Form 30695 Q_VA_Web_Browse_20181107_DOT
E-Government Website Customer Satisfaction Surveys
Q_VA_Web_Browse_20181107_DOT.xlsx
Mapping and Questionnaire Documents IA 30695 A2 (VA)
OMB: 1090-0008
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1090-0008 can be found here:
Document [xlsx]
Download: xlsx | pdf
Welcome and Thank You Text
Model Qsts
Current CQs
CQs (11-7-18)
CQs (10-5-18)
Overview
Foreign Language TranslationWelcome and Thank You Text
Model Qsts
Current CQs
CQs (11-7-18)
CQs (10-5-18)
Sheet 1: Foreign Language Translation
| Measure Name | VA Main V2 | (Remove this tab for non-international surveys) | 
|
||
| Custom Qualifier Page | Yes | ||||
| Custom Invitation Text | |||||
| Custom Tracker Text | |||||
| MID | Language | Target Country | Target Audience | Website URL | Notes |
|
|||||
Sheet 2: Welcome and Thank You Text
|
|
||||||
| Welcome and Thank You Text | ||||||
| Welcome Text | Thank You Text | |||||
| Thank you for visiting [Company/Site/Agency]. You've been randomly chosen to take part in a brief survey to let us know what we're doing well and where we can improve. Please take a few minutes to share your opinions, which are essential in helping us provide the best online experience possible. |
Thank you for taking our survey - and for helping us serve you better. We appreciate your input! |
|||||
| Welcome Text - Alternate | Thank You Text - Alternate | |||||
| Thank you for visiting [Company/Site/Agency]. You have been randomly selected to take part in this survey that is being conducted by ForeSee on behalf of the [Company/Site/Agency]. Please take a few minutes to give us your feedback. All results are strictly confidential. | Thank you for taking our survey - and for helping us serve you better. Please note you will not receive a response from us based on your survey comments. If you would like us to contact you about your feedback, please visit the Contact Us section of our web site. |
|||||
|
|
|||||
Sheet 3: Model Qsts
| Model Name | VA Main V2 |
|
||||||
| Model ID | FgowBUAkEoAdMFBUwNF4Zg4C | Underlined & Italicized: Re-order | ||||||
| Partitioned | 2 MQ | Pink: Addition | ||||||
| Date | 10/17/2016 | Blue: Reword | ||||||
| Label | Element Questions | Label | Satisfaction Questions | Label | Future Behaviors | |||
| Look and Feel (1=Poor, 10=Excellent, Don't Know) | Satisfaction | Return (1=Very Unlikely, 10=Very Likely) | ||||||
| 1 | Look and Feel - Appeal | Please rate the visual appeal of this site. | 19 | Satisfaction - Overall | What is your overall satisfaction with this site? (1=Very Dissatisfied, 10=Very Satisfied) |
22 | Return | How likely are you to return to this site in the next 90 days? |
| 2 | Look and Feel - Balance | Please rate the balance of graphics and text on this site. | 20 | Satisfaction - Expectations | How well does this site meet your expectations? (1=Falls Short, 10=Exceeds) |
Recommend Site (1=Very Unlikely, 10=Very Likely) | ||
| 3 | Look and Feel - Readability | Please rate the readability of the pages on this site. | 21 | Satisfaction - Ideal | How does this site compare to your idea of an ideal website? (1=Not Very Close, 10=Very Close) |
23 | Recommend Site | How likely are you to recommend this site to someone else? |
| Site Performance (1=Poor, 10=Excellent, Don't Know) | Primary Resource (1=Very Unlikely, 10=Very Likely) | |||||||
| 4 | Site Performance - Loading | Please rate how quickly pages load on this site. | 24 | Primary Resource | How likely are you to use this site as your primary resource for obtaining information about Veterans Affairs? | |||
| 5 | Site Performance - Consistency | Please rate the consistency of speed from page to page on this site. | ||||||
| 6 | Site Performance - Completeness | Please rate how completely the page content loads on this site. | ||||||
| Navigation (1=Poor, 10=Excellent, Don't Know) | ||||||||
| 7 | Navigation - Organized | Please rate how well the site is organized. | ||||||
| 8 | Navigation - Options | Please rate the options available for navigating this site. | ||||||
| 9 | Navigation - Layout | Please rate how well the site layout helps you find what you need. | ||||||
| Information Browsing (1=Poor, 10=Excellent, Don't Know) | ||||||||
| 10 | Information Browsing - Sort | Please rate the ability to sort information by criteria that are important to you on this site. | ||||||
| 11 | Information Browsing - Narrow | Please rate the ability to narrow choices to find the information you are looking for on this site. | ||||||
| 12 | Information Browsing - Features | Please rate how well the features on the site help you find the information you need. | ||||||
| Site Information (1=Poor, 10=Excellent, Don't Know) | ||||||||
| 13 | Site Information - Thoroughness | Please rate the thoroughness of information provided on this site. | ||||||
| 14 | Site Information - Understandable | Please rate how understandable this site’s information is. | ||||||
| 15 | Site Information - Answers | Please rate how well the site’s information provides answers to your questions. | ||||||
Sheet 4: Current CQs
| Model Name | VA Main V2 | 
|
|||||||
| Model ID | FgowBUAkEoAdMFBUwNF4Zg4C | Underlined & Italicized: Re-order | |||||||
| Partitioned | 2 MQ | Pink: Addition | |||||||
| Date | 8/1/2018 | Blue: Reword | |||||||
| QID | QUESTION META TAG | Skip From | Question Text | Answer Choices | Skip To | Required Y/N |
Type | Special Instructions | CQ Label |
| HAJ6991Q001 | How often do you visit the Veterans Affairs website (www.va.gov)? | This is my first time | Y | Radio button, one-up vertical | Skip Logic Group* | Visit Frequency | |||
| More than once a day | A | ||||||||
| About once a day | A | ||||||||
| About once a week | A | ||||||||
| About once a month | A | ||||||||
| Every 6 months or less | A | ||||||||
| HOP0276933 | A | During your visit today, did you notice the redesign of the va.gov site? | Yes | B, C | Y | Radio button, one-up vertical | Skip Logic Group* | New Site Notice Redesign | |
| No | |||||||||
| HOP0276934 | B | How does the new site compare to the previous design? | The new design is better | Y | Radio button, one-up vertical | Skip Logic Group* | New Site Comparison | ||
| About the same | |||||||||
| The new design is worse | B1 | ||||||||
| Unsure / Did not notice a change | |||||||||
| HOP0276936 | B1 | Please tell us why you feel the new design is worse than the previous site. | N | Text area, no char limit | Skip Logic Group* | OE_Site Inferior | |||
| HOP0276935 | C | Please tell us whether you agree or disagree with the following statement: The new site makes it easier to complete my task. |
Strongly Agree | Y | Radio button, one-up vertical | Skip Logic Group* | New Site Task | ||
| Agree | |||||||||
| Neutral / Unsure | |||||||||
| Disagree | C1 | ||||||||
| Strongly Disagree | C1 | ||||||||
| Don't know | |||||||||
| HOP0276937 | C1 | Please tell us what would make your task easier to complete. | N | Text area, no char limit | Skip Logic Group* | OE_Easier Task | |||
| HAJ6991Q002 | Which of the following describe you? Please select all that apply. | Veteran | B, D | Y | Checkbox, one-up vertical | Skip Logic Group* | Best describes you | ||
| Active duty | |||||||||
| Dependent or beneficiary of a veteran | |||||||||
| Spouse / relative of veteran | |||||||||
| Other | |||||||||
| HAJ6991Q004 | B | Please check the conflict(s) in which you served. | World War II | Y | Checkbox, one-up vertical | Skip Logic Group* | Veteran Era | ||
| Korean Conflict | |||||||||
| Vietnam Era | |||||||||
| Persian Gulf War | |||||||||
| Operation Enduring Freedom | |||||||||
| Operation Iraqi Freedom | |||||||||
| Operation New Dawn | |||||||||
| No conflict / war service | Mutually Exclusive | ||||||||
| HAJ6991Q005 | D | Did you serve in a combat role during your period of service? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | CombatService | ||
| No | |||||||||
| LAB6991Q023 | Did you visit any other Department of Veterans Affairs websites today? (Please select all that apply.) | Local Medical Center Website | Y | Checkbox, one-up vertical | Skip Logic Group* | VA Websites | |||
| Veterans Health Administration | |||||||||
| Veterans Benefits Administration | |||||||||
| National Cemetery Administration | |||||||||
| My HealtheVet | |||||||||
| eBenefits | |||||||||
| Vets.gov | |||||||||
| VA for Vets | |||||||||
| Explore VA | |||||||||
| Visited another Department of Veterans Affairs website not listed above | B | ||||||||
| Did not visit any other Department of Veterans Affairs websites today | Mutually Exclusive | ||||||||
| Don't know | Mutually Exclusive | ||||||||
| HAJ6991Q009 | B | What other Department of Veterans Affairs website did you access today? | N | Text area, no char limit | Skip Logic Group* | OE_VA Websites | |||
| HAJ6991Q010 | Where do you live? | Alabama | Y | Drop down, select one | Reside | ||||
| Alaska | |||||||||
| American Samoa | |||||||||
| Arizona | |||||||||
| Arkansas | |||||||||
| California | |||||||||
| Colorado | |||||||||
| Connecticut | |||||||||
| Delaware | |||||||||
| District of Columbia | |||||||||
| Florida | |||||||||
| Georgia | |||||||||
| Guam | |||||||||
| Hawaii | |||||||||
| Idaho | |||||||||
| Illinois | |||||||||
| Indiana | |||||||||
| Iowa | |||||||||
| Kansas | |||||||||
| Kentucky | |||||||||
| Louisiana | |||||||||
| Maine | |||||||||
| Maryland | |||||||||
| Massachusetts | |||||||||
| Michigan | |||||||||
| Minnesota | |||||||||
| Minor Outlying Islands | |||||||||
| Mississippi | |||||||||
| Missouri | |||||||||
| Montana | |||||||||
| Nebraska | |||||||||
| Nevada | |||||||||
| New Hampshire | |||||||||
| New Jersey | |||||||||
| New Mexico | |||||||||
| New York | |||||||||
| North Carolina | |||||||||
| North Dakota | |||||||||
| Northern Mariana Islands | |||||||||
| Ohio | |||||||||
| Oklahoma | |||||||||
| Oregon | |||||||||
| Pennsylvania | |||||||||
| Puerto Rico | |||||||||
| Rhode Island | |||||||||
| South Carolina | |||||||||
| South Dakota | |||||||||
| Tennessee | |||||||||
| Texas | |||||||||
| U.S. Virgin Islands | |||||||||
| Utah | |||||||||
| Vermont | |||||||||
| Virginia | |||||||||
| Washington | |||||||||
| West Virginia | |||||||||
| Wisconsin | |||||||||
| Wyoming | |||||||||
| Canada | |||||||||
| I live elsewhere | |||||||||
| LAB6991Q024 | Which category best describes the kind of information or services you were primarily looking for today? | Health Care | X1 | Y | Radio button, one-up vertical | Skip Logic Group* | Kind of Information | ||
| Disability and Compensation | X2 | ||||||||
| Education and Training | X3 | ||||||||
| Careers and Employment | X4 | ||||||||
| Pension | X5 | ||||||||
| Housing Assistance | X6 | ||||||||
| Life insurance | X7 | ||||||||
| Burials and Memorials | X8 | ||||||||
| Personal Records and Documents | X9 | ||||||||
| Family and Caregiver Benefits | |||||||||
| Servicemember Benefits | |||||||||
| VA Offices, Policy, and News | |||||||||
| Other | X11 | ||||||||
| LAB6991Q025 | X11 | What other kind of information or service were you looking for today? | N | Text area, no char limit | Skip Logic Group* | OE_Info or Service | |||
| LAB6991Q026 | X1 | What Health Care information or services were you looking for today? | Apply for Health Care | Y | Radio button, one-up vertical | Skip Logic Group* | Health Care Info | ||
| Refill or track prescriptions | |||||||||
| Send a message to your healthcare team | |||||||||
| Schedule or view appointments | |||||||||
| View lab or test results | |||||||||
| Other | B1 | ||||||||
| LAB6991Q027 | B1 | What other kind of Health Care information or service were you looking for today? | N | Text area, no char limit | Skip Logic Group* | OE_Health Care | |||
| LAB6991Q028 | X2 | What Disability and Compensation information or services were you looking for today? | File a claim | Y | Radio button, one-up vertical | Skip Logic Group* | Disability Info | ||
| Check status of a claim | |||||||||
| Add or remove a dependent | |||||||||
| Upload evidence or documentation | |||||||||
| Add or remove a dependent | |||||||||
| View payment history | |||||||||
| Other | B2 | ||||||||
| LAB6991Q029 | B2 | What other kind of Disability and Compensation information or service were you looking for today? | N | Text area, no char limit | Skip Logic Group* | OE_Disability | |||
| LAB6991Q030 | X3 | What Education and Training information or services were you looking for today? | Apply for GI Bill benefits | Y | Radio button, one-up vertical | Skip Logic Group* | Education Info | ||
| Check Post-9/11 GI Bill benefits | |||||||||
| Compare GI Bill benefits by school | |||||||||
| Change your current education benefits | |||||||||
| View payment history | |||||||||
| Other | B3 | ||||||||
| LAB6991Q031 | B3 | What other kind of Education and Training information or service were you looking for today? | N | Text area, no char limit | Skip Logic Group* | OE_Education | |||
| LAB6991Q032 | X4 | What Careers and Employment information or services were you looking for today? | Get career or employment assistance | Y | Radio button, one-up vertical | Skip Logic Group* | Careers Info | ||
| Apply for vocational rehab and employment benefits | |||||||||
| Education and career counseling | |||||||||
| Resources for family members | |||||||||
| Other | B4 | ||||||||
| LAB6991Q033 | B4 | What other kind of Careers and Employment information or service were you looking for today? | N | Text area, no char limit | Skip Logic Group* | OE_Careers | |||
| LAB6991Q034 | X5 | What Pension information or services were you looking for today? | Apply for pension benefits | Y | Radio button, one-up vertical | Skip Logic Group* | Pension Info | ||
| Eligibility Information | |||||||||
| Survivors Pension Information | |||||||||
| Manage your pension | |||||||||
| Other | B5 | ||||||||
| LAB6991Q035 | B5 | What other kind of Pension information or service were you looking for today? | N | Text area, no char limit | Skip Logic Group* | OE_Pension | |||
| LAB6991Q036 | X6 | What Housing Assistance information or services were you looking for today? | VA home loan benefits | Y | Radio button, one-up vertical | Skip Logic Group* | Housing Asst Info | ||
| Veterans housing assistance programs | |||||||||
| Check housing benefits status | |||||||||
| Eligibility Information | |||||||||
| Other | B6 | ||||||||
| LAB6991Q037 | B6 | What other kind of Housing Assistance information or service were you looking for today? | N | Text area, no char limit | Skip Logic Group* | OE_Housing Assistance | |||
| LAB6991Q038 | X7 | What Life Insurance information or services were you looking for today? | Apply for VA life insurance | Y | Radio button, one-up vertical | Skip Logic Group* | Life Insurance Info | ||
| Manage policy and benefits | |||||||||
| Information and resources | |||||||||
| Other | B7 | ||||||||
| LAB6991Q039 | B7 | What other kind of Life Insurance information or service were you looking for today? | N | Text area, no char limit | Skip Logic Group* | OE_Life Insurance | |||
| LAB6991Q040 | X8 | What Burials and Memorials information or services were you looking for today? | Apply for veterans burial benefits | Y | Radio button, one-up vertical | Skip Logic Group* | Burials and Memorials Info | ||
| Planning a burial | |||||||||
| Information and resources | |||||||||
| Other | B8 | ||||||||
| LAB6991Q041 | B8 | What other kind of Burials and Memorials information or service were you looking for today? | N | Text area, no char limit | Skip Logic Group* | OE_Burials | |||
| LAB6991Q042 | X9 | What Records and Document services were you looking for today? | Apply for a Veteran ID Card (VIC) | Y | Radio button, one-up vertical | Skip Logic Group* | Records Info | ||
| Request military records (DD214) | |||||||||
| Get medical records | |||||||||
| Download VA benefit letters | |||||||||
| Apply for a discharge upgrade | |||||||||
| Search historical military records | |||||||||
| Other | B9 | ||||||||
| LAB6991Q043 | B9 | What other kind of Records and Document service were you looking for today? | N | Text area, no char limit | Skip Logic Group* | OE_Records | |||
| HAJ6991Q013 | Did you find what you were looking for today? | Yes | Yes | Radio button, one-up vertical | Skip Logic Group* | Task Accomplishment | |||
| No | A | ||||||||
| HAJ6991Q014 | A | What were you unable to find during your visit today? | N | Text area, no char limit | Skip Logic Group* | OE_Unable to find | |||
| HAJ6991Q021 | Please select your age range. | 17 or under | Y | Radio button, one-up vertical | Age | ||||
| 18-24 | |||||||||
| 25-34 | |||||||||
| 35-44 | |||||||||
| 45-54 | |||||||||
| 55-64 | |||||||||
| 65-74 | |||||||||
| 75-84 | |||||||||
| 85+ | |||||||||
| I'd prefer not to answer | |||||||||
| HAJ6991Q022 | Please select your gender. | Female | Y | Radio button, one-up vertical | Gender | ||||
| Male | |||||||||
| I'd prefer not to answer | |||||||||
Sheet 5: CQs (11-7-18)
| Model Name | VA Main V2 |
|
|||||||
| Model ID | FgowBUAkEoAdMFBUwNF4Zg4C | Underlined & Italicized: Re-order | |||||||
| Partitioned | 2 MQ | Pink: Addition | |||||||
| Date | 8/1/2018 | Blue: Reword | |||||||
| QID | QUESTION META TAG | Skip From | Question Text | Answer Choices | Skip To | Required Y/N |
Type | Special Instructions | CQ Label |
| HAJ6991Q001 | How often do you visit the Veterans Affairs website (www.va.gov)? | This is my first time | Y | Radio button, one-up vertical | Skip Logic Group* | Visit Frequency | |||
| More than once a day | A | ||||||||
| About once a day | A | ||||||||
| About once a week | A | ||||||||
| About once a month | A | ||||||||
| Every 6 months or less | A | ||||||||
| A | During your visit today, did you notice the redesign of the va.gov site? | Yes | B, C | Y | Radio button, one-up vertical | Skip Logic Group* | New Site Notice Redesign | ||
| No | |||||||||
| B | How does the new site compare to the previous design? | The new design is better | Y | Radio button, one-up vertical | Skip Logic Group* | New Site Comparison | |||
| About the same | |||||||||
| The new design is worse | B1 | ||||||||
| Unsure / Did not notice a change | |||||||||
| B1 | Please tell us why you feel the new design is worse than the previous site. | N | Text area, no char limit | Skip Logic Group* | OE_Site Inferior | ||||
| C | Please tell us whether you agree or disagree with the following statement: The new site makes it easier to complete my task. |
Strongly Agree | Y | Radio button, one-up vertical | Skip Logic Group* | New Site Task | |||
| Agree | |||||||||
| Neutral / Unsure | |||||||||
| Disagree | C1 | ||||||||
| Strongly Disagree | C1 | ||||||||
| Don't know | |||||||||
| C1 | Please tell us what would make your task easier to complete. | N | Text area, no char limit | Skip Logic Group* | OE_Easier Task | ||||
| HAJ6991Q002 | Which of the following describe you? Please select all that apply. | Veteran | B, D | Y | Checkbox, one-up vertical | Skip Logic Group* | Best describes you | ||
| Active duty | |||||||||
| Dependent or beneficiary of a veteran | |||||||||
| Spouse / relative of veteran | |||||||||
| Other | |||||||||
| HAJ6991Q004 | B | Please check the conflict(s) in which you served. | World War II | Y | Checkbox, one-up vertical | Skip Logic Group* | Veteran Era | ||
| Korean Conflict | |||||||||
| Vietnam Era | |||||||||
| Persian Gulf War | |||||||||
| Operation Enduring Freedom | |||||||||
| Operation Iraqi Freedom | |||||||||
| Operation New Dawn | |||||||||
| No conflict / war service | Mutually Exclusive | ||||||||
| HAJ6991Q005 | D | Did you serve in a combat role during your period of service? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | CombatService | ||
| No | |||||||||
| LAB6991Q023 | Did you visit any other Department of Veterans Affairs websites today? (Please select all that apply.) | Local Medical Center Website | Y | Checkbox, one-up vertical | Skip Logic Group* | VA Websites | |||
| Veterans Health Administration | |||||||||
| Veterans Benefits Administration | |||||||||
| National Cemetery Administration | |||||||||
| My HealtheVet | |||||||||
| eBenefits | |||||||||
| Vets.gov | |||||||||
| VA for Vets | |||||||||
| Explore VA | |||||||||
| Visited another Department of Veterans Affairs website not listed above | B | ||||||||
| Did not visit any other Department of Veterans Affairs websites today | Mutually Exclusive | ||||||||
| Don't know | Mutually Exclusive | ||||||||
| HAJ6991Q009 | B | What other Department of Veterans Affairs website did you access today? | N | Text area, no char limit | Skip Logic Group* | OE_VA Websites | |||
| HAJ6991Q010 | Where do you live? | Alabama | Y | Drop down, select one | Reside | ||||
| Alaska | |||||||||
| American Samoa | |||||||||
| Arizona | |||||||||
| Arkansas | |||||||||
| California | |||||||||
| Colorado | |||||||||
| Connecticut | |||||||||
| Delaware | |||||||||
| District of Columbia | |||||||||
| Florida | |||||||||
| Georgia | |||||||||
| Guam | |||||||||
| Hawaii | |||||||||
| Idaho | |||||||||
| Illinois | |||||||||
| Indiana | |||||||||
| Iowa | |||||||||
| Kansas | |||||||||
| Kentucky | |||||||||
| Louisiana | |||||||||
| Maine | |||||||||
| Maryland | |||||||||
| Massachusetts | |||||||||
| Michigan | |||||||||
| Minnesota | |||||||||
| Minor Outlying Islands | |||||||||
| Mississippi | |||||||||
| Missouri | |||||||||
| Montana | |||||||||
| Nebraska | |||||||||
| Nevada | |||||||||
| New Hampshire | |||||||||
| New Jersey | |||||||||
| New Mexico | |||||||||
| New York | |||||||||
| North Carolina | |||||||||
| North Dakota | |||||||||
| Northern Mariana Islands | |||||||||
| Ohio | |||||||||
| Oklahoma | |||||||||
| Oregon | |||||||||
| Pennsylvania | |||||||||
| Puerto Rico | |||||||||
| Rhode Island | |||||||||
| South Carolina | |||||||||
| South Dakota | |||||||||
| Tennessee | |||||||||
| Texas | |||||||||
| U.S. Virgin Islands | |||||||||
| Utah | |||||||||
| Vermont | |||||||||
| Virginia | |||||||||
| Washington | |||||||||
| West Virginia | |||||||||
| Wisconsin | |||||||||
| Wyoming | |||||||||
| Canada | |||||||||
| I live elsewhere | |||||||||
| LAB6991Q024 | Which category best describes the kind of information or services you were primarily looking for today? | Health Care | X1 | Y | Radio button, one-up vertical | Skip Logic Group* | Kind of Information | ||
| Disability and Compensation | X2 | ||||||||
| Education and Training | X3 | ||||||||
| Careers and Employment | X4 | ||||||||
| Pension | X5 | ||||||||
| Housing Assistance | X6 | ||||||||
| Life insurance | X7 | ||||||||
| Burials and Memorials | X8 | ||||||||
| Personal Records and Documents | X9 | ||||||||
| Family and Caregiver Benefits | |||||||||
| Servicemember Benefits | |||||||||
| VA Offices, Policy, and News | |||||||||
| Other | X11 | ||||||||
| LAB6991Q025 | X11 | What other kind of information or service were you looking for today? | N | Text area, no char limit | Skip Logic Group* | OE_Info or Service | |||
| LAB6991Q026 | X1 | What Health Care information or services were you looking for today? | Apply for Health Care | Y | Radio button, one-up vertical | Skip Logic Group* | Health Care Info | ||
| Refill or track prescriptions | |||||||||
| Send a message to your healthcare team | |||||||||
| Schedule or view appointments | |||||||||
| View lab or test results | |||||||||
| Other | B1 | ||||||||
| LAB6991Q027 | B1 | What other kind of Health Care information or service were you looking for today? | N | Text area, no char limit | Skip Logic Group* | OE_Health Care | |||
| LAB6991Q028 | X2 | What Disability and Compensation information or services were you looking for today? | File a claim | Y | Radio button, one-up vertical | Skip Logic Group* | Disability Info | ||
| Check status of a claim | |||||||||
| Add or remove a dependent | |||||||||
| Upload evidence or documentation | |||||||||
| Add or remove a dependent | |||||||||
| View payment history | |||||||||
| Other | B2 | ||||||||
| LAB6991Q029 | B2 | What other kind of Disability and Compensation information or service were you looking for today? | N | Text area, no char limit | Skip Logic Group* | OE_Disability | |||
| LAB6991Q030 | X3 | What Education and Training information or services were you looking for today? | Apply for GI Bill benefits | Y | Radio button, one-up vertical | Skip Logic Group* | Education Info | ||
| Check Post-9/11 GI Bill benefits | |||||||||
| Compare GI Bill benefits by school | |||||||||
| Change your current education benefits | |||||||||
| View payment history | |||||||||
| Other | B3 | ||||||||
| LAB6991Q031 | B3 | What other kind of Education and Training information or service were you looking for today? | N | Text area, no char limit | Skip Logic Group* | OE_Education | |||
| LAB6991Q032 | X4 | What Careers and Employment information or services were you looking for today? | Get career or employment assistance | Y | Radio button, one-up vertical | Skip Logic Group* | Careers Info | ||
| Apply for vocational rehab and employment benefits | |||||||||
| Education and career counseling | |||||||||
| Resources for family members | |||||||||
| Other | B4 | ||||||||
| LAB6991Q033 | B4 | What other kind of Careers and Employment information or service were you looking for today? | N | Text area, no char limit | Skip Logic Group* | OE_Careers | |||
| LAB6991Q034 | X5 | What Pension information or services were you looking for today? | Apply for pension benefits | Y | Radio button, one-up vertical | Skip Logic Group* | Pension Info | ||
| Eligibility Information | |||||||||
| Survivors Pension Information | |||||||||
| Manage your pension | |||||||||
| Other | B5 | ||||||||
| LAB6991Q035 | B5 | What other kind of Pension information or service were you looking for today? | N | Text area, no char limit | Skip Logic Group* | OE_Pension | |||
| LAB6991Q036 | X6 | What Housing Assistance information or services were you looking for today? | VA home loan benefits | Y | Radio button, one-up vertical | Skip Logic Group* | Housing Asst Info | ||
| Veterans housing assistance programs | |||||||||
| Check housing benefits status | |||||||||
| Eligibility Information | |||||||||
| Other | B6 | ||||||||
| LAB6991Q037 | B6 | What other kind of Housing Assistance information or service were you looking for today? | N | Text area, no char limit | Skip Logic Group* | OE_Housing Assistance | |||
| LAB6991Q038 | X7 | What Life Insurance information or services were you looking for today? | Apply for VA life insurance | Y | Radio button, one-up vertical | Skip Logic Group* | Life Insurance Info | ||
| Manage policy and benefits | |||||||||
| Information and resources | |||||||||
| Other | B7 | ||||||||
| LAB6991Q039 | B7 | What other kind of Life Insurance information or service were you looking for today? | N | Text area, no char limit | Skip Logic Group* | OE_Life Insurance | |||
| LAB6991Q040 | X8 | What Burials and Memorials information or services were you looking for today? | Apply for veterans burial benefits | Y | Radio button, one-up vertical | Skip Logic Group* | Burials and Memorials Info | ||
| Planning a burial | |||||||||
| Information and resources | |||||||||
| Other | B8 | ||||||||
| LAB6991Q041 | B8 | What other kind of Burials and Memorials information or service were you looking for today? | N | Text area, no char limit | Skip Logic Group* | OE_Burials | |||
| LAB6991Q042 | X9 | What Records and Document services were you looking for today? | Apply for a Veteran ID Card (VIC) | Y | Radio button, one-up vertical | Skip Logic Group* | Records Info | ||
| Request military records (DD214) | |||||||||
| Get medical records | |||||||||
| Download VA benefit letters | |||||||||
| Apply for a discharge upgrade | |||||||||
| Search historical military records | |||||||||
| Other | B9 | ||||||||
| LAB6991Q043 | B9 | What other kind of Records and Document service were you looking for today? | N | Text area, no char limit | Skip Logic Group* | OE_Records | |||
| HAJ6991Q013 | Did you find what you were looking for today? | Yes | Yes | Radio button, one-up vertical | Skip Logic Group* | Task Accomplishment | |||
| No | A | ||||||||
| HAJ6991Q014 | A | What were you unable to find during your visit today? | N | Text area, no char limit | Skip Logic Group* | OE_Unable to find | |||
| HAJ6991Q021 | Please select your age range. | 17 or under | Y | Radio button, one-up vertical | Age | ||||
| 18-24 | |||||||||
| 25-34 | |||||||||
| 35-44 | |||||||||
| 45-54 | |||||||||
| 55-64 | |||||||||
| 65-74 | |||||||||
| 75-84 | |||||||||
| 85+ | |||||||||
| I'd prefer not to answer | |||||||||
| HAJ6991Q022 | Please select your gender. | Female | Y | Radio button, one-up vertical | Gender | ||||
| Male | |||||||||
| I'd prefer not to answer | |||||||||
Sheet 6: CQs (10-5-18)
| Model Name | VA Main V2 |
|
|||||||
| Model ID | FgowBUAkEoAdMFBUwNF4Zg4C | Underlined & Italicized: Re-order | |||||||
| Partitioned | 2 MQ | Pink: Addition | |||||||
| Date | 8/1/2018 | Blue: Reword | |||||||
| QID | QUESTION META TAG | Skip From | Question Text | Answer Choices | Skip To | Required Y/N |
Type | Special Instructions | CQ Label |
| HAJ6991Q001 | How often do you visit the Veterans Affairs website (www.va.gov)? | This is my first time | Y | Radio button, one-up vertical | Skip Logic Group* | Visit Frequency | |||
| More than once a day | |||||||||
| About once a day | |||||||||
| About once a week | |||||||||
| About once a month | |||||||||
| Every 6 months or less | |||||||||
| HAJ6991Q002 | Which of the following describe you? Please select all that apply. | Veteran | B, D | Y | Checkbox, one-up vertical | Skip Logic Group* | Best describes you | ||
| Active duty | |||||||||
| Dependent or beneficiary of a veteran | |||||||||
| Spouse / relative of veteran | |||||||||
| Other | |||||||||
| HAJ6991Q004 | B | Please check the conflicts(s) in which you served. | World War II | Y | Checkbox, one-up vertical | Skip Logic Group* | Veteran Era | ||
| Korean Conflict | |||||||||
| Vietnam Era | |||||||||
| Persian Gulf War | |||||||||
| Operation Enduring Freedom | |||||||||
| Operation Iraqi Freedom | |||||||||
| Operation New Dawn | |||||||||
| No conflict / war service | Mutually Exclusive | ||||||||
| HAJ6991Q005 | D | Did you serve in a combat role during your period of service? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | CombatService | ||
| No | |||||||||
| Did you visit any other Department of Veterans Affairs websites today? (Please select all that apply.) | Local Medical Center Website | Y | Checkbox, one-up vertical | Skip Logic Group* | VA Websites | ||||
| Veterans Health Administration | |||||||||
| Veterans Benefits Administration | |||||||||
| National Cemetery Administration | |||||||||
| My HealtheVet | |||||||||
| eBenefits | |||||||||
| Vets.gov | |||||||||
| VA for Vets | |||||||||
| Explore VA | |||||||||
| Visited another Department of Veterans Affairs website not listed above | B | ||||||||
| Did not visit any other Department of Veterans Affairs websites today | Mutually Exclusive | ||||||||
| Don't know | Mutually Exclusive | ||||||||
| HAJ6991Q009 | B | What other Department of Veterans Affairs website did you access today? | N | Text area, no char limit | Skip Logic Group* | OE_VA Websites | |||
| HAJ6991Q010 | Where do you live? | Alabama | Y | Drop down, select one | Reside | ||||
| Alaska | |||||||||
| American Samoa | |||||||||
| Arizona | |||||||||
| Arkansas | |||||||||
| California | |||||||||
| Colorado | |||||||||
| Connecticut | |||||||||
| Delaware | |||||||||
| District of Columbia | |||||||||
| Florida | |||||||||
| Georgia | |||||||||
| Guam | |||||||||
| Hawaii | |||||||||
| Idaho | |||||||||
| Illinois | |||||||||
| Indiana | |||||||||
| Iowa | |||||||||
| Kansas | |||||||||
| Kentucky | |||||||||
| Louisiana | |||||||||
| Maine | |||||||||
| Maryland | |||||||||
| Massachusetts | |||||||||
| Michigan | |||||||||
| Minnesota | |||||||||
| Minor Outlying Islands | |||||||||
| Mississippi | |||||||||
| Missouri | |||||||||
| Montana | |||||||||
| Nebraska | |||||||||
| Nevada | |||||||||
| New Hampshire | |||||||||
| New Jersey | |||||||||
| New Mexico | |||||||||
| New York | |||||||||
| North Carolina | |||||||||
| North Dakota | |||||||||
| Northern Mariana Islands | |||||||||
| Ohio | |||||||||
| Oklahoma | |||||||||
| Oregon | |||||||||
| Pennsylvania | |||||||||
| Puerto Rico | |||||||||
| Rhode Island | |||||||||
| South Carolina | |||||||||
| South Dakota | |||||||||
| Tennessee | |||||||||
| Texas | |||||||||
| U.S. Virgin Islands | |||||||||
| Utah | |||||||||
| Vermont | |||||||||
| Virginia | |||||||||
| Washington | |||||||||
| West Virginia | |||||||||
| Wisconsin | |||||||||
| Wyoming | |||||||||
| Canada | |||||||||
| I live elsewhere | |||||||||
| Which category best describes the kind of information or services you were primarily looking for today? | Health Care | X1 | Y | Radio button, one-up vertical | Skip Logic Group* | Kind of Information | |||
| Disability and Compensation | X2 | ||||||||
| Education and Training | X3 | ||||||||
| Careers and Employment | X4 | ||||||||
| Pension | X5 | ||||||||
| Housing Assistance | X6 | ||||||||
| Life insurance | X7 | ||||||||
| Burials and Memorials | X8 | ||||||||
| Personal Records and Documents | X9 | ||||||||
| Family and Caregiver Benefits | |||||||||
| Servicemember Benefits | |||||||||
| VA Offices, Policy, and News | |||||||||
| Other | X11 | ||||||||
| X11 | What other kind of information or service were you looking for today? | N | Text area, no char limit | Skip Logic Group* | OE_Info or Service | ||||
| X1 | What Health Care information or services were you looking for today? | Apply for Health Care | Y | Radio button, one-up vertical | Skip Logic Group* | Health Care Info | |||
| Refill or track prescriptions | |||||||||
| Send a message to your healthcare team | |||||||||
| Schedule or view appointments | |||||||||
| View lab or test results | |||||||||
| Other | B1 | ||||||||
| B1 | What other kind of Health Care information or service were you looking for today? | N | Text area, no char limit | Skip Logic Group* | OE_Health Care | ||||
| X2 | What Disability and Compensation information or services were you looking for today? | File a claim | Y | Radio button, one-up vertical | Skip Logic Group* | Disability Info | |||
| Check status of a claim | |||||||||
| Add or remove a dependent | |||||||||
| Upload evidence or documentation | |||||||||
| Add or remove a dependent | |||||||||
| View payment history | |||||||||
| Other | B2 | ||||||||
| B2 | What other kind of Disability and Compensation information or service were you looking for today? | N | Text area, no char limit | Skip Logic Group* | OE_Disability | ||||
| X3 | What Education and Training information or services were you looking for today? | Apply for GI Bill benefits | Y | Radio button, one-up vertical | Skip Logic Group* | Education Info | |||
| Check Post-9/11 GI Bill benefits | |||||||||
| Compare GI Bill benefits by school | |||||||||
| Change your current education benefits | |||||||||
| View payment history | |||||||||
| Other | B3 | ||||||||
| B3 | What other kind of Education and Training information or service were you looking for today? | N | Text area, no char limit | Skip Logic Group* | OE_Education | ||||
| X4 | What Careers and Employment information or services were you looking for today? | Get career or employment assistance | Y | Radio button, one-up vertical | Skip Logic Group* | Careers Info | |||
| Apply for vocational rehab and employment benefits | |||||||||
| Education and career counseling | |||||||||
| Resources for family members | |||||||||
| Other | B4 | ||||||||
| B4 | What other kind of Careers and Employment information or service were you looking for today? | N | Text area, no char limit | Skip Logic Group* | OE_Careers | ||||
| X5 | What Pension information or services were you looking for today? | Apply for pension benefits | Y | Radio button, one-up vertical | Skip Logic Group* | Pension Info | |||
| Eligibility Information | |||||||||
| Survivors Pension Information | |||||||||
| Manage your pension | |||||||||
| Other | B5 | ||||||||
| B5 | What other kind of Pension information or service were you looking for today? | N | Text area, no char limit | Skip Logic Group* | OE_Pension | ||||
| X6 | What Housing Assistance information or services were you looking for today? | VA home loan benefits | Y | Radio button, one-up vertical | Skip Logic Group* | Housing Asst Info | |||
| Veterans housing assistance programs | |||||||||
| Check housing benefits status | |||||||||
| Eligibility Information | |||||||||
| Other | B6 | ||||||||
| B6 | What other kind of Housing Assistance information or service were you looking for today? | N | Text area, no char limit | Skip Logic Group* | OE_Housing Assistance | ||||
| X7 | What Life Insurance information or services were you looking for today? | Apply for VA life insurance | Y | Radio button, one-up vertical | Skip Logic Group* | Life Insurance Info | |||
| Manage policy and benefits | |||||||||
| Information and resources | |||||||||
| Other | B7 | ||||||||
| B7 | What other kind of Life Insurance information or service were you looking for today? | N | Text area, no char limit | Skip Logic Group* | OE_Housing Assistance | ||||
| X8 | What Burials and Memorials information or services were you looking for today? | Apply for veterans burial benefits | Y | Radio button, one-up vertical | Skip Logic Group* | Burials and Memorials Info | |||
| Planning a burial | |||||||||
| Information and resources | |||||||||
| Other | B8 | ||||||||
| B8 | What other kind of Burials and Memorials information or service were you looking for today? | N | Text area, no char limit | Skip Logic Group* | OE_Burials | ||||
| X9 | What Records and Document services were you looking for today? | Apply for a Veteran ID Card (VIC) | Y | Radio button, one-up vertical | Skip Logic Group* | Records Info | |||
| Request military records (DD214) | |||||||||
| Get medical records | |||||||||
| Download VA benefit letters | |||||||||
| Apply for a discharge upgrade | |||||||||
| Search historical military records | |||||||||
| Other | B9 | ||||||||
| B9 | What other kind of Records and Document service were you looking for today? | N | Text area, no char limit | Skip Logic Group* | OE_Records | ||||
| HAJ6991Q013 | Did you find what you were looking for today? | Yes | Yes | Radio button, one-up vertical | Skip Logic Group* | Task Accomplishment | |||
| No | A | ||||||||
| HAJ6991Q014 | A | What were you unable to find during your visit today? | N | Text area, no char limit | Skip Logic Group* | OE_Unable to find | |||
| HAJ6991Q021 | Please select your age range. | 17 or under | Y | Radio button, one-up vertical | Age | ||||
| 18-24 | |||||||||
| 25-34 | |||||||||
| 35-44 | |||||||||
| 45-54 | |||||||||
| 55-64 | |||||||||
| 65-74 | |||||||||
| 75-84 | |||||||||
| 85+ | |||||||||
| I'd prefer not to answer | |||||||||
| HAJ6991Q022 | Please select your gender. | Female | Y | Radio button, one-up vertical | Gender | ||||
| Male | |||||||||
| I'd prefer not to answer | |||||||||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |
© 2024 OMB.report | Privacy Policy