VA Form 10-211007 HEC Online Survey

OMB 2900-0761
Estimated Burden: 4.2 min.

The Health Eligibility Center (HEC) Online Survey
THE PAPERWORK REDUCTION ACT OF 1995 requires us to notify you that this information collected is in accordance with the
clearance requirements of section 3507 of this Act. The public reporting burden for this collection of information is estimated to average 4.2
minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information. No person will be penalized for failing to furnish this information if it
does not display a current valid OMB control number. This collection of information is intended to fulfill the need identified by the
Department of Veterans Affairs in their call for evaluation and improvements to the current Patient Satisfaction program. Your obligation to
respond to this survey is voluntary and failure to furnish this information will have no effect on any of your benefits.

Survey of your experience with the HEC correspondence process.

This is an anonymous survey. If you have any questions or concerns regarding this survey, please
contact Dennis Boyette at 404-828-5398 or dennis.boyette@va.gov
Here is a question
about the letter you
just wrote. In terms of
your satisfaction, how
would you rate our
explanation of what
was done for you?
Thinking about the
letter you wrote, how
would you rate how
long you waited to get
a response?

Overall quality of
correspondence
process.

How long did you wait
between the days you
wrote your letter and
the day you received
a response to your
letter?

Poor

Fair

Good

Very
Good

Excellent

Poor

Fair

Good

Very
Good

Excellent

Poor

Fair

Good

Very
Good

Excellent

Same
Day

1-3
Days

4-7
Days

Submit

8-14
Days

15-30
Days

31-60
Days

More
Than
61 Days