Veterans Benefits Administration (VBA) Loan Guaranty Service (LGY) Customer Statisfaction Surveys

2008 VA SPECIALLY ADAPTED HOUSING: ELIGIBLE NON-GRANTEE SURVEY
OMB Control Number: 2900-

– Public Reporting Burden Statement

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 5 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. Failure to furnish the requested
information will have no adverse affect on any VA benefits 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 VA
benefits processing system and for associated administrative purposes. If you have comments regarding this burden estimate or any aspects of this collection of information, call
1-800-827-1000 for mailing information on where to send your comments.

3. If YES to Q1: From which source did you first
learn about the program? (Mark only ONE.)

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

Letter from VA which awarded benefits for
my service-connected disability
Pre-Discharge Briefings (TAP/DTAP)
VA Benefits Counselor
Lender or Real Estate Agent
VA Medical Center or clinic
Another Veteran
Internet site
VA pamphlet or brochure
Veteran Service Organization
Other (please specify below):

Incorrect Marks

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

1. Prior to receiving this survey, were you
aware of VA's Specially Adapted Housing
grant program?
Yes (GO to Q3)
No (GO to Q2)

4. Did you ever submit an application for the
Specially Adapted Housing grant program
(VA Form 26-4555)?
Yes (GO to Q6)
No (GO to Q5)
Don't remember/Don't know (GO to Q6)
5. If NO to Q4: What is the major reason
you never submitted an application?

2. If NO to Q1: Which of the following would
have been the BEST way for VA to inform
you about the Specially Adapted Housing
grant program?

I want to apply, but am unsure about how
to apply for the grant
My current home meets my needs
I do not want to use the grant
I plan on moving in the future, and want
to wait to use my grant at that time
The application and/or grant process
seemed too time consuming
The application and/or grant process
seemed too complex or complicated
The available SAH grant amount was not
large enough to accommodate my needs
I elected to use an alternative source of funding

Letter from VA which awarded benefits for
my service-connected disability
Pre-Discharge Briefings (TAP/DTAP)
VA Benefits Counselor
VA Medical Center or clinic
VA pamphlet or brochure
Internet site
Other (please specify below):

If you responded to Q2, you have completed
the survey. Please return your questionnaire
in the postage-paid envelope. Thank you.

If you responded to Q5, you have completed
the survey. Please return your questionnaire
in the postage-paid envelope.
Thank you.

DO NOT WRITE IN THIS AREA

6. If YES to Q4: Did you have an initial
in-person interview with the VA Specially
Adapted Housing Agent, to discuss the
grant program and process?

10. Did you encounter any difficulties or
problems during the Specially Adapted
Housing grant approval process?
Yes (GO to Q11)
No (GO to Q12)

Yes (GO to Q7)
No (GO to Q8)
Don't know/Not sure (GO to Q8)
11.
7. If YES to Q6: After this interview, did you
understand the Specially Adapted Housing
grant process enough to proceed with
obtaining the grant?
Yes
No

8. If YES to Q7: Did you also submit
Supplemental Application (VA Form
26-4555c) to obtain the Specially Adapted
Housing grant?
Yes (GO to Q10)
No (GO to Q9)
Don't know/Don't remember (GO to Q12)

9. If NO to Q8: What is the major reason you did
not submit the Supplemental Application?
I had difficulty completing the Supplemental
Application forms
I felt the Supplemental Application asked for
information that I should not have to provide
The application and/or grant process
seemed too time consuming
The application and/or grant process
seemed too complex or complicated
I realized the SAH Grant amount was not
large enough to accommodate my needs
I elected to use an alternative source of
funding
Other (please specify below):

If you responded to Q9, you have completed
the survey. Please return your questionnaire
in the postage-paid envelope.
Thank you.

If YES to Q10: What part or parts of the
Specially Adapted Housing grant approval
process presented the most difficulty for
you? (Mark all that apply.)
Securing the services of a contractor
Obtaining a performance bond
Developing the building/remodeling plans
Obtaining medical and/or contractor bid
waivers
Providing all the necessary financial
information
Obtaining other documentation
(please specify below):

Other problems (please specify below):

12. What was the major factor that ultimately
prevented you from obtaining or using
Specially Adapted Housing grant funds?
(Mark only ONE.)
My Supplemental Application (VA Form
26-4555c) was denied
I decided to defer using my grant to a later
time
I decided that I no longer needed the grant
I did not have enough help from VA during
the grant application process
The application and/or grant process
seemed too complex or complicated
I realized that the Specially Adapted Housing
grant was not large enough to accommodate
my needs
I found an alternative source of funding
Other (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.

RD24159-PFI-54321