Form 039 2020 039 SSA mySSA Web AccountManagement_09_24_20

---

Overview

Welcome and Thank You Text
Model Qsts
Current CQs
CQs (08-18-2020)

---

Sheet 1: Welcome and Thank You Text

Model Instance Name:

SSA My Social Security V3

MID:

Partitioned Yes

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 our site. You've been randomly chosen to take part in a brief survey to let us 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 us 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 website.

us

---

Sheet 2: Model Qsts

Model Name		SSA MySSA V3					Red & Strike-Through: Delete
Model ID		FtssMMEVVU58x8hlxFYwdg4C					Underlined & Italicized: Re-order
Partitioned		Yes - 2 MQ					Pink: Addition
Date		8/19/2019					Blue: Reword
	Label	Element Questions		Label	Satisfaction Questions		Label	Future Behaviors
		Site Performance (1=Poor, 10=Excellent, Don't Know)			Satisfaction			Recommend (1=Very Unlikely, 10=Very Likely)
1	Site Performance - Speed	Please rate the speed that pages and content loaded for you.	16	Satisfaction - Overall	What is your overall satisfaction with this application? (1=Very Dissatisfied, 10=Very Satisfied)	19	Recommend	How likely are you to recommend this application to someone else?
2	Site Performance - Completeness	Please rate the consistency of complete loading of pages and content.	17	Satisfaction - Expectations	How well does this application meet your expectations? (1=Falls Short, 10=Exceeds)			Use Other Online Services (1=Very Unlikely, 10=Very Likely)
3	Site Performance -Responsiveness	Please rate the responsiveness of the pages to your actions.	18	Satisfaction - Ideal	How does this application compare to your idea of an ideal application? (1=Not Very Close, 10=Very Close)	20	Use Other Online Services	How likely are you to use other Social Security online services?
		Look and Feel (1=Poor, 10=Excellent, Don't Know)
4	Look and Feel - Appeal	Please rate the visual appeal of the pages that you visited.
5	Look and Feel - Spacing	Please rate the spacing between items on the pages that you visited.
6	Look and Feel - Readability	Please rate the legibility of the pages that you visited.
		Navigation (1=Poor, 10=Excellent, Don't Know)
7	Navigation - Ease	Please rate the ease of finding what you were looking for.
8	Navigation - Layout	Please rate the page layout on displaying content and links where you could find them.
9	Navigation - Links	Please rate the links on taking you where you needed to go.
		Site Information (1=Poor, 10=Excellent, Don't Know)
10	Site Information - Relevance	Please rate the relevance to your interests of the information that you found.
11	Site Information - Thoroughness	Please rate the thoroughness of the information that you found.
12	Site Information - Readability	Please rate the readability of the information that you found.
		Account Management (1=Poor, 10=Excellent, Don't Know)
13	Account Management - Simplicity	Please rate the simplicity of account management on this site.
14	Account Management - Efficiency	Please rate the efficiency of account management on this site.
15	Account Management - Essential Information	Please rate the presentation of essential account information.

---

Sheet 3: Current CQs

				red & strike-through: DELETE
SSA My Social Security V3				underlined & italicized: RE-ORDER
	FtssMMEVVU58x8hlxFYwdg4C			pink: ADDITION
Partitioned Yes	1/11/2018			blue + -->: REWORDING
SSA My Social Security V3 CUSTOM QUESTION LIST
QID	Skip Logic Label	Question Text	AnswerIDs (DOT)	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Required Y/N	Special Instructions	CQ Label
SBD8779Q001		How often do you access (or plan to access) your my Social Security account?		Once a year		Radio button, one up vertical	Y		Access Frequency - NEW
				Once every six months
				Once every three months
				Once a month
				More than once a month
				Not sure
SZA0375687		Did you create a new my Social Security account today?		Yes, this is my first time accessing my Social Security		Radio button, one up vertical	Y		Create mySSA account
				No, I had already had a my Social Security account
		Have you elected a delivery preference for your notices in Message Center?		Yes	A	Radio button, one up vertical	Y	Skip Logic Group	Notice preference
				No
				Don't know
	A	Did you request to receive both a paper and online copy of notices in Message Center?		Yes	B	Radio button, one up vertical	Y	Skip Logic Group	Receive paper and online
				No
				Don't know
	B	Why did you request to receive both a paper and online copy of notices in Message Center?				Text area, no Char limit	N	Skip Logic Group	Why receive notices both ways
SBD8779Q002		What is your reason for visiting my Social Security today? (Check all that apply)		To get a Benefit Verification Letter	A	check box, one up vertical	Y	Skip Logic Group	Primary Reason
				To access my online notices (e.g., COLA)	B,C,D,E,F,G
				To view my Benefits and Payment Details
				To enroll in or update my direct deposit
				To use the myRetirement Calculator	U
				To change my address with SSA
				To print or view my online Social Security Statement	H
				To make sure my earnings record is correct
				To replace my Social Security Card or get a new card	I
				To check the Status of my recently filed application for benefits
				To learn about the benefits to which I might be entitled
				To apply only for Social Security or Medicare Only benefits
				To report my wages	J
				To request a replacement SSA-1099 (or SSA-10425) for tax purposes
				To add Extra Security to my online account
				Just curious – wanted to see what information was contained in my Social Security account
				Other Reason for visiting today	K
SBD8779Q003	B	How difficult or easy was it to access your Cost of Living Adjustment (COLA) notice online?		Very difficult		Radio button, one-up vertical	Y	Skip Logic Group	Ease of access COLA
				Somewhat difficult
				Neither difficult or easy
				Somewhat easy
				Very easy
SBD8779Q004	C	Do you have any suggestions for improving our online notices?				text, no char limit	N	Skip Logic Group	Improve Online notices
SBD8779Q005	D	If you owed us money, would you like the option to make a payment on line?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Pay online option
				No
				Don't know/Not applicable
SBD8779Q006	E	Are you aware that the communication delivery preference gives you the option to get your notices either electronically or by mail?		Yes	L	Radio button, one-up vertical	Y	Skip Logic Group	Understand communication delivery preference
				No
SBD8779Q007	L	How easy or difficult was it to change your communication delivery preference?		Very difficult		Radio button, one-up vertical	Y	Skip Logic Group	Ease of changing communication delivery
				Somewhat difficult
				Neither easy or difficult
				Somewhat easy
				Very easy
				Don't know/Not applicable
SBD8779Q008	F	Are you comfortable receiving notices electronically?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Comfortable receiving notices online
				No
				Don't know
SBD8779Q009	G	Would you recommend accessing notices online to your family and friends?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Recommend accessing notices online
				No
				Don't know/Not applicable
SBD8779Q010	H	How often do you review your online Social Security Statement?		This is my first time		Radio button, one-up vertical	Y	Skip Logic Group	Freq View Statement
