A social security questionnaire is drafted to record the feedback of people in order to judge the actual conditions of Law & order, to understand the social requirements, implementation the ethical standards and revising the effective policies for the welfare of masses. Sometimes such questionnaire feedback is used by the magazines and online resources to conduct some studies.

Sample Social Security Questionnaire:

Name: __________________

Date of Birth: ___/____/____     Age: _______

Address: ________________________________

Home Phone: ______________ Cell Number: ______________

Email Address: ______________________

You’re Profession: ____________________

Social security Number: _______________

Q1: Have you ever applied for your social security benefits?

  • Yes
  • No
  • Please specifies the reason for applying: _____________________

Q2: The time you applied for the social security benefits, was your application denied by the authority?

  • Yes
  • No
  • Mention the reason of denial: _______________________

Q3: How do you rate the social security benefits?

  • Outstanding
  • Effective
  • Good
  • Not enough

Q4: Are you having any kind of physical injury and mental depression for which you are interested to apply for social security benefits?

  • Physically challenged
  • Mental illness
  • None of the above mentioned

Q5: How did you get the above specified injury and illness?

  • At work
  • In social collapse
  • Accidental
  • Others, ____________________

Q6: According to you, what is the importance of social security benefits for people?


Q7: Which of the following social security benefits requires improvement?

  • Medical facilities
  • Cultural values
  • Labour benefits
  • Social security services

Q8: Would you like to suggest us some changes to make the social security benefits more accessible?