Pension Enrollment Survey

Voice of Veteran (VOV) Continuous Measurement Surveys

VBA_Pension_Enrollment questionnaire_Revised for FY17_Clean_07.12.16

Pension Enrollment Survey

OMB: 2900-0782

Document [docx]
Download: docx | pdf

Voice of the Veteran Enrollment Satisfaction

Pension


OMB Control Number: 2900-0782

Respondent burden: 10 minutes

Expiration date: XX-XX-XXXX



Pension sample population definition: All records for which a Master Record did not exist prior to the 30 day period. The sample will be created monthly. Count of beneficiaries who have received a decision in all 3 PMCs within the past 30 days for the following EP series 120s, 147, 149s, 150 with the claim label of reopen, 180s, and 190s. Note: Only beneficiaries in the aforementioned EP codes should be included, exclude all other EPs. [DO NOT INCLUDE]


[DO NOT DISPLAY/IDENTIFY SECTION HEADERS. DISPLAY SINGLE QUESTION PER PAGE.]


[RESPONSE CODES APPEAR IN BRACKETS AT THE END OF EACH RESPONSE FOR SINGLE RESPONSES AND IN THE PROGRAMMING INSTRUCTIONS FOR MULTIPLE RESPONSES.]

Benefit Information


  1. How did you FIRST learn about VA pension benefit programs? (Mark only one) If you are unsure, please indicate the first way you remember learning about VA benefit programs. [RADIO BUTTONS. SINGLE RESPONSE.]

    1. Online (e.g., eBenefits.va.gov, VA website, etc.) [1]

    2. Mail (from VA) [4]

    3. In person with a VA representative (e.g., VA medical center, VA Vet Center, Regional Office, etc.)

    4. Transition Assistance Program/Disabled Transition Assistance Program briefings [6]

    5. Veterans Service Organizations (e.g., Amer. Legion, DAV, VFW, PVA, MOPH, etc.)

(Specify) ______________ [TEXT BOX. FORCE TEXT IF RESPONSE IS SELECTED. 50 CHARACTER MAX.] [7]

    1. Other Veterans [13]

    2. Friends or family [15]

    3. Assisted living facility or any senior living facility (nursing home or ILS)

    4. Other (Specify) ___________________[TEXT BOX. FORCE TEXT IF RESPONSE IS SELECTED. 50 CHARACTER MAX.] [97]

    5. Don’t know or not sure [99]


  1. What method(s) do you MOST FREQUENTLY use to obtain general information about VA pension benefits? (Mark all that apply) [CHECK BOXES. MULTIPLE RESPONSE. CODE EACH RESPONSE AS 0 IF UNCHECKED OR 1 IF CHECKED]

    1. Online (e.g., eBenefits.va.gov, VA website, etc.)

    2. Phone

    3. Mail (from VA)

    4. E-mail

    5. In person with a VA representative (e.g., VA medical center, VA Vet Center, Regional Office, etc.)

    6. Veterans Service Organizations (e.g., Amer. Legion, DAV, VFW, PVA, MOPH, etc.) (Specify) _________________[TEXT BOX. FORCE TEXT IF RESPONSE IS SELECTED. 50 CHARACTER MAX.]

    7. Friends or family

    8. Other (Specify) ___________________[TEXT BOX. FORCE TEXT IF RESPONSE IS SELECTED. 50 CHARACTER MAX.]

    9. Don’t know or not sure [MUTUALLY EXCLUSIVE RESPONSE.]

    10. None of the above [MUTUALLY EXCLUSIVE RESPONSE.]



  1. How frequently would you like to receive communications (e.g., e-mails, letters, newsletters, etc.) about VA pension benefits? (Mark only one) [RADIO BUTTONS. SINGLE RESPONSE.]

    1. Weekly [1]

    2. Monthly [2]

    3. Quarterly (every 3 months) [3]

    4. Semi-annually (twice per year) [4]

    5. Annually (once per year) [5]

    6. Never [6]

    7. Don’t know or not sure [99]


  1. How would you like to receive information from VA about applying for VA pension benefits? (Mark all that apply) [CHECK BOXES. MULTIPLE RESPONSE. CODE EACH RESPONSE AS 0 IF UNCHECKED OR 1 IF CHECKED]

    1. Phone

    2. Mail

    3. E-mail

    4. Online (e.g., eBenefits.va.gov, VA website, etc.)

    5. In person at a Regional Office

    6. Veterans Service Organizations (e.g., Amer. Legion, DAV, VFW, PVA, MOPH, etc.) (Specify) ___________________[TEXT BOX. FORCE TEXT IF RESPONSE IS SELECTED. 50 CHARACTER MAX.]

