Form 1047 2014 802 Benefits.gov 5-31-14

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Overview

Welcome and Thank You (5-14-14)
Welcome and Thank You Text
W&TY Text (3-7-14)
Current Model Qsts Update
Current Model Qsts
CQ Updates 5-31-14
Current CQs
CQs edits for DOT (2-7-14)
CQs (1-9-13)
CQs (1-13 edits)
Custom Qsts (7-3-12)
Custom Qsts (6-15-11)
Custom Qsts 4-29-11

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Sheet 1: Welcome and Thank You (5-14-14)

Model Instance Name:
FILL IN MEASURE NAME
MID:	Existing Measure - Please fill in; New Measure - DOT will fill in
Date:	Fill In Date
Welcome and Thank You Text
	Directions:
	This welcome text is shown at the top of the questionnaire window and the thank you text at the bottom. This is a good place to mention the site/company/agency name so the visitor knows whom they are taking the survey for. Feel free to modify the standard Welcome and Thank you text shown in the boxes below. Please read comments before using any of the text.
					Examples
					Welcome Text Example
	Welcome Text
	bharati.hulbanni: if STORES MEASURE: do NOT use any welcome text. Thanks for visiting our site. You've been randomly chosen to take part in a brief survey to let us know what we're doing well and where we can improve. Please take a few minutes to share your opinions, which are essential in helping us provide the best online experience possible. Please make sure and rate ONLY your experience on Benefits.gov and no other websites. Please note: Benefits.gov is an informational website that houses benefit program information and next steps on how to apply. Benefits.gov does not have access to agency databases and does not collect/request your personally identifiable information. Please contact the sponsoring Federal or state Agency for application statuses or additional information you may need.
					Thank You Text Example
	DEFAULT Thank You Text
	bharati.hulbanni: TY text can be used for all measure types (call center, web, stores, mobile etc.) Thank you for taking our survey - and for helping us serve you better. We appreciate your input!
	ALTERNATE WEB Thank You Text
	bharati.hulbanni: Use this TY text ONLY for WEB Thank you for taking our survey - and for helping us serve you better. Please note you will not receive a response from us based on your survey comments. If you would like us to contact you about your feedback, please visit the Contact Us section of our website.

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Sheet 2: Welcome and Thank You Text

Model Instance Name:
FILL IN MEASURE NAME
MID:	Existing Measure - Please fill in; New Measure - DOT will fill in
Date:	Fill In Date
Welcome and Thank You Text
	Directions:
	This welcome text is shown at the top of the questionnaire window and the thank you text at the bottom. This is a good place to mention the site/company/agency name so the visitor knows whom they are taking the survey for. Feel free to modify the standard Welcome and Thank you text shown in the boxes below. Please read comments before using any of the text.
					Examples
					Welcome Text Example
	Welcome Text
	bharati.hulbanni: if STORES MEASURE: do NOT use any welcome text. Thanks for visiting our site. You've been randomly chosen to take part in a brief survey to let us know what we're doing well and where we can improve. Please take a few minutes to share your opinions, which are essential in helping us provide the best online experience possible. Please note: Benefits.gov is an informational website that houses benefit program information and next steps on how to apply. Benefits.gov does not have access to agency databases and does not collect/request your personally identifiable information. Please contact the sponsoring Federal or state Agency for application statuses or additional information you may need.
					Thank You Text Example
	DEFAULT Thank You Text
	bharati.hulbanni: TY text can be used for all measure types (call center, web, stores, mobile etc.) Thank you for taking our survey - and for helping us serve you better. We appreciate your input!
	ALTERNATE WEB Thank You Text
	bharati.hulbanni: Use this TY text ONLY for WEB Thank you for taking our survey - and for helping us serve you better. Please note you will not receive a response from us based on your survey comments. If you would like us to contact you about your feedback, please visit the Contact Us section of our website.

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Sheet 3: W&TY Text (3-7-14)

Model Instance Name:
FILL IN MEASURE NAME
MID:	Existing Measure - Please fill in; New Measure - DOT will fill in
Date:	Fill In Date
Welcome and Thank You Text
	Directions:
	This welcome text is shown at the top of the questionnaire window and the thank you text at the bottom. This is a good place to mention the site/company/agency name so the visitor knows whom they are taking the survey for. Feel free to modify the standard Welcome and Thank you text shown in the boxes below. Please read comments before using any of the text.
					Examples
					Welcome Text Example
	Welcome Text
	bharati.hulbanni: if STORES MEASURE: do NOT use any welcome text. Thanks for visiting our site. You've been randomly chosen to take part in a brief survey to let us know what we're doing well and where we can improve. Please take a few minutes to share your opinions, which are essential in helping us provide the best online experience possible. Please note: Benefits.gov is an informational website that houses benefit program information and next steps on how to apply. Benefits.gov does not have access to agency databases and does not collect/request your personally identifiable information. Please contact the sponsoring Federal or state Agency for application statuses or additional information you may need.
					Thank You Text Example
	DEFAULT Thank You Text
	bharati.hulbanni: TY text can be used for all measure types (call center, web, stores, mobile etc.) Thank you for taking our survey - and for helping us serve you better. We appreciate your input!
	ALTERNATE WEB Thank You Text
	bharati.hulbanni: Use this TY text ONLY for WEB Thank you for taking our survey - and for helping us serve you better. Please note you will not receive a response from us based on your survey comments. If you would like us to contact you about your feedback, please visit the Contact Us section of our website.

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Sheet 4: Current Model Qsts Update

Model Instance Name:
Benefits.gov v2
MID: 1QRBQVt00VlYwxsMAAs01A==
Date:
\
Model questions utilize the ACSI methodology to determine scores and impacts
	ELEMENTS (drivers of satisfaction)		CUSTOMER SATISFACTION		FUTURE BEHAVIORS
	Benefit Search Process (1=Poor, 10=Excellent, Don't Know)		Satisfaction		Return (1=Very Unlikely, 10=Very Likely)
1	Please rate the how well the benefit search features streamline the search process.	21	What is your overall satisfaction with this site? (1=Very Dissatisfied, 10=Very Satisfied)	24	How likely are you to return to this site?
2	Please rate the features available for refining benefit search results.	22	How well does this site meet your expectations? (1=Falls Short, 10=Exceeds)		Recommend (1=Very Unlikely, 10=Very Likely)
3	Please rate how well the benefit search features minimize the amount of time needed to get useful results.	23	How does this site compare to your idea of an ideal website? (1=Not Very Close, 10=Very Close)	25	How likely are you to recommend this site to someone else?
	Look and Feel (1=Poor, 10=Excellent, Don't Know)
4	Please rate the visual appeal of this site.
5	Please rate the balance of graphics and text on this site.
6	Please rate the readability of the pages on this site.
7	Navigation (1=Poor, 10=Excellent, Don't Know)
8	Please rate how well the site is organized.
9	Please rate the options available for navigating this site.
	Please rate how well the site layout helps you find what you are looking for.
10	Please rate the number of clicks to get where you want on this site.
11	Benefit Information (1=Poor, 10=Excellent, Don't Know)
12	Please rate the amount of information provided about the benefit programs.
13	Please rate the usefulness of the information about the benefit programs.
14	Please rate your perception of the accuracy of the information about the benefit programs.
15	Site Performance (1=Poor, 10=Excellent, Don't Know)
16	Please rate how quickly pages load on this site.
	Please rate the consistency of speed from page to page on this site.
17	Please rate the ability to load pages without getting error messages on this site.
19	Benefit Search Results - Relevance (1=Poor, 10=Excellent, Don't Know)
20	Please rate how well the benefit search results match your request.
	Please rate the benefit search results' listing/ranking order.
	Please rate the relevance of the benefit search results to your information needs.

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Sheet 5: Current Model Qsts

Model Instance Name:
Benefits.gov v2
MID: 1QRBQVt00VlYwxsMAAs01A==
Date:
\
Model questions utilize the ACSI methodology to determine scores and impacts
	ELEMENTS (drivers of satisfaction)		CUSTOMER SATISFACTION		FUTURE BEHAVIORS
	Benefit Search Process (1=Poor, 10=Excellent, Don't Know)		Satisfaction		Return (1=Very Unlikely, 10=Very Likely)
1	Please rate how well the benefit search features streamline the search process.	21	What is your overall satisfaction with this site? (1=Very Dissatisfied, 10=Very Satisfied)	24	How likely are you to return to this site?
2	Please rate the features available for refining benefit search results.	22	How well does this site meet your expectations? (1=Falls Short, 10=Exceeds)		Recommend (1=Very Unlikely, 10=Very Likely)
3	Please rate how well the benefit search features minimize the amount of time needed to get useful results.	23	How does this site compare to your idea of an ideal website? (1=Not Very Close, 10=Very Close)	25	How likely are you to recommend this site to someone else?
	Look and Feel (1=Poor, 10=Excellent, Don't Know)
4	Please rate the visual appeal of this site.
5	Please rate the balance of graphics and text on this site.
6	Please rate the readability of the pages on this site.
7	Navigation (1=Poor, 10=Excellent, Don't Know)
8	Please rate how well the site is organized.
9	Please rate the options available for navigating this site.
	Please rate how well the site layout helps you find what you are looking for.
10	Please rate the number of clicks to get where you want on this site.
11	Benefit Information (1=Poor, 10=Excellent, Don't Know)
12	Please rate the amount of information provided about the benefit programs.
13	Please rate the usefulness of the information about the benefit programs.
14	Please rate your perception of the accuracy of the information about the benefit programs.
15	Site Performance (1=Poor, 10=Excellent, Don't Know)
16	Please rate how quickly pages load on this site.
	Please rate the consistency of speed from page to page on this site.
17	Please rate the ability to load pages without getting error messages on this site.
19	Benefit Search Results - Relevance (1=Poor, 10=Excellent, Don't Know)
20	Please rate how well the benefit search results match your request.
	Please rate the benefit search results' listing/ranking order.
	Please rate the relevance of the benefit search results to your information needs.

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Sheet 6: CQ Updates 5-31-14

Model Instance Name:	Model Instance Name:		red & strike-through: DELETE
Benefits.gov v2	Benefits.gov v2		underlined & italicized: RE-ORDER
MID: 1QRBQVt00VlYwxsMAAs01A==	MID: 1QRBQVt00VlYwxsMAAs01A==		pink: ADDITION
Date:	2/5/2014		blue + -->: REWORDING
Benefits.gov v2 CUSTOM QUESTION LIST
QID (Group ID)	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
EDO11044		Which of the following best describes your role in visiting today?	Agency Representative, Benefit Advocate/Caseworker		Radio button, one-up vertical	Single	Y	OPS Group	Role
			Disabled
			Injured/Sick
			Low Income
			Military (Active or Retired) or military dependent
			Parent/Caregiver
			Student
			Senior/Retiree
			Unemployed
			Other, please specify:	A
EDO11045	A	Other role			Text area, no char limit	Single	N	OPS Group	Other_Role
EDO11046		How frequently do you visit this site?	This is my first time visiting		Radio button, one-up vertical	Single	Y		First Time Visitor
			Weekly
			Monthly
			Several times per year
EDO11047		What was your primary purpose for visiting today?	To find more information about a specific program		Radio button, one-up vertical	Single	Y		Purpose
			I need help, but do not know what is available
			I want to apply for a specific benefit online
			I am curious about programs available to me
			Other	A
HAR0048522	A	What was your other primary purpose for visiting today?			Text area, no char limit		N		OE_Purpose
EDO11048		Which of the following best describes the type of information you were looking for today?	Disability benefits		Radio button, one-up vertical	Single	Y	Skip Logic Group	Kind of Information
			Child care assistance
			Educational assistance
			Energy assistance
			Financial assistance
			Food/nutrition assistance
			Grants
			Housing assistance
			Loans
			Medicaid
			General program information
			Other, please specify:	A
EDO11049	A	What kind of information were you looking for today?			Text area, no char limit		N		OE_Kind of Information
EDO11050		Did you find what you were looking for?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group	Find
			Not yet	B, F, H
EDO11051	B	What were you looking for?			Text area, no char limit	Single	N	Skip Logic Group	OE_Looking For
HAR0048523	F	What will you do next?	Return to the site later and try again		Radio button, one-up vertical	Single	Y	Skip Logic Group	Not Find_Do next
			Nothing, although I did not find what I wanted
			Other, please specify:	G
HAR0048524	G	Please specify what you will do next.			Text area, no char limit		N	Skip Logic Group	OE Not Find_Do Next
	H	How confident were you that you would find this information on Benefits.gov?	1 = Not at all confident		Radio button, scale, no don't know	Single	Y		How Confident
			2
			3
			4
			5
			6
			7
			8
			9
			10 = Extremely confident
		Did you leave Benefits.gov to visit one of our Partner agency's websites?	Yes		Radio button, one-up vertical	Single	Y		Leave Benefits.gov
			No
EDO11052		What is the primary search method you used to search for benefits while on the site?	Benefit Finder tool					Skip Logic Group	Search Method Used
			Search (located in the top right corner of the homepage)	D
			Browse by category	D
			Browse by state	D
			Browse by federal agency	D
			Other resources	D
EDO11055	D	Why didn't you use the Benefit Finder tool?	I did not see it					Skip Logic Group	Why Didn't Use Tool
			It asked too many questions
			I had a specific program I was looking for
			I chose to use one of the other ways to search
			There were technical difficulties with the tool (e.g. page did not load completely, error message, slow search speed, etc.)
			Other, please specify:	Z
EDO11056	Z	Why didn't you use the Benefit Finder tool?			Text area, no char limit	Single	N	Skip Logic Group	OE_Didn't Use Tool
ACQhar0020677		Did you use any of the following resources to help you on the website today?	YouTube tutorial video	X	Radio button, one-up vertical	Single	Y	Skip Logic Group	Resources
			FAQs	X
			Contact Us	X
			Advocacy Page	X
			Other, please specify	V, X
			I did not use any website resources to help me understand the tool.
ACQhar0020678	V	What other resource did you use to help you understand the website?			Text area, no char limit		N	Skip Logic Group	Other_Resources
ACQhar0020679	X	Did the resource(s) you used help you understand how to use the website?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group	Resources Help
			No
ACQhar0020680		Is there any resource that Benefits.gov could add to provide more guidance to help you use the website? If so, please explain.			Text area, no char limit		N		OE_Guidance
ACQWro0013996		Please tell us about your experience with your primary search method. (Please select all that apply.)	Search results were helpful		Checkbox, one-up vertical	Multi	Y	OPS Group	Search Experience
			Results were not relevant/not what I wanted
			Too many results/I needed to refine my search
			Not enough results
			Returned NO results
			There were technical difficulties with the tool (e.g. page did not load completely, error message, slow search speed, etc.)
			I experienced a different search issue (please explain):	L
ACQWro0013997	L	Other search issue:			Text field, <100 char	Single	N	OPS Group	Other_Search Experience
ACQWro0013995		Were you looking for benefits for yourself or someone else?	I was looking for benefits for myself.	H	Radio button, one-up vertical	Single	Y	Skip Logic Group
			I was looking for benefits for someone else.	H
			Not Applicable
EDO11057	H	Were you (or the person for whom you were searching) eligible for any program(s)?	Yes - eligible for at least one program	DD	Radio button, one-up vertical	Single	Y	Skip Logic Group	Eligible for Programs
			No
			I don't know yet
EDO11058	DD	Did you successfully email your results?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group	Email Results Successfully
			No	E
			I did not want to email my results.
EDO11059	E	Why didn't you successfully email your results?			Text area, no char limit		N	Skip Logic Group	OE_Email Results Unsuccessful
EDO11060		Did the benefit program description give you enough information?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group	Description Enough Info
			No	F
EDO11061	F	What additional information do you need?			Text area, no char limit		N	Skip Logic Group	OE_Additional Information
EDO11064		Do you subscribe to the Benefits.gov Compass eNewsletter?	Yes		Radio button, one-up vertical	Single	Y	OPS Group	eNewsletter
			No
			No, but I'd like to. My e-mail is	A
EDO11065	A	Email to subscribe to newsletter			Text area, no char limit	Single	N	OPS Group	Email Address for Newsletter
HAR0048525		Which of the following sources drove you to visit the site today?	Message or recommendation from a friend on a social network		Checkbox, one-up vertical	Multi	Y		Sources Driving to Site
			Video I saw on YouTube
			Internet blogs or discussion forums
			Social networks (Facebook, Twitter)
			Message directly from Benefits.gov on a social network
			Benefits.gov Compass eNewsletter
			Search engine results
			Referral from a friend, social services, counselor, or someone else I know
			Newspaper, TV, Radio
			Government Website
			Non-government Website
			Book
			My own previous experience with Benefits.gov drove me to the site today
			Don't know
			Other
EDO11066		What is your gender?	Male		Radio button, one-up vertical	Single	Y		Gender
			Female
			Prefer not to answer
ACQSto0005806		How do you describe your race or ethnicity?	Black or African American		Radio button, one-up vertical	Single	Y		Ethnicity
			White
			Asian
			American Indian or Alaska Native
			Hispanic
			Native Hawaiian or Other Pacific Islander (NHOPI)
			Some other race
			Prefer not to answer
EDO11068		What is your age range?	Under 18		Radio button, one-up vertical	Single	Y		Age
			18-24
			25-34
			35-44
			45-54
			55-64
			65 and older
			Prefer not to answer
EDO11069		What best describes your income range?	Under $25,000		Radio button, one-up vertical	Single	Y		Income
			$25,000 - $49,999
			$50,000 - $74,999
			$75,000 or higher
			Prefer not to answer
EDO11070		Which of the following best describes the highest level of education you have completed?	Did not complete high school		Radio button, one-up vertical	Single	Y		Education
			High school graduate
			Some college/vocational school
			College graduate
			Some postgraduate school
			Graduate/professional degree
			Prefer not to answer
EDO11072		If you could make one improvement to the site, what would it be?			Text area, no char limit	Single	N		OE_Improvement
HAR0048526	C	Have you ever accessed Benefits.gov using a mobile phone or tablet?	Yes	Y, Z	Radio button, one-up vertical	Single	Y	Skip Logic Group*	Mobile Site Usage
			No, but I plan to do so	Z
			No, and I don't plan to do so
HAR0048527	Y	What was the main reason you last visited Benefits.gov using a mobile phone or tablet?			Text area, no char limit	Single	N		Mobile Primary Reason
HAR0048528	Z	What resources/additional resources might you want to access from Benefits.gov using a mobile phone or tablet?			Text area, no char limit	Single	N		Mobile Resources
HAR0048529		Would you like to have the option to apply for benefits online through Benefits.gov?	Yes		Radio button, one-up vertical	Single	Y		Apply Online
			No

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Sheet 7: Current CQs

Model Instance Name:	Model Instance Name:		red & strike-through: DELETE
Benefits.gov v2	Benefits.gov v2		underlined & italicized: RE-ORDER
MID: 1QRBQVt00VlYwxsMAAs01A==	MID: 1QRBQVt00VlYwxsMAAs01A==		pink: ADDITION
Date:	2/5/2014		blue + -->: REWORDING
Benefits.gov v2 CUSTOM QUESTION LIST
QID (Group ID)	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
EDO11044		Which of the following best describes your role in visiting today?	Agency Representative, Benefit Advocate/Caseworker		Radio button, one-up vertical	Single	Y	OPS Group	Role
			Disabled
			Injured/Sick
			Low Income
			Military (Active or Retired) or military dependent
			Parent/Caregiver
			Student
			Senior/Retiree
			Unemployed
			Other, please specify:	A
EDO11045	A	Other role			Text area, no char limit	Single	N	OPS Group	Other_Role
EDO11046		How frequently do you visit this site?	This is my first time visiting		Radio button, one-up vertical	Single	Y		First Time Visitor
			Weekly
			Monthly
			Several times per year
EDO11047		What was your primary purpose for visiting today?	To find more information about a specific program		Radio button, one-up vertical	Single	Y		Purpose
			I need help, but do not know what is available
			I want to apply for a specific benefit online
			I am curious about programs available to me
			Other	A
	A	What was your other primary purpose for visiting today?			Text area, no char limit		N		OE_Purpose
EDO11048		Which of the following best describes the information you were looking for today?	Disability benefits		Radio button, one-up vertical	Single	Y	Skip Logic Group	Kind of Information
			Financial assistance
			Grants
			Housing assistance
			Loans
			Medicaid
			General program information
			Other, please specify:	A
EDO11049	A	What kind of information were you looking for today?			Text area, no char limit		N		OE_Kind of Information
EDO11050		Did you find what you were looking for?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group	Find
			Not yet	B, F
EDO11051	B	What were you looking for?			Text area, no char limit	Single	N	Skip Logic Group	OE_Looking For
ACQWro0013993	F	What will you do next?	Return to the site later and try again		Radio button, one-up vertical	Single	N	Skip Logic Group	Not Find_Do next
			Nothing, although I did not find what I wanted
			Other, please specify:	G
	G	Please specify what you will do next.			Text area, no char limit		N	Skip Logic Group	OE Not Find_Do Next
EDO11052		What is the primary search method you used to search for benefits while on the site?	Benefit Finder tool					Skip Logic Group	Search Method Used
			Search (located in the top right corner of the homepage)	D
			Browse by category	D
			Browse by state	D
			Browse by federal agency	D
			Other resources	D
EDO11055	D	Why didn't you use the Benefit Finder tool?	I did not see it					Skip Logic Group	Why Didn't Use Tool
			It asked too many questions
			I had a specific program I was looking for
			I chose to use one of the other ways to search
			There were technical difficulties with the tool (e.g. page did not load completely, error message, slow search speed, etc.)
			Other, please specify:	Z
EDO11056	Z	Why didn't you use the Benefit Finder tool?			Text area, no char limit	Single	N	Skip Logic Group	OE_Didn't Use Tool
ACQhar0020677		Did you use any of the following resources to help you on the website today?	YouTube tutorial video	X	Radio button, one-up vertical	Single	Y	Skip Logic Group	Resources
			FAQs	X
			Contact Us	X
			Advocacy Page	X
			Other, please specify	V, X
			I did not use any website resources to help me understand the tool.
ACQhar0020678	V	What other resource did you use to help you understand the website?			Text area, no char limit		N	Skip Logic Group	Other_Resources
ACQhar0020679	X	Did the resource(s) you used help you understand how to use the website?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group	Resources Help
			No
ACQhar0020680		Is there any resource that Benefits.gov could add to provide more guidance to help you using the website? If so, please explain.			Text area, no char limit		N		OE_Guidance
ACQWro0013996		Please tell us about your experience with your primary search method. (Please select all that apply.)	Search results were helpful		Checkbox, one-up vertical	Multi	Y	OPS Group	Search Experience
			Results were not relevant/not what I wanted
			Too many results/I needed to refine my search
			Not enough results
			Returned NO results
			There were technical difficulties with the tool (e.g. page did not load completely, error message, slow search speed, etc.)
			I experienced a different search issue (please explain):	L
ACQWro0013997	L	Other search issue:			Text field, <100 char	Single	N	OPS Group	Other_Search Experience
ACQWro0013995		Were you looking for benefits for yourself or someone else?	I was looking for benefits for myself.	H	Radio button, one-up vertical	Single	Y	Skip Logic Group
			I was looking for benefits for someone else.	H
			Not Applicable
EDO11057	H	Were you (or the person for whom you were searching) eligible for any program(s)?	Yes - eligible for at least one program	DD	Radio button, one-up vertical	Single	Y	Skip Logic Group	Eligible for Programs
			No
			I don't know yet
EDO11058	DD	Did you successfully email your results?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group	Email Results Successfully
			No	E
			I did not want to email my results.
EDO11059	E	Why didn't you successfully email your results?			Text area, no char limit		N	Skip Logic Group	OE_Email Results Unsuccessful
EDO11060		Did the benefit program description give you enough information?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group	Description Enough Info
			No	F
EDO11061	F	What additional information do you need?			Text area, no char limit		N	Skip Logic Group	OE_Additional Information
EDO11064		Do you subscribe to the Benefits.gov Compass eNewsletter?	Yes		Radio button, one-up vertical	Single	Y	OPS Group	eNewsletter
			No
			No, but I'd like to. My e-mail is	A
EDO11065	A	Email to subscribe to newsletter			Text area, no char limit	Single	N	OPS Group	Email Address for Newsletter
		Which of the following sources drove you to visit the site today?	Message or recommendation from a friend on a social network		Checkbox, one-up vertical	Multi	Y		Sources Driving to Site
			Video I saw on YouTube
			Internet blogs or discussion forums
			Social networks (Facebook, Twitter)
			Message directly from Benefits.gov on a social network
			Benefits.gov Compass eNewsletter
			Search engine results
			Referral from a friend, social services, counselor, or someone else I know
			Newspaper, TV, Radio
			Government Website
			Non-government Website
			Book
			My own previous experience with Benefits.gov drove me to the site today
			Don't know
			Other
EDO11066		What is your gender?	Male		Radio button, one-up vertical	Single	Y		Gender
			Female
			Prefer not to answer
ACQSto0005806		How do you describe your race or ethnicity?	Black or African American		Radio button, one-up vertical	Single	Y		Ethnicity
			White
			Asian
			American Indian or Alaska Native
			Hispanic
			Native Hawaiian or Other Pacific Islander (NHOPI)
			Some other race
			Prefer not to answer
EDO11068		What is your age range?	Under 18		Radio button, one-up vertical	Single	Y		Age
			18-24
			25-34
			35-44
			45-54
			55-64
			65 and older
			Prefer not to answer
EDO11069		What best describes your income range?	Under $25,000		Radio button, one-up vertical	Single	Y		Income
			$25,000 - $49,999
			$50,000 - $74,999
			$75,000 or higher
			Prefer not to answer
EDO11070		Which of the following best describes the highest level of education you have completed?	Did not complete high school		Radio button, one-up vertical	Single	Y		Education
			High school graduate
			Some college/vocational school
			College graduate
			Some postgraduate school
			Graduate/professional degree
			Prefer not to answer
EDO11072		If you could make one improvement to the site, what would it be?			Text area, no char limit	Single	N		OE_Improvement
	C	Have you ever accessed Benefits.gov using a mobile phone or tablet?	Yes	Y, Z	Radio button, one-up vertical	Single	Y	Skip Logic Group*	Mobile Site Usage
			No, but I plan to do so	Z
			No, and I don't plan to do so
	Y	What was the main reason you last visited Benefits.gov using a mobile phone or tablet?			Text area, no char limit	Single	N		Mobile Primary Reason
	Z	What resources/additional resources might you want to access from Benefits.gov using a mobile phone or tablet?			Text area, no char limit	Single	N		Mobile Resources
		Would you like to have the option to apply for benefits online through Benefits.gov?	Yes		Radio button, one-up vertical	Single	Y		Apply Online
			No

---

Sheet 8: CQs edits for DOT (2-7-14)

Model Instance Name:

Model Instance Name:

red & strike-through: DELETE

Benefits.gov v2

Benefits.gov v2

underlined & italicized: RE-ORDER

MID: 1QRBQVt00VlYwxsMAAs01A==

MID: 1QRBQVt00VlYwxsMAAs01A==

pink: ADDITION

Date:

2/5/2014

blue + -->: REWORDING

Benefits.gov v2 CUSTOM QUESTION LIST

QID (Group ID)

Skip Logic Label

Question Text

Answer Choices (limited to 50 characters)

Skip to

Type (select from list)

Single or Multi

Required Y/N

Special Instructions

25 character limit. CQ Label

EDO11044

Which of the following best describes your role in visiting today?

Agency Representative, Benefit Advocate/Caseworker

Radio button, one-up vertical

Single

Y

OPS Group

Role

Benefit Advocate/Caseworker

Disabled

Disabled Veteran

Disaster Victim

Federal employee or retiree

Injured/Sick

Low Income

Military (Active)

Military Dependent

Military (Active or Retired) or military dependent

Parent/Caregiver

Student

Senior/Retiree

Veteran

Veteran Dependent

Unemployed

Other, please specify:

A

EDO11045

A

Other role

Text area, no char limit

Single

N

OPS Group

Other_Role

EDO11046

How frequently do you visit this site?

This is my first time visiting

Radio button, one-up vertical

Single

Y

First Time Visitor

Weekly

Monthly

Several times per year

EDO11047

What was your primary purpose for visiting today?

To find more information about a specific program

Radio button, one-up vertical

Single

Y

Purpose

I need help, but do not know what is available

I am looking for free money from the government

I want to apply for a specific benefit online

I am curious about programs available to me

Other

A

A

Text area, no char limit

N

OE_Purpose

EDO11048

Which of the following best describes the information you were looking for today?

Disability benefits

Radio button, one-up vertical

Single

Y

Skip Logic Group

Kind of Information

Financial assistance

Grants

Housing assistance

Loans

Lost money

Medicaid

General program information

Other, please specify:

A

EDO11049

A

What kind of information were you looking for today?

Text area, no char limit

N

OE_Kind of Information

EDO11050

Did you find what you were looking for?

Yes

Radio button, one-up vertical

Single

Y

Skip Logic Group

Find

Not yet

B, F

EDO11051

B

What were you looking for?

Text area, no char limit

Single

N

Skip Logic Group

OE_Looking For

ACQWro0013993

F

How will you continue your search for benefits, since you did not find what you were looking for?

Text area, no char limit

Single

N

Skip Logic Group

ACQWro0013993

F

What will you do next?

Return to the site later and try again

Radio button, one-up vertical

Single

N

Skip Logic Group

Not Find_Do next

Nothing, although I did not find what I wanted

Other, please specify:

G

G

Please specify what you will do next.

Text area, no char limit

N

Skip Logic Group

OE Not Find_Do Next

EDO11052

What is the primary search method you used to search for benefits while on the site?

Benefit Finder tool

Skip Logic Group

Search Method Used

Search (located in the top right corner of the homepage)

D

Browse by category

D

Browse by state

D

Browse by federal agency

D

Other resources

D

EDO11055

D

Why didn't you use the Benefit Finder tool?

I did not see it

Skip Logic Group

Why Didn't Use Tool

It asked too many questions

I had a specific program I was looking for

I chose to use one of the other ways to search

There were technical difficulties with the tool (e.g. page did not load completely, error message, slow search speed, etc.)

