Download:
pdf |
pdfFiling a Request for
Decision Review Survey
AMO VSignals
DRAFT: V9
<03/11/20>
Working Draft, Pre-Decisional, Deliberative document - Internal VA Use Only
One or more items on this page require your attention.
The VA provides free, confidential support 24/7 for Veterans and their family and friends.
If you are in crisis, contact the Veterans Crisis Line by dialing 1 (800) 273-8255 (Press
1), or texting 838255, or visiting https://www.veteranscrisisline.net. If you are homeless
or at risk of homelessness, contact the National Call Center for Homeless Veterans
(NCCHV) by dialing 1 (877) 424-3838 or visiting https://www.va.gov/HOMELESS/.
OMB Number: 2900-0770
Expiration: TBD
Estimated Burden: 3 minutes
Help us serve you better.
Thank you for filing a request for a decision review through the Appeals
Improvement and Modernization Act process. We want to understand
your experience in this process.
This survey should take you approximately 3 minutes to complete. Please respond to all
questions in order to continue the survey.
x Error: This is required.
Please indicate how you filed your decision review request:
by mail or fax
dropped it off at a VA Regional Office
my private attorney or Veterans Service Officer filed it for me
x Error: This is required.
Please indicate the help you relied on the most throughout the decision review process:
VA Regional Office employee
VA Call Center Representative
National Veteran Service Organization Representative
County Veteran Service Officer
State Veterans Service Organization Representative
Note: Responses 1-7
populate conditional text
Question 1, Page 2.
Response 8 results in
exclusion of Question 1,
Page 2.
Private attorney
Family member or friend
I filed my decision review request independently.
x Error: This is required.
Please indicate the VA resource you relied on the most throughout the decision review
process:
VA notification letter issued with my claim decision
VA website (e.g., va.gov)
VA print media (i.e., benefits booklet, pamphlet, brochure or poster)
VA digital/social media (e.g., VA Facebook, YouTube)
I did not use any VA resources.
Note: Responses 1-4
populate conditional text
Question 2, Page 2.
Response 5 results in
exclusion of Question 2,
Page 2.
Next
By filling out this survey, you are authorizing VA database access to retrieve Veteran contact information to follow up with
you accordingly for purposes of service recovery, potential crisis, or to learn more about feedback you have shared
regarding your experience with VA. "This information is collected in accordance with section 3507 of the Paperwork
Reduction Act of 1995. Title 38, United States Code, allows us to ask for this information. We estimate that you will need an
average of 3 minutes to review the instructions and complete this survey. The results of this survey will be used to inform
opportunities for program improvement in the quality of VA services. Participation in this survey is voluntary, and your
decision not to respond will have no impact on VA benefits or services which you may currently be receiving. VA cannot
conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are not required to
respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB
Internet Page at https://www.reginfo.gov/public/do/PRAMain. Information gathered will be kept private to the extent provided
by law.
Privacy Policy
AMO VSignals
DRAFT: V9
<03/11/20>
Working Draft, Pre-Decisional, Deliberative document - Internal VA Use Only
One or more items on this page require your attention.
The VA provides free, confidential support 24/7 for Veterans and their family and friends.
If you are in crisis, contact the Veterans Crisis Line by dialing 1 (800) 273-8255 (Press
1), or texting 838255, or visiting https://www.veteranscrisisline.net. If you are homeless
or at risk of homelessness, contact the National Call Center for Homeless Veterans
(NCCHV) by dialing 1 (877) 424-3838 or visiting https://www.va.gov/HOMELESS/.
OMB Number: 2900-0770
Expiration: TBD
Estimated Burden: 3 minutes
Help us understand your most
recent experience filing a request
for a decision review.
By indicating how much you agree or disagree with the statements below,
you directly help us improve VA services. Please respond to all questions in
order to continue the survey.
x Error: This is required.
The clearly explained the available decision review
options.
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
x Error: This is required.
The clearly communicated the available decision review
options.
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
x Error: This is required.
It was easy to find the help I needed to select which decision review option was best for
my claim.
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
x Error: This is required.
I knew which form I needed for the decision review option that I chose.
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
Not Applicable
(N/A)
x Error: This is required.
It was easy to understand what information was needed to complete the decision review
form.
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
Not Applicable
(N/A)
x Error: This is required.
I am satisfied with my experience filing a request.
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
x Error: This is required.
I trust VA to fulfill our country's commitment to Veterans.
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
Finish
By filling out this survey, you are authorizing VA database access to retrieve Veteran contact information to follow up with
you accordingly for purposes of service recovery, potential crisis, or to learn more about feedback you have shared
regarding your experience with VA. "This information is collected in accordance with section 3507 of the Paperwork
Reduction Act of 1995. Title 38, United States Code, allows us to ask for this information. We estimate that you will need an
average of 3 minutes to review the instructions and complete this survey. The results of this survey will be used to inform
opportunities for program improvement in the quality of VA services. Participation in this survey is voluntary, and your
decision not to respond will have no impact on VA benefits or services which you may currently be receiving. VA cannot
conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are not required to
respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB
Internet Page at https://www.reginfo.gov/public/do/PRAMain. Information gathered will be kept private to the extent provided
by law.
Privacy Policy
AMO VSignals
DRAFT: V9
<03/11/20>
Working Draft, Pre-Decisional, Deliberative document - Internal VA Use Only
The VA provides free, confidential support 24/7 for Veterans and their family and friends.
If you are in crisis, contact the Veterans Crisis Line by dialing 1 (800) 273-8255 (Press
1), or texting 838255, or visiting https://www.veteranscrisisline.net. If you are homeless
or at risk of homelessness, contact the National Call Center for Homeless Veterans
(NCCHV) by dialing 1 (877) 424-3838 or visiting https://www.va.gov/HOMELESS/.
OMB Number: 2900-0770
Expiration: TBD
Estimated Burden: 3 minutes
Thank you for choosing VA.
The U.S. Department of Veterans Affairs uses these surveys to collect
your feedback in order to continuously improve your experience with VA
services. You may expect a follw-up survey upon receiving a decision
about your most recent .
VA may contact you in the future for additional information on your
feedback.
Please visit https://www.va.gov/decision-reviews/ to learn more about
VA’s modernized appeals process.
By filling out this survey, you are authorizing VA database access to retrieve Veteran contact information to follow up with
you accordingly for purposes of service recovery, potential crisis, or to learn more about feedback you have shared
regarding your experience with VA. "This information is collected in accordance with section 3507 of the Paperwork
Reduction Act of 1995. Title 38, United States Code, allows us to ask for this information. We estimate that you will need an
average of 3 minutes to review the instructions and complete this survey. The results of this survey will be used to inform
opportunities for program improvement in the quality of VA services. Participation in this survey is voluntary, and your
decision not to respond will have no impact on VA benefits or services which you may currently be receiving. VA cannot
conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are not required to
respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB
Internet Page at https://www.reginfo.gov/public/do/PRAMain. Information gathered will be kept private to the extent provided
by law.
Privacy Policy
Higher Level Review
- Survey
AMO VSignals
DRAFT: V9
<03/11/20>
Working Draft, Pre-Decisional, Deliberative document - Internal VA Use Only
One or more items on this page require your attention.
The VA provides free, confidential support 24/7 for Veterans and their family and friends.
If you are in crisis, contact the Veterans Crisis Line by dialing 1 (800) 273-8255 (Press
1), or texting 838255, or visiting https://www.veteranscrisisline.net. If you are homeless
or at risk of homelessness, contact the National Call Center for Homeless Veterans
(NCCHV) by dialing 1 (877) 424-3838 or visiting https://www.va.gov/HOMELESS/.
Help us serve you better.
OMB Number: 2900-0770
Expiration: TBD
Estimated Burden: 3 minutes
Note: This page is only
displayed if invitation file
indicates a claimant has
received and informal
conference.
Thank you for filing for a Higher-Level Review through the Appeals
Improvement and Modernization Act process. We want to understand
your experience filing for your Higher-Level Review.
This survey should take you approximately 3 minutes to complete. Please respond to all
questions in order to continue the survey.
x Error: This is required.
When VA called me or met with me for an informal conference to discuss my claim:
I spoke to the VA decision maker.
I spoke to the VA decision maker with my representative.
My representative spoke to the VA decision maker without me.
I did not participate in an informal conference.
Note: Responses 1 and 2
result in inclusion of Questions
1 and 2, Page 2. Responses 3
and 4 result in exclusion of
Questions 1 and 2, Page 2.
Next
By filling out this survey, you are authorizing VA database access to retrieve Veteran contact information to follow up with
you accordingly for purposes of service recovery, potential crisis, or to learn more about feedback you have shared
regarding your experience with VA. "This information is collected in accordance with section 3507 of the Paperwork
Reduction Act of 1995. Title 38, United States Code, allows us to ask for this information. We estimate that you will need an
average of 3 minutes to review the instructions and complete this survey. The results of this survey will be used to inform
opportunities for program improvement in the quality of VA services. Participation in this survey is voluntary, and your
decision not to respond will have no impact on VA benefits or services which you may currently be receiving. VA cannot
conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are not required to
respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB
Internet Page at https://www.reginfo.gov/public/do/PRAMain. Information gathered will be kept private to the extent provided
by law.
Privacy Policy
AMO VSignals
DRAFT: V9
<03/11/20>
Working Draft, Pre-Decisional, Deliberative document - Internal VA Use Only
One or more items on this page require your attention.
The VA provides free, confidential support 24/7 for Veterans and their family and friends.
If you are in crisis, contact the Veterans Crisis Line by dialing 1 (800) 273-8255 (Press
1), or texting 838255, or visiting https://www.veteranscrisisline.net. If you are homeless
or at risk of homelessness, contact the National Call Center for Homeless Veterans
(NCCHV) by dialing 1 (877) 424-3838 or visiting https://www.va.gov/HOMELESS/.
OMB Number: 2900-0770
Expiration: TBD
Estimated Burden: 3 minutes
Help us understand your most Note: Only
include “Thank
recent experience with the
you...” text
below if this is
first page of
Higher-Level Review process. the
the survey.
Thank you for filing for a Higher-Level Review through the Appeals
Improvement and Modernization Act process. We want to understand
your experience filing for your Higher-Level Review.
By indicating how much you agree or disagree with the statements below,
you directly help us improve VA services. This survey should take you
approximately 3 minutes to complete. Please respond to all questions in
order to continue the survey. Note: Only include “This survey should take you
approximately 3 minutes to complete” text abovee
if this is the first page of the survey.
x Error: This is required.
When VA called me or met with me for an informal conference to discuss my claim, I
understood that the purpose is to identify any errors of law or fact in my prior claim
decision.
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
x Error: This is required.
When VA called me or met with me for an informal conference to discuss my claim, the
VA decision maker that conducted my informal conference was helpful.
