Attachment D - 2025 NCA NOK Memorial Products Survey.pdf

An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is 2900-0571, and it expires 09/30/2026.

Public reporting burden for this collection of information is estimated to average 20 minutes per respondent, per year, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate and any other aspect of this collection of information, including suggestions for reducing the burden, to VA Reports Clearance Officer at VACOPaperworkReduAct@va.gov. Please refer to OMB Control No. 2900-0571 in any correspondence. Do not send your completed VA Survey to this email address.

The information you supply will be confidential and protected by the Privacy Act of 1974 (5 U.S.C. 522a) and the VA’s confidentiality statute (38 U.S.C. 5701) as implemented by 38 CFR 1.526(a) and 38 CFR 1.576(b). Disclosure of information involves releases of statistical data and other non-identifying data for the improvement of services within the National Cemetery Administration and for associated administrative purposes.

Marking Instructions

• Use pencil or pen. Make heavy dark marks that fill the circles completely. If you wish to change an answer, erase cleanly (pencil) or put an “X” over the incorrect response (pen).

• Fill in one answer circle for each question unless it states “Mark all that apply.”

• When you are finished, please place the questionnaire in the enclosed postage-paid envelope and put it in the mail.

Correct Mark

Incorrect Marks

The survey will take about 20 minutes to complete. Please read each question carefully before making your response. You may complete the survey on-line using the link address noted on the cover letter (https://bit.ly/MPE2025E) or by using the enclosed paper copy in this mailing. To access the survey on-line, enter your unique survey ID code ([MasterID]) on the main screen.

If you have any questions or concerns, please contact the Survey Help Line at 1-833-231-7069 or email VistraResearch@ConsultVistra.com.

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NATIONAL CEMETERY ADMINISTRATION

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OMB Control Number 2900-0571 Estimated Completion Time: 20 Minutes

U.S. DEPARTMENT OF VETERANS AFFAIRS

NATIONAL CEMETERY ADMINISTRATION

VA Memorial Products:

2025 Next of Kin/Family Member Satisfaction Survey

(Headstones/Markers/Medallions and Presidential Memorial Certificates)

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BARCODE

SEE MARKING INSTRUCTIONS ON THE COVER. Correct Mark Incorrect Marks

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Reason for Choosing the Cemetery / Support and Information Received at your Time of Need

1. Why did you inter your loved one in the cemetery you chose rather than in a VA national or state, tribal or territorial Veterans cemetery? (Mark all that apply)

Chose interment in a family plot Didn’t know how to make arrangements at a national or state, tribal or territorial Veterans cemetery My loved one wanted to be close to other relatives or friends already buried in the cemetery I chose The cemetery location will make it easier to visit my loved one’s gravesite It was a more affordable burial option The funeral director did not inform me of my options to use a national or State/Tribal cemetery I trust the cemetery I chose more than other options Other (specify) _______________________

2. What would have helped you choose a national, state, tribal or territorial Veterans cemetery?

3. Did you attend the committal service?

Yes No Don’t remember/Not certain No committal service was held

4. Prior to your time of need, were you aware of the benefits related to burial in a national, state, tribal or territorial cemetery?

Yes No GO TO QUESTION #6

5. How did you learn of these benefits prior to your time of need? (Mark all that apply)

Family member/friends Funeral home Military discharge related materials Other Veteran/Active-duty member Pre-Need Burial Eligibility Determination Veterans Service Organization VA/NCA pamphlet, newsletter, brochure VA/NCA website Other VA organization Professional/military association meetings Local news VA/NCA public service announcement/ advertisement VA/NCA social media (Facebook or X, formerly known as Twitter) Other (specify): ______________________

6. Did the funeral director provide information about burial and memorial benefits available for Veterans? (Mark all that apply)

Not applicable: Funeral Director not used Funeral Director provided information about VA burial benefits for Veterans Funeral Director provided information about VA memorial benefits for Veterans No, the Funeral Director did not provide information about either VA burial or memorial benefits

7. Did you call the NCA Applicant Assistance number (1-800-697-6947) for assistance with a headstone, marker, or medallion?

Yes No GO TO QUESTION #10 Don’t know GO TO QUESTION #10

8. Why did you call NCA? (Mark all that apply) To check on the status of an order To get help with ordering a marker To file a complaint about a marker Other (specify): ______________________

9. How satisfied were you with the service you received from the NCA Customer Service Representative?

Very satisfied Somewhat satisfied Neither satisfied nor dissatisfied Somewhat dissatisfied Very dissatisfied

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10. Did you visit the VA website for information about ordering the headstone, marker, or medallion?

Yes No GO TO QUESTION #13

11. What type of information were you looking for on VA’s website? (Mark all that apply)

How to order a headstone/marker/medallion Download an order form Find information on documentation needed Find out what could go on the headstone/ marker/medallion Find information on the certificate signed by the President of the United States honoring the Veteran’s service Other (specify): _______________________

12. How satisfied were you with the ease of finding the information you were looking for on VA’s website?

Very satisfied Somewhat satisfied Neither satisfied nor dissatisfied Somewhat dissatisfied Very dissatisfied

13. What type of headstone, marker, or medallion did you order?

Bronze (metal plate) Stone (granite or marble) Bronze medallion

14. How did you order the headstone, marker, or medallion? (Mark only one)

Via the mail Via fax Online via QuickSubmit Via the Funeral Director Other (specify): _______________________

15. Who helped you with ordering the headstone/ marker/medallion? (Mark all that apply) Family member Funeral director Cemetery representative VA employee Other (specify) _______________________ No one

16. How satisfied were you with the process you used to order the headstone, marker, or medallion?

Very satisfied Somewhat satisfied Neither satisfied nor dissatisfied Somewhat dissatisfied Very dissatisfied

17. When you were applying for the headstone, marker, or medallion, were you aware that the following items could be added to the headstone, marker, or medallion:

An inscription

Birth date/Date of death

Highest rank attained

War service

Emblem of belief

Valor Awards

Terms of endearment

Nicknames

Civilian credentials (i.e., Doctor)

Special unit designations

Other military credentials

18. If you were aware of the availability of an inscription, how did you learn about what could be included in the inscription? (Mark all that apply)

I read it on the application I looked it up on the VA website I was informed by the Funeral Director I was informed by a VA employee I was not aware Other (specify): _______________________

19. About how long after ordering the headstone, marker, or medallion did it arrive?

Less than 1 month Between 1 and 2 months Between 2 and 3 months Between 3 and 4 months More than 4 months Has not arrived yet Don’t know/Not sure

Ye s

No Do n’ t k no w

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20. How satisfied were you with the amount of time it took to receive the headstone, marker, or medallion?

Very satisfied Somewhat satisfied Neither satisfied nor dissatisfied Somewhat dissatisfied Very dissatisfied Don’t know/Marker or headstone has not arrived yet

21. When the headstone or marker arrived, was the inscription accurate?

Yes No Don’t know/Haven’t seen

22. Overall, how satisfied were you with the quality and appearance of the headstone, marker, or medallion when it arrived?

Very satisfied Somewhat satisfied Neither satisfied nor dissatisfied Somewhat dissatisfied Very dissatisfied Don’t know/Haven’t seen

23. Was there a delay in the placement of the headstone, marker, or medallion because of a difficulty paying the setting fee?

Yes No Don’t know

24. How would you have preferred to be notified about the delivery status of your headstone, marker, or medallion?

Postcard Email Letter Other (specify): _______________________ I didn’t need delivery status

25. Overall, how satisfied were you with your experiences with VA memorial products and services?

Very satisfied Somewhat satisfied Neither satisfied nor dissatisfied Somewhat dissatisfied Very dissatisfied I did not make the arrangements

26. Please add any comments regarding the process or support you received from NCA Memorial Products Service.

The Presidential Memorial Certificate and the NCA Pre-Need Eligibility Registration Process

If your loved one was NOT a Veteran, please go to Question #31.

27. Did you order and/or receive a certificate signed by the President of the United States honoring the Veteran’s service?

Yes – Requested and received Yes – Received, but not requested No – Requested, not received GO TO

QUESTION #31

No – Did not receive GO TO QUESTION #31 Don’t know what this is GO TO QUESTION #31

For information about the Presidential Memorial Certificate (the certificate signed by the President of the United States honoring the Veteran’s service) or to order more copies visit our website at www.cem.va.gov/pmc.asp.

28. How satisfied were you with the quality of the certificate signed by the President of the United States honoring the Veteran’s service?

Very satisfied GO TO QUESTION #30 Somewhat satisfied GO TO QUESTION #30 Neither satisfied nor dissatisfied Somewhat dissatisfied Very dissatisfied

29. Why were you not satisfied with the quality of the certificate signed by the President of the United States honoring Veteran’s service?

(Mark all that apply)

Envelope was bent/torn Name was misspelled Poor print quality Other (specify): _______________________

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30. How satisfied were you with the amount of time it took to receive the certificate signed by the President of the United States honoring the Veteran’s service?

Very satisfied Somewhat satisfied Neither satisfied nor dissatisfied Somewhat dissatisfied Very dissatisfied

31. Are you aware of the NCA Pre-Need Eligibility process?

Yes No GO TO QUESTION #35

32. How did you first become aware of the Pre-Need opportunity? (Mark only one)

Family member/friends Funeral home Military discharge related materials Other Veteran/Active-duty member Pre-Need Burial Eligibility Determination Veterans Service Organization VA/NCA pamphlet, newsletter, brochure VA/NCA website Other VA organization Professional/military association meetings Local news VA/NCA public service announcement/ advertisement VA/NCA social media (Facebook or X, formerly known as Twitter) Other (specify): ______________________

33. Have you applied for Pre-Need Eligibility?

Yes No GO TO QUESTION #35

34. Were you satisfied with the length of time it took to receive a certificate of eligibility?

Yes No Have not received yet

35. Are you aware of the PACT Act (The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act) and the expanded eligibility of VA health care for Veterans with toxic exposure?

Yes No Don’t know what this is

Demographics Disclaimer Statement:

Although responding to the following question(s) is voluntary, VA strongly encourages you to provide as much data and information as possible. Your responses will not be connected to you as an individual. These responses will help improve customer experience, approved research, and the quality of care and services for all Veterans.

They will not be used to update your customer profile or other demographics found in any of your VA records. VA follows strict security and privacy practices and adheres to VA’s data ethics standards to keep secure.

36. Was your loved one your…..

Spouse Partner Parent Child Other relative Not a relative

37. Are you a Veteran?

Yes No GO TO QUESTION #40

38. In which of the following eras did you serve?

(Mark all that apply)

World War II (12/7/1941 – 12/31/1946) Korean Conflict (6/27/1950 – 1/31/1955) Vietnam Era (11/1/1955 – 5/7/1975) Gulf War (8/2/1990 – 4/6/1991) Operation Enduring Freedom (OEF) (10/7/2001 – 12/28/2014) Operation Iraqi Freedom (OIF) (3/19/2003 – 8/31/2010) Operation New Dawn (9/1/2010 – 12/15/2011) Other/Don’t know

39. Are you a Veteran married/partnered to a Veteran?

Yes No

Please note: Veterans who are married to Veterans are entitled to individual gravesite and headstone/marker/medallion benefits. Visit www.va.gov/burials-memorials/eligibility/

40. In what year were you born?

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41. What is your sex?

Female Male

42. Was your loved one female or male?

Female Male

43. What is your race and/or ethnicity?

(Mark all that apply)

American Indian or Alaska Native For example, Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, Aztec, Maya, etc.

Asian For example, Chinese, Asian Indian, Filipino, Vietnamese, Korean, Japanese, etc.

Black or African American For example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc.

Hispanic or Latino For example, Mexican, Puerto Rican, Salvadoran, Cuban, Dominican, Guatemalan, etc.

Middle Eastern or North African For example, Lebanese, Iranian, Egyptian, Syrian, Iraqi, Israeli, etc.

Native Hawaiian or Pacific Islander For example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc.

White For example, English, German, Irish, Italian, Polish, Scottish, etc.

44. What was your loved one’s race and/or ethnicity? (Mark all that apply)

American Indian or Alaska Native For example, Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, Aztec, Maya, etc.

Asian For example, Chinese, Asian Indian, Filipino, Vietnamese, Korean, Japanese, etc.

Black or African American For example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc.

Hispanic or Latino For example, Mexican, Puerto Rican, Salvadoran, Cuban, Dominican, Guatemalan, etc.

Middle Eastern or North African For example, Lebanese, Iranian, Egyptian, Syrian, Iraqi, Israeli, etc.

Native Hawaiian or Pacific Islander For example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc.

White For example, English, German, Irish, Italian, Polish, Scottish, etc.

45. What language do you mainly speak at home?

English Spanish Chinese Tagalog Vietnamese Arabic Some other language (specify): __________

46. In what belief tradition was the burial conducted?

Christian Catholic Muslim Jewish Buddhist Hindu Atheist Agnostic None Other (specify): ______________________ Choose not to answer

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Thank you very much for taking the time to complete this questionnaire.

PLEASE mail this completed questionnaire in the enclosed pre-paid envelope as soon as possible.

If you misplaced the pre-paid envelope, you may mail the completed survey to the following address using your own envelope:

NATIONAL CEMETERY ADMINISTRATION

PO BOX 510570

LIVONIA, MI 48151-9807

If you have any questions about this research, please contact the Survey Help Line at 1-833-231-7069 or email VistraResearch@ConsultVistra.com.

47. Have you or your loved one used any other VA Benefits? (Mark all that apply)

Have not used other VA benefits Bereavement Counseling Dependency and Indemnity Compensation

(DIC)

Housebound Allowance Aid and Attendance VA Life Insurance Pension Education benefits Other (specify): _______________________

48. Please use this space to elaborate on any additional aspects of your experience you would like to share with the NCA.

49. Are you willing to participate in a Focus Group discussion?

No Yes If you are interested in participating in a focus group discussion to assist the National Cemetery Administration with improving its quality of service to Veterans and their families, please complete the information below:

In what way would you be willing to participate in the focus group? (Mark all that apply) Online By phone In person at a focus group facility

Name: ______________________________

Phone Number:_______________________

Email: ______________________________

Your participation will have no impact on your VA benefits.

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