Sample NCA2020 NOK English Survey.pdf

PDF 146 KB Posted Dec 21, 2020

Attached to: B550--NCA Customer Satisfaction Survey. Base plus 4 years. Federal contract opportunity
Solicitation number: 36C78621Q0056
Issued by: Department of Veterans Affairs National Cemetery Administration

About this file

Written by GovTribe AI · Dec 28, 2023

This is a Request for Quotes (RFQ) from the Department of Veterans Affairs National Cemetery Administration for a base year plus four option years of customer satisfaction survey administration services. Key details include:

Surveys include the National Cemeteries Next-of-Kin/Family Member Satisfaction Survey, VA Memorial Products Next-of-Kin/Family Member Satisfaction Survey, State or Tribal Veterans Cemeteries Next-of-Kin/Family Member Satisfaction Survey, and Funeral Director Satisfaction Survey.
Services required are survey development, translation, web and paper administration, sampling, analyses, and annual strategic and national reporting for burial programs.
The period of performance is the date of award through 365 days for the base year, with four option years that can be exercised.
The solicitation is set aside for Service-Disabled Veteran-Owned Small Businesses. Quotes are due by January 8, 2021. Award will be fixed price. Evaluation will consider technical approach, past performance, and price.

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

U.S. DEPARTMENT OF VETERANS AFFAIRS

NATIONAL CEMETERY ADMINISTRATION:

NATIONAL CEMETERIES 2020 NEXT OF KIN/FAMILY

MEMBER SATISFACTION SURVEY

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:The survey will take about 20 minutes to complete. Please read each question carefully and respond by filling in the square that most closely represents your opinion.

• Use pencil or pen. Make heavy dark marks that fill the square 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

[MASTER ID]

2020 Next of Kin Satisfaction Survey

Q1 Since the committal service, how many times have you visited the national cemetery where your loved one was interred?

1-3 times

4-6 times

7-9 times

10 or more times

None, I have not visited

Q2 How far do you reside from the national cemetery?

Less than 15 miles

15 to 29 miles

30 to 44 miles

45 to 59 miles

60 to 75 miles

More than 75 miles

Q3 Which of the following factors limit the number of times you visit the national cemetery where your loved one is interred? (Mark all that apply)

Distance to the national cemetery

Access to transportation

Health status

Other (specify):

Q4 Have you ever served on active duty in the U.S. Armed Forces, either in the regular military or a National Guard or Reserve Unit?

Yes

Q5 Prior to the time of need, were you aware of the benefits related to burial in a national cemetery?

Yes

No Go to Q7

Q6 How did you learn of these benefits prior to your time of need? (Mark all that apply)

Family member/friend

Pre-Need burial eligibility determination

Funeral home

Military discharge related materials

Other Veteran/active duty member

VA/NCA pamphlet, brochure, newsletter

VA/NCA website

VA/NCA social media

Veterans service organization

Other VA organization

Local newspaper/news report

Public events

Professional/military association meetings

Q7 Prior to the time of need, what do you think is the BEST way for the national cemetery to convey information regarding benefits?

E-mail

VA/NCA website

VA/NCA social media (Facebook or Twitter)

Newsletter/flyer

Local newspaper/television news reports

Public events (e.g., parades, speeches)

Professional/military association meetings

Other (specify):

Q8 Overall, how satisfied are you with the information you were provided throughout your experiences with the national cemetery?

Very Satisfied

Somewhat satisfied

Neither satisfied nor dissatisfied

Somewhat dissatisfied

Very dissatisfied

Q9 To what extent were you informed of the details (e.g., length of service, use of committal shelters) related to the committal service prior to attending the service?

Very Informed

Somewhat informed

Neither informed nor uninformed

Somewhat uninformed

Very uninformed

Q10 Did you or a family member personally schedule the interment through the National Cemetery Scheduling Office (1-800-535-1117)?

Yes

No, a funeral director scheduled it on my behalf Go to Q12

Don’t know Go to Q12

Q11 How satisfied were you with the service you or your family member received from the National Cemetery Scheduling Office?

Very Satisfied

Somewhat Satisfied

Neither satisfied nor dissatisfied

Somewhat dissatisfied

Very dissatisfied

Q12 At the committal service, did your family have any of the following special needs or requests? (Mark all that apply)

Visit the gravesite

View the burial

Specific religious practices (e.g. blessing the gravesite)

Specific cultural practice (e.g. spreading placement of earth/soil into the grave)Additional seating at the committal service

Handicapped accommodations

No, my family did not have any special needs or requests Go to Q14

Q13 Was the cemetery able to accommodate these special needs or requests to your satisfaction?

Yes, completely

Yes, somewhat

No, and I understand why

No, and I do not understand why

Q14 In what religious practice was the burial conducted?

Christian

Catholic

Muslim

Jewish

Buddhist

Hindu

Atheist

Agnostic

None

Other (specify):

Q15 Prior to the service for your loved one, did you view the NCA videos illustrating different committal service options at VA national cemeteries?

Yes, I viewed it online

Yes, the funeral director provided it

No Go to Q18

Q16 Please indicate your level of agreement with the following statement: The video(s) helped me understand the burial process at the national cemetery.

Strongly Agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

Q17 Was your experience at the national cemetery similar to the video on service options you viewed?

Yes

Q18 If your loved one received military funeral honors, how satisfied were you with the quality of the honors received?

Very satisfied

Somewhat satisfied

Neither satisfied nor dissatisfied

Somewhat dissatisfied

Very dissatisfied

My loved one did not receive military funeral honors

Q19 Overall, how satisfied were you with the committal service at the national cemetery?

Very satisfied

Somewhat satisfied

Neither satisfied nor dissatisfied

Somewhat dissatisfied

Very dissatisfied

Q20 Were the headstone, marker, or columbarium niche cover inscription options explained to you?

Yes

Not sure/don't know

Q21 Did you feel you had sufficient time to make a decision on the headstone, marker, or columbarium niche cover inscription?

Yes

Q22 How satisfied were you with the length of time it took for the permanent headstone, marker, or columbarium niche cover to be in place?

Very satisfied

Somewhat satisfied

Neither satisfied nor dissatisfied

Somewhat dissatisfied

Very dissatisfied

Don’t know/the marker or headstone has not yet arrived Go to Q25

Q23 When the headstone, marker, or columbarium niche cover arrived, was the inscription accurate?

Yes

Don't know

Q24 Overall, how satisfied were you with the quality and appearance of the headstone, marker, or columbarium niche cover when it arrived?

Very satisfied

Somewhat satisfied

Neither satisfied nor dissatisfied

Somewhat dissatisfied

Very dissatisfied

If your loved one was NOT a Veteran, please go to Q28.

Q25 If your loved one was a Veteran; did you receive a certificate signed by the President of the United States honoring the Veteran’s service?

Yes

No Go to Q28

Q26 How satisfied were you with the quality of the certificate signed by the President of the United States honoring the Veteran’s service? (Mark all that apply.)

Very Satisfied

Satisfied

Neither satisfied nor dissatisfied

Somewhat dissatisfied

Very dissatisfied

Envelope was bent/torn

Name was misspelled

Poor print quality