Office Visit Surveys

Generic Clearance of Customer Satisfaction Surveys

Office Visitor Survey Questionnaires

Office Visit Surveys

OMB: 0960-0526

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ABOUT OUR OFFICE VISITOR SURVEY
We would like to know about your recent visit to one of our local field or hearing offices. The survey should
take about 5 minutes to complete.
Answer all questions as directed. The instructions may tell you to skip over some questions. When that
happens, you will see an arrow with a note telling you what question to answer next:
Example:



Yes

 GO to next question.



 SKIP to question 11.

INSTRUCTIONS FOR MARKING YOUR ANSWERS
• Use a pen with blue or black ink.

• Make no stray marks.

• Do not use a pen with ink that soaks through the paper.

• Keep all entries within the appropriate boxes.

Please do not write any of your personal information anywhere on this survey form.
Mark [X] ONE rating for each question.

Excellent

Very
Good

Good

Fair

Poor

Very
Poor

1. Office location



2. Office hours



5. Office comfort (seating, temperature, etc.)



6. Office appearance (clean, pleasant, etc.)



7. Office privacy



3. Signs/instructions explaining how to check in
when you got to the office
4. Usefulness of Social Security information in
the waiting area (posters, pamphlets, TV
presentations, etc.)

8. Did you have an appointment?
Mark [X] ONE.
 Yes 

GO to next question.

 No 

SKIP to question 11.

9. How quickly you got an appointment



10. Convenience of the date and time of the
appointment



11. Waiting time to be served in the office



12. About how many minutes did you have to wait?
Mark [X] ONE.
 Up to 10 minutes
 More than 10 and up to 30 minutes
 More than 30 and up to 60 minutes
 More than 60 minutes

13. Courtesy of the staff



14. How well the staff knew their jobs



15. How clearly the staff explained things



16. Overall, how would you rate Social Security’s
service during your recent office visit?



17. Were you able to take care of your business in one visit to the local office?
Mark [X] ONE.
 Yes
 No

18. Did you use any of the online services available through the Self-Help Computer in the office?
Mark [X] ONE.
 Yes

GO to next question.

 No 

SKIP to question 21.

19. Were you able to complete your business using the Self-Help Computer in the office?
Mark [X] ONE.
 Yes 

SKIP to question 21.

 No 

GO to next question.

20. Why were you not able to complete your business using the Self-Help Computer in the office?
Explain:_____________________________________________________________________________
_______________________________________________________________________________________
21. Did this interaction increase your confidence in Social Security’s in-person service?
Mark [X] ONE.
 Yes
 No

22. Before you went to the office, did you try to take care of this business earlier?
Mark [X] ONE.
 Yes 

GO to next question.

 No 

SKIP to question 25.

23. What else did you do? Did you:
Mark [X] ALL that apply.
 Call Social Security’s National 800 Number
 Call the local office
 Visit a local office
 Try to use Social Security’s website

24. Why weren’t you able to take care of your business in your earlier contact?
Mark [X] ALL that apply.
 I couldn’t get through on the phone
 The wait was too long at the office
 The office was closed
 The staff told me I had to come into the office
 I didn’t have all the information or documents I needed
 The staff couldn’t answer my question
 I couldn’t find what I needed on the website
 I tried an online service but it didn’t work for me
 I tried to file an application online, but I do not have a my Social Security account
 I tried to create a my Social Security account, but it didn’t work for me

Now we would like to ask you about doing business on the Internet.
25. First, do you currently use the Internet?
Mark [X] ONE.
 Yes

GO to next question.

 No 

SKIP to question 30.

26. We offer a service called “my Social Security” where people can create a secure online account with a user
name and password to conduct various types of business. For example, people who receive benefits can use
it to change their address. Have you already created your my Social Security account?
Mark [X] ONE.
 Yes 

GO to next question.

 No 

SKIP to question 28.

