National Survey of Veterans, Active Duty Service Members, Activated National Guard and Reserve Members, Family Members and Survivors

National Survey of Veterans, Active Duty Service Members, Activated National Guard and Reserve Members, Family Members and Survivors

Veteran Survey 03APR2009

National Survey of Veterans, Active Duty Service Members, Activated National Guard and Reserve Members, Family Members and Survivors

OMB: 2900-0732

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Department of Veterans Affairs
National Survey of Veterans (NSV)
Veteran Survey

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information
unless it displays a valid OMB control number. The valid OMB control number for this information collection is xxx-xxxx.
The time required to complete this information collection is estimated to average 35 minutes per response, including the
time to review instructions, search existing data resources, gather the data needed, and complete and review the
information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving
this form, please write to: VA, xxxx

If you have any questions or concerns, please call the NSV Survey Helpline at 1-888-NSV-2009 or send an
email to NSV@westat.com

Instructions to Complete the Survey



To answer a question, simply check the box that best represents your answer.



You will sometimes be asked to skip questions based on your answers. In addition, certain
sections of the questionnaire may not apply to you.



Please choose only one answer per question, unless the question indicates Mark all that
apply.

A3.

Section A
Background Questions
A1. Have you ever served on active duty in the
U.S. Armed Forces?

When did you serve on active duty in the U.S.
Armed Forces? Mark all that apply.
September 2001 or later
August 1990 to August 2001 (includes
Persian Gulf War)

Yes, now on active duty

May 1975 to July 1990

Yes, on active duty in the past, but not
now  Go to Question A1b

Vietnam era (August 1964 to April 1975)

No, never on active duty except for
initial/basic training

February 1955 to July 1964

No, never served in the U.S. Armed Forces

January 1947 to June 1950

Korean War (July 1950 to January 1955)
World War II (December 1941 to December
1946)

A1a. Thank you. This survey is intended for
Veterans of active duty service. Please return
the survey in the enclosed pre-paid return
envelope.

November 1941 or earlier

A4.

A1b. Was any of this active duty service part of a
mobilization or activation while serving as a
member of the National Guard or Reserve
Component?

Did you deploy in support of Operation
Enduring Freedom (OEF) or Operation Iraqi
Freedom (OIF)?
Yes
No

Never served on active duty as a member of
the National Guard/Reserve Component

A5.

Yes, served on active duty while in the
National Guard/Reserves (and I am still
serving in the National Guard/Reserves)

In what year did you first enter active duty?
Year

Yes, served on active duty while in the
National Guard/Reserves (and have
separated/retired from the National
Guard/Reserves)

A6.

In what year were you last released from
active duty?
Year

A2.

In which branch or branches did you serve on
active duty? Mark all that apply.

A7.

Army

Did you ever serve in a combat or war zone?
[NOTE: Persons serving in a combat or war
zone usually receive combat zone tax
exclusion, imminent danger pay, or hostile
fire pay.]

Navy
Air Force
Marine Corps

Yes

Coast Guard

No

Other (e.g., the Public Health Service, the
Environmental Services Administration, the
National Oceanic and Atmospheric
Administration, U.S. Merchant Marine)

A8.

During your military service, were you ever
exposed to dead, dying, or wounded people?
Yes
No

1

A9.

Were you ever a prisoner of war?

B2.

Yes
No

Below is a list of topics about Veteran’s
benefits and services. Please indicate
whether you have looked for information on
these in the past 12 months.
Yes No

A10. During your military service, were you ever
exposed to environmental hazards such as
Agent Orange, chemical warfare agents,
ionizing radiation, or other potentially toxic
substances?

a. Eligibility for VA health care
b. Locating a VA health care facility (such as
a VA hospital or medical center)
c.

VA life insurance

d. VA home loans

Definitely Yes

e. VA education and training

Probably Yes

f.

Probably No

VA vocational rehabilitation

g. VA burial and memorial benefits

Definitely No

h. VA disability compensation and pension

Don’t know

Section B
Familiarity With Veteran Benefits
B1. Please indicate how much you agree or
disagree with the following statements regarding
the Veterans benefits provided by Department of
Veterans Affairs (VA).

i.

VA benefits for dependents and survivors

j.

VA transition assistance

k.

VA prescription benefits

B3.

While you were on active duty, did you attend
any of the transition assistance workshops
known as the Transition Assistance Program
(TAP) or the Disabled Transition Assistance
Program (DTAP)?
Yes
No  Go to Section C

B3a. How useful did you find the transition
program in providing information about VA
benefits and services?

a. I thoroughly understand
the Veteran’s benefits
that are available to me.
b. I thoroughly understand
the Veteran’s health care
benefits I’m entitled to.
c. I thoroughly understand
the Veteran’s burial
benefits available to me.
d. I thoroughly understand
the Veteran’s education
and training benefits I’m
entitled to from VA.
e. I thoroughly understand
the Veteran’s life
insurance benefits I’m
entitled to.
f. I thoroughly understand
the Veterans Home Loan
Guaranty benefits I’m
entitled to.

Very useful
Useful
Somewhat useful
Not useful

B3b. Please indicate how much you agree or
disagree with the following statement.
I have a thorough understanding of what VA
benefits are available based on the VA
benefits briefing.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Section C appears on the next page.

2

B3c. How beneficial was the VA benefits portion of
the briefing?

C2.

Do you have a VA service-connected
disability rating?

Very beneficial

Yes

Somewhat beneficial

No  Go to Question C3

Not at all beneficial

C2a. What is your current VA service-connected
disability rating?

B3d. Was the VA benefits presenter
knowledgeable on the subject?

0 percent

Very knowledgeable

10 or 20 percent

Somewhat knowledgeable

30 to 40 percent

Not at all knowledgeable

50 to 60 percent
70 percent or higher
Don’t know

Section C
Disability and Vocational Rehabilitation
C1. Have you ever applied for VA disability
compensation benefits?

C2b. Has your VA service-connected disability ever
prevented you from getting or holding a job?
Yes

Yes  Go to Question C2

No  Go to Question C3

No

C2c. Does your VA service-connected disability
currently keep you from getting or holding a
job?

C1a. What are the reasons you haven’t applied for
any VA disability benefits? Mark all that apply.
Don’t have a service-connected disability

Yes

Not aware of VA service-connected disability
program

No

Don’t think I’m entitled or eligible

C3.

Getting military disability pay
Getting disability income from another source

What is the status of your most recent claim
application?
Approved

Don’t think disability is severe enough

Waiting for decision from VA regional office

Don’t know how to apply

Waiting for decision from the board of appeals

Don’t want any assistance
Don’t need assistance

Denied

Applying is too much trouble or red tape

Don't know

Never thought about it
Other  Please specify below

C4.

Are you currently receiving monthly disability
payments from VA?
Yes
No  Go to Question C7

Don’t know
QUESTION C1a SKIPS TO SECTION D
ON PAGE 5 

C5.

Please indicate what sort of VA disability
income you are receiving. Mark all that apply.
Service-connected disability compensation
Non-service-connected disability pension

Question C7 appears on the next page.

Question C2 appears in the next column.

3

C6.

During the past year, how important was the
disability payment benefit you received from VA
in helping you meet your financial needs?

C10. If you are employed, what VA services were
helpful to you in obtaining a job? Mark all that
apply.

Extremely important

Educational services

Very important

Financial assistance

Moderately important

Job development training

Slightly important

Job placement services

Not at all important
Don’t know

C7.

Not employed
Other  Please specify below

Have you ever used vocational rehabilitation
services from VA?
Yes  Go to Question C9

C11. If you used VA vocational rehabilitation
benefits but were also eligible for GI Bill
benefits, why did you choose VA vocational
rehabilitation services? Mark all that apply.

No

C8.

What are the reasons you have not used any
VA vocational rehabilitation services? Mark all

Financial benefit

that apply.

Don’t have a service-connected disability

Payment of tuition and books

Didn’t think disability was severe enough

Length of training program

Didn’t know how to apply for or get needed
benefits

Support of VA vocational rehabilitation
counselor

Didn’t want financial assistance from VA

Assistance in finding employment

Didn’t need financial assistance from VA

Referral for medical or dental benefits

Applying was too much trouble or red tape

Other  Please specify below

Never considered applying
Got assistance from somewhere else
Got better/didn’t need assistance any more

C12. Why did you stop participating in the VA
vocational rehabilitation program?

