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Palliative care is an important and emerging issue for health care providers, educators, and the general public. As medical advances increase life expectancy, more and more people suffer from chronic and progressively disabling diseases that require treatment for depression and assistance with pain and symptom manageme...
Pursuant to a legislative requirement, GAO reported on the extent to which projects under section 781 of the Public Health Service Act have furthered the knowledge and practice of palliative care, particularly with regard to curricula offered and used in medical schools. GAO's preliminary work showed that no fiscal yea...
The U.S. government is one of the world’s largest property owners, with a real estate portfolio of over 400,000 defense and civilian buildings and over one-half billion acres of land. As we and others have previously reported, federal asset managers are confronted with numerous challenges in managing this multibillion-...
The U.S. government is one of the world's largest property owners, with a real estate portfolio of more than 400,000 defense and civilian buildings and more than one-half billion acres of land. Each year, the federal government spends billions of dollars to maintain its buildings. Even so, the General Services Administ...
EPA administers and oversees grants primarily through the Office of Grants and Debarment, 10 program offices in headquarters, and program offices and grants management offices in EPA’s 10 regional offices. Figure 1 shows the key EPA offices involved in grants activities for headquarters and regions. The management of E...
The Environmental Protection Agency (EPA) has faced persistent challenges in managing its grants, which constitute over one-half of the agency's budget, or about $4 billion annually. These challenges include achieving and measuring environmental results from grant funding. It is easier to measure grant activities (outp...
At the end of July 2010, over 10,000 military medical personnel were deployed to Iraq and Afghanistan, 70 percent of whom were Army servicemembers. Of that number, about 4,000 medical personnel were in Iraq and about 6,000 were in Afghanistan. The United States’ military presence in Iraq is scheduled to end no later th...
For ongoing operations in Afghanistan and Iraq, military medical personnel are among the first to arrive and the last to leave. Sustained U.S. involvement in these operations has placed stresses on the Department of Defense's (DOD) medical personnel. As the U.S. military role in Iraq and Afghanistan changes, the Army m...
DOD has established criteria for the types of items that are required to be marked with IUID labels. For principal end items and contractor-marked secondary items, the criteria are as follows: 1. all items for which the government’s unit acquisition cost is $5,000 or more; 2. items for which the government’s unit acqui...
IUID technology allows DOD to assign a unique number to an item and use that number to manage that item in a variety of logistics processes. In 2003, DOD began implementation of IUID and has estimated that it could improve the accountability and maintenance of its property and equipment and save from $3 billion to $5 b...
The Disaster Relief Act included approximately $50 billion in supplemental appropriations for fiscal year 2013 to 19 agencies for 61 specific programs for expenses related to the consequences of Hurricane Sandy. Under the authority granted by the Balanced Budget and Emergency Deficit Control Act of 1985, as amended, OM...
In late October 2012, Hurricane Sandy devastated portions of the Mid-Atlantic and northeastern United States, leaving victims of the storm and their communities in need of financial assistance for disaster relief aid. On January 29, 2013, the President signed the Disaster Relief Appropriations Act, 2013, which provided...
Foster care begins when a child is removed from his or her parents or guardians and placed under the responsibility of a state child welfare agency. Removal from the home can occur because of physical abuse or neglect. It can also occur when a child’s own behavior or condition is beyond the control of his or her family...
Foster children have often been removed from abusive or neglectful homes and tend to have more mental health conditions than other children. Treatment may include psychotropic drugs but their risks to children are not well understood. Medicaid, administered by states and overseen by the Department of Health and Human S...
In February 2011, Boeing won the competition to develop the Air Force’s next generation aerial refueling tanker aircraft, the KC-46. To develop a tanker, Boeing modified a 767 aircraft in two phases. In the first phase, Boeing modified the design of the 767 with a cargo door and an advanced flight deck display borrowed...
The KC-46 tanker modernization program, valued at about $44 billion, is among the Air Force's highest acquisition priorities. Aerial refueling—the transfer of fuel from airborne tankers to combat and airlift forces—is critical to the U.S. military's ability to effectively operate globally. The Air Force initiated the K...
Biological threats that could result in catastrophic consequences exist in many forms and arise from multiple sources. For example, several known biological agents could be made into aerosolized weapons and intentionally released in a transportation hub or other populated urban setting, introduced into the agricultural...
The 2001 anthrax attacks brought attention to the potentially devastating consequences of a biological attack. DHS operates a program, known as BioWatch, intended to help detect such an attack by airborne pathogens. The currently deployed technology can take 12 to 36 hours to confirm the presence of pathogens. DHS has ...
The purpose of the HUBZone program, which was established by the HUBZone Act of 1997, is to stimulate economic development, through increased employment and capital investment, by providing federal contracting preferences to small businesses in economically distressed communities or HUBZone areas. The types of areas in...
The Small Business Administration's (SBA) Historically Underutilized Business Zone (HUBZone) program provides federal contracting assistance to small firms located in economically distressed areas, with the intent of stimulating economic development. Questions have been raised about whether the program is targeting the...
DOD contracting officers use a structured approach called the Weighted Guidelines Method to develop profit objectives for use in contract negotiations. Using these profit guidelines, contracting officers address a contractor’s (1) risk in fulfilling the contract requirements, known as performance risk; (2) degree of co...
In negotiating profit on contracts, the Department of Defense (DOD) requires contracting officers to set negotiating objectives by relying on guidelines in defense regulations. Congress mandated that DOD review its profit guidelines and consider whether modifying them would provide more incentive for contractors to dev...
Public and private organizations rely on computer systems to transfer increasing amounts of money; sensitive, proprietary economic and commercial information; and classified and sensitive but unclassified defense and intelligence information. The increased transfer of critical information increases the risk that malici...
Pervasive and sustained computer-based attacks pose a potentially devastating impact to systems and operations and the critical infrastructures they support. Addressing these threats depends on effective partnerships between the government and private sector owners and operators of critical infrastructure. Federal poli...
In the aftermath of September 11, 2001, there is heightened concern that terrorists may try to smuggle nuclear or radiological materials into the United States. These materials could be used to produce either an IND or an RDD. An IND is a crude nuclear bomb made with highly enriched uranium or plutonium. Nonproliferati...
