The Visa Waiver Program (VWP), which allows citizens of certain countries to visit the United States for up to three months without a visa, has two explicit missions: to enhance national security and to boost the U.S. travel and tourism sectors. On November 8, 2019, the United States designated Poland into the VWP, bringing the number of participating countries to 39. A concern for Congress is whether the VWP exposes the United States to security threats, despite implementation of strict security requirements over recent years. At the same time, because of longstanding congressional interest in promoting the U.S. travel and tourism sectors, many lawmakers support adding more countries to the VWP. A key goal of the VWP is to improve standards for aviation security, travel documents, and law enforcement in countries around the world. To qualify for the VWP, countries must issue electronic passports, report information on all lost and stolen passports to the United States through the International Criminal Police Organization (INTERPOL), and share information on travelers who may pose a terrorist or criminal threat. Every VWP traveler must obtain preclearance to board a flight to the United States through the Electronic System for Travel Authorization (ESTA). Supporters of the VWP see admission into the program as an incentive for foreign countries to increase their security infrastructure and information sharing with the United States. A competing view is that despite security improvements following the 2015 terrorist attacks in Europe, such as screening of passengers entering under the VWP based on past travel to a country known as a terrorist sanctuary, the program remains a national security vulnerability. Another objective of the VWP is to facilitate and encourage foreign business and leisure travel from high-volume and low-risk countries to the United States. In FY2018, 22.8 million nonimmigrant visitorsâconstituting nearly one-third of all visitor admissions to the United Statesâarrived through the VWP. Figures from U.S. Travel, the industry group representing travel and tourism organizations, show that nationals from VWP countries generated an estimated $190 billion in economic activity and supported close to 1 million jobs in the United States in 2017. In addition, the U.S. government's National Travel and Tourism Office (NTTO) reports that a record 80 million international travelers visited the United States in 2018, with the number falling slightly in 2019. The number of foreign visitor arrivals in 2019 indicated that the United States would likely fall short of the goal set by the federal government's travel and tourism strategy of attracting 100 million visitors annually by the end of 2021. The COVID-19 pandemic has sharply reduced foreign tourism in 2020 as countries have discouraged international travel and required arriving passengers to quarantine themselves for extended periods, probably putting the 2021 goal out of reach. Nonetheless, advocates for the U.S. travel and tourism industries argue that adding more countries to the VWP would further promote tourism, trade, and commerce by increasing the number of overseas visitors traveling to the United States. Activity in the 116 th Congress related to the VWP seeks to expand the number of countries by changing the qualification criteria or designating specific countries. Other bills would rename the VWP to "Secure Travel Partnership" to reflect one of its main goals of securing U.S. borders. Legislation in the 116 th Congress also addresses the ESTA fee paid by VWP applicants. In December 2019, Congress authorized the continued use of the ESTA fee to partially fund Brand USA, a national tourism promotion program, through September 30, 2027. Congress also raised the ESTA fee from $14 to $21 (Division I, Title 8 of P.L. 116-94 ). The effective date of the new ESTA fee has not yet been announced.


Bacterial infections have become more difficult, and sometimes impossible, to treat due to antibiotic resistance, which occurs when bacteria develop the ability to defeat the available drugs designed to kill them. Concerns about rising rates of resistance to available treatment options prompted the federal government to create the 5-year National Action Plan in 2015. The plan called for federal agencies to strengthen surveillance, advance the development of diagnostic tests and new antibiotics, and slow the emergence of resistant bacteria, among other things. GAO was asked to review federal efforts to address antibiotic resistance. This report examines federal efforts and challenges related to (1) surveillance of antibiotic resistance, (2) the development and use of diagnostic testing to identify antibiotic resistance, (3) the development of treatments for resistant infections, and (4) appropriate antibiotic use. GAO reviewed literature and agency documents; interviewed agency officials and health care industry, drug industry, and other stakeholders; and held a meeting of international and U.S. experts to obtain their views. The precise magnitude of the problem of antibiotic resistance is unknown. The Centers for Disease Control and Prevention (CDC) has made progress in expanding surveillance of infections from certain antibiotic-resistant bacteria in the United States and abroad but faces several challenges. Note: This figure tracks a type of carbapenem-resistant Enterobacteriaceae (CRE), which, according to CDC, is a “nightmare bacteria” resistant to nearly all available antibiotics. Shading indicates CDC confirmed the presence of these bacteria within that state in that year or a previous one. CDC faces challenges in conducting surveillance for antibiotic resistance due to the limited data it is able to collect through various surveillance systems. For example, CDC's primary surveillance system for gonorrhea—which CDC classified as an urgent antibiotic resistance threat affecting over half a million patients annually—currently tracks only an estimated 1 to 2 percent of all U.S. cases and only in males. CDC has not fully evaluated the representativeness of the gonorrhea surveillance system's results. However, it could do so, for example, by comparing the trends in their limited sample population with trends it can establish in the overall U.S. population via additional studies. Such an evaluation could give CDC more confidence that the system's data accurately reflect national trends. Federal agencies have taken steps to advance the development and use of diagnostic tests to identify antibiotic-resistant bacterial infections, but these efforts have limitations. For example, agencies have conducted some studies to establish whether testing can lead to positive health care outcomes, such as reduced rates of antibiotic-resistant infections. However, more such studies are needed, according to experts and agency officials. Without information to guide test usage, clinicians may not be able to select appropriate treatments for their patients. One reason for the insufficient number of studies is that Department of Health and Human Services (HHS) agencies that are in a position to conduct or fund such studies—such as CDC and the Biomedical Advanced Research and Development Authority—disagree about what each agency should do. By clarifying roles and responsibilities, HHS agencies could more effectively address the need for more studies. The resulting studies could help demonstrate the value of diagnostic tests for antibiotic resistance, potentially increasing their use and improving patient care. Experts warn that the current pipeline of antibiotics in development is insufficient to meet the threat of resistance. Several challenges impede the development of new treatments for resistant infections, notably inadequate return on investment for drug companies largely due to low prices and a limited patient population for whom these treatments would be appropriate. While HHS and Department of Defense agencies have provided financial premarket incentives to support antibiotic research and development, experts, federal officials and antibiotic developers agree that more postmarket incentives are needed to overcome the economic challenges. Advisory groups, including a presidential advisory council, and others have called for new postmarket incentives and identified multiple options for their design, including market entry rewards and reimbursement reform (see figure). However, HHS has not developed a strategy to further incentivize development of new treatments for antibiotic-resistant infections, and it may need to request authority and appropriations to create and implement certain types of incentives. Until such incentives are developed, more drug companies may exit the antibiotic development sector, and the pipeline of new treatments may continue to decrease. Federal agencies have made several efforts to promote the appropriate use of antibiotics across health care settings through antibiotic stewardship—giving patients the right antibiotic at the right time, in the right dose, and for the right duration. However, key challenges remain. For example, federal agencies require only certain types of health care facilities to implement stewardship programs. In addition, CDC is limited in its ability to monitor and improve appropriate antibiotic use, in part because providers are not generally required to report antibiotic use data to a centralized database. The 5-year National Action Plan for Combating Antibiotic-Resistant Bacteria (National Action Plan) calls for strengthening antibiotic stewardship and for the timely reporting of antibiotic use data across health care settings. An executive order directs an interagency task force—the Combating Antibiotic-Resistant Bacteria (CARB) Task Force, coordinated by HHS—to provide annual updates to the President on, among other things, plans for addressing any barriers to full implementation of the National Action Plan. However, in its progress reports covering the first 4 years of the National Action Plan's implementation, the task force did not identify plans to address barriers to expanding antibiotic stewardship programs or the collection of antibiotic use data. Until it does so, the government will not have reasonable assurance that it is fully implementing the National Action Plan and addressing antibiotic resistance.


The William D. Ford Federal Direct Loan (Direct Loan) program is the single largest source of federal financial assistance to support students' postsecondary educational pursuits. The U.S. Department of Education estimates that in FY2020, $100.2 billion in new loans will be made through the program. As of the end of the second quarter of FY2019, $1.2 trillion in principal and interest on Direct Loan program loans, borrowed by or on behalf of 34.5 million individuals, remained outstanding. For many individuals, borrowing a federal student loan through the Direct Loan program may be among their first experiences in incurring a major financial obligation. Upon obtaining a loan, a borrower assumes a contractual obligation to repay the debt over a period that may span a decade or more. Loans were first made through the Direct Loan program in 1994. Since then, Congress has periodically made changes to the program and the terms and conditions of loans. Changes have impacted program aspects such as the availability of loan types, interest rates, loan repayment, loan discharge and forgiveness, and the consequences of default. Over time, the accumulation of changesâmany of which are differentially applicable to borrowers or loan typesâhas resulted in a set of loan terms and conditions that are voluminous and complex. Congress may contemplate making future changes to loan terms and conditions. This report has been prepared to provide Congress with a comprehensive description of the terms and conditions and borrower benefits that are applicable to loans made through the Direct Loan program. Emphasis is placed on discussing loan types, provisions related to borrower eligibility, amounts that may be borrowed, interest and fees, loan repayment, repayment relief, loan forgiveness benefits, the consequences of default, and the methods used to ensure borrowers are informed about the terms and conditions of their loans and their obligation to repay them. Direct Loan Types Four types of loans are available through the Direct Loan program. Direct Subsidized Loans are available only to undergraduate students with financial need. Direct Unsubsidized Loans are available both to undergraduate students and graduate students. Direct PLUS Loans may be borrowed by graduate students and by the parents of undergraduate students dependent upon them for financial support. Direct Consolidation Loans allow borrowers to combine debt from multiple existing federal student loans into a single new loan. Eligibility and Amounts That May Be Borrowed Whether an individual may borrow a loan and the amount he or she may borrow are determined by the interaction of many factors. Eligibility to borrow varies by loan type, borrower characteristics, program level, and class level. The amount an individual may borrow is subject to annual and aggregate borrowing limits, and federal need analysis and packaging procedures. Loans are made available in amounts constrained by program rules, butâwith the exception of Direct PLUS Loansâwithout consideration of a borrower's ability to repay. Eligibility to borrow a Direct PLUS Loan depends on an individual's creditworthiness. Interest on Direct Loan Program Loans Procedures for calculating interest vary by loan type, repayment status, and the period during which a loan was made. In limited circumstances, the federal government subsidizes, or does not charge, interest that would otherwise accrue. Interest subsidies are mostly limited to Direct Subsidized Loans; however, certain interest subsidies may be provided on all loan types. Loan Repayment Plans Numerous repayment plans, each with different payment structures and maximum durations, are available. Among the various plans, income-driven repayment (IDR) plans cap monthly payments at a specific percentage of a borrower's discretionary income. For most repayment plans, monthly payments must cover the interest that accrues; however, the IDR plans allow for negative amortization, in which case monthly payments may be for less than the interest that accrues. Deferment and Forbearance Periods of deferment and forbearance offer a borrower temporary relief from the obligation to make monthly payments. In certain instances, interest subsidies may be provided during periods of deferment; however, interest subsidies are not available during periods of forbearance. Loan Discharge and Loan Forgiveness A borrower may be relieved of the obligation to repay his or her loans in certain circumstances. Student loan debt may be discharged on the basis of borrower hardship (e.g., death, total and permanent disability, school closure) or may be forgiven following an extended period of repayment according to an IDR plan or completion of a period of public service. Loan Default, Its Consequences, and Resolution If a borrower defaults, the loan becomes due in full and the borrower loses eligibility for many benefits, as well as access to other forms of federal student aid. The government also uses numerous means to collect on defaulted student loan debt. A limited set of options is available for a borrower to bring a defaulted loan back into good standing. Loan Counseling and Disclosures Student borrowers are required to undergo financial counseling, which is designed to provide them with comprehensive information on the terms and conditions of their loans as well as their rights and the responsibilities they assume as borrowers. Loan terms and conditions are specified in a promissory note, which is a contract that establishes the borrower's obligation to repay the loan, and in a plain language disclosure document that uses simplified terms to explain a loan's terms and conditions and the borrower's rights and responsibilities.


The Windfall Elimination Provision (WEP) and the Government Pension Offset (GPO) are two separate provisions that reduce Social Security benefits for workers and/or and their eligible family members if the worker receives (or is entitled to) a pension based on employment not covered by Social Security. Certain beneficiaries may be subject to both the WEP and the GPO if they are dually entitled to Social Security retirement and spousal (or survivors') benefits and also receive a noncovered government pension. As of December 2018, 263,775 Social Security beneficiaries were affected by both the WEP and the GPO. They accounted for 38% of spouses and survivors affected by the GPO and 14% of beneficiaries affected by the WEP. The provisions' benefit offsets create complications in calculating and administering Social Security benefits. Overpayments to dually entitled Social Security beneficiaries affected by both the WEP and the GPO have been an issue for the Social Security Administration (SSA) since the WEP was enacted in 1983. In January 2013, SSA's Office of the Inspector General (OIG) estimated that SSA has overpaid approximately $349.5 million to 10,546 dually entitled beneficiaries who were identified among those in current-payment status and whose WEP reduction was not applied properly and $320.6 million to 10,122 dually entitled beneficiaries in current-payment status whose GPO offset was not imposed correctly. OIG's estimates further indicated that SSA overpaid those beneficiaries an additional $231.9 million from 2013 to 2017, and that SSA may continue overpaying them approximately $46.4 million annually if no corrective action is taken. Other studies show that beneficiaries who were subject to both the WEP and the GPO tended to have lower average Social Security benefits and household wealth than those affected by only the WEP or the GPO. In addition, some state and local government employees might become dually entitled and subject to both provisions through an extension of Social Security coverage under a Section 218 Agreement.


The World Bank and others have reported that some money transmitters have been losing access to banking services. Money transmitters play an important role in the financial system, in part because they provide financial services to people less likely to use traditional banking services. GAO was asked to review the causes and potential effects of derisking by banks. This report examines, among other issues, (1) the extent to which banks are terminating or limiting services for money transmitters, (2) challenges in assessing banks' BSA/AML compliance related to money transmitters, and (3) regulators' actions to address derisking concerns. GAO reviewed bank examination reports and documents, held eight discussion groups with federal bank examiners, surveyed a nationally representative sample of 406 banks (excluding credit unions), and interviewed federal and bank officials, money transmitters, industry associations, and other stakeholders. From 2014 through 2016, 40 of 86 banks with money transmitter customers that responded to GAO's survey indicated they terminated at least one money transmitter account for money-laundering-related reasons. Money transmitters transfer money for their customers to recipients domestically or internationally. Common reasons given for terminating accounts included the customer not providing information needed to satisfy the banks' due diligence requirements under Bank Secrecy Act (BSA)/anti-money laundering (AML) regulations and that the cost of BSA/AML compliance made these customers unprofitable. However, banks also cited concerns that these customers drew heightened regulatory oversight; this may indicate “derisking,” the practice of banks limiting services or closing accounts with customers to avoid any perceived regulatory concerns about facilitating money laundering. Federal bank examiners in some of GAO's discussion groups identified challenges in assessing banks' compliance with due diligence requirements. In 2005, the Department of the Treasury's (Treasury) Financial Crimes Enforcement Network (FinCEN) and the federal banking regulators issued interagency interpretive guidance to clarify BSA/AML requirements and supervisory expectations for banks providing banking services to money transmitters. The guidance was incorporated in the Federal Financial Institutions Examination Council BSA/AML examination manual. However, examiners from some discussion groups said it was unclear how much due diligence is reasonable to expect banks to conduct for their money transmitter customers. For example, while the manual's examination guidance pertaining to money transmitters states that due diligence on higher-risk accounts can include reviewing the money transmitter's BSA/AML compliance program or conducting on-site visits, the related examination procedures do not clarify what these reviews or visits might entail. Unless federal banking regulators take steps to improve examiners' ability to evaluate banks' compliance with BSA/AML requirements as applied to money transmitter accounts, examiners may not be fully achieving examination objectives. In response to derisking concerns associated with money transmitters, FinCEN and the federal banking regulators have issued general guidance that discourages banks from terminating accounts with any particular customer type without evaluating individual customers' risks. In prior work, GAO noted that regulators had not fully evaluated how banks' regulatory concerns may be influencing decisions to derisk. GAO recommended that FinCEN and the federal banking regulators conduct a retrospective review of BSA regulations and their implementation, with a focus on how banks' regulatory concerns may affect their decisions to provide services. According to federal banking regulators and FinCEN, they and Treasury established an interagency working group in early 2018 that they believe will address the recommendation. The working group has taken important steps toward improving the efficiency and effectiveness of BSA/AML supervision, including issuing an interagency statement intended to improve the transparency of the risk-focused approach examiners use to plan and conduct BSA examinations. However, the working group has not yet evaluated the full range of factors that may influence banks to derisk.


The World Health Organization (WHO) declared the Zika virus a public health emergency of international concern in February 2016. According to WHO, as of March 2017, 79 countries and territories—including 48 in the Western Hemisphere—reported evidence of ongoing Zika transmission. In April 2016, USAID and State repurposed $215 million for Zika from funds appropriated for Ebola. Subsequently, the Zika Response and Preparedness Appropriations Act, 2016, provided over $175 million in supplemental funding to USAID and State to support Zika response efforts overseas. The act also included a provision for GAO to review the status of USAID and State actions to respond to Zika. In March 2019, the Centers for Disease Control and Prevention downgraded its international travel warning for Zika. This report examines (1) the status of USAID and State funding for U.S. Zika response overseas, (2) activities supported by these funds, and (3) implementation challenges, if any, and responses to any challenges. GAO reviewed information from U.S. agencies and met with U.S. and host country officials in Washington, D.C. GAO also conducted fieldwork in a nongeneralizable sample of countries in Latin America and the Caribbean where agencies implemented key response activities. The U.S. Agency for International Development (USAID) and the Department of State (State) obligated $385 million of the total $390 million available for international Zika response and disbursed $264 million as of September 2018. USAID obligated 95 percent of the total funding. USAID and State provided some country information to Congress but did not provide, or take steps to track, funding on a country basis. According to USAID officials, tracking funding information by country would be helpful in the future. The ability to compile funding by country when responding to future infectious disease outbreaks would enable USAID to provide additional information to key decision makers to better support spending oversight and inform budgetary and planning decisions. In response to the Zika outbreak, USAID and State supported a broad range of activities overseas, including mosquito control, research efforts, and medical evacuations. In one activity, USAID implementing partners monitored mosquito populations; in another, they researched methods to reduce Zika virus transmission rates. USAID implementing partners reported various outputs from selected activities. For example, an implementing partner reported that its awareness campaign on Zika prevention reached more than 5 million people. USAID faced sustainability and timeliness challenges in implementing its Zika response. According to agency and other officials, one-time funding and a short time frame posed a challenge related to sustainability of Zika response activities. In response, USAID worked to align activities with those of host governments and other organizations so they could continue in the long term. However, USAID's emergency response planning did not fully address the challenge of timely implementation of response activities in countries without bilateral USAID health programs. Twenty-two of 26 countries with Zika response activities did not have bilateral USAID health programs when the Zika outbreak began. As a result, response activities took additional time to deploy in some countries where USAID first had to establish relationships with key host country officials. Although USAID developed an infectious disease response plan in 2018, the plan does not provide guidance on how to address the timely implementation challenge in countries without bilateral health programs. By improving its planning, such as by adding such guidance in its 2018 plan, USAID would be better positioned to respond quickly to future disease outbreaks.


The acquisition cost for the F-35 program increased substantially in 2019, partially due to the program's addition of estimated costs for modernization of hardware and software systems, referred to as its Block 4 efforts. This is the fifth report under the provision that Congress included in statute for GAO to review the F-35 program annually until the program reaches full-rate production. This is also the first report under another provision in statute to review the program's production and Block 4 progress annually through 2024. Among other objectives, this report assesses (1) the program's production performance and (2) the program's modernization cost estimate and development progress. GAO reviewed Department of Defense (DOD) and contractor documentation and interviewed DOD officials and contractor representatives. The F-35 program is at risk of missing its test schedule and not meeting manufacturing leading practices. In 2019, the F-35 program conducted much of its planned operational testing but extended the schedule by 9 months, which delays the program's full-rate production decision to between September 2020 and March 2021. Over that time, the program will continue to deliver aircraft. In addition, while the F-35 program has increased the production rate and negotiated lower aircraft prices, it is not meeting manufacturing leading practices identified by GAO. Specifically, only about 3,000 of the over 10,000 airframe contractor's manufacturing key processes meet predefined design standards for ensuring product quality. Also, the fielded aircraft, over 500 so far, do not meet the program's reliability and maintainability goals. Although the contractor is changing manufacturing processes to address problems and improve efficiency, more remains to be done. Unless the program office evaluates the risks of not meeting these leading practices, the military services and international partners are at risk of not receiving the quality aircraft they purchased. In addition, the July 2019 suspension of Turkey from the F-35 program—due to security concerns after its acquisition of Russian defense equipment—is likely to compound production risks. The program has identified new sources for 1,005 parts produced by Turkish suppliers, but the program is assessing the effect of 15 key parts not currently being produced at the needed production rate. In 2019, estimated development costs to modernize the F-35's hardware and software systems—known as Block 4—increased by over $1.5 billion. The cost increase puts estimated Block 4 development costs at $12.1 billion. However, the cost estimate did not fully adhere to leading practices, such as including all life cycle costs. In addition, while development will continue through 2026, reports on Block 4 that the program submits to Congress are slated to end in 2023. Without continued Block 4 reporting through the development phase, Congress will lack important oversight information.


The asset management industry is large and complex. Asset management companiesâalso known as investment management companies, or asset managersâare companies that manage money for a fee with the goal of growing it for those who invest with them. The most well-known product these companies create are investment funds. Many types of investment funds exist, including mutual funds, exchange-traded funds (ETFs), hedge funds, private equity, and venture capital. Their business practices and the types of regulatory requirements to which they are subject are far from standardized. Investment funds differ by, among other things, asset risk profile, investor access, portfolio company operations, and the ease of buying or selling their shares. In addition to investment funds, the asset management industry also consists of entities that connect funds to investors and other services, such as investment advice providers and custodians. Asset managers collectively manage trillions in assets, including investment savings, of nearly half of all U.S. households. The industry has experienced periods of high growth largely attributable to retail investors' increased reliance on asset managers to invest their money for them rather than investing their own money themselves. The Securities and Exchange Commission (SEC) is the primary regulator overseeing the asset management industry. The industry is governed by a somewhat fragmented regulatory regime stemming from several different statutes. Most of the regulatory framework was created in the 1930s and 1940s, but the business practices and trends affecting the industry are evolving. Examples of this evolution include (1) the rapid growth of the industry; (2) the increasing dependency of American businesses on capital market financing; (3) the shift from active to passive investment style; and (4) the expansion of the private securities markets. Congress has shown interest in issues relating to the asset management industry. During the 116 th Congress, lawmakers have held related hearings on asset management, financial innovation, investor protection, financial stability, and leveraged lending. Three areas that have been of particular interest to many are as follows: Whether the asset management industry has any implications for financial stability in the United States. Some financial authorities state that asset management companies did not pose much concern to financial stability during the 2007-2009 financial crisis period, with the exception of money market mutual funds. This is because asset managers are generally agents who provide investment services to clients without taking direct risk of financial loss. But some argue that structural vulnerabilities do exist and could be observed in certain financial instruments. Their implications, however, are uncertain. Whether regulation of the asset management industry provides sufficient access and protection for retail investors. The investor protection concerns center on investor access restrictions, especially for private funds. Private funds are perceived to have a higher risk and return profile relative to public funds, thus leading to discussions of investor protection and equal access to investment opportunities. The impact of financial technology on the industry, and whether the current regulatory framework is adequate to address these new technologies. Financial innovation is an integral part of the asset management industry's development, and it creates policy and regulatory debates regarding the extent to which the new technologies are appropriately served by the existing regulatory regime. One of the common goals of policymaking in this area is to protect investors without hindering innovation.


The census, apportionment, and redistricting are interrelated activities that affect representation in the U.S. House of Representatives. Congressional apportionment (or reapportionment) is the process of dividing seats for the House among the 50 states following the decennial census. Redistricting refers to the process that follows, in which states create new congressional districts or redraw existing district boundaries to adjust for population changes and/or changes in the number of House seats for the state. At times, Congress has passed or considered legislation addressing apportionment and redistricting processes under its broad authority to make law affecting House elections under Article I, Section 4, of the U.S. Constitution. These processes are all rooted in provisions in Article I, Section 2 (as amended by Section 2 of the Fourteenth Amendment). Seats for the House of Representatives are constitutionally required to be divided among the states, based on the population size of each state. To determine how many Representatives each state is entitled to, the Constitution requires the national population to be counted every 10 years, which is done through the census. The Constitution also limits the number of Representatives to no more than one for every 30,000 persons, provided that each state receives at least one Representative. Additional parameters for the census and for apportionment have been established through federal statutes, including timelines for these processes; the number of seats in the House; and the method by which House seats are divided among states. Congress began creating more permanent legislation by the early 20 th century to provide recurring procedures for the census and apportionment, rather than passing measures each decade to address an upcoming reapportionment cycle. Federal law related to the census process is found in Title 13 of the U.S. Code , and two key statutes affecting apportionment today are the Permanent Apportionment Act of 1929 and the Apportionment Act of 1941. April 1 of a year ending in "0" marks the decennial census date and the start of the apportionment population counting process; the Secretary of Commerce must report the apportionment population of each state to the President by the end of that year. Within the first week of the first regular session of the next Congress, the President transmits a statement to the House relaying state population information and the number of Representatives each state is entitled to. Each state receives one Representative, as required by the Constitution, and the remaining seats are distributed using a mathematical approach known as the method of equal proportions, as established by the Apportionment Act of 1941. Essentially, a ranked "priority list" is created that indicates which states will receive the 51 st -435 th House seats, based on a calculation involving the population size of each state and the number of additional seats a state has received. The U.S. apportionment population from the 2010 census was 309,183,463, reflecting a 9.9% increase since 2000, and 12 House seats were reapportioned among 18 states. After a census and apportionment are completed, state officials receive updated population information from the U.S. Census Bureau and the state's allocation of House seats from the Clerk of the House. Single-member House districts are required by 2 U.S.C. Â§2c, and certain other redistricting standards, largely related to the composition of districts, have been established by federal statute and various legal decisions. Current federal parameters related to redistricting criteria generally address population equality and protections against discrimination for racial and language minority groups under the Voting Rights Act of 1965 (VRA), as amended. Previous federal apportionment statutes have, at times, included other district criteria, such as geographic compactness or contiguity, and these standards have sometimes been referred to in U.S. Supreme Court cases, but they are not included in the current federal statutes that address the apportionment process. These redistricting principles and others, such as considering existing political boundaries, preserving communities of interest, and promoting political competition, have been commonly used across states, and many are reflected in state laws today. The procedural elements of redistricting are generally governed by state laws, and state redistricting practices can vary regarding the methods used for drawing districts, timeline for redistricting, and which actors (e.g., elected officials, designated redistricting commissioners, and/or members of the public) are involved in the process. Mapmakers must often make trade-offs between one redistricting consideration and others, and making these trade-offs can add an additional challenge to an already complicated task of ensuring "fair" representation for district residents. Despite technological advances that make it easier to design districts with increasing geographic and demographic precision, the overall task of redistricting remains complex and, in many instances, can be controversial. A majority of states, for example, faced legal challenges to congressional district maps drawn following the 2010 census, and several cases remained pending in 2019âless than a year before the next decennial census date.


The commercial space transportation industry provides launch services that enable national-security and commercial satellites, among other things, to be sent into orbit for government and private customers. Continued growth and evolution in the industry is expected as reliance on space-based applications increases. AST is charged with overseeing the industry, including licensing and monitoring launch vehicle operations. GAO was asked to review developments in this industry. This report (1) describes FAA's actions to integrate commercial space launches into the national airspace and (2) examines how well-positioned AST is to determine its current and future workforce needs, among other objectives. GAO reviewed relevant statutes, regulations, and FAA guidance; compared FAA's workforce management efforts to key principles for effective workforce planning; and interviewed FAA officials and U.S. commercial launch providers that had conducted an FAA-licensed launch as of January 2018, among other industry stakeholders. The Office of Commercial Space Transportation (AST) within the Federal Aviation Administration (FAA), in collaboration with other FAA offices, is taking a range of actions, such as testing new technologies, to improve how efficiently FAA integrates space vehicle launch operations into the national airspace. According to FAA officials, the amount of airspace that FAA closes to other airspace users is larger and remains closed longer than may be needed to ensure public safety. To help remedy this situation, FAA is piloting prototype technologies that would collect launch vehicles' location data in real-time and transmit them to air traffic controllers. Officials said the earliest these technologies could be implemented would be 2022. In March 2019, FAA published an announcement seeking interest from industry on partnering with FAA to further develop the technologies. Meanwhile, FAA is assessing how existing air traffic control technologies could be used to help reduce the effects of launches on other airspace users. Since 2016, AST has taken steps to improve how it determines its current workforce needs to carry out its mission including licensing commercial launch vehicle operations. These steps include more comprehensively monitoring staff time spent on specific activities and measuring the volume of the staff's work. While AST officials told us that AST is planning to continue to improve its workforce-planning efforts, GAO found that some aspects of AST's efforts fall short of key principles of strategic workforce planning. Such principles underscore the importance of determining both current and future workforce needs and identifying potential gaps in employee skills. For example: AST does not project its workload beyond a 2-year budget cycle, limiting its ability to effectively and strategically plan for its longer-term workforce needs. According to officials, it can take a few years for engineers with certain skills to be trained and have sufficient experience to lead projects. Further, AST officials told GAO that hiring technically qualified personnel, including positions that require considerable training and experience to be a fully functioning employee, is challenging. AST officials said that they are considering projecting their workload estimates further into the future, but they have neither formally committed to doing so nor established a timeline with milestones. AST officials acknowledged that the information AST currently collects on the skills of its staff is not sufficient to allow them to identify gaps between the skills and competencies needed and those that its workforce currently possesses or may need in the future, such as expertise in flight safety analysis. AST officials told GAO that they plan to develop a tool that could collect information annually from staff and managers about the specific skills and competencies that individual staff currently possess. As of May 2019, however, AST had neither developed a draft of the tool nor established a timeline for finalizing it. Without this information, AST lacks reasonable assurance that its current workforce possesses the requisite skills and competencies, and AST may not be best positioned to proactively determine how to align its staff to carry out its mission.


The conflicts in Iraq and Afghanistan have presented a new challenge for the United States as servicemembers returned from combat with serious injuries that may have been fatal in previous conflicts. These servicemembers require ongoing personal care services, which are often provided by family members and loved ones. In recognition of this significant challenge, Congress enacted the Caregivers and Veterans Omnibus Health Services Act of 2010 ( P.L. 111-163 ), which required the Department of Veterans Affairs (VA) to establish specific supports for caregivers of veterans. The Veterans Health Administration (VHA), within VA, offers caregiver support through two programs that were established by the act: a Program of General Caregiver Support Services ( general caregivers program ); and a Program of Comprehensive Assistance for Family Caregivers ( family caregiver s program ). The general caregivers program offers a basic level of support, such as education and training, to caregivers of veterans of all eras enrolled in VA health care. The family caregivers program offers comprehensive supports, such as health care benefits and a monthly stipend, to caregivers of veterans who were seriously injured in the line of duty on or after September 11, 2001 (post-9/11 veterans). VA refers to these two programs collectively as the Caregiver Support Program. The general caregivers program does not have an application or eligibility determination process. The limited services provided under this program are, generally, available to all caregivers of veterans enrolled in VA health care. Veterans and caregivers who apply for the family caregivers program undergo a multistep eligibility determination process that includes an initial assessment, education, training, and an in-home assessment. VA determines both administrative and clinical eligibility of veterans and caregivers. Caregivers who are eligible and designated as a family caregiver receive a unique suite of comprehensive services and benefits to help them provide care to the veteran. The VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018 (VA MISSION Act; P.L. 115-182 , as amended) required VA to expand eligibility for the family caregivers program to caregivers of veterans of all eras. Expansion is being implemented in two phases, as required by the VA MISSION Act. Veterans who were seriously injured in the line of duty before May 7, 1975, are to become eligible first. Two years later, veterans who served and were injured in the line of duty between May 7, 1975, and September 11, 2001, are to become eligible for the program. This expansion, which has yet to go into effect, is expected to generate a large increase in enrollment and may lead to changes to the underlying structure of the family caregivers program due to a large increase in the number of eligible individuals. Unlike the population currently eligible for the program, this newly eligible population comprises older individuals who may have different disabling conditions that require personal care assistance, which may present a challenge to eligibility determination based on an injury in the line of duty. Eligibility expansion is contingent on the implementation and certification of a functioning information technology (IT) system required to fully support the program. The VA MISSION Act required that VA complete certification of a system by October 1, 2019. VA did not meet that deadline and has not yet certified an IT system. VA published a proposed rule to implement the changes required under the VA MISSION Act on March 6, 2020. The public comment period for the proposed rule ends on May 5, 2020. This report provides an overview of the VA Caregiver Support Program, including eligibility criteria that veterans and caregivers must meet to qualify for both the family caregivers program and the general caregivers program; a catalogue of the services and benefits provided under the two programs; and current issues related to implementation of modifications under the VA MISSION Act. The Appendix provides background on the program evolution and a legislative history of the program.


The cost to repair and upgrade the nation's surface transportation system to meet current and future demands is estimated in the hundreds of billions of dollars. In December 2015, Congress established a DOT discretionary grant program to fund nationally significant freight and highway projects. DOT awarded $1.54 billion for such projects for fiscal years 2017 and 2018. GAO was asked to review DOT's process for evaluating and selecting applications for awards. This report discusses the consistency and transparency of DOT's process for evaluating and awarding INFRA grants for the fiscal-year 2017–2018 round of funding, among other objectives. GAO reviewed DOT's documentation of its evaluation process, and interviewed DOT staff and officials, as well as 11 INFRA applicants selected to ensure diversity in projects' size, type, location, and award status, as well as type of applicant. The Department of Transportation's (DOT) process for reviewing applications for grants to fund projects under the Infrastructure for Rebuilding America (INFRA) program lacked consistency and transparency in aspects related to following up with applicants and evaluating applications. Following up with applicants. DOT must determine that an applicant's project meets statutory requirements in order for the project to be eligible for an INFRA award. DOT initially found that 97 applications had insufficient information for an eligibility determination. DOT followed up with 42 of the 97 applicants to request additional information. DOT did not sufficiently document why it followed up with certain applicants over others. If DOT does not clearly communicate and document its process regarding applicant follow-up, the process lacks transparency and the assurance of fairness. Evaluating applications. In addition to the statutory requirements, DOT established merit criteria (e.g., economic vitality) to evaluate projects against, and stated that competitive projects would substantively address all of the criteria. DOT teams scored the projects on how well they addressed each criterion. However, DOT forwarded the information on all 165 projects that were found to be statutorily eligible to the Secretary for potential award, regardless of how well they scored on the merit criteria. In the end, DOT awarded some projects that did not address all of the criteria. Several applicants told GAO they were uncertain how DOT determines which projects should receive awards. In addition, DOT's documentation does not provide insight into why projects were selected for awards, an issue GAO has previously noted and recommended DOT address. The above limitations reflect long-standing issues GAO has identified in DOT's discretionary grant programs. Specifically, since 2011, GAO has recommended actions to increase consistency and transparency. In some cases, DOT implemented the recommendations for one program, but GAO later found similar problems in other programs. After finding repeated issues, GAO recommended in 2016 that DOT develop a department-wide directive that would, among other things, require that key decisions be documented. DOT agreed with the recommendation. In a March 2019 memo, DOT directed offices to implement GAO's recommendation by June 2019. However, it is unclear how this action will improve transparency and consistency because, among other things, DOT did not communicate how offices should sufficiently document decisions to ensure that the rationale for decisions is clear. The next reauthorization of surface transportation programs provides Congress the opportunity to build requirements for greater consistency and transparency into DOT's grant programs. This is particularly important as DOT has two additional rounds of INFRA funding to award under the FAST Act, and the President's Budget proposal proposed providing an additional $1 billion to INFRA. Absent effective action by DOT going forward, the recurring and long-standing issues GAO has identified could continue to affect DOT's competitive discretionary grant programs.


Before a drug can be marketed in the United States, FDA must determine that the drug is safe and effective for its intended use through a review of evidence that a drug sponsor—the entity seeking to market the drug—submits in an NDA. The review is conducted by one of FDA's divisions (17, at the time of GAO's review) that each specialize in a specific group of drug products, such as hematology products. NDA reviews are complex, and may involve not only an initial review, but also reviews of resubmissions if the initial review does not result in approval. Under FDA's PDUFA commitments, FDA's goal is to complete reviews of 90 percent of NDAs within specific time frames linked to key features of the NDAs. GAO was asked to examine NDA review times across FDA's divisions. In this report, GAO examines (among other things) differences between FDA divisions in the key features of the NDAs they review and initial review times, as well as the extent to which key NDA features contribute to these differences. GAO analyzed data from FDA's Center for Drug Evaluation and Research regarding 637 NDAs submitted from fiscal years 2014 through 2018. These data also included biologic license applications submitted to the center. GAO excluded NDAs that were withdrawn by the applicant before FDA completed a review, as well as NDAs for which FDA had not completed a review by March 31, 2019. GAO also interviewed FDA officials about the agency's review process and these review times. Four key features of new drug applications (NDA) are linked to the time the Food and Drug Administration (FDA) takes to complete initial reviews of NDAs. Three key NDA features determine the time frames for initial review that would meet FDA's goals under the Prescription Drug User Fee Act (PDUFA) and its reauthorizations, which authorize FDA to collect user fees from drug sponsors: Whether or not the NDA qualifies for the priority review program, which is generally an expedited program for drugs that provide significant therapeutic improvements in the prevention, diagnosis, or treatment of a serious condition when compared to available drugs. The PDUFA goal for review of a priority NDA is 4 months less than for an otherwise similar standard NDA, for which the goal is to complete the review in 10 months. Whether or not the NDA involves a new molecular entity (an active ingredient that has not been previously marketed or approved in the United States). The PDUFA goal for review of an NDA with a new molecular entity is 2 months longer than for an NDA without one. Whether or not the applicant submits a major amendment (additional or new information, such as a major new clinical study) while the NDA is under review. The PDUFA goal for a review of an NDA may be extended by 3 months if the applicant submits a major amendment. The fourth key NDA feature is whether or not it qualified for one or more of three other expedited programs for drugs intended to treat serious or life-threatening conditions. GAO's analysis of 637 NDAs submitted from fiscal years 2014 through 2018 indicated that the proportion of NDAs with these key features differed among FDA review divisions. For example, 6 percent of the NDAs reviewed by the dermatology and dental division had a priority designation, compared to 56 percent for the anti-infective division. FDA has reported that some divisions, such as the oncology divisions, generally regulate products for conditions that are more likely to be serious or life-threatening, and, therefore, those products may be more likely to qualify for priority designation and other expedited programs. GAO found that FDA's divisions differed in the average number of days they took to complete an initial review of NDAs, and these differences largely reflected the key features of the NDAs they reviewed. GAO's analysis shows that the time FDA took to complete an initial review of NDAs was affected by (1) the target time frame for completion of the review under the agency's PDUFA goals, (2) the number of expedited programs for which the NDA qualified, and (3) the division performing the review. GAO also found that the target time frame for review was largely responsible for differences in initial review times. Specifically, NDAs with key features that resulted in shorter target time frames for review under FDA's PDUFA goals had shorter initial review times. Controlling for the effects of these target time frames and the number of expedited programs for which the NDA qualified, GAO found that most of the divisions' average review times were similar to (within 2 weeks of) each other.


The current economic expansion is the longest in recorded U.S. history, but it has not been characterized by rapid economic growth. From the beginning of the current economic expansion in the third quarter of 2009 to the second quarter of 2017, this expansion had the lowest economic growth rate of any expansion since World War II, averaging 2.2%. For the next five quarters, growth accelerated to 3.1%. However, growth has slowed since, averaging 2.1% over the next four quarters beginning in the fourth quarter of 2018. The slower growth rate has been widespread, but has been particularly concentrated in business investment and exports. Private forecasters expect this slower pace to continue in 2020. A similar growth pattern has not been observed in labor markets, as monthly employment growth was only slightly lower in the slower-growth period than in the faster-growth period. A number of developments have influenced growth since 2017: Fiscal policy . The federal budget deficit rose from 3.5% of gross domestic product (GDP) in FY2017 to 3.9% in FY2018. Deficit-financed tax or spending policy changes stimulate overall economic activity in the short run, but stimulus fades over time. The deficit increased partly as a result of P.L. 115-97 , which cut taxes beginning in calendar year 2018, with the budgetary effects peaking in FY2019. Monetary policy. The Federal Reserve raised short-term interest rates gradually from a range of 0.25%-0.5% in December 2016 to a range of 2.25%-2.5% in December 2018. Higher interest rates reduce interest-sensitive spending, such as business investment and consumer durables. Rates were then cut in 2019 to a range of 1.5%-1.75%. Regulatory policy . The Administration reported that agencies have undertaken 393 deregulatory actions and 52 significant regulatory actions since FY2017, at a net benefit totaling $50.9 billion, based on agency estimates. Deregulatory actions that reduced costs for businesses could boost their output levels. Trade policy . Since 2017, the Administration has proposed a series of escalating tariffs and other import restrictions on major trading partners, such as China. In response, affected countries have often proposed retaliatory trade restrictions on U.S. exports. Trade restrictions have a mixed direct effect on growth through their impact on U.S. exports and imports. However, they are generally thought to have a negative indirect effect on growth through their impact on real income, financial conditions, and business investment. Stock market . Stock prices (as measured by the S&P 500 index) rose by 38% between November 4, 2016, and January 26, 2018, with little volatility by historical standards. Since then, volatility has risen. Favorable financial conditions make it easier for firms to finance investment and may lead asset holders to consume more through a wealth effect . Global growth . Global growth fell from 3.8% in 2017 to 3.6% in 2018 to a projected 3.0% in 2019. This reduces foreign demand for U.S. exports, all else equal. Over time, economists believe that the economy cannot grow faster than its trend or potential growth rate, which is determined by how quickly labor, the capital stock, and productivity grow. It appears that the growth rate has reverted to its trend growth rate since the fourth quarter of 20s18. Regulatory policy changes and fiscal stimulus may have contributed to the temporary increase in growth, but do not appear to have led to a permanent acceleration in trend growth. This slower rate of growth would be problematic if growth continued to decelerate toward zero, but most forecasters do not expect this to happen. On the contrary, this slower rate of growth could make a recession less likely because it reduces the probability that the economy will overheat, which has been the cause of some past recessions. It is unusual for fiscal and monetary policy to remain stimulative when the economy has fully recovered from a recession. As a result, there is less remaining headroom than usual for the Federal Reserve to reduce interest rates (monetary stimulus) or Congress to increase the deficit (fiscal stimulus) going forward. Policymakers face a choice between maintaining existing fiscal and monetary stimulus to maintain growth and removing stimulus so that there is more scope to employ stimulus in the next recession.


The decennial census is a costly and complex undertaking and its success depends largely on the Bureau's ability to locate every person residing in the United States. To accomplish this monumental task, the Bureau must maintain accurate address and map information for every person's residence. If this information is inaccurate, people can be missed, counted more than once, or included in the wrong location. To help control costs and to improve accuracy, the Bureau used new procedures to build its address list for 2020. GAO was asked to review how the in-field address canvassing operation performed. This report (1) determines the extent to which the Bureau followed its plans and schedule for in-field address canvassing, and (2) identifies the successes and challenges that occurred during 2020 Census In-Field Address Canvassing that have potential implications for future operations. To address these objectives, GAO reviewed key documents including the 2020 Census operational plan that discussed the goals and objectives for the operation. GAO observed in-field address canvassing across the country at 18 area census offices, including a mix of rural and urban locations. GAO also interviewed field supervisors, listers, and office management to discuss the operation's successes and challenges. GAO provided a draft of this report to the Bureau. The Bureau provided technical comments, which were incorporated as appropriate. The Census Bureau (Bureau) completed in-field address canvassing as scheduled on October 11, 2019, despite nationwide hiring shortfalls. The Bureau credits this success to better-than-expected productivity—the actual hourly productivity rate for the operation was 19.8 addresses versus the anticipated rate of 15.8 addresses. The total workload included more than 50 million addresses. GAO observations of in-field address canvassing found that a majority of field staff (listers) generally followed procedures, but there were a number of exceptions. For example, 14 of 59 listers we observed did not consistently knock on every door as required to confirm the address and ask about “hidden” housing units. Not knocking on doors or asking about hidden housing units represents missed opportunities to potentially add missing addresses to the Bureau's address file. GAO communicated to Bureau officials that listers were not following procedures and they sent out a nationwide reminder for listers to do so. The Bureau credits efficiency gains to new systems for assigning work and a new reporting mechanism for collecting timecards, but experienced delays in hiring for address canvassing. Though address canvassing productivity was higher than expected, in some parts of the country the operation was at risk of falling behind because of a shortage of listers. The Bureau told GAO that it filled the gap with listers who lived well outside of the area in which they were supposed to work—in some cases from a different state. The Bureau is taking actions to address hiring problems for later operations, including nonresponse follow-up, when the Bureau intends to hire between 320,000 to 500,000 enumerators to follow up with households that did not initially respond to the census. Those actions include increasing wage rates in 73 percent of the counties nationwide.


The decennial census is a crucial, constitutionally mandated activity with immutable deadlines. To meet these statutory deadlines, the Bureau carries out thousands of activities that need to be successfully completed on schedule for an accurate, cost-effective head count. These activities include opening area census offices, recruiting and hiring a large temporary workforce, and training that workforce. GAO was asked to review the Bureau's plans for critical logistical support activities. This report (1) assesses the Bureau's progress in opening area census offices; (2) determines the extent to which the Bureau is following its field hiring and recruiting strategy for the 2020 Census; and (3) determines the extent to which the Bureau has followed its plans for training field staff, and whether this training approach is consistent with selected leading practices. To assess the extent to which the Bureau is following its plans for opening area census offices, recruiting and hiring, and training, GAO reviewed current Bureau planning documents and schedules, and interviewed Bureau officials, including officials at the Bureau's six regional offices. GAO used its guide to training ( GAO-04-546G ) as criteria for selected leading practices. To help control the cost of the 2020 Census while maintaining accuracy, the Census Bureau (Bureau) is making significant changes in three areas—office space, recruiting and hiring, and training—compared to prior decennials. The Bureau is reducing its use of office space, hiring fewer census field staff, and adopting a blended training approach of instructor-led, computer-based, and hands-on training (see figure). GAO found that the the Bureau generally appears to be positioned to carry out these activities as planned, if implemented properly. Opening offices. While the Bureau experienced early delays when regions were trying to find office space and acquire leases, Bureau officials said that the deadlines for the later phases of renovations will allow them to make up time lost. As of June 2019, there were signed leases for 247 of 248 offices. Recruiting and hiring. As of June 2019, the Bureau was exceeding its recruiting goals for early operations, but identified challenges in areas such as completing background checks and hiring during low unemployment, especially for partnership specialist positions. GAO will continue to monitor these challenges, as recruiting and hiring for the census continues. Training. The Bureau generally followed its training plans for 2020 and generally followed selected leading practices for its training approach. However, GAO found that the Bureau does not have goals and performance measures for evaluating its new training approach. Without goals and performance measures the Bureau will not be able to accurately assess the cost and benefits of its new training approach.


The decennial census is used to apportion seats in Congress, redraw congressional districts, and allocate hundreds of billions of dollars in federal assistance annually and helps to guide public policy decisions based on social, economic, and demographic data. While recent censuses appear to have been increasingly accurate, measurement errors are not evenly distributed across the population. Given the uses of census data, ensuring an accurate count is important. As part of its partnership and outreach efforts, the U.S. Census Bureau's (Bureau) Partnership Program works with local and national organizations, businesses, and governments to promote awareness of and participation in the census, as well as to help recruit census workers. GAO was asked to review the Bureau's partnership and outreach efforts, including paid advertising and targeted communications. This report examines the Bureau's progress in addressing selected prior census challenges in these areas. GAO reviewed relevant Bureau planning documentation, collected regular Bureau reports on progress, and interviewed Bureau officials responsible for partnership and outreach efforts. GAO provided a draft of this report to the Bureau. The Bureau agreed with the report's findings. The Partnership Program, a core component of the Bureau's partnership and outreach activities, delivers outreach to partnering organizations at the national and local levels in order to ensure a more complete and accurate count. These partners include retail associations, tribal, state, and local governments, local businesses, and non-profit organizations, among others. Roughly 1,500 partnership specialists, who are temporary Bureau employees responsible for building relationships with and obtaining commitments from these partners, help to implement the Partnership Program, which exists alongside several other components of the Integrated Partnership and Communications operation, as shown below. The Bureau experienced delays, however, in getting these employees onboarded. The Bureau has taken important actions to address challenges that GAO, the Bureau, and others have previously identified. These challenges include: (1) Enumerating hard-to-count groups; (2) Mobilizing partnership and outreach resources; (3) Coordinating outreach across the Bureau's organization and operations; and (4) Measuring outcomes. Events taking place during implementation of partnership and outreach activities, such as the COVID-19 outbreak, provide a salient basis for which to continue to monitor these challenges and any effects they may have on the census. Moreover, continued monitoring of the Bureau's survey of public awareness of and sentiment toward the census, for example, will provide information on whether difficulties experienced in getting partnership specialists onboarded had an effect on the success of the Bureau's outreach.


The decennial census produces data vital to the nation. The data are used for congressional apportionment and redistricting; to allocate billions each year in federal funds; and to provide a social, demographic, and economic profile of the nation to guide policy decisions at all levels of government. Given census data's importance, it is incumbent upon the Bureau to ensure their quality. If people are counted in the wrong place, some states and localities may unduly lose or gain political power through apportionment and redistricting disproportionate to their actual population. Poor outcomes can also result if some households are over counted due to multiple responses, not counted due to missing responses, or miscounted due to incomplete or conflicting responses. GAO was asked to describe the Bureau's plans for the 2020 Census to resolve multiple, missing, incomplete, and conflicting responses. This report describes how, for 2020, the Bureau plans to (1) determine where to count people, including those in complex living situations, and how this differs from 2010; and (2) resolve multiple, missing, incomplete, and conflicting responses after data collection, and how this differs from 2010. GAO reviewed relevant Bureau documents and interviewed officials responsible for the 2020 Census. GAO provided a draft of this report to the Bureau. The Bureau provided technical comments, which were incorporated as appropriate. To determine where people should be counted during each decennial census, the Census Bureau (Bureau) has established residence criteria (see figure). For most people, applying these criteria is straightforward. For others who may be more mobile, like members of the military, college students, migrant farm workers, and people living in group quarters such as federal detention centers or in-patient hospice facilities, it can be more complicated. Therefore, for each decennial the Bureau issues guidance describing how the criteria should be applied to certain complex living situations. For the 2020 Census, the Bureau has updated its guidance on where to count people in six complex living situations, such as U.S. employees deployed overseas. The Bureau plans to count people in other living situations in the same manner as it did in 2010. As in 2010, the Bureau will count prisoners at the correctional facility where they are housed, but also plans to make other resources available to states that want to use prisoners' in-state, pre-incarceration addresses for redistricting purposes instead of their prison addresses. To resolve multiple responses for a single address, for 2020 the Bureau plans to use a longstanding automated routine—its Primary Selection Algorithm—to determine who to count at the address. For 2020, Bureau documents indicate it updated the algorithm after reviewing various response scenarios and data from past censuses and tests. To resolve missing household responses following data collection, as it did in 2010, the Bureau plans to use for 2020 a technique it refers to as count imputation, which draws data from similar nearby households to determine whether a housing unit exists, whether it is occupied, and, if so, by how many people. However, for 2020, the Bureau will also try to reduce the number of households which otherwise would have required count imputation and help reduce follow-up field work by drawing on relevant data from administrative records of sufficient quality in conjunction with its non-response follow-up field work. To resolve incomplete and conflicting information within a household response, the Bureau plans to use a technique it refers to as edit and characteristic imputation. This technique involves drawing data from the same household response, prior census and other administrative records or similar nearby households, which the Bureau believes will improve data quality and produce more accurate results.


The economic effects of the Coronavirus Disease 2019 (COVID-19) pandemic has led Congress to enact general fiscal stimulus in the form of tax cuts and spending increases. Further stimulus may be considered. This report discusses tax cuts enacted during the Great Recession, as well as those recently enacted and those under consideration. In response to the Great Recession several types of tax cuts were debated as possible fiscal stimulusâwith fiscal stimulus legislation enacted in February 2008 ( P.L. 110-185 ) and a much larger one in February 2009 ( P.L. 111-5 ). Both bills included individual tax cuts aimed at lower- and middle-income individuals, along with business tax cuts. In December 2010, along with an extension of expiring tax cuts, a temporary payroll tax cut was adopted. Many, but not all, tax cuts that were expiring after 2012 were extended permanently. A tax cut for stimulus is more effective the greater the fraction of it that is spent. Empirical evidence suggests individual tax cuts will be more likely to be spent if they go to lower-income individuals, making the tax rebate for lower-income individuals likely more effective than several other tax cuts. There is some weak evidence that tax cuts received in a lump sum will have a smaller stimulative effect than those reflected in paychecks, but this evidence is uncertain. However, studies of the 2001 rebate found that a significant amount of that rebate was spent. While temporary individual tax cuts likely have smaller effects than permanent ones, temporary cuts contingent on spending (such as temporary investment subsidies or a sales tax holiday) are likely more effective than permanent cuts. (Sales tax holidays may, however, be very difficult to implement.) The effect of business tax cuts is uncertain, but likely small for tax cuts whose main effects are through cash flow. Multiplier estimates reflect these considerations. Multiplier estimates from fiscal stimulus enacted during the Great Recession suggest that the most effective tax stimulus provisions in the recent legislation addressing the COVID-19 pandemic were likely the individual rebates, with business provisions having smaller effects. The Paycheck Protection Program and spending and transfer programs were also likely to have larger effects, although some of these demand-side stimulus programs that transferred incomes to individuals may be less effective due to the unique nature of the supply constraints in the current environment. Even if they do not stimulate spending, these measures could also be viewed as relief measures that may help individuals and businesses deal with debt and be more able to comply with social distancing measures designed to prevent the spread of the coronavirus.


The federal government and states share responsibility for the health and welfare of about 1.5 million individuals—most of them vulnerable older adults—receiving long-term care in nursing homes and assisted living facilities covered by Medicare and Medicaid. For nursing homes, which provide skilled nursing care, federal law defines applicable quality standards and CMS provides guidance for nursing homes and the state survey agencies to help protect residents from elder abuse. For assisted living facilities, which provide assistance with activities of daily living in a residential setting, CMS defines the framework states must establish to oversee these facilities if covered under Medicaid. This includes requiring states to demonstrate to CMS that they are assuring quality including the obligation to protect against elder abuse. GAO was asked to review federal oversight of elder abuse reporting, investigation, and law enforcement notification in both nursing homes and assisted living facilities. In this report, GAO describes federal requirements for reporting, investigating, and notifying law enforcement about elder abuse in both types of facilities. GAO reviewed relevant laws and regulations and agency guidance, and interviewed CMS and state officials from three states selected for variation in HCBS waiver program size and geography. GAO also interviewed representatives from national stakeholder groups representing consumers, facilities, Medicaid directors, and abuse investigators. In comments on this report, HHS highlighted the distinct oversight frameworks for the two settings and noted that CMS is undertaking efforts to strengthen oversight. The Centers for Medicare & Medicaid Services (CMS) oversees the Medicare and Medicaid programs and is responsible for safeguarding the health and welfare of beneficiaries living in nursing homes and assisted living facilities. This includes safeguarding older residents from abuse—referred to as elder abuse. CMS delegates responsibility for overseeing this issue to state survey agencies, which are responsible for overseeing nursing homes. When assisted living facilities provide services to Medicaid beneficiaries, they are indirectly subject to CMS oversight through the agency's oversight of state Medicaid agencies. GAO found that there are specific federal requirements for nursing homes and state survey agencies for reporting, investigating, and notifying law enforcement about elder abuse in nursing homes. (See table below). For example, state survey agencies must prioritize reports of elder abuse in nursing homes based on CMS's specified criteria and investigate within specific time frames. In contrast, there are no similar federal requirements for assisted living facilities—which are licensed and regulated by states. Instead, CMS requires state Medicaid agencies to develop policies to ensure the reporting and investigation of elder abuse in assisted living facilities. For example, CMS requires that state Medicaid agencies establish their own policies and standards for prioritizing reports when investigating incidents in assisted living facilities. Officials from the three selected states in GAO's review said they apply certain federal nursing home requirements and investigation time frames for assisted living facilities when overseeing elder abuse.


The federal government annually spends over $90 billion on IT. Despite this large investment, projects too frequently fail or incur cost overruns and schedule slippages while contributing little to mission-related outcomes. Effectively implementing workforce planning activities can facilitate the success of major acquisitions. GAO was asked to conduct a government-wide review of IT workforce planning. The objective was to determine the extent to which federal agencies effectively implemented IT workforce planning practices. To do so, GAO compared IT workforce policies and related documentation from each of the 24 Chief Financial Officers Act of 1990 agencies to activities from an IT workforce planning framework GAO issued. GAO rated each agency as having fully, substantially, partially, minimally, or not implemented for each activity. GAO supplemented its reviews of agency documentation by interviewing agency officials. Federal agencies varied widely in their efforts to implement key information technology (IT) workforce planning activities that are critical to ensuring that agencies have the staff they need to support their missions. Specifically, at least 23 of the 24 agencies GAO reviewed partially implemented, substantially implemented, or fully implemented three activities, including assessing gaps in competencies and staffing. However, most agencies minimally implemented or did not implement five other workforce planning activities (see figure). Agencies provided various reasons for their limited progress in implementing workforce planning activities, including competing priorities (six agencies), and limited resources (three agencies). Until agencies make it a priority to fully implement all key IT workforce planning activities, they will likely have difficulty anticipating and responding to changing staffing needs and controlling human capital risks when developing, implementing, and operating critical IT systems.


The federal government conducts many activities that protect parties from the effects of adverse events—for instance, by providing flood insurance, guaranteeing mortgage loans, or making payments to beneficiaries of deceased military personnel. Identifying these activities and understanding the fiscal exposures they create can be a challenge, making it difficult for Congress to oversee them through the budget and appropriation processes. GAO was asked to update information on federal insurance activities it created in 2005 ( GAO-05-265R ) and identify opportunities for improving budgeting for such activities. This report (1) identifies and provides cost- and exposure-related information on federal activities that transfer risk or losses to the government, and (2) illustrates challenges GAO identified in past reports with measuring and reporting fiscal exposures in budget documents. GAO primarily reviewed government-wide financial and budget data, the Catalog of Federal Domestic Assistance, and the U.S. Code. GAO also drew on previous work, conducted interviews with the Office of Management and Budget, Department of the Treasury, and other agencies, and reviewed agency financial and budget documents. Through analysis of sources containing government-wide information on federal activities, GAO identified 148 federal insurance and other activities that transfer risk or losses from adverse events to the government (see fig.). Unlike private insurance, the activities do not necessarily have a contract or charge premiums or fees in exchange for assuming risk. Even when premiums or fees exist they may not cover all costs, as federal expenditures can be driven by policy goals or agency missions rather than the aim of fiscal solvency. GAO generally was able to provide financial or budget information for the activities. Source: GAO . | GAO-19-353 Note: GAO's results are based solely on the criteria GAO developed for this report and the sources and methodology it used. Other criteria, sources, or methodologies might yield lists that differ from GAO's in number and composition of activities. a GAO identified 13 Treasury accounts that accounted for 99 percent of all federal employee and veterans benefits liabilities to the federal government as of September 30, 2017. These include accounts that fund retirement benefits, disability insurance, health insurance, and life insurance programs for civilian and military employees. The government's primarily cash-based budget generally does not record the full cost of commitments incurred until corresponding payments are made in the future. Therefore, the budget may not accurately reflect federal costs or the likely claim on federal resources for such activities. For some claims, such as pension and life insurance, the federal commitment occurs years before payments are reflected in the budget. Additionally, payments the government may be expected to make based on policies or past practices (but is not legally required to make) may not be evident in the budget. For example, the Commercial Space Launch Insurance Program created a potential liability to the government of up to $3.1 billion per licensed space launch in 2017 but never has been included in the budget. GAO previously recommended ( GAO-08-206 , and reiterated in GAO-14-28 ) that Congress consider expanding the use of accrual-based information in the budget documents submitted to Congress. However, this recommendation has not been implemented. Accrual measurement would provide enhanced control over future spending by recognizing long-term costs when decisions are made.


The federal government has a long history of investing in programs for feeding children, starting with federal aid for school lunch programs in the 1930s. Today, federal child nutrition programs support food served to children in schools and a variety of other institutional settings. Administered by the U.S. Department of Agriculture's (USDA's) Food and Nutrition Service (FNS), child nutrition programs include the National School Lunch Program (NSLP), School Breakfast Program (SBP), Child and Adult Care Food Program (CACFP), Summer Food Service Program (SFSP), Fresh Fruit and Vegetable Program (FFVP), and Special Milk Program (SMP). The child nutrition programs vary in terms of size and target populations. The largest programs are NSLP and SBP (the "school meals programs"), which subsidize meals for nearly 30 million children in approximately 94,300 elementary and secondary schools nationwide. The other child nutrition programs serve fewer children. CACFP supports meals served to children in child care, day care, and afterschool settings; SFSP provides funding for summer meals; FFVP sponsors fruit and vegetable snacks in elementary schools; and SMP subsidizes milk in schools and institutions that do not participate in other child nutrition programs. In general, the largest subsidies are provided for free or reduced-price meals and snacks served to children in low-income households. Federal spending on child nutrition programs and activities totaled approximately $23 billion in FY2019, the majority of which was mandatory spending. Most child nutrition programs are considered "appropriated entitlements," meaning that their authorizing statutes establish a legal obligation to make payments, but that obligation is fulfilled through funding that is provided in annual appropriations acts. Most of the funding is provided in the form of per-meal cash reimbursements that states distribute to schools and institutions. A smaller amount of federal funding is provided in the form of federally purchased commodity foods and cash for states' administrative expenses. The child nutrition programs are primarily governed by two statutes: the Richard B. Russell National School Lunch Act and the Child Nutrition Act of 1966 as amended. These laws were most recently reauthorized by the Healthy, Hunger-Free Kids Act of 2010 (HHFKA, P.L. 111-296 ), which made several changes to the child nutrition programs. For example, the act created the Community Eligibility Provision, an option for eligible schools to provide free meals to all students. It also required USDA to update nutrition standards in the school meals programs and CACFP within a certain timeframe. Certain provisions of the HHFKA expired at the end of FY2015. However, these expirations have had a minimal impact on program operations, which continue with annual appropriations. The 114 th Congress began but did not complete a reauthorization of child nutrition programs. In the 115 th Congress, there was no significant reauthorization activity. As of the date of this report, leadership on both committees of jurisdiction (the Senate Agriculture, Nutrition, and Forestry Committee and the House Committee on Education and Labor) have announced plans to work on reauthorization in the 116 th Congress. Selected legislative issues are discussed in CRS Report R45486, Child Nutrition Programs: Current Issues .


Before a drug can be marketed in the United States, FDA must determine that the drug is safe and effective for its intended use through a review of evidence that a drug sponsor—the entity seeking to market the drug—submits in an NDA. The review is conducted by one of FDA's divisions (17, at the time of GAO's review) that each specialize in a specific group of drug products, such as hematology products. NDA reviews are complex, and may involve not only an initial review, but also reviews of resubmissions if the initial review does not result in approval. Under FDA's PDUFA commitments, FDA's goal is to complete reviews of 90 percent of NDAs within specific time frames linked to key features of the NDAs. GAO was asked to examine NDA review times across FDA's divisions. In this report, GAO examines (among other things) differences between FDA divisions in the key features of the NDAs they review and initial review times, as well as the extent to which key NDA features contribute to these differences. GAO analyzed data from FDA's Center for Drug Evaluation and Research regarding 637 NDAs submitted from fiscal years 2014 through 2018. These data also included biologic license applications submitted to the center. GAO excluded NDAs that were withdrawn by the applicant before FDA completed a review, as well as NDAs for which FDA had not completed a review by March 31, 2019. GAO also interviewed FDA officials about the agency's review process and these review times. The Department of Health and Human Services provided technical comments on a draft of this report, which GAO incorporated as appropriate. Four key features of new drug applications (NDA) are linked to the time the Food and Drug Administration (FDA) takes to complete initial reviews of NDAs. Three key NDA features determine the time frames for initial review that would meet FDA's goals under the Prescription Drug User Fee Act (PDUFA) and its reauthorizations, which authorize FDA to collect user fees from drug sponsors: Whether or not the NDA qualifies for the priority review program, which is generally an expedited program for drugs that provide significant therapeutic improvements in the prevention, diagnosis, or treatment of a serious condition when compared to available drugs. The PDUFA goal for review of a priority NDA is 4 months less than for an otherwise similar standard NDA, for which the goal is to complete the review in 10 months. Whether or not the NDA involves a new molecular entity (an active ingredient that has not been previously marketed or approved in the United States). The PDUFA goal for review of an NDA with a new molecular entity is 2 months longer than for an NDA without one. Whether or not the applicant submits a major amendment (additional or new information, such as a major new clinical study) while the NDA is under review. The PDUFA goal for a review of an NDA may be extended by 3 months if the applicant submits a major amendment. The fourth key NDA feature is whether or not it qualified for one or more of three other expedited programs for drugs intended to treat serious or life-threatening conditions. GAO's analysis of 637 NDAs submitted from fiscal years 2014 through 2018 indicated that the proportion of NDAs with these key features differed among FDA review divisions. For example, 6 percent of the NDAs reviewed by the dermatology and dental division had a priority designation, compared to 56 percent for the anti-infective division. FDA has reported that some divisions, such as the oncology divisions, generally regulate products for conditions that are more likely to be serious or life-threatening, and, therefore, those products may be more likely to qualify for priority designation and other expedited programs. GAO found that FDA's divisions differed in the average number of days they took to complete an initial review of NDAs, and these differences largely reflected the key features of the NDAs they reviewed. GAO's analysis shows that the time FDA took to complete an initial review of NDAs was affected by (1) the target time frame for completion of the review under the agency's PDUFA goals, (2) the number of expedited programs for which the NDA qualified, and (3) the division performing the review. GAO also found that the target time frame for review was largely responsible for differences in initial review times. Specifically, NDAs with key features that resulted in shorter target time frames for review under FDA's PDUFA goals had shorter initial review times. Controlling for the effects of these target time frames and the number of expedited programs for which the NDA qualified, GAO found that most of the divisions' average review times were similar to (within 2 weeks of) each other.


The federal government has been involved in preserving and improving passenger rail service since 1970, when the bankruptcies of several major railroads threatened the continuance of passenger trains. Congress responded by creating Amtrakâofficially, the National Railroad Passenger Corporationâto preserve a basic level of intercity passenger rail service, while relieving private railroad companies of the obligation to maintain a business that had lost money for decades. In the years since, the federal government has funded Amtrak and, in recent years, has funded passenger-rail efforts of varying size and complexity through grants, loans, and tax subsidies. Efforts to improve intercity passenger rail can be broadly grouped into two categories: incremental improvement of existing services operated by Amtrak and implementation of new rail service where none currently exists. Efforts have been focused on identifying corridors where passenger rail travel times would be competitive with driving or flying (generally less than 500 miles long) and where population density and intercity travel demand create favorable conditions for rail service. Improving existing routes: On the busy Northeast Corridor line owned by Amtrak, several projects to modernize or extend the life of existing infrastructure have been completed using federal grants overseen by the Federal Railroad Administration (FRA). Amtrak has also received annual appropriations above authorized levels for use on the Northeast Corridor in recent years, but proposed projects to add capacity or reduce trip times require a level of investment that outstrips existing options for passenger rail funding. Federal grants have enabled state-supported routes off the Northeast Corridor to add additional trains per day and/or to reduce trip times (whether by increasing speeds or rerouting trains onto more direct alignments). Some grant funds have also preserved service on Amtrak's long-distance lines, which account for under 15% of ridership but incur the largest operating subsidies. State-supported and long-distance routes generally operate over tracks owned and maintained by freight railroads (called "host" railroads), which can interfere with existing service and complicate plans to add trains to already congested freight lines. Interference by freight trains has been cited by Amtrak as a major contributor to its trains' poor on-time performance, although freight railroads sometimes dispute this. A federal law passed in 2008 was designed to hold host railroads to new performance standards, but has been the subject of court challenges for nearly a decade. While legal issues surrounding on-time performance standards may be resolved in the short term, on-time performance has fallen from its system-wide high of 80% (four trains out of five arriving at all stops on time) achieved in 2012 and has been slow to rebound. New rail services: Amtrak has partnered with several states to extend existing routes beyond their former termini to serve new stations, sometimes using additional federal grant money. A high-profile project to build a truly high-speed rail system in California was awarded nearly $4 billion out of the roughly $10 billion appropriated for intercity rail projects in 2009-2010, but projected costs exceed earlier estimates and current funding is sufficient to build only an initial segment. The Trump Administration is now seeking the return of some federal grants. A smaller and less technically complex project to introduce new rail service connecting Chicago, IL, and Iowa City, IA, received federal funding but was delayed at the state level, and it is not clear when or if it will be completed. Meanwhile, several efforts are under way in the private sector to bring intercity passenger rail to major urban corridors. One of these, the Brightline service in Florida, has already begun serving Miami and West Palm Beach on a line that will eventually reach Orlando. While privately funded and operated, these projects do benefit from public assistance in other ways, as Brightline was allowed to issue tax-subsidized qualified private activity bonds to finance construction. Pilot programs to allow private railroads to compete for the right to serve existing Amtrak routes have been less successful. Rail programs were included in the most recent surface transportation authorization, which expires at the end of FY2020. Issues in reauthorization include whether and how to fund plans to build new infrastructure for improved rail services, especially on the federally owned Northeast Corridor; federal support for operating intercity rail services; the process by which rail lines are planned; the obligations of freight railroads to carry passenger trains; and whether other opportunities exist for the private sector to build or operate passenger rail services.