National Disaster Response: FEMA Should Take Action to Improve	 
Capacity and Coordination between Government and Voluntary	 
Sectors (27-FEB-08, GAO-08-369).				 
                                                                 
Using lessons from the 2005 Gulf Coast hurricanes, the federal	 
government released the National Response Framework (NRF) in	 
January 2008. This report examines (1) why the primary role for  
mass care in the NRF shifted from the Red Cross to the Federal	 
Emergency Management Agency (FEMA), and potential issues with	 
implementation, (2) whether National Voluntary Organizations	 
Active in Disasters (NVOAD)--an umbrella organization of 49	 
voluntary agencies--is equipped to fulfill its NRF role, (3) the 
extent to which FEMA has addressed issues with mass care for the 
disabled since the hurricanes, (4) the extent to which major	 
voluntary agencies have prepared to better serve the disabled	 
since the hurricanes, and (5) the extent to which FEMA has	 
addressed issues voluntary agencies faced in receiving Public	 
Assistance reimbursement. To analyze these issues, GAO reviewed  
the NRF and other documents, and interviewed officials from FEMA,
voluntary agencies, and state and local governments.		 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-08-369 					        
    ACCNO:   A81089						        
  TITLE:     National Disaster Response: FEMA Should Take Action to   
Improve Capacity and Coordination between Government and	 
Voluntary Sectors						 
     DATE:   02/27/2008 
  SUBJECT:   Aid for the disabled				 
	     Disabilities					 
	     Disaster planning					 
	     Disaster recovery plans				 
	     Disaster relief aid				 
	     Emergency management				 
	     Emergency preparedness				 
	     Emergency preparedness programs			 
	     Emergency response 				 
	     Emergency response personnel			 
	     Emergency response plans				 
	     Federal agencies					 
	     Federal/state relations				 
	     Hurricane Katrina					 
	     Hurricanes 					 
	     Interagency relations				 
	     Natural disasters					 
	     Program evaluation 				 
	     Public assistance programs 			 
	     Volunteer services 				 
	     Program coordination				 
	     Program implementation				 
	     National Response Plan				 

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GAO-08-369

   

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Report to Congressional Requesters: 

United States Government Accountability Office: 
GAO: 

February 2008: 

National Disaster Response: 

FEMA Should Take Action to Improve Capacity and Coordination between 
Government and Voluntary Sectors: 

GAO-08-369: 

GAO Highlights: 

Highlights of GAO-08-369, a report to congressional requesters. 

Why GAO Did This Study: 

Using lessons from the 2005 Gulf Coast hurricanes, the federal 
government released the National Response Framework (NRF) in January 
2008. This report examines (1) why the primary role for mass care in 
the NRF shifted from the Red Cross to the Federal Emergency Management 
Agency (FEMA), and potential issues with implementation, (2) whether 
National Voluntary Organizations Active in Disasters (NVOAD)ï¿½an 
umbrella organization of 49 voluntary agenciesï¿½is equipped to fulfill 
its NRF role, (3) the extent to which FEMA has addressed issues with 
mass care for the disabled since the hurricanes, (4) the extent to 
which major voluntary agencies have prepared to better serve the 
disabled since the hurricanes, and (5) the extent to which FEMA has 
addressed issues voluntary agencies faced in receiving Public 
Assistance reimbursement. To analyze these issues, GAO reviewed the NRF 
and other documents, and interviewed officials from FEMA, voluntary 
agencies, and state and local governments. 

What GAO Found: 

FEMA and the Red Cross agreed that FEMA should be the primary agency 
for mass care in the NRF because the primary agency should be able to 
direct federal agenciesï¿½ resources to meet mass care needs, which the 
Red Cross cannot do. The shifting roles present several implementation 
issues. For example, while FEMA has enhanced responsibilities for 
coordinating the activities of voluntary organizations, it does not 
currently have a sufficient number of specialized staff to meet this 
responsibility. 

NVOAD has characteristics that help it carry out its broad role of 
facilitating voluntary organization and government coordination, but 
limited staff resources constrain its ability to effectively fulfill 
its role in disaster response situations. NVOAD held daily conference 
calls with its members after Hurricane Katrina, but these calls were 
not an effective means of sharing information, reflecting the fact that 
NVOAD had only one employee at the time of Katrina. 

FEMA has begun taking steps in several areas to improve mass care for 
the disabled based on lessons learned from the Gulf Coast hurricanes. 
For example, FEMA hired a Disability Coordinator to integrate 
disability issues into federal emergency planning and preparedness 
efforts. However, FEMA has generally not coordinated with a key federal 
disability agency, the National Council on Disability, in the 
implementation of various initiatives, as required by the Post-Katrina 
Emergency Management Reform Act of 2006. 

The Red Cross has taken steps to improve mass care services for the 
disabled, but still faces challenges. For example, the Red Cross 
developed a shelter intake form to assist staff in determining whether 
a particular shelter can meet an individualï¿½s needs. However, Red Cross 
officials said that some local chapters are still not fully prepared to 
serve individuals with disabilities. Other voluntary organizations had 
not identified a need to improve services for individuals with 
disabilities, and we did not identify concerns with their services. 
FEMA has partially addressed the issues faced by local voluntary 
organizations, such as churches, in seeking Public Assistance 
reimbursement for mass care-related expenses after the hurricanes. At 
the time of the hurricanes, a key FEMA reimbursement program was not 
designed for a disaster of Katrinaï¿½s magnitude, but FEMA has changed 
its regulations to address this issue. Local voluntary organizations 
also had difficulty getting accurate information about reimbursement 
opportunities. Key FEMA staff had not received training on 
reimbursement policies and sometimes did not provide accurate 
information, and some of the information on FEMAï¿½s Web site was not 
presented in a user-friendly format. FEMA has not addressed these 
communication issues. 

What GAO Recommends: 

GAO recommends that (1) FEMA improve coordination with voluntary 
agencies, such as by enhancing capabilities of its specialized staff, 
(2) NVOAD improve information-sharing during the response to disasters, 
and (3) FEMA increase coordination with the National Council on 
Disability. Agency officials agreed with the recommendations. 
[hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-08-369]. 

To view the full product, including the scope and methodology, click on 
the link above. For more information, contact Cynthia Fagnoni at (202) 
512-7215 or [email protected]. 

[End of section] 

Contents: 

Letter: 

Results in Brief: 

Background: 


FEMA Became the Primary Mass Care Agency Because the Red Cross Cannot 
Direct Federal Resources, and the Shifting Roles Present Several 
Implementation Issues: 

NVOAD Has Several Characteristics That Help It Carry Out Its ESF-6 
Role, but Is Constrained by Limited Staff Resources: 

FEMA Has Made Progress Addressing Mass Care Issues for the Disabled, 
but Has Generally Not Coordinated as Required with NCD: 

The Red Cross Has Taken Steps to Better Serve the Disabled, but 
Continues to Face Challenges: 

Local Voluntary Agencies Faced Several Problems in Obtaining 
Reimbursement and FEMA Has Partially Addressed These Issues: 

Conclusion: 

Recommendations: 

Agency Comments and Our Evaluation: 

Appendix I: Objectives, Scope, and Methodology: 

Appendix II: NVOAD Members: 

Appendix III: Job Duties of FEMA Voluntary Agency Liaisons: 

Appendix IV: Shelter Intake Form: 

Appendix V: Comments from NVOAD: 

Appendix VI: Comments from NCD: 

Appendix VII: GAO Contact and Staff Acknowledgments: 

Bibliography: 

Related GAO Products: 

Tables: 

Table 1: NVOAD Responsibilities under the NRF: 

Figures: 

Figure 1: Red Cross Roles in Disaster Response: 

Figure 2: FEMA Regions Covered by Voluntary Agency Liaisons, as of 
December 2007: 

Figure 3: Information Flow on NVOAD Conference Calls after Hurricane 
Katrina: 

Figure 4: FEMA Response to NCD Coordination Requirements in the Post- 
Katrina Act, as of December 2007: 

Abbreviations: 

ADA: Americans with Disabilities Act: 

DHS: Department of Homeland Security: 

ESF: emergency support function: 

FEMA: Federal Emergency Management Agency: 

NCD: National Council on Disability: 

NRF: National Response Framework: 

NRP: National Response Plan: 

NSS: National Shelter System: 

NVOAD: National Voluntary Organizations Active in Disasters: 

OIG: Office of the Inspector General: 

VAL: Voluntary Agency Liaison: 

[End of section] 

United States Government Accountability Office:
Washington, DC 20548: 

February 27, 2008: 

Congressional Requesters: 

The 2005 Gulf Coast hurricanes caused extensive human suffering and 
damage along the Gulf Coast, and highlighted the need for improved 
coordination of mass care services, such as shelter and feeding. 
Voluntary organizations, including the American Red Cross and the 
Salvation Army, play a critical role in providing these services after 
disasters. Using lessons learned from the hurricanes, the Department of 
Homeland Security (DHS) has developed the National Response Framework 
(NRF) that defines the roles of federal, state, local, tribal 
governments; the private sector; and voluntary organizations in 
response to disasters, including mass care. The NRF--which was released 
in January 2008--designates 15 emergency support functions (ESF) that 
address specific disaster response needs. The NRF made a key change to 
the prior 2004 National Response Plan (NRP) by shifting the primary 
agency responsibility for coordinating federal support for mass care 
under the sixth emergency support function (ESF-6) from the Red Cross 
to the Federal Emergency Management Agency (FEMA), a federal agency 
that is a component of DHS. [Footnote 1] As the primary agency for mass 
care, FEMA is responsible for convening organizations that are part of 
ESF-6 after disasters and responding to state requests for assistance 
by directing resources from federal agencies to meet state needs. Under 
the NRF, states continue to have principal responsibility for meeting 
mass care needs. 

When responding to a disaster, states utilize the mass care services of 
voluntary organizations. The Red Cross--the nation's largest mass care 
provider--has two distinct roles in disaster response. As a support 
agency under ESF-6 of the NRF, the Red Cross assists FEMA and states in 
coordinating mass care activities. The Red Cross also maintains a 
separate role outside of the federal framework as a private mass care 
service provider using donated funds. National Voluntary Organizations 
Active in Disasters (NVOAD), an umbrella organization of 49 nonprofits 
(see app. II for a list of NVOAD members as of December 2007), is also 
a support agency under ESF-6. NVOAD has responsibility for sharing 
information and facilitating collaboration among its members while 
these organizations plan for and respond to disasters. As support 
agencies, the Red Cross and NVOAD work with FEMA at the nation's 
disaster response center after disasters. After Hurricanes Katrina and 
Rita, mass care services to the disabled and elderly were identified as 
a key problem. Partly in response, Congress passed the Post-Katrina 
Emergency Management Reform Act of 2006[Footnote 2] (Post-Katrina Act 
or the Act), which included provisions directing FEMA to assist states, 
localities, and voluntary organizations in preparing to serve these 
populations. 

After Katrina, local voluntary organizations--such as churches--played 
a critical role in providing mass care. At one point after Katrina, 
nearly as many evacuees were staying in shelters operated by churches 
and other small nonprofits as were staying in Red Cross shelters. 
[Footnote 3] These organizations often sought reimbursement for related 
expenses through the Public Assistance program, which is administered 
by FEMA. The federal government generally provides funds to state and 
local governments through the Public Assistance program, which then 
reimburse voluntary organizations. 

Our previous work on the federal response to the 2005 Gulf Coast 
hurricanes identified three main areas of concern: a lack of clearly 
defined roles and responsibilities, the capabilities to perform those 
roles and responsibilities, and accountability for resources.[Footnote 
4] This report examines the following questions: (1) What was the 
rationale of DHS for shifting the primary role for coordinating mass 
care from the Red Cross to FEMA, and what are potential implementation 
issues associated with this change? (2) How well equipped is NVOAD to 
fulfill its role in ESF-6 of the NRF? (3) To what extent has FEMA 
addressed issues that arose after Hurricanes Katrina and Rita with the 
provision of mass care services to the disabled and elderly? (4) To 
what extent have major national voluntary organizations made 
preparations since Hurricanes Katrina and Rita to better meet the mass 
care needs of the disabled and elderly? and (5) What difficulties did 
local voluntary organizations providing mass care after Katrina and 
Rita face in being reimbursed under FEMA's Public Assistance Program, 
and to what extent has FEMA addressed these issues? 

To obtain information on changes in the roles of FEMA and the Red Cross 
under the NRF, we reviewed key FEMA and Red Cross documents, such as 
the new NRF, and interviewed officials from FEMA, the Red Cross, other 
major national voluntary organizations, including the Salvation Army 
and Southern Baptists, and emergency management officials from a 
selection of states that included Louisiana, Mississippi, and nine 
other states throughout the country to help us identify potential 
implementation issues with the shift in roles in the new ESF-6. We 
gathered information about NVOAD's capability to perform its NRF role 
by reviewing NVOAD documents about its member services, internal 
governance, funding and plans for the future. We also interviewed 
officials from NVOAD, eight of NVOAD's member organizations, and FEMA 
to obtain additional information. To gather information about the 
efforts made by FEMA and voluntary organizations to improve services 
for individuals with disabilities and the elderly, we interviewed FEMA 
officials, officials from five major national voluntary organizations- 
the Red Cross, Salvation Army, Catholic Charities, Southern Baptists, 
and United Way-local-and state-level emergency managers from 
Mississippi, Louisiana, and Texas, and officials from advocacy groups 
for elderly and disabled populations.[Footnote 5] We also reviewed FEMA 
and Red Cross documents that pertained to the elderly and disabled. To 
examine issues related to the Public Assistance Program, we reviewed 
FEMA's regulations, policies, and protocols for reimbursements at the 
time of Katrina and subsequent changes to these regulations, policies 
and procedures. We also reviewed FEMA's website and interviewed 
officials within FEMA's Public Assistance Program, FEMA's Voluntary 
Agency Liaisons, local voluntary organizations providing mass care that 
sought reimbursement, and state and local governments in the Gulf Coast 
region. Finally, we reviewed reports on the response to the Gulf Coast 
hurricanes. For a list of the reports that we reviewed, see our 
bibliography. 

We conducted this performance audit between January 2007 and February 
2008 in accordance with generally accepted government auditing 
standards. Those standards require that we plan and perform the audit 
to obtain sufficient, appropriate evidence to provide a reasonable 
basis for our findings and conclusions based on our audit objectives. 
We believe that the evidence obtained provides a reasonable basis for 
our findings and conclusions based on our audit objectives. 

Results in Brief: 

DHS and the Red Cross agreed that the mass care primary agency role in 
the NRF should be shifted from the Red Cross to FEMA in large part 
because the primary agency needs to be able to direct federal 
resources, which the Red Cross cannot do. Although the Red Cross' 
specific responsibilities in ESF-6 have largely remained the same as it 
shifts to a support agency role, a key change is that the Red Cross 
will be responsible for reporting data from only Red Cross shelters-- 
not all shelters, as was previously required. States will report data 
from non-Red Cross shelters. The changing ESF-6 roles of the Red Cross 
and FEMA raise several potential implementation issues once the NRF 
takes effect. First, the NRF includes expectations for the development 
of a shelter database to be used for collecting and reporting shelter 
data. Although FEMA and the Red Cross have developed an initial 
database for collecting and reporting shelter data, FEMA is still 
working to develop a federal shelter database that will track 
demographic data on shelter populations. Second, officials in some 
states we contacted were concerned about their ability to collect and 
report complete information from shelters. In particular, state 
officials were concerned about collecting data from unplanned shelters, 
which are usually opened by organizations with no disaster response 
experience. Third, while ESF-6 calls for an enhanced federal effort in 
helping coordinate voluntary agency assistance, FEMA does not have 
enough staff resources to fulfill this responsibility. Voluntary Agency 
Liaisons (VAL) are FEMA employees who coordinate the activities of 
voluntary organizations and FEMA, but currently there is only one full- 
time VAL who can work on the full range of coordination issues in each 
FEMA region, which can include up to eight states. In addition, VALs do 
not currently receive any role-specific training. Last, although FEMA 
has made progress, the agency has not yet completed its efforts to 
identify and fill gaps in mass care capabilities. For example, FEMA has 
completed an initial analysis of gaps in state mass care capabilities 
in 18 states, but is still working to expand this initiative to all 
states. 

Although NVOAD has several characteristics that help it carry out its 
role in coordinating the activities of voluntary organizations under 
ESF-6, staff limitations constrain its ability to effectively fulfill 
its role in disaster response. NVOAD is well positioned for its 
coordination role because it does not compete with its members for 
donor funds and brings together voluntary organizations with diverse 
objectives under one organization. NVOAD's mission has historically 
been building relationships among its members and sharing information 
prior to disasters, and most NVOAD member organizations with which we 
spoke said that it is effective in this role. NVOAD's ESF-6 role also 
includes coordination responsibilities after disasters, but NVOAD's 
coordination efforts in responding to Hurricanes Katrina and Rita were 
not an effective way of providing key information, according to NVOAD 
members we spoke with. NVOAD's primary form of communication with its 
members during the Gulf Coast hurricanes was daily conference calls, 
but the calls often ran long and dealt with many issues that were not 
of relevance to the whole group. NVOAD's executive director told us 
that these problems were due to staff limitations--during Katrina NVOAD 
had only one staff person, and currently it has two. NVOAD's new 
executive director agreed that the communication strategy after Katrina 
was not effective, and told us that improving NVOAD's use of Web- 
technology to better share information after disasters is one of 
several key areas for improvement. 

FEMA has made progress in addressing a number of the problems with the 
provision of mass care for the disabled since the hurricanes, but has 
generally not coordinated with disability experts as required by the 
Post-Katrina Act. After Hurricanes Katrina and Rita, reports from 
several federal agencies identified specific steps FEMA should take to 
improve mass care services for the disabled in two key areas: providing 
information to help states plan for meeting the needs of this 
population and increasing the participation of people with disabilities 
and subject matter experts in the planning process. FEMA has begun 
addressing both of these issues as it implements requirements of the 
Post-Katrina Act. To help with state planning efforts, FEMA has 
developed a standard definition of "special needs" populations, which 
refers to individuals who may need additional assistance after 
disasters in functional areas such as maintaining independence, 
communication, or medical care. In addition, in accordance with the 
requirements of the Act, FEMA has appointed a Disability Coordinator 
who is responsible for integrating disability issues into federal 
emergency planning and preparedness efforts. However, FEMA has 
generally not coordinated with the National Council on Disability 
(NCD)--a federal agency that addresses disability issues--as required 
by the Act. We found that FEMA did not coordinate with NCD on several 
initiatives for which the Act specifically required coordination, such 
as an initiative to define the disaster response capabilities state and 
local governments should possess. As a result, disability-related 
concerns may not be fully addressed. 

Of the major national voluntary organizations we examined, only the Red 
Cross has taken steps to better prepare for meeting the mass care needs 
of disabled individuals, and the Red Cross faces continuing challenges 
in ensuring that these needs will be met. We identified two major 
concerns with the Red Cross' services after the Gulf Coast hurricanes: 
a lack of appropriate intake procedures that resulted in some 
individuals with disabilities who could have been served being turned 
away from Red Cross shelters, and a lack of accessibility for the 
disabled in some shelters. The Red Cross has developed a shelter intake 
form that should allow volunteers to better determine whether a 
particular shelter can meet an individual's needs. The Red Cross has 
also developed new training for its mass care managers to help them 
address the needs of the disabled. Red Cross headquarters officials 
told us, however, that some Red Cross local chapters are still not 
fully prepared to serve individuals with disabilities and that it has 
been difficult to encourage local chapters to implement accessibility 
policies. Officials from the other major national voluntary 
organizations said that the hurricanes had heightened their awareness 
of issues faced by the disabled but that they had not identified a need 
to improve services for these individuals. We did not find issues with 
these organizations' services, largely because these organizations 
focus on feeding and other services that require fewer modifications 
for the disabled than sheltering. 

Voluntary organizations faced two types of difficulties in seeking 
reimbursement under the Public Assistance program: limitations in the 
scope of program coverage and communication difficulties. At the time 
of Katrina, FEMA regulations only allowed voluntary organizations 
providing services within disaster areas to be reimbursed by state and 
local governments for mass care expenses, despite the fact that Katrina 
evacuees dispersed throughout the country. FEMA has since amended these 
regulations to allow voluntary organizations acting on behalf of 
eligible disaster victims outside of declared disaster zones to be 
reimbursed for services provided. Voluntary organizations also faced 
problems in obtaining clear and accurate information about 
reimbursement policies and procedures, but FEMA has not addressed this 
issue. FEMA VALs--FEMA's key liaisons to the voluntary sector--do not 
receive training on Public Assistance program policies, and many 
representatives of voluntary organizations that sought assistance from 
VALs told us that VALs either could not provide them with basic 
information or provided them with the wrong information. In addition, 
although FEMA Public Assistance program policies are available on 
FEMA's Web site, we found that some of the information is not presented 
in a user-friendly format that would help voluntary organizations 
navigate Public Assistance opportunities and does not include contact 
information for obtaining assistance. 

We are making several recommendations to improve the ability of federal 
agencies and voluntary organizations to coordinate and respond to 
disasters. To ensure that FEMA has the staff resources necessary to 
meet its role in coordinating with voluntary organizations, we 
recommend that FEMA take action to enhance the capabilities of its VAL 
workforce. We are also recommending that to improve its ability to meet 
its NRF information-sharing responsibilities after disasters, NVOAD 
assess its members' information needs and improve its communication 
strategies, and that FEMA provide technical assistance to NVOAD in this 
effort. To ensure that disability issues are fully included in FEMA's 
planning efforts, we are recommending that FEMA develop specific action 
steps for how it will coordinate with NCD with regard to relevant 
provisions of the Post-Katrina Act. In addition, to help ensure that 
voluntary organizations can readily obtain clear and accurate 
information about the Public Assistance program, we are recommending 
that FEMA take action to make the information on its Web site about 
reimbursement opportunities for voluntary organizations more user- 
friendly. Agency officials agreed with our recommendations. 

Background: 

Hurricanes Katrina and Rita caused extensive human suffering and damage 
in Louisiana, Mississippi, and Texas. Hurricane Katrina made landfall 
in Mississippi and Louisiana on August 29, 2005, and alone caused more 
damage than any other single natural disaster in the history of the 
United States. Hurricane Katrina destroyed or made uninhabitable an 
estimated 300,000 homes--more than three times the total number of 
homes destroyed by the four major hurricanes that hit the continental 
United States in August and September 2004. Hurricane Rita followed on 
September 24, 2005, making landfall in Texas and Louisiana and adding 
to the devastation. Hurricane Katrina alone caused $96 billion property 
damage. 

Voluntary Organizations' Roles in Disasters: 

Voluntary organizations have historically played a large role in the 
nation's response to disasters. These organizations raised more than 
$3.4 billion in cash donations in response to the Gulf Coast hurricanes 
as of February 2006, according to the Center on Philanthropy at Indiana 
University. The American Red Cross raised more than $2.1 billion, about 
two-thirds of all dollars raised. The Salvation Army raised the second- 
highest amount, $325 million, Catholic Charities raised about $150 
million, and the Southern Baptist National Convention raised about $20 
million. 

Voluntary organizations' roles in responding to disasters can vary. 
Some, including the American Red Cross and the Salvation Army, are 
equipped to arrive at a disaster scene and provide immediate mass care, 
including food, shelter, and clothing, and in some circumstances, 
emergency financial assistance to affected persons. Other voluntary 
organizations focus on providing longer-term assistance, such as job 
training, scholarships, or mental health counseling. In addition, 
churches and other community organizations that do not traditionally 
play a role in disaster response may begin providing these services. 
For example, many small churches and other organizations provided 
sheltering services after the Gulf Coast hurricanes. 

The Red Cross: 

Since its founding in 1881, the Red Cross has offered humanitarian care 
to the victims of war and devastating natural disasters. The 
organization is a private nonprofit entity but, since 1905, has had a 
congressional charter. Under the congressional charter the purposes of 
the Red Cross are to provide volunteer humanitarian assistance to the 
armed forces, serve as a medium of communication between the people of 
the United States and the armed forces, and provide disaster prevention 
and relief services. Although it is congressionally chartered, the Red 
Cross provides these services as a private organization. 
Following a disaster, the Red Cross serves as a direct service provider 
to disaster victims. In this capacity, the organization provides 
services that include feeding, sheltering, financial assistance, and 
emergency first aid. 

After Hurricanes Katrina and Rita, the Red Cross estimated that it 
provided more than 3.7 million hurricane victims with financial 
assistance, 3.4 million overnight stays in almost 1,100 shelters, and 
more than 27.4 million hot meals and 25.2 million snacks. According to 
the Red Cross, its efforts after Hurricanes Katrina and Rita were 
larger than for any previous disaster relief effort. For example, the 
Red Cross provided more than six times the number of shelter nights 
after Katrina and Rita than it did in the entire 2004 hurricane season, 
when four major hurricanes--Charley, Francis, Ivan, and Jeanne--struck 
the continental United States in August and September. 

The NRF: 

The NRF is a guide to how the nation conducts all-hazards disaster 
response, including support for voluntary organizations providing 
shelter, food, and other mass care services. The NRF revises the 
nation's prior disaster plan, the NRP, which was originally signed by 
major federal government agencies, the Red Cross and NVOAD in 2004. 
Major federal government agencies, the Red Cross, NVOAD, and other 
voluntary organizations are included in the NRF. The NRF is designed on 
the premise that disaster response is generally handled by local 
jurisdictions. In the vast majority of disasters, local emergency 
personnel, such as police, fire, public health, and emergency 
management personnel, act as first responders and identify needed 
resources to aid the community. Local jurisdictions can also call on 
state resources to provide additional assistance. The federal 
government responds to state or local requests for assistance when an 
incident occurs that exceeds state or local response capability or when 
an incident falls within its own response authorities. In such 
situations it may use the National Response Framework to involve all 
appropriate response partners. The primary authority under which the 
federal government provides assistance to states after a disaster is 
the Robert T. Stafford Disaster Relief and Emergency Assistance Act 
(Stafford Act). [Footnote 6] It authorizes the President to issue a 
major disaster or emergency declaration when a state's resources are 
overwhelmed and the governor makes a request for federal assistance. 
Under the Stafford Act, the federal government provides assistance for 
mass care, debris removal, restoration of facilities, and financial aid 
to families and individuals, among other activities. After disasters 
that result in extraordinary levels of mass casualties or damage, 
called catastrophes, the federal government can invoke the Catastrophic 
Incident Annex of the NRF. The Annex does not assume that local 
governments--which may no longer be functioning--will ask for 
assistance, but rather that the federal government will provide 
resources to the local level before being asked. 

ESF-6: 

In addition to outlining the organizational structure used to respond 
to disasters, the National Response Framework designates 15 emergency 
support functions. ESF-6 creates a working group of key federal 
agencies and voluntary organizations to coordinate federal assistance 
in support of state and local efforts to provide: 

* mass care, including sheltering, feeding, and emergency first aid; 
* emergency assistance, such as coordination with voluntary 
organizations; reunification of families; pet evacuation and 
sheltering; support to specialized shelters; and support to medical 
shelters; 
* housing, both short-and long-term; and: 
* human services, such as counseling and processing of benefits. 

The NRF assigned FEMA to be the primary agency for a new component of 
ESF-6, called emergency assistance, to ensure that immediate needs that 
are beyond the scope of traditional mass care are addressed. Emergency 
assistance adds new expectations for coordination with voluntary 
organizations by the ESF-6 working group, stating that the group works 
with non-governmental and faith-based organizations to facilitate an 
inclusive, coordinated response effort. In addition, the emergency 
assistance component includes the expectation that a National Shelter 
System (NSS) will provide data from shelters. The NSS is a Web-based 
system that provides information on shelter facilities, capacity, and 
population counts. 

In addition to its role as a service provider, the Red Cross has 
specific responsibilities as a support agency under ESF-6. ESF-6 
specifies that these activities are separate from its role as a direct 
service provider. The Red Cross announced in January 2008 that it 
planned to make significant layoffs to its staff at the Red Cross 
national headquarters. These layoffs could potentially have 
implications for the Red Cross' capacity to meet its NRF 
responsibilities. However, the Red Cross had not announced details of 
these layoffs as of mid-February 2008. Figure 1 describes the Red 
Cross' roles as a service provider, and in ESF-6.  

Figure 1: Red Cross Roles in Disaster Response:  

[See PDF for image] 

This figure is a listing of the following information:  

American Red Cross as a private service provider: 
* Shelters; 
* Feeds; 
* Provides emergency first-aid; 
* Distributes emergency supplies; 
* Provides mental health support; 
* Provides emergency financial assistance to families; 
* Assists in reuniting family members. 

American Red Cross as an ESF-6 support agency: 
FEMA, NRF; States; American Red Cross: combine to provide a safety net: 
* Provides Red Cross staff to work daily at DHS/FEMA regional offices 
in support of ESF #6 Mass Care activities; 
* Provides specially trained liaisons to work at designated DHS/FEMA 
locations to support ESF #6 Mass Care activities as requested; 
* Provides subject-matter expertise on general mass care planning, 
preparedness, and response activities, as well as Red Cross-specific 
activities in these areas; 
* Provides information on current Red Cross mass care activities as 
requested prior to and during response operations.  

Source: GAO analysis; images: Art Explosion.  

[End of table]  

Mass care for individuals with disabilities:  

Estimates place the population of individuals with disabilities in the 
United States at nearly 20 percent of the entire population, and the 
percentage of people over age 80 with disabilities at 72 percent. 
Although there are few statistics on the impact of Hurricane Katrina on 
the disabled, the White House report on the federal response to Katrina 
estimated that over two-thirds of the 1,300 victims who died were over 
age 60. Individuals with disabilities are a diverse group, including 
those with disabilities affecting individuals' functioning in a number 
of different ways. For example, some disabilities, such as paraplegia, 
affect individuals' mobility, and other disabilities, such as deafness, 
affect communication. Many of these disabilities can be prepared for 
and accommodated in general population shelters. For example, with 
modifications to existing facilities, many mobility impairments can be 
addressed. These modifications can include ensuring accessible routes 
for people with wheelchairs, crutches, or walkers from sleeping 
quarters to dining areas and toilet/bathing areas, ramps, and handrails 
in toilet facilities. Modifications for communication-related 
disabilities can include braille signs for the blind. State and local 
governments operate medical shelters for those individuals with serious 
medical needs, including some disabled individuals.  

