ACSI Questionnaire for Government Services

ACSI Questionnaire for
Government Services
(For input to model in Figure 2)
INTRODUCTION
Hello, I'm (NAME) calling on behalf of the University of Michigan. We are conducting research on how
satisfied users are with services provided by Federal government agencies and private companies as part
of the American Customer Satisfaction Index. You may have read something about the American
Customer Satisfaction Index in USA Today, The Wall Street Journal, or your local newspaper.
Today I want to ask you about services you may have received from the (AGENCY/PROGRAM). The
purpose of the research is to help this government agency improve its services to you and to people like
you. Your answers are voluntary, but your opinions are very important for this research. Your response
will remain completely anonymous. This interview will take 8-10 minutes* and is authorized by Office of
Management and Budget Control No. 1090-0007.
[ADD ANY NEEDED SCREENING QUESTIONS HERE]
Now, I am going to ask you some questions about the [AGENCY] [ACTIVITIES/SERVICES/PRODUCTS]
with which you have had experience.
Q1. Before you used the [AGENCY/PROGRAM], you probably knew something about the
[AGENCY/PROGRAM]. Now think back and remember your expectations of the overall quality of the
[AGENCY/PROGRAM]. Please give me a rating on a 10-point scale on which “1” means your
expectations were “not very high” and “10” means your expectations were “very high.”
How would you rate your expectations of the overall quality of [AGENCY/PROGRAM]?
1 TO 10__________
11 Don’t know
12 Refused
Now, let’s think about _______
Q2. [QUESTION RATING AN ASPECT OF ACTIVITY 1] Again, we will use a 10-point scale on which…
1 TO 10 __________
11 Don’t know
12 Refused
*Insert

15-17 minutes for RDD samples for which respondents can be interviewed about two agencies.

Q3. [SECOND QUESTION RATING AN ASPECT OF ACTIVITY 1]
1 TO 10 __________
11 Don’t know
12 Refused
And next, considering ________
Q4. [QUESTION RATING AN ASPECT OF ACTIVITY 2]
1 TO 10 __________

11 Don’t know
12 Refused
Q5. [SECOND QUESTION RATING AN ASPECT OF ACTIVITY 2]
1 TO 10 __________
11 Don’t know
12 Refused
And thinking about_________
Q6. [QUESTION RATING AN ASPECT OF ACTIVITY 3]
1 TO 10 __________
11 Don’t know
12 Refused
Q7. [SECOND QUESTION RATING AN ASPECT OF ACTIVITY 3]
1 TO 10 __________
11 Don’t know
12 Refused
Q8. [OPTIONAL QUESTION ABOUT SERVICES]
Q9. [OPTIONAL QUESTION ABOUT SERVICES]
Q10. Please consider all your experiences in the past two years with the [AGENCY/SERVICES/
PRODUCTS]. Using a 10-point scale, on which “1” means “not very high” and “10” means “very high,”
how would you rate the overall quality of the [AGENCY/SERVICES/PRODUCTS]?
1 TO 10__________
11 Don’t know
12 Refused
Satisfaction includes many things. Let’s move on and talk about your overall satisfaction with the
[AGENCY].
Q11. First, please consider all your experiences to date with the [AGENCY/SERVICES/PRODUCTS].
Using a 10-point scale on which “1” means “very dissatisfied” and 10 means “very satisfied,” how satisfied
are you with the [AGENCY/SERVICES/PRODUCTS]?
1 TO 10__________
11 Don’t know
12 Refused

