Sample NCA2020 State and Tribal English Survey.pdf

PDF 147 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 administration of its customer satisfaction survey program over a potential five-year period. The contractor will develop and manage four surveys: the National Cemeteries Next-of-Kin/Family Member Satisfaction Survey, the VA Memorial Products Next-of-Kin/Family Member Satisfaction Survey, the State or Tribal Veterans Cemeteries Next-of-Kin/Family Member Satisfaction Survey, and the Funeral Director Satisfaction Survey. Key responsibilities include survey instrument design, translation, web and print administration, sampling, data analysis, and reporting. The contractor must also provide project management tools, technical assistance, and strategic measures reporting. The award will be a firm-fixed-price contract to the responsible offeror providing the best overall benefit. The period of performance is the date of award through one base year and four option years. Quotes are due by January 8, 2021.

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36C78621Q0056.docx	DOCX document	Dec 21, 2020
SOW.pdf	PDF	Dec 21, 2020

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

U.S. DEPARTMENT OF VETERANS AFFAIRS

NATIONAL CEMETERY ADMINISTRATION

STATE OR TRIBAL VETERANS 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 of the response 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 293997-3

[MASTER ID]

2020 State or Tribal Veterans Cemeteries Satisfaction Survey

Q1 Since the committal service, how many times have you visited the State or Tribal Veterans 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 State or Tribal Veterans 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 State or Tribal Veterans Cemetery where your loved one is interred? (Mark all that apply)

Distance to 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 State or Tribal Veterans 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

Another Veteran/active duty member

State or Tribal/VA/NCA pamphlet, brochure, newsletter

State or Tribal/VA/NCA website

State or Tribal/VA/NCA/ social media (Facebook or Twitter)

Veterans Service Organization

Other State, Tribal, or VA organization

Local newspaper/television news report

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

Professional/military association meeting

Q7 Prior to the time of need, what do you think is the BEST way for the State or Tribal Veterans Cemetery to convey information regarding benefits?

E-mail

State or Tribal/VA/NCA website

State or Tribal/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 that you were provided throughout your experience with the State or Tribal Veterans Cemetery?

Very satisfied

Somewhat satisfied

Neither satisfield nor disatisfied

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 informed

Very uninformed

Q10 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 religeous 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 accomodations

No, my family did not have any special needs or requests Go to Q12

Q11 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

Q12 In what religious practice was the burial conducted?

Christian

Catholic

Muslim

Jewish

Buddist

Hindu

Atheist

Agnostic

None

Other (specify):

Q13 Prior to the service for your loved one, did you view the NCA videos illustrating different committal service options at State and Tribal Veterans Cemeteries?

Yes, I viewed it online

Yes, the funeral director provided it

No go to Q16

Q14 Please indicate your level of agreement with the following statement: The video(s) helped me understand the burial process at the State or Tribal Veterans Cemetery.

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

Q15 Was your experience at the State or Tribal Veterans Cemetery similar to the video on service options you viewed?

Yes

Q16 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

Q17 Overall, how satisfied were you with the committal service at the State or Tribal Veterans Cemetery?

Very satisfied

Somewhat satisfied

Neither satisfied nor dissatisfied

Somewhat dissatisfied

Very dissatisfied

Q18 Were the headstone, marker, or columbarium niche cover inscription options explained to you?

Yes

Not sure/don't know

Q19 Did you feel you had sufficient time to make a decision on the headstone, marker, or columbarium niche cover inscription?

Yes

Q20 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 Q23

Q21 When the headstone, marker, or columbarium niche cover arrived, was the inscription accurate?

Yes

Don't know

Q22 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 Question 26.

Q23 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 Q26

Q24 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