VA NCA 2013 Customer Satisfaction Survey Questionnaire

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U.S. DEPARTMENT OF VETERANS AFFAIRS
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NATIONAL CEMETERY ADMINISTRATION
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ATIONAL EMETERIES:
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Please read and answer the following question first.
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Have you visited a national cemetery in the past 12 months?
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\ No (STOP. You do not have to complete the rest of this questionnaire, but please return the
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questionnaire in the enclosed postage-paid envelope.)
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\ Yes (Continue on to the next question.)
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OMB Control Number 2900-0571
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Public Reporting Burden Statement
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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
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is estimated to average 20 minutes per response, including the time necessary for reviewing instructions, searching existing data
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sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The information
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collected is intended to be used in making improvements in services within the National Cemetery Administration of the
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Department of Veterans Affairs and for associated administrative purposes. Failure to furnish the requested information will have
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no adverse effect on any VA benefit to which you may be entitled.
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The information you supply will be confidential and protected by the Privacy Act of 1974 (5 U.S.C. 522a) and the VA’s
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confidentiality statute (38 U.S.C. 5701) as implemented by 38 CFR 1.526(a) and 38 CFR 1.576(b). Disclosure of information
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involves releases of statistical data and other non-identifying data for the improvement of services within the National Cemetery
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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,
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Washington DC 20420. SEND COMMENTS ONLY. DO NOT SEND THIS FORM OR REQUESTS FOR BENEFITS TO THIS
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ADDRESS.
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Marking Instructions
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The survey will take about 20 minutes to complete.
Correct Mark
Incorrect Marks
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Please read each question carefully and respond by filling in the
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oval of the response that most closely represents your opinion.
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• Use pencil or pen. Make heavy dark marks that fill the ovals completely. If you wish to change an answer, erase cleanly
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(pencil) or put an “X” over the incorrect response (pen).
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• Fill in one answer oval for each question unless it tells you to “mark all that apply.”
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• When you are finished, please place the questionnaire in the enclosed postage-paid envelope and put it in the mail.
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SERIAL #
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DO NOT WRITE IN THIS AREA
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288706-2
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OMB APPROVAL NO. 2900-0571

N
C
2013 SATISFACTION SURVEY

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Yes

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SEE MARKING INSTRUCTIONS ON THE COVER.
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Next-of-Kin: Respond to the questions on the left column of the page, beginning with Question 1.
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Funeral Directors: Respond to the questions on the right column of the page, beginning with Question A.
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Questions for Next-of-Kin
Questions for Funeral Directors
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Please complete this survey based on your
A. Looking at the attached form, please identify
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experiences at the national cemetery where
the national cemetery with which you most
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your loved one was interred.
frequently do business and fill in the
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1. Since the committal service, how many
corresponding number in the spaces below.
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times have you visited the national cemetery
Please complete this survey based on your
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where your loved one was interred?
experiences at this national cemetery within
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the last 12 months.
\1–3
\ 10 or more
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\4–6
\ None, I have
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not visited
\7–9
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0
0
0
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\
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2. Your recently deceased loved one was your...
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\ Spouse
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\ Parent
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4
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\ Brother/Sister
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5
\ Son/Daughter (includes stepchildren)
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6
6
6
\ Other relative
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7
7
7
\ Friend
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8
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3. How far do you reside from the national
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9
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\
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cemetery?
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\ Less than 15 miles
\ 45 to 59 miles
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B. How far is your funeral home from the
\ 15 to 29 miles
\ 60 to 75 miles
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national cemetery with which you most
\ 30 to 44 miles
\ Over 75 miles
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frequently do business?
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\ Less than 15 miles
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4. Do the following factors limit the number
\ 15 to 29 miles
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of times you visit the national cemetery
\ 30 to 44 miles
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where your loved one is interred? (Please
\ 45 to 59 miles
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mark Yes or No for each item below.)
\ 60 to 75 miles
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\ Over 75 miles
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a. Distance to the national cemetery. . . \ \
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C. How long has your funeral home worked
b. Travel time to the national cemetery. \ \
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with the national cemetery?
c. Inconvenient location of the national
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cemetery (e.g., neighborhood, no
\ Less than 1 year
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direct route). . . . . . . . . . . . . . . . . . . . \ \
\ 1 to 4 years
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d. My access to transportation
\ 5 to 8 years
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(private or public). . . . . . . . . . . . . . . . \ \
\ 9 to 12 years
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e. My health status (e.g., physical
\ 13 years or more
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limitation or constraints) . . . . . . . . . . \ \
\ Don’t know
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f. Other (please specify in General
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Comments, page 8). . . . . . . . . . . . . . \ \
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5. Have you ever served on active duty in the
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U.S. armed forces, either in the regular
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military or a National Guard or reserve unit?
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\ Yes
\ No
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Next-of-Kin: Respond to the questions on the left column of the page.
Funeral Directors: Respond to the questions on the right column of the page.

