Fiscal Year (FY) 2017 Office Visitor Survey (OVS)/

Generic Clearance of Customer Satisfaction Surveys

Office Visitor Survey Questionnaires and Coorespondence

Fiscal Year (FY) 2017 Office Visitor Survey (OVS)/

OMB: 0960-0526

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0960-0526 can be found here:

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First Survey Interval

Give Social Security a Report Card…
Using the rating scale shown below, please rate the service you received the day of your
visit. There is space at the end of the survey where you can explain your answers.
E = Excellent

VG = Very Good

G = Good

F = Fair

Based on your recent visit, mark [X] ONE
rating for:

P = Poor

VP = Very Poor

NA = Not Applicable

Office location

Office hours

Signs/instructions explaining how to
check in when you got to the office

Usefulness of Social Security information
in the waiting area (posters, pamphlets,
TV presentations, etc.)

Office comfort (seating, temperature, etc.)

Office appearance (clean, pleasant, etc.)

Office privacy

Did you have an appointment?

10. Convenience of the date and time of the
appointment

11. Waiting time to be served in the office

Mark [X] ONE.
Yes  (Go to 9.)
No  (Skip to 11.)
9.

How quickly you got an appointment

12. About how many minutes did you have to wait?
Mark [X] ONE.
Up to 10 minutes
More than 10 and up to 30 minutes
More than 30 and up to 60 minutes
More than 60 minutes
13.

Helpfulness of the staff

14.

Courtesy of the staff

15.

How well the staff knew their jobs

16.

How clearly the staff explained things

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First Survey Interval
17.

Was the staff able to take care of your business completely when you visited the office that
day?
Mark [X] ONE.
Yes
No

Mark [X] ONE rating.

18.

Overall, how would you rate
Social Security’s service during your
E
VG
G
F
P
recent office visit?
We would like to know a little more about how you took care of your recent business.
19.

Before you were served in the office, did you try to take care of this same business earlier?
Mark [X] ONE.
Yes (Go to 20.)
No  (Skip to 22.)

20.

What else did you do? Did you:
Mark [X] ALL that apply.
Call Social Security’s National 800 Number
Call the local office
Visit a local office, or
Try to use Social Security’s website

21.

Why weren’t you able to take care of your business in your earlier contact?
Mark [X] ALL that apply.
I couldn’t get through on the phone
The wait was too long at the office
The office was closed
The staff told me I had to come into the office
I didn’t have all the information or documents I needed
The staff couldn’t answer my question
I couldn’t find what I needed on the website
I tried an online service but it didn’t work for me

Now we would like to ask you about doing business on the Internet.
22.

First, do you currently use the Internet?
Mark [X] ONE.
Yes (Go to 23.)
No  (Skip to 34.)

Please continue on the next page 
[Identifier – Number and Bar Code]

First Survey Interval
23.

How do you access the Internet? Do you use:
Mark [X] ONE.
Only a personal computer or laptop computer
Only a wireless handheld device (smartphone, tablet, etc.)
Both a PC and a wireless handheld device

The list below describes different activities people can do on the Internet. Please tell us whether
you do each of the online activities listed below often, sometimes, or never.
Mark [X] ONE answer for each question.

24.

Send email

Often

Sometimes

Never

25.

Look for information online

Often

Sometimes

Never

26.

Make purchases online

Often

Sometimes

Never

27.

Bank or pay bills online

Often

Sometimes

Never

28.

Text message or chat

Often

Sometimes

Never

29.

Use Facebook, Twitter, or some other
Often
Sometimes
Never
social networking site
Social Security offers a service called “my Social Security” where people can create a secure
online account with a user name and password to conduct various types of business. For
example, people who receive benefits can use it to change their address. Have you heard
about the “my Social Security” account?

30.

Mark [X] ONE.
Yes (Go to 31.)
No  (Skip to 32.)
31.

Have you already created your “my Social Security” account?
Mark [X] ONE.
Yes (Skip to 34.)
No  (Go to 32.)

32.

How likely would you be to create a “my Social Security” account for handling future business
on Social Security’s website?
Mark [X] ONE.
Very Likely (Skip to 34.)
Somewhat Likely (Skip to 34.)
Not Very Likely, or (Go to 33.)
Not at all likely (Go to 33.)

Please continue on the next page 
[Identifier – Number and Bar Code]

First Survey Interval
33.

What is the main reason you might not be likely to create a “my Social Security” account?
Mark [X] ONE.
Prefer to speak to a person
Concerned about security of my information
Problem with computer or Internet access
Concerned that completing my business online might be too hard
Some other reason Explain:_____________________________________________

34.

Sometimes because of a medical condition, people need special accommodations to conduct
their business with Social Security. When you do business with Social Security, in person,
on the telephone, or online, do you need them to provide any special accommodations
because of a medical condition?
Mark [X] ONE.
Yes  (Go to 35.)
No (Skip to 37.)

35.

Do you need special accommodations because of a:
Mark [X] ALL that apply.
Physical limitation (for example, wheelchair access)
Visual limitation (for example, large print or Braille documents)
Deafness or difficulty hearing (for example, sign language interpreter), or
Another limitation (for example, trouble understanding or remembering things)

36.

How satisfied are you with how well Social Security meets your need for special
accommodations? Are you:
Mark [X] ONE.
Very satisfied
Somewhat satisfied
Somewhat dissatisfied, or
Very dissatisfied

37.

Please use this space to explain why you rated any item “F” (fair), “P” (poor), or “VP”
(very poor) or to explain any of your other answers.
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Thank you for taking the time to rate Social Security!
Please send us your “Report Card” in the enclosed postage-paid envelope as soon as possible.

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Expiration Date: Month/Year

Second Survey Interval

Give Social Security a Report Card…
We would like to ask you a few questions about how you found out what you needed to do to
apply for a Social Security card.
1. First, did you contact Social Security to find out how to apply for a new or replacement
Social Security card before you visited the Social Security Card Center?
Mark [X] ONE.
Yes
No  (Skip to 4)
2.

How did you contact Social Security for that information? Did you:
Mark [X] ALL that apply.
Call Social Security’s National 800 number
Call a Social Security office
Visit a Social Security office, or
Visit Social Security’s website

Using the rating scale shown below, please rate the following items about your experience
applying for a Social Security card. There is space at the end of the survey where you can
explain your answers.
E = Excellent

VG = Very Good

G = Good

F = Fair

P = Poor

VP = Very Poor

NA = Not Applicable

Mark [X] ONE rating for each question.

3. Information you received before your visit about how to apply
for a new or replacement Social Security card

Office location

Office hours

Signs/instructions explaining how to check in when you got
to the office
Usefulness of Social Security information in the waiting area
(posters, pamphlets, TV presentations, etc.)

7.
8.

Office comfort (seating, temperature, etc.)

Office appearance (clean, pleasant, etc.)

10. Office privacy

11. Waiting time to be served in the office

12. About how many minutes did you have to wait?
Mark [X] ONE.
Up to 10 minutes
More than 10 and up to 30 minutes
More than 30 and up to 60 minutes
More than 60 minutes

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Expiration Date: Month/Year

Second Survey Interval
Mark [X] ONE rating.

13. Helpfulness of the staff

14. Courtesy of the staff

15. How well the staff knew their jobs

16. How clearly the staff explained things

17. Were you able to take care of your business in one visit to the Social Security Card Center?
Mark [X] ONE.
Yes
No
Mark [X] ONE rating.

18. Overall, how would you rate Social Security’s service during
your recent visit?

19. To serve you better in the future, we would like to know how you prefer to do business with
Social Security. First, what is your preferred language?
Mark [X] ONE.
English
Spanish
Other Explain:______________________________________________
20. Do you currently use the Internet?
Mark [X] ONE.
Yes
No  (Skip to 33.)
21.

How do you access the Internet? Do you use:
Mark [X] ONE.
Only a personal computer or laptop
Only a wireless handheld device (smartphone, tablet, etc.)
Both a personal computer and a wireless handheld device

Please continue on the next page 
[Identifier – Number and Bar Code]

Second Survey Interval
The list below describes different activities people can do on the Internet. Please tell us whether you
do each of the online activities listed below often, sometimes, or never.
Mark [X] ONE answer for each question.

22.

Send email

Often

Sometimes

Never

23.

Look for information online

Often

Sometimes

Never

24.

Make purchases online

Often

Sometimes

Never

25.

Bank or pay bills online

Often

Sometimes

Never

26.

Text message or chat

Often

Sometimes

Never

27.

Use Facebook, Twitter, or some other social
networking site

Often

Sometimes

Never

28.

Social Security offers a service called “my Social Security” where people can create a secure
online account with a user name and password to conduct various types of business. For
example, people who receive benefits can use it to change their address. Have you heard about
the “my Social Security” account?
Mark [X] ONE.
Yes (Go to 29.)
No  (Skip to 30.)

29.

Have you already created your “my Social Security” account?
Mark [X] ONE.
Yes (Skip to 32.)
No  (Go to 30.)

30.

How likely would you be to create a “my Social Security” account for handling future business on
Social Security’s website?
Mark [X] ONE.
Very Likely (Skip to 32.)
Somewhat Likely (Skip to 32.)
Not Very Likely, or (Go to 31.)
Not at all likely (Go to 31.)

Please continue on the next page 
[Identifier – Number and Bar Code]

Second Survey Interval
31.

32.

Sometimes because of a medical condition, people need special accommodations to conduct
their business with Social Security. When you do business with Social Security, in person, on
the telephone, or online, do you need them to provide any special accommodations because of a
medical condition?
Mark [X] ONE.
Yes  (Go to 33)
No  (Skip to 35.)

33. Do you need special accommodations because of a:
Mark [X] ALL that apply.
Physical limitation (for example, wheelchair access)
Visual limitation (for example, large print or Braille documents)
Deafness or difficulty hearing (for example, sign language interpreter), or
Another limitation (for example, trouble understanding or remembering things)
34.

How satisfied are you with how well Social Security meets your need for special
accommodations? Are you:
Mark [X] ONE.
Very satisfied
Somewhat satisfied
Somewhat dissatisfied, or
Very dissatisfied

35. Please use this space to explain why you rated any item “F” (fair), “P” (poor), or “VP” (very poor)
or to explain any of your other answers.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Thank you for taking the time to rate Social Security!
Please send us your “Report Card” in the enclosed postage-paid envelope as soon as possible.

First Survey Interval
FY 2017 Office Visitor Survey - Pre-Notice Postcard

Dear Social Security Customer:
Social Security believes that conducting surveys is one of the best ways to find out how
well we are serving you. That’s why we will soon be asking you to give us your opinion
about the service you received during a recent visit to a local Social Security office or
Social Security hearing office.
In a few days, you will receive a short questionnaire in the mail from [insert contractor
name], who is conducting this survey for Social Security. When you receive their
envelope, we hope that you will take the time to answer our questions and tell us what
you think of our service.
We look forward to hearing your opinions.

Michelle A. King
Deputy Commissioner
Office of Budget, Finance, Quality, and Management
Social Security Administration

First Survey Interval
FY 2017 Office Visitor Survey – Initial Cover Letter

Dear Social Security Customer:
As I noted in my recent postcard, Social Security is conducting a survey to find out how
well we served you during your recent visit to a local Social Security office or
Social Security hearing office. Please take 5 minutes to fill out the enclosed "Report
Card" and return the form as soon as possible in the postage-paid envelope provided.
Please be assured that [insert contractor name], who is conducting this survey for us, will
only give your responses to my staff here at Social Security and will not use them for any
other purpose. Social Security will report the survey results by summarizing the answers
of everyone who takes the survey; we will not report any individual responses.
If you have a question about Social Security benefits, please visit our web site
at www.socialsecurity.gov or call our toll-free information line at 1-800-772-1213.
We appreciate your taking time out of your busy schedule to answer our survey.
Sincerely,

Michelle A. King
Deputy Commissioner
Office of Budget, Finance, Quality, and Management
Social Security Administration

Enclosures

First Survey Interval
FY 2017 Office Visitor Survey – Follow-up Cover Letter

Dear Social Security Customer:
About a week ago we sent you a survey form, “Give Social Security a Report Card,” to
find out how well we served you when you visited a local Social Security office or
Social Security hearing office. We haven’t yet heard from you and it’s important that we
gather opinions from as many people as possible. If you have already mailed in your
completed survey form, please discard this letter. We sincerely appreciate your help, and
we look forward to receiving your response.
However, if you have not yet had time to fill out and return your survey, please take a
few minutes right now to do that. The form is short and takes less than 5 minutes to
complete. In case you misplaced the survey, we have enclosed another copy along with a
postage-paid return envelope.
Please be assured that [insert contractor name], who is conducting this survey for us, will
only give your responses to my staff here at Social Security and will not use them for any
other purpose. Social Security will report the survey results by summarizing the answers
of everyone who takes the survey; we will not report any individual responses.
If you have a question about Social Security benefits, please visit our web site
at www.socialsecurity.gov or call our toll-free information line at 1-800-772-1213.
We would appreciate receiving your completed survey as soon as possible.
Sincerely,

Michelle A. King
Deputy Commissioner
Office of Budget, Finance, Quality, and Management
Social Security Administration

Enclosures

First Survey Interval
FY 2017 Office Visitor Survey – Prenotice Postcard – Spanish

Estimado(a) Cliente del Seguro Social:
La Administración del Seguro Social cree que una de las mejores maneras de saber si
el público está satisfecho con nuestro servicio es a través de encuestas. Es por eso que
muy pronto le estaremos pidiendo su opinión sobre el servicio que recibió durante su
reciente visita a la oficina del Seguro Social o la oficina de audiencias del Seguro Social.
En unos días, usted recibirá un corto cuestionario por correo de [insert contractor name],
quien está llevando a cabo esta encuesta por parte del Seguro Social. Cuando lo reciba,
esperamos que tome el tiempo para contestar nuestras preguntas y decirnos lo que piensa
de nuestro servicio.
Esperamos escuchar sus opiniones.
Michelle A. King
Comisionado Adjunto
Oficina de Administración de Presupuestos, Contabilidad y Rendimiento
Administración del Seguro Social

First Survey Interval
FY 2017 Office Visitor Survey – Initial Cover Letter - Spanish

Estimado(a) [insert name]:
Según le indiqué en la tarjeta postal que le envié recientemente, el Seguro Social está
llevando a cabo una encuesta para obtener su opinión sobre el servicio que recibió
durante su reciente visita a la oficina local del Seguro Social o la oficina de audiencias.
Por favor tómese 5 minutos para llenar la “Tarjeta de Calificación” adjunta y devolverla
lo antes posible en el sobre franqueado provisto.
Por favor, siéntase seguro de que [insert contractor name], quien está llevando a cabo
esta encuesta por nosotros, proveerá sus respuestas solamente a mi personal aquí en el
Seguro Social y no las usará para ningún otro propósito. El Seguro Social presentará los
resultados de la encuesta con un resumen de las respuestas de todas las personas que
tomen la misma; no presentaremos informes individuales de las respuestas.
Si tiene alguna pregunta sobre los beneficios de Seguro Social, por favor visite nuestro
sitio de Internet en www.segurosocial.gov o llame a nuestro número gratis para
información al 1-800-772-1213.
Le agradecemos que haya tomado el tiempo para contestar nuestra encuesta.
Sinceramente,

Michelle A. King
Comisionado Adjunto
Oficina de Administración de Presupuestos, Contabilidad y Rendimiento
Administración del Seguro Social

Anexos

First Survey Interval
FY 2017 Office Visitor Survey- Follow-up Cover Letter – Spanish

Estimado(a) [insert name]:
Alrededor de una semana atrás, le enviamos un formulario de encuesta, “Déle una Tarjeta
de Calificación al Seguro Social,” pidiéndole su opinión sobre el servicio que recibió
cuando visitó la oficina local del Seguro Social o la oficina de audiencias. No hemos
oído de usted y es muy importante que reunamos opiniones de tantas personas como sea
posible. Si ya nos envió la encuesta completada, favor de ignorar esta carta.
Sinceramente apreciamos su ayuda y estamos ansiosos de recibir su respuesta.
Sin embargo, si todavía no ha tenido tiempo de llenar y devolver su encuesta, por favor
tome unos minutos ahora mismo para hacerlo. El formulario es corto y le tomará menos
de 5 minutos en llenarlo. En caso que haya perdido la encuesta, hemos incluido otra
copia junto con un sobre franqueado.
Por favor, siéntase seguro de que [insert contractor name], quien está llevando a cabo
esta encuesta por nosotros, proveerá sus respuestas solamente a mi personal aquí en el
Seguro Social y no las usará para ningún otro propósito. El Seguro Social presentará los
resultados de la encuesta con un resumen de las respuestas de todas las personas que
tomen la misma; no presentaremos informes individuales de las respuestas.
Si tiene alguna pregunta sobre los beneficios de Seguro Social, por favor visite nuestro
sitio de Internet en www.segurosocial.gov o llame a nuestro número gratis para
información al 1-800-772-1213.
Le agradeceríamos si recibimos su encuesta llena lo antes posible.
Sinceramente,

Michelle A. King
Comisionado Adjunto
Oficina de Administración de Presupuestos, Contabilidad y Rendimiento
Administración del Seguro Social

Anexos

Second Survey Interval
FY 2017 Social Security Card Center Survey - Pre-Notice Postcard

Dear Social Security Customer:
Social Security believes that conducting surveys is one of the best ways to find out how
well we are serving you. That’s why we will soon be asking you to give us your opinion
about the service you (or someone else on your behalf) received during a recent visit to a
Social Security Card Center.
In a few days, you will receive a short questionnaire in the mail from [insert contractor
name], who is conducting this survey for Social Security. When you receive their
envelope, we hope that you will take the time to answer our questions and tell us what
you think of our service.
We look forward to hearing your opinions.
Michelle A. King
Deputy Commissioner
Office of Budget, Finance, Quality, and Management
Social Security Administration