Just had claim approved
Other  Please specify below

Not applicable—I am still in the program
 Go to Section D
Completed my program  Go to Question C14
Financial barriers

QUESTION C8 SKIPS TO SECTION D
ON PAGE 5 

C9.

Changed jobs
Medical reasons

How important were these VA vocational
rehabilitation services in helping you meet
employment goals or in helping you get a job?

Other  Please specify below

Extremely important
Very important
Moderately important
Slightly important
Not at all important

Question C14 appears on the next page.
Section D appears in the next column.

4

C13. If you discontinued a VA vocational rehabilitation
program, what services could have helped you
complete your program? Mark all that apply.

D3.

In the past week, have you required
assistance in the following activities due to
a health condition?

Financial support
Flexible training program
Job placement services
Independent living services
Other  Please specify below

a. Bathing
b. Eating
c.

QUESTION C13 SKIPS TO
SECTION D BELOW

Transferring from bed or a
chair

d. Using the toilet

C14. If you completed the VA vocational
rehabilitation program, what services helped
you complete your program? Mark all that

e. Walking around your home
f.

apply.

Dressing

g. Preparing meals

Testing and evaluation

h. Managing your money

Guidance and counseling
Training and education

i.

Doing household chores

Medical and dental referral

j.

Using the telephone

k.

Taking medications properly

Financial support
Job placement
Employment follow-up

D4.

Other  Please specify below

Are you currently in need of the aid and
attendance of another person or are you
permanently housebound?
Yes
No

Section D
Health Status
D1. In general, would you say your health is…

D5.

Have you smoked at least 100 cigarettes in
your entire life?
Yes

Excellent

No

Very good
Good

D6.

Fair
Poor

Do you now smoke cigarettes every day,
some days, or not at all?
Every day

D2.

How would you rate the health of your teeth
and gums? Would you say it is…

Some days
Not at all
No response

Excellent
Very good
Good
Fair
Poor

5

E3.

Section E
Health Care
E1. Have you ever been enrolled in VA health
care?

No, no need for health care services at all
Yes – I received services at VA / VA paid for
services

Yes
No

No – I did not receive VA services / VA did not
pay for services

Don’t know

E2.

In the last 6 months, did you use any VA
health care services, or did you have any of
your health care paid for by VA?

Don’t know/Don’t remember

Have you ever used any VA health care
benefits?

E3a. What were the reasons you didn’t use the VA
health care services in the past six months?

Yes  Go to Question E3
No

Mark all that apply.

Don’t know

Do not need any care
Not aware of the VA health care benefits

E2a. What are the reasons you never used any VA
health care benefits? Mark all that apply.

Do not believe self entitled or eligible for
health care benefits

Did not need any care

Bad prior experience

Not aware of VA health care benefits

Do not know how to apply for health care
benefits

Not entitled or eligible for health care benefits
Do not know how to apply for health care
benefits

Do not need or want assistance from VA
Applying for health care benefits too much
trouble or red tape

Did not need or want assistance from VA
Too much trouble or red tape

Never considered getting any health care from
VA

Never considered getting any health care from
VA

Don’t think VA health care would be as good
as that available elsewhere

Don’t think VA health care would be as good
as that available elsewhere

Uses other sources for health care

I use other sources for health care

VA care is difficult to access (parking and/or
appointment availability)

VA care is difficult to access (parking,
distance, appointment availability)

VA care is difficult to access due to distance

Applied, but was told that I am not eligible

I do not feel welcome at VA

Other  Please specify below

VA does not provide the services that I need
Other  Please specify below

Don’t know
Don’t know

QUESTION E2a SKIPS TO QUESTION E4
ON THE NEXT PAGE 

Question E3 appears in the next column.

6

E4.

Please tell us whether you have used any of the following health services for yourself in the last six
months?

Service

From VA or
paid for by
VA?

From any
other
source?