Questions for Next-of-Kin

Questions for Funeral Directors
D. Of the eligible veteran families you serve,
approximately what percent choose burial in
the national cemetery?

6. Prior to your time of need, to what extent
were you aware of the benefits related to
burial in a national cemetery?

\ Completely aware
\ Somewhat aware
\ Unaware (SKIP TO Q8)

\ 1 – 4%
\ 5 – 9%
\ 10 – 14%
\ 15 – 24%
\ 25 – 49%
\ 50 – 74%
\ 75 – 100%

7. How did you learn of these benefits prior to
your time of need? (Mark all that apply)

\ Family member/friend
\ Funeral home
\ Military discharge-related materials
\ Other veteran/active duty member
\ VA/NCA pamphlet, brochure, newsletter
\ VA/NCA Web site
\ VA/NCA social media (Facebook or Twitter)
\ Veterans Service Organization

E. How would you characterize the overall
communication from the national cemetery
to your funeral home?
\ Excellent
\ Good
\ Fair
\ Poor

(including State or County organizations)

F. Do you feel that you are well informed by
the national cemetery of its policies and
procedures?
\ Yes, well informed
\ Yes, somewhat well informed
\ No, not well informed

\ Other VA organization
\ Local newspaper/television news reports
\ Public events (e.g., parades, exhibits,
speeches)

\ Professional/military association meetings
or conventions

8. Prior to the time of need, what is the BEST
way for the national cemetery to convey
information regarding benefits? (Mark only one)

\ E-mail
\ VA/NCA Web site
\ VA/NCA social media (Facebook or Twitter)
\ Newsletter/flyer
\ Local newspaper/television news reports
\ Public events (e.g., parades, exhibits,

G. In general, of the following services, which
one provides you the MOST information
about national cemetery policies and
procedures? (Mark only one)

\ VA/NCA Web site
\ Local newspaper/television news reports
\ Public events (e.g., parades, exhibits,
speeches)

\ Professional associations/conventions/
meetings

speeches)

\ Veterans Service Officers
\ Outreach by cemetery staff
\ Other

\ Professional/military association meetings
or conventions

\ Other

H. What national cemetery policies or
procedures do you feel you could use more
information about? (Mark all that apply)

9. To what extent were you informed of the
details (e.g., length of service, use of
committal shelters) related to the committal
service prior to attending the service?

\ None, I feel well informed
\ Eligibility requirements for burial in a

\ Very informed
\ Somewhat informed
\ Neither informed nor uninformed
\ Somewhat uninformed
\ Very uninformed

national cemetery

\ Scheduling process
\ Military funeral honors
\ Presidential Memorial Certificates
\ Floral policy
\ Headstone, marker, or columbarium
niche cover inscription options

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Next-of-Kin: Respond to the questions on the left column of the page.
Funeral Directors: Respond to the questions on the right column of the page.

