Analytic Map - SAH Servicing

Question #	Question	Source	Uses	Justification
Factor 1	Benefit Eligibility and Assessment		Determine if Veteran experience differs based on the level of engagement with VBA during the application process	Satisfaction with the experience may be higher or lower dependent upon the level of interaction a Veteran has with VBA during the application process. The level of interaction will be determined based on the various experiences a Veteran might have during the application for benefits. These various experiences are represented in this section. These questions will help us differentiate Veteran satisfaction based on the various touch points related to their benefit eligibility and application, identify areas where improvements to the process can occur and prioritize them based on the impact of the Benefit Eligibility and Assessment Process factor to overall Veteran satisfaction.
	(If you have submitted an application for Specially Adapted Housing Benefits, please continue, otherwise skip to Q62)
1	At the beginning of the grant application process, how much did you understand the Specially Adaptive Housing grant program? (Mark only one)	2004 VA SPECIALLY ADAPTED HOUSING: ELIGIBLE NON-GRANTEE SURVEY	Assess Veteran understanding of the program pre-application	Veterans' satisfaction with the benefit application process may vary based on their level of understanding of the process and subsequent expectations. This question will be used to understand the variation based on Veterans' level of understanding at the beginning of the process.
	a.      Completely
	b.      Mostly
	c.      Somewhat
	d.      Only a little
	e.      Not at all
2	Was this your first time submitting an application for your Specially Adapted Housing benefit? (Mark only one)	VA SPECIALLY ADAPTED HOUSING: ELIGIBLE NON-GRANTEE SURVEY	Measure historical experience with applying for SAH benefit	Satisfaction may vary dependent upon whether or not this is the Veterans' first application for their Specially Adapted Housing benefit. This question will determine if there are differences based on Veterans historical experience with the process.
	a. Yes
	b. No
	c. Don’t know or not sure
	(Ask Q3 if Q2 is no, all others, go to Q4)
3	How many times have you used your SAH grant?	Benefit Experience Requirement	Measure degree of experience using the SAH benefit	Veterans who have used multiple grant for the benefit may have a different level of satisfaction than those who have fewer uses of the benefit.
	a. 1
	b. 2
	c. 3
	d. Don’t know or not sure
4	Thinking about your most recent Specially Adapted Housing benefit application, what method did you use to apply for your benefit? (Mark only one)	Contact Assessment	Measure the effectiveness of various methods of applying for benefit	Veteran satisfaction may differ based on the method they used to apply for their benefit. This will help to identify areas where Veterans are experiencing difficulty with the process and potential opportunities for improvement.
	a. Veterans Online Application
	b. Mail
	c. In person at a Regional Office
	d. In person at a Veterans Service Organization, e.g., Disabled American Veterans, Veterans of Foreign Wars, Paralyzed Veterans of America, etc.
	e. Other (Specify) ___________________
	f. Don’t know or not sure
5	For this most recent application, did you fill out the application form yourself? (Mark only one)	Application Experience Requirement	Assess Veteran involvement in filling out the application	Veterans who received assistance from someone else in filling out the application form may have different expectations and needs related to the application process. This helps identify Veterans' needs.
	a. Yes
	b. No, I had assistance
	c. Don’t know or not sure
	(Ask Q6 if Q5 is yes, otherwise go to Q7)
6	If you were updated on the status of your SAH application, how were you updated on the status of your Specially Adapted Housing application? (Mark all that apply)	Application Experience Requirement	Measure methods of providing status updates	Differences in the way Veterans are informed about the status of their application may impact their experience and satisfaction with the process.
	a. I was not contacted
	b. Mail
	c. E-mail
	d. Phone
	e.  Other(Specifcy)__________
	f.  Don’t know or not sure
7	After you submitted your most recent SAH application, did a SAH agent contact you within 30 days?	VA SPECIALLY ADAPTED HOUSING Program SURVEY	Measure receipt of contact related to timing	Setting expectations for timing is an important part of the enrollment process. Veterans who received information about the time frame for reviewing the application may have different levels of satisfaction than those who did not receive this information. This question will help guide the standards for providing information to Veterans during application review and assist in developing performance benchmarks.
	a. Yes
	b. No
	c. Don't know or not sure
	(If Yes to Q7, answer Q8-9, all others go to Q10)
8	How soon after you were contacted did you meet with a Specially Adapted Housing representative from VA in person for your initial appointment? (Mark only one)	Benefit Experience Requirement	Measure duration between application submittal and contact by SAH representative	Veteran satisfaction may differ based on the amount of time between the application submittal and the initial contact by a Specially Adapted Housing representative. This question allows us to determine benchmarks for the initial contact by determining the breakpoints at which satisfaction begins to decline.
	a. Less than 30 days
	b. More than 30 days
	c. Don’t know or not sure
9	When you met with the Specially Adapted Housing representative in person, which of the following did they discuss, if any: (Mark all that apply)	Benefit Experience Requirement	Assess the level of information provided during the initial meeting	Veteran satisfaction with the process may vary based upon the extent of the information they receive during the meeting with the Specially Adapted Housing representative. This information will be used to guide standards for providing information during the initial meeting.