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
x Error: This is required.
I received the results of my Higher-Level Review in a reasonable amount of time.
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
x Error: This is required.
VA’s notification letter clearly explained the reasons and bases for my Higher-Level
Review decision.
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
x Error: This is required.
VA’s notification letter about my Higher-Level Review made it clear that I had additional
options if I wanted further review of VA’s decision on my claim.
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
x Error: This is required.
I am satisfied with VA's Higher-Level Review Process.
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
x Error: This is required.
I trust VA to fulfill our country's commitment to Veterans.
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
Finish
By filling out this survey, you are authorizing VA database access to retrieve Veteran contact information to follow up with
you accordingly for purposes of service recovery, potential crisis, or to learn more about feedback you have shared
regarding your experience with VA. "This information is collected in accordance with section 3507 of the Paperwork
Reduction Act of 1995. Title 38, United States Code, allows us to ask for this information. We estimate that you will need an
average of 3 minutes to review the instructions and complete this survey. The results of this survey will be used to inform
opportunities for program improvement in the quality of VA services. Participation in this survey is voluntary, and your
decision not to respond will have no impact on VA benefits or services which you may currently be receiving. VA cannot
conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are not required to
respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB
Internet Page at https://www.reginfo.gov/public/do/PRAMain. Information gathered will be kept private to the extent provided
by law.
Privacy Policy
AMO VSignals
DRAFT: V9
<03/11/20>
Working Draft, Pre-Decisional, Deliberative document - Internal VA Use Only
The VA provides free, confidential support 24/7 for Veterans and their family and friends.
If you are in crisis, contact the Veterans Crisis Line by dialing 1 (800) 273-8255 (Press
1), or texting 838255, or visiting https://www.veteranscrisisline.net. If you are homeless
or at risk of homelessness, contact the National Call Center for Homeless Veterans
(NCCHV) by dialing 1 (877) 424-3838 or visiting https://www.va.gov/HOMELESS/.
OMB Number: 2900-0770
Expiration: TBD
Estimated Burden: 3 minutes
Thank you for choosing VA.
The U.S. Department of Veterans Affairs uses these surveys to collect
your feedback in order to continuously improve your experience with VA
services. VA may contact you in the future for additional information on
your feedback.
Please visit https://www.va.gov/decision-reviews/ to learn more about
VA’s modernized appeals process.
By filling out this survey, you are authorizing VA database access to retrieve Veteran contact information to follow up with
you accordingly for purposes of service recovery, potential crisis, or to learn more about feedback you have shared
regarding your experience with VA. "This information is collected in accordance with section 3507 of the Paperwork
Reduction Act of 1995. Title 38, United States Code, allows us to ask for this information. We estimate that you will need an
average of 3 minutes to review the instructions and complete this survey. The results of this survey will be used to inform
opportunities for program improvement in the quality of VA services. Participation in this survey is voluntary, and your
decision not to respond will have no impact on VA benefits or services which you may currently be receiving. VA cannot
conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are not required to
respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB
Internet Page at https://www.reginfo.gov/public/do/PRAMain. Information gathered will be kept private to the extent provided
by law.
Privacy Policy
Supplemental
Claim - Survey
AMO VSignals
DRAFT: V9
<03/11/20>
Working Draft, Pre-Decisional, Deliberative document - Internal VA Use Only
One or more items on this page require your attention.
The VA provides free, confidential support 24/7 for Veterans and their family and friends.
If you are in crisis, contact the Veterans Crisis Line by dialing 1 (800) 273-8255 (Press
1), or texting 838255, or visiting https://www.veteranscrisisline.net. If you are homeless
or at risk of homelessness, contact the National Call Center for Homeless Veterans
(NCCHV) by dialing 1 (877) 424-3838 or visiting https://www.va.gov/HOMELESS/.
OMB Number: 2900-0770
Expiration: TBD
Estimated Burden: 3 minutes
Help us serve you better.
Thank you for filing for a Supplemental Claim through the Appeals
Improvement and Modernization Act process. We want to understand
your experience filing for your Supplemental Claim.
This survey should take you approximately 3 minutes to complete. Please respond to all
questions in order to continue the survey.
x Error: This is required.
Were you scheduled for a VA examination to support your Supplemental Claim?
Yes
No
Next
Note: Response “yes” results
in inclusion of Question 1,
Page 2. Response “no” results
in exclusion of Question 1,
Page 2.
By filling out this survey, you are authorizing VA database access to retrieve Veteran contact information to follow up with
you accordingly for purposes of service recovery, potential crisis, or to learn more about feedback you have shared
regarding your experience with VA. "This information is collected in accordance with section 3507 of the Paperwork
Reduction Act of 1995. Title 38, United States Code, allows us to ask for this information. We estimate that you will need an
average of 3 minutes to review the instructions and complete this survey. The results of this survey will be used to inform
opportunities for program improvement in the quality of VA services. Participation in this survey is voluntary, and your
decision not to respond will have no impact on VA benefits or services which you may currently be receiving. VA cannot
conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are not required to
respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB
Internet Page at https://www.reginfo.gov/public/do/PRAMain. Information gathered will be kept private to the extent provided
by law.
Privacy Policy
AMO VSignals
DRAFT: V9
<03/11/20>
Working Draft, Pre-Decisional, Deliberative document - Internal VA Use Only
One or more items on this page require your attention.
The VA provides free, confidential support 24/7 for Veterans and their family and friends.
If you are in crisis, contact the Veterans Crisis Line by dialing 1 (800) 273-8255 (Press
1), or texting 838255, or visiting https://www.veteranscrisisline.net. If you are homeless
or at risk of homelessness, contact the National Call Center for Homeless Veterans
(NCCHV) by dialing 1 (877) 424-3838 or visiting https://www.va.gov/HOMELESS/.
OMB Number: 2900-0770
Expiration: TBD
Estimated Burden: 3 minutes
Help us understand your most
recent experience with the
Supplemental Claim process.
By indicating how much you agree or disagree with the statements below,
you directly help us improve VA services. Please respond to all questions in
order to continue the survey.
x Error: This is required.
I understood the need for a VA examination to support my Supplemental Claim.
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
x Error: This is required.
It was easy to identify what evidence I needed to support my Supplemental Claim.
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
x Error: This is required.
I received the results of my Supplemental Claim in a reasonable amount of time.
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
x Error: This is required.
I knew where to look for status updates about my Supplemental Claim while I waited for
a decision.
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
x Error: This is required.
VA’s notification letter clearly explained the reasons and bases for my Supplemental
Claim decision.
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
x Error: This is required.
I am satisfied with VA's Supplemental Claim process.
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
x Error: This is required.
I felt that VA met its Duty to Assist requirements by gathering all of the identified
evidence for my Supplemental Claim.
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
x Error: This is required.
I trust VA to fulfill our country's commitment to Veterans.
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
Finish
By filling out this survey, you are authorizing VA database access to retrieve Veteran contact information to follow up with
you accordingly for purposes of service recovery, potential crisis, or to learn more about feedback you have shared
regarding your experience with VA. "This information is collected in accordance with section 3507 of the Paperwork
Reduction Act of 1995. Title 38, United States Code, allows us to ask for this information. We estimate that you will need an
average of 3 minutes to review the instructions and complete this survey. The results of this survey will be used to inform
opportunities for program improvement in the quality of VA services. Participation in this survey is voluntary, and your
decision not to respond will have no impact on VA benefits or services which you may currently be receiving. VA cannot
conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are not required to
respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB
Internet Page at https://www.reginfo.gov/public/do/PRAMain. Information gathered will be kept private to the extent provided
by law.
Privacy Policy
AMO VSignals
DRAFT: V9
<03/11/20>
Working Draft, Pre-Decisional, Deliberative document - Internal VA Use Only
The VA provides free, confidential support 24/7 for Veterans and their family and friends.
If you are in crisis, contact the Veterans Crisis Line by dialing 1 (800) 273-8255 (Press
1), or texting 838255, or visiting https://www.veteranscrisisline.net. If you are homeless
or at risk of homelessness, contact the National Call Center for Homeless Veterans
(NCCHV) by dialing 1 (877) 424-3838 or visiting https://www.va.gov/HOMELESS/.
OMB Number: 2900-0770
Expiration: TBD
Estimated Burden: 3 minutes
Thank you for choosing VA.
The U.S. Department of Veterans Affairs uses these surveys to collect
your feedback in order to continuously improve your experience with VA
services. VA may contact you in the future for additional information on
your feedback.
Please visit https://www.va.gov/decision-reviews/ to learn more about
VA’s modernized appeals process.
By filling out this survey, you are authorizing VA database access to retrieve Veteran contact information to follow up with
you accordingly for purposes of service recovery, potential crisis, or to learn more about feedback you have shared
regarding your experience with VA. "This information is collected in accordance with section 3507 of the Paperwork
Reduction Act of 1995. Title 38, United States Code, allows us to ask for this information. We estimate that you will need an
average of 3 minutes to review the instructions and complete this survey. The results of this survey will be used to inform
opportunities for program improvement in the quality of VA services. Participation in this survey is voluntary, and your
decision not to respond will have no impact on VA benefits or services which you may currently be receiving. VA cannot
conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are not required to
respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB
Internet Page at https://www.reginfo.gov/public/do/PRAMain. Information gathered will be kept private to the extent provided
by law.
Privacy Policy
Filing a Request for
Decision Review Email
AMO VSignals
DRAFT: V9
<03/11/20>
Working Draft, Pre-Decisional, Deliberative document - Internal VA Use Only
EMAIL SUBJECT LINE: Filing a Request for a VA Decision Review Survey. (3 minutes)
EMAIL PREVIEW HEADER: Tell us about your experience filing a request for a VA Decision Review.
OMB Number: 2900-0770
Expiration: TBD
Estimated Burden: 3 minutes
Your opinion matters.
Dear ,
We care about your experience with VA. Please take this 3
minute survey to tell us about your most recent experience
filing a request for a decision review. Your feedback is truly
appreciated and will help us understand how we can
improve.
Take Our Survey
Thank you,
Veterans Experience Office
Department of Veterans Affairs
Whether you’re just getting out of the service or you’ve been a civilian for years, the VA Welcome Kit
can help guide you to the benefits and services you’ve earned.
The Veterans Crisis Line provides free, confidential support for Veterans and their families and
friends in crisis. Dial 1 (800) 273-8255 (Press 1), or text 838255 to receive confidential support 24/7
(System of Records Notice VA158VA10NC5). Visit https://www.veteranscrisisline.net for
more information.
Additionally, the National Call Center for Homeless Veterans (NCCHV) provides free, confidential
support for Veterans and their family members and friends who are homeless or at risk of
homelessness. Veterans can either call or chat online with the National Call Center for Homeless
Veterans where trained counselors are ready to talk confidentially 24 hours a day, 7 days a week.
