Federal Disability Assistance: Wide Array of Programs Needs to be
Examined in Light of 21st Century Challenges (02-JUN-05,	 
GAO-05-626).							 
                                                                 
In 2003, GAO designated modernizing federal disability programs  
as a high-risk area requiring urgent attention and organizational
transformation to ensure that programs function as efficiently	 
and effectively as possible. GAO found that although social	 
attitudes have changed and medical advancements afford greater	 
opportunities for people with disabilities to work, the Social	 
Security Administration and the Department of Veterans Affairs	 
have maintained an outmoded approach that equated disability with
inability to work. We have prepared this report under the	 
Comptroller General's authority as part of a continued effort to 
help policymakers better understand the extent of support	 
provided by federal programs to people with disabilities and to  
assist them in determining how these programs could be better	 
aligned to more effectively meet the needs of individuals with	 
disabilities in the 21st century. This report identifies (1) the 
wide array of federal programs that serve people with		 
disabilities, and (2) the major challenges these federal programs
face in the 21st century. In addition, GAO presents factors	 
policy makers and program administrators should address in	 
assessing whether, and how, they could be transformed to better  
meet 21st century challenges.					 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-05-626 					        
    ACCNO:   A25641						        
  TITLE:     Federal Disability Assistance: Wide Array of Programs    
Needs to be Examined in Light of 21st Century Challenges	 
     DATE:   06/02/2005 
  SUBJECT:   Aid for the disabled				 
	     Disabilities					 
	     Disability benefits				 
	     Disability insurance				 
	     Eligibility criteria				 
	     Federal aid programs				 
	     Federal social security programs			 
	     Health care programs				 
	     Medicaid						 
	     Medicare						 
	     Persons with disabilities				 
	     Program evaluation 				 
	     Program management 				 
	     Surveys						 
	     SSA Disability Insurance Program			 

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GAO-05-626

United States Government Accountability Office

GAO

                       Report to Congressional Committees

June 2005

FEDERAL DISABILITY ASSISTANCE

Wide Array of Programs Needs to be Examined in Light of 21st Century Challenges

GAO-05-626

[IMG]

June 2005

FEDERAL DISABILITY ASSISTANCE

Wide Array of Programs Needs to be Examined in Light of 21st Century Challenges

                                 What GAO Found

More than 20 federal agencies and almost 200 programs provide a wide range
of assistance to people with disabilities, including employmentrelated
services, medical care, and monetary support. About half of these programs
serve only people with disabilities while the rest serve people both with
and without disabilities. In fiscal year 2003, more than $120 billion in
federal funds was spent on programs that only serve people with
disabilities, with over 80 percent of these funds spent on monetary
support (see figure below). In addition, considerable funds are spent on
people with disabilities by programs that also serve people without
disabilities, like Medicare and Medicaid.

Federal Spending for Wholly Targeted Programs by Primary Type of
Assistance, Fiscal Year 2003

1%

Other

2%

Employment-related

2%

Medical care

Education

Monetary support

Source: GAO analysis of survey data.

The program challenges cited most frequently in our recent survey of
nearly 200 programs serving people with disabilities are largely
consistent with several of the key findings from past reports that led GAO
to place federal programs supporting people with disabilities on its
high-risk list. Both our recent survey and our past work have identified
challenges in (1) ensuring timely and consistent processing of
applications; (2) ensuring timely provision of services and benefits; (3)
interpreting complex eligibility requirements;( 4) planning for growth in
the demand for benefits and services; (5) making beneficiaries or clients
aware of benefits and services; and (6) communicating or coordinating with
other federal disability programs.

In light of the vital role federal programs play in providing assistance
to people with disabilities and in helping to ensure an adequate national
labor force, we have identified a number of factors that are important to
consider in assessing the need for, and nature of, program transformations
including (1) program design issues; (2) fiscal implications of proposed
program changes; and (3) feasibility of implementing program changes.

                 United States Government Accountability Office

Contents

Letter

Results in Brief
Background
Over 20 Different Agencies Administer Almost 200 Programs That

Provide a Wide Range of Assistance Federal Programs That Support People
with Disabilities Face An Array of Challenges Key Factors to Consider in
Transforming Programs for the 21st Century

                                       1

                                      2 4

                                       5

                                       17

                                       21

Appendix I Scope and Methodology

Appendix II Federal Programs Serving People with Disabilities

Appendix III GAO Contact and Staff Acknowledgments

Tables

Table 1: Federal Agencies That Administer Programs Assisting People with
Disabilities 7 Table 2: Number of Programs Serving People with
Disabilities, by Federal Agency and Primary Type of Assistance 12

Figures

Figure 1: Primary Types of Assistance Provided by Federal Programs to
Individuals with Disabilities, Indicating Percentage of Programs Providing
Such Assistance and Examples of Programs

Figure 2: Number of Federal Programs Providing Various Primary Types of
Assistance to Individuals with Disabilities Figure 3: Percentage of
Federal Programs Providing Multiple Types of Assistance Figure 4: Federal
Spending for Wholly Targeted Programs by Agency, Fiscal Year 2003 Figure
5: Federal Spending for Wholly Targeted Programs by Primary Type of
Assistance, Fiscal Year 2003

8

9 10 15 16

Figure 6: Key Factors and Questions Concerning Transformation of Programs
Serving Individuals with Disabilities 22

Abbreviations

CFDA Catalog of Federal Domestic Assistance
CFFR Consolidated Federal Funds Report
DI Disability Insurance
GAO Government Accountability Office
HHS Department of Health and Human Services
SSA Social Security Administration
VA Department of Veterans Affairs

This is a work of the U.S. government and is not subject to copyright
protection in the United States. It may be reproduced and distributed in
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separately.

United States Government Accountability Office Washington, DC 20548

June 2, 2005

Congressional Committees

In 2003, GAO designated modernizing federal disability programs as a
high-risk area-one that requires urgent attention and organizational
transformation to ensure that programs function in the most economical,
efficient, and effective manner possible. This designation was based on
more than a decade of research focusing primarily on the nation's largest
disability programs, which are administered by the Social Security
Administration (SSA) and the Department of Veterans Affairs (VA). GAO's
work has found that these programs are neither well aligned with 21st
century realities nor are they well-positioned to provide meaningful and
timely support for Americans with disabilities. For example, despite
opportunities afforded by medical and technological advancements and the
growing expectations that people with disabilities can and want to work,
federal disability programs remain grounded in an approach that equates
medical conditions with the incapacity to work. Given the projected
slowdown in the growth of the nation's labor force, it is imperative that
those who can work are supported in their efforts to do so. Yet federal
disability programs are not well-positioned to provide this support.
Solutions to these problems are likely to require fundamental changes,
including regulatory and legislative action.

In addition to disability programs operated within SSA and VA, there are a
number of other federal programs that provide various levels of support to
individuals with disabilities. We have prepared this report under the
Comptroller General's authority as part of a continued effort to help
policy makers better understand the extent of support provided by federal
programs to people with disabilities and to assist them in determining how
these programs could more effectively meet the needs of individuals with
disabilities in the 21st century. In this report, we (1) identify the many
federal programs that play a role in supporting people with disabilities
and (2) identify some of the major challenges that federal programs face
in supporting people with disabilities in the 21st century. We also
present factors that we believe are important for programs to consider in
assessing whether, and how, they could be transformed to better meet 21st
century challenges. As this report may prove helpful in the deliberations
of committees with oversight responsibilities or jurisdiction over
disability issues, we have addressed this report to each of these
committees.

Results in Brief

To obtain information on federal disability programs and the challenges
they face, we (1) reviewed the Catalog of Federal Domestic Assistance1
(CFDA) and agency Web sites to identify federal programs that provide
assistance to people with disabilities; (2) conducted a Web-based survey
of the programs we identified to obtain descriptive information on these
programs and the challenges they face; (3) interviewed selected agency
officials and officials from disability advocacy organizations to obtain
additional information on the challenges federal programs face; and (4)
reviewed pertinent agency documents, GAO reports, and academic research on
disability issues. We conducted our work between March 2004 and March 2005
in accordance with generally accepted government auditing standards. For
more details about our scope and methodology, see appendix I.

More than 20 federal agencies and almost 200 programs serve people with
disabilities in a multifaceted and complex manner. About half of these
programs serve only people with disabilities, while the rest serve people
both with and without disabilities. Together these programs provide a wide
range of assistance such as employment-related services, medical care,
civil protections or legal services, education, and monetary support.
Multiple agencies administer programs that provide similar types of
assistance, but these programs often serve different populations of people
with disabilities because of varying eligibility criteria. For example,
the Department of Education and the Department of Veterans Affairs have
separate programs that provide vocational rehabilitation services to
American Indians and veterans, respectively. In fiscal year 2003, over
$120 billion in federal funds were spent on programs that only serve
people with disabilities, with over 80 percent of these funds spent on
monetary support.2 Although insufficient data were available to estimate
the total additional funds spent on people with disabilities by programs
that also serve people without disabilities, this amount is significant
given that benefit payments in fiscal year 2002 for people with
disabilities for

1 The Catalog of Federal Domestic Assistance is a database of all federal
programs available to state and local governments (including the District
of Columbia); federallyrecognized Indian tribal governments; territories
(and possessions) of the United States; domestic public, quasi-public, and
private profit and nonprofit organizations and institutions; specialized
groups; and individuals.

2 The $120 billion estimate represents reported obligations for fiscal
year 2003 and includes administrative costs for some programs (i.e., those
that included these costs when reporting total program spending to us).

two such programs alone-Medicare and Medicaid-amounted to about $132
billion.

The challenges cited most frequently in our recent survey of nearly 200
programs serving people with disabilities are largely consistent with
several of the key findings from our past reports that led GAO to place
federal programs supporting people with disabilities on its high-risk
list. Our past work examining the federal government's disability
programs- particularly those administered by SSA and VA-revealed
challenges these programs face in a variety of areas including ensuring
timely and consistent processing of applications for assistance, ensuring
timely provision of services and benefits, interpreting complex
eligibility requirements, planning for growth in the demand for program
benefits and services, making beneficiaries or clients aware of program
services or benefits, and communicating and coordinating with other
federal programs serving individuals with disabilities. Our recent survey
of nearly 200 programs serving people with disabilities indicates that
many of these programs face challenges similar to those we have previously
identified. For example, in responding to our survey, 54 percent of the
programs that provide medical care and 46 percent of the programs that
provide employment-related assistance reported that planning for growth in
the demand for assistance was a major or moderate challenge. In addition,
53 percent of the programs that provide monetary support to people with
disabilities reported that interpreting complex eligibility requirements
was a major or moderate challenge.

Over the past several years, GAO has identified the need to reexamine and
transform federal disability programs to better position the government to
meet the new challenges and changing expectations of the 21st century. We
have identified several key factors that are important to consider in
assessing the need for, and nature of, program transformations including
(1) program design issues, particularly those affecting individual work
incentives and supports; (2) fiscal implications of proposed program
changes, such as their affordability and effects on federal and state
spending and tax revenues; and (3) feasibility of implementing program
changes, which would include considering whether appropriate processes and
systems are in place including those related to the planning and
management of human capital and information technology. In addition to
considering these factors, it is also important that some mechanism be
established for looking across programs to assess their overall
effectiveness and integration and whether they achieve similar or
complementary goals.

Background

Recent economic, medical, technological, and social changes have increased
opportunities for individuals with disabilities to live with greater
independence and more fully participate in the workforce. For example,
over the past several decades, the economy has shifted towards serviceand
knowledge-based jobs that may allow greater participation for some persons
with physical limitations. Also, advances in medicine and assistive
technologies-such as improved treatments for mental illnesses and advanced
wheelchair design-afford greater opportunities for some people with
disabilities. In addition, social and legal changes have promoted the goal
of greater inclusion of people with disabilities in the mainstream of
society, including adults at work. For example, the Americans with
Disabilities Act supports the full participation of people with
disabilities in society and fosters the expectation that people with
disabilities can work and have the right to work. More recently, the
President announced the New Freedom Initiative, a set of guiding
principles and initiatives aimed at improving the integration of people
with disabilities in all aspects of society, including employment.

Public concern and congressional action have produced a broad array of
federal programs designed to help people with disabilities. However, our
prior reviews of the largest federal disability programs indicate that
such programs have not evolved in line with these larger societal changes
and therefore, are poorly positioned to provide meaningful and timely
support for people with disabilities. Furthermore, program enrollment and
costs for the largest federal disability programs have been growing and
are poised to grow even more rapidly in the future, further contributing
to the federal government's large and growing long-term structural
deficit.3 For example, from 1982 to 2002, the number of disabled workers
receiving benefits under SSA's Disability Insurance (DI) program doubled
from 2.6 million to 5.5 million, while payments quadrupled from about
$14.8 billion to $60 billion. Moreover, these disability programs are
poised to grow even more as baby boomers reach their disability-prone
years. This program growth is exacerbated by the low rate of return to
work for individuals with disabilities receiving cash and medical
benefits. In addition, the projected slowdown in the growth of the
nation's labor force has made it more imperative that those who can work
are supported in their efforts to do so.

3 Long-term budget simulations by GAO, the Congressional Budget Office,
and others show that, over the long term the U.S. faces a large and
growing structural deficit due primarily to known demographic trends and
rising health care costs.

Over 20 Different Agencies Administer Almost 200 Programs That Provide a
Wide Range of Assistance

We identified over 20 federal agencies and almost 200 federal programs
that are either wholly or partially targeted to serving people with
disabilities. These programs provide a wide range of assistance such as
employment-related services, medical care, and monetary support. Multiple
agencies run programs that provide similar types of assistance, but these
programs often serve different populations of people with disabilities
because of varying eligibility criteria. About 59 percent of the programs
we identified provide indirect support to people with disabilities through
means such as grants to states, while the rest provide support directly to
people with disabilities. In fiscal year 2003, over $120 billion in
federal funds were spent on programs that serve only people with
disabilities. Although there were insufficient data available to estimate
the total additional funds spent on people with disabilities by programs
that also serve people without disabilities, benefit payments for people
with disabilities for two such programs alone-Medicare and Medicaid-
amounted to about $132 billion in fiscal year 2002.

Multiple Federal Agencies Administer Programs Serving People with
Disabilities

Twenty-one federal agencies-under the jurisdiction of more than 10
Congressional committees-administer 192 programs that target or give
priority to people with disabilities (see table 1). However, four
agencies- the departments of Health and Human Services (HHS), Education,
Veterans Affairs, and Labor-are responsible for over 65 percent of these
programs. About half of the programs that we identified are wholly
targeted (targeted exclusively) to people with disabilities. The rest of
the programs are partially targeted to people with disabilities-they serve
people with and without disabilities.4 Specifically, of the 192 programs
we identified, 95 reported being wholly targeted, and 97 reported being
partially targeted. The wholly targeted programs reported that they served
over 34 million beneficiaries or clients in fiscal year 2003, with the
largest among these-SSA's DI program and VA's Veterans Compensation for
Service-Connected Disability program-serving about 10 million of these
beneficiaries. Although some of the partially targeted programs we
surveyed could not provide data on the number of people with disabilities
they serve, our survey data indicate that these programs served at least

4 We considered a program to be wholly or partially targeted to people
with disabilities if it met one or more of the following criteria: (1)
people with disabilities are specifically mentioned in legislation as a
targeted group, (2) people are eligible for the program wholly because of
a disability, (3) people are eligible for the program partially because of
a disability, (4) people with disabilities are given special consideration
in eligibility determinations, or (5) people with disabilities are given
priority in being served.

15 million beneficiaries or clients with disabilities in fiscal year 2003,
with the largest of these programs-SSA's Supplemental Security Income
Program-serving about 5.7 million of these beneficiaries.5

5 The number of beneficiaries or clients served by these programs in any
given year is probably significantly higher than the numbers we report
here for fiscal year 2003 because many programs did not provide us with
estimates of the number of beneficiaries or clients they serve, or they
provided us with estimates for a different fiscal year. Wholly targeted
programs reported serving a total of about 44 million beneficiaries or
clients, 10 million of whom were for fiscal years other than 2003.
Similarly, partially targeted programs reported serving a total of about
22 million beneficiaries, 7 million of whom were for fiscal years other
than 2003.

Table 1: Federal Agencies That Administer Programs Assisting People with
Disabilities

                                                              Total number of 
                                                                     programs 
                                        Number of Number of supporting people 
                                           wholly partially              with 
             Federal agencies           targeted  targeted       disabilities 
                                        programs  programs  
      Department of Health and Human           17        23 
                 Services                                   
         Department of Education               27         6 
      Department of Veterans Affairs           20        12 
           Department of Labor                  8        14 
     Department of Housing and Urban                        
               Development                      6        10 
      Social Security Administration            6         4 
        Department of Agriculture               1         8 
       Department of Transportation             2         4 
          Department of Justice                 0         5 
       Equal Employment Opportunity                         
                Commission                      1         2 
      Office of Personnel Management            2         1 
          Department of Commerce                0         2 
          Department of Treasury                0         2 
           Library of Congress                  1         1 
               Access Board                     1         0 
    Committee for Purchase from People                      
                   Who                                      
      are Blind or Severely Disabled            1         0 
          Department of Defense                 1         0 

                 Department of Energy 0                    1                1 
              Department of the Interior 1                 0                1 
              Railroad Retirement Board 0                  1                1 
            Small Business Administration 0                1                1 
       Total number of programs in our survey 95          97              192 
                 Source: GAO analysis of survey data.             

Federal Programs Provide Federal programs provide a wide range of
assistance to people with a Wide Range of disabilities (see fig. 1). The
most common primary types of assistance Assistance to People with provided
are employment-related services and medical care, although a Disabilities
number of programs provide civil protections or legal services, education,

and monetary support as well as other benefits or services (see fig. 2).

Figure 1: Primary Types of Assistance Provided by Federal Programs to
Individuals with Disabilities, Indicating Percentage of Programs Providing
Such Assistance and Examples of Programs

                      Source: GAO analysis of survey data.

Figure 2: Number of Federal Programs Providing Various Primary Types of
Assistance to Individuals with Disabilities

Number of programs Employment-related

            Medical careCivil protectionsor legal services Education

ysuppor

Monetar

                                       t

ormationInfdissemination

                             Housingsonal assistant

vicesser

ansportation rT

                                     Loans

hnologyAssistivetec

                                   Food Other

reP

Primary type of assistance

                          Partially targeted programs

                            Wholly targeted programs

Source: GAO analysis of survey data.

Most of the federal programs provide more than one type of assistance and
over one-quarter of the programs provide three or more types of assistance
to people with disabilities (see fig. 3). For example, the Developmental
Disabilities Basic Support and Advocacy Grants program run by HHS provides
multiple types of assistance to people with disabilities including
housing, education, transportation, and information dissemination
services.

Figure 3: Percentage of Federal Programs Providing Multiple Types of Assistance

                 Percentage of programs providing assistance 50

                                       47

                                       40

                                       30

                                       20

                                      10 0

12 3456 or more

Number of types of assistance provided

                      Source: GAO analysis of survey data.

Note: Numbers in this figure do not add up to 100 percent due to rounding.

About 59 percent of the programs we identified provide support indirectly
through other entities such as state agencies or private organizations,
while the rest provide it directly to people with disabilities. For
example, the Department of Education's Preschool Grants program provides
special education to preschool children with disabilities via funding to
state education agencies, whereas the Department of Labor's Coal Mine
Workers' Compensation program provides monetary support directly to
eligible coal mine workers with disabilities. Of the programs that provide
assistance indirectly to people with disabilities, the most common means
is through nonfederal government entities (e.g., state or local agencies).

Multiple Federal Agencies Multiple federal agencies administer programs
that provide similar types Provide Similar Types of of assistance to
people with disabilities (see table 2). For example, seven Assistance
agencies-including the Social Security Administration, the Committee for

the Purchase from People who are Blind or Severely Disabled, the Office of
Personnel Management, and the departments of Agriculture, Education,
Labor, and Veterans Affairs-administer 28 programs that primarily provide
employment-related services to people with disabilities.

