PSTAP Long Survey Item Matrix 5-16-22

PSTAP Long Survey Item Matrix 5-16-22.xlsx

Post Separation TAP Assessment Survey

PSTAP Long Survey Item Matrix 5-16-22

OMB: 2900-0864

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Overview

Objectives
TAP
Employment
Education
Health and Relation
Finance
QoL and Feedback


Sheet 1: Objectives

Number Objective
1 Examine the relationship between attendance in TAP courses and the use of VA Benefits—controlling for demographic and contextual factors (for example, geographic region, age, education, etc.)
2 Analyze the effect of participation in TAP courses on the long-term outcomes of Veterans in the broad life domains of employment, education, health and social relationships, financial, and overall satisfaction and well-being—in particular, calculate change scores (such as income increase from T1 to T2), and estimate the effect of TAP and other transition activities on those scores, controlling for other factors.
3 Identify areas of improvement for TAP and the broader transition process to guide training and/or operational activities aimed at enhancing the quality of service provided to transitioning service members, Veterans, their families and caregivers.

Sheet 2: TAP

Question # Question# 2022 Question Question 2022 Response Type Response Options Response Options 2022 Topic(s) Objective(s) Type of Change Comments
1a 1a To what extent do you agree or disagree with each of the following statements about the VA TAP Benefits briefings?: Overall, the VA TAP Benefit briefings were beneficial in helping me gain the information and skills I needed to prepare me for my transition and post-military life.
Scale 1 (Strongly Disagree); 2 (Disagree); 3 (Neither Agree or Disagree); 4 (Agree); 5 (Strongly Agree); Not Applicable
TAP 1 No Change
1b 1b To what extent do you agree or disagree with each of the following statements about the VA TAP Benefits briefings?: Overall, the courses provided the information I needed for a seamless transition to post-military life.
Scale 1 (Strongly Disagree); 2 (Disagree); 3 (Neither Agree or Disagree); 4 (Agree); 5 (Strongly Agree); Not Applicable
TAP 1 No Change
1c 1c To what extent do you agree or disagree with each of the following statements about the VA TAP Benefits briefings?: Overall, I continue to use what I learned from the VA TAP Benefits and Services briefings.
Scale 1 (Strongly Disagree); 2 (Disagree); 3 (Neither Agree or Disagree); 4 (Agree); 5 (Strongly Agree); Not Applicable
TAP 1 No Change
1d 1d To what extent do you agree or disagree with each of the following statements about the VA TAP Benefits briefings?: The information provided during the VA TAP Benefit briefings courses continues to assist me in my transition to civilian employment.
Scale 1 (Strongly Disagree); 2 (Disagree); 3 (Neither Agree or Disagree); 4 (Agree); 5 (Strongly Agree); Not Applicable
TAP, Employment 1 No Change
2a 2a How knowledgeable are you about the process needed to: Apply for VA benefits
Scale 1 (Not knowledgeable at all); 2 (Not very knowledgeable); 3 (Moderately knowledgeable); 4 (Very knowledgeable); 5 (Extremely knowledgeable); Not applicable
Benefits 1,2,3 No Change
2b 2b How knowledgeable are you about the process needed to: Prepare for changes in my economic situation after service
Scale 1 (Not knowledgeable at all); 2 (Not very knowledgeable); 3 (Moderately knowledgeable); 4 (Very knowledgeable); 5 (Extremely knowledgeable); Not applicable
Employment 1,2,3 No Change
2c 2c How knowledgeable are you about the process needed to: Prepare for changes in my personal life
Scale 1 (Not knowledgeable at all); 2 (Not very knowledgeable); 3 (Moderately knowledgeable); 4 (Very knowledgeable); 5 (Extremely knowledgeable); Not applicable
Relationships 1,2,3 No Change
2d 2d How knowledgeable are you about the process needed to: Avoid potential homelessness
Scale 1 (Not knowledgeable at all); 2 (Not very knowledgeable); 3 (Moderately knowledgeable); 4 (Very knowledgeable); 5 (Extremely knowledgeable); Not applicable
Housing 1,2,3 No Change
2e 2e How knowledgeable are you about the process needed to: Apply for VA health care
Scale 1 (Not knowledgeable at all); 2 (Not very knowledgeable); 3 (Moderately knowledgeable); 4 (Very knowledgeable); 5 (Extremely knowledgeable); Not applicable
Health Care 1,2,3 No Change
2f 2f How knowledgeable are you about the process needed to: Otain mental health counseling or assistance
Scale 1 (Not knowledgeable at all); 2 (Not very knowledgeable); 3 (Moderately knowledgeable); 4 (Very knowledgeable); 5 (Extremely knowledgeable); Not applicable
Health Care 1,2,3 No Change
3a 3a In the last 12 months have you applied for these VA benefits, or do you plan to apply in the future?: VA Disability Compensation
Select One No; Yes, you applied in the last 12 months; Yes, you plan to apply; Did not know about this benefit; Not sure
Benefits 1,2,3 No Change
3b 3b In the last 12 months have you applied for these VA benefits, or do you plan to apply in the future?: VA Education (e.g., post 9/11 GI Bill, Montgomery Bill, etc.)
Select One No; Yes, you applied in the last 12 months; Yes, you plan to apply; Did not know about this benefit; Not sure
Benefits, Education 1,2,3 No Change
3c 3c In the last 12 months have you applied for these VA benefits, or do you plan to apply in the future?: VA Life Insurance (e.g., Veteran Group Life Insurance)
Select One No; Yes, you applied in the last 12 months; Yes, you plan to apply; Did not know about this benefit; Not sure
Benefits 1,2,3 No Change
3d 3d In the last 12 months have you applied for these VA benefits, or do you plan to apply in the future?: VA Home Loans
Select One No; Yes, you applied in the last 12 months; Yes, you plan to apply; Did not know about this benefit; Not sure
Benefits, Housing 1,2,3 No Change
3e 3e In the last 12 months have you applied for these VA benefits, or do you plan to apply in the future?: VA Vocational Rehabilitation & Employment In the last 12 months have you applied for these VA benefits, or do you plan to apply in the future?: VA Veteran Readiness and Employment (formerly known as Vocational Rehabilitation and Employment Select One No; Yes, you applied in the last 12 months; Yes, you plan to apply; Did not know about this benefit; Not sure
Benefits, Employment 1,2,3 Wording change
3f 3f In the last 12 months have you applied for these VA benefits, or do you plan to apply in the future?: VA Health Care
Select One No; Yes, you applied in the last 12 months; Yes, you plan to apply; Did not know about this benefit; Not sure
Benefits, Health Care 1,2,3 No Change
4 4 In the past 12 months, how useful has the information you received during the VA TAP Benefits briefings?
Select One a)Not useful
b)Somewhat not useful
c)Neutral
d)Somewhat useful
e)Extremely useful
f)Not Applicable
a)Not useful at all
b)Not very useful
c)Neutral
d)Somewhat useful
e)Extremely useful
f)Not applicable
TAP 1 No Change