Select the one source that provides the largest
financial support, if there are multiple sources.
Source (enter number from list): 

a. Overnight stay in a hospital for
medical or surgical care

Yes

Yes 

No

No

01 = CHAMPUS, CHAMPVA,
TRICARE, or the military

b. Outpatient care for doctor visits,
urgent care, routine exams,
medical tests, or shots

Yes

Yes 

02 = Medicare

No

No

c.

03 = Medigap insurance
[Medicare Supplement]

Yes

Yes 

04 = Medicaid

No

No

05 = Some other government
program

Yes

Yes 

No

No

06 = Private insurance from an
employer, union, or directly

Yes

Yes 

07 = Out of pocket by you or your
family

No

No

08 = Anyone else

Yes

Yes

No

No

Yes

Yes 

No

No

h. Care for any prosthetics or
medical equipment, including
home oxygen

Yes

Yes 

No

No

i.

Care for hearing aids or eye
glasses

Yes

Yes 

No

No

Overnight stay in a rehabilitation
hospital or nursing care facility

Yes

Yes 

No

No

Yes

Yes 

No

No

Yes

Yes 

No

No

Yes

Yes 

No

No

Overnight stay in a hospital for
mental health or substance
abuse treatment

d. Outpatient visits for
psychological counseling,
therapy or mental health, or
substance abuse treatment
e. Prescription medications
f.

Over the counter medications

g. In-home health care for yourself

j.

k.

Dental care

l.

Emergency Room

m. Other types of medical
treatment
 Please specify below

7

E5.

WOMEN ONLY:
E6. During the past 12 months, have you used
women's health care services, for example,
for pap smears or prenatal care?

How much do you agree or disagree with the
following statements?

Yes
No  Go to Question E8

a. If the cost of health care to
me increases, I will use VA
more.

E7.

b. I would only use VA if I did
not have access to any other
source of health care.
c.

During the past 12 months, have you
received women's health care services at any
of the following?
Yes No

I have a doctor outside VA
who I really like and trust.

a. A primary care clinic at a VA facility

d. Veterans who can afford to
use other sources of health
care should leave VA to
those who really need it.

b. A women’s health clinic or
gynecology clinic at a VA facility

e. Veterans like me who use
VA are satisfied with the
health care they receive.

d. A primary care provider or facility
outside VA

f.

c.

A provider or facility outside VA,
but paid for by VA

e. A women's healthcare provider or
gynecology clinic outside VA

VA health care providers
explain treatment/diagnoses
in a way that patients can
understand.

MEN AND WOMEN:
E8. If you needed long-term nursing home care,
would you:

g. There is a VA provider in my
area that offers all of the
health care services that
Veterans like me need.

Definitely go to VA
Maybe go to VA

h. I have one particular health
care provider who is in
charge of my care.

Definitely go somewhere else

E9.

What is the primary way you plan to use VA
health care in the future?
As your primary source of health care

WOMEN ARE ASKED TO ANSWER
QUESTIONS E6 and E7

Backup to non-VA care for some minor
services

MEN ARE ASKED TO SKIP TO QUESTION E8

A “safety net” to use only if needed
For prescriptions
For specialized care
Some other way
No plans to use VA for health care

8

Section F
Health Insurance
F1. Are you CURRENTLY covered by any of the
following types of health insurance or health
coverage plans? Mark all that apply.

THOSE ON MEDICARE ARE ASKED TO ANSWER
QUESTIONS F2 – F3
ALL OTHERS PLEASE SKIP TO
QUESTION F4 BELOW 

Insurance through a current or former
employer or union (of yours or another family
member)

MEDICARE RECIPIENTS:

Insurance purchased directly from an
insurance company (by you or another family
member)

F2.

Medicare, for people 65 and older, or people
with certain disabilities

Did you choose to receive your Medicare
coverage through a Medicare Advantage
Plan and not through the original Medicare
Plan?
Yes

Medicaid, Medical Assistance, or any kind of
government-assistance plan for those with low
incomes or a disability

No

F2a. Does your Medicare coverage pay for…

VA (including those who have ever used or
enrolled for VA health care)

Yes No

TRICARE, TRICARE for Life or other military
health care

a. Care if you are hospitalized?