Questions for Next-of-Kin

Questions for Funeral Directors

0. Overall, how satisfied are you with the
1
information you were provided throughout
your experiences with the national cemetery?

I. What is the best way for the national
cemetery to communicate with your funeral
home regarding changes in its policies and
procedures? (Mark only one)
\ Phone
\ Fax
\ Letter
\ Email
\ VA/NCA Web site
\ Newsletter or flyer

\ Very satisfied
\ Somewhat
\ Somewhat satisfied
dissatisfied
\ Neither satisfied
\ Very dissatisfied
nor dissatisfied

1. At the committal service, did your family
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have any of the following special needs or
requests? (Mark all that apply)

J. Overall, how satisfied are you with the
communication between your funeral home
and the national cemetery?
\ Very satisfied
\ Somewhat satisfied
\ Neither satisfied nor dissatisfied
\ Somewhat dissatisfied
\ Very dissatisfied

\ Visit the gravesite
\ View the burial
\ Special music
\ Special religious practices (e.g., blessing
the gravesite)

\ Additional seating at the committal service
\ Handicapped accommodations
\ No, my family did not have any special

K. Overall, how would you compare the level
of service you receive from the national
cemetery with the level of service you
receive from private cemeteries?
\ Superior to private cemeteries
\ Better than private cemeteries
\ About the same
\ Worse than private cemeteries
\ Much worse than private cemeteries
\ Don’t know/not applicable

needs or requests (SKIP TO Q13)

2. Was the cemetery able to accommodate
1
these special needs or requests to your
satisfaction?

\ Yes, completely
\ Yes, somewhat
\ No, and I understand why
\ No, and I did not understand why
If your loved one was NOT a veteran, please SKIP
TO Q15.
3. If your loved one was a veteran, did your
1
family request military funeral honors?

\ Yes, and honors were provided
\ Yes, but honors were not provided
(SKIP TO Q15)

\ No, did not request military funeral honors
(SKIP TO Q15)

4. How satisfied were you with the quality of
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the military funeral honors your loved one
received?

\ Very satisfied
\ Somewhat
\ Somewhat satisfied
dissatisfied
\ Neither satisfied
\ Very dissatisfied
nor dissatisfied

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Next-of-Kin: Respond to the questions on the left column of the page.
Funeral Directors: Respond to the questions on the right column of the page.

Questions for Next-of-Kin

Questions for Funeral Directors

5. Overall, how satisfied were you with the
1
committal service at the national cemetery?

L. Overall, how would you compare the
appearance of the national cemetery with
the appearance of private cemeteries?

\ Very satisfied
\ Somewhat
\ Somewhat satisfied
dissatisfied
\ Neither satisfied
\ Very dissatisfied
nor dissatisfied

6. Were the headstone, marker, or columbarium
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niche cover inscription options explained to
you?

M. To what extent do you understand the
eligibility requirements for burial in a
national cemetery, including eligibility for
reservists and veteran dependents?
\ Understand completely
\ Understand somewhat
\ Do not understand

\ Yes
\ No (SKIP TO Q20)
\ Not sure/don’t know (SKIP TO Q20)
7. Which of the following inscription options
1
were explained to you? (Mark all that apply)

\ Military service information (e.g., rank,

N. How well do you understand the headstone,
marker, or columbarium niche cover
inscription options available to next of kin?
\ Understand completely
\ Understand somewhat
\ Do not understand

service, valor awards)

\ Emblems of belief (e.g., religious symbols)
\ Terms of endearment (e.g., beloved father)
8. Did you feel you had sufficient time to
1
make a decision on the headstone, marker,
or columbarium niche cover inscription
options?

