NOK 2013 VA MPS Survey

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

1

How did you know about the headstone, marker,
medallion service provided by the VA?
(Mark all that apply)

4a How satisfied were you with the process you used

to order the headstone, marker, or medallion?
O
O
O
O
O

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

5

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

Very Satisfied
Somewhat Satisfied
Neither Satisfied nor Dissatisfied
Somewhat Dissatisfied
Very Dissatisfied

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)

2a

Did you have any issues while affixing the Bronze
Medallion to the headstone or markers?

O
O
O
O

O Yes
O No GO TO Q3

2b

5b How satisfied were you with the service you
received from the 800 number customer service
representative?

IF YES, Please explain the difficulty you faced in
affixing the medallion to a headstone or marker.

O
O
O
O
O

_____________________________________________
_____________________________________________
___________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
3

Who helped you with ordering the
headstone/marker/medallion? (Mark all that
apply)
O
O
O
O
O
O

6

Family member
Funeral Director
Cemetery Representative
VA Employee
Other (Specify) ________________________
No one

Very Satisfied
Somewhat Satisfied
Neither Satisfied nor Dissatisfied
Somewhat Dissatisfied
Very Dissatisfied

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
O
O
O

How to order a headstone/marker/medallion
Download an order form
Find information on documentation needed
Find information on the Presidential
Memorial Certificate Program
O Find out what could go on the marker
O Other (Specify) _______________________

4 How did you order the headstone, marker, or

medallion?
(Mark only one)
O
O
O
O

To check on the status of my order
To get help with ordering the marker
To file a complaint about the marker
Other (Specify) _______________________

Via the mail
Via Fax
Via the Funeral Director
Other (Specify) _______________________

2

6b How satisfied were you with the ease of finding

8a

the information you were looking for?
O
O
O
O
O
7

Very Satisfied
Somewhat Satisfied
Neither Satisfied nor Dissatisfied
Somewhat Dissatisfied
Very Dissatisfied

O
O
O
O
O

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

O
O
O
O
O
O
O
O
O
O
O
O

O
O
O
O
O
O
O
O
O
O
O
O

An inscription
Birthdate/Date of death
Highest rank attained
War service
Emblem of belief
Valor Awards
Terms of endearment
Nicknames
Civilian credentials (i.e., Doctor)
Special unit designations
Other military credentials
Space for future inscriptions

9

Don’t
Know
O
O
O
O
O
O
O
O
O
O
O
O

10

I read it on the application
I looked it up on the VA web site
The Funeral Director told me
A VA employee told me
Other (Specify) ____________________

11a

About how long after ordering the headstone,
marker, or medallion did it arrive?
O
O
O
O
O

Excellent
Above Average
Average
Below Average
Extremely Poor

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

inscription, how did you learn about what could
be included in the inscription? (Mark all that
apply)

8

Postcard
E-mail
Letter
Other (Specify) _______________________
I don’t care to be notified

Generally, how would you rate the overall quality
of the VA headstones, markers or medallions
received from VA?
O
O
O
O
O

11

Very Satisfied
Somewhat Satisfied
Neither Satisfied nor Dissatisfied
Somewhat Dissatisfied
Very Dissatisfied

How would you prefer to be notified about the
status of your headstone, marker or medallion?
O
O
O
O
O

7a IF you were aware of the availability of an

O
O
O
O
O

How satisfied were you with the amount of time it
took to receive the headstone, marker, or
medallion?

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
O
O
O
O

Less than 1 month
Between 1 and 2 months
Between 2 and 3 months
Over 3 months
Don’t Know GO TO Q9

3

Strongly Agree
Agree
Neither Agree, nor Disagree
Disagree
Strongly Disagree

12

Overall, how satisfied were you with your
experiences with the VA Memorial Programs
Service products and services?
O
O
O
O
O

13

17

Very Satisfied
Somewhat Satisfied
Neither Satisfied nor Dissatisfied
Somewhat Dissatisfied
Very Dissatisfied

O Yes
O No

Were you required to pay any unexpected fees
regarding your government headstone, marker or
medallion?
O
O
O
O

Yes, but they were reasonable
Yes, and the costs were substantial
No GO TO Q14
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

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)?

4

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.
2013 VA Memorial Programs Service Survey
c/o ICF International
980 Beaver Creek Drive
Martinsville, VA 24112