Other, please specify:

Z

EDO11056

Z

Why didn't you use the Benefit Finder tool?

Text area, no char limit

Single

N

Skip Logic Group

OE_Didn't Use Tool

ACQhar0020677

Did you use any of the following resources to help you on the website today?

YouTube tutorial video

X

Radio button, one-up vertical

Single

Y

Skip Logic Group

Resources

FAQs

X

Contact Us

X

Advocacy Page

X

Other, please specify

V, X

I did not use any website resources to help me understand the tool.

ACQhar0020678

V

What other resource did you use to help you understand the website?

Text area, no char limit

N

Skip Logic Group

Other_Resources

ACQhar0020679

X

Did the resource(s) you used help you understand how to use the website?

Yes

Radio button, one-up vertical

Single

Y

Skip Logic Group

Resources Help

No

ACQhar0020680

Is there any resource that Benefits.gov could add to provide more guidance to help you using the website? If so, please explain.

Text area, no char limit

N

OE_Guidance

ACQWro0013996

Please tell us about your experience with your primary search method. (Please select all that apply.)

Search results were helpful

Checkbox, one-up vertical

Multi

Y

OPS Group

Search Experience

Results were not relevant/not what I wanted

Too many results/I needed to refine my search

Not enough results

Returned NO results

There were technical difficulties with the tool (e.g. page did not load completely, error message, slow search speed, etc.)

Received error message(s)

Search speed was too slow

I experienced a different search issue (please explain):

L

ACQWro0013997

L

Other search issue:

Text field, <100 char

Single

N

OPS Group

Other_Search Experience

ACQWro0013995

Were you looking for benefits for yourself or someone else?

I was looking for benefits for myself.

H

Radio button, one-up vertical

Single

Y

Skip Logic Group

I was looking for benefits for someone else.

H

Not Applicable

EDO11057

H

Were you (or the person for whom you were searching) eligible for any program(s)?

Yes - eligible for at least one program

DD

Radio button, one-up vertical

Single

Y

Skip Logic Group

Eligible for Programs

No

I don't know yet

EDO11058

DD

Did you successfully email your results?

Yes

Radio button, one-up vertical

Single

Y

Skip Logic Group

Email Results Successfully

No

E

I did not want to email my results.

EDO11059

E

Why didn't you successfully email your results?

Text area, no char limit

N

Skip Logic Group

OE_Email Results Unsuccessful

EDO11071

Did you expect to be eligible for a program that was not on your list?

Text area, no char limit

Single

N

OE_Eligible for Other Programs

EDO11060

Did the benefit program description give you enough information?

Yes

Radio button, one-up vertical

Single

Y

Skip Logic Group

Description Enough Info

No

F

EDO11061

F

What additional information do you need?

Text area, no char limit

N

Skip Logic Group

OE_Additional Information

EDO11064

Do you subscribe to the Benefits.gov Compass eNewsletter?

Yes

Radio button, one-up vertical

Single

Y

OPS Group

eNewsletter

No

No, but I'd like to. My e-mail is

A

EDO11065

A

Email to subscribe to newsletter

Text area, no char limit

Single

N

OPS Group

Email Address for Newsletter

Which of the following sources drove you to visit the site today?

Message or recommendation from a friend on a social network

Checkbox, one-up vertical

Multi

Y

Sources Driving to Site

Video I saw on YouTube

Internet blogs or discussion forums

Social networks (Facebook, Twitter)

Message directly from Benefits.gov on a social network

Benefits.gov Compass eNewsletter

Search engine results

Referral from a friend, social services, counselor, or someone else I know

Newspaper, TV, Radio

Government Website

Non-government Website

Book

My own previous experience with Benefits.gov drove me to the site today

Don't know

Other

Bonnie Richards: Client has indicated SMV is longer valuable as a index for them. They are removing the standard questions and asking a more customized about "what drove visitors to the site" They understand that they will not receive SMV index info. MMW2935

Which of the following sources drove you to visit the site today? Please rank the top 3 (Rank 1 is most important). Rank 1 (Required)

Message or recommendation from a friend on a social network

Drop down, select one

Single

Y

Rank Group

SV - Rank 1

Video I saw on YouTube

Internet blogs or discussion forums

Adjust Template/Style Sheet

Advertising on social networks (Facebook, Twitter)

Randomize

Message directly from the company on a social network

Online Pinboard (Pinterest)

Mobile phone text messages or alerts

Instant Message from a friend or colleague

Familiarity with the site

Benefits.gov Compass eNewsletter

Search engine results

Referral from a friend, social services, counselor, or someone else I know

Newspaper, TV, Radio

Government Website

Non-government Website

Book

Don't know

Anchor Answer Choice

Other

Anchor Answer Choice

MMW2936

Rank 2 (Optional)

Message or recommendation from a friend on a social network

Drop down, select one

Single

N

Rank Group

SV - Rank 2

Video I saw on YouTube

Internet blogs or discussion forums

Adjust Template/Style Sheet

Advertising on social networks (Facebook, Twitter)

Randomize

Message directly from the company on a social network

Online Pinboard (Pinterest)

Mobile phone text messages or alerts

Instant Message from a friend or colleague

Familiarity with the site

Benefits.gov Compass eNewsletter

Search engine results

Referral from a friend, social services, counselor, or someone else I know

Newspaper, TV, Radio

Government Website

Non-government Website

Book

Don't know

Anchor Answer Choice

Other

Anchor Answer Choice

MMW2937

Rank 3 (Optional)

Message or recommendation from a friend on a social network

Drop down, select one

Single

N

Rank Group

SV - Rank 3

Video I saw on YouTube

Internet blogs or discussion forums

Adjust Template/Style Sheet

Advertising on social networks (Facebook, Twitter)

Randomize

Message directly from the company on a social network

Online Pinboard (Pinterest)

Mobile phone text messages or alerts

Instant Message from a friend or colleague

Familiarity with the site

Benefits.gov Compass eNewsletter

Search engine results

Referral from a friend, social services, counselor, or someone else I know

Newspaper, TV, Radio

Government Website

Non-government Website

Book

Don't know

Anchor Answer Choice

Other

Anchor Answer Choice

ACQWro0013994

If you heard about this website from a social network, please specify the site (i.e. Facebook, Twitter, YouTube)

Text area, no char limit

N

SV - Other Social Network

EDO11066

What is your gender?

Male

Radio button, one-up vertical

Single

Y

Gender

Female

Bonnie Richards: Added this answer choice and changed question to be required. Prefer not to answer

ACQSto0005806

How do you describe your race or ethnicity?

Black or African American

Radio button, one-up vertical

Single

Y

Ethnicity

White

Asian

American Indian or Alaska Native

Hispanic

Native Hawaiian or Other Pacific Islander (NHOPI)

Some other race

Prefer not to answer

EDO11068

What is your age range?

Under 18

Radio button, one-up vertical

Single

Y

Age

18-24

25-34

35-44

45-54

55-64

65 and older

Prefer not to answer

EDO11069

What best describes your income range?

Under $25,000

Radio button, one-up vertical

Single

Y

Income

$25,000 - $49,999

$50,000 - $74,999

$75,000 or higher

Prefer not to answer

EDO11070

Which of the following best describes the highest level of education you have completed?

Did not complete high school

Radio button, one-up vertical

Single

Y

Education

High school graduate

Some college/vocational school

College graduate

Some postgraduate school

Graduate/professional degree

Prefer not to answer

ACQhar0020681

Approximately how long were you on the Benefits.gov website?

Less than 30 minutes

Radio button, one-up vertical

Single

Y

Skip Logic Group

Time

30 minutes - 1 hour

1 - 2 hours

Z

More than 2 hours

Z

ACQhar0020682

Z

What could have been done to help you reduce the time you spent on Benefits.gov?

Text area, no char limit

N

Skip Logic Group

OE_Less Time

EDO11072

If you could make one improvement to the site, what would it be?

Text area, no char limit

Single

N

OE_Improvement

C

Have you ever accessed Benefits.gov using a mobile phone or tablet?

Yes

Y, Z

Radio button, one-up vertical

Single

Y

Skip Logic Group*

Mobile Site Usage

No, but I plan to do so

Z

No, and I don't plan to do so

Y

What was the main reason you last visited Benefits.gov using a mobile phone or tablet?

Text area, no char limit

Single

N

Mobile Primary Reason

Z

What resources/additional resources might you want to access from Benefits.gov using a mobile phone or tablet?

Text area, no char limit

Single

N

Mobile Resources

Would you like to have the option to apply for benefits online through Benefits.gov?

Yes

Radio button, one-up vertical

Single

Y

Apply Online

No

---

Sheet 9: CQs (1-9-13)

Model Instance Name:

red & strike-through: DELETE

Benefits.gov v2

underlined & italicized: RE-ORDER

MID: 1QRBQVt00VlYwxsMAAs01A==

pink: ADDITION

Date:

6/19/2012

blue + -->: REWORDING

Benefits.gov v2 CUSTOM QUESTION LIST

QID (Group ID)

Skip Logic Label

Question Text

Answer Choices (limited to 50 characters)

Skip to

Type (select from list)

Single or Multi

Required Y/N

Special Instructions

25 character limit. CQ Label

EDO11044

Which of the following best describes you?

Agency Representative

Radio button, one-up vertical

Single

Y

OPS Group

Role

Benefit Advocate/Caseworker

Disabled

Disabled Veteran

Disaster Victim

Federal employee or retiree

Injured/Sick

Low Income

Military (Active)

Military Dependent

Parent/Caregiver

Student

Senior/Retiree

Veteran

Veteran Dependent

Unemployed

Other, please specify:

A

EDO11045

A

Other role

Text area, no char limit

Single

N

OPS Group

Other_Role

EDO11046

How frequently do you visit this site?

This is my first time visiting

Radio button, one-up vertical

Single

Y

First Time Visitor

Weekly

Monthly

Several times per year

EDO11047

To find more information about a specific program

Radio button, one-up vertical

Single

Y

Purpose

I need help, but do not know what is available

I am looking for free money from the government

I want to apply for a specific benefit online

I am curious about programs available to me

Other

EDO11048

What kind of information were you looking for today?