\ Yes

\ Superior to private cemeteries
\ Better than private cemeteries
\ About the same
\ Worse than private cemeteries
\ Much worse than private cemeteries
\ Don’t know/not applicable

O. How easy is the process of scheduling an
interment at the national cemetery?
\ Very easy
\ Somewhat easy
\ Neither easy nor hard
\ Somewhat hard
\ Very hard

\ No

9. Who explained headstone, marker, or
1
columbarium niche cover inscription
options to you?

P. How long does it typically take to confirm
the scheduling of an interment at the
national cemetery?

\ National cemetery representative ONLY
\ Funeral director ONLY
\ BOTH the national cemetery
representative and the funeral director

\ Less than 1 hour
\ 1 to 2 hours
\ 3 to 4 hours
\ 5 to 8 hours
\ 1 to 2 days
\ More than 2 days

\ NEITHER the national cemetery nor the
funeral director

0. How satisfied were you with the length of
2
time it took for the permanent headstone,
marker, or columbarium niche cover to be
in place?

\ Very satisfied
\ Somewhat satisfied
\ Neither satisfied nor dissatisfied
\ Somewhat dissatisfied
\ Very dissatisfied
\ Don’t know/the marker or headstone has
not yet arrived (SKIP TO Q23)

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Next-of-Kin: Respond to the questions on the left column of the page.
Funeral Directors: Respond to the questions on the right column of the page.

Questions for Next-of-Kin

Questions for Funeral Directors

1. When the headstone, marker, or columbarium
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niche cover arrived, was the inscription
accurate?

\ Yes
\ No
\ Don’t know

\ Very satisfied
\ Somewhat satisfied
\ Neither satisfied nor dissatisfied
\ Somewhat dissatisfied
\ Very dissatisfied

2. Overall, how satisfied were you with the
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quality and appearance of the headstone,
marker, or columbarium niche cover when
it arrived?

R. During committal services, how often do
you receive the support you need from
cemetery staff?

\ Very satisfied
\ Somewhat satisfied
\ Neither satisfied nor dissatisfied
\ Somewhat dissatisfied
\ Very dissatisfied

\ Always
\ For the most part
\ Occasionally
\ Never

If your loved one was NOT a veteran, please
SKIP TO Q24.

S. Generally, how often do committal services
at the national cemetery start on time?

\ Always
\ For the most part
\ Occasionally
\ Never

3. If your loved one was a veteran, did you
2
receive a Presidential Memorial Certificate?

\ Yes

\ No

T. If you are delayed in arriving at the national
cemetery for a scheduled service, how
successful is the cemetery in adjusting the
schedule to accommodate the family?

4. Looking back at your overall experiences
2
with the national cemetery, which items
would you have liked more information
about? (Mark all that apply)

\ None, I was well informed
\ Details of the committal service
\ Military funeral honors
\ Location of gravesite
\ Layout of cemetery (maps)
\ Directions to cemetery
\ Presidential Memorial Certificate
\ Floral policy
\ Headstone or marker inscription options
\ Timeline for placement of headstone/

\ Very successful
\ Somewhat successful
\ Neither successful nor unsuccessful
\ Somewhat unsuccessful
\ Very unsuccessful
\ Don’t know/Not applicable
U. How easy is it to schedule military honors at
the national cemetery?

\ Very easy
\ Somewhat easy
\ Neither easy nor hard
\ Somewhat hard
\ Very hard

marker

25. After the loss of your loved one...
a. Did you need bereavement counseling or
support?

\ Yes

\ No

V. To what extent is the quality of military
honors acceptable?

\ Don’t know

\ Very acceptable
\ Somewhat acceptable
\ Neither acceptable nor unacceptable
\ Somewhat unacceptable
\ Very unacceptable

b. Did you seek bereavement counseling or
support?

\ Yes

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Q. Overall, how satisfied were you with the
length of time it took to confirm the
scheduling of an interment?

