| Number | Objective |
| 1 | Identify what is most important to Veterans in determining their satisfaction with TAP |
| 2 | Determine what to do to improve the experience |
| 3 | Serve to guide training and/or operational activities aimed at enhancing the quality of service provided to Veterans |
| Question # | Question | Response Type | Response Options | Topic(s) | Objective(s) |
| 1 | Which TAP classes did you complete before you or your family member transitioned from the military or were released from active duty (If Reserve component)? Circle all that apply | Multiple Choice | a) Transition GPS 5-day course; b) VA Benefits Briefings (two classes outlining the VA benefits and services available, how to use them and how to apply); c) Transition Overview (e.g., Resilient Transitions); d) Personal Financial Planning for Transition (e.g., financial readiness); e) Military Occupational Classification “MOC” Crosswalk (e.g., helps you be more marketable in the civilian sector); f) Department of Labor Employment Workshop (e.g., career development skills such as interviewing, networking, and writing resumes; g) Accessing Higher Education Track (e.g., how to achieve academic education success and finance education); h) Entrepreneurship Track (e.g., SBA or “Boots to Business”); i) Career Credentialing and Apprenticeship Track (CT3, previously called CTT or sometimes “career training track”); j) None of the above; k) Don’t know | TAP | 1, 2, 3 |
| 2 | In what capacity did you attend TAP training? Circle all that apply | Multiple Choice | a) Servicemember (Active duty, Guard or Reserve); b) Veteran; c) Spouse; d) Other family member; e) Caregiver |
TAP | 1, 2, 3 |
| 3 | How did you complete the module(s)? Circle the answer that is closest to your experience | Select one | a) I took all or almost all in a traditional classroom setting; b) I took all or almost all virtually (e.g., online); c) I took 3 to 4 of my modules/tracks in a classroom and 3 to 4 virtually; d) None of the above describes my experiences | TAP | 1, 2, 3 |
| 4a | When considering the course information for each TAP module, how useful was the content during your transition? Check one box for each module: VA Benefits I/II | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | TAP, Benefits | 2 |
| 4b | When considering the course information for each TAP module, how useful was the content during your transition? Check one box for each module: Career Technical Training Track (CT3, previously called CTT or sometimes “career training track”) | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | TAP, Employment | 2 |
| 4c | When considering the course information for each TAP module, how useful was the content during your transition? Check one box for each module: Transition Overview (e.g., Resilient Transitions) | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | TAP | 2 |
| 4d | When considering the course information for each TAP module, how useful was the content during your transition? Check one box for each module: Personal Financial Planning for Transition (e.g., financial readiness) | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | TAP, Finances | 2 |
| 4e | When considering the course information for each TAP module, how useful was the content during your transition? Check one box for each module: Military Occupational Classification Crosswalk “MOC” Crosswalk (e.g., helps you be more marketable in the civilian sector) | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | TAP, Employment | 2 |
| 4f | When considering the course information for each TAP module, how useful was the content during your transition? Check one box for each module: Department of Labor Employment Workshop (e.g., career development skills such as interviewing, networking, and writing resumes) | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | TAP, Employment | 2 |
| 4g | When considering the course information for each TAP module, how useful was the content during your transition? Check one box for each module: Accessing Higher Education Track | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | TAP, Education | 2 |
| 4h | When considering the course information for each TAP module, how useful was the content during your transition? Check one box for each module: Entrepreneurship Track | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | TAP, Employment | 2 |
| 4i | When considering the course information for each TAP module, how useful was the content during your transition? Check one box for each module: OPM’s Federal Employment Training (e.g., federal hiring program) | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | TAP, Employment | 2 |
