Download:
pdf |
pdfOMB APPROVAL NO. 2900-0571
U.S. DEPARTMENT OF VETERANS AFFAIRS
NATIONAL CEMETERY ADMINISTRATION
NATIONAL CEMETERIES:
2012 SATISFACTION SURVEY
Please read and answer the following question first.
Have you visited a national cemetery in the past 12 months?
No (STOP. You do not have to complete the rest of this questionnaire, but
please return the questionnaire in the enclosed postage-paid envelope.)
Yes (Continue on to the next question.)
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 this collection of information is estimated to average 20 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 (005G2), 810 Vermont Ave., NW, Washington DC 20420. SEND COMMENTS ONLY. DO NOT SEND THIS FORM OR
REQUESTS FOR BENEFITS TO THIS ADDRESS.
Marking Instructions
The survey will take about 20 minutes to complete.
Please read each question carefully and respond by filling in the
oval of the response that most closely represents your opinion.
Correct Mark
Incorrect Marks
• Use pencil or pen. Make heavy dark marks that fill the ovals completely. If you wish to change an answer,
erase cleanly (pencil) or put an “X” over the incorrect response (pen).
• Fill in one answer oval for each question unless it tells you to “mark all that apply.”
• When you are finished, please place the questionnaire in the enclosed postage-paid envelope and put it in
the mail.
–1–
SEE MARKING INSTRUCTIONS ON THE COVER.
Correct Mark
Incorrect Marks
Next-of-Kin: Respond to the questions on the left column of the page, beginning with Question 1.
Funeral Directors: Respond to the questions on the right column of the page, beginning with Question A.
Questions for Funeral Directors
Questions for Next-of-Kin
Please complete this survey based on your
experiences at the national cemetery where your
loved one was interred.
1. Since the committal service, how many
times have you visited the national cemetery
where your loved one was interred?
1–3
10 or more
4–6
None, I have
7–9
not visited
A. Looking at the attached form, please identify
the national cemetery with which you
most frequently do business and fill in the
corresponding number in the spaces below.
Please complete this survey based on your
experiences at this national cemetery within the
past 12 months.
2. Your recently deceased loved one was
your...
Spouse
Parent
Brother/Sister
Son/Daughter (includes stepchildren)
Other relative
Friend
3. How far do you reside from the national
cemetery?
Less than 15 miles
15 to 29 miles
30 to 44 miles
45 to 59 miles
60 to 75 miles
Over 75 miles
4. Do the following factors limit the number of
times you visit the national cemetery where
your loved one is interred? (Please mark Yes
or No for each item below.)
Yes No
a. Distance to the national cemetery........
b. Travel time to the national cemetery....
c. Inconvenient location of the national
cemetery (e.g., neighborhood, no
direct route)..........................................
d. My access to transportation
(private or public).................................
e. My health status (e.g., physical
limitation or constraints).......................
f. Other (please specify in General
Comments, page 8).............................
0
0
1
1
0
1
2
2
2
3
3
3
4
4
4
5
5
5
6
6
6
7
7
7
8
8
8
9
9
9
B. How far is your funeral home from the
national cemetery with which you most
frequently do business?
Less than 15 miles
15 to 29 miles
30 to 44 miles
45 to 59 miles
60 to 75 miles
Over 75 miles
C. How long has your funeral home worked
with the national cemetery?
Less than 1 year
1 to 4 years
5 to 8 years
9 to 12 years
13 years or more
Don’t know
5. Have you ever served on active duty in the
U.S. armed forces, either in the regular
military or a National Guard or reserve unit?
Yes
No
–2–
Next-of-Kin: Respond to the questions on the left column of the page.
Funeral Directors: Respond to the questions on the right column of the page.
Questions for Funeral Directors
Questions for Next-of-Kin
6. Prior to your time of need, to what extent
were you aware of the benefits related to
burial in a national cemetery?
