Appendix A

OMB Control Number 2900-0571

Estimated Completion Time: 20 Minutes

U.S. DEPARTMENT OF VETERANS AFFAIRS

NATIONAL CEMETERY ADMINISTRATION:

NATIONAL CEMETERIES 2020 NEXT OF KIN/FAMILY MEMBER SATISFACTION SURVEY

The VA may not conduct, sponsor, or require the respondent to respond to this collection of information unless it displays a valid OMB Control Number. All responses to this collection are voluntary. Public reporting burden for this collection of information is estimated to average 20 minutes per response, including the time necessary for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

The information collected is intended to be used in making improvements in services within the National Cemetery Administration of the Department of Veterans Affairs and for associated administrative purposes. Failure to furnish the requested information will have no adverse effect on any VA benefit to which you may be entitled.

The information you supply will be confidential and protected by the Privacy Act of 1974 (5 U.S.C. 522a) and the VA’s confidentiality statute (38 U.S.C. 5701) as implemented by 38 CFR 1.526(a) and 38 CFR 1.576(b). Disclosure of information involves releases of statistical data and other non-identifying data for the improvement of services within the National Cemetery Administration and for associated administrative purposes.

Please send any comments regarding this burden estimate or any other aspect of this collection, including suggestions for reducing this burden, to: VA Clearance Officer (005G2), 810 Vermont Ave., NW, Washington, D.C. 20420. SEND COMMENTS ONLY. DO NOT SEND THIS FORM OR REQUESTS FOR BENEFITS TO THIS ADDRESS.

Marking Instructions:

The survey will take about 20 minutes to complete. Please read each question carefully and respond by filling in the circle of the response that most closely represents your opinion.

Use pencil or pen. Make heavy dark marks that fill the circles completely. If you wish to change an answer, erase cleanly (pencil) or put an “X” over the incorrect response (pen).

Fill in one answer circle for each question unless it tells you to “mark all that apply.”

When you are finished, please place the questionnaire in the enclosed postage-paid envelope and put it in the mail.

If you have any questions or concerns, please call the Survey Help Desk toll-free number that can be found in the letter that accompanied this survey.

2020 VA National Cemetery Next of Kin Satisfaction Survey

Q1. Are you aware of the Pre-Need Eligibility process to find out in advance if you are eligible for burial in a VA national cemetery?

• Yes

• No. Go to Q4.

Q2. Do you intend to apply?

• Yes, I intend to apply.

• No, I do not plan to apply because I already know I am eligible for burial at a VA National Cemetery.

• No, I do not plan to apply but I think I am eligible for burial at a VA National Cemetery.

• No, I do not plan to apply because I already know that I am not eligible for burial at a VA National Cemetery.

• No, I do not plan to apply for a reason other than those specified in the above options.

Q3. If you applied, were you satisfied with the length of time it took to receive a certificate of approval?

• Yes

• No

• Not applicable

Q4. Prior to your time of need, were you aware of the benefits related to burial in a VA national cemetery?

• Yes

• No. Go to Q6.

Q5. How did you learn of these benefits prior to your time of need? (Mark all that apply)

• Family member/friend

• Pre-Need burial eligibility determination

• Funeral home

• Military discharge related materials

• Other Veteran/active duty member

• VA/NCA pamphlet, brochure, newsletter

• VA/NCA website

• VA/NCA social media

• Veterans Service Organization

• Other VA organization

• Local newspaper/news report

• Public events

• Professional/military association meetings

Q6. Prior to the time of need, what is the BEST way for the VA National Cemetery Association to convey information regarding benefits? (Please select only one option.)

• E-mail

• VA/NCA website

• VA/NCA social media (Facebook or Twitter)

• Newsletter/flyer

• Local newspaper/television news reports

• Public events (e.g., parades, speeches)

• Professional/military association meetings including Veteran Service Organizations

• Other (specify): [open text box] to remove

Q7. Did you or a family member personally schedule the interment through the National Cemetery Scheduling Office (1-800-535-1117)?

• Yes

• No, a funeral director scheduled it on my behalf. Go to Q9.

• Don’t know. Go to Q10.

Q8. How satisfied were you with the service you or your family member received from the National Cemetery Scheduling Office?

• Very satisfied

• Somewhat satisfied

• Neither satisfied nor dissatisfied

• Somewhat dissatisfied

• Very dissatisfied

Q9. Did your loved one have a committal service?

• Yes, at the time of interment.

• No, there was not a committal service at time of interment due to the coronavirus pandemic, but a follow-up memorial service was conducted at a later date.

• No, there was not a committal service at time of interment due to the coronavirus pandemic and there was not a follow-up memorial service at a later time. Go to Q19.

• No, there was not a committal service for a reason other than the coronavirus pandemic. Go to Q19.

