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pdfVEAC
V8.1 DRAFT 06/21/2021
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: 3 minutes
Help us serve you better.
We want to hear about your experience as a Peer-to-Peer participant or a
Peer-to-Peer provider. The survey should take you approximately 3
minutes to complete.
Please identify your role within the Veterans Experience Action Center.
Required
Peer-to-Peer participant [ Logic: If Select, move to page 2 when selecting next]
Peer-to-Peer provider
[ Logic: If Select, move to page 10 when selecting next]
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. 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 3 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 unless exception.]
Privacy Policy
VEAC
V8.1 DRAFT 06/21/2021
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: 3 minutes
Help us serve you better.
We want to hear about your experience as a Peer-to-Peer participant.
The survey should take you approximately 3 minutes to complete.
Which of the following best defines you as a participant of the Veterans Experience
Action Center? Required
Service Member
Veteran
Family
Caregiver
How would you describe your gender? Required
Male
Female
Non-Binary/Third Gender
Prefer not to say
How would you describe your race? Select all that apply.
Required
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Are you Hispanic or Latino? Required
Yes
No
What is your age group? Required
< 30
30-39
40-49
50-59
60-69
> 70
Next
[ Logic: Proceed to Page 3. ]
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 3 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 unless exception.]
Privacy Policy
VEAC
V8.1 DRAFT 06/21/2021
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: 3 minutes
Help us serve you better.
We want to hear about your experience as a Peer-to-Peer participant.
The survey should take you approximately 3 minutes to complete.
Please provide your zip code. Enter 00000 if using an APO/FPO. Required
0/5
[ Logic: Set character count to 5 digits for this input. An input greater or less than 5 characters will result in an
error.]
Do you currently receive VA health care services? Required
Recently enrolled
Currently enrolled
Never enrolled
Previously enrolled
[ Logic: If response option 1, 2, and 4 are selected, proceed to page 5. If response option 3 are selected, proceed to page 4. ]
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. 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 3 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 unless exception.]
Privacy Policy
VEAC
V8.1 DRAFT 06/21/2021
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: 3 minutes
Help us serve you better.
We want to hear about your experience as a Peer-to-Peer participant.
The survey should take you approximately 3 minutes to complete.
Please indicate why you are not currently enrolled in VA health care. Select all that
apply. Required
I did not know I was eligible for VA health care.
I do not know how to connect with VA.
I do not know how to enroll with VA.
I do not wish to apply for any VA benefits.
I find the VA to be too complicated to navigate.
I haven't had the time to look into VA health care.
I receive health care through my employer.
I was not found eligible for VA health care.
Next
[ Logic: Proceed to Page 5. ]
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 3 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 unless exception.]
Privacy Policy
VEAC
V8.1 DRAFT 06/21/2021
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: 3 minutes
Help us serve you better.
We want to hear about your experience as a Peer-to-Peer participant.
The survey should take you approximately 3 minutes to complete.
Do you currently receive VA benefits such as compensation, pension, education, home
loan, or pre-burial benefits? Required
Yes
No
Previously received VA benefits
[ Logic: if response option 1 and 3 are selected, proceed to page 7. If response option 2 is selected, proceed to page 6. ]
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. 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 3 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 unless exception.]
Privacy Policy
VEAC
V8.1 DRAFT 06/21/2021
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: 3 minutes
Help us serve you better.
We want to hear about your experience as a Peer-to-Peer participant.
The survey should take you approximately 3 minutes to complete.
Please indicate the reason why you are currently not receiving VA benefits. Select all
that apply. Required
I did not know I was eligible for VA benefits.
I do not wish to apply for any VA benefits.
I was not found eligible for VA benefits.
I find the VA to be too complicated to navigate.
I do not know how to connect with VA.
I do not know how to enroll with VA.
I've previously received VA benefits. (e.g. GI Bill, home loan, insurance)
Next
[ Logic:Proceed to page 7. ]
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 3 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 unless exception.]
Privacy Policy
VEAC
V8.1 DRAFT 06/21/2021
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: 3 minutes
Help us serve you better.
We want to hear about your experience as a Peer-to-Peer participant.
The survey should take you approximately 3 minutes to complete.
Is this your first time connecting to a Peer-to-Peer Center?
Required
Yes
No
Please indicate when you served in the military. Select all that apply. Required
World War II: 12/7/1941 - 12/31/1946
Korean Conflict: 06/27/1950 - 01/31/1955
Vietnam Era: 02/28/1961 - 05/07/1975
Cold War/Peace Time Era: 1975-1991
Gulf War 1 Era: 8/2/1990 - 10/6/2001
Post 9/11 Era: 10/7/2001 - Present
Other
What information and/or services did you receive from your participation with the Peerto-Peer Provider? Select all that apply. Required
Connection to VSO/CVSO
Information about the Peer-to-Peer organization
Services in the community (e.g. counseling, healthcare, financial, transportation)
VA Benefits
VA Health Care
VA Mental Health
Did you experience any challenges connecting with the Peer-to-Peer Provider. Required
Yes
No
[ Logic: If the option “Yes” is selected, proceed to page 8. If the option “No” is selected, proceed to page 9.]
