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

Department of Veterans Affairs
National Survey of Veterans (NSV)
Surviving Spouse 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 12 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.

A4.

Section A
Familiarity With Veteran Benefits
A1. In the past year, have you received any
information regarding Department of
Veterans Affairs (VA) benefits/services?
Yes

a. Eligibility for VA health care

No  Go to Question A3

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

Don’t Know

A2.

Through what means did you receive
information regarding VA benefits/services?

c.

e. VA education and training

Through mail

f.

Through email
Through a newsletter
Through TV/media

h. VA benefits for dependents
and survivors

Other  Please specify below

Below is a list of topics about VA benefits and
services. Please indicate whether you have
looked for information on these in the past
year.
Yes No

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

d. VA home loans
e. VA education and training
f.

VA burial and memorial benefits

g. VA disability compensation and pension
h. VA benefits for dependents and survivors
i.

VA transition assistance

j.

VA prescription benefits

k.

“No Fee” Passports

VA burial and memorial
benefits

g. VA disability compensation
and pension

Through VA newsletter

c.

VA life insurance

d. VA home loans

Mark all that apply.

A3.

Please indicate your level of awareness for
the following VA benefits and services:

1

i.

VA transition assistance

j.

VA prescription benefits

k.

“No Fee” Passports

B5.

Section B
Employment
B1. During the last week, were you…

{
B2.

How satisfied are you with your employment
and career opportunities?
Does not apply, I am not interested in
employment

Working, or on paid vacation or sick leave
from work

Very satisfied
Satisfied

Not working, but looking for work  Go to
Question B5

Dissatisfied
Very dissatisfied

Not working and not looking for work  Go to
Question B5

Section C
Your Veteran Spouse
C1. When did your spouse leave the military?

On average, how many hours a week do you
spend working for pay or for a family
business or farm?

Year

Hours

C2.
If you work less than 35 hours a week, please
answer the next question. If you work at least
35 hours a week, please go to question B4.
B3.

How many years did your spouse serve in
military service?
Years

C3.

Which of the following are reasons why you
are working less than 35 hours a week?

Was your Veteran spouse discharged from
military service for a service-connected
disability?

Do not want to work 35 hours or more

Yes

Need flexibility

No

Could only find part-time work

Don’t Know

Seasonal work

C4.

Child care responsibilities
Other family/personal obligations

What year did your Veteran spouse die?
Year

Health/medical limitations
Need schooling/training/certification

C5.

In school

Did your Veteran spouse’s death result from
any of the following causes?

Other

B4.

Yes No

How long have you worked at your current
job?

a. A disease or injury incurred or aggravated
in the line of duty while on active duty or
active duty for training

Instruction: For example, 6 months would be
coded as: 00 06.

b. An injury incurred or aggravated in the line
of duty while on inactive duty training

Years

c.

Months

A service-connected disability

d. A condition directly related to a serviceconnected disability
e. An in the line of duty event that happened
on active duty that was not due to
misconduct

Question B5 appears in the next column.

2

C6.

At the time of their death, was your Veteran
spouse…
Yes

No

Section E
Health Insurance
E1. Are you CURRENTLY covered by any of the
following types of health insurance or health
coverage plans? Mark all that apply.

Don’t
know

a. Continuously rated totally
disabled for a period of 10 years
immediately preceding death?

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

b. Continuously rated totally
disabled from the date of military
discharge and for at least 5 years
immediately preceding death
c.

C7.

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

A former POW who died after
September 30, 1999, and who
was continuously rated totally
disabled for a period of at least
one year preceding death

Medicare, for people 65 and older, or people
with certain disabilities
Medicaid, Medical Assistance, or any kind of
government-assistance plan for those with low
incomes or a disability

Did your spouse have a service-connected
disability rating?

TRICARE or other military health care
CHAMPVA (Civilian Health and Medical
Program of VA)

Yes
No  Go to Section D

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

C7a. Did his/her service-connected disability ever
prevent him/her from getting or holding a job?
Yes
No

C8.

Was your spouse a prisoner of war?

E2.

Yes
No

How familiar are you with the benefits and
eligibility criteria associated with CHAMPVA?
Extremely familiar
Moderately familiar

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

Somewhat familiar
Slightly familiar
Not at all familiar

Excellent
Very good
Good
Fair
Poor

D2.

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

3

F2b. How important was the VA educational
assistance in helping you meet your
educational goals or preparing you to get a
better job?

Section F
Educational Assistance
These next few questions ask about your experience
with education assistance provided by the Department of
Veterans Affairs.

F1.

Extremely important
Very important
Moderately important

Have you ever used any VA educational
assistance?

Slightly important
Not at all important

Yes
No  Go to Question F3

F2.

QUESTION F2b SKIPS TO SECTION G
ON THE NEXT PAGE 

How did you use the VA educational
assistance? Mark all that apply.

F3.

Took college or university coursework leading
to a bachelor or graduate degree

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

that apply.

Attended business, technical or vocational
school training leading to a certificate or
diploma

Not aware of VA educational assistance

Participated in an apprenticeship or on-job
training program

My period of eligibility expired/ran out

Don’t believe entitled or eligible for
educational assistance
Do not know how to apply for educational
assistance

Took correspondence courses
Took flight training

Do not need any additional education or
training

Received tutorial assistance, refresher
courses, or deficiency training

Do not need or want assistance from VA

Attended a teacher certification program

Too much trouble or red tape

Do something else  Please specify below

Never considered getting educational
assistance from VA
Other  Please specify below

F2a. Did you complete your training, or receive a
primary degree or certificate for which you
were enrolled and receiving VA education
benefits?
Yes
No

Question F3 appears on the next column.

4

G3b. When did you use the VA home loan
guaranty program?

Section G
Home Loans
G1. What would you say your current living
arrangement is?

During my spouse’s active duty service
After my spouse’s active duty service
Both during and after my spouse’s active duty
service

Rent my home
Own my home—with an outstanding
mortgage

G4. What is the most important reason you
chose to get a VA home loan?

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

No down payment required

Other

Convenience
No mortgage insurance required

G2. Have you ever obtained a home loan to
purchase a home, refinance a home loan or
make home improvements?

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

Yes
No  Go to Section H

QUESTION G4 SKIPS TO SECTION H
ON THE NEXT PAGE 

G2a. When obtaining financing for this loan, did
your lender discuss VA's home loan guaranty
program with you as a possible option?

G5. If you have not used the VA home loan
program, what was the main reason you did
not?

Yes
No

A conventional FHA mortgage was easier or
less expensive for me to obtain

Don’t remember

I applied for a VA home loan, but did not
qualify

G3. Have you ever used the VA home loan
guaranty program?

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

Yes, currently have VA home loan

I thought that the process for obtaining a VA
loan would take too long

Yes, not currently, but have had VA home
loan in the past

My lender and/or realtor discouraged the use
of the VA program

No, never have had VA home loan  Go to
Question G5

The VA funding fee was too high
I didn’t know about the program

G3a. How long ago did you obtain your most
recent home loan?

Other  Please specify below

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

G6. Are you aware that VA has a home loan
guaranty program for surviving spouses?

More than 20 years ago

Yes
No
Question G5 appears in the next column.
Section H appears on the next page.

5

H3.

Section H
Burial Benefits
H1. How satisfied are you with your ability to get
accurate information about burial benefits?

Don’t

Yes No know
a. Burial at a VA National or State
Veterans cemetery

Does not apply, I have not tried to get
information

b. Headstone and burial markers
provided by VA at private
cemeteries

Very satisfied
Satisfied

c.

Neither satisfied nor dissatisfied

H2.

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

Presidential Memorial Certificates
for next of kin

Dissatisfied

d. Cash plot allowance

Very dissatisfied

e. Cash burial allowance
f.

Military Funeral Honors

g. Receiving a U.S. Flag

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

H4.

Was your spouse buried in a VA National or
State Veterans cemetery?
Yes  Go to Section I
No

a. Maintenance of the
cemetery grounds

H5.

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

Were you aware that your spouse could have
been buried at a VA National or State
Veterans cemetery?
Yes

Maintenance of other
landscape features

No

d. Appearance of committal
shelters
e. Appearance of individual
gravesites
f.

Maintenance of cemetery
buildings and roads

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

Public ceremonies and
events that honor Veterans

j.

Presentation of military
funeral honors

k.

Other  Please specify
below

Section I appears on the next page.

6

I3.

Section I
Burial Plans

Don’t know eligibility criteria

The next several questions will be about issues
surrounding burial plans. We understand these
questions might be emotional and therefore difficult
questions to think about and answer. All we ask is
that you try to answer the questions the best you can.

I1.

What would you say are your main reasons for
not planning to be buried in a VA National or
State Veterans cemetery? Mark all that apply.
Spouse is not buried there
Quality of services
Don’t know how to make arrangements with VA
Made other arrangements

What type of burial do you think you'll have?
In-ground, casket burial

VA services don’t accommodate religious
preferences

Cremation, in-ground burial

Veterans cemetery too far away (distance)

Cremation columbarium (a vault for cremated
remains)

Travel time to Veterans cemetery too long
Appearance of cemetery doesn’t meet my
expectations

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

Want location close to other family members

Something else

Want services that are not available at
Veterans cemetery

Don’t know

Too difficult to make arrangements with VA

I2.

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

Unable to make advance arrangements with VA
Other  Please specify below

Yes
No  Go to Question I3
Don’t know
Don’t Know

I2a. What would you say are your reasons for
planning to be buried in a VA National or
State Veterans cemetery? Mark all that apply.

I4.

No cost
Spouse buried there
Friends or family buried there
Quality of services

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

Unacceptable = You would never choose this
type of burial

The honor of burial in a VA National shrine
My spouse’s connection to the military/past
service to country
Other  Please specify below

a. Casket burial, in-ground
b. Casket burial, in a mausoleum
c.
Don’t Know

Cremation, ashes buried in-ground

d. Cremation, ashes placed in a
columbarium

QUESTION I2a SKIPS TO QUESTION I4
IN THE NEXT COLUMN 

e. Cremation, ashes scattered
f.

Question I3 appears in the next column.

7

Cremation, ashes kept by my family

J4a. Where do you go on-line to send or receive
emails? Mark all that apply.

Section J
Internet Use
J1. Do you use the Internet, at least
occasionally?

Home
Work

Yes

School

No  Go to Question J4

Public Library
Community Center

J2.

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

Someone else’s house
Some other place

At least once a day
At least once a week but not every day

J5.

At least once a month but less than once a
week

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

At least once a year but less than once a
month
Less than once a year

J3.

a. Obtaining news and
information

Where do you go on-line to use the Internet?

b. Carrying out research on
services

Mark all that apply.
Home

c.

Work

Purchasing goods or
services

d. Responding to polls or
surveys

School
Public Library
Community Center

e. Obtain information about VA
benefits

Someone else’s house

f.

Apply for VA benefits

Some other place

J4.

J6.

Do you send or receive emails, at least
occasionally?

Would you like to receive VA information
through the Internet or the World Wide Web?
Yes

Yes

No

No Go to Question J5

Question J5 appears in the next column.

8

Section K
Income
K1.

K2.

Please indicate whether your family received
income (past 12 months) in any of the
categories listed below.

This includes income from all sources
mentioned in Question K1.

Please think about income from all members
of this family who are 15 years of age or older.
Yes

No

Which income range category represents
your total combined income during the past
12 months?

Less than $5,000

Don’t
know

$5,000 to $7,499

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

$7,500 to $9,999

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

$12,500 to $14,999

c.

$10,000 to $12,499
$15,000 to $19,999
$20,000 to $24,999

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

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

d. Social Security or Railroad
Retirement

$35,000 to $39,999

e. Supplemental Security Income
(SSI)

$50,000 to $59,999

f.

$40,000 to $49,999
$60,000 to $74,999

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

$75,000 to $99,999
$100,000 to $149,999
$150,000 or more

g. Retirement, survivor, or
disability pensions
h. VA Dependency and Indemnity
Compensation (DIC)
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

9

L6.

Section L
Demographics
L1. What is your gender?

What is your race? Mark all that apply.
White
Black or African American
American Indian or Alaska Native

Male

Asian Indian

Female

L2.

Chinese

What is your year of birth?

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

Year

L3.

Native Hawaiian

Please indicate the number of dependent
children you have.

Guamanian or Chamorro
Samoan

Number of minor children
(age 17 and younger)

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

Number of adult children attending
High School and/or College (age 18-22)

L4.

L7.

What is your current marital status?

{

What is the highest degree or level of school
you have completed?
Less than high school
High school diploma / GED
Some college credit, but less than one year of
college credit

L8.

Married
Widowed
Divorced
Separated

What age were you when you remarried?

One or more years of college credit, no degree

Age

Associate’s degree (for example, AA, AS)
Bachelor’s degree (for example, BA, BS)

L9.

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

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

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

A street address with a house or building
number

Doctorate degree (for example, PhD, EdD)

An address with a rural route number

L5.

Are you of Hispanic, Latino, or Spanish origin?

A U.S. Post Office Box

No, not of Hispanic, Latino, or Spanish origin

A commercial mailbox establishment

Yes, Cuban
Yes, Mexican, Mexican American, Chicano

L10. At how many different addresses do you
receive your personal mail?

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

Number

10

Thank you for your participation
in this very important survey.

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