				At least once a year
				Every 6 months
				Every 3 months or more frequently
SZA0375707	U	Did use of the Retirement Calculator help eliminate the need to call our national phone service or visit a local Social Security office?		Yes	V,W,X	Radio button, one-up vertical	Y	Skip Logic Group	RE eliminated need to call or visit
				No
				I was exploring the tools available within my Social Security and had not planned to contact SSA.
SZA0375708	V	Were the estimates from the Retirement Calculator easy to understand?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Estimates easy to understand
				No
				Don't know
SZA0375727	W	Please indicate your level of agreement with the following statements: The estimates provided by the Retirement Calculator were displayed in an easy to understand format which allowed me to understand my Social Security Retirement options.		1=Strongly Disagree	Y	Radio button, scaled, no don't know	Y	Skip Logic Group	RE gave understanding of future earnings
				2	Y
				3
				4
				5 =Strongly Agree
SZA0375747	Y	What suggestions do you have for displaying retirement estimates?				Text area, no Char limit	N	Skip Logic Group	OE_Preferred format
SZA0375767	X	The Retirement Calculator gave me an understanding of how my future earnings may affect my Social Security Retirement benefits.		1=Strongly Disagree		Radio button, scaled, no don't know	Y	Skip Logic Group	RE format
				2
				3
				4
				5=Strongly Agree
SBD8779Q011	A	For which Agency or program do you need a Benefit Verification Letter? (Check all that apply)		Medicare		check box vertical one up	Y	Skip Logic Group	Agency Need
				Medicaid
				State or Local Department of Social Services
				HUD - Federal Housing Admin. (FHA) and/or Section 8 Housing
				USDA - SNAP (Food Stamps)
				Department of Veterans Affairs
				IRS
				Court
				Want a copy for personal use
				Bank or financial institution
				Education-related
				Medical-related
				Healthcare signup and/or verification
				Requesting a Retirement Visa from another country
				Other agency or program	M
SBD8779Q012	M	Which "other" agency or program requested your Benefit Verification information?				Text area, no Char limit	N	Skip Logic Group	OPS_Other Agency
SBD8779Q013	K	Please tell us what your primary reason was for visiting today:				Text area, no Char limit	N	Skip Logic Group	OPS_Primary Reason
SBD8779Q014	I	For which purpose or program do you need a replacement SSN Card? (Check all that apply)		Proof of identity		checkbox vertical, one up	Y	Skip Logic Group	Purpose for SSN Card
				Tax purposes
				Education-related
				Required for my job
				Passport
				Bank or financial institution
				Income assistance
				Other (Please specify)	N
SBD8779Q015	N	Please explain for which purpose or program you need a replacement SSN card.				Text area, no Char limit	N	Skip Logic Group	OPS_Purpose Other
SBD8779Q016	J	Who are you reporting wages for?		Myself only		Radio button, one-up vertical	Y	Skip Logic Group	Reporting For
				My spouse only	O,P
				Myself and my spouse	O,P
				Myself and another individual (not spouse)	O,P,Q
				Other relative only	O,P
				Other	O,P,Q
SBD8779Q017	Q	What is your relationship to the individual you are reporting wages for?				Text area, no Char limit	N	Skip Logic Group	OE_Report For
SBD8779Q018	P	What type of benefits does the person you are reporting for receive?		Disability		Radio button, one-up vertical	Y	Skip Logic Group	Benefit Type Reporting
				Supplemental Security Income (SSI)
				Both Disability and SSI
				Don't know
SBD8779Q019	O	Was the person you wanted to report wages for listed?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	OE_Relationship
				No
SBD8779Q020	J	Was the employer listed?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Employer listed
				No
SBD8779Q021	J	Are you reporting for more than one employer for the same person?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Reporting multiple employers
				No
SBD8779Q022	J	Are you currently working?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Currently working
				No
