2009 VA Memorial Products Survey
(Headstones/Markers and Presidential Memorial Certificate)
OMB Control Number 2900-0571
Public Reporting Burden Statement
VA may not conduct, sponsor, or require the respondent to respond to this collection of information unless it displays a valid OMB Control Number. All responses to this collection are voluntary. Public reporting burden for the collection of information is estimated to average 10 minutes per response, including the time necessary for reviewing instructions searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The information collected is intended to be used in making improvements in services within the National Cemetery Administration of the Department of Veterans Affairs and for associated administrative purposes. Failure to furnish the requested information will have no adverse effect on any VA benefit to which you may be entitled.
The information you supply will be confidential and protected by the Privacy Act of 1974 (5 U.S.C. 522a) and the VA’s confidentiality statute (38 U.S.C. 5701) as implemented by 38 CFR 1.526(a) and 38 CFR 1.576(b). Disclosure of information involves releases of statistical data and other non-identifying data for the improvement of services within the National Cemetery Administration and for associated administrative purposes. Please send any comments regarding this burden estimate or any other aspect of this collection including suggestions for reducing this burden to VA Clearance Officer (005R1B), 810 Vermont Ave, NW, Washington, DC 20420. SEND COMMENTS ONLY. DO NOT SEND THIS FORM OR REQUESTS FOR BENEFITS TO THIS ADDRESS.
1
How
did you know about the headstone/marker service provided by the
VA?
(Mark all
that apply)
O Learned from veteran/family member
O Learned from Funeral Director
O Learned from Cemetery Representative
O Learned from VA employee
O My own research
O Other (Specify) _______________________
2 What type of headstone/marker did you order?
O Bronze (metal plate)
O Stone (granite or marble)
3 Who helped you with ordering the headstone/marker? (Mark all that apply)
O Family member
O Funeral Director
O Cemetery Representative
O VA Employee
O Other (Specify) ________________________
O No one
4 How did you order the headstone/marker?
(Mark all that apply)
O Over the Phone
O Via the mail
O Via Fax
O Via the Funeral Director
O Other (Specify) _______________________
4b How satisfied were you with the process you used to order the headstone/marker?
O Very Satisfied
O Somewhat Satisfied
O Neither Satisfied nor Dissatisfied
O Somewhat Dissatisfied
O Very Dissatisfied
5 Did you call an 800 number for assistance at any point?
O Yes
O No (GO TO Q6)
5b IF YES, why did you call the 800 number?
(Mark all that apply)
O To check on the status of my order
O To get help with ordering the marker
O To file a complaint about the marker
O Other (Specify) _______________________
5c How satisfied were you with the service you received from the 800 number service rep?
O Very Satisfied
O Somewhat Satisfied
O Neither Satisfied nor Dissatisfied
O Somewhat Dissatisfied
O Very Dissatisfied
6 Did you visit the VA web site for information about ordering the headstone/marker?
O Yes
O No (GO TO Q7)
6b IF YES, what type of information were you looking for? (Mark all that apply)
O How to order a marker
O Download an order form
O Find information on documentation needed
O Find information on the Presidential
Memorial Certificate Program
O Find out what could go on the marker
O Other (Specify) _______________________
6c How satisfied were you with the ease of finding the information you were looking for?
O Very Satisfied
O Somewhat Satisfied
O Neither Satisfied nor Dissatisfied
O Somewhat Dissatisfied
O Very Dissatisfied
7 When you were applying for the headstone or marker, were you aware that the following items were available to be placed on the marker:
|
No |
Yes |
Don’t Know |
An inscription |
O |
O |
O |
Birthdate/Date of death |
O |
O |
O |
Highest rank attained |
O |
O |
O |
War service |
O |
O |
O |
Emblem of belief |
O |
O |
O |
Valor Awards |
O |
O |
O |
Terms of endearment |
O |
O |
O |
Nicknames |
O |
O |
O |
Civilian credentials (i.e., Doctor) |
O |
O |
O |
Special unit designations |
O |
O |
O |
Other military credentials |
O |
O |
O |
Space for future inscriptions |
O |
O |
O |
7b IF you were aware of the availability of an inscription, how did you learn about what could be included in the inscription? (Mark all that apply)
O I read it on the application
O I looked it up on the VA web site
O The Funeral Director told me
O A VA employee told me
O Other (Specify) ____________________
8 About how long after ordering the headstone/marker did it arrive?
O Less than 1 month
O Between 1 and 2 months
O Between 2 and 3 months
O Over 3 months
O DON’T KNOW (GO TO Q9)
8b How satisfied were you with the amount of time it took to receive the headstone/marker?
O Very Satisfied
O Somewhat Satisfied
O Neither Satisfied nor Dissatisfied
O Somewhat Dissatisfied
O Very Dissatisfied
9 How would you prefer to be notified about the status of your marker?
O Postcard
O E-mail
O Letter
O Other (Specify) _______________________
O I don’t care to be notified
10 Please indicate your level of agreement with the following statement: The overall quality of the headstone or marker I received from VA was excellent.
O Strongly Agree
O Agree
O Neither Agree, nor Disagree
O Disagree
O Strongly Disagree
11 Did you order and/or receive a Presidential Memorial Certificate (PMC)?
O Yes - Requested and Received
O Yes - Received, but not requested
O No – Requested, not received SKIP TO Q12
O No – Did not Receive SKIP TO Q12
O Don’t know what this is SKIP TO Q12
11b Please indicate your level of agreement with the following statement: The overall qualify of the Presidential Memorial Certificate (PMC) I received from the VA was excellent.
O Strongly Agree
O Agree
O Neither Agree, nor Disagree
O Disagree
O Strongly Disagree
12 Overall, how satisfied were you with your experiences with the VA?
O Very Satisfied
O Somewhat Satisfied
O Neither Satisfied nor Dissatisfied
O Somewhat Dissatisfied
O Very Dissatisfied
13 Were you required to pay any unexpected fees regarding your government headstone/marker?
O Yes, but they were reasonable
O Yes, and the costs were substantial
O No
O DON’T KNOW
14 Do you have any additional comments concerning how the VA could improve its memorial products, services and programs?
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Thank you very much for taking the time to complete this questionnaire. PLEASE mail this completed questionnaire in the postage-paid envelope as soon as possible. If you have any questions about this research, you may call us at 1-800-659-5432.
VA Memorial Products Survey; c/o Abt SRBI; 8403 Colesville Road; Suite 820; Silver Spring, MD 20910
File Type | application/msword |
File Title | LONGITUDINAL HEALTH STUDY OF |
Author | va user |
File Modified | 2010-04-21 |
File Created | 2010-04-21 |