Download:
pdf |
pdfOMB Control Number 2900-0571
Estimated Completion Time: 20 Minutes
U.S. DEPARTMENT OF VETERANS AFFAIRS
NATIONAL CEMETERY ADMINISTRATION
NATIONAL CEMETERIES:
2022 NEXT OF KIN/FAMILY MEMBER SATISFACTION SURVEY
VA may not conduct, sponsor, or require the respondent to respond to this collection of information unless it displays a valid
OMB Control Number. All responses to this collection are voluntary. Public reporting burden for this collection of information
is estimated to average 20 minutes per response, including the time necessary for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The information
collected is intended to be used in making improvements in services within the National Cemetery Administration of the
Department of Veterans Affairs and for associated administrative purposes. Failure to furnish the requested information will have
no adverse effect on any VA benefit to which you may be entitled.
The information you supply will be confidential and protected by the Privacy Act of 1974 (5 U.S.C. 522a) and the VA’s confidentiality
statute (38 U.S.C. 5701) as implemented by 38 CFR 1.526(a) and 38 CFR 1.576(b). Disclosure of information involves releases
of statistical data and other non-identifying data for the improvement of services within the National Cemetery Administration
and for associated administrative purposes. Please send any comments regarding this burden estimate or any other aspect of this
collection, including suggestions for reducing this burden, to VA Clearance Officer (005G2), 810 Vermont Ave., NW, Washington
DC 20420. SEND COMMENTS ONLY. DO NOT SEND THIS FORM OR REQUESTS FOR BENEFITS TO THIS ADDRESS.
Marking Instructions
The survey will take about 20 minutes to complete.
Please read each question carefully and respond by filling in the
circle of the response that most closely represents your opinion.
Correct Mark
Incorrect Marks
• Use pencil or pen. Make heavy dark marks that fill the circles completely. If you wish to change an answer, erase cleanly
(pencil) or put an “X” over the incorrect response (pen).
• Fill in one answer circle for each question unless it tells you to “Mark all that apply.”
• When you are finished, please place the questionnaire in the enclosed postage-paid envelope and put it in the mail.
If you have any questions or concerns, please contact the Survey Help Line at 1-833-231-7069
or [email protected].
BARCODE
NATIONAL CEMETERY ADMINISTRATION
< MasterID >
295127-2
-1-
SEE MARKING INSTRUCTIONS ON THE COVER.
Correct Mark
Incorrect Marks
Please complete this survey based on your
experiences at the national cemetery where your
loved one was interred.
7. How did you learn of these benefits prior to your
time of need? (Mark all that apply)
Family member/friends
1. Due to Covid-19 pandemic restrictions, was
a committal service held at the cemetery for
your loved one?
Funeral home
Military discharge-related materials
Other Veteran/active duty member
Pre-Need Burial Eligibility Determination
Veterans Service Organization
VA/NCA pamphlet, newsletter, brochure
VA/NCA website
Other VA organization
Professional/military association meetings
Public events (e.g., parades, speeches)
Local newspaper/news report
VA/NCA social media (Facebook or Twitter)
Yes
N
o
Don’t know
2. How many times h
. ave you visited the national
cemetery where.your loved one was interred?
1–3
4–6
7–9
10 or more
None, I have not visited
3. How far do you reside from the national
cemetery?
Less than 15 miles
15 to 29 miles
30 to 44 miles
45 to 59 miles
60 to 75 miles
More than 75 miles
8. Prior to the time of need, what is the BEST way
for the national cemetery to convey information
regarding benefits? (Mark only one)
4. Which of the following factors limit the number
of times you visit the national cemetery where
your loved one is interred? (Mark all that apply)
Distance to the national cemetery
Access to transportation
Health status
Other (specify) __________________________
5. Have you ever served on active duty in the U.S.
Armed Forces, either in the regular military or a
National Guard or Reserve Unit?
Yes
No
6. Prior to your time of need, were you aware
of the benefits related to burial in a national
cemetery?
