Form 10-316d SSG Fox SPGP - Corrective Action Plan (CAP)

Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program (SSG Fox SPGP)
Corrective Action Plan (CAP)
VA Form 10-316d							OMB Control Number: 2900-XXXX
							Estimated Burden: 30 Minutes
							Expiration Date: 04/30/2025
The Paperwork Reduction Act of 1995: This information is collected in accordance with Section 3507 of the Paperwork Reduction Act of 1995. The public reporting burden for this
collection of information is estimated to average 30 minutes per response, including the time to review instructions, search existing data sources, gather and maintain data needed,
and complete and review the collection of information. Respondents should be aware that 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. This collection of information is intended for use by the SSG Fox SPGP as the Grantee's Corrective Action Plan (CAP). Your response
to this information collection is mandatory, if a CAP is necessary, and failure to provide the requested information may adversely affect your continued participation in the SSG Fox SPGP.
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 SSG Fox SPGP. 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 SSG Fox Suicide Prevention Grant Program.
Grantee Name:
Program Number:
Date issued
Response Deadline
SSG Fox SPGP 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: