A letter report issued by the Government Accountability Office with an abstract that begins "Biomonitoring, which measures chemicals in people's tissues or body fluids, has shown that the U.S. population is widely exposed to chemicals used in everyday products. Some of these have the potential to cause cancer or birth defects. Moreover, children may be more vulnerable to harm from these chemicals than adults. The Environmental Protection Agency (EPA) is authorized under the Toxic Substances Control Act (TSCA) to control chemicals that pose unreasonable health risks. GAO was asked to review the (1) extent to which EPA incorporates information from biomonitoring studies into its assessments of chemicals, (2) steps that EPA has taken to improve the usefulness of biomonitoring data, and (3) extent to which EPA has the authority under TSCA to require chemical companies to develop and submit biomonitoring data to EPA."

Testimony issued by the Government Accountability Office with an abstract that begins "Since 1990, GAO has designated the Department of Defense's (DOD) management of its major weapon acquisitions as a high-risk area; however DOD's problems delivering weapon systems on time, at the estimated cost, in the planned amounts, and with the promised performance go back decades. Congress and DOD have continually explored ways to improve acquisition outcomes, yet problems persist. The committee asked GAO to testify on measures needed to reform the acquisition of major weapon systems and related legislative proposals. Specifically, this statement will describe the poor outcomes on weapon system investments that make reform imperative; attributes of the requirements, funding, and acquisition processes that will need to change for reform to be effective; and positive steps that Congress and DOD have taken to improve weapon program outcomes. The statement will also examine other factors that should be considered as the committee moves forward with its reform efforts. The testimony is drawn from GAO's body of work on DOD's requirements, funding, and acquisition processes. GAO has made numerous recommendations aimed at improving DOD's management of its major weapon acquisitions, but it is not making any new recommendations in this …

Correspondence issued by the Government Accountability Office with an abstract that begins "Recent increases in prescription drug costs have been fueled in part by the high and rising cost of specialty prescription drugs. Specialty prescription drugs are typically used to treat chronic or life-threatening conditions, such as multiple sclerosis and cancer, for which few other treatment options exist. The drugs typically have few competitors or generic alternatives and may require frequent dosage adjustment, special storage, patient education, or special methods of administration, such as by injection. Costs for specialty prescription drugs are usually high, typically ranging from $1,200 to $40,000 for a 30-day supply. Health plans--including those participating in the Federal Employees Health Benefits Program (FEHBP), which covers nearly 8 million federal employees, dependents, and retirees-- provide coverage for many specialty drugs. Enrollees may be required to pay a portion of specialty drug costs through a copayment--a flat dollar amount--or coinsurance--a percentage share of the drug's actual costs. To manage the high and rising costs of these drugs, some health plans have begun to require enrollees to contribute a greater share of their costs, such as by increasing the use of coinsurance. Congress asked us to examine the costs that …

A letter report issued by the Government Accountability Office with an abstract that begins "The Global Positioning System (GPS), which provides positioning, navigation, and timing data to users worldwide, has become essential to U.S. national security and a key tool in an expanding array of public service and commercial applications at home and abroad. The United States provides GPS data free of charge. The Air Force, which is responsible for GPS acquisition, is in the process of modernizing GPS. In light of the importance of GPS, the modernization effort, and international efforts to develop new systems, GAO was asked to undertake a broad review of GPS. Specifically, GAO assessed progress in (1) acquiring GPS satellites, (2) acquiring the ground control and user equipment necessary to leverage GPS satellite capabilities, and evaluated (3) coordination among federal agencies and other organizations to ensure GPS missions can be accomplished. To carry out this assessment, GAO's efforts included reviewing and analyzing program documentation, conducting its own analysis of Air Force satellite data, and interviewing key military and civilian officials."

