OMB Control Number: 2900-0864
Respondent
Burden: 9.25 minutes
Expiration
Date: XX/XX/20XX
RESPONDENT BURDEN: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is 2900-0864, and it expires XX/XX/20XX. Public reporting burden for this collection of information is estimated to average 9.25 minutes per respondent, per year, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate and any other aspect of this collection of information, including suggestions for reducing the burden, to VA Reports Clearance Officer at vapra@va.gov. Please refer to OMB Control No. 2900-XXXX in any correspondence. Do not send your completed VA Form XXX to this email address.
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Strongly disagree |
Disagree |
Neither agree nor disagree |
Agree |
Strongly agree |
Not applicable |
Overall, the VA TAP Benefits and Services briefings were beneficial in helping me gain the information and skills I needed to prepare me for my post-military life. |
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Overall, the courses provided the information I needed for a seamless transition to post-military life. |
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Overall, I continue to use what I learned from the VA TAP Benefits and Services briefings. |
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The information provided during the VA TAP Benefits and Services briefings courses continues to assist me in my transition to civilian employment. |
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Not knowledgeable at all |
Not very knowledgeable |
Moderately knowledgeable |
Very knowledgeable |
Extremely knowledgeable |
Not Applicable |
Apply for VA benefits? |
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Prepare for changes in my economic situation after service? |
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Prepare for changes in my personal life? |
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Avoid potential homelessness? |
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Apply for VA Health Care? |
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Obtain mental health counseling or assistance? |
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Avoid predatory financial practices? |
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No |
Yes, you applied in the last 12 months |
Yes, you plan to apply |
Did not know about this benefit |
Not sure |
VA Disability Compensation |
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VA Education (e.g, post 9/11 GI Bill, Montgomery Bill, etc.) |
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VA Life Insurance (e.g., Veterans' Group Life Insurance) |
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VA Home Loans |
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VA Veteran Readiness and Employment (formerly known as Vocational Rehabilitation and Employment) |
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VA Health Care |
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VA Caregiver Program |
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Not useful at all
Not very useful
Neutral
Somewhat useful
Extremely useful
Not applicable
5) In the past 12 months, have you contacted a Veteran Service Organization (VSO) for help understanding or claiming VA benefits, seeking employment, or adjusting to civilian life?
Yes
No à
Skip to Q7
Was not aware of VSOs à
Skip to Q7
6) Please rate your experience with the VSO on the following items. Mark the appropriate box for each benefit.
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Unacceptable |
Needs Improvement |
Average |
Good |
Outstanding |
Not Applicable |
Information provided by the VSO |
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Ease of contacting the VSO |
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Your overall experience with the VSO |
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7) Have you use services from a VA Vet Center?
Yes
No à Skip to Q8
8) What VA Vet Center services did you use? Mark all that apply.
Individual or group counseling
Family counseling
Employment assessment
VBA Benefits assistance
Medical screening/referral
Other_______
Prefer not to answer
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Extremely challenging |
Very challenging |
Moderately challenging |
A little challenging |
Not at all challenging |
Not applicable |
Prefer not to answer |
Managing my expectations about the salary earned in a civilian job. |
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Knowing the steps in conducting a job search. |
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Understanding how my military experiences translate to civilian job requirements. |
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Adapting to differences between military and civilian workforce cultures, norms and behaviors. |
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Interacting with civilians who are not familiar with the military. |
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Working with civilians who share different values from me. |
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Learning to have a better work-life balance after the transition |
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Missing the camaraderie and teamwork that was part of the military culture. |
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Self-employed
Work for a business, non-profit, or government agency (not self-employed)
Not employed - pursuing education/training à Skip to Q21
Not employed - Retired and chose not to pursue further employment àSkip to Q21
Not employed - I want to work but cannot find a job à Skip to Q19
Not employed - I am currently taking time off (greater than 6 months) à Skip to Q21
Not employed - Other reason - Please specify (): _________________________________________________ à Skip to Q21
Prefer not to answer
I work full-time (without an additional part-time job)
I work full-time, and have an additional part-time job
I don’t have a full-time job, I work part-time by choice
I work part-time at one job, but would like full-time employment
I work part-time at more than one job, but would like full-time employment
Permanent
Temporary or Seasonal
Yes
No à Skip to Q15
[ ] By choice
[ ] Could not find a full-time job
[ ] Because one job did not provide enough for myself and/or my family
[ ] Promotion
[ ] Raise
[ ] Did not receive promotion or raise
Does not match skillset
Does not match skillset because I wanted to pursue a different line of work
Slightly matches
Somewhat matches
Considerably matches
Completely matches my skillset
Yes, I own my own company and have ____ employees excluding myself: _________________________________________________*
Yes, I have a side-business/hobby I use to supplement my income
Yes, I have taken tangible steps to start a business during the last 12 months (by myself or with others)
No
Yes, was let go or laid off from a job
No
Yes, I quit or resigned from a job
No à Skip to Q21
________Higher pay
________Better fit for my skills and abilities
________Want a permanent position
________Job satisfaction/better work environment
________Something more interesting
________More flexible schedule
________Better training and educational opportunities
________Better hours
________Want more hours/full-time position
________More opportunities for advancement
________Shorter commute
________Prefer not to answer
Yes
No à Skip to Q23
________Higher pay
________Better fit for my skills and abilities
________Want a permanent position
________Job satisfaction/better work environment
________Something more interesting
________More flexible schedule
________Better training and educational opportunities
________Better hours
________Want more hours/full-time position
________More opportunities for advancement
________Shorter commute
________Prefer not to answer
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Enrolled/ registered in the past 12 months |
Enrolled/ registered prior to past 12 months |
Used services in the past 12 months |
Used services prior to past 12 months |
Never used |
Not applicable |
VA Health Care System (e.g., myHealtheVet.gov) |
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Department of Labor’s American Job Center |
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VA Benefits Website (e.g., eBenefits) |
[ ] |
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Commercial job site (e.g., Indeed, LinkedIn, etc.) |
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USAJOBS (federal employment) |
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[ ] USAJOBS (e.g., federal jobs)
[ ] VA Veteran Readiness and Employment (formerly known as Vocational Rehabilitation and Employment)
[ ] Department of Labor’s American Job Center
[ ] U.S. Chamber of Commerce Foundation’s Hiring Our Heroes Fast Track
[ ] Commercial job site (e.g., Indeed, LinkedIn, etc.)
[ ] Private or non-profit sector (e.g., applying directly, through a recruiter, Veteran hiring initiative, etc.)
[ ] Disabled Veterans’ Outreach Program
[ ] Other - Please specify (Required): _________________________________________________*
[ ] None
[ ] Education at a college or university, full-time
[ ] Education at a college or university, part-time
[ ] Technical or vocational training/obtain license or certificate, full-time
[ ] Technical or vocational training/obtain license or certificate, part-time
[ ] Other - Please specify (Required): _________________________________________________*
[ ] No – Skip to Q32
26) How many academic credit hours did you complete during the past 12 months?
1 to 10
11 to 20
21 to 30
31 to 40
41 or more
Credits were not recorded
Did not complete any credits this year
[ ] Yes, apprenticeship
[ ] Yes, internship
[ ] No
Yes
No à Skip to Q30
[ ] Trade/technical school certification/degree
[ ] Apprenticeship certification
[ ] Associate Degree (e.g. AA, AS)
[ ] 4-year college degree (e.g., BA, AB, BS)
[ ] Master’s degree (e.g., MA, MS, MSW, MBA)
[ ] Professional degree (e.g., MD, DDS, DVM, LLB, JD)
[ ] Doctorate degree (e.g., PhD, EdD)
[ ] Prefer not to answer
________Student Loans
________GI Bill
________Working part-time or full-time
________Scholarship
________Money from other sources (e.g., parents, relatives, savings, etc.)
________Other (e.g., VR&E, Target Foundation, etc.)
[ ] None of the above
________Prefer not to answer
[ ] Transfer to another beneficiary
[ ] Saving it for future educational purposes
[ ] Have used all my funds/eligibility
[ ] Did not know about GI Bill
[ ] Other, please specify: _________________________________________________*
[ ] Not applicable
Yes
No
Yes
No
Yes
No à Skip to Q37
Yes
No
Yes
No
Yes
No à Skip to Q40
Yes
No
Yes
No
[ ] Employer-provided health insurance (could be from your current or former employer, a family member’s current or former employer, or a union)
[ ] A plan you purchased through a healthcare exchange (e.g., Healthcare.gov, State exchange, Affordable Care Act/ “Obamacare”, etc.)
[ ] TRICARE
[ ] VA
[ ] Medicaid
[ ] Medicare
[ ] Other government assisted health plan
[ ] Something else - Please specify (Required): _________________________________________________*
[ ] Prefer not to answer
[ ] None of the above
Employer-provided health insurance (could be from your current or former employer, a family member’s current or former employer, or a union)
A plan you purchased through a healthcare exchange (e.g., Healthcare.gov, State exchange, Affordable Care Act/ “Obamacare”, etc.)
TRICARE
VA
Medicaid
Medicare
Other government assisted health plan
Something else - Please specify (Required): _________________________________________________*
Prefer not to answer
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Very dissatisfied |
Somewhat Dissatisfied |
Neither satisfied nor dissatisfied |
Somewhat satisfied |
Very satisfied |
Your physical health? |
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Your emotional/mental health? |
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Your health care? |
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Living with a domestic partner à Skip to Q45
Never married
Married-first and only marriage à Skip to Q45
Married-second or later marriage à Skip to Q45
Separated
Divorced
Widowed
Prefer not to answer
Currently in a relationship
Not currently in a relationship
Prefer not to answer
Yes
No
Prefer not to answer
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None |
One |
Two |
Three or Four |
Five to Eight |
Nine or more |
Prefer not to answer |
How many relatives do you see or hear from at least once a month? |
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How many relatives do you feel comfortable with that you can talk about private matters? |
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How many relatives do you feel close to such that you could call on them for help? |
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None |
One |
Two |
Three or Four |
Five to Eight |
Nine or more |
Prefer not to answer |
How many of your friends do you see or hear from at least once a month? |
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How many friends do you feel comfortable with that you can talk about private matters? |
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How many friends do you feel close to such that you could call on them for help? |
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Never |
Hardly Ever |
Some of the Time |
Often |
How often do you feel that you lack companionship? |
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How often do you feel left out? |
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How often do you feel isolated from others? |
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Yes
No
50) In the last 12 months, which of the following food assistance programs did your household use?
SNAP (food stamps)
WIC (Women, Infant, and Children’s Program)
K-12 School Meal Programs
Food pantry/food bank
Other food assistance program (supplemental food program, Meals on Wheels, or other), specify ____
My household has not used any food assistance programs
Yes
No
Yes
No
Yes
No
No, my household is not more than one month behind in debt payments
Yes, my household is over one month behind in debt payments
Not applicable- my household does not have any debt
Prefer not to answer
Rent an apartment, house, or room
Own an apartment or house
Live with a friend or relative and not paying rent
Live in a dormitory at school
Live in a medical or assisted living facility, such as a hospital or rehab center
Live in transitional housing (e.g., a halfway house)
Live in a car, on the street, or in a homeless shelter
Somewhere else - Please specify (Required): _________________________________________________*
Prefer not to answer
Yes
No
Prefer not to answer
57) During the past 12 months, how many months were you employed?
Months employed: _____________________
Was not employed at any time during the past 12 months
58) During the past 12 months, how much did you earn from all jobs or businesses before taxes and other deductions?
Yearly salary: _____________________
59) During the past 12 months, what was your gross income? (Your gross income includes income you received from all sources, before taxes, including earnings from a job, benefits received from government programs, and any retirement, pension, investing, or savings income that you receive regular payments from.)
_________________________________________________
60) During the past 12 months, what was your gross household income? (Your household income is the combined before-tax income of people who share their income and live in the same home. Typically, this would be you and your spouse.)
_________________________________________________
Number of people (Required): _________________________________________________*
Prefer not to answer
Yes
No à Skip to Q64
_________________________________________________
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No satisfaction at all (0) |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
Completely satisfied (10) |
Prefer not to answer |
Thinking about your own life and personal circumstances, how satisfied are you with your life as a whole? |
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How satisfied are you with your quality of life? |
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How satisfied are you with your health? |
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How satisfied are you with your personal relationships? |
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How satisfied are you with feeling part of your community? |
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How satisfied are you with your future security? |
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____________________________________________
____________________________________________
____________________________________________
____________________________________________
: _________________________________________________*
I do not have an email address.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Matthew Branner |
File Modified | 0000-00-00 |
File Created | 2025-09-28 |