Online Services Customer Satisfaction Survey

Model Instance Name:
SSA Extra Help

Question Text
What is your reason for visiting Extra Help for
Medicare Prescription Plan Costs today?

Answer Choices
To start a new application
To return to a saved application
To check the status of my application
To research / learn about Extra Help For
Medicare Prescription Plans

Were you able to access your saved application with
the Reentry number?

Yes
No

If you were not able to access your saved application,
did you create a new application?

Yes
No

Are you applying for Help with Medicare Prescription
Plan costs for yourself or are you helping someone
else?

Myself
My Spouse
Myself and my spouse
My parent/parents
Another relative
A friend
My client

Please indicate your level of agreement with the
following statements about your interaction today: I
am satisfied with the service I received from the
Social Security Administration.

1=Strongly Disagree
2
3
4
5=Strongly Agree

This interaction increased my confidence in the
Social Security Administration.

1=Strongly Disagree
2
3
4
5=Strongly Agree

My need was addressed.

1=Strongly Disagree
2
3
4
5=Strongly Agree

It was easy to complete what I needed to do.

1=Strongly Disagree
2
3
4
5=Strongly Agree

It took a reasonable amount of time to do what I
needed to do.

1=Strongly Disagree
2
3
4
5=Strongly Agree

How did you first hear about the online Application for
Help with the Medicare Prescription Plan Drug
Costs?

The official Social Security website
(www.ssa.gov)
The Medicare website
On another website
A Social Security employee told me about it
A Social Security publication
A Medicare publication
A letter from Social Security
From my doctor or another professional
At the Pharmacy
From my insurance company
At my Senior/Community Center
A newspaper, magazine, television or other
media source
Used a search engine (Google, Bing, etc.)
Social media (e.g., Facebook, Twitter, blog, etc.)
Word-of-mouth
Other

What other way did you learn about the online Extra
Help for Medicare Prescription Plans cost
application?
Please tell us what website you used to get to online
Extra Help with Medicare Prescription Plans cost.

The official SSA.gov Website

Medicare.gov website
AARP
Other
Please tell us what other website you used.
What is your age?

Under 18
18 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 or older
Prefer not to answer

Please tell us in what way we can improve the
application for Help with Medicare Prescription Plan
Drug Costs? (Please do not include any personal
information in your answer).

Model Instance Name:
SSA My Social Security
Question Text
How often do you access (or plan to access) your my
Social Security account?

Did you create a new my Social Security account
today?

What is your reason for visiting my Social Security
today? (Check all that apply)

Answer Choices
Once a year
Once every six months
Once every three months
Once a month
More than once a month
Not sure
Yes, this is my first time accessing my Social
Security
No, I had already had a my Social Security
account
To get a Benefit Verification Letter
To access my online notices (e.g., COLA)
To view my Benefits and Payment Details
To enroll in or update my direct deposit

To use the myRetirement Calculator
To change my address with SSA
To print or view my online Social Security
Statement
To make sure my earnings record is correct
To replace my Social Security Card or get a new
card
To check the Status of my recently filed
application for benefits
To learn about the benefits to which I might be
entitled
To apply only for Social Security or Medicare
Only benefits
To report my wages
To request a replacement SSA-1099 (or SSA10425) for tax purposes
To add Extra Security to my online account
Just curious – wanted to see what information
was contained in my Social Security account
Other Reason for visiting today
How difficult or easy was it to access your Cost of
Living Adjustment (COLA) notice online?

Very difficult
Somewhat difficult
Neither difficult or easy
Somewhat easy
Very easy

Do you have any suggestions for improving our
online notices?
If you owed us money, would you like the option to
make a payment on line?

Yes
No
Don't know/Not applicable

Are you aware that the communication delivery
preference gives you the option to get your notices
either electronically or by mail?

Yes
No

How easy or difficult was it to change your
communication delivery preference?

Are you comfortable receiving notices electronically?

Very difficult
Somewhat difficult
Neither easy or difficult
Somewhat easy
Very easy
Don't know/Not applicable
Yes
No

Don't know
Would you recommend accessing notices online to
your family and friends?

How often do you review your online Social Security
Statement?

Did use of the Retirement Calculator help eliminate
the need to call our national phone service or visit a
local Social Security office?

Were the estimates from the Retirement Calculator
easy to understand?

Yes
No
Don't know/Not applicable
This is my first time
At least once a year
Every 6 months
Every 3 months or more frequently
Yes

No
I was exploring the tools available within my
Social Security and had not planned to contact
SSA.
Yes
No
Don't know

Please indicate your level of agreement with the
following statements: The estimates provided by the
Retirement Calculator were displayed in an easy to
understand format which allowed me to understand
my Social Security Retirement options.

1=Strongly Disagree

2
3
4
5 =Strongly Agree
What suggestions do you have for displaying
retirement estimates?
The Retirement Calculator gave me an
understanding of how my future earnings may affect
my Social Security Retirement benefits.

For which Agency or program do you need a Benefit
Verification Letter? (Check all that apply)

1=Strongly Disagree
2
3
4
5=Strongly Agree
Medicare
Medicaid
State or Local Department of Social Services

HUD - Federal Housing Admin. (FHA) and/or
Section 8 Housing
USDA - SNAP (Food Stamps)
Department of Veterans Affairs
IRS
Court
Want a copy for personal use
Bank or financial institution
Education-related
Medical-related
Healthcare signup and/or verification
Requesting a Retirement Visa from another
country
Other agency or program
Which "other" agency or program requested your
Benefit Verification information?
Please tell us what your primary reason was for
visiting today:
For which purpose or program do you need a
replacement SSN Card? (Check all that apply)

Proof of identity
Tax purposes
Education-related
Required for my job
Passport
Bank or financial institution
Income assistance
Other (Please specify)

Please explain for which purpose or program you
need a replacement SSN card.
Who are you reporting wages for?

What is your relationship to the individual you are
reporting wages for?
What type of benefits does the person you are
reporting for receive?

Was the person you wanted to report wages for
listed?

Myself only
My spouse only
Myself and my spouse
Myself and another individual (not spouse)
Other relative only
Other

Disability
Supplemental Security Income (SSI)
Both Disability and SSI
Don't know
Yes

Was the employer listed?
Are you reporting for more than one employer for the
same person?
Are you currently working?
How long did it take you to submit your wages?

Before today's visit, what other methods have you
used to report wages? (Check all that apply)

Do you plan to electronically report additional wages
in the future?

How do you plan to report future wages?

What method do you prefer to use to report your
wages?

Were the instructions you received helpful?

No
Yes
No
Yes
No
Yes
No
5 minutes or less
6-10 minutes
11-15 minutes
More than 15 minutes
Unsure
Did not submit wages
Field Office
Mail
Fax
Phone
Other
Yes
No
Don't know
Desktop/Laptop
Tablet
Mobile Device
Don't know
Field Office
Mail
Fax
Phone
Other
Yes
No

How can we improve the wage reporting application?
Do you currently have a SNO formatted notice like
Braille, Audio CD, or Data CD?

How do you like your current SNO format?

Yes
No
Don't Know
1=Very Dissatisfied

Do you use your SNO notice?

Does the SNO format meet your needs?

Would you want to stop receiving your notice in its
current SNO format?

2=Somewhat dissatisfied
3=Neither satisfied or dissatisfied
4=Somewhat satisfied
5=Very satisfied
Yes
No
Don't Know
Yes
No
Don't Know
Yes
No
Don't Know

Why would you want to stop receiving your notice in
its current SNO format?
Did you register for your my Social Security online or
in person?

Please select the approximate length of time it took
for you complete your registration

Why did you decide to register in-person?

Please describe your in-person registration
experience.
Did you find the instructions for creating a username,
password and registering a second factor to be
clear?

Registered online on my first attempt
Registered online after prior unsuccessful
attempts
Registered with in-person assistance from my
local SSA office
Registered using the SSA Express
Not sure or don't remember
Less than 15 minutes
More than 15 but less than 30 minutes
30 minutes or more
I was unsuccessful registering online and was
required to do so in-person
I preferred registering for a my Social Security
account in-person at my SSA office
Employee offered the option for me to register for
a my Social Security account

Yes

Partially
No
Please explain what was not clear about any of the
instructions.

Do you have any concerns about the security of the
personal information contained in your my Social
Security account?

No

Yes
Please describe your security concerns.
Please indicate your level of agreement with the
following statements about your interaction today: I
am satisfied with the service I received from the
Social Security Administration.

1=Strongly Disagree
2
3
4
Strongly Agree=5

This interaction increased my confidence in the
Social Security Administration.

1=Strongly Disagree
2
3
4
Strongly Agree=5

My need was addressed.

1=Strongly Disagree
2
3
4
Strongly Agree=5

It was easy to complete what I needed to do.

1=Strongly Disagree
2
3
4
Strongly Agree=5

It took a reasonable amount of time to do what I
needed to do.

Did the information obtained during your my Social
Security account visit enable you to accomplish what
you wanted to do?

1=Strongly Disagree
2
3
4
Strongly Agree=5
Yes

No

Did you contact Social Security during your online
visit?

Yes
No

How did you contact Social Security?

How long was your wait to Chat with a representative
online?
Did the Chat representative answer your question?

Do you still have to call the 1-800 number or go into a
field office?
How satisfied were you with the Chat Service you
received today?

How satisfied were you with the Chat Representative
who assisted you today?

Please share any other feedback with us regarding
your Chat experience today.
Did you use the “Get Help” button or "Call Back"
button during your visit today?

Did you view the "Message Center" section during
your visit today?
Do you plan to view the "Message Center" in the
future?
Please select the category that includes your age:

Requested a Call Back
Email
Chat with an Online representative
About what I expected
Longer than I expected
Yes
Partially
No
Yes
No
Very Satisfied
Satisfied
Not Satisfied
Very Dissatisfied
Very Satisfied
Satisfied
Not Satisfied
Very Dissatisfied

Yes, I used the "Get Help" button only
Yes, I used the "Call Back" button only
Yes, I used both the "Get Help" button and "Call
Back" button
No, I used neither
Yes
No
Yes
No
35 and under
36 to 50
51 to 61
62
63
64

65
66
67
68 to 70
71 or older
Prefer not to answer
Please enter your 5 digit ZIP Code:
Do you have any suggestions for improving the my
Social Security registration process?
Do you have any suggestions for improving my
Social Security's content and features?

Model Instance Name:
SSA BSO

Question Text
How did you learn about Business Services Online?