27. What have you used your my Social Security account for?
Mark [X] ALL that apply.
 Requested a replacement Social Security card
 Checked the status of an application or appeal
 Filed an application for benefits
 Got my Social Security Statement
 Got my benefit verification letter
 Reported my wages
 Changed my address or phone number
 Started or changed direct deposit of my benefit payment
 Requested a replacement Medicare card
 Got a replacement SSA-1099 or SSA-1042 for tax season
 I have not yet used my account

All SKIP to question 30.
28. Do you plan to create a my Social Security account?
Mark [X] ONE.
 Yes 

SKIP to question 30.

 No 

GO to next question.

 I tried to create one, but it didn’t work for me SKIP to question 30.

29. What is the main reason you do not plan to create a my Social Security account?
Mark [X] ONE.
 Prefer to speak to a person
 Concerned about security of my information


Problem with computer or Internet access



Concerned that completing my business online might be too hard



Some other reason
Explain:________________________________________________________________________
________________________________________________________________________________

We would like to know a little more about you.
30. First, do you own a cell phone?
Mark [X] ONE.
 Yes

GO to next question.

 No

SKIP to question 33.

31. Do you use your cell phone to send and receive text messages?
Mark [X] ONE.


Yes



32. Do you use your cell phone to access the Internet?
Mark [X] ONE.


Yes



33. What is your age group? Are you:
Mark [X] ONE.
 Under age 30
 Age 30 to 49
 Age 50 to 64
 Age 65 to 74
 Age 75 or older

END OF SURVEY
Thank you for taking the time to complete this survey. Social Security will use your answers to improve our services. Please
return the completed questionnaire in the postage-paid envelope as soon as possible to:
Social Security Survey
[Contractor Return Address]

PRIVACY ACT STATEMENT

PAPERWORK REDUCTION ACT STATEMENT

The Social Security Administration is authorized to
collect the information for this survey under
Executive Order 12862, “Setting Customer Service
Standards.” Your response to these questions is
strictly voluntary. The information you provide will
be used to help us improve the service that we give
you. Your response will not be disclosed to any other
government or private agency.

This information collection meets the requirements of
44 U.S.C. § 3507, as amended by Section 2 of the
Paperwork Reduction Act of 1995. You do not need to
answer these questions unless we display a valid Office
of Management and Budget control number. We
estimate that it will take about 5 minutes to read the
instructions, gather the facts and answer the questions.
You may send comments on our time estimate above to:
Social Security Administration, 6401 Security Blvd.,
Baltimore, MD 21235-6401.

OMB Control No: 0960-0526
Expiration Date: TBD

Send only comments relating to our time estimate to this
address, not the completed form.

ABOUT OUR OFFICE VISITOR SURVEY
We would like to know about your recent visit to one of our Social Security card centers. The survey should
take about 5 minutes to complete.
Answer all questions as directed. The instructions may tell you to skip over some questions. When that
happens, you will see an arrow with a note telling you what question to answer next:
Example:



Yes

 GO to next question.



 SKIP to question 4.

INSTRUCTIONS FOR MARKING YOUR ANSWERS
• Use a pen with blue or black ink.

• Make no stray marks.

• Do not use a pen with ink that soaks through the paper.

• Keep all entries within the appropriate boxes.

Please do not write any of your personal information anywhere on this survey form.
1.

First, did you contact Social Security to find out how to apply for a new or replacement Social Security card
before you visited the Social Security Card Center?
Mark [X] ONE.

 Yes 

GO to next question.

 No 

SKIP to question 4.

How did you contact Social Security for that information? Did you:
Mark [X] ALL that apply.
 Call Social Security’s National 800 number
 Call a Social Security office
 Visit a Social Security office
 Visit Social Security’s website

Mark [X] ONE rating for each question.

Excellent

Very
Good

Good

Fair

Poor

Very
Poor

3. Information you received before your visit
about how to apply for a new or replacement
Social Security card



4. Office location



5. Office hours



6. Signs/instructions explaining how to check in
when you got to the office



Mark [X] ONE rating for each question.

