10-10171 VPS Survey Questions

OMB Number 2900-0770

Estimated Burden: 5 mins

EXP Date: 08/31/2017

VA CBO – Veterans Point of Service (VPS) Kiosk Satisfaction Survey

OMB 2900-0770

Estimated burden: 5 minutes

Expiration Date 08/31/2017

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 five (5) 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.

Veteran’s Point of Service (VPS) Satisfaction with the Veteran Kiosk

VA is requesting feedback concerning the use of Kiosks as an option for Point of Service encounters in VHA Medical facilities

Q1 - Did you require assistance using any of the kiosk features today?

Yes

No

Q2 - If you required assistance while at a kiosk, were you able to easily get in touch with someone who could help you?

Yes

No

N/A

Q3 – Was the kiosk easy to use?

Yes

No

If No, please explain

Q4 - Were you able to successfully check in for your appointment using the kiosk today?

Yes

No

Q5 - Would you recommend using the kiosk to another Veteran?

Yes

No

Q6 - How would you rate your overall satisfaction with the kiosk?

Excellent

Very Good

Good

Fair

Poor

Q7 – If you used the kiosk for mileage reimbursement, did you still have to see a Beneficiary Travel clerk?

Yes

No

N/A

Q8 – If you used the kiosk to request a copy of your medical records, was the delivery time acceptable?

Yes

No

N/A