Specially adapted Housing Survey

VA SPECIALLY ADAPTED HOUSING PROGRAM SURVEY

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 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.

Correct Mark
Incorrect Marks

Please read each question carefully and respond by filling in the circle of the response that most closely
represents your opinion.

3. How accurate was the information that you
received from this source?

Learning about the SAH Program

1. How did you first learn about the VA’s
Specially Adapted Housing (SAH) Program?
(Mark only ONE.)

Entirely accurate
Mostly accurate
Mostly inaccurate
Entirely inaccurate
Don’t know or not sure

Pre-discharge briefings
VA medical facility
VA pamphlets or brochures
VA Office
Other veterans
Lender
Veteran Service Organization
(Select only ONE.)
Disabled American Veterans (DAV)
Paralyzed Veterans of America (PVA)
Veterans of Foreign Wars (VFW)
American Legion
Blinded Veterans of America (BVA)
Vietnam Veterans of America (VVA)
Other (please specify below)
Letter from VA awarding service-connected
disability
Internet
Friends or family
Other (please specify below):

4. How long was it between the time that you
received notice of your 100% disability
rating and the time you learned about the
SAH program?
Less than 1 month
1-2 months
3-4 months
5-6 months
7 months to 1 year
More than 1 year
Don’t remember

Initial Letter of Notification

5. How long after you received your disability
rating did it take for you to receive your
initial letter of notification (26-39 letter) for
the SAH program?

2. Looking back, how much of what you
NEEDED TO KNOW did you get from this
source?

Less than 7 business days
7 business days to one month
One month to three months
More than three months
I did not receive the 26-39 letter (SKIP to Q7)
Don’t remember

All
Most
Some
Little
None

DO NOT WRITE IN THIS AREA

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6. How reasonable was the amount of time
it took to receive your initial letter of
notification (26-39 letter) for the SAH
program?

Program Eligibility and Application

11. From where did you receive correspondence
for the rating decision and your eligibility for
the SAH program? (Mark only ONE.)

Very reasonable
Reasonable
Neither reasonable nor unreasonable
Unreasonable
Very unreasonable
Don’t know or not sure

The SAH agent
The VA Rating Board (who processed
your disability claim)
Veteran Service Organization
(Select only one)
Disabled American Veterans (DAV)
Paralyzed Veterans of America (PVA)
Veterans of Foreign Wars (VFW)
American Legion
Blinded Veterans of America (BVA)
Vietnam Veterans of America (VVA)
Other (please specify below)
Other (please specify below):

7. In your opinion, what is a reasonable
amount of time to receive your initial
letter of notification?
Less than 7 business days
7 business days to one month
One month to three months
More than three months

8. Was your SAH application ever denied in
the past?

12. Did you submit an application (VA Form 264555) for the SAH grant BEFORE receiving
an eligibility rating decision?

Yes
No (SKIP to Q11)
Not applicable, never applied before

Yes
No (SKIP to Q14)
Don’t know or not sure

9. If so, for what reason was your SAH
application denied?

13.

10. Did you appeal your initial C&P eligibility
rating?

Prior to receiving your rating decision, when
you submitted your application (VA Form 264555), how completely did you understand
the eligibility requirements for the grant
program?
Completely
Mostly
Somewhat
Not at all
Don’t know or not sure

14. Were you aware that eligibility for the SAH
program is determined by VA Compensation
& Pension (C&P) Service as a part of your
service-connected disability benefits?

Yes
No
Not applicable

Yes
No
Don’t know or not sure

15. Did you have any problems with the SAH
application (VA Form 26-4555)?
Yes
No (SKIP to Q17)
Don’t know or not sure
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16. What specific problems did you have with
the application? (Mark ALL that apply.)

21. How would you rate the information provided
by the SAH agent (e.g., brochures, pamphlets,
video, and handbook)?

It asked for information I felt VA should
already have
It asked for information that was difficult to
supply
Print was hard to read
Some questions were not clear or were
confusing
Some instructions were confusing
Other (please specify below):

Excellent
Good
Fair
Poor
Don’t know or not sure

22. Overall, how would you rate the SAH agent’s
communication with you?
Excellent
Good
Fair
Poor
Don’t know or not sure

17. How completely did VA keep you informed
about the status of your SAH application or
grant process?
Completely - I always knew my status
Mostly - I had a few questions
Somewhat - I had a lot of questions
Not at all - I knew nothing about my status
Don’t know or not sure

23. Were there times the SAH agent, or other
VA employee gave you answers to
questions that appeared to be inconsistent
with the answer from another VA staff
person?
Yes
No
Don’t know or not sure

SAH Contact(s)/Communication

18. Did initial contact with your SAH agent occur
within 30 working days after you received
your initial letter of notification (26-39 letter)
for the SAH program?

24. Was your SAH agent the same person
throughout the entire process (i.e., initial
interview, planning and processing of
grant)?

Yes
No
Don’t know or not sure

Yes (SKIP to Q26)
No
Don’t know or not sure

19. Did the SAH agent inform you of other VA
resources or programs for which you might
be eligible?

25. Did the change in SAH agents create a
problem for you?

Yes
No (SKIP to Q22)
Don’t know or not sure

Yes
No
Don’t know or not sure

20. Which resources did your SAH agent
identify? (Mark ALL that apply.)

26. Were you involved in decisions about the
planned adaptations as much as you
wanted to be?

VA Vocational Rehabilitation and
Employment Independent Living Program
Home Improvement and Structural
Alteration (H.I.S.A.) Grant
Other

Yes
No
Don’t know or not sure

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33. Aside from scheduled visits, what was the
method you most often used to contact the
SAH agent? (Mark only ONE.)

27. Were you able to spend as much time with
the SAH agent as you wanted?
Yes
No
Don’t know or not sure

Phone (Toll Free call)
Phone (local call)
Fax
E-mail (computer)
Letter
No contact beyond scheduled visits

28. Did you have confidence and trust in the
SAH agent you worked with?
Yes
No
Don’t know or not sure

34. What method do you prefer VA use to
contact you regarding your SAH benefits?
(Mark only ONE.)
Telephone
E-mail
Personal visit
Letter

29. Did the SAH agent treat you with respect
and dignity?
Yes
No
Don’t know or not sure

35. If you called the SAH agent, what happened
when you called to discuss your grant with
the SAH agent? (Mark ALL that apply.)

30. Did the SAH agent show consideration for
your family and friends?

My call was answered promptly
The phone rang many times before it was
answered
I talked to several people before talking to
the right person
I left a message and was called back
I left a message and no one called me back
I was disconnected
Other (please specify below):

Yes
No
Don’t know or not applicable

31. If authorized, did the SAH agent talk to your
family and/or friends about your health care
or an adaptive item?
Yes (SKIP to Q33)
No
Don’t know or not applicable

36. How responsive was the SAH agent to your
questions and inquiries?
32. If the SAH agent did NOT talk with your
family and/or friends about your health care
or adaptive features, was it because . . . ?
(Mark ALL that apply.)

Very responsive
Somewhat responsive
Somewhat unresponsive
Very unresponsive
Don’t know or not sure

The SAH agent did not appear to have the
time to listen to my concerns
The SAH agent did not ask about my
concerns
The SAH agent was not readily accessible
Too many interruptions/ no privacy
Other (please specify below):

37. Were you generally able to get all of the
information you needed on the first call or
contact?
Yes
No
Don’t know or not sure

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38. If the SAH agent was unavailable, were
other VA staff members responsive to the
questions you had about your grant?
(Mark only ONE.)

43. For your Type A grant, which of the available
plans did you choose? (Mark only ONE.)
Housing to be built on land to be acquired
Housing to be built on land previously
acquired
Remodel an existing home
Acquired an existing home already adapted
Other (please specify below):

Yes
No
I didn’t have any questions
The SAH agent was always available
Don’t know or not sure

39. When you met or telephoned the SAH agent,
did he/she give you a chance to discuss the
modifications you wanted?

44. For your Type A grant, was the plan that you
ultimately chose your first choice?

Yes
No
Don’t know or not sure

Yes (SKIP to Q51)
No (GO to Q45)
Don’t know or not sure (SKIP to Q51)

40. How would you rate the courtesy of your
SAH agent?

45. Which Plan Type was your first choice?
(Mark only ONE.)

Very courteous
Courteous
Neither courteous nor discourteous
Discourteous
Very discourteous
Don’t know or not sure

Housing to be built on land to be acquired
Housing to be built on land previously
acquired
Remodel an existing home
Acquired an existing home already adapted
Other (please specify below):

41. How courteous were the other VA employees
you dealt with?
46. Why did you choose an alternate plan?
(Mark ALL that apply.)