Excellent

Very
Good

Good

Fair

Poor

Very
Poor

7. Usefulness of Social Security information in
the waiting area (posters, pamphlets, TV
presentations, etc.)



8. Office comfort (seating, temperature, etc.)



9. Office appearance (clean, pleasant, etc.)



10. Office privacy



11. Waiting time to be served in the office



13. Courtesy of the staff



14. How well the staff knew their jobs



15. How clearly the staff explained things



16. Overall, how would you rate
Social Security’s service during your recent
visit?



12. About how many minutes did you have to wait?
Mark [X] ONE.
 Up to 10 minutes
 More than 10 and up to 30 minutes
 More than 30 and up to 60 minutes
 More than 60 minutes

17. Were you able to take care of your business in one visit to the Social Security Card Center?
Mark [X] ONE.
 Yes
 No

18. Did this interaction increase your confidence in Social Security’s in-person service?
Mark [X] ONE.
 Yes
 No

19. To serve you better in the future, we would like to know how you prefer to do business with Social Security.
First, what is your preferred language?
Mark [X] ONE.


English



Spanish



Other Explain:______________________________________________

20. Do you currently use the Internet?
Mark [X] ONE.


Yes

GO to next question.



No 

SKIP to question 25.

22. We offer a service called my Social Security where people can create a secure online account with a user
name and password to conduct various types of business. For example, people who receive benefits can
use it to change their address. Have you already created your my Social Security account?
Mark [X] ONE.


Yes

GO to next question.



No 

SKIP to question 25.

23. Were you aware that in some states, you could request a replacement Social Security card online with your
my Social Security” account?
Mark [X] ONE.


Yes

GO to next question.



No 

SKIP to question 25.

24. Why did you choose to visit a Social Security office to request your replacement Social Security card
instead of requesting one online?
Mark [X] ONE best answer.
 I attempted to request one online, but it did not work for me
 I needed it right away.
 I prefer to receive service in person.
 I did not have access to the Internet.
 I do not live in one of the states that allows this
 I needed to change information on my card
 I do not have a driver’s license or a state-issued identification card
 I needed an original Social Security card
 Some other reason (Please explain):

__________________________________________________________________________________
__________________________________________________________________________________

We would like to know a little more about you.
25. First, do you own a cell phone?
Mark [X] ONE.
 Yes



GO to next question.

 No



SKIP to question 28.

26. Do you use your cell phone to send and receive text messages?
Mark [X] ONE.
 Yes
 No

27. Do you use your cell phone to access the Internet?
Mark [X] ONE.
 Yes
 No

28. What is your age group? Are you:
Mark [X] ONE.
 Under age 30
 Age 30 to 49
 Age 50 to 64
 Age 65 to 74
 Age 75 or older

END OF SURVEY
Thank you for taking the time to complete this survey. Social Security will use your answers to improve our services.
Please return the completed questionnaire in the postage-paid envelope as soon as possible to:
Social Security Survey
[Contractor Return Address]

PRIVACY ACT STATEMENT

PAPERWORK REDUCTION ACT STATEMENT

OMB Control No: 0960-0526
Expiration Date: TBD
Send only comments relating to our time estimate to this
address, not the completed form.

First Survey Interval
FY 2020 Office Visitor Survey - Pre-Notice Postcard

Dear Social Security Customer:
Social Security believes that conducting surveys is one of the best ways to find out how
well we are serving you. That’s why we will soon be asking you to give us your opinion
of the recent service you received from us.
In a few days, you will receive a short questionnaire in the mail from [insert contractor
name], who is conducting this survey for Social Security. When you receive its
envelope, please take the time to answer our questions and tell us what you think of our
service.
We look forward to hearing your opinions.
B. Chad Bungard
Deputy Commissioner
for Analytics, Review, and Oversight
Social Security Administration

