Form 10-0507 Veterans Health Benefits Handbook Satisfaction Survey

OMB 2900-0773
Estimated Burden: 5 min
OMB EXP Date: XX/XX/XXXX

Department of Veterans Affairs

Veterans’ Health Benefits Handbook
Veterans Satisfaction Survey
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 0MB number. VA anticipates that the time expended by all individuals who
complete this survey will average 5 minutes. Customer satisfaction surveys are 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 shape the direction and focus of specific programs and services. Disclosure of information
involves release of statistical data and other non-identifying data for the improvement of services within the VA healthcare
system and associated administrative purposes. Submission of this form is voluntary and failure to respond will have no
impact on benefits to which you may be entitled.

On a scale of 1 to 5 please rate the following questions:
1. Was the information in your Handbook easy to read and understand?
1 - Very Dissatisfied

2 - Dissatisfied

3 - Neither Satisfied nor Dissatisfied

4 –Satisfied

5 - Very Satisfied
2. How well did you like the overall layout and presentation of the information (was it easy to
find what you were looking for?)
1 - Very Dissatisfied

2 - Dissatisfied

3 - Neither Satisfied nor Dissatisfied

4 –Satisfied

5 - Very Satisfied
3. Was your personalized information accurate (was your name, eligibility factors, preferred
facility and contact numbers correct)?
1 - Very Dissatisfied

2 - Dissatisfied

3 - Neither Satisfied nor Dissatisfied

4 –Satisfied

5 - Very Satisfied
4.

What is your overall satisfaction with your Veterans Health Benefits Handbook?
1 - Very Dissatisfied

2 - Dissatisfied

3 - Neither Satisfied nor Dissatisfied

4 –Satisfied

5 - Very Satisfied
5. Was the Handbook useful or resourceful (will you be using it again for information)?
1 – Very Unlikely

2 – Unlikely

3 – Neither Likely nor Unlikely

4 – Likely

5 – Very Likely

6. Will the information in your Handbook increase the likelihood for you to use Veteran Health
Administration Services?
1 – Very Unlikely

VA Form 10-0507
Jun 2010

2 – Unlikely

3 – Neither Likely nor Unlikely

4 – Likely

5 – Very Likely

Please tell us how you feel about the following statement:
Q7

I trust VA to fulfill our country's commitment to
veterans.
1 -Strongly agree
2 -Somewhat agree
3- Neither agree or disagree
4 - Somewhat disagree
5 – Strongly disagree

Consider all your recent experiences with VA (which may have included healthcare benefits programs, or memorial services). Please
tell us how you feel about the following statement:
Q8

I got the service I needed.
1 -Strongly agree
2 -Somewhat agree
3 -Neither agree or Disagree
4 -Somewhat disagree
5 -Strongly disagree

Q9

It was easy to get what I needed.
1 - Strongly agree
2 -Somewhat agree
3 -Neither agree or Disagree
4 -Somewhat disagree
5 -Strongly disagree

Q10 I felt like a valued customer.
1 -Strongly agree
2 -Somewhat agree
3 -Neither agree or Disagree
4 -Somewhat disagree
5 -Strongly disagree