Form Healthy Teaching K Healthy Teaching K Healthy Teaching Kitchen Final v2 RL Edits

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/.

Your opinion matters.

Please take this brief, eleven question survey to let us know about your experience with the VA Healthy Teaching Kitchen class(es). By completing this survey, we can better serve you and other Veterans. Thank you for choosing VA and helping us improve the Veteran Experience at VA.

This voluntary survey should take you approximately 5 minutes to complete.

1) What state is your VA facility located in?(Logic: Required)

2) Which Facility did you visit?(Logic: Required)

3) The Healthy Teaching Kitchen instructor explained healthy eating and cooking to me in a way that I was able to understand.

Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree

4) After attending Healthy Teaching Kitchen, I will practice the skills the instructor talked about in class.

Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree

5) The instructor asked if I understood or gave me an opportunity to demonstrate what I learned during Healthy Teaching Kitchen (such as safe knife skills, following a recipe, or preparing a recipe)

Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree N/A

6) As a result of the Healthy Teaching Kitchen class(es), I feel confident that I can make changes that support my health and wellness.

Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree

7) As a result of the Healthy Teaching Kitchen class(es), I have learned to adjust recipes to meet my health goals.

Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree

8) As a result of the Healthy Teaching Kitchen class(es), I have learned to adjust recipes to use what I have available.

Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree

9) The Healthy Teaching Kitchen instructor treated me in a respectful manner

Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree

10) I would recommend Healthy Teaching Kitchen classes to other Veterans.

Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree

11) I trust the Healthy Teaching Kitchen as part of my overall VA healthcare. (Logic: Required)

Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree

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.