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)
Active Duty 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 12 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

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

{
B2.

Section C
Health Status
C1. In general, would you say your health is…

Working, or on paid vacation or sick leave
from work

Excellent

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

Good

Very good
Fair

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

Poor

C2.

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

Yes

Hours

No

If you work less than 35 hours a week, please
answer the next question. If you work at least
35 hours a week, please skip to B4.
B3.

Section D
Health Insurance
D1. Are you CURRENTLY covered by any of the
following types of health insurance or health
coverage plans? Mark all that apply.

Which of the following are reasons why you
are working less than 35 hours a week?
Do not want to work 35 hours or more

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

Need flexibility while spouse is deployed
Could only find part-time work

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

Seasonal work
Child care responsibilities
Other family/personal obligations

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

Health/medical limitations
Need schooling/training/certification

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

In school
Other

B4.

TRICARE or other military health care

How long have you worked at your current job?

CHAMPVA (Civilian Health and Medical
Program of VA)

Instruction: For example, 6 months would be
coded as: 00 06
Years

B5.

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

Indian Health Service

Months

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

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

2

E4.

Section E
Home Loans
E1. What would you say your current living
arrangement is?

No down payment required
Convenience
No mortgage insurance required

Rent my home

Loan more likely to be approved

Own my home—with an outstanding
mortgage

VA’s assistance to avoid foreclosure
Previous experience with the VA loan
program

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

E2.

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

QUESTION E4 SKIPS TO SECTION F
ON THE NEXT PAGE 

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

E5.

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

Yes
No  Go to Section F

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

E2a. When obtaining financing for this loan, did
your lender discuss VA's home loan guaranty
program with you as a possible option?

I did not apply because I did not think that I
would qualify
I thought that the process for obtaining a VA
loan would take too long

Yes
No

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

Don’t remember

The VA funding fee was too high

E3.

I didn’t know about the program

Have you ever used the VA home loan
guaranty program?

Other  Please specify below

Yes, currently have VA home loan
Yes, not currently, but have had VA home
loan in the past
No, never have had VA home loan  Go to
Question E5

E6.

E3a. How long ago did you obtain your most
recent home loan?

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

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

Question E5 appears in the next column.
Section F appears on the next page.
3

F3.

Section F
Burial Benefits
F1. 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.

F2.

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 G
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

G1. What type of burial do you think you'll have?

d. Appearance of committal
shelters

In-ground, casket burial
Cremation, in-ground burial

e. Appearance of individual
gravesites
f.

Cremation columbarium (a vault for cremated
remains)

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

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

Don’t Know

G2. Do you plan to be buried in a VA National or
State Veterans cemetery?
Yes
No  Go to Question G3
Don’t know

Question G3 appears on the next page.
4

G2a. What would you say are your reasons for
planning to be buried in a VA National or
State Veterans cemetery? Mark all that apply.

G4. For each of the burial options listed below,
please tell us if you consider the option
preferable, acceptable, or unacceptable.

No cost

Preferable

Spouse planning to be buried there

Acceptable = Not your first choice, but
would be OK

Friends or family buried there

= Your first choice (choose one)

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.

Cremation, ashes buried in-ground

d. Cremation, ashes placed in a
columbarium

Don’t know

e. Cremation, ashes scattered

G3. 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

apply.

Don’t know eligibility criteria
Spouse is not planning to be buried there

Section H
Internet Use
H1. 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 H4

Veterans cemetery too far away (distance)

H2.

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

Wanted location close to other family
members

At least once a week but not every day

Wanted services that weren’t available at
Veterans cemetery

At least once a month but less than once a
week

Too difficult to make arrangements with VA

At least once a year but less than once a
month

Unable to make advance arrangements with
VA
Other  Please specify below

Less than once a year

Don’t Know

Question H4 appears on the next page.
5

H3.

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

H6.

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
Community center

Section I
Demographics
I1. What is your gender?

Someone else’s house
Some other place

Male

H4.

Female

Do you send or receive emails, at least
occasionally?
I2.

Yes
No  Go to Question H5

Year

H4a. Where do you go on-line to send or receive
emails? Mark all that apply.

I3.

Home

Please indicate the number of dependent
children you have.
Number of minor children
(age 17 and younger)

Work
School

Number of adult children attending
High School and/or College (age 18-22)

Public library
Community center

I4.

Someone else’s house
Some other place

H5.

What is your year of birth?

What is the highest degree or level of school
you have completed?
Less than high school
High school diploma / GED

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

Some college credit, but less than 1 year of
college credit
1 or more years of college credit, no degree
Associate’s degree (for example, AA, AS)
Bachelor’s degree (for example, BA, BS)

a. Obtaining news and
information

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

b. Carrying out research on
services
c.

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

Purchasing goods or
services

Doctorate degree (for example, PhD, EdD)

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

Apply for VA benefits

6

I5.

Are you of Hispanic, Latino, or Spanish
origin?

I6.

What is your race? Mark all that apply.
White

No, not of Hispanic, Latino, or Spanish origin

Black or African American

Yes, Cuban

American Indian or Alaska Native

Yes, Mexican, Mexican American, Chicano

Asian Indian

Yes, Puerto Rican

Chinese

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

Filipino
Other Asian (for example, Hmong, Laotian,
Thai, Pakistani, Cambodian, and so on)
Native Hawaiian
Guamanian or Chamorro
Samoan
Other Pacific Islander (for example, Fijian,
Tongan, and so on)

I7.

What is your current marital status?
Married
Widowed
Divorced
Separated

Thank you for your participation
in this very important survey.

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