Form ECCC - VET HOME Su ECCC - VET HOME Su ECCC - VET HOME Survey Wireframes

VET HOME ECCC Survey
V1 DRAFT 05/25/2023
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 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/.

Help us serve you better.
1. The VET-HOME agent I interacted with was helpful.

2. The call with VET-HOME was informative.

OMB Number: 2900-0876
Expiration: 2/28/2026
Estimated Burden: 5 minutes

3. I am satisfied with the service I received from VET-HOME

4. I trust VA to fulfill our country’s commitment to Veterans. Required

Thank you for choosing VA.
The U.S. Department of Veterans Affairs uses these surveys to collect your feedback in order to
continuously improve your experience with VA services.
Please visit VA.gov to explore benefits, resources, and information at VA.

We are asking for this information so that you can provide compliments, recommendations, or concerns to
VA. By filling out this survey, you are authorizing VA database access to retrieve Veteran contact
information to follow up with you accordingly for purposes of service recovery, potential crisis, or to learn
more about feedback you have shared regarding your experience with VA. Your contact information and
response may be referred to the Veterans Crisis Line if an automated review indicates your response
may be concerning. The Veterans Crisis Line may contact you for follow up as a result of that referral. 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 5 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. VA will not disclose your personal
information to third parties outside VA without your consent or when immediately responding to an
expressed concern. Send comments regarding this burden estimate or any other aspect of this
information collection, including suggestions for reducing this burden to [email protected].
Hyperlink: https://www.reginfo.gov/public/do/PRAMain