Two Customer Satisfaction Surveys - Disability Awarness Campaign Media Survey and Disability Program Feedback Survey

Disability Awareness Campaign - Fact Sheet Survey

Organization

*1. Name of your organization, company, or agency

Fact Sheets

2. When you used the fact sheet, Facts About Social Security's Disability Program, how
did you provide it to the public?
c Printouts
d
e
f
g

c A link to the fact sheet from my organization's website
d
e
f
g

Other (please specify) 

Prints

3. How many fact sheets printouts did you distribute?

Quality

4. How would you rate the quality of the fact sheet?
j Excellent
k
l
m
n

j Above average
k
l
m
n
j Average
k
l
m
n

j Below average
k
l
m
n
j Poor
k
l
m
n

Page 1

Disability Awareness Campaign - Newsletter Articles Survey
Organization

*1. Name of your organization, company, or agency

2. Has your organization printed any of the newsletter articles either online or in a printed
newsletter?

j Yes
k
l
m
n
j No
k
l
m
n

Newsletter Information

3. What is the name of your organization's newsletter?

4. How many subscribers does your newsletter have?

5. If your organization used any of the following articles, please indicate the date of the
post.
MM

DD

YYYY

1

/

/

2

/

/

3

/

/

Rate Newsletter Articles

6. How would you rate the overall quality of the newsletter articles provided?
j Excellent
k
l
m
n

j Above average
k
l
m
n
j Average
k
l
m
n

j Below average
k
l
m
n
j Poor
k
l
m
n

Page 1

Disability Awareness Campaign - Newsletter Articles Survey
7. What other newsletter articles would you like to see on the "Disability Materials for
Groups and Organizations" web page?
5
6  

OMB Control No. 0960-0788
Paperwork Reduction Act Statement
Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. §3507, as
amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions
unless we display a valid Office of Management and Budget control number. We estimate that it will take about 2
minutes to complete this survey. You may send comments on our time estimate above: SSA, 6401 Security Blvd.,
Baltimore, MD 21235-6401. Send only comments relating to our time estimate to this address.

Page 2

Disability Awareness Campaign - Poster Survey
Types of Media

*1. Name of your organization, company, or agency

Posters

2. Which of the following posters did you print and distribute? Select all that apply.
c Amputee & Post­Traumatic Stress Disorder
d
e
f
g
c Spinal Cord Injury
d
e
f
g

c Clinical Depression
d
e
f
g
c Vision Impairment
d
e
f
g

c Brittle Bone Disease
d
e
f
g
c Down Syndrome
d
e
f
g
c Cerebral Palsy
d
e
f
g

c Breast Cancer
d
e
f
g

c Multiple Sclerosis
d
e
f
g
c Schizophrenia
d
e
f
g

c Congenital Disorder
d
e
f
g

c Hearing Impairment
d
e
f
g

c Social Security works aggressively to prevent, detect and prosecute fraud (SSN Card)
d
e
f
g

c Social Security works aggressively to prevent, detect and prosecute fraud (Man & Computer)
d
e
f
g
c Facts About Social Security’s Disability Program (colorful)
d
e
f
g

c Facts About Social Security’s Disability Program (list version)
d
e
f
g

c Did you know: Social Security disability insurance makes it possible…
d
e
f
g

c Did you know: People who receive Social Security disability payments…
d
e
f
g

3. In total, about how many posters did you distribute?
Number

Page 1

Disability Awareness Campaign - Poster Survey
4. How would you rate the quality of the poster(s)?
j Excellent
k
l
m
n

j Above average
k
l
m
n
j Average
k
l
m
n

j Below average
k
l
m
n
j Poor
k
l
m
n

5. What other posters would you like to see on the "Disability Materials for Groups and
Organizations" web page?
5
6  

OMB Control No. 0960-0788
Paperwork Reduction Act Statement
Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. §3507,
as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions
unless we display a valid Office of Management and Budget control number. We estimate that it will take
about 2 minutes to complete this survey. You may send comments on our time estimate above: SSA, 6401
Security Blvd., Baltimore, MD 21235-6401. Send only comments relating to our time estimate to this
address.

Page 2

Disability Awareness Campaign - PowerPoint Survey
Organization

*1. Name of your organization, company, or agency

PowerPoint Slides

2. Has your organization used the PowerPoint, "Social Security's Disability Programs" in
any presentations?

j Yes
k
l
m
n
j No
k
l
m
n

Your Presentations

3. If your organization used the PowerPoint, "Social Security's Disability Programs," what
was/were the date(s) of your presentation(s)?
MM

DD

YYYY

Date 1

/

/

Date 2

/

/

Date 3

/

/

Date 4

/

/

Date 5

/

/

4. What was the audience size for each of your presentations?
Date 1
Date 2
Date 3
Date 4
Date 5

Rate PowerPoint

Page 1

Disability Awareness Campaign - PowerPoint Survey
5. How would you rate the quality of the PowerPoint provided?
j Excellent
k
l
m
n

j Above average
k
l
m
n
j Average
k
l
m
n

j Below average
k
l
m
n
j Poor
k
l
m
n

6. What other PowerPoint presentations would you like to see on the "Disability Materials
for Groups and Organizations" web page?
5
6  

OMB Control No. 0960-0788
Paperwork Reduction Act Statement
Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C.
§3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these
questions unless we display a valid Office of Management and Budget control number. We estimate that it
will take about 2 minutes to complete this survey. You may send comments on our time estimate above:
SSA, 6401 Security Blvd., Baltimore, MD 21235-6401. Send only comments relating to our time estimate to
this address.

