Form VA Form 10165 VA Form 10165 U.S. Department of Veterans Affairs Supplier Perception

Supplier Perception Survey FY 2015

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 30 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. SEND COMMENTS ONLY.

OMB Approval No. 2900-0751

Estimated burden 30 minutes
Expiration: XXX_20XX

Notes:

• An “X” denotes a “select one” option; an “O” denotes “check all that apply.”

• Q39, which asks about business categories, was already in the survey so we only added in Q41, which asks about which offices they interact with.

• The first three tables are randomized both in terms of what order the tables appear and what order each individual question appears within the table.

	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 of your VA contracting office communications
Q02	Quality of your VA contracting office communications
Q03	Completeness of information communicated by your VA contracting office
Q04	Your VA contracting office integrity
Q05	Your VA contracting office technical competence
Q06	Your VA contracting office procurement competence
Q07	Your VA contracting office supported offices (ultimate customers) program management competence
Q08	Transparency of your VA contracting office acquisition/procurement processes
Q09	Extent to which your VA contracting office provides an effective interface between its management and yours
Q10	Your VA contracting office ability to present “one face” in your dealings across multiple functions
Q11	Extent to which your VA contracting office makes it easy for you to succeed in effectively providing the goods and services they procure
Q12	Your VA contracting office overall procurement process

Barbaricum, LLC
819 7^th St NW, Washington, DC 20001

	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
Q13	Your VA contracting office cooperation in resolving problems such as invoice rejections, payment, or price discrepancies
Q14	Your VA contracting office honors contract payment terms
Q15	Your commitment to your VA contracting office for a long term business relationship
Q16	Your VA contracting office commitment to you for a long term business relationship
Q17	Overall quality of the working relationship between your VA contracting office and your company
Q18	Your VA contracting office collaborates with you to identify mutual risk
Q19	Your VA contracting office collaborates with you to share mutual risk
Q20	Your VA contracting office collaborates with you to mitigate mutual risk
Q21	Your VA contracting office concern for your profitability
Q22	Your VA contracting office processes to allow you to provide best value
Q23	Your VA contracting office effectiveness in sharing risk, reducing your need to build risk into your pricing
Q24	Your VA contracting office effectiveness in focusing on total cost of ownership

Barbaricum, LLC
819 7^th St NW, Washington, DC 20001

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Supplier Perception Survey

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Supplier Perception Survey

	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
Q25	Your VA customer’s emphasis on quality and commitment to continuous improvement
Q26	Your VA acquisition team’s effectiveness in soliciting and implementing your ideas to improve the quality of the good or services you supply
Q27	Consistency/quality of your VA customer’s requirements for documentation such as statements of work, drawings and specifications, etc.
Q28	Willingness/desire of your VA customer to commit (fund) quality resources to help you meet quality related requirements
Q29	Your VA acquisition team’s in soliciting and implementing your ideas to improve the design or technical specifications of the goods and services you provide
Q30	Your VA acquisition team’s effectiveness in integrating your technical resources and expertise into new product development projects
Q31	Effectiveness of your VA acquisition team’s written technical requirements in developing the required solution
Q32	Effectiveness of your VA acquisition team’s written technical requirements in facilitating easy flow down of requirements to you
Q33	Does your VA contracting office help you in providing goods and services? If so, how?
	X	[Open Ended]

Barbaricum, LLC
819 7^th St NW, Washington, DC 20001

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Supplier Perception Survey

Q34	Does your VA contracting office hinder you in providing goods and services? If so, how?
	X	[Open Ended]

Q35	Is your VA contracting office a customer of choice? Why or why not?
	X	[Open Ended]

Q36	Any general comments on your VA contracting office?
	X	[Open Ended]

Q37	What percentage of your revenue is currently with your VA customers?
	X	0-10%
	X	11%-20%
	X	21%-30%
	X	31%-40%
	X	41%-50%
	X	51%-60%
	X	61%-70%
	X	71%-80%
	X	81%-90%
	X	91%-100%
	X	Unsure

Q38	Do you intend to increase the percentage of business you do with your VA customers in the future?
	X	No
	X	Yes
	X	Unsure

Q39	What is your business status 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

Barbaricum, LLC
819 7^th St NW, Washington, DC 20001

^{VA Form}

Barbaricum, LLC
819 7^th St NW, Washington, DC 20001

	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

Q40	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)

Q41	Which of the following VA contracting offices do you interact with? Select all that apply.
	O	Procurement and Logistics Office (VHA)
	O	National Healthcare Acquisition (NAC)
	O	Veterans Benefits Administration (VBA)
	O	Office of Acquisition Operations (OAO)
	O	Office of Construction & Facilities Management (CFM)
	O	National Cemetery Administration (NCA)
	O	Other (please specify)
	O	Don’t Know

Q42	How long (in years) has your company done business with VA?
	X	[drop down]

Q43	Are you currently under contract with VA?
	X	No
	X	Yes

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Supplier Perception Survey