A terrorist's use of a radiological dispersal device (RDD) or improvised nuclear device (IND) to release radioactive materials into the environment could have devastating consequences. The timely cleanup of contaminated areas, however, could speed the restoration of normal operations, thus reducing the adverse conseque...
NextGen is a modernization effort begun in 2004 by FAA to transform the nation’s ground-based ATC system into a system that uses satellite- based navigation and other advanced technology. This effort is a multiyear, incremental transformation that will introduce new technologies and leverage existing technologies to af...
FAA is responsible for overseeing the national airspace system, which comprises ATC systems, procedures, facilities, and aircraft, and the people who operate them. FAA is implementing NextGen to move the current radar-based ATC system to one that is based on satellite navigation and automation. It is essential that FAA...
The Civil Reserve Air Fleet (CRAF) is a voluntary, contract-based agreement between DOD and U.S. commercial air carriers that augments DOD’s military airlift capability during times of war and national emergency. It was created in 1951 to augment DOD airlift capability during a national defense-related crisis. The Nati...
To move passengers and cargo, DOD supplements its military aircraft with cargo and passenger aircraft from volunteer commercial carriers participating in the CRAF program. Participating carriers commit their aircraft to support a range of military operations in exchange for peacetime business. A House Armed Services Co...
The CFO Act of 1990 was enacted to address longstanding problems in financial management in the federal government. The act established CFO positions throughout the federal government and mandated that, within each of the largest federal departments and agencies, the CFO oversee all financial management activities rela...
Pursuant to a legislative requirement, GAO provided information on the qualifications, including formal education, professional work experience, training, and professional certifications of personnel serving in key financial management positions in the Army. GAO noted that: (1) the four Army financial management execut...
In preparation for the initiation of Operation Iraqi Freedom (OIF), the United States deployed four Army divisions and their supporting reserve component units, a Marine Expeditionary Force, and a significant portion of the Navy’s and Air Force’s combat power to southwest Asia. The Army’s Third Infantry Division (mecha...
The high pace of military operations in Iraq and elsewhere has generated a multibillion dollar equipment maintenance requirement that must be addressed after units return home. Upon returning from deployments, active, reserve, and National Guard units reconstitute, or restore, their equipment to a condition that enable...
As computer technology has advanced, federal agencies have become dependent on computerized information systems to carry out their operations and to process, maintain, and report essential information. Virtually all federal operations are supported by automated systems and electronic data, and agencies would find it di...
Pervasive and sustained cyber attacks continue to pose a potentially devastating threat to the systems and operations of the federal government. In recent months, federal officials have cited the continued efforts of foreign nations and criminals to target government and private sector networks; terrorist groups have e...
Almost 4 years after Hurricane Katrina, the children living in the greater New Orleans area may be at particular risk for needing mental health services, but certain barriers may impede the delivery of such care. Since Hurricane Katrina, there has been increasing emphasis on providing community-based, rather than hospi...
The greater New Orleans area--Jefferson, Orleans, Plaquemines, and St. Bernard parishes--has yet to fully recover from the effects of Hurricane Katrina. As a result of the hurricane and its aftermath, many children experienced psychological trauma, which can have long-lasting effects. Experts have previously identified...
Financing elementary and secondary education requires a large amount of money; in school year 1993-94, total expenditures in all U.S. elementary and secondary schools totaled an estimated $285 billion. In most of the 50 states, education is the largest single expenditure category in the state budget, accounting for 20....
Pursuant to a congressional request, GAO reviewed the experiences of three states that reformed their school finance systems, focusing on the: (1) reforms made to each school finance system; (2) legal, budgetary, and political pressures that state legislatures faced in making the reforms; and (3) impact of the legislat...
The 10 federal financial regulatory agencies in our review vary in size, mission, funding structure, whether they bargain with a union, and how long they have been implementing aspects of performance-based pay systems. For example, FHFB is the smallest agency with just over 120 employees, while FDIC, the largest agency...
Congress granted financial regulators flexibility to establish their own compensation systems and required certain agencies to seek to maintain comparability with each other in pay and benefits to help the agencies overcome impediments to recruiting and retaining employees and avoid competing for the same employees. In...
If ATATs are highly technical and organized or marketed, they are often referred to as abusive tax shelters. According to IRS, abusive tax shelters result in unlawful tax evasion. Our report on business network-based tax evasion illustrates how one type of evasive transaction—the installment sale bogus optional basis—o...
Abusive tax avoidance transactions (ATAT) range from frivolous tax schemes to highly technical and abusive tax shelters marketed to taxpayers by promoters selling tax advice. ATATs threaten the U.S. tax system's integrity if honest taxpayers believe that others do not pay their fair share of taxes. GAO was asked to (1)...
The Foundation was established as an independent executive branch agency in 1992 to honor Morris K. Udall’s 30 years of service in the House of Representatives as a leader on issues related to the environment and Native Americans. In 2009, its authorizing legislation was amended to also honor Stewart L. Udall’s public ...
In December 2013, GAO issued a report that described the Foundation's actions to improve its internal control assessment process and its controls over personnel and contracting. A fiscal year 2015 congressional directive includes a provision for GAO to conduct a follow-up evaluation of the Foundation's internal control...
The need for strong leadership and a governmentwide strategic view of information management has long been recognized as critical. Along with establishing a single policy framework for federal management of information resources and formalizing the institutionalization of IRM as the approach governing information activ...
Congress passed the Paperwork Reduction Act (PRA) to establish a single, overarching policy framework for the management of government information resources. The act established information resources management (IRM) as an approach governing the collection, dissemination, security, privacy, and management of informatio...
Customs began ACE in 1994, and its early estimate of the cost and time to develop the system was $150 million over 10 years. At this time, Customs also decided to first develop a prototype of ACE, referred to as NCAP (National Customs Automation Program prototype), and then to complete the system. In May 1997, we testi...
Pursuant to a congressional request, GAO discussed the Customs Service's management of its Automated Commercial Environment (ACE) system. GAO noted that: (1) the need to leverage information technology to improve the way that Customs does business in the import arena is undeniable; (2) Customs' existing import processe...
To qualify for SNF care, Medicare beneficiaries typically need to be admitted to a SNF within 30 days after discharge from a hospital stay of at least 3 days and need care for a condition that was treated during the hospital stay or that arose while receiving SNF care. Medicare may cover up to 100 days per episode of S...