First Survey Interval
FY 2020 Office Visitor Survey – Initial Cover Letter

Dear Social Security Customer:
As noted in our recent postcard, Social Security is conducting a survey to find out how
well we served you during your recent visit to a local Social Security office. Please take
a few minutes to fill out the enclosed questionnaire and return it as soon as possible in the
postage-paid envelope provided. (Please do not put any personal information related
to Social Security business in the envelope with your completed survey.)
Please be assured that [Contractor Name], who is conducting this survey for us, will give
your responses to only my staff here at Social Security and will not use them for any
other purpose. Social Security will report the survey results by summarizing the answers
of everyone who takes the survey. We will not report any individual responses.
If you have a question about Social Security benefits, please visit our website at
www.socialsecurity.gov or call our toll-free information line at 1-800-772-1213
(TTY 1-800-325-0778).
We appreciate you taking time out of your busy schedule to complete the survey.
Sincerely,

B. Chad Bungard
Deputy Commissioner
for Analytics, Review, and Oversight
Social Security Administration

Enclosures

First Survey Interval
FY 2020 Office Visitor Survey – Follow-up Cover Letter

Dear Social Security Customer:
A few weeks ago, we sent you a survey to find out how well we served you when you
visited a Social Security local office. We haven’t yet heard from you, and it’s important
that we gather opinions from as many people as possible. If you have already returned
your completed survey, please discard this letter. We sincerely appreciate your help, and
we look forward to receiving your response.
If you have not yet had time complete the survey, please take a few minutes right now to
do that. The form is short and takes less than 10 minutes to complete. In case you
misplaced the survey, we have enclosed another copy along with a postage-paid return
envelope. (Please do not put any information related to Social Security business in
the envelope with your completed survey.)
Please be assured that [Contractor Name], who is conducting this survey for us, will give
your responses to only my staff here at Social Security and will not use them for any
other purpose. Social Security will report the survey results by summarizing the answers
of everyone who takes the survey. We will not report any individual responses.
If you have a question about Social Security benefits, please visit our website at
www.socialsecurity.gov or call our toll-free information line at 1-800-772-1213
(TTY 1-800-325-0778).
We would appreciate receiving your completed survey as soon as possible.
Sincerely,

B. Chad Bungard
Deputy Commissioner
for Analytics, Review, and Oversight
Social Security Administration

Enclosures

First Survey Interval
FY 2020 Office Visitor Survey – Prenotice Postcard – Spanish

Estimado(a) Cliente del Seguro Social:
La Administración del Seguro Social cree que una de las mejores maneras de saber si
el público está satisfecho con nuestro servicio es a través de encuestas. Es por eso que
muy pronto le estaremos pidiendo su opinión sobre el servicio que recibió durante su
reciente visita a la oficina del Seguro Social o la oficina de audiencias del Seguro Social.
En unos días, usted recibirá un corto cuestionario por correo de [insert contractor name],
quien está llevando a cabo esta encuesta por parte del Seguro Social. Cuando lo reciba,
esperamos que tome el tiempo para contestar nuestras preguntas y decirnos lo que piensa
de nuestro servicio.
Esperamos escuchar sus opiniones.
B. Chad Bungard
Comisionado Adjunto
Oficina de Análisis, Revisión y Supervisión
Administración del Seguro Social

First Survey Interval
FY 2020 Office Visitor Survey – Initial Cover Letter - Spanish

Estimado(a) [insert name]:
Según le indiqué en la tarjeta postal que le envié recientemente, el Seguro Social está
llevando a cabo una encuesta para obtener su opinión sobre el servicio que recibió
durante su reciente visita a la oficina local del Seguro Social o la oficina de audiencias.
Por favor tómese 5 minutos para llenar la “Tarjeta de Calificación” adjunta y devolverla
lo antes posible en el sobre franqueado provisto.
Por favor, siéntase seguro de que [insert contractor name], quien está llevando a cabo
esta encuesta por nosotros, proveerá sus respuestas solamente a mi personal aquí en el
Seguro Social y no las usará para ningún otro propósito. El Seguro Social presentará los
resultados de la encuesta con un resumen de las respuestas de todas las personas que
tomen la misma; no presentaremos informes individuales de las respuestas.
Si tiene alguna pregunta sobre los beneficios de Seguro Social, por favor visite nuestro
sitio de Internet en www.segurosocial.gov o llame a nuestro número gratis para
información al 1-800-772-1213.
Le agradecemos que haya tomado el tiempo para contestar nuestra encuesta.
Sinceramente,