Yes
No –> Go To #8
< MasterID >
Other (specify) ___________________________
-2-
E-mail
Newsletter/flyer
VA/NCA website
Local newspaper/television news reports
VA/NCA social media (Facebook or Twitter)
Professional/military association meetings
Public events (e.g., parades, speeches)
Other (specify) ___________________________
9. Overall, how satisfied are you with the
information you were provided throughout your
experiences with the national cemetery?
ery satisfied
V
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
10. To what extent were you informed of the
details (e.g., length of service, use of committal
shelters) related to the committal service prior to
attending the service?
Very informed
Somewhat informed
Neither informed nor uninformed
Somewhat uninformed
Very uninformed
SEE MARKING INSTRUCTIONS ON THE COVER.
Correct Mark
11. Did you or a family member personally schedule
the interment through the National Cemetery
Scheduling Office (1-800-535-1117)?
16. Prior to the service for your loved one, did
you view the NCA videos illustrating different
committal service options at VA national
cemeteries?
Y
es
N
o, a funeral director scheduled
it on my behalf –> Go To #13
Don’t know –> Go To #13
12. How satisfied were you with the service you or
your family member received from the National
Cemetery Scheduling Office?
Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
V
isit the gravesite
View the burial
Specific religious practices (e.g., blessing the
gravesite)
Specific cultural practices (e.g., spreading
placement of earth/soil into the grave)
Additional seating at the committal service
Handicapped accommodations
No, my family did not have any special needs
or requests –> Go To #15
14. Was the cemetery able to accommodate these
special needs or requests to your satisfaction?
es, completely
Y
Yes, somewhat
No, and I understand why
No, and I did not understand why
15. In what religious practice was the burial
conducted?
hristian
C
Catholic
Muslim
Jewish
Buddhist
Hindu
Atheist
Agnostic
None
Other (specify) _________________________
Yes, I viewed it online
Yes, the funeral director provided it
No -> Go To #19
Please indicate your level of agreement with the
following statement:
17. The video(s) helped me understand the burial
process at the national cemetery.
13. At the committal service, did your family have
any of the following special needs or requests?
(Mark all that apply)
Incorrect Marks
trongly agree
S
Agree
Neither agree nor disagree
Disagree
Strongly disagree
18. Was your experience at the national cemetery
similar to the video on service options you
viewed?
Yes
No
19. If your loved one received military funeral
honors, how satisfied were you with the quality
of the honors received?
Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
My loved one did not receive military funeral
honors
20. Overall, how satisfied were you with the
committal service at the national cemetery?
Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
21. Were the inscription options for the headstone,
marker, or columbarium niche cover explained
to you?
-3-
Yes
No
Not sure/don’t know
< MasterID >
SEE MARKING INSTRUCTIONS ON THE COVER.
Correct Mark
22. Did you feel you had sufficient time to make
a decision on the headstone, marker, or
columbarium niche cover inscription?
Yes
No
23. How satisfied were you with the length of time
it took for the permanent headstone, marker,
or columbarium niche cover to be in place?
Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
Don’t know/the marker or headstone
has not yet arrived –> Go To #26
Yes
No
Don’t know
Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
No -> Go To #30
For information about the certificate signed by the
President of the United States honoring the Veteran’s
service or to order more copies, please visit our web
page at www.cem.va.gov/pmc.asp.
27. How satisfied were you with the quality of
the certificate signed by the President of the
United States honoring the Veteran’s service?
Very satisfied –> Go To #29
Somewhat satisfied –> Go To #29
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
< MasterID >
Envelope was bent/torn
Name was misspelled
Poor print quality
Other problem (specify)____________
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
30. NCA Pre-Need Eligibility Process:
a. Are you aware of the NCA
.Pre-Need Eligibility Process? Yes No
b. Have you applied?
Yes No
c. Do you intend to apply?
Yes No
Yes No
31. Looking back at your overall experiences with
the national cemetery, which items would you
have liked more information about?
(Mark all that apply)
26. Did you receive a certificate signed by the
President of the United States honoring the
Veteran’s service?
Yes
d. If you applied, were you
satisfied with the length of
time it took to receive a
certificate of approval?
If your loved one was NOT a Veteran please go
to Question 30.
29. Receiving the certificate signed by the President
of the United States honoring the Veteran’s
service at the committal service (rather than
receiving it in the mail) would enhance the
meaning of the recognition.
25. Overall, how satisfied were you with the
quality and appearance of the headstone,
marker, or columbarium niche cover when it
arrived?
28. Why were you not satisfied with the quality of the
certificate signed by the President of the United
States honoring the Veteran’s service?
(Mark all that apply)
Please indicate your level of agreement with the
following statement:
24. When the headstone, marker, or columbarium
niche cover arrived, was the inscription
accurate?
Incorrect Marks
-4-
one, I was well informed
N
Details of the committal service
Floral policy
Military funeral honors
Headstone or marker inscription options
Location of gravesite
Certificate signed by the President of the
United States honoring the Veteran’s service
Layout of cemetery (maps)
Timeline for placement of headstone/marker
Directions to cemetery
Other (specify) ___________________________
Don’t
kn
not ap ow/
plicab
le
Agree
Strong
ly
disagre
e
Strong
For the following series of statements
please indicate your level of agreement.
Disagre
e
Incorrect Marks
Neithe
r
nor dis agree
agree
Correct Mark
ly agre
e
SEE MARKING INSTRUCTIONS ON THE COVER.
32. The upkeep of the headstones, markers, or columbarium niche
covers is excellent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
33. The committal shelter used for the service was private, clean,
and free of safety hazards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
34. The cemetery honors all Veterans and their service to our nation. . . .
35. There are sufficient signs within the cemetery to assist visitors. .
36. The quality of service received from cemetery staff is excellent.
37. The national cemetery staff was courteous . . . . . . . . . . . . . . . . . .
38. The national cemetery staff was professional in terms of being
knowledgeable, helpful, and responsive . . . . . . . . . . . . . . . . . . . . .
39. The appearance of my loved one’s gravesite/columbaria is
excellent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
40. The information kiosks (i.e., gravesite locators) are helpful to me.
41. The overall appearance of the national cemetery is excellent . . .
42. Overall, I am satisfied with my experience at the national
cemetery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
43. I would recommend the cemetery to Veteran families during their
time of need . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
44. I am willing to rely on VA and the National Cemetery
Administration to meet the burial needs of Veterans in the future.
45. I am willing to rely on VA and the National Cemetery
Administration to maintain national cemeteries as national
shrines in the future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
46.
My experiences with the national cemetery exceeded my
expectations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
47. Have you visited a State or Tribal Veterans Cemetery?
48. Based on your visit, the appearance of the
State or Tribal Veterans Cemetery compares
favorably to the VA national cemetery.
Yes
No –> Go To #50
Don’t know/not applicable –> Go To #50
Please indicate your level of agreement with the
following statements.
-5-
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
< MasterID >
SEE MARKING INSTRUCTIONS ON THE COVER.
Correct Mark
49. Based on your visit, the quality of service
at the State or Tribal Veterans Cemetery
compares favorably to the VA national
cemetery.
51. What is your gender?
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Male
Female
52. In what year were you born?
________________________
53. Are you Hispanic or Latino?
50. The honor of being interred at a State or Tribal
Veterans Cemetery is equivalent to that of
being interred at a VA national cemetery.
Incorrect Marks
Yes
No
54. What is your race? (Mark one or more)
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Don’t know/not applicable
hite
W
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or other Pacific Islander
55. Please use this space to elaborate on any aspect of your experience at the national cemetery you
wish to share with us. If your comment is in response to a specific question, please reference the
question number.
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Note: If you would like to be contacted by the cemetery where your loved one is interred, please write your
name and contact information (address or telephone number):
_____________________________________________________________________________________________
Thank you very much for taking the time to complete this questionnaire.
PLEASE mail this completed questionnaire in the enclosed pre-paid envelope as soon as possible.
If you misplaced the pre-paid envelope, you may mail the completed survey to the following address
using your own envelope:
DEPARTMENT OF VETERANS AFFAIRS
VA NCA CUSTOMER SATISFACTION SURVEY
PO BOX 510570
LIVONIA, MI 48151
If you have any questions about this research, please contact the Survey Help Line at 1-833-231-7069
or [email protected].
-6-
< MasterID >
| File Type | application/pdf |
| File Modified | 2021-09-03 |
| File Created | 2021-09-03 |