Medicare paid $28.6 billion to SNFs for nearly 1.7 million beneficiaries in 2014. About 15,000 SNFs provide short-term skilled nursing and rehabilitative care after an acute care hospital stay. As of 2014, 70 percent of SNFs were for-profit, 24 percent were nonprofit, and 5 percent were government-operated. About three...
Partnerships, S-Corps, and trusts are commonly referred to as flow-through entities, as they do not generally pay taxes on income. Instead, they distribute net income—as well as losses—to partners, shareholders, and beneficiaries, respectively, who are subsequently required to report the net income or loss on their ind...
Over a trillion dollars in income was distributed in tax year 2002 by flow-through entities, such as partnerships, subchapter S corporations, and trusts, to their partners, shareholders, or beneficiaries, respectively. The Internal Revenue Service (IRS) estimates that from 6 to 15 percent of such income is unreported o...
Veterans aged 65 or older are increasing both in number and in the percentage of the veteran population receiving VA health care services. More significantly, the number of veterans aged 75 and older, the heaviest users of nursing home care, is increasing rapidly. VA estimates that the number of veterans aged 75 and ol...
Pursuant to a congressional request, GAO provided information on the Department of Veterans Affairs' (VA) nursing home programs, focusing on: (1) the distribution of veterans in VA, community, and state veterans nursing homes; (2) the costs to VA for VA, community, and state veterans nursing homes; (3) the factors affe...
DOE has more than 50 major sites in 35 states where the department carries out its varied missions, including developing, maintaining, and securing the nation’s nuclear weapons capability, cleaning up the nuclear and hazardous wastes resulting from long-term weapons production, and conducting basic energy and scientifi...
Federal policy requires that small businesses receive the maximum practicable opportunity for providing goods and services to federal agencies through prime contracts--direct contracts between the government and a contractor. The Department of Energy (DOE) buys more than $20 billion in goods and services annually. GAO ...
IRS received approximately $197 million to implement 54 Recovery Act provisions. The Joint Committee on Taxation (JCT) estimated that these 54 provisions would cost about $325 billion between fiscal year 2009 and fiscal year 2019. (App. III shows the estimated cost of each provision.) JCT’s estimate can be reconciled w...
The American Recovery and Reinvestment Act of 2009 (Recovery Act), was enacted to bolster the struggling U.S. economy at an estimated cost of $787 billion, of which more than a third was in the form of tax relief to the public. This report (1) describes the status of the Internal Revenue Service's (IRS) implementation ...
Treatment options for individuals with ESRD include kidney transplants or maintenance dialysis. Kidney transplants are not a practical option on a wide scale, as suitable donated organs are scarce. Consequently, dialysis is the treatment used by most individuals with ESRD. Hemodialysis, the most common form of dialysis...
Medicare spent about $10.1 billion in 2011 on dialysis treatments and related items and services for about 365,000 beneficiaries with end-stage renal disease (ESRD). Most individuals with ESRD are eligible for Medicare. As required by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), CMS impleme...
According to the Bureau, no accurate estimate exists of the total number of Americans living abroad. The Constitution and federal law give the Bureau discretion to decide whether to count American citizens living abroad. In prior censuses, the Bureau has generally included “federally affiliated” groups—members of the m...
The U.S. Census Bureau (Bureau) has typically counted overseas members of the military, federal civilian employees, and their dependents. However, it usually excluded private citizens residing abroad. In July 2004, the Bureau completed a test of the practicality of counting all overseas Americans. GAO was asked to asse...
The National Defense Authorization Act for Fiscal Year 2006 established the authority for the Section 1206 and 1207 programs. Section 1206 authorizes the Secretary of Defense to use up to $350 million each year, with the concurrence of the Secretary of State, to train and equip foreign military and nonmilitary maritime...
In 2006, the United States created two new programs, authorized in Sections 1206 and 1207 of the Fiscal Year 2006 National Defense Authorization Act, to respond to the threats of global terrorism and instability. These programs have provided over $1.3 billion in military and nonmilitary aid to 62 countries and are due ...
The overall effectiveness of the Senate’s computer controls is dependent on the controls implemented by (1) SCC, which operates the Senate mainframe computer, (2) system users, which include all Member offices and Senate Committees, and (3) the Office of Telecommunications, which maintains telecommunication equipment a...
Pursuant to a congressional request, GAO evaluated and tested the general computer controls that affect the overall security and effectiveness of the Senate Computer Center's (SCC) financial systems, focusing on whether those controls: (1) protect data, files, and programs from unauthorized access; (2) prevent unauthor...
Influenza is more severe than some viral respiratory infections, such as the common cold. During an annual influenza season, most people who contract influenza recover completely in 1 to 2 weeks, but some develop serious and potentially life-threatening medical complications, such as pneumonia. People aged 65 years and...
Concern has been rising about the nation's preparedness to respond to vaccine shortages that could occur in future annual influenza seasons or during an influenza pandemic--a global influenza outbreak. Although the timing or extent of a future influenza pandemic cannot be predicted, studies suggest that its effect in t...
The LDA requires lobbyists to register with the Secretary of the Senate and the Clerk of the House and to file quarterly reports disclosing their lobbying activity. Lobbyists are required to file their registrations and reports electronically with the Secretary of the Senate and the Clerk of the House through a single ...
LDA requires lobbyists to file quarterly lobbying disclosure reports and semiannual reports on certain political contributions. The law also requires that GAO annually audit lobbyists' compliance with the LDA. GAO's objectives were to (1) audit the extent to which lobbyists can demonstrate compliance with disclosure re...
Payment card use has grown dramatically since the introduction of cards in the beginning of the 20th century. Hotels, oil companies, and department stores issued cards associated with charge accounts before World War I. In 1950, Diners Club established the first general purpose charge card that allowed its cardholders ...
When a consumer uses a credit card to make a purchase, the merchant does not receive the full purchase amount because a certain portion of the sale is deducted to compensate the merchant's bank, the bank that issued the card, and the card network that processes the transaction. The level and growth of these rates have ...
CARE Act base grants are distributed through a formula that includes HIV/AIDS case counts. Through its HIV/AIDS surveillance system, CDC receives case counts from states, the District of Columbia, and U.S. territories and associated jurisdictions. CDC provides these case counts to HRSA so that HRSA may determine CARE A...
Funds are made available under the Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (CARE Act) for individuals affected by HIV/AIDS. Part A provides for grants to metropolitan areas and Part B provides for grants to states and territories and associated jurisdictions for HIV/AIDS services and for AIDS Drug...