Post-Katrina Act:  

On October 4, 2006, Congress passed the Post-Katrina Emergency 
Management Reform Act of 2006. That Act elevated FEMA's status within 
the Department of Homeland Security, enhanced its organizational 
autonomy, and redefined its role. It provided that FEMA's primary 
mission is to reduce the loss of life and property and protect the 
United States from all hazards by leading efforts to prepare for, 
respond to, and recover from natural disasters, acts of terrorism, 
other man-made disasters, and catastrophic incidents. In partnership 
with state, local, and tribal governments, emergency response 
providers, the private sector, and nongovernmental organizations as 
well as other federal agencies, FEMA is tasked with building a national 
system of emergency management. The Act included a number of provisions 
that should provide a new focus on assistance to individuals with 
disabilities in connection with these efforts. It directs the 
Administrator of FEMA to appoint a Disability Coordinator who is 
required to report directly to the Administrator to ensure that the 
needs of individuals with disabilities are being properly addressed in 
emergency preparedness and disaster relief, and assigns a detailed set 
of responsibilities to the Coordinator. The Post-Katrina Act provides 
authority for FEMA to address the needs of individuals with 
disabilities by adding the Americans with Disabilities Act's definition 
of "individual with a disability" to the Stafford Act and requires that 
the FEMA Administrator develop guidelines concerning the provision of 
services to individuals with disabilities in connection with emergency 
facilities and equipment. The Post-Katrina Act adds individuals with 
disabilities and those with limited English proficiency to the 
discrimination prohibition provisions of the Stafford Act and directs 
FEMA to work with state and local governments to identify critical gaps 
in regional capabilities to respond to populations with special needs.  

Public Assistance Program: 

The Public Assistance program provides assistance primarily to state 
and local governments to repair and rebuild damaged public 
infrastructure and includes activities such as removing debris, 
repairing roads, and reconstructing government buildings and utilities. 
Specifically, applicants submit requests for work that are considered 
for eligibility and subsequent funding. FEMA obligates funds for 
approved projects, providing specific amounts to complete discrete work 
segments on projects, while state and local governments pay the 
remainder based on the state's cost share agreement with FEMA. As of 
March 16, 2007, FEMA has obligated about $4.6 billion to Louisiana and 
about $2 billion to Mississippi through its Public Assistance program. 
Under the Public Assistance program, state and local governments can 
reimburse voluntary organizations for several types of expenses. First, 
they can be reimbursed for facility damage if they meet certain 
eligibility criteria such as being an educational, medical or custodial 
care facility. Second, voluntary organizations can be reimbursed for 
evacuation and sheltering expenses (such as increased utility expenses, 
cots, and food). The Post-Katrina Act expanded the universe of 
voluntary organizations eligible for reimbursement for facilities 
damage after future disasters. Private non-profit facilities that serve 
certain specified functions (education, utility, irrigation, emergency, 
medical, rehabilitation, and temporary custodial care) as defined by 
the President, no longer need to provide essential services of a 
governmental nature to the general public in order to be eligible for 
reimbursement. The Act also added another group of private nonprofit 
facilities potentially eligible for assistance by defining the term to 
include any facility providing essential services of a governmental 
nature to the general public (including museums, zoos, performing arts 
facilities, and community arts centers), as defined by the President. 
The facilities in this group are similar to those identified in FEMA 
regulations. Under the Public Assistance program, the federal 
government typically pays 75 percent of costs, and state governments 
pay 25 percent, however, after Katrina the federal government paid 100 
percent of the cost-share requirement in 45 states that sheltered 
evacuees. 

FEMA Became the Primary Mass Care Agency Because the Red Cross Cannot 
Direct Federal Resources, and the Shifting Roles Present Several 
Implementation Issues: 

FEMA replaced the American Red Cross as the primary agency for mass 
care in large part because the two organizations agreed that the 
primary agency needs to be able to direct federal resources. Although 
the Red Cross' specific responsibilities under the NRF have largely 
remained the same, one change is that the Red Cross will no longer be 
expected to report data for all shelters, only Red Cross shelters. The 
changing roles of the Red Cross and FEMA present several implementation 
issues. With respect to sheltering, the NRF includes the expectation 
that a national shelter system will be developed to collect and report 
shelter data. FEMA and the Red Cross have developed an initial system 
for collecting and reporting data on shelters, but FEMA is still 
working to develop a federal shelter database. Furthermore, some states 
have indicated that they are concerned about their ability to collect 
and report data from non-Red Cross shelters. In addition, the NRF 
places increased responsibility on FEMA for coordinating with voluntary 
organizations, but FEMA does not have sufficient staff resources to 
meet this responsibility. Last, although FEMA has made progress, its 
efforts to identify and fill gaps in mass care capabilities are not yet 
complete. 

FEMA and Red Cross Agreed That FEMA Should Be the Primary Mass Care 
Agency Because It Can Direct Federal Resources: 

The Red Cross and FEMA agreed in February 2007 letters that because the 
Red Cross cannot legally direct federal resources, FEMA is better 
positioned to be the primary agency for ESF-6 mass care. The letters 
indicated that the primary agency for mass care should be able to 
direct federal resources in response to state requests for assistance, 
which the Red Cross--as a nongovernmental entity--does not have the 
legal authority to do. The Red Cross' inability to direct federal 
resources after the Gulf Coast hurricanes contributed to problems that 
we highlighted in our June 2006 report.[Footnote 7] After Katrina, the 
Red Cross could not go directly to federal agencies for resources to 
fulfill requests for assistance, but instead had to request these items 
through FEMA, which then directed the appropriate federal agencies to 
supply the needed materials or services. This resulted in confusion 
about roles and led to duplicative requests. 

In the February 2007 letters, the Red Cross and FEMA also agreed that 
the expansion of ESF-6 to include a new function--emergency assistance-
-provided another reason why FEMA should be the primary agency for mass 
care. The primary agency for mass care will need to coordinate mass 
care activities with the primary agency for emergency assistance--FEMA-
-and having different primary agencies could make this more difficult. 
For example, Red Cross and FEMA officials told us that Red Cross is not 
knowledgeable about activities in the emergency assistance function, 
which would make it difficult for them to coordinate these activities 
with mass care. FEMA and the Red Cross agreed that having FEMA serve as 
the primary agency for all four functions of ESF-6 would help ensure a 
unified command structure during operational response. 

Although the Red Cross role for mass care under the NRF will shift from 
that of a primary agency to a support agency, its specific 
responsibilities will largely remain the same as under the NRP. For 
example, the organization still provides staff to work at DHS offices 
to support ESF-6 activities and supports DHS in working with state 
agencies for mass care in planning and preparedness activities. 
However, the Red Cross will no longer have two key responsibilities 
that it had under the NRP. First, the Red Cross will no longer be 
responsible for filling out requests from states and other local 
organizations for federal assistance after a disaster and sending them 
to FEMA. This activity will now be performed primarily by states. Under 
the NRF, the Red Cross will provide guidance to states as they 
determine their needs for federal assistance. FEMA did tell us, 
however, that in some rare circumstances the Red Cross may fill out 
requests independently of states. States also filled out these requests 
under the NRP--along with the Red Cross--and state officials that we 
interviewed told us that they were familiar with this process. Second, 
the Red Cross will no longer be responsible for reporting data on the 
number and characteristics of people in shelters that are operated by 
organizations other than the Red Cross. After Katrina, the Red Cross 
was responsible for reporting data on all shelters to FEMA, including 
those operated by other organizations, but both FEMA and the Red Cross 
reported problems with this process. Now, states are responsible for 
reporting data on non-Red Cross shelters to FEMA. 

Several Implementation Issues Are Associated with the Shift in Primary 
Agency for Mass Care: 

The shifting ESF-6 roles of the Red Cross and FEMA present several 
implementation issues for FEMA, including reporting shelter data, 
coordinating with voluntary organizations and identifying and filling 
gaps in mass care capabilities. 

National Shelter System: 

In its role as primary agency, FEMA has made progress toward meeting 
NRF expectations for an NSS, but still faces several challenges. An 
initial NSS that is owned and was paid for by the Red Cross, with FEMA 
as a partner agency, is currently operational. However, FEMA is still 
working to develop a federal NSS that will be owned and housed at FEMA. 
When the federal NSS is complete, the Red Cross will enter and verify 
data for Red Cross shelters, and states will enter and verify data for 
all other shelters. FEMA officials told us that the federal NSS will be 
finished in spring 2008. Although the current version of the NSS can 
provide information on shelter location, capacity, population, physical 
accessibility for people with disabilities, and managing agency, the 
system cannot track demographic data on the types of populations 
residing in shelters. FEMA officials told us that FEMA is working to 
address this and other issues that have been identified by states in 
the federal NSS. For example, states identified the need for 
integrating Geographic Information Systems (GIS) into the system to 
provide data that are more accurate. FEMA told us that it would 
incorporate these elements into the updated system. 

In addition, many states still need to enter data into the system in 
preparation for disasters. FEMA officials said that as of November 
2007, no more than four states had inserted shelter location data and, 
as a result, most of the data in the system is on Red Cross shelters. 
The accuracy of the shelter data is contingent upon states reporting 
information into the system and updating it frequently, according to 
FEMA officials. Some state officials told us that they had just 
recently received training on NSS and were currently in the process of 
compiling the data needed. FEMA has offered states the opportunity to 
have FEMA staff help include non-Red Cross shelter data in the NSS 
after a disaster until NSS implementation is complete. FEMA officials 
told us that it will take 2 to 3 years to fully implement the federal 
NSS, because of training and time needed for states to collect, input, 
and verify data. 

During the 2007 California wildfires, FEMA deployed staff to help state 
officials collect and report data from non-Red Cross shelters with the 
NSS because California officials had not yet entered shelter data into 
the system. California officials said that the NSS was useful because 
it gave a single, accurate report on the shelter population. 

Data from Unplanned Shelters: 

State officials we spoke with told us that they could collect shelter 
data from pre-planned shelters, but officials in some states were 
concerned about their capacity to collect and report data from 
unplanned shelters that are likely to open after a major disaster. 
These shelters are likely to open if designated shelter sites are 
overcrowded, evacuees are unable to reach designated sites, or the 
designated sites are affected by the disaster. Officials from some 
states told us that they do not have a mechanism in place to collect 
data from the small, independent organizations that typically open 
these shelters. In contrast, officials from another state told us that 
they do not anticipate the need for unplanned shelters to open after a 
major disaster, and, as a result, are not concerned about collecting 
these data. 

Collecting data on unplanned shelters was a significant challenge after 
Hurricane Katrina.[Footnote 8] There was no centralized system in place 
for collecting and reporting these data after Hurricane Katrina and, as 
a result, these data often went unreported, according to FEMA and Red 
Cross officials. Because government and voluntary organizations did not 
know where many of these people were staying, this led to problems 
planning for and delivering needed resources. 

Coordination with Voluntary Organizations: 

Changes in FEMA's role under ESF-6 also present implementation issues 
with respect to coordination with voluntary organizations. The NRF 
includes a new component on voluntary organization coordination 
requiring that the ESF-6 working group--for which FEMA is the primary 
agency--coordinate federal response efforts with state, local, private, 
non-governmental, and faith-based organizations' efforts. As the 
primary agency for ESF-6, FEMA will be primarily responsible for 
addressing these issues. These requirements for coordination with 
voluntary organizations are more extensive and specific than in the 
NRP, and FEMA officials told us that FEMA voluntary agency liaisons 
(VAL) will fill this role. VALs are FEMA staff members who coordinate 
the activities of voluntary organizations with FEMA. Most FEMA VALs are 
based in FEMA regions and work with state and local voluntary 
organizations, and the regional offices of national voluntary 
organizations (see app. III for a job description for VALs). 

While the NRF calls for an enhanced FEMA role in helping coordinate 
voluntary agency assistance, FEMA does not have the staff resources 
necessary to meet this objective. As of July 2007, each FEMA region had 
one full-time VAL who could work on the entire range of coordination 
issues with voluntary organizations, as shown in figure 2.[Footnote 9] 
FEMA regions can include up to eight states. FEMA VALs are tasked with 
coordinating FEMA activities and policies with voluntary organizations 
across their regions and building the capacity of these organizations 
according to voluntary organization and FEMA officials. Effective VALs 
build relationships and network, however, many officials from voluntary 
organizations and multiple senior FEMA VALs told us that there are not 
enough full-time VALs for them to develop strong relationships in all 
of the areas covered. For example, one of the primary responsibilities 
of VALs is to improve coordination with state-and local-level voluntary 
organizations, but officials from FEMA and voluntary organizations said 
that in many states coordination between these organizations and 
government is weak. In addition, officials from some voluntary 
organizations told us that VALs have so much work it is difficult to 
communicate with them. Officials from voluntary organizations also said 
that there were not enough VALs after disasters. During the response to 
disasters, VALs can be pulled out of their own regions to assist in 
disaster-affected areas. For example, after Katrina, VALs from across 
the country were brought to the Gulf Coast. As a result, during Katrina 
these VALs were not available to respond to their own smaller scale 
regional disasters, even though they had built relationships with 
voluntary organizations in those states. At the time of Katrina, FEMA 
was providing states with assistance for 38 other disasters across the 
nation. Disaster research experts told us that there should be 
additional FEMA VALs in each region.[Footnote 10] FEMA officials told 
us that there are no plans to change the current staffing structure for 
VALs. A review of the response to Katrina by the DHS Office of the 
Inspector General (OIG) identified broader problems with human capital 
management at FEMA. For example, the DHS OIG found that FEMA does not 
have staff or plans adequate to meet its human capital needs during 
catastrophic disasters.[Footnote 11] 

Figure 2: FEMA Regions Covered By Voluntary Agency Liaisons, As Of 
December 2007: 

[See PDF for image] 

This figure is a map of the United States illustrating the ten FEMA 
regions and indicating that there is one full-time VAL per region and 2 
area offices. There are 36 Katrina VALs in the Gulf Coast States. 85 
reserve VALs across the country only become active during disasters. 
Source: GAO analysis; map, Map Resources. 

[End of figure] 

FEMA has two other types of VALs, reserves and Katrina VALs. However, 
the job responsibilities of these individuals constrain them from 
performing many VAL job duties. FEMA had 85 reserve VALs that it can 
call upon in response to major disasters, and 36 Katrina VALs as of 
December 2007. The reserve VALs are only activated during disasters, 
however, and are not available to network and build the capacity of 
voluntary organizations during preparedness. Furthermore, the Katrina 
VALs are designated specifically to address Katrina-related issues and 
FEMA is not planning to retain these individuals after Katrina-related 
work is finished. 

In addition, VALs do not receive role-specific training and, as a 
result, some VALs have not been fully prepared for their duties. The 
lack of specialized training has resulted in VALs not always being 
prepared to coordinate FEMA activities with the voluntary sector. For 
example, VALs do not receive any training on how voluntary 
organizations can receive reimbursement for their mass care activities 
during disasters. One voluntary organization official that we spoke 
with said that, while some VALs were very helpful in that they had 
access to information and resources that they would not have had 
otherwise and understood FEMA policies, other VALs were not familiar 
with key FEMA Public Assistance policies for the reimbursement of 
voluntary organizations. A senior FEMA official told us that FEMA has 
completed a VAL Handbook and is preparing to develop a pilot training 
for VALs. The DHS OIG also found that FEMA does not have an organized 
system of employee development.[Footnote 12] 

Identifying and Filling Gaps in Mass Care Capabilities: 

FEMA's broad new responsibilities under the Post-Katrina Act, and 
FEMA's new role as the primary agency for mass care, also present 
implementation issues for FEMA with regard to identifying and filling 
gaps in mass care capabilities. Although FEMA has taken several steps 
to address these issues, FEMA's efforts are not yet complete. For 
example, the Post-Katrina Act specifically requires that FEMA identify 
gaps in mass care capabilities at the state level. In response, FEMA 
has undertaken a gap analysis initiative that examines, by state, the 
gaps in disaster preparedness. This initiative, which began in 2007, 
has begun identifying gaps in hurricane-prone states along the Eastern 
seaboard and Gulf Coast. A FEMA official responsible for these efforts 
told us that the initial gap analysis had been completed in 18 high- 
risk states as of December 2007. Eventually, FEMA plans to roll this 
initiative out in every state, and to make it all-hazards rather than 
hurricane-specific. 

FEMA officials told us that they are also working to identify resources 
for situations in which the mass care capabilities of government and 
voluntary organizations are exceeded, but that FEMA is still working to 
develop a standardized system for coordinating these resources. FEMA 
officials told us that FEMA has developed contracts with private 
companies for mass care and other disaster resources for situations in 
which federal capabilities are exceeded. After Katrina, FEMA made four 
noncompetitive awards to companies for housing services. These 
contracts have since been broadened through a competitive process so 
that if a disaster struck now they could also include facility 
assessment for shelters, facility rehabilitation--including making 
facilities accessible--feeding, security, and staffing shelters. The 
FEMA official in charge of these contracts said that contractors had 
assessed facilities to determine whether they could be used as shelters 
in the Gulf Coast during the summer of 2007. He said that these 
contracts gave the federal government the option of purchasing whatever 
resources it needs in response to disasters. FEMA officials told us, 
however, that they prefer using federal resources when possible because 
contract services are more expensive. Another round of contracts will 
be awarded in May 2008 on a competitive basis. 

However, FEMA is still working to standardize training, resources, and 
terminology across the many different organizations--including the 
private sector--involved in disaster response to improve coordination 
among these organizations. FEMA is working to develop standardized 
training that could be provided to staff from all of these 
organizations. FEMA is currently working with the Red Cross to develop 
a standardized training based on current Red Cross training, according 
to a FEMA official responsible for these efforts. Having standardized 
training could, for example, make it easier for employees of 
organizations providing services contracted by the federal government 
to work in shelters operated by other organizations. A key FEMA 
official said that this standardized training should be complete by 
summer 2008. FEMA is also working to standardize disaster relief 
resources and terminology across the providers of mass care services. 
The FEMA official said that this allows disaster service providers to 
communicate more readily, and to share resources across organizations 
when necessary. NVOAD is assisting FEMA by coordinating efforts among 
voluntary organizations to standardize the types of resources used in 
disaster response. FEMA and NVOAD officials told us that having 
organizations use the same language and resources makes it easier to 
scale up disaster response operations. 

NVOAD Has Several Characteristics That Help It Carry Out Its ESF-6 
Role, but Is Constrained by Limited Staff Resources: 

NVOAD is in a unique position to coordinate voluntary organizations 
active in disaster assistance under ESF-6. NVOAD brings together 
voluntary organizations with diverse objectives and sizes under one 
organization. Moreover, NVOAD does not compete with its members for 
funds, since it is not a direct service provider. While NVOAD has 
facilitated relationship building among its members prior to disasters, 
its coordination efforts in responding to Hurricanes Katrina and Rita 
were not an effective way of providing key information. Due to staff 
limitations, the organization was unable to fully meet its information- 
sharing responsibilities under ESF-6 during the Gulf Coast hurricanes. 
Using lessons learned from Katrina, NVOAD has identified ways to 
potentially improve information sharing with its members, such as 
through enhanced use of web technology. 

NVOAD Is Positioned to Be a Coordinating Body and Has Facilitated 
Relationship Building among Members prior to Disasters: 

For several reasons, NVOAD is well positioned to coordinate voluntary 
organizations active in disaster assistance under ESF-6. First, NVOAD 
is a coordinating agency, not a direct service provider. This means 
NVOAD does not compete with its members for funds. Instead, the 
organization is primarily funded by member organizations. 

Second, NVOAD brings together voluntary organizations with diverse 
objectives, and sizes. NVOAD brings together organizations that provide 
various types of disaster response and recovery services, such as 
sheltering, feeding, home-building, and case management services, as 
well as both secular and faith-based organizations. Officials from 
member organizations told us that NVOAD helps them prepare for 
disasters by developing relationships with other individuals active in 
disaster response and recovery. These officials told us that developing 
these relationships is a critical part of preparing for disasters, and 
that NVOAD provided an opportunity to get to know officials from other 
organizations. 

Although members we spoke with noted that NVOAD's efforts were useful 
in providing opportunities for networking and collaboration, some of 
the larger and older members maintained that the organization does not 
represent their needs well. For example, officials from one member 
organization told us that NVOAD is increasingly serving the needs of 
new, start-up disaster response organizations, rather than focusing on 
its larger members. NVOAD's executive director said that one strength 
of the organization is that it gives smaller members representation in 
ESF-6. 

NVOAD Is Considering Enhancing Web Technology to Address Coordination 
Problems after Katrina, but Has Limited Staff Resources: 

NVOAD has historically helped organizations prepare for disaster 
response through relationship building, but as shown in table 1, the 
NRF also includes responsibilities for NVOAD in disaster response, in 
addition to disaster preparedness. NVOAD's ESF-6 roles and 
responsibilities have remained the same as those specified in the NRP, 
and include information-sharing and convening voluntary organizations, 
but do not include directing the activities of its members.[Footnote 
13] NVOAD fulfills its ESF-6 information-sharing role in several ways. 
First, NVOAD provides information about its members' services to FEMA, 
such as where its members are operating and what services they are 
providing. One FEMA official said that having NVOAD report information 
for all of its members made it easy to get updates from the voluntary 
sector. Second, the NVOAD organization structure provides a system for 
coordination after disasters. NVOAD includes a number of committees 
composed of NVOAD member organizations that address key mass care 
issues after disasters, such as managing donations and long-term 
recovery. For example, after the 2007 California wildfires the 
donations management committee immediately met with state officials to 
identify warehouse space to store goods donated by the private sector 
until they were needed. Third, NVOAD shares information with voluntary 
organizations about the situation on the ground and services being 
provided by different organizations after disasters. For example, after 
Katrina, NVOAD hosted daily conference calls for several months after 
Katrina to coordinate with its members. These conference calls provided 
situation updates, brought new organizations up to speed on the basics 
of disaster response, and gave organizations a forum to share 
information and collaborate with each other. 

Table 1: NVOAD Responsibilities under the NRF: 

* Facilitates and encourages collaboration, communication, cooperation, 
and coordination, and builds relationships among members while groups 
plan and prepare for emergencies and disaster incidents. 
* Assists in communicating to the government and the public the 
services provided by its national member organizations. 
* Facilitates information sharing during planning, preparedness, 
response, and recovery, and after a disaster incident. 
* Provides members with information pertaining to the severity of the 
disaster, needs identified, and actions of volunteers throughout the 
response, relief, and recovery process. 
* Provides guidance in sharing client information, in promoting 
spiritual and emotional care, and in the management of unaffiliated 
volunteers and unsolicited donated goods, as needed. 

Source: FEMA documents. 

[End of table] 

We found that these conference calls were not an effective way of 
communicating after the hurricanes. The conference calls included NVOAD 
members, federal agencies, and voluntary organizations that were not 
NVOAD members, some of which were new to the disaster response field. 
FEMA officials provided information on the situation on the ground and 
explained how FEMA was providing assistance. We participated in one 
conference call and found that it was difficult to follow. It was 
challenging to identify which region of the disaster zone speakers were 
discussing, members were discussing different issues that were not 
relevant to everyone on the call, and there were too many people on the 
call. NVOAD members with whom we spoke identified similar concerns 
about the effectiveness of the conference calls. NVOAD's executive 
director said that there were often 75 to 100 people on a single 
conference call after Katrina. Some NVOAD members also told us that the 
conference calls often ran long, which could get in the way of 
effectively meeting hurricane victims' needs. Figure 3 shows the flow 
of information during NVOAD phone calls. 

Figure 3: Information Flow on NVOAD Conference Calls after Hurricane 
Katrina: 

[See PDF for image] 

This figure is an illustration of the Information Flow on NVOAD 
Conference Calls after Hurricane Katrina. The following information is 
depicted: 

FEMA: 
* send updates and situation reports to NVOAD; 
* receive on-the-ground updates of current services from NVOAD. 

NVOAD: 
* receive updates and situation reports from FEMA; 
* relay that information to NVOAD members, nonmembers, and other 
federal agencies; 
* receive on-the-ground updates of current services from NVOAD members, 
nonmembers, and other federal agencies; 
* relay that information to FEMA. 

Source: GAO analysis; images (Art Explosion). 

[End of figure] 

NVOAD's executive director at the time of Katrina said that NVOAD was 
limited by staff resources and, as a result, couldn't do more than 
provide conference calls. During Hurricanes Katrina and Rita, NVOAD had 
one staff person. NVOAD currently has two staff persons: an executive 
director and an administrative position. NVOAD's fiscal year 2006 
operating budget was about $270,000, and NVOAD relies primarily on 
funds from its members, According to NVOAD's current executive 
director. NVOAD dues currently range from $3500 per member each year 
for its largest members to $750 for its smaller members, according to 
the executive director. Since the 2005 Gulf Coast hurricanes, NVOAD has 
increased its membership from 40 to 49, and the organization is 
currently considering increasing membership further. 

NVOAD's current executive director told us that the organization of the 
conference calls after Katrina was not an effective way to communicate 
with its members. NVOAD has identified ways to potentially enhance 
information sharing with its members. The current executive director 
told us that better use of web technology would allow NVOAD to provide 
members with disaster updates and information about member services on 
the ground in real time. NVOAD members that we spoke with told us that 
it would be helpful if NVOAD used web technology to provide certain 
information so that they wouldn't need to participate in lengthy 
conference calls. One voluntary organization official suggested that 
key information could be provided online, such as updates about the 
situation on the ground, information about what organizations are 
operating in the disaster zone, and what services are being provided by 
those organizations. However, the executive director said that 
improving the organization's use of Web technology would require 
additional resources. 

FEMA Has Made Progress Addressing Mass Care Issues for the Disabled, 
but Has Generally Not Coordinated as Required with NCD: 

FEMA has started addressing the problems with mass care services for 
the disabled that occurred after Hurricanes Katrina and Rita. Various 
assessments of FEMA's performance after the hurricanes identified 
needed improvements by FEMA in two areas: providing guidance to assist 
states and others in planning to better meet the needs of the disabled, 
and increasing the participation of people with disabilities and 
subject-matter experts in the planning process. The Post-Katrina Act 
included requirements in each area, and FEMA has taken actions in both 
of these areas. For example, in response to the Act, FEMA hired a 
Disability Coordinator to integrate disability issues into federal 
emergency planning and preparedness efforts. However, FEMA has 
generally not coordinated with NCD as required by the Act, which could 
result in disability-related concerns not being fully addressed. 
Key Gaps in Federal and State Mass Care Planning Efforts for 
Individuals with Disabilities Were Identified after the Hurricanes: 
After the 2005 Gulf Coast hurricanes, reports from the Senate Committee 
on Homeland Security and Governmental Affairs, DHS, and NCD identified 
a lack of planning as one of the most significant problems related to 
the provision of mass care to the disabled. For example, FEMA's 
Nationwide Plan Review, released in June 2006, reviewed the planning 
efforts of states and major urban areas. The report found that "One of 
the most serious deficiencies uncovered in the Review was inadequate 
planning for special needs populations,"[Footnote 14] and that no state 
or urban area was found to have sufficiently planned for these 
populations. The Nationwide Plan Review also recommended several 
specific steps that FEMA should take to help state and local 
governments with such planning: 

* develop a consistent definition of "special needs" to clarify state 
planning efforts; 
* help local governments plan by providing guidance on disability- 
related demographic analysis, and: 
* increase the participation of people with disabilities and subject- 
matter experts in the planning and preparedness process. 

In addition to recommending actions to be taken by FEMA, the Nationwide 
Plan Review also found that states need stronger accountability for the 
provision of mass care to people with disabilities. The review 
concluded that states should develop standards for the care of 
individuals with disabilities, with an emphasis on ensuring that 
accessibility for persons with disabilities is a priority factor in 
selecting emergency shelter sites. 

FEMA Has Begun Addressing the Issues with Mass Care for the Disabled, 
but Has Generally Not Coordinated with NCD as Required: 

FEMA has taken several steps to help improve planning for the disabled 
population. For example, FEMA developed a consistent definition of the 
term "special needs" that is used in the NRF. The Nationwide Plan 
Review said that at the time of Katrina the term lacked the specificity 
needed for emergency managers to accurately determine the capabilities 
necessary to respond to community needs. Through a working group of 
stakeholders, FEMA developed a definition of special needs that refers 
to those who may have additional needs before, during, or after an 
incident in one or more of the following functional areas: maintaining 
independence, communication, transportation, supervision, and medical 
care.[Footnote 15] For example, hearing-impaired individuals would be 
categorized as those needing assistance with communication. FEMA is 
also developing guidance for states as they plan for serving disabled 
populations. One such initiative has been developing guidance on 
collecting data on disabled populations, which was expected to be 
released in December 2007 according to a FEMA official. This guidance 
will respond to the Nationwide Plan Review's recommendation that the 
federal government help state and local governments incorporate 
disability-related demographic analysis into emergency planning. In 
addition, in September 2007, FEMA released target capabilities that 
define the disaster response capabilities that states should have, 
including capabilities for the disabled. For example, the document 
includes a capability that states should "Develop plans, policies, and 
procedures to ensure maximum retention of people with disabilities in 
general population shelters." A second phase of the target capabilities 
project will include capabilities that states should have for 
populations that require medical care. 

The Post-Katrina Act required that FEMA take steps to include people 
with disabilities, and subject-matter experts in the field, in planning 
and preparedness efforts, as recommended by the Review. FEMA appointed 
a Disability Coordinator, as required by the Act, who began work for 
FEMA in the summer of 2007. FEMA officials told us that this individual 
has begun working across FEMA to include disability-related concerns in 
FEMA initiatives, and with disability organizations to ensure that 
their concerns are addressed. For example, the Coordinator has been 
involved in the drafting of the NRF according to a FEMA official. In 
addition, the Coordinator was on the ground in California to assist 
with meeting the needs of individuals with disabilities after the 
wildfires in the fall of 2007. For example, the Coordinator worked to 
ensure that information and materials disseminated to the public were 
in alternative formats. 

