People With Disabilities: Federal Programs Could Work Together More
Efficiently to Promote Employment (Letter Report, 09/03/96,
GAO/HEHS-96-126).

Pursuant to a congressional request, GAO reviewed federal programs
targeted to disabled persons, focusing on: (1) how many of the programs
provide employment-related services; (2) coordination of information,
eligibility criteria, and services among various programs; and (3) the
programs' effectiveness in promoting employment among disabled persons.

GAO found that: (1) 130 federal programs provide services to disabled
persons; (2) in fiscal year 1994, federal agencies spent over $60
billion on 69 programs exclusively targeted to disabled persons and
between $81 billion and $184 billion on 61 other programs targeted to a
wider clientele that gave special consideration to disabled persons; (3)
most program expenditures supported income maintenance and health care
programs; (4) employment-oriented programs constituted only 26 of the
130 programs and received only 2.5 to 4 percent of total federal funding
for such programs in 1994; (5) 57 other programs provided indirect
employment assistance; (6) most programs provide services through states
and local governments, and nonprofit and private organizations; (7)
various program funding mechanisms affect the distribution of program
funds among states; (8) the federal government funds a wide range of
services to address major employment barriers; (9) disabled persons who
need services from more than one program find the programs' differing
eligibility criteria and numerous service providers burdensome; (10) the
lack of program coordination and information sharing leads to service
duplication and gaps, and past efforts to improve service coordination
have only been marginally successful; (11) some state and local agencies
have improved service delivery to disabled persons and reduced program
costs; and (12) few programs have been evaluated for their
effectiveness, since many agencies do not require or collect data on
program outcomes.

--------------------------- Indexing Terms -----------------------------

 REPORTNUM:  HEHS-96-126
     TITLE:  People With Disabilities: Federal Programs Could Work 
             Together More Efficiently to Promote Employment
      DATE:  09/03/96
   SUBJECT:  Disabled persons
             Employment or training programs
             Aid for the disabled
             State-administered programs
             Data collection operations
             Eligibility criteria
             Interagency relations
             Intergovernmental relations
             Vocational rehabilitation
IDENTIFIER:  Early Intervention State Grants for Infants and Toddlers 
             with Disabilities
             Independent Living Services for Older Blind Individuals 
             Program
             VA Disabled Veteran Outreach Program
             Job Training Partnership Act Program
             Dept. of Education Vocational Rehabilitation Program
             VA Vocational Rehabilitation Program
             Social Security Disability Insurance Program
             Projects with Industry Program
             Supplemental Security Income Program
             California
             California School-to-Work Transition Partnership
             Massachusetts
             SSA Plan for Achieving Self-Support Program
             
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Cover
================================================================ COVER


Report to the Chairman, Subcommittee on Employer-Employee Relations,
Committee on Economic and Educational Opportunities,
House of Representatives

September 1996

PEOPLE WITH DISABILITIES - FEDERAL
PROGRAMS COULD WORK TOGETHER MORE
EFFICIENTLY TO PROMOTE EMPLOYMENT

GAO/HEHS-96-126

Disability Programs

(205295)


Abbreviations
=============================================================== ABBREV

  ADA - Americans With Disabilities Act
  ADL - activities of daily living
  CFDA - Catalog of Federal Domestic Assistance
  CFFR - Consolidated Federal Funds Report
  CPS - Current Population Survey
  DI - Disability Insurance
  DOT - Department of Transportation
  ES - employment service
  HHS - Department of Health and Human Services
  HUD - Department of Housing and Urban Development
  IADL - independent activities of daily living
  IDEA - Individuals With Disabilities Education Act
  JAN - Job Accommodation Network
  JTPA - Job Training Partnership Act
  NCD - National Council on Disability
  NHIS - National Health Interview Survey
  OTA - Office of Technology Assessment
  PASS - Plan to Achieve Self-Support
  PWI - Projects With Industry
  SBA - Small Business Administration
  SIPP - Survey of Income and Program Participation
  SSA - Social Security Administration
  SSI - Supplemental Security Income
  SWITP - School-to-Work Interagency Transition Partnership
  TJTC - Targeted Jobs Tax Credit
  VA - Department of Veterans Affairs
  WHO - World Health Organization

Letter
=============================================================== LETTER


B-266310

September 3, 1996

The Honorable Harris W.  Fawell
Chairman, Subcommittee on
 Employer-Employee Relations
Committee on Economic and
 Educational Opportunities
House of Representatives

Dear Mr.  Chairman: 

Over the past decade in the United States, attitudes about people
with disabilities have changed significantly.  A growth in public
awareness of the capabilities of people with disabilities, a new
emphasis on their inclusion in society, and a movement toward
strategies promoting their economic self-sufficiency reflect this
changed view.  These changes in attitudes have influenced several
recent major legislative initiatives:  the Supported Employment
program in 1986, the Americans With Disabilities Act (ADA) in 1990,
and the amendments to the Rehabilitation Act.  Although these
initiatives are designed to help promote the employment of people
with disabilities, they have not represented a substantial overhaul
of U.S.  disability policy.  Instead, as experts have noted, they
have added to or expanded an already existing program structure,
parts of which have been in place for many decades. 

Because these legislative initiatives have raised concerns about the
ability of federal programs that target people with disabilities to
work together, you asked us to examine and describe these programs,
emphasizing those that relate to employment.  Specifically, we
focused on the following questions: 

1.  Which federal programs target people with disabilities, and how
many of these programs provide employment-related services? 

2.  To what extent are information, eligibility, and services
coordinated under these programs? 

3.  What does available evidence suggest about the effectiveness of
federal programs in promoting employment among people with
disabilities? 

To accomplish these objectives, we integrated evidence from the
literature, from analyses of the most current available databases,
and from interviews with consumers and public and private
organizations.  We identified the range of federal programs, their
funding levels, and the services they provide through a review of
federal statutes and regulations, consultations with agency
officials, and information from a variety of sources--agency reports,
budget documents, the Catalog of Federal Domestic Assistance, the
most current expenditure data (fiscal year 1994) available from the
Consolidated Federal Funds Report, and our previous reports.  Using
the economics and social science literature, combined with evidence
from available databases, including the 1990 census and the 1993
National Health Interview Survey, for example, we identified
characteristics of the population of people with disabilities and
gathered information on employment barriers posed by their special
needs.  However, we did not independently verify data that we
received from public or private databases.  We also interviewed
disability experts, consumers, service providers, and public
officials at the federal, state, and local levels to help determine
how federal programs address these barriers to employment.  Our work
was completed between April 1995 and July 1996 in accordance with
generally accepted government auditing standards.  For more detailed
information on our scope and methodology, see appendix I. 


   RESULTS IN BRIEF
------------------------------------------------------------ Letter :1

The federal government funds a broad range of services to assist the
millions of people with disabilities.  This effort is diffuse,
however, with federal assistance provided through 130 programs in 19
federal agencies.  For many of these programs, service delivery
filters down to numerous public and private agencies at the state and
local level.  In fiscal year 1994, the federal government spent over
$60 billion on 69 programs targeted exclusively to people with
disabilities.  In addition, people with disabilities benefited from
between $81 billion and $184 billion in spending through 61 partially
targeted programs.  These partially targeted programs gave special
consideration to people with disabilities, even though they serve a
much broader clientele.\1

The majority of federal expenditures were associated with income
maintenance and health care programs.  In 1994, programs that focused
specifically on employment assistance constituted a relatively small
proportion of all disability programs (26 of 130) and received a
relatively small proportion of total federal funding for such
programs (from 2.5 to 4 percent).  A larger number of programs and a
greater share of federal dollars, however, were devoted to programs
that provide employment-
related services such as transportation, accessible housing, and
independent living services. 

Our review suggests that programs helping people with disabilities do
not work together as efficiently as they could to share information
about their programs and overcome obstacles posed by differing
eligibility criteria and numerous service providers.  Because people
with disabilities often face multiple barriers to employment,
including insufficient job training, lack of transportation, and
employer discrimination, they may require services from more than one
program to make employment feasible.  However, each program has its
own eligibility requirements and applicants must often establish
eligibility separately because no effective mechanism exists to
promote or ensure coordination.  Similarly, because services are
often not coordinated among programs, people with disabilities may
receive duplicate services or face service gaps. 

Although the general lack of coordination suggests that program
efficiency could be improved, scant evidence exists for evaluating
the effectiveness of these programs either individually or
collectively.  Despite the size of the federal commitment, few
programs are required to gather the outcome data necessary for
reliable program evaluation.  Many of the 26 employment-focused
programs that we identified have had little or no formal evaluation
in recent years.  The difficulties associated with comparing data
from different programs also hinder evaluation efforts.  In many
instances, service providers track different consumer information,
use different eligibility criteria, and have different rules on
confidentiality.  Therefore, without improving coordination, imposing
requirements on data collection may not necessarily facilitate
evaluation. 

Past federal efforts to reorganize and restructure service delivery
have succeeded only marginally compared with more modest, local
initiatives.  Federal agencies have an opportunity to learn from some
recent state and local efforts to improve the coordination of
programs helping people with disabilities.  Some state and local
programs reported improved service delivery along with reduced
program costs, thus providing resources that could be redirected
toward improving services or evaluating program performance. 


--------------------
\1 Because the agencies responsible for many of these partially
targeted programs could not separate program expenditures into
disability-related and nondisability-related categories, our
estimated range reflects the substantial uncertainty surrounding
federal expenditures to help people with disabilities.  See app.  I. 


   BACKGROUND
------------------------------------------------------------ Letter :2

In the last 10 years, the Congress has expanded federal efforts to
promote employment for people with more severe disabilities by
creating new programs, expanding existing programs, and providing
employment protections.  In the past, social attitudes toward people
with mental retardation or psychiatric conditions often labeled them
as unemployable outside of institutions or sheltered workshops and
thus unable to benefit from job training or vocational
rehabilitation.  However, recent advances in assistive technology,
particularly in computers, have made many personal limitations less
prohibitive barriers to work.  Voice recognition software, for
example, allows those who do not have use of their hands to produce
documents on a computer.  In addition, the development of supported
employment, in which ongoing on-the-job support is provided to people
with disabilities through a job coach, has demonstrated that many
people previously considered unemployable could work alongside people
without disabilities.  In response to these developments, the
Congress has created new programs to promote the increased use of
assistive technology and to provide states with funding specifically
designated for supported employment.  In addition, the Congress has
amended the Rehabilitation Act to strengthen the requirement that
states serve individuals with severe disabilities. 

In 1990, the Congress provided educational and employment protections
to people with disabilities.  For example, ADA prohibited employment
discrimination on the basis of disability by state and local
governments and many private-sector employers, as long as the person
was qualified and able to perform the essential job functions "with
or without reasonable accommodation."\2 Similarly, in the Individuals
With Disabilities Education Act (IDEA), the Congress mandated that
all children with disabilities be provided a "free, appropriate
public education," and courts interpreting the law have required that
this education be provided in "the least restrictive environment."
This provision emphasized a clear presumption that children with
disabilities should be mainstreamed--that is, taught in regular
classrooms when possible. 


--------------------
\2 This provision requires employers to provide what is necessary
(for example, equipment, modifications to work station, and the like)
for the individual to do the job as long as accommodating the
disability is not an undue hardship for the employer. 


   130 FEDERAL PROGRAMS TARGET
   PEOPLE WITH DISABILITIES
------------------------------------------------------------ Letter :3

Over many years, public concern and congressional action have
produced a broad continuum of services and policies designed to help
people with disabilities.  We identified 19 different federal
departments or agencies that administered 130 programs targeting
people with disabilities in 1994.\3 These programs ranged from those
for toddlers with disabilities, for example, Early Intervention State
Grants for Infants and Toddlers With Disabilities--to those for the
elderly with disabilities, for example, Independent Living Services
for Older Blind Individuals.  These many programs provided education,
health care, and books and assisted with employment.  (For a list of
these programs, as well as targeting and funding information, see
app.  II.)

Of the 130 programs, 69 were wholly targeted (targeted exclusively)
to people with disabilities; the others were partially targeted--that
is, they provided services to a wider clientele but nonetheless gave
some priority or preference to people with disabilities.  In 1994,
the federal government spent over $60 billion through these 69 wholly
targeted programs, including efforts such as the Disabled Veterans'
Outreach program, which helps disabled veterans.  In addition, people
with disabilities benefited from between $81 billion and $184 billion
in federal spending through 61 partially targeted programs in areas
such as income support, housing, and transportation.\4

The federal commitment to helping people with disabilities has also
attempted to facilitate their employment both directly and
indirectly.  Of the 130 programs available in 1994, 26 provided
direct employment services such as skills training and job search
assistance.  For example, the Supported Employment program
established by the Rehabilitation Act is employment focused because
it provided training and placement services to people with severe
disabilities.  (Apps.  II and III provide details about these
programs.) Employment-focused programs in 1994 provided between $2.5
billion and $6.1 billion in services targeted to people with
disabilities. 

In addition, we identified 57 of 130 programs as related to
employment--that is, although not directed specifically at
employment, these programs may have indirectly affected employment
outcomes.  These include federal programs that help finance purchases
of assistive technology, such as specially designed wheelchairs or
computer software, which are employment related because they can
enable an individual with a disability to enter the workplace.  In
1994, employment-related programs provided between $62 billion and
$156 billion in services targeted to people with disabilities. 

The remaining 47 of the 130 federal programs were unrelated to
employment.  Federal efforts to promote early intervention services
for toddlers with disabilities are an example of these types of
programs.  (See fig.  1.)

   Figure 1:  Employment Focus of
   Federal Disability Programs in
   1994

   (See figure in printed
   edition.)

Notes:  Employment-focused programs provide services that directly
facilitate finding and maintaining employment such as job training
and placement assistance.

Employment-related programs indirectly facilitate work through
services such as assistive technology, transportation, health
insurances, and the like. 

Many of these employment-focused and -related programs provided a
specific service rather than a broad range of services to people with
disabilities.  For example, the Department of Transportation (DOT)
funds capital improvements for local transit systems and also
provides funds for paratransit services.\5 The Job Training
Partnership Act (JTPA) program, although only partially targeted to
people with disabilities, emphasizes shorter term skill training and
provides only a limited range and amount of support services. 
Important exceptions to this are the vocational rehabilitation
programs; both the federal-state Vocational Rehabilitation program
and the Veterans' Vocational Rehabilitation program can provide a
wide variety of services designed to promote employment. 


--------------------
\3 We defined a program as targeted to people with disabilities if
either people with disabilities were the ultimate beneficiary of this
assistance, if disability was a criterion for eligibility, or if the
program gave priority or preference to people with disabilities.  We
excluded those programs that may serve some people with disabilities
but were not specifically intended to address disability.  For
example, people with disabilities may receive Aid to Families With
Dependent Children but their eligibility for this program does not
arise from their disability.  We also omitted programs that
exclusively fund research related to specific medical conditions. 
See app.  I. 

\4 This broad range reflects the fact that many partially targeted
programs do not track expenditure by target or recipient group.  See
app.  I. 

\5 Paratransit is a service specifically designed for individuals
unable to use regular fixed-route transportation.  Other federal
agencies (such as the Department of Health and Human Services) also
provide funding for paratransit. 


      DEGREE OF FEDERAL FINANCING
      AND RESPONSIBILITY VARIES
      AMONG DISABILITY PROGRAMS
      AND STATES
---------------------------------------------------------- Letter :3.1

Although the federal government provides funds for all 130 programs,
the extent of the federal role in their administration varies
considerably.  Federal programs provide assistance directly to the
individual or indirectly through other public or private service
providers at the state and local levels.  Programs that provide
assistance indirectly often involve limited responsibilities for the
federal government in administering services. 

For some programs, assistance or services flow directly from the
federal government to the individual with a disability.  For example,
income support payments under the Social Security Disability
Insurance (DI) program flow directly to beneficiaries, and phone
calls requesting information from the Education Department's
Information Clearinghouse are a direct service from the federal
government.  The largest federal programs in terms of spending--the
income maintenance and health care programs--generally deliver
assistance directly to individuals; however, if these programs are
excluded, states receive a substantial amount of the funds provided
through disability programs. 

For many programs, assistance or services flow indirectly from the
federal government through state governments, which are responsible
for delivering services to individuals with disabilities.  For
example, under the federal-state Vocational Rehabilitation program,
the federal government allocates program funds to the states, which
have authority to deliver services.\6 For some programs, the states
may provide funds to other entities, such as local governments or
nonprofit or private agencies, to administer services.  In the states
we visited, funds from federal disability programs were further
distributed to a wide range of state agencies--
departments of rehabilitation services, employment and training,
developmental disabilities, mental health, education, and those for
the deaf and hard of hearing, or the blind, for example. 

For many other programs, assistance or services flow indirectly from
the federal government to other organizations such as state or local
agencies or nonprofit or private organizations.  For example, the
Projects With Industry (PWI) program may be administered through
other public, private, or nonprofit agencies.\7 Under these programs,
federal agencies allocate grants on the basis of the application or
proposal submitted by an organization or agency, which is then
responsible for providing services.  Federal funds allocated through
these programs provide support for special projects in delivering
disability services; others support research or train state or local
professionals to work more effectively with people with disabilities. 
(See fig.  2.)

