National Survey of Veterans, Active Duty Service Members, Activated National Guard and Reserve Members, Family Members and Survivors

Department of Veterans Affairs
National Survey of Veterans (NSV)
Veteran Spouse Survey

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information
unless it displays a valid OMB control number. The valid OMB control number for this information collection is xxx-xxxx.
The time required to complete this information collection is estimated to average 15 minutes per response, including the
time to review instructions, search existing data resources, gather the data needed, and complete and review the
information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving
this form, please write to: VA, xxxx

If you have any questions or concerns, please call the NSV Survey Helpline at 1-888-NSV-2009 or send an
email to [email protected]

Instructions to Complete the Survey



To answer a question, simply check the box that best represents your answer.



You will sometimes be asked to skip questions based on your answers. In addition, certain
sections of the questionnaire may not apply to you.



Please choose only one answer per question, unless the question indicates Mark all that
apply.

A4.

Section A
Familiarity With Veteran Benefits
A1. In the past year, have you received any
information regarding VA benefits/services?

Please indicate your level of awareness for
the following VA benefits and services:

Yes
No  Go to Question A3

a. Eligibility for VA health care

Don’t Know

A2.

b. Locating a VA health care
facility (such as a VA
hospital or medical center)

Through what means did you receive
information regarding VA benefits/services?

c.

Mark all that apply.

d. VA home loans

Through mail

e. VA education and training

Through email

f.

Through a unit newsletter
Other  Please specify below

h. VA disability compensation
and pension

Below is a list of topics about VA benefits and
services. Please indicate whether you have
looked for information on these in the past
year.
Yes No

a. Eligibility for VA health care
b. Locating a VA health care facility
(such as a VA hospital or medical center)
c.

VA life insurance

d. VA home loans
e. VA education and training
f.

VA vocational rehabilitation

g. VA burial and memorial benefits
h. VA disability compensation and pension
i.

VA benefits for dependents and survivors

j.

VA transition assistance

k.

VA prescription benefits

VA vocational rehabilitation

g. VA burial and memorial
benefits

Through VA newsletter

A3.

VA life insurance

1

i.

VA benefits for dependents
and survivors

j.

VA transition assistance

k.

VA prescription benefits

B4.

Section B
Employment
B1. During the last week, were you…

{
B2.

How long have you worked at your current
job?
Instruction: For example, 6 months would be
coded as: 00 06.

Working, or on paid vacation or sick leave
from work

Years

Not working, but looking for work  Go to
Question B5

B5.

Not working and not looking for work  Go to
Question B5

Months

How satisfied are you with your employment
and career opportunities?
Does not apply, I am not interested in
employment
Very satisfied

On average, how many hours a week do you
spend working for pay or for a family
business or farm?

Satisfied
Dissatisfied

Hours

Very dissatisfied

Section C
Your Veteran Spouse
C1. When did your spouse leave the military?

If you work less than 35 hours a week, please
answer the next question. If you work at least
35 hours a week, please go to Question B4.

Year

B3.

Which of the following are reasons why you
are working less than 35 hours a week?

C2.

Mark all that apply.

Do not want to work 35 hours or more

How many years did your spouse serve in
military service?
Years

Need flexibility due to spouse’s employment
Could only find part-time work

C3.

Seasonal work
Child care responsibilities
Responsible for caring for my spouse’s
health/medical limitations

Was your Veteran spouse discharged from
military service for a service-connected
disability?
Yes
No

My personal health/medical limitations

Don’t Know

Other family/personal obligations
Need schooling/training/certification
In school
Other

Question B5 appears in the next column.

2

E2.

Section D
Disability

Yes

About your Veteran spouse…

D1.

No

Does your spouse have a service-connected
disability rating?

Section F
Health Insurance
F1. Are you CURRENTLY covered by any of the
following types of health insurance or health
coverage plans? Mark all that apply.

Yes
No  Go to Section E

D1a. Does his/her service-connected disability
ever prevent him/her from getting or holding a
job?

