Form 1113 2014 868 PSC

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Overview

Welcome and Thank You Text
Current Model Qsts
Current Custom Qsts
Current Custom Qsts (5-27-14)
Custom Qsts (3-1-13)

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Sheet 1: Welcome and Thank You Text

Model Instance Name:
U.S. Dept of Health and Human Services Program Support Center
MID:	Existing Measure - Please fill in; New Measure - DOT will fill in
Date:	Fill In Date
Welcome and Thank You Text
	Directions:
	This welcome text is shown at the top of the questionnaire window and the thank you text at the bottom. This is a good place to mention the site/company/agency name so the visitor knows whom they are taking the survey for. Feel free to modify the standard Welcome text shown in the box below.
					Examples
					Welcome Text Example
	Welcome Text
	Thank you for visiting PSC.gov. You have been randomly selected to take part in a brief survey to let the Program Support Center know what we’re doing well and where we can improve. Please take a few minutes to share your opinions, which are essential in helping us provide the best online experience possible.
					Thank You Text Example
	Thank You Text
	Thank you for taking our survey – and for helping PSC serve you better. Please note you will not receive a response from us based on your survey comments. If you would like us to contact you about your feedback, please visit the Contact Us section of our web site.

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Sheet 2: Current Model Qsts

Model Instance Name:
U.S. Dept of Health and Human Services Program Support Center
MID:	Existing Measure - Please fill in; New Measure - DOT will fill in
Date:	Fill In Date
Program Support Center Web Survey
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		Return (1=Very Unlikely, 10=Very Likely)
	Please rate the accuracy of information on this site.		What is your overall satisfaction with this site? (1=Very Dissatisfied, 10=Very Satisfied)		How likely are you to return to this site?
	Please rate the quality of information on this site.		How well does this site meet your expectations? (1=Falls Short, 10=Exceeds)		Recommend (1=Very Unlikely, 10=Very Likely)
	Please rate the freshness of content on this site.		How does this site compare to your idea of an ideal website? (1=Not Very Close, 10=Very Close)		How likely are you to recommend this site to someone else?
	Look and Feel (1=Poor, 10=Excellent, Don't Know)				Primary Resource (1=Very Unlikely, 10=Very Likely)
	Please rate the visual appeal of this site.				How likely are you to use this site as your primary resource for obtaining information from this organization?
	Please rate the balance of graphics and text on this site.
	Please rate the readability of the pages on this site.
	Navigation (1=Poor, 10=Excellent, Don't Know)
	Please rate how well the site is organized.
	Please rate the options available for navigating this site.
	Please rate how well the site layout helps you find what you are looking for.
	Please rate the number of clicks to get where you want on this site.
	Search (1=Poor, 10=Excellent, Don't Know)
	Please rate the relevance of search results on this site.
	Please rate the organization of search results on this site.
	Please rate how well the search results help you decide what to select.
	Please rate how well the search feature helps you to narrow the results to find what you want.
	Site Performance (1=Poor, 10=Excellent, Don't Know)
	Please rate how quickly pages load on this site.
	Please rate the consistency of speed from page to page on this site.
	Please rate the ability to load pages without getting error messages on this site.

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Sheet 3: Current Custom Qsts

