VRE CH31 - Partici VRE CH31 - Participating in VR&E Survey

Clearance for A-11 Section 280 Improving Customer Experience Information Collection

VRE CH31 - Participating in VR&E Survey Wireframes

OMB: 2900-0876

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VR&E Chapter 31
V19 DRAFT <11/04/2022>
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: Dial 988 (Press 1) or
1 (800) 273-8255 (Press 1), text 838255, or visit 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: 5 Minutes

Help us serve you better.
We want to hear about your experience participating in the Veteran
Readiness & Employment (VR&E) Program, also known as Chapter 31.
By responding to this survey, you will directly help us improve the
program and provide better support to Veterans like you. Your ability to
become employed and live independently is important to us!
This survey should take approximately 5 minutes to complete.
What are the three most important qualities in making a VR&E counselor collaborative and
consultative? Select up to three [limit to three selections]
[Logic: If more than 3 selected, show error message at top of page and inline.]

Prompt in responding to me and my requests
Knowledgeable about which VR&E services I am eligible and bestsuited for
Establishes a good rapport with me
Listens to my concerns
Provides valuable guidance based on my needs
X Error: You may only select up to 3 choices

What factors might contribute to Veterans in VR&E being unsure about what tools,
resources, and services VR&E will provide to them? [select all that apply]
Lack of clear communication
Not enough information overall
Lack of specific options that might be appropriate for a specific Veteran
Not using written or visual materials to explain options
Too much information is provided at one time

This feature is important to VR&E:
Option to select employment goals or independent living goals
Strongly
Disagree
1

Disagree

Neither Agree
nor Disagree

Agree

2

3

4

Strongly
Agree

Not Applicable
(N/A)

5

This feature is important to VR&E:
Option to select a training facility and/or apprenticeships/on-the-job training site
Strongly
Disagree
1

Disagree

Neither Agree
nor Disagree

Agree

2

3

4

Strongly
Agree

Not Applicable
(N/A)

5

This feature is important to VR&E:
Training on how to become employed
Strongly
Disagree
1

Disagree

Neither Agree
nor Disagree

Agree

2

3

4

Strongly
Agree

Not Applicable
(N/A)

5

This feature is important to VR&E:
Identifying activities to encourage me to reach my employment goals or independent
living goals
Strongly
Disagree

Disagree

Neither Agree
nor Disagree

Agree

Strongly
Agree

1

2

3

4

5

Not Applicable
(N/A)

Please indicate your satisfaction with the following:
My counselor shows empathy and concern for me as a person
Very
Dissatisfied

Dissatisfied

Neutral

Satisfied

Very
Satisfied

1

2

3

4

5

Not Applicable
(N/A)

Please indicate your satisfaction with the following:
My counselor actively participates in my VR&E experience
Very
Dissatisfied

Dissatisfied

Neutral

Satisfied

Very
Satisfied

1

2

3

4

5

Not Applicable
(N/A)

Please indicate your satisfaction with the following:
My counselor is prompt in responding to me
Very
Dissatisfied

Dissatisfied

Neutral

Satisfied

Very
Satisfied

1

2

3

4

5

Not Applicable
(N/A)

Please indicate your satisfaction with the following:
How frequently my counselor reaches out to me
Very
Dissatisfied

Dissatisfied

Neutral

Satisfied

Very
Satisfied

1

2

3

4

5

Not Applicable
(N/A)

Please indicate your satisfaction with the following:
My counselor makes it clear where I am in the process and what the next step will be
Very
Dissatisfied

Dissatisfied

Neutral

Satisfied

Very
Satisfied

1

2

3

4

5

Not Applicable
(N/A)

Please indicate your satisfaction with the following:
Ease of getting tools and resources
Very
Dissatisfied

Dissatisfied

Neutral

Satisfied

Very
Satisfied

1

2

3

4

5

Not Applicable
(N/A)

Please indicate your satisfaction with the following:
Timeliness of my education and subsistence allowance payments
Very
Dissatisfied

Dissatisfied

Neutral

Satisfied

Very
Satisfied

1

2

3

4

5

Not Applicable
(N/A)

Please indicate your satisfaction with the following:
The education/training I receive fits my specific needs
Very
Dissatisfied

Dissatisfied

Neutral

Satisfied

Very
Satisfied

1

2

3

4

5

Not Applicable
(N/A)

I trust VR&E to help me prepare for, obtain, and maintain suitable employment or achieve
independence in daily living. Required
Strongly
Disagree

Disagree

Neither Agree
nor Disagree

Agree

Strongly
Agree

1

2

3

4

5

Finish

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. VA cannot conduct or sponsor a
collection of information unless a valid OMB control number is displayed. 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 5 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. 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.

Privacy Policy

VR&E Chapter 31
V19 DRAFT <11/04/2022>
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: Dial 988 (Press 1) or
1 (800) 273-8255 (Press 1), text 838255, or visit 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: 5 Minutes

Thank you for choosing VA.
The U.S. Department of Veterans Affairs uses these surveys to collect
your feedback in order to continuously improve your experience with VA
services.
Please visit VA.gov to explore benefits, resources, and information
at VA.

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 5 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.

Privacy Policy


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