2900-0876-Y3 Board Hearing Survey

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OMB Number: 2900-0876
Expiration: 09/30/2023
Estimated Burden: 2 minutes

Help us serve you better.
Tell us about your experience with your Board hearing.
Please respond to the following statements on a scale of 1 (Strongly
Disagree) to 5 (Strongly Agree).

I understood what I needed to do to prepare for my hearing (for example: gathering evidence,
requesting legal aid, etc.). Required
Strongly
Disagree

Disagree

Neither Agree
nor Disagree

Agree

Strongly
Agree

1

2

3

4

5

I knew what to expect on the day of the hearing. Required
Strongly
Disagree

Disagree

Neither Agree
nor Disagree

Agree

Strongly
Agree

1

2

3

4

5

I received a hearing date in a timely fashion. Required
Strongly
Disagree

Disagree

Neither Agree
nor Disagree

Agree

Strongly
Agree

1

2

3

4

5

The Veterans Law Judge (VLJ) who held the hearing listened to me. Required
Strongly
Disagree

Disagree

Neither Agree
nor Disagree

Agree

Strongly
Agree

1

2

3

4

5

The Veterans Law Judge (VLJ) explained things to me in a way that was easy to
understand. Required
Strongly
Disagree

Disagree

Neither Agree
nor Disagree

Agree

Strongly
Agree

1

2

3

4

5

If necessary, it was clear to me how to submit new evidence following my hearing.
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 Board of Veterans’ Appeals. Required
Strongly
Disagree

Disagree

Neither Agree
nor Disagree

Agree

Strongly
Agree

1

2

3

4

5

I trust the Board of Veterans’ Appeals to fulfill our country’s commitment to Veterans
and their families. Required
Strongly
Disagree

Disagree

Neither Agree
nor Disagree

Agree

Strongly
Agree

1

2

3

4

5

In the event you cancelled, rescheduled, or did not attend your hearing, please indicate
why from the options below. Required
I had a conflict on the day of my hearing.
I did not receive enough notice of the date/time of my hearing.
I requested a different Board review option (such as direct docket or evidence docket).

My representative advised me to do so.
My representative was not able to attend the hearing with me.
I did not have adequate transportation for the day of the hearing.
There were traffic, illness or weather issues on the day of the hearing.
I forgot about my hearing.
Other

Would you like to provide additional feedback with a concern, compliment, or
recommendation about your experience receiving your Board decision? Please select
from one of the following options.
- Select your response -

Use the text box below to enter details of the additional feedback (optional). Please do
not include any personally identifiable information, Social Security Number, Veteran ID,
or medical information, but do provide details about your experience.

0/400

Would you like to volunteer your demographic information to help VA better serve you?
Yes
No

Because serving you is our top priority, if you provide feedback, you may be contacted by VA.
We are asking for this information so that you can provide compliments, recommendations, or concerns to VA.1 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 may utilize individual Veteran survey data from this survey or other sources to ensure the final
scores truly and accurately represent the experiences of Veterans. 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 2 minutes 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 which you may currently be
receiving. 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 https://www.reginfo.gov/public/do/PRAMain. Information gathered will be kept private
to the extent provided by law.

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Help VA improve its Services
We are working to better understand our customers. The following
questions are voluntary. By providing your data, your responses can
help us improve VA care and services. Thank you for your participation.

Are you Hispanic or Latino?
Yes
No

What is your race? Please select one or more.
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White

How would you describe your gender?
Male
Female
Non-Binary/ Third Gender
Prefer not to say

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Thank you for taking the time to fill out this survey. We greatly appreciate
your feedback which will help us better serve you. Please visit VA.gov to
explore benefits, resources, and information at VA.
The Veterans Crisis Line provides free, confidential support for Veterans
in crisis and their families and friends. Dial 1 (800) 273-8255 (Press 1), or
text 838255 to receive confidential support 24/7. Visit
https://www.veteranscrisisline.net/ for more information

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