SBD8779Q023	J	How long did it take you to submit your wages?		5 minutes or less		Radio button, one-up vertical	Y	Skip Logic Group	Time Submit Wage
				6-10 minutes
				11-15 minutes
				More than 15 minutes
				Unsure
				Did not submit wages
SBD8779Q024	J	Before today's visit, what other methods have you used to report wages? (Check all that apply)		Field Office		Checkbox, one-up vertical	Y	Skip Logic Group	Other reporting methods
				Mail
				Fax
				Phone
				Other
SBD8779Q025	J	Do you plan to electronically report additional wages in the future?		Yes	R	Radio button, one-up vertical	Y	Skip Logic Group	Plan report electronically
				No	S
				Don't know
SBD8779Q026	R	How do you plan to report future wages?		Desktop/Laptop		Radio button, one-up vertical	Y	Skip Logic Group	How Report Again
				Tablet
				Mobile Device
				Don't know
SBD8779Q027	S	What method do you prefer to use to report your wages?		Field Office		Radio button, one-up vertical	Y	Skip Logic Group	Preferred method reporting
				Mail
				Fax
				Phone
				Other
SBD8779Q028	J	Were the instructions you received helpful?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Instructions Helpful
				No	T
SBD8779Q029	T	How can we improve the wage reporting application?				Text area, no Char limit	N	Skip Logic Group	OE_Improve Instructions
		Are you currently receiving Special Notice Options (SNO) like Braille, Audio CD, Data CD, or Large Print as your notice format?		Yes	A, B, D	Radio button, one-up vertical	Y	Skip Logic Group	SNO notice
				No
				Don't Know
	A	How satisfied are you with your current SNO format?		1=Very Dissatisfied		Radio button, one-up vertical	Y	Skip Logic Group	Satisfied with SNO notice
				2=Somewhat dissatisfied
				3=Neither satisfied or dissatisfied
				4=Somewhat satisfied
				5=Very satisfied
	B	Do you use your SNO notice?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Use SNO notice
				No
				Don't Know
	D	Would you like to stop receiving your notice in its current SNO format?		Yes	E	Radio button, one-up vertical	Y	Skip Logic Group	Stop receiving SNO format
				No
				Don't Know
	E	Do you know how to change/stop receiving your notice in its current SNO format?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Know how to stop
				No
				Don't Know
	F	Why would you like to stop receiving your notice in its current SNO format?				Text area, no Char limit	N	Skip Logic Group	OE_Why stop SNO in format
SBD8779Q030		Did you register for your my Social Security online or in person?		Registered online on my first attempt	A	Radio button, one-up vertical	Y	Skip Logic Group	How Registered
				Registered online after prior unsuccessful attempts	A
				Registered with in-person assistance from my local SSA office	A,B
				Registered using the SSA Express
				Not sure or don't remember
SBD8779Q031	A	Please select the approximate length of time it took for you complete your registration		Less than 15 minutes		Radio button, one-up vertical	Y	Skip Logic Group	Reg Time
				More than 15 but less than 30 minutes
				30 minutes or more
SBD8779Q032	B	Why did you decide to register in-person?		I was unsuccessful registering online and was required to do so in-person	C	Radio button, one-up vertical	Y	Skip Logic Group	Reg In person
				I preferred registering for a Social Security account in-person at my SSA office	C
				Employee offered the option for me to register for a Social Security account	C
SBD8779Q033	C	Please describe your in-person registration experience.				Text area, no char limit	N	Skip Logic Group	OE_In-person Experience
SBD8779Q034		Did you find the instructions for creating a username, password and registering a second factor to be clear?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Instructions Understand
				Partially	A
				No	A
SBD8779Q035	A	Please explain what was not clear about any of the instructions.				Text area, no char limit	N	Skip Logic Group	OE_Instructions
SBD8779Q036		Do you have any concerns about the security of the personal information contained in your my Social Security account?		No		Radio Button, One-up	Y	Skip Logic Group	Security Concerns
				Yes	B
