Form 2900-0876 MyHealth 2900-0876 MyHealth 2900-0876 MyHealtheVet and Oracle Health Survey

Estimated Burden 3 minutes

1. Were you able to complete your task today?

   1. Yes

   2. No

2. Please rate your experience with this site today.

   1. Very bad

   2. Somewhat bad

   3. Neither good nor bad

   4. Somewhat good

   5. Very good

3. Why did you select that rating?

   1. Open text

4. What is your overall satisfaction with this site?

   1. Not at all satisfied

   2. Dissatisfied

   3. Neither Satisfied or Dissatisfied

   4. Satisfied

   5. Very Satisfied

5. How did this interaction change your trust in Veteran Affairs?

   1. Decreased my trust

   2. Somewhat decreased my trust

   3. Neither increased nor decreased my trust

   4. Somewhat increased my trust

   5. Increased my trust

6. How much do you trust Veteran Affairs to fulfill our country’s commitment to Veterans?

   1. High level of distrust

   2. Modest level of distrust

   3. Neither trust or distrust

   4. Somewhat increased my trust

   5. Increased my trust

7. Please rate how understandable this site's information is.

   1. 1 = Poor

   2. 2

   3. 3

   4. 4

   5. 5 = Excellent

8. Please rate how well the site's information provides answers to your questions.

   1. 1 = Poor

   2. 2

   3. 3

   4. 4

   5. 5 = Excellent

9. Please rate how completely the page content loads on this site.

   1. 1 = Poor

   2. 2

   3. 3

   4. 4

   5. 5 = Excellent

10. How frequently do you visit this website?

    1. First time

    2. Daily or more than once a day

    3. About once a week

    4. About once a month

    5. About every 6 months

    6. Less than every 6 months

    7. Not sure/ do not recall

11. What is your age range?

    1. Under 20

    2. 20-29

    3. 30-39

    4. 40-49

    5. 50-59

    6. 60-69

    7. 70-79

    8. 80 or older

12. What is your gender?

    1. Male

    2. Female

    3. Transgender Male

    4. Transgender Female

    5. Non-Binary

    6. Prefer not to say

13. In which state do you receive medical care?

    1. Dropdown list

14. Which Medical Center in ____ did you visit?

    1. Dropdown list

15. This website provides articles on topics of interest to Veterans. What topics are you most interested in for upcoming articles?

3