Model Instance Name:			red & strike-through: DELETE
U.S. Dept of Health and Human Services Program Support Center			underlined & italicized: RE-ORDER
MID: Existing Measure - Please fill in; New Measure - DOT will fill in			pink: ADDITION
Date:	8/1/2011		blue + -->: REWORDING
U.S. Dept of Health and Human Services Program Support Center CUSTOM QUESTION LIST
QID	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
SAC0426		Which of the following best describes why you decided to visit PSC.gov today?	To find information on a service or product	A	Radio button, one-up vertical	Single	Y	Skip Logic Group	Visit Reason
			To access the ITAS system to log or check my time
			To download forms	B
			To find specific contact information for an employee or department
			Other (please specify)	C
SAC0427	B	Which forms did you plan to download today?			Text area, no char limit		N	Skip Logic Group	OE Forms
SAC0428	C	Why did you visit the Program Support Center today?			Text area, no char limit		N	Skip Logic Group	Other Visit Reason
SAC0429	A	On which product or service were you looking for information today? (Check all that apply)	Accounting		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Product/Service
			Automated External Defibrillator
			Board for Corrections
			Child Care Subsidy Program
			Customer Contact Center
			Debt Collection
			Departmental Forms Management
			Digital Conversion and Archiving of Documents
			Employee Assistance Program
			Employee Child Care Centers
			Environmental Health
			Facilities Operations & Management
			Financial Reporting
			Freedom of Information Act (FOIA)
			GO!card® Transit Benefits
			Grant Payments
			Graphic Arts
			Health Clinics
			Indirect Cost Negotiations
			Labor and Moving
			Mail Delivery
			Mail Screening
			McKinney-Vento Act Administration
			Medical Supply
			Negotiated Contracts and Simplified Acquisitions
			Organizational Development and Leadership
			Payroll Liaison
			Personal Property Management System
			Printing
			Product Distribution
			Property Disposal
			Purchase Card Management
			Real Property Strategy
			Regional Support
			Section 508 Compliance Testing and Remediation
			Shredding
			Storage
			Travel Arrangements and Reimbursements
			Wellness/Fitness
			Work/Life Program
			Other (please specify)	D
SAC0430	D	Other services or products:			Text area, no char limit		N	Skip Logic Group	Other Product/Service
SAC0431		Are you a Health & Human Services Employee?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group	HHS?
			No	A
SAC0432	A	With which federal agency are you currently employed?	Agency for International Development		Radio button, one-up vertical	Single	Y	Skip Logic Group	Federal Agency
			Department of Agriculture
			Department of Commerce
			Department of Defense
			Department of Education
			Department of Homeland Security
			Department of Housing and Urban Development
			Department of the Interior
			Department of Justice
			Department of Labor
			Department of State
			Department of the Interior
			Department of the Treasury
			Department of Transportation
			Department of Veterans Affairs
			Executive Office of the President
			Federal Legislative Branch
			General Accounting Office
			General Services Administration
			Independent Agencies
			Judicial Branch
			National Aeronautics and Space Administration
			Office of Personnel Management
			Peace Corps
			Postal Service
			Private Vendor
			Quasi Official INTNL & Non Govt
			Railroad Retirement Board
			Securities and Exchange Commission
			Other federal agency (please specify)	B
			Do not work for a federal agency
SAC0433	B	Other federal agency:			Text area, no char limit	Single	N	Skip Logic Group	Other Federal Agency
SAC0435		How often do you visit PSC.gov?	This is my first visit		Radio button, one-up vertical	Single	Y		Visit Frequency
			A few times per year
			A few times per month
			A few times per week
			Everyday
			Multiple times per day
SAC0436		Did you accomplish your goal in visiting PSC.gov today?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group	Accomplish Goal?
			No	B
			I did not have a specific goal in visiting PSC.gov today.
CAS0058762	B	Why could you not accomplish your goal today?			Text area, no char limit		N	Skip Logic Group	OE_ Why not accomplish
SAC0438		What suggestions do you have about how to make PSC.gov more helpful to visitors like you?			Text area, no char limit	Single	N		Suggested Changes

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Sheet 4: Current Custom Qsts (5-27-14)