Table 2: Number of Programs Serving Individuals with Disabilities, by
Federal Agency and Primary Type of Assistance

                 Monetary Medical Personal                         Employment- 
                                  assistant                        
  Federal agency support     care  services Housing Food Education     related 
Access Board         0       0         0       0    0         0 
  Committee for                                                    
  Purchase From                                                    
  People Who Are                                                   
     Blind or                                                      
     Severely           0       0         0       0    0         0 
     Disabled                                                      
  Department of         0       0         0       3    3         0 
Agriculture                                                     
  Department of         0       0         0       0    0         0 
     Commerce                                                      
  Department of         0       0         0       0    0         0 
     Defense                                                       
  Department of         0       0         3       0    0        12 
    Education                                                      
  Department of         0       0         0       0    0         0 
      Energy                                                       
  Department of                                                    
    Health and                                                     
  Human Services        2      13         0       0    2         1 
  Department of                                                    
Housing and                                                     
      Urban             0       0         0       8    0         0 
Development                                                     
  Department of         1       0         0       0    0         1 
     Justice                                                       
  Department of         4       0         0       0    0         0 
      Labor                                                        
  Department of         0       0         0       0    0         1 
     Interior                                                      
  Department of         0       0         0       0    0         0 
  Transportation                                                   
  Department of         0       0         0       0    0         0 
     Treasury                                                      
  Department of                                                    
     Veterans           7      15         0       1    0         3 
     Affairs                                                       
      Equal                                                        
    Employment                                                     
Opportunity                                                     
    Commission          0       0         0       0    0         0 
    Library of          0       0         0       0    0         0 
     Congress                                                      
    Office of                                                      
    Personnel                                                      
    Management          0       0         0       0    0         0           2 
     Railroad                                                                  
    Retirement          1       0         0       0    0         0           0
      Board                                                        
  Small Business        0       0         0       0    0         0           0 
  Administration                                                   
      Social                                                                   
     Security           4       0         0       0    0         0           4
  Administration                                                   
      Total            19      28         3      12    5        18          28 

Civil protections Information Assistive Other
or legal services Loans Transportation dissemination technology assistance
Totals

                                    0 0 0001

              0      0            0           0           0                 0 
              0      0            0           0           2                 0 
              0      0            0           0           0                 2 
              0      0            0           0           1                 0 
              3      2            0           2           0                 4 
              0      0            0           0           0                 1 
              4      0            0           3           0                15 
              3      1            0           2           0                 2 
              3      0            0           0           0                 0 
              2      0            1           5           0                 0 
              0      0            0           0           0                 0 
              0      0            5           1           0                 0 
              0      0            0           0           0                 2 
              0      2            1           0           0                 0 

                                    3 0 0000

                                    0 0 0002

                                    0 0 0100

                            0 0 0000 1 0 0 0001 1 0 0 0200 10 18 5 716 330192

Source: GAO analysis of survey data.

Although programs from multiple agencies provide the same primary type of
assistance, these programs often have varying eligibility criteria that
may limit the populations served to distinct groups of people with
disabilities. For example, the American Indian Vocational Rehabilitation
Services program run by the Department of Education and the Department

of Veterans Affairs' Vocational Rehabilitation for Disabled Veterans
program each provide employment-related assistance, but to distinct groups
of people.6 Furthermore, the 28 programs that primarily provide
employment-related services often have distinct eligibility criteria
beyond the specific populations served.

Billions Are Spent on Programs for People with Disabilities

The programs that provide assistance only to people with disabilities
spent over $120 billion in fiscal year 2003.7 SSA and VA accounted for
about 88 percent of this amount (see fig. 4). In particular, SSA's DI
program accounted for about 64 percent of the total spending for wholly
targeted programs, and the VA's Veterans Compensation for
Service-Connected Disability program accounted for approximately 17
percent of this total. Approximately 86 percent of the wholly targeted
program spending was for programs that primarily provided monetary support
to people with disabilities (see fig. 5).

6 Approximately 77 percent of the wholly targeted programs we identified
limit eligibility to a specific population of people who have a disability
(e.g., to a certain age group, disability type, or population group).

7 Of the 95 wholly targeted programs in our analysis, we were able to
obtain some type of spending data for 85 programs (either from federal
government data on program spending or from our web-based survey). The
$120 billion estimate represents reported obligations for fiscal year 2003
and includes administrative costs for some programs (i.e., those that
included these costs when reporting total program spending to us).
However, data on fiscal year 2003 obligations were not available or
reported for some programs. In those instances, some programs instead
provided data on outlays or appropriations, and these data, in some cases,
pertained to a fiscal year other than 2003. For example, in addition to
the more than $120 billion in fiscal year 2003 obligations that we report,
other wholly targeted programs reported outlays of over $7 billion in
fiscal year 2003. (See appendix I for a more detailed discussion of our
methodology and see appendix II for a more detailed listing of spending by
individual programs.)

Figure 4: Federal Spending for Wholly Targeted Programs by Agency, Fiscal
Year 2003

                                       1%

                                 Other agencies

                                       2%

                                      HHS

                                   Education

                                       VA

                                      SSA

Source: GAO analysis of survey data.

Note: The percentages in this figure are calculated based on fiscal year
2003 program obligations that we were able to identify. Therefore, it does
not reflect the spending of a number of programs (and agencies) for which
we were unable to obtain any fiscal year 2003 spending data or which
provided data representing program outlays rather than obligations. For
example, the Department of Labor's reported outlays of almost $3 billion
for wholly targeted programs are not reflected in this figure. For a more
comprehensive listing of program spending, see appendix II. Numbers in
this figure do not add up to 100 percent due to rounding.

Figure 5: Federal Spending for Wholly Targeted Programs by Primary Type of
Assistance, Fiscal Year 2003

1%

Other assistance

2%

Employment-related

2%

Medical care

Education

Monetary support

Note: The percentages in this figure are calculated based on fiscal year
2003 program obligations that we were able to identify. Therefore, it does
not reflect the spending of a number of programs for which we were unable
to obtain any fiscal year 2003 spending data or which provided data
representing program outlays rather than obligations. For a more
comprehensive listing of program spending, see appendix II. Numbers in
this figure do not add up to 100 percent due to rounding.

In addition to the billions of dollars spent on programs that serve only
people with disabilities, additional amounts are spent on individuals with
disabilities by partially targeted programs whose beneficiaries also
include people without disabilities. While we were not provided with
sufficient data to determine the total amount spent by all of these
partially targeted programs on benefits or services for individuals with
disabilities,8 these costs are certainly significant given that they
include such programs as Supplemental Security Income (SSI), Medicaid, and
Medicare. In 2002, SSI paid about $26 billion in cash benefits to people
with disabilities and

8 Some of these programs were unable to provide us with information
pertaining to their programs' spending on people with disabilities because
they do not separately track or collect spending data for individuals with
disabilities.

Federal Programs That Support People with Disabilities Face an Array of
Challenges

Medicaid and Medicare together paid about $132 billion in benefits for
such individuals.

Both our past work and our recent survey of federal programs supporting
people with disabilities indicate that these programs face a number of
challenges. Among these are challenges in ensuring timely and consistent
processing of applications for assistance, ensuring timely provision of
services and benefits, interpreting complex eligibility requirements,
planning for growth in the demand for program benefits and services,
making beneficiaries or clients aware of program services or benefits, and
communicating or coordinating with other federal programs.

Timely and Consistent Processing of Applications for Assistance

Our past work examining disability programs administered by SSA and VA
highlighted the challenges that federal programs face in ensuring timely
and consistent processing of applications for assistance. Both SSA and VA
have experienced lengthy processing times for disability claims over the
past several years, with claimants waiting, on average, more than 4 months
for an initial decision and for more than 1 year for a decision on appeal
of a denied claim. In addition, we have also pointed out that
inconsistencies in these agencies' disability claim decisions across
adjudicative levels and locations have raised questions about the
fairness, integrity, and cost of these programs. Our survey provides
further evidence of such challenges facing programs that provide monetary
support. Almost half of these programs reported that ensuring timely
processing of applications was a major or moderate challenge,9 and more
than one-quarter of monetary support programs reported that consistent
processing of applications was a major or moderate challenge.10

9 In discussing our survey results throughout the remainder of this
section, our figures regarding the percentage of programs that considered
particular issues to be a "challenge" includes programs that identified an
issue as either a "major" or "moderate" challenge in their responses to
our survey. Also, the survey results presented in this section combine
responses from both grant-making and non-grant-making programs. The
responses of grant-making programs reflect these programs' views of the
challenges their grantees face. A more complete tabulation of the survey
results related to program challenges is available on the GAO Web site at
www.gao.gov/cgi-bin/getrpt?GAO-05-695SP.

10 Of all 192 federal programs included in our analysis, including
programs providing monetary support, 21 percent reported that ensuring
timely processing of applications for assistance was a challenge and 15
percent reported that ensuring consistent processing of applications for
assistance was a challenge.

Timely Provision of Services and Benefits

Our past work also identified the challenges encountered by federal
programs in ensuring timely provision of services and benefits. For
example, we noted that structural weaknesses in SSA's DI and SSI programs
have prevented the agency from offering return-to-work services when it
may help most-soon after a person becomes disabled. Our survey indicates
that some other federal programs also face the challenge of providing
services in a timely fashion. For example, 38 percent of the programs that
provide employment-related assistance to people with disabilities reported
that ensuring timely provision of services and benefits was a challenge.11
Officials from the Department of Education, for instance, told us that of
the 80 Vocational Rehabilitation (VR) agencies they are responsible for
overseeing, about half of these agencies operate under a special procedure
for prioritizing services12 because the demand for VR services outweighs
the available resources.

Interpreting Complex Eligibility Requirements

Our past work indicated that SSA and VA's eligibility requirements are
complex and difficult to interpret. For example, we have reported that the
high costs of administering SSA's DI program reflects the complex and
demanding nature of making disability decisions. Our survey provides
further evidence of such challenges for federal disability programs. For
example, 53 percent of programs providing monetary support to people with
disabilities reported that interpreting complex eligibility requirements
was a challenge.13

Planning for Growth in the Our past work noted that federal disability
programs are facing challenges Demand for Services and in planning for the
anticipated increase in demand for their benefits and Benefits services.
For example, by the year 2010, SSA expects the number of Social

Security DI beneficiaries to increase by more than one-third over 2001

levels. However, our past work found that most of the state Disability

Determination Services agencies responsible for processing DI claims face

11 Of all 192 federal programs included in our analysis, including
programs providing employment-related assistance, 24 percent reported that
ensuring timely provision of services and benefits was a challenge.