	a. Freedom of choice
	b. Temporary Residence Adaptation grant option
	c. The grant program and benefits
	d. Veteran’s responsibility
	e. Design and construction/remodeling considerations
	f. Personal finances
	g. Escrow and release of funds
	h. Your desired modifications
	i. Requirements for modifications
	j. Limits of the grant amount
	k. Your individual concerns
	l. Other (Specify) ___________________
	m. None of the above
	n. Don’t know or not sure
10	If your SAH grant was ever delayed, why was there a delay? (Mark all that apply)	Benefit Experience Requirement	Assess the reasons for application delays	Understanding the reasons for delays may provide information to guide processes and communication to prevent delays in the application process.
	a. Incomplete information
	b. Missing information
	c. Awaiting rating decision from C&P to determine eligibility
	d. Other (Specify) ___________________
	e. Don’t know or not sure
11	From the time you submitted your SAH application, how long did it take to receive your approval notification? (Open Capture) Please respond using any or all of the following categories	VA SPECIALLY ADAPTED HOUSING Program SURVEY	Measure the duration of time between the application submittal and the approval notification and identify an opportunity to engage with the veteran and improve process/communications	Veteran satisfaction may differ based on the amount of time between the application submittal and the approval notification. This question allows us to determine benchmarks for application processing by determining the breakpoints at which satisfaction begins to decline.
	a. Less than 30 days
	b. More than 30 days
	c. Don’t know or not sure
	The following question asks you to rate various aspects of your experience with Specially Adapted Housing, using a scale of 1 to 10 where 1 is Unacceptable, 10 is Outstanding, and 5 is Average.
12	Please rate your experience with the SAH grant application process on the following items:		These items will be used in the development of the index model, which will determine the factors that have the largest impact on the overall Veteran experience with the benefit enrollment process.	Satisfaction with benefit eligibility and assessment process represents one of the main elements of Veterans' experience with the benefit enrollment process. These items represent key attributes in the enrollment process and will be compared to other factors to determine the areas of improvement with the greatest overall impact. These metrics will also allow us to compare the experience of Veterans with different levels of engagement with VBA during enrollment for their benefit.
	a. Ease of completing the application	VBA Performance Metric
	b. Timeliness of initial eligibility notification	VBA Performance Metric
	c. Flexibility of application methods	VBA Performance Metric
	d. Overall rating of application process	VBA Performance Metric
Factor 2	Grant Process		Determine if Veteran satisfaction differs based on the experience with VBA during the grant process	Satisfaction with the experience may be higher or lower dependent upon the level of interaction a Veteran has with VBA during the grant process. The level of interaction will be determined based on the various experiences a Veteran might have during the process. These various experiences are represented in this section. These questions will help us differentiate Veteran satisfaction based on the various touch points related to their grant process, identify areas where improvements to the process can occur and prioritize them based on the impact of the Grant Process factor to overall Veteran satisfaction.
	Grant Planning
	(If you have received approval notification on your grant application, whether or not your grant has been disbursed, please answer Q13-26, all others go to Q27)
13	Which adaptive items did you/do you intend to use your SAH grant for? (Mark all that apply)	VA SPECIALLY ADAPTED HOUSING Program SURVEY	Measure intended usage of SAH grant	Veterans experience with the process may vary depending upon how they intend to use their benefit.
	a. Ramps (exterior or interior)
	b. Grab bars
	c. Wider door opening
	d. Wider hallways
	e. Accessible bathroom(s)/shower(s)
	f. Accessible kitchen
	g. Accessible bedroom(s)
	h. Elevators, ramps, or entrances on ground floor
	i. Level thresholds
	j. Lighting
	k. Garage/carport construction or modification
	l. Construction of emergency entrances/exits
	m. Other (Specify) ___________________
	n. Don't know or not sure
14	If authorized, did the SAH agent talk to your family and/or friends about your health care or adaptive item(s)? (Mark only one)	Benefit Experience Requirement	Assess support network involvement with SAH agent	Veterans whose family or friends spoke with the SAH agent may have a different experience with the process as a result of additional support they may be receiving. This may impact their level of satisfaction with the process.
	a. Yes
	b. No
	c. Don't know or not sure
	d. Interview with SAH agent not yet conducted
15	Did the SAH agent talk to you and/or your family and friends about the Temporary Residence Adaptation (TRA) grant? (Mark only one)	Benefit Experience Requirement	Assess receipt of information related to the TRA grant	Veterans who are currently in a temporary living situation may benefit from receiving information about the TRA grant program. This question will provide information to assess whether or not this information is being provided and identify opportunities for communicating information to Veterans.
	a. Yes
	b. No
	c. Don't know or not sure
	d. Interview with SAH agent not yet conducted
16	Did you request a list of contractors from VA?	Benefit Experience Requirement	Assess the support provided with locating contractors	Veterans whose requested a list of contractors may have a different experience with the process as a result of additional support they may be receiving. This may impact their level of satisfaction with the process.
	a. Yes
	b. No
	c. Don't know or not sure
	(If you have completed the planning for your modifications or adaptations, please answer Q17-Q38, all others go to Q39)
17	How many bids did you receive for your desired modifications/adaptations or new home construction? (Mark only one)	Benefit Experience Requirement	Measure extent of effort involved in planning modifications	Veterans who received multiple bids for their planned adaptations may have different experiences and expectations about the process that may impact their level of satisfaction.
	a. Number of bids __________________
	b. Have not yet begun bid process
	c. Don't know or not sure
18	If any, which desired adaptive items were not covered as a result of an insufficient grant amount? (Mark all that apply)	VA SPECIALLY ADAPTED HOUSING Program SURVEY	Measure actual usage of SAH grant	Veterans experience with the process may vary depending upon differences between how they intended to use the benefit and how they were actually able to use the benefit.
	a. Ramps (exterior or interior)
	b. Grab bars
	c. Wider door opening
	d. Wider hallways
	e. Accessible bathroom(s)/shower(s)
	f. Accessible kitchen
	g. Accessible bedroom(s)
	h. Elevators, ramps, or entrances on ground floor
	i. Level thresholds
	j. Lighting
	k. Garage/carport construction or modification
	l. Construction of emergency entrances/exits
	m. Other (Specify) ___________________
	n. All desired adaptive items were covered
19	During the grant process, did you have to submit any required documentation (e.g., building plans or financial statements) more than once? (Mark only one)	Application Experience Requirement	Allow us to determine if the Veteran had an additional level of engagement with VBA related to having to provide duplicate information	Veteran satisfaction may differ based on whether or not they have to provide duplicate information during the process. This will help us identify an area of potential improvement based on a comparison of levels of satisfaction between those who did have to submit duplicate information versus those who did not.
	a. Yes
	b. No
	c. Don’t know or not sure
	(Ask Q20-21 if Q19 is Yes, all others go to Q22)
20	How many times did you have to submit required documentation? (Open Capture)	Application Experience Requirement	Assess the degree of effort expended in providing duplicate information	Veteran satisfaction may vary dependent on the number of times they have to provide the same information. The process of providing the same information more than once can potentially negatively impact the Veteran experience as a result of frustration that may occur. This question assists in identifying and setting benchmarks for potential areas of improvement.
	a. Number of times _____________
	b. Don’t know or not sure
21	Why did you have to resubmit required documentation? (Mark all that apply)	Application Experience Requirement	Determine the reasons why information was provided more than once	It is important to determine the reasons why information is typically provided more than once to develop actionable recommendations related to reducing redundant processes. This question will assist in determining actionable recommendations for improving the Veteran experience related to providing duplicate information.
	a. Incomplete documentation
	b. Missing documentation
	c. Other (Specify) ___________________
	d. Don’t know or not sure
22	Did the SAH agent talk to your contractor about the planned modifications?	Benefit Experience Requirement	Assess SAH agent involvement with the modification process	Veterans whose SAH agents were more involved in the modification process may have a different level of satisfaction than those whose SAH agent was not involved. This question will be used to determine how agent involvement impacts satisfaction and guide processes related to developing best practices for agent involvement.
	a.      Yes
	b.      No
	c.      Don’t know or not sure
	Home Modification/Construction Process
	(Answer Q23-Q37 if you have completed the modification process, whether or not your grant funds have been disbursed, all others skip to Q38)
23	How long did it take for your new specially adapted house to be built or existing home to be modified? (Open Capture)	Benefit Experience Requirement	Measure the duration of time required to complete adaptations/modifications	Veterans experience and satisfaction may vary based on the duration of time required to make the adaptations/modifications.
	a. Months (0-99 months) _____________
	b. Modifications still in process
	c. Don’t know or not sure
	d. Not applicable
24	Was the work on your or your family members’ home completed as planned? (Mark only one)	Benefit Experience Requirement	Measure completeness of work	Veterans experience may vary based on whether or not the work was completed as planned. Veteran satisfaction may be lower in cases where the work did not match what was discussed during planning.
	a. Yes
	b. No
	c. Don’t know or not sure
	d. Not applicable
25	Was the work completed on time? (Mark only one)	Benefit Experience Requirement	Assess timeliness of work completed	Veterans may be less satisfied with their experience if the work is not completed on time compared to cases where the work is completed on time. This question helps identify the variation in satisfaction based on the whether or not the work was completed on time.
	a. Yes
	b. No
	c. Don’t know or not sure
26	Please rate your experience with the contractor on the following items, using a scale of 1 to 10 where 1 is Unacceptable, 10 is Outstanding, and 5 is Average.		Measure satisfaction with the Contractor	The Contractor is a key touch point in the modification process. Veterans satisfaction may differ based on their experience with their Contractor. This question will be used to understand how satisfaction with the Contractor is impacted by different experiences within the process and help improve the services to Veterans.
