VA Memorial Products Survey, (Headstones, Markers, Medallions, and Presidential Memorial Certificates)
NCA Customer Satisfaction Surveys
NoK 2012 VA MPS Surveyv4 (2) (2)
VA Memorial Products Survey, (Headstones, Markers, Medallions, and Presidential Memorial Certificates)
OMB: 2900-0571
Next of Kin VA Memorial Products Survey
(Headstones/Markers/Medallions and Presidential Memorial Certificates)
OMB Control Number 2900-0571
Public Reporting Burden 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 the collection of information is estimated to average 10 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. The information collected is intended to be used in making improvements in services within the National Cemetery Administration of the Department of Veterans Affairs and for associated administrative purposes. Failure to furnish the requested information will have no adverse effect on any VA benefit 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 National Cemetery Administration and for associated administrative purposes. Please send any comments regarding this burden estimate or any other aspect of this collection including suggestions for reducing this burden to VA Clearance Officer (005G2), 810 Vermont Ave, NW, Washington, DC 20420. SEND COMMENTS ONLY. DO NOT SEND THIS FORM OR REQUESTS FOR BENEFITS TO THIS ADDRESS.
1
How
did you know about the headstone, marker, medallion service provided
by the VA?
(Mark
all that apply)
O Learned from veteran/family member
O Learned from Funeral Director
O Learned from Cemetery Representative
O Learned from VA employee
O My own research
O Other (Specify) _______________________
2 What type of headstone, marker, or medallion did you order?
O Bronze (metal plate) GO TO Q3
O Stone (granite or marble) GO TO Q3
O
Bronze Medallion
2a Did you have any issues while affixing the Bronze Medallion to the headstone or markers?
O
Yes
O No GO TO Q3
2b IF YES, Please explain the difficulty you faced in affixing the medallion to a headstone or marker.
_____________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
3 Who helped you with ordering the headstone/marker/medallion? (Mark all that apply)
O Family member
O Funeral Director
O Cemetery Representative
O VA Employee
O Other (Specify) ________________________
O No one
4 How did you order the headstone, marker, or medallion?
(Mark only one)
O Via the mail
O Via Fax
O Via the Funeral Director
O Other (Specify) _______________________
4a How satisfied were you with the process you used to order the headstone, marker, or medallion?
O Very Satisfied
O Somewhat Satisfied
O Neither Satisfied nor Dissatisfied
O Somewhat Dissatisfied
O Very Dissatisfied
5 Did you call an 800 number for assistance at any point?
O
Yes
O No GO TO Q6
5a IF YES, why did you call the 800 number?
(Mark all that apply)
O To check on the status of my order
O To get help with ordering the marker
O To file a complaint about the marker
O Other (Specify) _______________________
5b How satisfied were you with the service you received from the 800 number customer service representative?
O Very Satisfied
O Somewhat Satisfied
O Neither Satisfied nor Dissatisfied
O Somewhat Dissatisfied
O Very Dissatisfied
6 Did you visit the VA web site for information about ordering the headstone, marker, or medallion?
O
Yes
O No GO TO Q7
6a IF YES, what type of information were you looking for? (Mark all that apply)
O How to order a headstone/marker/medallion
O Download an order form
O Find information on documentation needed
O Find information on the Presidential
Memorial Certificate Program
O Find out what could go on the marker
O Other (Specify) _______________________
6b How satisfied were you with the ease of finding the information you were looking for?
O Very Satisfied
O Somewhat Satisfied
O Neither Satisfied nor Dissatisfied
O Somewhat Dissatisfied
O Very Dissatisfied
7 When you were applying for the headstone, marker or medallion, were you aware that the following items were available to be placed on the marker:
|
No |
Yes |
Don’t Know |
An inscription |
O |
O |
O |
Birthdate/Date of death |
O |
O |
O |
Highest rank attained |
O |
O |
O |
War service |
O |
O |
O |
Emblem of belief |
O |
O |
O |
Valor Awards |
O |
O |
O |
Terms of endearment |
O |
O |
O |
Nicknames |
O |
O |
O |
Civilian credentials (i.e., Doctor) |
O |
O |
O |
Special unit designations |
O |
O |
O |
Other military credentials |
O |
O |
O |
Space for future inscriptions |
O |
O |
O |
7a IF you were aware of the availability of an inscription, how did you learn about what could be included in the inscription? (Mark all that apply)
O I read it on the application
O I looked it up on the VA web site
O The Funeral Director told me
O A VA employee told me
O Other (Specify) ____________________
8 About how long after ordering the headstone, marker, or medallion did it arrive?
O Less than 1 month
O Between 1 and 2 months
O Between 2 and 3 months
O Over 3 months
O Don’t Know GO TO Q9
8a How satisfied were you with the amount of time it took to receive the headstone, marker, or medallion?
O Very Satisfied
O Somewhat Satisfied
O Neither Satisfied nor Dissatisfied
O Somewhat Dissatisfied
O Very Dissatisfied
9 How would you prefer to be notified about the status of your headstone, marker or medallion?
O Postcard
O E-mail
O Letter
O Other (Specify) _______________________
O I don’t care to be notified
10 Generally, how would you rate the overall quality of the VA headstones, markers or medallions received from VA?
O Excellent
O Above Average
O Average
O Below Average
O Extremely Poor
11 Did you order and/or receive a Presidential Memorial Certificate (PMC)?
O Yes - Requested and Received
O Yes - Received, but not requested
O No – Requested, not received SKIP TO Q12
O No – Did not Receive SKIP TO Q12
O Don’t know what this is SKIP TO Q12
11a Please indicate your level of agreement with the following statement: The overall quality of the Presidential Memorial Certificate (PMC) I received from the VA was excellent.
O Strongly Agree
O Agree
O Neither Agree, nor Disagree
O Disagree
O Strongly Disagree
12 Overall, how satisfied were you with your experiences with the VA Memorial Programs Service products and services?
O Very Satisfied
O Somewhat Satisfied
O Neither Satisfied nor Dissatisfied
O Somewhat Dissatisfied
O Very Dissatisfied
13 Were you required to pay any unexpected fees regarding your government headstone, marker or medallion?
O
Yes, but they were reasonable
O
Yes, and the costs were substantial
O No GO TO Q14
O Don’t Know GO TO Q14
13a If you ordered a Bronze headstone, marker or medallion, what unexpected amount were you required to pay?
$_____________
13b If you ordered a Stone headstone, marker or medallion, what unexpected amount were you required to pay?
$_____________
13c If you ordered a Bronze Medallion, what unexpected amount were you required to pay?
$_____________
14 What is the Gender of your loved one?
O Female
O Male
15 Was your loved one Hispanic or Latino?
O Hispanic
O Latino
16 What is the race of your loved one?
O White
O Black or African American
O American Indian or Alaska Native
O Asian
O Native Hawaiian or other Pacific Islander
17 Are you also a Veteran (served on active duty in the U.S. Armed Forces, either in the regular military or a National Guard or Reserve Unit)?
O Yes
18 Do you have any additional comments concerning how the VA Memorial Programs Service could improve its services and programs?
Thank you very much for taking the time to complete this questionnaire. PLEASE mail this completed questionnaire in the postage-paid envelope as soon as possible. If you have any questions about this research, you may call us at (855) 215-1023.
2012 VA Memorial Programs Service Survey,
c/o ICF International
980 Beaver Creek Drive
Martinsville, VA 24112
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Eric Malloy |
| File Modified | 0000-00-00 |
| File Created | 2021-01-30 |
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