Indian Health Service

b. Doctor's office visits?

Any other type of health insurance or health
coverage plan  Please specify below

c.

F3.

Prescription drug coverage, "Part D"?

Do you purchase any private health care
coverage to supplement Medicare; that is to
pay for services Medicare does not pay for?
Yes
No

F1a. Who provides this coverage? Mark all that
apply.

Current employer, including COBRA coverage

ALL RESPONDENTS:

Former employer

F4.

Individually purchased coverage
Federal, State, County, or local community
health services program

Does any of this insurance coverage include
prescription drug coverage?
Yes
No

Family member, such as a spouse, parent,
etc.

F5.

Or from somewhere else?  Please specify
below

Do you currently have prescription drug
coverage from VA?
Yes
No
Don’t know

9

F6.

How much do you agree or disagree with the
following statements?

G2a. How did you use the VA education benefit?
Mark all that apply.

Took college or university coursework leading
to a bachelor or graduate degree
Attended business, technical or vocational
school training leading to a certificate or
diploma

a. I feel I know what is
available to me through my
VA health coverage.

Participated in an apprenticeship or on-job
training program

b. My family has a health
insurance plan that
adequately covers me and
my family.

Took correspondence courses
Took flight training
Received tutorial assistance, refresher
courses, or deficiency training
Attended a teacher certification program
Did something else  Please specify below

Section G
Education and Training
These next few questions ask about your experience
with education and training benefits provided by the
Department of Veterans Affairs. This does not include
tuition assistance (TA) you may have received while
on active duty.

G2b. Did you complete your training, or receive the
primary degree or certificate for which you
were enrolled and receiving VA education
benefits?

G1. Excluding VA vocational rehabilitation, have
you used any other VA education or training
benefits?

Yes
No

Yes
No  Go to Question G3

G2c. How important were your VA education
benefits in helping you meet your educational
goals or preparing you to get a better job?

G2. Please indicate when you used the VA
education and training benefits. Mark all that

Extremely important

apply.

During active duty service

Very important

After active duty service

Moderately important

Both during and after active duty service

Slightly important
Not at all important

Have never used education and training
benefits  Go to Question G3

QUESTION G2c SKIPS TO QUESTION G4
ON THE NEXT PAGE 

Question G3 appears on the next page.

10

G3. What are the reasons you haven’t used any
of the VA educational assistance? Mark all

Section H
Employment
H1. During the last week, were you…

that apply.

I used state education benefits from the
National Guard instead

{

Not aware of VA education or training benefits
Don’t believe entitled or eligible for education
or training benefits

Working, or on paid vacation or sick leave
from work  Go to Question H2
Not working, but looking for work  Go to
Question H2
Not working and not looking for work

Time ran out
Don’t know how to apply for education or
training benefits

H1a. What is the main reason you were not looking for
work?

Don’t need any additional education or
training

You are retired

Don’t need or want assistance from VA

You are disabled

Too much trouble or red tape

You stopped looking for work because you
could not find work

Never considered getting any education or
training from VA

You were temporarily laid off from work

Didn’t pay into training funds during active
duty

You were taking care of your home and family

Other  Please specify type below

Other  Please specify below

You were going to school

G4. Other than the VA assistance you noted
previously, have you received any other
education or training assistance since
discharge or separation?

H2.

Does your most recent civilian job generally
match the occupations you were trained for
while you were in the military?
Yes

Yes

No

No  Go to Question G6

Have not had any civilian jobs  Go to
Question H4

G5. What type of other education or training
assistance have you had since discharge or
separation?  Please specify below

H3.

How much did the training, skills or
experiences you gained in the military apply
to your most recent civilian job?
A lot
Some
A little

G6. While on active duty, did you use the
military’s tuition assistance (TA)?

Not at all

Yes
No

Question H4 appears on the next page.

11

H4.

H5.

When you left the Service, how well prepared
were you to enter the civilian job market?

I1b. What are the reasons you don’t have VA life
insurance coverage? Mark all that apply.

