Survey of Veterans Recently Separated

Sur vey o f Vet er ans
Rec ent l y Separ at ed
OMB Control Number: 2900-XXXX
Public Reporting Burden and Privacy Act Statement
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 15
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. Failure to furnish the requested information
will have no adverse affect on any VA benefits 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 VA benefits processing
system and for associated purposes. If you have
comments regarding this burden estimate or any aspects
of this collection of information, call 1-800-827-1000 for
mailing information on where to send your comments.

ABOUT YOU
1.

What is your highest level of education
completed?
Some high school
High school graduate or GED certificate
Some college
College graduate
Post-graduate study or degree

2.

Are you... (mark all that apply)
American Indian or Alaska Native
Asian
Black/African American
Native Hawaiian or other Pacific Islander
White
Prefer not to answer
Other

3.

Latino/Hispanic
Yes
No

4.

What is your current marital status?
Married
Separated
Divorced
Widowed
Not married
Prefer not to answer

5.

In which zip code
do you currently
reside?

6.

How far do you live from the nearest
military installation?
Less than 10 minutes
10 - 19 minutes
20 - 29 minutes
30 - 59 minutes
60 minutes or more

SINCE SEPARATION FROM ACTIVE DUTY

Answer questions 6 - 8 If you have separated from active
duty service between May 2008 ~ April 2009. All others
proceed to question 9.

7.

Between your date of separation and
today, how many month(s), if any, were
you unemployed?
NONE (skip to Question 9)
Less than 1 month
1 - 3 months
4 - 6 months
7 - 9 months
10 - 12 months
More than 12 months

8.

What is the main reason for that unemployment?
(mark all that apply)
Temporarily unable to work because of an injury
Temporarily unable to work because of an illness
Unable to work because of a chronic health condition or disability
Retired
Pregnancy/Childbirth
Taking care of children/other persons
Going to school
Unable to find work
Laid off (temporarily or indefinite)
Waiting for a new job to begin
Not interested in working at a job
Some other reason (please specify below)

9.

During that period(s) of unemployment, have you
done any work at all for pay?
Yes
No

CURRENT EMPLOYMENT
10. Which one of the following best

describes your current employment
status? (mark only one)
Full-time

Answer questions 12 - 15 if you have separated from active duty
between May 2008 ~ April 2009. All others skip to question 16.

13. What was your base annual salary at

time of separation from active duty?
RECORD AMOUNT:

Part-time

Retired

Unemployed

Self-employed/Temporary employment (e.g.,
day labor, one-time jobs, odd jobs, informal jobs,
etc.)

14. What additional annual salary (i.e.,

Military Occupational Specialty (MOS),
hazard, danger, spousal maintenance,
etc.) did you receive at time of
separation from active duty?
RECORD AMOUNT:

Prefer not to answer
15. What is the total gross income you have
11. How many months have you been in

your current employment
status/position?

received since your separation from
active duty?
RECORD AMOUNT:

Less than 1 month
1 - 3 months
4 - 6 months
7 - 9 months
10 - 12 months

16. What are the sources of your current

monthly salary or income? (mark all
that apply.)

More than 12 months
Salary/wage
12. Is your employer... (please check only

Tips/bonuses/commisions

one)
A Government organization, including Armed
Forces

Benefits (e.g., disability, government assistance,
workers compensations, etc.)

Private, for profit company (i.e., retail, service,
etc.)

Other

Non-Profit Organization, including tax exempt
and charitable organizations
Self-employed/temporary employment

17. Taking into account all sources of

income, what is your current gross
yearly income?
$18,000 or less

NA

$18,001 - $25,000
$25,001 - $35,000
$35,001 - $45,000
$45,001 - $55,000
$55,001 - $65,000
$65,001 or more

Housing
18. Are you aware of mortgage protection

under the Servicemembers Civil Relief
Act (SCRA)?
Yes
No
Not sure

19. Did you receive any mortgage foreclosure protection under SCRA during your time of

service?
Yes (proceed to question 20)
No
Not sure
20. If you answered 'No' or 'Not sure', please select a reason from the choices below.
Not needed (proceed to question 23)
Not eligible (proceed to question 23)
Not requested (proceed to question 23)
Not aware of SCRA during service (proceed to question 23)

If you answered 'Yes' to question 18 above, please answer questions 20 - 22 about the
extent to which each protection afforded by the SCRA helped you avoid foreclosure.

Very great
extent
Great extent
21. Foreclosure delayed

while on active duty
22. Interest rate reduced to

make payments
manageable
23. Foreclosure delayed

after separation from
active duty

Neither great
nor little
Little extent
extent

Very little
extent

Not used

24. At the time of your separation from active

duty, what was your living situation?
Owned a home outright (no mortgage)
Had a mortgage on a home
Rented
Temporarily stayed with friends/family with no rent
Lived in base housing
Other
25. How many months did you remain in that

living situation after your separation from
active duty?
Less than 1 month
1 - 3 months
4 - 6 months
7 - 9 months
10 - 12 months
More than 12 months
26. What was your level of satisfaction with

your living situation at time of separation
from active duty?
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied

27. Are you aware of the VA Home Loan

Program?
Yes
No

28. Do you now, or have you ever had a VA

loan?
Yes
No
Not sure
29. Have you ever been behind in your

mortgage payments by 2 months or
more since separation from active
duty?
Yes
No
Not sure
Don't know
30. Have you ever been behind in your

rental payments by 2 months or more
since separation from active duty?
Yes
No
Not sure
Don't know
31. Has your home ever been referred to

foreclosure since separation from
active duty?
Yes
No
Don't know
32. Have you ever been threatened with

eviction from a rental property since
separation from active duty?
Yes
No
Don't know

33. Has the income you earned since separation

from active duty...
Improved your housing situation
Had little or no impact on your housing situation
Worsened your housing situation
34. If you receive disability compensation from VA,

how did the time taken to process your claim
impact the quality of your living situation?
(select only one)
Not much impact (continued same living situation)
Some impact (had difficulty in maintaining living situation)
Significant impact (had to seek other living situation)
Severe impact (forced to move to other living situation)
Do not receive disability compensation
Filed and waiting for a decision on my disability
compensation status/rating

35. If you are waiting on a decision from VA about a

claim for disability compensation, how is the time
to process your claim impacting the quality of
your living situation? (select only one)
Not much impact (continued same living situation)
Some impact (had difficulty in maintaining living situation)
Significant impact (had to seek other living situation)
Severe impact (forced to move to other living situation)
Not waiting on a claim decision from VA
36. What is your current living situation?
Own a home outright (no mortgage)
Have a mortgage on a home
Renting
Temporarily staying with friends/family with no rent
Live in base housing
Other
37. What is your level of satisfaction with your

current living situation?
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied

Comments

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