Proposed Satisfaction Survey

HHS.gov Feedback Survey Content
Content Rewrites to Make to Design
Survey
Internal note: pages and questions not numbered

Title
Help us improve HHS.gov

Page 1 - Intro Text
This survey should take no more than 3 minutes to complete. We will use your answers
to improve the experience for millions of Americans who use HHS.gov.
This survey is conducted in accordance with Executive Order 12862. With the possible
exception of email address, the survey does not collect personal information. Fields that
are required include an asterisk (*).
For immediate help, contact us.
Form Approved OMB# XXXX-XXXX Exp. Date X/XX/XXXX

Page 2 – Why visit
[Radio buttons, randomized but Other listed last]
Why did you visit HHS.gov today?*
• To learn about health insurance options.
• To learn about my health rights or the Health Insurance Portability and
Accountability Act (HIPAA).
• To file a complaint about a violation of health rights or the Health Insurance
Portability and Accountability Act (HIPAA).
• To learn about public health emergencies. For example, COVID-19 or the opioid
crisis.
• To get assistance through human services or programs. For example, poverty
guidelines or locations for head start centers.
• To access information related to research on human test subjects.
• To learn about the process of applying for a HHS grant.

•

Other (Please specify).
o [Smaller text below] Do not include personal information.
o [text field]

Back / NextForm Approved OMB# XXXX-XXXX Exp. Date X/XX/XXXX

Page 3 – Looking for
[Radio buttons]
Were you able to find what you were looking for?
• Yes
• Partially
• No
• Not sure yet/still looking
Back / Next
Form Approved OMB# XXXX-XXXX Exp. Date X/XX/XXXX

Page 4 - Comment
Feel free to leave a comment if you’d like.
• [Smaller text below] Do not include personal information.
• [text area that scrolls]
Back / Next
Form Approved OMB# XXXX-XXXX Exp. Date X/XX/XXXX

Page 5 - Audience
[Radio buttons]
In order to better understand user preferences, we would like to know more about you.
With which of the following groups do you most strongly identify?
• Academics/Research
• Media/Journalist
• Grant Applicant
• Government Employee (non-HHS staffdiv or opdiv such as CDC or NIH)
• Health Care Professionals
• Public Policy Professionals
• HHS Employees/Contractors
• Parents/Caretakers
• Human Services Professionals
• Students/Youth
• Legal Professional
• General Public – please consider other options first

Back / Next
Form Approved OMB# XXXX-XXXX Exp. Date X/XX/XXXX

Page 6 – Email for feedback
[Radio buttons]
If you provide your email address, it may be used to contact you about future feedback
studies about ways to improve HHS.gov. Your email address will not be linked to your
responses and will be deleted upon the completion of any participation in feedback
studies or after one year of inactivity. You will only be contacted about future feedback
studies, not for other purposes. For immediate help not related to providing feedback on
HHS.gov, contact us.
Would you like us to contact you for your feedback on ways to improve HHS.gov for
users?
• Yes
• No
[If yes to above, email address line. If no do not show or require.]
Email address*
• [Email field]
Back / Submit
Form Approved OMB# XXXX-XXXX Exp. Date X/XX/XXXX

Page 7 – Thank you
We value your feedback! Thank you for helping us improve HHS.gov.
Exit survey
Form Approved OMB# XXXX-XXXX Exp. Date X/XX/XXXX