Other_how did you hear
Which services of Business Services Online did you
use today? (Choose all that apply)

Answer Choices
SSA Speaker at a Conference
Direct Mail I Received from Social Security
Booth at an accounting/payroll conference
Webcast
SSA/IRS Reporter
CPA/Accountant
Other Direct Contact Initiated by Social Security
Professional Association
Social media (e.g., Facebook, Twitter, blog, etc.)
IRS Forms, Instructions & Publications
Other (please specify)
W-2 Online
W-2c Online
View Submission Status
View Employer Report Status
View Errors
View Notices
SSN Verification
Registration Services
Resubmission Services
Consent-Based Services
Appointed Representative Services
Representative Payee Accounting Report

What specific improvements would you like to see in
Internet Representative Payee Accounting?
What specific improvements would you like to see in
Business Services Online?
How would you describe your role? (Select all that
apply)

Representative payee
Appointed Representative
Accountant/CPA
Administrative Assistant
Accounts Payable/HR
Attorney
Bookkeeper
Business Manager
Business Owner
Church Officer
Clerical Staff
Corporate Officer
Finance Staff
Office Manager
Other (please specify)

Other_describe
Please describe the size of your business, based on
your number of employees/workers, including
yourself.

Rate the ease with which you located the Business
Services Online website? (1 = Very Difficult; 10 =
Very Easy)

Micro (10 or less)

Small (11-50)
Medium (51-250)
Large (more than 250)
1 = Very Difficult

2
3
4
5
6
7
8
9
10 = Very Easy
Please indicate your level of agreement with the
following statements about your interaction today: I
am satisfied with the service I received from the
Social Security Administration.

1=Strongly Disagree
2=Disagree
3=Neutral

4=Agree
5=Strongly Agree
This interaction increased my confidence in the
Social Security Administration.

1=Strongly Disagree
2=Disagree
3=Neutral
4=Agree
5=Strongly Agree

My need was addressed.

1=Strongly Disagree
2=Disagree
3=Neutral
4=Agree
5=Strongly Agree

It was easy to complete what I needed to do.

1=Strongly Disagree
2=Disagree
3=Neutral
4=Agree
5=Strongly Agree

It took a reasonable amount of time to do what I
needed to do.

1=Strongly Disagree
2=Disagree
3=Neutral
4=Agree
5=Strongly Agree

Model Instance Name:
SSA Disability

Question Text
How did you learn about Business Services Online?
Are you applying online for yourself or are you
helping someone else?

Answer Choices
SSA Speaker at a Conference
Myself
Helping a Spouse/Relative/Friend
Professional Helping a Client
Other

Were you able to create or log in to your mySSA
account?

Yes
No
Don't know

Why were you not able to create or log in to your
mySSA account?

Please describe why you were not able to create or
log in to your mySSA account.
How did you learn about the Social Security online
disability application? (Select all that apply)

Did not have required information to create
account
Could not remember my password
Other
Don't know

Official Social Security website (www.ssa.gov)
Online social media (Facebook, Twitter, etc.)
A general web search (e.g., Google, Bing, etc.)
Traditional media (TV, radio, newspaper, etc.)
Social Security Statement
Social Security publication
Social Security employee
Relative or friend
Doctor, social worker, attorney, or other
professional
I saw the link while I was checking my online
statements
Other, please specify

Please specify how you learned about this online
disability application.
Before visiting SSA.gov did you first try to accomplish
your task in any of the following ways?

Did you use any of the following to prepare to apply
online? (Select all that apply.)

How helpful did you find the Disability Benefits
Checklist?

How helpful did you find the instructional video?

Calling Social Security's 1-800 number
Visiting my local Social Security office
Calling my local Social Security office
No, I visited SSA.gov first
Not sure
I used the Disability Benefits Checklist
I watched the instructional video
I used other information on the Social Security
website to prepare
I used another resource to prepare to apply
online
I did not use any resources to prepare to apply
online
Very helpful
Somewhat helpful
Not at all helpful
Very helpful
Somewhat helpful
Not at all helpful

How helpful did you find the other information on the
Social Security website?

Very helpful
Somewhat helpful
Not at all helpful

Please describe what other resource(s) you used to
prepare to apply online?
Did you apply for SSI (Supplemental Security
Income) today along with disability?

Are you aware that additional information may be
required to determine your eligibility for SSI
(Supplemental Security Income)?
Do you intend to apply for SSI (Supplemental
Security Income) in the future?

Yes
No, I applied only for disability
Not sure
Yes

No
Yes

No
Not sure
Did the site clearly describe what you wanted to know Yes
about SSI (Supplemental Security Income)?
No
Not sure/Was not looking for SSI information
Please describe what was not clear.
Did you start a new online disability application today
or did you return to a saved application?
Were you able to access your previously saved
online application with your Reentry number?

Were you aware you could find your re-entry number
in mySSA "Your Benefit Applications"?
Do you have a mySSA account?

If you were not able to access your saved application,
did you create a new application?
Did you complete and submit your online disability
application today?

Started a new application
Returned to work on a saved application
Yes, I was able to use the Reentry number that
was provided to me
No, I was not able to use the Reentry number that
was provided to me
No, I did not have my Reentry number
Yes
No
Yes
No
Don't know
Yes
No
Yes
No, I plan to complete and submit later

If you did not complete and submit your online
disability application today, please tell us why.

No, I do not plan to complete and submit the
online application
I didn't have information I needed like names,
addresses, or dates
I didn't understand what the questions meant or
how to answer
I needed to view my Social Security Statement
and/or verify that my earnings record is correct
My disabling condition prevents me from working
with a computer for long periods
I had a limited amount of time/family demands
that kept me from working on it for very long
I had technical problems like an error message or
a mistake I couldn't fix
There are too many questions
It takes too long to fill out
It's too complicated to complete without help
None of the above
Other, please specify

Please tell us why you did not complete and submit
your online disability application today.
Do you plan to do any of the following as a next step? Call Social Security's 1-800 number
Visit my local Social Security office
Call my local Social Security office
Other (please specify)
What do you plan to do next?
So far, how long have you worked on this disability
Up to 30 minutes
online application?
More than 30 minutes up to 1 hour
More than 1 hour up to 2 hours
More than 2 hours up to 3 hours
More than 3 hours up to 4 hours
More than 4 hours
How many times did you work on your online
One Time
disability application?
Two Times
Three Times
Four Times
Five or More Times
How did you locate the online disability application
I used the Online Services link on the Social
today?
Security homepage
I followed a link from somewhere else on the
Social Security website
I used Social Security's online search

I used a search engine (i.e. Google, Bing, etc.) to
locate the online application
I had bookmarked the site
Other, please specify
Please describe how you arrived at this online
disability application today.
How easy was it for you to find the link to apply for
Disability online?

Please tell us why it was hard to locate the link to
apply for disability online. (Select all that apply.)

Please explain the reason why it was hard for you to
find the online application.
Once you found the application, did you have any
difficulties completing it? (Select all that apply.)

Very easy
Somewhat easy
Somewhat hard
Very hard
I could not find where to start a new online
application
The "Apply for Benefits" was not clear to me
Not clear where to go to return to my previously
saved application
I could not find the correct link to select
The link(s) did not work on the Social Security
website
The information did not seem to be organized in a
logical manner
I used the search feature but the results didn’t
seem to apply
I tried to find the application using the FAQs links
Other, please specify

I did not have any difficulties
Forms/questions were difficult to understand
Needed more room on form to include my
information
Other, please specify

Please describe your difficulty.
Why did you choose to apply online? (Select all that
apply.)

I prefer to use online services as much as
possible
I learned about applying online while visiting
Social Security's website
A Social Security employee recommended that I
apply online
I can't get to my local Social Security Office
A friend or relative recommended that I apply
online
I knew that if I had a question or problem applying
online, I could still get help from Social Security

I am filing on behalf of another person
I did not want to go to a local Social Security
office
I did not want to apply over the phone
Other, please specify
Please specify why you choose to apply online
Please indicate your level of agreement with the
following statements about your interaction today: I
am satisfied with the service I received from the
Social Security Administration.

1=Strongly Disagree
2=Disagree
3=Neutral
4=Agree
5=Strongly Agree

This interaction increased my confidence in the
Social Security Administration.

1=Strongly Disagree
2=Disagree
3=Neutral
4=Agree
5=Strongly Agree

My need was addressed.

1=Strongly Disagree
2=Disagree
3=Neutral
4=Agree
5=Strongly Agree

It was easy to complete what I needed to do.

1=Strongly Disagree
2=Disagree
3=Neutral
4=Agree
5=Strongly Agree

It took a reasonable amount of time to do what I
needed to do.

What is your current marital status?

1=Strongly Disagree
2=Disagree
3=Neutral
4=Agree
5=Strongly Agree
Married
Significant Other/Partner
Separated
Divorced

Widowed
Never Married/Single
Prefer not to answer
Other, please specify
Other marital status
What is your age?

Under 18
18 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 or older
Prefer not to answer

Do you have any suggestions for improving Social
Security's online disability application?

Model Instance Name:
SSA iClaim

Question Text
What type of benefits were you applying for?

Answer Choices
Retirement
Medicare only
Disability
Both Retirement and Disability
Spouse's
Other

Are you applying online for yourself or are you
helping someone else?

Myself
Helping a Spouse/Relative/Friend
Professional Helping a Client
Other

Were you able to create or log in to your mySSA
account?

Yes
No
Don't know

Why were you not able to create or log in to your
mySSA account?

Did not have required information to create
account
Could not remember my password
Other
Don't know

Why were you not able to create or log in to your
mySSA account?
How did you connect to SSA today?

Desktop
Laptop
Smartphone
Tablet

From where did you connect to SSA today?

At home
In office/place of employment
A friend or relative's place
Public library
Social Security Office
Social Security Kiosk
Other agency
Other, please specify

Did you connect through a unique Social Security
icon featured on the computer's desktop?

Yes

No
How did you link to the SSA website?
Please describe the location.
Please tell us how and from where you connected
with SSA during your visit today:

How did you learn about applying for Retirement,
Disability or Medicare online? (Select all that apply.)

Official Social Security website (www.ssa.gov)

Social Media (Blog, Facebook, Twitter, etc.)
A general web search (e.g. Google, Bing, etc.)
An online ad (Banner/Image)
An online video
Radio
Television
A newspaper or magazine article
A newspaper or magazine ad
An email from Social Security
My Social Security statement
A Social Security employee
A relative or friend
A community group or association
A billboard or other printed ad
Other, please specify
How did you make contact with a Social Security
employee?

Called the national 800 number
Called a local Social Security office
Visited a local Social Security office
At a Social Security sponsored event
Other, please specify

Please describe how you made contact with a Social
Security employee.

Please specify how you learned about this online
application.
Did you use any of the following to prepare to apply
online? (Select all that apply.)

Reviewed my online Social Security Statement

Reviewed the Social Security statement that was
mailed to me
I used the Retirement Estimator or other tools on
the Social Security website
I watched the instructional video
I used other information on the Social Security
website to prepare
I used another resource to prepare to apply
online
I used the Retirement/Medicare Checklist
I did not use any resources to prepare to apply
online
How helpful did you find the online Social Security
Statement?

Very helpful
Somewhat helpful
Not at all helpful

How helpful did you find the estimator tools on the
website?

Very helpful
Somewhat helpful
Not at all helpful

How helpful did you find the instructional video?

Very helpful
Somewhat helpful
Not at all helpful

How helpful did you find the other information on the
Social Security website?

Very helpful

Somewhat helpful
Not at all helpful
How helpful did you find the Retirement/Medicare
Checklist?

Very helpful
Somewhat helpful
Not at all helpful

Please describe what other resource(s) you used to
prepare to apply online?

How did you determine when to start receiving your
benefits? (Select all that apply.)

Online Statement

Picked one of the dates that was listed in the
application
Retirement Estimator
Financial Planner
SSA Publications
Did you start a new online application today or did
you return to a previously saved application?

Started a new application

Returned to work on a saved application
Were you able to access your previously saved
online application with your Reentry number?

Yes, I was able to use the Reentry number that
was provided to me

No, I was not able to use the Reentry number that
was provided to me
No, I did not have my Reentry number
Were you aware you could find your re-entry number
in mySSA "Your Benefit Applications"?

Yes

No
Do you have a mySSA account?

Yes
No
Don't know

If you were not able to access your saved application,
did you create a new application?

Yes

No
Did you complete and submit your online application
today?

Yes

No, I plan to complete and submit it later
No, I do not plan to complete and submit my
online application
During your visit today did you look for any additional
information for any of the following? (Select all that
apply.)

Medicare coverage

Other health insurance coverage
None of the above
If you did not complete and submit your online
application today, please tell us why.

I didn't have information I needed like names,
addresses, or dates

I didn't understand what the questions meant or
how to answer
I wanted to use the Retirement Estimator to
reconsider my retirement options
I needed to view my Social Security Statement
and/or verify that my earnings record is correct

My disabling condition prevents me from working
with a computer for long periods
I had a limited amount of time/family demands
that kept me from working on it for very long

I had technical problems, e.g.,an error message
or a mistake I couldn't fix
There are too many questions
It takes too long to fill out
It's too complicated to complete without help
I wanted to create mySSA account before filing
Other, please specify
What is your other reason?
So far, how long have you worked on this online
application?

Up to 15 minutes

16 minutes - 30 minutes
31 minutes - 1 hour
More than 1 hour up to 2 hours
More than 2 hours
How did you find where to create an application for
Retirement, Medicare or Disability?

Used the Online Services link on the Social
Security homepage

Followed a link from somewhere else on the
Social Security website
Used Social Security's online search feature
Used a search engine (e.g., Google, Bing, etc.)
Followed a link from medicare.gov
Followed a link from another website (e.g., AARP,
an attorney's website, etc.)
I clicked around until I found it
I had bookmarked the site
I used the link in the online statement
Other, please specify
Please describe how you arrived at this online claim
application today.
How easy was it for you to find the Social Security
online application?

Very easy
Somewhat easy
Somewhat hard
Very hard

Please tell us why it was hard to locate the claim
application. (Select all that apply.)

Could not find where to start a new online
application

The "Apply for Benefits" was not clear to me
Not clear where to go to return to my previously
saved application
It was not clear to me where the links would lead

I had difficulty using a link on the Social Security
website
The information did not seem to be organized in a
logical manner
I used the search feature but the results didn’t
seem to apply
I tried to use the FAQ's, but couldn't find the
online application link
Other, please specify
Please explain the reason why it was hard for you to
find the online claim application.

Why did you choose to apply online? (Select all that
apply.)

I prefer to use online services as much as
possible
I learned about applying online while visiting
Social Security's website (www.ssa.gov)
A Social Security employee recommended that I
apply online
I can't get to my local Social Security Office
A friend or relative recommended that I apply
online
I knew that if I had a question or problem applying
online, I could still get help from Social Security

I did not want to go to a local Social Security
office
I did not want to apply over the phone
I saw the link while I was checking my online
statements
Other, please specify
Please specify why you choose to apply online:
What is the reason that you cannot get to your local
office?

After your visit today, what do you plan to do next?

Nothing, I submitted my claim
I will return to check the status of my application
I will return to complete my claim
Browse the SSA website
I will call Social Security’s 1-800 number
I will visit my local Social Security Office
I do not know what I will do next at this time

Please indicate your level of agreement with the
following statements about your interaction today: I
am satisfied with the service I received from the
Social Security Administration.

1=Strongly Disagree

2
3
4
5=Strongly Agree

This interaction increased my confidence in the
Social Security Administration.

1=Strongly Disagree

2
3
4
5=Strongly Agree
My need was addressed.

1=Strongly Disagree
2
3
4
5=Strongly Agree

It was easy to complete what I needed to do.

1=Strongly Disagree

2
3
4
5=Strongly Agree
It took a reasonable amount of time to do what I
needed to do.