Completely aware
Somewhat aware
Unaware (SKIP TO Q8)
7. How did you learn of these benefits prior to
your time of need? (Mark all that apply)
Family member/friend
Funeral home
Military discharge-related materials
Other veteran/active duty member
VA/NCA pamphlet, brochure, newsletter
VA/NCA Web site
VA/NCA social media (Facebook or Twitter)
Veterans Service Organization
(including State or County organizations)
Other VA organization
Local newspaper/television news reports
Public events (e.g., parades, exhibits,
speeches)
Professional/military association meetings
or conventions
8. Prior to the time of need, what is the BEST
way for the national cemetery to convey
information regarding benefits? (Mark only
one)
E-mail
VA/NCA Web site
VA/NCA social media (Facebook or Twitter)
Newsletter/flyer
Local newspaper/television news reports
Public events (e.g., parades, exhibits,
speeches)
Professional/military association meetings
or conventions
Other
D. Of the eligible veteran families you serve,
approximately what percent choose burial in
the national cemetery?
1 – 4%
5 – 9%
10 – 14%
15 – 24%
25 – 49%
50 – 74%
75 – 100%
E. How would you characterize the overall
communication from the national cemetery
to your funeral home?
Excellent
Good
Fair
Poor
F. Do you feel that you are well informed by
the national cemetery of its policies and
procedures?
Yes, well informed
Yes, somewhat well informed
No, not well informed
G. In general, of the following services, which
one provides you the MOST information
about national cemetery policies and
procedures? (Mark only one)
9. To what extent were you informed of the
details (e.g., length of service, use of
committal shelters) related to the committal
service prior to attending the service?
Very informed
Somewhat informed
Neither informed nor uninformed
Somewhat uninformed
Very uninformed
–3–
VA/NCA Web site
Local newspaper/television news reports
Public events (e.g., parades, exhibits,
speeches)
Professional associations/conventions/
meetings
Veterans Service Officers
Outreach by cemetery staff
Other
Next-of-Kin: Respond to the questions on the left column of the page.
Funeral Directors: Respond to the questions on the right column of the page.
Questions for Funeral Directors
Questions for Next-of-Kin
10. Overall, how satisfied are you with the
information you were provided throughout
your experiences with the national
cemetery?
Very satisfied
Somewhat
Somewhat satisfied
dissatisfied
Neither satisfied
Very
nor dissatisfied
dissatisfied
11. At the committal service, did your family
have any of the following special needs or
requests? (Mark all that apply)
Visit the gravesite
View the burial
Special music
Special religious practices (e.g., blessing
the gravesite)
Additional seating at the committal service
Handicapped accommodations
No, my family did not have any special
needs or requests (SKIP TO Q13)
12. Was the cemetery able to accommodate
these special needs or requests to your
satisfaction?
Yes, completely
Yes, somewhat
No, and I understand why
No, and I did not understand why
If your loved one was NOT a veteran, please SKIP
TO Q15
13. If your loved one was a veteran, did your
family request military funeral honors?
Yes, and honors were provided
Yes, but honors were not provided
(SKIP TO Q15)
No, did not request military funeral honors
(SKIP TO Q15)
H. What national cemetery policies or
procedures do you feel you could use more
information about? (Mark all that apply)
None, I feel well informed
Eligibility requirements for burial in a
national cemetery
Scheduling process
Military funeral honors
Presidential Memorial Certificates
Floral policy
Headstone, marker, or columbarium
niche cover inscription options
I. What is the best way for the national
cemetery to communicate with your funeral
home regarding changes in its policies and
procedures? (Mark only one)
Phone
Fax
Letter
Email
VA/NCA Web site
Newsletter or flyer
J. Overall, how satisfied are you with the
communication between your funeral home
and the national cemetery?
Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
14. How satisfied were you with the quality of
the military funeral honors your loved one
received?
Very satisfied
Somewhat
Somewhat satisfied
dissatisfied
Neither satisfied
Very
nor dissatisfied
dissatisfied
15. Overall, how satisfied were you with the
committal service at the national cemetery?
Very satisfied
Somewhat
Somewhat satisfied
dissatisfied
Neither satisfied
Very
nor dissatisfied
dissatisfied
–4–
Next-of-Kin: Respond to the questions on the left column of the page.
Funeral Directors: Respond to the questions on the right column of the page.
