Specialty Adapted Housing (SAH) Servicing Survey

VA_Surv9_SvcSAH_5.26.16_v9 5/26/16 2:20 PM Page 1

Specially Adapted Housing
Servicing Satisfaction
MARKING INSTRUCTIONS
Please fill the response oval completely
and print clearly.

USE BLACK OR BLUE INK
(NO RED) to complete the survey.

CORRECT:

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INCORRECT:

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9

OMB Control No. 2900-0782
Throughout the questionnaire, you may be asked to skip certain questions that may not apply to you.

Benefit Eligibility and Assessment
1.

Before we begin, please indicate your relation to the Veteran eligible for or in receipt of the Specially Adapted Housing grant:
(MARK

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3.

ONLY ONE)

I am the caretaker
I am the Veteran
Other (Please specify): ___________________________
I am the spouse
Prefer not to answer
I am a family member or friend
Have you submitted an application for Specially Adapted Housing benefits?
PLEASE ANSWER “YES” IF YOU HAVE SUBMITTED AN APPLICATION AND ARE EITHER IN PROCESS OF COMPLETING YOUR GRANT OR HAVE COMPLETED YOUR GRANT.
Don’t know or not sure (SKIP TO Q46)
No (SKIP TO Q46)
Yes
At the beginning of the grant application process, how much did you understand the Specially Adapted Housing grant program?
ONLY ONE)

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benefit? (MARK ONLY ONE)
eBenefits.va.gov
Mail
In person at a Regional Office
In person at a Veterans Service Organization (e.g., Amer.
Legion, DAV, VFW, PVA, MOPH, etc.)

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ONLY ONE)

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Don’t know or not sure
No
Yes
When you met with the Specially Adapted Housing representative in person, which of the following did they discuss, if any:
(MARK ALL THAT APPLY)

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Was your SAH grant ever delayed?
= Don’t know or not sure
= Yes = No
If your SAH grant was ever delayed, why was there a delay?
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Freedom of choice
Temporary Residence Adaptation grant option
The grant program and benefits
Veteran’s responsibility (e.g., selecting contractor,
escrow agent, etc.)
Design and construction/remodeling considerations
Personal finances
Escrow and release of funds

7.

(SKIP TO Q9)

8.

Other (Please specify): ___________________________________
Don’t know or not sure

After you submitted your most recent SAH application (VA Form 26-4555), did a SAH agent contact you within 7 business days?
(MARK

6.

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Not at all
Only a little
Somewhat
Mostly
Completely
Thinking about your most recent Specially Adapted Housing benefit application, what method did you use to apply for your

Your desired modifications
Requirements for modifications
Limits of the grant amount
Your individual concerns
Other (Please specify): ___________________________________
Have not met with SAH representative in person
Don’t know or not sure

(SKIP TO Q9)
(MARK ALL THAT APPLY)

Incomplete/incorrect information
Contractor delay
SAH agent delay

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Delay on my end
Other (Please specify): _____________________________________
Don’t know or not sure
© 2016 J.D. Power and Associates. All Rights Reserved.

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VA_Surv9_SvcSAH_5.26.16_v9 5/26/16 2:20 PM Page 2

Benefit Eligibility and Assessment (Continued)
9.

Did you receive written notice from VA that your grant was conditionally approved?

10.

Yes
No (SKIP TO Q11)
Don’t know or not sure (SKIP TO Q11)
From the time you submitted your SAH application, how long did it take to receive your approval notification? (MARK ONLY ONE)

11.

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Less than 30 days

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More than 30 days

Don’t know or not sure

The following question asks you to rate various aspects of your experience with Specially Adapted Housing, using a scale of
1 to 10, where 1 is Unacceptable, 10 is Outstanding, and 5 is Average.
Please rate your experience with the SAH grant application process on the following items:
(MARK ONLY ONE PER ROW)
Unacceptable
Average
Outstanding
1

a.
b.

Ease of completing the application
Timeliness of initial eligibility notification

c.
d.

Flexibility of application methods
Overall rating of application process

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£
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£

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5

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10

N/A

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NA
NA
NA

Grant Planning
12.

Have you received a final approval notification on your grant application?
PLEASE ANSWER “YES” IF YOU HAVE RECEIVED A FINAL APPROVAL NOTIFICATION, REGARDLESS
Yes
No (SKIP TO Q31)
Don’t know or not sure (SKIP TO Q31)

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OF WHETHER YOUR GRANT HAS BEEN DISBURSED

During the grant process, did you have to submit any required documentation (e.g., building plans or financial statements) more
than once? (MARK ONLY ONE)

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Yes

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No (SKIP TO Q16)

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Not applicable (SKIP TO Q16)

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Don’t know or not sure (SKIP TO Q16)

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How many times did you have to submit required documentation?