	a. Courtesy of the contractor	VBA Performance Metric
	b. Knowledge of the contractor	VBA Performance Metric
	c. Timeliness of the modification/construction process	VBA Performance Metric
	d. Overall rating of contractor	VBA Performance Metric
	Completion of the Grant Process
27	How long has your current SAH application been pending?	Application Experience Requirement	Measure duration between application submittal and receipt of benefit	Veteran satisfaction may differ based on the amount of time between the application submittal and benefit receipt. This question allows us to determine benchmarks for the initial contact by determining the breakpoints at which satisfaction begins to decline.
	a.      < 30 days
	b.      1-12 Months
	c.      >1 year
	d.      Don’t know or not sure
28	What is the reason your grant app is pending?	Application Experience Requirement	Allows us to identify the reasons why applications are pending	Veteran satisfaction may differ based on the reason their grant application is pending. This question allows us to determine benchmarks for the initial contact by determining the breakpoints at which satisfaction begins to decline.
	a. Need to submit required documentation
	b. Waiting for confirmation from VA
	c. Waiting on medical rating from compensation services
	d. Other
	e. Don’t know or unsure
29	Was your SAH agent the same person throughout the entire process (i.e., initial interview, planning, and processing of grant)? (Mark only one)	VA SPECIALLY ADAPTED HOUSING Program SURVEY	Assess variations in the SAH contacts	Veterans who interact with more than one SAH agent may have different levels of satisfaction compared to those who only interact with one agent through the entire process. This question will help understand the degree of variation in satisfaction.
	a. Yes
	b. No
	c. Don't know or not sure
	(Ask Q30 if Q29 is No, all others go to Q31)
30	Did the change in SAH agents create a problem for you? (Mark only one)	VA SPECIALLY ADAPTED HOUSING Program SURVEY	Measure impact of multiple SAH agents	This question will help assess the perception of problems related to having multiple SAH agents.
	a. Yes
	b. No
	c. Don't know or not sure
31	Did your SAH agent involve you in decisions about the planned adaptations? (Mark only one)	VA SPECIALLY ADAPTED HOUSING Program SURVEY	Measure level of collaboration with SAH agent	Veterans whose SAH agents involve them in the planning process may have a different level of engagement versus others. This may impact their satisfaction with the process overall.
	a. Yes
	b. No
	c. Don't know or not sure
32	How many appointments did you have with your SAH Agent before your grant process was complete? (Mark only one)	Application Experience Requirement	Measure the number of appointments with SAH agent	Satisfaction may vary based on the number of appointments with the SAH agent. This may indicate a different level of engagement or involvement with the process that can potentially impact Veteran satisfaction. This question will be used to identify breakpoints at which satisfaction levels change.
	a. Number of appointments ____________
	b. Don’t know or not sure
33	Using the same scale of 1 to 10 where 1 is Unacceptable, 10 is Outstanding, and 5 is Average, please rate your experience with your Specially Adaptive Housing agent(s) during the SAH grant application process on the following items:		Measure satisfaction with the SAH agent	Veterans satisfaction may differ based on their experience with their SAH agent. This question will be used to understand how satisfaction with the SAH agent is impacted by different experiences within the process and help provide guidelines for improving services to Veterans.
	a.      Promptness of scheduling appointments or returning calls	VBA Performance Metric
	b.      Courtesy of the agent	VBA Performance Metric
	c.      Knowledge of the agent	VBA Performance Metric
	d.      Agent’s concern for your needs	VBA Performance Metric
	e.      Timeliness of completing your adaptation plan	VBA Performance Metric
	f.        Overall SAH agent experience
34	Were your Specially Adapted Housing grant funds available for initial disbursement: (Mark only one)	Benefit Experience Requirement	Assess timing of grant fund disbursement	The length of time spent planning the use of education benefits may also relate to the Veteran experience during the enrollment process.
	a.      Early
	b.      On time
	c.      Late
	d.      Don’t know or not sure
35	Was your Specially Adapted Housing grant the amount you expected? (Mark only one)	Benefit Experience Requirement	Assess Veteran expectations about the grant amount	Veterans whose expectations of the grant amount differ from the amount they received may have different levels of satisfaction with the process. It is important to understand how expectations may affect Veterans' satisfaction and potentially identify opportunities to improve information communication.
	a.      Yes
	b.      No
	c.      Don’t know or not sure
36	Based on your grant coverage, were you able to obtain all modifications/adaptations that you needed?	Benefit Experience Requirement	Measure Veteran personal expenditures on planned modifications	Veterans who need to contribute personal funding toward their modifications may have different levels of satisfaction than those who do not have to do so. This helps to identify Veterans needs.
	a.      Yes
	b.      No
	c.      Don’t know or not sure
37	If you were not able to use the SAH grant program, what would be your most likely housing situation? (Mark only one)	Respondent Classification	Assess degree of need for SAH grant	Veterans who would not have been able to adapt or modify may have a different level of need as a result of a change in living situation. Those whose living situation would not change may have different levels of satisfaction with the process.
	a.      Living in assisted living facility
	b.      Living in the same house or apartment without adaptations
	c.      Living with a family member or a friend
	d.      Other
	e.      Don't know or not sure
38	The following question asks you to rate various aspects of your experience with Specially Adapted Housing benefits, using a scale of 1 to 10 where 1 is Unacceptable, 10 is Outstanding, and 5 is Average.		These items will be used in the development of the index model, which will determine the factors that have the largest impact on the overall Veteran experience with grant and servicing process.	Satisfaction with the grant process represents one of the main elements of Veterans' experience with the enrollment for their benefit. These items represent key attributes in the overall process and will be compared to other factors to determine the areas of improvement with the greatest overall impact. These metrics will also allow us to compare the experience of Veterans with different experiences with VBA during the process.