Second Survey Interval
FY 2017 Social Security Card Center Survey – Initial Cover Letter

Dear Social Security Customer:
As I noted in my recent postcard, Social Security is conducting a survey to find out how
well we served you (or someone else on your behalf) during your recent visit to a
Social Security Card Center. Please take 5 minutes to fill out the enclosed "Report Card"
and return the form as soon as possible in the postage-paid envelope provided.
Please be assured that [insert contractor name], who is conducting this survey for us, will
only give your responses to my staff here at Social Security and will not use them for any
other purpose. Social Security will report the survey results by summarizing the answers
of everyone who takes the survey; we will not report any individual responses.
If you have a question about Social Security benefits, please visit our web site
at www.socialsecurity.gov or call our toll-free information line at 1-800-772-1213.
We appreciate your taking time out of your busy schedule to answer our survey.
Sincerely,

Michelle A. King
Deputy Commissioner
Office of Budget, Finance, Quality, and Management
Social Security Administration

Enclosures

Second Survey Interval
FY 2017 Social Security Card Center Survey – Follow-up Cover Letter

Dear Social Security Customer:
About a week ago we sent you a survey form, “Give Social Security a Report Card,” to
find out how well we served you when you (or someone else on your behalf) visited a
Social Security Card Center. We haven’t yet heard from you and it’s important that we
gather opinions from as many people as possible. If you have already mailed in your
completed survey form, please discard this letter. We sincerely appreciate your help, and
we look forward to receiving your response.
However, if you have not yet had time to fill out and return your survey, please take a
few minutes right now to do that. The form is short and takes less than 5 minutes to
complete. In case you misplaced the survey, we have enclosed another copy along with a
postage-paid return envelope.
Please be assured that [insert contractor name], who is conducting this survey for us, will
only give your responses to my staff here at Social Security and will not use them for any
other purpose. Social Security will report the survey results by summarizing the answers
of everyone who takes the survey; we will not report any individual responses.
If you have a question about Social Security benefits, please visit our web site
at www.socialsecurity.gov or call our toll-free information line at 1-800-772-1213.
We would appreciate receiving your completed survey as soon as possible.
Sincerely,

Michelle A. King
Deputy Commissioner
Office of Budget, Finance, Quality, and Management
Social Security Administration
Enclosures

Both Survey Intervals
Office Visitor Survey and Social Security Card Center Survey – Privacy Act

PRIVACY ACT STATEMENT
The Social Security Administration is authorized to collect the information for this survey
under Executive Order 12862, “Setting Customer Service Standards.” Your response to
these questions is strictly voluntary. The information you provide will be used to help us
improve the service that we give you. Your response will not be disclosed to any other
government or private agency.

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 5 minutes to read the instructions, gather the facts, and
answer the questions. You may send comments on our time estimate above to:
Social Security Administration, 6401 Security Blvd., Baltimore, MD 21235-6401.
Send only comments relating to our time estimate to this address, not the completed
form.

First Survey Interval
Office Visitor Survey Privacy Act - Spanish

DECLARACIÓN DE LA LEY DE CONFIDENCIALIDAD
La Administración del Seguro Social tiene la autorización de colectar la información para
esta encuesta bajo la orden ejecutiva 12862, «Setting Customer Service Standards» (en
español, «Estableciendo el nivel de la calidad del servicio al consumidor»).
Sus respuestas a estas preguntas son completamente voluntarias. La información que nos
provea se usará para ayudarnos a mejorar el servicio que le proveemos. Sus respuestas
no serán divulgadas a otras agencias gubernamentales o privadas.

LEY PARA LA REDUCCIÓN DE TRÁMITES
Esta recopilación de información cumple con los requisitos de 44 U.S.C. &3507, según
enmendada por la sección 2 de La Ley para la Reducción de Trámites del 1995. No es
requisito que usted conteste estas preguntas a menos que el formulario de la encuesta
muestre un número de control válido de la Oficina de Administración y Presupuesto.
Calculamos que le tomará 5 minutos para llenar esta encuesta. Esto incluye el tiempo
que le tomará leer las instrucciones, recaudar los datos y contestar las preguntas. Puede
enviar comentarios sobre nuestro cálculo del tiempo mencionado anteriormente a:
Social Security Administration, 6401 Security Blvd., Baltimore, MD 21235-6401.
Envíe sólo los comentarios sobre nuestra estimación de tiempo a esta dirección, no el
formulario lleno.

File Type	application/pdf
File Title	Help us improve the service you get from Social Security
Author	dpse
File Modified	2016-09-14
File Created	2016-09-14