   Figure 2:  Distribution of
   Disability Programs Providing
   Services--Directly or
   Indirectly--to People With
   Disabilities

   (See figure in printed
   edition.)


--------------------
\6 The Vocational Rehabilitation program distributes funds to states
through formula allocations, with each state program generally
establishing its own funding formula or grant criteria for local
providers that deliver services directly. 

\7 See app.  III for details on this program. 


      VARIETY OF PROGRAM FUNDING
      MECHANISMS INFLUENCES THE
      DISTRIBUTION OF FUNDS TO
      STATES
---------------------------------------------------------- Letter :3.2

Although many federal programs have decentralized the provision of
services to state governments, the programs have adopted a variety of
funding mechanisms to do so, including funding formulas based on
different criteria as well as varying procedures for awarding grants. 
The variation in these funding mechanisms affects the distribution of
federal funds to states.  States may receive more or less money
depending on the size and characteristics of their targeted
population as well as their success in pursuing grants and other
awarded monies.  In our analysis of statewide 1990 funding data for
the eight wholly targeted employment-
focused programs and statewide 1990 census data, we found that the
disabled working-age population\8 as a percentage of the total
working-age population varied between 7 and 15 percent.  Federal
programs distributed to states between $200 and $1,100 per
working-age person with a disability.  Some states like Florida,
Georgia, and South Carolina received between $200 and $350 per
working-age person with a disability; sparsely populated states like
Wyoming and Alaska received between $800 and $1,100 per working-age
person with a disability.  (See app.  IV.)


--------------------
\8 Includes any noninstitutionalized person between the ages of 16
and 64 who reported a work, mobility, or personal care limitation. 


   FEDERAL DISABILITY PROGRAMS
   CONFRONT EXTENSIVE EMPLOYMENT
   NEEDS OF PEOPLE WITH
   DISABILITIES
------------------------------------------------------------ Letter :4

Promoting employment is one of the most important challenges
confronting federal assistance to people with disabilities.  People
with disabilities constitute an underutilized workforce and a
potential resource to the U.S.  economy.  Surveys have estimated that
18 to 40 percent of people with disabilities have jobs--far below the
73 percent of people without impairments.\9 Yet in these surveys,
most individuals with disabilities indicated that their disability
did not prevent them from working.  For example, although 8.2 percent
of individuals were identified as having a work disability in the
1990 census, only a little over half of those said that they could
not work.\10

Increased employment would alleviate the poor economic condition of
people with disabilities, many of whom struggle to get by on marginal
resources.  According to 1990 census estimates, 22 percent of
working-age people with disabilities live on or below the poverty
line, and an additional 12 percent can be classified as "near poor"
(with incomes between 101 and 150 percent of the poverty line).\11
Not surprisingly, many people with disabilities turn to public
assistance.  In 1992, approximately 3.5 million disabled workers
participated in the Social Security Administration's (SSA) DI
program, and approximately 4 million people with disabilities
participated in the Supplemental Security Income (SSI) program. 
Aside from Social Security income, census figures indicate that
people with disabilities were also more likely to receive other forms
of public assistance.  Only 2 percent of working-age people without
disabilities--
those aged 16 to 64--reported receiving public assistance income,
compared with 15 percent of working-age people with disabilities.\12


--------------------
\9 Calculating the employment rate of people with disabilities
depends on the particular survey and the definition of disability
that survey uses.  For example, the 1990 census found that 18 percent
of individuals who identified themselves as having a mobility
limitation were employed, and 33 percent of those who said they are
limited in the kind or amount of work they can do were employed.  In
a 1994 Louis Harris poll of 1,021 people who identified themselves as
having a disability, 31 percent said they were employed.  For a
discussion of the definitions of disability, see app.  V. 

\10 Many jobless people with disabilities also appear to want to
work.  When the 1994 Louis Harris survey asked people with
disabilities without jobs whether they would prefer to work, 42
percent said they would prefer to work and would be able to do so. 

\11 In comparison, the 1990 census reported that 10 percent of
working-age people without disabilities were living in poverty, and
an additional 6 percent were near poor. 

\12 Although the census asked separate questions about Social
Security income and public assistance income, some respondents may
have confused the two and reported SSI or DI benefits as public
assistance.  For this reason, these figures should be interpreted
cautiously. 


      FEDERAL GOVERNMENT FINANCES
      A WIDE RANGE OF SERVICES TO
      ADDRESS MAJOR EMPLOYMENT
      BARRIERS
---------------------------------------------------------- Letter :4.1

Our discussions with disability experts, consumers, and officials
from public and private agencies identified multiple barriers that
contribute to the relatively low employment rates for people with
disabilities.  Some of the major employment barriers they identified
are listed in table 1, which also includes examples of federal
efforts addressing each barrier. 



                          Table 1
          
            Examples of Employment Barriers for
            People With Disabilities and Federal
               Efforts Addressing These Needs

                              Examples of federal efforts
                              addressing this employment
Employment barriers           barrier
----------------------------  ----------------------------
Low education levels          IDEA and related programs,
                              vocational education,
                              funding for Gallaudet
                              University, Department of
                              Veterans Affairs (VA)
                              Vocational Rehabilitation

Limited skill training        Vocational Rehabilitation,
                              VA Vocational
                              Rehabilitation, JTPA

Lack of access to assistive   Technology assistance
technology                    programs, Medicare and
                              Medicaid, Vocational
                              Rehabilitation

Lack of access to employer-   No direct efforts\a
based health insurance

Negative attitudes and        Prohibition against
employer discrimination       discrimination by federal
                              contractors, state and local
                              governments, and private
                              employers and enforcement
                              efforts

Lack of accessible            ADA, DOT funds for capital
transportation                improvements, VA funding for
                              auto modifications

Work disincentives of income  Plan to Achieve Self-
maintenance programs          Support (PASS) program under
                              SSA

Other employment barriers     Programs such as library
for specific disability       services for the blind and
groups, for example,          funding for higher education
communication issues for the  for the deaf at Gallaudet
deaf                          University
----------------------------------------------------------
Note:  For more detailed descriptions of employment-focused programs,
see app.  III. 

\a ADA does not allow employers to discriminate in hiring on the
basis of individual employee health insurance costs. 


      EMPLOYMENT BARRIERS CAN
      LIMIT JOB OPPORTUNITIES FOR
      PEOPLE WITH DISABILITIES
---------------------------------------------------------- Letter :4.2

For many individuals with disabilities, employment barriers can
restrict the range of employment opportunities available.  For
example, the 40 percent of people with disabilities who have less
than a high school education may find the job market particularly
difficult, especially with the general decline in the number of lower
skill jobs available in many industries.  According to 1990 census
figures, people with disabilities were nearly twice as likely to have
less than a high school education (40 to 21 percent); similarly,
individuals without impairments were more than twice as likely to
have a college degree or more (21 to 9 percent). 

In contrast, although a lack of skill training can limit employment
opportunities, access to appropriate technology can expand the range
of possibilities.  In a National Council on Disability (NCD) report,
users of assistive technology reported that such equipment enabled
them to work more productively for more hours, increase their
earnings, and either keep their jobs or obtain employment.\13

Obtaining access to supportive technologies, however, is often
difficult for many people with disabilities.  The Council reported
that a person with severe disabilities may be considered eligible
for, and benefit from, more than 20 federal programs in the area of
assistive technology.  Yet the report cites that the many
inconsistencies between and within these programs lead to an
extraordinary amount of confusion and frustration for individuals
with disabilities and their families.  Moreover, even if a person is
clearly eligible for all services, he or she must negotiate multiple
eligibility requirements--
perhaps including medical examinations, additional documentation, and
interviews with officials from multiple agencies--to get access to
services under several narrowly focused programs. 

People with disabilities also face problems with accessing
nongovernment-supported health care due to preexisting conditions. 
For example, while ADA does not allow employers to discriminate on
the basis of health care costs, the President's Committee on
Employment of Persons With Disabilities cited employer discrimination
in accessing nongovernment-supported health insurance as a major
employment barrier.  For example, employers, especially small
businesses, may find that sometimes the premiums for employee group
health insurance will increase significantly if an employee with a
disability is included in the policy.  Although measuring the extent
of discrimination is difficult, several research studies have found
that wages and hiring rates are lower for individuals with
disabilities than for those without impairments, even after
differences in education, experience, and other factors are accounted
for.\14

In addition to these barriers, people with disabilities face other
obstacles in taking advantage of available employment opportunities. 
For example, many of the federal and state officials we spoke with,
along with other experts, identified the lack of accessible
transportation as especially problematic.  The U.S.  transportation
system is heavily automobile based, but people with disabilities are
less able to rely on cars than individuals without impairments. 
According to census data, 14 percent of people with disabilities did
not have an automobile in the household, compared with 6 percent of
people without disabilities.  Some disabilities (such as blindness)
make driving impractical; others require costly adjustments, such as
hand controls or a lift, to a standard automobile.  In addition,
financial considerations may limit access to automobiles for many
people with disabilities, especially for the over 10 million people
with disabilities who reported incomes of less than $10,000 in 1990. 
The need to rely on public transportation may especially restrict
employment options for people with disabilities who live in rural
areas. 

People with disabilities who rely on income support programs such as
Social Security DI or SSI may also be discouraged from attempting to
work by the prospect of losing their benefits, particularly their
health insurance coverage.  Disability advocates and rehabilitation
counselors believe that the fear of losing medical coverage is one of
the most significant barriers to the participation of SSI and DI
beneficiaries in the Vocational Rehabilitation program, their return
to work, or both.\15 In recent years, other initiatives have adopted
additional procedures to mitigate these work disincentives, but
relatively few beneficiaries have taken advantage of these
provisions. 


--------------------
\13 Study on the Financing of Assistive Technology Devices and
Services for Individuals with Disabilities, National Council on
Disability (Washington, D.C.:  1993). 

\14 See Marjorie Baldwin and W.  Johnson, "Labor Market
Discrimination Against Men With Disabilities," Journal of Human
Resources, Vol.  223, No.  1 (1994), pp.  1-19; Jean-Francois Ravaud,
Beatrice Madiot, and Isabelle Ville, "Discrimination Towards Disabled
People Seeking Employment," Social Science and Medicine, Vol.  35,
No.  8 (1992), pp.  951-58; and William G.  Johnson and James
Lambrinos, "Wage Discrimination Against Handicapped Men and Women,"
Journal of Human Resources, Vol.  20, No.  2 (1985) pp.  264-77. 

\15 SSA Disability:  Program Redesign Necessary to Encourage Return
to Work (GAO/HEHS-96-62, Apr.  24, 1996). 


   DESPITE ITS IMPORTANCE,
   COORDINATION HAS BEEN DIFFICULT
   TO ACHIEVE
------------------------------------------------------------ Letter :5

Because people with disabilities may need a variety of services to
seek or retain employment, and with federal assistance dispersed
among many programs and agencies, coordination of these activities is
especially important.  Programs and agencies may coordinate in
different ways, from sharing basic program information to
establishing compatible eligibility criteria to cooperating in
service provision.  (See table 2.)



                          Table 2
          
               Types of Program Coordination

Type        Definition
----------  ----------------------------------------------
Informatio  Ensuring that program administrators are
nal         knowledgeable about the requirements and
            services of related programs, enabling them to
            better plan their activities, share
            information, overcome institutional barriers,
            and help beneficiaries access appropriate
            resources from other programs.

Eligibilit  Establishing similar, compatible eligibility
y           requirements for programs with overlapping
            target populations. Eligibility coordination
            and streamlining documentation not only reduce
            the administrative burden on participants, but
            also reduce the amount of program time
            required to make assessments and process
            applications.

Service     Enabling beneficiaries to have easy access to
            the services they need to avoid duplication or
            service gaps. Interagency service linkages
            enable agencies to ensure that individual
            programs support each other.
----------------------------------------------------------
Our review raised questions about the extent to which federal
disability programs achieve coordination in any of these areas.  Many
of the agencies responsible for federal disability programs did not
engage, or engaged very little, in basic informational coordination
either with each other, state and local agencies, the private sector,
or the disability community.  Eligibility coordination was also
lacking; similarly, service coordination appeared to be uncommon. 

Coordination in any of these areas appeared to be a formidable task
for several reasons.  First, many of the recent initiatives targeted
to people with disabilities added to or expanded an already existing
program structure organized to address the needs of nondisabled
people.  As a result, administrators, particularly those who manage
partially targeted programs, often do not fully understand the needs
of people with disabilities\16 and do not place a high priority on
coordinating with organizations serving their special needs.  Second,
many federal programs rely on service providers at the state and
local levels for direct service delivery.  In addition to the 130
federal programs overseen by 19 agencies in 1994, states distributed
program administration and authority to a variety of agencies:  state
departments of employment and training; state rehabilitation
departments; state education departments; state departments for the
blind, deaf, or developmentally disabled; state health departments;
and others.  Many of these different agencies also apply their own
eligibility criteria, creating even greater variation.  One
disability researcher reported that when he surveyed states and asked
which departments provided disability-related services, he received
almost as many different responses as there were respondents. 
Finally, federal and state officials also identified turf battles,
different orientations and approaches, and competing program
objectives as other impediments to coordination. 


--------------------
\16 PASS Program:  SSA Work Incentive for Disabled Beneficiaries
Poorly Managed (GAO/HEHS-96-51, Feb.  28, 1996). 


      LIMITED COMMUNICATION EXISTS
      AMONG AGENCIES SERVING
      PEOPLE WITH DISABILITIES
---------------------------------------------------------- Letter :5.1

Although federal assistance to people with disabilities is dispersed
among many programs and service delivery agencies at the state and
local level, limited informational coordination exists among agencies
about these programs and how they fit together.  Federal officials
did not systematically share program information and ongoing
developments with their counterparts at other federal, state, local,
and nonprofit agencies or with the private sector or the disability
community.  Some federal officials we interviewed did not know of the
existence of other federal programs helping people with disabilities. 
Although others knew of these programs, they seldom or never talked
with agency officials from other programs nor did they keep up with
ongoing program developments. 

Limited informational coordination by federal administrators was
common, particularly among those who manage partially targeted
programs.  For example, one Labor official, commenting on the
department's lack of outreach to the disability community, said that
the Department "does not even talk to its [disabled] customers."\17
Similarly, we consistently heard from disability advocates, state and
local officials, service providers, and private employers that JTPA
does not effectively serve the needs of people with disabilities. 
State officials told us that, in fact, some JTPA offices were
situated in locations that were inaccessible to people with mobility
limitations. 

One consequence of this limited informational coordination was the
difficulty people with disabilities experienced in getting reliable
information about federal services.  In particular, although the
majority of SSI field offices and their staff reported that they
spent time providing program information, according to our 1991
study,\18 state and local officials told us that consumers often
received inconsistent answers to commonly asked questions about SSI,
work, and rehabilitation.  The lack of consistent, accurate
information about SSI, work, and rehabilitation could magnify some of
the work disincentives created by provisions of income support
programs.  One consumer we interviewed stated that getting answers to
questions about work and rehabilitation was difficult because SSI/DI
administrators did not understand the needs that were specific to her
disability.\19 She also told us that getting incomplete information
made employment a risky proposition because she could lose her health
benefits and not have the earning power to replace them.\20

Lack of informational coordination also has negative consequences for
employers and service providers, both public and private.  For
example, in some states, counselors from vocational rehabilitation
programs do not have access to job listings from agencies that
administer employment and training programs.  The absence of such
linkages for sharing information can present undue burdens on
employers.  For example, without such information sharing, counselors
from separate agencies may independently contact the same employer to
develop employment opportunities for people with disabilities. 
Having different service providers--a vocational rehabilitation
counselor, an employment training specialist, a supported employment
job developer, or a representative from PWI--contact one employer can
undermine the relationship between service providers, employers, and
the disability community. 


--------------------
\17 This observation is supported by the 1994 results of the Louis
Harris survey.  When asked how much they knew about state or local
job counseling and employment services for people with disabilities,
67 percent of the full-time students or job trainees with
disabilities said they were either "not too familiar" or "not
familiar at all" with these services. 

\18 Social Security:  District Managers' Views on Outreach for
Supplemental Security Income Programs (GAO/HRD 91-19FS, Oct.  30,
1990). 

\19 These statements were consistent with findings from another GAO
study citing lack of awareness and understanding about disability and
rehabilitation issues among SSI staff (GAO/HEHS-96-51, Feb.  28,
1996, pp.  22-23). 

\20 For example, people with disabilities often cannot get health
insurance through an employer because of exclusions based on
pre-existing conditions.  To replace the lost health care and income
support from federal programs, a person with a disability would have
to earn as much as $50,000 per year, according to the President's
Committee on Employment of Persons With Disabilities. 


      FEDERAL AND STATE AGENCIES
      APPLY A WIDE RANGE OF
      ELIGIBILITY CRITERIA
---------------------------------------------------------- Letter :5.2

Eligibility coordination is similarly limited among federal programs
and agencies.  Each federal program has congressionally authorized
eligibility and scope-of-service requirements.  Differences in
eligibility criteria can make access to services a complex process,
however, and could confuse people with disabilities as well as those
who serve them.  We identified at least 14 different definitions of
disability used by federal programs alone, and many of these
definitions provided considerable agency and state discretion in
eligibility determination.  For example, in assessing eligibility for
services, one program permitted each of its 300 field offices
considerable discretion in defining disability.  State officials who
serve people with disabilities told us that the requirements for
participating in this program are very strenuous and a paper chase is
required to apply. 

Even when programs may have well-defined criteria within their own
departments, these criteria may differ from those used by other
agencies.  For example, programs administered through the Department
of Education, such as Vocational Education and Vocational
Rehabilitation, defined eligibility in terms of physical or mental
impairments, whereas the programs administered through Social
Security (DI and SSI) defined disability in terms of the inability to
work.  (See app.  V.)

In addition to the federal eligibility definitions, many states have
the flexibility to develop and apply additional eligibility criteria
and standards.  For example, according to federal officials,
theoretically, each state can have its own definition of
developmental disabilities.  State agencies may use the federal
definition of developmental disabilities or the state's definition. 
For someone to be eligible for services in one state, mental
retardation has to be the primary disability.  Other states define
developmental disability in terms of intelligence quotient with
differing thresholds.  A 1988 report from the Training and Research
Institute for People With Disabilities cited that among state
agencies serving the mentally retarded or developmentally disabled
population, only 40 percent evaluated their consumers using the
relevant federal definitions and standards and none of the state
vocational rehabilitation agencies evaluated their consumers
according to federal criteria.\21 We also found in a recent study
that state vocational rehabilitation agencies used criteria that were
more restrictive than federal standards in screening SSI/DI
participants.\22 Restrictive standards allowed state rehabilitation
agencies to limit the referrals they receive from the Social Security
offices to those they considered to be the best rehabilitation
candidates. 

The wide variation in eligibility standards limits the possibilities
for linkages among programs, such as reciprocal referrals or
eligibility agreements, in which agencies or programs can establish
that eligibility for one program would expedite service provision
from another.  Such linkages could reduce confusion and service
delays to consumers, despite the variation in eligibility, yet we
found few examples of such reciprocal agreements.  For example, few
linkages exist between state vocational rehabilitation programs and
federal or state employment and training agencies.  In our 1992 study
of support services under JTPA, only 24 percent (131 of 557) of local
organizations surveyed said that they had coordination agreements
with the state rehabilitation agencies.\23

Although in many cases variation in eligibility requirements may be
appropriate or necessary, collectively these differences make federal
programs difficult for consumers to use.  For example, in the area of
assistive technology, consumers testified at public forums convened
by NCD that one device or piece of equipment has to be defined in
different ways to meet eligibility requirements under different
programs, each with its own funding limitations.  Different rules are
further complicated by differences in interpretating guidelines in an
agency within a state and across states.  Even if a person is clearly
eligible for all services, he or she must negotiate multiple
eligibility requirements--perhaps including medical examinations,
documentation, and interviews with officials from multiple
programs--to access services under several narrowly focused programs. 
Routinely, people with disabilities must go to several different
offices to get services. 

Similarly, different standards and criteria also increase costs for
service providers and can limit their participation.  For example, an
international nonprofit organization that provides a variety of
employment and rehabilitation services for the disabled told us that
some local chapters of the organization choose not to participate in
some programs that have a federal and state component.  These local
chapters would prefer to spend their resources on delivering services
instead of negotiating different processes in a variety of agencies. 


--------------------
\21 National Perspectives on Integrated Employment:  State MR/DD
Agency Trends, Training and Research Institute for People With
Disabilities, 1993. 

\22 GAO/HEHS-96-62, Apr.  24, 1996, p.  49. 

\23 Job Training Partnership Act:  Actions Needed to Improve
Participant Support Services (GAO/HEHS-92-124, June 12, 1992). 


      MANY AGENCIES HAVE NOT
      COORDINATED SERVICES FOR
      PEOPLE WITH DISABILITIES
---------------------------------------------------------- Letter :5.3

Established, well-maintained service coordination among programs also
appears uncommon, resulting in inefficiencies and limiting
private-sector participation and support.  For example, many experts
believe that increased access to regular fixed-route transportation
facilitates the employment of people with disabilities. 
Transportation continues to be problematic, however, particularly in
rural areas.  Although different federal and state programs provided
separate transportation funding for the elderly and the disabled,
these services were not required to be coordinated at the local
level.  Thus, federal and state officials told us that, for example,
in one county a half-empty van providing transportation for the
elderly and another half-empty van providing transportation for the
disabled may be traveling the same routes at the same time. 

Poor service coordination can also discourage employer efforts to
work with programs and help people with disabilities.  Private-sector
partners involved with government programs told us that service
coordination is essential for them.  Officials from one corporate
partner told us that having a single point of contact--rather than
having to deal with multiple programs and administrators--is crucial
to the company's ability to participate in a program employing
individuals with psychiatric disabilities.  Another corporate
official explained that lack of responsiveness and service
coordination among multiple employment programs--along with
reductions in financial incentives--contributed to her company's
decision to discontinue its efforts to participate in job training
programs for the disadvantaged and for people with disabilities. 


      BROAD-BASED EFFORTS TO
      REDUCE FRAGMENTATION IN
      FEDERAL PROGRAMS HAVE FALLEN
      SHORT
---------------------------------------------------------- Letter :5.4

The diffusion of federal assistance to people with disabilities is
not unique to these programs, and efforts to address the resulting
problems are not new.  For more than 30 years, the Congress, federal
agencies, and others have recognized that most public and private
human service agencies are organized to address a narrow range of
issues and individuals.  Nevertheless, their periodic attempts to
reorganize and reshape the way human services are delivered have met
with only marginal success. 

Public and private officials from all levels of government and
service delivery have tried different approaches to change the way
human services are planned, funded, and administered.  As we
identified in a previous study, however, broad-based efforts to
eliminate fragmentation by creating a new service delivery system
have faced many obstacles and met with limited success.\24 Mandates
alone are unlikely to secure the significant time and resource
commitments needed from officials to initiate and sustain systemwide
reform.  In contrast, less ambitious efforts to improve coordination
among service providers have succeeded somewhat in enhancing
services.  These efforts did not try to reorganize agencies'
administrative structures; they improved services by taking a more
modest, practical approach, focusing on the point of delivery and
adapting to local conditions.  Specifically, they linked individuals,
services, and programs by (1) convincing service providers and
officials of the need to cooperate and developing incentives for them
to participate in the effort, (2) getting key participants to agree
to the goals of the initiative and the role of each party in
implementing changes, and (3) establishing a forum to
institutionalize changes and continue ongoing communication. 


--------------------
\24 Integrating Human Services:  Linking At-Risk Families With
Services More Successful Than System Reform Efforts (GAO/HRD-92-108,
Sept.  24, 1992). 


      SOME STATE AND LOCAL
      INITIATIVES SHOW PROMISE IN
      IMPROVING COORDINATION
---------------------------------------------------------- Letter :5.5

Some states have developed strategies that use the practical and
modest approach that we had previously identified as improving
coordination.  For example, in California, one rural county we
visited appeared to be improving services and reducing program costs. 
Despite significant barriers to coordination, state and local
officials were improving communication among service providers and
linking people with disabilities to the services they need in a
comprehensive manner.  Officials reported that their coordination
efforts had reduced time and expense for administrators and consumers
by 40 to 50 percent. 

In this case, state and local officials created a collaborative
forum--the School-to-Work Interagency Transition Partnership
(SWITP)--that uses interagency linkages at the local level to help
students with disabilities successfully transition from school to
work.  Officials formed a transition team composed of the student,
parents, school counselors, representatives from the local JTPA
program, and the state vocational rehabilitation agency.  The team
meets to identify a student's employment goals and devises a plan to
tailor available services to the student's aspirations for achieving
independent living.  Representatives from almost all of the necessary
services usually attend the meeting, and they work with the student
and his family to identify priorities and overcome barriers.  For
example, one student could not take needed computer classes because
of a lack of access to public transportation, but buying a car would
have jeopardized the student's income maintenance and health care
benefits.  Because the agencies were working together in a team
format to coordinate services, they quickly identified and
implemented a solution. 

Transition team members said that students liked being part of the
team because it gave them greater personal independence.  One of the
students who participated in the transition team told us it had been
indispensable in guiding him from high school to independent living. 
The student had only work experience as a janitor, but the team
helped him to identify his skill strengths and weaknesses as well as
his own aspirations for other vocations.  School counselors provided
insights about the student's disability, and the JTPA staff
identified relevant training the student needed.  The end product of
the meeting was a strategic plan, which gave the employment
specialist a basis on which to approach employers, emphasizing the
student's skills and their benefits to employers.  Despite initial
employer reluctance, the team placed the student temporarily for
on-the-job training and continued to support both the employer and
the student after the placement.  The student's enthusiasm and
willingness to learn impressed the employer, and, 4 years later, the
student was still employed there as a custom upholsterer--at well
above the minimum wage. 

Although SWITP's comprehensive team assessment and planning process
is targeted to youth with disabilities, it mirrors the challenges and
strategies that have faced other programmatic efforts to improve
services.\25 Like administrators of adolescent drug prevention
programs, SWITP service providers faced tasks of coordinating diverse
external agency procedures, documentation, and personalities.  SWITP
service providers noted that they often need conflict management
skills, a strong focus on the student's needs, and patience to
overcome the turf concerns of specialized professionals and their
agencies to provide the full range of services necessary for their
participants.  SWITP providers also found that coordination was
enhanced by using a master document containing the information
necessary for each agency to meet each program's data requirements. 
Although the master document does not replace all other
documentation, it condenses the multiple intake documents previously
required from students.  In addition, service providers regularly
consult each other about changes in their programs and consumers,
which has enhanced their ability to follow up with their students
long after they have left the program.  SWITP service providers
reported strong support for the process because it fosters trust ("we
don't feel threatened by one another"), noting that this trust has
given them greater flexibility in helping their students achieve
their goals. 

States are also exploring other strategies to improve communication
and overcome organizational barriers.  For example, Massachusetts has
created interagency agreements establishing forums in which state
agency personnel can discuss and systematically train each other
about their respective missions, procedures, standards, and target
populations.  Nevada and Massachusetts have also reported
arrangements for exchanging electronic information between vocational
rehabilitation and employment and training agencies, which has
facilitated reciprocal referrals. 


--------------------
\25 Adolescent Drug Use Prevention:  Common Features of Promising
Community Programs (GAO/PEMD-92-2, Jan.  16, 1992). 


   AGENCIES GENERALLY DO NOT KNOW
   IF EMPLOYMENT-FOCUSED PROGRAMS
   ARE WORKING EFFECTIVELY
------------------------------------------------------------ Letter :6

While the variety of programs and agencies engaged in serving people
with disabilities raises questions about the efficiency of federal
efforts, the effectiveness of these efforts is also unclear.  Most of
the 26 employment-
focused programs we examined have not been formally evaluated.  For
many of the employment-focused programs, no statutory or agency data
collection requirements exist.  Federal officials explained that few
formal evaluations have been conducted because of the lack of data
collection, limited resources, and in many instances the data
collection problems posed by federal and state program flexibility. 

The absence of legislative and agency data collection requirements,
coupled with limited available resources, precludes effectiveness
studies for many of the programs we visited.  Many of the agencies
administering these 26 employment-focused programs did not require or
collect data on program outcomes--specifically, data on whether
participants got jobs and kept them, what wages they received, and
whether they received employee benefits such as health insurance. 
For example, JTPA has no statutory requirement for service delivery
areas to report the characteristics of the services delivered to
people with disabilities or how they are delivered.  Program
officials told us that, with the limited resources of most agencies,
they lack the capabilities to initiate data collection efforts. 

For some of the programs that did collect outcome data, the
information collected was not sufficient to adequately link outcomes
to the services provided.  For example, although service providers
for the Supported Employment program provided detailed information on
program participant performance and initial placement, they were not
required to track consumers after an 18-month period, making any
long-term assessment of the linkage between training and employment
difficult. 

Without a concurrent effort to improve coordination at all service
levels, however, imposing reporting or assessment requirements may
not improve the basis for evaluation.  Given the flexibility each
state has in choosing its own standards and definitions, outcome
tracking can be a formidable task.  In many instances, service
providers, both public and private, use different intake data,
eligibility criteria, paperwork requirements, software, and
confidentiality rules.  Consequently, "people aren't talking the same
language," as one state official summarized, and considerable
investments would be required to develop more uniform documentation
and data to accommodate the many definitions and standards used.  For
example, different agencies and organizations at the state level
provide funds for supported employment services.  Federal officials
told us, however, that mental health agencies have a different
definition of services that constitute supported employment than do
the vocational rehabilitation agencies.  Without better coordination,
data collection and tracking will remain a costly endeavor, and
program administrators will lack confidence that their programs are
effective, either individually or in combination with other services. 

The Congress has in the past directed agencies involved in research
and evaluation of programs serving people with disabilities to
improve their coordination.  For example, according to a report from
the Office of Technology Assessment (OTA), Education's Rehabilitation
Services Administration signed a memorandum of understanding in 1993
with other agencies involved in similar research and evaluation.\26
The memorandum was intended to initiate collaboration of service
delivery, staff training, and evaluation activities for the
rehabilitation and employment of people with psychiatric
disabilities.  Similarly, the National Task Force on Rehabilitation
and Employment of Psychiatric Disabilities tried to promote
collaboration in the research and evaluation of federal
rehabilitation and employment efforts.  The task force met quarterly
for 3 years, but attendance declined significantly, with many members
complaining about its voluntary nature and limited impact on
policies.  The OTA report stated that experts and advocates commented
to them that such efforts had achieved only mixed success, leading to
OTA's conclusion that "while mechanisms for communicating across
agencies have or do exist, they lie moribund at the present time."


--------------------
\26 Psychiatric Disabilities, Employment, and the Americans With
Disabilities Act, Office of Technology Assessment (Washington, D.C.: 
Mar.  1994). 


   CONCLUSION
------------------------------------------------------------ Letter :7

Our review raises questions about the efficiency of federal efforts
to help people with disabilities.  In 1994, the federal government
provided a broad range of services to people with disabilities
through 130 different programs, 19 federal agencies, and a multitude
of public and private agencies at the state and local levels. 
Although research groups and independent panels have stressed the
need to simplify and streamline programs serving people with
disabilities, suggestions for creating a new system to deliver
services may be difficult to implement.  In 1992, we urged caution
when the Congress considered initiatives for federal, state, and
local organizations to make fundamental changes in human service
delivery systems, and we also urge caution for programs serving
people with disabilities.  Although the potential benefits of
creating a new system to deliver services more comprehensively to
people with disabilities may be great, so are the barriers and the
risks of failure.  Obstacles preventing officials from reorganizing
service agencies, creating new funding and service agreements, and
divesting authority from their own agencies are difficult to
overcome.  Mandates alone are unlikely to secure the significant time
and resource commitments needed from officials--whether they are
charged with directing reforms or have responsibility for
administering services. 

In the current fiscal environment, a renewed focus by federal
agencies on improving coordination would be a useful step toward
improving services and enhancing the customer orientation of their
programs.  Given the multifaceted federal effort, better coordination
is crucial to any strategy to eliminate duplication and service gaps
and to enhance the efficiency of programs administered by the many
public agencies at all levels of government.  Without such an effort,
assessing the impact of the federal commitment to people with
disabilities and the relevance of improvement measures, such as
program consolidation, becomes virtually impossible.  We have
identified several state and local initiatives that have shown
promise in meeting the challenges of coordination; other initiatives
most likely exist throughout the nation.  These efforts appear to
have succeeded somewhat in reducing duplication and service gaps,
while saving agencies money.  In light of these initiatives, the
major Departments serving people with disabilities--Education, Labor,
and Health and Human Services (HHS)--have an opportunity to identify,
encourage, support, and learn from the innovative solutions being
developed at the state and local levels. 


   AGENCY COMMENTS
------------------------------------------------------------ Letter :8

The Departments of Labor, Education, and Transportation provided
comments on our draft report, agreeing with our findings and
conclusions.  (See app.  VI for a copy of written comments from the
Department of Labor.) Each of these agencies also provided technical
comments, which we incorporated in the report as appropriate.  HHS
did not provide comments on the report within the time available. 


---------------------------------------------------------- Letter :8.1

As arranged with your office, we are sending copies of this report to
the Secretaries of Labor, Education, and Health and Human Services. 
GAO contacts and staff acknowledgments for this report appear in
appendix VII.  Please call me on (202) 512-7014 if you or your staff
have any questions. 

Sincerely yours,

Carlotta C.  Joyner
Director, Education and
 Employment Issues


OBJECTIVES, SCOPE, AND METHODOLOGY
=========================================================== Appendix I

This report identifies and describes federal programs designed to
assist people with disabilities, with a special emphasis on programs
promoting employment.  Specifically, we focused on the following
questions:  (1) Which federal programs target people with
disabilities, and how many of these programs provide
employment-related services?  (2) To what extent are information,
eligibility, and services coordinated under these programs?  (3) What
does available evidence suggest about the efficiency or effectiveness
of federal programs in promoting employment among people with
disabilities? 

To accomplish these objectives, we integrated evidence from the
literature, from analyses of available databases, and from interviews
with consumers and public and private organizations.  We interviewed
officials of federal agencies that administer programs targeted to
people with disabilities.  We also interviewed disability advocates;
officials of nonprofit groups; and state and local officials in
Massachusetts, California, Virginia, and Nevada.  We chose these
states on the basis of expert opinions and agency officials to obtain
a variety of geographic locations, program sizes, and administrative
structures.  In addition, we interviewed consumers and several
private-sector participants in several of these states to obtain
their perspectives on how these programs promote employment of people
with disabilities.  We reviewed the literature on labor economics and
employment programs, generally, and on people with disabilities, in
particular, to obtain information on the problems and employment
barriers such individuals face and on federal efforts to surmount
these barriers.  We also reviewed agency documents and legislation to
help determine the purpose, eligibility requirements, and services
authorized under these programs. 

To profile the population of people with disabilities, we used
several databases.  In addition to relying on previously published
results from the Current Population Survey (CPS), the Survey of
Income and Program Participation (SIPP), and the 1995 National
Organization on Disability/Louis Harris Survey on Employment of
Persons With Disabilities, we analyzed information from the 1990
census and from the 1993 National Health Interview Survey (NHIS). 
Our estimates from the 1990 census were based on a 5-percent subset
of the full census sample--approximately 15.9 percent of all U.S. 
housing units consisting of over 12 million people and 5 million
housing units.  These households received the long form of the census
questionnaire, which collects detailed information on many variables,
including several different ways of measuring disability status.  The
1993 NHIS is a personal interview household survey using a nationwide
sample of 109,671 civilian noninstitutionalized people in the United
States.  The two surveys differ in the content of their
disability-related questions as well as in the other information
gathered.  For example, NHIS was useful in estimating the prevalence
of chronic conditions, information the census does not gather.  The
census database provided more precise information on the geographic
distribution of people with disabilities. 


   IDENTIFYING FEDERAL PROGRAMS
   THAT TARGET PEOPLE WITH
   DISABILITIES
--------------------------------------------------------- Appendix I:1

The major sources used to identify federal programs were the Catalog
of Federal Domestic Assistance (CFDA), agency documents, and
interviews with federal officials.  We defined a federal program as a
function of a federal agency that provides assistance or benefits\27
to a state or states, territorial possession, county, city, other
political subdivision, or grouping or instrumentality thereof; or to
any domestic profit or nonprofit corporation, institution, or
individual, other than an agency of the federal government.  We
defined the scope of our review to include those programs meeting one
or more of the following criteria:  (1) people with disabilities are
specifically mentioned in the legislation as a targeted group; (2)
people are eligible for the program wholly or partially because of a
disability; (3) people with disabilities are given special
consideration in eligibility assessments; or (4) program officials
are directed to give priority to serving people with disabilities. 
In general, we included all programs that explicitly recognized
disability or handicap, regardless of how (or whether) the program or
legislation defined disability. 

Programs that serve individuals without respect to disability but
that serve some individuals with disabilities (for example, Aid to
Families With Dependent Children) are beyond the scope of this
report.  We also omitted those programs that exclusively funded
medical research.  Our definition of federal programs also excluded
federal legislation that does not authorize the direct expenditure of
federal funds but instead provides indirect support or imposes
mandates on federal or nonfederal entities.  For example, the
Javits-Wagner-O'Day Act of 1971 authorizes federal agencies to
procure selected goods and services from sheltered workshops for
blind or severely disabled individuals.\28 Although we excluded these
types of federal efforts from our analysis of federal programs, we
described some of the most important of these efforts in the report. 

To analyze in more detail those programs that affect employment
issues, we divided these federal programs into three groups:  (1)
employment-
focused programs that provide services such as job training,
supported employment, job placement, and employment counseling; (2)
employment-related programs that provide services that could reduce
barriers to employment--such as transportation, health care, or
assistive technology; (3) programs unrelated to employment that
provide services that are unconnected (or could have only a remote
connection) to employment--such as services to infants and toddlers. 


--------------------
\27 Our definition of a program is consistent with that of the CFDA,
which states that assistance or benefits includes any activity,
service, or anything of value, the principal purpose of which is to
accomplish a public purpose authorized by federal statute. 

\28 This act was an amendment to the Wagner-O'Day Act of 1938, which
authorized purchases from sheltered workshops for blind individuals. 


   IDENTIFYING INFORMATION ON
   PROGRAM EXPENDITURES
--------------------------------------------------------- Appendix I:2

We gathered information on 1990 and 1994 expenditures using the
Consolidated Federal Funds Report (CFFR) compiled by the Bureau of
the Census.  The CFFR tracks the majority of federal domestic outlays
and is the best information available on expenditures or obligations. 
For some programs, agencies had not reported information to the
Census Bureau; we attempted to gather the information from the
agencies.  In other cases, this information was not available.  For
many of these cases, the agency performed the program's activity in
conjunction with other agency activities, and we could not
distinguish funds spent for one activity from funds spent for the
other.  For this reason, our estimates of total expenditures on
disability-related programs are likely to be underestimated.  In
addition, our estimates reflect federal outlays only and exclude any
supplements from states and localities.  (These estimates, which
appear in table II.1 in app.  II, reflect the federal
expenditures/obligation for the entire program unless noted
otherwise.)

Many federal programs are partially targeted toward people with
disabilities--that is, the programs target multiple groups of
individuals, with people with disabilities being only one and not
necessarily the most important one.  For some of these programs,
agency officials track program expenditures by target group.  For
example, the Health Care Financing Administration tracks Medicare
expenditures for the aged and for the disabled.  Many partially
targeted programs, however, do not track expenditures by targeted
group.  For example, the Transportation Department's Federal Transit
Administration finances public transit systems, along with capital
improvement funds to make mass transit more accessible to people with
disabilities.  Agency officials have found it impractical to track
disability-related expenditures under this program, particularly
since it is impossible to know riders' disability status and whether
or not they are using public transportation for work or some other
activity.  Because we could not distinguish expenditures under many
partially targeted programs, we created an interval estimate of
disability- related expenditures.  At the lower bound, none of the
expenditures for these programs were included; at the upper bound,
all expenditures for these programs were included. 


FEDERAL PROGRAMS TARGETING PEOPLE
WITH DISABILITIES
========================================================== Appendix II

This appendix presents an overview in table II.1 of the 130 federal
programs that we identified as targeted to people with
disabilities.\29 Each program's administering department or agency,
services, and the individuals or groups who ultimately benefit from
these services are included.  Each program's 1994 funding, the degree
of targeting, and the type of applicant are also included.  The order
we used to list programs corresponds to the five-digit program
identification number assigned by the Catalog of Federal Domestic
Assistance (CFDA). 

The first column of table II.1 contains the CFDA five-digit program
identification number.  The first two digits identify the federal
department or agency that administers the program, and the last three
digits are unique codes identifying a program.  For example, programs
starting with "14" are administered by the Department of Housing and
Urban Development (HUD) and those starting with "96" by the Social
Security Administration (SSA).  For programs not listed in the CFDA,
the table uses the alphanumeric code the Bureau of the Census has
assigned.  For example, Funding for the American Printing House for
the Blind is allocated through the Department of Education.  All
Education programs start with "84" as a program identification, and
the additional alpha codes "JJJ" or "JAW" are assigned by the Bureau
of the Census.  Column 2 identifies the descriptive title listed in
the CFDA.  Column 3 shows the federal department, agency, commission,
council, or instrumentality of the government with direct
responsibility for program management. 

Column 4 provides the most prominent services authorized under each
program.  Although other services may also be available, the table
cites those services relevant to people with disabilities. 

Column 5 describes the ultimate beneficiaries of federal assistance. 
Although other groups or individuals may benefit from a program, the
table only describes characteristics relevant to people with
disabilities. 

Column 6 shows information about targeting:  All programs that are
partially targeted have a "P" in column 6.  A partially targeted
program is one that serves people with disabilities and others; a
wholly targeted program provides assistance only to people with
disabilities.  Programs with a "W" in this column are considered
wholly targeted. 

Column 7 shows federal expenditures and/or obligations for the entire
program in 1994, unless noted otherwise.\30 Broadly, the CFDA
specifies three categories of federal assistance:  financial,
nonfinancial, or a combination of both.  For programs that provide
any financial assistance, the table shows the total amount spent or
obligated in 1994 as identified through the Bureau of the Census. 
Programs that provide nonfinancial assistance have "NF" in column 7
because the census only tracks financial assistance for each program. 
Some programs have "NA" in column 7 because expenditure information
was unavailable.\31

Column 8 identifies the applicant for each program.  The CFDA defines
applicants as any entity or individual eligible to receive funds from
a federal program.  Generally, the applicant and the beneficiary will
be the same individual or group for programs that provide assistance
directly from a federal agency.  However, financial assistance that
passes through state or local governments will have different
applicants and beneficiaries.  We classified applicants into the
following five groups:  individuals, nonfederal governmental
entities, nongovernmental entities, other, and the general public. 



                                                                      Table II.1
                                                       
                                                        Federal Programs Targeting People With
                                                                     Disabilities


                                                                                    Expenditure            Nonfeder
                                                                          Targetin         s or            al
                                                                          g         obligations            governme
                                                            Beneficiary   P=partia     for 1994            nt        Nongovernmen
Program                         Department                  eligibility\  l                 (in  Individu  entities  tal                     General
number      Program title       or agency\a   Services      b             W=wholly     dollars)  als       \c        entities\d    Other\e   public\f
----------  ------------------  ------------  ------------  ------------  --------  -----------  --------  --------  ------------  --------  --------
10.415      Rural Rental        USDA          Housing       Low-income    P         512,374,225  X         X         X
            Housing Loans                                   families,
                                                            the elderly,
                                                            and people
                                                            with
                                                            disabilities
                                                            in rural
                                                            areas

14.135      Mortgage            HUD           Housing       The elderly   P         396,179,600            X         X
            Insurance--Rental                               and people
            and Cooperative                                 with
            Housing for                                     disabilities
            Moderate Income
            Families, Elderly,
            Market Interest
            Rate

14.138      Mortgage            HUD           Housing       The elderly   P           3,913,500            X         X
            Insurance--Rental                               and people
            Housing for the                                 with
            Elderly                                         disabilities

14.170      Congregate Housing  HUD           Housing,      The elderly   P           6,059,000  X         X
            Services                          food, and     and people
                                              other         with
                                                            disabilities

14.181      Supportive Housing  HUD           Housing       Very low      W          26,230,293                      X
            for People With                                 income and
            Disabilities                                    physically
                                                            or
                                                            developmenta
                                                            lly disabled
                                                            or
                                                            chronically
                                                            mentally ill

14.182      Section 8 New       HUD           Housing       Very low-     P             199,107  X
            Construction                                    income
                                                            families and
                                                            lower income
                                                            single
                                                            persons with
                                                            a disability

14.235      Supportive Housing  HUD           Housing       Homeless      P         103,056,242            X         X
            Demonstration                                   individuals
            Program                                         and
                                                            families,
                                                            especially
                                                            those with
                                                            disabilities

14.238      Shelter Plus Care   HUD           Housing and   Homeless      P           1,665,292            X
                                              support       people,
                                              services      especially
                                                            those with
                                                            disabilities

14.407      Architectural       HUD           Investigatio  Individuals   W                NF\g  X
            Barriers Act                      n of          with
            Enforcement                       complaints    accessibilit
                                                            y complaints

14.414      Non-                HUD           Investigatio  Individuals   W                  NF  X
            Discrimination on                 n of          with
            the Basis of                      complaints    discriminati
            Disability by                                   on or
            Public Entities                                 accessibilit
                                                            y complaints
                                                            concerning
                                                            public
                                                            housing

16.101      Equal Employment    Justice       Investigatio  Individuals   P                  NF  X
            Opportunity                       n of          with
                                              complaints    discriminati
                                              information   on
                                                            complaints

16.105      Civil Rights of     Justice       Investigatio  Institutiona  P                  NF  X
            Institutionalized                 n of          lized
            Persons                           complaints    individuals
                                              information

16.108      Americans With      Justice       Information   People with   W           1,611,240            X         X
            Disabilities Act                                disabilities
            Technical                                       , state and
            Assistance Program                              local
                                                            governments,
                                                            and profit
                                                            and
                                                            nonprofit
                                                            organization
                                                            s

17.207      Employment Service  Labor         Job training  Job seekers,  P         905,562,244            X
                                              and/or        with
                                              placement     priority to
                                              assistance    people with
                                                            disabilities

17.248      Employment and      Labor         Research      Researchers   P           7,292,013            X         X
            Training Research
            and Demonstration
            Projects

17.249      Employment          Labor         Job training  Job seekers   P                  NA            X         X             X
            Services and Job                  and other     with low
            Training--Pilot                   related       income and/
            and Demonstration                 services      or other
            Programs                                        labor market
                                                            disadvantage
                                                            s, including
                                                            disability

17.250      Job Training        Labor         Job training  Job seekers   P         2,617,524,3            X
            Partnership Act                   and other     with low                         15
                                              related       income and/
                                              services      or other
                                                            labor market
                                                            disadvantage
                                                            s, including
                                                            disability

17.301      Non-                Labor         Legal         Individuals   P                  NF  X
            Discrimination and                assistance    with
            Affirmative Action                              discriminati
            by Federal                                      on
            Contractors and                                 complaints
            Federally Assisted                              involving
            Construction                                    federal
            Contractors                                     contractors

17.302      Longshore and       Labor         Income        Longshore     W           7,279,539  X
            Harbor Workers'                   support       and harbor
            Compensation                                    workers
                                                            injured or
                                                            disabled on
                                                            the job

17.307      Coal Mine Workers'  Labor         Income        Disabled      W         534,304,493  X
            Compensation                      support       coal miners,
                                                            widows, and
                                                            other
                                                            surviving
                                                            dependents

17.801      Disabled Veterans   Labor         Job training  Disabled      W          85,100,000            X
            Outreach Program                  and/or        veterans
                                              placement     seeking jobs
                                              assistance

17.802      Veterans            Labor         Job training  Veterans      P          11,965,306            X         X
            Employment Program                and other     with
                                              related       service-
                                              services      connected
                                                            disability,
                                                            veterans of
                                                            Vietnam era,
                                                            or recently
                                                            separated
                                                            veterans

20.106      Airport             DOT           Transportati  Airport       P         1,686,906,6            X         X
            Improvement                       on            authorities                      85
            Program                                         or
                                                            organization
                                                            s; airport
                                                            users to
                                                            comply with
                                                            ADA

20.500      Federal Transit     DOT           Transportati  Public        P         2,000,959,9            X         X
            Capital                           on            transit                          99
            Improvement Grants                              agencies;
                                                            public
                                                            transit
                                                            users to
                                                            comply with
                                                            ADA

20.513      Capital Assistance  DOT           Transportati  Elderly and   P                  NA                      X
            Program for                       on            people with
            Elderly Persons                                 disabilities
            and Persons With
            Disabilities

27.005      Federal Employment  OPM           Placement     People with   W                  NF                      X
            for Individuals                   assistance;   disabilities
            With Disabilities                 information

30.011      Employment          EEOC          Investigatio  People with   W                  NF  X
            Discrimination--                  n of          disabilities
            Title 1 of the                    complaints    who have
            Americans With                                  discriminati
            Disabilities Act                                on
            (ADA)                                           complaints

30.012      Employment          EEOC          Information   People with   W                  NF  X         X         X             X
            Discrimination--                                disabilities
            Title 1 of the ADA                              , state and
            Technical                                       local
            Assistance                                      governments,
                                                            and profit
                                                            and
                                                            nonprofit
                                                            organization
                                                            s

42.001      Books for the       LC            Books on      Blind and     W                  NF  X
            Blind and                         tape,         other
            Physically                        braille,      physically
            Handicapped                       large type,   disabled
                                              etc.          people

47.041      Engineering Grants  NSF           Research      Researchers,  P         352,933,495  X         X         X             X
                                                            with some
                                                            preference
                                                            to women,
                                                            minorities,
                                                            and people
                                                            with
                                                            disabilities

53.001      Employment          PCEPD         Technical     People with   W           1,068,000  X         X         X             X
            Promotion of                      assistance    disabilities
            People With                       and training  , public and
            Disabilities                                    private
                                                            organization
                                                            s

59.021      Handicapped         SBA           Business      Nonprofit     W           9,784,823                      X
            Assistance Loans                  loans to      sheltered
                                              individuals   workshops or
                                              and           handicapped-
                                              sheltered     owned
                                              workshops     businesses

59.038\h    Veterans Loan       SBA           Business      Small         P          12,613,135  X
            Program                           loans         businesses
                                                            owned by
                                                            Vietnam-era
                                                            veterans or
                                                            veterans
                                                            with
                                                            disability

64.007      Blind               VA            Medical and   Blind         W                  NF  X
            Rehabilitation                    support       veterans
            Centers and                       services
            Clinics

64.008      Veterans            VA            Medical and   Low-income    W                  NF  X
            Domiciliary Care                  support       veterans
                                              services      with
                                                            disabilities

64.009      Veterans            VA            Medical and   Low-income    P                  NF  X
            Hospitalization                   support       veterans and
                                              services      veterans
                                                            with
                                                            nonservice-
                                                            connected
                                                            disabilities

64.010      Veterans Nursing    VA            Medical and   Low-income    P                  NF  X
            Home Care                         support       veterans and
                                              services      veterans
                                                            with
                                                            service-
                                                            connected
                                                            disabilities

64.011      Veterans            VA            Medical care  Certain       P                  NF  X
            Outpatient Care                                 veterans
                                                            with
                                                            disabilities

64.013      Veterans            VA            Medical care  Veterans      W                  NF  X
            Prosthetic                                      with
            Appliances                                      disabilities

64.014      Veterans State      VA            Medical care  Veterans      W          17,544,609            X
            Domiciliary Care                                with
                                                            disabilities

64.015      Veterans State      VA            Medical care  Veterans      W         136,206,330            X
            Nursing Home Care                               with
                                                            disabilities

64.016      Veterans State      VA            Medical care  Veterans      W           4,338,955            X
            Hospital                                        with
            Care                                            disabilities

64.100      Autos and Adaptive  VA            Transportati  Service       W          24,990,946  X
            Equipment for                     on            members and
            Certain Disabled                                veterans
            Vets and Members                                with
            of Armed Forces                                 disabilities

64.104      Pension for         VA            Income        Veterans      W         2,225,579,3  X
            NonService-                       support       with                             47
            Connected                                       disabilities
            Disability for
            Veterans

64.106      Specially Adapted   VA            Housing       Veterans      W           8,044,137  X
            Housing for                                     with
            Disabled Veterans                               disabilities

64.109      Veterans            VA            Income        Veterans      W         10,976,393,  X
            Compensation for                  support       with                            239
            Service-Connected                               service-
            Disability                                      connected
                                                            disabilities

64.116      Vocational          VA            Job training  Certain       W         2,690,171,1  X
            Rehabilitation for                and/or        veterans                         45
            Disabled Veterans                 placement     with
                                              assistance    service-
                                                            connected
                                                            disabilities

64.118      Veterans Housing-   VA            Adapted       Certain       W                  NA  X
            -Direct Loans for                 housing       veterans
            Disabled Veterans                 loans         with
                                                            specific
                                                            permanent
                                                            and total
                                                            disabilities

64.123      Vocational          VA            Job training  Certain       P                  NA  X
            Training for                      and/or        recipients
            Certain Veterans                  placement     of VA
            Receiving VA                      assistance    disability
            Pensions                                        pensions

81.042      Weatherization      Energy        Financial     Low-income    P         206,552,044            X         X
            Assistance for                    assistance    households,
            Lower-Income                      to            with special
            Persons                           weatherize    emphasis on
                                              homes         the elderly
                                                            and people
                                                            with
                                                            disabilities

84.009\i    Chapter 1           Education     Education     Children      W         113,432,639            X
            Assistance to                                   with
            States for                                      disabilities
            Children With                                   through age
            Disabilities                                    21 in state-
                                                            operated or
                                                            -supported
                                                            schools

84.023      Special Education-  Education     Education     Children and  W          18,856,693            X         X
            -Innovation and                                 youth with
            Development                                     disabilities

84.024      Early Education     Education     Education     Children      W          19,010,910            X         X
            for Children With                               with
            Disabilities                                    disabilities
                                                            aged 8 and
                                                            under

84.025      Services for        Education     Education     Deaf-blind    W          12,312,577            X         X
            Children With                                   children and
            Deaf-Blindness                                  young adults

84.026      Media and           Education     Media and     Individuals   W          12,366,277            X         X
            Captioning                        captioning    with
            Services for                                    disabilities
            Individuals With
            Disabilities

84.027      Special Education-  Education     Education     Children      W         2,659,361,6            X
            -Grants to States                               with                             47
                                                            disabilities

84.028      Special Education-  Education     Information   Children and  W           6,778,000            X         X
            -Regional Resource                              youth with
            Centers                                         disabilities
                                                            ;
                                                            individuals
                                                            seeking
                                                            information

84.029      Special Education-  Education     Training for  Special       W         104,492,784            X         X
            -Personnel                        disability    education
            Development and                   professional  personnel;
            Parent Training                   s             children and
                                                            youth with
                                                            disabilities
                                                            and their
                                                            parents

84.030      Clearinghouses for  Education     Information   Individuals   W           2,149,639            X         X
            Individuals With                                with
            Disabilities                                    disabilities
                                                            ;
                                                            individuals
                                                            seeking
                                                            information

84.034      Library Services    Education     Library       Individuals   P          82,056,525            X
                                              materials     with
                                              and related   disabilities
                                              support       and others
                                                            with
                                                            inadequate
                                                            library
                                                            service

84.048      Vocational          Education     Education     Individuals   P         941,065,735            X
            Education--Basic                                in
            Grants to States                                vocational
                                                            education
                                                            programs,
                                                            with special
                                                            priority to
                                                            several
                                                            groups,
                                                            including
                                                            individuals
                                                            with
                                                            disabilities

84.078      Post-Secondary      Education     Education     Individuals   W           8,701,278            X         X
            Education Programs                              with
            for Persons With                                disabilities
            Disabilities                                    in selected
                                                            postsecondar
                                                            y education
                                                            programs

84.086      Special Education-  Education     Education     Children and  W           8,945,872            X         X
            -Program for                                    youths with
            Severely Disabled                               severe
            Children                                        disabilities

84.125      Clearinghouse on    Education     Information   Individuals   W                  NF                                              X
            Disability                                      and
            Information                                     organization
                                                            s seeking
                                                            information
                                                            about
                                                            disability
                                                            issues

84.126      Rehabilitation      Education     Job training  People with   W         2,029,629,7            X
            Services--                        and/or        disabilities                     38
            Vocational                        placement
            Rehabilitation                    assistance
            Grants to States

84.128      Rehabilitation      Education     Job training  People with   W          20,918,755            X         X
            Services--Service                 and/or        disabilities
            Projects                          placement
                                              assistance

84.129      Rehabilitation      Education     Job training  Rehabilitati  W          25,133,000            X         X
            Long-Term Training                and/or        on
                                              placement     professional
                                              assistance    s

84.132      Centers for         Education     Independent   Individuals   W          36,483,522            X         X
            Independent Living                living        with
                                                            significant
                                                            disabilities

84.133      National Institute  Education     Research      Researchers;  W          66,552,586  X         X         X
            on Disability and                               individuals
            Rehabilitation                                  with
            Research                                        disabilities

84.158      Secondary           Education     Education     Youths with   W          21,588,505            X         X
            Education and                                   disabilities
            Transitional
            Services for Youth
            With Disabilities

84.159      Special Education-  Education     Research      Researchers;  W           2,012,603            X         X
            -Special Studies                                individuals
            for Persons With                                with
            Disabilities                                    disabilities
                                                            , especially
                                                            children and
                                                            youths

84.160      Training            Education     Training for  Interpreters  W           1,510,000            X         X
            Interpreters for                  disability    for deaf or
            Individuals Who                   professional  deaf-blind;
            Are Deaf and                      s             deaf and
            Individuals Who                                 deaf-blind
            Are Deaf-Blind                                  individuals

84.161      Rehabilitation      Education     Information,  Individuals   W           9,502,000            X
            Services--Client                  independent   with
            Assistance Program                living        disabilities

84.169      Independent         Education     Independent   Individuals   W          17,882,970            X
            Living--State                     living        with
            Grants                                          disabilities

84.173      Special Education-  Education     Education     Preschoolers  W         406,103,320            X
            -Preschool Grants                               with
                                                            disabilities

84.174      Vocational          Education     Education     Individuals   P          11,528,750            X
            Education--                                     with
            Community Based                                 disabilities
            Organizations                                   and other
                                                            individuals
                                                            in need of
                                                            special
                                                            prevocationa
                                                            l education

84.177      Rehabilitation      Education     Independent   Individuals   W           8,025,915            X
            Services--                        living        55 and older
            Independent Living                              with severe
            Services for Older                              visual
            Individuals Who                                 impairments
            Are Blind

84.180      Technology          Education     Assistive     Children and  W          10,077,164            X         X
            Applications for                  technology,   youths with
            Individuals With                  education     disabilities
            Disabilities

84.181      Special Education-  Education     State         Infants and   W         228,380,473            X
            -Grants for                       planning      toddlers
            Infants and                                     with
            Families With                                   disabilities
            Disabilities

84.187      Supported           Education     Job training  Individuals   W          34,170,640            X         X
            Employment                        and/or        with severe
            Services for                      placement     disabilities
            Individuals With                  assistance
            Severe
            Disabilities

84.224      State Grants for    Education     Assistive     Individuals   W          36,148,396            X
            Assistive                         technology    with
            Technology                                      disabilities

84.231\j    Demonstration and   Education     Assistive     Individuals   W                  NA            X         X
            Innovation                        technology    with
            Projects                                        disabilities

84.234      Projects With       Education     Job training  Individuals   W          21,850,110            X         X
            Industry                          and/or        with
                                              placement     disabilities
                                              assistance

84.235      Special Projects    Education     Job training  Individuals   W          20,599,717            X         X
            and Demos for                     and/or        who are
            Providing                         placement     deaf, blind,
            Vocational Rehab.                 assistance    or mobility
            Services to                                     impaired in
            Individuals With                                isolated
            Severe                                          populations
            Disabilities                                    such as
                                                            Native
                                                            Americans

84.236\k    Training and        Education     Information,  People with   W                  NA            X         X
            Public Awareness                  assistive     disabilities
            Projects in Tech.                 technology
            Related Assist.
            for Individuals
            With Disabilities

84.237      Special Education-  Education     Education     Children and  W           3,873,888            X         X
            -Program for                                    youths with
            Children With                                   serious
            Serious Emotional                               emotional
            Disturbance                                     disturbances

84.240      Program of          Education     Protection    People with   W           5,400,000            X
            Protection and                    of legal and  disabilities
            Advocacy of                       human rights
            Individual Rights

84.246      Rehabilitation      Education     Training for  Professional  W             738,543            X         X
            Short-Term                        disability    s working
            Training                          professional  with
                                              s             individuals
                                                            with
                                                            disabilities

84.250      Rehabilitation      Education     Job training  American      W           6,508,329                      X
            Services--                        and/or        Indians with
            American Indians                  placement     disabilities
            With Disabilities                 assistance    residing on
                                                            reservations

84.263      Rehabilitation      Education     Training for  Professional  W           1,052,732            X         X
            Training--                        disability    s working
            Experimental and                  professional  with
            Innovative                        s             individuals
            Training                                        with
                                                            disabilities

84.264      Rehabilitation      Education     Training for  Professional  W           6,290,552            X         X
            Training--                        disability    s working
            Continuing                        professional  with
            Education                         s             individuals
                                                            with
                                                            disabilities

84.265      Rehabilitation      Education     Training for  Individuals   W           5,924,555            X
            Training--State                   disability    working for
            Vocational Rehab.                 professional  state
            Unit In-Service                   s             vocational
            Training                                        rehabilitati
                                                            on agencies

84.JAV      Funding for         Education     Education     Deaf          W          52,715,000                      X
            Gallaudet                                       individuals
            University                                      in certain
                                                            postsecondar
                                                            y programs

84.JAW      Funding for         Education     Education     Blind         W           6,643,000                      X
            American Printing                               persons
            House for the
            Blind

84.JCN      Funding for         Education     Education     Deaf          W             193,000                      X
            Construction at                                 individuals
            National Technical                              in certain
            Institute for the                               postsecondar
            Deaf                                            y programs

84.JKZ      Disabled Infants    Education     Education     Infants and   W                  NA                      X
            and Toddlers                                    toddlers
                                                            with
                                                            disabilities

84.JJF      Model Secondary     Education     Education     Deaf youths   W             (4,020)                      X
            Schools for the
            Deaf

88.001      Architectural and   ATBCB         Information,  Individuals   W                  NA                                              X
            Transportation                    enforce       with
            Barriers                          federal laws  accessibilit
            Compliance Board                                y complaints
            (ATBCB)                                         or seeking
                                                            information

92.001      National Council    NCD           Information,  Individuals   W                  NA            X         X
            on Disability                     research,     seeking
            (NCD)                             monitoring    information
                                              public laws

93.001      Civil Rights        HHS           Enforce       Individuals   P                  NF  X
            Compliance                        federal laws  with
            Activities                                      discriminati
                                                            on
                                                            complaints
                                                            or seeking
                                                            information

93.132      Managed Care Demo   HHS           Referral and  SSI referral  W          14,271,645            X
            Models for SSI                    monitoring    and
            Beneficiaries                     medical care  monitoring
            Disabled Due to                                 agencies
            Addiction to
            Alcohol and Other
            Drugs

93.138      Protection and      HHS           Protection    Individuals   W          21,378,618            X         X
            Advocacy for                      and advocacy  who are
            Individuals with                                admitted,
            Mental Illness                                  residing, or
                                                            discharged
                                                            from a
                                                            treatment
                                                            facility

93.150      Projects for        HHS           Rehabilitati  Individuals   P          28,874,000            X
            Assistance in                     on and        at risk for
            Transition from                   housing       homelessness
            Homelessness                                    or homeless
                                                            and
                                                            suffering
                                                            from serious
                                                            mental
                                                            illness

93.173      Research Related    HHS           Research      Researchers;  W         147,391,280            X         X
            to Deafness and                                 individuals
            Communication                                   with
            Disorders                                       deafness or
                                                            communicatio
                                                            n disorders

93.184      Disabilities        HHS           State         People with   W           9,722,813            X         X
            Prevention                        planning      disabilities
                                                            and their
                                                            families and
                                                            the general
                                                            public

93.572      Emergency           HHS           Housing and   Homeless      P          19,822,356            X         X
            Community Services                support       individuals,
            for the Homeless                  services      with special
                                                            emphasis on
                                                            homeless
                                                            individuals
                                                            with
                                                            disabilities
                                                            , and
                                                            elderly

93.600      Head Start          HHS           Education,    Low-income    P         3,288,875,8            X         X
                                              health, and   children,                        58
                                              other         especially
                                              support       children
                                              services      with
                                                            disabilities

93.613      Mental Retardation  HHS           Assistance    Mentally      W                  NF                                              X
            President's                       in            retarded
            Committee on                      coordinating  individuals
            Mental Retardation                federal
                                              activities
                                              and
                                              information

93.630      Developmental       HHS           Information,  People with   W          92,374,368            X
            Disabilities Basic                legal         developmenta
            Support and                       assistance    l
            Advocacy Grants                                 disabilities

93.631      Developmental       HHS           Information,  People with   W           4,965,620            X         X
            Disabilities                      research      developmenta
            Projects of                                     l
            National                                        disabilities
            Significance

93.632      Developmental       HHS           Training for  People with   W          18,271,614            X         X
            Disabilities                      disability    developmenta
            University                        professional  l
            Affiliated                        s             disabilities
            Programs

93.647      Social Services     HHS           Research,     Researchers;  P          13,711,262            X
            Research and                      information   low-income,
            Demonstration                                   developmenta
                                                            lly
                                                            disabled,
                                                            and Native
                                                            American
                                                            individuals

93.656      Temporary Child     HHS           Temporary     Children      P          11,712,432            X
            Care and Crisis                   child care    with
            Nurseries                                       disabilities
                                                            and abused
                                                            or neglected
                                                            children

93.659      Adoption            HHS           Assistance    Children      P         317,396,990            X
            Assistance                        with          with
                                              adoption      disabilities
                                              costs         and their
                                                            adoptive
                                                            parents

93.673      Grants to States    HHS           State         Children and  W          12,938,241            X
            for Planning and                  planning      elderly
            Development of                                  dependents
            Dependent Care                                  and their
            Programs                                        families,
                                                            especially
                                                            those with
                                                            developmenta
                                                            l
                                                            disabilities

93.674      Independent Living  HHS           Skill         Youths 16     W          70,834,870            X
                                              development,  and over who
                                              education,    receive or
                                              training      have
                                                            received
                                                            foster care
                                                            payments

93.773      Medicare Hospital   HHS           Medical care  People 65     P         11,700,000,  X
            Insurance                                       and over and                    000
                                                            other                     (disabled
                                                            qualified                     only)
                                                            disabled

93.774      Medicare            HHS           Medical care  People 65     P         7,800,000,0  X
            Supplementary                                   and over and                     00
            Medical Insurance                               those who                 (disabled
                                                            qualify for                   only)
                                                            hospital
                                                            insurance
                                                            benefits

93.778      Medical Assistance  HHS           Medical care  Low-income    P         42,231,000,            X
            Program                                         people over                     000
                                                            65, blind or              (disabled
                                                            disabled                      only)

93.929      Center for Medical  HHS           Research and  Researchers,  W          11,913,915            X         X
            Rehabilitation                    training      people with
            Research                                        disabilities

93.955      Health and Safety   HHS           Information,  Construction  P          15,348,905            X         X
            Programs for                      prevention    workers
            Construction
            Workers

93.956      Centers for         HHS           Research,     Researchers,  W           2,109,625                      X
            Agricultural                      injury        general
            Research, Disease,                prevention    public
            Injury Prevention

93.965      Coal Miners         HHS           Medical care  Coal workers  P           4,142,000            X         X
            Respiratory                                     with
            Impairment                                      respiratory
            Treatment Clinics                               impairments
            and Services                                    and their
                                                            families

94.011\l    Foster              CNS           Physical,     Elderly;      P          65,863,323            X         X
            Grandparents                      emotional,    also
                                              and mental    children
                                              care          with special
                                                            needs,
                                                            including
                                                            children
                                                            with
                                                            disabilities

96.001\m    Social Security--   SSA           Income        People who    P         38,458,439,  X
            Disability                        support       are unable                      713
            Insurance                                       to engage in
                                                            any
                                                            substantial
                                                            gainful
                                                            activity by
                                                            reason of a
                                                            medical/
                                                            mental
                                                            impairment
                                                            that is
                                                            expected to
                                                            last or has
                                                            lasted for
                                                            12 months
                                                            and eligible
                                                            dependents

96.002\n    Social Security--   SSA           Income        People with   P         18,900,000,  X
            Retirement                        support       disabilities                    000
            Insurance                                       who "can't                (disabled
                                                            work" and                     only)
                                                            were
                                                            disabled
                                                            before age
                                                            22 and some
                                                            of their
                                                            dependents

96.004\o    Social Security--   SSA           Income        Survivors of  P         63,247,942,  X
            Survivors                         support       Social                          288
            Insurance                                       Security-
                                                            insured
                                                            individuals,
                                                            with special
                                                            provisions
                                                            to people
                                                            with
                                                            disabilities

96.005\p    Special Benefits    SSA           Income        Individuals   W         759,710,101  X
            for Disabled Coal                 support       disabled
            Miners                                          from black
                                                            lung or
                                                            other lung
                                                            disease
                                                            directly
                                                            caused by
                                                            coal mine
                                                            employment

96.006\q    SSI                 SSA           Income        Low-income    P         26,010,116,  X
                                              support       elderly and                     116
                                                            people with
                                                            disabilities
                                                            who "can't
                                                            work"

96.007\r    Social Security--   SSA           Research and  Certain SSI   NA                 NA            X         X
            Research and                      client        beneficiarie
            Demonstration                     assistance    s
-----------------------------------------------------------------------------------------------------------------------------------------------------
\a CNS=Corporation for National Service; DOT=Department of
Transportation; Education=Department of Education; EEOC=Equal
Employment Opportunity Commission; Energy=Department of Energy;
HHS=Department of Health and Human Services; HUD=Department of
Housing and Urban Development; Justice=Department of Justice;
Labor=Department of Labor; LC=Library of Congress; NSF=National
Science Foundation; OPM=Office of Personnel Management;
PCEPD=President's Committee on the Employment of Persons With
Disabilities; SBA=Small Business Administration; SSA=Social Security
Administration; USDA=Agriculture; VA=Department of Veterans Affairs. 

\b See introduction to this app.  for explanation of beneficiary. 

\c This includes a state agency, county, parish, municipality, city,
town, township, village, local public authority, school or special
district, council of government, or any other instrumentality of a
state, local, or regional government. 

\d This includes a private institution or other quasi-public,
nonprofit organization such as a community action agency, private
agency, cooperative, or any other entity that is nongovernmental. 

\e Includes federal agencies. 

\f Usually applies to programs such as technical assistance efforts
or information clearinghouses. 

\g NF=nonfinancial assistance; NA=not available.  See introduction to
this app.  for more details. 

\h Program officials told us that 59.038 was eliminated in 1995;
however, the program still appeared in the 1995 CFDA. 

\i Program 84.009 was deleted in 1995. 

\j Program 84.231 was deleted in 1995. 

\k Program 84.236 was deleted in 1995. 

\l Before 1995, program 94.011 was identified as 72.001. 

\m Before 1995, program 96.001 was identified as 93.802. 

\n Before 1995, program 96.002 was identified as 93.803. 

\o Before 1995, program 96.004 was identified as 93.805. 

\p Before 1995, program 96.005 was identified as 93.806. 

\q Before 1995, program 96.006 was identified as 93.807. 

\r Before 1995, program 96.007 was identified as 93,812. 


--------------------
\29 See app.  I for details on our selection criteria. 

\30 Agencies responsible for many of the partially targeted programs
could not separate programs expenditures/obligations into
disability-related and nondisability-related categories. 

\31 See app.  I for details about this database. 


FEDERAL EMPLOYMENT INITIATIVES
TARGETED TO PEOPLE WITH
DISABILITIES
========================================================= Appendix III

Over several decades, congressional concern about employment
opportunities for people with disabilities has led to more than two
dozen federal employment-focused programs.\32 In addition, the
Congress has provided certain employment protections to people with
disabilities, for example, by barring discrimination in employment on
the basis of disability.  Finally, several laws also provide a
variety of mechanisms that indirectly support the employment of
people with disabilities, for example, by authorizing federal
purchases from nonprofit organizations that employ people with
disabilities.  These federal employment initiatives incorporate three
approaches toward employing individuals with disabilities: 

  -- In sheltered employment, individuals with disabilities work in a
     "sheltered workshop," which is a controlled environment
     providing job operations involving a limited set of tasks. 
     Sheltered employment is most frequently used with individuals
     with severe functional limitations, although the blind have a
     long history of working in sheltered employment operations. 

  -- Under supported employment, individuals with disabilities are
     integrated into a work setting but are provided postemployment
     services, frequently including job coaches or on-the-job
     training, to help facilitate the transition to employment. 
     Federal initiatives for supported employment are intended for
     individuals with relatively severe disabilities. 

  -- Competitive employment most often refers to a regular job, in
     which an individual does not receive postemployment services. 
     The majority of federal placement initiatives for people with
     disabilities are aimed at placing individuals with disabilities
     in competitive employment.  Services provided under such federal
     efforts include job training, educational support, counseling,
     assessment, and placement. 


--------------------
\32 Employment-focused programs provide services, such as job
training, supported employment, job placement, and employment
counseling, that directly facilitate employment.  (See app.  I.)


   FEDERAL EFFORTS TO PROMOTE
   COMPETITIVE EMPLOYMENT INCLUDE
   LEGISLATIVE MANDATES AND
   PARTIALLY AND FULLY TARGETED
   PROGRAMS
------------------------------------------------------- Appendix III:1

Federal efforts to promote the employment of people with disabilities
are largely aimed at competitive employment.  Some of the federal
programs with a goal of competitive employment are designed
exclusively for people with disabilities.  Others, however, are part
of the wider federal effort to promote job opportunities for people
who are disadvantaged in the labor market.  For example, the Job
Training Partnership Act (JTPA) provides job training services mainly
to the economically disadvantaged, but people with disabilities who
are not economically disadvantaged may also qualify.  Both wholly and
partially targeted federal employment programs rely heavily on
leveraging support from the private sector to place individuals in
jobs and move them toward economic self-sufficiency. 


      VOCATIONAL REHABILITATION
----------------------------------------------------- Appendix III:1.1

The largest federal effort focused exclusively on facilitating
employment of people with disabilities is the Vocational
Rehabilitation program.  Vocational rehabilitation formula grants are
provided to a state on the basis of the state's per capita income and
overall population.\33 States are required to submit a plan for
providing services to the Commissioner of Rehabilitation Services
Administration and to match 21.3 percent of federal funds.  Services
that can be provided with these grant funds include job training,
assessment, counseling, maintenance during rehabilitation, personal
assistance, placement or rehabilitation technology, and assistance in
operating a business.  Vocational rehabilitation counselors must draw
up an Individual Employment Plan for each client to specify what that
client needs to move toward employability.  The program provides
services as specified in the plan; these services can include
virtually anything deemed necessary to facilitate a positive
employment outcome.  The emphasis of the program remains on
competitive employment, but it can place individuals in supported or
sheltered employment as well. 

A number of other programs support the Basic State Grants for
Vocational Education.\34 For example, several programs provide
funding to train vocational rehabilitation personnel through state
agencies or other public or private organizations.\35 An estimated
44,034 people participated in training (including continuing
education programs) in fiscal year 1993.  Another support program for
the vocational rehabilitation system provides funding for special
projects and demonstration efforts.\36 In fiscal year 1994, this
program funded 11 new grants and 87 continuation projects in
supported employment.  These efforts emphasized (among other areas)
services to individuals with specific learning disabilities, for
example, individuals with long-term mental illness and transition
services for youths with special needs.  In addition, other federal
programs provide grants to Native American tribes for vocational
rehabilitation services to individuals living on reservations;
another provides vocational rehabilitation services to migrant and
seasonal farmworkers.\37


--------------------
\33 See app.  II for more information on Rehabilitation
Services--Vocational Rehabilitation Grants to States (84.126). 

\34 See app.  II for more information on Vocational Education--Basic
Grants to States (84.048). 

\35 See app.  II for more information on the following programs: 
Rehabilitation Long-Term Training (84.129); Rehabilitation Short-Term
Training (84.246); Rehabilitation Short-Term--Experimental and
Innovative Training (84.263); Rehabilitation Training--Continuing
Education (84.264); and Rehabilitation Training--State Vocational
Rehabilitation Unit In-Service Training (84.265). 

\36 See app.  II for more information on Special Projects and
Demonstrations for Providing Vocational Rehabilitation Services to
Individuals With Severe Disabilities (84.235). 

\37 See app.  II for more information on Rehabilitation
Services--American Indians With Disabilities (84.250) and
Rehabilitation Services--Services Projects (84.128). 


      PROJECTS WITH INDUSTRY
----------------------------------------------------- Appendix III:1.2

The Projects With Industry (PWI) program is one of the few federal
efforts that engages the private sector as a partner in expanding
employment opportunities for people with disabilities.\38 Services
provided to individuals with disabilities vary with different
projects but generally include evaluation, counseling, training, job
development, and job placement.  Services may also be provided to
employers, sometimes including job-site or equipment modification. 
The PWI program may involve grants or contracts with individual
employers, state vocational rehabilitation units, or other public or
private organizations.  Each grantee must develop and work with a
Business Advisory Council, with representatives from private industry
and organized labor, and individuals with disabilities. 


--------------------
\38 The PWI program was authorized under the Rehabilitation Act of
1973.  See app.  II for more information on the program (84.234). 


      VOCATIONAL REHABILITATION
      FOR VETERANS
----------------------------------------------------- Appendix III:1.3

The Department of Veterans Affairs (VA) has established two programs
to provide vocational rehabilitation services to veterans with
disabilities.\39 VA generally provides services to honorably
discharged veterans who have received a 20-percent or higher VA
disability rating\40

for a service-
connected disability.  Under a second program, veterans who are
receiving a VA pension may also qualify for vocational rehabilitation
services.  Case managers in these programs can provide whatever
services the veteran needs to facilitate employment.  Some of these
services include evaluation, counseling, education, training, and job
placement assistance; many veterans with disabilities receive
financing for higher education.  However, these vocational services
are time limited.  Veterans must generally complete the training
portion of their vocational rehabilitation plan within 48 months;
participants generally cannot receive services after 12 years from
the date on which their eligibility was established.\41 In program
year 1995, approximately 48,000 veterans with disabilities received
vocational rehabilitation services. 


--------------------
\39 See app.  II for more information on Vocational Rehabilitation
for Disabled Veterans (64.116) and Vocational Training for Certain
Veterans Receiving VA Pensions (64.123). 

\40 To assess eligibility for this and other VA programs, VA assesses
disability on a percentage scale based on the kind and the severity
of impairment.  A veteran may receive a disability score of up to 100
percent (in 10-percent increments) for VA eligibility purposes. 

\41 In exceptional circumstances, VA may grant a waiver to these time
limitations. 


      JTPA PROGRAMS
----------------------------------------------------- Appendix III:1.4

JTPA provides job training and employment-seeking skills.  It is
primarily directed to economically disadvantaged people but also
includes others who face employment barriers.  JTPA features a unique
partnership of the federal government, the states, and the private
sector.\42 Although JTPA does provide support services such as child
care and transportation, local JTPA providers are restricted in the
amount they can spend and they often spend less than permitted. 
Thus, people with disabilities who require more extensive support
services may need to access other programs to supplement JTPA
services.  In addition to its primary training program, JTPA also
encompasses the residential Job Corps program and research, pilot,
and demonstration efforts.\43 Individuals with disabilities can be
served under all these JTPA programs, and the needs of individuals
with disabilities receive special consideration in the awarding of
discretionary JTPA projects.  For example, in 1995, special project
grants were awarded to organizations, such as Goodwill Industries and
the American Rehabilitation Association, to provide job search
assistance and job placement to people with disabilities.  In
addition, people with disabilities can sometimes qualify for JTPA
without meeting income guidelines because they face a barrier to
employment.  JTPA's focus for its clients with disabilities remains
competitive employment, although JTPA funds can be used for supported
employment efforts as well. 


--------------------
\42 See app.  II for more information on JTPA (17.250). 

\43 See app.  II for more information on Employment and Training
Research and Demonstration Projects (17.248) and Employment Services
and Job Training--Pilot and Demonstration Programs (17.249). 


      EMPLOYMENT SERVICE
----------------------------------------------------- Appendix III:1.5

Established by the Depression-era Wagner-Peyser Act,\44 the
state-federal employment service (ES) provides employment offices to
assist individuals looking for jobs and employers looking for
workers.  Through many local offices, the ES program offers an array
of services, including job counseling, skills assessment and testing,
job search workshops, job opening identification, and referrals to
employers.\45 Services provided by ES, however, are frequently
limited to job listings and some counseling.  Although these services
are available to everyone, states are required to give special
consideration to people with disabilities by requiring every local ES
office to designate at least one staff member to help individuals
with disabilities locate employment or training.  In program year
1994, ES provided assistance to an estimated 625,133 people with
disabilities, which accounted for approximately 3.3 percent of ES'
total clientele. 


--------------------
\44 The Congress passed the Wagner-Peyser Act in 1933.  Subsequent
amendments to the act, especially the 1954 amendments, strengthened
the priority placed on serving people with disabilities. 

\45 See app.  II for more information on ES (17.207). 


      SCHOOL-TO-WORK TRANSITION
      GRANTS
----------------------------------------------------- Appendix III:1.6

With a joint Education/Vocational Rehabilitation plan approved by the
Department of Education, states can receive project grants to provide
school-to-work transition services to secondary students (14 and
older) with disabilities.\46 Many of these projects implement the
Individuals With Disabilities Education Act's (IDEA) requirement to
provide transition services.  Other institutions, such as colleges
and universities and other nonprofit organizations, are also eligible
for project grants to improve the school-to-work transition for
students with disabilities. 


--------------------
\46 This program is authorized under the Individuals With
Disabilities Education Act Part C.  See app.  II for more information
on Secondary Education and Transitional Services for Youth With
Disabilities (84.158). 


      SMALL BUSINESS LOANS
----------------------------------------------------- Appendix III:1.7

Although vocational rehabilitation programs can also provide
financing for small businesses, competitive employment remains that
program's primary emphasis.  The Handicapped Assistance Loan program
awards loans to small businesses that are 100-percent owned by
individuals with disabilities to provide construction or working
capital.  Under this program, the Small Business Administration (SBA)
guarantees commercial loans with extended repayment periods to
businesses.  This program can also be used for sheltered workshops,
as described in more detail later.\47


--------------------
\47 Until 1995, SBA operated a similar program that guaranteed some
loans and also provided direct lending to disabled and Vietnam-era
veterans.  This program was discontinued for lack of funding.  See
app.  II for more information on the Handicapped Assistance Loan
(59.021) and the Veterans Loan programs (59.038). 


      PRESIDENT'S COMMITTEE ON
      EMPLOYMENT OF PERSONS WITH
      DISABILITIES
----------------------------------------------------- Appendix III:1.8

Since 1947, the President's Committee on Employment of Persons With
Disabilities has made efforts to develop public-private partnerships
and encourage businesses to hire individuals with disabilities.\48
The committee's activities include information dissemination and
coordination as well as operating the Job Accommodation Network
(JAN).  JAN provides information on workplace accommodations to
employers, rehabilitation professionals, and individuals through a
toll-free number. 


--------------------
\48 See app.  II for more information on this program (53.001). 


      FEDERAL EMPLOYMENT FOR
      PEOPLE WITH DISABILITIES
----------------------------------------------------- Appendix III:1.9

The Office of Personnel Management operates the federal Selective
Placement Program, which provides federal agencies with assistance in
placing federal employees who have become disabled and in recruiting
employees with disabilities to federal service.  Under this program,
people with disabilities can apply for federal employment without
going through the normal competitive process.\49


--------------------
\49 See app.  II for more information on this program (27.005). 


      AMERICANS WITH DISABILITIES
      ACT
---------------------------------------------------- Appendix III:1.10

The Americans With Disabilities Act (ADA) of 1990 established a clear
and comprehensive prohibition against discrimination on the basis of
disability.  Among other protections, ADA established regulations
focused on removing architectural, communications, and transportation
barriers.  Regarding employment, ADA essentially prohibits
organizations employing 15 or more employees from discriminating
against a qualified individual with a disability because of the
disability in the job application or hiring process, in advancement
or discharge of employees, employee compensation, job training, or
other conditions of employment.  ADA protects individual applicants
or employees as long as they can perform all essential functions of
the job with or without reasonable accommodation.  To be reasonable,
an accommodation must not impose an undue hardship on the employer
and must enable the individual with a disability to perform the
necessary work.  For example, a reasonable accommodation for an
individual in a wheelchair might be to raise his or her desk so that
the wheelchair can fit comfortably beneath it.  ADA is a mandate and
not a federal program as such, although programs have been set up to
enforce the provisions of the law.\50

Nonetheless, the ADA remains a key part of the federal commitment to
promote employment of people with disabilities. 


--------------------
\50 See app.  II for more information on Equal Employment Opportunity
(16.101), Civil Rights of Institutionalized Persons (16.105), and the
ADA Technical Assistance program (16.108). 


      NONDISCRIMINATION IN
      EMPLOYMENT
---------------------------------------------------- Appendix III:1.11

Through several different legislative actions, the federal government
has prohibited employment discrimination solely on the basis of
disability for federal contractors, state and local governments, and
private businesses with 15 or more employees.  Several programs have
been set up to enforce these provisions.  The Office of Federal
Contract Compliance Programs is responsible for investigating
complaints against federal contractors.\51 The Department of Justice
is responsible for investigating and prosecuting cases of employment
discrimination under ADA against state and local governments, and the
Equal Employment Opportunity Commission is responsible for ADA cases
involving private-sector employees.  These bodies may prosecute a
case, decide that no cause for suit exists, or give clearance for an
individual to file the case in federal court on his or her own. 


--------------------
\51 See app.  II for more information on Non-Discrimination and
Affirmative Action by Federal Contractors and Federally Assisted
Construction Contractors (17.301). 


      RANDOLPH-SHEPPARD VENDING
      PROGRAM
---------------------------------------------------- Appendix III:1.12

The Randolph-Sheppard Act in 1936 set up a program for blind
individuals that gives organizations working with the blind
preference in operating vending facilities on federal property. 
Under this program, these organizations may be granted rights to
place vending machines or sell other items in federal buildings.  The
gross receipts of Randolph-Sheppard vending facilities totaled $388.8
million during fiscal year 1990. 


      TARGETED JOBS TAX CREDIT
---------------------------------------------------- Appendix III:1.13

The Targeted Jobs Tax Credit (TJTC), which expired in 1994, was
established by the Congress to promote employment for disadvantaged
people.  The Congress authorized this special tax credit to induce
private businesses to employ people who were chronically unemployed,
disadvantaged youth, welfare recipients, and people with
disabilities.  The tax credit amounted to 40 percent of the first
$6,000 in wages during the first year of employment.  For an employer
to qualify for the tax credit, the worker must have been employed for
at least 90 days or have completed at least 120 hours of work. 
Approximately 8 percent of the individuals benefiting from the TJTC
were people with disabilities. 


   FEDERAL FINANCING FOR SUPPORTED
   EMPLOYMENT IS LIMITED
------------------------------------------------------- Appendix III:2

Two federal programs provide financing for supported employment
programs:  one program provides aid to state programs, the other
finances projects directly.\52 In addition, many states finance some
supported employment services through state grant programs that
receive funds from HHS to provide services to individuals with
developmental disabilities.  These programs provide ongoing (although
generally time-limited) postemployment support to individuals with
disabilities to help them maintain community employment. 


--------------------
\52 Both supported employment programs derive their authorization
from the 1986 amendments to the Rehabilitation Act of 1973.  See app. 
II for more information on Supported Employment Services for
Individuals With Severe Disabilities (84.187) and Rehabilitation
Services--Service Projects (84.128). 


      SUPPORTED EMPLOYMENT GRANTS
      TO STATES
----------------------------------------------------- Appendix III:2.1

Under this program, states are given formula grants to provide
supported employment services.  This program is intended to provide
services to individuals with severe disabilities to allow them to get
jobs.\53 These services can include job coaches, ongoing supports,
training for coworkers, and a variety of other services designed to
enable individuals to adjust to the workplace.  Services provided
under this program are generally limited to 18 months; after this
time, states must either find additional funds to pay for continuing
services or discontinue the services and see if the individual can
continue without the additional support. 


--------------------
\53 See app.  II for more information on Supported Employment
Services for Individuals With Severe Disabilities (84.187). 


      SUPPORTED EMPLOYMENT SPECIAL
      PROJECTS
----------------------------------------------------- Appendix III:2.2

This program awards grants to public and nonprofit agencies,
including states, to conduct special projects and demonstrations to
expand or assist supported employment services to individuals with
the most severe disabilities.\54 In fiscal year 1993, this program
supported 13 new community-based projects, 14 continuing
community-based projects, and 16 grants to states for systems-change
projects.  Services under this program are like services provided
under the state grant and can include assistance to employers in
training coworkers, assistive technology, and job coaches.  Like the
formula grants to states program, this program allows recipients to
use these funds to build community capacity to provide these
services. 


--------------------
\54 This program also supports recreational activities for
individuals with disabilities to aid in their employment, mobility,
socialization, independence, and community integration.  An estimated
20,346 people were served under this portion of the program.  See
app.  II for more information on Special Projects and Demonstrations
for Providing Vocational Rehabilitation Services to Individuals With
Severe Disabilities (84.235). 


   FEDERAL GOVERNMENT PROVIDES
   INDIRECT SUPPORT FOR SHELTERED
   WORKSHOPS
------------------------------------------------------- Appendix III:3

Federal financial help also supports sheltered workshop employment
for people with disabilities.  This support, however, is generally
somewhat indirect, coming from federal purchases, exemptions from
federal wage laws, and some business loans.\55


--------------------
\55 As with supported employment, some states choose to use their
funding under developmental disabilities programs to support
sheltered workshops. 


      FEDERAL PURCHASES
      (JAVITS-WAGNER-O'DAY ACT)
----------------------------------------------------- Appendix III:3.1

The Javits-Wagner-O'Day Act established an initiative under which
federal agencies may purchase selected goods and services from
sheltered workshop providers.  In fiscal year 1991, $431.55 million
in contracts were awarded to 497 such workshops. 


      RELIEF FROM MINIMUM WAGE
      LAWS
----------------------------------------------------- Appendix III:3.2

Under the Fair Labor Standards Act, sheltered workshops may apply to
the Secretary of Labor for exemptions from the minimum wage law. 


      SMALL BUSINESS LOANS
----------------------------------------------------- Appendix III:3.3

SBA may award handicapped assistance loans to sheltered workshops for
construction or working capital.  For workshops to be eligible, at
least 75 percent of the work hours for the direct production must be
performed by people with disabilities.  The Handicapped Assistance
Loan program also provides loans to small businesses wholly owned by
people with disabilities. 


GEOGRAPHIC DISTRIBUTION OF
EXPENDITURES FOR SELECTED WHOLLY
TARGETED, EMPLOYMENT-FOCUSED
PROGRAMS
========================================================== Appendix IV

The disability programs we examined differ in their services,
objectives, size and scope, and in how they distribute program
dollars.  Although many of these federal programs allocate their
funding to state governments or local providers, the programs
generally have established different mechanisms for doing so.  For
example, the federal-state Vocational Rehabilitation program
allocates its funding to state governments on the basis of a formula
that includes state population and per capita income.  By contrast,
the Labor Department's Special Projects for Employment of Persons
With Disabilities program awards grants to states or local providers
on the basis of applications and proposals.  Thus, the aggregate
distribution of funds among states and geographic areas reflects
these different allocation mechanisms in combination and may not
resemble the distribution that would result from any one mechanism in
particular.  In addition, the aggregate distribution of funds among
states under a multiple program structure may not represent the
distribution that would have been chosen under a more integrated
system. 

To illustrate the distribution effects of the allocation mechanisms
currently used by disability programs, we examined the state
distribution of funds for those wholly targeted, employment-focused
programs that channel funds to locations nationwide.  We compared
this distribution with the distribution of people with disabilities
by state and then looked at the per capita amounts available to each
state under these programs. 

Our analysis focused on eight programs that represent the majority of
funds distributed under employment-focused programs.\56 We chose to
limit our illustration to wholly targeted programs because people
with disabilities represent a relatively small portion of clients
served by many of the partially targeted programs.  Without reliable
data on state-by-state spending on people with disabilities only, we
could not incorporate partially targeted programs without distorting
the analysis.  Of the 26 employment-focused programs that we
identified, 9 were partially targeted and thus excluded from our
analysis.  An additional four programs provided advice to people with
disabilities and their employers from central locations, and five
programs did not report state-by-state spending information.  Thus,
eight programs remained for our analysis.  Table IV.1 shows 1990
federal expenditures of eight wholly targeted, employment-focused
programs. 



                         Table IV.1
          
            Federal Expenditures of Eight Wholly
           Targeted, Employment-Focused Programs,
                          in 1990

                                    Funding
                                    mechanis
                                    m/cost
                                    sharing
Progra                              or
m                         Applican  matching  Expenditures
number  Program title     t\a       (Y/N)\b        in 1990
------  ----------------  --------  --------  ------------
17.801  Disabled          State     Formula       $964,852
        Veterans'         employme  grants
        Outreach          nt        (N)
                          agencies

59.021  Handicapped       Nonprofi  Direct      12,508,329
        Assistance Loans  t         loans
                          agencies  (N)
                          and
                          individu
                          als

64.116  Vocational        Individu  Direct     129,062,141
        Rehabilitation    al        payments
        for Disabled      veterans  (N)
        Veterans

84.126  Rehabilitation    State     Formula   2,028,193,74
        Services--        agencies  grants               4
        Vocational                  (Y)
        Rehabilitation
        Grants to States

84.128  Rehabilitation    State     Project     69,114,000
        Services--        and       grants
        Service Projects  nonprofi  (Y)
                          t
                          agencies

84.129  Rehabilitation    State     Project     29,507,158
        Long-Term         and       grants
        Training          nonprofi  (Y)
                          t
                          agencies

84.158  Secondary         State     Project      7,922,550
        Education and     and       grants
        Transitional      nonprofi  (N)
        Services for      t
        Youth With        agencies
        Disabilities

84.187  Supported         State     Formula     34,220,912
        Employment        agencies  grants
        Services for      and       (N)
        Individuals With  other
        Severe            private
        Disabilities      or
                          nonprofi
                          t
                          agencies

==========================================================
Total                                         $2,311,493,6
                                                        86
----------------------------------------------------------
\a The Catalog of Federal Domestic Assistance (CFDA) states that
applicants and beneficiaries are generally the same for programs that
provide assistance directly from a federal agency.  However,
financial assistance from state or local governments or other
entities has different applicants and beneficiaries.  Applicants are
those individuals or entities that can apply for federal assistance. 
Beneficiaries are those individuals or entities that ultimately
benefit from federal assistance. 

\b Some programs--those designated as "Y" in table IV.1--have a
cost-sharing component or may require a matching amount.  For
example, the Vocational Rehabilitation program is 80-percent federal,
and the states provide an additional 20 percent.  Our expenditure
estimates only reflect federal outlays. 

Sources:  CFDA and the Consolidated Federal Funds Report (CFFR),
Bureau of the Census. 

We obtained the information in this appendix from publicly available
data through the Bureau of the Census.  Specifically, we derived
summary statistics from the Census of Population and Housing, 1990,
and we derived expenditure data from the Consolidated Federal Funds
Report (CFFR).  Our selection of employment programs was based on the
availability of expenditure data for wholly targeted programs. 


--------------------
\56 A wholly targeted program is one that only serves the needs of
people with disabilities.  Employment-focused programs are those that
directly facilitate employment through services such as job training
and placement and employment counseling.  See app.  I. 


   MANY WHOLLY TARGETED,
   EMPLOYMENT-FOCUSED PROGRAMS
   DISTRIBUTE BENEFITS THROUGH
   STATE OR NONPROFIT AGENCIES
-------------------------------------------------------- Appendix IV:1

As shown in table IV.1, approximately $2.3 billion was distributed in
1990 through eight employment programs that were wholly targeted to
people with disabilities.  Many of these programs funded state,
local, private, or nonprofit entities that administered services in
their area.  These organizations included institutions of higher
learning, state vocational rehabilitation agencies, job training
councils, local educational agencies, or other appropriate public or
private nonprofit institutions.  No single agency or department had
both the responsibility and authority to administer these employment
programs.  Of the eight we selected, the Department of Labor, the
Small Business Administration (SBA), and the Department of Veterans
Affairs (VA) administered one program each.  The remaining five
programs were administered through the Department of Education,
including the largest, Vocational Rehabilitation (see table IV.1). 

Programs that used a decentralized program structure distribute funds
through a formula or project proposals (see table IV.1).  The largest
program, Rehabilitation Services--Vocational Rehabilitation Grants to
States, distributes funds through a formula and accounts for over 80
percent of the total amount available for people with disabilities in
employment assistance.  Formulas are also used by the Supported
Employment and the Disabled Veterans' Outreach programs.  Under these
programs, the states' annual allotment is based on population
characteristics such as per capita income, total population, or the
number of disabled veterans in the state.  Programs that used project
grants to make allotments include Rehabilitation Services--Service
Projects, Rehabilitation Long-Term Training, and Secondary Education
and Transitional Services for Youth With Disabilities.  For each of
these, the state or service provider must apply for funding. 
Consequently, the variation in expenditures may relate to the
population characteristics as well as the success of these local
organizations in pursuing additional funds. 


   PEOPLE WITH DISABILITIES AS A
   PERCENTAGE OF THE WORKING-AGE
   POPULATION GENERALLY HIGHEST IN
   SOUTHERN STATES
-------------------------------------------------------- Appendix IV:2

As shown in figure IV.1, in 1990, the disabled working-age population
as a percentage of the total working-age population across states
varied between 7 and 15 percent.\57 Southern states had the highest
concentration of the disabled.  For example, the percentage of
working-age disabled people in West Virginia was around 15 percent of
the total working-age population.  Other southern states were also in
the higher end of the distribution.  States such as Kentucky and
Alabama registered a disabled working-age population around 13
percent.  In highly populated states like California, New York,
Texas, Florida, and Illinois, the disabled working-
age population was generally between 10 and 11 percent.  In contrast,
sparsely populated states, such as Wyoming, and states in the High
Plains, such as North Dakota and South Dakota, had disabled
working-age populations of less than 10 percent. 

   Figure IV.1:  People With
   Disabilities as a Percentage of
   the Working-Age Population

   (See figure in printed
   edition.)


--------------------
\57 These figures reflect a composite of individuals 16 to 64 who
reported a work, mobility, or personal care limitation to the 1990
census.  The size of the disability population is extremely sensitive
to how disability is defined.  Our estimates are derived using data
from the Bureau of the Census (see apps.  I and V for additional
details). 


   DISTRIBUTION OF FEDERAL FUNDS
   FOR EMPLOYMENT-FOCUSED PROGRAMS
   DIFFERS FROM THAT OF
   WORKING-AGE PEOPLE WITH
   DISABILITIES
-------------------------------------------------------- Appendix IV:3

As shown in figure IV.2, in 1990, these programs distributed to
states between $200 and $1,100 per working-age person with a
disability.  Approximately 40 states have less than $500 available
per person in the working-age disabled population.  Although southern
states have higher percentages of people with disabilities in their
working-age population, these states were in the lower end of the
expenditure distribution.  Florida, Georgia, and South Carolina, for
example, have between $200 and $350 available per disabled person. 
Large, highly populated states such as California and New York, were
also in the lower end of the distribution, although sparsely
populated states, such as Wyoming and North Dakota, were in the
higher end. 

   Figure IV.2:  Expenditures on
   Employment-Focused Programs per
   Working-Age Person With a
   Disability

   (See figure in printed
   edition.)


   DATA LIMITATIONS OF THIS
   ANALYSIS
-------------------------------------------------------- Appendix IV:4

The distribution of federal dollars must be interpreted cautiously
due to limitations in the availability of data for several reasons. 
First, data derived from the CFFR are the best estimates of federal
obligations or outlays available.\58 Because these data are
estimates, however, in any given year, actual outlays may be higher
or lower because program funds may be deobligated at any time. 
Similarly, although this analysis accounts for the majority of
federal expenditures on employment-focused programs, we could not
obtain sufficiently reliable data to allow us to analyze expenditures
on partially targeted programs. 

Moreover, per capita amounts may conceal reasonable underlying
factors not captured by our data sets such as money that states or
local jurisdictions raise.  For example, the largest employment
program, Vocational Rehabilitation, requires state and local
jurisdictions to provide a matching component.  While these funds
increase the overall expenditures available, our estimates reflect
only federal outlays. 


--------------------
\58 The outlays include grants, direct loans, guaranteed loans,
indemnity claims, retirement and disability claims, federal insurance
coverage as well as some data on procurement contracts. 


DEFINITIONS OF DISABILITY AND
POPULATION ESTIMATES OF PEOPLE
WITH DISABILITIES
=========================================================== Appendix V


   DISABILITY IS DIFFICULT TO
   DEFINE AND MEASURE
--------------------------------------------------------- Appendix V:1

One of the most contentious aspects of disability research is also
the most basic--the definition of disability.  Different federal
programs use different operational definitions of disability, as do
researchers, advocacy groups, and other interested parties.  Some of
this variation occurs because many groups define disability for
different purposes and thus use different criteria for evaluating a
definition.  For example, a relatively broad definition of disability
would encompass a wide array of people with disabilities; however,
some broader definitions can be quite subjective.  Researchers may
prefer a definition that can be used with existing data sources;
program officials must be concerned with definitions that can be
measured and verified.  Three fundamental issues about the nature of
disability contribute to these definition and measurement
differences: 

  -- Scope of definition--Defining disability involves distinguishing
     between normal variations among individuals and conditions that
     are disabling. 

