Document
Survey: Crosswalk
ICR 202609-0938-011 · OMB 0938-1382 · Object 172934200.
Document Viewer [xlsx]
Document Metadata
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
|---|---|
| File Title | Survey: Crosswalk |
| Author | Tess Hines |
| Last Modified By | Calc |
| File Modified | 2026-04-16 |
| File Created | 2026-10-10 |
| Conversion State | complete |
Extracted Text
CMS 10910 - IKN Pop-up Survey for Desktop and Mobile Question Number Current Question Version Current Answer(s) Version Future Question Version Question 1 "Based on my experience on InsureKidsNow.gov, I trust that InsureKidsNow is working in the best interest of the American public. " Yes/No [single select, required] "Based on my experience on InsureKidsNow.gov, I trust that InsureKidsNow is working in the best interest of the American public. " Question 2 "Which of these best describes you?" Question 3 Question 4 Question 5 Question 6 Question 7 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) [open text] "What was the main reason you came to CHIP eligibility or coverage information InsureKidsNow.gov today? If you came for more than Find a Dentist one reason, please pick the main one." Outreach information or materials Other (Please specify) [open text] "What about today's interaction made the I accomplished my task difference? (Select all that apply)" **only shows if The website was easy to navigate "Yes" answer to question 1 Found what I needed quickly The information was easy to understand Something else [open text] "Which of these best describes you?" I did not complete my task "What could have been better? (Select all that apply)" **only shows if "No" answer to question 1 The website was difficult to navigate It took too long to do what I needed to do The information was hard to understand Something else [open text] If you used the InsureKidsNow.gov search feature, Yes did it help you find what you were looking for today? No Does not apply - N/A "What was the main reason you came to InsureKidsNow.gov today? If you came for more than one reason, please pick the main one." "What about today's interaction made the difference? (Select all that apply)" N/A "How satisfied are you with your overall experience on Medicaid.gov?" CMS 10910 - IKN Pop-up Survey for Desktop and Mobile Question Number Current Question Version Question 8 "You told us you were dissatisfied with one or more [open text] parts of your experience. To help us improve, please tell us why. Question 9 Please be specific, but protect your privacy - don't include personal information, like your phone number, address, or Social Security number." [only shows if answer to Question 1 = "No"] "How can we improve your overall experience on InsureKidsNow.gov? Please be specific, but protect your privacy - don't include personal information, like your phone number, address, or Social Security number." [only shows if answer to Question 1 = "Yes"] Current Answer(s) Version [open text] Future Question Version N/A "How can we improve your overall experience on InsureKidsNow.gov? Please be specific, but protect your privacy - don't include personal information, like your phone number, address, or Social Security number." p Survey for Desktop and Mobile Future Answer(s) Version Type of Change(s) from Description of Change from Current to Current to Future Version Future Version Yes/No (single select, required) No change No change No burden implications 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) [open text] CHIP eligibility or coverage information Find a Dentist Outreach information or materials Other (Please specify) [open text] Accomplishing my task Website navigation Find what I need Able to understand the information Something else [open text] No change No change No burden implications No change No change No burden implications Revision to future answers Minor wording changes to existing categories are being made based on user feedback and industry best practices No burden implications N/A Removal The revised wording to question 4 eliminates the need for this logic-based alternative question/answer set No burden implications N/A Removal This question/answer set is no longer necessary No burden implications Extremely dissatisfied Slightly dissatisfied Neither satisfied nor dissatisfied Slightly satisfied Extremely satisfied Addition to survey - consistent This is a simple 1-5 Likert satisfaction selection, No burden implications with Medicaid.gov Feedback maintaining consistency across all surveys tool Burden Implications p Survey for Desktop and Mobile Future Answer(s) Version Type of Change(s) from Description of Change from Current to Current to Future Version Future Version N/A Removal This question/answer set is no longer necessary No burden implications [open text] No change No change Burden Implications No burden implications