ADSS_Supplemental_Survey_Instrument

OMB CONTROL NUMBER: 0704-0604

OMB EXPIRATION DATE: XX/XX/XXXX

AGENCY DISCLOSURE NOTICE

The public reporting burden for this collection of information, 0704-0604, is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at [email protected]. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.

2021 Survey of Active Duty Spouses - S

BACKGROUND INFORMATION

SRMRSTS

1. What is your marital status?

1		Married
2		Separated
3		Divorced
4		Widowed

ADSPSE

2. Is your spouse currently serving on active duty (not a member of the National Guard or Reserve)?

2		Yes
1		No

LIFE IN THE MILITARY

MILSAT

3. Overall, how satisfied are you with the military way of life?

5		Very satisfied
4		Satisfied
3		Neither satisfied nor dissatisfied
2		Dissatisfied
1		Very dissatisfied

MILSTAY

4. Do you think your spouse should stay on or leave active duty?

5		I strongly favor staying
4		I somewhat favor staying
3		I have no opinion one way or the other
2		I somewhat favor leaving
1		I strongly favor leaving

YOUR COMMENTS

COMM1IMP

5. Please share what the military could do to improve support for you and your family. Do not provide any personally identifiable information.

COMMQOL

6. Please describe the top issue(s) impacting the quality of life for you and your family. Do not provide any personally identifiable information.

SUPPEMAIL

7. Please share your e-mail address and cell phone number below if you'd like to participate in future opportunities to weigh in on critical issues that impact military families.

	Email:
	Cell Phone:

THANK YOU

INELIGNODATA

8. [Ask if Q1 = "Widowed" OR Q1 = "Divorced" OR Q2 = "No"] Based on your answers to previous questions, you are ineligible to take this survey. If you feel you have encountered this message in error, click the back arrow button and check your answers.

For further help, please call our Survey Processing Center toll-free at 1-800-881-5307 or e-mail [email protected]. Do not provide any personally identifiable information.

OPA 1