However, FEMA has generally not coordinated with NCD, as required by 
the Act. The Act requires FEMA to coordinate with NCD in the 
implementation of several different initiatives as shown in figure 4. 
NCD and FEMA officials told us that NCD had not been consulted for many 
of these initiatives. For example, NCD was not consulted about the 
Comprehensive Assessment System, which assesses the nation's prevention 
capabilities and overall readiness. FEMA officials who work on this 
initiative said that they had not consulted directly with NCD, but were 
coordinating with the officials within FEMA who are knowledgeable about 
disability issues. Other FEMA officials said that NCD has provided 
public comment on the NRF and other key FEMA documents. Officials from 
NCD said that there has been little coordination with FEMA and that 
they had not been offered the chance to provide input on a number of 
these initiatives. As a result, disability-related issues may not be 
fully addressed. In the Nationwide Plan Review, FEMA reported that it 
is important to include the disabled in planning because it provides 
responders with hands-on experience about the needs of people with 
disabilities in disaster situations, and provides planners with the 
ability to test their plans and modifications. The two organizations 
have met several times to discuss how coordination would occur, most 
recently in October 2007. However, as of January 2008, the agencies had 
not agreed to specific action steps for how they would coordinate. 

Figure 4: FEMA Response to NCD Coordination Requirements in the Post- 
Katrina Act, as of December 2007: 

[See PDF for image] 

This figure depicts the following data: 

Requirements of the Act: Coordinate with NCD in the development of 
target capabilities[A]; 
FEMA implementation status: NCD not consulted; Phase I of the target 
capabilities released in September 2007. 

Requirements of the Act: Coordinate with NCD in development of a 
National Training Program document for emergency responders[B]; 
FEMA implementation status: NCD not consulted for National Training 
Program; Draft released in September 20007. 

Requirements of the Act: Coordinate with NCD in development of a 
Comprehensive Assessment System to assess the nationï¿½s prevention 
capabilities and overall preparedness, including operational 
readiness[C]; 
FEMA implementation status: NCD not consulted; Program was operational 
when the Act was signed. 

Requirements of the Act: Coordinate with NCD in development of a 
Remedial Action Management Program to identify and disseminate lessons 
learned and best practices and conduct remedial action tracking[D]; 
FEMA implementation status: NCD not consulted; Program was operational 
when the Act was signed. 

Requirements of the Act: Coordinate with NCD in the development of 
guidelines for accommodating individuals with disabilities after 
disaster[E]; 
FEMA implementation status: NCD provided input. 

Requirements of the Act: Coordinate with NCD in the development of a 
national disaster housing strategy[F]; 
FEMA implementation status: NCD provided input. 

Source: Post Katrina Act and interviews with FEMA and NCD officials. 

[A] Pub. L. No. 102-295, sec. 646, 120 Stat. 1426. 
[B] Pub. L. No. 102-295, sec. 648, 120 Stat. 1427. 
[C] Pub. L. No. 102-295, sec. 649, 120 Stat. 1428. 
[D] Pub. L. No. 102-295, sec. 650, 120 Stat. 1428. 
[E] Pub. L. No. 102-295, sec. 689, 120 Stat. 1448. 
[F] Pub. L. No. 102-295, sec. 683, 120 Stat. 1446. 

[End of figure] 

In response to requirements of the Post-Katrina Act, FEMA has also 
taken steps to address the need for greater state accountability for 
the mass care needs of individuals with disabilities. The Act requires 
that, as part of FEMA's gap analysis initiative, FEMA identify gaps in 
response capabilities for special needs populations at the state level. 
The template used by state and federal planners to identify gaps 
requires a substantial amount of information about special needs 
sheltering. For example, one of the indicators of readiness is whether 
states have formulas established for estimating the number of special 
needs evacuees who will require public shelter. 

In response to Post-Katrina Act requirements, FEMA also released 
guidance in August 2007 on accommodating disabled individuals. The 
guidance identifies laws that apply to nonprofits involved in disaster 
response and provides short summaries of each law. The guidance does 
not provide tools that states and nonprofits can use to implement these 
requirements. FEMA is planning to release additional guidance to 
provide state and local officials with additional information to 
improve sheltering for individuals with disabilities. In July 2007, the 
Department of Justice, which enforces the Americans with Disabilities 
Act[Footnote 16] (ADA), released detailed operational guidance for 
accommodating disabled populations in emergency shelters. This guidance 
provides a checklist that can be used to evaluate the accessibility of 
potential shelter sites. The checklist includes detailed questions that 
could assist shelter managers in evaluating shelter sites, such as 
whether there is an accessible route from shelter living space to the 
shelter's health and medical facilities. FEMA's August 2007 guidance 
includes a Web site link to the Department of Justice guidance. 

The Red Cross Has Taken Steps to Better Serve the Disabled, but 
Continues to Face Challenges: 

The Red Cross has taken several steps to address problems that occurred 
after the Gulf Coast hurricanes in meeting the mass care needs of 
disabled individuals. These problems included a lack of appropriate 
intake procedures, resulting in some disabled individuals being turned 
away from Red Cross shelters, and a lack of accessible shelter 
facilities. For example, in some shelters medical units were located on 
upper floors or other inaccessible areas, and individuals with mobility 
impairments were not provided with accessible alternatives. In response 
to such problems, the Red Cross has developed an intake form intended 
to assist volunteers in determining whether a particular shelter can 
meet an individual's needs and also developed new training on serving 
the disabled. However, the Red Cross continues to face challenges in 
this area: Red Cross officials said that local chapters have 
considerable autonomy within the organization and that it can be 
difficult to encourage chapters to implement accessibility policies. 
Other major national voluntary organizations that we examined had 
increased their attention to services for the disabled, but did not 
identify a need to improve their services for this population. We did 
not identify concerns with the services of these organizations. 
The Red Cross Has Taken Steps to Help Local Chapter Officials Serve the 
Disabled, including Developing a Shelter Intake Form and Training: 
After Hurricane Katrina, officials from the government and disability 
organizations identified two main concerns with the mass care services 
provided by the Red Cross to individuals with disabilities. The first 
was that some Red Cross shelter managers did not use shelter intake 
procedures that would have enabled them to identify individuals' 
specific disabilities and determine whether the shelter could serve 
those individuals. As a result, many individuals with disabilities were 
sent to medical shelters, which could result in families being split up 
or placing greater demands on the more resource intensive services 
provided in medical shelters. 

The Red Cross, in partnership with the Department of Health and Human 
Services, has developed a shelter intake form to address this problem 
after future disasters. The form provides a series of questions for 
shelter workers in general shelters to ask incoming evacuees (see app. 
IV for the shelter intake form). The form will allow shelter managers 
to identify disabilities and determine whether the shelter can meet the 
individual's needs, according to officials from the Red Cross and the 
Department of Health and Human Services. NCD officials told us that 
they think the form will help shelter managers make good decisions 
about whether individuals with disabilities can enter a shelter. The 
Red Cross distributed the form to its chapters along with guidance, but 
the form was often not used after the California wildfires in Red Cross 
shelters. Red Cross officials said that procedural changes like this 
often take time to be fully implemented in chapters. Officials from 
California also said that the form was not used in some cases because 
it took too long to fill out. 

The second problem identified after Hurricane Katrina was that the some 
Red Cross shelters were not accessible to individuals with disabilities 
and that the Red Cross was often not prepared to take action to make 
these facilities accessible or provide accessible alternatives. For 
example, one on-site volunteer repeatedly complained to Red Cross 
officials and shelter managers about the lack of accessible medical 
services for people with mobility disabilities. In a letter to the Red 
Cross, he wrote: 

"I have told Cajundome officials, medical staff, and Red Cross 
personnel about this problem. But I have been unsuccessful in getting 
it resolved. I have seen many frail people struggle to climb or descend 
the stairs in order to get medical attention, and I have personally 
seen two very exhausted men in wheelchairs almost decide to forego 
triage or other medical attention because of the difficulty of 
accessing this unit."[Footnote 17] 

Other frequent concerns were that accessible shower and restroom 
facilities were not provided, and that individuals with training to 
serve disabled individuals were not permitted in Red Cross shelters. 
NCD and other disability organizations have reported that these 
problems and others existed prior to Katrina. 

Officials from the Red Cross national headquarters told us that the Red 
Cross is required to comply with the ADA and, therefore, its chapters 
must make plans and take actions so that individuals with disabilities 
can stay in Red Cross shelters.[Footnote 18] Red Cross officials said 
that the only individuals who are not able to stay at Red Cross 
shelters are those with serious medical needs, and that the 
organization does not have the ability to serve these individuals. They 
said that this policy was in place at the time of Katrina and Rita. 
Federal officials and disability advocates agreed that there are some 
individuals who are not able to stay at Red Cross shelters because 
their needs are too serious. Red Cross officials also said that the Red 
Cross does not own the facilities that it uses for sheltering in a 
disaster, and that not every building that is large enough to shelter a 
community and withstand a disaster was constructed in accordance with 
current accessibility standards. The Red Cross said that it surveys 
potential shelter facilities prior to disasters and that accessibility 
to people with disabilities is one of the factors considered when 
determining whether to use a facility as a shelter. 

The Red Cross has begun addressing concerns about accessibility of its 
shelters by developing training for Red Cross employees and volunteers 
about meeting the needs of individuals with disabilities. The training 
presents information about Red Cross policies on accessibility and 
modification requirements for emergency shelters and provides examples 
of how Red Cross staff could address specific situations. It does not 
provide specific operational guidance for chapters about how to 
implement these requirements. The training, which was developed in 
collaboration with disability advocates, is required for Red Cross 
workers who have leadership roles in providing mass care after 
disasters. The training is not required for Red Cross volunteers, 
although it is recommended for key Red Cross volunteers who respond to 
disasters anywhere in the nation. 

In addition, the Red Cross told us that it has prepositioned items that 
will improve shelter accessibility for individuals with mobility 
impairments in key warehouses across the country. These items included 
8,000 cots that are designed for easy transitions from a wheelchair, 
commode chairs, and shower stools. 

Red Cross headquarters officials told us that some local chapters are 
still not fully prepared to serve individuals with disabilities after 
disasters. These officials said that, although the Red Cross has taken 
steps to educate their employees and volunteers since Katrina, it has 
been difficult to encourage chapters to prepare for and implement 
accessibility policies. Red Cross headquarters officials said that Red 
Cross chapters have considerable autonomy within the organization. 

Katrina Made Other Major National Voluntary Organizations More Aware of 
Disability Issues, but They Did Not Identify a Need to Improve Services 
for the Disabled: 

Officials from the Salvation Army, Southern Baptists, and Catholic 
Charities told us that these organizations have not made changes to 
their disaster services for the disabled, although they said that 
Katrina made them more aware of disability issues. We did not identify 
significant concerns with their services, however, largely because 
sheltering--which requires many modifications for individuals with 
disabilities--is not the focus of these organizations' services. 
Instead, these organizations specialize in services such as feeding. 
One official from a disability organization indicated that meeting 
specialized dietary needs could sometimes be a disaster-response issue, 
but that it is a much lower priority than problems with sheltering. 

Local Voluntary Agencies Faced Several Problems in Obtaining 
Reimbursement and FEMA Has Partially Addressed These Issues: 

Voluntary organizations faced limitations in the scope of program 
coverage and communication difficulties while trying to obtain 
reimbursement under the Public Assistance program after Katrina. The 
Public Assistance reimbursement program was not designed for a disaster 
of Katrina's magnitude because it only offered reimbursement to 
voluntary organizations in the disaster zone, even though evacuees 
dispersed throughout the country. FEMA has since changed its 
regulations so that after future disasters voluntary organizations 
serving evacuees outside of declared disaster zones can be reimbursed. 
Voluntary organizations also faced significant communication problems 
as they sought reimbursement, but FEMA has not taken steps to address 
these communication issues. Some voluntary organizations said that 
VALs--FEMA's liaisons to the voluntary sector--could not provide them 
with information about the Public Assistance program or provided them 
with the wrong information. FEMA VALs do not receive training on Public 
Assistance program policies. In addition, we found that some of the 
information on FEMA's Web site about the Public Assistance program was 
not presented in a user-friendly format that would help voluntary 
organizations successfully navigate reimbursement policies and 
procedures. As a result of these various communication problems, some 
organizations said that they never found out about reimbursement 
opportunities, or got so frustrated with the process that they chose 
not to apply. 

Limited Scope of Program Led to Reimbursement Difficulties, but FEMA 
Revised Regulations to Address This Issue: 

At the time of Hurricane Katrina, voluntary organizations were 
potentially eligible to be reimbursed for mass care expenditures only 
in areas that were within disaster zones, as declared by the President. 
Because of the scale of the disaster, however, hundreds of thousands of 
Gulf Coast residents evacuated to areas of the country outside of the 
declared disaster zone. Many of these evacuees were sheltered by small 
local voluntary organizations, such as churches, which were not 
eligible for reimbursement under Public Assistance policies at the 
time. 

On September 9, 2005--about 2 weeks after Katrina made landfall--FEMA 
issued a memorandum stating that the President had declared an 
emergency in states receiving Katrina victims. This permitted voluntary 
organizations in states across the nation that were sheltering evacuees 
from Katrina to receive reimbursement for mass care expenses. FEMA 
changed its regulations in July 2006 to allow eligible public and 
private non-profit entities outside of a declared disaster zone to 
receive reimbursement for mass care expenses, without the requirement 
for presidential declarations in each area where disaster victims are 
sheltered. 

This change contributed to confusion among voluntary organizations 
about the Public Assistance program after the hurricanes. Many 
officials from voluntary organizations told us that changing 
reimbursement policies caused confusion and made it difficult for them 
to get reimbursed, and that in some cases they gave up on seeking 
reimbursement. 

FEMA Strategies for Communicating about the Public Assistance Program 
Were Often Not Effective: 

Although FEMA and affected states took steps to publicize the Public 
Assistance program, many voluntary organizations did not receive key 
information. Voluntary organizations reported numerous problems, such 
as not learning about Public Assistance reimbursement opportunities, 
not being able to obtain information about how to apply, and not being 
able to obtain assistance with the application process. Clear and 
accurate communication was particularly important because many of the 
voluntary organizations that were providing services had not sought 
reimbursement for services before.[Footnote 19] Because organizations 
did not always receive needed information, some organizations either 
never found out about reimbursement opportunities, or got so frustrated 
with the process that they withdrew their applications. 

FEMA officials told us that they communicate Public Assistance policies 
to voluntary organizations after disasters in three ways. First, states 
and FEMA coordinate in convening meetings to make voluntary 
organizations aware of Public Assistance program reimbursement 
opportunities. Second, FEMA officials, including VALs, often respond to 
questions from applicants. Third, FEMA provides information about the 
Public Assistance program via its Web site. As described in FEMA's 
December 2005 review of the response to Katrina, FEMA's role in 
publicizing reimbursement opportunities is particularly important after 
large-scale disasters in which local governments are severely 
compromised or no longer functioning. 

There were several problems, however, with FEMA's efforts to publicize 
and communicate about the Public Assistance program with voluntary 
organizations after the Gulf Coast hurricanes. First, because many of 
the organizations responding to Katrina were small and had not received 
Public Assistance funding in the past, they often did not find out 
about briefings on the program. As a result, they missed an opportunity 
to receive information about being reimbursed. 

