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<10/31/18>
Working Draft, Pre-Decisional, Deliberative document - Internal VA Use Only
The VA provides free, confidential support 24/7 for Veterans and their family and friends.
If you are in crisis, contact the Veterans Crisis Line by dialing 1 (800) 273-8255 (Press
1), or texting 838255, or visiting https://www.veteranscrisisline.net. If you are homeless
or at risk of homelessness, contact the National Call Center for Homeless Veterans
(NCCHV) by dialing 1 (877) 424-3838 or visiting https://www.va.gov/HOMELESS/.
OMB Number: 2900-0770
Expiration: 09/30/2020
Estimated Burden: 2 minutes
Help us serve you better
We want to hear about your recent / / experience. By
indicating how much you agree or disagree with the statements below,
you directly help us improve VA services.
This survey should take you approximately 2 minutes to complete.
The information provided by the phone representative was explained in terms I could
understand. Required
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
The phone representative answered my question on the issue I recently called about.
Required
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
The phone representative treated me with courtesy and respect. Required
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
The length of time it took to get connected to a phone representative was reasonable.
Required
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
The information provided during the call helped me feel that I have a better
understanding of my issue and next steps. Required
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
I am satisfied with the service I received from the / / . Required
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
I trust VA to fulfill our country’s commitment to Veterans. Required
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
Can VA contact you about your feedback? Required
Yes, VA can contact me about my experience.
No, I do not want VA to contact me about my experience.
Finish
We are asking for this information so that you can provide compliments, recommendations, or concerns to VA. This
information is collected in accordance with section 3507 of the Paperwork Reduction Act of 1995. Title 38, United States
Code, allows us to ask for this information. We estimate that you will need an average of one minute to review the
instructions and complete this survey. The results of this survey will be used to inform opportunities for program
improvement in the quality of VA services. Participation in this survey is voluntary, and your decision not to respond will have
no impact on VA benefits or services to which you may currently be receiving. By filling out this survey, you are authorizing
VA database access to retrieve veteran contact information to follow up with you accordingly for purposes of service
recovery, potential crisis, or to learn more about feedback you have shared regarding your experience with VA. VA cannot
conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are not required to
respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB
Internet Page at www.reginfo.gov/public/do/PRAMain.
Privacy Policy
VBA Contact Centers
<10/31/18>
Working Draft, Pre-Decisional, Deliberative document - Internal VA Use Only
The VA provides free, confidential support 24/7 for Veterans and their family and friends.
If you are in crisis, contact the Veterans Crisis Line by dialing 1 (800) 273-8255 (Press
1), or texting 838255, or visiting https://www.veteranscrisisline.net. If you are homeless
or at risk of homelessness, contact the National Call Center for Homeless Veterans
(NCCHV) by dialing 1 (877) 424-3838 or visiting https://www.va.gov/HOMELESS/.
OMB Number: 2900-0770
Expiration: 09/30/2020
Estimated Burden: 2 minutes
Thank you for your choosing VA
The U.S. Department of Veterans Affairs uses these surveys to collect
your feedback in order to continuously improve your experience with VA
services.
Please visit VA.gov to explore benefits, resources, and information
at VA.
We are asking for this information so that you can provide compliments, recommendations, or concerns to VA. This
information is collected in accordance with section 3507 of the Paperwork Reduction Act of 1995. Title 38, United States
Code, allows us to ask for this information. We estimate that you will need an average of one minute to review the
instructions and complete this survey. The results of this survey will be used to inform opportunities for program
improvement in the quality of VA services. Participation in this survey is voluntary, and your decision not to respond will have
no impact on VA benefits or services to which you may currently be receiving. By filling out this survey, you are authorizing
VA database access to retrieve veteran contact information to follow up with you accordingly for purposes of service
recovery, potential crisis, or to learn more about feedback you have shared regarding your experience with VA. VA cannot
conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are not required to
respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB
Internet Page at www.reginfo.gov/public/do/PRAMain.
Privacy Policy
| File Type | application/pdf |
| File Modified | 2018-10-31 |
| File Created | 2018-10-31 |