A letter report issued by the Government Accountability Office with an abstract that begins "Health-care-associated infections (HAI) are infections that patients acquire while receiving treatment for other conditions. Normally treated with antimicrobial drugs, HAIs are a growing concern as exposure to multidrug-resistant organisms (MDRO) becomes more common. Infections caused by MDROs, such as methicillin-resistant Staphylococcus aureus (MRSA), lead to longer hospital stays, higher treatment costs, and higher mortality. In response to demands for more public information on HAIs, some states began to establish HAI public reporting systems. The federal Centers for Disease Control and Prevention (CDC) developed a system--the National Healthcare Safety Network (NHSN)--to collect HAI data from hospitals and some states have chosen to use it for their programs. In addition, some hospitals have adopted initiatives to reduce MRSA by routinely testing some or all patients and isolating those who test positive for MRSA from contact with other patients. GAO was asked to examine (1) the design and implementation of state HAI public reporting systems, (2) the initiatives hospitals have undertaken to reduce MRSA infections, and (3) the experience of certain early-adopting hospitals in overcoming challenges to implement such initiatives. GAO interviewed state officials, reviewed documents, and surveyed or …

A letter report issued by the Government Accountability Office with an abstract that begins "The Federal Aviation Administration (FAA) seeks to make the U.S. aviation system one of the safest in the world. However, a 2005 Department of Transportation Inspector General investigation found that FAA had issued medical certificates to a small percentage of pilots with disqualifying medical conditions, such as heart conditions, schizophrenia, and drug or alcohol addiction. In response to your request, our report addresses the following questions: (1) what procedures does FAA use to certify that pilot applicants meet medical standards and (2) how does FAA determine that medical certificates have been properly issued? In addressing these objectives, GAO researched FAA guidance and federal regulations; interviewed federal officials; analyzed FAA's application review procedures, quality assurance program, and its use of the National Driver Register; and conducted a data match between FAA's pilot registry and Social Security Administration's disability programs. The data match does not determine if pilots receiving disability benefits have medical conditions that would disqualify them from holding an FAA medical certificate. GAO is not making recommendations in this report. The Department of Transportation generally agreed with our findings. FAA and the Social Security Administration provided …

A letter report issued by the Government Accountability Office with an abstract that begins "The International Marriage Broker Regulation Act of 2005 (IMBRA) was enacted to address issues of domestic violence and abuse against noncitizens (beneficiaries) married or engaged to U.S. citizens (petitioners) who have petitioned for them to immigrate to the U.S., including those who met through an international marriage broker (IMB). IMBRA mandated that GAO study the act's impact on the visa process for noncitizen spouses and fiance(e)s. This report addresses the extent to which the U.S. Citizenship and Immigration Services (USCIS), a component of the Department of Homeland Security (DHS); the Department of State (DOS); and the Department of Justice (DOJ) have implemented IMBRA, and the extent to which USCIS and DOS have collected and maintained data for this GAO report as required by IMBRA. To address these objectives, GAO reviewed the act and related legislation, analyzed IMBRA implementation guidance and available data on applications filed, and interviewed officials at USCIS, DOS, and DOJ."

A letter report issued by the Government Accountability Office with an abstract that begins "Competitive sourcing is aimed at promoting competition between federal employees and the private sector as a way to improve government operations. Key work activities--those that are either inherently governmental or core to the agency's mission--are generally exempt from competitions. In fiscal year 2004, Congress began placing spending limitations on the Forest Service's competitive sourcing program because of concerns about how the program was managed. Also, like other agencies, the Forest Service must report annually to Congress on the savings achieved from any competitions it conducted. GAO was asked to determine the extent to which the Forest Service has (1) plans and guidance to help implement its competitive sourcing program effectively and (2) sufficient cost data to ensure that it complied with its spending limitations and accurately reported its savings to Congress for fiscal years 2004 through 2006. To answer these objectives, GAO examined the agency's strategic plan, guidance, and available cost data for competitive sourcing and interviewed key agency officials."