12 Under the Rehabilitation Act of 1973, states that cannot provide
vocational rehabilitation services to all eligible applicants must provide
assurances that those with the most severe disabilities will be selected
first under "order of selection" criteria.

13 Of all 192 federal programs included in our analysis, including
programs providing monetary support, 30 percent reported that interpreting
complex eligibility requirements was a challenge.

significant challenges in ensuring there are enough trained staff to
handle DI as well as SSI claims. Similarly, in our prior work we reported
that despite VA's recent progress in reducing its disability claims
workload, it will be difficult for the agency to cope with future workload
increases due to several factors, including increased demand for services
as a result of military conflicts and legislative mandates. Our survey of
federal disability programs indicates that planning for growth in the
demand for benefits or services is also a challenge for other programs
that support people with disabilities. For example, 54 percent of the
programs that provide medical care and almost half of the programs that
provide employment-related assistance reported that planning for growth in
the demand for assistance was a challenge.14 Our discussions with
responsible agency officials reinforced the challenges posed by potential
growth in demand for program services or benefits. For example, officials
from the Department of Labor's one-stop center program15 told us they are
not sure if the program has sufficient resources to meet any increased
demand for services that might result from the outreach they are
conducting to people with disabilities.

Making Beneficiaries or Clients Aware of Program Services and Benefits

Our past work highlighted challenges in making beneficiaries aware of
services offered under federal disability programs. For example, we
reported that SSA's work incentives are ineffective in motivating people
to work, in part, because many beneficiaries are unaware that the work
incentives even exist. Our survey indicated that 69 percent of programs
that disseminate information to people with disabilities reported that
making beneficiaries or clients aware of their programs' services was a
challenge.16 The need to make people more aware of disability program
services has also been noted by other entities. For example, in 1999, the

14 Of all 192 federal programs included in our analysis, including
programs providing medical care and employment-related assistance, 36
percent reported that planning for growth in the demand for assistance was
a challenge.

15 The Workforce Investment Act of 1998 (WIA) requires states and
localities to bring together a number of federally funded employment and
training services into a single system-the one-stop system. Funded through
different federal agencies, these programs are to provide services through
a statewide network of one-stop career centers to adults, dislocated
workers, and youth.

16 Of all 192 federal programs included in our analysis, including
information dissemination programs, 38 percent reported that making
beneficiaries or clients aware of their programs' services and benefits
was a challenge.

Presidential Task Force on Employment of Adults with Disabilities17
suggested that the White House take more action to make people aware of
programs that support people with disabilities.

Communication and Coordination among Programs Serving Individuals with
Disabilities

Both our work and the work of others suggests some weaknesses in
communication and coordination among various federal disability programs.
In a 1996 report, we noted that programs helping people with disabilities
do not work together as efficiently as they could to share information
about their programs and to overcome obstacles posed by differing
eligibility criteria and numerous service providers. We said that the lack
of coordination among programs could result in duplication or gaps in
services provided to people with disabilities. Others have also identified
the need for greater coordination among federal disability programs. For
example, in announcing the New Freedom Initiative-a federal effort to
remove barriers and promote community integration for people with
disabilities-the President identified policy areas, such as the provision
of assistive technology, where better federal coordination was needed.
Also, in a review of programs for low-income adults with disabilities,
Urban Institute researchers described the safety net supporting such
individuals as "a tangled web of conflicting goals and gaps in needed
services."18 In addition, officials at the National Council on Disability
told us that although various interagency commissions exist to address
issues faced by people with disabilities, most of these commissions have
weak authority or have never met as a group. Our survey provides further
evidence of the coordination and communication challenges facing federal
programs serving individuals with disabilities. About one-third of these
programs indicated that, in their efforts to support people with
disabilities, they experienced challenges in obtaining

17 The Presidential Task Force on the Employment of People with
Disabilities was established to create a coordinated and aggressive
national policy to bring adults with disabilities into gainful employment
at a rate that is as close to the employment rate of the general adult
population. The Task Force published a series of reports over the course
of four years entitled Re-charting the Course.

18 David Wittenburg and Melissa Favreault, "Safety Net or Tangled Web? An
Overview of Programs and Services for Adults with Disabilities,"
Occasional Paper Number 68, The Urban Institute, p. 23 (Washington, D.C.;
November 2003).

information from or coordinating with other federal or nonfederal

19

programs.

Key Factors to Consider in Transforming Programs for the 21st Century

Over the past several years, GAO, in reporting that the largest federal
disability programs were mired in outdated concepts of disability, has
identified the need to reexamine and transform these programs to better
position the government to meet the challenges and expectations of the
21st century. In identifying the wide range of federal programs serving
individuals with disabilities and some of the major challenges these
programs face, this report raises several questions about whether other
federal disability programs may also need to be reoriented and
transformed. In particular, are the nearly two hundred programs that
provide assistance to people with disabilities well-suited to address
these challenges, and are they structured in a manner that collectively
allows them to provide coherent and seamless support to people with
disabilities? Also, in light of the nation's large and growing structural
deficit, do these programs represent the most cost-effective approaches to
serving individuals with disabilities?

On the basis of more than a decade of research focusing on the nation's
largest disability programs and our review of prior GAO reports examining
efforts to reform federal programs and transform agencies, we have
identified several key factors that are important to consider in assessing
the need for, and nature of, program transformations. In particular, our
prior work identifying shortcomings in the work incentives and supports
provided by the largest federal disability programs indicates that these
basic program design issues need to be addressed. Second, given the tight
fiscal constraints facing both federal and state governments, programs
will need to carefully consider the sustainability of current costs and
the potential costs associated with transformation initiatives. Finally,
programs will need to evaluate the feasibility of any transformation
efforts, considering whether appropriate processes and systems- including
those related to the planning and management of human capital and
information technology-are in place to effectively carry out current
operations or proposed changes. Figure 6 presents a list of questions that
may serve as a guide for addressing these factors.

19 Although our survey asked programs to report information sharing or
coordination challenges with both federal and nonfederal programs, most of
the respondents who reported having such challenges indicated that these
challenges related to their interactions with other federal programs,
either within or outside of their own agency.

Figure 6: Key Factors and Questions Concerning Transformation of Programs
Serving Individuals with Disabilities

                           Program Design-Individual incentives and supports: 
      o  Are the program's eligibility criteria up to date, taking into       
      consideration (1) medical and technological advances; (2) changes in    
      the labor market (e.g., shift toward more service and knowledge-based   
      work); (3) social changes (e.g., altered expectations focusing on work  
      and self-sufficiency and legal protections for workers with             
      disabilities); and (4) changing demographics (i.e., aging of the Baby   
      Boom generation)?  o  Does the program appropriately identify those who 
      can't work and provide them with financial support?  o  Does the        
      program provide effective work supports to individuals to enhance their 
      chances of entering, returning to, or staying in the workforce?  o      
      Does the program provide return to work assistance at the optimal time  
      (i.e., soon after a person incurs a disability, when they may be more   
      motivated to return to work)?  o  Should some beneficiaries be required 
      to accept assistance to enhance work capacities as a precondition for   
      benefits?  o  Is the program sufficiently coordinated with related      
      programs to provide coherent and integrated assistance to individuals   
      with disabilities as well as incentives promoting work?  o  Is the      
      program flexible enough to support the changing needs of people with    
      disabilities?                                                           
                                                         Fiscal implications: 
      o  What would be the program costs (both short and long term) of        
      specific efforts to streamline and modernize disability programs and    
      what are the implications of these costs for the nation's fiscal        
      outlook?  o  What would be the financial benefits (e.g., increased tax  
      revenues from individuals who return to work) of such efforts?  o  Who  
      will pay for program benefits and services (e.g., medical and assistive 
      technologies) and will beneficiaries be required to defray some portion 
      of the costs?  o  What are the fiscal implications for states and       
      localities and for nongovernmental organizations?                       
                            Feasibility of Implementation and Transformation: 
      o  Has the program established clear standards, and are these standards 
      applied accurately and consistently?  o  Does the program have          
      personnel who are capable of carrying out eligibility determinations    
      and assessments?  o  Are eligibility determinations and assessments     
      completed in a timely manner?  o  Does the program have appropriate     
      controls in place to ensure program integrity?  o  Does the program     
      make use of information systems which not only facilitate day-to-day    
      processing needs but also provide sufficient information for longer     
      term performance evaluation and policy assessment?                      

Source: GAO.

In addition to addressing these questions, which will provide a basic
framework for individually assessing existing programs and proposals for
transforming them, it is also important that some mechanism be established
for looking across programs to assess their overall

effectiveness and integration and whether they are designed to achieve
similar or complimentary goals. The diffusion of responsibility for
federal programs serving people with disabilities across multiple agencies
and the absence of any clear central authority for guiding a fundamental
reassessment of federal disability policy will likely pose significant
impediments to such action. However, a reexamination could serve to
identify programs and policies that are outdated or ineffective while
improving the targeting and efficiency of remaining programs through such
actions as redesigning allocation and cost-sharing provisions and
consolidating facilities and programs. Our recently issued report
concerning "21st Century Challenges" identifies approaches-such as the use
of special temporary commissions to develop policy proposals and the
exercise of congressional oversight through hearings on the activities of
federal agencies-that may be used for such a reexamination should the
Congress choose to pursue this course of action.20 Addressing the
individual program transformation questions we identify above in
conjunction with a reexamination of how these programs work collectively
represent key steps in efforts to meet 21st century social and economic
expectations of individuals with disabilities and the general public.

Copies of this report are being sent to: the Secretaries of Agriculture,
Commerce, Defense, Education, Energy, Health and Human Services, Housing
and Urban Development, Interior, Justice, Labor, Transportation, Treasury,
and Veterans Affairs; the Commissioner of SSA; the Director of the Office
of Personnel Management; the Administrator of the Small Business
Administration; the Chairman of the Railroad Retirement Board; the
Chairperson of the Committee for Purchase from People who are Blind or
Severely Disabled; the Chair of the Access Board; the Chair of the Equal
Employment Opportunity Commission; the Librarian of Congress; appropriate
congressional committees; and other interested parties. The report is also
available at no charge on GAO's Web site at http://www.gao.gov.

20 GAO, 21st Century Challenges: Reexamining the Base of the Federal
Government, GAO-05-325SP (Washington, D.C.: February 2005).

If you or your staff have any questions about this report, please contact
me at (202) 512-7215 or [email protected]. Contact points for our Offices
of Congressional Relations and Public Affairs may be found on the last
page of this report. GAO staff who made major contributions to this report
are listed in appendix III.

Robert E. Robertson Director, Education, Workforce, and Income Security
Issues

List of Committees

The Honorable Thad Cochran
Chairman
The Honorable Robert C. Byrd
Ranking Minority Member
Committee on Appropriations
United States Senate

The Honorable Charles E. Grassley
Chairman
The Honorable Max Baucus
Ranking Minority Member
Committee on Finance
United States Senate

The Honorable Michael B. Enzi
Chairman
The Honorable Edward M. Kennedy
Ranking Minority Member
Committee on Health, Education, Labor,

and Pensions United States Senate

The Honorable Susan Collins
Chairman
The Honorable Joseph Lieberman
Ranking Minority Member
Committee on Homeland Security

and Governmental Affairs
United States Senate

The Honorable Larry Craig
Chairman
The Honorable Daniel Akaka
Ranking Minority Member
Committee on Veterans' Affairs
United States Senate

The Honorable Jerry Lewis
Chairman
The Honorable David R. Obey
Ranking Minority Member
Committee on Appropriations
House of Representatives

The Honorable John A. Boehner
Chairman
The Honorable George Miller
Ranking Minority Member
Committee on Education and

the Workforce
House of Representatives

The Honorable Joe Barton
Chairman
The Honorable John D. Dingell
Ranking Minority Member
Committee on Energy and Commerce
House of Representatives

The Honorable Tom Davis
Chairman
The Honorable Henry A. Waxman
Ranking Minority Member
Committee on Government Reform
House of Representatives

The Honorable Steve Buyer
Chairman
The Honorable Lane Evans
Ranking Minority Member
Committee on Veterans' Affairs
House of Representatives

The Honorable William M. Thomas
Chairman
The Honorable Charles B. Rangel
Ranking Minority Member
Committee on Ways and Means
House of Representatives

                       Appendix I: Scope and Methodology

For our review, we defined a federal program as a function of a federal
agency that provides assistance or benefits to a state or states,
territorial possession, county, city, other political subdivision, or
grouping or instrumentality thereof; or to any domestic profit or
nonprofit corporation, institution, or individual, other than an agency of
the federal government.1 We defined the scope of our review to include
those federal programs meeting one of more of the following criteria: (1)
people with disabilities are specifically mentioned in a program's
authorizing legislation as a targeted group, (2) people are eligible for
the program wholly because of a disability, (3) people are eligible for
the program partially because of a disability, (4) people with
disabilities are given special consideration in eligibility
determinations, or (5) people with disabilities are given priority in
being served. Programs that serve individuals without respect to
disability (i.e., disability is not an explicit criteria for program
eligibility) but that serve some individuals with disabilities (such as
Temporary Assistance for Needy Families) are beyond the scope of our
review. In addition, we excluded programs whose principal focus is
research, demonstrations, training for professionals who work with people
with disabilities, technical assistance, or special transportation, as
well as disability retirement programs for federal workers.

To develop a list of programs that met these criteria, we first conducted
a systematic search in the Catalog of Federal Domestic Assistance (CFDA)
to identify programs that have some role in serving people with
disabilities and the respective agencies responsible for administering
each of these programs. In addition, we reviewed federal agency Web sites
to identify additional programs that were not included in the CFDA. We
then submitted the list of programs administered by each agency to that
agency for verification. (The final list of programs along with some
descriptive information on each program can be found in app. II.) In
developing our list, we included federal programs regardless of how the
benefit, service,

1 Our definition of a program is derived from the Catalog for Federal
Domestic Assistance (CFDA), a database of all federal programs available
to state and local governments (including the District of Columbia);
federally-recognized Indian tribal governments; territories (and
possessions) of the United States; domestic public, quasi-public, and
private profit and nonprofit organizations and institutions; specialized
groups; and individuals. The CFDA states that "A `Federal domestic
assistance program' may in practice be called a program, an activity, a
service, a project, a process, or some other name, regardless of whether
it is identified as a separate program by statute or regulation." The CFDA
further notes that " `Assistance' or `benefits' refers to the transfer of
money, property, services, or anything of value, the principal purpose of
which is to accomplish a public purpose of support or stimulation
authorized by federal statute."

Appendix I: Scope and Methodology

or assistance is ultimately delivered to the individual (e.g., directly by
the federal agency or indirectly by another entity, such as a state
agency).

To obtain information on federal programs supporting people with
disabilities and the challenges they face, we conducted a Web-based
survey, which collected basic information on each program, including the
types of assistance provided, whether the assistance is provided directly
to beneficiaries or indirectly through other entities, whether the program
is partially or wholly targeted to people with disabilities, the number of
beneficiaries served, program spending, and the challenges faced by these
programs (i.e., obstacles that hindered a program's ability to effectively
and efficiently support people with disabilities). (A more complete
tabulation of the survey results related to program challenges is
available on the GAO Web site at www.gao.gov/cgi-bin/getrpt?GAO-05-695SP.)
To identify the appropriate program officials to respond to the survey, we
submitted the list of programs that we compiled to liaisons at each
agency. These liaisons then identified the appropriate respondents at
their respective agencies. We pretested the content and format of our
survey with officials from eight programs to determine if it was
understandable and if the information was feasible to collect, and we
refined the survey as appropriate. We then sent e-mail notifications to
the identified officials of 299 programs beginning on June 15, 2004,
asking them to complete the survey by June 28, 2004. To encourage
respondents to complete the survey, we sent e-mail messages to prompt each
nonrespondent 1 and 2 weeks after the initial e-mail message. We closed
the survey on August 16, 2004. We obtained survey responses from 258
programs, for an overall response rate of 86 percent. In addition, for 11
of the 41 programs that did not submit survey responses, we obtained
descriptive information from the CFDA to answer a limited number of survey
questions to the extent that such information was available. Based on
responses to survey questions asking programs to identify the criteria
they apply in serving people with disabilities and the primary type of
assistance they provide, we identified 192 programs (comprising 64 percent
of all programs surveyed) that met our criteria for defining programs as
either wholly or partially targeted towards serving individuals with
disabilities.

Although our survey asked programs to provide spending data, because of
limitations or inconsistencies in the spending information reported by
survey respondents, we obtained spending data from the Consolidated
Federal Funds Report (CFFR)-a database compiled by the Bureau of the

Appendix I: Scope and Methodology

Census-for all of the relevant programs listed in this database.2 For
programs that did not have data reported in the CFFR, we used spending
information from the survey data. In a few cases where spending data was
not available from either the CFFR or survey data, we obtained this
information from the CFDA. To verify the spending data that we present in
this report, we sent each program an e-mail message asking them to confirm
the amounts we had identified. While many programs confirmed the spending
amounts that we listed in our message, others identified different
amounts. The spending data we present in this report are based on the
final verified spending amounts identified by programs in their response
to our e-mail. These data are not entirely consistent across programs. For
example, while most of these data represent spending for fiscal year 2003,
some programs instead provided data for other fiscal years. Also, some
programs included administrative costs in their spending figures while
others did not include such costs. In addition, while the majority of the
spending data we report represent program obligations, some of the data
instead represent outlays.3 Of the 95 wholly targeted programs in our
analysis, we were able to obtain some type of spending data for 85
programs. However, many partially targeted programs were unable to provide
us with data pertaining to their programs' spending on people with
disabilities because they do not separately track or collect such data for
these individuals. As a result, we do not present spending data in this
report for partially targeted programs except for three programs
(Supplemental Security Income, Medicare, and Medicaid) for which we were
able to obtain a breakdown of spending on people with disabilities from
agency documents.

Because we relied extensively on program spending data derived from the
2003 CFFR data that are available on-line from the CFFR Web site
(http://www.census.gov/govs/www/cffr.html), we conducted limited tests of
the reliability of these data, including frequency analyses of critical
data fields. We restricted our reliability assessment to the specific
variables that were pertinent to our analysis. These tests indicated that
the critical

2 The CFFR reports federal government expenditures or obligations in
state, county, and subcounty areas of the United States as well as the
District of Columbia and U.S. outlying areas. Various federal government
agencies provide the data for this report from their existing reporting
systems.

3 In addition, several programs provided us with data on their
appropriations, rather than either obligations or outlays.

Appendix I: Scope and Methodology

data fields were sufficiently complete and accurate for the purposes of
our analysis.

To obtain additional information on the challenges faced by programs, we
conducted interviews with federal agency officials and officials from
disability advocacy organizations, and reviewed pertinent agency
documents, GAO reports, and academic research on disability issues.

To identify questions that should be addressed in transforming federal
disability programs, we reviewed the major findings and recommendations
that have resulted from the substantial body of GAO research on federal
disability programs over the past decade. We also examined past GAO
reports on program reform and organizational transformation throughout the
federal government.

Because our questionnaire was not a sample survey, there are no sampling
errors. However, the practical difficulties of conducting any survey may
introduce errors, commonly referred to as nonsampling errors. For example,
difficulties in how a particular question is interpreted, in the sources
of information that are available to respondents, or in how the data are
entered into a database or were analyzed, can introduce unwanted
variability into the survey results. We took steps in the development of
the questionnaire, the data collection, and the data analysis to minimize
these nonsampling errors. For example, social science survey specialists
designed the questionnaire in collaboration with GAO staff with subject
matter expertise. Then, as mentioned earlier, the draft questionnaire was
pretested with program officials to ensure that the questions were
relevant, clearly stated, and easy to comprehend. When the data were
analyzed, a second, independent analyst checked all computer programs.
Since this was a Web-based survey, respondents entered their answers
directly into the electronic questionnaire. This eliminated the need to
have the data keyed into a database, thus removing an additional source of
error.

