Form CSS7 Insurance Website CSS

OMB Approved

No. 3206-0236

Insurance Website Customer Satisfaction Survey

Privacy Act Statement

Collection of this information is authorized by Section 4702 of Title 5, U.S. Code.

• Your responses to this survey are voluntary and there is no penalty if you choose not to respond. However, maximum participation is encouraged so that the data will be complete and representative.

• The principal purpose in collecting this information is to gather input from employees about their experiences in working for the [Agency]. Routine uses are identifying organizational strengths and challenges and identifying strategies that will help improve the work environment.

• In any public release of survey results, no data will be disclosed that could be used to match your responses with your identity because there will be no individual identifiers associated with the data. All email addresses will be stripped and discarded automatically when the completed survey is submitted.

Public Burden Statement

We estimate this feedback survey will take an average of 1 minute to complete, 3 minutes if additional comments are included. Send comments regarding our time estimate or any other aspect of this form, including suggestions for reducing completion time, to the Office of Personnel Management, Program Planning and Evaluation Group, Angelo Cueto, (3206-0236), 1900 E. Street N.W., Washington, DC. 20415-7900. The OMB number 3206-0236 is currently valid. OPM may not collect this information, and you are not required to respond, unless this number is displayed.

Please take a minute to answer these questions about the Federal Benefits website.  We appreciate your feedback.

 

1.  The information on the website is clearly written and easy to understand.

 Very dissatisfied

 Dissatisfied

 Neither dissatisfied nor satisfied

 Satisfied

 Very satisfied

 

2.  The information on the website met my needs to make health insurance decisions.

 Very dissatisfied

 Dissatisfied

 Neither dissatisfied nor satisfied

 Satisfied

 Very satisfied

 

3.  The layout of the website is well-organized and clear.

 Very dissatisfied

 Dissatisfied

 Neither dissatisfied nor satisfied

 Satisfied

 Very satisfied

 

4.  Overall, how satisfied are you with the website?

 Very dissatisfied

 Dissatisfied

 Neither dissatisfied nor satisfied

 Satisfied

 Very satisfied

 

5.  Are you:

 A Federal employee

 A Federal retiree / annuitant

 Other

 

6. Please add any additional comments or suggestions.