Sheet 3: Employment

Question # Question# 2022 Question Question 2022 Response Type Response Options Response Options 2022 Topic(s) Objective(s) Type of Change Comments
5a 5a In the last 12 months, how challenging have the following areas been for you as you continue your transition into civilian life?: Managing my expectations about the salary earned in a civilian job.
Scale 1 (Not at all challenging); 2 (A little challenging); 3 (Moderately challenging); 4 (Very challenging); 5 (Extremely challenging); Not Applicable; Prefer not to answer
Employment, Job Search 1,2 Wording change
5b 5b In the last 12 months, how challenging have the following areas been for you as you continue your transition into civilian life?: Knowing the steps in conducting a job search.
Scale 1 (Not at all challenging); 2 (A little challenging); 3 (Moderately challenging); 4 (Very challenging); 5 (Extremely challenging); Not Applicable; Prefer not to answer
Employment, Job Search 1, 2 No Change
5c 5c In the last 12 months, how challenging have the following areas been for you as you continue your transition into civilian life?: Understanding how my military experiences translate to civilian job requirements.
Scale 1 (Not at all challenging); 2 (A little challenging); 3 (Moderately challenging); 4 (Very challenging); 5 (Extremely challenging); Not Applicable; Prefer not to answer
Employment, Job Search 1, 2 No Change
5d 5d In the last 12 months, how challenging have the following areas been for you as you continue your transition into civilian life?: Adapting to differences between military and civilian workforce cultures, norms, and behaviors.
Scale 1 (Not at all challenging); 2 (A little challenging); 3 (Moderately challenging); 4 (Very challenging); 5 (Extremely challenging); Not Applicable; Prefer not to answer
Employment, Relationships 1, 2 No Change
5e 5e In the last 12 months, how challenging have the following areas been for you as you continue your transition into civilian life?: Interacting with civilians who are not familiar with the military.
Scale 1 (Not at all challenging); 2 (A little challenging); 3 (Moderately challenging); 4 (Very challenging); 5 (Extremely challenging); Not Applicable; Prefer not to answer
Employment, Relationships 1, 2 No Change
5f 5f In the last 12 months, how challenging have the following areas been for you as you continue your transition into civilian life?: Working with civilians who share different values from me.
Scale 1 (Not at all challenging); 2 (A little challenging); 3 (Moderately challenging); 4 (Very challenging); 5 (Extremely challenging); Not Applicable; Prefer not to answer
Employment, Relationships 1, 2 No Change

5g
In the last 12 months, how challenging have the following areas been for you as you continue your transition into civilian life?: Learning to have a better work-life balance after the transition Scale
1 (Not at all challenging); 2 (A little challenging); 3 (Moderately challenging); 4 (Very challenging); 5 (Extremely challenging); Not Applicable; Prefer not to answer Employment, Relationships 1, 2 New question

5h
In the last 12 months, how challenging have the following areas been for you as you continue your transition into civilian life?: Missing the camaraderie and teamwork that was part of the military culture. Scale
2 (Not at all challenging); 2 (A little challenging); 3 (Moderately challenging); 4 (Very challenging); 5 (Extremely challenging); Not Applicable; Prefer not to answer Employment, Relationships 1, 2 New question
6 6 What is your current employment status?
Select One a)Self-employed
b)Work for a business, non-profit, or government agency (not self-employed)
c)Not employed – pursuing education/training
d)Not employed – Retired and not pursuing further employment
e)Not employed – I want to work but cannot find a job
f)Not employed – I am currently taking time off (greater than 6 months)
g)Not employed – Other Reason Please Specify
h)Prefer not to answer

Employment, Job Status 2 No Change
7 7 Please describe your current employment Please describe your current employment: Select the ONE answer that best describes your current employment Select One I work full-time (without an additional part-time job)
I work full time, and have an additional part time job
I don’t have a full-time job, I work part-time by choice
I work part-time at one job, but would like full-time employment
I work part-time at more than one job, but would like full-time employment
I work full-time (without an additional part-time job)
I work full-time, and have an additional part-time job
I don’t have a full-time job, I work part-time by choice
I work part-time at one job, but would like full-time employment
I work part-time at more than one job, but would like full-time employment
Employment, Job Status 2 Wording change Response Options changed
8 8 Are you currently working in a permanent position or one that is temporary or seasonal?
Select One a)Permanent
b)Temporary or Seasonal

Employment, Job Status 2 No Change
9 9 Do you currently work more than one job?
Select One a)Yes
b)No

Employment, Job Status 2 No Change
10 10 Why do you work more than one job
Select One a)By choice
b)Could not find a full-time job
c)Because one job did not provide enough for myself and/or my family

Employment, Job Status 2 No Change
11 11 In the last 12 months, did you receive a promotion or raise with your current employer?
Select One a)Promotion
b)Raise
c)Did not receive a promotion or raise

Employment 2 No Change
12 12 How well does your current job match with the skills you have built through your military service?
Select One a)Does not match skillset
b)Does not match skillset because I wanted to pursue a different line of work
c)Slightly matches
d)Somewhat matches
e)Considerably matches
f)Completely matches my skillset

