Social Security Statement

	ABOUT OUR my Social Security OFFICE VISITOR SURVEY
	We would like to know why some my Social Security account holders choose to visit a Social Security office instead of using our website to conduct their business. The survey should take less than 10 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:	o Yes  GO TO question 2.
			o No  SKIP to question 3.
	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.
	Mark X to indicate your answer. If you want to change your answer, completely fill in the answer box for the wrong answer and mark X in the box next to the correct answer.
	Please do not write any of your personal information anywhere on this survey form.
YOUR REQUEST FOR A REPLACEMENT SOCIAL SECURITY CARD

	1.		Social Security records show that you recently visited an office to request a replacement Social Security card. Did you visit a local office to get a replacement Social Security card?
			Mark [X] ONE answer.
			Yes, I did recently visit a local office to get a replacement Social Security card.GO TO question 2.
			Yes, I did recently visit a local office, but I did not request a replacement Social Security card.SKIP to question 19.
			No, I did not, nor do I remember recently visiting a local office.STOP! Do not complete this survey. Please leave the rest of the survey blank and return it in the enclosed envelope with only this box marked. Thank you for your time.
	In the state where you live, any person with a my Social Security account can request a replacement Social Security card online if they: Are a U.S. citizen age 18 or older Have a driver's license or a state-issued identification card Have a U.S. mailing address, or an APO, FPO, or DPO address Are not requesting a change to their name, date of birth, place of birth and/or gender
	2.		Based on the information above, were you eligible to request a replacement card online?
		Mark [X] ONE answer.
		Yes  SKIP to question 4.
		No  GO TO question 3.

	3.		Why were you not eligible to request a replacement Social Security card online?
			Mark [X] ALL that apply.
		I am not a U.S. citizen age 18 or older.
		I did not have a driver's license or a state-issued identification card.
		 SKIP to question 19. I did not have a U.S. mailing address. I needed a change to my name, date of birth, place of birth and/or gender.

	4.			Prior to your visit to a local office, did you know that you had a my Social Security account?
					Mark [X] ONE answer.
		Yes  GO TO question 5.
		No  SKIP to question 19.

	5.		Did you know that you could request a replacement Social Security card online with your my Social Security account?
		Mark [X] ONE answer.
		Yes  GO TO question 6.
		No  SKIP to question 19.

6.	Did you try to use your my Social Security account to request a replacement Social Security card?
	Mark [X] ONE answer.
	Yes, I tried to request one online, but I was not able to get into my account.  GO TO question 7.
	Yes, I was able to get into my account, but I couldn’t request a replacement card.  SKIP to question 8.
	No, I did not try to get one online with my Social Security account.  SKIP to question 17.

7.	Why weren’t you able to get into your account?
	Mark [X] ALL that apply.
	I couldn’t remember my username or password.
	I couldn’t answer the security questions.
	I got locked out.
	 SKIP to question 19. I couldn’t access the Internet.
	I didn’t have access to my email or cell phone to receive a security code.
	I couldn’t wait 5-10 days to reset where my security codes are sent.
	It was too hard or complicated.
	Some other reason (Please explain):

8.	Why weren’t you able to get a replacement Social Security card online using your my Social Security account?
	Mark [X] ALL that apply.
	My name or Social Security Number I entered didn’t match Social Security records.
	My driver's license or ID card information I entered didn’t match motor vehicle records.
	The address I entered could not be verified.
	Records indicated I have a pending request for a replacement card.
	It was too hard or complicated.
	Some other reason (Please explain):

 GO TO question 9.

9.	Did you use the “Get Help” tool that is available in your my Social Security account?
	Mark [X] ONE answer.
	Yes  GO TO question 10.
	No  SKIP to question 19.

10.	Did you view one of the popular questions available to customers or did you type your question into the search box?
	Mark [X] ONE answer.
	 GO TO question 11. I viewed one of the popular questions.
	I typed my question into the search box.
	I did both.
	No, I did not do either.  SKIP to question 13.

11.	Did the information answer your question(s)?
	Mark [X] ONE answer.
	Yes  SKIP to question 13.
	No  GO TO question 12.