We performed our work at various locations in Washington, D.C. We
conducted our work between March 2004 and March 2005 in accordance with
generally accepted government auditing standards.

Appendix II: Federal Programs Serving People with Disabilities

The following table presents an overview of the 192 federal programs that
we identified as targeted to people with disabilities. The information
presented in this table is based mostly on the programs' survey responses,
although it also presents data obtained from other sources. In particular,
the spending information is derived from multiple sources, including
programs' survey responses and federal government reports on program
spending. The spending data we present below represent either obligations,
expenditures, or appropriations, as indicated by the table notes
accompanying each reported amount. Due to the various sources that we used
to identify program spending and possible inconsistencies in these data
(e.g., differences in the fiscal years for which spending was reported by
programs), we advise caution in efforts to compare or sum spending figures
across programs. Also, given the significant limitations in the spending
data available for partially targeted programs, we do not present such
data in this table. (See app. 1 for a more detailed discussion of our
methodology for collecting spending data and other information on these
programs.)

               Federal Programs Serving People with Disabilities

                                                    Direct or                 
                                                           indirect Wholly or 
                                     Spending (for assistance partially       
                                              fiscal year 2003 to targeted to 
                                               unless individuals individuals 
                     Primary area of           otherwise with with            
     Program              assistance     indicated) disabilities disabilities 

Access Board

Access Board 	Other: Guidelines $4,000,000a,b,c Indirect Wholly on
accessibility

Committee for Purchase From People Who Are Blind or Severely Disabled

Javits-Wagner-O Day Program (Committee for Purchase From
Employment-$4,629,000a,b,c Indirect Wholly People Who Are Blind or
Severely Disabled) related

                           Department of Agriculture

      Assistive & Ergonomic Technology     Assistive         Direct Partially 
           (Target Center, USDA,                                    
             Washington, D.C.)            technology                
     Assistive and Ergonomic Technology    Assistive         Direct           
          (Midwest Target Center,                                   Partially
            St. Louis, Missouri)          technology                
      Assistive Technology Program for                $4,002,000a,c           
         Farmers with Disabilities:       Employment-      Indirect    Wholly
             AgrAbility Project             related                 
     Child and Adult Care Food Program       Food          Indirect Partially 
                Food Stamps                  Food            Direct Partially 
      Rural Rental Assistance Payments      Housing        Indirect Partially 

Appendix II: Federal Programs Serving People with Disabilities

                                                       Direct or 
                                                        indirect Wholly or    
                                                   Spending (for  partially   
                                                      assistance 
                                             fiscal year 2003 to  targeted to 
                                              unless individuals  individuals 
                             Primary area of   otherwise with        with     
            Program            assistance             indicated) disabilities 
                                                    disabilities 
     Rural Rental Housing        Housing                Indirect  Partially   
             Loans                                               
Section 538 Rural Rental      Housing                Indirect  Partially   
Housing Guaranteed Loans                                      
      Summer Food Service         Food                  Indirect              
     Program for Children                                         Partially

                  Department of Commerce Department of Defense

Public Telecommunications Facilities       Other:       Indirect Partially 
                  Program                                           
                                         Telecommunication          
                                          and information           
                                            technology              

    Technology Opportunities Program        Other:        Indirect  Partially 
                                      Telecommunication            
                                       and information             
                                          technology               

Computer/Electronic Accommodations Program	Assistive $4,662,000a,b,c
Direct Wholly technology

                            Department of Education

         Access to Telework             Loans      $20,000,000a,c      Wholly 
                                                   Indirect         
     Adult Education and Family       Education            Indirect Partially 
      Literacy Act State Grants                                     
     American Indian Vocational                     $28,399,000d,e            
       Rehabilitation Services       Employment-        Direct         Wholly
                                       related                      
American Printing House for the     Other:      $15,399,000d,e             
                Blind                Educational   Indirect            Wholly
                                      materials                     
                                     Information   $22,289,000a,c             
      Assistive Technology Act                     Indirect            Wholly
                                    dissemination                   
        Assistive Technology            Loans      $13,001,000a,f,c    Wholly 
    Alternative Financing Program                  Indirect         
     Assistive Technology State                     $4,573,000d,e             
      Grants for Protection and         Civil          Indirect     
              Advocacy             protections or                      Wholly
                                   legal services                   
Carl D. Perkins Vocational and     Education            Indirect           
      Technical Education State                                     Partially
               Grants                                               
                                        Civil       $12,068,000a,g            
      Client Assistance Program    protections or       Direct         Wholly
                                   legal services                   
      Congressionally-Directed         Other:       $3,517,000a,c             
              Projects               Disability-       Indirect        Wholly
                                       related                      
                                      earmarks                      
        Gallaudet University          Education              Direct Partially 
    Helen Keller National Center                    $8,660,000a,c             
                                     Employment-        Direct         Wholly
                                       related                      
                                      Personal      $68,820,000a,g            
     Independent Living Services      assistant         Direct         Wholly
                                      services                      

Appendix II: Federal Programs Serving People with Disabilities

                                                    Direct or                 
                                                           indirect Wholly or 
                                     Spending (for assistance partially       
                                              fiscal year 2003 to targeted to 
                                               unless individuals individuals 
                     Primary area of           otherwise with with            
     Program              assistance     indicated) disabilities disabilities 

Independent Living Services     Personal                                   
    for Older Individuals Who      assistant     $27,538,000a,g Direct Wholly
            are Blind                                                  
                                   services                            
    Independent Living State       Personal                                   
             Grants                assistant     $21,930,000a,g Direct Wholly
                                   services                            
      Migrants and Seasonal                          $2,306,000a,c            
           Farmworkers            Employment-          Indirect        Wholly
                                    related                            
       National Technical          Education     $53,699,000a,g Direct Wholly 
     Institute for the Deaf                                            
     Native Hawaiian Special       Education         $3,100,000d,e     Wholly 
            Education                                  Indirect        
Payments for Children with      Education     $50,669,000a,g        Wholly 
          Disabilities                           Indirect              
    Program of Protection and                                                 
     Advocacy of Individual    Civil protections                       
             Rights                   or         $16,585,000a,g Direct Wholly
                                legal services                         
     Projects with Industry       Employment-    $21,708,000a,g Direct Wholly 
                                    related                            
    Randolph-Sheppard Vending                    $31,400,000a,f,c             
       Facilities Program         Employment-    Indirect              Wholly
                                    related                            
                                    Other:           $2,354,000a,g            
      Recreational Programs      Recreational          Indirect        Wholly
                                   programs                            

     Rehabilitation Services                    $2,480,000,000a,g             
    Vocational Rehabilitation    Employment-         Direct            Wholly
            Grants to                                               
              States               related                          
Special Education-Pre-School   Education      $384,223,000a,g       Wholly 
          Grant Program                              Direct         
Special Education-Grants for                  $429,307,000a,g              
    Infants and Families with   Other: Early         Direct            Wholly
           Disabilities         intervention                        
                                  services                          
Special Education-Grants to    Education     $8,858,398,000a,g      Wholly 
              States                                 Direct         
     Special Education-Parent    Information                                  
       Information Centers                    $26,327,000a,g Direct    Wholly
                                dissemination                       
Special Education-Technology   Education          $37,962,000a,g           
      and Media Services for                               Indirect    Wholly
         Individuals with                                           
           Disabilities                                             
           Star Schools           Education                Indirect Partially 
       Supported Employment                                                   
     Services for Individuals                 $37,525,000a,g Direct 
           with Severe           Employment-                           Wholly
           Disabilities            related                          
    Tech Prep Education State     Education                Indirect Partially 
              Grants                                                
       TRIO Student Support       Education                Indirect Partially 
             Services                                               
       Department of Energy                                         
    Weatherization Assistance                              Indirect           
      for Low-Income Persons    Other: Energy                       Partially

                                   efficiency

Appendix II: Federal Programs Serving People with Disabilities

                                                    Direct or                 
                                                           indirect Wholly or 
                                     Spending (for assistance partially       
                                              fiscal year 2003 to targeted to 
                                               unless individuals individuals 
                     Primary area of           otherwise with with            
     Program              assistance     indicated) disabilities disabilities 

                    Department of Health and Human Services

          Adoption Assistance        Monetary support      Indirect Partially 
     Aging and Disability Resource     Information         Indirect           
                Center                                              Partially
                                      dissemination                 
Alzheimer's Disease Demonstration  Other: Respite       Indirect Partially 
           Grants to States                                         
    Attention Deficit Hyperactivity    Information         Indirect           
               Disorder                                             Partially
                                      dissemination                 
                                                      $5,563,000d,e           
      Black Lung Clinics Program       Medical care     Indirect       Wholly

       Block Grants for                                                       
Community Mental Health      Other:      $437,140,000a,b,c Indirect Wholly
           Services                                                    
                            Development of                             
                             comprehensive                             
                            systems of care                            

Child Care Mandatory and Matching Funds                 Indirect Partially 
     of the Child Care Other: Child care                            
       and Development Fund subsidies                               
        Civil Rights and Privacy Rule                                         
Compliance Activities Civil protections                   Direct 
                     or                                             Partially
                            legal services                          
    Comprehensive Community Mental Health  $80,078,000d,e Indirect            
     Services for Children Medical care                                Wholly
     with Serious Emotional Disturbances                            
      Developmental Disabilities Basic                                        
     Support and Advocacy Grants Other:                             
                   Systems                 $133,236,000d,e Indirect    Wholly
                                change and                          
                         capacity building                          
Developmental Disabilities Projects of                                     
        National Significance Other:       $12,403,000h,g Indirect  
                 Independent                                           Wholly
                            living support                          

Disabilities Prevention (Disability  Other: Capacity $25,551,000d,e Wholly 
               and Health)                              Indirect       
                                         building and                  
                                          information                  
                                         dissemination                 

     Early Hearing Detection &   Other: Early              Indirect Partially 
          Identification                                            
                                 hearing                            
                                 detection                          
    Family Support Payments to   Monetary                  Indirect           
    States Assistance Payments   support                            Partially
      (Adult Programs in the                                        
           Territories)                                             
Grants to Provide Outpatient                                               
    Early Intervention Services  Medical care   $19,000d,e Indirect 
               with                                                    Wholly
      Respect to HIV Disease                                        
     Hansen's Disease National   Medical care              Indirect Partially 
      Ambulatory Care Program                                       
            Head Start             Education               Indirect Partially 
      HIV Care Formula Grants    Medical care  $1,022,337,000d,e       Wholly 
                                               Indirect             
HIV Emergency Relief Project  Medical care  $600,673,000d,e                
              Grants                           Indirect                Wholly

Appendix II: Federal Programs Serving People with Disabilities

                                                    Direct or                 
                                                           indirect Wholly or 
                                     Spending (for assistance partially       
                                              fiscal year 2003 to targeted to 
                                               unless individuals individuals 
                     Primary area of           otherwise with with            
     Program              assistance     indicated) disabilities disabilities 

       Maternal and Child Health Federal      Medical care Indirect Partially 
             Consolidated Programs-                                 
Special Projects of Regional and National                        
Significance/Awareness and Access to Care                        
                for Children and                                    
              Youth with Epilepsy                                   

     Maternal and Child Health                   $1,873,000a,b,c              
       Federal Consolidated      Other: Systems  Indirect              Wholly
             Programs-                                              
Special Projects of Regional     building                        
           and National                                             
    Significance/CISS/Community                                     
         Systems for CSHCN                                          
     Maternal and Child Health                                                
       Federal Consolidated          Other:                  Direct 
             Programs-                                              Partially
Special Projects of Regional  Infrastructure                     
           and National                and                          
        Significance/Early                                          
    Detection and Intervention   support systems                    
     for Children with Autism                                       
     Maternal and Child Health                                                
    Services Block Grant to the  Other: Systems            Indirect 
              States             of                                 Partially
             (Title V)                care                          
      Medicaid Infrastructure                    $35,000,000a,i               
       Grants To Support the         Other:      Indirect           
            Competitive                                                Wholly
     Employment of People with   Infrastructure                     
           Disabilities                and                          
                                  coordination                      
        Medical Assistance        Medical care             Indirect Partially 
         Program-Medicaid                                           
    Medicare Hospital Insurance   Medical care               Direct Partially 
      Medicare Supplementary      Medical care               Direct Partially 
         Medical Insurance                                          
     National Family Caregiver   Other:                    Indirect           
              Support            Multifaceted                       Partially
                                 support systems                    
Nutrition Services Incentive       Food                 Indirect Partially 
              Program                                               
    PATH Formula Grant-Homeless  Other: Outreach   $41,306,000d,e             
                                                       Direct          Wholly
                                    and case                        
                                   management.                      
    Protection and Advocacy for                  $34,620,000a,b,j,i           
      Individuals with Mental    Civil           Indirect           
              Illness            protections or                        Wholly
                                 legal services                     
    Real Choice Systems Grants       Other:                Indirect           
       for Community Living                                         Partially
                                 Infrastructure                     
                                       and                          
                                     support                        
                                    services                        
    Ryan White CARE Act - Title                  $69,936,000d,e               
    IV: Grants for Coordinated    Medical care   Indirect           
                HIV                                                    Wholly
      Services and Access to                                        
        Research for Women                                          
    Ryan White HIV/AIDS Dental    Medical care     $9,843,000a,c       Wholly 
          Reimbursements                              Indirect      
     Special Programs for the    Other:                                       
     Aging Title III, Part B,    Multifaceted              Indirect 
            Grants for                                              Partially
Supportive Services & Senior  support systems                    
              Centers                                               
     Special Programs for the                                                 
      Aging Title III, Part C         Food                 Indirect 
             Nutrition                                              Partially
             Services                                               
Special Projects of National   Medical care             Indirect           
Significance (Ryan White CARE                                    Partially
               Act)                                                 

Appendix II: Federal Programs Serving People with Disabilities

                                                       Direct or 
                                                        indirect Wholly or    
                                                   Spending (for  partially   
                                                      assistance 
                                                fiscal year 2003  targeted to 
                                                       to        
                                                          unless  individuals 
                                                     individuals 
                               Primary area of   otherwise with      with     
            Program              assistance           indicated) disabilities 
                                                    disabilities 
     Traumatic Brain Injury      Information            Indirect  Partially   
                                dissemination                    
       Voting Access for                                                      
        Individuals with      Civil protections  $2,000,000d,e   
    Disabilities-Grants for                  or     Indirect        Wholly
    Protection and Advocacy                                      
            Systems            legal services                    

Voting Access for Individuals with Disabilities-Grants to States Civil
protections or $12,849,000d,e Indirect Wholly and Local Governments legal
services

                  Department of Housing and Urban Development

     Architectural Barriers Act   Civil protections       NA Direct    Wholly 
            Enforcement           or                                
                                   legal services                   
Assisted Living Conversion for                          Indirect           
    Eligible Multifamily Housing       Housing                      Partially
              Projects                                              
      Elderly/Disabled Service     Other: Service          Indirect           
        Coordinator Program                                         Partially
                                    coordination                    
      Fair Housing Initiatives    Other: Fair              Indirect           
              Program             housing                           Partially
                                     assistance                     
     Housing Opportunities for         Housing      $252,200,000a,g    Wholly 
         Persons with AIDS                          Indirect        
        Lower Income Housing                               Indirect           
    Assistance Program Section 8       Housing                      Partially
      Moderate Rehabilitation                                       
     Mortgage Insurance Rental          Loans              Indirect Partially 
      Housing for the Elderly                                       
    Multifamily Housing Service      Information             Direct           
            Coordinators                                            Partially
                                    dissemination                   
       Non-Discrimination in                                                  
       Federally Assisted and     Civil protections       NA Direct 
             Conducted            or                                   Wholly
     Programs (on the Basis of     legal services                   
            Disability)                                             
     Non-Discrimination on the                                                
Basis of Disability by Public  Civil protections       NA Direct 
              Entities            or                                   Wholly
                                   legal services                   
     Public and Indian Housing         Housing             Indirect Partially 
      Resident Opportunity and       Information           Indirect           
          Self-Sufficiency                                          Partially
                                    dissemination                   
        Section 202 Housing            Housing             Indirect Partially 
         Shelter Plus Care             Housing      $76,822,000d,e     Wholly 
                                                    Indirect        
Supportive Housing for Persons      Housing      $286,652,000a,g    Wholly 
         with Disabilities                          Indirect        
     Supportive Housing Program        Housing             Indirect Partially 
       Department of Justice                                        
          Civil Rights of         Civil protections        Indirect           
     Institutionalized Persons    or                                Partially
                                   legal services                   
                                  Civil protections        Indirect           
    Equal Employment Opportunity  or                                Partially
                                   legal services                   

Appendix II: Federal Programs Serving People with Disabilities

                                                            Direct or         
                                                           indirect Wholly or 
                                                     Spending (for assistance 
                                                     partially                
                                                          fiscal year 2003 to 
                                                                  targeted to 
                                                           unless individuals 
                                                                  individuals 
                                     Primary area of   otherwise with with    
             Program                 assistance       indicated) disabilities 
                                                                 disabilities 
Protection of Voting Rights  Civil protections or       Indirect Partially 
                                   legal services    
     Public Safety Officers'        Monetary support         Direct Partially 
         Benefits Program                            
     Public Safety Officers'         Education                                
      Educational Assistance                                 Direct Partially

                              Department of Labor

        Coal Mine Workers'      Monetary support   $370,389,000a,c     Wholly 
           Compensation                                Direct       
       Disability Info.gov         Information               Direct Partially 
                                  dissemination                     
                                                   $3,000,000a,b,c            
       Disability Navigator        Employment-        Indirect         Wholly
                                     related                        
Disabled Veterans' Outreach                             Indirect           
             Program               Employment-                      Partially
                                     related                        
Employer Assistance Referral                            Indirect           
             Network               Employment-                      Partially
                                     related                        
        Employment Service         Information             Indirect Partially 
                                  dissemination                     
        Energy Employees'                                                     
       Occupational Illness                                  Direct 
           Compensation         Monetary support                    Partially
             Program                                                
        Federal Employees'      Monetary support  $2,345,471,000a,c    Wholly 
       Compensation Program                            Direct       
    Job Accommodation Network      Information             Indirect Partially 
                                  dissemination                     
            Job Corps              Employment-               Direct Partially 
                                     related                        
       Longshore and Harbor     Monetary support      $2,817,000a,c    Wholly 
      Workers' Compensation                                Indirect 
              O*Net                Information             Indirect Partially 
                                  dissemination                     
    Office of Federal Contract  Civil protections            Direct           
       Compliance Programs                     or                   Partially
                                 legal services                     
      One-Stop Career Center                               Indirect           
              System               Employment-                      Partially
                                     related                        
        Small Business and                                                    
    Self-Employment for People     Information             Indirect 
               with                                                 Partially
           Disabilities           dissemination                     
          United We Ride         Transportation            Indirect Partially 
     Veteran's Preference in                              NA Direct           
        Federal Employment         Employment-                         Wholly
                                     related                        
        Veterans Workforce                                 Indirect           
       Investment Programs         Employment-                      Partially
                                     related                        

Appendix II: Federal Programs Serving People with Disabilities

                                                          Direct or           
                                                           indirect Wholly or 
                                                Spending (for assistance      
                                                partially                     
                                                 fiscal year 2003 to targeted 
                                                                           to 
                                                           unless individuals 
                                                                  individuals 
                                Primary area of      otherwise with with      
           Program              assistance            indicated) disabilities 
                                                                 disabilities 
Wage and Hour Division  Civil protections or            NA Indirect Wholly 
                                 legal services 
      WIA Youth Program                                                       
      (formula grants)         Employment-                   Direct Partially
                                 related        
    Work Incentives Grant                       $20,000,000a,i Indirect       
                               Employment-      Wholly                        
                                 related        
    Workforce Recruitment                                                     
           Program             Employment-      $500,000a,b,c Indirect Wholly
                                 related        

                           Department of the Interior

  Assistance for Indian Children with Severe Disabilities Education $60,000d,k
                   Direct Wholly Department of Transportation

     Capital and Training Assistance   Transportation $6,905,000a,i    Wholly 
        Program for Over-the-Road                          Indirect 
            Bus Accessibility                                       
     Capital Assistance Program for                        Indirect           
       Elderly Persons and Persons     Transportation               Partially
            with Disabilities                                       
        Capital Investment Grants      Transportation      Indirect Partially 
       FTA general activities and       Information   $3,000,000a,c           
     technical assistance related to                    Indirect       Wholly
            disability issues          dissemination                
    Nonurbanized Area Formula Program  Transportation      Indirect Partially 
     Urbanized Area Formula Program    Transportation      Indirect Partially 

                             Department of Treasury

Tax Deduction to remove barriers for the Elderly and Disabled	Other: Tax
Indirect Partially deduction

        Work Opportunity Tax Credit Other: Tax credit Indirect Partially

                         Department of Veterans Affairs

     Automobiles and Adaptive                      $30,013,000d,k             
       Equipment for Certain      Transportation       Direct          Wholly
             Disabled                                               
    Veterans and Members of the                                     
           Armed Forces                                             
Blind Rehabilitation Centers    Medical care   $59,569,000a,b,c     Wholly 
                                                  Indirect          
         Compensation for                                                     
Service-Connected Deaths for                              Direct 
             Veterans'           Monetary support                   Partially
            Dependents                                              
    Life Insurance for Veterans  Monetary support            Direct Partially 
        Montgomery GI Bill                                                    
      Educational Assistance        Education                Direct Partially
           (Chapter 30)                                             
       Monthly Allowance for                       $13,900,000d,l             
Children of Vietnam Veterans                        Direct       
             Born with           Monetary support                      Wholly
           Spina Bifida                                             
      Native American Veteran         Loans                  Direct Partially 
        Direct Loan Program                                         
            Pension for                                                       
       Non-Service-Connected                      $2,489,932,000d,l 
      Disability for Veterans    Monetary support Direct               Wholly

Appendix II: Federal Programs Serving People with Disabilities

                                                       Direct or 
                                                        indirect Wholly or    
                                                   Spending (for  partially   
                                                      assistance 
                                           fiscal year 2003 to    targeted to 
                                              unless individuals  individuals 
                            Primary area      otherwise with         with     
                                 of                              
           Program           assistance               indicated) disabilities 
                                                    disabilities 
     Pension to Veterans         Monetary                                     
    Surviving Spouses, and        support                 Direct  Partially
           Children                                              
       Post-Vietnam Era                                                       
    Veterans' Educational     Education                   Direct  Partially
          Assistance                                             
SMI: Psychotic Disorders Medical care   $1,655,076,000a,b,c      Wholly    
                                                  Direct         
          SMI: PTSD         Medical care   $139,873,000a,b,m,c      Wholly    
                                                  Direct         
     SMI: Substance Abuse   Medical care     $44,083,000a,b,c       Wholly    
                                                  Direct         
      Specially Adapted                                                       
     Housing for Disabled      Housing    $17,324,000d,k Direct     Wholly
           Veterans                                              
      Spinal Cord Injury    Medical care    $301,666,000a,b,c       Wholly    
                                                  Direct         
Survivors and Dependents   Education   $275,123,000d,k Direct    Wholly    
    Educational Assistance                                       
    Traumatic Brain Injury  Medical care  $12,668,000a,c Direct     Wholly    
    Veterans Compensation        Monetary   $20,622,189,000d,l                
    for Service-Connected         support         Direct            Wholly
          Disability                                             
     Veterans Dental Care   Medical care                  Direct  Partially   
Veterans Dependency and                  $3,773,937,000d,l                 
    Indemnity Compensation       Monetary         Direct         
             for                  support                           Wholly
Service-Connected Death;                                      
Compensation for Service                                      
     Veterans Domiciliary   Medical care    $295,505,000a,b,c       Wholly    
             Care                                 Direct         
     Veterans Home-Based    Medical care                  Direct  Partially   
         Primary Care                                            
           Veterans                                                           
    Housing-Guaranteed and      Loans                     Direct  Partially
        Insured Loans                                            
    Veterans Medical Care   Medical care                  Direct  Partially   
           Benefits                                              
    Veterans Nursing Home   Medical care   $1,684,725,000a,b,c                
             Care                                 Direct            Wholly

       Veterans Prosthetic      Medical care   $523,366,000h,g         Wholly 
           Appliances                          Direct               
Veterans State Domiciliary   Medical care               Indirect Partially 
              Care                                                  
     Veterans State Hospital    Medical care   $41,937,000d,e          Wholly 
              Care                             Indirect             
Veterans State Nursing Home  Medical care   $327,524,000d,e         Wholly 
              Care                             Indirect             
Vocational and Educational                                                 
    Counseling for Separating                                Direct 
             Service             Employment-                        Partially
      Members (Chapter 36)         related                          
    Vocational Rehabilitation                  $376,622,000d,k                
      for Disabled Veterans      Employment-   Direct                  Wholly
                                   related                          
     Vocational Training and                                                  
Rehabilitation for Vietnam                                       
            Veterans'            Employment-   $26,000a,b,c Direct     Wholly
Children with Spina Bifida                                       
     or Other Covered Birth        related                          
             Defects                                                
        Equal Opportunity                                           
      Employment Commission                                         
    Employment Discrimination                                                 
       Section 501 of the      Civil                         Direct 
         Rehabilitation        protections or                       Partially
     Act (federal employees)   legal services                       
    Employment Discrimination                                                 
      State and Local Fair     Civil                       Indirect 
           Employment          protections or                       Partially
Practices Agency Contracts  legal services                       
    Employment Discrimination                                                 
    Title I of The Americans   Civil                      NA Direct 
              with             protections or                          Wholly
        Disabilities Act       legal services                       

Appendix II: Federal Programs Serving People with Disabilities

                                                    Direct or                 
                                                           indirect Wholly or 
                                     Spending (for assistance partially       
                                              fiscal year 2003 to targeted to 
                                               unless individuals individuals 
                     Primary area of           otherwise with with            
     Program              assistance     indicated) disabilities disabilities 

  Library of Congress Office of Personnel Management Railroad Retirement Board

         Access Programs        Other:                       Direct Partially 
                                Accessibility                       
                                of facilities and                   
                                     services                       
     Library Services for the                                                 
       Blind and Physically                        $50,632,000a,b,c 
           Handicapped            Other: Library   Direct              Wholly
                                     service.                       

     Federal Employment Assistance for     Employment-  NA Indirect    Wholly 
                  Veterans                                          
                                             related                
     Federal Employment for Individuals                 NA Indirect           
             with Disabilities             Employment-                 Wholly
                                             related                
     Government Telework Program Guide     Information     Indirect Partially 
                                          dissemination             

    Social Insurance for Railroad Workers Monetary support Direct Partially

                         Small Business Administration

Veterans Entrepreneurial Training and Counseling 	Other: Multi-Direct
Partially faceted services for small businesses

                         Social Security Administration

     AeDib - Electronic                                                       
      Disability Claims      Employment-                   Indirect Partially
Imaging and Processing                                           
           Project             related                              
       Social Security                                                        
     Benefits Planning,      Information    $23,000,000a,b,c        
       Assistance, and                      Indirect                
          Outreach                                                     Wholly
           Program          dissemination                           
       Social Security     Monetary support   $77,146,763,000d,l       Wholly 
    Disability Insurance                            Direct          
       Social Security     Monetary support                  Direct Partially 
    Retirement Insurance                                            
    Social Security State                                                     
       Grants for Work                       $7,000,000h,g Indirect 
    Incentives Assistance                                           
             to              Employment-                               Wholly
Disabled Beneficiaries      related                              
       Social Security     Monetary support                  Direct Partially 
     Survivors Insurance                                            
      State Vocational                                                        
     Rehabilitation Cost                                NA Indirect 
    Reimbursement Program    Employment-                               Wholly
                               related                              
    Supplemental Security  Monetary support                  Direct Partially 
           Income                                                   
       Ticket to Hire        Information       $140,000a,c Indirect    Wholly 
                            dissemination                           
Ticket to Work and Work                              NA Indirect           
     Incentives Program      Employment-                               Wholly
                               related                              

Source: GAO analysis of survey data and of program information presented
in federal government reports (see table notes below).

Appendix II: Federal Programs Serving People with Disabilities

Note: "NA" means Not Available.

aData source: Program-reported data (e.g., through our survey or agency
correspondence).

bSurvey respondent indicated that this figure includes administrative
costs.

cExpenditure.

dData source: Consolidated Federal Funds Report.

eThe data sources used for the CFFR vary by major category of federal
government expenditure or obligation. The spending data for this program
are included in CFFR's "Grant" category, which includes formula grants,
project grants, block grants, and cooperative agreements. The data for
about 98 percent of all grants reported in the CFFR come from the Federal
Assistance Award Data System, which represent the federal obligations
incurred at the time the grant is awarded.

fData for FY 2001.

gObligation.

hData source: Catalog of Federal Domestic Assistance.

iAppropriation.

jData for FY 2004.

kThe data sources used for the CFFR vary by major category of federal
government expenditure or obligation. The spending data for this program
are included in CFFR's "Other Direct Payments" category. The data for this
category come from the Federal Assistance Award Data System. These amounts
generally represent obligations incurred during the fiscal year.

lThe data sources used for the CFFR vary by major category of federal
government expenditure or obligation. The spending data for this program
are included in CFFR's "Retirement and disability payments to individuals"
category. The data for this category are compiled by federal agencies for
the Federal Assistance Award Data System. Reported amounts represent
obligations of federal funds during the fiscal year.

mData for FY 2002.

Appendix III: GAO Contact and Staff Acknowledgments

GAO Contact

Staff Acknowledgments

(130360)

Robert E. Robertson, (202) 512-7215

The following individuals made important contributions to this report:
Shelia D. Drake, Erin M. Godtland, Joel A. Green, Mark de la Rosa, David
J. Forgosh, Mark Trapani, Stuart M. Kaufman, and Daniel A. Schwimer.

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