A letter report issued by the Government Accountability Office with an abstract that begins "During the late 1990s, many petroleum companies merged to stay profitable while crude oil prices were low, and in recent years mergers have continued. Congress and others have concerns about the impact mergers might be having on competition in U.S. petroleum markets. The Federal Trade Commission (FTC) has the authority to maintain competition in the petroleum industry and reviews proposed mergers to determine whether they are likely to diminish competition or increase prices, among other things. GAO was asked to examine (1) mergers in the U.S. petroleum industry and changes in market concentration since 2000 and (2) the steps FTC uses to maintain competition in the U.S. petroleum industry, and the roles other federal and state agencies play in monitoring petroleum industry markets. In conducting this study, GAO worked with petroleum industry experts to delineate regional markets and to develop estimates of refinery gasoline production capacity in order to calculate market concentration. GAO used public and private data as well as interviews for its analyses."

Correspondence issued by the Government Accountability Office with an abstract that begins "The principal role of the Chemical Safety and Hazard Investigation Board (CSB) is to investigate accidental releases of regulated or extremely hazardous substances to determine the conditions and circumstances that led to the accident and to identify the cause or causes so that similar accidents might be prevented. Accidental releases of these toxic and hazardous chemicals occur frequently and often have serious consequences. CSB reported to Congress that the agency received notification of approximately 900 chemical accidents in calendar year 2007, and that 31 of these accidents were serious or even fatal events that warranted the commitment of CSB investigators. CSB began operating in 1998 as an independent agency created under the Clean Air Act Amendments of 1990. The act directs CSB to (1) investigate and report on the cause or probable cause of any accidental chemical releases from stationary sources resulting in a fatality, serious injury, or substantial property damages; (2) make recommendations to reduce the likelihood or consequences of accidental chemical releases and propose corrective measures; and (3) establish regulations for reporting accidental releases. The agency publishes investigative reports and issues safety studies and videos to …

A letter report issued by the Government Accountability Office with an abstract that begins "The Implementation Plan for the National Strategy for Pandemic Influenza states that in an influenza pandemic, the primary response will come from states and localities. To assist them with pandemic planning and exercising, Congress has provided $600 million to states and certain localities. The Department of Homeland Security (DHS) established five federal influenza pandemic regions to work with states to coordinate planning and response efforts. GAO was asked to (1) describe how selected states and localities are planning for an influenza pandemic and who they involved, (2) describe the extent to which selected states and localities conducted exercises to test their influenza pandemic planning and incorporated lessons learned as a result, and (3) identify how the federal government can facilitate or help improve state and local efforts to plan and exercise for an influenza pandemic. GAO conducted site visits to five states and 10 localities."

A letter report issued by the Government Accountability Office with an abstract that begins "In August 2005, Congress established the Safe Routes to School (SRTS) program primarily to encourage children to walk and bicycle to school. GAO was asked to determine (1) the steps the Federal Highway Administration (FHWA) and states have taken to implement the program, (2) the extent to which FHWA and states have evaluated the results of the program, and (3) how the program is related to other surface transportation programs and some considerations for future reauthorization. GAO reviewed statutes, regulations, and guidance; analyzed program obligation data and funds awarded by states; and interviewed officials with FHWA, state departments of transportation, and local grant recipients."

A letter report issued by the Government Accountability Office with an abstract that begins "The federal government plans to spend about $70 billion on information technology (IT) projects during fiscal year 2008. Consequently, it is important that projects be managed effectively to ensure that public resources are wisely invested. At times, a project's cost, schedule, and performance goals--known as its baseline--are modified to reflect changed development circumstances. These changes--called a rebaselining--can be done for valid reasons, but can also be used to mask cost overruns and schedule delays. GAO was asked to (1) determine the extent of and the primary reasons for IT project rebaselining and (2) determine whether federal agencies have sound policies for rebaselining projects. To do this, GAO surveyed the managers of a random sample of 180 projects selected from the 778 major IT projects the 24 major agencies plan to invest in during fiscal year 2008. GAO also compared agencies' rebaselining policies to best practices."

A letter report issued by the Government Accountability Office with an abstract that begins "In accordance with 36 U.S.C. 2103, GAO is responsible for conducting audits of the agencywide financial statements of the American Battle Monuments Commission (the Commission). GAO audited the financial statements of the Commission for the fiscal years ended September 30, 2007, and 2006. The audits were done to determine whether, in all material respects, (1) the Commission's financial statements were presented fairly, and (2) Commission management maintained effective internal control over financial reporting and compliance with laws and regulations. Also, GAO tested Commission management's compliance with selected laws and regulations. The Commission was created in 1923 to commemorate the sacrifices and achievements of U.S. Armed Forces where they have served overseas since April 6, 1917, and locations within the United States as directed by Congress. The Commission designs, operates, and maintains 24 American military cemeteries on foreign soil and 25 federal memorials, monuments, and markers, 22 of which are on foreign soil, that were financed from appropriated funds. The Commission was also responsible for designing and constructing the national World War II Memorial on the Capitol Mall in Washington, D.C., and for maintaining seven nonfederal memorials …

Testimony issued by the Government Accountability Office with an abstract that begins "The United States has reimbursed Pakistan, a key ally in the global war on terror, about $5.56 billion in Coalition Support Funds (CSF) for its efforts to combat terrorism along its border with Afghanistan. The Department of Defense (Defense) provides CSF for costs incurred in direct support of U.S. military operations. Pakistan is the largest recipient of CSF, receiving 81 percent of CSF reimbursements. This testimony focuses on (1) the extent to which Defense has consistently applied its guidance to validate the reimbursements claimed by Pakistan and (2) how the Office of the Defense Representative to Pakistan's (ODRP) role has changed over time. This statement is based on a concurrently issued GAO report titled Combating Terrorism: Increased Oversight and Accountability Needed over Pakistan Reimbursement Claims for Coalition Support Funds, GAO-08-806 (Washington, D.C.: June 24, 2008)."

Correspondence issued by the Government Accountability Office with an abstract that begins "Recent operations in Iraq, Afghanistan, and other locations around the world have highlighted the need for U.S. forces to train as they intend to fight. Department of Defense (DOD) training ranges and operating areas are required to be managed and operated to support their long-term viability and utility to meet the national defense mission. The use of military training ranges enhances training by providing realistic, hands-on experience. Sustainable training range management focuses on the practices that allow the military to manage its ranges in a way that ensures their usefulness well into the future. Because the military faces obstacles in acquiring new training lands, the preservation and sustainable management of its current lands must be priorities. New advances in technology, coupled with a shift in force posture, mean that DOD needs to continually update and maintain its training ranges. Military training ranges vary in size from a few acres--for small arms training--to over a million acres for large maneuver exercises and weapons testing, and include broad open ocean areas for offshore training and testing. These ranges face ever increasing limitations and restrictions on land, water, and airspace as …

Testimony issued by the Government Accountability Office with an abstract that begins "In 2004, Congress directed the Department of Defense (DOD) to establish a comprehensive policy to prevent and respond to sexual assaults involving servicemembers. Though not required to do so, the Coast Guard has established a similar program. This statement addresses the extent to which DOD and the Coast Guard (1) have developed and implemented policies and programs to prevent, respond to, and resolve sexual assault incidents involving servicemembers; (2) have visibility over reports of sexual assault; and (3) exercise oversight over reports of sexual assault. This statement draws on GAO's preliminary observations from an ongoing engagement examining DOD's and the Coast Guard's programs to prevent and respond to sexual assault. In conducting its ongoing work GAO reviewed legislative requirements and DOD and Coast Guard guidance, analyzed sexual assault incident data, and obtained through surveys and interviews the perspective on sexual assault matters of more than 3,900 servicemembers stationed in the United States and overseas. The results of GAO's survey and interviews provide insight into the implementation of the programs but are nongeneralizable. GAO expects to issue its final report in August 2008 and to make a number of …

Testimony issued by the Government Accountability Office with an abstract that begins "The U.S. federal government has played an ever-increasing role in providing benefits to individuals injured as a result of exposure to harmful substances. Over the years, it has established several key compensation programs, including the Black Lung Program, the Vaccine Injury Compensation Program (VICP), the Radiation Exposure Compensation Program (RECP), and the Energy Employees Occupational Illness Compensation Program (EEOICP), which GAO has reviewed in prior work. Most recently, the Congress introduced legislation to expand the benefits provided by the September 11th Victim Compensation Fund of 2001. As these changes are considered, observations about other federal compensation programs may be useful. In that context, GAO's testimony today will focus on four federal compensation programs, including (1) the structure of the programs; (2) the cost of the programs through fiscal year 2004, including initial cost estimates and the actual costs of benefits paid, and administrative costs; and (3) the number of claims filed and factors that affect the length of time it takes to finalize claims and compensate eligible claimants. To address these issues, GAO relied on its 2005 report on four federal compensation programs. As part of that work, …

Testimony issued by the Government Accountability Office with an abstract that begins "Congress created individual retirement accounts (IRAs) with two goals: (1) to provide a retirement savings vehicle for workers without employer-sponsored retirement plans, and (2) to preserve individuals' savings in employer-sponsored retirement plans when they change jobs or retire. Questions remain about IRAs' effectiveness as a vehicle to facilitate new, or additional, retirement savings. GAO was asked to report on (1) the role of IRAs in retirement savings, (2) the prevalence of employer-sponsored and payroll-deduction IRAs and barriers discouraging employers from offering these IRAs, and (3) changes that are needed to improve IRA information and oversight. GAO reviewed published reports from government and financial industry sources and interviewed retirement and savings experts, small business representatives, IRA providers, and federal agency officials."

Testimony issued by the Government Accountability Office with an abstract that begins "DOD's investment in weapon systems represents one of the largest discretionary items in the budget. The department expects to invest about $900 billion (fiscal year 2008 dollars) over the next 5 years on development and procurement with more than $335 billion invested specifically in major defense acquisition programs. Every dollar spent inefficiently in acquiring weapon systems is less money available for other budget priorities--such as the global war on terror and growing entitlement programs. This testimony focuses on (1) the overall performance of DOD's weapon system investment portfolio; (2) our assessment of 72 weapon programs against best practices standards for successful product developments; and (3) potential solutions and recent DOD actions to improve weapon program outcomes. It is based on GAO-08-467SP, which included our analysis of broad trends in the performance of the programs in DOD's weapon acquisition portfolio and our assessment of 72 defense programs, and recommendations made in past GAO reports. DOD was provided a draft of GAO-08-467SP and had no comments on the overall report, but did provide technical comments on individual assessments. The comments, along with the agency comments received on the individual assessments, …

A letter report issued by the Government Accountability Office with an abstract that begins "Over the past several years, GAO has issued numerous reports and testimonies on internal control breakdowns in certain individual agencies' purchase card programs. In light of these findings, GAO was asked to analyze purchase card transactions governmentwide to (1) determine whether internal control weaknesses existed in the government purchase card program and (2) if so, identify examples of fraudulent, improper, and abusive activity. GAO used statistical sampling to systematically test internal controls and data mining procedures to identify fraudulent, improper, and abusive activity. GAO's work was not designed to determine the overall extent of fraudulent, improper, or abusive transactions."

A letter report issued by the Government Accountability Office with an abstract that begins "Improvised explosive devices (IED) have been and continue to be a significant threat to U.S. forces. The Department of Defense (DOD) expanded efforts to defeat IEDs with the establishment of the Joint Improvised Explosive Device Defeat Organization (JIEDDO) in January 2006. GAO was asked to review JIEDDO's management and operations. For this second report in its series, GAO determined (1) the extent to which JIEDDO's management processes provide adequate assurances that its financial information is accurate and provides transparency over its operations and (2) the extent to which JIEDDO identifies, records, tracks, and reports numbers of all personnel, including contractors. GAO analyzed data for the first half of fiscal year 2007, which included 47 funding transactions totaling $1.34 billion for 24 initiatives to address these objectives."

Correspondence issued by the Government Accountability Office with an abstract that begins "The Department of Defense (DOD) relies on contractors to perform many of the functions needed to support troops in deployed locations. For example, at Camp Arifjan, Kuwait the Army uses contractors to provide logistics support for operations in Iraq and Afghanistan. Contractors at Camp Arifjan refurbish and repair a variety of military vehicles such as the Bradley Fighting Vehicle, armored personnel carriers, and the High-Mobility, Multi-Purpose Wheeled Vehicle (HMMWV). However, while contractors provide valuable support to deployed forces, we have frequently reported that long-standing DOD contract management and oversight problems increase the opportunity for waste and make it more difficult for DOD to ensure that contractors are meeting contract requirements efficiently, effectively, and at a reasonable price. This report discusses information about Task Order 1 that we developed during our review. Our objectives were to (1) evaluate the contractor's performance of maintenance and supply services under Task Order 1, (2) determine the extent to which the Army's quality assurance and contract management activities implement key principles of quality assurance and contract management regulations and guidance, and (3) determine the extent to which the Army is adequately staffed to …

A letter report issued by the Government Accountability Office with an abstract that begins "In January 2007 the President announced an initiative, referred to as Grow the Force, to increase the end strength in the Army by more than 74,000 by 2013 and the Marine Corps by 27,000 personnel by 2011 to enhance U.S. forces, reduce stress on deployable personnel, and provide necessary forces for success in the Global War on Terrorism. The Department of Defense (DOD) estimates that it will need more than $17 billion for facilities to accommodate the planned personnel increases. GAO was asked to review (1) the process the Army and Marine Corps used to develop construction projects associated with Grow the Force, (2) the extent to which the projects submitted in DOD's budget requests for fiscal years 2007 and 2008 support the initiative, and (3) whether the Army and Marine Corps plan to use temporary facilities while construction projects are completed. GAO reviewed the construction projects associated with Grow the Force in DOD's budget requests for fiscal years 2007 and 2008, reviewed stationing documents, and interviewed officials at Army and Marine Corps headquarters and six installations on the process used to develop projects. In comments …

A letter report issued by the Government Accountability Office with an abstract that begins "The Centers for Medicare & Medicaid Services (CMS) is responsible for providing beneficiaries timely and accurate information about Medicare. Receiving nearly 30 million calls in 2007, 1-800-MEDICARE, operated by a contractor, is the most common way members of the public get program information. The help line provides services both to English-speaking and limited English proficiency (LEP) callers. In this report, GAO describes (1) the extent to which access performance standards and targets have been met by the current contractor, (2) the efforts by CMS to provide LEP callers access to help line services and wait times experienced by these callers, and (3) CMS's oversight of callers' access to 1-800-MEDICARE and the information's accuracy. To conduct this work, GAO reviewed documents and analyzed help line data through July 2008. In addition, GAO interviewed agency staff, industry experts, and officials at four federal agencies with high call volume contact centers."

A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Defense's (DOD) C-5 Galaxy and C-17 Globemaster III aircraft play key roles in transporting weapons and other cargo. Since September 2001, these aircraft have delivered over 2.4 million tons of cargo to staging and operating bases in Iraq and Afghanistan. Yet determining the number and mix to meet current and future airlift requirements has become increasingly challenging given distinct differences between the two aircraft. While the C-5 can carry more cargo, the newer C-17 is more flexible since it can deliver to forward-deployed bases and has a higher mission capable rate. GAO was asked to identify the impact C-5 modernization cost increases have had on the mix of aircraft; assess the current C-5 modernization cost estimate; and identify C-17 production plans and issues related to production line shutdown. To conduct its work, GAO reviewed options DOD considered to meet its current and future strategic airlift requirements, and evaluated C-5 modernization and C-17 production line shut down cost estimates."

A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Energy (DOE) oversees contractors that operate more than 200 "high-hazard" nuclear facilities, where an accident could have serious consequences for workers and the public. DOE is charged with regulating the safety of these facilities. A key part of DOE's self-regulation is the Office of Health, Safety and Security (HSS), which develops, oversees, and helps enforce nuclear safety policies. This is the only DOE safety office intended to be independent of the program offices, which carry out mission responsibilities. This report examines (1) the extent to which HSS meets GAO's elements of effective independent nuclear safety oversight and (2) the factors contributing to any identified shortcomings with respect to these elements. GAO reviewed relevant DOE policies, interviewed officials and outside safety experts, and surveyed DOE sites to determine the number and status of nuclear facilities. GAO also assessed oversight practices against the criteria for independent oversight GAO developed based on a series of reports on DOE nuclear safety and discussions with nuclear safety experts."

Correspondence issued by the Government Accountability Office with an abstract that begins "Federal laws and regulations require that safety-related transportation professionals undergo screening to ensure that they can safely perform their jobs. Medical certification and background checks of selected pilots, vessel masters, and commercial drivers are part of the requirements for licensing these workers. Certification or licensing also includes testing workers' knowledge and skills required for the jobs. These checks are critical because physically or mentally unfit transportation workers pose a danger to themselves and to the public. Because of concerns raised by recent investigations of the reliability of pilot medical certifications, Congress asked us to first describe the requirements for medical and background checks for selected transportation workers. Accordingly, we addressed the following questions for (1) medical certification and (2) background checks: What are the regulations governing pilots, vessel masters, and commercial drivers and what role do government entities have in completing the certifications and background checks? A second report, which will be issued mid-2008, will provide information about the steps that the Federal Aviation Administration (FAA) takes to check the accuracy of pilot medical certificates. Federal regulations require that pilots have both pilot certificates and medical certificates prior …