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pdfOMB Control Number 2900-0571
Estimated Completion Time: 20 Minutes
U.S. DEPARTMENT OF VETERANS AFFAIRS
NATIONAL CEMETERY ADMINISTRATION
VA Memorial Products:
2022 Next of Kin/Family Member Satisfaction Survey
(Headstones/Markers/Medallions and Presidential Memorial Certificates)
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 >
295126-2
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SEE MARKING INSTRUCTIONS ON THE COVER.
Correct Mark
1. How or from whom did you learn about the
headstone, marker, or medallion benefit
provided by the VA? (Mark all that apply)
Veteran/family member
Funeral Director
Cemetery Representative
VA employee
My own research
Other (specify) _________________________
Incorrect Marks
6. How did you order the headstone, marker, or
medallion? (Mark only one)
Via the mail
Via fax
Via the Funeral Director
Other (specify) ___________________________
7. How satisfied were you with the process
you used to order the headstone, marker,
or medallion?
2. What type of headstone, marker, or medallion
did you order?
Bronze (metal plate) –> Go To #5
Stone (granite or marble) –> Go To #5
Bronze Medallion
3. Did you have any problems while affixing
the Bronze Medallion to the headstone or
markers?
8. Did you call the NCA Applicant Assistance
number (1-800-697-6947) for assistance with a
headstone, marker, or medallion?
Yes
No –> Go To #5
Have not affixed medallion yet –> Go To #5
Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
Yes
No –> Go To #12
Don’t Know
4. Please explain the difficulty you faced in
affixing the medallion to a headstone or
marker.
________________________________________
9. Did you speak with an National Cemetery
Administration (NCA) Customer Service
representative initially, or were you transferred to
NCA by a VA Customer Service representative?
________________________________________
________________________________________
________________________________________
________________________________________
10. Why did you call NCA? (Mark all that apply)
________________________________________
________________________________________
________________________________________
5. Who helped you with ordering the
headstone/marker/medallion?
(Mark all that apply)
Family member
Funeral Director
Cemetery Representative
VA employee
Other (specify) ________________________
No one
S
poke with an NCA Customer Service
representative initially
Transferred to NCA
Don’t know/Can’t recall
T
o check on the status of an order
To get help with ordering a marker
To file a complaint about a marker
Other (specify) ___________________________
11. How satisfied were you with the service you
received from the NCA Customer Service
representative?
ery satisfied
V
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
12. Did you visit the VA website for information
about ordering the headstone, marker, or
medallion?
< MasterID >
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Yes
No –> Go To #15
SEE MARKING INSTRUCTIONS ON THE COVER.
Correct Mark
13. What type of information were you looking for
on VA’s website? (Mark all that apply)
17. About how long after ordering the headstone,
marker, or medallion did it arrive?
Less than 1 month
Between 1 and 2 months
Between 2 and 3 months
Between 3 and 4 months
More than 4 months
Has not arrived yet
Don’t know
ow to order a headstone/marker/medallion
H
Download an order form
F
ind information on documentation needed
F
ind out what could go on the headstone/
marker/medallion
F
ind information on the certificate signed by
the President of the United States honoring
the Veteran’s service
Other (specify) __________________________ 18. How satisfied were you with the amount of
time it took to receive the headstone, marker,
14. How satisfied were you with the ease of finding
or medallion?
the information you were looking for on VA’s
Very satisfied
website?
Somewhat satisfied
Very satisfied
Neither satisfied nor dissatisfied
Somewhat satisfied
Somewhat dissatisfied
Neither satisfied nor dissatisfied
Very dissatisfied
Somewhat dissatisfied
Very dissatisfied
19. How would you have preferred to be notified
about the delivery status of your headstone,
15. When you were applying for the headstone,
marker, or medallion?
marker, or medallion, were you aware that
Postcard
the following items could be added to the
E-mail
headstone, marker, or medallion:
Letter
Other (specify) _______________________
An inscription
I don’t care to be notified
Birth date/Date of death
Highest rank attained
20. Please indicate your level of agreement with the
War service
following statement: The overall quality of the
Emblem of belief
headstone, marker, or medallion I received from
Valor Awards
the VA was excellent.
Terms of endearment
Strongly agree
Nicknames
Agree
Civilian credentials (i.e., Doctor)
Neither agree nor disagree
Special unit designations
Disagree
Other military credentials
Strongly disagree
16. If you were aware of the availability of an
inscription, how did you learn about what
could be included in the inscription?
(Mark all that apply)
Don’t K
No
Yes
now
Incorrect Marks
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.
I read it on the application
I looked it up on the VA website
21. Did you order and/or receive a certificate signed
by the President of the United States honoring
I was informed by the Funeral Director
the Veteran’s service?
I was informed by a VA employee
Yes – Requested and received
I was not aware
Yes – Received, but not requested
Other (specify) __________________________
No – Requested, not received –> Go To #24
No – Did not receive –> Go To #24
Don’t know what this is –> Go To #24
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< MasterID >
SEE MARKING INSTRUCTIONS ON THE COVER.
Correct Mark
22. How satisfied were you with the quality of
the certificate signed by the President of the
United States honoring the Veteran’s service?
V
ery satisfied –> Go To #24
Somewhat satisfied –> Go To #24
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
Incorrect Marks
27. If you ordered a Bronze
marker, what setting fee
were you required to
pay? (Please round up to
nearest whole dollar.)
$
28. If you ordered a Granite/
Marble headstone or
marker, what setting fee
were you required to pay?
(Please round up to
nearest whole dollar.)
$
29. If you ordered a Bronze
Medallion, what fee were
you required to pay
to have the medallion
placed on your privately
purchased headstone?
(Please round up to
nearest whole dollar.)
$
23. 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)____________
24. Overall, how satisfied were you with your
experiences with the VA Memorial Products
Service products and services?
V
ery satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
25. N
CA 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
d. If you applied, were you
satisfied with the length of
time it took to receive a
certificate of approval?
Yes No
26. Were you required to pay any setting fees
regarding your VA-issued headstone, marker,
or medallion?
Y
es, but they were reasonable
Y
es, and the costs were substantial
N
o –> Go To #31
D
on’t know –> Go To #31
< MasterID >
30. Was there a delay in the placement of the
headstone, marker or medallion because of
a difficulty to pay the setting fee?
Yes
No
Don’t know
-4-
SEE MARKING INSTRUCTIONS ON THE COVER.
Correct Mark
Incorrect Marks
31. What was the gender of your loved one?
Female
Male
36. Was your loved one your spouse?
32. Was your loved one Hispanic or Latino?
Yes
No
37. Are you aware that Veterans who are married
to Veterans are entitled to individual gravesite
headstone/marker/ medallion benefits?
33. What was the race of your loved one?
(Mark one or more)
White
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or other Pacific Islander
34. Are you a Veteran (served on active duty in
the U.S. Armed Forces, either in the regular
military or a National Guard or Reserve Unit)?
Yes
No –> Go To #38
35. In which of the following eras did you serve?
(Mark all that apply)
orld War II
W
Korean War
Vietnam War
Gulf War
Operation Enduring Freedom (OEF)
Operation Iraqi Freedom (OIF)
Operation New Dawn
Yes
Yes
No –> Go To #38
No
38. What is your gender?
Male
Female
39. In what year were you born?
________________________
40. Are you Hispanic or Latino?
Yes
No
41. What is your race?
(Mark one or more)
White
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or other Pacific Islander
42. D
o you have any additional comments concerning how the VA Memorial Products Service could
improve its services and programs? If your comment is in response to a specific question, please
reference the question 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].
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| File Type | application/pdf |
| File Modified | 2021-09-03 |
| File Created | 2021-09-03 |