SBD8779Q037	B	Please describe your security concerns.				Text area, no char limit	N	Skip Logic Group	OE_Security Concern. OCBO-Cx: Sentiment Analysis
SBD8779Q038		Please indicate your level of agreement with the following statements about your interaction today: I am satisfied with the service I received from the Social Security Administration.		1=Strongly Disagree		Radio Button, Scale, No don't know	Y		A11-Satisfied
				2
				3
				4
				Strongly Agree=5
SBD8779Q039		This interaction increased my confidence in the Social Security Administration.		1=Strongly Disagree		Radio Button, Scale, No don't know	Y		A11-Trust
				2
				3
				4
				Strongly Agree=5
SBD8779Q040		My need was addressed.		1=Strongly Disagree		Radio Button, Scale, No don't know	Y		A11-Quality
				2
				3
				4
				Strongly Agree=5
SBD8779Q041		It was easy to complete what I needed to do.		1=Strongly Disagree		Radio Button, Scale, No don't know	Y		A11-Ease
				2
				3
				4
				Strongly Agree=5
SBD8779Q042		It took a reasonable amount of time to do what I needed to do.		1=Strongly Disagree		Radio Button, Scale, No don't know	Y		A11-Speed
				2
				3
				4
				Strongly Agree=5
SBD8779Q043		Did the information obtained during your my Social Security account visit enable you to accomplish what you wanted to do?		Yes		Radio button, one up	Yes	Skip Logic Group	Ability to Accomplish
				No
SBD8779Q044		Did you contact Social Security during your online visit?		Yes	A	Radio button, one-up vertical	Y	Skip Logic Group	Contacted SSA
				No
SBD8779Q045	A	How did you contact Social Security?		Requested a Call Back		Radio button, one-up vertical	Y	Skip Logic Group	How contacted SSA
				Email
				Chat with an Online representative	B,C,D,E
SBD8779Q046	B	How long was your wait to Chat with a representative online?		About what I expected		Radio button, one-up vertical	Y	Skip Logic Group	Click to chat wait
				Longer than I expected
SBD8779Q047	C	Did the Chat representative answer your question?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Click to chat answer
				Partially
				No
SBD8779Q048	D	Do you still have to call the 1-800 number or go into a field office?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Click to chat Call
				No
SBD8779Q049	D	How satisfied were you with the Chat Service you received today?		Very Satisfied		Radio button, one-up vertical	Y	Skip Logic Group	Click to chat service
				Satisfied
				Not Satisfied
				Very Dissatisfied
SBD8779Q050	D	How satisfied were you with the Chat Representative who assisted you today?		Very Satisfied		Radio button, one-up vertical	Y	Skip Logic Group	Click to chat representative
				Satisfied
				Not Satisfied
				Very Dissatisfied
SBD8779Q051	E	Please share any other feedback with us regarding your Chat experience today.				Text area, no Char limit	N	Skip Logic Group	Chat Feedback. OCBO-Cx: Sentiment Analysis
SBD8779Q052		Did you use the “Get Help” button or "Call Back" button during your visit today?		Yes, I used the "Get Help" button only		Radio button, one up vertical	Y		Get Help Button or Call Back
				Yes, I used the "Call Back" button only
				Yes, I used both the "Get Help" button and "Call Back" button
				No, I used neither
SBD8779Q053		Did you view the "Message Center" section during your visit today?		Yes		Radio button, one up	Y	Skip Logic Group	Message Center
				No	B
SBD8779Q054	B	Do you plan to view the "Message Center" in the future?		Yes		Radio button, one up	Y	Skip Logic Group	Use Message Center Future
				No
SBD8779Q055		Please select the category that includes your age:		35 and under		Radio button, one up	N		Age
				36 to 50
				51 to 61
				62
				63
				64
				65
				66
				67
				68 to 70
				71 or older
				Prefer not to answer
SBD8779Q056		Please enter your 5 digit ZIP Code:				Text area, 100 char limit	N		OE_ZIP
SBD8779Q057		Do you have any suggestions for improving the my Social Security registration process?				Text area, no char limit	N		OE_Improve Reg		OE_Improve Contents. OCBO-Cx: Sentiment Analysis
SBD8779Q058		Do you have any suggestions for improving my Social Security's content and features?				Text area, no char limit	N		OE_Improve Contents. OCBO-Cx: Sentiment Analysis

