Insure Kids Now Pop-up Survey

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Survey Un

QID

Question Type

Question Text

BLOCK 1: INTRO
We are interested in your opinion to continuously
improve our website for you. This short survey will
take approximately 2 minutes to complete.

Intro Message

Descriptive Text

Intro Message

Descriptive Text

All responses to this survey are voluntary and
anonymous.
According to the Paperwork Reduction Act of 1995,
no persons are required to respond to a collection
of information unless it displays a valid OMB control
number. The valid OMB control number for this
information collection is 0938-1382. This number is
valid thru 12/31/2026.

BLOCK 2: Default Question Block

Q0

Q0.1

Q1

This question will record the recipient's browser
information. It will not be displayed to the user.
- Browser Type
- Browser Version
- Operating System
- Screen Resolution
- User Agent
Descriptive Text
This question lets you record and manage how long
a participant spends on this page. This question will
not be displayed to the participant.
Descriptive Text
Based on my experience on InsureKidsNow.gov, I
trust that InsureKidsNow is working in the best
Multiple Choice (single select) interest of the American public.

PAGE BREAK

Q2

PAGE BREAK

Multiple Choice (single select) Which of these best describes you?

Q3

What was the main reason you came to
InsureKidsNow.gov today? If you came for more
Multiple Choice (single select) than one reason, please pick the main one.

PAGE BREAK

Q4

What about today's interaction made the difference?
Multiple Choice (multi-select) (Select all that apply)

PAGE BREAK

Q5

How satisfied are you with your overall experience
Multiple Choice (single select) on InsureKidsNow.gov?

BLOCK 3 - Open Text
How can we improve your overall experience on
InsureKidsNow.gov?

Q6

Text Entry

Please be specific, but protect your privacy - don't
include personal information, like your phone
number, address, or Social Security number. We thank you for your time

END OF S

Your response has

Survey Unit Testing

Insur

Next bu

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Answer Choices (if applicable)

Answer
Choices
Numeric Values
(recodes)

Required?

Display Logic

Randomize
Answer
Choices?

NA

N

N

N

N

NA

N

N

N

N

N/A

N

N

N

N

N/A

N

N

N

N

Yes
No

N

Y

N

N

Person looking for Helth Insurance
information
Person using "Find a Dental Provider" tool
Healthcare professional or administrative
staff
Government employee
Community outreach partner
Other (Please specify)

N

Y

N

N

CHIP eligibility or coverage information
Find a Dentist
Outreach information or materials
Other (Please specify)

N

Y

N

N

Accomplishing my task
Website navigation
Find what I need
Able to understand the information
Something else (open text box)

N

Y

N

N

Extremely dissatisfied
Slightly dissatisfied
Neither satisfied nor dissatisfied
Slightly satisfied
Extremely satisfied

N

Y

N

N

Y

N

N

Open
text
box taking this survey.
N
We thank you for your
time
spent

END OF SURVEY

Your response has been recorded.

InsureKidsNow.gov theme
Next button and Back button
Compact question spacing
Auto advance on pages

Comments / Additional
Configuration Notes

These are background questions
and should not display to the
survey taker.
These are background questions
and should not display to the
survey taker.