Model Instance Name: | |||||||||||||
SSA My Social Security v2 | |||||||||||||
MID: | |||||||||||||
Partitioned Yes | |||||||||||||
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 | |||||||||||||
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 |
Err:508 | |||||||||
SSA My Social Security v2 | underlined & italicized: RE-ORDER | ||||||||
Err:508 | 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,N5 | ||||||||
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 | ||||||||
RUS0280248 | C2 | How much do you agree or disagree with the following statement? I am comfortable receiving notices only online. | RUS0280248A001 | Strongly disagree | Radio button, one-up vertical | Y | Skip Logic Group | Comfortable COLA online | |
RUS0280248A002 | Somewhat disagree | ||||||||
RUS0280248A003 | Neither agree or disagree | ||||||||
RUS0280248A004 | Somewhat agree | ||||||||
RUS0280248A005 | Strongly agree | ||||||||
RUS0280250 | C4 | Do you have any suggestions for improving our online notices? | text, no char limit | N | Skip Logic Group | Improve Online notices | |||
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 |
Model Name | SSA MySSA V3 | |||||||
Model ID | Underlined & Italicized: Re-order | |||||||
Partitioned | Yes - 2 MQ | 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 | 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. |
File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
File Modified | 0000-00-00 |
File Created | 0000-00-00 |