Disability benefits

Radio button, one-up vertical

Single

Y

Skip Logic Group

Kind of Information

Financial assistance

Grants

Housing assistance

Loans

Lost money

Medicaid

General program information

Other, please specify:

A

EDO11049

A

What kind of information were you looking for today?

Text area, no char limit

N

OE_Kind of Information

EDO11050

Did you find what you were looking for?

Yes

Radio button, one-up vertical

Single

Y

Skip Logic Group

Find

Not yet

B, F

EDO11051

B

What were you looking for?

Text area, no char limit

Single

N

Skip Logic Group

OE_Looking For

ACQWro0013993

F

How will you continue your search for benefits, since you did not find what you were looking for?

Text area, no char limit

Single

N

Skip Logic Group

EDO11052

What is the primary search method you used to search for benefits while on the site?

Benefit Finder tool

Skip Logic Group

Search Method Used

Search (located in the top right corner of the homepage)

D

Browse by category

D

Browse by state

D

Browse by federal agency

D

Other resources

D

EDO11055

D

Why didn't you use the Benefit Finder tool?

I did not see it

Skip Logic Group

Why Didn't Use Tool

It asked too many questions

I had a specific program I was looking for

I chose to use one of the other ways to search

Other, please specify:

Z

EDO11056

Z

Why didn't you use the Benefit Finder tool?

Text area, no char limit

Single

N

Skip Logic Group

OE_Didn't Use Tool

ACQhar0020677

Did you use any of the following resources to help you on the website today?

YouTube tutorial video

X

Radio button, one-up vertical

Single

Y

Skip Logic Group

Resources

FAQs

X

Contact Us

X

Advocacy Page

X

Other, please specify

V, X

I did not use any website resources to help me understand the tool.

ACQhar0020678

V

What other resource did you use to help you understand the website?

Text area, no char limit

N

Skip Logic Group

Other_Resources

ACQhar0020679

X

Did the resource(s) you used help you understand how to use the website?

Yes

Radio button, one-up vertical

Single

Y

Skip Logic Group

Resources Help

No

ACQhar0020680

Is there any resource that Benefits.gov could add to provide more guidance to help you using the website? If so, please explain.

Text area, no char limit

N

OE_Guidance

ACQWro0013996

Please tell us about your experience with your primary search method. (Please select all that apply.)

Search results were helpful

Checkbox, one-up vertical

Multi

Y

OPS Group

Search Experience

Results were not relevant/not what I wanted

Too many results/I needed to refine my search

Not enough results

Returned NO results

Received error message(s)

Search speed was too slow

I experienced a different search issue (please explain):

L

ACQWro0013997

L

Other search issue:

Text field, <100 char

Single

N

OPS Group

Other_Search Experience

ACQWro0013995

Were you looking for benefits for yourself or someone else?

I was looking for benefits for myself.

H

Radio button, one-up vertical

Single

Y

Skip Logic Group

I was looking for benefits for someone else.

H

Not Applicable

EDO11057

H

Were you (or the person for whom you were searching) eligible for any program(s)?

Yes - eligible for at least one program

DD

Radio button, one-up vertical

Single

Y

Skip Logic Group

Eligible for Programs

No

I don't know yet

EDO11058

DD

Did you successfully email your results?

Yes

Radio button, one-up vertical

Single

Y

Skip Logic Group

Email Results Successfully

No

E

I did not want to email my results.

EDO11059

E

Why didn't you successfully email your results?

Text area, no char limit

N

Skip Logic Group

OE_Email Results Unsuccessful

EDO11071

Did you expect to be eligible for a program that was not on your list?

Text area, no char limit

Single

N

OE_Eligible for Other Programs

EDO11060

Did the benefit program description give you enough information?

Yes

Radio button, one-up vertical

Single

Y

Skip Logic Group

Description Enough Info

No

F

EDO11061

F

What additional information do you need?

Text area, no char limit

N

Skip Logic Group

OE_Additional Information

EDO11064

Do you subscribe to the Benefits.gov Compass eNewsletter?

Yes

Radio button, one-up vertical

Single

Y

OPS Group

eNewsletter

No

No, but I'd like to. My e-mail is

A

EDO11065

A

Email to subscribe to newsletter

Text area, no char limit

Single

N

OPS Group

Email Address for Newsletter

MMW2935

Which of the following sources drove you to visit the site today? Please rank the top 3 (Rank 1 is most important). Rank 1 (Required)

Message or recommendation from a friend on a social network

Drop down, select one

Single

Y

Rank Group

SV - Rank 1

Video I saw on YouTube

Internet blogs or discussion forums

Adjust Template/Style Sheet

Advertising on social networks (Facebook, Twitter)

Randomize

Message directly from the company on a social network

Online Pinboard (Pinterest)

Mobile phone text messages or alerts

Instant Message from a friend or colleague

Familiarity with the site

Benefits.gov Compass eNewsletter

Search engine results

Referral from a friend, social services, counselor, or someone else I know

Newspaper, TV, Radio

Government Website

Non-government Website

Book

Don't know

Anchor Answer Choice

Other

Anchor Answer Choice

MMW2936

Rank 2 (Optional)

Message or recommendation from a friend on a social network

Drop down, select one

Single

N

Rank Group

SV - Rank 2

Video I saw on YouTube

Internet blogs or discussion forums

Adjust Template/Style Sheet

Advertising on social networks (Facebook, Twitter)

Randomize

Message directly from the company on a social network

Online Pinboard (Pinterest)

Mobile phone text messages or alerts

Instant Message from a friend or colleague

Familiarity with the site

Benefits.gov Compass eNewsletter

Search engine results

Referral from a friend, social services, counselor, or someone else I know

Newspaper, TV, Radio

Government Website

Non-government Website

Book

Don't know

Anchor Answer Choice

Other

Anchor Answer Choice

MMW2937

Rank 3 (Optional)

Message or recommendation from a friend on a social network

Drop down, select one

Single

N

Rank Group

SV - Rank 3

Video I saw on YouTube

Internet blogs or discussion forums

Adjust Template/Style Sheet

Advertising on social networks (Facebook, Twitter)

Randomize

Message directly from the company on a social network

Online Pinboard (Pinterest)

Mobile phone text messages or alerts

Instant Message from a friend or colleague

Familiarity with the site

Benefits.gov Compass eNewsletter

Search engine results

Referral from a friend, social services, counselor, or someone else I know

Newspaper, TV, Radio

Government Website

Non-government Website

Book

Don't know

Anchor Answer Choice

Other

Anchor Answer Choice

ACQWro0013994

If you heard about this website from a social network, please specify the site (i.e. Facebook, Twitter, YouTube)

Text area, no char limit

N

SV - Other Social Network

EDO11066

What is your gender?

Male

Radio button, one-up vertical

Single

N

Gender

Female

ACQSto0005806

How do you describe your race or ethnicity?

Black or African American

Radio button, one-up vertical

Single

N

Ethnicity

White

Asian

American Indian or Alaska Native

Hispanic

Native Hawaiian or Other Pacific Islander (NHOPI)

Some other race

EDO11068

What is your age range?

Under 18

Radio button, one-up vertical

Single

N

Age

18-24

25-34

35-44

45-54

55-64

65 and older

EDO11069

What best describes your income range?

Under $25,000

Radio button, one-up vertical

Single

N

Income

$25,000 - $49,999

$50,000 - $74,999

$75,000 or higher

EDO11070

Which of the following best describes the highest level of education you have completed?

Did not complete high school

Radio button, one-up vertical

Single

N

Education

High school graduate

Some college/vocational school

College graduate

Some postgraduate school

Graduate/professional degree

ACQhar0020681

Approximately how long were you on the Benefits.gov website?

Less than 30 minutes

Radio button, one-up vertical

Single

Y

Skip Logic Group

Time

30 minutes - 1 hour

1 - 2 hours

Z

More than 2 hours

Z

ACQhar0020682

Z

What could have been done to help you reduce the time you spent on Benefits.gov?

Text area, no char limit

N

Skip Logic Group

OE_Less Time

EDO11072

If you could make one improvement to the site, what would it be?

Text area, no char limit

Single

N

OE_Improvement

---

Sheet 10: CQs (1-13 edits)

Model Instance Name:

red & strike-through: DELETE

Benefits.gov v2

underlined & italicized: RE-ORDER

MID: 1QRBQVt00VlYwxsMAAs01A==

pink: ADDITION

Date:

6/19/2012

blue + -->: REWORDING

Benefits.gov v2 CUSTOM QUESTION LIST

QID (Group ID)

Skip Logic Label

Question Text

Answer Choices (limited to 50 characters)

Skip to

Type (select from list)

Single or Multi

Required Y/N

Special Instructions

25 character limit. CQ Label

EDO11044

Which of the following best describes you?

Agency Representative

Radio button, one-up vertical

Single

Y

OPS Group

Role

Benefit Advocate/Caseworker

Disabled

Disabled Veteran

Disaster Victim

Federal employee or retiree

Injured/Sick

Low Income

Military (Active)

Military Dependent

Parent/Caregiver

Student

Senior/Retiree

Veteran

Veteran Dependent

Unemployed

Other, please specify:

A

EDO11045

A

Other role

Text area, no char limit

Single

N

OPS Group

Other_Role

EDO11046

This is my first time visiting

Radio button, one-up vertical

Single

Y

First Time Visitor

Weekly

Monthly

Several times per year

EDO11047

What was your primary purpose for visiting today?

To find more information about a specific program

Radio button, one-up vertical

Single

Y

Purpose

I need help, but do not know what is available

I am looking for free money from the government

I want to apply for a specific benefit online

I am curious about programs available to me

Other

EDO11048

Disability benefits

Radio button, one-up vertical

Single

Y

Skip Logic Group

Kind of Information

Financial assistance

Grants

Housing assistance

Loans

Lost money

Medicaid

General program information

Other, please specify:

EDO11049

What kind of information were you looking for today?

Text area, no char limit

N

OE_Kind of Information

EDO11050

Did you find what you were looking for?

Yes

Radio button, one-up vertical

Single

Y

Skip Logic Group

Find

Not yet

B, F

EDO11051

B

What were you looking for?

Text area, no char limit

Single

N

Skip Logic Group

OE_Looking For

ACQWro0013993

F

How will you continue your search for benefits, since you did not find what you were looking for?

Text area, no char limit

Single

N

Skip Logic Group

EDO11052

What is the primary search method you used to search for benefits while on the site?

Benefit Finder tool

Skip Logic Group

Search Method Used

Search (located in the top right corner of the homepage)

D

Browse by category

D

Browse by state

D

Browse by federal agency

D

Other resources

D

EDO11055

D

Why didn't you use the Benefit Finder tool?

I did not see it

Skip Logic Group

Why Didn't Use Tool

It asked too many questions

I had a specific program I was looking for

I chose to use one of the other ways to search

Other, please specify:

Z

EDO11056

Z

Why didn't you use the Benefit Finder tool?

Text area, no char limit

Single

N

Skip Logic Group

OE_Didn't Use Tool

Did you use any of the following resources to help you on the website today?

YouTube tutorial video

X

Radio button, one-up vertical

Single

Y

Skip Logic Group

Resources

FAQs

X

Contact Us

X

Advocacy Page

X

Other, please specify

V, X

I did not use any website resources to help me understand the tool.

V

What other resource did you use to help you understand the website?

Text area, no char limit

N

Skip Logic Group

Other_Resources

X

Did the resource(s) you used help you understand how to use the website?

Yes

Radio button, one-up vertical

Single

Y

Skip Logic Group

Resources Help

No

Is there any resource that Benefits.gov could add to provide more guidance to help you using the website? If so, please explain.

Text area, no char limit

N

OE_Guidance

ACQWro0013996

Please tell us about your experience with your primary search method. (Please select all that apply.)

Search results were helpful

Checkbox, one-up vertical

Multi

Y

OPS Group

Search Experience

Results were not relevant/not what I wanted

Too many results/I needed to refine my search

Not enough results

Returned NO results

Received error message(s)

Search speed was too slow

I experienced a different search issue (please explain):

L

ACQWro0013997

L

Other search issue:

Text field, <100 char

Single

N

OPS Group

Other_Search Experience

ACQWro0013995

Were you looking for benefits for yourself or someone else?

I was looking for benefits for myself.

H

Radio button, one-up vertical

Single

Y

Skip Logic Group

I was looking for benefits for someone else.

H

Not Applicable

EDO11057

H

Were you (or the person for whom you were searching) eligible for any program(s)?

Yes - eligible for at least one program

DD

Radio button, one-up vertical

Single

Y

Skip Logic Group

Eligible for Programs

No

I don't know yet

EDO11058

DD

Did you successfully email your results?

Yes

Radio button, one-up vertical

Single

Y

Skip Logic Group

Email Results Successfully

No

E

I did not want to email my results.

EDO11059

E

Why didn't you successfully email your results?

Text area, no char limit

N

Skip Logic Group

OE_Email Results Unsuccessful

EDO11071

Did you expect to be eligible for a program that was not on your list?

Text area, no char limit

Single

N

OE_Eligible for Other Programs

EDO11060

Did the benefit program description give you enough information?

Yes

Radio button, one-up vertical

Single

Y

Skip Logic Group

Description Enough Info

No

F

EDO11061

F

What additional information do you need?

Text area, no char limit

N

Skip Logic Group

OE_Additional Information

EDO11064

Do you subscribe to the Benefits.gov Compass eNewsletter?

Yes

Radio button, one-up vertical

Single

Y

OPS Group

eNewsletter

No

No, but I'd like to. My e-mail is

A

EDO11065

A

Email to subscribe to newsletter

Text area, no char limit

Single

N

OPS Group

Email Address for Newsletter

MMW2935

Message or recommendation from a friend on a social network

Drop down, select one

Single

Y

Rank Group

SV - Rank 1

Video I saw on YouTube

Internet blogs or discussion forums

Adjust Template/Style Sheet

Advertising on social networks (Facebook, Twitter)

Randomize

Message directly from the company on a social network

Online Pinboard (Pinterest)

Mobile phone text messages or alerts

Instant Message from a friend or colleague

Familiarity with the site

Benefits.gov Compass eNewsletter

Search engine results

Referral from a friend, social services, counselor, or someone else I know

Newspaper, TV, Radio

Government Website

Non-government Website

Book

Don't know

Anchor Answer Choice

Other

Anchor Answer Choice

MMW2936

Rank 2 (Optional)

Message or recommendation from a friend on a social network

Drop down, select one

Single

N

Rank Group

SV - Rank 2

Video I saw on YouTube

Internet blogs or discussion forums

Adjust Template/Style Sheet

Advertising on social networks (Facebook, Twitter)

Randomize

Message directly from the company on a social network

Online Pinboard (Pinterest)

Mobile phone text messages or alerts

Instant Message from a friend or colleague

Familiarity with the site

Benefits.gov Compass eNewsletter

Search engine results

Referral from a friend, social services, counselor, or someone else I know

Newspaper, TV, Radio

Government Website

Non-government Website

Book

Don't know

Anchor Answer Choice

Other

Anchor Answer Choice

MMW2937

Rank 3 (Optional)

Message or recommendation from a friend on a social network

Drop down, select one

Single

N

Rank Group

SV - Rank 3

Video I saw on YouTube

Internet blogs or discussion forums

Adjust Template/Style Sheet

Advertising on social networks (Facebook, Twitter)

Randomize

Message directly from the company on a social network

Online Pinboard (Pinterest)

Mobile phone text messages or alerts

Instant Message from a friend or colleague

Familiarity with the site

Benefits.gov Compass eNewsletter

Search engine results

Referral from a friend, social services, counselor, or someone else I know

Newspaper, TV, Radio

Government Website

Non-government Website

Book

Don't know

Anchor Answer Choice

Other

Anchor Answer Choice

ACQWro0013994

If you heard about this website from a social network, please specify the site (i.e. Facebook, Twitter, YouTube)

Text area, no char limit

N

SV - Other Social Network

EDO11066

What is your gender?

Male

Radio button, one-up vertical

Single

N

Gender

Female

ACQSto0005806

How do you describe your race or ethnicity?

Black or African American

Radio button, one-up vertical

Single

N

Ethnicity

White

Asian

American Indian or Alaska Native

Hispanic

Native Hawaiian or Other Pacific Islander (NHOPI)

Some other race

EDO11068

What is your age range?

Under 18

Radio button, one-up vertical

Single

N

Age

18-24

25-34

35-44

45-54

55-64

65 and older

EDO11069

What best describes your income range?

Under $25,000

Radio button, one-up vertical

Single

N

Income

$25,000 - $49,999

$50,000 - $74,999

$75,000 or higher

EDO11070

Which of the following best describes the highest level of education you have completed?

Did not complete high school

Radio button, one-up vertical

Single

N

Education

High school graduate

Some college/vocational school

College graduate

Some postgraduate school

Graduate/professional degree

Approximately how long were you on the Benefits.gov website?

Less than 30 minutes

Radio button, one-up vertical

Single

Y

Skip Logic Group

Time

30 minutes - 1 hour

1 - 2 hours

Z

More than 2 hours

Z

Z

What could have been done to help you reduce the time you spent on Benefits.gov?

Text area, no char limit

N

Skip Logic Group

OE_Less Time

EDO11072

If you could make one improvement to the site, what would it be?

Text area, no char limit

Single

N

OE_Improvement

---

Sheet 11: Custom Qsts (7-3-12)

Model Instance Name:

red & strike-through: DELETE

Benefits.gov v2

underlined & italicized: RE-ORDER

MID: 1QRBQVt00VlYwxsMAAs01A==

pink: ADDITION

Date:

6/19/2012

blue + -->: REWORDING

Benefits.gov v2 CUSTOM QUESTION LIST

QID (Group ID)

Skip Logic Label

Question Text

Answer Choices (limited to 50 characters)

Skip to

Type (select from list)

Single or Multi

Required Y/N

Special Instructions

25 character limit. CQ Label

EDO11044

Which of the following best describes you?

Agency Representative

Radio button, one-up vertical

Single

Y

OPS Group

Role

Benefit Advocate/Caseworker

Disabled

Disabled Veteran

Disaster Victim

Federal employee or retiree

Injured/Sick

Low Income

Military (Active)

Military Dependent

Parent/Caregiver

Student

Senior/Retiree

Veteran

Veteran Dependent

Unemployed

Other, please specify:

A

EDO11045

A

Other role

Text area, no char limit

Single

N

OPS Group

Other_Role

EDO11046

Is this your first time visiting Benefits.gov? How frequently do you visit this site?

Yes This is my first time visiting

Radio button, one-up vertical

Single

Y

First Time Visitor

Weekly

Monthly

Several times per year

No

EDO11047

To find more information about a specific program

Radio button, one-up vertical

Single

Y

Purpose

I need help, but do not know what is available

I am looking for free money from the government

I want to apply for a specific benefit online

I am curious about programs available to me

Other

EDO11048

What kind of information were you looking for today?

Disability benefits

Radio button, one-up vertical

Single

Y

Skip Logic Group

Kind of Information

Financial assistance

Grants

Housing assistance

Loans

Lost money

Medicaid

General program information

Other, please specify:

EDO11049

What kind of information were you looking for today?

Text area, no char limit

N

OE_Kind of Information

EDO11050

Did you find what you were looking for?

Yes

Radio button, one-up vertical

Single

Y

OPS Group Skip Logic Group

Find

Not yet, I was looking for:

B, F

EDO11051

B

Not yet, I was looking for: What were you looking for?

Text area, no char limit

Single

N

OPS Group Skip Logic Group

OE_Looking For

F

How will you continue your search for benefits, since you did not find what you were looking for?

Text area, no char limit

Single

N

Skip Logic Group

EDO11052

What is the primary search method you used to search for benefits while on the site?

Benefit Finder tool

Y

Skip Logic Group

Search Method Used

Search (located in the top right corner of the homepage)

Y,D

Browse by category

Y,D

Browse by state

Y,D

Browse by federal agency

Y,D

Other resources

Y,D

EDO11053

Y

Was the primary search method you used helpful?

Yes

Radio button, one-up vertical

Single

Y

Skip Logic Group

Search Method Helpful

No

C

EDO11054

C

Why don't you feel the primary search method you used was helpful?

Text area, no char limit

N

Skip Logic Group

OE_Search Method NOT HELPFUL

EDO11055

D

Why didn't you use the Benefit Finder tool?