The federal real property portfolio is vast and diverse—totaling over 900,000 buildings and structures—including office buildings, warehouses, laboratories, hospitals, and family housing—worth hundreds of billions of dollars. The six largest federal property holders—DOD, GSA, the U.S. Postal Service, and the Department...
The federal government holds more than 45,000 underutilized properties that cost nearly $1.7 billion annually to operate, yet significant obstacles impede efforts to close, consolidate, or find other uses for them. In January 2003, GAO designated federal real property management as a high-risk area, in part because of ...
In 1992 the National Commission on Severely Distressed Public Housing (the Commission) reported that approximately 86,000, or 6 percent, of the nation’s public housing units were severely distressed—characterized by physical deterioration and uninhabitable living conditions, high levels of poverty, inadequate and fragm...
Since fiscal year 1992, the Department of Housing and Urban Development (HUD) has awarded more than $6 billion in HOPE VI program grants to public housing authorities to revitalize severely distressed public housing and provide supportive services to residents. HUD has encouraged housing authorities to use their HOPE V...
The Congress has long recognized the value of allowing laboratories to conduct a certain amount of discretionary research. The current LDRD program grew out of legislation enacted in 1977 that authorized the use of a reasonable amount of laboratory funds to conduct employee-suggested, research and development (R&D) pro...
The Department of Energy (DOE) created the Laboratory Directed Research and Development (LDRD) program in fiscal year 1992. This program formalized a long-standing policy of giving its multi-program national laboratories discretion to conduct self-initiated, independent research and development (R&D). Since then, DOE's...
This background section describes (1) objectives, milestones, and management considerations in the B61-12 LEP and (2) DOE directives and NNSA policy letters and how they apply to programs such as the B61-12 LEP. The B61-12 consists of two major assemblies: the bomb assembly and the tail kit guidance assembly. NNSA mana...
Weapons in the U.S. nuclear stockpile are aging. NNSA and DOD undertake LEPs to refurbish or replace nuclear weapons' aging components. In 2010, they began an LEP to consolidate four versions of a legacy nuclear weapon, the B61 bomb, into a bomb called the B61-12 (see fig.). NNSA and DOD have stated they must complete ...
The concept of establishing a position to integrate management functions within federal departments can be traced back to the first Hoover Commission, which was charged by Congress with reviewing and recommending ways to improve the organization and operation of federal agencies. The commission, which lasted from 1947 ...
Agencies across the federal government are embarking on large-scale organizational transformations to address 21st century challenges. One proposed approach to address systemic federal governance and management challenges involves the creation of a senior-level position--a chief operating officer (COO)/chief management...
The C-130 Hercules aircraft is a medium-range, tactical airlift aircraft designed primarily for transporting personnel and cargo. The aircraft was originally flown in 1954 and has been under continuous production ever since. The Air Force currently has approximately 700 C-130s of various configurations in its current C...
Pursuant to a congressional request, GAO reviewed the Air Force's C-130 program, focusing on: (1) the mission of the current and planned C-130 fleet; (2) the C-130 requirements for the Air National Guard and Air Force Reserve; (3) the C-130 procurement history in the Guard and Reserve units; (4) the Air Force's plans f...
Hepatitis C was first recognized as a unique disease in 1989. It is the most common chronic blood-borne infection in the United States and is a leading cause of chronic liver disease. The virus causes a chronic infection in 85 percent of cases. Hepatitis C, which is the leading indication for liver transplantation, can...
Hepatitis C is a chronic disease caused by a blood-borne virus that can lead to potentially fatal liverrelated conditions. In 2001, GAO reported that the VA missed opportunities to test about 50 percent of veterans identified as at risk for hepatitis C. GAO was asked to (1) review VA's fiscal year 2002 performance meas...
US-VISIT is a governmentwide program intended to enhance the security of U.S. citizens and visitors, facilitate legitimate travel and trade, ensure the integrity of the U.S. immigration system, and protect the privacy of our visitors. To achieve its goals, US-VISIT is to collect, maintain, and share information on cert...
The Department of Homeland Security (DHS) has spent and continues to invest hundreds of millions of dollars each year in its U.S. Visitor and Immigrant Status Indicator Technology (US-VISIT) program to collect, maintain, and share information on selected foreign nationals who enter and exit the United States at over 30...
In the past, we have suggested four broad principles or criteria for a budget process. A process should provide information about the long-term impact of decisions, both macro—linking fiscal policy to the long-term economic outlook—and micro—providing recognition of the long-term spending implications of government com...
This testimony discusses the budget process established by the Budget Enforcement Act, which will expire in fiscal year 2002. Because the goal of achieving zero deficits has been achieved, the focus of the budget process has shifted to to the allocation of surpluses among debt reduction, spending increases, and tax cut...
It is estimated that DOD employs more than 400 different tester types. This equipment is used to diagnose problems in aircraft avionics and weapon system components so that the component can be repaired and replaced on the aircraft or put into the supply system for future use. For example, testers may be used to diagno...
The services have billions of dollars worth of outdated and obsolete automatic test equipment (ATE) used to test components on military aircraft or weapon systems. Department of Defense (DOD) policy advocates the development and acquisition of test equipment that can be used on multiple types of weapon systems and airc...
Over the past 7 years, DOD has increasingly used the SRB program to address retention shortfalls. The program’s budget has grown from $308 million in fiscal year 1997 to an estimated $734 million in fiscal year 2003—a 138 percent increase after the effect of inflation was held constant (see fig. 1). The budget is estim...
The Department of Defense (DOD) uses the Selective Reenlistment Bonus (SRB) program to reenlist military personnel in critical specialties. In fiscal years 1997-2003, the program budget rose 138 percent, from $308 million to $734 million. In fiscal year 2003, the House Appropriations Committee directed the Secretary of...
ERISA established the broad fiduciary requirements related to private pension plans and was designed to protect the pension and welfare benefit rights of workers and their beneficiaries. The act requires a plan fiduciary to act “…solely in the interest of plan participants and beneficiaries and for the exclusive purpos...
In 1998, about 100 million Americans were covered in private pension plans with assets totaling about $4 trillion. The retirement security of plan participants can be affected by how certain issues are voted on during company stockholders meetings. Fiduciaries, having responsibility for voting on such issues on behalf ...