Model Instance Name:			red & strike-through: DELETE
U.S. Dept of Health and Human Services Program Support Center			underlined & italicized: RE-ORDER
MID: Existing Measure - Please fill in; New Measure - DOT will fill in			pink: ADDITION
Date:	8/1/2011		blue + -->: REWORDING
U.S. Dept of Health and Human Services Program Support Center CUSTOM QUESTION LIST
QID	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
SAC0426		Which of the following best describes why you decided to visit PSC.gov today?	To find information on a service or product	A	Radio button, one-up vertical	Single	Y	Skip Logic Group	Visit Reason
			To access the ITAS system to log or check my time
			To download forms	B
			To find specific contact information for an employee or department
			Other (please specify)	C
SAC0427	B	Which forms did you plan to download today?			Text area, no char limit		N	Skip Logic Group	OE Forms
SAC0428	C	Why did you visit the Program Support Center today?			Text area, no char limit		N	Skip Logic Group	Other Visit Reason
SAC0429	A	On which product or service were you looking for information today? (Check all that apply)	Accounting		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Product/Service
			Automated External Defibrillator
			Board for Corrections
			Child Care Subsidy Program
			Customer Contact Center
			Debt Collection
			Departmental Forms Management
			Digital Conversion and Archiving of Documents
			Employee Assistance Program
			Employee Child Care Centers
			Environmental Health
			Facilities Operations & Management
			Financial Reporting
			Freedom of Information Act (FOIA)
			GO!card® Transit Benefits
			Grant Payments
			Graphic Arts
			Health Clinics
			Indirect Cost Negotiations
			Labor and Moving
			Mail Delivery
			Mail Screening
			McKinney-Vento Act Administration
			Medical Supply
			Negotiated Contracts and Simplified Acquisitions
			Organizational Development and Leadership
			Payroll Liaison
			Personal Property Management System
			Printing
			Product Distribution
			Property Disposal
			Purchase Card Management
			Real Property Strategy
			Regional Support
			Section 508 Compliance Testing and Remediation
			Shredding
			Storage
			Travel Arrangements and Reimbursements
			Wellness/Fitness
			Work/Life Program
			Other (please specify)	D
SAC0430	D	Other services or products:			Text area, no char limit		N	Skip Logic Group	Other Product/Service
SAC0431		Are you a Health & Human Services Employee?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group	HHS?
			No	A
SAC0432	A	With which federal agency are you currently employed?	Agency for International Development		Radio button, one-up vertical	Single	Y	Skip Logic Group	Federal Agency
			Department of Agriculture
			Department of Commerce
			Department of Defense
			Department of Education
			Department of Homeland Security
			Department of Housing and Urban Development
			Department of the Interior
			Department of Justice
			Department of Labor
			Department of State
			Department of the Interior
			Department of the Treasury
			Department of Transportation
			Department of Veterans Affairs
			Executive Office of the President
			Federal Legislative Branch
			General Accounting Office
			General Services Administration
			Independent Agencies
			Judicial Branch
			National Aeronautics and Space Administration
			Office of Personnel Management
			Peace Corps
			Postal Service
			Private Vendor
			Quasi Official INTNL & Non Govt
			Railroad Retirement Board
			Securities and Exchange Commission
			Other federal agency (please specify)	B
			Do not work for a federal agency
SAC0433	B	Other federal agency:			Text area, no char limit	Single	N	Skip Logic Group	Other Federal Agency
SAC0434		In which U.S. state are you based?	Alabama		Drop down, select one	Single	Y		State
			Alaska
			Arkansas
			Arizona
			California
			Colorado
			Connecticut
			District of Columbia
			Delaware
			Florida
			Georgia
			Hawaii
			Idaho
			Illinois
			Indiana
			Kansas
			Kentucky
			Louisiana
			Maryland
			Massachusetts
			Maine
			Michigan
			Minnesota
			Missouri
			Mississippi
			Montana
			Nebraska
			New Hampshire
			New Jersey
			New Mexico
			Nevada
			New York
			North Carolina
			North Dakota
			Ohio
			Oklahoma
			Oregon
			Pennsylvania
			Rhode Island
			South Carolina
			South Dakota
			Tennessee
			Texas
			Utah
			Virginia
			Vermont
			West Virginia
			Washington
			Wisconsin
			Wyoming
			Outside the U.S.
SAC0435		How often do you visit PSC.gov?	This is my first visit		Radio button, one-up vertical	Single	Y		Visit Frequency
			A few times per year
			A few times per month
			A few times per week
			Everyday
			Multiple times per day
SAC0436		Did you accomplish your goal in visiting PSC.gov today?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group	Accomplish Goal?
			No	B
			I did not have a specific goal in visiting PSC.gov today.
SAC0437	A	Which goal could you not accomplish on PSC.gov today?			Text area, no char limit	Single	N	Skip Logic Group	Goal Not accomplished
	B	Why could you not accomplish your goal today?			Text area, no char limit		N	Skip Logic Group	OE_ Why not accomplish
SAC0438		What suggestions do you have about how to make PSC.gov more helpful to visitors like you?			Text area, no char limit	Single	N		Suggested Changes
SAC0439		What do you plan to do next?	Call someone to learn more about products and services available		Radio button, one-up vertical	Single	Y		Do next?
			Email someone to learn more about products and services available
			Call someone to order or purchase products or services available
			Email someone to order or purchase products or service available
			Download the PSC Service and Product Directory
			I do not plan to do any of the above
SAC0440		If you could purchase products or services using this website, how likely would you be to place your order online?	Very likely		Radio button, one-up vertical	Single	Y	Skip Logic Group	Likely to purchase online
			Somewhat likely
			Somewhat unlikely	A
			Very unlikely	A
SAC0441	A	Why would you be unlikely to order online?			Text area, no char limit		N	Skip Logic Group	Why unlikely to purchase online

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Sheet 5: Custom Qsts (3-1-13)