I did not see it

Skip Logic Group

Why Didn't Use Tool

It asked too many questions

I had a specific program I was looking for

I chose to use one of the other ways to search

Other, please specify:

Z

EDO11056

Z

Why didn't you use the Benefit Finder tool?

Text area, no char limit

Single

N

Skip Logic Group

OE_Didn't Use Tool

Please tell us about your experience with your primary search method. (Please select all that apply.)

Search results were helpful

Checkbox, one-up vertical

Multi

Y

OPS Group

Search Experience

Results were not relevant/not what I wanted

Too many results/I needed to refine my search

Not enough results

Returned NO results

Received error message(s)

Search speed was too slow

I experienced a different search issue (please explain):

L

L

Other search issue:

Text field, <100 char

Single

N

OPS Group

Other_Search Experience

Were you looking for benefits for yourself or someone else?

I was looking for benefits for myself.

H

Radio button, one-up vertical

Single

Y

Skip Logic Group

I was looking for benefits for someone else.

H

Not Applicable

EDO11057

H

Yes - eligible for at least one program

DD

Radio button, one-up vertical

Single

Y

Skip Logic Group

Eligible for Programs

No

I don't know yet

Not Applicable

EDO11058

DD

Did you successfully email your results?

Yes

Radio button, one-up vertical

Single

Y

Skip Logic Group

Email Results Successfully

No

E

I did not want to email my results.

EDO11059

E

Why didn't you successfully email your results?

Text area, no char limit

N

Skip Logic Group

OE_Email Results Unsuccessful

EDO11071

Denise.Philips: This was moved to be asked by the other eligibility questions. Did you expect to be eligible for a program that was not on your list?

Text area, no char limit

Single

N

OE_Eligible for Other Programs

EDO11060

Did the benefit program description give you enough information?

Yes

Radio button, one-up vertical

Single

Y

Skip Logic Group

Description Enough Info

No

F

EDO11061

F

What additional information do you need?

Text area, no char limit

N

Skip Logic Group

OE_Additional Information

EDO11062

How did you find out about our site?

E-mail/Mail

Radio button, one-up vertical

Single

Y

OPS Group

Find Out About Site

Benefits.gov Compass eNewsletter

Government Website

Non-government Website

Newspaper/TV/Radio

Referral from a friend

Search Engine

Social Services/Counselor

Social Media (i.e. Facebook or Twitter)

Other, please specify:

A

EDO11063

A

Other, Find out about site

Text area, no char limit

Single

N

OPS Group

Other_Find Out About Site

EDO11064

Do you subscribe to the Benefits.gov Compass eNewsletter?

Yes

Radio button, one-up vertical

Single

Y

OPS Group

eNewsletter

No

No, but I'd like to. My e-mail is

A

EDO11065

A

Email to subscribe to newsletter

Text area, no char limit

Single

N

OPS Group

Email Address for Newsletter

Which of the following sources drove you to visit the site today? Please rank the top 3 (Rank 1 is most important). Rank 1 (Required)

Message or recommendation from a friend on a social network

Drop down, select one

Single

Y

Rank Group

SV - Rank 1

Video I saw on YouTube

Internet blogs or discussion forums

Adjust Template/Style Sheet

Advertising on social networks (Facebook, Twitter)

Randomize

Message directly from the company on a social network

Online Pinboard (Pinterest)

Mobile phone text messages or alerts

Instant Message from a friend or colleague

Familiarity with the site

Benefits.gov Compass eNewsletter

Search engine results

Referral from a friend, social services, counselor, or someone else I know

Newspaper, TV, Radio

Government Website

Non-government Website

Book

Don't know

Anchor Answer Choice

Other

Anchor Answer Choice

Rank 2 (Optional)

Message or recommendation from a friend on a social network

Drop down, select one

Single

N

Rank Group

SV - Rank 2

Video I saw on YouTube

Internet blogs or discussion forums

Adjust Template/Style Sheet

Advertising on social networks (Facebook, Twitter)

Randomize

Message directly from the company on a social network

Online Pinboard (Pinterest)

Mobile phone text messages or alerts

Instant Message from a friend or colleague

Familiarity with the site

Benefits.gov Compass eNewsletter

Search engine results

Referral from a friend, social services, counselor, or someone else I know

Newspaper, TV, Radio

Government Website

Non-government Website

Book

Don't know

Anchor Answer Choice

Other

Anchor Answer Choice

Rank 3 (Optional)

Message or recommendation from a friend on a social network

Drop down, select one

Single

N

Rank Group

SV - Rank 3

Video I saw on YouTube

Internet blogs or discussion forums

Adjust Template/Style Sheet

Advertising on social networks (Facebook, Twitter)

Randomize

Message directly from the company on a social network

Online Pinboard (Pinterest)

Mobile phone text messages or alerts

Instant Message from a friend or colleague

Familiarity with the site

Benefits.gov Compass eNewsletter

Search engine results

Referral from a friend, social services, counselor, or someone else I know

Newspaper, TV, Radio

Government Website

Non-government Website

Book

Don't know

Anchor Answer Choice

Other

Anchor Answer Choice

If you heard about this website from a social network, please specify the site (i.e. Facebook, Twitter, YouTube)

Text area, no char limit

N

SV - Other Social Network

EDO11066

What is your gender?

Male

Radio button, one-up vertical

Single

N

Gender

Female

ACQSto0005806

How do you describe your race or ethnicity?

Black or African American

Radio button, one-up vertical

Single

N

Ethnicity

White

Asian

American Indian or Alaska Native

Hispanic

Native Hawaiian or Other Pacific Islander (NHOPI)

Some other race

EDO11068

What is your age range?

Under 18

Radio button, one-up vertical

Single

N

Age

18-24

25-34

35-44

45-54

55-64

65 and older

EDO11069

What best describes your income range?

Under $25,000

Radio button, one-up vertical

Single

N

Income

$25,000 - $49,999

$50,000 - $74,999

$75,000 or higher

EDO11070

Which of the following best describes the highest level of education you have completed?

Did not complete high school

Radio button, one-up vertical

Single

N

Education

High school graduate

Some college/vocational school

College graduate

Some postgraduate school

Graduate/professional degree

EDO11072

If you could make one improvement to the site, what would it be?

Text area, no char limit

Single

N

OE_Improvement

---

Sheet 12: Custom Qsts (6-15-11)

Model Instance Name:				red & strike-through: DELETE
Benefits.gov v2				underlined & italicized: RE-ORDER
MID: 1QRBQVt00VlYwxsMAAs01A==				pink: ADDITION
Date:				blue + -->: REWORDING
Benefits.gov v2 CUSTOM QUESTION LIST
QID (Group ID)	Skip Logic Label	Question Text	Answer IDs (DOT ONLY)	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions
EDO11044		Which of the following best describes you?	EDO11044A001	Agency Representative		Radio button, one-up vertical	Single	Y	OPS Group
			EDO11044A002	Benefit Advocate/Caseworker
			EDO11044A003	Disabled
			EDO11044A004	Disabled Veteran
			EDO11044A005	Disaster Victim
			EDO11044A006	Federal employee or retiree
			EDO11044A007	Injured/Sick
			EDO11044A008	Low Income
			EDO11044A009	Military (Active)
			EDO11044A010	Military Dependent
			EDO11044A011	Student
			EDO11044A012	Senior/Retiree
			EDO11044A013	Veteran
			EDO11044A014	Veteran Dependent
			EDO11044A015	Unemployed
			EDO11044A016	Other, please specify:	A
EDO11045	A	Other role				Text area, no char limit	Single	N	OPS Group
EDO11046		Is this your first time visiting Benefits.gov?	EDO11046A001	Yes
			EDO11046A002	No
EDO11047		What was your primary purpose for visiting today?	EDO11047A001	To find more information about a specific program		Radio button, one-up vertical	Single	Y
			EDO11047A002	I need help, but do not know what is available
			EDO11047A003	I am looking for free money from the government
			EDO11047A004	I want to apply for a specific benefit online
			EDO11047A005	I am curious about programs available to me
			EDO11047A006	Other
EDO11048		What kind of information were you looking for today?	EDO11048A001	Disability benefits		Radio button, one-up vertical	Single	Y	Skip Logic Group
			EDO11048A002	Financial assistance
			EDO11048A003	Grants
			EDO11048A004	Housing assistance
			EDO11048A005	Loans
			EDO11048A006	Lost money
			EDO11048A007	Medicaid
			EDO11048A008	General program information
			EDO11048A009	Other, please specify:
EDO11049		What kind of information were you looking for today?				Text area, no char limit		N
EDO11050		Did you find what you were looking for?	EDO11050A001	Yes		Radio button, one-up vertical	Single	Y	OPS Group
			EDO11050A002	Not yet, I was looking for:	B
EDO11051	B	Not yet, I was looking for:				Text area, no char limit	Single	N	OPS Group
EDO11052		What is the primary search method you used to search for benefits while on the site?	EDO11052A001	Benefit Finder tool	Y				Skip Logic Group
			EDO11052A002	Search (located in the top right corner of the homepage)	Y,D
			EDO11052A003	Browse by category	Y,D
			EDO11052A004	Browse by state	Y,D
			EDO11052A005	Browse by federal agency	Y,D
			EDO11052A006	Other resources	Y,D
EDO11053	Y	Was the primary search method you used helpful?	EDO11053A001	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group
			EDO11053A002	No	C
EDO11054	C	Why don't you feel the primary search method you used was helpful?				Text area, no char limit		N	Skip Logic Group
EDO11055	D	Why didn't you use the Benefit Finder tool?	EDO11055A001	I did not see it					Skip Logic Group
			EDO11055A002	It asked too many questions
			EDO11055A003	I had a specific program I was looking for
			EDO11055A004	I chose to use one of the other ways to search
			EDO11055A005	Other, please specify:	Z
EDO11056	Z	Why didn't you use the Benefit Finder tool?				Text area, no char limit	Single	N	Skip Logic Group
EDO11057		Were you (or the person for whom you were searching) eligible for any program(s)?	EDO11057A001	Yes - eligible for at least one program	DD	Radio button, one-up vertical	Single	Y	Skip Logic Group
			EDO11057A002	No
			EDO11057A003	I don't know yet
			EDO11057A004	Not Applicable
EDO11058	DD	Did you successfully email your results?	EDO11058A001	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group
			EDO11058A002	No	E
EDO11059	E	Why didn't you successfully email your results?				Text area, no char limit		N	Skip Logic Group
EDO11060		Did the benefit program description give you enough information?	EDO11060A001	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group
			EDO11060A002	No	F
EDO11061	F	What additional information do you need?				Text area, no char limit		N	Skip Logic Group
EDO11062		How did you find out about our site?	EDO11062A001	E-mail/Mail		Radio button, one-up vertical	Single	Y	OPS Group
			EDO11062A002	Benefits.gov Compass eNewsletter
			EDO11062A003	Government Website
			EDO11062A004	Non-government Website
			EDO11062A005	Newspaper/TV/Radio
			EDO11062A006	Referral from a friend
			EDO11062A007	Search Engine
			EDO11062A008	Social Services/Counselor
			EDO11062A10	Social Media (i.e. Facebook or Twitter)
			EDO11062A009	Other, please specify:	A
EDO11063	A	Other, Find out about site				Text area, no char limit	Single	N	OPS Group
EDO11064		Do you subscribe to the Benefits.gov Compass eNewsletter?	EDO11064A001	Yes		Radio button, one-up vertical	Single	Y	OPS Group
			EDO11064A002	No
			EDO11064A003	No, but I'd like to. My e-mail is	A
EDO11065	A	Email to subscribe to newsletter				Text area, no char limit	Single	N	OPS Group
EDO11066		What is your gender?	EDO11066A001	Male		Radio button, one-up vertical	Single	N
			EDO11066A002	Female
		How do you describe your race or ethnicity?		Black or African American		Radio button, one-up vertical	Single	N
				White
				Asian
				American Indian or Alaska Native
				Hispanic
				Native Hawaiian or Other Pacific Islander (NHOPI)
				Some other race
EDO11068		What is your age range?	EDO11068A001	Under 18		Radio button, one-up vertical	Single	N
			EDO11068A002	18-24
			EDO11068A003	25-34
			EDO11068A004	35-44
			EDO11068A005	45-54
			EDO11068A006	55-64
			EDO11068A007	65 and older
EDO11069		What best describes your income range?	EDO11069A001	Under $25,000		Radio button, one-up vertical	Single	N
			EDO11069A002	$25,000 - $49,999
			EDO11069A003	$50,000 - $74,999
			EDO11069A004	$75,000 or higher
EDO11070		Which of the following best describes the highest level of education you have completed?	EDO11070A001	Did not complete high school		Radio button, one-up vertical	Single	N
			EDO11070A002	High school graduate
			EDO11070A003	Some college/vocational school
			EDO11070A004	College graduate
			EDO11070A005	Some postgraduate school
			EDO11070A006	Graduate/professional degree
EDO11071		Did you expect to be eligible for a program that was not on your list?				Text area, no char limit	Single	N
EDO11072		If you could make one improvement to the site, what would it be?				Text area, no char limit	Single	N

