Open Recommendations

Work with the Idaho Department of Labor to ensure timely reporting of the Forms SSA-4513 and SSA 4514.

We recommend that management ensure control operators remain abreast of significant changes in the environment and respond appropriately when performing internal control responsibilities.

The VA Nebraska—Western Iowa Health Care System Director ensures the installation of night lighting changes to accommodate patient comfort and facility staff’s ability to safely conduct rounding in applicable inpatient mental health unit patient rooms.

The VA Nebraska—Western Iowa Health Care System Director ensures establishment and implementation of guidance related to the facility inpatient mental health unit staff’s use and security of handheld flashlights to ensure appropriate education and training of handheld flashlights usage and storage.

The VA Nebraska—Western Iowa Health Care System Director establishes and ensures implementation of a patient safety observation rounds standard operating procedure consistent with Veterans Health Administration requirements.

The VA Nebraska—Western Iowa Health Care System Director reviews facility Mental Health Environment of Care Checklist processes related to development of mitigation plans as required by the Veterans Health Administration, and monitors compliance.

The VA Nebraska—Western Iowa Health Care System Director ensures compliance with Veterans Health Administration staffing requirements for areas identified as high-risk, such as the inpatient mental health unit, and monitors compliance.

The Under Secretary for Health evaluates the Veterans Health Administration written guidance for high-risk workplace staffing and determines if clarification is needed.

The VA Nebraska—Western Iowa Health Care System Director ensures staff that may provide coverage on the inpatient mental health unit receive applicable Prevention and Management of Disruptive Behavior training for high-risk units.

The VA Nebraska—Western Iowa Health Care System Director strengthens processes to ensure that supervisors are made aware of staff members that have not completed the applicable Prevention and Management of Disruptive Behavior training for high-risk units, to include the hands-on component, and monitors compliance.

The Under Secretary for Health considers written guidance regarding risk for violence assessment use in units identified as a high-risk workplace that can be used to temporarily change a unit’s acuity level and staffing needs.

The VA Nebraska"Western Iowa Health Care System Director evaluates the root cause analysis processes regarding reporting of action items and outcome measures in accordance with Veterans Health Administration requirements, takes action as needed, and monitors compliance.

The VA Nebraska"Western Iowa Health Care System Director evaluates processes requesting and reporting changes to authorized and operating beds on the inpatient mental health unit, takes action as needed, and monitors compliance.

The VA Midwest Health Care Network Director strengthens processes to ensure adequate oversight and adherence to Veterans Health Administration requirements pertaining to changes to authorized and operating inpatient mental health unit beds.

The VA Nebraska"Western Iowa Health Care System Director reviews and ensures consistent application of facility nursing leaders use of risk for violence assessment on the inpatient mental health unit, and monitors for compliance.

The VA Nebraska"Western Iowa Health Care System Director ensures the installation of night lighting changes to accommodate patient comfort and facility staffs ability to safely conduct rounding in applicable inpatient mental health unit patient rooms.

The VA Nebraska"Western Iowa Health Care System Director ensures establishment and implementation of guidance related to the facility inpatient mental health unit staffs use and security of handheld flashlights to ensure appropriate education and training of handheld flashlights usage and storage.

The VA Nebraska"Western Iowa Health Care System Director establishes and ensures implementation of a patient safety observation rounds standard operating procedure consistent with Veterans Health Administration requirements.

The VA Nebraska"Western Iowa Health Care System Director reviews facility Mental Health Environment of Care Checklist processes related to development of mitigation plans as required by the Veterans Health Administration, and monitors compliance.

The VA Nebraska"Western Iowa Health Care System Director ensures compliance with Veterans Health Administration staffing requirements for areas identified as high-risk, such as the inpatient mental health unit, and monitors compliance.

The Under Secretary for Health evaluates the Veterans Health Administration written guidance for high-risk workplace staffing and determines if clarification is needed.

The VA Nebraska"Western Iowa Health Care System Director ensures staff that may provide coverage on the inpatient mental health unit receive applicable Prevention and Management of Disruptive Behavior training for high-risk units.

The VA Nebraska"Western Iowa Health Care System Director strengthens processes to ensure that supervisors are made aware of staff members that have not completed the applicable Prevention and Management of Disruptive Behavior training for high-risk units, to include the hands-on component, and monitors compliance.

The Under Secretary for Health considers written guidance regarding risk for violence assessment use in units identified as a high-risk workplace that can be used to temporarily change a units acuity level and staffing needs.

Work with the Illinois Department of Human Services to ensure it accurately charges expenditures related to Social Security Administration programs.

Develop and implement a formal, documented grant closeout process that includes clear policies and procedures aligned with federal requirements.

Provide training to relevant staffs on the new grant closeout policies and procedures to ensure consistent understanding and application across all grant programs.

Update the NARA 111, NARA Directives, for the development, approval, and maintenance of internal policies and SOPs.

Ensure a NARA executive oversees and monitors the periodic review and update of the policies and SOPs.

Update the travel policy and continue efforts to ensure that all written policies and procedures are reviewed and revised in a timely manner.

We recommend that management:
• Implement audit logging monitoring controls to reduce the risk that inappropriate and/or unusual activity that may compromise the integrity and availability of systems and data goes undetected and resolved.
• Design, document, and implement preventive controls to remove system application access within an acceptable timeframe following a user’s separation date.
• Enforce existing policies to ensure that all users are included within quarterly user access reviews.

It is recommended that GPO strengthen the controls related to the review and approval of employee separation personnel actions and reinforce the requirements in OPM's Guide to Processing Personnel Actions, specifically as it relates to the timeliness of review and approval.

GPO strengthens controls related to the review and certification of printing vendor invoices and reinforce the requirements in SOP 12-0023, Examination of Printing Invoices, specifically as it relates to supporting documentation requirements for vendor invoices.

It is recommended that GPO design and implement effective monitoring controls related to the review and approval for the processing of new hire employee actions and reinforce the requirements in OPM's Guide to Processing Personnel Actions, specifically as it relates to the timeliness of supervisor authorizations.

It is recommended that GPO design and implement monitoring controls related to the review and certification of employee timesheets and reinforce the requirements in GPO Directive 440.12C, specifically as it relates to the separation of duties between the timekeeper and certifying official roles.

It is recommended that GPO establish procedures within its review control for the OWCP liability adjustment to independently assess the reliability of data received from DOL. This may include performing reasonableness checks such as detailed trend/variance analysis, reconciliations, or reviewing supporting documentation.

Strengthen RD’s continuous review and monitoring controls to identify and timely deobligate ULOs that are not properly authorized and supported by appropriate documentation; that have been completed and not closed out; and under which no future expenditures are expected.

Determine whether the identified undocumented grant is valid, and properly document review and approval thereof.

Deobligate the identified invalid ULOs that are outstanding.

Strengthen their risk assessment process by considering the gap period between the last SOC 1 reports and PBGC’s fiscal year end to determine the sufficiency of internal controls relevant to PBGC’s financial reporting processed by the service organizations. Such considerations should be documented.

Design and implement additional controls based on the results of PBGC’s risk assessment process.

We recommend that the Chief Operating Officer for Federal Student Aid (FSA), in conjunction with the Commissioner for NCES, require SNHU to update its existing policies and procedures for identifying full-time undergraduate students who were seeking their first postsecondary certificate or degree for the IPEDS SFA survey to ensure student cohorts are identified consistent with the Keyholder Handbook and survey instructions.

We also recommend that the Chief Operating Officer for FSA consider taking appropriate action pursuant to subpart G of 34 C.F.R. 668 because the school reported inaccurate and incorrect information to IPEDS through the SFA survey for the 2021–2022 reporting period.

We recommend that the Chief Operating Officer for FSA, in conjunction with the Commissioner for NCES, require SNHU to update its policies and procedures for collecting, verifying, and reporting accurate data for the Graduation Rates survey to align with current IPEDS reporting requirements and ensure accurate classification of first-time, full-time undergraduate students seeking their first postsecondary education degree or certificate.

We also recommend the Chief Operating Officer for FSA consider taking appropriate action pursuant to subpart G of 34 C.F.R. 668 because the school reported inaccurate and incorrect information to IPEDS through the Graduation Rates survey for the 2021–2022 reporting period.

We recommend that the Chief Operating Officer for FSA, in conjunction with the Commissioner for NCES, require SNHU to update its existing policies and procedures to ensure that the cost of attendance data reported for the IPEDS Institutional Characteristics survey are accurate and supported by source documentation.

We recommend that EXIM design, document, and implement controls to ensure [language withheld based on applicable Freedom of Information Act exemptions] that logical access is restricted to only authorized users.

The New York/New Jersey VA Healthcare Network Director evaluates the circumstances that led to Network and Syracuse VA Medical Center leaders not following clinical restructuring requirements according to VHA Directive 1043.

The Syracuse VA Medical Center Director evaluates the implementation of high reliability organization principles when communicating changes to clinical operations that include stakeholders, service and section leaders, and staff input.

The Syracuse VA Medical Center Director evaluates facility contract processes and takes action to ensure leaders maintain adequate oversight of contracting milestones.