Form 10-398a Corrective Action Plan (CAP)

Telehealth Grant Program (THGP)
Corrective Action Plan (CAP)
VA Form 10-398a							OMB Control Number: 2900-XXXX
							Estimated Burden: 30 Minutes
							Expiration Date: XX/XX/20XX
VA Burden Statement: 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-XXXX, and it expires XX/XX/20XX. Public reporting burden for this collection of information is estimated to average 30 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
[email protected].
Please refer to OMB Control No. 2900-XXXX in any correspondence. Do not send your completed VA Form 10-398a to this email address.
Privacy Act Statement: VA is asking you to provide the information requested in this plan under the authority of 38 U.S.C. section 7366 in order for the VA to assess your CAP, as necessary,
and maintain oversight of your participation in the program. VA may use or disclose your CAP information as permitted by law. VA may make a "routine use" disclosure of the information
for: civil or criminal law enforcement; congressional communications; the collection of money owed to the United States; litigation in which the United States is a party or has interest;
the administration of VA programs, including verification of eligibility to participate; and personnel administration. You must provide the requested information to VA in order to continue
participation with the Telehealth Grant Program.
Grantee Name:
Program Number:
Date issued
Response Deadline
Telehealth Grant Program Point of Contact:
Instructions:
Corrective Action Plan
Finding/Concern Identified	Reason for the Non-Compliance and Plan to Address the Issue	Timeline/Action Steps for accomplishing corrective action and who will be involved in each step of the process				Describe system of internal controls to prevent reoccurrence	If a repeat finding: Provide documentation/evidence that the finding has been corrected. Evidence should include plan or system of internal controls to prevent the finding from reoccurring.
Prepopulated from Grant Team
Name:
Title
Date: