Congressional Response Team Customer Satisfaction Survey

Congressional Response Team Customer Satisfaction Survey

OMB No. 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 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 online survey will lead to improvements in the quality of service delivery to United States Congressional Offices from the Veterans Health Administration (VHA) Office of Community Care Congressional Response Team. Participation in this survey is voluntary and failure to respond will have no impact on benefits to which you may be entitled.

Privacy Act Statement: This survey is not a collection of personal information; please do not enter any personal information in the open text fields. By voluntarily providing information on www.va.gov/purchasedcare/index.asp, you are consenting to VA’s use and disclosure of that information in the manner described in this limited policy. The VA general Web privacy policy is available at www.va.gov/privacy.

Unique Identifier Code (UIC)

Please enter the UIC that is printed under your office name in the email survey invitation (7-8 characters):

______________________________

The statements and questions in this survey are regarding your experience with the VHA Office of Community Care Congressional Response Team.

Please think about your experiences with the Congressional Response Team.

Courteous

Ο Always Ο Most of the Time Ο Sometimes Ο Rarely Ο Never

Understand VHA Community Care Programs

Ο Always Ο Most of the Time Ο Sometimes Ο Rarely Ο Never

Know how to take action on my inquiry

Ο Always Ο Most of the Time Ο Sometimes Ο Rarely Ο Never

Empathetic to my specific needs

Ο Always Ο Most of the Time Ο Sometimes Ο Rarely Ο Never

Consistently perform to my expectations

Ο Always Ο Most of the Time Ο Sometimes Ο Rarely Ο Never

Adequately accessible for advice and assistance

Ο Always Ο Most of the Time Ο Sometimes Ο Rarely Ο Never

Keep me informed of conditions and changes that affect me

Ο Always Ο Most of the Time Ο Sometimes Ο Rarely Ο Never

Work with me to ensure I get what I need

Ο Always Ο Most of the Time Ο Sometimes Ο Rarely Ο Never

Policies and procedures for inquiries are easy to understand

Ο Always Ο Most of the Time Ο Sometimes Ο Rarely Ο Never

The next questions are regarding your satisfaction with the response(s) you have received to your inquiry(s) to the Congressional Response Team.

Response to Inquiries:

Complete

Ο Always Ο Most of the Time Ο Sometimes Ο Rarely Ο Never

Consistent

Ο Always Ο Most of the Time Ο Sometimes Ο Rarely Ο Never

Easy to understand

Ο Always Ο Most of the Time Ο Sometimes Ο Rarely Ο Never

Provide enough information to satisfy my needs

Ο Always Ο Most of the Time Ο Sometimes Ο Rarely Ο Never

Received in a timely manner

Ο Always Ο Most of the Time Ο Sometimes Ο Rarely Ο Never

How long on average does it take for you to receive a response to your inquiry(s)?

Ο 1-10 days Ο 11-20 days Ο 21-30 days Ο 31-45 days Ο 46-60 days Ο over 60 days Ο NA

The next questions are regarding any problems and complaints you may have encountered with the Congressional Response Team.

Have you experienced a problem or had a complaint with the Congressional Response Team?

Ο Yes Ο No (Please skip to the next section, Overall Satisfaction)

Problems and complaints:

Resolved quickly

Ο Always Ο Most of the Time Ο Sometimes Ο Rarely Ο Never

Resolved with minimal effort on my part

Ο Always Ο Most of the Time Ο Sometimes Ο Rarely Ο Never

Congressional Response Team:

Flexible in finding solutions to problems

Ο Always Ο Most of the Time Ο Sometimes Ο Rarely Ο Never

Effectively handle problems or mistakes

Ο Always Ο Most of the Time Ο Sometimes Ο Rarely Ο Never

In which of the following areas did you experience the problem(s)? Mark all that apply

Ο Completeness of Response Ο Consistency of Response

Ο Ease of Understanding Response Ο Timeliness of Response

Ο Other – please specify __________________________________________________________

Describe the problem(s) and how the problem(s) was resolved. ______________________________

________________________________________________________________

Overall Satisfaction

Overall, how satisfied are you with your interaction with the Congressional Response Team?

Ο Very Ο Satisfied Ο Somewhat Ο Somewhat Ο Dissatisfied Ο Very

Satisfied Satisfied Dissatisfied Dissatisfied

What is the Congressional Response Team doing well? ____________________________________

_______________________________________________________________

How can the Congressional Response Team improve? ____________________________________

_______________________________________________________________

Are there any services or outreach currently not being offered by the Congressional Response Team that you feel would be helpful in order for you to better inform your constituents? ________________________________________________________________________________

_______________________________________________________________

Overall Experience with Department of Veterans Affairs (VA)

Now think about your experiences with all the services provided by the VA (which includes healthcare, benefits programs or memorial services).

Please tell us how you feel about the following statements:

I got the service I needed.

Ο Strongly Ο Agree Ο Neither Agree Ο Disagree Ο Strongly

Agree nor Disagree Disagree

It was easy to get the service I needed.

Ο Strongly Ο Agree Ο Neither Agree Ο Disagree Ο Strongly

Agree nor Disagree Disagree

I felt like a valued customer.

Ο Strongly Ο Agree Ο Neither Agree Ο Disagree Ο Strongly

Agree nor Disagree Disagree

I trust VA to fulfill our country’s commitment to Veterans.

Ο Strongly Ο Agree Ο Neither Agree Ο Disagree Ο Strongly

Agree nor Disagree Disagree

END OF SURVEY Thank you for your time!