---

Sheet 4: CQs (08-18-2020)

				red & strike-through: DELETE
SSA My Social Security V3				underlined & italicized: RE-ORDER
	FtssMMEVVU58x8hlxFYwdg4C			pink: ADDITION
Partitioned Yes	1/11/2018			blue + -->: REWORDING
SSA My Social Security V3 CUSTOM QUESTION LIST
QID	Skip Logic Label	Question Text	AnswerIDs (DOT)	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Required Y/N	Special Instructions	CQ Label
SBD8779Q001		How often do you access (or plan to access) your my Social Security account?		Once a year		Radio button, one up vertical	Y		Access Frequency - NEW
				Once every six months
				Once every three months
				Once a month
				More than once a month
				Not sure
SZA0375687		Did you create a new my Social Security account today?		Yes, this is my first time accessing my Social Security		Radio button, one up vertical	Y		Create mySSA account
				No, I had already had a my Social Security account
SBD8779Q002		What is your reason for visiting my Social Security today? (Check all that apply)		To get a Benefit Verification Letter	A	check box, one up vertical	Y	Skip Logic Group	Primary Reason
				To access my online notices (e.g., COLA)	B,C,D,E,F,G
				To view my Benefits and Payment Details
				To enroll in or update my direct deposit
				To use the myRetirement Calculator	U
				To change my address with SSA
				To print or view my online Social Security Statement	H
				To make sure my earnings record is correct
				To replace my Social Security Card or get a new card	I
				To check the Status of my recently filed application for benefits
				To learn about the benefits to which I might be entitled
				To apply only for Social Security or Medicare Only benefits
				To report my wages	J
				To request a replacement SSA-1099 (or SSA-10425) for tax purposes
				To add Extra Security to my online account
				Just curious – wanted to see what information was contained in my Social Security account
				Other Reason for visiting today	K
SBD8779Q003	B	How difficult or easy was it to access your Cost of Living Adjustment (COLA) notice online?		Very difficult		Radio button, one-up vertical	Y	Skip Logic Group	Ease of access COLA
				Somewhat difficult
				Neither difficult or easy
				Somewhat easy
				Very easy
SBD8779Q004	C	Do you have any suggestions for improving our online notices?				text, no char limit	N	Skip Logic Group	Improve Online notices
SBD8779Q005	D	If you owed us money, would you like the option to make a payment on line?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Pay online option
				No
				Don't know/Not applicable
SBD8779Q006	E	Are you aware that the communication delivery preference gives you the option to get your notices either electronically or by mail?		Yes	L	Radio button, one-up vertical	Y	Skip Logic Group	Understand communication delivery preference
				No
SBD8779Q007	L	How easy or difficult was it to change your communication delivery preference?		Very difficult		Radio button, one-up vertical	Y	Skip Logic Group	Ease of changing communication delivery
				Somewhat difficult
				Neither easy or difficult
				Somewhat easy
				Very easy
				Don't know/Not applicable
SBD8779Q008	F	Are you comfortable receiving notices electronically?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Comfortable receiving notices online
				No
				Don't know
SBD8779Q009	G	Would you recommend accessing notices online to your family and friends?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Recommend accessing notices online
				No
				Don't know/Not applicable
SBD8779Q010	H	How often do you review your online Social Security Statement?		This is my first time		Radio button, one-up vertical	Y	Skip Logic Group	Freq View Statement
				At least once a year
				Every 6 months
				Every 3 months or more frequently
SZA0375707	U	Did use of the Retirement Calculator help eliminate the need to call our national phone service or visit a local Social Security office?		Yes	V,W,X	Radio button, one-up vertical	Y	Skip Logic Group	RE eliminated need to call or visit
				No
				I was exploring the tools available within my Social Security and had not planned to contact SSA.
SZA0375708	V	Were the estimates from the Retirement Calculator easy to understand?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Estimates easy to understand
				No
				Don't know
SZA0375727	W	Please indicate your level of agreement with the following statements: The estimates provided by the Retirement Calculator were displayed in an easy to understand format which allowed me to understand my Social Security Retirement options.		1=Strongly Disagree	Y	Radio button, scaled, no don't know	Y	Skip Logic Group	RE gave understanding of future earnings
				2	Y
				3
				4
				5 =Strongly Agree
SZA0375747	Y	What suggestions do you have for displaying retirement estimates?				Text area, no Char limit	N	Skip Logic Group	OE_Preferred format
SZA0375767	X	The Retirement Calculator gave me an understanding of how my future earnings may affect my Social Security Retirement benefits.		1=Strongly Disagree		Radio button, scaled, no don't know	Y	Skip Logic Group	RE format
				2
				3
				4
				5=Strongly Agree
SBD8779Q011	A	For which Agency or program do you need a Benefit Verification Letter? (Check all that apply)		Medicare		check box vertical one up	Y	Skip Logic Group	Agency Need
				Medicaid
				State or Local Department of Social Services