B. Chad Bungard
Comisionado Adjunto
Oficina de Análisis, Revisión y Supervisión
Administración del Seguro Social
Anexos

First Survey Interval
FY 2020 Office Visitor Survey- Follow-up Cover Letter – Spanish

Estimado(a) [insert name]:
Alrededor de una semana atrás, le enviamos un formulario de encuesta, “Déle una Tarjeta
de Calificación al Seguro Social,” pidiéndole su opinión sobre el servicio que recibió
cuando visitó la oficina local del Seguro Social o la oficina de audiencias. No hemos
oído de usted y es muy importante que reunamos opiniones de tantas personas como sea
posible. Si ya nos envió la encuesta completada, favor de ignorar esta carta.
Sinceramente apreciamos su ayuda y estamos ansiosos de recibir su respuesta.
Sin embargo, si todavía no ha tenido tiempo de llenar y devolver su encuesta, por favor
tome unos minutos ahora mismo para hacerlo. El formulario es corto y le tomará menos
de 5 minutos en llenarlo. En caso que haya perdido la encuesta, hemos incluido otra
copia junto con un sobre franqueado.
Por favor, siéntase seguro de que [insert contractor name], quien está llevando a cabo
esta encuesta por nosotros, proveerá sus respuestas solamente a mi personal aquí en el
Seguro Social y no las usará para ningún otro propósito. El Seguro Social presentará los
resultados de la encuesta con un resumen de las respuestas de todas las personas que
tomen la misma; no presentaremos informes individuales de las respuestas.
Si tiene alguna pregunta sobre los beneficios de Seguro Social, por favor visite nuestro
sitio de Internet en www.segurosocial.gov o llame a nuestro número gratis para
información al 1-800-772-1213.
Le agradeceríamos si recibimos su encuesta llena lo antes posible.
Sinceramente,

B. Chad Bungard
Comisionado Adjunto
Oficina de Análisis, Revisión y Supervisión
Administración del Seguro Social
Anexos

Second Survey Interval
FY 2020 Social Security Card Center Survey - Pre-Notice Postcard

Dear Social Security Customer:
Social Security believes that conducting surveys is one of the best ways to find out how
well we are serving you. That’s why we will soon be asking you to give us your opinion
of the recent service you received from us.
In a few days, you will receive a short questionnaire in the mail from [Contractor Name],
who is conducting this survey for Social Security. When you receive its envelope, please
take the time to answer our questions and tell us what you think of our service.
We look forward to hearing your opinions.

B. Chad Bungard
Deputy Commissioner
for Analytics, Review, and Oversight
Social Security Administration

Second Survey Interval
FY 2020 Social Security Card Center Survey – Initial Cover Letter

Dear Social Security Customer:
As noted in our recent postcard, Social Security is conducting a survey to find out how
well we served you during your recent visit to a Social Security Card Center. Please take
a few minutes to fill out the enclosed questionnaire and return it as soon as possible in the
postage-paid envelope provided. (Please do not put any personal information related
to Social Security business in the envelope with your completed survey.)
Please be assured that [Contractor Name], who is conducting this survey for us, will give
your responses to only my staff here at Social Security and will not use them for any
other purpose. Social Security will report the survey results by summarizing the answers
of everyone who takes the survey. We will not report any individual responses.
If you have a question about Social Security benefits, please visit our website at
www.socialsecurity.gov or call our toll-free information line at 1-800-772-1213
(TTY 1-800-325-0778).
We appreciate you taking time out of your busy schedule to complete the survey.
Sincerely,

