VA Form 10-10167 Customer Satisfaction Survey on VA Research Communicatio

OMB Number 2900-0770

Estimated Burden: 3 mins

EXP Date: XX/XX/2017

Customer Satisfaction Survey on VA Research Communication (VA Research Currents)

OMB 2900-0770

Estimated burden: 3 minutes

Expiration Date xx/xx/xxxx

The Paperwork Reduction Act of 1995: This information is collected in accordance with section 3507 of the Paperwork Reduction Act of 1995. Accordingly, we may not conduct or sponsor and you are not required to respond to, a collection of information unless it displays a valid OMB number. We anticipate that the time expended by all individuals who complete this survey will average three (3) minutes. This includes the time it will take to follow instructions, gather the necessary facts and respond to questions asked. Customer satisfaction is used to gauge customer perceptions of VA services as well as customer expectations and desires. The results of this telephone/mail survey will lead to improvements in the quality of service delivery by helping to achieve services. Participation in this survey is voluntary and failure to respond will have no impact on benefits to which you may be entitled.

VA Research Currents reader survey

VA research improves VA health care and Veterans’ lives. Our job in VA Research Communications is to keep Veterans and the public informed about this vital work. By completing this survey, you will help us in that effort. This survey is anonymous: It does not ask for your name. You may skip any question you do not wish to answer, but we hope you will answer as many as possible so that we can do a better job of keeping Veterans and the public informed.

To select an answer, place an X in the box next to your choice [X].

1. Have you received the publication VA Research Currents by mail or looked through a copy at a VA facility? Please select all that apply.

 I have received VA Research Currents in the mail at home or at work.

 I have looked through VA Research Currents at a VA facility one or more times before today.

 This is the first time I have looked through an issue of VA Research Currents.

2. When you receive VA Research Currents by mail or when you look through an issue at a VA facility, how often do you read one or more articles?

 This is the first issue I’ve seen.

 I usually read one or more articles.

 I sometimes read one or more articles.

 I rarely read one or more articles.

 I never read one or more articles.

3. Which of the following recent issues of VA Research Currents have you looked through? Please select all that apply.

 Spring 2015 (This issue)

 Winter 2014/2015 (Cover story: Pressure points)

 Fall 2014 (Cover story: One-two punch for Alzheimer’s?)

 Other (Please specify __________________________________)

4. Please tell us your impressions of VA Research Currents by marking [X] one box in each row to indicate your opinion. Selecting the middle box (4) means you think VA Research Currents is about average regarding that feature.

			About Average 
Boring	1	2	3	4	5		6	7	Interesting
Difficult to Read	1	2	3	4	5		6	7	Easy to Read
Poorly designed	1	2	3	4	5		6	7	Attractively designed
Poorly written	1	2	3	4	5		6	7	Well-written
Poor-quality photos	1	2	3	4	5		6	7	Good-quality photos
Not relevant	1	2	3	4	5		6	7	Relevant
Hard to understand	1	2	3	4	5		6	7	Easy to understand
Not informative	1	2	3	4	5		6	7	Informative
Poor use of taxpayer money	1	2	3	4	5		6	7	Good use of taxpayer money

5. VA Research Currents has:

 Too many pages

 About the right number of pages

 Not enough pages

 I have no opinion on this question

6. VA Research Currents is mailed out every three months. This is:

 Too frequent

 About the right frequency

 Not frequent enough

 I have no opinion on this question

Next, please tell us a little about your background so that we can better serve our readers.

7. Are you a VA staff member?

 Yes

 No

8. Are you a Veteran?

 Yes Please continue with Question 8a.

 No  Please skip to Question 9.

8a. Do you currently belong to a Veterans Service Organization (VSO)? Please select all that
apply.

 I do not currently belong to any VSO.
 American Legion
 AMVETS
 Disabled American Veterans
 Veterans of Foreign Wars
 Vietnam Veterans of America
 Other (please specify) ___________________________________________

8b. Which branch of the military have you served in (active duty, guard, or reserve)? Please select all that apply.

