In February 2009, the President signed into law the American Recovery and Reinvestment Act (ARRA) that included $150 million for Veterans Health Administration (VHA) to provide grants for construction of State extended care facilities. In March 2009, the Office of Inspector General (OIG) initiated an audit to determine if VHA had implemented adequate oversight mechanisms to monitor outcomes of the State Home Construction Grant (SHCG) Program and provide sufficient accountability and transparency of ARRA funds. While conducting the audit, we identified staffing concerns that needed immediate management attention to ensure accomplishment of ARRA and Office of Management and Budget (OMB) objectives. Specifically, VHA’s Strategic Planning and Finance Office (SPF) does not have sufficient and adequately trained staff to accomplish increased SHCG Program workload to ensure grants are processed efficiently and effectively. ARRA presents an opportunity for VHA to make needed or neglected investments in State’s acquisition, construction, and remodeling of nursing home, domiciliary, and or adult day care facilities for veterans disabled by age or disease. The SHCG Program’s insufficient and inadequately trained staff jeopardizes these opportunities by delaying the obligation of ARRA funds; failing to ensure adequate transparency and accountability of Program performance; and increasing the risk of Program fraud, waste, and abuse. We recommended that the Acting Under Secretary for Health expedite actions to acquire sufficient trained and experienced staff to meet the increased SHCG Program workload, monitoring and reporting requirements, and accelerated timeframes associated with ARRA spending. The Acting Under Secretary concurred with our conclusion and recommendation. We consider the Acting Under Secretary’s planned actions acceptable and we will follow up on their implementation.