12.	Why didn’t the information answer your question?
	 GO TO question 13.

13.	Did you ask to talk to an expert?
	Mark [X] ONE answer.
	Yes  GO TO question 14.
	No  SKIP to question 19.

14.	Did you request a callback or did you call Social Security?
	Mark [X] ONE answer.
	I requested a callback.
	 GO TO question 15. I called Social Security.
	I did both. No, I did not do either.

15.	Was Social Security able to help you with your problem?
	Mark [X] ONE answer.
	Yes  SKIP to question 19.
	No GO TO question 16.

16.	 SKIP to question 19. Why wasn’t the employee able to help?

17.	Why didn’t you try to use your my Social Security account to request a replacement Social Security card?
	Mark [X] ALL that apply.
	 GO TO question 17a. I thought it would be quicker to go to the office.
	I did not have access to the Internet.
	I do not have a printer.
	I’m concerned about privacy/security.
	I thought it would it be too hard or complicated.
	Some other reason (Please explain):

17a. When requesting a benefit verification letter, do you prefer to receive service in person?

• Yes  GO TO questions 18.

• No  SKIP TO question 19.

18.	Among the following reasons given below, please choose the one best response that explains why in-person service appeals to you.
	Mark [X] ONE answer.
	I can get answers to my questions right away.
	It creates a record of my transaction.
	 GO TO question 19. Someone can be held accountable if something goes wrong.
	It’s more convenient to go to an office.
	I’m worried I wouldn’t be able to do it myself.
	I like being served by someone I am familiar with.
	Some other reason (Please explain):

VISITING SOCIAL SECURITY

Please rate the service you received when you visited the Social Security office.

Mark [X] ONE answer for every item.		Excellent	Very Good	Good	Fair	Poor	Very Poor
19.	Office location
20.	Office hours
21.	Signs/instructions explaining how to check in when you got to the office
22.	Office comfort (seating, temperature, etc.)
23.	Office appearance (clean, pleasant, etc.)
24.	Office privacy
25.	Courtesy of the staff
26.	Waiting time to be served in the office

Mark [X] ONE answer.		Less than 10 minutes		Between 10 and 30 minutes	Between 31 and 60 minutes	More than 60 minutes
27.	How long did you wait to be served?	□	□		□	□

28.	Did you have to visit the office more than once to get the service you needed?
	Mark [X] ONE answer.
	Yes
	 GO TO question 29. No

Mark [X] ONE answer.		Excellent	Very Good	Good	Fair	Poor	Very Poor
29.	Overall, how would you rate the service you received when you visited the office?

USING YOUR my Social Security ACCOUNT ON SOCIAL SECURITY’S WEBSITE

30.	Do you plan to use your my Social Security for future business?
	Mark [X] ONE answer.
	Yes  GO TO question 31.
	No  SKIP to question 32.
31.		What do you plan to use your my Social Security account for?
		Mark [X] ALL that apply.
		Request a replacement Social Security card
		Check the status of an application or appeal
		Get my Social Security Statement
		Get a benefit verification letter
		Report your wages if you work
		Change your address or phone number
		 SKIP to question 34. Start or change direct deposit of your benefit payment
		Request a replacement Medicare card
		Get a replacement SSA-1099 or SSA-1042S for tax season
		Get personalized retirement benefit estimates
		Opt out of mailed notices
		Access the Representative Payee Portal

32.	Why won’t you use your my Social Security account for future business?
	Mark [X] ONE answer.
	It is easier to understand things explained by a person.
	I can get questions answered right away by a person.
	I am concerned about security or privacy of my information.
	My computer is too old/Internet service is too slow I don’t have a computer, printer, or Internet service. I am locked out of my account.
	I don’t have the necessary computer skills or experience.
	I am concerned it might be too hard or complicated.
	Some other reason I won’t use my Social Security account. (Please explain): I can’t think of any reason why I won’t use it.
33.	What do you plan to do instead of using your my Social Security account for future business?
	Mark [X] ALL that apply.
	 GO TO question 34. Call the National 800 Number
	Call a local office
	Visit a local office
34.	Social Security is constantly striving to provide excellent service and we would like to get your ideas about how we could improve services. If you would be willing to help Social Security, please provide your contact information below.
	Home Phone Number:_______________
	Cell Phone Number:_________________ Email Address:______________________

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 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.

OMB Control No: 0960-0526 Expiration Date: TBD

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