| 5a | To what extent do you agree or disagree with each of the following statements about TAP?: Overall, the program was beneficial in helping me gain the information and skills I needed to prepare me for my transition and post-military life. | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | TAP, Quality of Life | 1, 2, 3 |
| 5b | To what extent do you agree or disagree with each of the following statements about TAP?: Overall, the program enhanced my confidence in transition planning. | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | TAP | 1, 2, 3 |
| 5c | To what extent do you agree or disagree with each of the following statements about TAP?: Overall, I used what I learned from the program during my transition. | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | TAP | 1, 2, 3 |
| 5d | To what extent do you agree or disagree with each of the following statements about TAP?: I was given the time I needed during my military career to attend TAP courses. | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | TAP | 1, 2, 3 |
| 5e | To what extent do you agree or disagree with each of the following statements about TAP?: My immediate leadership was supportive of my transition to civilian life (e.g., attending TAP courses, attaining Career Readiness Standards). | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | TAP | 1, 2, 3 |
| 5f | To what extent do you agree or disagree with each of the following statements about TAP?: The process of transitioning from active duty was more challenging than I expected. | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | TAP | 1, 2, 3 |
| 5g | To what extent do you agree or disagree with each of the following statements about TAP?: I am adjusting well at working towards my civilian goals (e.g., employment, education, and/or entrepreneurship goals). | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | TAP, Employment, Education | 1, 2, 3 |
| 5h | To what extent do you agree or disagree with each of the following statements about TAP?: The information provided during TAP assisted me in my transition to civilian employment. | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | TAP, Employment | 1, 2, 3 |
| 6 | Thinking about your transition, what did you find helpful or what could be improved to better prepare you for civilian life? (1,000 characters) | Write-In | TAP | 1, 2, 3 |
| Question # | Question | Response Type | Response Options | Topic(s) | Objective(s) |
| 7a | I understand the VA benefits are available to: Me as a Veteran | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | Benefits | 2 |
| 7b | I understand the VA benefits are available to: My Family | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | Benefits | 2 |
| 8a | The VA benefits modules of TAP helped me transition to civilian life by providing information or resources on how to: Apply for VA benefits | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | TAP, Benefits | 2, 3 |
| 8b | The VA benefits modules of TAP helped me transition to civilian life by providing information or resources on how to: Prepare for potential impact to my economic wellbeing after my service | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | TAP, Benefits | 2, 3 |
| 8c | The VA benefits modules of TAP helped me transition to civilian life by providing information or resources on how to: Prepare for changes in my personal life | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | TAP, Benefits | 2, 3 |
| 8d | The VA benefits modules of TAP helped me transition to civilian life by providing information or resources on how to: Prevent potential homelessness | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | TAP, Benefits | 2, 3 |
| 8e | The VA benefits modules of TAP helped me transition to civilian life by providing information or resources on how to: Obtain VA health care | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | TAP, Benefits | 2, 3 |
| 8f | The VA benefits modules of TAP helped me transition to civilian life by providing information or resources on how to: Seek help for mental health concerns I might experience | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | TAP, Benefits | 2, 3 |
| 9a | Have you ever applied or do you intend to apply for any of these VA benefits?: VA Disability Compensation | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | Benefits | 1 |
| 9b | Have you ever applied or do you intend to apply for any of these VA benefits?: VA Education (e.g, post 9/11 GI Bill, Montgomery Bill, etc.) | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | Benefits, Education | 1 |