Testimony issued by the Government Accountability Office with an abstract that begins "Health centers funded through grants under the Health Center Program--managed by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS)--provide comprehensive primary care services for the medically underserved. The statement GAO is issuing today summarizes an August 2008 report, Health Resources and Services Administration: Many Underserved Areas Lack a Health Center Site, and the Health Center Program Needs More Oversight (GAO-08-723). In that report, GAO examined to what extent medically underserved areas (MUA) lacked health center sites in 2006 and 2007. To do this, GAO obtained and analyzed HRSA data and grant application"

A letter report issued by the Government Accountability Office with an abstract that begins "Following September 11, 2001, the number of international students coming to the United States dropped for the first time in over 30 years. While enrollments have rebounded, the U.S. image has declined in the Muslim world and elsewhere. To improve global attitudes toward America, the U.S. government funds higher education for international students to facilitate exchanges, promote understanding among peoples in different countries, and build capacity in developing nations. To provide insight on how higher education is used to advance public diplomacy and development assistance goals, we examined (1) the objectives the United States and selected peer governments seek to advance through higher education for international students and the approaches they employ to attract international students, and (2) the characteristics of major U.S. and peer government programs that fund higher education for international students to support public diplomacy and development goals. GAO collected information from the United States, Australia, China, the European Commission, Germany, and the United Kingdom."

Other written product issued by the Government Accountability Office with an abstract that begins "This is an e-supplement to GAO-09-347. This document presents a bibliography of a literature review conducted as part of our work on emergency department crowding (GAO-09-347). As part of our work to analyze and report on information made available since 2003 about (1) three indicators of emergency department crowding--ambulance diversion, wait times, and patient boarding, and (2) factors that contribute to emergency department crowding, we conducted a literature review of 197 articles, including articles published in peer-reviewed and other periodicals, publications from professional, research, and other organizations, and reports issued by federal and state agencies. In examining the information made available since 2003 about indicators of crowding during our literature review, we also analyzed articles for what was reported on the effect of crowding on patient quality of care and proposed strategies to address crowding. In order to obtain these articles, we conducted structured searches of 16 research databases and obtained articles identified as a result of interviews with federal officials, professional and research organizations, and subject-matter experts, and through searches of related Web sites. We reviewed 197 articles, publications, and reports (which we call articles) …

A letter report issued by the Government Accountability Office with an abstract that begins "Hospital emergency departments are a major part of the nation's health care safety net. Of the estimated 119 million visits to U.S. emergency departments in 2006, over 40 percent were paid for by federally-supported programs. These programs--Medicare, Medicaid, and the State Children's Health Insurance Program--are administered by the Department of Health and Human Services (HHS). There have been reports of crowded conditions in emergency departments, often associated with adverse effects on patient quality of care. In 2003, GAO reported that most emergency departments in metropolitan areas experienced some degree of crowding (Hospital Emergency Departments: Crowded Conditions Vary among Hospitals and Communities, GAO-03-460). For example, two out of every three metropolitan hospitals reported going on ambulance diversion--asking ambulances to bypass their emergency departments and instead transport patients to other facilities. GAO was asked to examine information made available since 2003 on emergency department crowding. GAO examined three indicators of emergency department crowding--ambulance diversion, wait times, and patient boarding--and factors that contribute to crowding. To conduct this work, GAO reviewed national data; conducted a literature review of 197 articles; and interviewed officials from HHS and professional and research …

A letter report issued by the Government Accountability Office with an abstract that begins "Hurricane Katrina was the most destructive disaster in our nation's history and it highlighted gaps in preparedness for a catastrophic disaster. The Federal Emergency Management Agency (FEMA), a component within the Department of Homeland Security (DHS), is the lead federal agency responsible for developing a national preparedness system. The system includes policies and plans as well as exercises and assessments of capabilities across many public and private entities. GAO was asked to assess the extent to which FEMA has (1) developed policies and plans that define roles and responsibilities; (2) implemented the National Exercise Program, a key tool for examining preparedness; (3) developed a national capabilities assessment; and (4) developed a strategic plan that integrates these elements of the preparedness system. GAO analyzed program documents, such as after-action reports, and visited six states located in disaster regions. While the results of these visits are not generalizable, they show how select states carry out their efforts."

Other written product issued by the Government Accountability Office with an abstract that begins "The new President, the new Congress, and the American people have been understandably focused on addressing problems with financial markets and responding to the economic downturn. However, the nation will need to apply the same level of intensity to the nation's long-term fiscal challenge. As shown in the figure below and the attached charts, GAO's updated simulations continue to show escalating and persistent debt that illustrates the long-term fiscal outlook is unsustainable. By 2025, debt held by the public under the Alternative simulation exceeds the historical high reached in the aftermath of World War II."

A letter report issued by the Government Accountability Office with an abstract that begins "The Community Development Financial Institutions (CDFI) Fund in the Department of the Treasury has awarded $19.5 billion of the $26 billion in New Markets Tax Credits (NMTC) it is authorized to award through 2009 to encourage investment in low-income communities. The NMTC allows investors to claim a tax credit in exchange for investing in Community Development Entities (CDE) that reinvest the funds in qualified communities. Recent congressional interest has focused on participation by minority CDEs. As requested, this report (1) identifies the number of minority and non-minority CDEs that have applied to the CDFI Fund and received NMTC awards, (2) explains the process by which the CDFI Fund makes NMTC awards and summarizes application scores, (3) describes challenges, if any, minority and non-minority CDEs face in applying for and receiving NMTC awards and (4) identifies efforts the CDFI Fund and others are taking to assist minority CDEs in applying for NMTC awards. GAO analyzed CDFI Fund application data and interviewed minority and non-minority CDE officials, the CDFI Fund, and industry groups."

Correspondence issued by the Government Accountability Office with an abstract that begins "The detonation of a nuclear weapon or radiological dispersal device (RDD) in the United States or elsewhere would cause decision makers to immediately demand information on the nature of the device--including its design, the materials used to build it, and the materials' source--as well as the identification of the perpetrators. Technical nuclear forensics--the analysis of nuclear or radiological materials that are intercepted or the radioactive debris and prompt output signals (such as gamma rays) produced by a nuclear event--can contribute to the identification of the sources of these materials and the processes used to create them. Analytical techniques developed to determine the nature of nuclear tests can be used if terrorists were to detonate a nuclear device or RDD and radioactive debris samples were recovered (known as "postdetonation" nuclear forensics). Nuclear forensic techniques also could potentially be used to determine the origin of nuclear or radiological materials or devices seized prior to their use in a weapon (known as "predetonation" nuclear forensics). The U.S. government's predetonation nuclear forensics capabilities have been demonstrated in investigations on seized nuclear material from illicit smuggling operations. In addition, it is important to …

Testimony issued by the Government Accountability Office with an abstract that begins "Despite a growing investment in space, the majority of large-scale acquisition programs in the Department of Defense's (DOD) space portfolio have experienced problems during the past two decades that have driven up cost and schedules and increased technical risks. The cost resulting from acquisition problems along with the ambitious nature of space programs have resulted in cancellations of programs that were expected to require investments of tens of billions of dollars. Along with the cost increases, many programs are experiencing significant schedule delays--as much as 7 years--resulting in potential capability gaps in areas such as positioning, navigation, and timing; missile warning; and weather monitoring. This testimony focuses on (3) the condition of space acquisitions, (1) causal factors, (2) observations on the space industrial base, and (4) recommendations for better positioning programs and industry for success. In preparing this testimony, GAO relied on its body of work in space and other programs, including previously issued GAO reports on assessments of individual space programs, common problems affecting space system acquisitions, and DOD's acquisition policies."

Correspondence issued by the Government Accountability Office with an abstract that begins "This letter formally transmits the summary of an oral briefing we gave in response to a mandate in the Consolidated Security, Disaster Assistance, and Continuing Appropriations Act, 2009, and subsequent agency comments. This mandate required the Department of Homeland Security (DHS) to prepare an expenditure plan that satisfied 12 specified conditions, and for the plan to be submitted to and approved by the House and Senate Appropriations Committees before the agency could obligate $400 million of the approximately $775 million appropriated for U.S. Customs and Border Protection (CBP) fencing, infrastructure, and technology. In response to this requirement, DHS submitted a plan on March 4, 2009, titled "U.S. Customs and Border Protection: Secure Border Initiative Border Security, Fencing, Infrastructure and Technology (BSFIT) Fiscal Year 2009 Expenditure Plan." As required by the act, we reviewed the plan and on March 12 and March 13, 2009, briefed staff of the Senate and House Appropriations Subcommittees, respectively, on the analysis of whether the plan satisfied the 12 specified legislative conditions."

A letter report issued by the Government Accountability Office with an abstract that begins "The U.S. Department of Agriculture (USDA) administers the federal crop insurance program with private insurance companies, which, in turn, work with insurance agencies that sell crop insurance. In 2008, according to USDA, the program cost $6.5 billion, including about $2.0 billion in allowances to insurance companies to cover their administrative and operating (A&O) expenses, such as salaries and sales commissions to agencies. GAO was asked to examine (1) the reasons for recent substantial increases in A&O allowances, and the purposes for which insurance companies use these allowances, and (2) insurance agencies' expenses for selling federal crop insurance policies, and questionable practices, if any, that agencies use to compete for business among farmers. GAO analyzed USDA and private insurers' data, among other things."