Very well prepared

Not aware of VA insurance benefits

Well prepared

Not entitled or eligible

Neither well nor poorly prepared

Don’t know how to apply for benefits

Poorly prepared

Don’t need any insurance

Very poorly prepared

Don’t need or want assistance from VA

Not applicable; I was not interested in entering
the civilian job market

Too much trouble or red tape
Never considered getting any insurance from VA
Elected to forgo coverage while on active duty

To what extent do you agree with the
following statements?

Never converted active duty life insurance
policy to Veteran’s policy
Allowed policy to lapse
Other  Please specify below

a. The military allowed me
enough time to prepare
for my transition and job
search.
b. My chain of command
was supportive when I
began transition
processing.

I2.

Excluding a VA life insurance policy, do you
currently have life insurance from any other
sources?
Yes
No  Go to Question I3

I2a. If yes, how much?

Section I
Life Insurance
I1. Are you currently covered by VA life
insurance (e.g., Veterans' Group Life
Insurance/VGLI, Service-Disabled Veterans'
Insurance/SDVI)?

Less than $10,000
$10,000 to $49,999
$50,000 to $99,999
$100,000 to $199,999

Yes, covered by VGLI

$200,000 to $399,999

Yes, covered by SDVI  Go to Question I2

$400,000 to $599,999

No, not covered by VA life insurance  Go to
Question I1b

$600,000 to $999,999
$1,000,000 or more

I1a. What is the best way for VA to
communicate VGLI program changes?

I3.

Email
Direct mailings

Were you aware that you could have converted
your Servicemembers’ Life Insurance SGLI to
VGLI after you were discharged from service?

Veterans Affairs (VA) insurance web site
(www.insurance.VA.gov)

Yes

Other

Does not apply to me (SGLI was not available
to me)

No

QUESTION I1a SKIPS TO QUESTION I2
IN THE NEXT COLUMN 

Does not apply to me (I did not have SGLI
while on active duty)

Question I1b appears in the next column.
Question I2 appears in the next column.

12

J4a. How long ago did you obtain your most
recent home loan?

Section J
Home Loans
J1. What would you say your current living
arrangement is?

Within last 5 years
6-10 years ago
11-20 years ago

Rent my home

More than 20 years ago

Own my home—with an outstanding
mortgage

J4b. When did you use the VA home loan
guaranty program?

Own my home—no mortgage balance
Occupy dwelling with no payment of cash rent

During active duty service

Other

J2.

After active duty service
Both during and after active duty service

Are you aware that VA has a home loan
guaranty program for eligible Veterans?

J5.

Yes
No

J3.

VA loan program is offered only to U.S.
Veterans

Have you ever obtained a home loan to
purchase a home, refinance a home loan or
make home improvements?

No down payment required
Convenience

Yes

No mortgage insurance required

No  Go to Section K

Loan more likely to be approved
VA’s assistance to avoid foreclosure
Previous experience with the VA loan
program

J3a. When obtaining financing for this loan, did
your lender discuss VA's home loan guaranty
program with you as a possible option?

QUESTION J5 SKIPS TO SECTION K
ON THE NEXT PAGE 

Yes
No
Don’t remember

J4.

What is the most important reason you
chose to get a VA home loan?

Have you ever used the VA home loan
guaranty program?
Yes, currently have VA home loan
Yes, not currently, but have had VA home
loan in the past
No, never have had VA home loan  Go to
Question J6

Questions J6 appears on the next page.
Section K appears on the next page.

13

J6.

If you have not used the VA home loan
program, what was the main reason you did
not?

K2.

How important to you are the following factors
to maintaining VA National cemeteries as
shrines that honor Veterans?

A conventional FHA mortgage was easier or
less expensive for me to obtain
I applied for a VA home loan, but did not
qualify

a. Maintenance of cemetery
grounds

I did not apply because I did not think that I
would qualify

b. Upkeep of headstones,
markers, and wall covers for
cremated remains

I thought that the process for obtaining a VA
loan would take too long
My lender and/or realtor discouraged the use
of the VA program

c.

The VA funding fee was too high

d. Appearance of committal
shelters

I didn’t know about the program

Maintenance of other
landscape features

e. Appearance of individual
gravesites

Other  Please specify below

f.