Questions for Funeral Directors
Questions for Next-of-Kin
16. Were the headstone, marker, or
columbarium niche cover inscription
options explained to you?
Yes
No (SKIP TO Q20)
Not sure/don’t know (SKIP TO Q20)
17. Which of the following inscription options
were explained to you? (Mark all that apply)
Military service information (e.g., rank,
service, valor awards)
Emblems of belief (e.g., religious symbols)
Terms of endearment (e.g., beloved father)
18. Did you feel you had sufficient time to
make a decision on the headstone, marker,
or columbarium niche cover inscription
options?
Yes
No
19. Who explained headstone, marker, or
columbarium niche cover inscription
options to you?
National cemetery representative ONLY
Funeral director ONLY
BOTH the national cemetery
representative and the funeral director
NEITHER the national cemetery nor the
funeral director
20. How satisfied were you with the length of
time it took for the permanent headstone,
marker, or columbarium niche cover to be
in place?
Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
Don’t know/the marker or headstone has
not yet arrived (SKIP TO Q23)
21. When the headstone, marker, or
columbarium niche cover arrived, was the
inscription accurate?
Yes
No
Don’t know
K. Overall, how would you compare the level
of service you receive from the national
cemetery with the level of service you
receive from private cemeteries?
Superior to private cemeteries
Better than private cemeteries
About the same
Worse than private cemeteries
Much worse than private cemeteries
Don’t know/not applicable
L. Overall, how would you compare the
appearance of the national cemetery with
the appearance of private cemeteries?
Superior to private cemeteries
Better than private cemeteries
About the same
Worse than private cemeteries
Much worse than private cemeteries
Don’t know/not applicable
M. To what extent do you understand the
eligibility requirements for burial in a
national cemetery, including eligibility for
reservists and veteran dependents?
Understand completely
Understand somewhat
Do not understand
N. How well do you understand the headstone,
marker, or columbarium niche cover
inscription options available to next of kin?
Understand completely
Understand somewhat
Do not understand
O. How easy is the process of scheduling an
interment at the national cemetery?
Very easy
Somewhat easy
Neither easy nor hard
Somewhat hard
Very hard
–5–
Next-of-Kin: Respond to the questions on the left column of the page.
Funeral Directors: Respond to the questions on the right column of the page.
Questions for Next-of-Kin
Questions for Funeral Directors
22. Overall, how satisfied were you with the
quality and appearance of the headstone,
marker, or columbarium niche cover when
it arrived?
Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
P. How long does it typically take to confirm
the scheduling of an interment at the
national cemetery?
Less than 1 hour
1 to 2 hours
3 to 4 hours
5 to 8 hours
1 to 2 days
More than 2 days
If your loved one was NOT a veteran, please SKIP
TO Q24.
Q. Overall, how satisfied were you with
the length of time it took to confirm the
scheduling of an interment?
Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
23. If your loved one was a veteran, did you
receive a Presidential Memorial Certificate?
No
Yes
24. Looking back at your overall experiences
with the national cemetery, which items
would you have liked more information
about? (Mark all that apply)
None, I was well informed
Details of the committal service
Military funeral honors
Location of gravesite
Layout of cemetery (maps)
Directions to cemetery
Presidential Memorial Certificate
Floral policy
Headstone or marker inscription options
Timeline for placement of headstone/
marker
25. After the loss of your loved one...
a. Did you need bereavement counseling or
support?
Yes
No
Don’t know
b. Did you seek bereavement counseling or
support?
Yes
No
26. Have you contacted VA to find out if you
are eligible for VA survivor benefits?
Yes
No
Don’t know
R. During committal services, how often do
you receive the support you need from
cemetery staff?
Always
For the most part
Occasionally
Never
S. Generally, how often do committal services
at the national cemetery start on time?
Always
For the most part
Occasionally
Never
T. If you are delayed in arriving at the national
cemetery for a scheduled service, how
successful is the cemetery in adjusting the
schedule to accommodate the family?
Very successful
Somewhat successful
Neither successful nor unsuccessful
Somewhat unsuccessful
Very unsuccessful
Don’t know/Not applicable
27. Are you eligible for VA survivor benefits?
Yes
No
Don’t know
28. If eligible, have you applied for VA survival
benefits?