15.

Why did you have to resubmit required documentation? (MARK ALL THAT APPLY)
Incomplete documentation
Other (Please specify): ________________________________
Design or plan changes
Don’t know or not sure
SAH agent did not receive documentation

16.

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# of Times

Don’t know or not sure

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Was your SAH agent the same person throughout the entire process (i.e., initial interview, planning, and processing of grant)? (MARK ONLY ONE)
Yes (SKIP TO Q18)

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No

Don’t know or not sure (SKIP TO Q18)

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Did the change in SAH agents create a problem for you? (MARK ONLY ONE)

18.

How many in person appointments did you have with your
SAH agent before your grant process was complete?

19.

Using the same scale of 1 to 10 where 1 is Unacceptable, 10 is Outstanding, and 5 is Average, please rate your experience with
your Specially Adapted Housing agent(s) during the SAH grant application process on the following items:
(MARK ONLY ONE PER ROW)
Unacceptable
Average
Outstanding

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Yes

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Promptness of scheduling appointments or returning calls

b.

Courtesy of the agent

c.

Knowledge of the agent

d.

Agent’s concern for your needs

e.

Timeliness of completing your adaptation plan

f.

Overall SAH agent experience

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# of Appointments

1

a.

No

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5

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Don’t know or not sure

Don’t know or not sure

6

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7

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•
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10

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N/A

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NA
NA
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NA

NA

Home Modification/Construction Process
20.

Have you completed the construction process?
PLEASE ANSWER “YES” IF YOU HAVE COMPLETED THE CONSTRUCTION PROCESS, REGARDLESS OF WHETHER YOUR GRANT FUNDS HAVE BEEN DISBURSED.

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21.

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Yes
No (SKIP TO Q33)
Don’t know or not sure (SKIP TO Q33)
How long did it take for your new specially adapted house to be built or existing home to be modified? (MARK ONLY ONE)
PLEASE CONSIDER ONLY THE TIMEFRAME IT TOOK FROM THE BEGINNING OF CONSTRUCTION TILL THE CONSTRUCTION WAS COMPLETE.

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# of Months

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Don’t know or not sure

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VA_Surv9_SvcSAH_5.26.16_v9 5/26/16 2:20 PM Page 3

Home Modification/Construction Process (Continued)
22.

Please rate your experience with the contractor on the following items, using a scale of 1 to 10 where 1 is Unacceptable,
10 is Outstanding, and 5 is Average. (MARK ONLY ONE PER ROW)
Unacceptable
Average
Outstanding
1

a.
b.
c.
d.

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Courtesy of the contractor
Knowledge of the contractor
Timeliness of the modification/construction process
Overall rating of contractor

2

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£
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5

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10

N/A

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NA

NA
NA

Completion of the Grant Process
23.

How many bids did you receive for your desired modifications/adaptations or new home construction? (MARK ONLY ONE)

24.

# of Bids
Have not yet begun bid process
Don’t know or not sure
Which adaptive items did you/do you intend to use your SAH grant for? (MARK ALL THAT APPLY)

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26.
27.

28.

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Ramps (exterior or interior)
Grab bars
Wider door opening
Wider hallways
Accessible bathroom(s)/shower(s)
Accessible kitchen

Accessible bedroom(s)
Flooring
Special equipment (e.g., elevators, lifts,
track systems)

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Construction of emergency
entrances/exits
Other (Please specify): __________________
Don’t know or not sure

Lighting
Garage/carport construction or modification

Was your Specially Adapted Housing grant the amount you expected? (MARK ONLY ONE)
Yes

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No

Don’t know or not sure

Based on your grant coverage, were you able to obtain all modifications/adaptations that you needed? (MARK ONLY ONE)
Yes (SKIP TO Q28)

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No

=

Don’t know or not sure (SKIP TO Q28)

Which desired adaptive items were not covered as a result of an insufficient grant amount? (MARK ALL THAT APPLY)
Ramps (exterior or interior)
Accessible bedroom(s)
Construction of emergency
Grab bars
Flooring
entrances/exits
Wider door opening
Special equipment (e.g., elevators, lifts,
Other (Please specify): __________________
Wider hallways
track systems)
All desired adaptive items were covered
Accessible bathroom(s)/shower(s)
Lighting
Don’t know or not sure
Accessible kitchen
Garage/carport construction or modification

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What was/is the total cost of your current modification/adaptation project?

$
29.

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Approximate Cost

Don’t know or not sure

If not for the SAH grant program, what would your housing situation be?
Living in assisted living facility
Other (Please specify): ________________
Living in the same house or apartment without adaptations
Don’t know or not sure
Living with a family member or a friend

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The following question asks you to rate various aspects of your experience with Specially Adapted Housing benefits, using a
scale of 1 to 10 where 1 is Unacceptable, 10 is Outstanding, and 5 is Average.
30.

Please rate your Specially Adapted Housing grant on the following items: (MARK ONLY ONE PER ROW)
Unacceptable
Average
1

31.

a.

Amount of grant coverage

b.

Usefulness of benefits or services

c.

Timeliness of receiving benefit payment or services

d.

Overall rating of benefit payment

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How long has your current SAH application been pending? (MARK ONLY ONE)

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Less than 30 days
1 - 6 Months

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7 - 12 months
More than 1 year

2

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3

£
£
£
£
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4

¢
¢
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5

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Outstanding
6

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7

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8

•
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10

N/A

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NA
NA
NA

Not applicable (SKIP TO Q33)
Don’t know or not sure

© 2016 J.D. Power and Associates. All Rights Reserved. 9

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VA_Surv9_SvcSAH_5.26.16_v9 5/26/16 2:20 PM Page 4

Completion of the Grant Process (Continued)
32.

33.

What is the reason your grant application is pending? (MARK ALL THAT APPLY)

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Need to submit required documentation
Waiting for confirmation from VA

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Waiting for confirmation from
contractor

Other
Don’t know or not sure

How much do you currently understand the Specially Adaptive Housing grant program? (MARK ONLY ONE)

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Completely

Mostly

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Somewhat

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Only a little

Not at all

Benefit Information
34.

How did you FIRST learn about the Specially Adapted Housing benefit? (MARK ONLY ONE)
IF YOU ARE UNSURE, PLEASE INDICATE THE FIRST WAY YOU REMEMBER LEARNING ABOUT THE SPECIALLY ADAPTED HOUSING BENEFIT.

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37.

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Veterans Service Organizations (e.g., Amer. Legion, DAV,
VFW, PVA, MOPH, etc.) (Please specify): __________________
Other Veterans
Other (Please specify): _______________________________________
Don’t know or not sure

What method(s) do you MOST FREQUENTLY use to obtain general information about VA’s Specially Adapted Housing benefits or
services? (MARK ALL THAT APPLY)

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36.

eBenefits.va.gov
Social media websites (e.g., Facebook, Twitter, etc.)
Mail from VA (e.g., notification/ratings letter)
In person with a VA representative (e.g., VA medical center,
VA Vet Center, Regional Office)
Transition Assistance Program/Disabled Transition Assistance
Program briefings

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eBenefits.va.gov
Social media websites (e.g., Facebook, Twitter, etc.)
Other websites (excluding VA or social media sites)
Phone
Mail
E-mail
In person with a VA representative (e.g., VA medical center,
VA Vet Center, Regional Office)

Veterans Service Organizations (e.g., Amer. Legion, DAV,
VFW, PVA, MOPH, etc.) (Please specify): ___________________
Disabled Veterans’ Outreach Program
Friends or family
Other (Please specify): _______________________________________
Don’t know or not sure
None of the above

How frequently would you like to receive communications (e.g., e-mails, letters, newsletters, etc.) from VA about Specially
Adapted Housing benefits or services? (MARK ONLY ONE)

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Weekly
Monthly

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Quarterly (every 3 months)
Semi-annually (twice per year)

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Annually (once per year)

Don’t know or not sure

Never

How would you like to receive information from VA about Specially Adapted Housing benefits or services? (MARK ALL THAT APPLY)

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Phone
Mail
E-mail
VA website
Social media websites (e.g., Facebook, Twitter, etc.)

In person at a Regional Office
Veterans Service Organizations (e.g., Amer. Legion, DAV,
VFW, PVA, MOPH, etc.) (Please specify): ___________________
Other (Please specify): ______________________________________
Don’t know or not sure

The following question asks you to rate various aspects of your experience with Specially Adapted Housing benefits, using a
scale of 1 to 10, where 1 is Unacceptable, 10 is Outstanding, and 5 is Average.
38.

Please rate your experience in obtaining information about your Specially Adapted Housing grant on the following items:
(MARK ONLY ONE PER ROW)

Unacceptable

¡
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1

a.

Ease of accessing information

b.

Availability of information

c.

Clarity of information

d.

Frequency of information provided by VA

e.

Usefulness of information

f.

Overall rating of information

Page 4

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Average

£
£
£
£
£
£
3

¢
¢
¢
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¢
¢
4

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∞
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5

Outstanding

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6

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7

•
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8

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10

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N/A
NA
NA
NA
NA
NA

VA_Surv9_SvcSAH_5.26.16_v9 5/26/16 2:20 PM Page 5

Overall Experience with Benefit
39.

Thinking about ALL aspects of your experience with Specially Adapted Housing benefits (e.g., grant application process, grant
planning process, home modification/construction process, completion of the grant process, obtaining information about your
grant, contacting VA), please rate VA overall, using a scale of 1 to 10 where 1 is Unacceptable, 10 is Outstanding, and 5 is Average.
(MARK ONLY ONE)
Unacceptable
Average
Outstanding
1

2

3

4

5

6

7

8

9

10

¡ ™ £ ¢ ∞ § ¶ • ª ‚
=

IF YOU HAVE COMPLETED THE ENTIRE GRANT PROCESS AND ALL OF YOUR FUNDS HAVE BEEN DISBURSED, PLEASE ANSWER Q40. OTHERWISE, PLEASE SKIP TO Q41.

40.

Do your housing adaptations help you live more independently? (MARK ONLY ONE)

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Yes

No

Overall Experience with VA
41.

Taking into consideration all of the non-medical benefits (e.g., education, compensation, pension, home loan guaranty,
vocational rehabilitation and employment, insurance, etc.) you have applied for or currently receive, please rate your
experience with VA overall, using a scale of 1 to 10 where 1 is Unacceptable, 10 is Outstanding, and 5 is Average. (MARK ONLY ONE)
(MARK ONLY ONE)

Unacceptable
1

42.
43.

Average
3

4

5

Outstanding
6

7

8

9

10

¡ ™ £ ¢ ∞ § ¶ • ª ‚
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Based on your experiences with VA, how likely are you to recommend to other Veterans VA benefits or services? (MARK ONLY ONE)

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Definitely will not

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Probably will not

Probably will

Definitely will

How much do you agree with the following statement:
“Receiving a Specially Adapted Housing Grant makes me feel that the Nation recognizes my service to our country.” (MARK ONLY ONE)

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44.

2

Strongly disagree

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Neither agree nor disagree

Somewhat agree

Somewhat disagree
Strongly agree
Now think about your experiences with all the services provided by the Department of Veterans Affairs (which include
healthcare, benefits programs, or memorial services). Please tell us how you feel about the following statements.
(MARK ONLY ONE PER STATEMENT)

Strongly
Disagree
a.
b.
c.
d.
45.

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I got the service I needed
It was easy to get the service I needed
I felt like a valued customer
I trust VA to fulfill our country’s commitment to Veterans

Disagree

Neutral

Agree

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£
£
£
£

¢
¢
¢
¢

Strongly
Agree

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Do you have any other comments or concerns about your experience?
__________________________________________________________________________________________________________
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Reasons for not using the SAH Grant
SAH GRANT (VA FORM 26-4555), PLEASE ANSWER Q46 ALL OTHERS SKIP TO Q48.
If you have not yet applied for the SAH grant program, what is the major reason you have not submitted an application?

IF YOU HAVE NOT YET APPLIED FOR YOUR

46.

(MARK ONLY ONE)

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Current home meets my needs
Do not want to use the grant
Plan on using the grant in the future
Application/grant process was too time consuming

Application/grant process was too complex
Grant amount was not large enough to meet my needs
Elected to use alternate source of funding
Other (Please specify): _____________________________________
© 2016 J.D. Power and Associates. All Rights Reserved. 9

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VA_Surv9_SvcSAH_5.26.16_v9 5/26/16 2:20 PM Page 6

Reasons for not using the SAH Grant (Continued)
SAH GRANT FUNDS, PLEASE ANSWER Q47, ALL OTHERS SKIP TO Q48.
What is the major reason preventing you from using the grant? (MARK ONLY ONE)

IF YOU HAVE APPLIED AND NOT YET USED YOUR

47.

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I was not aware I was eligible
Plan on using the grant in the future
No longer need the grant
Did not have enough help from VA
Application/grant process was too complex
Grant amount was not large enough to meet my needs

Elected to use alternate source of funding
Waiting for response from VA
Unable to find a contractor willing to complete the required
adaptations for the grant amount
Other (Please specify): ___________________________________

About You
Which adaptive items do you feel are necessary for living independently? (MARK ALL THAT APPLY)

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Ramps (exterior or interior)
Grab bars
Wider door opening
Wider hallways
Accessible bathroom(s)/shower(s)
Accessible kitchen
Accessible bedroom(s)
Elevators, ramps, or entrances on ground floor

Level thresholds
Lighting
Garage/carport construction or modification
Construction of emergency entrances/exits
Other (Please specify): ____________________________________
Don't know or not sure

THANK YOU FOR TAKING THE TIME TO PARTICIPATE IN THIS IMPORTANT STUDY.

Please return to:

J.D. Power and Associates Survey Processing Center

P.O. Box 510030 • Livonia, MI 48151-9907

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