1=Strongly Disagree
2
3
4

What is your current marital status?

5=Strongly Agree
Married
Significant Other/Partner
Separated
Divorced
Widowed
Never Married/Single
Prefer not to answer
Other, please specify

Other marital status
What is your age?

Under 18
18 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 or older
Prefer not to answer

Do you have any suggestions for improving Social
Security's online application.

Model Instance Name:
SSA Main Pages

Question Text
Please tell us how and from where you connected
with SSA during your visit today?

Answer Choices
Desktop computer/laptop from my home
Desktop computer/laptop from a friend or
relative's home
Desktop computer/laptop from my place of
employment
Public computer workstation in a library
Public computer workstation in some other
agency/social organization (e.g., social services,
Motor Vehicle Administration, housing agency,
hospital, etc.)
Public computer workstation made available at
my local Social Security office
SSA Express kiosk located in a public space or
governmental office
Other (please specify)

How did you connect to Social Security today?

From where did you connect to SSA today?

Desktop
Laptop
Smartphone
Tablet
At home
In office / place of employment
At a Friend or Relative's place
Public Library
Social Security Office
Social Security Kiosk
Other Agency
Other

Yes
Did you connect through a unique Social Security
icon featured on the computer's desktop?
No
How did you link to the SSA website?
Please describe the location.
Please tell us how and from where you connected
with SSA during your visit today?

How did you learn about the Social Security website?
(Check all that apply.)

A general web search (e.g., Google, Bing, etc.)
The radio
The television
An email from Social Security
A newspaper or magazine article
A newspaper or magazine ad
A billboard or other printed ad
An online ad (e.g., banner, image, etc.)
An online video
Social media (e.g., Facebook, Twitter, blog, etc.)
Friend, spouse, relative, neighbor, or
acquaintance
Mailed Social Security Statement
Other direct mail (e.g., Post Card)
Social Security employee
An SSA event
Community group or association
Government agency other than Social Security
(e.g., State, Federal)
Other, please explain

How did you learn about the Social Security website?
Which of the following best describes you?

I currently receive Social Security benefits (i.e.
retirement, survivor’s, disability, spouses,
Medicare and/or Supplemental Security Income)
I do not receive Social Security, Medicare or
Supplemental Security Income benefits at this
time
I am applying for Social Security, Supplemental
Security Income (SSI) benefits or Medicare
benefits.
I am a relative or friend helping someone with
Social Security benefits
I am an employer looking for Social Security
information and services
I am a professional helping someone else with a
Social Security matter
Other (please specify)

Other Role

What is the reason(s) for your visit today? (Check all
that apply)

To obtain general information about Social
Security programs and benefits
To review SSA’s Benefits Planners (i.e.,
Retirement Planner, Disability Planner and
Survivors Planner)
To view my online Social Security Statement
To use the Retirement Estimator
To apply for monthly Social Security Retirement
and/or Disability benefits (including Spouses
Benefits)
To apply for Medicare Only benefits
To apply for Extra Help with Medicare
Prescription Drug Plans
To apply for monthly Supplemental Security
Income (SSI) payments
To apply for Social Security Survivor benefits
and/or Lump Sum Death Payment
To check the status of my recently submitted
online application for benefits
To create (or access) a my Social Security
account
To manage the Social Security, SSI or Medicare
benefits that I receive
To appeal an unfavorable decision regarding my
application for benefits
To file W2/W3s
To complete a Representative Payee Accounting
form
To change information on my Social Security card
or replace a lost/stolen Social Security card
To obtain an SSA form or publication
To obtain SSA contact information (e.g., locate a
local SSA office, phone number, address, email,
etc.)
To change my address ( separate out - or change
my/sign up for direct deposit )
To sign up or change my direct deposit
information
To conduct research about Social Security
history, policies, regulations, etc. Suggest
Deleting this
Other (please specify)

What is the reason you are visiting SSA today?

Please tell us which SSA form or publication you
were seeking.
Did the Social Security home page help you find
what you were looking for?

Yes
No

Please tell us why the home page was not helpful.
Did you find the information you were looking for

Did you successfully complete your online
transaction?

Yes
No
Not yet, I am still looking
Not looking for anything specific
Yes
No

Please explain what prevented you from
accomplishing your goal on the site.
Since you were unable to accomplish your goal on
the site, what do you PREFER to do next?

I prefer calling the SSA 1-800 Number
I prefer calling my local Social Security office
I prefer visiting my local Social Security office
I prefer having an online solution (e.g., click-tochat, "Before You Start" checklist, instructional
video, email SSA feature, etc.)
I prefer sending a letter to Social Security
Other (please specify)
Not sure

What do you plan to do next?
Which type of online solution would you prefer to
use?

Click-to-chat
Email
"Before You Start" checklist
Instructional video
Other (please specify)

What other type of online solution would you prefer to
use?
Did you use the Frequently Asked Questions
(“FAQs”) to find information?

Did the Frequently Asked Questions give you the
information you needed?

Yes
No
Not sure
Yes
No

Please tell us about your concerns or problems when
using the Frequently Asked Questions.
How often do you visit this site?

This is my first time
At least once a year
Every 6 months
Every 3 months
Once a month
More frequently than once a month

If there was one thing you could change about the
Social Security web site, please tell us what it would
be.

Model Instance Name:
SSA iAppeals

Question Text
Which type of appeal did you work on today?
Why didn't you use the attachment feature?