Page 2

Disability Awareness Campaign - Social Media Survey
Organization

*1. Name of your organization, company, or agency

Social Media ­ Facebook

2. Does your organization have a FaceBook page?

j Yes
k
l
m
n
j No
k
l
m
n

FaceBook

3. How many friends follow your organization's FaceBook page?

4. If your organization posted any of the following social media posts to FaceBook, please
indicate the date of the post.
MM

DD

YYYY

The Social Security Act sets out a very strict definition of disability

/

/

Severe disabilities often mean a shorter time collecting benefits

/

/

The onset of disability is unpredictable and can happen to anyone at any age

/

/

Social Security disability is insurance coverage that workers earn

/

/

As experts projected for decades, Social Security claims have increased 

/

/

/

/

significantly
Social Security Disability payments are modest

5. How would you rate the quality of the materials provided?
j Excellent
k
l
m
n

j Above average
k
l
m
n
j Average
k
l
m
n

j Below average
k
l
m
n
j Poor
k
l
m
n

Social Media ­ Twitter

Page 1

Disability Awareness Campaign - Social Media Survey
6. Does your organization have a Twitter account?

j Yes
k
l
m
n
j No
k
l
m
n

Twitter

7. How many followers does your organization's Twitter account have?

8. If your organization posted any of the following social media posts to Twitter, please
indicate the date of the post.
MM

DD

YYYY

The Social Security Act sets out a very strict definition of disability

/

/

Severe disabilities often mean a shorter time collecting benefits

/

/

The onset of disability is unpredictable and can happen to anyone at any age

/

/

Social Security disability is insurance coverage that workers earn

/

/

As experts projected for decades, Social Security claims have increased 

/

/

/

/

significantly
Social Security Disability payments are modest

9. How would you rate the quality of the materials provided?
j Excellent
k
l
m
n

j Above average
k
l
m
n
j Average
k
l
m
n

j Below average
k
l
m
n
j Poor
k
l
m
n

Other Social Media

10. Does your organization use some other type of social media?

j Yes
k
l
m
n
j No
k
l
m
n

Other Social Media

11. What other type(s) of social media does your organization use?

Page 2

Disability Awareness Campaign - Social Media Survey
12. How many people do you reach with your organization's other account?

13. If your organization posted any of the following social media posts to your
organization's other social media account, please indicate the date of the post.
MM

DD

YYYY

The Social Security Act sets out a very strict definition of disability

/

/

Severe disabilities often mean a shorter time collecting benefits

/

/

The onset of disability is unpredictable and can happen to anyone at any age

/

/

Social Security disability is insurance coverage that workers earn

/

/

As experts projected for decades, Social Security claims have increased 

/

/

/

/

significantly
Social Security Disability payments are modest

Wish List

14. What other social media materials would you like to see?
5
6  

OMB Control No. 0960-0788
Paperwork Reduction Act Statement
Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. §3507,
as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions
unless we display a valid Office of Management and Budget control number. We estimate that it will take
about 2 minutes to complete this survey. You may send comments on our time estimate above: SSA, 6401
Security Blvd., Baltimore, MD 21235-6401. Send only comments relating to our time estimate to this address.

Page 3

Disability Awareness Campaign - Video Survey

Organization

*1. Name of your organization, company, or agency

Shared Videos

2. From the list of videos below, indicate those which you shared on You Tube by showing
the date of the post.
MM

DD

YYYY

Personal Interview Video – Sarah

/

/

Personal Interview Video – Richard

/

/

Personal Interview Video – Erika

/

/

Personal Interview Video – Karen

/

/

Personal Interview Video – Carrie

/

/

Personal Interview Video – William

/

/

American Sign Language Video – Social Security, SSI and Medicare

/

/

Rate Videos

3. How would you rate the quality of the video(s) provided?
j Excellent
k
l
m
n

j Above average
k
l
m
n
j Average
k
l
m
n

j Below average
k
l
m
n
j Poor
k
l
m
n

4. What other videos would you like to see on the "Disability Materials for Groups and
Organizations" web page?
5
6  

Page 1

Disability Awareness Campaign - Web Widget Survey
Organization

*1. Name of your organization, company, or agency

Web Widgets

2. From the list of logos below, indicate which you used on your website by showing the
date of the post.
MM

DD

YYYY

FACES AND FACTS OF DISABILITY – Round

/

/

FACES AND FACTS OF DISABILITY– Square

/

/

Rate Web Widgets

3. How would you rate the quality of the web widget(s) provided?
j Excellent
k
l
m
n

j Above average
k
l
m
n
j Average
k
l
m
n

j Below average
k
l
m
n
j Poor
k
l
m
n

4. What other web widgets would you like to see on the "Disability Materials for Groups
and Organizations" web page?
5
6  

OMB Control No. 0960-0788
Paperwork Reduction Act Statement
Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. §3507,
as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions
unless we display a valid Office of Management and Budget control number. We estimate that it will take about
2 minutes to complete this survey. You may send comments on our time estimate above: SSA, 6401 Security
Blvd., Baltimore, MD 21235-6401. Send only comments relating to our time estimate to this address.

Page 1