Form MOVE! Maintenance MOVE! Maintenance MOVE! Maintenance Pilot Program Survey Wireframe

Title: MOVE! Maintenance Pilot Program Survey

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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 988 (Press 1), or 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: 2/28/2026

Estimated Burden:3 minutes

Survey Introduction: We want to hear about your experience with the new MOVE! Maintenance sessions. By responding to this survey, you will directly help us improve the program and provide better support to Veterans like you.

Questions:

1. Which MOVE! Maintenance session are you providing feedback for? Required

1

2

3

4

5

6

7

8

9

10

11

[ Dropdown answer selection. Respondents will select only one session number. ]

2. How helpful was the information presented in this session?

1. Extremely unhelpful

2. Somewhat unhelpful

3. Neutral

4. Somewhat helpful

5. Extremely helpful

3. How acceptable was the content of this session?

1. Extremely unacceptable

2. Somewhat unacceptable

3. Neutral

4. Somewhat acceptable

5. Extremely acceptable

4. How much did you like this session?

1. Not at all

2. Not very much

3. Neutral

4. Somewhat

5. Very much

5. How satisfied were you with this session?

1. Not at all satisfied

2. Slightly satisfied

3. Moderately satisfied

4. Satisfied

5. Extremely satisfied

6. How likely would you be to recommend that this session be included in future programs?

1. Extremely unlikely

2. Unlikely

3. Neutral

4. Likely

5. Extremely likely

7. How much did you learn in this session?

1. Nothing at all

2. Almost nothing

3 . A slight amount

4. A fair amount

5. A good amount

8. How much did this session change how your think or feel about yourself?

1. Not at all

2. Slightly

3. Somewhat

4. A moderate amount

5. A great deal

9. How much did this session help you with your weight management goals?

1. Not at all helpful

2. Not very helpful

3. Slightly helpful

4. Somewhat helpful

5. Extremely helpful

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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.