    7. Other (Specify) ___________________[TEXT BOX. FORCE TEXT IF RESPONSE IS SELECTED. 50 CHARACTER MAX.]

    8. Don’t know or not sure [MUTUALLY EXCLUSIVE RESPONSE.]



The following question asks you to rate various aspects of your experience with VA’s pension benefit using a scale of 1 to 10, where 1 is Unacceptable, 10 is Outstanding, and 5 is Average. [SHOW ON SAME PAGE AS THE QUESTION THAT FOLLOWS]


  1. When thinking about your most frequently used methods of communication please rate your experience in obtaining information about your benefit application on the following items: (Mark only one per row) [SHOW RESPONSES IN GRID WITH 10-POINT SCALE IN COLUMNS AND ATTRIBUTES/RESPONSES IN ROWS (SEE JDPA CONVENTIONS DOCUMENT PG. 1 FOR SPECIFIC DETAILS OF LAYOUT). EVENLY SPACED RADIO BUTTONS/COLUMNS, ALTERNATE SHADES IN ROWS. SINGLE RESPONSE PER ROW. RANDOMIZE ALL ATTRIBUTES EXCEPT THE LAST ONE.]

    1. Ease of accessing information [ALLOW N/A RESPONSE][1-10, N/A=99]

    2. Availability of information [ALLOW N/A RESPONSE] [1-10, N/A=99]

    3. Clarity of information [ALLOW N/A RESPONSE] [1-10, N/A=99]

    4. Usefulness of information [ALLOW N/A RESPONSE] [1-10, N/A=99]

    5. Frequency of information provided by VA [ALLOW N/A RESPONSE] [1-10, N/A=99]

    6. Overall rating of information [1-10]



Benefit Eligibility and Application Process



  1. Thinking about your most recent pension benefit application, what method did you use to apply for your benefit? (Mark only one) [RADIO BUTTONS. SINGLE RESPONSE]

    1. Online (Skip to Q8)

    2. Mail [2]

    3. In person with a VA representative (e.g., VA medical center, VA Vet Center, Regional Office, etc.)


    1. In person at a Veterans Service Organization (e.g., Amer. Legion, DAV, VFW, PVA, MOPH, etc.) [4]

    2. Other (Specify) ___________________ [TEXT BOX. FORCE TEXT IF RESPONSE IS SELECTED. 50 CHARACTER MAX.] [97]

    3. Don’t know or not sure [99]


(Ask Q7 if Q6 ≠ Online, otherwise go to Q8


  1. Would you be willing and able to submit applications online if the VA was able to process your claim quicker (possibly within 2-14 days)?

    1. Yes [1]

    2. No [0]

    3. I do not have access to a computer/Internet [96]

    4. Don’t know or not sure [99]


  1. After you submitted your application, did you receive a notification/confirmation from VA that your claim was received? [RADIO BUTTONS. SINGLE REPONSE.]

    1. Yes [1]

    2. No [0]

    3. Don’t know or not sure [99]


(Ask Q9-14 if Q8 is Yes, otherwise go to Q15)


  1. Thinking about the notification/confirmation from VA, was it clear and easy to understand? (Mark only one) [RADIO BUTTONS. SINGLE REPONSE.]

    1. Not at all clear [1]

    2. Somewhat clear [2]

    3. Completely clear [3]

    4. Don’t know or not sure [99]

    5. I did not read the letter [96]


  1. Did you contact VA to obtain clarification about any of the notifications/confirmations you received? [RADIO BUTTONS. SINGLE REPONSE.]

    1. Yes [1]

    2. No [0]

    3. Don’t know or not sure [99]


  1. Did you provide VA with the documentation that was requested in the notifications/confirmations? (Mark only one) [RADIO BUTTONS. SINGLE REPONSE.]

