Form 2020-2900-0876-P2 Service-Level Measurement- PREVENTS Survey

The VA provides free, confidential support 2417 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 httRs:llwww.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 httRs:/lwww.va.gov/HOMELESS/.

0MB Number: TBD
Expiration: TBD
Estimated Burden: 5 minutes

Your expert opinions are valuable to us!
Please take a few minutes to provide feedback about Mental Health and
Suicide Prevention in support of the PREVENTS Executive Order.
This survey should take you approximately 2 minutes to complete.

Please enter your name.

What is your Agency/Organization/Affiliation?

Please enter your email address.

Please enter your phone number.

Which of these terms best represents you? Select all that apply.
Veteran
Active Military, Guard/Reserve
Family Member
Caregiver
Survivor
CVEB Member
VA Employee
Clinician
Other

How might we foster positive, social connectedness with Veterans, family members,
caregivers, and survivors in communities?

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How can the VA improve efforts to address suicide among service members and
Veterans?

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Do you have anything else you'd like to tell the VA about preventing suicide among
Veterans and service members?

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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. VA may utilize individual Veteran survey data from this survey or other sources to ensure the final scores truly and accurately
represent the experiences of Veterans. We estimate that you will need an average of 5 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 to which you may currently be receiving. VA cannot
conduct or sponsor a collection of information unless a valid 0MB control number is displayed. You are not required to respond to a collection of
information if this number is not displayed. Valid 0MB control numbers can be located on the 0MB Internet Page at httRs:l/www.reginfo.gov/Rublic/
do/PRAMain.