10-0485 Group 12 Survey

OMB No. 2900-XXXX

Estimated Burden: 10 Minutes

OMB Expiration Date: XX/XX/XXXX

If Q1= No then go to exit screen

If Q1= Yes then go to Q2

If Q2= Yes then go to exit screen

If Q1= No then go to Q3

If Q1= No AND respondent = Group 1 then go to Q3(1)

If Q1= No AND respondent = transitional or homeless Veteran then go to Q3(2)

If Q3= No then go to exit screen

If Q3= Yes then go to Q4

If Q7 ‘other (specify)’ = yes, then pop-up box for response.

If Q11 = a social worker, administrative staff, someone helping you, or other go to Q12

If Q11 = The Hospital or clinic website or My HealtheVet go to Q13

If Q14 = Never then go to Q18

If Q14 = Rarely, at least once a month, at least once a week, or daily then go to Q15