Maintenance of cemetery
buildings and roads

g. Cemetery’s front gate and
entrance area
h. Availability of parking and/or
restrooms

Section K
Burial Benefits
K1.

How satisfied are you with your ability to get
accurate information about burial benefits?

i.

Public ceremonies and
events that honor Veterans

j.

Presentation of military
funeral honors

k.

Other  Please specify
below

Does not apply, I have not tried to get
information
Very satisfied
Satisfied

K3.

Neither satisfied or dissatisfied
Dissatisfied

Please indicate if you have heard about the
following burial benefits before today.

Don’t

Yes No know

Very dissatisfied
a. Burial at a VA National or State
Veterans cemetery
b. Headstone and burial markers
provided by VA at private
cemeteries
c.

Presidential Memorial Certificates
for next of kin

d. Cash plot allowance
e. Cash burial allowance
f.

Military Funeral Honors

g. Receiving a U.S. Flag

14

L3.

Section L
Burial Plans
L1.

Don’t know eligibility criteria

What type of burial do you think you'll have?

Quality of services

In-ground, casket burial
Cremation, in-ground burial

Don’t know how to make arrangements with
VA

Cremation columbarium (a vault for cremated
remains)

Made other arrangements
VA services don’t accommodate religious
preferences

Mausoleum (i.e. tomb within a monument or
building)

Veterans cemetery too far away (distance)

Something else

Travel time to Veterans cemetery too long

Don’t know

L2.

What are your main reasons for not planning
to be buried in a VA National or State
Veterans cemetery? Mark all that apply.

Appearance of cemetery doesn’t meet my
expectations

Do you want to be buried in a VA National or
State Veterans cemetery?

Want location close to other family members

Yes

Want services that are not available at
Veterans cemetery

No  Go to Question L3

Too difficult to make arrangements with VA

Don’t know

Unable to make advance arrangements with
VA

L2a. What are your reasons for wanting to be
buried in a VA National or State Veterans
cemetery? Mark all that apply.

Other  Please specify below

No cost
Friends or family buried there

Don’t Know

Quality of services
The honor of burial in a VA National shrine

L4.

My spouse’s connection to the military/past
service to country
Other  Please specify below

If you choose to be buried in a private
cemetery, do you think you'll have your burial
place marked by a headstone or marker
provided by VA (at no cost to you)?
Yes  Go to Question L5
No
Don’t know  Go to Question L5

Don’t Know
QUESTION L2a SKIPS TO QUESTION L5
ON THE NEXT PAGE 

Question L3 appears in the next column.

Question L5 appears on the next page.

15

L4a. What are the main reasons you don’t plan to
use a headstone or marker provided by VA?

Section M
Internet Use

Mark all that apply.

Don’t know about headstones and markers for
Veterans

M1. Do you use the Internet, at least
occasionally?

Made other arrangements

Yes

Wants headstone similar to other family
members

No  Go to Question M4

Doesn’t like VA headstones and markers

M2. How often do you access the Internet or
World Wide Web?

Other  Please specify below

At least once a day
At least once a week but not every day
At least once a month but less than once a
week

Don’t know

L5.

At least once a year but less than once a
month

For each of the burial options listed below,
please tell us if you consider the option
preferable, acceptable, or unacceptable.
Preferable

= Your first choice (choose one)

Acceptable

= Not your first choice, but would
be OK

Less than once a year

M3. Where do you go on-line to use the Internet?
Mark all that apply.
Home

Unacceptable = You would never choose this
type of burial

Work
School
Public library
Community center
Someone else’s house

a. Casket burial, in-ground

Some other place

b. Casket burial, in a mausoleum
c.

Cremation, ashes buried in-ground

M4. Do you send or receive emails, at least
occasionally?

d. Cremation, ashes placed in a
columbarium

Yes

e. Cremation, ashes scattered
f.

No  Go to Question M5

Cremation, ashes kept by my family

Question M5 appears on the next page.

16

M4a. Where do you go on-line to send or receive
emails? Mark all that apply.

Section N
Income

Home
Work

N1.

School
Public Library

Please indicate whether your family received
income (past 12 months) in any of the
categories listed below.
Please think about income from all members
of this family who are 15 years of age or older.

Community Center
Someone else’s house
Some other place

Yes
a. Wages, salary, commissions,
bonuses, or tips from all jobs

M5. How willing are you to use the Internet for the
following activities?

b. Self-employment income from
own nonfarm businesses or
farm businesses, including
proprietorships and partnerships
c.

a. Obtaining news and
information
b. Carrying out research on
services
c.

d. Social Security or Railroad
Retirement

Purchasing goods or
services

e. Supplemental Security Income
(SSI)

d. Responding to polls or
surveys

f.

e. Obtain information about VA
benefits
f.

Interest, dividends, net rental
income, royalty income, or
income from estates and trusts

Any public assistance or welfare
payments from the state or local
welfare office

g. Retirement, survivor, or
disability pensions

Apply for VA benefits

h. Veterans’ (VA) service-connected
disability compensation payments

M6. Have you ever used the “MyHealtheVet” web
site to obtain information related to your
personal VA health care?
Yes
No

M7. Would you like to receive VA information
through the Internet or the World Wide Web?
Yes
No

17

i.

All other VA payments
(e.g., VA education payments)

j.

Any other sources of income
received regularly such as
unemployment compensation,
child support or alimony

No

Don’t
know

N2.

Which income range category represents the
total combined income of all members of this
family during the past 12 months?

O4. What is the highest degree or level of school
you have completed?
Less than high school

This includes income from all sources
mentioned in Question N1 above.

High school diploma / GED

Less than $5,000

Some college credit, but less than 1 year of
college credit

$5,000 to $7,499

1 or more years of college credit, no degree

$7,500 to $9,999

Associate’s degree (for example, AA, AS)

$10,000 to $12,499

Bachelor’s degree (for example, BA, BS)

$12,500 to $14,999

Master’s degree (for example, MA, MS,
MEng, MEd, MSW, MBA)

$15,000 to $19,999

Professional degree beyond a bachelor’s
degree (for example, MD, DDS, DVM, LLB,
JD)

$20,000 to $24,999
$25,000 to $29,999
$30,000 to $34,999

Doctorate degree (for example, PhD, EdD)

$35,000 to $39,999
$40,000 to $49,999

O5. Are you of Hispanic, Latino, or Spanish
origin?

$50,000 to $59,999
$60,000 to $74,999

No, not of Hispanic, Latino, or Spanish origin

$75,000 to $99,999

Yes, Cuban

$100,000 to $149,999

Yes, Mexican, Mexican American, Chicano

$150,000 or more

Yes, Puerto Rican
Yes, another Hispanic, Latino, or Spanish
origin For example: Argentinean,
Colombian, Dominican, Nicaraguan,
Salvadoran, Spaniard, and so on  Please
specify below

Section O
Demographics
O1. What is your gender?
Male
Female

O2. What is your year of birth?
Year

O3. Please indicate the number of dependent
children you have.
Number of minor children
(age 17 and younger)
Number of adult children attending
High School and/or College (age 18-22)

18

O6. What is your race? Mark all that apply.

O8. At which of the following types of addresses
does your household receive mail? Mark all

White

that apply.

Black or African American

A street address with a house or building
number

American Indian or Alaska Native
Asian Indian

An address with a rural route number

Chinese

A U.S. Post Office Box

Filipino

A commercial mailbox establishment

Other Asian (for example, Hmong, Laotian,
Thai, Pakistani, Cambodian, and so on)

O9. At how many different addresses do you
receive your personal mail?

Native Hawaiian
Guamanian or Chamorro

Number

Samoan
Other Pacific Islander (for example, Fijian,
Tongan, and so on)

O7. What is your current marital status?
Now Married
Widowed
Divorced
Separated
Never Married
Civil Commitment or Union

Thank you for your participation
in this very important survey.

19

If found please return to:
Westat
1600 Research Blvd, RA 1136
Rockville, MD 20850


File Typeapplication/pdf
File TitleContract GS-23F-8144H
File Modified2009-04-06
File Created2009-04-02

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