Two Customer Satisfaction Surveys - Field Office Comment Card and CSS Intercepts

OUR COMMITMENT TO YOU
When you conduct business with us:

• We will provide service through knowledgeable employees who will treat

you with courtesy, dignity and respect every time you do business with us.

• We will provide you with our best estimate of the time needed to complete
your request and fully explain any delays.

• We will clearly explain our decisions so you can understand why and how
we made them and what to do if you disagree.

• We will make sure our offices are safe and pleasant and our services are
accessible.

• When you make an appointment, we will service you within 10 minutes of
the scheduled time.

• When you call our 800 number, you will get through to it within 5 minutes of

Social Security Administration

Form Approved OMB No. 0960-0526

HOW ARE WE DOING?
DATE
DID YOU VISIT FOR:
A Social Security Card

An Appeal

Retirement or Survivors Benefits

A Personal Earnings Statement

Disability Benefits

Report a Change for Your Records

SSI Benefits

Other (specify)

offices, we will mail it to you within 5 working days of receiving all the
information we need. If you have an urgent need for the Social Security
number, we will tell you the number within 1 working day.

PRIVACY ACT
The Social Security Administration is authorized to collect the information on
this comment card under Section 702 of Title VII of the Social Security Act.
Your response to these questions is strictly voluntary. The information you
provide will be used to help us improve the service that we give you.
Paperwork Reduction Act Statement - This information collection meets the
requirements of 44 U.S. C. § 3507, as amended by section 2 of the Paperwork
Reduction Act of 1995. You do not need to answer these questions unless
we display a valid Office of Management control number. We estimate that it
will take you about 5 minutes to read instructions, gather the facts, and answer
the questions. SEND OR BRING THE COMPLETED FORM TO YOUR
LOCAL SOCIAL SECURITY OFFICE. The office is listed under
U.S. Government agencies in your telephone directory or you may call
Social Security at 1-800-772-1213 (TTY 1-800-325-0778). You may send
comments on our time estimate above to SSA, 6401 Security Blvd., Baltimore,
MD 21235-6401. Send only comments relating to our time estimate to this
address, not the completed form.

PLEASE FILL OUT AND MAIL

How long did you wait to be served?

Did you have an appointment?
Yes

30 minutes or less

If yes, appt. time

No

More than 30 minutes
Blacken the circle which corresponds closest to your feelings.

HOW SATISFIED WERE YOU WITH:

your first try.

• If you request a new or replacement Social Security card from one of our

0960-0788

TIME

Very
Satisfied

Very
Dissatisfied

The overall service you received?

1

2

3

4

5

6

Our appointment system?

1

2

3

4

5

6

The time you waited to be served?

1

2

3

4

5

6

The comfort of the waiting area?

1

2

3

4

5

6

The privacy in the office?

1

2

3

4

5

6

The courtesy of the staff?

1

2

3

4

5

6

The knowledge of the staff?

1

2

3

4

5

6

The helpfulness of the staff?

1

2

3

4

5

6

The accuracy of our information?

1

2

3

4

5

6

The clarity of our information?

1

2

3

4

5

6

COMMENTS/SUGGESTIONS TO IMPROVE OUR SERVICE

Name (Optional)

Telephone Number (Optional)
(Area Code)

Address (Optional)
Form SSA-117-PC (01-2010)

To the Public We Serve:

PERMIT NO. 18452
WASHINGTON, DC

BUSINESS REPLY MAIL

FIRST-CLASS MAIL

POSTAGE WILL BE PAID BY SOCIAL SECURITY ADMINISTRATION

SOCIAL SECURITY ADMINISTRATION

The Social Security Administration is committed to
high quality service. Providing high quality service is
more than just a slogan to us. It is our
commitment to find out what you want and then
continually improve the ways we deliver service to
meet your expectations.
You can help us to improve our service by taking a
few minutes to answer the questions on this
customer comment card. Please answer these
questions based on your own experience with
Social Security.
Don’t delay; your responses are very important.
Please mail the completed postage-paid comment
card to us.
Thank you for your assistance.
Best regards,

Office Manager