The Crime Awareness and Campus Security Act of 1990 and its implementing regulations require colleges, as a condition for participating in federal financial aid programs authorized under title IV of the Higher Education Act of 1965, as amended, to publish and distribute an annual security report that includes statement...
Pursuant to a congressional request, GAO reviewed the progress made under the Crime Awareness and Campus Security Act, focusing on: (1) how the Department of Education has implemented and monitored compliance with the act; (2) the kinds of problems, if any, colleges are having in complying with the act; and (3) the req...
PPACA establishes certain conditions governing participation in the CO-OP program. Specifically, PPACA defines a CO-OP as a health insurance issuer organized under state law as a nonprofit, member corporation of which the activities substantially consist of the issuance of qualified health plans in the individual and s...
The Patient Protection and Affordable Care Act (PPACA) established the CO-OP loan program, which helped create 23 consumer-governed, nonprofit health insurance issuers known as CO-OPs. To foster the creation of the CO-OPs, PPACA authorized two types of loans: (1) start-up loans, which help cover the costs of establishi...
Beginning in 1993, both Congress and the administration agreed that federal employment levels should be cut as a means of reducing federal costs and controlling deficits. Through a series of executive orders and legislation, goals were established for reducing federal staffing levels. Two driving forces in the reductio...
Pursuant to a congressional request, GAO reviewed the Department of Housing and Urban Development (HUD), the Department of the Interior, the General Services Administration (GSA), the National Aeronautics and Space Administration (NASA), and the Office of Personnel Management (OPM) to obtain information on the effects ...
The Chesapeake Bay is the largest of the nation’s estuaries, measuring nearly 200 miles long and 35 miles wide at its widest point. Roughly half of the bay’s water comes from the Atlantic Ocean, and the other half is freshwater that drains from the land and enters the bay through the many rivers and streams in its wate...
The Chesapeake Bay Program (Bay Program) was created in 1983 when Maryland, Pennsylvania, Virginia, the District of Columbia, the Chesapeake Bay Commission, and the Environmental Protection Agency (EPA) agreed to establish a partnership to restore the Bay. The partnership's most recent agreement, Chesapeake 2000, sets ...
AFRICOM is DOD’s newest geographic combatant command and was designated fully operational in September 2008. The command’s area of responsibility comprises all the countries on the African continent except Egypt. According to AFRICOM officials, Camp Lemonnier, Djibouti, is the only DOD site in Africa with a long-term u...
Since its establishment in 2008, AFRICOM has increased its footprint in Africa to support its mission—building African partner capabilities and deterring threats to regional security. In tandem with AFRICOM's growing footprint will be a continued reliance on contractors to support the command's operations. Accordingly,...
To a large degree, spectrum management policies flow from the technical characteristics of the radio spectrum. Although the radio spectrum spans the range from 3 kilohertz to 300 gigahertz, 90 percent of its use is concentrated in the 1 percent below 3.1 gigahertz. The crowding in this region has occurred because these...
The radiofrequency spectrum is the medium that enables wireless communications of all kinds, such as mobile phone and paging services, radio and television broadcasting, radar, and satellite-based services. As new spectrum-dependent technologies are developed and deployed, the demand for this limited resource has escal...
CMS administers the Medicare program with the assistance of about 50 claims administration contractors. As part of their duties, contractors deny claims that are the responsibility of other insurers. In addition, they are required to recover mistaken payments that were made before it could be determined that the benefi...
Last year, employer-sponsored group health plans (EGHP) were responsible for most of the nearly $183 million in outstanding Medicare secondary payer (MSP) debt. MSP debts arise when Medicare inadvertently pays for services that are subsequently determined to be the financial responsibility of another. The Centers for M...
The purpose of the HUBZone program, established by the HUBZone Act of 1997, is to stimulate economic development in economically distressed communities (HUBZones) by providing federal contracting preferences to eligible small businesses. The types of areas in which HUBZones may be located are defined by law and consist...
Economic development programs-- administered efficiently and effectively--can contribute to the well-being of the economy at the least cost to taxpayers. Such programs can encompass small business development and contracting. To encourage such contracting, Congress created programs--such as the Historically Underutiliz...
Crash parts are generally made of sheet metal or plastic and installed on the exterior of a motor vehicle. These parts include hoods, doors, fenders, and trunk lids. Crash parts exclude mechanical parts such as batteries, filters, shock absorbers, and spark plugs. Body shops often use a mix of parts in collision repair...
Although the National Highway Traffic Safety Administration (NHTSA) has the authority to regulate aftermarket crash parts, the agency has not developed safety standards for them because it has not determined that any aftermarket crash parts contain safety-related defects. NHTSA has more limited authority to regulate th...
The Federal Reserve System is involved in many facets of wholesale and retail payment systems in the United States, including providing wire transfers of funds and securities; providing for the net settlement of check clearing arrangements, automated clearinghouse (ACH) networks, and other types of payment systems; cle...
The central banks of major industrialized countries have agreed on common policy objectives and presented them in the Core Principles for Systematically Important Payment Systems. Intended to help promote safer and more efficient payment systems worldwide, the Core Principles outline specific policy recommendations for...
Emissions from a variety of human-generated sources, including commercial aircraft, trap heat in the atmosphere and contribute to climate change. During flight operations, aircraft emit a number of greenhouse gas and other emissions, including carbon dioxide, nitrogen oxides (NOx), soot, and water vapor. Figure 1 shows...
Aircraft emit greenhouse gases and other emissions, contributing to increasing concentrations of such gases in the atmosphere. Many scientists and the Intergovernmental Panel on Climate Change (IPCC)--a United Nations organization that assesses scientific, technical, and economic information on climate change--believe ...
With responsibility for about 375,000 passenger vehicles and light trucks,the federal government operates one of the largest motor vehicle fleets in the United States. The federal motor vehicle fleet provides transportation to support government activities, such as law enforcement and health care. The federal fleet cos...
Pursuant to a congressional request, GAO reviewed the federal government's management of its motor vehicle fleet, focusing on: (1) obstacles to achieving cost-efficient fleet management; and (2) public and private fleet management practices that might be applicable to the federal fleet. GAO found that: (1) obstacles to...