Dial 1 (877) 424-3838 or visit https://www.va.gov/HOMELESS/ to receive confidential support.
Please do not reply to this email - it is unmonitored.
If you wish to share your feedback, please do so by .
You received this email because you provided your email address to VA. If you would like to opt out
from receiving future surveys, please click below.
Unsubscribe from this VA Survey | Privacy Policy
By filling out this survey, you are authorizing VA database access to retrieve Veteran contact
information to follow up with you accordingly for purposes of service recovery, potential crisis, or to
learn more about feedback you have shared regarding your experience with VA. "This information is
collected in accordance with section 3507 of the Paperwork Reduction Act of 1995. Title 38, United
States Code, allows us to ask for this information. We estimate that you will need an average of 3
minutes to review the instructions and complete this survey. The results of this survey will be used
to inform opportunities for program improvement in the quality of VA services. Participation in this
survey is voluntary, and your decision not to respond will have no impact on VA benefits or services
which you may currently be receiving. VA cannot conduct or sponsor a collection of information
unless a valid OMB control number is displayed. You are not required to respond to a collection of
information if this number is not displayed. Valid OMB control numbers can be located on the OMB
Internet Page at https://www.reginfo.gov/public/do/PRAMain. Information gathered will be kept
private to the extent provided by law.
AMO VSignals
DRAFT: V9
<03/11/20>
Working Draft, Pre-Decisional, Deliberative document - Internal VA Use Only
EMAIL SUBJECT LINE: We Still Want to Hear about Your Experience Filing a Request for a Decision Review. (3 minutes)
EMAIL PREVIEW HEADER: Tell us about your experience filing a request for a VA Decision Review.
OMB Number: 2900-0770
Expiration: TBD
Estimated Burden: 3 minutes
Your feedback is important to us.
Dear ,
VA still wants to hear about your most recent experience
filing a request for a decision review. Please let us know
how we are doing by taking a 3 minute survey regarding
your experience.
Take Our Survey
Thank you,
Veterans Experience Office
Department of Veterans Affairs
Whether you’re just getting out of the service or you’ve been a civilian for years, the VA Welcome Kit
can help guide you to the benefits and services you’ve earned.
The Veterans Crisis Line provides free, confidential support for Veterans and their families and
friends in crisis. Dial 1 (800) 273-8255 (Press 1), or text 838255 to receive confidential support 24/7
(System of Records Notice VA158VA10NC5). Visit https://www.veteranscrisisline.net for
more information.
Additionally, the National Call Center for Homeless Veterans (NCCHV) provides free, confidential
support for Veterans and their family members and friends who are homeless or at risk of
homelessness. Veterans can either call or chat online with the National Call Center for Homeless
Veterans where trained counselors are ready to talk confidentially 24 hours a day, 7 days a week.
Dial 1 (877) 424-3838 or visit https://www.va.gov/HOMELESS/ to receive confidential support.
Please do not reply to this email - it is unmonitored.
If you wish to share your feedback, please do so by .
You received this email because you provided your email address to VA. If you would like to opt out
from receiving future surveys, please click below.
Unsubscribe from this VA Survey | Privacy Policy
By filling out this survey, you are authorizing VA database access to retrieve Veteran contact
information to follow up with you accordingly for purposes of service recovery, potential crisis, or to
learn more about feedback you have shared regarding your experience with VA. "This information is
collected in accordance with section 3507 of the Paperwork Reduction Act of 1995. Title 38, United
States Code, allows us to ask for this information. We estimate that you will need an average of 3
minutes to review the instructions and complete this survey. The results of this survey will be used
to inform opportunities for program improvement in the quality of VA services. Participation in this
survey is voluntary, and your decision not to respond will have no impact on VA benefits or services
which you may currently be receiving. VA cannot conduct or sponsor a collection of information
unless a valid OMB control number is displayed. You are not required to respond to a collection of
information if this number is not displayed. Valid OMB control numbers can be located on the OMB
Internet Page at https://www.reginfo.gov/public/do/PRAMain. Information gathered will be kept
private to the extent provided by law.
AMO VSignals
DRAFT: V9
<03/11/20>
Working Draft, Pre-Decisional, Deliberative document - Internal VA Use Only
EMAIL SUBJECT LINE: “Unmonitored Automated Email: U.S. Department of Veterans Affairs”
OMB Number: 2900-0770
Expiration: TBD
This is an unmonitored email address.
The Veterans Crisis Line provides free, confidential support for Veterans
and their families and friends in crisis. Dial 1 (800) 273-8255 (Press 1), or
text 838255 to receive confidential support 24/7 (System of Records Notice
VA158VA10NC5). Visit https://www.veteranscrisisline.net for more
information.
Additionally, the National Call Center for Homeless Veterans (NCCHV)
provides free, confidential support for Veterans and their family members
and friends who are homeless or at risk of homelessness. Veterans can
either call or chat online with the National Call Center for Homeless
Veterans where trained counselors are ready to talk confidentially 24 hours
a day, 7 days a week. Dial 1 (877) 424-3838 or visit
https://www.va.gov/HOMELESS/ to receive confidential support.
Thank you,
Veterans Experience Office
Department of Veterans Affairs
Please do not reply to this email - it is unmonitored.
If you wish to share your feedback, please do so by .
You received this email because you provided your email address to VA. If you would like to opt out
from receiving future surveys, please click below.