B. Chad Bungard
Deputy Commissioner
for Analytics, Review, and Oversight
Social Security Administration

Enclosures

Second Survey Interval
FY 2020 Social Security Card Center Survey – Follow-up Cover Letter

Dear Social Security Customer:
A few weeks ago, we sent you a survey to find out how well we served you when you
visited a Social Security Card Center. We haven’t yet heard from you, and it’s important
that we gather opinions from as many people as possible. If you have already returned
your completed survey, please discard this letter. We sincerely appreciate your help, and
we look forward to receiving your response.
If you have not yet had time complete the survey, please take a few minutes right now to
do that. The form is short and takes less than 10 minutes to complete. In case you
misplaced the survey, we have enclosed another copy along with a postage-paid return
envelope. (Please do not put any information related to Social Security business in
the envelope with your completed survey.)
Please be assured that [Contractor Name], who is conducting this survey for us, will give
your responses to only my staff here at Social Security and will not use them for any
other purpose. Social Security will report the survey results by summarizing the answers
of everyone who takes the survey. We will not report any individual responses.
If you have a question about Social Security benefits, please visit our website at
www.socialsecurity.gov or call our toll-free information line at 1-800-772-1213
(TTY 1-800-325-0778).
We would appreciate receiving your completed survey as soon as possible.
Sincerely,

B. Chad Bungard
Deputy Commissioner
for Analytics, Review, and Oversight
Social Security Administration

Enclosures

Both Survey Intervals
Office Visitor Survey and Social Security Card Center Survey – Privacy Act

PRIVACY ACT STATEMENT
The Social Security Administration is authorized to collect the information for this survey
under Executive Order 12862, “Setting Customer Service Standards.” Your response to
these questions is strictly voluntary. The information you provide will be used to help us
improve the service that we give you. Your response will not be disclosed to any other
government or private agency.

PAPERWORK REDUCTION ACT STATEMENT
This information collection meets the requirements of 44 U.S.C. § 3507, as amended by
Section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these
questions unless we display a valid Office of Management and Budget control number.
We estimate that it will take about 10 minutes to read the instructions, gather the facts,
and answer the questions. You may send comments on our time estimate above to:
Social Security Administration, 6401 Security Blvd., Baltimore, MD 21235-6401. Send
only comments relating to our time estimate to this address, not the completed form.

First Survey Interval
Office Visitor Survey Privacy Act - Spanish
DECLARACIÓN DE LA LEY DE CONFIDENCIALIDAD
La Administración del Seguro Social tiene la autorización de colectar la información para
esta encuesta bajo la orden ejecutiva 12862, «Setting Customer Service Standards» (en
español, «Estableciendo el nivel de la calidad del servicio al consumidor»).
Sus respuestas a estas preguntas son completamente voluntarias. La información que nos
provea se usará para ayudarnos a mejorar el servicio que le proveemos. Sus respuestas
no serán divulgadas a otras agencias gubernamentales o privadas.

LEY PARA LA REDUCCIÓN DE TRÁMITES
Esta recopilación de información cumple con los requisitos de 44 U.S.C. &3507, según
enmendada por la sección 2 de La Ley para la Reducción de Trámites del 1995. No es
requisito que usted conteste estas preguntas a menos que el formulario de la encuesta
muestre un número de control válido de la Oficina de Administración y Presupuesto.
Calculamos que le tomará 10 minutos para llenar esta encuesta. Esto incluye el tiempo
que le tomará leer las instrucciones, recaudar los datos y contestar las preguntas. Puede
enviar comentarios sobre nuestro cálculo del tiempo mencionado anteriormente a:
Social Security Administration, 6401 Security Blvd., Baltimore, MD 21235-6401. Envíe
sólo los comentarios sobre nuestra estimación de tiempo a esta dirección, no el
formulario lleno.

File Type	application/pdf
Author	609733
File Modified	2022-03-01
File Created	2022-03-01