| 9c | Have you ever applied or do you intend to apply for any of these VA benefits?: VA Life Insurance (e.g., Veteran Group Life Insurance) | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | Benefits | 1 |
| 9d | Have you ever applied or do you intend to apply for any of these VA benefits?: VA Home Loans | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | Benefits | 1 |
| 9e | Have you ever applied or do you intend to apply for any of these VA benefits?: VA Vocational Rehabilitation & Employment | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | Benefits, Employment | 1 |
| 9f | Have you ever applied or do you intend to apply for any of these VA benefits?: VA Health care | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | Benefits, Health Care | 1 |
| Question # | Question | Response Type | Response Options | Topic(s) | Objective(s) |
| 10 | Do you recall using a VA Benefits Advisor to follow up on concerns or obtain additional information after the TAP training? Circle one answer | Yes/No | a)Yes b)No |
Benefits | 1, 2, 3 |
| 11a | Please rate your experience with the VA Benefits Advisor (VA Rep) on the following items as it relates to your transition. Check the appropriate box for each benefit: Knowledge of the VA Benefits Advisor | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | Benefits | 1 |
| 11b | Please rate your experience with the VA Benefits Advisor (VA Rep) on the following items as it relates to your transition. Check the appropriate box for each benefit: Information provided by the VA Benefits Advisor | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | Benefits | 1 |
| 11c | Please rate your experience with the VA Benefits Advisor (VA Rep) on the following items as it relates to your transition. Check the appropriate box for each benefit: Accessibility of the VA Benefits Advisor during your transaction | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | Benefits | 1 |
| 11d | Please rate your experience with the VA Benefits Advisor (VA Rep) on the following items as it relates to your transition. Check the appropriate box for each benefit: Your overall experience with the VA Benefits Advisor | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | Benefits | 1 |
| Question # | Question | Response Type | Response Options | Topic(s) | Objective(s) |
| 12a | Thinking about your transition to the civilian world, please rate the extent to which you found the following items challenging during the transition process on a scale of 1 to 5 where 1 is “Not at all challenging” and 5 is “Extremely challenging": Expectations about the salary I can expect in a civilian job. | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | Employment, Finances | 1, 2, 3 |
| 12b | Thinking about your transition to the civilian world, please rate the extent to which you found the following items challenging during the transition process on a scale of 1 to 5 where 1 is “Not at all challenging” and 5 is “Extremely challenging": Specific steps I should take in conducting a job search | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | Employment | 1, 2, 3 |
| 12c | Thinking about your transition to the civilian world, please rate the extent to which you found the following items challenging during the transition process on a scale of 1 to 5 where 1 is “Not at all challenging” and 5 is “Extremely challenging": How to translate my military experience to civilian job requirements. | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | Employment | 1, 2, 3 |
| 12d | Thinking about your transition to the civilian world, please rate the extent to which you found the following items challenging during the transition process on a scale of 1 to 5 where 1 is “Not at all challenging” and 5 is “Extremely challenging": Difference between military and civilian workforce cultures and norms about expected behaviors. | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | Employment, Relationships | 1, 2, 3 |
| 12e | Thinking about your transition to the civilian world, please rate the extent to which you found the following items challenging during the transition process on a scale of 1 to 5 where 1 is “Not at all challenging” and 5 is “Extremely challenging": Understanding how to interact with civilians who are not familiar with the military. | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | Relationships | 1, 2, 3 |
