Insurance Surveys

XXXXXXXXXXXXX In Reply Refer To:

XXXXXXXXXXXXX 310/292-S

XXXXXXXXXXXXX XXXXXXXXXXXX

Dear XXXXXXXXXX:

We recently processed a cash surrender on your government life insurance.

Now we would like to know if we did the best possible job. You can help us by doing the following:

1. Fill out the enclosed survey.

2. Send it to us in the enclosed envelope. (We've paid for the postage.)

Completing the survey is voluntary, and it will help us improve our service.

If you have any questions and would like us to call you, fill in the box at the bottom of the survey.

Thank you for taking your time to help us. Please return your survey as soon as possible to make sure we can include your responses in the results.

Sincerely yours,

JACQUELINE Y. HOWARD

Chief, Policyholders Services Division

Enclosures

Survey

Postage Paid Envelope

VA GOVERNMENT LIFE INSURANCE

CASH SURRENDER SURVEY

	Strongly Agree	Agree	Neither Agree nor Disagree	Disagree	Strongly Disagree	No Other Insurance
1. It was easy to obtain the cash surrender.	[ ]	[ ]	[ ]	[ ]	[ ]
2. Instructions for applying were clear.	[ ]	[ ]	[ ]	[ ]	[ ]
3. Your payment was received in a timely manner.	[ ]	[ ]	[ ]	[ ]	[ ]
4. The amount you received was correct.	Yes [ ]				No [ ]
5. The overall quality of service was good.	[ ]	[ ]	[ ]	[ ]	[ ]
6. Our service was good when compared with other life insurance companies.	[ ]	[ ]	[ ]	[ ]	[ ]	[ ]

7. How can we improve our service?

Complete This Section ONLY If You Would Like Someone To Call You About This Insurance

• Yes, I would like an Insurance Representative to call me about my recent request.

Name:______________________ Daytime Phone Number:__________________________

Insurance File Number:____________________ Best time to call during the day:_______________

(MMMMYYYY)(survey #)

Privacy Act Information: 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 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.

Public Reporting Burden Statement: VA may not conduct or sponsor, and respondent is not required to respond to this collection of information unless it displays a valid OMB Control Number. Public reporting burden for this collection of information is estimated to average 6 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. If you have comments regarding this burden estimate or any other aspect of this collection of information, call 1-800-827-1000.

(OMB Approval No. 2900-0569)