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pdfVFCE Veterans Experience Action Center Event Survey (Initial Email)
FINAL
Working Draft, Pre-Decisional, Deliberative document – Internal VA Use Only
EMAIL SUBJECT LINE: VFCE VEAC Experience Survey (5 minutes).
EMAIL PREHEADER: Tell us about your experience with the VEAC event.
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: 2900-0876
Expiration: 03/31/2023
Estimated Burden: 5 minutes
Your opinion matters.
Dear ,
We want to hear about your experience with VA. Please
take this 5-minute survey to let us know about your
experience with the Veterans Experience Action Center
(VEAC) event in between and . The more information you share with us, the better
we can serve you.
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
We are asking for this information so that you can provide compliments, recommendations, or
concerns to VA. 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. 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. 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 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 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.
VFCE Veterans Experience Action Center Event Survey (Follow Up Email)
FINAL
Working Draft, Pre-Decisional, Deliberative document – Internal VA Use Only
EMAIL SUBJECT LINE: VFCE VEAC Experience Survey (5 minutes).
EMAIL PREHEADER: We still want to hear about your experience with the VEAC event.
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: 2900-0876
Expiration: 03/31/2023
Estimated Burden: 5 minutes
Your feedback is important to us.
Dear ,
VA still wants to hear about your experience with the
Veterans Experience Action Center (VEAC) event in
between and . Please let
us know how we are doing by taking a 5-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
We are asking for this information so that you can provide compliments, recommendations, or
concerns to VA. 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. 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. 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 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 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.
VFCE Veterans Experience Action Center Event Survey (Feedless Link)
FINAL
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: 2900-0876
Expiration: 03/31/2023
Estimated Burden: 5 minutes
Help us serve you better.
We want to hear about your experience with the Veterans Experience
Action Center (VEAC) event. Your answers to these questions directly
help us improve our services.
This survey should take approximately 5 minutes to complete. Please respond to all questions
to complete the survey.
What best describes you as you’re participating in this Veterans Experience Action
Center (VEAC) event? Required
Veteran
Active Military/National Guard/Reserve
Family Member
Caregiver
Survivor
Is this the first time you have interacted with VA? Required
Yes
No
Unsure
Do you currently receive VA health care services or VA benefits, such as compensation,
pension, education, home loan, or pre-burial benefits? Required
Yes
Note: Display question only if answer is “No” or
“Unsure” in previous question (Is this the first time
you have interacted with VA?).
No
Unsure
Please indicate why you may not have interacted with VA. Please select all the following
reasons that apply.
Required
Note: Display question
only if answer is “Yes” or
I did not know I was eligible for VA health care or benefits
“Unsure” in the question:
“Is this the first time you
I haven’t had the time to look into VA health care or benefits have interacted with VA?”
I did not wish to apply for any VA health care or benefits
I did not know how to apply for VA health care or benefits
Other
What information and/or services did you receive while attending the outreach event?
Please select all that apply. Required
Appeals Status and General Assistance
Burial and Memorial Service
Caregiver Support
Claims Status and General Assistance
Community Services
File a New or Increased Claim for Benefits
First Time Filing a VA Claim
General Health Care Information and Assistance
State Benefits
VA Health Care Eligibility and Enrollment
Other
Did you have any challenges attending the outreach event? Please select all that apply.
Required
No challenges
Making an appointment
Call wasn't conducted at the time I desired
Issues with calls (call went too long, too many transfers, too long to be
connected to resource provider)
Technical failures (dropped calls, audio problems)
Other
Required
Please describe what challenge you had with attending the VEAC event.
Note: only display if “Other” is selected in previous question (Did you have any challenges
attending the outreach event? Please select all that apply.)
I was able to get my information and/or service support needs met at the outreach
event.
Required
Strongly
Neither Agree
Strongly
Disagree
Agree
Disagree
nor Disagree
Agree
1
2
3
4
5
It was easy to get the information and/or services that I needed at the outreach event.
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
Required
I felt respected and valued during my participation at the outreach event. Required
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
I trust VA and its community partners (state/county/local service providers) to meet my
needs from the outreach event. Required
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
I would recommend this outreach event to other Veterans. Required
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
What is your gender?
Female
Male
Transgender Female
Transgender Male
Non-Binary/Third Gender
Choose Not to Respond
Other
What race/ethnicity do you identify with? Please select all that apply.
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White
What ZIP code do you consider your primary residence? (Enter ‘00000’ if using an APO/
FPO) Required
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. 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. 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 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 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.
[Logic: 1). Required if CCR Open Text Box is included on survey. 2). Always required on footer]
Privacy Policy
VFCE Veterans Experience Action Center Event Survey (Feedless Link)
FINAL
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: 2900-0876
Expiration: 03/31/2023
Estimated Burden: 5 minutes
Thank you for participating in the
survey.
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. 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. 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 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 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.
[Logic: 1). Required if CCR Open Text Box is included on survey. 2). Always required on footer]
Privacy Policy
VFCE Veterans Experience Action Center Event Survey (Email Invite)
FINAL
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: 2900-0876
Expiration: 03/31/2023
Estimated Burden: 5 minutes
Help us serve you better.
We want to hear about your experience with the Veterans Experience
Action Center (VEAC) event. Your answers to these questions directly
help us improve our services.
This survey should take approximately 5 minutes to complete. Please respond to all questions
to complete the survey.
What best describes you as you’re participating in this Veterans Experience Action
Center (VEAC) event? Required
Veteran
Active Military/National Guard/Reserve
Family Member
Caregiver
Survivor
Is this the first time you have interacted with VA? Required
Yes
No
Unsure
Do you currently receive VA health care services or VA benefits, such as compensation,
pension, education, home loan, or pre-burial benefits? Required
Yes
Note: Display question only if answer is “No” or
“Unsure” in previous question (Is this the first time
you have interacted with VA?).
No
Unsure
Please indicate why you may not have interacted with VA. Please select all the following
reasons that apply.
Required
Note: Display question
only if answer is “Yes” or
I did not know I was eligible for VA health care or benefits
“Unsure” in the question:
“Is this the first time you
I haven’t had the time to look into VA health care or benefits have interacted with VA?”
I did not wish to apply for any VA health care or benefits
I did not know how to apply for VA health care or benefits
Other
What information and/or services did you receive while attending the outreach event?
Please select all that apply. Required
Appeals Status and General Assistance
Burial and Memorial Service
Caregiver Support
Claims Status and General Assistance
Community Services
File a New or Increased Claim for Benefits
First Time Filing a VA Claim
General Health Care Information and Assistance
State Benefits
VA Health Care Eligibility and Enrollment
Other
Did you have any challenges attending the outreach event? Please select all that apply.
Required
No challenges
Making an appointment
Call wasn't conducted at the time I desired
Issues with calls (call went too long, too many transfers, too long to be
connected to resource provider)
Technical failures (dropped calls, audio problems)
Other
Required
Please describe what challenge you had with attending the VEAC event.
Note: only display if “Other” is selected in previous question (Did you have any challenges
attending the outreach event? Please select all that apply.)
I was able to get my information and/or service support needs met at the outreach
event.
Required
Strongly
Neither Agree
Strongly
Disagree
Agree
Disagree
nor Disagree
Agree
1
2
3
4
5
It was easy to get the information and/or services that I needed at the outreach event.
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
Required
I felt respected and valued during my participation at the outreach event. Required
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
I trust VA and its community partners (state/county/local service providers) to meet my
needs from the outreach event. Required
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
I would recommend this outreach event to other Veterans. Required
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
What race/ethnicity do you identify with? Please select all that apply.
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White
Would you like to provide additional feedback with a concern, compliment, or
recommendation about your experience(s) with VEAC events? Please select from one of
the following options. Required
Select your response
Compliment
Concern
Recommendation
Will not provide additional feedback
Use the text box below to enter details of the additional feedback (optional). Please do
not include any personally identifiable information, Social Security Number, Veteran ID,
or medical information, but do provide details about your experience.
Finish
We are asking for this information so that you can provide compliments, recommendations, or concerns to VA. 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. 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. 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 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 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.
[Logic: 1). Required if CCR Open Text Box is included on survey. 2). Always required on footer]
Privacy Policy
VFCE Veterans Experience Action Center Event Survey (Email Invite)
FINAL
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: 2900-0876
Expiration: 03/31/2023
Estimated Burden: 5 minutes
Thank you for participating in the
survey.
We are asking for this information so that you can provide compliments, recommendations, or concerns to VA. 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. 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. 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 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 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.
[Logic: 1). Required if CCR Open Text Box is included on survey. 2). Always required on footer]
Privacy Policy
| File Type | application/pdf |
| File Modified | 2022-03-10 |
| File Created | 2022-03-10 |