| 12f | Thinking about your transition to the civilian world, please rate the extent to which you found the following items challenging during the transition process on a scale of 1 to 5 where 1 is “Not at all challenging” and 5 is “Extremely challenging": Working with civilians who share different values from what I was accustomed to in the military. | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | Employment, Relationships | 1, 2, 3 |
| 12g | Thinking about your transition to the civilian world, please rate the extent to which you found the following items challenging during the transition process on a scale of 1 to 5 where 1 is “Not at all challenging” and 5 is “Extremely challenging": Communicating in civilian terms rather than using military vocabulary and acronyms. | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | Relationships | 1, 2, 3 |
| 12h | Thinking about your transition to the civilian world, please rate the extent to which you found the following items challenging during the transition process on a scale of 1 to 5 where 1 is “Not at all challenging” and 5 is “Extremely challenging": Learning to have a better work-life balance after the transition | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | Quality of Life | 1, 2, 3 |
| 12i | Thinking about your transition to the civilian world, please rate the extent to which you found the following items challenging during the transition process on a scale of 1 to 5 where 1 is “Not at all challenging” and 5 is “Extremely challenging": Missing the camaraderie and teamwork that was part of the military culture. | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | Quality of Life, Relationships | 1, 2, 3 |
| 12j | Thinking about your transition to the civilian world, please rate the extent to which you found the following items challenging during the transition process on a scale of 1 to 5 where 1 is “Not at all challenging” and 5 is “Extremely challenging": Working at a slower pace than when in the military. | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | Employment | 1, 2, 3 |
| 12k | Thinking about your transition to the civilian world, please rate the extent to which you found the following items challenging during the transition process on a scale of 1 to 5 where 1 is “Not at all challenging” and 5 is “Extremely challenging": Working at a faster pace than when in the military. | Scale | 1 (Not effective at all); 2 (Not very effective); 3 (Moderately effective); 4 (Very effective); 5 (Extremely effective); Not applicable | Employment | 1, 2, 3 |
| 13 | Did you obtain employment after your separation, retirement, or release from active duty service? Circle one answer | Select one | a) Yes, self-employed; b) Yes, not self-employed; c) No, I am pursuing education/training before starting work Skip to #21; d) No, I retired and chose not to pursue further employment Skip to #21; e) No, I want to work but cannot find a job Skip to #19; f) No, I am taking extended time off (greater than 6 months, other than terminal leave) before starting work or school Skip to #24; g) No, other reason Please specify: ________________________________________ Skip to #21; h) Prefer not to answer | Employment | 1 |
| 14 | How long did it take you to find your current job? Circle one answer | Select one | a) 1-2 months prior to separating; b) 3-6 months; c) 6 months to 1 year; d) More than 1 year | Employment | 1 |
| 15 | Are you currently working in a permanent position or one that is temporary or seasonal? Circle one answer | Select one | a) Permanent; b) Temporary or Seasonal | Employment | 1 |
| 16 | Are you engaged in any entrepreneurial (e.g., starting your own business) activities? Circle one answer that best describes your current activities | Select one | a) Yes, I own my own company and have ____ (list # of employees excluding myself); b) Yes, I have a side-business/hobby I use to supplement my income; c) Yes, I have taken tangible steps to start a business during the last 12 months (by myself or with others); d) No | Employment | 1 |
| 17 | Describe your current employment: Circle the answer that best describes your current employment | Select one | a) I work full-time; b) I work part-time Please select one ☐ By choice ☐ Because I could not find a full-time job; c) I work more than one job Please select one: ☐ By choice ☐ Because I could not find a full-time job ☐ Because one job did not provide enough for my family | Employment | 1 |
| 18 | Including your current job(s), how many jobs have you had since you separated from the military? | __ __ jobs; ☐ Prefer not to answer |
Employment | 1 | |
| 19 | Are you actively looking for a new job? Circle one answer | Select one | a) Yes; b) No Skip to #21 | Employment | 1 |