Q12. Considering all of your expectations, to what extent has the [AGENCY/SERVICES/PRODUCTS]
fallen short of your expectations or exceeded your expectations? Using a 10-point scale on which “1” now
means “falls short of your expectations” and “10” means “exceeds your expectations,” to what extent has
the [AGENCY] fallen short of or exceeded your expectations?
1 TO 10__________
11 Don’t know
12 Refused
Q13. Forget the [AGENCY] for a moment. Now, I want you to imagine an ideal [AGENCY/SERVICES/
PRODUCTS]. (PAUSE) How well do you think the [AGENCY] compares with that ideal
[AGENCY/SERVICES/PRODUCTS]? Please use a 10-point scale on which “1” means “not very close to
the ideal” and “10” means “very close to the ideal.”
1 TO 10__________
11 Don’t know
12 Refused
Next, I want you to think about any communication you may have had with the [AGENCY] regarding
complaints about your experience.
Q14. Have you complained to the [AGENCY] in the past year?
1 Yes
2 No
3 Don’t know
4 Refused
{IF Q14 = 1, ASK Q14A – 14B; OTHERWISE GO TO Q15}
Q14A. How well, or poorly, was your most recent complaint handled? Using a 10-point scale on which “1”
means “handled very poorly” and “10” means “handled very well,” how would you rate the handling of
your complaint?
1 TO 10___________
11 Don’t know/not relevant/did not use
12 Refused
Q14B. How difficult or easy was it to make your most recent complaint? Using a 10-point scale on which
“1” means “very difficult” and “10” means “very easy,” how difficult or easy was it to make a complaint?
1 TO 10___________
11 Don’t know/not relevant/did not use
12 Refused

Q15. If asked, how willing would you be to say positive or good things about the job the [AGENCY] is
doing in [SPECIFIC SERVICE]? Using a 10-point scale on which “1” means “not at all willing” and “10”
means “very willing,” how willing would you be to say good things about the agency’s handling of
[SPECIFIC SERVICE]?
1 TO 10__________
11 Don’t know
12 Refused
Q16. How confident are you that [AGENCY] will do a good job in the future of providing [SPECIFIC
SERVICE]? Using a 10-point scale on which “1” means “not at all confident” and “10” means “very
confident,” how confident are you that [AGENCY] will do a good job in the future providing [SPECIFIC
SERVICE]?
1 TO 10__________
11 Don’t know
12 Refused

ACSI Questionnaire
Demographics
Now, we need to ask a few demographic questions for the ACSI consumer profile...
QD1. What is your age, please?
[RECORD NUMBER OF YEARS 18-84] _____
98 Don’t know
99 Refused
____________________________________________________________________________
QD2. What is the highest level of formal education you completed? (READ CODES 1 - 5)
1 Less than high school
2 High school graduate
3 Some college or associate degree
4 College graduate
5 Post-Graduate
6 Don’t know
7 Refused
____________________________________________________________________________
QD3. Are you of Hispanic, Latino or Spanish origin?
1 Yes
2 No
3 Don’t know
4 Refused
____________________________________________________________________________
QD4. Do you consider your race(s) as:
(READ CODES 1 - 5; ACCEPT UP TO FIVE MENTIONS)
1 White
2 Black/African American
3 American Indian/Alaska Native
4 Asian
5 Native Hawaiian or other Pacific Islander
6 (DO NOT READ) Other race
7 Don’t know
8 Refused

______________________________________________________________________________
QD5. What was your total annual family income in 2004? (READ CODES 1 - 7)
1 Under $20,000
2 $20,000 but less than $30,000
3 $30,000 but less than $40,000
4 $40,000 but less than $60,000
5 $60,000 but less than $80,000
6 $80,000 but less than $100,000
7 $100,000 or more
8 Don’t know
9 Refused
_______________________________________________________________________
[QD6] [RECORD GENDER BY OBSERVATION]
1 Male
2 Female
_______________________________________________________________________
[MOVE IN DMA FROM SAMPLE]: _____
________________________________________________________________________
[MOVE IN MSA CODE FROM SAMPLE]: _____
_________________________________________________________________________
[MOVE IN STATE FROM SAMPLE]: _____
_________________________________________________________________________
[MOVE IN MET STATUS CODE FROM SAMPLE]: _____
_________________________________________________________________________