724 2013 724 NIAMS Questionnaire
American Customer Satisfaction Index (ACSI) E-Government Website Customer Satisfaction Surveys
2013 724 NIAMS Questionnaire.xlsx
2013 722 CMS NGS DME MAC Questionnaire - 2013 726 MARAD Questionnaire
OMB: 1090-0008
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1090-0008 can be found here:
Document [xlsx]
Download: xlsx | pdf
Current Model Qsts
Current Custom Qsts
Custom Qsts (1-9-12)
Custom Qsts (9-28-10)
Types
Overview
GuidelinesCurrent Model Qsts
Current Custom Qsts
Custom Qsts (1-9-12)
Custom Qsts (9-28-10)
Types
Sheet 1: Guidelines
| Questionnaire Management Guidelines | ||||||||||||||||||||
| Goals: | ||||||||||||||||||||
| � | One consolidated document to track all model and CQ changes throughout the life of the project | |||||||||||||||||||
| � | Questionnaire always matches the live survey | |||||||||||||||||||
| � | Easy and error-free way to submit CQ changes | |||||||||||||||||||
| � | All changes tracked and reflected in one document (DOT will help) | |||||||||||||||||||
| Basic rules: | ||||||||||||||||||||
| 1 | This questionnaire has to match the live survey | |||||||||||||||||||
| 2 | All changes to the live measure need to be tracked and archived in one document | |||||||||||||||||||
| 3 | All CQ change requests have to be submitted using this document | |||||||||||||||||||
| SRA: | 1) marks up changes and submits the entire document to DOT | |||||||||||||||||||
| DOT: | 1) archives change request on separate tab | |||||||||||||||||||
| 2) implements change(s) | ||||||||||||||||||||
| 3) updates the document to reflect all implemented changes in the "clean" questionnaire - SRA can send to the client and use for future CQ changes | ||||||||||||||||||||
| 4 | DOT safeguards correct formats - your next CQ changes have to be submitted using one survey document with appropriate color-coding | |||||||||||||||||||
Sheet 2: Current Model Qsts
| Model Instance Name: | |||||
| NIAMS Survey | |||||
| MID: | pNdwFkVhhx9dMQUowQBVVw== | ||||
| Date: | 8/8//2008 | ||||
| NIAMS Survey MODEL QUESTION LIST | |||||
| Model questions utilize the ACSI methodology to determine scores and impacts | |||||
| ELEMENTS (drivers of satisfaction) | CUSTOMER SATISFACTION | FUTURE BEHAVIORS | |||
| Content (1=Poor, 10=Excellent, Don't Know) | Satisfaction (1=Poor, 10=Excellent) | Likelihood to Return (1=Not Very Likely, 10=Very Likely) | |||
| 1 | Please rate the accuracy of information on this site. | 23 | What is your overall satisfaction with this site? | 26 | How likely are you to return to this site? |
| 2 | Please rate the quality of information on this site. | 24 | How well does this site meet your expectations? | Recommend (1=Not Very Likely, 10=Very Likely) | |
| 3 | Please rate the freshness of content on this site. | 25 | How does this site compare to your idea of an ideal website? | 27 | How likely are you to recommend this site to someone else? |
| Functionality (1=Poor, 10=Excellent, Don't Know) | Primary Resource (1=Not Very Likely, 10=Very Likely) | ||||
| 4 | Please rate the usefulness of the services provided on this site. | 28 | How likely are you to use this site as your primary resource for obtaining information from this organization? | ||
| 5 | Please rate the convenience of the services on this site. | ||||
| 6 | Please rate the ability to accomplish what you wanted to on this site. | ||||
| Look and Feel (1=Poor, 10=Excellent, Don't Know) | |||||
| 7 | Please rate the ease of reading this site. | ||||
| 8 | Please rate the clarity of site organization. | 
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| 9 | Please rate the clean layout of this site. | ||||
| Navigation (1=Poor, 10=Excellent, Don't Know) | |||||
| 10 | Please rate the degree to which the number of steps it took to get where you want is acceptable. | ||||
| 11 | Please rate the ability to find the information you want on this site. | ||||
| 12 | Please rate the clarity of site map/directory. | ||||
| 13 | Please rate the ease of navigation on this site. | ||||
| Site Performance (1=Poor, 10=Excellent, Don't Know) | |||||
| 14 | Please rate the speed of loading the page on this site. | ||||
| 15 | Please rate the consistency of speed on this site. | ||||
| 16 | Please rate the reliability of site performance on this site. | ||||
| Search (1=Poor, 10=Excellent, Don't Know) | |||||
| 23 | Please rate the usefulness of search results on this site. | ||||
| 24 | Please rate how this site provides comprehensive search results. | ||||
| 25 | Please rate the organization of search results for this site. | ||||
| 26 | Please rate how the search feature helps you to narrow the results to find the information you want. | ||||
