Pension Servicing Survey

VA_Surv8_PensSvc_5.26.16 _v8 5/26/16 12:50 PM Page 1

Pension
Servicing 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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INCORRECT:

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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 VA’s 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): __________

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.

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What method(s) do you MOST FREQUENTLY use to obtain general information about VA pension benefits? (MARK ALL THAT APPLY)
Online (e.g., eBenefits.va.gov, VA website, etc.)
Veterans Service Organizations (e.g., Amer. Legion, DAV,
Phone
VFW, PVA, MOPH, etc.) (Please specify): __________________
Mail (from VA)
Friends or family
E-mail
Other (Please specify): ___________________________________
In person with a VA representative (e.g., VA medical center,
Don’t know or not sure
VA Vet Center, Regional Office, etc.)
None of the above

3.

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

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(MARK ONLY ONE)

4.

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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 pension benefits? (MARK ALL THAT APPLY)
Phone
Mail
E-mail
Online (e.g., eBenefits.va.gov, VA website, etc.)
In person at a Regional Office

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Veterans Service Organizations (e.g., Amer. Legion, DAV,
VFW, PVA, MOPH, etc.) (Please specify): _____________
Other (Please specify): ________________________________
Don’t know or not sure
© 2016 J.D. Power and Associates. All Rights Reserved.

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VA_Surv8_PensSvc_5.26.16 _v8 5/26/16 12:50 PM Page 2

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,
5.

where 1 is Unacceptable, 10 is Outstanding, and 5 is Average.
When thinking about your most frequently used methods of communication, please rate your experience in obtaining
information about your benefit on the following items:
(MARK ONLY ONE PER ROW)
Unacceptable
Average
Outstanding
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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2

3

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£
£
£
£
£
£

4

¢
¢
¢
¢
¢
¢

5

∞
∞
∞
∞
∞
∞

6

§
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§

7

¶
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8

•
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•

9

ª
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ª

10

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N/A

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NA

NA
NA
NA
NA

Benefit Entitlement
6.

7.

What is your preferred method to submit a claim? (MARK ONLY ONE)

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Mail
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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Online (SKIP TO Q8)
Other (Please specify): ________________________________
Don’t know or not sure

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

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Yes

No

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I do not have access to a computer/Internet

Don’t know or not sure

8.

Did VA require you to provide additional medical evidence after you submitted your claim? (MARK ONLY ONE)

9.

Were you required to undergo a VA medical evaluation as a result of your claim? (MARK ONLY ONE)

10.

Did the exam seem appropriate and/or address your claimed condition(s)? (MARK ONLY ONE)

11.

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

12.

Yes
Yes
Yes

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No (SKIP TO Q11)
No (SKIP TO Q11)
No

Yes (SKIP TO Q13)

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Don’t know or not sure (SKIP TO Q11)
Don’t know or not sure (SKIP TO Q11)

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Not applicable (SKIP TO Q11)

Don’t know or not sure
No

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Don’t know or not sure (SKIP TO Q13)

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Not applicable (SKIP TO Q13)

What did you find unclear/didn't understand about your ineligibility decision? Please specify: _____________________________________
__________________________________________________________________________________________________________

13.

In the past 6 months, have you submitted any documentation required to verify your eligibility for benefits (e.g., income
verification, marriage certificate, medical records, dependent information, etc.)? (MARK ONLY ONE)

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15.

Yes

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No (SKIP TO Q16)

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Don’t know or not sure (SKIP TO Q16)

Was there any change (increase or decrease) to your pension benefits based on the verification of the documents
submitted? (MARK ONLY ONE)

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Yes

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No (SKIP TO Q16)

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Don’t know or not sure (SKIP TO Q16)

Were you informed as to the reason why your benefit payment changed? (MARK ONLY ONE)
Yes

No

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Don’t know or not sure

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Benefit Entitlement (Continued)
The following question asks you to rate various aspects of your experience with your pension benefits, using a scale of 1 to 10
where 1 is Unacceptable, 10 is Outstanding, and 5 is Average.
16.

Unacceptable

Please rate your pension benefits
on the following items: (MARK ONLY ONE PER ROW)
a. Amount of pension benefit payment
b.

Timeliness of receiving benefit payment

c.

Overall rating of your benefit

1

2

Average
3

4

5

Outstanding
6

7

8

9

10

N/A

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¡ ™ £ ¢ ∞ § ¶ • ª ‚
NA
NA

Overall Experience with Benefit
17.

Thinking about ALL aspects of your experience with your pension benefits, please rate VA overall, using a 1 to 10 scale
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
18.

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
1

2

Average
3

4

5

Outstanding
6

7

8

9

10

¡ ™ £ ¢ ∞ § ¶ • ª ‚
19.

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.

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Neutral

Agree

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£
£
£
£

¢
¢
¢
¢

Strongly
Agree

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Do you have any other comments or concerns about your experience?
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
© 2016 J.D. Power and Associates. All Rights Reserved. 8

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

Page 3

234332/0216/8

20.

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

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