10-367a Budget Changes and Corrective Action Plan (CAP) - LSV-A
Legal Services for Veterans – Legal Assistance for Access to VA Programs (LSV-A) Grant Program (AS17-P)
Budget Changes and Corrective Action Plan (CAP)_LSV-A Grant_rev Sep 2024.xlsm
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Tab 2 CAP
PRA and Privacy Statements
Overview
Tab 1 Variance ReportTab 2 CAP
PRA 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 | ||||||||
| TAB 1: Grantee Financial Variance Report (Budget Changes) | Estimated Burden: 120 minutes | ||||||||
| VA Form 10-367a (11HPO) | Expiration Date: XX/XX/20XX | ||||||||
| Name of Grantee: | |||||||||
| LSV-A Grant 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 Services (Minimum of 90% of Total LSV 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 Services 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 Services | #REF! | #REF! | #REF! | #REF! | |||||
| II. Administrative Expenses (Maximum of 10% of Total LSV 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: Tab 2 CAP
| Legal Services for Veterans - Legal Assistance with Access to VA Programs (LSV-A) Grant Program | |||||||
| Corrective Action Plan (CAP) | |||||||
| VA Form | 10-367a | OMB Control Number: 2900-XXXX | |||||
| Estimated Burden: 120 Minutes | |||||||
| Grantee Name: | Expiration Date: XX/XX/20XX | ||||||
| Program Number: | |||||||
| Date issued | |||||||
| Response Deadline | |||||||
| LSV-A Grant 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: | |||||||
Sheet 3: PRA 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 120 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 10-367a 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. |
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |
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