Pension Enrollment Survey

VA_Surv11_PenEnrol_5.17.16_v11 5/17/16 1:07 PM Page 1

Pension
Enrollment Satisfaction

MARKING INSTRUCTIONS
Please fill the response oval completely
and print clearly.

USE BLACK OR BLUE INK
(NO RED) to complete the survey.

CORRECT:

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=7 =3 =

INCORRECT:

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!!

11

OMB Control No. 2900-0782

Throughout the questionnaire, you may be asked to skip certain questions that may not apply to you.

Benefit Information
1.

How did you FIRST learn about the VA pension benefit programs? (MARK ONLY ONE)
IF YOU ARE UNSURE, PLEASE INDICATE THE FIRST WAY YOU REMEMBER LEARNING ABOUT VA BENEFIT PROGRAMS.

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Online (e.g., eBenefits.va.gov, VA website, etc.)
Mail (from VA)
In person with a VA representative (e.g., VA medical
center, VA Vet Center, Regional Office, etc.)
Transition Assistance Program/Disabled Transition
Assistance Program briefings
Veterans Service Organizations (e.g., Amer. Legion, DAV,
VFW, PVA, MOPH, etc.) (Please specify): _________________

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Other Veterans
Friends or family
Assisted living facility or any senior living facility
(nursing home or ILS)
Other (Please specify): ____________________________________
Don’t know or not sure

___________________________________________________________

2.

3.

What method(s) do you MOST FREQUENTLY use to obtain general information about VA pension benefits? (MARK ALL THAT APPLY)

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Veterans Service Organizations (e.g., Amer. Legion, DAV,
VFW, PVA, MOPH, etc.) (Please specify): __________________

____________________________________________________________

Friends or family
Other (Please specify): ____________________________________
Don’t know or not sure
None of the above

How frequently would you like to receive communications (e.g., e-mails, letters, newsletters, etc.) about VA pension benefits?
(MARK ONLY ONE)

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Online (e.g., eBenefits.va.gov, VA website, etc.)
Phone
Mail (from VA)
E-mail
In person with a VA representative (e.g., VA medical
center, VA Vet Center, Regional Office, etc.)

Weekly
Monthly

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Quarterly (every 3 months)
Semi-annually (twice per year)

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Annually (once per year)

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Don’t know or not sure

Never

How would you like to receive information from VA about applying for VA pension benefits? (MARK ALL THAT APPLY)

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Phone
Mail
E-mail

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In person at a Regional Office

Other (Please specify): _________________

Veterans Service Organizations (e.g., Amer. Legion,
Don’t know or not sure
DAV, VFW, PVA, MOPH, etc.) (Please specify): ___________________________________________________________

Online (e.g., eBenefits.va.gov, VA website, etc.)
© 2016 J.D. Power and Associates. All Rights Reserved.

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Benefit Information (Continued)
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.
5.

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)
Unacceptable
1

a.

Ease of accessing information

b.

Availability of information

c.

Clarity of information

d.

Usefulness of information

e.

Frequency of information provided by VA

f.

Overall rating of information

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¡
¡
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2

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™
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Average
3

£
£
£
£
£
£

4

¢
¢
¢
¢
¢
¢

5

∞
∞
∞
∞
∞
∞

Outstanding
6

§
§
§
§
§
§

7

¶
¶
¶
¶
¶
¶

8

•
•
•
•
•
•

9

ª
ª
ª
ª
ª
ª

10

‚
‚
‚
‚
‚
‚

N/A

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NA

NA

NA

NA

NA

Benefit Eligibility and Application Process
6.

Thinking about your most recent pension benefit application, what method did you use to apply for your benefit?
(MARK ONLY ONE)

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7.

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)? (MARK ONLY ONE)

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8.

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Yes

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No

I do not have access to a computer/Internet

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Don’t know or not sure

After you submitted your application, did you receive a notification/confirmation from VA that your claim was received?
(MARK ONLY ONE)

9.

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Online (SKIP TO Q8)
Other (Please specify): ____________________________________
Mail
Don’t know or not sure
In person with a VA representative (e.g., VA medical
center, VA Vet Center, Regional Office, etc.)
In person at a Veterans Service Organization (e.g., Amer. Legion, DAV,
VFW, PVA, MOPH, etc.)

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Yes

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No (SKIP TO Q15)

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Don’t know or not sure (SKIP TO Q15)

Thinking about the notification/confirmation from VA, was it clear and easy to understand? (MARK ONLY ONE)
Not at all clear
Somewhat clear

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Completely clear

I did not read the letter

Don’t know or not sure

10.

Did you contact VA to obtain clarification about any of the notification(s)/confirmation(s) you received? (MARK ONLY ONE)

11.

Did you provide VA with the documentation that was requested in the notification(s)/confirmation(s)? (MARK ONLY ONE)

12.

13.

Yes
Yes

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No

No (SKIP TO Q13)

Don’t know or not sure

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Nothing was requested (SKIP TO Q13)

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Don’t know or not sure (SKIP TO Q13)

How did you submit the documentation to VA that was requested in the notification/confirmation? (MARK ONLY ONE)

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

Through a Veterans Service Organization (e.g., Amer.
Legion, DAV, VFW, PVA, MOPH, etc.)
Other (Please specify): ____________________________________
Don’t know or not sure

What is your preferred method for submitting documentation to VA? (MARK ONLY ONE)

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

Page 2

Through a Veterans Service Organization (e.g., Amer.
Legion, DAV, VFW, PVA, MOPH, etc.)
Other (Please specify): ____________________________________
Don’t know or not sure

VA_Surv11_PenEnrol_5.17.16_v11 5/17/16 1:07 PM Page 3

Benefit Eligibility and Application Process (Continued)
14.

Did you receive a subsequent notification requesting information in support of your claim from VA? (MARK ONLY ONE)

15.

During the application process, did you have to provide the same information more than once? (MARK ONLY ONE)

16.

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Yes
Yes

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No

No (SKIP TO Q17)

Don’t know or not sure

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Don’t know or not sure (SKIP TO Q17)

What information did you have to provide more than once? (MARK ALL THAT APPLY)
Discharge papers (DD214)

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Proof of dependency

Service treatment records

(e.g., marriage license,

Private medical records

Other (Please specify): ________________________________
Don’t know or not sure

birth certificate, etc.)

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.
17.

Please rate your experience with the benefit application process on the following items: (MARK ONLY ONE PER ROW)
Unacceptable
Average
2

1

a.

Ease of completing the application

b.

Timeliness of eligibility/entitlement notification

c.

Flexibility of application methods

d.

Overall rating of application process

¡
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¡

™
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3

£
£
£
£

4

¢
¢
¢
¢

5

∞
∞
∞
∞

6

§
§
§
§

7

¶
¶
¶
¶

8

•
•
•
•

Outstanding
9

ª
ª
ª
ª

10

N/A

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NA
NA
NA

PLEASE ANSWER Q18-Q20 IF YOU WERE PREVIOUSLY FOUND INELIGIBLE FOR VA BENEFITS. OTHERWISE, PLEASE SKIP TO Q21.

18.

If you were previously found ineligible for VA benefit payments, did you understand why you were found ineligible?
(MARK ONLY ONE)

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19.

20.

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Yes

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No

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Don’t know or not sure

Not applicable, never been found ineligible

Were you provided information about how to appeal your decision? (MARK ONLY ONE)

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Yes

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No

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Don’t know or not sure

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. (MARK ONLY ONE)
Unacceptable
Average
Outstanding
1

2

3

4

5

6

7

8

9

10

¡ ™ £ ¢ ∞ § ¶ • ª ‚
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.
21.

Please rate your benefit payment on the following items: (MARK ONLY ONE PER ROW)
Unacceptable
1

a.
b.
c.

2

Average
3

4

5

Outstanding
6

7

8

9

10

N/A

¡ ™ £ ¢ ∞ § ¶ • ª ‚ =
¡ ™ £ ¢ ∞ § ¶ • ª ‚ =
¡ ™ £ ¢ ∞ § ¶ • ª ‚

Amount of benefit payment
Timeliness of receiving initial benefit payment
Overall rating of your benefit payment

NA

NA

© 2016 J.D. Power and Associates. All Rights Reserved. 11

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Overall Application Experience
22.

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)
Unacceptable
1

2

Average
3

4

5

Outstanding
6

7

8

9

10

¡ ™ £ ¢ ∞ § ¶ • ª ‚
Overall Experience with VA
23.

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)
Unacceptable
Average
Outstanding
1

2

3

4

5

6

7

8

9

10

¡ ™ £ ¢ ∞ § ¶ • ª ‚
24.

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
a.
b.
c.
d.

¡
¡
¡
¡

Neutral

Agree

™
™
™
™

£
£
£
£

¢
¢
¢
¢

Strongly
Agree

∞
∞
∞
∞

Do you have any other comments or concerns about your experience?
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________

THANK YOU FOR TAKING THE TIME TO PARTICIPATE IN THIS IMPORTANT STUDY.

Please return to: J.D. Power and Associates Survey Processing Center
P.O. Box 510030 • Livonia, MI 48151-9907
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234332/0216/11

25.

I got the service I needed
It was easy to get the service I needed
I felt like a valued customer
I trust VA to fulfill our country’s commitment to Veterans

Disagree