    1. Yes [1]

    2. No [0]

    3. Nothing was requested [96]

    4. Don’t know or not sure [99]


(Ask Q12 if Q11 is yes, otherwise go to Q13)

  1. How did you submit the documentation to VA that was requested in the notification/confirmation? (Mark only one) [RADIO BUTTONS. SINGLE REPONSE.]

    1. Online

    2. In person with a VA representative (e.g., VA medical center, VA Vet Center, Regional Office, etc.)

    3. Mail

    4. Through a Veterans Service Organization (e.g., Amer. Legion, DAV, VFW, PVA, MOPH, etc.) [3]

    5. Other (Specify) ___________________[TEXT BOX. FORCE TEXT IF RESPONSE IS SELECTED. 50 CHARACTER MAX.] [97]

    6. Don’t know or not sure [99]


  1. What is your preferred method for submitting the documentation to VA? (Mark only one) [RADIO BUTTONS. SINGLE REPONSE.]

    1. Online

    2. In person with a VA representative (e.g., VA medical center, VA Vet Center, Regional Office, etc.) [2]

    3. Mail

    4. Through a Veterans Service Organization (e.g., Amer. Legion, DAV, VFW, PVA, MOPH, etc.) [4]

    5. Other (Specify) ___________________[TEXT BOX. FORCE TEXT IF RESPONSE IS SELECTED. 50 CHARACTER MAX.] [97]

    6. Don’t know or not sure [99]


  1. Did you receive a subsequent notification requesting information in support of your claim from VA? (Mark only one) [RADIO BUTTONS. SINGLE REPONSE.]

    1. Yes [1]

    2. No [0]

    3. Don’t know or not sure [99]


  1. During the application process, did you have to provide the same information more than once? (Mark only one) [RADIO BUTTONS. SINGLE REPONSE.]

    1. Yes [1]

    2. No [0]

    3. Don’t know or not sure [99]



(Ask Q16 if Q15 is Yes, otherwise go to Q17)

  1. What information did you have to provide more than once? (Mark all that apply) [CHECK BOXES. MULTIPLE RESPONSE. CODE EACH RESPONSE AS 0 IF UNCHECKED OR 1 IF CHECKED]

    1. Discharge papers (DD214)

    2. Service treatment records

    3. Private medical records

    4. Proof of dependency (e.g., marriage license, birth certificate, etc.)

    5. Other (Specify) ___________________[TEXT BOX. FORCE TEXT IF RESPONSE IS SELECTED. 50 CHARACTER MAX.]

    6. Don’t know or not sure



The following question asks you to rate various aspects of your experience with your pension benefit application using a scale of 1 to 10, where 1 is Unacceptable, 10 is Outstanding, and 5 is Average. [SHOW ON SAME PAGE AS THE QUESTION THAT FOLLOWS]


  1. Please rate your experience with the benefit application process on the following items: (Mark only one per row) [SHOW RESPONSES IN GRID WITH 10-POINT SCALE IN COLUMNS AND ATTRIBUTES/RESPONSES IN ROWS (SEE JDPA CONVENTIONS DOCUMENT PG. 1 FOR SPECIFIC DETAILS OF LAYOUT). EVENLY SPACED RADIO BUTTONS/COLUMNS, ALTERNATE SHADES IN ROWS. SINGLE RESPONSE PER ROW. RANDOMIZE ALL ATTRIBUTES EXCEPT THE LAST ONE.]

    1. Ease of completing the application [ALLOW N/A RESPONSE][1-10, N/A=99]

    2. Timeliness of eligibility/entitlement notification [ALLOW N/A RESPONSE] [1-10, N/A=99]

    3. Flexibility of application methods [ALLOW N/A RESPONSE] [1-10, N/A=99]

    4. Overall rating of application process [1-10]


(Paper Only Instruction: Ask Q18-20 if previously found ineligible for VA benefit payments, otherwise go to Q21)

  1. If you were previously found ineligible for VA benefit payments, did you understand why you were found ineligible? (Mark only one) [RADIO BUTTONS. SINGLE RESPONSE]

    1. Yes [1]

    2. No [0]

    3. Don’t know or not sure [99]

    4. Not applicable, never been found ineligible [96]



  1. Were you provided information about how to appeal your decision? (Mark only one) [RADIO BUTTONS. SINGLE RESPONSE]

    1. Yes [1]

    2. No [0]

    3. Don’t know or not sure [99]


  1. Using a scale of 1 to 10, where 1 is Unacceptable, 10 is Outstanding, and 5 is Average, please rate the clarity of the information you were provided about appealing your decision. [SHOW RESPONSES IN GRID WITH 10-POINT SCALE IN COLUMNS AND SINGLE ROW (SEE JDPA CONVENTIONS DOCUMENT PG. 1 FOR SPECIFIC DETAILS OF LAYOUT). EVENLY SPACED RADIO BUTTONS/COLUMNS, SINGLE RESPONSE PER ROW.][1-10]




Benefit Entitlement


The following question asks you to rate various aspects of your experience with your pension benefit payment using a scale of 1 to 10, where 1 is Unacceptable, 10 is Outstanding, and 5 is Average. [SHOW ON SAME PAGE AS THE QUESTION THAT FOLLOWS]


  1. Please rate your benefit payment on the following items: (Mark only one per row) [SHOW RESPONSES IN GRID WITH 10-POINT SCALE IN COLUMNS AND ATTRIBUTES/RESPONSES IN ROWS (SEE JDPA CONVENTIONS DOCUMENT PG. 1 FOR SPECIFIC DETAILS OF LAYOUT). EVENLY SPACED RADIO BUTTONS/COLUMNS, ALTERNATE SHADES IN ROWS. SINGLE RESPONSE PER ROW. RANDOMIZE ALL ATTRIBUTES EXCEPT THE LAST ONE.]

    1. Amount of benefit payment [ALLOW N/A RESPONSE][1-10, N/A=99]

    2. Timeliness of receiving initial benefit payment [ALLOW N/A RESPONSE] [1-10, N/A=99]

    3. Overall rating of your benefit payment [1-10]



Overall Application Experience


  1. Thinking about ALL aspects of your experience applying for your pension benefit, please rate VA overall, using a scale of 1 to 10 where 1 is Unacceptable, 10 is Outstanding, and 5 is Average. (Mark only one) [SHOW RESPONSES IN GRID WITH 10-POINT SCALE IN COLUMNS AND SINGLE ROW (SEE JDPA CONVENTIONS DOCUMENT PG. 1 FOR SPECIFIC DETAILS OF LAYOUT). EVENLY SPACED RADIO BUTTONS/COLUMNS, SINGLE RESPONSE PER ROW.] [1-10]



Overall Experience with VA


  1. Taking into consideration all of the non-medical benefits (e.g., education, compensation, pension, home loan guaranty, vocational rehabilitation and employment, insurance, etc.) you have applied for or currently receive, please rate your experience with VA overall, using a scale of 1 to 10 where 1 is Unacceptable, 10 is Outstanding, and 5 is Average. (Mark only one) [SHOW RESPONSES IN GRID WITH 10-POINT SCALE IN COLUMNS AND SINGLE ROW (SEE JDPA CONVENTIONS DOCUMENT PG. 1 FOR SPECIFIC DETAILS OF LAYOUT). EVENLY SPACED RADIO BUTTONS/COLUMNS, SINGLE RESPONSE PER ROW.] [1-10]


  1. Now think about your experiences with all the services provided by the Department of Veterans Affairs (which include healthcare, benefits programs, or memorial services). Please tell us how you feel about the following statements. (Mark only one per statement)

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

  1. I got the service I needed






  1. It was easy to get the service I needed






  1. I felt like a valued customer






  1. I trust VA to fulfill our country’s commitment to Veterans








  1. Do you have any other comments or concerns about your experience? (Open Capture) [OPEN-END. TEXT BOX. 1000 CHARACTERS MAX. ALLOW NO COMMENT, MUTUALLY EXCLUSIVE CHECK BOX. CODE NO COMMENT AS 0 IF UNCHECKED AND 1 IF CHECKED]

____________________________________________________



10

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleWe are conducting a survey on behalf of the Veteran’s Benefits Administration to understand Veterans’ experience with the [INSER
Authorangelafa
File Modified0000-00-00
File Created2021-01-23
© 2024 OMB.report | Privacy Policy