About 40 million people globally were living with HIV/AIDS as of December 2003, most of them in sub-Saharan Africa; few have access to treatment. Propelled by recent advances in ARV treatment, PEPFAR is the first U.S. program to seek to dramatically expand HIV/AIDS treatment in resource- poor settings. PEPFAR builds on...
The President's Emergency Plan for AIDS Relief (PEPFAR), announced January 2003, aims to provide 2 million people with anti-retroviral (ARV) treatment in 14 of the world's most severely affected countries. In May 2003 legislation established the position of the U.S. Global AIDS Coordinator in the State Department. GAO ...
The Postal Reorganization Act provided USPS with authority to offer nonpostal services. USPS used this authority to introduce a wide array of products, such as prepaid phone cards; an electronic funds transfer service between the United States and Mexico (Dinero Seguro); and retail merchandise, such as T-shirts, mugs, ...
USPS continues to face a dire financial situation. Reducing costs is essential, but USPS also must generate additional revenue through the sale of products and services. PAEA, enacted in 2006, eliminated USPS's authority to offer nonpostal services unless they were offered as of January 1, 2006, and expressly grandfath...
An influenza pandemic is caused by a novel strain of influenza virus for which there is little resistance and which therefore is highly transmissible among humans. Unlike incidents that are discretely bounded in space or time (e.g., most natural or man-made disasters), an influenza pandemic is not a singular event, but...
The current H1N1 pandemic highlights the threat posed to our nation by an influenza pandemic. The previous administration's Homeland Security Council (HSC) issued the Implementation Plan for the National Strategy for Pandemic Influenza (Plan) in May 2006 to help address a pandemic. The Government Accountability Office ...
To determine which federal government programs and functions should be designated high risk, we use our guidance document, Determining Performance and Accountability Challenges and High Risks.consider qualitative factors, such as whether the risk involves public health or safety, service delivery, national security, na...
VA operates one of the largest health care delivery systems in the nation, including 150 medical centers and more than 800 community-based outpatient clinics. Enrollment in the VA health care system has grown significantly, increasing from 6.8 to 8.9 million veterans between fiscal years 2002 and 2013. Over this same p...
Of the eleven agencies that currently have SBIR programs, two—NIH and DoD—account for the largest share of awards. Large agencies, such as NIH and DoD, generally rely on the various components within the agency such as the 23 participating institutes and centers within NIH and the 10 participating military and defense ...
The Small Business Innovation Research (SBIR) program is a three phase program that increases the use of small businesses to meet federal research needs and encourages commercialization of this research. Venture capital is one source of funding to help commercialize SBIR projects. To receive an award firms must meet ow...
The President’s Budget for Fiscal Year 2006 included 1,087 IT projects, totaling about $65 billion. The planned expenditures at the civilian agencies comprised about $35 billion of that total cost. In particular, the five departments in our review made up about one-third of the civilian planned expenditures (see fig. 1...
Each year, agencies submit to the Office of Management and Budget (OMB) a Capital Asset Plan and Business Case--the exhibit 300--to justify each request for a major information technology (IT) investment. The exhibit's content should reflect controls that agencies have established to ensure good project management, as ...
IRS engages in hundreds of data-sharing arrangements with state revenue, human services, and law enforcement agencies for tax compliance and other purposes. In a small portion of IRS’s federal-state data-sharing arrangements, states require federal tax compliance to qualify for a state business license. In some instanc...
The California Department of Industrial Relations, Division of Labor Standards Enforcement (DLSE), requires applicants for California business licenses in three industries--farm labor contracting, garment manufacturing, and car washing and polishing--to be in compliance with federal employment tax obligations to qualif...
Recruitment and retention of adequate numbers of qualified workers are major concerns for many health care providers today. While current data on supply and demand for many categories of health workers are limited, available evidence suggests emerging shortages in some fields, for example, among nurses and nurse aides....
This testimony discusses (1) the shortage of healthcare workers and (2) the lessons learned by the National Health Service Corps (NHSC) in addressing these shortages. GAO found that problems in recruiting and retaining health care professionals could worsen as demand for these workers increases. High levels of job diss...
Medicare covers items such as hospital beds, wheelchairs, and blood glucose monitors under its DME benefit because they are specifically included in the Medicare statute’s definition of DME. Other items are covered under the Medicare DME benefit based on CMS’s interpretation of the statute, which does not elaborate on ...
In 2015, Medicare spent $6.7 billion for DME. CMS's definition of DME generally precludes potential disposable DME substitutes from coverage. Congress included a provision in law for GAO to review the potential role of disposable medical devices as substitutes for DME. This report examines (1) potential disposable DME ...
Decades of conflict have left Afghanistan a poor nation with high illiteracy, weak government institutions, and a high level of corruption. According to Transparency International’s index of perceived corruption, Afghanistan is tied with Burma as the world’s second most corrupt nation. The United States has allocated a...
The U.S. Agency for International Development (USAID) and the Department of Defense (DOD) award direct assistance to Afghanistan, using bilateral agreements and multilateral trust funds that provide funds through the Afghan national budget. GAO assessed (1) the extent to which the United States, through USAID and DOD, ...
When a servicemember is charged with misconduct—such as drug use, insubordination, absence from the military without leave, or criminal behavior—the military can take action to separate the servicemember through either a punitive discharge or an administrative separation. A punitive discharge generally involves a trial...
The Carl Levin and Howard P. “Buck” McKeon National Defense Authorization Act for Fiscal Year 2015 contains a provision that GAO examine the effect of PTSD, TBI, and certain other conditions on separations for misconduct. This report examines (1) the number of servicemembers separated for misconduct who were diagnosed ...
NAGPRA requires federal agencies to (1) identify their Native American human remains, funerary objects, sacred objects, and objects of cultural patrimony, (2) try and determine if a cultural affiliation exists with a present day Indian tribe or Native Hawaiian organization, and (3) generally repatriate the culturally a...
The National Museum of the American Indian Act of 1989 (NMAI Act), as amended in 1996, generally requires the Smithsonian Institution to inventory and identify the origins of its Indian and Native Hawaiian human remains and objects placed with them (funerary objects) and repatriate them to culturally affiliated Indian ...
FDA is responsible for protecting public health by ensuring the safety and efficacy of medical products marketed in the United States—including drugs, medical devices, and biologics—and the safety of nearly all food products other than meat and poultry, regardless of whether they were manufactured domestically or overs...