Very courteous
Courteous
Neither courteous nor discourteous
Discourteous
Very discourteous
Don’t know or not sure
Not applicable

The house wasn’t feasible for SAH
adaptation (SKIP to Q51)
The house didn’t meet SAH requirements
(SKIP to Q51)
The original plan was too expensive
(SKIP to Q51)
Didn’t have time (SKIP to Q51)
SAH agent advised me (SKIP to Q51)
Other (please specify below):

Grant Type and Plans

42. Which SAH grant did you receive?
(Mark only ONE.)
Type A (Paraplegic Housing). (GO to Q43)
Type B (Adaptive Housing). (SKIP to Q47)
Don’t know or not sure (SKIP to Q51)

Please continue on the next page.

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47. For your Type B grant, which of the following
plans did you choose? (Mark only ONE.)

Receiving the Grant Funds

51. Did you receive the maximum grant amount?

Adapted a house that was purchased
Adapted a house which a family member
purchased
Adapted a house that was already owned
Adapted a house already owned by a
family member
Purchased a house which has already
been adapted
Other (please specify below):

Yes (SKIP to Q53)
No
Don’t know or not sure

52. At the beginning of the grant process, how
completely did you understand the amount
that the grant would provide?
Completely
Mostly
Somewhat
A little
Not at all
Don’t know or not sure

48. For your Type B grant, was the plan that you
chose your first choice?
Yes (SKIP to Q51)
No
Don’t know or not sure (SKIP to Q51)

53. How would you rate the adequacy of the
grant amount provided by the Specially
Adapted Housing program?

49. Which Plan Type was your first choice?
(Mark only ONE.)

Very adequate (SKIP to Q58)
Somewhat adequate (SKIP to Q58)
Somewhat inadequate
Very inadequate
Don’t know or not sure (SKIP to Q58)

Adapted a house that was purchased
Adapted a house which a family member
purchased
Adapted a house that was already owned
Adapted a house already owned by a
family member
Purchased a house which has already
been adapted
Other (please specify below):

54. What was the PRIMARY reason the grant
amount provided by the Specially Adapted
Housing Program was inadequate?
(Mark only ONE.)
Maximum Loan Amount was not sufficient to
cover the costs and requirements for
adaptation of the house.
I incurred significant out-of-pocket expenses.
Housing in the area is very expensive, which
limited adaptations.
It was hard to find a contractor willing to
do work for the amount of money the grant
provided.
Other (please specify below):

50. Why did you choose an alternate plan?
(Mark ALL that apply.)
The house wasn’t feasible for SAH
adaptation
The house didn’t meet SAH requirements
The original plan was too expensive
Didn’t have time
SAH agent advised me
Other (please specify below):

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55. Would your adaptation plans have changed if
you had been permitted to use the available
grant funds on more than one occasion?

Using the SAH Grant: Adaptive Items

61. How long did it take for your new specially
adapted house to be built or existing home
to be modified? (Mark only ONE.)

Yes
No (SKIP to Q57)
Not sure

15-30 days
30-60 days
60-90 days
90-120 days
More than 120 days

56. Would you have used a portion of the
available grant funds to adapt a family
member’s home to meet your needs?
Yes
No
Not sure

62. For which adaptive items (i.e., ramps, grab
bars, wide doorways and hallways) did you
have to use your SAH grant?
(Mark ALL that apply.)

57. Would you have utilized the SAH grant if it
was available to you while you were still on
Active Duty?

Ramp(s) (exterior or interior)
Grab bars
Wider door opening
Wider hallways
Accessible bathroom(s)
Accessible kitchen
Accessible bedroom(s)
Elevators, ramps or entrances on ground floor
Level thresholds
Lighting
Garage construction or modification
Other (please specify below):

Yes
No
Not sure

58. In conjunction with your SAH grant, did you
obtain a VA home loan from a private lender?
Yes
No (SKIP to Q61)
Don’t know or not sure

63. Were there any items or features that you
believe are necessary for you to
successfully live independently, but that the
SAH grant amount did not cover?

