Download:
pdf |
pdfOMB Control Number 2900-0571
Estimated Completion Time: 20 Minutes
U.S. DEPARTMENT OF VETERANS AFFAIRS
NATIONAL CEMETERY ADMINISTRATION
VA Memorial Products:
2025 Next of Kin/Family Member Satisfaction Survey
(Headstones/Markers/Medallions and Presidential Memorial Certificates)
VA may not conduct, sponsor, or require the respondent to respond to this collection of information unless it displays a valid
OMB Control Number. All responses to this collection are voluntary. Public reporting burden for this collection of information is
estimated to average 20 minutes per response, including the time necessary for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The information
collected is intended to be used in making improvements in services within the National Cemetery Administration of the
Department of Veterans Affairs and for associated administrative purposes. Failure to furnish the requested information will have
no adverse effect on any VA benefit to which you may be entitled.
The information you supply will be confidential and protected by the Privacy Act of 1974 (5 U.S.C. 522a) and the VA’s confidentiality
statute (38 U.S.C. 5701) as implemented by 38 CFR 1.526(a) and 38 CFR 1.576(b). Disclosure of information involves releases
of statistical data and other non-identifying data for the improvement of services within the National Cemetery Administration and for
associated administrative purposes. Please send any comments regarding this burden estimate or any other aspect of this collection,
including suggestions for reducing this burden, to VA Clearance Officer (005G2), 810 Vermont Ave., NW, Washington DC 20420.
SEND COMMENTS ONLY. DO NOT SEND THIS FORM OR REQUESTS FOR BENEFITS TO THIS ADDRESS.
The survey will take about 20 minutes to complete. Please read each question carefully before making
your response. You may complete the survey on-line using the link address noted on the cover letter
(https://bit.ly/MPE2025E) or by using the enclosed paper copy in this mailing. To access the survey
on-line, enter your unique survey ID code ([MasterID]) on the main screen.
Marking Instructions
• Use pencil or pen. Make heavy dark marks that fill the circles
completely. If you wish to change an answer, erase cleanly (pencil)
or put an “X” over the incorrect response (pen).
• Fill in one answer circle for each question unless it states “Mark all
that apply.”
• When you are finished, please place the questionnaire in the enclosed
postage-paid envelope and put it in the mail.
Correct Mark
Incorrect Marks
If you have any questions or concerns, please contact the Survey Help Line at 1-833-231-7069
or email VistraResearch@ConsultVistra.com.
BARCODE
NATIONAL CEMETERY ADMINISTRATION
295126-2
< MasterID >
-1-
SEE MARKING INSTRUCTIONS ON THE COVER.
Correct Mark
5. How did you learn of these benefits prior to
your time of need? (Mark all that apply)
Reason for Choosing the Cemetery / Support
and Information Received at your Time of Need
1. Why did you inter your loved one in the
cemetery you chose rather than in a VA
national or state, tribal or territorial Veterans
cemetery? (Mark all that apply)
Chose interment in a family plot
Didn’t know how to make arrangements
at a national or state, tribal or territorial
Veterans cemetery
My loved one wanted to be close to other
relatives or friends already buried in the
cemetery I chose
The cemetery location will make it easier
to visit my loved one’s gravesite
It was a more affordable burial option
The funeral director did not inform me of
my options to use a national or State/Tribal
cemetery
I trust the cemetery I chose more than
other options
Other (specify) _______________________
2. What would have helped you choose a
national, state, tribal or territorial Veterans
cemetery?
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
Yes
No
Don’t remember/Not certain
No committal service was held
4. Prior to your time of need, were you aware
of the benefits related to burial in a national,
state, tribal or territorial cemetery?
Yes
No
< MasterID >
Family member/friends
Funeral home
Military discharge related materials
Other Veteran/Active-duty member
Pre-Need Burial Eligibility Determination
Veterans Service Organization
VA/NCA pamphlet, newsletter, brochure
VA/NCA website
Other VA organization
Professional/military association meetings
Local news
VA/NCA public service announcement/
advertisement
VA/NCA social media (Facebook or X,
formerly known as Twitter)
Other (specify): ______________________
6. Did the funeral director provide information
about burial and memorial benefits available
for Veterans? (Mark all that apply)
Not applicable: Funeral Director not used
Funeral Director provided information about
VA burial benefits for Veterans
Funeral Director provided information about VA
memorial benefits for Veterans
No, the Funeral Director did not provide
information about either VA burial or
memorial benefits
7. Did you call the NCA Applicant Assistance
number (1-800-697-6947) for assistance with a
headstone, marker, or medallion?
Yes
No GO TO QUESTION #10
Don’t know GO TO QUESTION #10
8. Why did you call NCA? (Mark all that apply)
3. Did you attend the committal service?
Incorrect Marks
GO TO QUESTION #6
-2-
To check on the status of an order
To get help with ordering a marker
To file a complaint about a marker
Other (specify): ______________________
9. How satisfied were you with the service you
received from the NCA Customer Service
Representative?
Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
Correct Mark
10. Did you visit the VA website for information
about ordering the headstone, marker, or
medallion?
16. How satisfied were you with the process
you used to order the headstone, marker, or
medallion?
How to order a headstone/marker/medallion
Download an order form
Find information on documentation needed
Find out what could go on the headstone/
marker/medallion
Find information on the certificate signed by
the President of the United States
honoring the Veteran’s service
Other (specify): _______________________
17. When you were applying for the
headstone, marker, or medallion,
were you aware that the following
items could be added to the
headstone, marker, or medallion:
An inscription
Birth date/Date of death
Highest rank attained
War service
Emblem of belief
Valor Awards
Terms of endearment
Nicknames
Civilian credentials (i.e., Doctor)
Special unit designations
Other military credentials
12. How satisfied were you with the ease of
finding the information you were looking for
on VA’s website?
Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
Bronze (metal plate)
Stone (granite or marble)
Bronze medallion
14. How did you order the headstone, marker, or
medallion? (Mark only one)
Via the mail
Via fax
Online via QuickSubmit
Via the Funeral Director
Other (specify): _______________________
I read it on the application
I looked it up on the VA website
I was informed by the Funeral Director
I was informed by a VA employee
I was not aware
Other (specify): _______________________
19. About how long after ordering the headstone,
marker, or medallion did it arrive?
15. Who helped you with ordering the headstone/
marker/medallion? (Mark all that apply)
18. If you were aware of the availability of an
inscription, how did you learn about what
could be included in the inscription? (Mark all
that apply)
13. What type of headstone, marker, or medallion
did you order?
ow
11. What type of information were you looking
for on VA’s website? (Mark all that apply)
Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
Don’t k
n
GO TO QUESTION #13
No
Yes
No
Incorrect Marks
Yes
SEE MARKING INSTRUCTIONS ON THE COVER.
Family member
Funeral director
Cemetery representative
VA employee
Other (specify) _______________________
No one
-3-
Less than 1 month
Between 1 and 2 months
Between 2 and 3 months
Between 3 and 4 months
More than 4 months
Has not arrived yet
Don’t know/Not sure
< MasterID >
SEE MARKING INSTRUCTIONS ON THE COVER.
Correct Mark
20. How satisfied were you with the amount of
time it took to receive the headstone, marker,
or medallion?
Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
Don’t know/Marker or headstone has not
arrived yet
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
Yes
No
Don’t know/Haven’t seen
______________________________________
The Presidential Memorial Certificate and the
NCA Pre-Need Eligibility Registration Process
22. Overall, how satisfied were you with the
quality and appearance of the headstone,
marker, or medallion when it arrived?
If your loved one was NOT a Veteran, please go to
Question #31.
Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
Don’t know/Haven’t seen
27. Did you order and/or receive a certificate
signed by the President of the United States
honoring the Veteran’s service?
Yes – Requested and received
Yes – Received, but not requested
No – Requested, not received GO TO
QUESTION #31
No – Did not receive GO TO QUESTION #31
Don’t know what this is GO TO QUESTION #31
23. Was there a delay in the placement of the
headstone, marker, or medallion because
of a difficulty paying the setting fee?
Yes
No
Don’t know
For information about the Presidential Memorial
Certificate (the certificate signed by the President
of the United States honoring the Veteran’s service)
or to order more copies visit our website at
www.cem.va.gov/pmc.asp.
24. How would you have preferred to be notified
about the delivery status of your headstone,
marker, or medallion?
Postcard
Email
Letter
Other (specify): _______________________
I didn’t need delivery status
25. Overall, how satisfied were you with your
experiences with VA memorial products
and services?
28. How satisfied were you with the quality of the
certificate signed by the President of the United
States honoring the Veteran’s service?
Very satisfied GO TO QUESTION #30
Somewhat satisfied GO TO QUESTION #30
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
29. Why were you not satisfied with the quality
of the certificate signed by the President of
the United States honoring Veteran’s service?
(Mark all that apply)
Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
I did not make the arrangements
< MasterID >
26. Please add any comments regarding the
process or support you received from NCA
Memorial Products Service.
______________________________________
21. When the headstone or marker arrived, was
the inscription accurate?
Incorrect Marks
-4-
Envelope was bent/torn
Name was misspelled
Poor print quality
Other (specify): _______________________
SEE MARKING INSTRUCTIONS ON THE COVER.
Correct Mark
30. How satisfied were you with the amount
of time it took to receive the certificate
signed by the President of the United States
honoring the Veteran’s service?
Demographics Disclaimer Statement:
Although responding to the following question(s)
is voluntary, VA strongly encourages you to provide
as much data and information as possible. Your
responses will not be connected to you as an
individual. These responses will help improve
customer experience, approved research, and
the quality of care and services for all Veterans.
They will not be used to update your customer
profile or other demographics found in any of your
VA records. VA follows strict security and privacy
practices and adheres to VA’s data ethics standards
to keep secure.
Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
31. Are you aware of the NCA Pre-Need Eligibility
process?
Yes
No
36. Was your loved one your…..
GO TO QUESTION #35
32. How did you first become aware of the
Pre-Need opportunity? (Mark only one)
Family member/friends
Funeral home
Military discharge related materials
Other Veteran/Active-duty member
Pre-Need Burial Eligibility Determination
Veterans Service Organization
VA/NCA pamphlet, newsletter, brochure
VA/NCA website
Other VA organization
Professional/military association meetings
Local news
VA/NCA public service announcement/
advertisement
VA/NCA social media (Facebook or X,
formerly known as Twitter)
Other (specify): ______________________
Yes
No
GO TO QUESTION #35
Yes
No
GO TO QUESTION #40
World War II (12/7/1941 – 12/31/1946)
Korean Conflict (6/27/1950 – 1/31/1955)
Vietnam Era (11/1/1955 – 5/7/1975)
Gulf War (8/2/1990 – 4/6/1991)
Operation Enduring Freedom (OEF)
(10/7/2001 – 12/28/2014)
Operation Iraqi Freedom (OIF)
(3/19/2003 – 8/31/2010)
Operation New Dawn
(9/1/2010 – 12/15/2011)
Other/Don’t know
39. Are you a Veteran married/partnered to a
Veteran?
Yes
No
Have not received yet
Yes
No
Please note: Veterans who are married to Veterans are
entitled to individual gravesite and
headstone/marker/medallion benefits. Visit
www.va.gov/burials-memorials/eligibility/
35. Are you aware of the PACT Act (The Sergeant
First Class Heath Robinson Honoring our
Promise to Address Comprehensive Toxics
Act) and the expanded eligibility of VA health
care for Veterans with toxic exposure?
Spouse
Partner
Parent
Child
Other relative
Not a relative
38. In which of the following eras did you serve?
(Mark all that apply)
34. Were you satisfied with the length of time it
took to receive a certificate of eligibility?
37. Are you a Veteran?
33. Have you applied for Pre-Need Eligibility?
Incorrect Marks
40. In what year were you born?
Yes
No
Don’t know what this is
__ __ __ __
-5-
< MasterID >
SEE MARKING INSTRUCTIONS ON THE COVER.
Correct Mark
41. What is your sex?
Female
Male
Incorrect Marks
44. What was your loved one’s race and/or
ethnicity? (Mark all that apply)
American Indian or Alaska Native
For example, Navajo Nation, Blackfeet Tribe
of the Blackfeet Indian Reservation of
Montana, Native Village of Barrow
Inupiat Traditional Government, Nome
Eskimo Community, Aztec, Maya, etc.
42. Was your loved one female or male?
Female
Male
Asian
For example, Chinese, Asian Indian, Filipino,
Vietnamese, Korean, Japanese, etc.
41. What is your race and/or ethnicity?(Mark all
that apply)
Black or African American
For example, African American, Jamaican,
Haitian, Nigerian, Ethiopian, Somali, etc.
American Indian or Alaska Native
For example, Navajo Nation, Blackfeet Tribe
of the Blackfeet Indian Reservation of
Montana, Native Village of Barrow
Inupiat Traditional Government, Nome
Eskimo Community, Aztec, Maya, etc.
Hispanic or Latino
For example, Mexican, Puerto Rican,
Salvadoran, Cuban, Dominican, Guatemalan,
etc.
Asian
For example, Chinese, Asian Indian, Filipino,
Vietnamese, Korean, Japanese, etc.
Middle Eastern or North African
For example, Lebanese, Iranian, Egyptian,
Syrian, Iraqi, Israeli, etc.
Black or African American
For example, African American, Jamaican,
Haitian, Nigerian, Ethiopian, Somali, etc.
Hispanic or Latino
For example, Mexican, Puerto Rican,
Salvadoran, Cuban, Dominican, Guatemalan,
etc.
Middle Eastern or North African
For example, Lebanese, Iranian, Egyptian,
Syrian, Iraqi, Israeli, etc.
Native Hawaiian or Pacific Islander
For example, Native Hawaiian, Samoan,
Chamorro, Tongan, Fijian, Marshallese, etc.
White
For example, English, German, Irish, Italian,
Polish, Scottish, etc.
45. What language do you mainly speak at
home?
Native Hawaiian or Pacific Islander
For example, Native Hawaiian, Samoan,
Chamorro, Tongan, Fijian, Marshallese, etc.
White
For example, English, German, Irish, Italian,
Polish, Scottish, etc.
English
Spanish
Chinese
Tagalog
Vietnamese
Arabic
Some other language (specify): __________
46. In what belief tradition was the burial
conducted?
< MasterID >
-6-
Christian
Catholic
Muslim
Jewish
Buddhist
Hindu
Atheist
Agnostic
None
Other (specify): ______________________
Choose not to answer
SEE MARKING INSTRUCTIONS ON THE COVER.
Correct Mark
47. Have you or your loved one used any other VA
Benefits? (Mark all that apply)
Have not used other VA benefits
Bereavement Counseling
Dependency and Indemnity Compensation
(DIC)
Housebound Allowance
Aid and Attendance
VA Life Insurance
Pension
Education benefits
Other (specify): _______________________
48. Please use this space to elaborate on any
additional aspects of your experience you
would like to share with the NCA.
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
Incorrect Marks
49. Are you willing to participate in a Focus Group
discussion?
o
N
Yes If you are interested in participating in
a focus group discussion to assist the National
Cemetery Administration with improving
its quality of service to Veterans and their
families, please complete the information
below:
In what way would you be willing to participate
in the focus group? (Mark all that apply)
Online
By phone
In person at a focus group facility
Name: ______________________________
Phone Number:_______________________
Email: ______________________________
Your participation will have no impact on your VA
benefits.
______________________________________
______________________________________
______________________________________
______________________________________
Thank you very much for taking the time to complete this questionnaire.
PLEASE mail this completed questionnaire in the enclosed pre-paid envelope as soon as possible.
If you misplaced the pre-paid envelope, you may mail the completed survey to the following address
using your own envelope:
NATIONAL CEMETERY ADMINISTRATION
PO BOX 510570
LIVONIA, MI 48151-9807
If you have any questions about this research, please contact the Survey Help Line at 1-833-231-7069
or email VistraResearch@ConsultVistra.com.
-7-
< MasterID >
PAGE INTENTIONALLY
LEFT BLANK
< MasterID >
-8-
| File Type | application/pdf |
| File Modified | 2025-02-19 |
| File Created | 2024-08-27 |