Insurance through a current or former
employer or union (of yours or another family
member)

Yes

Insurance purchased directly from an insurance
company (by you or another family member)

No

Medicare, for people 65 and older, or people
with certain disabilities

D1b. What is his/her current service-connected
disability rating?
10 or 20 percent

Medicaid, Medical Assistance, or any kind of
government-assistance plan for those with low
incomes or a disability

30 to 40 percent

TRICARE or other military health care

50 to 60 percent

CHAMPVA (Civilian Health and Medical
Program of VA)

0 percent

70 percent or higher

Indian Health Service

Don’t know

D2.

Are you currently in need of the aid and
attendance of another person or are you
permanently housebound?

Any other type of health insurance or health
coverage plan  Please specify below

Was your spouse a prisoner of war?
Yes
No

F2.

Section E
Health Status
E1. In general, would you say your health is…

How familiar are you with the benefits and
eligibility criteria associated with CHAMPVA?
Extremely familiar

Excellent

Moderately familiar

Very good

Somewhat familiar

Good

Slightly familiar

Fair

Not at all familiar

Poor

3

G2b. How important was the VA educational
assistance in helping you meet your
educational goals or preparing you to get a
better job?

Section G
Educational Assistance
These next few questions ask about your experience
with education assistance provided by the Department of
Veterans Affairs.

Extremely important
Very important
Moderately important

G1. Have you ever used any VA educational
assistance?

Slightly important
Not at all important

Yes
No  Go to Question G3

QUESTION G2B SKIPS TO
SECTION H ON THE NEXT PAGE 

G2. How did you use the VA educational
assistance? Mark all that apply.

G3. What are the reasons you haven’t used any
of the VA educational assistance? Mark all

Took college or university coursework leading
to a bachelor or graduate degree

that apply.

Attended business, technical or vocational
school training leading to a certificate or
diploma

Not aware of VA educational assistance

Participated in an apprenticeship or on-job
training program

My period of eligibility expired/ran out

Don’t believe I’m entitled to or eligible for
educational assistance
Do not know how to apply for educational
assistance

Took correspondence courses
Took flight training

Do not need any additional education or
training

Received tutorial assistance, refresher
courses, or deficiency training

Do not need or want assistance from VA

Attended a teacher certification program

Too much trouble or red tape

Did something else  Please specify below

Never considered getting educational
assistance from VA
Other  Please specify type below

G2a. Did you complete your training, or receive the
primary degree or certificate for which you
were enrolled and receiving VA education
benefits?
Yes
No

Question G3 appears in the next column.

4

H3b. When did you use the VA home loan
guaranty program?

Section H
Home Loans
H1. What would you say your current living
arrangement is?

During my spouse’s active duty service
After my spouse’s active duty service
Both during and after my spouse’s active duty
service

Rent my home
Own my home—with an outstanding
mortgage

H4.

Own my home—no mortgage balance
Occupy dwelling with no payment of cash rent

No down payment required

Other

H2.

Convenience
No mortgage insurance required

Have you ever obtained a home loan to
purchase a home, refinance a home loan or
make home improvements?

Loan more likely to be approved
VA’s assistance to avoid foreclosure
Previous experience with the VA home loan
program

Yes
No  Go to Section I

QUESTION H4 SKIPS TO SECTION I
ON THE NEXT PAGE 

H2a. When obtaining financing for this loan, did
your lender discuss VA's home loan guaranty
program with you as a possible option?

H5.

Yes
No

If you have not used the VA home loan program,
what was the main reason you did not?
A conventional FHA mortgage was easier or
less expensive for me to obtain

Don’t remember

H3.

What is the most important reason you
chose to get a VA home loan?

I applied for a VA home loan, but did not
qualify

Have you ever used the VA home loan
guaranty program?

I did not apply because I did not think that I
would qualify

Yes, currently have VA home loan

I thought that the process for obtaining a VA
loan would take too long

Yes, not currently, but have had VA home
loan in the past

My lender and/or realtor discouraged the use
of the VA home loan program

No, never have had VA home loan  Go to
Question H5

The VA funding fee was too high
I didn’t know about the program

H3a. How long ago did you obtain your most
recent home loan?