				HUD - Federal Housing Admin. (FHA) and/or Section 8 Housing
				USDA - SNAP (Food Stamps)
				Department of Veterans Affairs
				IRS
				Court
				Want a copy for personal use
				Bank or financial institution
				Education-related
				Medical-related
				Healthcare signup and/or verification
				Requesting a Retirement Visa from another country
				Other agency or program	M
SBD8779Q012	M	Which "other" agency or program requested your Benefit Verification information?				Text area, no Char limit	N	Skip Logic Group	OPS_Other Agency
SBD8779Q013	K	Please tell us what your primary reason was for visiting today:				Text area, no Char limit	N	Skip Logic Group	OPS_Primary Reason
SBD8779Q014	I	For which purpose or program do you need a replacement SSN Card? (Check all that apply)		Proof of identity		checkbox vertical, one up	Y	Skip Logic Group	Purpose for SSN Card
				Tax purposes
				Education-related
				Required for my job
				Passport
				Bank or financial institution
				Income assistance
				Other (Please specify)	N
SBD8779Q015	N	Please explain for which purpose or program you need a replacement SSN card.				Text area, no Char limit	N	Skip Logic Group	OPS_Purpose Other
SBD8779Q016	J	Who are you reporting wages for?		Myself only		Radio button, one-up vertical	Y	Skip Logic Group	Reporting For
				My spouse only	O,P
				Myself and my spouse	O,P
				Myself and another individual (not spouse)	O,P,Q
				Other relative only	O,P
				Other	O,P,Q
SBD8779Q017	Q	What is your relationship to the individual you are reporting wages for?				Text area, no Char limit	N	Skip Logic Group	OE_Report For
SBD8779Q018	P	What type of benefits does the person you are reporting for receive?		Disability		Radio button, one-up vertical	Y	Skip Logic Group	Benefit Type Reporting
				Supplemental Security Income (SSI)
				Both Disability and SSI
				Don't know
SBD8779Q019	O	Was the person you wanted to report wages for listed?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	OE_Relationship
				No
SBD8779Q020	J	Was the employer listed?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Employer listed
				No
SBD8779Q021	J	Are you reporting for more than one employer for the same person?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Reporting multiple employers
				No
SBD8779Q022	J	Are you currently working?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Currently working
				No
SBD8779Q023	J	How long did it take you to submit your wages?		5 minutes or less		Radio button, one-up vertical	Y	Skip Logic Group	Time Submit Wage
				6-10 minutes
				11-15 minutes
				More than 15 minutes
				Unsure
				Did not submit wages
SBD8779Q024	J	Before today's visit, what other methods have you used to report wages? (Check all that apply)		Field Office		Checkbox, one-up vertical	Y	Skip Logic Group	Other reporting methods
				Mail
				Fax
				Phone
				Other
SBD8779Q025	J	Do you plan to electronically report additional wages in the future?		Yes	R	Radio button, one-up vertical	Y	Skip Logic Group	Plan report electronically
				No	S
				Don't know
SBD8779Q026	R	How do you plan to report future wages?		Desktop/Laptop		Radio button, one-up vertical	Y	Skip Logic Group	How Report Again
				Tablet
				Mobile Device
				Don't know
SBD8779Q027	S	What method do you prefer to use to report your wages?		Field Office		Radio button, one-up vertical	Y	Skip Logic Group	Preferred method reporting
				Mail
				Fax
				Phone
				Other
SBD8779Q028	J	Were the instructions you received helpful?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Instructions Helpful
				No	T
SBD8779Q029	T	How can we improve the wage reporting application?				Text area, no Char limit	N	Skip Logic Group	OE_Improve Instructions
		Are you currently receiving Special Notice Options (SNO) like Braille, Audio CD, Data CD, or Large Print as your notice format?		Yes	A, B, D	Radio button, one-up vertical	Y	Skip Logic Group	SNO notice
				No
				Don't Know
	A	How satisfied are you with your current SNO format?		1=Very Dissatisfied		Radio button, one-up vertical	Y	Skip Logic Group	Satisfied with SNO notice
				2=Somewhat dissatisfied
				3=Neither satisfied or dissatisfied
				4=Somewhat satisfied
				5=Very satisfied
	B	Do you use your SNO notice?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Use SNO notice
				No
				Don't Know
	D	Would you like to stop receiving your notice in its current SNO format?		Yes	E	Radio button, one-up vertical	Y	Skip Logic Group	Stop receiving SNO format
				No
				Don't Know
	E	Do you know how to change/stop receiving your notice in its current SNO format?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Know how to stop
				No
				Don't Know
	F	Why would you like to stop receiving your notice in its current SNO format?				Text area, no Char limit	N	Skip Logic Group	OE_Why stop SNO in format
SBD8779Q030		Did you register for your my Social Security online or in person?		Registered online on my first attempt	A	Radio button, one-up vertical	Y	Skip Logic Group	How Registered
				Registered online after prior unsuccessful attempts	A
				Registered with in-person assistance from my local SSA office	A,B
				Registered using the SSA Express
				Not sure or don't remember
SBD8779Q031	A	Please select the approximate length of time it took for you complete your registration		Less than 15 minutes		Radio button, one-up vertical	Y	Skip Logic Group	Reg Time
				More than 15 but less than 30 minutes
				30 minutes or more
SBD8779Q032	B	Why did you decide to register in-person?		I was unsuccessful registering online and was required to do so in-person	C	Radio button, one-up vertical	Y	Skip Logic Group	Reg In person
				I preferred registering for a my Social Security account in-person at my SSA office	C
				Employee offered the option for me to register for a my Social Security account	C
SBD8779Q033	C	Please describe your in-person registration experience.				Text area, no char limit	N	Skip Logic Group	OE_In-person Experience
SBD8779Q034		Did you find the instructions for creating a username, password and registering a second factor to be clear?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Instructions Understand
				Partially	A
				No	A
SBD8779Q035	A	Please explain what was not clear about any of the instructions.				Text area, no char limit	N	Skip Logic Group	OE_Instructions
SBD8779Q036		Do you have any concerns about the security of the personal information contained in your my Social Security account?		No		Radio Button, One-up	Y	Skip Logic Group	Security Concerns
				Yes	B
SBD8779Q037	B	Please describe your security concerns.				Text area, no char limit	N	Skip Logic Group	OE_Security Concern. OCBO-Cx: Sentiment Analysis
SBD8779Q038		Please indicate your level of agreement with the following statements about your interaction today: I am satisfied with the service I received from the Social Security Administration.		1=Strongly Disagree		Radio Button, Scale, No don't know	Y		A11-Satisfied
				2
				3
				4
				Strongly Agree=5
SBD8779Q039		This interaction increased my confidence in the Social Security Administration.		1=Strongly Disagree		Radio Button, Scale, No don't know	Y		A11-Trust
				2
				3
				4
				Strongly Agree=5
SBD8779Q040		My need was addressed.		1=Strongly Disagree		Radio Button, Scale, No don't know	Y		A11-Quality
				2
				3
				4
				Strongly Agree=5
SBD8779Q041		It was easy to complete what I needed to do.		1=Strongly Disagree		Radio Button, Scale, No don't know	Y		A11-Ease
				2
				3
				4
				Strongly Agree=5
SBD8779Q042		It took a reasonable amount of time to do what I needed to do.		1=Strongly Disagree		Radio Button, Scale, No don't know	Y		A11-Speed
				2
				3
				4
				Strongly Agree=5
SBD8779Q043		Did the information obtained during your my Social Security account visit enable you to accomplish what you wanted to do?		Yes		Radio button, one up	Yes	Skip Logic Group	Ability to Accomplish
				No
SBD8779Q044		Did you contact Social Security during your online visit?		Yes	A	Radio button, one-up vertical	Y	Skip Logic Group	Contacted SSA
				No
SBD8779Q045	A	How did you contact Social Security?		Requested a Call Back		Radio button, one-up vertical	Y	Skip Logic Group	How contacted SSA
				Email
				Chat with an Online representative	B,C,D,E
SBD8779Q046	B	How long was your wait to Chat with a representative online?		About what I expected		Radio button, one-up vertical	Y	Skip Logic Group	Click to chat wait
				Longer than I expected
SBD8779Q047	C	Did the Chat representative answer your question?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Click to chat answer
				Partially
				No
SBD8779Q048	D	Do you still have to call the 1-800 number or go into a field office?		Yes		Radio button, one-up vertical	Y	Skip Logic Group	Click to chat Call
				No
SBD8779Q049	D	How satisfied were you with the Chat Service you received today?		Very Satisfied		Radio button, one-up vertical	Y	Skip Logic Group	Click to chat service
				Satisfied
				Not Satisfied
				Very Dissatisfied
SBD8779Q050	D	How satisfied were you with the Chat Representative who assisted you today?		Very Satisfied		Radio button, one-up vertical	Y	Skip Logic Group	Click to chat representative
				Satisfied
				Not Satisfied
				Very Dissatisfied
SBD8779Q051	E	Please share any other feedback with us regarding your Chat experience today.				Text area, no Char limit	N	Skip Logic Group	Chat Feedback. OCBO-Cx: Sentiment Analysis
SBD8779Q052		Did you use the “Get Help” button or "Call Back" button during your visit today?		Yes, I used the "Get Help" button only		Radio button, one up vertical	Y		Get Help Button or Call Back
				Yes, I used the "Call Back" button only
				Yes, I used both the "Get Help" button and "Call Back" button
				No, I used neither
SBD8779Q053		Did you view the "Message Center" section during your visit today?		Yes		Radio button, one up	Y	Skip Logic Group	Message Center
				No	B
SBD8779Q054	B	Do you plan to view the "Message Center" in the future?		Yes		Radio button, one up	Y	Skip Logic Group	Use Message Center Future
				No
SBD8779Q055		Please select the category that includes your age:		35 and under		Radio button, one up	N		Age
				36 to 50
				51 to 61
				62
				63
				64
				65
				66
				67
				68 to 70
				71 or older
				Prefer not to answer
SBD8779Q056		Please enter your 5 digit ZIP Code:				Text area, 100 char limit	N		OE_ZIP
SBD8779Q057		Do you have any suggestions for improving the my Social Security registration process?				Text area, no char limit	N		OE_Improve Reg		OE_Improve Contents. OCBO-Cx: Sentiment Analysis
SBD8779Q058		Do you have any suggestions for improving my Social Security's content and features?				Text area, no char limit	N		OE_Improve Contents. OCBO-Cx: Sentiment Analysis