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. 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 3 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 unless exception.]
Privacy Policy
VEAC
V8.1 DRAFT 06/21/2021
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: 3 minutes
Help us serve you better.
We want to hear about your experience as a Peer-to-Peer participant.
The survey should take you approximately 3 minutes to complete.
Select a reason why it was challenging to connect with the Peer-to-Peer provider. Required
Select your response
Appointment not conducted at the time requested
Did not receive resources and or information requested
Did not respond to my email
Did not return my call
Issues making an appointment
No face-to-face presence in my community
No social media access
Not accessible in my community
Transportation not available
Unable to navigate social media site
Working hours are not accessible when I am available
Other
Next
[ Logic: Proceed to page 9. ]
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 3 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 unless exception.]
Privacy Policy
VEAC
V8.1 DRAFT 06/21/2021
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: 3 minutes
Help us serve you better.
We want to hear about your experience as a Peer-to-Peer participant.
The survey should take you approximately 3 minutes to complete.
I was able to get my information and/or service support needs met through the Veterans
Experience Action Center in a reasonable timeframe. Required
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
The Veterans Experience Action Center provided a seamless introduction to VA
services. Required
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
I felt respected and valued during my engagement with the Veterans Experience Action
Center. Required
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
I felt reassured by the guidance provided as a participant with the Veterans Experience
Action Center. Required
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
The Veterans Experience Action Center provided information and next steps that were
relevant and easy for me to understand. Required
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
I felt my Peer-to-Peer provider listened to and considered my needs. Required
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
Next
[ Logic:Proceed to close out page]
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 3 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 unless exception.]
Privacy Policy
VEAC
V8.1 DRAFT 06/21/2021
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: 3 minutes
Help us serve you better.
We want to hear about your experience as a Peer-to-Peer provider. The
survey should take you approximately 3 minutes to complete.
Please provide your zip code. Enter 00000 if using an APO/FPO. Required
0/5
[ Logic: Set character count to 5 digits for this input. An input greater or less than 5 characters will result in an error. ]
Are you assisting a participant who needs care for a medical or mental health
concern? Required
Yes
No
Please indicate your relationship with the participant. Required
Existing relationship
New relationship
Please indicate when the participant served in the military. Select all that apply. Required
World War II: 12/7/1941 - 12/31/1946
Korean Conflict: 06/27/1950 - 01/31/1955
Vietnam Era: 02/28/1961 - 05/07/1975
Cold War/Peace Time Era: 1975-1991
Gulf War 1 Era: 8/2/1990 - 10/6/2001
Post 9/11 Era: 10/7/2001 - Present
Other
Please select what information and/or services you provided the participant. Select all
that apply. Required
Connection to VSO/CVSO
Information about the Peer-to-Peer organization
Services in the community (e.g. counseling, healthcare, financial, transportation)
VA Benefits
VA Health Care
VA Mental Health
Did VA provide you with the resources you needed to be successful? Required
Yes
No
What additional resources would be most helpful to you and/or to the participant you
assisted? Please do not include any personally identifiable information, Social Security
Number, Veteran ID, or medical information.
0/250
[ Logic: Set a character count to 250 for this input. An input greater than 250 characters will not be accepted. ]
Resources were available that allowed me to provide information and/or service support
in a reasonable timeframe. Required
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
Resources were available that allowed me to provide a seamless introduction to VA
services. Required
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
I felt respected and valued working with the Veterans Experience Action Center.
Required
Strongly
Neither Agree
Strongly
Disagree
Agree
Disagree
nor Disagree
Agree
1
2
3
4
5
Resources and guidance were provided that allowed me to be helpful to the participant.
Required
Strongly
Neither Agree
Strongly
Disagree
Agree
Disagree
nor Disagree
Agree
1
2
3
4
5
I was provided resources that the participant found easy to understand. Required
Strongly
Disagree
Disagree
Neither Agree
nor Disagree
Agree
Strongly
Agree
1
2
3
4
5
Next
[ Logic:Proceed to close out page]
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 3 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 unless exception.]
Privacy Policy
VEAC
V8.1 DRAFT 06/21/2021
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: 3 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. To get information on access to VA healthcare or a Peer-to-Peer
network in your community, send an email to
[email protected]
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 3 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 unless exception.]
Privacy Policy
| File Type | application/pdf |
| File Modified | 2021-06-21 |
| File Created | 2021-06-21 |