Respondent Identification

VA Form 10-10161     OMB Approval Number 2900-0843     Expiration Date: 10/31/2024 (Estimated Burden Avg: 6 minutes)

The Paperwork Reduction Act of 1995: This information is collected in accordance with section 3507 of the Paperwork Reduction Act of 1995. Accordingly, we may not conduct or sponsor, and you are not required to respond to, a collection of information unless it displays a valid OMB number. We anticipate that the time expended by all individuals who complete this survey will average 6 minutes. This includes the time it will take to follow instructions, gather the necessary facts, and respond to questions asked. Veteran satisfaction is used to gauge Veteran perceptions of VA services, as well as expectations and desires. The results of this survey/assessment will lead to improvements in the quality of service delivery by helping to shape the direction and focus of services and the Veteran experience. Participation in this survey is voluntary, and failure to respond will have no impact on benefits to which you may be entitled.

Question Title

* 1. Which of the following best describes your reasons for taking the CHALENG survey?