Employment 2 No Change
13 13 During the last 12 months, have you engaged in any entrepreneurial activities? During the last 12 months, have you engaged in any entrepreneurial (e.g., starting your own business) activities?  Select One a)Yes, own my own company and have ____ (list # of employees excluding myself)
b)Yes, have a side-business, gig, or work as a contractor (e.g., work for Uber, Task Rabbit, etc.)
c)Yes, have taken tangible steps to start a business during the last 12 months (by myself or with others)
d)No

Employment, Job Status 1, 2 Wording change
14 14 In the last 12 months have you quit, resigned, or been laid off from a job? In the last 12 months, were you let go or laid off from a job? Select One a)Yes, I quit or resigned from a job
b)Yes, was let go from a job
c)Yes, I was laid off
d)No
Yes, was let go or laid off from a job
No
Employment, Job Status 2 Wording change

15
In the last 12 months, have you quit or resigned from a job? Select One
Yes, I quit or resigned from a job
No
Employment, Job Status 2 New question Added in order to understand how someone lost/left their job
15 16 Please rank your top three reasons you quit or resigned? Please rank your top three reasons you quit or resigned? Please rank up to three reasons for quitting or resigning by placing a 1, 2, and 3 in the boxes below with one being the primary or most important reason for resigning Rank 1,2,3 a)Higher pay
b)Better fit for my skills and abilities
c)Want a permanent position
d)Job satisfaction/better work environment
e)Something more interesting
f)More flexible schedule
g)Better training and educational opportunities
h)Better hours
i)Want more hours/full-time position
j)More opportunities for advancement
k)Shorter commute
l)Prefer not to answer

Employment, Job Status 2, 3 Wording change
16 17 Are you actively looking for a new job?
Yes/ No a)Yes
b)No

Employment 2 No Change
17 18 What are the primary reasons you are looking for another job What are the primary reasons you are looking for another job? Please rank up to three reasons for looking for another job by placing a 1, 2, and 3 in the boxes below with one being the primary or most important reason for looking for another job. Rank 1,2,3 a)Higher pay
b)Better fit for my skills and abilities
c)Want a permanent position
d)Job satisfaction/better work environment
e)Something more interesting
f)More flexible schedule
g)Better training and educational opportunities
h)Better hours
i)Want more hours/full-time position
j)More opportunities for advancement
k)Shorter commute
l)Prefer not to answer

Employment, Quality of Life 2, 3 Wording change
18a 19a In the past 12 months have you enrolled, registered, or established a profile or online account with any of the following?: VA Health Care System (e.g., myHealtheVet.gov)
Select One Enrolled/ registered in the past 12 months; Enrolled/ registered prior to past 12 months; Used services in the past 12 months; Used services prior to past 12 months; Never used; Not Applicable
Employment, Job Search 1, 2, 3 No Change
18b 19b In the past 12 months have you enrolled, registered, or established a profile or online account with any of the following?: Department of Labor’s American Job Center
Select One Enrolled/ registered in the past 12 months; Enrolled/ registered prior to past 12 months; Used services in the past 12 months; Used services prior to past 12 months; Never used; Not Applicable
Employment, Job Search 1, 2, 3 No Change
18c 19c In the past 12 months have you enrolled, registered, or established a profile or online account with any of the following?:VA Benefits Website (e.g., eBenefits)
Select One Enrolled/ registered in the past 12 months; Enrolled/ registered prior to past 12 months; Used services in the past 12 months; Used services prior to past 12 months; Never used; Not Applicable
Employment, Job Search 1, 2, 3 No Change
18d 19d In the past 12 months have you enrolled, registered, or established a profile or online account with any of the following?: Commercial job site (e.g., Indeed, LinkedIn, etc.)
Select One Enrolled/ registered in the past 12 months; Enrolled/ registered prior to past 12 months; Used services in the past 12 months; Used services prior to past 12 months; Never used; Not Applicable
Employment, Job Search 1, 2, 3 No Change
18e 19e In the past 12 months have you enrolled, registered, or established a profile or online account with any of the following?: USAJOBS (federal employment)
Multiple Choice Enrolled/ registered in the past 12 months; Enrolled/ registered prior to past 12 months; Used services in the past 12 months; Used services prior to past 12 months; Never used; Not Applicable
Employment, Job Search 1, 2, 3 No Change
19 20 In the past 12 months, did you use any of these resources to assist in obtaining employment?
Multiple Choice a)USAJOBS (e.g., federal jobs)
b)Vocational Rehabilitation and Employment (VR&E)
c)Department of Labor’s American Job Center
d)U.S. Chamber of Commerce Foundation’s Hiring Our Heroes Fast Track
e)Commercial job site (e.g., Indeed, LinkedIn, etc.)
f)Private or non-profit sector (e.g., applying directly, through a recruiter, Veteran hiring initiative, etc.)
g)Other Please specify: ______________________________________________

