to answer the questions | |||||||||
| I had difficulty editing the medical information (e.g., doctors, medication, etc.) | |||||||||
| I had difficulty editing other information | |||||||||
| I was unable to print the application | |||||||||
| I did not have enough time to complete the application | |||||||||
| I received an error message or was “kicked out” of the appeal | |||||||||
| The text box blanks did not allow enough characters for my answers | |||||||||
| Other | L | ||||||||
| I did not have any difficulties | Mutually Exclusive | ||||||||
| KMJ4615Q057 | L | So that we can better identify the difficulties you indicated above, please provide specific information if possible. (e.g., Which questions or sections were difficult? Where did you receive an error message? etc.) | N | Text field, <100 char | Skip Logic Group* | OE_Medical Form Experience | |||
| KMJ4615Q058 | M | Did you have ALL of your personal and medical information ready when you started? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | Medical Info | ||
| No | N,O | ||||||||
| KMJ4615Q059 | N | What personal and/or medical information did you not have ready when you started? | N | Text field, <100 char | Skip Logic Group* | OE_Medical Info | |||
| KMJ4615Q060 | O | Could we have provided any additional information or assistance to help you be more prepared? | N | Text field, <100 char | Skip Logic Group* | Medical Info Help | |||
| KMJ4615Q061 | P | How can we improve the online disability appeal? Please be as specific as possible. (Examples: What information could we have provided upfront? Do you have any suggested changes or updates?) | N | Text field, <100 char | Skip Logic Group* | Medical Improvement | |||
| KMJ4615Q062 | 1 | Which of the following best describes your role in using the online appeal today? | Self | Y | Radio button, one-up vertical | Skip Logic Group* | Other Role | ||
| Attorney or attorney's staff | |||||||||
| Non-attorney representative or non-attorney representative's staff | |||||||||
| Other third party representative (e.g., family member, social service agency worker, case manager) | |||||||||
| KMJ4615Q063 | 2 | How much time have you spent on your online appeal? | Less than 10 minutes | Y | Radio button, one-up vertical | Skip Logic Group* | Other Time | ||
| 10 - 20 minutes | |||||||||
| 21 - 40 minutes | |||||||||
| 41 minutes - 1 hour | |||||||||
| More than 1 hour but less than 2 hours | |||||||||
| More than 2 hours | |||||||||
| Not sure | |||||||||
| KMJ4615Q064 | 3 | Did you experience any of the following while completing the online appeal? Check all that apply. | The questions did not seem to be organized in a logical manner | Y | Checkbox, one-up vertical | Skip Logic Group* | Other Form Experience | ||
| I had difficulty understanding the questions because they were not clearly written | |||||||||
| I did not have the information necessary to answer the questions | |||||||||
| I had difficulty editing the required information | |||||||||
| I had difficulty editing other information | |||||||||
| I was unable to print the application | |||||||||
| I did not have enough time to complete the application | |||||||||
| I received an error message or was “kicked out” of the appeal | |||||||||
| The text box blanks did not allow enough characters for my answers | |||||||||
| Other | 4 | ||||||||
| I did not have any difficulties | Mutually Exclusive | ||||||||
| KMJ4615Q065 | 4 | Please provide specific information as to your difficulty. (Which questions or sections were difficult? Where did you receive an error message? etc.) | N | Text field, <100 char | Skip Logic Group* | OE_Other Form Experience | |||
| KMJ4615Q066 | 5 | Did you have ALL of your information ready when you started? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | Other Info | ||
| No | 6,7 | ||||||||
| KMJ4615Q067 | 6 | What information did you not have ready when you started? | N | Text field, <100 char | Skip Logic Group* | OE_Other Info | |||
| KMJ4615Q068 | 7 | Could we have provided any additional information or assistance to help you be more prepared? | N | Text field, <100 char | Skip Logic Group* | Other Info Help | |||
| KMJ4615Q069 | 8 | Did you submit your appeals application today? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | Other Submit | ||
| No | 9 | ||||||||
| KMJ4615Q070 | 9 | What do you plan to do next? | I will complete my appeal at a later time | Y | Radio button, one-up vertical | Skip Logic Group* | Other Do Next | ||
| Browse the SSA website | |||||||||
| I will visit my local Social Security Office | |||||||||
| Call the SSA 1-800 number | |||||||||
| I do not know what I will do next at this time | |||||||||
| Other (please specify) | OT | ||||||||
| BUC0250387 | OT | What do you plan to do next? | Y | Text area no limit | OE_Do next | ||||
| KMJ4615Q071 | 10 | How can we improve the online appeal? Please be as specific as possible. (Examples: What information could we have provided upfront? Do you have any suggested changes or updates?) | N | Text field, <100 char | Skip Logic Group* | Other Improvement | |||
| UNG0123786 | Did you have any documents to upload? | Yes | A | Y | Radio button, one-up vertical | Skip Logic Group* | Upload Docs | ||
| No | |||||||||
| UNG0123810 | A | Did you use the attachment feature to upload your documents? | Yes | C | Y | Drop down, select one | Skip Logic Group* | Use Attachment Feature | |
| No | D | ||||||||
| UNG0123811 | C | Please tell us how easy it was to upload your attachments. | I had little or no difficulty uploading my attachment(s) | Y | Radio button, one-up vertical | Skip Logic Group* | Ease of Upload | ||
| I found it somewhat difficult to upload my attachment(s) | E | ||||||||
| UNG0123787 | E | Please describe the difficulty you experienced. | N | Text field, <100 char | Skip Logic Group* | OE_UploadDifficulty | |||
| UNG0123840 | D | Why didn't you use the attachment feature? | I will upload them later because I am not finished yet | Y | Radio button, one-up vertical | Skip Logic Group* | Did Not Attach | ||
| I do not have electronic copies of my document(s) to upload | |||||||||
| I was not clear on how to upload my document(s) | |||||||||
| I did not see the attachment feature | |||||||||
| I forgot to upload my document(s) | |||||||||
| My documents were too big to upload | |||||||||
| Received an error message | |||||||||
| Other, please specify | F | ||||||||
| UNG0123841 | F | Please specify your other reason. | N | Text field, <100 char | Skip Logic Group* | OE_Did Not Attach | |||
| MAC0714 | How helpful was the information on the online appeal Welcome Page? | Very helpful | Y | Drop down, select one | Welcome Page | ||||
| Somewhat helpful | |||||||||
| Not helpful at all | |||||||||
| Did not read the Welcome Page | |||||||||
| CAS0045693 | How helpful were the links to pop-up help pages (as indicated by a blue question mark) throughout the online appeal application? | Very helpful | Y | Drop down, select one | Pop-up Help Links | ||||
| Somewhat helpful | |||||||||
| Not helpful at all | |||||||||
| Did not read the help links | |||||||||
| Did not see the blue question marks | |||||||||
| STE0078190 | How helpful was the “Information You Will Need” checklist that was provided on the disability appeal Welcome Page? | Very helpful | Y | Drop down, select one | Checklist Helpful | ||||
| Somewhat helpful | |||||||||
| Not helpful at all | |||||||||
| Did not review the checklist | |||||||||
| Don't remember seeing the link to the checklist | |||||||||
| MAC0713 | Please rate the ease of navigating through the online appeal. | Very easy | Y | Drop down, select one | Ease of Navigating | ||||
| Somewhat easy | |||||||||
| Somewhat difficult | |||||||||
| Very difficult | |||||||||
| 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 | |||||||||
| STE0078182 | What is your permanent residence? | United States or one of its territories / commonwealths | Y | Radio button, one-up vertical | Residence | ||||
| Foreign country | |||||||||
| I prefer not to answer | |||||||||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |
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