Nutrition and Food Service Inpatient Survey - Updated Question

OMB Number: 2900-0876

Expiration: 2/28/2026

Estimated Burden: 5 minutes

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: Dial 988 (Press 1) or 1 (800) 273-8255 (Press 1), text 838255, or visit 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/.

We want to hear about your experience with meals while you’re in this hospital. By responding to this survey, you will directly help us improve the food services we provide to patients like you. VA wants to provide Veterans with the best meal service possible while they’re in the hospital!

This voluntary survey will take about 5 minutes to complete.

1. Which of the following units are you a patient in? (Select only one option)

• Inpatient

• Community Living Center

• Domiciliary/Residential Treatment Program

• Unsure

2. The Food Service employees who deliver my meals are polite and courteous.

Never Rarely Sometimes Usually Always

3. The menus offer a good variety of choices.

Never Rarely Sometimes Usually Always I wasn’t offered a meal choice

4. My meals taste good.

Never Rarely Sometimes Usually Always

5. My meals look good.

Never Rarely Sometimes Usually Always

6. Cold food is served cold enough.

Never Rarely Sometimes Usually Always

7. Hot food is served hot enough.

Never Rarely Sometimes Usually Always

8. My meals arrive on time.

Never Rarely Sometimes Usually Always

9. My tray includes everything it is supposed to include according to the tray ticket.

Never Rarely Sometimes Usually Always I didn’t see a tray ticket

10. Overall, I am satisfied with my food service experience.

Strongly Disagree Disagree Neither Agree Strongly Agree

11. I trust this hospital to serve nutritious meals that promote good health. Logic: Required

Strongly Disagree Disagree Neither Agree Strongly Agree

12. Can VA Contact you about your feedback? Logic: Required. If yes is selected proceed to questions 13-14. If no is selected skip 13-14.

• Yes, VA can contact me about my experience.

• No, I do not want VA to contact me about my experience.

13. Name: Logic: Required if yes is selected for question 12.

14. Room# Logic: Required if yes is selected for question 12.

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.

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. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden to [email protected]. VA will not disclose your personal information to third parties outside VA without your consent or when immediately responding to an expressed concern or need for immediate information or resources.