| 20 | What are the primary reasons you are looking for another job? Circle all that apply | Multiple Choice | a) Higher pay; b) Better fit for my skills and abilities; c) Want a permanent position; d) Job satisfaction/better work environment; e) Something more interesting; f) More flexible schedule; g) Better training and educational opportunities; h) Better hours; i) Want more hours/full-time position; j) More opportunities for advancement; k) Shorter commute; l) Prefer not to answer | Employment | 1, 2 |
| 21 | Have you ever enrolled, registered, or established a profile or online account with any of the following? Circle all that apply | Multiple Choice | a) VA Health Care System (e.g., myHealtheVet.gov); b) Department of Labor’s American Job Center; c) VA Benefits Website (e.g., eBenefits); d) Commercial job site (e.g., Indeed, LinkedIn, etc.); e) Other Please specify: ______________________________________________; f) None; g) Prefer not to answer | Employment | 2, 3 |
| 22 | Did you ever gain employment support through any of these resources? Circle all that apply | Multiple Choice | a) USAJOBS (e.g., federal jobs); b) Vocational Rehabilitation and Employment (VR&E); c) Department of Labor’s American Job Center; d) U.S. Chamber of Commerce Foundation’s Hiring Our Heroes Fast Track; e) Commercial job site (e.g., Indeed, LinkedIn, etc.); f) Private or non-profit sector (e.g., applying directly, through a recruiter, Veteran hiring initiative, etc.); g) Other Please specify: ______________________________________________ | Employment | 2, 3 |
| Question # | Question | Response Type | Response Options | Topic(s) | Objective(s) |
| 23 | What is the highest degree or level of school you have completed? If currently enrolled, mark the previous grade or highest degree received. Circle one answer | Select one | a) High school equivalent (e.g., GED) or less; b) High school graduate; c) Trade/technical school; d) Some college; e) Associate degree (e.g., AA, AS); f) 4-year college degree (e.g., BA, AB, BS); g) Master’s degree (e.g., MA, MS, MSW, MBA); h) Professional degree (e.g., MD, DDS, DVM, LLB, JD); i) Doctorate degree (e.g., PhD, EdD); j) Prefer not to answer | Education | 1 |
| 24 | Are you currently in any education and/or training programs? Circle all that apply | Multiple Choice | a) Education at a college or university, full-time; b) Education at a college or university, part-time; c) Technical or vocational training/obtain license or certificate, full-time; d) Technical or vocational training/obtain license or certificate, part-time; e) Other Please specify: _____________; f) | Education | 1 |
| 25 | How are you paying for your education/training? Circle all that apply | Multiple Choice | a) Student Loans; b) GI Bill; c) Working part-time or full-time; d) Scholarship; e) Money from other sources (e.g., parents, relatives, savings, etc.); f) Other (e.g., VR&E, Target Foundation, etc.) Please specify: _______________; g) Prefer not to answer | Education | 1, 3 |
| 26a | In the last 3 months of your post military education or training, how satisfied have you been with: The quality of your education or training experience | Scale | 1 (Very Dissatisfied); 2 (Somewhat Dissatisfied); 3 (Neither satisfied nor dissatisfied); 4 (Somewhat satisfied); 5 (Very satisfied) | Education | 1 |
| 26b | In the last 3 months of your post military education or training, how satisfied have you been with: The extent to which your education or training is advancing your career goals | Scale | 2 (Very Dissatisfied); 2 (Somewhat Dissatisfied); 3 (Neither satisfied nor dissatisfied); 4 (Somewhat satisfied); 5 (Very satisfied) | Education, Employment | 1 |
| 26c | In the last 3 months of your post military education or training, how satisfied have you been with: Your learning environment (e.g., teachers and other students, educational setting) | Scale | 3 (Very Dissatisfied); 2 (Somewhat Dissatisfied); 3 (Neither satisfied nor dissatisfied); 4 (Somewhat satisfied); 5 (Very satisfied) | Education, Relationships | 1 |
| Question # | Question | Response Type | Response Options | Topic(s) | Objective(s) |
| 27 | Do you have an ongoing physical health condition, illness, or disability (e.g., high blood pressure, pain)? If no, skip to #29 | Yes/No | a)Yes b)No c)Prefer not to answer |
Health | 1 |
| 28 | Are you currently seeking treatment for your physical health condition(s)? | Yes/No | a)Yes b)No c)Prefer not to answer |
Health, Healthcare | 1, 2, 3 |
| 29 | Do you have an ongoing mental/emotional health condition, illness, or disability (e.g., depression, anxiety)? If no, skip to #31 | Yes/No | a)Yes b)No c)Prefer not to answer |
Health | 1 |
| 30 | Are you currently seeking treatment for your mental/emotional health condition(s)? | Yes/No | a)Yes b)No c)Prefer not to answer |
Health, Healthcare | 1, 2, 3 |
| 31 | Do you have healthcare coverage? If no, skip to #33 | Yes/No | a)Yes b)No c)Prefer not to answer |
Health, Healthcare, Benefits | 1, 2, 3 |
| 32 | Which of the following best describe your main sources of healthcare coverage? Circle one answer | Select one | a) Employer-provided health insurance (could be from your current or former employer, a family member’s current or former employer, or a union); b) A plan you purchased through a healthcare exchange (e.g., Healthcare.gov, State exchange, Affordable Care Act/ “Obamacare”, etc.); c) TRICARE; d) VA; e) Medicaid; f) Medicare; g) Other government assisted health plan; h) Something else Please specify: ___________; i) Prefer not to answer | Healthcare, Benefits | 1, 2, 3 |
| 33a | Over the last 3 months, how satisfied have you been with: Your physical health | Scale | 1 (Very Dissatisfied); 2 (Somewhat Dissatisfied); 3 (Neither satisfied nor dissatisfied); 4 (Somewhat satisfied); 5 (Very satisfied) | Health | 1 |
| 33b | Over the last 3 months, how satisfied have you been with: Your emotional/mental health | Scale | 2 (Very Dissatisfied); 2 (Somewhat Dissatisfied); 3 (Neither satisfied nor dissatisfied); 4 (Somewhat satisfied); 5 (Very satisfied) | Health | 1 |
| 33c | Over the last 3 months, how satisfied have you been with: Your health care | Scale | 3 (Very Dissatisfied); 2 (Somewhat Dissatisfied); 3 (Neither satisfied nor dissatisfied); 4 (Somewhat satisfied); 5 (Very satisfied) | Health | 1 |
| 34 | What is your marital status? Circle one answer | Select one | a) Living with a domestic partner; b) Never married; c) Married-first and only marriage ; d) Married-second or later marriage ; e) Separated; f) Divorced; g) Widowed; h) Prefer not to answer | Relationships | 1 |
| 35 | Are you currently in a romantic relationship? Circle one answer | Select one | a) Currently in a relationship; b) Not currently in a relationship; c) Prefer not to answer | Relationships | 1 |
| 36 | Are you a parent or have you served in a parenting role during the past three months (including both your own biological children and other children for whom you have parenting responsibilities)? Circle one answer | Select one | a) Yes; b) No c) Prefer not to answer | Relationships, Family | 1, 2 |
| 37 | How many children do you have in the following age categories (including both your own biological children and other children for whom you have parenting responsibilities)? | Numerical Value | Under 5 years old | Relationships, Family | 1 |
| 37 | How many children do you have in the following age categories (including both your own biological children and other children for whom you have parenting responsibilities)? | Numerical Value | Age 5 through 12 years old | Relationships, Family | 1 |
| 37 | How many children do you have in the following age categories (including both your own biological children and other children for whom you have parenting responsibilities)? | Numerical Value | Age 13 through 18 years old | Relationships, Family | 1 |
| 37 | How many children do you have in the following age categories (including both your own biological children and other children for whom you have parenting responsibilities)? | Numerical Value | Age 19 through 26 years old | Relationships, Family | 1 |
| 37 | How many children do you have in the following age categories (including both your own biological children and other children for whom you have parenting responsibilities)? | Numerical Value | 27+ years old | Relationships, Family | 1 |
| 37 | How many children do you have in the following age categories (including both your own biological children and other children for whom you have parenting responsibilities)? | Numerical Value | Prefer not to answer | Relationships, Family | 1 |
| 38a | FAMILY: Considering the people to whom you are related by birth, marriage, adoption, etc.: How many relatives do you see or hear from at least once a month? | Scale | None (0); One (1); Two (2); Three or Four (3); Five thru Eight(4); Nine or more (5); Prefer not to answer | Relationships, Family | 1 |
| 38b | FAMILY: Considering the people to whom you are related by birth, marriage, adoption, etc.: How many relatives do you feel at ease with that you can talk about private matters? |
Scale | None (0); One (1); Two (2); Three or Four (3); Five thru Eight(4); Nine or more (5); Prefer not to answer | Relationships, Family | 1 |