---

Sheet 13: Custom Qsts 4-29-11

Model Instance Name:				red & strike-through: DELETE
Benefits.gov v2				underlined & italicized: RE-ORDER
MID: 1QRBQVt00VlYwxsMAAs01A==				pink: ADDITION
Date:				blue + -->: REWORDING
Benefits.gov v2 CUSTOM QUESTION LIST
QID (Group ID)	Skip Logic Label	Question Text	Answer IDs (DOT ONLY)	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions
EDO11044		Which of the following best describes you?	EDO11044A001	Agency Representative		Radio button, one-up vertical	Single	Y	OPS Group
			EDO11044A002	Benefit Advocate/Caseworker
			EDO11044A003	Disabled
			EDO11044A004	Disabled Veteran
			EDO11044A005	Disaster Victim
			EDO11044A006	Federal employee or retiree
			EDO11044A007	Injured/Sick
			EDO11044A008	Low Income
			EDO11044A009	Military (Active)
			EDO11044A010	Military Dependent
			EDO11044A011	Student
			EDO11044A012	Senior/Retiree
			EDO11044A013	Veteran
			EDO11044A014	Veteran Dependent
			EDO11044A015	Unemployed
			EDO11044A016	Other, please specify:	A
EDO11045	A	Other role				Text area, no char limit	Single	N	OPS Group
EDO11046		Is this your first time visiting BENEFITS.GOV?	EDO11046A001	Yes
			EDO11046A002	No
EDO11047		What was your primary purpose for visiting today?	EDO11047A001	To find more information about a specific program		Radio button, one-up vertical	Single	Y
			EDO11047A002	I need help, but do not know what is available
			EDO11047A003	I am looking for free money from the government
			EDO11047A004	I want to apply for a specific benefit online
			EDO11047A005	I am curious about programs available to me
			EDO11047A006	Other
EDO11048		What kind of information were you looking for today?	EDO11048A001	Disability benefits		Radio button, one-up vertical	Single	Y	Skip Logic Group
			EDO11048A002	Financial assistance
			EDO11048A003	Grants
			EDO11048A004	Housing assistance
			EDO11048A005	Loans
			EDO11048A006	Lost money
			EDO11048A007	Medicaid
			EDO11048A008	General program information
			EDO11048A009	Other, please specify:
EDO11049		What kind of information were you looking for today?				Text area, no char limit		N
EDO11050		Did you find what you were looking for?	EDO11050A001	Yes		Radio button, one-up vertical	Single	Y	OPS Group
			EDO11050A002	Not yet, I was looking for:	B
EDO11051	B	Not yet, I was looking for:				Text area, no char limit	Single	N	OPS Group
EDO11052		What is the primary search method you used to search for benefits while on the site?	EDO11052A001	Benefit Finder tool	Y				Skip Logic Group
			EDO11052A002	Search (located in the top right corner of the homepage)	Y,D
			EDO11052A003	Browse by category	Y,D
			EDO11052A004	Browse by state	Y,D
			EDO11052A005	Browse by federal agency	Y,D
			EDO11052A006	Other resources	Y,D
EDO11053	Y	Was the primary search method you used helpful?	EDO11053A001	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group
			EDO11053A002	No	C
EDO11054	C	Why don't you feel the primary search method you used was helpful?				Text area, no char limit		N	Skip Logic Group
EDO11055	D	Why didn't you use the Benefit Finder tool?	EDO11055A001	I did not see it					Skip Logic Group
			EDO11055A002	It asked too many questions
			EDO11055A003	I had a specific program I was looking for
			EDO11055A004	I chose to use one of the other ways to search
			EDO11055A005	Other, please specify:	Z
EDO11056	Z	Why didn't you use the Benefit Finder tool?				Text area, no char limit	Single	N	Skip Logic Group
EDO11057		Were you (or the person for whom you were searching) eligible for any program(s)?	EDO11057A001	Yes - eligible for at least one program	DD	Radio button, one-up vertical	Single	Y	Skip Logic Group
			EDO11057A002	No
			EDO11057A003	I don't know yet
			EDO11057A004	Not Applicable
EDO11058	DD	Did you successfully email your results?	EDO11058A001	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group
			EDO11058A002	No	E
EDO11059	E	Why didn't you successfully email your results?				Text area, no char limit		N	Skip Logic Group
EDO11060		Did the Benefits detail provide enough information for you to move forward in your efforts to obtain help?	EDO11060A001	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group
			EDO11060A002	No	F
EDO11061	F	What additional information do you need?				Text area, no char limit		N	Skip Logic Group
EDO11062		How did you find out about our site?	EDO11062A001	E-mail/Mail		Radio button, one-up vertical	Single	Y	OPS Group
			EDO11062A002	GovBenefits.gov Connection Newsletter
			EDO11062A003	Government Website
			EDO11062A004	Non-government Website
			EDO11062A005	Newspaper/TV/Radio
			EDO11062A006	Referral from a friend
			EDO11062A007	Search Engine
			EDO11062A008	Social Services/Counselor
				Social Media (i.e. Facebook or Twitter)
			EDO11062A009	Other, please specify:	A
EDO11063	A	Other, Find out about site				Text area, no char limit	Single	N	OPS Group
EDO11064		Do you subscribe to the GovBenefits.gov Connections e-newsletter?	EDO11064A001	Yes		Radio button, one-up vertical	Single	Y	OPS Group
			EDO11064A002	No
			EDO11064A003	No, but I'd like to. My e-mail is	A
EDO11065	A	Email to subscribe to newsletter				Text area, no char limit	Single	N	OPS Group
EDO11066		What is your gender?	EDO11066A001	Male		Radio button, one-up vertical	Single	N
			EDO11066A002	Female
EDO11067		How do you describe your race or ethnicity?	EDO11067A001	Alaska Native		Radio button, one-up vertical	Single	N
			EDO11067A002	American Indian
			EDO11067A003	Asian
			EDO11067A004	Black or African American
			EDO11067A005	Hispanic
			EDO11067A006	Native American
			EDO11067A007	Pacific Islander
			EDO11067A008	White or Caucasian
EDO11068		What is your age range?	EDO11068A001	Under 18		Radio button, one-up vertical	Single	N
			EDO11068A002	18-24
			EDO11068A003	25-34
			EDO11068A004	35-44
			EDO11068A005	45-54
			EDO11068A006	55-64
			EDO11068A007	65 and older
EDO11069		What best describes your income range?	EDO11069A001	Under $25,000		Radio button, one-up vertical	Single	N
			EDO11069A002	$25,000 - $49,999
			EDO11069A003	$50,000 - $74,999
			EDO11069A004	$75,000 or higher
EDO11070		Which of the following best describes the highest level of education you have completed?	EDO11070A001	Did not complete high school		Radio button, one-up vertical	Single	N
			EDO11070A002	High school graduate
			EDO11070A003	Some college/vocational school
			EDO11070A004	College graduate
			EDO11070A005	Some postgraduate school
			EDO11070A006	Graduate/professional degree
EDO11071		We're trying to understand if visitors are finding programs and aren't eligible, or aren't finding programs at all. Do you have any thoughts on this topic?				Text area, no char limit	Single	N
EDO11072		If you could make one improvement to the site, what would it be?				Text area, no char limit	Single	N