Q10. Prior to attending the service, to what extent were you informed of the details (e.g., length of service, use of committal shelters) related to the committal or memorial service?

• Very informed

• Somewhat informed

• Neither informed nor uninformed

• Somewhat uninformed

• Very uninformed

Q11. At the service, did your family have any of the following special needs or requests?

• Visit the gravesite

• View the burial

• Specific religious practices (e.g. blessing the gravesite)

• Specific cultural practice (e.g. spreading placement of earth/soil into the grave)

• Additional seating at the committal service

• Access for people with disabilities

• No, my family did not have any special needs or requests.

Q12. Was the cemetery able to accommodate the special needs or requests at the time of the service to your satisfaction?

• Yes, completely

• Yes, somewhat

• No, and I understand why

• No, and I do not understand why

• Don't know/Not applicable

Q13. The committal shelter used for the committal or memorial service was private, clean, and free of safety hazards.

• Strongly agree

• Agree

• Neither agree nor disagree

• Disagree

• Strongly disagree

• Don't know/Not applicable

Q14. Overall, how satisfied were you with the committal or memorial service at the VA national cemetery?

• Very satisfied

• Somewhat satisfied

• Neither satisfied nor dissatisfied

• Somewhat dissatisfied

• Very dissatisfied

Q15. If your loved one received military funeral honors, how satisfied were you with the quality of the honors received?

• Very satisfied

• Somewhat satisfied

• Neither satisfied nor dissatisfied

• Somewhat dissatisfied

• Very dissatisfied

• My loved one did not receive military funeral honors

Q16. Prior to the committal or memorial service for your loved one, did you view the NCA videos illustrating different service options at VA national cemeteries?

• Yes, I viewed it online.

• Yes, the funeral director provided it.

• No. Go to Q19.

Q17. The video(s) helped me understand the burial process at the national cemetery.

• Strongly Agree

• Agree

• Neither agree nor disagree

• Disagree

• Strongly disagree

Q18. Was your experience at the national cemetery similar to the videos on service options you viewed?

• Yes

• No

Q19. Looking back at your overall experience with the national cemetery, which items would you have liked more information about?

• None, I was well informed

• Details of the committal service

• Military funeral honors

• Location of gravesite

• Layout of cemetery (maps)

• Directions to cemetery

• Presidential Memorial Certificate

• Floral policy

• Headstone or marker inscription options

• Timeline for placement of headstone/marker

If your loved one was NOT a veteran, please go to Question 24.

A Presidential Memorial Certificate, referred to as a PMC, is a certificate signed by the President of the United States honoring the Veteran’s service. For more information about the PMC, or to order more copies, please visit our web page at www.cem.va.gov/pmc.asp.

Q20. If your loved one was a Veteran, did you receive a Presidential Memorial Certificate (PMC) honoring the Veteran’s service?

• Yes

• No. Go to Q24.

Q21. Please indicate your level of agreement with the following statements

Receiving the PMC at the committal or memorial service rather than receiving it in the mail enhances the meaning of the recognition.

• Strongly agree

• Agree

• Neither agree nor disagree

• Disagree

• Strongly disagree

• Don't know

Q22. How satisfied were you with the quality of the PMC?

• Very Satisfied

• Somewhat satisfied

• Satisfied

• Neither satisfied nor dissatisfied

• Somewhat dissatisfied

• Very dissatisfied

Q23. Please identify any issues that existed with the PMC that you received.

• Not applicable

• No issues with quality

• Envelope was bent/torn

• Misspelled name

• Poor print quality

• Other problem [open text box]

Q24. Were the headstone, marker, or columbarium niche cover inscription options explained to you?

• Yes

• No

• Not sure/Don't know

Q25. Did you feel you had sufficient time to make a decision on the headstone, marker, or columbarium niche cover inscription?

• Yes

• No

• Not sure/Don't know

Q26. How satisfied were you with the length of time it took for the permanent headstone, marker, or columbarium niche cover to be in place?

• Very satisfied

• Somewhat satisfied

• Neither satisfied nor dissatisfied

• Somewhat dissatisfied

• Very dissatisfied

• Don’t know/the marker or headstone has not yet arrived. Go to Q29.

Q27. When the headstone, marker, or columbarium niche cover arrived, was the inscription accurate?

• Yes

• No

• Don’t know

Q28. Overall, how satisfied were you with the quality and appearance of the headstone, marker, or columbarium niche cover when it arrived?

• Very satisfied

• Somewhat satisfied

• Neither satisfied nor dissatisfied

• Somewhat dissatisfied

• Very dissatisfied

Please indicate your level of agreement with the following statements.

Q29. The appearance of my loved one's gravesite/columbaria is excellent.

• Strongly agree

• Agree

• Neither agree nor disagree

• Disagree

• Strongly disagree

• Don't know/Not applicable

Q30. The upkeep of the headstones, markers, or columbarium niche covers is excellent.

• Strongly agree

• Agree

• Neither agree nor disagree

• Disagree

• Strongly disagree

• Don't know/Not applicable

Q31. The information kiosks at the national cemetery (i.e., gravesite locators) are helpful to me.

• Strongly agree

• Agree

• Neither agree nor disagree

• Disagree

• Strongly disagree

• Don't know/Not applicable

Q32. There are sufficient signs within the national cemetery to assist visitors.

• Strongly agree

• Agree

• Neither agree nor disagree

• Disagree

• Strongly disagree

• Don't know/Not applicable

Q33. The national cemetery staff was courteous.

• Strongly agree

• Agree

• Neither agree nor disagree

• Disagree

• Strongly disagree

• Don't know/Not applicable

Q34. The quality of service received from the national cemetery staff is excellent.

• Strongly agree

• Agree

• Neither agree nor disagree

• Disagree

• Strongly disagree

• Don't know/Not applicable

Q35. The VA national cemetery honors all Veterans and their service to our nation.

• Strongly agree

• Agree

• Neither agree nor disagree

• Disagree

• Strongly disagree

• Don’t know/Not applicable

Q36. I am willing to rely on the VA and the National Cemetery Administration to meet the burial needs of Veterans in the future.

• Strongly agree

• Agree

• Neither agree nor disagree

• Disagree

• Strongly disagree

• Don't know/Not applicable

Q37. I am willing to rely on the VA and the National Cemetery Administration to maintain national cemeteries as national shrines in the future.

• Strongly agree

• Agree

• Neither agree nor disagree

• Disagree

• Strongly disagree

• Don't know/Not applicable

Q38. I would recommend the national cemetery to Veteran families during their time of need.

• Strongly agree

• Agree

• Neither agree nor disagree

• Disagree

• Strongly disagree

• Don't know/Not applicable

Q39. The overall appearance of the national cemetery is excellent.

• Strongly agree

• Agree

• Neither agree nor disagree

• Disagree

• Strongly disagree

• Don't know/Not applicable

Q40. Overall, I am satisfied with the information provided to me throughout my experience with the national cemetery.

• Strongly agree

• Agree

• Neither agree nor disagree

• Disagree

• Strongly disagree

• Don't know/Not applicable

Q41. Overall, I am satisfied with my experience at the national cemetery.

• Strongly agree

• Agree

• Neither agree nor disagree

• Disagree

• Strongly disagree

• Don't know/Not applicable

Q42. My experience with the national cemetery exceeded my expectations.

• Strongly agree

• Agree

• Neither agree nor disagree

• Disagree

• Strongly disagree

• Don't know/Not applicable

Q43. Have you visited a State or Tribal Veterans Cemetery?

• Yes

• No. Go to Q47.

Q44. The honor of being interred at a State or Tribal Veterans Cemetery is equivalent to that of being interred at the VA national cemetery.

• Strongly agree

• Agree

• Neither agree nor disagree

• Disagree

• Strongly disagree

• Don't know/Not applicable

Q45. Based on your visit(s), the quality of service at the State or Tribal Veterans Cemetery compares favorably to the VA national cemetery.

• Strongly agree

• Agree

• Neither agree nor disagree

• Disagree

• Strongly disagree

• Don't know/Not applicable

Q46. Based on your visit(s), the appearance of the State or Tribal Veterans Cemetery compares favorably to the VA national cemetery.

• Strongly agree

• Agree

• Neither agree nor disagree

• Disagree

• Strongly disagree

• Don't know/Not applicable

Q47. Since the committal or memorial service, how many times have you visited the national cemetery where your loved one was interred?

• 1-3 times

• 4-6 times

• 7-9 times

• 10 or more times

• None, I have not visited

Q48. Which of the following factors limit the number of times you visit the national cemetery where your loved one is interred?

• Distance to the national cemetery

• Access to transportation

• Health status

• Other

Q49. What is your sex?

• Male

• Female

Q50. Are you Hispanic or Latino?

• Yes

• No

Q51. What is your race? (Mark one or more)

• White

• Black or African American

• American Indian or Alaska Native Asian

• Asian

• Native Hawaiian or Other Pacific Islander

Q52. What is your age?

• Under 18

• 18 to 29

• 30 to 39

• 40 to 49

• 50 to 59

• 60 to 69

• 70 to 79

• 80 or over

Q53. In what religious practice was the burial conducted?

• Christian

• Catholic

• Muslim

• Jewish

• Buddhist

• Hindu

• Atheist

• Agnostic

• None

• Other (specify)

Q54. Please use this space to elaborate on any aspect of your experience at the national cemetery you wish to share with us. If your comment is in response to a specific question, please reference the question number.

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If you would like to be contacted by the cemetery, please write your name and contact information (address or telephone number):

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