Employment, Job Search 1, 2, 3 No Change

Sheet 4: Education

Question # Question# 2022 Question Question 2022 Response Type Response Options Response Options 2022 Topic(s) Objective(s) Type of Change Comments
20 21 Are you currently in any education and/or training programs?
Multiple Choice a)Education at a college or university, full-time
b)Education at a college or university, part-time
c)Technical or vocational training/obtain license or certificate, full-time
d)Technical or vocational training/obtain license or certificate, part-time
e)Other Please specify: ______________________________________________
f)No

Education 2 No Change
21 22 In the past 12 months, have you engaged in an apprenticeship or internship program?
Multiple Choice a)Yes, apprenticeship
b)Yes, internship
c)No

Education 2 No Change
22 23 In the past 12 months, have you obtained any new degrees or certifications?
Yes/ No a)Yes
b)No


2 No Change
23 24 Please select all degrees and certifications you have obtained in the last 12 months.
Multiple Choice a)Trade/technical school certification/degree
b)Apprenticeship certification
c)Associate degree (e.g., AA, AS)
d)4-year college degree (e.g., BA, AB, BS)
e)Master’s degree (e.g., MA, MS, MSW, MBA)
f)Professional degree (e.g., MD, DDS, DVM, LLB, JD)
g)Doctorate degree (e.g., PhD, EdD)
h)Prefer not to answer

Education 2 No Change
24 25 Please rank the methods you are using to pay for your education/training? Please rank the methods you are using to pay for your education/training: For each method used, please rank the selections beginning with 1 for the primary method. Rank a)___Student Loans
b)___GI Bill
c)___Working part-time or full-time
d)___Scholarship
e)___Money from other sources (e.g., parents, relatives, savings, etc.)
f)___Other (e.g., VR&E, Target Foundation, etc.) Please specify: _____________________________________________
g)Prefer not to answer

Education, Finance 1, 2, 3 Wording change
25 26 If you did not choose GI Bill above, why did you not use your GI Bill to pay for your education?
Multiple Choice a)Transfer to another beneficiary
b)Saving it for future educational purposes
c)Have used all of my funds/eligibility
d)Did not know about GI Bill
e)Other, Please specify: _______________________________________
f)Not applicable

Education 1, 3 No Change
26 27 Does your current level of education allow you to pursue your career goals?
Yes/ No a)Yes
b)No

Education 2, 3 No Change
27 28 Does your current level of education allow you to meet your personal salary goals?
Yes/ No a)Yes
b)No

Education 2, 3 No Change

Sheet 5: Health and Relation

Question # Question# 2022 Question Question 2022 Response Type Response Options Response Options 2022 Topic(s) Objective(s) Type of Change Comments
28 29 Do you have an ongoing physical health condition, illness, or disability (e.g., high blood pressure, pain)?
Yes/ No a)Yes
b)No

Health Care, Quality of Life 2 No Change
29 30 Did you develop this condition within the last 12 months?
Yes/ No a)Yes
b)No

Health Care, Quality of Life 2 No Change
30 31 Are you currently seeking treatment for your physical health condition(s)?
Yes/ No a)Yes
b)No