Sheet 3: Current Custom Qsts
Sheet 4: Custom Qsts (1-9-12)
Sheet 5: Custom Qsts (9-28-10)
| Model Instance Name: | |||||||||
| NIAMS Survey | underlined & italicized: RE-ORDER | ||||||||
| MID: pNdwFkVhhx9dMQUowQBVVw== | pink: ADDITION | ||||||||
| Date: | 3/1/2008 | blue + -->: REWORDING | |||||||
| NIAMS Survey CUSTOM QUESTION LIST | |||||||||
| QID | Skip Logic Label / question order | Question Text | Answer Choices (limited to 50 characters) |
Skip to | Type (select from list) | Single or Multi | Required Y/N |
Special Instructions | |
| C6139 | How frequently do you visit this website? | First time | Radio button, one-up vertical | Single | Y | ||||
| More than once a day | |||||||||
| Daily | |||||||||
| About once a week | |||||||||
| About once a month | |||||||||
| Every 6 months or less | |||||||||
| C6143 | Which of the following best describes your role in coming to the website today? | General public | Radio button, one-up vertical | Single | Y | ||||
| Representative from voluntary organization | |||||||||
| Representative from professional organization | |||||||||
| Patient | |||||||||
| Family member of a patient | |||||||||
| Scientist/Researcher | |||||||||
| Student | |||||||||
| Teacher | |||||||||
| Retired | |||||||||
| Health professional | |||||||||
| Media | |||||||||
| Other | |||||||||
| C6140 | Which of the following best describes what you are looking for visiting the website today? | Health related information | A | Radio button, one-up vertical | Single | Y | |||
| Patient research registries | |||||||||
| Grant information | |||||||||
| Contracts information | |||||||||
| NIAMS laboratories | |||||||||
| Clinical trials/studies with patients | |||||||||
| Researcher resources | |||||||||
| News and events | |||||||||
| Employment opportunities | |||||||||
| Information about NIAMS | |||||||||
| Links to other organizations | |||||||||
| Information in Spanish | |||||||||
| Other | B | ||||||||
| C6141 | B | What other information were you looking for today? |
Text field, <100 char | Open | N | ||||
| ACQOsl0002004 | A | What type of health related information were you primarily looking for today? | Arthritis/rheumatic diseases | Radio button, one-up vertical | Single | Y | |||
| Bone health and/or diseases | |||||||||
| Skin diseases | |||||||||
| Muscle injury and/or diseases | |||||||||
| Other | C | ||||||||
| ACQOsl0002005 | C | What other type of health related information were you looking for? | Text field, <100 char | Open | N | ||||
| C51948 | Did you find what you were looking for? | Yes | Dropdown (Select-one) | Single | Y | ||||
| No | A | ||||||||
| Still looking | |||||||||
| C6142 | A | What information could you not find? |
Text field, <100 char | Open | N | ||||
| CJDV00081 | How do you plan to use the information you find on this site today? | To share and discuss with my health care provider | Radio button, one-up vertical | Single | Y | ||||
| To address personal health issues | |||||||||
| To aid others who have health concerns | |||||||||
| To pursue a career as a medical researcher | |||||||||
| To support new or current research projects | |||||||||
| To explore or support business opportunities in the field of biomedical research | |||||||||
| To explore what you have to offer (just browsing) | |||||||||
| Physicians & other health care providers - improved understanding of basic research concepts and findings for my own clinical research | |||||||||
| Physicians & other health care providers - improved understanding of clinical research findings for my patient practice | |||||||||
| Other | |||||||||
| C51949 | How did you look for the information today? | I used the search function | Radio button, one-up vertical | Single | Y | ||||
| I used links from the Home Page | |||||||||
| I navigated using the top and left side navigation bars | |||||||||
| I got to the page through a link of another site | |||||||||
| I had a bookmark on the page I wanted | |||||||||
| I was browsing | |||||||||
| C6144 | How could we improve our information to best meet your needs? | Text area, no char limit | Single | N | |||||
Sheet 6: Types
| Types | Instructions | |
| Text field, <100 char | Randomize | |
| Text area, no char limit | ||
| Drop down, select one | ||
| Radio button, one-up vertical | ||
| Radio button, two-up vertical | ||
| Radio button, three-up vertical | ||
| Radio button, scale, has don't know | ||
| Radion button, scale, no don't know | ||
| Checkbox, one-up vertical | ||
| Checkbox, two-up vertical | ||
| Checkbox, three-up vertical |
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |
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