59. How would you rate your lender’s attitude
toward helping you with your financial
needs?
Excellent
Good
Fair
Poor

60. How reasonable was the amount of time it
took your lender to process your loan?
Very reasonable
Reasonable
Neither reasonable nor unreasonable
Unreasonable
Very unreasonable
Don’t know or not sure
Please continue on the next page.

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64. Overall, how would you rate the adequacy of
the adaptive items (e.g., ramps, grab bars)
that were installed in your house using your
SAH grant? (Mark only ONE.)

Satisfaction with Contractor

67. How many bids were requested from
licensed contractors?

Very adequate (SKIP to Q66)
Adequate (SKIP to Q66)
Inadequate
Very inadequate
Don’t know or not sure (SKIP to Q66)

1
2
3 or more

68. How difficult was it to identify contractors in
your area?

65. Please explain why the adaptive items that
were installed in your house were
inadequate.

Extremely easy
Easy
Neither easy nor difficult
Difficult
Very difficult

69. With regard to adapted housing designs,
how knowledgeable was the contractor?
Very knowledgeable
Somewhat knowledgeable
Somewhat unknowledgeable
Very unknowledgeable
66. Please select the adaptive items that you
believe are the most important to living
independently. (Rank TOP 3 adaptive
items in order of importance.)
(Mark only one.)
(Mark only one.)
(Mark only one.)

70. How responsive was the contractor after the
contract was accepted?
Very responsive
Somewhat responsive
Somewhat unresponsive
Very unresponsive

#3 in Importance
#2 in Importance
#1 in Importance

Ramp(s) (exterior or interior) . . . . . . . . .
Grab bars . . . . . . . . . . . . . . . . . . . . . . . . . .
Wider door opening . . . . . . . . . . . . . . . . .
Wider hallways . . . . . . . . . . . . . . . . . . . . . .
Accessible bathroom(s) . . . . . . . . . . . . . .
Accessible kitchen . . . . . . . . . . . . . . . . . .
Accessible bedroom(s) . . . . . . . . . . . . . .
Elevators, ramps or entrances
on ground floor . . . . . . . . . . . . . . . . . . . . . .
Level thresholds . . . . . . . . . . . . . . . . . . . .
Lighting . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Garage construction or modification . .
Other (please specify below):

71. Did the contractor complete the work as
planned?
Yes (SKIP to Q75)
No
Don’t know or not sure

72. Was the work completed correctly?
Yes
No
Don’t know or not sure

73. Was the work completed on time?
Yes
No
Don’t know or not sure

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74. Please explain why the contractor did not
complete the work:

Overall Impressions of the
Specially Adapted Housing Program

78. Overall, how satisfied are you with the SAH
Program (e.g., application process, maximum
loan amount, services, etc.)?
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied

79. Would you recommend the VA Specially
Adapted Housing Grant Program to other
veterans with service-connected
disabilities?

Satisfaction with Inspector

75. The inspector answered all my questions
regarding the construction inspection
process.

Yes
No
Don’t know or not sure

Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Don’t know or not sure

80. Now that you have been in your specially
adapted home for awhile, how well have the
adaptations met your expectations?
(Mark only ONE.)
The adaptations exceeded my expectations
The adaptations met my expectations
The adaptations were below my
expectations
The adaptations were far below my
expectations

76. The inspector treated me with respect and
dignity.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Don’t know or not sure

81. Do the housing adaptations help you live
more independently?
Yes
No
Don’t know or not sure

77. How satisfied are you with the inspector’s
performance?
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
Don’t know or not sure

Please continue on the next page.

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82. If you were not able to use the SAH grant
program, what would be your most likely
housing situation? (Mark only ONE.)

83. Does getting a SAH grant help you feel that
the Nation recognizes your service to our
country?

Live in a nursing home
Live in the same house or apartment,
without adaptations
Live with a family member or a friend
Other living situation (specify below):

Yes
No

Don’t know or not sure

PLEASE DO NOT WRITE
IN THIS AREA

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84. If you could change one thing about the Specially Adapted Housing Grant program or service
you recieved from the VA, what would it be? (Please specify below.)

85. Do you have any other comments? (Please specify below.)

Thank you for taking the time to complete this survey. Your answers are very important
to us. Please return your questionnaire in the postage-paid envelope.

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DO NOT WRITE IN THIS AREA

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RD24065-PFI-54321