ANI Reroute to WBDOC Project

ANI Reroute to WBDOC Project Questionnaire

1. Do you know the telephone number, starting with the area code, of the phone you are using to place this call? *

Yes

No

No caller on the line

Caller does not want to participate

2. Starting with the area code, what is the telephone number of the phone you are using to place this call? *

3. Are you calling from a: *

mobile/cell phone

residence phone

business phone

pay phone

internet phone

unknown

4. What phone company did you use to make this call? *

5. From what State, U.S. Territory or country are you calling? *

FOR CST USE ONLY
6. Was this call for legitimate SSA business? *

Yes

No

7. Reason for non-SSA call

Fax/computer generated call

Noise/dead air/busy signal

Telemarketer

Another Government Agency

Wrong telephone number

None of the above

Date/Time

Date/Time Date

Date/Time Hours   Date/Time Minutes

Additional Questions Displayed in Response Summary

4a. Please enter "Other" telephone company. *

5a. Please specify "Other" country

Prepared by Office of Telephone Services November 4, 2011 Page 1