Testimony issued by the Government Accountability Office with an abstract that begins "In 2003, the Financial Literacy and Education Improvement Act created the Financial Literacy and Education Commission, which comprises 20 federal agencies and which the Department of the Treasury's (Treasury) Office of Financial Education coordinates. Responding to a mandate in the act, GAO assessed the Commission's effectiveness and in December 2006 recommended that the Commission (1) incorporate additional elements into its national strategy to help it serve as a true implementation plan, measure results, and ensure accountability; (2) expand current efforts to cultivate sustainable partnerships with states, localities, nonprofits, and private entities; (3) obtain independent reviewers for the required assessments of overlap in federal activities and the availability and impact of federal materials; and (4) measure customer satisfaction with its Web site and test its usability. This statement discusses the Commission's progress in implementing GAO's recommendations and key challenges the Commission faces. To address these objectives, GAO reviewed annual reports, meeting minutes, budget, and other information from the Commission, Treasury, and related entities, and interviewed selected representatives."

Testimony issued by the Government Accountability Office with an abstract that begins "The National Defense Authorization Act for Fiscal Year 2008 (NDAA 2008) requires the Departments of Defense (DOD) and Veterans Affairs (VA) to jointly develop and implement comprehensive policies on the care, management, and transition of recovering servicemembers. The Senior Oversight Committee (SOC)--jointly chaired by DOD and VA leadership--has assumed responsibility for these policies. The NDAA 2008 also requires GAO to report on the progress DOD and VA make in developing and implementing the policies. This statement provides preliminary information on (1) the progress DOD and VA have made in jointly developing the comprehensive policies required in the NDAA 2008 and (2) the challenges DOD and VA are encountering in the joint development and initial implementation of these policies. GAO determined the current status of policy development by assessing the status reported by SOC officials and analyzing supporting documentation. To identify challenges, GAO interviewed the Acting Under Secretary of Defense for Personnel and Readiness, the Executive Director and Chief of Staff of the SOC, the departmental co-leads for most of the SOC work groups, the Acting Director of DOD's Office of Transition Policy and Care Coordination, and other knowledgeable …

Correspondence issued by the Government Accountability Office with an abstract that begins "Grants.gov is the central grant identification and application portal for the more than 1,000 federal grants programs offered by 26 federal grant-making agencies and organizations. The Office of Management and Budget (OMB) created Grants.gov, to streamline administrative grant application requirements and reduce the burden on applicants, among other things. On March 6, 2009, Grants.gov began posting specific grant opportunities provided in the American Recovery and Reinvestment Act of 2009 (Recovery Act). As a result, submissions have escalated to an unprecedented level. During the first week in April, Grants.gov processed almost 11,500 applications, or about three times the weekly average number of submissions in fiscal year 2008. One day that week Grants.gov accepted 3,555 applications--the largest 1-day total to date. On March 9, 2009, OMB notified federal agencies that over the past several months Grants.gov had experienced increased activity beyond what was originally anticipated by the system, which had at times resulted in noticeably degraded performance. OMB further noted that given the expected increase in application volume because of the Recovery Act, the system was at significant risk of failure, thus potentially hampering Recovery Act implementation. To reduce demand …

Testimony issued by the Government Accountability Office with an abstract that begins "The American Recovery and Reinvestment Act of 2009 (Recovery Act) provided $48.1 billion in additional spending at the Department of Transportation (DOT) for investments in transportation infrastructure, including highways, passenger rail, and transit. This statement provides a general overview of (1) selected states' use of Recovery Act funds for highway programs, (2) the approaches taken by these states to ensure accountability for these funds, and (3) the selected states' plans to evaluate the impact of the Recovery Act funds that they receive for highway programs. This statement is based on work in which GAO examined the use of Recovery Act funds by a core group of 16 states and the District of Columbia, representing about 65 percent of the U.S. population and two-thirds of the intergovernmental federal assistance available through the Act. GAO issued its first bimonthly report on April 23, 2009."

Testimony issued by the Government Accountability Office with an abstract that begins "For decades, there have been allegations of discrimination in the U.S. Department of Agriculture (USDA) programs and workforce. Reports and congressional testimony by the U.S. Commission on Civil Rights, the U.S. Equal Employment Opportunity Commission, a former Secretary of Agriculture, USDA's Office of Inspector General, GAO, and others have described weaknesses in USDA's programs--in particular, in resolving complaints of discrimination and in providing minorities access to programs. The Farm Security and Rural Investment Act of 2002 authorized the creation of the position of Assistant Secretary for Civil Rights (ASCR), giving USDA an executive that could provide leadership for resolving these long-standing problems. This testimony focuses on USDA's efforts to (1) resolve discrimination complaints, (2) report on minority participation in USDA programs, and (3) strategically plan its efforts. This testimony is based on new and prior work, including analysis of ASCR's strategic plan; discrimination complaint management; and about 120 interviews with officials of USDA and other federal agencies, as well as 20 USDA stakeholder groups. USDA officials reviewed the facts upon which this statement is based, and we incorporated their additions and clarifications as appropriate. GAO plans a future …

Testimony issued by the Government Accountability Office with an abstract that begins "The Department of Veterans Affairs (VA) estimates it will provide health care to 5.8 million patients with appropriations of about $41 billion in fiscal year 2009. It provides a range of services, including primary care, outpatient and inpatient services, long-term care, and prescription drugs. VA formulates its health care budget by developing annual estimates of its likely spending for all its health care programs and services, and includes these estimates in its annual congressional budget justification. GAO was asked to discuss budgeting for VA health care. As agreed, this statement addresses (1) challenges VA faces in formulating its health care budget and (2) issues surrounding the possibility of providing advance appropriations for VA health care. This testimony is based on prior GAO work, including VA Health Care: Budget Formulation and Reporting on Budget Execution Need Improvement (GAO-06-958) (Sept. 2006); VA Health Care: Long-Term Care Strategic Planning and Budgeting Need Improvement (GAO-09-145) (Jan. 2009); and VA Health Care: Challenges in Budget Formulation and Execution (GAO-09-459T) (Mar. 2009); and on GAO reviews of budgets, budget resolutions, and related legislative documents. We discussed the contents of this statement with VA officials."

Testimony issued by the Government Accountability Office with an abstract that begins "Since 2001, Department of Defense's (DOD) spending on goods and services has more than doubled to $388 billion in 2008, while the number of civilian and military acquisition personnel has remained relatively stable. To supplement its in-house workforce, DOD relies heavily on contractor personnel. If it does not maintain an adequate workforce, DOD places its billion-dollar acquisitions at an increased risk of poor outcomes and vulnerability to fraud, waste, and abuse. This testimony is based on GAO's March 2009 report and addresses DOD's efforts to assess the sufficiency of the total acquisition workforce and to improve its management and oversight of that workforce. It also discusses selected practices of leading organizations that may provide DOD with insights for its efforts."

Correspondence issued by the Government Accountability Office with an abstract that begins "In connection with fulfilling our requirement to audit the financial statements of the U.S. government, we audited and reported on the Schedules of Federal Debt Managed by the Bureau of the Public Debt (BPD) for the fiscal years ended September 30, 2008 and 2007. As part of these audits, we performed a review of the general and application information security controls over key BPD financial systems. As we reported in connection with our audit of the Schedules of Federal Debt for the fiscal years ended September 30, 2008 and 2007, we concluded that BPD maintained, in all material respects, effective internal control relevant to the Schedule of Federal Debt related to financial reporting and compliance with applicable laws and regulations as of September 30, 2008, that provided reasonable assurance that misstatements, losses, or noncompliance material in relation to the Schedule of Federal Debt would be prevented or detected on a timely basis. However, we found deficiencies involving information security controls that we do not consider to be significant deficiencies. With regard to financial reporting and compliance with applicable laws and regulations, BPD mitigated the potential effect of such …

Testimony issued by the Government Accountability Office with an abstract that begins "This testimony discuss the U.S. Government Accountability Office's (GAO) budget request for fiscal year 2010. In fiscal year 2008 GAO delivered advice and analyses to the Congress in response to requests from all of the standing committees of the House and the Senate and over 80 percent of their subcommittees. The hard work of our staff yielded significant results across the government, including expert testimony at over 300 congressional hearings, hundreds of improvements in government operations, and billions in financial benefits. While we will strive to make progress in responding to new congressional requests sooner with our fiscal year 2009 funding level, our fiscal year 2010 request would enable GAO to make more progress in addressing the issues of greatest interest to the Congress and the American public during these challenging times."