Unsubscribe from this VA Survey | Privacy Policy
By filling out this survey, you are authorizing VA database access to retrieve Veteran contact
information to follow up with you accordingly for purposes of service recovery, potential crisis, or to
learn more about feedback you have shared regarding your experience with VA. "This information is
collected in accordance with section 3507 of the Paperwork Reduction Act of 1995. Title 38, United
States Code, allows us to ask for this information. We estimate that you will need an average of 3
minutes to review the instructions and complete this survey. The results of this survey will be used
to inform opportunities for program improvement in the quality of VA services. Participation in this
survey is voluntary, and your decision not to respond will have no impact on VA benefits or services
which you may currently be receiving. VA cannot conduct or sponsor a collection of information
unless a valid OMB control number is displayed. You are not required to respond to a collection of
information if this number is not displayed. Valid OMB control numbers can be located on the OMB
Internet Page at https://www.reginfo.gov/public/do/PRAMain. Information gathered will be kept
private to the extent provided by law.
Higher Level
Review - Email
AMO VSignals
DRAFT: V9
<03/11/20>
Working Draft, Pre-Decisional, Deliberative document - Internal VA Use Only
EMAIL SUBJECT LINE: VA Higher-Level Review survey. (3 minutes)
EMAIL PREVIEW HEADER: Tell us about your experience with the VA Higher-Level Review survey.
OMB Number: 2900-0770
Expiration: TBD
Estimated Burden: 3 minutes
Your opinion matters.
Dear ,
We care about your experience with VA. Please take this 3
minute survey to tell us about your most recent HigherLevel Review Experience. Your feedback is truly
appreciated and will help us understand how we can
improve.
Take Our Survey
Thank you,
Veterans Experience Office
Department of Veterans Affairs
Whether you’re just getting out of the service or you’ve been a civilian for years, the VA Welcome Kit
can help guide you to the benefits and services you’ve earned.
The Veterans Crisis Line provides free, confidential support for Veterans and their families and
friends in crisis. Dial 1 (800) 273-8255 (Press 1), or text 838255 to receive confidential support 24/7
(System of Records Notice VA158VA10NC5). Visit https://www.veteranscrisisline.net for
more information.
Additionally, the National Call Center for Homeless Veterans (NCCHV) provides free, confidential
support for Veterans and their family members and friends who are homeless or at risk of
homelessness. Veterans can either call or chat online with the National Call Center for Homeless
Veterans where trained counselors are ready to talk confidentially 24 hours a day, 7 days a week.
Dial 1 (877) 424-3838 or visit https://www.va.gov/HOMELESS/ to receive confidential support.
Please do not reply to this email - it is unmonitored.
If you wish to share your feedback, please do so by .
You received this email because you provided your email address to VA. If you would like to opt out
from receiving future surveys, please click below.
Unsubscribe from this VA Survey | Privacy Policy
By filling out this survey, you are authorizing VA database access to retrieve Veteran contact
information to follow up with you accordingly for purposes of service recovery, potential crisis, or to
learn more about feedback you have shared regarding your experience with VA. "This information is
collected in accordance with section 3507 of the Paperwork Reduction Act of 1995. Title 38, United
States Code, allows us to ask for this information. We estimate that you will need an average of 3
minutes to review the instructions and complete this survey. The results of this survey will be used
to inform opportunities for program improvement in the quality of VA services. Participation in this
survey is voluntary, and your decision not to respond will have no impact on VA benefits or services
which you may currently be receiving. VA cannot conduct or sponsor a collection of information
unless a valid OMB control number is displayed. You are not required to respond to a collection of
information if this number is not displayed. Valid OMB control numbers can be located on the OMB
Internet Page at https://www.reginfo.gov/public/do/PRAMain. Information gathered will be kept
private to the extent provided by law.
AMO VSignals
DRAFT: V9
<03/11/20>
Working Draft, Pre-Decisional, Deliberative document - Internal VA Use Only
EMAIL SUBJECT LINE: We still want to hear about your Higher-Level Review experience. (3 minutes)
EMAIL PREVIEW HEADER: Tell us about your experience with the VA Higher-Level Review survey.
OMB Number: 2900-0770
Expiration: TBD
Estimated Burden: 3 minutes
Your feedback is important to us.
Dear ,
VA still wants to hear about your most recent Higher-Level
Review experience. Please let us know how we are doing
by taking a 3 minute survey regarding your experience.
Take Our Survey
Thank you,
Veterans Experience Office
Department of Veterans Affairs
Whether you’re just getting out of the service or you’ve been a civilian for years, the VA Welcome Kit
can help guide you to the benefits and services you’ve earned.
The Veterans Crisis Line provides free, confidential support for Veterans and their families and
friends in crisis. Dial 1 (800) 273-8255 (Press 1), or text 838255 to receive confidential support 24/7
(System of Records Notice VA158VA10NC5). Visit https://www.veteranscrisisline.net for
more information.
Additionally, the National Call Center for Homeless Veterans (NCCHV) provides free, confidential
support for Veterans and their family members and friends who are homeless or at risk of
homelessness. Veterans can either call or chat online with the National Call Center for Homeless
Veterans where trained counselors are ready to talk confidentially 24 hours a day, 7 days a week.
Dial 1 (877) 424-3838 or visit https://www.va.gov/HOMELESS/ to receive confidential support.
Please do not reply to this email - it is unmonitored.
If you wish to share your feedback, please do so by .
You received this email because you provided your email address to VA. If you would like to opt out
from receiving future surveys, please click below.