\ No

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Questions for Next-of-Kin Only
(Funeral Directors, please skip to Q33)
29. Overall, what was the single biggest
contributing factor to the decision to bury
your loved one in a national cemetery?
(Mark only one)

6. Have you contacted VA to find out if you
2
are eligible for VA survivor benefits?

\ Yes

\ No

\ Don’t know

\ Honor the wishes of my loved one
\ Recognition of military service
\ Other family member also buried at

27. Are you eligible for VA survivor benefits?

\ Yes

\ No

\ Don’t know

national cemetery

\ Location
\ Affordability

8. If eligible, have you applied for VA survival
2
benefits?
\ Yes
\ No
\ Don’t know

30. What is your gender?

\ Male

\ Female

31. Are you Hispanic or Latino?

(For information on survivor benefits, contact
VA 800.827.1000)

\ Yes

\ No

32. What is your race? (Mark one or more)

\ White
\ Black or African American
\ American Indian or Alaskan Native
\ Asian
\ Native Hawaiian or other Pacific Islander

Strongly

Agree

Neither
nor disa agree
gree

Disagree

Strongly
disagree

Don’t kn
Not app ow/
licable

agree

Questions for All Participants

a. The maintenance of the cemetery grounds is excellent. . . . . . . . . . \

\

\

\

\

\

b. The upkeep of the headstones, markers, or columbarium niche
covers is excellent. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \

\

\

\

\

\

c. The maintenance of other landscape features (e.g., flowers,
trees, shrubs) is excellent. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \

\

\

\

\

\

d. The committal shelter used for the service was clean, free of
safety hazards, and private . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \

\

\

\

\

\

e. There is adequate handicap accessibility for visitors who need it. . \

\

\

\

\

\

f. The availability of restrooms is suitable to accommodate visitors
on busy days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \

\

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g. The cemetery honors all veterans and their service to our nation. . \

\

\

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\

\

h. There are sufficient signs within the cemetery to assist visitors. . . \

\

\

\

\

\

i. Parking at the cemetery is adequate to accommodate visitors on
most days. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \

\

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3. Please indicate your level of agreement with
3
the following statements.

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Don’t kn
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l. The national cemetery staff was courteous. . . . . . . . . . . . . . . . . . . . . . \

\

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m. The national cemetery staff was professional in terms of being
knowledgeable, helpful, and responsive. . . . . . . . . . . . . . . . . . . . . . . . . \

\

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\

\

n. The national cemetery hours of operation meet my needs. . . . . . . . . . \

\

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\

o. The appearance of my loved one’s gravesite/columbaria is excellent. \

\

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p. The information kiosks (i.e., gravesite locators) are helpful to me. . . . \

q. Public ceremonies and events at the cemetery promote a sense of
patriotism and heritage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \

\

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r. The overall appearance of the national cemetery is excellent. . . . . . . \

\

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s. Overall, I am satisfied with my experiences at the national cemetery. \

t. I would recommend the cemetery to veteran families during their
time of need. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \

u. I am willing to rely on VA and the National Cemetery Administration
to meet the burial needs of veterans in the future. . . . . . . . . . . . . . . . . \

\

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v. I am willing to rely on VA and the National Cemetery Administration
to maintain national cemeteries as national shrines in the future. . . . \

\

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w. My experiences with the national cemetery exceeded my
expectations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \

\

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\

\

Disagree

\

j. The cemetery’s roadways and intersections are safe and easily
navigated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \

k. The quality of service received from cemetery staff is excellent. . . . . \

Neither
nor disa agree
gree

\

Please indicate your level of agreement with
the following statements.

Agree

Strongly
disagree

agree

Questions for All Participants (continued)

Strongly

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General Comments: Please use this space to elaborate on any aspect of your experiences at the national
cemetery you wish to share with us.

Note: If you would like to be contacted by the cemetery, please write your name and contact information
(address or telephone number):
Thank you for taking the time to complete this survey. Your answers are very important to ensure that the services provided
by national cemeteries meet your needs and expectations. Please return your questionnaire in the postage-paid envelope.

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