SAC0429	A	On which product or service were you looking for information today? (Check all that apply)	SAC0429A001	Accounting Services		Checkbox, one-up vertical	Multi	Y	Skip Logic Group	Product/Service
			SAC0429A002	Asset Management
			SAC0429A003	Automated External Defibrillator Services
			SAC0429A004	Background Investigations
			SAC0429A005	Board for Corrections
			SAC0429A006	Building Management
			SAC0429A007	Clinical Health and Wellness Services
			SAC0429A008	Compensation Services
			SAC0429A009	Conference Services
			SAC0429A010	Cooperative Administrative Support Units (CASUs)
			SAC0429A011	Cost Allocation/Indirect Cost Negotiations
				Child Care Subsidy Program
				Customer Contact Center
			SAC0429A012	Debt Collection
			SAC0429A013	Departmental Forms Management
				Digital Conversion and Archiving of Documents
			SAC0429A014	Digital Fingerprinting and Special Agency Checks
			SAC0429A015	Employee Assistance Program
			SAC0429A016	Employee Child Care Services Centers
			SAC0429A017	Environmental Health Services
				Facilities Operations & Management
			SAC0429A018	Financial Enterprise Systems Management
			SAC0429A019	Financial Reporting
			SAC0429A020	Freedom of Information Act (FOIA)
				GO!card® Transit Benefits
				Grant Payments
			SAC0429A021	General Storage
			SAC0429A022	Graphic Arts
			SAC0429A023	HHS Information Hotline
			SAC0429A024	HHS Travel Services
			SAC0429A025	HSPD-12 (PIV) Badge Recertification
			SAC0429A026	HSPD-12 Services
			SAC0429A027	Human Resource Systems
				Health Clinics
				Indirect Cost Negotiations
			SAC0429A028	IT Infrastructure and Operations Services
			SAC0429A029	IT Security Services
				Labor and Moving
				Mail Delivery
			SAC0429A030	Mail Screening
				McKinney-Vento Act Administration
				Medical Supply
			SAC0429A031	Mail Management and Policy Branch
			SAC0429A032	Medical Affairs
				__>Negotiated Contracts and Simplified Acquisitions
				Organizational Development and Leadership
			SAC0429A033	Payroll Liaison
				Personal Property Management System
				Printing
			SAC0429A034	ONE-DHHS Contact Center
			SAC0429A035	Payment Management (Grant) Services
			SAC0429A036	Payroll Accounting Services
			SAC0429A037	Payroll Services
			SAC0429A038	Physical Security
			SAC0429A039	Printing Procurement
			SAC0429A040	Product Distribution
			SAC0429A041	Project Management
			SAC0429A042	Property Disposal
			SAC0429A043	Purchase Card Management
			SAC0429A044	Real Property Strategy
			SAC0429A045	Regional Support Program
				Section 508 Compliance Testing and Remediation
			SAC0429A046	Relocation Services
			SAC0429A047	Shredding
				Storage
			SAC0429A048	Simplified Acquisitions
			SAC0429A049	Space Acquisition
			SAC0429A050	Space Alterations
			SAC0429A051	Subsidized Mass Transit Tickets (Transhare and GO!card)
			SAC0429A052	Supply Service Center
			SAC0429A053	Telecommunications Management
			SAC0429A054	Telecommunications Services
			SAC0429A055	Vehicle Rental Services
				Travel Arrangements and Reimbursements
			SAC0429A056	Wellness/Fitness
			SAC0429A057	Work/Life Services Program
			SAC0429A058	Other (please specify)	D
SAC0430	D	Other services or products:				Text area, no char limit		N	Skip Logic Group	Other Product/Service
SAC0431		Are you a Health & Human Services Employee?	SAC0431A001	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group	HHS?
			SAC0431A002	No	A
SAC0432	A	With which federal agency are you currently employed?	SAC0432A001	Agency for International Development		Radio button, one-up vertical	Single	Y	Skip Logic Group	Federal Agency
			SAC0432A002	Department of Agriculture
			SAC0432A003	Department of Commerce
			SAC0432A004	Department of Defense
			SAC0432A005	Department of Education
			SAC0432A006	Department of Homeland Security
			SAC0432A007	Department of Housing and Urban Development
			SAC0432A008	Department of the Interior
			SAC0432A009	Department of Justice
			SAC0432A010	Department of Labor
			SAC0432A011	Department of State
			SAC0432A012	Department of the Interior
			SAC0432A013	Department of the Treasury
			SAC0432A014	Department of Transportation
			SAC0432A015	Department of Veterans Affairs
			SAC0432A016	Executive Office of the President
			SAC0432A017	Federal Legislative Branch
			SAC0432A018	General Accounting Office
			SAC0432A019	General Services Administration
			SAC0432A020	Independent Agencies
			SAC0432A021	Judicial Branch
			SAC0432A022	National Aeronautics and Space Administration
			SAC0432A023	Office of Personnel Management
			SAC0432A024	Peace Corps
			SAC0432A025	Postal Service
			SAC0432A026	Private Vendor
			SAC0432A027	Quasi Official INTNL & Non Govt
			SAC0432A028	Railroad Retirement Board
			SAC0432A029	Securities and Exchange Commission
			SAC0432A030	Other federal agency (please specify)	B
SAC0433	B	Other federal agency:				Text area, no char limit	Single	N	Skip Logic Group	Other Federal Agency
SAC0434		In which U.S. state are you based?	SAC0434A001	Alabama		Drop down, select one	Single	Y		State
			SAC0434A002	Alaska
			SAC0434A003	Arkansas
			SAC0434A004	Arizona
			SAC0434A005	California
			SAC0434A006	Colorado
			SAC0434A007	Connecticut
			SAC0434A008	District of Columbia
			SAC0434A009	Delaware
			SAC0434A010	Florida
			SAC0434A011	Georgia
			SAC0434A012	Hawaii
			SAC0434A013	Idaho
			SAC0434A014	Illinois
			SAC0434A015	Indiana
			SAC0434A016	Kansas
			SAC0434A017	Kentucky
			SAC0434A018	Louisiana
			SAC0434A019	Maryland
			SAC0434A020	Massachusetts
			SAC0434A021	Maine
			SAC0434A022	Michigan
			SAC0434A023	Minnesota
			SAC0434A024	Missouri
			SAC0434A025	Mississippi
			SAC0434A026	Montana
			SAC0434A027	Nebraska
			SAC0434A028	New Hampshire
			SAC0434A029	New Jersey
			SAC0434A030	New Mexico
			SAC0434A031	Nevada
			SAC0434A032	New York
			SAC0434A033	North Carolina
			SAC0434A034	North Dakota
			SAC0434A035	Ohio
			SAC0434A036	Oklahoma
			SAC0434A037	Oregon
			SAC0434A038	Pennsylvania
			SAC0434A039	Rhode Island
			SAC0434A040	South Carolina
			SAC0434A041	South Dakota
			SAC0434A042	Tennessee
			SAC0434A043	Texas
			SAC0434A044	Utah
			SAC0434A045	Virginia
			SAC0434A046	Vermont
			SAC0434A047	West Virginia
			SAC0434A048	Washington
			SAC0434A049	Wisconsin
			SAC0434A050	Wyoming
			SAC0434A051	Outside the U.S.
SAC0435		How often do you visit PSC.gov?	SAC0435A001	This is my first visit		Radio button, one-up vertical	Single	Y		Visit Frequency
			SAC0435A002	A few times per year
			SAC0435A003	A few times per month
			SAC0435A004	A few times per week
			SAC0435A005	Every day
			SAC0435A006	Multiple times per day
SAC0436		Did you accomplish your goal in visiting PSC.gov today?	SAC0436A001	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group	Accomplish Goal?
			SAC0436A002	No	A
			SAC0436A003	I did not have a specific goal in visiting PSC.gov today.
SAC0437	A	Which goal could you not accomplish on PSC.gov today?				Text area, no char limit	Single	N	Skip Logic Group	Goal Not accomplished
SAC0438		What suggestions do you have about how to make PSC.gov more helpful to visitors like you?				Text area, no char limit	Single	N		Suggested Changes
SAC0439		What do you plan to do next?	SAC0439A001	Call someone to learn more about products and services available		Radio button, one-up vertical	Single	Y		Do next?
			SAC0439A002	Email someone to learn more about products and services available
			SAC0439A003	Call someone to order or purchase products or services available
			SAC0439A004	Email someone to order or purchase products or service available
			SAC0439A005	Download the PSC Service and Product Directory
			SAC0439A006	I do not plan to do any of the above
SAC0440		If you could purchase products or services using this website, how likely would you be to place your order online?	SAC0440A001	Very likely		Radio button, one-up vertical	Single	Y	Skip Logic Group	Likely to purchase online
			SAC0440A002	Somewhat likely
			SAC0440A003	Somewhat unlikely	A
			SAC0440A004	Very unlikely	A
SAC0441	A	Why would you be unlikely to order online?				Text area, no char limit		N	Skip Logic Group	Why unlikely to purchase online