Second, VALs--a key FEMA link to the voluntary sector--were not 
provided with information about the program. VALs are often in the 
field working with voluntary organizations providing disaster response 
services, and are potentially well-positioned to inform these 
organizations about Public Assistance opportunities and tell them where 
they can go for additional information. Yet many officials from local 
voluntary organizations told us that VALs had either not informed them 
about the program, could not tell them where to get the needed forms, 
or had provided them with information that was incorrect. For example, 
one representative of a voluntary organization told us that VALs had 
not told the organization about reimbursement opportunities, and that 
when she found out about the program, the VAL could not tell her where 
to obtain more information. 

FEMA officials told us that the Public Assistance program has 
traditionally not worked closely with VALs--who are part of FEMA's 
Individual Assistance program, as opposed to the Public Assistance 
program--to publicize the program. A Public Assistance official said 
that FEMA has publicized the program through its Web site and state 
efforts, and that there have been no efforts to work more closely with 
FEMA VALs since Katrina. FEMA officials told us that there is currently 
no training for VALs on Public Assistance policies. Several FEMA VALs 
told us that closer coordination between the program and FEMA VALs 
would help publicize the program. 

Finally, our review of FEMA's Web site, and comments from a number of 
voluntary organizations, indicate that the Web site was not effective 
in providing these organizations with the information about Public 
Assistance opportunities after the Gulf Coast hurricanes. The two 
Public Assistance reimbursement opportunities that voluntary 
organizations told us they applied for--reimbursement for mass care and 
for facilities damage--include different eligibility and procedural 
requirements for voluntary organizations.[Footnote 20] Voluntary 
organization officials told us that they are not accustomed to working 
with technical policies, and that they needed a clear, step-by-step 
explanation of the Public Assistance opportunities and requirements. 
FEMA provided an online fact sheet regarding the opportunity for 
voluntary organizations to apply for Public Assistance reimbursement 
for mass care costs several weeks after Hurricane Katrina made 
landfall. However, the Web site does not include user-friendly 
information for voluntary organizations about opportunities for 
reimbursement for facilities damage. In addition, FEMA's Public 
Assistance Web site does not include contact information for specific 
offices or officials who can help organizations develop reimbursement 
applications for either program. 

Conclusion: 

Hurricanes Katrina and Rita brought widespread devastation and 
challenged all levels of government and voluntary organizations. Using 
lessons learned from Katrina, FEMA and voluntary organizations have 
begun taking steps to improve mass care services for future disasters, 
such as replacing the National Response Plan with the National Response 
Framework. 

The NRF includes an enhanced role for FEMA in coordinating with 
voluntary organizations. FEMA VALs--employees who are FEMA's primary 
link to the voluntary sector--will have primary responsibility for this 
role. However, the size of FEMA's VAL workforce is not sufficient to 
meet FEMA's NRF responsibilities for voluntary agency coordination. 
Having only one full-time VAL in each region who can work on the entire 
range of coordination issues with voluntary organizations can limit 
VALs' ability to build successful relationships in their states, a 
critical element of fulfilling their responsibilities. In addition, 
VALs receive no role-specific training, and no training on a key 
federal program that reimburses voluntary organizations after 
disasters. If FEMA does not take steps to address these issues, it will 
encounter difficulties in meeting its NRF role of coordinating with 
voluntary organizations, and the nation is likely to see some of the 
same coordination problems that occurred after the Gulf Coast 
hurricanes. 

Under the NRF, NVOAD plays a critical role in sharing disaster 
information among national voluntary organizations, and FEMA plays an 
important role in supporting coordination among these organizations. 
After Hurricanes Katrina and Rita, timely information was important for 
organizations' efforts to provide disaster services, but the daily 
conference calls hosted by NVOAD were an ineffective communication 
strategy. NVOAD's executive director has indicated that improving the 
organization's communication systems is a priority, but NVOAD has only 
two staff members and limited funding. Without FEMA's assistance, NVOAD 
may not have the technical capacity to adequately assess and improve 
its communications systems. Unless NVOAD and FEMA work together to 
systematically assess and expand NVOAD's information sharing efforts, 
NVOAD members are likely to face continued communication problems after 
disasters. 

FEMA has begun taking actions to improve the mass care services 
provided to the disabled after disasters, including actions to 
implement relevant provisions of the Post-Katrina Act. As FEMA noted in 
the Nationwide Plan Review, it is critical that federal, state, and 
local governments increase the participation of people with 
disabilities and subject-matter experts in the development and 
execution of plans and training. However, FEMA has generally not 
coordinated with NCD in its efforts to implement relevant provisions of 
the Act, as required by the Act. Unless FEMA begins working more 
closely with NCD, emergency planners may not fully incorporate this 
population's needs into planning efforts. 

Small voluntary organizations played a key role in the mass care 
response to Katrina, but were often unfamiliar with how to navigate 
these federal reimbursement procedures. Although FEMA has posted the 
Public Assistance program policies for voluntary organizations on its 
Web site, the site does not provide key information about opportunities 
for voluntary organizations to be reimbursed for facilities damage in a 
user-friendly format. In addition, the Web site does not include 
contact information voluntary organizations could use to get more 
information. Unless FEMA provides information in a more user-friendly 
format, some voluntary organizations may be unable to take advantage of 
reimbursement opportunities after future disasters, which could be an 
incentive to stop providing mass care services. 

Recommendations: 

To provide greater assurance that FEMA has adequate staff capabilities 
to support the agency's enhanced role under the NRF in helping 
coordinate with voluntary organizations, we recommend that the 
Secretary of Homeland Security direct the Administrator of FEMA to take 
action to enhance the capabilities of its VAL workforce, such as: 

* converting some Katrina VALs into full-time VALs able to work on the 
entire range of coordination issues with voluntary organizations; 

* increasing the number of full-time VALs; or: 

* providing role-specific training to VALs, including providing them 
with information about Public Assistance opportunities and policies for 
voluntary organizations. 

To improve NVOAD's effectiveness in meeting its NRF information-sharing 
responsibilities after disasters, we recommend that NVOAD assess 
members' information needs, and improve its communication strategies 
after disasters. As part of this effort, NVOAD should examine how best 
to fund improved communication strategies, which may include developing 
a proposal for FEMA funding. To facilitate the implementation of 
improved communication strategies, NVOAD may want to consider 
strategies for increasing staff support for NVOAD after disasters, such 
as having staff from NVOAD member organizations temporarily detailed to 
NVOAD. In addition, in light of FEMA's enhanced role under the NRF in 
helping coordinate the activities of voluntary organizations in 
disasters, we recommend that the Secretary of Homeland Security direct 
the Administrator of FEMA to provide technical assistance to NVOAD, as 
needed, as NVOAD works to improve its communication strategies. 
To ensure that the needs of individuals with disabilities are fully 
integrated into FEMA's efforts to implement provisions of the Act that 
require FEMA to coordinate with NCD, we recommend that the Secretary of 
Homeland Security direct the Administrator of FEMA to develop a 
detailed set of measurable action steps, in consultation with NCD, for 
how FEMA will coordinate with NCD. 

To help ensure that voluntary organizations can readily obtain clear 
and accurate information about the reimbursement opportunities offered 
by the Public Assistance program, we recommend that the Secretary of 
Homeland Security direct the Administrator of FEMA to take action to 
make the information on FEMA's Web site about reimbursement 
opportunities for voluntary organizations more user-friendly. This 
could include: 

* developing a user-friendly guide or fact sheet that provides an 
overview of opportunities for reimbursement for facilities damage; and: 

* providing contact information for organizations to get more 
information about Public Assistance program opportunities. 

Agency Comments and Our Evaluation: 

We provided a draft of this report to the Secretary of the Department 
of Homeland Security. DHS agreed with our recommendations. DHS provided 
technical comments only, which we incorporated as appropriate. We also 
provided a draft of relevant sections of this report to the Red Cross. 
The Red Cross provided several technical comments that we incorporated 
as appropriate. 

After reviewing the section of this report pertaining to NVOAD, the 
NVOAD Board President and Executive Director agreed with our findings 
and recommendation regarding improving information sharing after 
disasters. NVOAD added that it would be in favor of FEMA providing 
support to implement this recommendation through its Disaster 
Assistance Directorate. NVOAD's comments are reprinted in appendix V. 
In addition, we provided the Chairman of NCD with a draft copy of the 
section of this report addressing issues with coordination between FEMA 
and NCD under the Post-Katrina Act. NCD agreed with the report's 
findings and recommendation for this section. NCD's comments are 
reprinted in appendix VI. 

We are sending copies of this report to the Secretary of the Department 
of Homeland Security, the Red Cross, appropriate congressional 
committees, and other interested parties. We will also make copies 
available to others upon request. In addition, the report will be 
available at no charge on GAO's Web site at [hyperlink, 
http://www.gao.gov]. Please contact me at (202) 512-7215 if you or your 
staff have any questions about this report. Contact points for our 
Offices of Congressional Relations and Public Affairs may be found on 
the last page of this report. Other major contributors to this report 
are listed in appendix IV. 

Signed by: 

Cynthia M. Fagnoni:
Managing Director, Education, Workforce and Income Security Issues: 

List of Congressional Requesters: 

The Honorable Joseph I. Lieberman: 
Chairman: 
The Honorable Susan M. Collins: 
Ranking Member: 
Committee on Homeland Security and Governmental Affairs: 
United States Senate: 

The Honorable Charles E. Grassley: 
Ranking Member: 
Committee on Finance: 
United States Senate: 

The Honorable Edward M. Kennedy: 
Chairman: 
The Honorable Michael B. Enzi: 
Ranking Member: 
Committee on Health, Education, Labor, and Pensions: 
United States Senate: 

The Honorable Herb Kohl: 
Chairman: 
Special Committee on Aging: 
United States Senate: 

The Honorable Bennie G. Thompson: 
Chairman: 
Committee on Homeland Security: 
House of Representatives: 

The Honorable David E. Price: 
Chairman: 
Subcommittee on Homeland Security: 
Committee on Appropriations: 
House of Representatives: 

[End of section] 

Appendix I: Objectives, Scope, and Methodology: 

As part of our body of work examining the response of the federal 
government and others to Hurricanes Katrina and Rita, we conducted a 
review of various issues pertaining to the role of voluntary 
organizations in providing mass care services. To obtain information 
about the rationale for, and implications of, the shift in the primary 
mass care role in the National Response Framework (NRF) from the Red 
Cross to the Federal Emergency Management Agency (FEMA), we reviewed 
letters between FEMA and the Red Cross documenting reasons for the 
shift in the primary agency role from the Red Cross to FEMA, the 
National Response Framework, information about the National Shelter 
System, the Post Katrina Emergency Management Reform Act, and 
information about the responsibilities of Voluntary Agency Liaisons. We 
also observed a demonstration of the National Shelter System. We 
interviewed officials from FEMA with responsibility for ESF-6, 
including FEMA Voluntary Agency Liaisons (VALs) in headquarters and in 
the field, and from national offices of voluntary organizations, 
including the Red Cross, National Voluntary Organizations Active in 
Disaster, the Salvation Army, the United Way, America's Second Harvest, 
Catholic Charities, and the Southern Baptist Convention. We also 
interviewed emergency management officials from a selection of states 
that included Louisiana, Mississippi, and nine other randomly selected 
states throughout the country. 

To obtain information about NVOAD's efforts to coordinate with the 
voluntary sector, we reviewed documents about its member services, 
internal governance, funding, and plans for the future. We also 
interviewed NVOAD's former and current executive directors, chairman of 
the board, officials from eight of NVOAD's member organizations, and 
FEMA officials and disaster response experts who have worked with 
NVOAD. We also interviewed an official who manages a Web site used to 
coordinate disaster relief by the United Nations High Commission for 
Refugees, and reviewed the Web site. 

To obtain information about the efforts of FEMA and major national 
voluntary organizations to improve services for the disabled since 
Katrina, we reviewed the Post-Katrina Emergency Management Reform Act 
(the Act), the Americans with Disabilities Act (ADA), and guidance 
released by the Justice Department about ADA, and also and conducted 
document reviews with FEMA, the American Red Cross, and the Southern 
Baptist Convention. These included documents related to FEMA's efforts 
to improve services for the disabled and respond to the Act's 
requirements, such as the Target Capabilities and guidelines for 
accommodating individuals with disabilities. In addition, we reviewed a 
number of Red Cross documents related to services for individuals with 
disabilities, including training materials and a shelter intake form. 
We also interviewed officials from DHS, FEMA, the Red Cross, the 
Southern Baptists, Salvation Army, the United Way, and Catholic 
Charities, and state-level emergency managers from Mississippi, 
Louisiana, and Texas. Our interviews with FEMA included individuals 
from the various initiatives required by the Act to consult with the 
National Council on Disability, and FEMA's Disability Coordinator. In 
addition, we interviewed officials from the National Council on 
Disabilities, a number of disability advocacy organizations, such as 
the National Spinal Cord Injury Association, and several advocacy 
groups for the elderly, such as the American Association of Retired 
Persons. We also reviewed a survey of 95 Red Cross chapters that was 
conducted by the Disability Relations Group, an organization that 
conducts survey research on disability issues. Due to several 
methodological limitations--for example, we could not determine the 
response rate to the survey--we did not cite the results of this survey 
in the report. 

To collect information about how FEMA coordinated with small voluntary 
organizations through the Public Assistance program, we conducted 
document reviews of FEMA's Public Assistance program, including FEMA 
Public Assistance policies, and documentation of changes to those 
policies, and reviewed information about the program on FEMA's Web 
site. We also interviewed FEMA officials from the Public Assistance 
office, and several FEMA VALs. We spoke with representatives of 
approximately 10 local voluntary organizations that provided services 
in the Gulf Coast after the hurricanes, and the Director of Long-Term 
Recovery for the Louisiana Association of Nonprofits--a group that 
works with nonprofits that applied for reimbursement. In addition, we 
spoke with state government officials from Louisiana, Mississippi, and 
Texas, officials from Baton Rouge and Houston, and several disaster 
response experts familiar with Public Assistance. 

We reviewed reports on the response to the Gulf Coast hurricanes issued 
by the DHS Office of Inspector General, the House of Representatives, 
the White House, the Senate Committee on Homeland Security and 
Governmental Affairs, the National Council on Disability, the Appleseed 
Foundation, the American Association of Retired Persons, the 
International Association of Assembly Managers, and the Aspen 
Institute. 

In addition, this report drew from research conducted for GAO-06-712, 
which was released in June 2006. For that report, we conducted site 
visits to Louisiana, Mississippi, and Texas. We toured damage caused by 
the hurricanes in New Orleans, Louisiana, and Biloxi, Mississippi. 
Additionally we toured the FEMA Joint Field Offices that were located 
in Baton Rouge, Biloxi, and Austin; local emergency operations centers 
in Baton Rouge and Austin; as well as distribution centers established 
by the Red Cross and the Salvation Army. On these site visits, we met 
with local chapters of the Red Cross, the Salvation Army, Catholic 
Charities, and the United Way. We held two additional discussion 
groups--one in Jackson, Mississippi, and one in Houston, Texas--to 
obtain the perspectives of local voluntary organizations that provided 
disaster relief on their efforts to be reimbursed under the Public 
Assistance program, and other issues. We spoke with key local emergency 
managers from East Baton Rouge, New Orleans, Austin, and Houston, as 
well as the State of Texas. We also spoke with FEMA Voluntary Agency 
Liaisons in Louisiana, Mississippi, and Texas. 

In addition, for the June 2006 report we conducted a discussion group 
at a Board of Directors meeting for the National Voluntary 
Organizations Active in Disaster that included representatives from the 
United Methodist Committee on Relief, America's Second Harvest, and 
Lutheran Disaster Response. We also observed a National Voluntary 
Organizations Active in Disaster conference call in November 2005. 
These conference calls took place daily after the Gulf Coast hurricanes 
and included representatives from local and national voluntary 
organizations, as well as federal agencies, such as FEMA. 
We conducted this performance audit between January 2007 and February 
2008, and work for the previous report, GAO-06-712, between October 
2005 and June 2006, in accordance with generally accepted government 
auditing standards. Those standards require that we plan and perform 
the audit to obtain sufficient, appropriate evidence to provide a 
reasonable basis for our findings and conclusions based on our audit 
objectives. We believe that the evidence obtained provides a reasonable 
basis for our findings and conclusions based on our audit objectives. 

[End of section] 

Appendix II: NVOAD Members: 

* Adventist Community Services: 
* America's Second Harvest: 
* American Baptist Men/USA: 
* American Disaster Reserve: 
* American Radio Relay League, Inc. (ARRL): 
* American Red Cross: 
* Ananda Marga Universal Relief Team (AMURT): 
* Catholic Charities USA: 
* Christian Disaster Response: 
* Christian Reformed World Relief Committee (CRWRC): 
* Church of the Brethren-Brethren Disaster Ministries: 
* Church World Service: 
* Churches of Scientology Disaster Response: 
* Convoy of Hope: 
* Disaster Psychiatry Outreach: 
* Episcopal Relief and Development: 
* Feed the Children: 
* Friends Disaster Service, Inc. 
* HOPE Coalition America: 
* Humane Society of the United States: 
* International Aid: 
* International Critical Incident Stress Foundation: 
* International Relief and Development (IRD): 
* International Relief Friendship Foundation (IRFF): 
* Lutheran Disaster Response: 
* Medical Teams International: 
* Mennonite Disaster Service: 
* Mercy Medical Airlift (Angel Flight): 
* National Association of Jewish Chaplains: 
* National Emergency Response Team: 
* National Organization for Victim Assistance: 
* Nazarene Disaster Response: 
* Operation Blessing: 
* Points of Light Foundation and Volunteer Center National Network: 
* Presbyterian Church (USA): 
* REACT International, Inc. 
* Samaritan's Purse: 
* Save the Children: 
* Society of St. Vincent de Paul: 
* Southern Baptist Convention: 
* The Phoenix Society for Burn Survivors: 
* The Salvation Army: 
* Tzu Chi Foundation: 
* United Church of Christ - Wider Church Ministries: 
* United Jewish Communities: 
* United Methodist Committee on Relief: 
* United Way of America: 
* Volunteers of America: 
* World Vision: 

[End of section] 

Appendix III: Job Duties of FEMA Voluntary Agency Liaisons: 

* Assist voluntary agencies in the development and promotion of state 
and local Voluntary Organizations Active in Disasters (VOAD) and other 
coalitions such as unmet needs/resource coordination committees for 
long-term recovery. 

* Initiate and maintain a close working relationship between FEMA and 
voluntary agencies including soliciting participation of the voluntary 
agencies in preparedness activities such as training and exercises to 
improve response and recovery capacity. 

* Provide technical advice to FEMA Regional and Area Offices, other 
federal agencies, and state emergency management officials regarding 
the roles and responsibilities of all VOAD members, and other voluntary 
agencies active in disaster and emergency situations. 

* Assist and collaborate with other FEMA Regional and Area Offices 
staff, in the development and maintenance of emergency response and 
recovery plans to ensure that voluntary agencies' capabilities, 
specifically as they relate to emergency assistance, mass shelter and 
feeding, donations management, and other voluntary agency disaster 
relief activities are recognized in the plans. 

* Assist with the collection and dissemination of information 
concerning emergency incidents, including initial damage assessment, 
emergency response activities, and continued response and long-term 
recovery activities/plans of voluntary agencies. 

* Assist and support the FEMA Individual Assistance officer on disaster 
operations in providing consultative support to voluntary agency 
leadership and encouraging collaboration among voluntary agencies. 

* Provide or make available to the voluntary agencies information on 
the status of federal and state response and recovery programs and 
activities. 

Source: FEMA documents. 

[End of table] 

[End of section] 

Appendix IV: Shelter Intake Form: 

[See PDF for image] 

American Red Cross - U.S. Department of Health and Human Services: 
Initial Intake and Assessment Tool: 

Date/Time: 
Shelter Name/Location: 
DRO Name/Number: 
Name of person: 
Age: 
Names/ages of all family members present: 
Age, gender, NOK/guardian: 
Home address: 
Name of staff initiating assessment: 
Contact number: 

Initial Intake: 
We will now be asking you a series of questions - Will you need 
assistance with understanding or answering these questions? 
Yes/No: 
Action to be taken: If yes, determine needs in conjunction with shelter 
manager and Health Services. 
Comments (include name of affected family members): 

Initial Intake: 
What language are you most comfortable with? 
Action to be taken: If other than English, refer to shelter manager if 
interpreter is needed. Once interpreter is available, return to initial 
intake. 
Comments (include name of affected family members): 

Initial Intake: 
Do you have a medical or health concern right now? 
Yes/No: 
Action to be taken: If yes, stop interview and refer to Health Services 
immediately. 
Comments (include name of affected family members): 

Initial Intake: 
How are you feeling? Physically? Emotionally? 
Action to be taken: If life threatening, call 911. Other urgent needs - 
refer to Health Services (HS) or Disaster mental Health (DMH) now. 
Comments (include name of affected family members): 

Initial Intake: 
Do you need any medicine, equipment, or other items for daily living? 
Yes/No: 
Action to be taken: If yes, refer to Health Services and ask next 
question. 
Comments (include name of affected family members): 

Initial Intake: 
Do you need a caregiver or personal assistant? 
Yes/No: 
Action to be taken: If yes, ask next question. If no, skip next 
question. 
Comments (include name of affected family members): 

Initial Intake: 
Is your caregiver present and planning to remain with you? 
Yes/No: 
Action to be taken: If yes, name the person. If no, refer to Health 
Services. 
Comments (include name of affected family members): 

Initial Intake: 
Do you use a service animal? 
Yes/No: 
Action to be taken: If yes, ask the next two (2) questions. If no, skip 
the next two (2) questions. 
Comments (include name of affected family members): 

Initial Intake: 
Is the animal with you? 
Yes/No: 
Action to be taken: If no, ask the next question. 
Comments (include name of affected family members): 

Initial Intake: 
If No, do you know where the service animal is? 
Yes/No: 
Action to be taken: If no, notify local animal control of loss and 
attempt to identify potential resources for replacement. 
Comments (include name of affected family members): 

Initial Intake: 
In under the age of 18, do you have a family member or responsible 
person with you? 
Yes/No: 
Action to be taken: If no, refer to Health Services or Disaster mental 
Health. If yes, locate parent or guardian to continue interview. 
Comments (include name of affected family members): 

Initial Intake: 
This question is only relevant for interviews conducted at HHS medical 
facilities. Are you presently receiving any benefits 
(Medicare/Medicaid)? 
Yes/No: 
Action to be taken: If yes, list type and benefit number(s), if 
available. 
Comments (include name of affected family members): 

Initial Intake: 
Do you have any severe environmental, food, or medication allergies? 
Yes/No: 
Action to be taken: If yes, refer to Health Services. 
Comments (include name of affected family members): 

Initial Intake: 
Question to interviewer: Would the person benefit from a more detailed 
health or mental health assessment? 
Yes/No: 
Action to be taken: If yes, refer to Health Services or Disaster mental 
Health. 
Comments (include name of affected family members): If client is 
uncertain or unsure of answer to any question. re to HS or DMH for more 
in-depth evaluation. 

Referred to Health Services? 
Yes/No: 

Referred to Disaster Mental Health: 
Yes/No: 

Assistance and Support Information: 
Have you been hospitalized or under the care of a physician in the past 
month? 
Yes/No: 
Action to be taken: If yes, list reason. 
Comments: 

Assistance and Support Information: 
Do you have a conditions that requires any special medical 
equipment/supplies? (Epipen, diabetes supplies, respirator, oxygen, 
dialysis, ostomy supplies, etc.) 
Yes/No: 
Action to be taken: If yes, list and list potential sources if 
available. 
Comments: 

Assistance and Support Information: 
Medications: Do you take any medication(s) regularly? 
Yes/No: 
Action to be taken: In no, skip to the question regarding hearing. 
Comments: 

Assistance and Support Information: 
Medications: When did you last take your medication? 
Action to be taken: Date/Time: 
Comments: 

Assistance and Support Information: 
Medications: When are you due for your next dose? 
Action to be taken: Date/Time: 
Comments: 

Assistance and Support Information: 
Medications: Do you have the medication with you? 
Yes/No: 
Action to be taken: If no, identify medications and process for 
replacement. 
Comments: 

Assistance and Support Information: 
Hearing: Do you need assistance in hearing me? 
Yes/No: 
Action to be taken: If yes, ask the next question. If no, skip the next 
question. 
Comments: 

Assistance and Support Information: 
Hearing: Would you like me to write the questions down? 
Yes/No: 
Action to be taken: If yes, give the client paper and pen. If no, go to 
the next category of questions. 
Comments: 

Assistance and Support Information: 
Hearing: Do you use a hearing aid? 
Yes/No: 
Action to be taken: If yes, ask the next two questions. If no, skip the 
next two questions. 
Comments: 

Assistance and Support Information: 
Hearing: Do you have your hearing aid with you? 
Yes/No: 
Action to be taken: If yes, ask the next two questions. If no, skip the 
next two questions. 
Comments: 

Assistance and Support Information: 
Hearing: Is the hearing aid working? 
Yes/No: 
Action to be taken: If no, identify potential resources for 
replacement. 
Comments: 

Assistance and Support Information: 
Hearing: Do you need a battery? 
Yes/No: 
Action to be taken: If yes, identify potential resources for 
replacement. 
Comments: 

Assistance and Support Information: 
Hearing: Do you need a sign language interpreter? 
Yes/No: 
Action to be taken: If yes, identify potential resources in conjunction 
with shelter manager. 
Comments: 

Assistance and Support Information: 
Hearing: How do you best communicate with others? 
Yes/No: 
Action to be taken: Sign language? Lip read? Use a TTY? Other 
(explain). 
Comments: 

Assistance and Support Information: 
Vision/Sight: Do you wear prescription glasses? 
Yes/No: 
Action to be taken: If yes, ask the next two questions. If no, skip the 
next two questions. 
Comments: 

Assistance and Support Information: 
Vision/Sight: Do you have your glasses with you or with your personal 
belongings? 
Yes/No: 
Action to be taken: If no, identify potential resources for 
replacement. 
Comments: 

Assistance and Support Information: 
Vision/Sight: Do you have difficulty seeing even with glasses? 
Yes/No: 
Action to be taken: If no, skip the remaining vision/sight questions 
and go to Activities of Daily living section. 
Comments: 

Assistance and Support Information: 
Vision/Sight: Do you use a white cane? 
Yes/No: 
Action to be taken: If yes, ask the next question. If no, skip the next 
question. 
Comments: 

Assistance and Support Information: 
Vision/Sight: Do you have your white cane with you? 
Yes/No: 
Action to be taken: If no, identify potential resources for 
replacement. 
Comments: 

Assistance and Support Information: 
Vision/Sight: Do you need assistance getting around, even with your 
white cane? 
Yes/No: 
Action to be taken: If yes, determine if accommodation can be made in 
the shelter. 
Comments: 

Assistance and Support Information: 
Vision/Sight: Do you need help moving around or getting in and out of 
bed? 
Yes/No: 
Action to be taken: If no, skip the remaining vision/sight questions 
and go to Activities of Daily living section. 
Comments: 

Assistance and Support Information: 
Vision/Sight: Do you rely on a mobility device such as a cane, walker, 
wheelchair or transfer board? 
Yes/No: 
Action to be taken: If no, skip the next question. If yes, list. 
Comments: 

Assistance and Support Information: 
Vision/Sight: Do you have the mobility device/equipment with you? 
Yes/No: 
Action to be taken: If no, consult with HS and shelter manager to 
determine if accommodation can be made in the shelter. 
Comments: 

Assistance and Support Information: 
Activities of Daily Living: Do you need help getting dressed? 
Yes/No: 
Action to be taken: If yes, explain. 
Comments: 

Assistance and Support Information: 
Activities of Daily Living: Do you need assistance using the bathroom? 
Yes/No: 
Action to be taken: If yes, explain. 
Comments: 

Assistance and Support Information: 
Activities of Daily Living: Do you need help bathing? 
Yes/No: 
Action to be taken: If yes, explain. 
Comments: 

Assistance and Support Information: 
Activities of Daily Living: Do you need help eating? Cutting food? 
Yes/No: 
Action to be taken: If yes, explain. 
Comments: 

Assistance and Support Information: 
Activities of Daily Living: Do you have a family member, friend, or 
caregiver with you to help with these activities. 
Yes/No: 
Action to be taken: If no, consult with HS and shelter manager to 
determine if general population shelter is appropriate. 
Comments: 

Assistance and Support Information: 
Nutrition: Do you wear dentures? 
Yes/No: 
Action to be taken: If yes, ask next question. If no, skip next two 
questions. 
Comments: 

Assistance and Support Information: 
Nutrition: Do you have them with you? 
Yes/No: 
Action to be taken: If no, identify potential sources for replacement. 
Comments: 

Assistance and Support Information: 
Nutrition: Are you on any special diet? 
Yes/No: 
Action to be taken: If yes, list special diet and notify feeding staff. 
Comments: 

Assistance and Support Information: 
Nutrition: Do you have any allergies to food? 
Yes/No: 
Action to be taken: If yes, list allergies. 
Comments: 

Assistance and Support Information: 
Interviewer Evaluation: Question to interviewer: Has the person been 
able to express his/her needs and make choices? 
Yes/No: 
Action to be taken: If no or uncertain, consult with DMH and shelter 
manager. 
Comments: 

Assistance and Support Information: 
Interviewer Evaluation: Question to interviewer: 
Yes/No: 
Action to be taken: 
Comments: 

Assistance and Support Information: 
Interviewer Evaluation: Question to interviewer: Can this shelter 
provide the assistance and support needed? 
Yes/No: 
Action to be taken: If no, collaborate with shelter manager on 
alternative sheltering options. 
Comments: 

Name of person collecting information: 
Signature: 
Date: 

[End of figure] 

[End of section] 

Appendix V: Comments from NVOAD: 

National Voluntary Organizations Active in Disaster: 

Promoting Cooperation, Communication, Coordination and Collaboration
During Disaster Preparedness, Response, Relief and Recovery: 

National VOAD: 
1720 I Street NW, Suite 700: 
Washington DC 20006: 
202-955-8396: 
202-955-5079 Fax: 
[hyperlink, http://www.nvoad.orq]: 

Andrew Sherrill: 
Assistant Director: 
Government Accountability Office: 
202-512-7252: 
[email protected]: 

January 31, 2008: 

Response: FEMA Should Take Action to Improve Capacity and Coordination 
between Government and Voluntary Sectors (GAO-08-369): 

Dear Mr. Sherrill: 

Thank you for the opportunity to respond to the draft report "FEMA 
Should Take Action to Improve Capacity and Coordination between 
Government and Voluntary Sectors (GAO-08-369). 

After reviewing the components of the report relevant to National 
Voluntary Organizations Active in Disaster (National VOAD), we are in 
support of the conclusions drawn. The National VOAD Board and national 
office are very interested in building processes and systems to better 
support the member organizations as they provide their services. We are 
looking to develop communication systems that take better advantage of 
current technologies to create seamless coordination, while striving to 
maintain the grassroots approach that provides our members' speed and 
flexibility in times of disaster. 

The National VOAD role in the National Response Framework is not only 
information sharing and convening voluntary organizations, but to also 
serve as a coordinating entry point for member organizations to 
actively engage in a national response. Our member organizations are 
active in response, relief and recovery. In order to facilitate a more 
rapid response, their activities related to these roles are coordinated 
under the Disaster Assistance Directorate of FEMA. 

The Disaster Assistance Directorate of FEMA has a tradition of support 
for National VOAD and its member organizations. It is good to see a 
recommendation that renews and enhances this relationship, and we would 
be pleased to see this support grow. While the report is general in its 
reference to FEMA, we would be in support of FEMA carrying out these 
recommendations through their Disaster Assistance Directorate. 

Sincerely, 

Thomas Hazelwood: 
National VOAD Board President: 
Executive Secretary US Disaster Response: 
United Methodist Committee on Relief: 

Diana Rothe-Smith: 
Executive Director: 
National VOAD: 

[End of section] 

Appendix VI Comments from NCD: 

National Council On Disability: 
1331 F Street, NW, Suite 1050: 
Washington, D.C. 20004-1107: 
(202) 272-2004 Voice: 
(202) 272-2074 TT: 
(202) 272-2022 Fax: 

An independent federal agency working with the President and the 
Congress to increase the inclusion, independence, and empowerment of 
all Americans with disabilities. 

January 25, 2008: 

Cynthia M. Fagnoni: 
Managing Director: 
Education, Workforce, and Income Security Issues: 
U.S. Government Accountability Office: 
441 G. Street, NW: 
Washington, DC 20548: 

Dear Ms. Fagnoni: 

Thank you for the opportunity to provide written comments on the 
Government Accountability Office (GAO) draft report entitled "National 
Disaster Response: FEMA Should Take Action to Improve Capacity and 
Coordination between Government and Voluntary Sectors." This is the 
National Council on Disability's (NCD) response to your draft report. 
We agree with the draft report's findings, analyses, and conclusions as 
they reference NCD. We also agree with the following specific report 
recommendation: 

"To ensure that the needs of individuals with disabilities are fully 
integrated into FEMA's efforts to implement provisions of the Act that 
require FEMA to coordinate with NCD, we recommend that the 
Administrator of FEMA develop a detailed set of measurable action 
steps, in consultation with NCD, for how FEMA will coordinate with 
NCD." 

This report from GAO reflects both the progress and prospects of our 
responsibilities to work with FEMA under the aegis of the Post-Katrina 
Emergency Management Reform Act (PKA) of 2006, as enacted by the 
Department of Homeland Security Appropriations Act, 2007 (Public Law 
109-295). 

We realize that P.L. 109-295 included NCD at a critical time in FEMA's 
history. We recognize that Congress believed NCD has valuable 
perspective, knowledge and resources to, offer to FEMA during the 
reorganization and redirection of its efforts. We also believe that 
Congress intended for NCD to assume and exercise a supportive role with 
FEMA under P.L.109-295. 

As we have from the moment that the PKA was signed into law, NCD has 
remained resolute in its commitment to implementing the requirements of 
the law in the new role that Congress has crafted for us in relation to 
FEMA. We have also been proactive in our attempts to work with FEMA, 
and continue to seek opportunities to strengthen that partnership 
wherever possible. 

In the interest of completing these critical responsibilities, and on 
behalf of millions of Americans with disabilities, we look forward to 
working toward the implementation of this GAO report recommendation as 
detailed above. Again, thank you for the opportunity to comment upon 
the draft report. 

Sincerely, 

Signed by: 

John R. Vaughn: 
NCD Chair: 

[End of section] 

Appendix VII: GAO Contact and Staff Acknowledgments: 

GAO Contact: 

Cindy Fagnoni (202) 512-7215 or [email protected]: 

Staff Acknowledgments: 

Andrew Sherrill, Acting Director, and Scott Spicer, Analyst in Charge, 
managed this assignment and made significant contributions to all 
aspects of this report. Farahnaaz Khakoo and Danielle Pakdaman also 
made significant contributions. Additionally, Cindy Bascetta, Mallory 
Barg Bulman, Karen Doran, Tom James, Bill Jenkins, Gale Harris, Chuck 
Wilson, and Walter Vance aided in this assignment. In addition, Jessica 
Botsford assisted in the legal analysis, and Charlie Willson assisted 
in the message and report development. 

[End of section] 

Bibliography: 

The American Association of Retired Persons. We Can Do Better: Lessons 
Learned for Protecting Older Persons in Disasters. Washington, D.C.: 
2006. 

The Appleseed Foundation. A Continuing Storm: The Ongoing Struggles of 
Hurricane Katrina Evacuees. Minneapolis, Minnesota: August 2006. 

The Aspen Institute. Weathering the Storm: The Role of Local Nonprofits 
in the Hurricane Katrina Relief Effort. Washington, D.C.: 2006. 

Congressional Research Service. Federal Emergency Management Policy 
Changes after Hurricane Katrina: A Summary of Statutory Provisions. 
Washington, D.C.: December 2006. 

Congressional Research Service. Reimbursement of Local Private 
Nonprofit Organizations under the Stafford Act. Washington, D.C.: 
January 2006. 

Department of Homeland Security. Nationwide Plan Review: Phase II 
Report. Washington, D.C.: June 2006. 

Department of Homeland Security, Office of Inspector General. A 
Performance Review of FEMA's Disaster Management Activities in Response 
to Hurricane Katrina. OIG-06-32. Washington, D.C.: March 2006. 

Federal Emergency Management Agency. DHS/FEMA Initial Response Hotwash 
Hurricane Katrina in Louisiana. New Orleans, Louisiana: February 2006. 

International Association of Assembly Managers. Mega-Shelter: Best 
Practices for Planning, Activation, Operations. Coppell, Texas: July 
2006. 

National Council on Disability. The Impact of Hurricanes Katrina and 
Rita on People with Disabilities: A Look Back and Remaining Challenges. 
Washington, D.C.: Aug. 3, 2006. 

United States House of Representatives, Select Bipartisan Committee to 
Investigate the Preparation for and Response to Hurricane Katrina. A 
Failure of Initiative. Washington, D.C.: Feb. 15, 2006. 

United States Senate Committee on Homeland Security and Governmental 
Affairs. Hurricane Katrina: A Nation Still Unprepared. Washington, 
D.C.: 2006. 

The White House. The Federal Response to Hurricane Katrina: Lessons 
Learned. Washington, D.C.: February 2006. 

[End of section] 

Related GAO Products: 

Disaster Assistance: Better Planning Needed for Housing Victims of 
Catastrophic Disasters. GAO-07-88. February 2007. 

Coast Guard: Observations on the Preparation, Response, and Recovery 
Missions Related to Hurricane Katrina. GAO-06-903. July 31, 2006. 

Child Welfare: Federal Action Needed to Ensure States Have Plans to 
Safeguard Children in the Child Welfare System Displaced by Disasters. 
GAO-06-944. July 28, 2006. 

Small Business Administration: Actions Needed to Provide More Timely 
Disaster Assistance. GAO-06-860. July 28, 2006. 

Disaster Preparedness: Limitations in Federal Evacuation Assistance for 
Health Facilities Should Be Addressed. GAO-06-826. July 20, 2006. 

Purchase Cards: Control Weakness Leave DHS Highly Vulnerable to 
Fraudulent, Improper, and Abusive Activity. GAO-06-957T. July 19, 2006. 

Individual Disaster Assistance Programs: Framework for Fraud 
Prevention, Detection, and Prosecution. GAO-06-954T. July 12, 2006. 

Expedited Assistance for Victims of Hurricanes Katrina and Rita: FEMA's 
Control Weaknesses Exposed the Government to Significant Fraud and 
Abuse. GAO-06-655. June 16, 2006. 

Hurricanes Katrina and Rita: Improper and Potentially Fraudulent 
Individual Assistance Payments Estimated to Be between $600 Million and 
$1.4 Billion. GAO-06-844T. June 14, 2006. 

Hurricanes Katrina and Rita: Coordination between FEMA and the Red 
Cross Should Be Improved for the 2006 Hurricane Season. GAO-06-712. 
June 8, 2006. 

Lessons Learned for Protecting and Educating Children after the Gulf 
Coast Hurricanes. GAO-06-680R. Washington, D.C.: May 11, 2006. 

Hurricane Katrina: Planning for and Management of Federal Disaster 
Recovery Contracts. GAO-06-622T. Washington, D.C.: April 10, 2006. 

Hurricane Katrina: Comprehensive Policies and Procedures Are Needed to 
Ensure Appropriate Use of and Accountability for International 
Assistance. GAO-06-460. Washington, D.C.: April 6, 2006. 

Hurricane Katrina: Status of the Health Care System in New Orleans and 
Difficult Decisions Related to Efforts to Rebuild It Approximately 6 
Months after Hurricane Katrina. GAO-06-576R. Washington, D.C.: March 
28, 2006. 

Agency Management of Contractors Responding to Hurricanes Katrina and 
Rita. GAO-06-461R. Washington, D.C.: March 15, 2006. 

Hurricane Katrina: GAO's Preliminary Observations Regarding 
Preparedness, Response, and Recovery. GAO-06-442T. Washington, D.C.: 
March 8, 2006. 

Emergency Preparedness and Response: Some Issues and Challenges 
Associated with Major Emergency Incidents. GAO-06-467T. Washington, 
D.C.: February 23, 2006. 

Disaster Preparedness: Preliminary Observations on the Evacuation of 
Hospitals and Nursing Homes Due to Hurricanes. GAO-06-443R. Washington, 
D.C.: February 16, 2006. 

Expedited Assistance for Victims of Hurricanes Katrina and Rita: FEMA's 
Control Weaknesses Exposed the Government to Significant Fraud and 
Abuse. GAO-06-403T. Washington, D.C.: February 13, 2006. 

Investigation: Military Meals, Ready-to-Eat Sold on eBay. GAO-06-410R. 
Washington, D.C.: February 13, 2006. 

Statement by Comptroller General David M. Walker on GAO's Preliminary 
Observations Regarding Preparedness and Response to Hurricanes Katrina 
and Rita. GAO-06-365R. Washington, D.C.: February 1, 2006. 

Federal Emergency Management Agency: Challenges for the National Flood 
Insurance Program. GAO-06-335T. Washington, D.C.: January 25, 2006. 

Hurricane Protection: Statutory and Regulatory Framework for Levee 
Maintenance and Emergency Response for the Lake Pontchartrain Project. 
GAO-06-322T. Washington, D.C.: December 15, 2005. 

Hurricanes Katrina and Rita: Provision of Charitable Assistance. GAO- 
06-297T. Washington, D.C.: December 13, 2005. 

[End of section] 

Footnotes: 

[1] The NRF will be effective as of March 22, 2008. Until that time, 
the NRP will remain in effect. 

[2] The Post-Katrina Emergency Management Reform Act of 2006, Pub. L. 
No. 109-295, Title VI. 

[3] For further information, see the Aspen Institute report in the 
bibliography at the end of this report. 

[4] GAO, Catastrophic Disasters: Enhanced Leadership, Capabilities, and 
Accountability Controls Will Improve the Effectiveness of the Nation's 
Preparedness, Response, and Recovery Systems, GAO-06-618 (Washington, 
D.C.: September 2006). 

[5] Advocates for the elderly and individuals with disabilities told us 
that the mass care issues faced by these groups are similar. We use the 
term individuals with disabilities to refer to both of these groups 
throughout this report. 

[6] Pub. L. No. 100-707, 42 U.S.C. ï¿½ 5121, et. seq. 

[7] GAO, Hurricanes Katrina and Rita: Coordination between FEMA and the 
Red Cross Should Be Improved for the 2006 Hurricane Season, GAO-06-712 
(Washington, D.C.: June 2006). 

[8] GAO, Disaster Assistance: Better Planning Needed for Housing 
Victims of Catastrophic Disasters, GAO-07-88 (Washington, D.C: Feb. 28, 
2007). 

[9] FEMA refers to these positions as Cadre of Regional Employees VALs. 
They are employed under 4-year contracts. 

[10] For example, the Aspen Institute report recommended that FEMA 
significantly develop and expand its VAL staffing. For further 
information, see the Aspen Institute report in our bibliography. 

[11] The FEMA initial review of the response to Katrina concurred with 
this finding. For more information, see the bibliography. 

[12] A FEMA review of the response to Katrina also found that there is 
virtually no training for personnel involved in response operations, 
and that FEMA responders should receive specialized training. For more 
information, see the bibliography. 

[13] While there were several small language changes in the NRF to 
NVOAD's responsibilities in ESF-6, NVOAD and FEMA told us that these 
were for clarification and did not represent substantive changes in 
NVOAD's responsibilities. 

[14] The term "special needs" refers to individuals likely to need 
special assistance after disasters, and includes the disabled and 
elderly. 

[15] ESF-6 specifies that this may include those who have disabilities, 
live in institutional settings, are elderly, are from diverse cultures, 
have limited English proficiency or are non-English speaking, are 
children, or are transportation disadvantaged. 

[16] Pub. L. No. 101-336, as amended, 42 U.S.C. ï¿½ 12101, et seq. The 
ADA provides broad non-discrimination protection for individuals with 
disabilities in employment, public services and public accommodations, 
and services operated by private entities. 

[17] Copy of correspondence from Nell Hahn, Advocacy Center of 
Lafayette, La. (Sept. 8, 2005). 

[18] 42 U.S.C. ï¿½12101 et seq. Under the ADA, shelters, whether provided 
by government or entitles such as the Red Cross, must provide equal 
access to all individuals. However, in general, the ADA does not 
require any action that would result in a fundamental alteration in the 
nature of a service, program, or activity or that would impose undue 
financial or administrative burdens. 

[19] The Aspen Institute found that many of the voluntary organizations 
that responded spontaneously to the hurricanes found themselves outside 
of FEMA's traditional funding circle because they do not typically 
respond to disasters. In addition, the report maintained that clear and 
accurate communication is needed because the Public Assistance 
application process and requirements for voluntary organizations are 
"byzantine." For more information, see the bibliography. 

[20] FEMA's Public Assistance policies for voluntary organizations 
provide specific eligibility guidelines. For example, FEMA policies 
that allow nonprofits to be reimbursed for facilities damage have 
specific requirements about the percentage of time and/or space that 
the facility must devote to meeting essential public purposes. 

[End of section] 

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