Unsubscribe from this VA Survey | Privacy Policy
By filling out this survey, you are authorizing VA database access to retrieve Veteran contact
information to follow up with you accordingly for purposes of service recovery, potential crisis, or to
learn more about feedback you have shared regarding your experience with VA. "This information is
collected in accordance with section 3507 of the Paperwork Reduction Act of 1995. Title 38, United
States Code, allows us to ask for this information. We estimate that you will need an average of 3
minutes to review the instructions and complete this survey. The results of this survey will be used
to inform opportunities for program improvement in the quality of VA services. Participation in this
survey is voluntary, and your decision not to respond will have no impact on VA benefits or services
which you may currently be receiving. VA cannot conduct or sponsor a collection of information
unless a valid OMB control number is displayed. You are not required to respond to a collection of
information if this number is not displayed. Valid OMB control numbers can be located on the OMB
Internet Page at https://www.reginfo.gov/public/do/PRAMain. Information gathered will be kept
private to the extent provided by law.
EMAIL SUBJECT LINE: “Unmonitored Automated Email: U.S. Department of Veterans Affairs”
OMB Number: 2900-0770
Expiration: TBD
This is an unmonitored email address.
The Veterans Crisis Line provides free, confidential support for Veterans
and their families and friends in crisis. Dial 1 (800) 273-8255 (Press 1), or
text 838255 to receive confidential support 24/7 (System of Records Notice
VA158VA10NC5). Visit https://www.veteranscrisisline.net for more
information.
Additionally, the National Call Center for Homeless Veterans (NCCHV)
provides free, confidential support for Veterans and their family members
and friends who are homeless or at risk of homelessness. Veterans can
either call or chat online with the National Call Center for Homeless
Veterans where trained counselors are ready to talk confidentially 24 hours
a day, 7 days a week. Dial 1 (877) 424-3838 or visit
https://www.va.gov/HOMELESS/ to receive confidential support.
Thank you,
Veterans Experience Office
Department of Veterans Affairs
Please do not reply to this email - it is unmonitored.
If you wish to share your feedback, please do so by .
You received this email because you provided your email address to VA. If you would like to opt out
from receiving future surveys, please click below.
Unsubscribe from this VA Survey | Privacy Policy
By filling out this survey, you are authorizing VA database access to retrieve Veteran contact
information to follow up with you accordingly for purposes of service recovery, potential crisis, or to
learn more about feedback you have shared regarding your experience with VA. "This information is
collected in accordance with section 3507 of the Paperwork Reduction Act of 1995. Title 38, United
States Code, allows us to ask for this information. We estimate that you will need an average of 3
minutes to review the instructions and complete this survey. The results of this survey will be used
to inform opportunities for program improvement in the quality of VA services. Participation in this
survey is voluntary, and your decision not to respond will have no impact on VA benefits or services
which you may currently be receiving. VA cannot conduct or sponsor a collection of information
unless a valid OMB control number is displayed. You are not required to respond to a collection of
information if this number is not displayed. Valid OMB control numbers can be located on the OMB
Internet Page at https://www.reginfo.gov/public/do/PRAMain. Information gathered will be kept
private to the extent provided by law.
Supplemental
Claim - Email
AMO VSignals
DRAFT: V9
<03/11/20>
Working Draft, Pre-Decisional, Deliberative document - Internal VA Use Only
EMAIL SUBJECT LINE: VA Supplemental Claim survey. (3 minutes)
EMAIL PREVIEW HEADER: Tell us about your experience with the VA Supplemental Claim survey.
OMB Number: 2900-0770
Expiration: TBD
Estimated Burden: 3 minutes
Your opinion matters.
Dear ,
We care about your experience with VA. Please take this 3
minute survey to tell us about your most recent
Supplemental Claim experience. Your feedback is truly
appreciated and will help us understand how we can
improve.
Take Our Survey
Thank you,
Veterans Experience Office
Department of Veterans Affairs
Whether you’re just getting out of the service or you’ve been a civilian for years, the VA Welcome Kit
can help guide you to the benefits and services you’ve earned.
The Veterans Crisis Line provides free, confidential support for Veterans and their families and
friends in crisis. Dial 1 (800) 273-8255 (Press 1), or text 838255 to receive confidential support 24/7
(System of Records Notice VA158VA10NC5). Visit https://www.veteranscrisisline.net for
more information.
Additionally, the National Call Center for Homeless Veterans (NCCHV) provides free, confidential
support for Veterans and their family members and friends who are homeless or at risk of
homelessness. Veterans can either call or chat online with the National Call Center for Homeless
Veterans where trained counselors are ready to talk confidentially 24 hours a day, 7 days a week.
Dial 1 (877) 424-3838 or visit https://www.va.gov/HOMELESS/ to receive confidential support.
Please do not reply to this email - it is unmonitored.
If you wish to share your feedback, please do so by .
You received this email because you provided your email address to VA. If you would like to opt out
from receiving future surveys, please click below.
Unsubscribe from this VA Survey | Privacy Policy
By filling out this survey, you are authorizing VA database access to retrieve Veteran contact
information to follow up with you accordingly for purposes of service recovery, potential crisis, or to
learn more about feedback you have shared regarding your experience with VA. "This information is
collected in accordance with section 3507 of the Paperwork Reduction Act of 1995. Title 38, United
States Code, allows us to ask for this information. We estimate that you will need an average of 3
minutes to review the instructions and complete this survey. The results of this survey will be used
to inform opportunities for program improvement in the quality of VA services. Participation in this
survey is voluntary, and your decision not to respond will have no impact on VA benefits or services
which you may currently be receiving. VA cannot conduct or sponsor a collection of information
unless a valid OMB control number is displayed. You are not required to respond to a collection of
information if this number is not displayed. Valid OMB control numbers can be located on the OMB
Internet Page at https://www.reginfo.gov/public/do/PRAMain. Information gathered will be kept
private to the extent provided by law.
