Form 10-367c Bi-annual Finance Report - LSV-A Grant

Legal Services for Veterans – Legal Assistance for Access to VA Programs (LSV-A) Grant Program (AS17-P)

Bi-annual Finance Report_LSV-A Grant_rev Sep 2024.xlsm

Bi-annual Finance Report - LSV-A

OMB:

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Overview

Tab 1 Variance Report
Burden and Privacy Statements


Sheet 1: Tab 1 Variance Report


Legal Services for Veterans -- Legal Assistance for Access to VA Programs (LSV-A) Grant Program




OMB Control Number: 2900-XXXX

VA Form 10-367c






Estimated Burden: 60 minutes

TAB 1: Bi-annual Financial Report - Variance Report






Expiration Date: XX/XX/20XX











Name of Grantee:




LSV-A Program Number:




LSV-A Grant Amount:




Grant Fiscal Year:














Program Expenses % of Total LSV-A Grant ACTUAL
LSV-A Grant Funds Spent
BUDGETED
LSV-A Grant Funds (FY24)
% VARIANCE
LSV-A Grant Funds
VARIANCE EXPLANATION

I. Provision and Coordination of Legal Clinics (Minimum of 90% of Total LSV-A Grant Amount)








1. Personnel/Labor # FTE % FTE Base Annual Salary/Wage





Title and Organization





0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0! 0


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!


0.0 0% $- #DIV/0! $- $- #DIV/0!

Subtotal Salaries/Wages


#DIV/0! $- $- #DIV/0!

Fringe Benefits @


#DIV/0! $- $- #DIV/0!

Subtotal Personnel


#DIV/0! $- $- #DIV/0!











2. Other Non-Personnel Provision and Coordination of Legal Clinic Expenses








Court Fees/ Filing Fees












#DIV/0! $- NA NA





#DIV/0! $- NA NA





#DIV/0! $- NA NA





#DIV/0! $- NA NA





#DIV/0! $- NA NA





#DIV/0! $- NA NA





#DIV/0! $- NA NA





#DIV/0! $- NA NA





#DIV/0! $- NA NA





#DIV/0! $- NA NA





#DIV/0! $- NA NA





















Subtotal Other Program Expenses


#REF! #REF! $- #REF!














# of Vehicles





Vehicle Lease Costs


#DIV/0! $- $- #DIV/0!











Subtotal Provision and Coordination of Legal Clinics


#REF! #REF! #REF! #REF!











II. Administrative Expenses (Maximum of 10% of Total LSV-A Grant Amount)












#DIV/0! $-
#DIV/0!





#DIV/0! $- $- #DIV/0!





#DIV/0! $- $- #DIV/0!





#DIV/0! $-
#DIV/0!





#DIV/0! $-
#DIV/0!





#DIV/0! $- $- #DIV/0!





#DIV/0! $- $- #DIV/0!





#DIV/0! $- $- #DIV/0!





#DIV/0! $- $- #DIV/0!





#DIV/0! $- $- #DIV/0!





#DIV/0! $- $- #DIV/0!





#DIV/0! $- $- #DIV/0!





#DIV/0! $- $- #DIV/0!





#DIV/0! $- $- #DIV/0!





#DIV/0! $- $- #DIV/0!





#DIV/0! $- $- #DIV/0!





#DIV/0! $- $- #DIV/0!





#DIV/0! $- $- #DIV/0!





#DIV/0! $- $- #DIV/0!





#DIV/0! $- $- #DIV/0!





#DIV/0! $- $- #DIV/0!





#DIV/0! $- $- #DIV/0!





#DIV/0! $- $- #DIV/0!





#DIV/0! $- $- #DIV/0!





#DIV/0! $- $- #DIV/0!





#DIV/0! $- $- #DIV/0!





#DIV/0! $- $- #DIV/0!





#DIV/0! $- $- #DIV/0!





#DIV/0! $- $- #DIV/0!





#DIV/0! $- $- #DIV/0!





#DIV/0! $- $- #DIV/0!





#DIV/0! $- $- #DIV/0!





#DIV/0! $- $- #DIV/0!





#DIV/0! $- $- #DIV/0!





#DIV/0! $- $- #DIV/0!

Subtotal Administrative Expenses


#DIV/0! $- $- #DIV/0!











Grand Total


#REF! #REF! #REF! #REF!

Sheet 2: Burden and Privacy Statements

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 60 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 VACOPaperworkReduAct@va,gov. Please refer to OMB Control No. 2900-XXXX in any correspondence. Do not send your completed VA Form 10-367c to this email address.

Privacy Act Statement: VA is asking you to provide the information requested in this report under the authority of 38 U.S.C. section 7366 in order for the VA to assess your financial budget situation, any CAP, and maintain oversight of your participation in the LSV-A Grant Program. VA may use or disclose your report 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 inwhich 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 LSV-A Grant Program.
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