Download:
pdf |
pdfOMB Control Number 2900-0571
Estimated Completion Time: 20 Minutes
U.S. DEPARTMENT OF VETERANS AFFAIRS
NATIONAL CEMETERY ADMINISTRATION
STATE OR TRIBAL VETERANS 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 >
293997-3
-1-
SEE MARKING INSTRUCTIONS ON THE COVER.
Correct Mark
Please complete this survey based on your
experiences at the State or Tribal Veterans Cemetery
where your loved one was interred.
1. Due to Covid-19 pandemic restrictions, was
a committal service held at the cemetery for
your loved one?
Yes
N
o
Don’t know
2. How many times have you visited the State or
Tribal Veterans 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 State or Tribal
Veterans 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
4. Which of the following factors limit the number
of times you visit the State or Tribal Veterans
Cemetery where your loved one is interred?
(Mark all that apply)
Distance to the 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?
Y
es
No
6. Prior to your time of need, were you aware of
the benefits related to burial in a State or
Tribal Veterans Cemetery?
Yes
No -> Go to #8
< MasterID >
-2-
Incorrect Marks
7. How did you learn of these benefits prior to your
time of need? (Mark all that apply)
Family member/friends
Funeral home
Veterans Service Organization
Other Veteran/active duty member
Pre-Need Burial Eligibility Determination
Military discharge-related materials
State or Tribal/VA/NCA pamphlet,
newsletter, brochure
Local newspaper/news report
Professional/military association meetings
Other State, Tribal, or VA organization
State or Tribal/VA/NCA website
Public events (e.g., parades, speeches)
State or Tribal/VA/NCA social media
(Facebook or Twitter)
Other (specify) ________________________
8. Prior to the time of need, what is the BEST
way for the State or Tribal Veterans Cemetery
to convey information regarding benefits?
(Mark only one)
E-mail
Newsletter/flyer
Local newspaper/television news reports
State or Tribal/VA/NCA website
Professional/military association meetings
State or Tribal/VA/NCA social media
(Facebook or Twitter)
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 State or Tribal Veterans
Cemetery?
Very satisfied
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. At the committal service, did your family have
any of the following special needs or requests?
(Mark all that apply)
Visit the gravesite
View the burial
Specific religious practices (e.g., blessing the
gravesite)
S
pecific cultural practices (e.g., spreading/
placement of earth/soil into the grave)
Additional seating at the committal service
Handicapped accommodations
N
o, my family did not have any special needs
or requests –> Go To #13
12. 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
Christian
Catholic
Muslim
Jewish
Buddhist
Hindu
Atheist
Agnostic
None
Other (specify) _________________________
14.
Prior to the service for your loved one, did
you view the NCA videos illustrating different
committal service options at State or Tribal
Veterans Cemeteries?
Y
es, I viewed it online
Yes, the funeral director provided it
No -> Go to #17
Please indicate your level of agreement with the
following statement:
15. The video(s) helped me understand the
burial process at the State or Tribal Veterans
Cemetery.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
16. Was your experience at the State or Tribal
Veterans Cemetery similar to the video on
service options you viewed?
Yes
No
17. If your loved one received military funeral
honors, how satisfied were you with the honors
received?
Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
My loved one did not receive military funeral
honors
18. Overall, how satisfied were you with the
committal service at the State or Tribal
Veterans Cemetery?
13. In what religious practice was the burial
conducted?
Incorrect Marks
Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
19. Were the inscription options for the headstone,
marker, or columbarium niche cover explained
to you?
Yes
No
Not sure/don’t know
20. Did you feel you had sufficient time to make
a decision on the headstone, marker, or
columbarium niche cover inscription?
Yes
No
21. How satisfied were you with the length of time
it took for the permanent headstone, marker, or
columbarium niche cover to be in place?
-3-
ery satisfied
V
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
Don’t know/the marker or headstone has not yet
arrived -> Go to #24
< MasterID >
SEE MARKING INSTRUCTIONS ON THE COVER.
Correct Mark
22. When the headstone, marker, or columbarium
niche cover arrived, was the inscription
accurate?
Yes
No
Don’t know
23. Overall, how satisfied were you with the
quality and appearance of the headstone,
marker, or columbarium niche cover when
it arrived?
ery satisfied
V
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
If your loved one was NOT a Veteran please go
to Question 28.
24. Did you receive a certificate signed by the
President of the United States honoring the
Veteran’s service?
Y
es
No –> Go To #28
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.
25. How satisfied were you with the quality of
the .certificate signed by the President of the
United States honoring the Veteran’s service?
ery satisfied –> Go To #27
V
Somewhat satisfied –> Go To #27
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
26. 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)
Envelope was bent/torn
Name was misspelled
Poor print quality
Other problem (specify)____________
< MasterID >
-4-
Incorrect Marks
Please indicate your level of agreement with the
following statement:
27. 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.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
28. Looking back at your overall experiences with
the State or Tribal Veterans Cemetery, which
items would you have liked more information
about? (Mark all that apply)
None, I was well informed
Certificate signed by the President of the
United States honoring the Veteran’s service
Details of the committal service
Headstone or marker inscription options
Military funeral honors
Floral policy
Location of gravesite
Layout of cemetery (maps)
Directions to cemetery
Other (specify) ________________________
Don’t k
n
not ap ow/
plicable
Strong
ly
disagre
e
Agree
Disagre
Strong
ly agre
For the following series of statements
please indicate your level of agreement.
e
Incorrect Marks
Neithe
r
nor dis agree
agree
Correct Mark
e
SEE MARKING INSTRUCTIONS ON THE COVER.
29. The upkeep of the headstones, markers, or columbarium niche
covers is excellent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
30. The committal shelter used for the service was private, clean,
and free of safety hazards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
31. The cemetery honors all Veterans and their service to our nation.
32. There are sufficient signs within the cemetery to assist visitors.
33. The quality of service received from cemetery staff is excellent.
34. The State or Tribal Veterans Cemetery staff was courteous . . . . .
35. The State or Tribal Veterans Cemetery staff was professional in
terms of being knowledgeable, helpful, and responsive . . . . . . . .
36. The appearance of my loved one’s gravesite/columbaria is
excellent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
37. The information kiosks (i.e., gravesite locators) are helpful to
me. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
38. The overall appearance of the State or Tribal Veterans Cemetery
is excellent. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
39. Overall, I am satisfied with my experience at the State or Tribal
Veterans Cemetery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
40. I would recommend the cemetery to Veteran families during their
time of need. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
41. I am willing to rely on the State or Tribal Veterans Cemetery to
meet the burial needs of Veterans in the future . . . . . . . . . . . . . . .
42. I am willing to rely on the State or Tribal governments to maintain
State or Tribal Veterans Cemeteries as national shrines in the
future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
43.
My experiences with the State or Tribal Veterans Cemetery
exceeded my expectations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
-5-
< MasterID >
SEE MARKING INSTRUCTIONS ON THE COVER.
Correct Mark
State or Tribal Veterans Cemeteries are
complements to VA’s national cemeteries. State
or Tribal Veterans Cemeteries, operated by
State or Tribal organizations, are expected to
be maintained and operated in a way befitting a
national shrine, as are VA’s national cemeteries
operated by the Federal Government. Your
answers to these questions will help us determine
how well we are doing that.
44. Please choose any of the following reasons
to describe why you selected the State or
Tribal Veterans Cemetery for your loved
one’s interment. (Mark all that apply)
My loved one wanted to be interred here.
O
ther family members are interred here.
The
appearance and quality of service
at the State or Tribal Veterans Cemetery
honors my loved one’s military service.
The
State or Tribal Veterans Cemetery is
close and easy to get to.
O
thers recommended the State or Tribal
Veterans Cemetery.
The
cost was reasonable to inter my loved
one.
T
here is no VA national cemetery
conveniently available for the interment of
my loved one.
O
ther (specify)
_________________________
Please indicate your level of agreement with the
following statement:
45. If I had been able, I would have chosen
to inter my loved one at a VA national
cemetery rather than the State or Tribal
Veterans Cemetery.
Strongly agree
Agree
Neither agree nor disagree –> Go To #47
Disagree –> Go To #47
Strongly disagree –> Go To #47
Incorrect Marks
46. Please choose any of the following reasons
to describe why you would have preferred
interment in a VA national cemetery rather
than a State or Tribal Veterans Cemetery.
(Mark all that apply)
My
loved one wanted to be interred in a VA
national cemetery.
Other family members are interred in a VA
national cemetery.
Others recommended the VA national cemetery.
There is no cost to inter my loved one at a
national cemetery.
A national cemetery is more prestigious than a
State or Tribal Veterans Cemetery.
The appearance and quality of service
at a national cemetery is superior to the
appearance and quality of service at a State or
Tribal Veterans Cemetery.
Other (specify)_________________________
47. Have you visited a 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.
48. Based on your visit, the appearance of the
State or Tribal Veterans Cemetery compares
favorably to the VA national cemetery.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
49. Based on your visit, the quality of service at the
State or Tribal Veterans Cemetery compares
favorably to the VA national cemetery.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
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.
< MasterID >
-6-
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Don’t know/not applicable
SEE MARKING INSTRUCTIONS ON THE COVER.
Male
Female
52. Are you Hispanic or Latino?
Yes
No
Incorrect Marks
53. What is your race? (Mark one or more)
51. What is your gender?
Correct Mark
hite
W
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or other Pacific Islander
54. In what year were you born?
________________________
55. Please use this space to elaborate on any aspect of your experience at the State or Tribal Veterans
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].
-7-
< MasterID >
PAGE INTENTIONALLY
LEFT BLANK
< MasterID >
-8-
| File Type | application/pdf |
| File Modified | 2021-09-03 |
| File Created | 2021-09-03 |