AMO VSignals
DRAFT: V9
<03/11/20>
Working Draft, Pre-Decisional, Deliberative document - Internal VA Use Only
EMAIL SUBJECT LINE: We still want to hear about your Supplemental Claim experience. (3 minutes)
EMAIL PREVIEW HEADER: Tell us about your experience with the VA Supplemental Claim survey.
OMB Number: 2900-0770
Expiration: TBD
Estimated Burden: 3 minutes
Your feedback is important to us.
Dear ,
VA still wants to hear about your most recent Supplemental
Claim experience. Please let us know how we are doing by
taking a 3 minute survey regarding your experience.
Take Our Survey
Thank you,
Veterans Experience Office
Department of Veterans Affairs
Whether you’re just getting out of the service or you’ve been a civilian for years, the VA Welcome Kit
can help guide you to the benefits and services you’ve earned.
The Veterans Crisis Line provides free, confidential support for Veterans and their families and
friends in crisis. Dial 1 (800) 273-8255 (Press 1), or text 838255 to receive confidential support 24/7
(System of Records Notice VA158VA10NC5). Visit https://www.veteranscrisisline.net for
more information.
Additionally, the National Call Center for Homeless Veterans (NCCHV) provides free, confidential
support for Veterans and their family members and friends who are homeless or at risk of
homelessness. Veterans can either call or chat online with the National Call Center for Homeless
Veterans where trained counselors are ready to talk confidentially 24 hours a day, 7 days a week.
Dial 1 (877) 424-3838 or visit https://www.va.gov/HOMELESS/ to receive confidential support.
Please do not reply to this email - it is unmonitored.
If you wish to share your feedback, please do so by .
You received this email because you provided your email address to VA. If you would like to opt out
from receiving future surveys, please click below.
Unsubscribe from this VA Survey | Privacy Policy
By filling out this survey, you are authorizing VA database access to retrieve Veteran contact
information to follow up with you accordingly for purposes of service recovery, potential crisis, or to
learn more about feedback you have shared regarding your experience with VA. "This information is
collected in accordance with section 3507 of the Paperwork Reduction Act of 1995. Title 38, United
States Code, allows us to ask for this information. We estimate that you will need an average of 3
minutes to review the instructions and complete this survey. The results of this survey will be used
to inform opportunities for program improvement in the quality of VA services. Participation in this
survey is voluntary, and your decision not to respond will have no impact on VA benefits or services
which you may currently be receiving. VA cannot conduct or sponsor a collection of information
unless a valid OMB control number is displayed. You are not required to respond to a collection of
information if this number is not displayed. Valid OMB control numbers can be located on the OMB
Internet Page at https://www.reginfo.gov/public/do/PRAMain. Information gathered will be kept
private to the extent provided by law.
AMO VSignals
DRAFT: V9
<03/11/20>
Working Draft, Pre-Decisional, Deliberative document - Internal VA Use Only
EMAIL SUBJECT LINE: “Unmonitored Automated Email: U.S. Department of Veterans Affairs”
OMB Number: 2900-0770
Expiration: TBD
This is an unmonitored email address.
The Veterans Crisis Line provides free, confidential support for Veterans
and their families and friends in crisis. Dial 1 (800) 273-8255 (Press 1), or
text 838255 to receive confidential support 24/7 (System of Records Notice
VA158VA10NC5). Visit https://www.veteranscrisisline.net for more
information.
Additionally, the National Call Center for Homeless Veterans (NCCHV)
provides free, confidential support for Veterans and their family members
and friends who are homeless or at risk of homelessness. Veterans can
either call or chat online with the National Call Center for Homeless
Veterans where trained counselors are ready to talk confidentially 24 hours
a day, 7 days a week. Dial 1 (877) 424-3838 or visit
https://www.va.gov/HOMELESS/ to receive confidential support.
Thank you,
Veterans Experience Office
Department of Veterans Affairs
Please do not reply to this email - it is unmonitored.
If you wish to share your feedback, please do so by .
You received this email because you provided your email address to VA. If you would like to opt out
from receiving future surveys, please click below.
Unsubscribe from this VA Survey | Privacy Policy
By filling out this survey, you are authorizing VA database access to retrieve Veteran contact
information to follow up with you accordingly for purposes of service recovery, potential crisis, or to
learn more about feedback you have shared regarding your experience with VA. "This information is
collected in accordance with section 3507 of the Paperwork Reduction Act of 1995. Title 38, United
States Code, allows us to ask for this information. We estimate that you will need an average of 3
minutes to review the instructions and complete this survey. The results of this survey will be used
to inform opportunities for program improvement in the quality of VA services. Participation in this
survey is voluntary, and your decision not to respond will have no impact on VA benefits or services
which you may currently be receiving. VA cannot conduct or sponsor a collection of information
unless a valid OMB control number is displayed. You are not required to respond to a collection of
information if this number is not displayed. Valid OMB control numbers can be located on the OMB
Internet Page at https://www.reginfo.gov/public/do/PRAMain. Information gathered will be kept
private to the extent provided by law.
| File Type | application/pdf |
| File Modified | 2020-04-01 |
| File Created | 2020-04-01 |