	Please rate your Specially Adapted Housing grant on the following items:
	a.      Amount of grant coverage	VBA Performance Metric
	b.      Timeliness of receiving benefit payment or services	VBA Performance Metric
	c.      Overall rating of benefit payment/entitlement	VBA Performance Metric
39	How much do you currently understand the Specially Adaptive Housing grant program? (Mark only one)	Respondent Classification	Assess Veteran understanding of the process post-application	Veterans' satisfaction with the grant process may vary based on their level of understanding of the process both before and after they've completed the process. This question will be used to understand the variation between Veterans' understanding of the process before and after they've reached completion. Veteran satisfaction may vary based on the degree of difference between these two metrics.
	a.      Completely
	b.      Mostly
	c.      Somewhat
	d.      Only a little
	e.      Not at all
Factor 3	Benefit Information		Allows us to determine if Veteran experience differs based on informational needs and usage patterns during the grant process	Satisfaction with the experience may be higher or lower dependent upon Veterans' informational needs and usage patterns during the grant process. The informational needs and usage patterns will be determined in this section. These questions will help us differentiate Veteran satisfaction based on benefit informational needs and usage, identify areas where improvements to the process can occur and prioritize them based on the impact of the Benefit Information factor to overall Veteran satisfaction.
	(If you have not yet submitted an application for SAH benefits, answer Q40, all others go to Q41)
40	Prior to receiving this survey, were you aware of the Specially Adapted Housing (SAH) and Temporary Residence Adaptation (TRA) grant program? (Mark only one)	VA SPECIALLY ADAPTED HOUSING: ELIGIBLE NON-GRANTEE SURVEY	Measure awareness of available grant programs	Establishing current levels of awareness among those who are eligible but have not applied for their benefit helps identify Veterans needs and contributes to the outreach strategy related to these programs.
	a. Yes
	b. No
	c. Don’t know or not sure
	(Ask Q41-45 If submitted an application or aware of the Specially Adapted Housing grant program, all others skip to Q46)
41	How did you FIRST learn about the Specially Adapted Housing benefit? (Mark only one) If you are unsure, please indicate the first way you remember learning about the Specially Adapted Housing benefit	VA SPECIALLY ADAPTED HOUSING Program SURVEY	Identify usage of available information sources	This will be used to assess Veteran point-of-entry for finding information about VA benefits and to evaluate usage patterns. This information will be used in the context of overall satisfaction with benefit information, including ease of accessing, availability, usefulness, and clarity of information and identifying information sources where any of these attributes has the potential for improvement.
	a. VA website
	b. VetSuccess.gov
	c. eBenefits.va.gov
	d. Mail (from VA)
	e. VA phone number (800-827-1000)
	f. Transition Assistance Program/Disabled Transition Assistance Program briefings
	g. Veterans Service Organizations, e.g., Disabled American Veterans, Veterans of Foreign Wars, Paralyzed Veterans of America, etc. (Specify) ___________________
	h. VA medical center
	i. VA Vet center
	j. In person at a Regional Office
	k. Social media websites (e.g., Facebook, Twitter, etc.)
	l. Personal visit from a VA employee
	m. Other Veterans
	n. Internet (excluding VA and social media sites)
	o. Friends or family
	p. Information came with notification/ratings letter
	q. Other publications (e.g., Army Times, local newspaper, etc.)
	r. Other (Specify) ___________________
	s. Don’t know or not sure
42	What method(s) do you MOST FREQUENTLY use to obtain general information about VA’s Specially Adapted Housing benefits or services? (Mark all that apply)	Outreach Requirement	Identify most preferred communication channel for benefits information	This will be used to assess Veteran most frequent source for finding information about VA benefits and to evaluate usage patterns. This information will be used in the context of overall satisfaction with benefit information, including ease of accessing, availability, usefulness, and clarity of information and identifying information sources where any of these attributes has the potential for improvement.
	a. Phone
	b. Mail
	c. E-mail
	d. In person at a Regional Office
	e. Veterans Service Organization, e.g., Disabled American Veterans, Veterans of Foreign Wars, Paralyzed Veterans of America, etc. (Specify) ___________________
	f. Disabled Veterans’ Outreach Program
	g. VA website
	h. VetSuccess.gov
	i. eBenefits.va.gov
	j. Social media websites (e.g., Facebook, Twitter, etc.)
	k. Other websites (excluding VA or social media sites)
	l. VA medical center
	m. VA Vet center
	n. Friends or family
	o. Other publications (e.g., Army Times, local newspaper, etc.)
	p. Other (Specify) ___________________
	q. Don’t know or not sure
	r. None of the above
43	How frequently would you like to receive communications (e.g., e-mails, letters, newsletters, etc.) from VA about Specially Adapted Housing benefits or services? (Mark only one)	Outreach Requirement	Measures the desired frequency of communications received from VA about their benefits	This question will assess the optimal frequency of communications, in addition to the number of communications, to help maintain an optimal communication strategy for outreach to Veterans about their benefits.
	a. Weekly
	b. Monthly
	c. Quarterly (every 3 months)
	d. Semi-annually (twice per year)
	e. Annually (once per year)
	f. Never
	g. Don’t know or not sure
44	How would you like to receive information from VA about Specially Adapted Housing benefits or services? (Mark all that apply)	Outreach Requirement	Assess Veterans' preferred communication methods	This question will help to assess the most desired methods of communication about VA benefits or services and help guide the strategy for information outreach to Veterans.
	a. Phone
	b. Mail
	c. E-mail
	d. VA website
	e. Social media websites (e.g., Facebook, Twitter, etc.)
	f. In person at a Regional Office
	g. Veterans Service Organization, e.g., Disabled American Veterans, Veterans of Foreign Wars, Paralyzed Veterans of America, etc. (Specify) ___________________
	h. Other (Specify) ___________________
	i. Don’t know or not sure
	The following question asks you to rate various aspects of your experience with Specially Adapted Housing benefits, using a scale of 1 to 10 where 1 is Unacceptable, 10 is Outstanding, and 5 is Average.
45	Please rate your experience in obtaining information about your Specially Adapted Housing grant on the following items:		These items will be used in the development of the index model, which will determine the factors that have the largest impact on the overall Veteran experience with the process.	Satisfaction with the benefit information represents one of the main elements of Veterans' experience with the process. These items represent key attributes in the process and will be compared to other factors to determine the areas of improvement with the greatest overall impact. These metrics will also allow us to compare the experience of Veterans with different information usage patterns and informational needs during the process.
	a. Ease of accessing information	VBA Performance Metric
	b. Availability of information	VBA Performance Metric
	c. Clarity of information	VBA Performance Metric
	d. Usefulness of information	VBA Performance Metric
	e. Frequency of information provided by VA	VBA Performance Metric
	f. Overall rating of information	VBA Performance Metric
Factor 4	Contact with VA		Determine if Veteran experience differs based on the level of contact and issue resolution during the process	Satisfaction with the enrollment experience may be higher or lower dependent upon Veterans' level of contact and issue resolution during the process. The level of contact will be determined in this section. These questions will help us differentiate Veteran satisfaction based on level of contact and issue resolution, identify areas where improvements to the process can occur and prioritize them based on the impact of the Contact factor to overall Veteran satisfaction.
46	Did you contact anyone from VA about your Specially Adapted Housing benefit (excluding contact related to an initial appointment with an SAH agent)? (Mark only one) (Mark only one)	Contact/Resolution Assessment	Assess whether or not contact occurred	This question allows us to assess whether or not someone has had a contact with VA about their benefit recently enough to evaluate their experience with the contact. Individuals who have had recent contact with VA about their benefit may exhibit different levels of satisfaction than those who have not had recent contact. This question allows us to assess the variation between these two groups.
	a. Yes
	b. No
	(Ask Q47-Q53 if Q46 is yes, all others skip to Q54)
47	How many times did you have contact with VA regarding your Specially Adapted Housing benefit in the past 6 months? (Open Capture)	Contact/Resolution Assessment	Measure the degree of contact	Veterans who have had more contacts with VA about their benefit may have different levels of satisfaction with the process than those with fewer contacts. Additionally, Veterans with more contacts may indicate an unmet need among Veterans that may be identified by this question. This will allow VA to benchmark the degree of contact over time to understand if there is an issue that needs to be addressed in the process (e.g., training, outreach, etc.).
	a. Number of contacts __________
	b. Don’t know or not sure
48	Which of the following best describes the reason for your most recent contact? (Mark only one)	Contact/Resolution Assessment	Evaluate the reason for the call	The reason for calling may contribute to the satisfaction related to the call experience. It is important to understand how satisfaction varies based on the type of call. This information will be used in conjunction with the VBA Call Center Satisfaction Research to analyze methods of contact/resolution.
	a. Resolve a problem
	b. Ask a question
	c. Request a change to your records/provide information
49	Can you briefly describe the nature of your most recent contact? (Mark all that apply)	Contact/Resolution Assessment	Assess the nature of the call	Understand the specific reason for the call to help identify potential needs of various groups of Veterans and the ability of VA to respond to those needs. This information may assist in developing actionable recommendations for training, information communication, etc. This information will be used in conjunction with the VBA Call Center Satisfaction Research to analyze methods of contact/resolution.
	a. Report the death of an individual who received VA benefits
	b. Submit a new grant application
	c. Appeal a decision on a grant application
	d. Question or problem about status of grant application
	e. Question or problem with the application
	f. Question about inconsistent information received from different VA or SAH agents
	g. Other (Specify) ___________________
50	Thinking about your most recent contact, how did you contact VA? (Mark only one)	Contact/Resolution Assessment	Allows us to measure the satisfaction with various methods of communication	Veterans' experiences with contacting VA may differ based on the method they use for contact. This may highlight contact methods that are used most frequently by Veterans and help identify processes VA can use to optimize those communication channels.
	a.      VA Toll-Free phone number
	b.      VA Regional office phone number
	c.      VA Main office phone number
	d.      Fax
	e.      Website
	f.        E-mail
	g.      Mail
	h.      In person
51	Was your most recent issue resolved? (Mark only one)	Contact/Resolution Assessment	Allows us to measure issue resolution	Veterans who have their issue resolved upon contacting VA may have different levels of satisfaction than those who do not have their issue resolved. This will allow us to set benchmarks for issue resolution and identify areas where contact can be improved based on the reason or nature of the call. This information will be used in conjunction with the VBA Call Center Satisfaction Research to analyze methods of contact/resolution.
	a. Yes
	b. No
	(Ask Q52 if Q51 is No, otherwise go to Q53)
52	Why wasn’t your most recent issue resolved? (Mark all that apply)	Contact/Resolution Assessment	Allows us to identify the reasons why issues were not resolved	This is important because it allows us to evaluate the reasons why there may be different levels of resolution depending on the nature and or reason for the call and assist in developing actionable courses of action based on study results.
	a. Did not receive all of the information required
	b. Received incorrect information
	c. Was referred to the incorrect office/person
	d. Waiting for follow-up from VA
	e. Other (Specify) _______________
	f. Don't know or not sure
53	Thinking of your most recent contact with the VA, how would you rate your overall customer service experience with the VA or VA representatives using a scale of 1 to 10 where 1 is Unacceptable, 10 is Outstanding, and 5 is Average. (Mark only one)	VBA Performance Metric	These items will be used in the development of the index model, which will determine the factors that have the largest impact on the overall Veteran experience with the enrollment for their benefit.	Satisfaction with Contacting VA represents one of the main elements of Veterans' experience with the enrollment for their benefit. These items represent key attributes in the ongoing servicing process and will be compared to other factors to determine the areas of improvement with the greatest overall impact. These metrics will also allow us to compare the experience of Veterans with different levels of contact during and immediately following the enrollment their benefit.
	Overall Experience with Benefit
54	What was/is the total cost of your current modification/adaptation project? (Open Capture)	Respondent Classification	Measure the total project cost of current modification	Veterans experiences with benefit may differ based on the total cost of their current modification/adaption project.
	a. Approximate cost (0-999,999)__________________
	b. Don’t know or not sure
55	Thinking about ALL aspects of your experience with Specially Adapted Housing benefits (e.g., grant application process, grant planning process, home modification/construction process, completion of the grant process, obtaining information about your grant, contacting VA), please rate VA overall, using a scale of 1 to 10 where 1 is Unacceptable, 10 is Outstanding, and 5 is Average. (Mark only one)	VBA Performance Metric	This item will be used in the development of the index model and will assist in creating an overall satisfaction score at the benefit enrollment level.	All factors will be assessed in the context of the overall satisfaction score to understand the relative importance of each factor on Veterans' overall satisfaction.
	(If you have completed the entire grant process and all of your funds have been disbursed, please answer Q65, all others go to Q66)
	(If you have completed the entire grant process and all of your funds have been disbursed, please answer Q56, all others go to Q57)
56	Do your housing adaptations help you live more independently? (Mark only one)	VA SPECIALLY ADAPTED HOUSING Program SURVEY	Measure impact of benefit on independent living	One purpose of the benefit is to allow Veterans to live more independently. This factor helps evaluate whether or not the benefit is accomplishing the intended purpose and helps identify Veterans' needs. This information is also needed to inform departmental budget/funding purposes.
	a. Yes
	b. No
	Overall Experience with VA
57	Taking into consideration all of the non-medical benefits (e.g., education, compensation and pension, home loan guaranty, vocational rehabilitation and employment, insurance, etc.) you have applied for or currently receive, please rate your experience with VA overall, using a scale of 1 to 10 where 1 is Unacceptable, 10 is Outstanding, and 5 is Average. (Mark only one)	VBA Performance Metric	This item will be used in the development of an index model for VBA overall across benefit lines and benefit status types (enrollment and servicing).	Overall satisfaction with each benefit line at the enrollment and servicing level will be evaluated in the context of the overall experience with VA to understand the relative impact of different experiences across benefit lines.
58	Based on your experiences with VA, how likely are you to recommend to other Veterans VA benefits or services? (Mark only one)	VBA Performance Metric	Assess Veteran advocacy of VA benefits or services	Veterans with a more positive experience with the benefit line and VA overall may be more likely to positively advocate VA to their peers. This question will help identify changes in advocacy based on changes in the level of satisfaction over time.
	a. Definitely will not
	b. Probably will not
	c. Probably will
	d. Definitely will
59	How likely are you to inform other Veterans about your experience with VA benefits or services? (Mark only one)	VBA Performance Metric	Assess Veteran advocacy of VA benefits or services	Veterans with a more positive experience with the benefit line and VA overall may be more likely to positively advocate VA to their peers. This question will help identify changes in advocacy based on changes in the level of satisfaction over time.
	a. Definitely will not
	b. Probably will not
	c. Probably will
	d. Definitely will
60	How much do you agree with the following statement: "Receiving a Specially Adapted Housing Grant makes me feel that the Nation recognizes my service to our country." (Mark only one)	SAH Requirement	Measure impact of benefit on Veteran recognition	One purpose of the benefit is to recognize Veterans' service. This factor helps evaluate whether or not the benefit is accomplishing the intended purpose.
	a.      Strongly disagree
	b.      Somewhat disagree
	c.      Neither agree nor disagree
	d.      Somewhat agree
	e.      Strongly agree
	Reasons for Not Using the SAH Grant
	(If you applied and have not used or you have not yet applied for your SAH grant, please answer Q61-73, all others skip to Q65)
	(If you have applied and not yet used your SAH grant funds, answer Q61, otherwise skip to Q70)
61	If you have applied and not yet used your SAH grant funds, do you intend to use them in the future? (Mark only one)	Respondent Classification	Measures intent to use SAH grant funds	Among Veterans who have applied but haven't used their benefit, it is important to understand whether or not they intend to use their benefit in the future.
	a. Yes
	b. No
	c. Don’t know or not sure
	(If you have not yet applied for your SAH grant, please answer Q62, all others skip to Q63)
62	If you have not yet applied for the SAH grant program, what is the major reason you have not submitted an application? (Mark only one)	VA SPECIALLY ADAPTED HOUSING: ELIGIBLE NON-GRANTEE SURVEY	Assess reasons for not submitting an application	This question helps understand the reasons why Veterans may not be submitting grant applications and helps guide the communication outreach conducted among these Veterans.
	a. Unsure how to apply
	b. Difficulty completing application forms
	c. Application forms asked for information VA already should have
	d. Current home meets my needs
	e. Do not want to use the grant
	f. Plan on using the grant in the future
	g. Application/grant process was too time consuming
	h. Application/grant process was too complex
	i. Grant amount was not large enough to meet my needs
	j. Elected to use alternate source of funding
	k. Not applicable
63	What is the major reason preventing you from using the grant? (Mark only one)	VA SPECIALLY ADAPTED HOUSING: ELIGIBLE NON-GRANTEE SURVEY	Assess reasons for not using grant	This question helps understand the reasons why Veterans may not be using grant funds and helps guide the communication outreach conducted among these Veterans.
	a. Application was denied
	b. Plan on using the grant in the future
	c. No longer need the grant
	d. Did not have enough help from VA in completing application
	e. Application/grant process was too complex
	f. Grant amount was not large enough to meet my needs
	g. Elected to use alternate source of funding
	h. Waiting for response from VA
	i. Unable to find a contractor willing to complete the required adaptations for the grant amount
	j. Not applicable
64	Please select which of the following, if any, would influence your decision about how or when to use your SAH grant funds. (Mark all that apply)	Benefit Experience Requirement	Identify the variables that influence Veterans' decisions to use the grant	This question helps identify potential drivers of Veterans' decisions to use the grant. This will assist in guiding the types of information that will be communicated during outreach activities.
	a. Ability to use grant on multiple occasions
	b. Ability to use grant funds while still on active duty
	c. Ability to adapt a family member's home
	d. None of the above
	About You
65	Which adaptive items do you feel are necessary for living independently? (Mark all that apply)	Respondent Classification	Assess Veteran perceptions of necessary adaptations	Veterans experience with the process may vary depending upon gaps between the adaptations covered by the grant and those that they feel are necessary to live independently. This helps identify Veterans' needs.
	a. Ramps (exterior or interior)
	b. Grab bars
	c. Wider door opening
	d. Wider hallways
	e. Accessible bathroom(s)/shower(s)
	f. Accessible kitchen
	g. Accessible bedroom(s)
	h. Elevators, ramps, or entrances on ground floor
	i. Level thresholds
	j. Lighting
	k. Garage/carport construction or modification
	l. Construction of emergency entrances/exits
	m. Other (Specify) ___________________
	n. Don't know or not sure
66	Do you have any other comments or concerns about your experience? (Open Capture)	Benefit Experience Requirement	Allow Veterans' the opportunity to provide additional information related to their experience	Veterans' may have additional information related to their experience that will help understand and interpret their overall experience. This may include elements of the experience that are not easily captured in quantitative form.
67	Would you like to provide an e-mail address so VA can contact you with general information about VA benefits and services? (Mark only one)	Contact Assessment	Opt-in for future contact by VA	Consent to contact respondent with more information on benefits and programs
	a. Yes
	b. No
	c. I do not have an e-mail address
	d. Prefer not to answer
	(Ask Q67 if Yes in Q68)
68	Please enter your preferred e-mail address where you would like to be contacted: (Open Capture)	Contact Assessment	Email contact information	Send additional information from VA to veterans - i.e. eBenefits information
	a. E-mail: