| VA STAFF SERGEANT FOX SUICIDE PREVENTION GRANT PROGRAM (SSG Fox SPGP) | OMB Control Number: 2900-XXXX | ||||||||
| TAB 1: Annual Grantee Financial Report - Variance Report | Estimated Burden: 45 Minutes | ||||||||
| VA Form 10-316e | 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 45 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 annual financial report. Your response to this information collection is mandatory, and failure to provide the requested information may adversely affect | |||||||||
| your continued participation in the SSG Fox Suicide Prevention Grant 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 annual financial situation and maintain | |||||||||
| oversight of your participation in the SSG Fox SPGP. VA may use or disclose your annual 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 to continue participation with the SSG Fox SPGP. | |||||||||
| Name of Grantee: | |||||||||
| SSG-Fox-SPGP Program Number: | |||||||||
| SSG-Fox-SPGP Grant Amount: | |||||||||
| Grant Fiscal Year: | |||||||||
| Program Expenses | % of Total Grant | ACTUAL Grant Funds Spent |
BUDGETED Grant Funds |
% VARIANCE Grant Funds |
VARIANCE EXPLANATION | ||||
| I. Provision and Coordination of Suicide Prevention Services (Minimum of 90% of Total SSVF 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. Temporary Financial Assistance | |||||||||
| Spent on Prevention Participants (Category 1) | |||||||||
| Transportation | #DIV/0! | $- | NA | NA | |||||
| Child Care | #DIV/0! | $- | NA | NA | |||||
| Other as approved by VA | #DIV/0! | $- | NA | NA | |||||
| Subtotal Temporary Financial Assistance | #REF! | #REF! | $- | #REF! | |||||
| 3. Other Non-Personnel Provision and Coordination of Suicide Prevention Services Expenses | |||||||||
| #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! | ||||||
| #DIV/0! | $- | $- | #DIV/0! | ||||||
| Subtotal Other Program Expenses | #DIV/0! | $- | $- | #DIV/0! | |||||
| # of Vehicles | |||||||||
| 4. Lease & Maintenance of Vehicle(s) | #DIV/0! | $- | $- | #DIV/0! | |||||
| Subtotal Provision and Coordination of Suicide Prevention Services | #REF! | #REF! | $- | #REF! | |||||
| II. Administrative Expenses (Maximum of 10% of Total SSVF 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! | |||||
| VA STAFF SERGEANT FOX SUICIDE PREVENTION GRANT PROGRAM (SSG Fox SPGP) | OMB Control Number: 2900-XXXX | |||||||||||||||
| TAB 2: Annual Grantee Financial Report - Program Expenditures by Subcontractor | Estimated Burden: 45 Minutes | |||||||||||||||
| VA Form 10-316e | Expiration Date: 04/30/2025 | |||||||||||||||
| Name of Grantee: | 0 | |||||||||||||||
| SSG Fox SPGP Program Number | 0 | |||||||||||||||
| SSG Fox SPGP Grant Amount: | $0.00 | |||||||||||||||
| Grant Fiscal Year: | 0 | |||||||||||||||
| PROGRAM EXPENSES BY SUBCONTRACTOR: | ||||||||||||||||
| Program Expenses | % of Total Grant | SPENT Grant Funds Total Annual to Date |
0 | INSERT SUB-CONTRACTOR NAME | INSERT SUB-CONTRACTOR NAME | INSERT SUB-CONTRACTOR NAME | INSERT SUB-CONTRACTOR NAME | INSERT SUB-CONTRACTOR NAME | INSERT SUB-CONTRACTOR NAME | INSERT SUB-CONTRACTOR NAME | INSERT SUB-CONTRACTOR NAME | INSERT SUB-CONTRACTOR NAME | INSERT SUB-CONTRACTOR NAME | |||
| I. Provision and Coordination of Suicide Prevention Services (Minimum of 90% of Total SSG Fox SPGP Grant Amount) | ||||||||||||||||
| 1. Personnel/Labor | ||||||||||||||||
| Subtotal Personnel | #DIV/0! | $- | $- | $- | $- | $- | $- | $- | $- | $- | $- | $- | ||||
| 2. Temporary Financial Assistance | #DIV/0! | $- | $- | $- | $- | $- | $- | $- | $- | $- | $- | $- | $- | |||
| 3. Other Non-Personnel Provision and Coordination of Suicide Prevention Services Expenses | ||||||||||||||||
| Subtotal Other Program Expenses | #DIV/0! | $- | $- | $- | $- | $- | $- | $- | $- | $- | $- | $- | $- | |||
| # of Vehicles | ||||||||||||||||
| 4. Lease & Maintenance of Vehicle(s) | 0 | #DIV/0! | $- | $- | $- | $- | $- | $- | $- | $- | $- | $- | $- | $- | ||
| Subtotal Provision and Coordination of Suicide Prevention Services | #DIV/0! | $- | $- | $- | $- | $- | $- | $- | $- | $- | $- | $- | $- | |||
| II. Administrative Expenses (Maximum of 10% of Total SSG Fox SPGP Grant Amount) | ||||||||||||||||
| Subtotal Administrative Expenses | #DIV/0! | $- | $- | $- | $- | $- | $- | $- | $- | $- | $- | $- | $- | |||
| Grand Total | #DIV/0! | $- | $- | $- | $- | $- | $- | $- | $- | $- | $- | $- | $- | |||
| % of Total SSG Fox SPGP Grant | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | ||||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |