CMS-10754 GADCS Feedback Application

We are committed to providing you with the best experience possible, so we welcome your feedback. Please fill out this questionnaire. Thank you.

1. Please select your GADCS user role (please check all that apply).

☐ Submitter

☐ Certifier

☐ Don’t know

2. How much do you agree or disagree with the following statements about the GADCS?

	Strongly Agree	Agree	Neither Agree Nor Disagree	Disagree	Strongly Disagree	Not Applicable/Did not use
The GADCS login process is straightforward.
After logging in, I was able to link to my NPI without difficulty.
The system is simple and easy to use.
The GADCS Help Desk responds in a timely way and resolves our issues.
The system works as expected.
The questions asked were applicable to my organization.

3. Did you have any technical problems using the system?

☐ Yes  If Yes, please explain. _____________________________________________

☐ No

Now we have a few questions about the GADCS User Guide.

4. Did you use the User’s Guide while testing the GADCS?

☐ Yes

☐ No

5. [If yes to 4] How helpful did you find the User’s Guide?  

☐ Extremely helpful

☐ Somewhat helpful

☐ Not at all helpful

6. [If yes to 4] The user guide contains:

☐ More information than I needed

☐ Just the right level of information

☐ Not enough information  Please explain. ________________________________________

7. Have you used any of these resources? Yes No

   1. Quick Reference Guide ☐ ☐

   2. Frequently Asked Questions (FAQ) ☐ ☐

   3. Printable Data Collection Instrument ☐ ☐

   4. Educational Webinars ☐ ☐

   5. Q&A Sessions ☐ ☐

8. Please share any other comments about the GADCS system or the User’s Guide here:

_____________________________________________________________________

Thank you for your time.