Supplier Perception Survey

Supplier Perception Survey FY 2017

The Paperwork Reduction Act of 1995 requires us to notify you that this information collection is in accordance with the clearance requirements of section 3507 of the Paperwork Reduction Act of 1995. VA may not conduct or sponsor, and you are not required to respond to, a collection of information unless it displays a valid OMB number. We anticipate that the time expended by all individuals who must complete this form will average 5 minutes. This includes the time it will take to read instructions, gather the necessary facts and fill out the form. Send comments regarding this burden estimate or any other aspects of this collection, including suggestions for reducing this burden, to VA Clearance Officer (005R1B), 810 Vermont Avenue, Washington, DC 20420.

OMB Approval No. 2900-0770

Estimated burden 5 minutes
Expiration: XXX_20XX

	Please evaluate your perception of your VA acquisition provider’s supply management practices compared to similar experiences with other companies. If you do business with other government agencies aside from your VA acquisition provider, use other agencies as a point of reference. For each question, select a number from 1 to 5, with 1 representing “much worse than other organizations,” 3 representing “similar to other organizations,” and 5 representing “much better than other organizations.”
		1	2	3	4	5
Q01	Timeliness/Quality/Completeness of VA contracting office’s communications
Q02	VA contracting/program management offices procurement/technical competence and contracting office’s integrity
Q03	Extent to which your VA contracting office makes it easy to succeed in effectively providing the goods and services being procured
Q04	VA contracting office honors contract payment terms and cooperates in resolving problems such as invoice rejections, payment, or price discrepancies
Q05	Mutual commitment between VA contracting office for a long term business relationship
Q06	Overall quality of the working relationship between your VA contracting office and your company
Q07	VA contracting office collaborates with you to identify/share/mitigate mutual risk
Q08	VA contracting office emphasis on commitment to continuous improvement
Q09	Effectiveness of your contracting office written technical requirements in developing the required solicitation
Q10	Consistency/Quality/Effectiveness of your VA contracting office written technical requirements
Q11	Consistency/quality of your VA contracting office request for information/documentation such as edits to drawings and/or specification, etc.

Q12	What is your business status as defined by Federal Standards – NAICS codes and Socio-Economic type? Select all that apply.
	O	Large Business
	O	Small Business
	O	8A Business
	O	Woman-owned Business
	O	HUBZone Business
	O	Service Disabled Veteran Owned Business
	O	Veteran Owned Business
	O	Small Disadvantaged Owned Business
	O	Other (please specify)
	O	Don’t Know

Q13	Are you currently under contract with VA?
		No
		Yes

Q14	What category is your firm associated with? Select all that apply.
	O	Pharmaceuticals
	O	Medical Supplies
	O	Medical Equipment
	O	Information Technology
	O	Construction
	O	Design Services
	O	Medical Services
	O	Private Health Care Providers
	O	Dental
	O	Other (please specify)

Q15	Which of the following VA contracting offices do you interact with? Select all that apply.
	O	Procurement and Logistics Office (VHA)
	O	National Acquisition Center (NAC)
	O	Veterans Benefit Administration (VBA)
	O	Office of Acquisition Operations (OAO)
	O	National Cemetery Administration (NCA)
	O	Office of Construction & Facilities Management (CFM)
	O	National Cemetery Administration (NCA)
	O	Other (please specify)
	O	Don’t Know

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Supplier Perception Survey