Veteran Experience and Satisfaction with the Department of Veteran Affairs Compensation and Pension Claims Examination

OMB Control No: 2900-0770

Respondent Burden: 5 minutes

Expiration Date: 08/31/2017

Compensation and Pension Examination Feedback

The Department of Veteran Affairs is working hard to improve the services we provide to Veterans like you. We ask that you take a few minutes to provide us feedback on the recent Compensation and Pension Examination you had so that we can continue to improve the process. Thank you for your time and for your service!
Which doctor did you see for your appointment?	What was the date of your appointment? (MM/DD/YYYY)
Please check the box that applies for the following questions:
How long from your scheduled appointment time did you wait to see the doctor? Less than 30 minutes 30 minutes 45 minutes 1 hour Greater than 1 hour
Performance of Administrative Staff Very Satisfied Somewhat Satisfied Neither Somewhat Dissatisfied Very Dissatisfied
Reasonableness of appointment time and place Very Satisfied Somewhat Satisfied Neither Somewhat Dissatisfied Very Dissatisfied
Cleanliness of examiner’s office Very Satisfied Somewhat Satisfied Neither Somewhat Dissatisfied Very Dissatisfied
Concern and attention demonstrated by the examiner Very Satisfied Somewhat Satisfied Neither Somewhat Dissatisfied Very Dissatisfied
Overall satisfied with the services provided Very Satisfied Somewhat Satisfied Neither Somewhat Dissatisfied Very Dissatisfied
Now think about your experience with all the services provided by the Department of Veteran Affairs (which include healthcare, benefits programs, or memorial services). Please tell us how you feel about the following statements. Please check the box that applies:
I got the service I needed Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree
It was easy to get the service I needed Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree
I felt like a valued customer Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree
I trust VA to fulfill our country’s commitment to Veterans Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree
Please provide any additional comments/suggestions
If you would like to be contacted by the VA, please include your contact information here Name: Email Address: Phone Number:
The Department of Veterans Affairs appreciates your time and feedback.
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 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 survey will lead to improvements in the quality of service delivery by helping to improve primary care services. Participation in this survey is voluntary and failure to respond will have no impact on benefits to which you may be entitled.