Please rate the ease of navigating through the online
appeal.

Answer Choices
Medical Disability Appeal
Other Non-Medical Appeal
I will upload them later because I am not finished
yet
I do not have electronic copies of my document(s)
to upload
I was not clear on how to upload my document(s)
I did not see the attachment feature
I forgot to upload my document(s)
My documents were too big to upload
Received an error message
Other, please specify
Very easy
Somewhat easy
Somewhat difficult
Very difficult

Which of the following best describes your role in
using the online appeal today?

Self
Attorney or attorney's staff

Did you complete an appeal for more than one client
during this session?
During this visit, how many clients did you file an
appeal for?

How often do you use the online appeal?

Did you start a new online appeal today or return to a
previously saved appeal?

Non-attorney representative or non-attorney
representative's staff
Other third party representative (e.g., family
member, social service agency worker, case
manager)
Yes
No
2
3
4 or more clients
This was the first time
Less than five times a week
5-10 times per week
11-25 times per week
More than 25 times per week
I started a new appeal
I returned to a previously saved appeal

Please tell us why you did not complete your appeal
during your initial session.
Did you complete and submit your online appeal
today?
How many attempts did you need to accomplish your
task?

Please tell us why you did not complete your appeals
application today. Check all that apply.

What is your other reason?
What do you plan to do next?

Yes, I completed and submitted my online appeal
today
No
1
2
3
4
5 or more
I didn't have information I needed to complete the
application, such as names, addresses, or dates
I didn't understand what the questions meant or
how to answer
My disabling condition prevents me from working
with a computer for long periods
I had a limited amount of time/family demands
that kept me from working on it for very long
I had technical problems, i.e., an error message
or a mistake I couldn't fix
It takes too long to fill out
It's too complicated to complete without help
Other, please specify
I will complete my appeal at a later time

How much time have you spent on your online
disability appeal?

Did you experience any of the following while
completing the online appeal? Check all that apply.

So that we can better identify the difficulties you
indicated above, please provide specific information if
possible. (e.g., Which questions or sections were
difficult? Where did you receive an error message?
etc.)
Did you have ALL of your personal and medical
information ready when you started?

Browse the SSA website
I will visit my local Social Security Office
I do not know what I will do next at this time
I do not plan to complete my appeal
Less than 20 minutes
20 - 40 minutes
41 minutes - 1 hour
More than 1 hour but less than 2 hours
More than 2 hours but less than 3 hours
More than 3 hours
Not sure
The questions did not seem to be organized in a
logical manner
I had difficulty understanding the questions
because they were not clearly written
I did not have the information necessary to
answer the questions
I had difficulty editing the medical information
(e.g., doctors, medication, etc.)
I had difficulty editing other information
I was unable to print the application
I did not have enough time to complete the
application
I received an error message or was “kicked out”
of the appeal
The text box blanks did not allow enough
characters for my answers
Other
I did not have any difficulties

Yes
No

What personal and/or medical information did you not
have ready when you started?
Could we have provided any additional information or
assistance to help you be more prepared?
How can we improve the online disability appeal?
Please be as specific as possible. (Examples: What
information could we have provided upfront? Do you
have any suggested changes or updates?)

Before visiting SSA.gov did you first try to accomplish
your task in any of the following ways?

Calling Social Security's 1-800 number
Visiting my local Social Security office
Calling my local Social Security office
No, I visited SSA.gov first
Not sure

How helpful was the “Information You Will Need”
checklist that was provided on the disability appeal
Welcome Page?

Please tell us how easy it was to upload your
attachments.

Which of the following best describes your role in
using the online appeal today?

How much time have you spent on your online
appeal?

Did you experience any of the following while
completing the online appeal? Check all that apply.

Very helpful

Somewhat helpful
Not helpful at all
Did not review the checklist
Don't remember seeing the link to the checklist
I had little or no difficulty uploading my
attachment(s)
I found it somewhat difficult to upload my
attachment(s)
Self
Attorney or attorney's staff
Non-attorney representative or non-attorney
representative's staff
Other third party representative (e.g., family
member, social service agency worker, case
manager)
Less than 10 minutes
10 - 20 minutes
21 - 40 minutes
41 minutes - 1 hour
More than 1 hour but less than 2 hours
More than 2 hours
Not sure
The questions did not seem to be organized in a
logical manner
I had difficulty understanding the questions
because they were not clearly written
I did not have the information necessary to
answer the questions
I had difficulty editing the required information
I had difficulty editing other information
I was unable to print the application

I did not have enough time to complete the
application
I received an error message or was “kicked out”
of the appeal
The text box blanks did not allow enough
characters for my answers
Other
I did not have any difficulties
Please provide specific information as to your
difficulty. (Which questions or sections were difficult?
Where did you receive an error message? etc.)
Did you have ALL of your information ready when
you started?

Yes
No

What information did you not have ready when you
started?
Could we have provided any additional information or
assistance to help you be more prepared?
Did you submit your appeals application today?
What do you plan to do next?

How can we improve the online appeal? Please be
as specific as possible. (Examples: What information
could we have provided upfront? Do you have any
suggested changes or updates?)
Did you have any documents to upload?
Did you use the attachment feature to upload your
documents?

Yes
No
I will complete my appeal at a later time
Browse the SSA website
I will visit my local Social Security Office
Call the SSA 1-800 number
I do not know what I will do next at this time
Other (please specify)

Yes
No
Yes
No
I found it somewhat difficult to upload my
attachment(s)

Please describe the difficulty you experienced.
Why didn't you use the attachment feature?

I will upload them later because I am not finished
yet
I do not have electronic copies of my document(s)
to upload
I was not clear on how to upload my document(s)
I did not see the attachment feature
I forgot to upload my document(s)

My documents were too big to upload
Received an error message
Other, please specify
Please specify your other reason.
How helpful was the information on the online appeal
Welcome Page?

How helpful were the links to pop-up help pages (as
indicated by a blue question mark) throughout the
online appeal application?

What is your permanent residence?

Very helpful
Somewhat helpful
Not helpful at all
Did not read the Welcome Page
Very helpful

Somewhat helpful
Not helpful at all
Did not read the help links
Did not see the blue question marks
United States or one of its territories /
commonwealths
Foreign country
I prefer not to answer

Model Instance Name:
SSA Retirement Estimator

Question Text
How did you connect to SSA today?

From where did you connect to SSA today?

Did you connect through a unique Social Security
icon featured on the computer's desktop?

Answer Choices
Desktop
Laptop
Smartphone
Tablet
At home
In office / place of employment
At a friend or relative's place
Public library
Social Security Office
Social Security Kiosk
Other agency
Other, please specify
Yes

No
How did you link to the SSA website?
Please describe the location.

Please tell us how and from where you connected
with SSA during your visit today.
How did you first learn about the Retirement
Estimator?

Social media (e.g., Blog, Facebook, Twitter, etc.)
Online search engine or other website (e.g.,
Google)
Linked from another website
An online ad (Banner/Image)
A newspaper or magazine article
A newspaper or magazine ad
An email from Social Security
My Social Security Statement
Social Security employee
Relative or friend
Social Security event
My employer or Human Resources department
My financial advisor
Word of mouth
Other, please specify

Please specify how you first learned about the
Retirement Estimator.
Please specify the website that led you to the
Retirement Estimator
How often do you use the Retirement Estimator?

When do you expect to file for retirement benefits?

How do you plan to file for retirement benefits?

Did you review your Social Security Statement before
using the Retirement Estimator?

This was the first time
Every few months or less often
Monthly
I use the Retirement Estimator more than once a
month
Within 6 months
Within 12 months
Within 1 to 3 years
More than 3 but less than 6 years
Don't know at this time
Online
Online with telephone or in-person assistance
By telephone interview
At my local Social Security office
Don't know at this time
Yes, I reviewed my paper Social Security
Statement.
Yes, I reviewed my online Social Security
Statement

No
Did you have difficulty navigating between your
online Social Security Statement and the Retirement
Estimator?

Yes

No
Please describe the difficulty you had navigating
between your online Social Security Statement and
the Retirement Estimator.

Do you plan to review your online Social Security
Statement next?

Yes
No

Did the Retirement Estimator provide you with all the
benefit estimates you were seeking today?

Yes

No
What other benefit estimates were you trying to
obtain?

Do you believe the retirement estimate(s) provided to
you was/were based on your entire Social Security
earnings record?

Yes

No
Please explain why you think that the retirement
estimate(s) was/were not based on your entire Social
Security earnings record?
How would you describe your navigation experience
on the SSA site today prior to arriving at the
Retirement Estimator? (Please select all that apply)

Please describe your navigation difficulty and identify
where on the Social Security website this problem
occurred

I had no difficulty navigating/browsing to the
Retirement Estimator
I had difficulty finding the links to the Retirement
Estimator
I had difficulty because the links did not take me
where I expected
I had difficulty because I experienced technical
difficulties (error messages, broken links, etc.)
I had a navigation difficulty not listed above:

Have you used any other SSA resources for your
retirement planning? (Please select all that apply)

Please describe what other resources you used to
help prepare/plan for your retirement.
After visiting the Retirement Estimator today, what do
you plan to do next?

Have you registered for a my Social Security
account?
What is the main reason you have not registered for
a my Social Security account?

Your Online Social Security Statement in the my
Social Security pages
Social Security’s Online Retirement Planner
Other Social Security Calculators offered on
ssa.gov
Frequently Asked Questions (FAQ) on ssa.gov
Other resources on the SSA website
I used resources outside of ssa.gov
I did not use any resources to prepare at this time

Nothing, the Retirement Estimator provided what
I needed
Try the Retirement Estimator again (at a later
time)
I am ready to file for Social Security Retirement
Benefits
Browse the SSA website
I will call Social Security’s 1-800 number
I will visit my local Social Security Office
I do not know what I will do next at this time
Yes
No
I plan to register for a my Social Security account
today.
I plan to register for a my Social Security account
in the near future.
I tried to register for a my Social Security account,
but was unsuccessful.
I am not sure why I need a my Social Security
account.
I do not want a my Social Security account.
Other, please specify

Please tell us why you have not registered for a my
Social Security account.
What is your age?

40 and under
41 to 50
51 to 61
62 to 64
65 to 67
68 to 70
Prefer not to answer

What is your current marital status?

Married
Significant Other/Partner
Separated
Divorced
Widowed
Never Married/Single
Prefer not to answer
Other, please specify

Other marital status
Do you have any suggestions for improving the
online Retirement Estimator application?

Which type of appeal did you work on today?

Medical Disability Appeal
Other Non-Medical Appeal