Health Care 2 No Change
31 32 Do you have an ongoing mental/emotional health condition, illness, or disability (e.g., depression, anxiety)?
Yes/ No a)Yes
b)No

Health Care, Quality of Life 2 No Change
32 33 Did you develop this condition within the last 12 months?
Yes/ No a)Yes
b)No

Health Care, Quality of Life 2 No Change
33 34 Are you currently seeking treatment for your mental/emotional health condition(s)?
Yes/ No a)Yes
b)No

Health Care 2 No Change
34 35 Select all of the healthcare resources in which you are currently enrolled?
Multiple Choice a)Employer-provided health insurance (could be from your current or former employer, a family member’s current or former employer, or a union)
b)A plan you purchased through a healthcare exchange (e.g., Healthcare.gov, State exchange, Affordable Care Act/“Obamacare”, etc.)
c)TRICARE
d)VA
e)Medicaid
f)Medicare
g)Other government assisted health plan
h)Something else Please specify: _______________________________________
i)Prefer not to answer

Health Care 1, 3 No Change
35 36 Of the healthcare resources selected above, please select your primary source of healthcare?
Select One a)Employer-provided health insurance (could be from your current or former employer, a family member’s current or former employer, or a union)
b)A plan you purchased through a healthcare exchange (e.g., Healthcare.gov, State exchange, Affordable Care Act/“Obamacare”, etc.)
c)TRICARE
d)VA
e)Medicaid
f)Medicare
g)Other government assisted health plan
h)Something else Please specify: _______________________________________
i)Prefer not to answer

Health Care 1, 3 No Change
36a 37a Over the last three months, how satisfied have you been with: Your physical health
Scale 1 (Very Dissatisfied); 2 (Somewhat dissatisfied); 3 (Neither satisfied nor dissatisfied); 4 (Somewhat satisfied); 5 (Very satisfied)
Health Care, Quality of Life 2 No Change
36b 37b Over the last three months, how satisfied have you been with: Your emotional/mental health
Scale 1 (Very Dissatisfied); 2 (Somewhat dissatisfied); 3 (Neither satisfied nor dissatisfied); 4 (Somewhat satisfied); 5 (Very satisfied)
Health Care, Quality of Life 2 No Change
36c 37c Over the last three months, how satisfied have you been with: Your health care
Scale 1 (Very Dissatisfied); 2 (Somewhat dissatisfied); 3 (Neither satisfied nor dissatisfied); 4 (Somewhat satisfied); 5 (Very satisfied)
Health Care, Quality of Life 2 No Change
37 38 What is your marital status?
Select One a)Living with a domestic partner
b)Never married
c)Married-first and only marriage
d)Married-second or later marriage
e)Separated
f)Divorced
g)Widowed
h)Prefer not to answer

Relationships, Family 2 No Change
38 39 Are you currently in a romantic relationship?
Select One a)Currently in a relationship
b)Not currently in a relationship
c)Prefer not to answer

Relationships, Family 2 No Change
39 40 Are you a parent or have you served in a parenting role during the past three months (including both your own biological children and other children for whom you have parenting responsibilities)?
Yes/ No a)Yes
b)No
c)Prefer not to answer

Relationships, Family 2 No Change
40a 41a FAMILY: Considering the people to whom you are related by birth, marriage, adoption, spouse/significant other, etc.: How many relatives do you see or hear from at least once a month?
Scale 0 (None); 1 (One); 2 (Two); 3 (Three or Four); 4 (Five thru Eight); 5 (Nine or more); Prefer not to answer
Relationships, Family 2 No Change
40b 41b FAMILY: Considering the people to whom you are related by birth, marriage, adoption, spouse/significant other, etc.: How many relatives do you feel comfortable with talking about private matters?
Scale 0 (None); 1 (One); 2 (Two); 3 (Three or Four); 4 (Five thru Eight); 5 (Nine or more); Prefer not to answer
Relationships, Family 2 No Change
40c 41c FAMILY: Considering the people to whom you are related by birth, marriage, adoption, spouse/significant other, etc.: How many relatives do you feel close to such that you could call on them for help?
Scale 0 (None); 1 (One); 2 (Two); 3 (Three or Four); 4 (Five thru Eight); 5 (Nine or more); Prefer not to answer
Relationships, Family 2 No Change
41a 42a FRIENDSHIPS: Considering all of your friends including those who live in your neighborhood: How many friends do you see or hear from at least once a month?
Scale 0 (None); 1 (One); 2 (Two); 3 (Three or Four); 4 (Five thru Eight); 5 (Nine or more); Prefer not to answer
Relationships, Friends 2 No Change
41b 42b FRIENDSHIPS: Considering all of your friends including those who live in your neighborhood: How many friends do you feel comfortable with talking about private matters?
Scale 0 (None); 1 (One); 2 (Two); 3 (Three or Four); 4 (Five thru Eight); 5 (Nine or more); Prefer not to answer
Relationships, Friends 2 No Change
41c 42c FRIENDSHIPS: Considering all of your friends including those who live in your neighborhood: c) How many friends do you feel close to such that you could call on them for help?
Scale 0 (None); 1 (One); 2 (Two); 3 (Three or Four); 4 (Five thru Eight); 5 (Nine or more); Prefer not to answer
Relationships, Friends 2 No Change
42a 43a Please tell us a little about your sense of connection with others: How often do you feel that you lack companionship?
Scale 0 (Never); 1 (Hardly Ever); 2 (Some of the Time); 3 (Often)
Relationships, Quality of Life 2 No Change
42b 43b Please tell us a little about your sense of connection with others: How often do you feel left out?
Scale 0 (Never); 1 (Hardly Ever); 2 (Some of the Time); 3 (Often)
Relationships, Quality of Life 2 No Change
42c 43c Please tell us a little about your sense of connection with others: How often do you feel isolated from others?
Scale 0 (Never); 1 (Hardly Ever); 2 (Some of the Time); 3 (Often)
Relationships, Quality of Life 2 No Change

Sheet 6: Finance

Question # Question# 2022 Question Question 2022 Response Type Response Options Response Option 2022 Topic(s) Objective(s) Type of Change Comments
43 44 Are you able to pay for all necessary expenses each month, such as mortgage/rent, debt payments, and groceries?
Yes/ No a)Yes
b)No
c)Prefer not to answer

Income 1, 2, 3 No Change
44 45 Does your household have at least 3 months of your typical expenses set aside in case of an unexpected financial event?
Yes/ No a)Yes
b)No
c)Prefer not to answer

Financial Planning 1, 2, 3 No Change
45 46 Does your household have the insurance coverage you and/or your family would need if an unexpected financial event were to occur (e.g., disability insurance, property insurance, and/or life insurance)?
Yes/ No a)Yes
b)No
c)Prefer not to answer

Financial Planning, Benefits 1, 2, 3 No Change
46 47 Has your household begun to set aside money for retirement?
Yes/ No a)Yes
b)No
c)Prefer not to answer

Financial Planning 1, 2, 3 No Change
47 48 Is your household more than one month behind on any debt payments (e.g., mortgage or credit card)?
Select One a)No, my household is not more than one month behind in debt payments
b)Yes, my household is over one month behind in debt payments
c)Not applicable- my household does not have any debt
d)Prefer not to answer

Financial Planning, Income 1, 2, 3 No Change
48 49 What is your current living situation?
Select One a)Rent an apartment, house, or room
b)Own an apartment or house
c)Live with a friend or relative and not paying rent
d)Live in a dormitory at school
e)Live in a medical or assisted living facility, such as a hospital or rehab center
f)Live in transitional housing (e.g., a halfway house)
g)Live in a car, on the street, or in a homeless shelter
h)Somewhere else Please specify: _______________________________________
i)Prefer not to answer

Housing 2 No Change
49 50 Are you currently concerned that you will lose your housing and be unable to find stable alternative housing?
Yes/ No a)Yes
b)No
c)Prefer not to answer

Housing 2 No Change
50 52 How many people are supported by your HOUSEHOLD income, including yourself, your significant other (if you have one), and anyone else partially or fully supported by this income whether or not they live with you?
Write-in a) ____ people
b)☐ Prefer not to answer

Finance 1, 2, 3 No Change
51a 51a Please mark your expected gross annual income range, including salary, as well as any retirement income such as your military retirement, any disability payments, real estate income, and any other sources of income, before taxes are taken out. If you are not sure, please make your best guess.: Your annual income
Select one a) Less than $40,000
b) $40,000 - $70,000
c) $70,001 - $100,000
d) $100,001 - $130,000
e) $130,001-$160,000
f) $160,001 - $190,000
g) Greater than $190,001
h) Prefer not to answer

Finances 1 No Change
51b 51b Please mark your expected gross annual income range, including salary, as well as any retirement income such as your military retirement, any disability payments, real estate income, and any other sources of income, before taxes are taken out. If you are not sure, please make your best guess.: HOUSEHOLD
Include all sources of income from all earners in your household. If you do not have other sources of income, and you are the only earner, this may be the same as your income.

Select one a) Less than $40,000
b) $40,000 - $70,000
c) $70,001 - $100,000
d) $100,001 - $130,000
e) $130,001-$160,000
f) $160,001 - $190,000
g) Greater than $190,001
h) Prefer not to answer

Finances 1 No Change
52 53 During the past 12 months, did you receive unemployment compensation?
Yes/ No a)Yes
b)No

Income, Employment, Job Status 2 No Change
53 54 How many weeks of unemployment did you receive?
Write-in ______ Weeks
Income, Employment, Job Status 2 No Change

Sheet 7: QoL and Feedback

Question # Question# 2022 Question Question 2022 Response Type Response Options Response Options 2022 Topic(s) Objective(s) Type of Change Comments
54a 55a The following questions ask how satisfied you feel, on a scale from 1 to 5.
1 means you feel no satisfaction at all and 5 means you feel completely satisfied.: Thinking about your own life and personal circumstances, how satisfied are you with your life as a whole?

Scale 1; 2; 3; 4; 5; Prefer not to answer
Quality of Life 2 No Change
54b 55b The following questions ask how satisfied you feel, on a scale from 1 to 5.
1 means you feel no satisfaction at all and 5 means you feel completely satisfied.: How satisfied are with your quality of life?

Scale 1; 2; 3; 4; 5; Prefer not to answer
Quality of Life 2 No Change
54c 55c The following questions ask how satisfied you feel, on a scale from 1 to 5.
1 means you feel no satisfaction at all and 5 means you feel completely satisfied.: How satisfied are you with your health?

Scale 1; 2; 3; 4; 5; Prefer not to answer
Health Care 2 No Change
54d 55d The following questions ask how satisfied you feel, on a scale from 1 to 5.
1 means you feel no satisfaction at all and 5 means you feel completely satisfied.: How satisfied are you with your personal relationships?

Scale 1; 2; 3; 4; 5; Prefer not to answer
Relationships, Family, Friends 2 No Change
55e 55e The following questions ask how satisfied you feel, on a scale from 1 to 5.
1 means you feel no satisfaction at all and 5 means you feel completely satisfied.: How satisfied are you with feeling part of your community?

Scale 1; 2; 3; 4; 5; Prefer not to answer
Relationships, Family, Friends 2 No Change
54f 55f The following questions ask how satisfied you feel, on a scale from 1 to 5.
1 means you feel no satisfaction at all and 5 means you feel completely satisfied.: How satisfied are you with your future security?

Scale 1; 2; 3; 4; 5; Prefer not to answer
Quality of Life 2 No Change
55 56 Thinking back to your transition process, is there anything else that VA could have done then or could be doing now to help you after your service? (1,000 characters)
Write-in

TAP 1, 2, 3 No Change
File Typeapplication/vnd.openxmlformats-officedocument.spreadsheetml.sheet
File Modified0000-00-00
File Created0000-00-00

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