Specially Adapted Housing Nongrantees Survey

Specially Adapted Housing: Eligible Non-Grantee Survey

1	Prior to receiving this survey, were you aware of VA’s Specially Adapted Housing grant program? Yes [Go to Q3] No [Go to Q2]
2	IF NO to Q1: Which of the following would have been the BEST way for VA to inform you about the Specially Adapted Housing grant program? Letter from VA which awarded benefits for my service-connected disability Pre-Discharge Briefings (TAP/DTAP) VA Benefits Counselor VA Medical Center or clinic VA pamphlet or brochure Internet site Other, Please Specify_____________ THIS ENDS THE SURVEY FOR THESE RESPONDENTS. RESPONDENTS INSTRUCTED TO GO TO SEPARATE PAGE WHERE THEY ARE THANKED FOR PARTICIPATING IN THE SURVEY.
3	IF YES to Q1: From which source did you first learn about the program? [Mark only one] Letter from VA which awarded benefits for my service-connected disability Pre-Discharge Briefings (TAP/DTAP) VA Benefits Counselor Lender or Real Estate Agent VA Medical Center or clinic Another Veteran Internet site VA pamphlet or brochure Veteran Service Organization Other, Please Specify_______________
4	Did you ever submit an application for the Specially Adapted Housing grant program (VA Form 26-4555)? Yes [Go to Q6] No [Go to Q5] Don’t Remember/Don’t Know [Go to Q6]
5	IF NO to Q4: What is the major reason you never submitted an application? I want to apply, but am unsure about how to apply for the grant My current home meets my needs I do not want to use the grant I plan on moving in the future, and want to wait to use my grant at that time The application and/or grant process seemed too time consuming The application and/or grant process seemed to complex or complicated The available SAH grant amount was not large enough to accommodate my needs I elected to use an alternative source of funding THIS ENDS THE SURVEY FOR THESE RESPONDENTS RESPONDENTS INSTRUCTED TO GO TO SEPARATE PAGE WHERE THEY ARE THANKED FOR PARTICIPATING IN THE SURVEY.
5.5	IF YES TO Q4: Did you have an initial in-person interview with the VA Specially Adapted Housing Agent, to discuss the grant program and process? Yes [Go to Q5.6] No [Go to Q6] Don’t Know/ Not Sure [Go to Q6]
5.6	IF YES TO Q5.5: After this interview, did you understand the Specially Adapted Housing grant process enough to proceed with obtaining the grant? Yes No
6	IF YES to Q5.6: Did you also submit the Supplemental Application (VA Form 26-4555c) to obtain the Specially Adapted Housing grant? Yes [Go to Q7] No [Go to Q6.5] Don’t know/ Don’t remember [Go to Q9]
6.5	IF NO to Q6: What is the major reason you did not submit the Supplemental Application? I had difficulty completing the Supplemental Application forms I felt the Supplemental Application asked for information that I should not have to provide The application and/or grant process seemed too time consuming The application and/or grant process seemed to complex or complicated I realized the SAH Grant amount was not large enough to accommodate my needs I elected to use an alternative source of funding Other, Please Specify____________ THIS ENDS THE SURVEY FOR THESE RESPONDENTS RESPONDENTS INSTRUCTED TO GO TO SEPARATE PAGE WHERE THEY ARE THANKED FOR PARTICIPATING IN THE SURVEY.

7	Did you encounter any difficulties or problems during the Specially Adapted Housing grant approval process? Yes [Go To Q8] No [Go to Q9]
8	IF YES to Q7: What part or parts of the Specially Adapted Housing grant approval process presented the most difficulty for you? [Mark all that apply] Securing the services of a contractor Obtaining a performance bond Developing the building/ remodeling plans Obtaining medical and/or contractor bid waivers Providing all the necessary financial information Obtaining other documentation (Please Specify) _____________ Other Problems (Please Specify) ______________________
9	What was the major factor that ultimately prevented you from obtaining or using Specially Adapted Housing grant funds? [Mark only one] My Supplemental Application (VA Form 4555c) was denied I decided to defer using my grant to a later time I decided that I no longer needed the grant I did not have enough help from VA in during the grant application process The application and/or grant process seemed to complex or complicated I realized that the Specially Adapted Housing grant was not large enough to accommodate my needs I found an alternative source of funding Other, Please Specify______________

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