| 38c | FAMILY: Considering the people to whom you are related by birth, marriage, adoption, etc.: How many relatives do you feel close to such that you could call on them for help? | Scale | None (0); One (1); Two (2); Three or Four (3); Five thru Eight(4); Nine or more (5); Prefer not to answer | Relationships, Family | 1 |
| 39a | FRIENDSHIPS: Considering all of your friends including those who live in your neighborhood: How many of your friends do you see or hear from at least once a month? | Scale | None (0); One (1); Two (2); Three or Four (3); Five thru Eight(4); Nine or more (5); Prefer not to answer | Relationships, Friendship | 1 |
| 39b | FRIENDSHIPS: Considering all of your friends including those who live in your neighborhood: How many friends do you feel at ease with that you can talk about private matters? | Scale | None (0); One (1); Two (2); Three or Four (3); Five thru Eight(4); Nine or more (5); Prefer not to answer | Relationships, Friendship | 1 |
| 39c | FRIENDSHIPS: Considering all of your friends including those who live in your neighborhood: How many friends do you feel close to such that you could call on them for help? | Scale | None (0); One (1); Two (2); Three or Four (3); Five thru Eight(4); Nine or more (5); Prefer not to answer | Relationships, Friendship | 1 |
| 40a | Here we want to know how you are feeling since your transition to civilian life?: How often do you feel that you lack companionship? | Scale | Never (0); Hardly Ever (1); Some of the Time (2); Often (3) | Relationships | 1, 2 |
| 40b | Here we want to know how you are feeling since your transition to civilian life?: How often do you feel left out? | Scale | Never (0); Hardly Ever (1); Some of the Time (2); Often (3) | Relationships | 1, 2 |
| 40c | Here we want to know how you are feeling since your transition to civilian life?: How often do you feel isolated from others? | Scale | Never (0); Hardly Ever (1); Some of the Time (2); Often (3) | Relationships | 1, 2 |
| Question # | Question | Response Type | Response Options | Topic(s) | Objective(s) |
| 41 | Are you able to pay for all necessary expenses each month, such as mortgage/rent, debt payments, and groceries? | Yes/No | Yes No Prefer not to answer |
Finances | 1 |
| 42 | Does your household have at least 3 months of your typical income set aside in case of an unexpected financial event? | Yes/No | Yes No Prefer not to answer |
Finances | 1, 2, 3 |
| 43 | Does your household have the insurance coverage you and/or your family would need if an unexpected financial event were to occur (e.g., disability insurance, property insurance, and/or life insurance)? | Yes/No | Yes No Prefer not to answer |
Finances | 1, 2, 3 |
| 44 | Has your household begun to set aside money for retirement? | Yes/No | Yes No Prefer not to answer |
Finances | 1, 2, 3 |
| 45 | Is your household more than one month behind on your debt payments (e.g., mortgage or credit card)? Circle one answer | Select one | a) No, my household is not more than one month behind in debt payments; b) Yes, my household is over one month behind in debt payments; c) Not applicable- my household does not have any debt; d) Prefer not to answer | Finances | 1 |
| 46 | Are you currently concerned that you will lose your housing and be unable to find stable alternative housing? Circle one answer | Yes/No | Yes No Prefer not to answer |
Finances, Housing | 1, 2 |
| 47 | How many people are supported by your HOUSEHOLD income, including yourself, your significant other (if you have one), and anyone else partially or fully supported by this income whether or not they live with you? | Numerical Value | __people; Prefer not to answer | Finances | 1 |
| 48 | What is your current living situation? Circle one answer | Select one | a) Rent an apartment, house, or room; b) Own an apartment or house; c) Live with a friend or relative and not paying rent; d) Live in a dormitory at school; e) Live in a medical or assisted living facility, such as a hospital or rehab center; f) Live in transitional housing (e.g., a halfway house); g) Live in a car, on the street, or in a homeless shelter; h) Somewhere else Please specify: _______________________________________; i) Prefer not to answer | Finances, Housing | 1 |
| 49a | Please mark expected annual income range, including salary, as well as any retirement income such as your military retirement, any disability payments, real estate income, and any other sources of income, before taxes are taken out. If you are not sure, please make your best guess.: Your annual income | Select one | Less than $40,000 $40,000 - $70,000 $70,001 - $100,000 $100,001 - $130,000 $130,001-$160,000 $160,001 - $190,000 Greater than $190,001 Prefer not to answer |
Finances | 1 |
| 49b | Please mark expected annual income range, including salary, as well as any retirement income such as your military retirement, any disability payments, real estate income, and any other sources of income, before taxes are taken out. If you are not sure, please make your best guess.: HOUSEHOLD Include all sources of income from all earners in your household. If you do not have other sources of income, and you are the only earner, this may be the same as your income. |
Select one | Less than $40,000 $40,000 - $70,000 $70,001 - $100,000 $100,001 - $130,000 $130,001-$160,000 $160,001 - $190,000 Greater than $190,001 Prefer not to answer |
Finances | 1 |
| Question # | Question | Response Type | Response Options | Topic(s) | Objective(s) |
| 50a | The following questions ask how satisfied you feel, on a scale from 0 to 10. [Zero means you feel no satisfaction at all and Ten (10) means you feel completely satisfied.] Thinking about your own life and personal circumstances, how satisfied are you with your life as a whole? |
Scale | 0 (No satisfaction at all) - 10 (Completely satisfied); Prefer not to answer | Quality of Life | 1 |
| 50b | The following questions ask how satisfied you feel, on a scale from 0 to 10. [Zero means you feel no satisfaction at all and Ten (10) means you feel completely satisfied.] How satisfied are with your standard of living? |
Scale | 0 (No satisfaction at all) - 10 (Completely satisfied); Prefer not to answer | Quality of Life | 1 |
| 50c | The following questions ask how satisfied you feel, on a scale from 0 to 10. [Zero means you feel no satisfaction at all and Ten (10) means you feel completely satisfied.] How satisfied are you with your health? |
Scale | 0 (No satisfaction at all) - 10 (Completely satisfied); Prefer not to answer | Quality of Life, Health | 1 |
| 50d | The following questions ask how satisfied you feel, on a scale from 0 to 10. [Zero means you feel no satisfaction at all and Ten (10) means you feel completely satisfied.] How satisfied are you with what you are achieving in life? |
Scale | 0 (No satisfaction at all) - 10 (Completely satisfied); Prefer not to answer | Quality of Life | 1 |
| 50e | The following questions ask how satisfied you feel, on a scale from 0 to 10. [Zero means you feel no satisfaction at all and Ten (10) means you feel completely satisfied.] How satisfied are you with your personal relationships? |
Scale | 0 (No satisfaction at all) - 10 (Completely satisfied); Prefer not to answer | Quality of Life, Relationships | 1 |
| 50f | The following questions ask how satisfied you feel, on a scale from 0 to 10. [Zero means you feel no satisfaction at all and Ten (10) means you feel completely satisfied.] How satisfied are you with how safe you feel? |
Scale | 0 (No satisfaction at all) - 10 (Completely satisfied); Prefer not to answer | Quality of Life | 1 |
| 50g | The following questions ask how satisfied you feel, on a scale from 0 to 10. [Zero means you feel no satisfaction at all and Ten (10) means you feel completely satisfied.] How satisfied are you with feeling part of your community? |
Scale | 0 (No satisfaction at all) - 10 (Completely satisfied); Prefer not to answer | Quality of Life, Relationships | 1 |
| 50h | The following questions ask how satisfied you feel, on a scale from 0 to 10. [Zero means you feel no satisfaction at all and Ten (10) means you feel completely satisfied.] How satisfied are you with your future security? |
Scale | 0 (No satisfaction at all) - 10 (Completely satisfied); Prefer not to answer | Quality of Life | 1 |
| 50i | The following questions ask how satisfied you feel, on a scale from 0 to 10. [Zero means you feel no satisfaction at all and Ten (10) means you feel completely satisfied.] How satisfied are you with your spirituality or religion? |
Scale | 0 (No satisfaction at all) - 10 (Completely satisfied); Prefer not to answer | Quality of Life | 1 |
| 51 | The VA is interested in the welfare of Veterans and their families as they transition into civilian life. Would you be willing to take part in a longer-term study to improve the transition process? You will be contacted no more than once per year. Circle one answer. | Yes/No | a) Yes i) e-mail address: _______________________ ii) I do not have an e-mail address); b) No |
Future Contact | 1, 2, 3 |
| 52 | Thinking back to your transition process, is there anything else that the VA could have done then or could be doing now to help you after your service? (1,000 characters) | Write-In | Transition, Improvement of Services | 1 |
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |