Sample NCA2020 MPS English Survey.pdf

OMB Control Number 2900-00571 Estimated Completion Time: 20 Minutes

U.S. DEPARTMENT OF VETERANS AFFAIRS

NATIONAL CEMETERY ADMINISTRATION

VA Memorial Products: 2020 NEXT OF KIN/FAMILY MEMBER SATISFACTION SURVEY (Headstones/Markers/Medallions and Presidential Memorial Certificates)

The VA may not conduct, sponsor, or require the respondent to respond to this collection of information unless it displays a valid OMB Control Number. All responses to this collection are voluntary. Public reporting burden for this collection of information is estimated to average 20 minutes per response, including the time necessary for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

The information collected is intended to be used in making improvements in services within the National Cemetery Administration of the Department of Veterans Affairs and for associated administrative purposes. Failure to furnish the requested information will have no adverse effect on any VA benefit to which you may be entitled. 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. Please send any comments regarding this burden estimate or any other aspect of this collection, including suggestions for reducing this burden, to: VA Clearance Officer (005G2), 810 Vermont Ave., NW, Washington, D.C.

20420.

SEND COMMENTS ONLY. DO NOT SEND THIS FORM OR REQUESTS FOR BENEFITS TO THIS

ADDRESS.

Marking Instructions: Please read each question carefully and respond by filling in the response square that most closely represents your opinion.

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

• Fill in one answer square for each question unless it tells you to “mark all that apply.”

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

If you have any questions or concerns, please call the Survey Help Desk at: (866) 730-8405.

NATIONAL CEMETERY ADMINISTRATION 295127-2

[MasterID]

2020 Memorial Products Survey

Q1 How did you learn about the headstone, marker, or medallion benefit provided by the VA?

(Mark all that apply)

Learned from a Veteran/family member

Learned from a Funeral Director

Learned from a Cemetery Representative

Learned from a VA employee

My own research

Other (specify):

Q2 What type of headstone, marker, or medallion did you order?

Bronze (metal plate) Go to Q5

Stone (granite or marble) Go to Q5

Bronze medallion

Q3 Did you have any problems while affixing the bronze medallion to the headstone or markers?

Yes

No Go to Q5

Have not affixed medallion yet Go to Q5

Q4 Please explain the difficulty you faced in affixing the medallion to a headstone or marker:

Q5 Who helped you with ordering the headstone/marker/medallion? (Mark all that apply)

Family member

Funeral Director

Cemetery Representative

VA employee

No one

Other (specify):

Q6 How did you order the headstone, marker, or medallion? (Mark only one)

Via the mail

Via fax

Via the Funeral Director

Other (specify):

Q7 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

Q8 Did you call the NCA Applicant Assistance number (1-800-697-6947) for assistance with a headstone, marker, or medallion?

Yes

No Go to Q12

Don’t Know

Q9 Did you speak with an NCA Customer Service representative initially, or were you transferred to NCA by a VA Customer Service representative?

Spoke with an NCA Customer Service representative initially

Transferred to NCA

Don’t know

Q10 Why did you call the 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):

Q11 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

Q12 Did you visit the VA website for information about ordering the headstone, marker, or medallion?

Yes

No Go to Q15

Q13 What type of information were you looking for on the VA’s website? (Mark all that apply)

How to order a headstone/marker/medallion

Download an order form

Find information on documentation needed

Find information on the Presidential Memorial Certificate Program

Find out what could go on the headstone/marker/medallion

Other (specify):

Q14 How satisfied were you with the ease of finding the information you were looking for on the VA’s website?

Very satisfied

Somewhat satisfied

Neither satisfied nor dissatisfied

Somewhat dissatisfied

Very dissatisfied

Q15 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

Yes No Don't know

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

Q16 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

Other (specify):

Q17 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

Don’t know

Q18 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

Q19 How would you have preferred to be notified about the delivery status of your headstone, marker, or medallion?

Postcard

E-mail

Letter

I don't care to be notified

Other (specify):

Q20 Please indicate your level of agreement with the following statement: “The overall quality of the headstone, marker, or medallion I received from VA was excellent.”

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

Q21 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 Q23

No – Did not receive Go to Q23

Don’t know what this is Go to Q23

Q22 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

Satisfied

Neither satisfied nor dissatisfied

Somewhat dissatisfied

Very dissatisfied

Envelope was bent/torn

Name was misspelled

Poor print quality

Other (specify)

For more information about the Presidential Memorial Certificate, or to order more copies, please visit our web page at www.cem.va.gov/pmc.asp

Q23 Overall, how satisfied were you with your experiences with the VA Memorial Products Service products and services?

Very satisfied

Somewhat satisfied

Neither satisfied nor dissatisfied

Somewhat dissatisfied

Very dissatisfied

Q24 Were you required to pay any fees regarding your government headstone, marker, or medallion?

Yes, but they were reasonable

Yes, and the costs were substantial

No Go to Q30

Don't know Go to Q30

Q25 Are you aware of the Pre-Need eligibility process?

Are you aware of the Pre-Need eligibility process?

Yes No

Have you applied?

Do you intend to apply?

If you applied, were you satisfied with the length of time it took to receive a certificate of approval?

Q26 If you ordered a bronze marker, what amount were you required to pay? (Please round up to nearest whole dollar.)

Q27 If you ordered a granite/marble headstone or marker, what amount were you required to pay? (Please round up to nearest whole dollar.)

Q28 If you ordered a bronze medallion, what amount were you required to pay? (Please round up to nearest whole dollar.)

Q29 Was there a delay in the placement of the headstone, marker, or medallion because of a difficulty to pay the setting fee?

Yes

No

Don't know

Q30 What was the gender of your loved one?

Male

Female

Q31 Was your loved one Hispanic or Latino?

Yes

No

Q32 What was the race of your loved one? (Mark one or more)

White

Black or African American

American Indian or Alaska Native

Asian

Native Hawaiian or other Pacific Islander

Q33 Are you a Veteran (served on active duty in the U.S. Armed Forces, either in the regular military or a National Guard or Reserve Unit)?

Yes

No Go to Q37

Q34 Which of the following war eras did you serve in? (Mark all that apply)

World War II

Korean War

Vietnam War

Gulf War

Operation Enduring Freedom (OEF)

Operation Iraqi Freedom (OIF)

Operation New Dawn

Q35 Was your loved one your spouse?

Yes

No Go to Q37

Q36 Are you aware that Veterans who are married to Veterans are entitled to individual gravesite headstone/marker/medallion benefits?

Yes

No

Q37 What is your gender?

Male

Female

Q38 In what year were you born?

Q39 Do you have any additional comments concerning how the VA Memorial Products Service could improve its services and programs? If your comment is in response to a specific question, please reference the question number.

Q40 [MasterID] Thank you very much for taking the time to complete this questionnaire.

Note: If you would like to be contacted by the cemetery, please write your name and contact information (address or telephone number):

PLEASE mail this completed questionnaire in the enclosed pre-paid envelope as soon as possible. If you have misplaced the pre-paid envelope, you may mail the completed survey to the following address using your own envelope:

DEPARTMENT OF VETERANS AFFAIRS

VA NCA CUSTOMER SATISFACTION SURVEY

PO BOX 3169

Catonsville, MD 21228 If you have any questions about this research, please contact the Survey Help Desk toll free at:

(866) 730-8405.