LSV_Budget Changes and Corrective Action Plan (CAP)_2022.xlsm
Legal Services for Homeless Veterans (LSV) Grant Program (AR33)
LSV_Budget Changes and Corrective Action Plan (CAP)_2022.xlsm
OMB: 2900-0905
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 2900-0905 can be found here:
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Tab 2 CAP
Overview
Tab 1 Variance ReportTab 2 CAP
Sheet 1: Tab 1 Variance Report
| Legal Services for Homeless Veterans and Veterans At-Risk for Homelessness (LSV) Grant Program | |||||||||
| TAB 1: Grantee Financial Variance Report | |||||||||
| VA Form 10-319b | |||||||||
| 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 120 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 LSV Program as the Grantee's budget change and CAP report. Your | |||||||||
| response to this information collection is mandatory, and failure to provide the requested information may adversely affect your continued participation in the LSV Program. | |||||||||
| 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 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 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 LSV Grant Program. | |||||||||
| Name of Grantee: | OMB Control Number: 2900-XXXX | ||||||||
| LSV Program Number: | Estimated Burden: 120 Minutes | ||||||||
| LSV Grant Amount: | Expiration Date: XXX XX, XXXX | ||||||||
| Grant Fiscal Year: | |||||||||
| Program Expenses | % of Total LSV Grant | ACTUAL LSV Grant Funds Spent |
BUDGETED LSV Grant Funds (FY23) |
% VARIANCE LSV 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 Homeless Veterans and Veterans At-Risk for Homelessness (LSV) Grant Program | |||||||
| Corrective Action Plan (CAP) | |||||||
| OMB Control Number: 2900-XXXX | |||||||
| Estimated Burden: 120 Minutes | |||||||
| Grantee Name: | Expiration Date: XXX XX, 2022 | ||||||
| Program Number: | |||||||
| Date issued | |||||||
| Response Deadline | |||||||
| LSV 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 fron Grant Team | |||||||
| Name: | |||||||
| Title | |||||||
| Date: | |||||||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |
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