OMB Number: 2900-0876
Expiration: 2/28/2026
Estimated Burden: 3 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/.
Help us serve you better.
Your opinion matters. We care about your time with VA. Please take this survey to let us know about your experience. The more information you share with us, the better we can serve you.
This voluntary survey should take you approximately 3 minutes to complete.
Customer First Name *required
2. Customer Last Name *required
3. City *required
4. State *required
5. Zip Code *required
6. Primary / Cell Phone (include area code) *required
7. Email Address *required
8. What services are you interested in receiving information about? (Select all that apply)
(VBA) File a new or increase claim for service-connection; obtain claim status for a previously filed claim; general counseling on claims for service-connection.
(VHA) Explore healthcare eligibility and enrollment, schedule health care appointments, speak to a patient advocate, and obtain general healthcare information and assistance on billing, Caregiver support, Care in the Community questions and referrals.
(NCA) Obtain information on Burial and Memorial Services such as Military Honors, location of Veteran burial, grave markers, burial reimbursement, pre-need eligibility for burial. Determine if you or your partner qualify for burial in a VA National Cemetery.
(Community Services) Obtain information on community services such as employment, housing, pro- bono legal assistance, temporary financial assistance, food supplementation, faith services, family support, and education.
(State Benefits) Explore the many state benefits available to qualified Veterans: Fishing and Hunting license discounts, tuition waivers, employment assistance, reduced or no real property taxes, free license plates and vehicle registration.
Other
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Smith, Bronte [USA] |
| File Modified | 0000-00-00 |
| File Created | 2025-05-19 |