Document

Track Change - Qualtrics Survey Script

ICR 202609-0938-011 · OMB 0938-1382 · Object 172936700.

Document Viewer [pdf]

Status: Original and derived artifacts are available for this document.

Download: pdf

Primary: pdfSource: application/pdf
Loading document viewer…

Document Metadata

Record metadata
application/pdf
Track Change - Qualtrics Survey Script
Rynes, Scott (CMS/OSPR)
Microsoft® Word for Microsoft 365
2026-09-11
2026-09-11
complete

Extracted Text

Proposed Qualtrics Survey Script:
1. Overall, how satisfied were you with your experience updating your data
requestworking with CMS? (1 – Very Dissatisfied, 2 – Somewhat Dissatisfied, 3 –
Neutral, 4 – Somewhat Satisfied, 5 – Very Satisfied)
2. How clear was the information you received throughout the updating process? (1 –
Not at all Clear, 2 – Slightly Clear, 3 – Moderately Clear, 4 – Very Clear, 5 – Extremely
Clear)
3. How satisfied were you with the timeliness of your request? (1 – Very Dissatisfied, 2
– Somewhat Dissatisfied, 3 – Neutral, 4 – Somewhat Satisfied, 5 – Very Satisfied)
4. What is one thing CMS could improve to make this process clearer or easier? (Free
Text)
5. What are aspects of this process that you found especially useful when working with
CMS? (Free Text)