Form 388 Dept of Labor 388 Dept of Labor 388 Dept of Labor EBSA Questionnaire FINAL

D ept of Labor EBSA Final

Department of Labor

Customer Satisfaction Survey

COBRA PREMIUM REDUCTION PROGRAM

Introduction (DO NOT READ)

Hello, I'm _____________ with (NAME), a market research firm, calling on behalf of the Department of Labor.

QA. May I speak with __________________________?

1. Yes, person available

2. Yes, but not available now (Schedule callback)

3. No, you cannot speak to the person

4. No one by that name at this number

DK

REF

{IF QA=3-4 OR DK OR REF, GO TO TERMINATE SCREEN; OTHERWISE CONTINUE}

(If person is available, reread intro if necessary and go to intro before Q1. If person is not available, schedule callback)

QX. Contact name

[RECORD CONTACT NAME]

[RECORD PHONE NUMBER]

________________________________________________________________________

We would like to ask you about your experiences with the services you received when you filed a request for the Department of Labor to review your employer’s decision to deny you the COBRA Premium Reduction, (also known as a COBRA subsidy). The purpose of the research is to help the Department of Labor improve its services to their customers.

Your name will be confidential, and your participation is voluntary. You may stop at any time or skip any question you do not wish to answer. This interview will take about 10 minutes and is authorized by Office of Management and Budget Control No. 1090-0007.

________________________________________________________________________

PROG. NOTE: TERMINATE SCREEN

Those are all of the questions I have for you. Thank you for your time.

Intake/Application Process (DO NOT READ)

After your employer denied your request for the COBRA premium reduction or subsidy, you submitted an application to the Department of Labor appealing that decision.

Q1. How did you submit your application for review?

1. E-file

2. U.S. Mail

3. Fax

Q2. If you did not file electronically, how did you obtain an application? (READ LIST)

1. Printed off the website

2. Picked it up from a one stop center

3. From my employer

4. Other (Specify)

Now, think about the overall process for obtaining, filling out and submitting your appeal to the Department of Labor

Q3. How clear were the instructions on how to apply?

Please use a scale from 1 to 10 where 1 is “not very clear” and 10 is “very clear” to rate the clarity of the instructions.

Q4. How easy was it to complete the application including gathering documents?

Please use a scale from 1 to 10 where 1 is “very difficult” and 10 is “very easy” to rate how easy it was to complete your application.

Q5. How easy was it to submit the application to the Department of Labor?

Please use a scale from 1 to 10 where 1 is “very difficult” and 10 is “very easy” to rate how easy it was to submit your application.

Q6. How easy was it to submit the supporting documents to the Department of Labor?

Please use a scale from 1 to 10 where 1 is “very difficult” and 10 is “very easy” to rate how easy it was to submit the supporting documents.

Q7. How did you submit your supporting documentation?

1. Uploaded it electronically

2. Mailed it to the PO box

3. By fax

(ASK Q8 IF Q7=2 Mailed it to the PO Box or 3 By fax)

Q8. Why did you choose not to submit your application and supporting documents electronically? (open end)

Q9. Did you request help from Department of Labor staff to complete the application?

1. Yes

2. No

3. Don’t remember

(ASK Q10 IF Q9=1 Yes)

Q10. On a scale of 1 to 10 where 1 is “not very helpful” and 10 is “very helpful” please rate how helpful the Department of Labor staff person(s) were in helping you complete the application.

Technical Review (DO NOT READ)

Now, think about all of the interactions you had with the Department of Labor staff while your appeal was being processed.

Please use a scale from 1 to 10, where 1 is “poor” and 10 is “excellent” to rate customer service from Department of Labor on the following, while your appeal was being processed…If a question does not apply to you; please respond “does not apply.”

Q11. Being responsive to your phone calls/emails etc.

Q12. Courtesy and professionalism of staff

Q13. Clearly communicating what was needed from you to process your application

Q14. Knowledge and ability to answer your questions

Determination Letter (DO NOT READ)

Now think about the letter that you received from the Department of Labor telling you whether or not you were eligible to receive the COBRA subsidy and how clearly it was written..

Q15. Using a scale from 1 to 10, where 1 is “not very clear” and 10 is “very clear”, please rate how clear was the reason for the decision?

Q16. Did EBSA decide in your favor?

1. Yes

2. No

3. Not sure

Q17. Did you feel the decision process was fair?

1. Yes

2. No

3. Not sure

Customer Satisfaction Index (DO NOT READ)

Think about all of your experiences with Department of Labor during the COBRA Subsidy Denial review process.

Q18. Using a scale of 1 to 10, where 1 means very dissatisfied and 10 means “very satisfied”, please rate your overall satisfaction with Department of Labor throughout the application and review process.

Q19. Now, think about your expectations for your interactions with Department of Labor related to the COBRA premium reduction review program and how well they met your expectations. Please rate how well your interactions with Department of Labor met your expectations

Use a scale from 1 to 10, where 1 means “falls short of your expectations” and 10 means “exceeds your expectations.”

Q20. Now, forget about your interactions with Department of Labor for a minute and think about an ideal interaction with a government agency for a similar program. How well did your interaction with Department of Labor compare to that ideal?

Please use a scale from 1 to 10, where 1 means “very far from the ideal” and 10 means “very close to the ideal.”

OPEN END (DO NOT READ)

Q21. Please share any final feedback you have regarding Department of Labor, the subsidy denial review program and what things could have improved the process. (Open End)

Thank you very much for your time today. Those are all of the questions that I have.

P age 5 of 5 Nov 2010