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pdfECCC_DMC
V1 DRAFT
12/17/20
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: 2900-0876
Expiration: 03/31/2023
Estimated Burden: 2 minutes
Help us serve you better.
We want to hear about your recent interaction with . By indicating how much you agree or disagree with the
statements below, you directly help us improve VA services.
This survey should take approximately 2 Minutes to complete.
I waited a reasonable amount of time to speak to a Debt Counselor.
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
The Debt Counselor took a reasonable amount of time to address my need.
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
I understood the information provided by the Debt Counselor.
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
The Debt Counselor I interacted with was helpful.
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
After speaking with the Debt Counselor, I understood what would happen next with
my request.
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
I am satisfied with the overall service I received from .
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.
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
Can VA contact you about your feedback?
Yes, VA can contact me about my experience.
No, I do not want VA to contact me about my experience.
Would you like to volunteer your demographic information to help VA better serve you?
Yes [Logic proceed to Demographics page]
No [Logic skip Demographics page]
Next
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.2 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.
1
[Logic: 1). Required if Service Recovery. 2). Required unless exception.]
Privacy Policy
ECCC_DMC
V1 DRAFT
12/17/20
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: 2900-0876
Expiration: 03/31/2023
Estimated Burden: 2 minutes
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
How would you describe your race? Please select all that apply.
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
Finish
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.2 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.
1
[Logic: 1). Required if Service Recovery. 2). Required unless exception.]
Privacy Policy
ECCC_DMC
V1 DRAFT
12/17/20
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: 2900-0876
Expiration: 03/31/2023
Estimated Burden: 2 minutes
Thank you for choosing VA.
The U.S. Department of Veterans Affairs uses these surveys to collect
your feedback in order to continuously to improve your experience with
VA services.
Please visit VA.gov to explore benefits, resources, and information
at 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.2 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.
1
[Logic: 1). Required if Service Recovery. 2). Required unless exception.]
Privacy Policy
| File Type | application/pdf |
| File Modified | 2020-12-18 |
| File Created | 2020-12-18 |