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

National Survey
of Veterans
A study on the benefits for Veterans, their
Spouses and Surviving Spouses

Department of Veterans Affairs
OMB# XXXX-XXXX
Expiration Date: XXXXXXXXXX

Commonly Asked Questions about the National Survey of Veterans

Q. Doesn't the VA know where all veterans are?
A.

There are many individuals for whom the VA does not have this information. For example, a
number of veterans have moved since they were last in touch with the VA. An important goal
of this study is to include as many veterans as possible.

Q. Why don't you ask any questions about VA benefits or services on this questionnaire?
A.

The purpose of this first questionnaire is to obtain up-to-date information for as many
veterans, spouses, and widows/widowers as possible. Using the information from this first
questionnaire, we will send a second questionnaire that will ask about the level of
awareness there is of VA benefits and services and whether eligible individuals know how
to access those benefits and services.

Q. If there are no veterans or spouses in my household should I respond?
A.

Yes, by returning this questionnaire we will know that we do not need to contact you in the
future.

Q. Can I use a pencil to fill out this questionnaire?
A.

Please use a blue or black pen. Do not use a pencil or felt-tip pen.

THANK YOU FOR YOUR GENEROUS COOPERATION. WE UNDERSTAND HOW
VALUABLE YOUR TIME AND ATTENTION ARE!
The Paperwork Reduction Act of 1995 requires us to notify you that this information collection is in accordance with the clearance
requirements of section 3507 of the Paperwork Reduction Act of 1995. The public reporting burden of this collection of information
is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the collection of information. Your obligation to respond
is voluntary. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any
penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. This
collection of information is intended to assist the Department of Veterans Affairs to assess future program and benefit needs.

START

è When responding, please think about everyone who is currently living at this address.
Be sure to think about yourself, as well as all the other adults in the household.

1.

Is there anyone in the household who is currently serving on Active Duty in the U.S. Armed
Forces, military Reserves or National Guard? (Active duty does not include training for the
Reserves or National Guard, but DOES include activation, for example, for the War in Iraq or
Afghanistan.)
YES
NO

2.

Is there anyone in this household who previously served on active duty? (Do not include
those currently serving.)
YES

Go to Question 9, page 2

NO
3.

(If YES) How many people in this household previously served on active duty?
Number who previously served on active duty

4.

Is there anyone in this household who previously served on active duty who is female?
YES
NO

5.

Please mark the period(s) of service for those in this household that previously served on
active duty.
YES
NO
September 2001 or later .......................................................................................
August 1990 to August 2001 (including Persian Gulf War) ...................................
May 1975 to July 1990 ..........................................................................................
Vietnam era (August 1964 to April 1975) ..............................................................
February 1955 to July 1964 ...................................................................................
Korean War (July 1950 to January 1955) ..............................................................
January 1947 to June 1950 ...................................................................................
World War II (December 1941 to December 1946) ...............................................
November 1941 or earlier ......................................................................................

6.

Is there anyone in this household who previously served on active duty who is:
YES

NO
18 - 30 years old?
31 - 54 years old?
55 - 74 years old?
75 years and older?

Please go to next page
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7.

Is there anyone in the household who previously served on active duty who is Hispanic or
Latino?
YES
NO

8.

Is there anyone in this household who previously served on active duty who is:
YES

NO
White?
Black or African American?
Asian?
American Indian or Alaska Native?
Native Hawaiian or Other Pacific Islander?

9.

This study will also survey spouses of veterans and widows/widowers of veterans.
Please think about everyone who lives in this household (including yourself).
Is there anyone in this household who is:
a. married to a veteran? (If you are a veteran, please include your spouse if
he/she lives in your household.) .......................................................................

YES

NO

b. a widow or widower of a veteran? .....................................................................
10.

We will be sending a more detailed questionnaire to the veteran, spouse of the veteran or
the widow/widower. What is the best way for us to send the questionnaire?
Using the Internet

11.

Mail a paper survey

go to END

There are no veterans, spouses or
widow/widowers in this household

go to END

(If Internet) To assist us sending the questionnaire, please provide an e-mail address.
e-mail address:
I do not want to provide an e-mail address

END
Please return this questionnaire in the postage paid envelope.
Thank-you for your assistance!
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