Other  Please specify below

Within last 5 years
6-10 years ago
11-20 years ago
More than 20 years ago

H6.

Are you aware that VA has a home loan
guaranty program for eligible spouses?
Yes
No

Question H5 appears in the next column
Section I appears on the next page.

5

I3.

Section I
Burial Benefits
I1. How satisfied are you with your ability to get
accurate information about burial benefits?

Don’t

Yes No know
a. Burial at a VA National or State
Veterans cemetery

Does not apply, I have not tried to get
information

b. Headstone and burial markers
provided by VA at private
cemeteries

Very satisfied
Satisfied

c.

Neither satisfied or dissatisfied

Presidential Memorial Certificates
for next of kin

Dissatisfied

d. Cash plot allowance

Very dissatisfied

e. Cash burial allowance
f.

I2.

Please indicate if you have heard about the
following burial benefits before today.

Military Funeral Honors

g. Receiving a U.S. Flag

How important to you are the following factors
to maintaining VA national cemeteries as
shrines that honor Veterans?

Section J
Burial Plans
The next several questions will be about issues
surrounding burial plans. We understand these
questions might be emotional and therefore difficult
questions to think about and answer. All we ask is
that you try to answer the questions the best you
can.

a. Maintenance of the
cemetery grounds
b. Upkeep of headstones,
markers, and wall covers for
cremated remains
c.

Maintenance of other
landscape features

J1.

What type of burial do you think you'll have?

d. Appearance of committal
shelters

In-ground, casket burial

e. Appearance of individual
gravesites

Cremation columbarium (a vault for cremated
remains)

f.

Cremation, in-ground burial

Maintenance of cemetery
buildings and roads

Mausoleum (i.e. tomb within a monument or
building)

g. Cemetery’s front gate and
entrance area

Something else
Don’t know

h. Availability of parking and/or
restrooms
i.

Public ceremonies and
events that honor Veterans

j.

Presentation of military
funeral honors

k.

Other  Please specify
below

J2.

Do you think you'll be buried in a VA National
or State Veterans cemetery?
Yes
No  Go to Question J3
Don’t know

Question J3 appears on the next page.

6

J2a. What would you say are your reasons for
planning to be buried in a VA National or
State Veterans cemetery? Mark all that apply.

J4.

For each of the burial options listed below,
please tell us if you consider the option
preferable, acceptable, or unacceptable.

No cost

Preferable

= Your first choice (choose one)

Spouse planning to be buried there

Acceptable

= Not your first choice, but would
be OK

Friends or family buried there

Unacceptable = You would never choose this
type of burial

Quality of services
The honor of burial in a VA National shrine
My spouse’s connection to the military/past
service to country
Other  Please specify below

a. Casket burial, in-ground
b. Casket burial, in a mausoleum
c.

d. Cremation, ashes placed in a
columbarium

Don’t Know

J3.

Cremation, ashes buried in-ground

e. Cremation, ashes scattered

What would you say are your main reasons
for not planning to be buried in a VA National
or State Veterans cemetery? Mark all that

f.

Cremation, ashes kept by my family

g. Something not listed

apply.

Don’t know eligibility criteria
Spouse does not plan to be buried there

Section K
Internet Use
K1. Do you use the Internet, at least
occasionally?

Quality of services
Don’t know how to make arrangements with
VA
Made other arrangements

Yes

VA services don’t accommodate religious
preferences

No  Go to Question K4

Veterans cemetery too far away (distance)

K2.

Travel time to Veterans cemetery too long
Appearance of cemetery doesn’t meet my
expectations

How often do you access the Internet or
World Wide Web?
At least once a day
At least once a week but not every day

Want location close to other family members

At least once a month but less than once a
week

Want services that are not available at
Veterans cemetery

At least once a year but less than once a
month

Too difficult to make arrangements with VA
Unable to make advance arrangements with
VA

Less than once a year

Other  Please specify below

Don’t Know
Question K4 appears on the next page.

7

K3.

Where do you go on-line to use the Internet?

K6.

Mark all that apply.

Would you like to receive VA information
through the Internet or the World Wide Web?

Home

Yes

Work

No

School
Public library

Section L
Income

Community center
Someone else’s house

L1.

Some other place

K4.

Do you send or receive emails, at least
occasionally?

Please indicate whether your family received
income (past 12 months) in any of the
categories listed below.
Please think about income from all members
of this family who are 15 years of age or older.

Yes
No  Go to Question K5

Yes
a. Wages, salary, commissions,
bonuses, or tips from all jobs

K4a. Where do you go on-line to send or receive
emails? Mark all that apply.

b. Self-employment income from
own nonfarm businesses or
farm businesses, including
proprietorships and partnerships

Home
Work
School

c.

Public library
Community center

d. Social Security or Railroad
Retirement

Someone else’s house
Some other place

K5.

Interest, dividends, net rental
income, royalty income, or
income from estates and trusts

e. Supplemental Security Income
(SSI)

How willing are you to use the Internet for the
following activities?

f.

Any public assistance or welfare
payments from the state or local
welfare office

g. Retirement, survivor, or
disability pensions
h. Veterans’ (VA) service-connected
disability compensation payments

a. Obtaining news and
information
b. Carrying out research on
services
c.

Purchasing goods or
services

d. Responding to polls or
surveys
e. Obtain information about VA
benefits
f.

Apply for VA benefits

8

i.

All other VA payments
(e.g., VA education payments)

j.

Any other sources of income
received regularly such as
unemployment compensation,
child support or alimony

No

Don’t
know

L2.

Which income range category represents
your total combined income during the past
12 months?

M4. What is the highest degree or level of school
you have completed?
Less than high school

This includes income from all sources
mentioned in Question L1 above.

High school diploma / GED
Some college credit, but less than 1 year of
college credit

Less than $5,000
$5,000 to $7,499

1 or more years of college credit, no degree

$7,500 to $9,999

Associate’s degree (for example, AA, AS)

$10,000 to $12,499

Bachelor’s degree (for example, BA, BS)

$12,500 to $14,999

Master’s degree (for example, MA, MS,
MEng, MEd, MSW, MBA)

$15,000 to $19,999
$20,000 to $24,999

Professional degree beyond a bachelor’s
degree (for example, MD, DDS, DVM, LLB,
JD)

$25,000 to $29,999
$30,000 to $34,999

Doctorate degree (for example, PhD, EdD)

$35,000 to $39,999
$40,000 to $49,999

M5. Are you of Hispanic, Latino, or Spanish
origin?

$50,000 to $59,999
$60,000 to $74,999

No, not of Hispanic, Latino, or Spanish origin

$75,000 to $99,999

Yes, Cuban

$100,000 to $149,999

Yes, Mexican, Mexican American, Chicano

$150,000 or more

Yes, Puerto Rican
Yes, another Hispanic, Latino, or Spanish
origin For example: Argentinean,
Colombian, Dominican, Nicaraguan,
Salvadoran, Spaniard, and so on  Please
specify below

Section M
Demographics
M1. What is your gender?
Male
Female

M2. What is your year of birth?
Year

M3. Please indicate the number of dependent
children you have.
Number of minor children
(age 17 and younger)
Number of adult children attending
High School and/or College (age 18-22)

9

M6. What is your race? Mark all that apply.

M7. What is your current marital status?

White

Married

Black or African American

Widowed

American Indian or Alaska Native

Divorced

Asian Indian

Separated

Chinese

M8. At which of the following types of addresses
does your household receive mail? Mark all

Filipino
Other Asian (for example, Hmong, Laotian,
Thai, Pakistani, Cambodian, and so on)

that apply.

A street address with a house or building
number

Native Hawaiian
Guamanian or Chamorro

An address with a rural route number

Samoan

A U.S. Post Office Box

Other Pacific Islander (for example, Fijian,
Tongan, and so on)

A commercial mailbox establishment

M9. At how many different addresses do you
receive your personal mail?
Number

Thank you for your participation
in this very important survey.

10

If found please return to:
Westat
1600 Research Blvd, RA 1136
Rockville, MD 20850