 Army

 Navy

 Air Force

 Marines

 Coast Guard

8c. How many years in total have you served in the military?

 1 – 5

 6 – 10

 11 – 15

 16 or more

8d. During which era(s) did you serve? Please select all that apply.

 World War II

 Korean War

 Vietnam War

 Gulf War

 OEF/OIF/OND

 Other

9. Do you work in research?

 Yes, inside VA

 Yes, outside VA

 No, I do not work in research

10. Do you work in the health field?

 Yes, inside VA

 Yes, outside VA

 No, I do not work in the health field

11. What is your gender?

 Male

 Female

 Prefer not to respond

12. What is your age?

 Under 18

 18-35

 36-54

 55 or older

13. What is the highest educational level you have attained?

 Less than high school or GED
 High school diploma or GED
 Vocational or other training after high school
 Associate’s (2-year) or bachelor’s (4-year) degree
 Graduate/advanced degree

14. What is your race? You may select more than one.

 White

 Black or African-American

 Asian

 Native Hawaiian or other Pacific Islander

 American Indian or Alaska Native

 Other

15. Are you of Hispanic or Latino origin or descent?

 Yes, Hispanic or Latino

 No, not Hispanic or Latino

16. What language do you speak most often at home?

 English

 Spanish

 Other (please specify): _________________

Finally, we would like to give you an opportunity to tell us your opinion of VA Research Currents in your own words, if you wish.

17. What do you like about VA Research Currents?

____________________________________________________________________________

____________________________________________________________________________

18. What do you dislike about VA Research Currents?

___________________________________________________________________________

____________________________________________________________________________

19. Do you have any suggestions to improve VA Research Currents?

__________________________________________________________________________

__________________________________________________________________________

Please place your completed survey in the envelope provided and put it in the mail—the postage has already been paid. You may also give the envelope with your survey inside to a VA staff member and ask him or her to place it in the mail.

Thank you for completing this survey and helping us do a better job of serving Veterans!

If you would like to receive Research Currents, you may fill out the separate card attached to this survey. If you would like to view Research Currents online, visit www.research.va.gov/currents. If you are a VA staff member who is interested in receiving print copies of VA Research Currents for a patient or client area at your facility, please email [email protected] with your request.

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[TO BE INCLUDED ON SEPARATE TEAR-OFF CARD, IN ADDITION TO SURVEY]

VA Research Currents is produced by the Office of Research and Development of the Department of Veterans Affairs. The newsletter provides Veterans and other stakeholders of VA research with news about research results, new initiatives, major awards, and other matters of interest. The newsletter is updated frequently on the website and produced in print four times per year.

To be added to the print or email mailing list for VA Research Currents, or to receive bulk copies for distribution at a VA medical center or clinic, email [email protected] or call 443-759-3456, or fill out this card, tear it off, and place it in the mail—the postage has already been paid. You may also give the card to a VA staff member and ask him or her to place it in the mail.

[GRAPHICS ON CARD: VA and ORD seal/logos; thumbnail of recent VA Research Currents front cover, on angle with drop shadow]

1. If you are not currently on our mailing list but would like to receive VA Research Currents, please enter your information here:

NAME ________________________________________________

ADDRESS ________________________________________________

EMAIL ________________________________________________

PHONE ________________________________________________

Check one or both boxes:

 Mail me a print copy (you will receive one every three months)

 Email me a link to your online edition (you will receive an email once every three
months)

2. If you already receive VA Research Currents but would like to be removed from our mailing list, please enter your information here:

NAME ________________________________________________

ADDRESS ________________________________________________

EMAIL ________________________________________________

Check one or both boxes:

 Please remove me from your regular mailing list.

 Please remove me from your email list.

3. If you are a VA staff member who is interested in receiving print copies of VA Research Currents for a patient or client area at your facility, please email your request to [email protected], or fill in #1 above and indicate how many copies you would like.

--THANK YOU--