In recent years, the United States experienced public health crises suspected to have been caused by the deliberate substitution or addition of harmful ingredients in food and drugs--specifically melamine in pet food and oversulfated chondroitin sulfate in the blood thinner heparin. These ingredients were evidently add...
The Exon-Florio amendment to the Defense Production Act, enacted in 1988, authorized the President to investigate the impact of foreign acquisitions of U.S. companies on national security and to suspend or prohibit acquisitions that might threaten national security. The President delegated the investigative authority t...
The 1988 Exon-Florio amendment to the Defense Production Act authorizes the President to suspend or prohibit foreign acquisitions of U.S. companies that may harm national security, an action the President has taken only once. Implementing Exon-Florio can pose a significant challenge because of the need to weigh securit...
The acquisition function plays a critical role in helping federal agencies fulfill their missions. Other transaction authority provides the ability to acquire cutting-edge science and technology, in part through attracting entities that typically have not pursued government contracts because of the cost and impact of c...
When DHS was created in 2002, Congress granted it special acquisition authority to use “other transaction” agreements, which are special vehicles used for research and development or prototype projects. Unlike conventional contracts, other transaction agreements offer flexibilities to reach entities that traditionally ...
Traditionally, financing the construction of public schools has been a function of local government. Until the 1940s, only 12 states provided any financial assistance for school construction. State participation increased during the baby boom of the 1950s, when local communities needed classrooms and states had surplus...
Pursuant to a congressional request, GAO examined the role of states in supporting school facilities improvements, focusing on: (1) state funding and technical assistance to local school districts; and (2) the extent to which states collect information on school building conditions. GAO found that: (1) most states have...
A comprehensive reassessment of agencies’ roles and responsibilities is central to any congressional and executive branch strategy that seeks to bring about a government that is not only smaller but also more efficient and effective. GPRA provides a legislatively based mechanism for Congress and the executive branch to...
GAO discussed: (1) the Government Performance and Results Act's (GPRA) potential contributions to congressional and executive branch decisionmaking; and (2) Congress' role in implementing GPRA. GAO noted that: (1) more federal agencies are recognizing the benefits of focusing on outcomes rather than activities to impro...
In 1972, the Congress established the Construction Grants Program to provide grants to help local governments construct wastewater treatment facilities. These federal grants provided most of the funding for these projects; the remainder was provided by the local government constructing the project. In 1987, the Congres...
Pursuant to a congressional request, GAO reviewed selected states' use of their revolving funds, focusing on the: (1) amount of funds lent and the percentage of available funds lent, as of the end of each state's fiscal year (FY) 1996; and (2) factors at the federal and state levels that constrained the amount and perc...
When fully implemented, SMS provides a continuous approach to managing safety risk, which FAA expects will improve aviation safety. SMS is not an additional safety program that is distinct from existing activities that accomplish an entity’s safety mission, such as quality management, quality assurance, or similar acti...
The U.S. aviation system is one of the safest in the world, reflecting the work of FAA, industry, and others to continually improve safety. To further enhance safety, in 2005, FAA began adopting a proactive, data-driven, risk-based approach to managing safety, referred to as SMS, and has proposed rules that would requi...
FBCB2 will be the principal digital command and control system for the Army at the brigade level and below and will constitute the third major component of the Army’s Battle Command System. Currently, the Battle Command System comprises the (1) Global Command and Control System-Army located at strategic and theater lev...
Pursuant to a congressional request, GAO reviewed the Army's acquisition plans for the Force XXI Battle Command, Brigade and Below (FBCB2) program, focusing on the: (1) program's significance to the Army's battlefield digitization goal; (2) Army's derivation of cost estimates; and (3) feasibility of the Army's fielding...
JSF is a joint, multinational acquisition program for the Air Force, Navy, Marine Corps, and eight cooperative international partners. The program began in November 1996 with a 5-year competition between Lockheed Martin and Boeing to determine the most capable and affordable preliminary aircraft design. Lockheed Martin...
The Joint Strike Fighter (JSF) program--a multinational acquisition program for the Air Force, Navy, Marine Corps, and eight cooperative international partners--is the Department of Defense's (DOD) most expensive aircraft acquisition program. DOD currently estimates it will spend $623 billion to develop, procure, and o...
To determine the soundness of IRS’s PDC study as primary support for IRS’s decision to discontinue contracting out tax debt collection, we reviewed the study report and supporting documents and other data. We interviewed IRS officials and contractors involved in the study. We also reviewed the report IRS commissioned t...
In September 2006, the Internal Revenue Service (IRS) started the private debt collection (PDC) program for using private collection agencies (PCA) to help collect some unpaid tax debts. Aware of concerns that PCAs might cost more than using IRS staff, IRS began studying the collection costs and performance of PCAs and...
Biocontainment laboratories—designed with specific environmental, storage, and equipment configurations—support containment efforts in the day-to-day work with biological agents. These labs are designed, constructed, and operated to (1) prevent accidental release of infectious or hazardous agents within the laboratory ...
As the number of biological labs increases, so too do the safety risks for lab workers. Data on these risks--collected through a safety reporting system (SRS) from reports of hazards, incidents, and accidents--can support safety efforts. However, no such system exists for all biological labs, and a limited system--mana...
OPA establishes a “polluter pays” system that places the primary burden of liability for the costs of spills on the party responsible for the spill in return for financial limitations on that liability. Under this system, the responsible party assumes, up to a specified limit, the burden of paying for spill costs—which...
On April 20, 2010, an explosion at the mobile offshore drilling unit Deepwater Horizon resulted in a massive oil spill in the Gulf of Mexico. The spill's total cost is unknown, but may result in considerable costs to the private sector, as well as federal, state, and local governments. The Oil Pollution Act of 1990 (OP...
DOD relies on a number of individual processes and activities, known collectively as supply chain management, to purchase, produce, and deliver items and services to military forces. The department relies on working capital (revolving) funds maintained by the defense and service logistics agencies to finance the flow o...
The availability of spare parts and other critical items provided through the Department of Defense's (DOD) supply chains affects the readiness and capabilities of U.S. military forces. Since 1990, GAO has designated DOD supply chain management as a high-risk area. In 2005, DOD developed a plan aimed at addressing supp...
The Government Performance and Results Act (GPRA) of 1993 requires federal agencies to establish measures to determine the results of their activities. Such measures are a prerequisite for making informed decisions on allocating scarce resources to areas likely to attain results that advance the agency’s mission and ac...
The U.S. tax system is based on taxpayers voluntarily complying with the tax laws. However, the Internal Revenue Service (IRS) last measured taxpayers' rate of compliance using 1988 tax returns. As time has passed, IRS has become concerned that its ability to understand the effectiveness of its programs and target audi...
Food and beverages have been served onboard Amtrak trains since Amtrak was created. Amtrak’s eleven commissaries are located around the country and are responsible for receiving, warehousing and stocking food, beverages, and other items for Amtrak’s onboard dining and café service. Until January 1999, Amtrak ran these ...
Amtrak has provided food and beverage service on its trains since it began operations in 1971. Amtrak has struggled since its inception to earn sufficient revenues and depends heavily on federal subsidies to remain solvent. While a small part of Amtrak's overall expenditures, Amtrak's food and beverage service illustra...
In our June 2016 report, we found that although the Coast Guard had assessed its Arctic capabilities and worked with its Arctic partners—such as other federal agencies— to carry out actions to help mitigate Arctic capability gaps—it had not systematically assessed how its actions have helped to mitigate these gaps. Spe...
The retreat of polar sea ice in the Arctic, as reported by the U.S. National Snow and Ice Data Center, combined with an expected increase in human activity there, has heightened U.S. and other nations' interests in the Arctic region in recent years. Growth in Arctic activity is expected to increase demand for services ...
The Federal Reserve System is composed of an independent government agency—the Board of Governors (Board)—and 12 regional Reserve Banks, each of which is located in a Federal Reserve district. (See fig. 1.) The Board is responsible for maintaining the stability of financial markets, supervising financial institutions s...
Efficiently managing the circulating coin inventory helps ensure that enough coins are available to meet public demand while avoiding unnecessary production and storage costs. The Federal Reserve fulfills the coin demand of the nation's depository institutions (e.g., commercial banks and credit unions) by managing Rese...
We defined the financial services industry to include the following sectors: depository credit institutions, which include commercial banks, thrifts (savings and loan associations and savings banks), and credit unions; holdings and trusts, which include investment trusts, investment companies, and holding companies; no...
As the U.S. workforce has become increasingly diverse, many private and public sector organizations have recognized the importance of recruiting and retaining minority and women candidates for key positions. However, previous congressional hearings have raised concerns about a lack of diversity at the management level ...
The 13th Congressional District of Florida comprises DeSoto, Hardee, Sarasota, and parts of Charlotte and Manatee Counties. In the November 2006 general election, there were two candidates in the race to represent the 13th Congressional District: Vern Buchanan, the Republican candidate, and Christine Jennings, the Demo...
In November 2006, about 18,000 undervotes were reported in Sarasota County in the race for Florida's 13th Congressional District (Florida-13). After the election results were contested in the House of Representatives, the task force unanimously voted to seek GAO's assistance in determining whether the voting systems co...
Originally, SSNs were used to keep track of earnings, contributions, and old-age, disability, and survivor benefits for people covered by the Social Security program. Increasingly, however, SSNs have been used for a wide variety of purposes by private firms and federal, state, and local governments. Cases in which inel...
In 2004, an estimated 35.7 million foreign-born people resided in the United States, and many legitimately have SSNs. Many of these individuals have Social Security numbers (SSNs) which can have a key role in verifying authorization to work in the United States. However, some foreign-born individuals have been given SS...
Managed by U.S. Customs and Border Protection (CBP), SBInet is to strengthen DHS’s ability to detect, identify, classify, track, and respond to illegal breaches at and between ports of entry. It includes the acquisition, development, integration, deployment, and operations and maintenance of a mix of surveillance techn...
The Department of Homeland Security's (DHS) Secure Border Initiative Network (SBInet) is to place surveillance systems along our nation's borders and provide Border Patrol command centers with the imagery and related tools and information needed to detect breaches and make agent deployment decisions. To deliver SBInet,...
The following programs are authorized under Title IV of the Higher Education Act, as amended: Pell grants—grants to undergraduate students who are enrolled in a degree or certificate program and have federally defined financial need. Stafford and PLUS loans—these loans may be made by private lenders and guaranteed by t...
Over half of the $80.4 billion in financial aid provided to college students in the 2000-01 school year came from the federal government in the form of grants and loans provided under Title IV of the Higher Education Act (HEA). To help finance their education, students and families may have received other funds from st...
Overall, agencies are taking high-risk problems seriously, trying to correct them, and making progress in many areas. The Congress has also acted to address several problems affecting these high-risk areas through oversight hearings and specific legislative initiatives. Full and effective implementation of legislative ...
GAO discussed major government programs and operations it has identified as high risk because of vulnerability to waste, fraud, abuse, and mismanagement and legislative and agency actions that have resulted in progress towards resolving these problems. GAO noted that: (1) without additional attention to resolve problem...
In conducting their operations, farmers are exposed to financial losses because of production risks—droughts, floods, and other natural disasters—as well as price risks. The federal government has played an active role in helping to mitigate the effects of these risks on farm income by promoting the use of crop insuran...
The U.S. Department of Agriculture (USDA) administers the federal crop insurance program with private insurance companies. In 2011, the program provided about $113 billion in insurance coverage for over 1 million policies. Program costs include subsidies to pay for part of farmers’ premiums. According to the Congressio...
The WBC program is administered through the Office of Women’s Business Ownership (OWBO) in SBA’s Office of Entrepreneurial Development (OED). The program was established by the Women’s Business Ownership Act of 1988 to provide long-term training, counseling, networking, and mentoring to women who own businesses or are ...
The Small Business Administration (SBA) provides training and counseling services to women entrepreneurs through the Women's Business Center (WBC) program. With approximately $12 million in fiscal year 2007, SBA funded awards to 99 WBCs. However, Congress and WBCs have expressed concerns about the uncertain nature of t...
All states, the District of Columbia, U.S. territories, and some Indian tribes have laws and/or codes requiring convicted sex offenders to register with local or state law enforcement authorities, the purpose of which is to enhance public protection and provide an additional investigative tool to law enforcement agenci...
To enhance public safety, all states have laws requiring convicted sex offenders to register with law enforcement authorities. Because ensuring compliance is a challenge, in part because offenders may move frequently, policy makers are considering a role for motor vehicle agencies. In response to section 636 of the Ada...