Project Reach Survey

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OMB Number 2900-0769
Estimated Burden: 10
minutes

RESPONDENT BURDEN: The Paperwork Reduction Act of 1995 requires
us to notify you that this information collection is in accordance with the
clearance requirements of section 3507 of this Act. The information is needed to
generate suggestions about VA’s homeless Veteran program. We estimate that you
will need an average of 10 minutes to complete this form. VA may not conduct,
sponsor or require the respondent to respond to this collection of information
unless it displays a valid OMB Control Number. Valid OMB control numbers can be
located on the OMB Internet Page at www.whitehouse.gov/omb/library/OMBINV.
Responding to this collection of information is voluntary. Send comments
regarding this burden estimate or any other aspects of this collection,
including suggestions for reducing this burden to VA Clearance Officer (005R1B)
810 Vermont Avenue, NW, Washington, DC 20420.

*
1. Name of the application you
reviewed

Name of the application you
reviewed

2. What is your
name (this is optional and will not be shared with the developers)?

What is your name (this is optional
and will not be shared with the developers)?

*
3. How user friendly would you rank
this app to navigate?

1 Poor

2

3

4

5 Highest

5 being the highest

*How user friendly would you rank
this app to navigate? 5 being the highest 1 Poor

5 being the
highest 2

5 being the
highest 3

5 being the
highest 4

5 being the
highest 5 Highest

Please provide any comments you
may have

*
4. Rate the overall design of this
app.

1 Poor

2

3

4

5 Highest

5 being the highest

*Rate the overall design of this app.
5 being the highest 1 Poor

5 being the
highest 2

5 being the
highest 3

5 being the
highest 4

5 being the
highest 5
Highest

*
5. Did you experience any crashes or
other major errors while evaluating this app?

Did you experience any crashes or
other major errors while evaluating this app?

*
6. Rate the quality of the
data/information contained within this app.

Very Unhelpful

Unhelpful

Neutral

Helpful

Very Helpful

Choose one

*Rate the quality of the
data/information contained within this app. Choose one Very
Unhelpful

Choose one
Unhelpful

Choose one
Neutral

Choose one
Helpful

Choose one
Very Helpful

*
7. Was there enough data/information
provided within this app? If not, what other type(s) of data would you suggest
be included?

Was there enough data/information
provided within this app? If not, what other type(s) of data would you suggest
be included?

*
8. Rate your overall satisfaction with
this app.

Very Unsatisfied

Unsatisfied

Neutral

Helpful

Very Helpful

Choose one

*Rate your overall satisfaction with
this app. Choose one Very Unsatisfied

Choose one
Unsatisfied

Choose one
Neutral

Choose one
Helpful

Choose one
Very Helpful

9. Please
provide any other comments/suggestions you have for improving this app.

Please provide any other
comments/suggestions you have for improving this
app.

*
10. If you could ask the developers to
add or change three items, what would you tell them to do?

If you could ask the developers to
add or change three items, what would you tell them to
do?

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