Yes
No
Don’t know
(For information on survivor benefits, contact
VA 800.827.1000)
–6–
Next-of-Kin: Respond to the questions on the left column of the page.
Funeral Directors: Respond to the questions on the right column of the page.
Questions for Funeral Directors
Questions for Next-of-Kin
29. Overall, what was the single biggest
contributing factor to the decision to bury
your loved one in a national cemetery?
(Mark only one)
Honor the wishes of my loved one
Recognition of military service
Other family member also buried at
national cemetery
Location
Affordability
30. What is your gender?
Male
Female
31. Are you Hispanic or Latino?
No
Yes
U. How easy is it to schedule military honors at
the national cemetery?
Very easy
Somewhat easy
Neither easy nor hard
Somewhat hard
Very hard
V. To what extent is the quality of military
honors acceptable?
Very acceptable
Somewhat acceptable
Neither acceptable nor unacceptable
Somewhat unacceptable
Very unacceptable
32. What is your race? (Mark one or more)
White
Black or African American
American Indian or Alaskan Native
Asian
Native Hawaiian or other Pacific Islander
a. The maintenance of the cemetery grounds is excellent..................
b. The upkeep of the headstones, markers, or columbarium niche
covers is excellent...............................................................................
c. The maintenance of other landscape features (e.g., flowers,
trees, shrubs) is excellent...................................................................
d. The committal shelter used for the service was clean, free of
safety hazards, and private.................................................................
e. There is adequate handicap accessibility for visitors who need it
f. The availability of restrooms is suitable to accommodate visitors
on busy days.......................................................................................
g. The cemetery honors all veterans and their service to our nation
h. There are sufficient signs within the cemetery to assist visitors...
i. Parking at the cemetery is adequate to accommodate visitors on
most days............................................................................................
–7–
dis
Do
No n’t k agre
e
t a no
pp w/
lica
ble
gly
Str
on
ree
ag
er
Dis
ith
Ne
ree
Ag
Str
on
gly
Please indicate your level of agreement with
the following statements.
ag
ag
ree
ree
no
rd
isa
gre
e
Questions for All Participants
Str
on
gl y
e
gre
ra
Dis
a
Ne
ith
e
e
Ag
re
j. The cemetery’s roadways and intersections are safe and easily
navigated................................................................................................
Str
on
gl y
ag
gre
ree
en
or
Please indicate your level of agreement with
the following statements.
di s
Do
No n’t k agre
e
t a no
pp w/
l i ca
bl e
di s
ag
ree
Questions for All Participants (continued)
k. The quality of service received from cemetery staff is excellent......
l. The national cemetery staff was courteous........................................
m. The national cemetery staff was professional in terms of being
knowledgeable, helpful, and responsive.............................................
n. The national cemetery hours of operation meet my needs...............
o. The appearance of my loved one’s gravesite/columbaria is
excellent.................................................................................................
p. The information kiosks (i.e., gravesite locators) are helpful to me..
q. Public ceremonies and events at the cemetery promote a sense
of patriotism and heritage.....................................................................
r. The overall appearance of the national cemetery is excellent..........
s. Overall, I am satisfied with my experiences at the national
cemetery.................................................................................................
t. I would recommend the cemetery to veteran families during their
time of need...........................................................................................
u. I am willing to rely on VA and the National Cemetery
Administration to meet the burial needs of veterans in the future...
v. I am willing to rely on VA and the National Cemetery
Administration to maintain national cemeteries as national
shrines in the future...............................................................................
w. My experiences with the national cemetery exceeded my
expectations...........................................................................................
General Comments: Please use this space to elaborate on any aspect of your experiences at the national
cemetery you wish to share with us.
Note: If you would like to be contacted by the cemetery, please write your name and contact information
(address or telephone number): ______________________________________________________________
Thank you for taking the time to complete this survey. Your answers are very important to ensure that the
services provided by national cemeteries meet your needs and expectations. Please return your questionnaire in
the postage-paid envelope.
–8–
| File Type | application/pdf |
| File Modified | 2012-04-05 |
| File Created | 2012-04-04 |