4158_Feedback Tab Survey_v3_Clean

SURVEY – FEEDBACK TAB

OMB Number (1530-0023)

PAPERWORK REDUCTION ACT NOTICE

Public reporting burden for this collection of information is estimated to average four minutes per response. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information to the Department of Treasury, Bureau of the Fiscal Service, Forms Management Officer, Parkersburg, WV 26106-1328.

FEEDBACK TAB IMAGE

Feedback Tab ‘button’ on all pages.

EFTPS.gov URL: https://www.eftps.gov/eftps/direct/EftpsHome.page

FEEDBACK TAB QUESTIONS

Feedback

Specific Feedback

I’d like to give feedback on a specific topic

Overall Feedback

I’d like to give feedback on the eftps.gov site

(QUESTION WILL POP ON SAME SCREEN ONCE FEEDTYPE TYPE IS SELECTED)

Q1 Please rate your overall experience with the EFTPS website.

(SINGLE PUNCH)

Poor									Excellent
1	2	3	4	5	6	7	8	9	10

(SHOW IF ‘SPECIFIC FEEDBACK’ SELECTED)

Q2 What would you like to give feedback about?

(ALLOW MULTIPLES, RANDOMIZE)

1 New enrollment

2 FAQs

3 Glossary

4 Make a tax payment

5 Cancel a tax payment

6 Change/Add financial institution

7 Update contact information

8 Check payment history

9 Find contact information

10 Other (Please specify)

Q3 IF RATING OF 1-8 AT Q1: What can we do to make the EFTPS website experience better? / IF RATING OF 9-10 AT Q1: Tell us what you liked about the EFTPS website experience?

(ALLOW NO COMMENT)

Example language keeping PII out of the open end:

Please do not include sensitive information, such as taxpayer ID, social security number, PIN, or password in your response. The security and confidentiality of your personal information is important to us.

Q4 Were you able to complete your primary task on the EFTPS website today?

Yes

No

Q5 How likely are you to call customer service support after your visit today?

(SINGLE PUNCH)

1 2 3 4 5 6 7 8 9 10

Not at all Likely Extremely Likely

CONTACT INFORMATION FOR CLOSED LOOP

(IF OPEN ENDS INCLUDE THE WORDS “CALL ME” OR “CONTACT ME,” CONTINUE; OTHERWISE SKIP TO CLOSING) (OE’s = Q3) – Will customize based on survey responses

CIQ1 If you would like someone from the U.S. Department of the Treasury to contact you, please provide the information below:

QNAME Name (optional):

QEMAIL E-mail Address (optional):

QPHONE Telephone Number (optional):

(Please do not include spaces or dashes) (SHOW THIS)

(INCLUDE CHECK BOX FOR “I do not wish to be contacted”)

Example language for recontacting taxpayers:

Thank you for providing your contact information. We apologize that you are having an issue and will have someone contact you within 48-72 business hours. If you need immediate assistance, please call xxxxxxxxxx.

CLOSING

Submit Feedback & Close

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