  -- Duration of a condition--Because a person's disability status
     may change over time, some researchers argue that disability
     should be continually re-evaluated and remeasured and that
     temporary or sporadic conditions should be considered in
     evaluating disability.  Others contend that only permanent
     conditions should be considered.  A condition (such as
     rheumatoid arthritis) may be limiting but may have only sporadic
     impact on an individual's ability to function--so even
     differentiating between permanent and temporary disabilities can
     be difficult. 

  -- Variation in application--Even with the most clear-cut
     definitions of disability, applying the criteria involves an
     inherent judgment.  Two parties may agree on a definition of
     disability but may then apply different classifications of who
     is disabled.  For example, a significant difference exists in
     the number of people identified as eligible for disability
     insurance by the state disability determination services and by
     administrative law judges.\59

Not only is disability hard to determine under any given definition,
but definitions of disability vary widely.  We identified many
different definitions used by programs, researchers, and advocacy
groups.  (Table V.1, at the end of this appendix, lists some examples
of these definitions and their sources.) Relying on functional
assessment, medical criteria, or individual perception, these
definitions emphasize different aspects of disability--from the
individual's ability to work, for example, to the role of the
person's physical environment in shaping the degree of disability. 

The number of disability definitions combined with differences in
measurement techniques have resulted in estimates of the number of
people with disabilities that range from 3.5 million to 49 million. 
Although many definitions are similar, even subtle differences in the
population included, the survey used, or the definition of disability
can have far-reaching effects on how many individuals are counted as
having a disability.  For example, estimates from the 1990 Survey of
Income and Program Participation (SIPP) indicated that 8.6 million
Americans aged 16 to 67 were "unable to work" due to disability; the
1990 census estimated that 6.6 million Americans aged 16 to 64 were
"unable to work" due to disability--a difference of nearly one-third. 
When the definition of disability is widened to include individuals
who are "limited in work," 1990 to 1993 estimates range from 12.9
million to 19.5 million.  Table V.2, at the end of this appendix,
shows the differences in the estimated disability prevalence in the
United States using different definitions and sources. 


--------------------
\59 Social Security:  Disability Rolls Keep Growing, While
Explanations Remain Elusive (GAO/HEHS-94-34, Feb.  11, 1994), pp. 
26-27. 


   DISABILITY IS MOST COMMONLY
   DEFINED BY MEASURES OF
   FUNCTIONAL LIMITATION
--------------------------------------------------------- Appendix V:2

The most common method of defining disability--both for researchers
and under federal programs--is based on functional limitation.  Under
this type of definition, an individual is considered to have a
disability if he or she is limited in, or unable to perform, a
certain activity or activities.  The definition can be broad or
narrow, depending on whether activities are specified narrowly or
widely and on whether the individual must be unable to do the
activity or must only be limited.  The term "limited" may refer to
the type or amount of activity.  For instance, a person with
arthritis may be unable to perform some types of household chores
(such as sewing) but may be able to do other tasks (like laundry)
without any problem.  Similarly, a person with another condition may
be able to do any chore for a short period of time but may need to
rest before attempting to complete the task.  Activities can also be
specified widely or narrowly.  For example, some survey questions
leave the term "activities" to be defined by the respondent.  Other
instruments confine the definition of activities to a specific list,
like the activities of daily living (ADL) or the independent
activities of daily living (IADL).\60 As an example, a broader
definition of disability could characterize individuals with a
disability as "limited in performing any of their usual activities;"
a narrower definition could characterize individuals with a
disability as being "unable to work at a full-time job."


--------------------
\60 ADLs include such activities as feeding and dressing oneself,
bathing, and the like.  IADLs include household chores such as
grocery shopping, meal preparation, and the like. 


      WIDELY RANGING FUNCTIONAL
      DEFINITIONS ARE MORE
      INCLUSIVE, BUT CAN BE HARDER
      TO MEASURE
------------------------------------------------------- Appendix V:2.1

Some disability advocates find a wide-ranging functional approach to
disability definition appealing because it measures the impact on an
individual's condition without regard to the cause of that condition. 
Others have criticized many of these definitions, however, as being
too general to make effective distinctions among individual cases. 
Although narrowing the scope of the activities considered would make
the definition more specific, it would also increase the probability
that individuals would be arbitrarily excluded.  In addition, even
when the activities are defined fairly narrowly--with ADLs or IADLs,
for example--measuring or verifying disability can be difficult. 

Survey evidence demonstrates the effect of adopting a widely ranging
functional definition as opposed to a narrower one.  For example,
when the 1990 census asked individuals if they were limited in their
mobility (for example, going out of the house or to a store by
themselves), an estimated 3.5 million individuals aged 16 to 64 were
identified as disabled.  However, in the 1991 SIPP, an estimated 27
million individuals aged 21 to 64 were identified as disabled when
the definition included having a functional limitation in any
activity; and an estimated 49 million individuals of all ages were
considered disabled when the definition included having a functional
limitation in any activity and when examples were provided. 


      "CAN'T WORK" DEFINITIONS ARE
      MORE SPECIFIC BUT STILL
      DIFFICULT TO APPLY
------------------------------------------------------- Appendix V:2.2

Several disability definitions take a narrow view of activity
limitation, with employment as the only activity.  For example,
income maintenance and pension programs often define disability to
include only those individuals who cannot work because of their
impairment.\61

These definitions allow programs to focus on individuals for whom
employment is deemed unfeasible and thus may be in greater need.  A
"can't work" definition, however, requires judgment not only of an
individual's physical conditions, but also of his or her capabilities
in a wide variety of potential employment situations.  This makes
implementing the definition problematic, especially in recent years
because improvements in information technology, an increased emphasis
on accommodation in the workplace, and new models of working with
individuals with disabilities (such as supported employment) have
complicated assessments of the ability to work.  Medical and legal
determination of the ability to work is thus labor intensive.  The
emphasis on ability to work has also been criticized by analysts who
believe that this definition creates a strong disincentive to
employment.  Because applicants must prove that they cannot work to
receive benefits and may risk losing these benefits if they become
employed, they may be reluctant to look for a job.  In addition,
having proved to the authorities that they are unable to work,
disability beneficiaries may agree with this assessment and thus not
try to enter the labor force. 

Many household surveys include questions that reflect this kind of
broad "can't work" definition, for example, "Do you have a health
condition that limits your ability to work?" or "Are you unable to
work because of a disability?" or "Do you have a condition that
limits the type or amount of work you can do?" In 1990, the number of
working-age individuals who reported they were unable to work or
limited in work ranged from 12.9 million to 19.5 million; the number
reported as unable to work ranged from 6.6 million to 14.2
million.\62


--------------------
\61 The major U.S.  income maintenance programs (Social Security's
Supplemental Security Income (SSI) and Disability Insurance (DI))
define disability this way. 

\62 Survey results on this particular question may suffer from
response bias, that is, respondents who are not in the labor
force--whether they receive government benefits or not--may prefer to
tell the interviewer that they cannot work rather than say they
choose not to work.  For this reason, all these estimates should be
interpreted cautiously. 


   DISABILITY SOMETIMES DEFINED AS
   THE PRESENCE OF SPECIFIC
   CONDITIONS
--------------------------------------------------------- Appendix V:3

Some definitions consider an individual disabled if he or she has one
or more of a specified list of medical conditions.  For example,
vocational education programs define students as having a disability
if they are "mentally retarded, hard of hearing, deaf, speech
impaired, visually handicapped, seriously emotionally disturbed,
orthopedically impaired, other health impaired, deaf-blind,
multihandicapped, or have specific learning disabilities, who because
of these impairments, need special education and related services,
and cannot succeed in the regular vocational education program
without special education assistance." In addition, some functional
definitions of disability specifically exclude certain conditions. 
For example, the definition of disability in the Americans With
Disabilities Act (ADA) excludes psychoactive substance abuse,
transsexualism, pedophilia, compulsive gambling, and kleptomania
(among other disorders). 

These definitions are presumably relatively straightforward because
they require only an assessment of a medical condition, not an
evaluation of an individual's ability to function with this
impairment.  However, a medical definition generally contains no
information on the severity of the condition and ignores potentially
debilitating conditions not included on the list.  Thus, a medically
based approach may sometimes be as arbitrary as a more subjective
definition.  In addition, medically based definitions would
presumably require certification and may be expensive to verify. 

Relatively little up-to-date information on the prevalence of
specific medical disorders exists in the United States.  The data
that are available, however, suggest that definitions of disability
based on medical conditions may be quite distinct from definitions
based on an individual's functional ability, and may classify large
numbers of individuals as having a disability.  For example, the 1993
National Health Interview Survey (NHIS) reported that, of Americans
aged 18 to 64, 13.2 million were hearing impaired; 5.8 million were
visually impaired; and 0.9 million had palsy, cerebral palsy, or
mental retardation.  Fully 61 percent of the visually impaired and 65
percent of the hearing impaired reported no limitation in the kind or
amount of work they could do--indicating that medical condition and
self-perception of ability to work are distinct concepts.  Results
from the National Comorbidity Survey administered between 1990 and
1992 indicated that during the previous 12 months as many as 29
percent of individuals may have had at least 1 of 14 psychiatric
disorders, including major depression, anxiety disorders, and
substance abuse.\63


--------------------
\63 Ronald C.  Kessler, et al., "Lifetime and 12-Month Prevalence of
DSM-III-R Psychiatric Disorders in the United States:  Results from
the National Comorbidity Survey," June 1993. 


   OTHER DISABILITY DEFINITIONS
   ARE LESS COMMONLY USED
--------------------------------------------------------- Appendix V:4

Researchers have used two other types of disability definitions that
are less practical for programmatic purposes.  For example,
individually defined disability is used in some survey data.  This
measure classifies an individual as disabled on the basis of
self-assessment or on the opinions of others.  No explicit definition
of disability is used, so each individual answers the question using
his or her own concept of what it means to be disabled.  An
individually defined concept of disability could capture some people
who would not be included under more restrictive definitions, but
this definition is likely to be inconsistent and thus unreliable to
distinguish among individual cases.  A second type of definition is
an environmental/
societal-based definition of disability, which emphasizes the role of
the surrounding environment in determining the extent of an
individual's limitations; that is, it assesses whether the person can
function independently given the environment he or she must face. 
These definitions require consideration of both the individual's
physical or mental condition and the surrounding environment.  For
example, under such a definition, an individual in a wheelchair may
be considered disabled if he or she lives in a city with no public
transportation and no curb cuts but might not be considered disabled
in a city that had these features.  Assessing functional ability in
the context of both the individual and the environment or society is
not only subjective but extremely difficult--the environment is all
encompassing and frequently changing.  However, this type of
definition does raise the public's awareness of the role of the
environment in determining individuals' capabilities. 



                                        Table V.1
                         
                           Examples of Different Definitions of
                              Disability, by Source and Type

Definition                                        Source\a                Type
------------------------------------------------  ----------------------  ---------------
". . . a limitation that affects an individual's  Disability community/   Functional
ability to perform certain functions."            advocacy group

"Had a disability or health problem that          Louis Harris Survey     Functional
prevented him or her from participating fully in  and DeJong
work, school, or other activities."

"Individuals with significant physical or mental  Centers for             Functional
impairments whose abilities to function           Independent Living
independently in the families or communities or   Program (84.132)
whose ability to obtain, maintain, or advance in
employment is substantially limited. Eligibility
shall not be based on the presence or absence of
any one or more specific severe disabilities."

". . . departure from normal role functioning     Nagi as quoted in       Functional
attributable to a health-related condition."      Chirikos

Unable to perform at least three ADLs or IADLs    HUD Congregate Housing  Functional/ADL
without assistance.\b                             (14.170)                or IADL

". . . any restriction or lack (resulting from    World Health            Functional
an impairment) to perform an activity in the      Organization (WHO)
manner or within the range considered normal."
(Note: WHO also defines an "impairment" as "a
psychological, anatomical, or mental loss, or
some other abnormality.")

". . . a physical or mental impairment which      ADA                     Functional
substantially limits one or more of the major
life activities of such individual; a record of
having such an impairment; or being regarded as
having such an impairment." (excluding specific
conditions, especially current substance abuse)

". . . are incapable of regularly pursuing any    Canadian disability     Functional/
substantially gainful employment due to a         insurance/income        can't work
disability that is likely to be of long or        maintenance program as
indefinite duration or is likely to result in     reported in Maki
death." Also, ". . . unable to perform their
usual occupation due to a disability that is
likely to be of long or indefinite duration or
is likely to result in death."

". . . individuals with mental or physical        German disability       Functional/
impairments that reduce their capacity to work    agency as reported in   can't work
by at least 50 percent; individuals who are at    Burkahauser
least 30 percent impaired and unemployed are
also considered handicapped."

Either (a) receives benefits from a government    Haveman and Wolfe       Functional/
disability program or (b) reports a limitation                            can't work
on his or her ability to work.

Limited in the type or amount of work (or         Reisine and Fifield;    Functional/
housekeeping if housekeeping is considered to be  Chirikos; DeJong;       can't work
the "primary occupation").                        Stern

The inability to engage in substantial gainful    DI and SSI              Functional/
activity, by any medically determinable physical                          can't work
or mental impairment which can be expected to
result in death or has lasted or is expected to
last for a continuous period of not less than 12
months.

Having one or more of the following physical      Stern                   Medical
conditions--"weakness/lack of strength; trouble
with fingers; trouble walking, standing, or with
stairs; in a wheelchair; trouble seeing/blind;
trouble with leaving bed or leaving home;
trouble lifting; deaf; trouble with stiffness or
pain; trouble with seizures or spasms; mental
illness; mental retardation."

"Mentally retarded, hard of hearing, deaf,        Vocational education    Medical
speech impaired, visually handicapped, seriously  programs; also other
emotionally disturbed, orthopedically impaired,   Education programs
other health impaired, deaf-blind,
multihandicapped, or have specific learning
disabilities, who because of these impairments,
need special education and related services and
cannot succeed in the regular vocational
education program without special education
assistance."

Having one or more of the following physical      DeJong                  Medical
conditions--"major amputations, cerebral palsy,
major head injury, Friedreich's ataxia, muscular
dystrophy, spina bifida, amyotrophic lateral
sclerosis, cystic fibrosis, spinal cord injury,
multiple sclerosis, post-polio, stroke."

Individuals with "mental retardation; hearing     Special education       Medical
impairments; speech, or language impairments;     programs
visual impairments; serious emotional
disturbance; orthopedic impairments; autism;
traumatic brain injury; other health
impairments; specific learning disabilities; . .
. that need special education and related
services."

"A person was defined as having a disability if   National Organization   Individually
he or she considered himself or herself to have   on Disability -Louis    defined
a disability or said that other people would      Harris Survey
consider him or her to be a person with a
disability."

How would you describe your health? (excellent,   Stern                   Individually
good, fair, poor)                                                         defined

Disability is ". . . the expression of a          Institute of Medicine   Societal based
physical or mental limitation in a social
context--the gap between a person's capabilities
and the demands of the environment. People with
such functional limitations are not inherently
disabled, that is, incapable of carrying out
their personal, familial, and social
responsibilities. It is this interaction of
their physical or mental limitations with social
and environmental factors that determines
whether they have a disability."

"The disadvantage or restriction of activity      Advocacy group          Societal based
caused by a contemporary social organization
which takes no or little account of people who
have physical impairments and thus excludes them
from the mainstream of social activities."
-----------------------------------------------------------------------------------------
\a See Bibligraphy for full citations. 

\b See footnote 60 for definitions of ADL and IADL. 



                                        Table V.2
                         
                          Estimated Disability Prevalence in the
                                  United States, 1990-93

Estimate of number                                                            Ages of
of people with          Percent of                                            population
disabilities (in          relevant  Data     Year of  Definition of           included in
millions)               population  source  estimate  disability              estimate
--------------------  ------------  ------  --------  ----------------------  -----------
3.5                            2.2  Census      1990  Functional--having a    16-64
                                                      mobility limitation

4.2                            2.7  NHIS        1993  Functional--limited in  18-64\a
                                                      an ADL

5.3                            3.4  Census      1990  Functional--having a    16-64
                                                      self-care limitation

6.6                            4.2  Census      1990  Work disability--       16-64
                                                      unable to work

7.2                            4.6  Census      1990  Functional--having a    16-64
                                                      mobility limitation or
                                                      a self-care limitation

8.6                            5.1  SIPP     1990-91  Work disability--       16-67
                                                      unable to work

9.2                            6.0  NHIS        1993  Work disability--       18-64
                                                      unable to work

11.5                           4.5  NHIS        1993  Functional--unable to   All ages
                                                      carry out major
                                                      activity

12.9                           8.2  Census      1990  Work disability--       16-64
                                                      either unable to work
                                                      or limited in work

14.2                           9.0  Curren      1990  CPS definition--        16-64
                                    t                 either unable to work
                                    Popula            or receiving
                                    tion              disability benefits
                                    Survey            from government income
                                    (CPS)             maintenance program

15.6                           9.5  CPS         1993  CPS definition--        16-64
                                                      either unable to work
                                                      or receiving
                                                      disability benefits
                                                      from government income
                                                      maintenance program

16.4                          10.4  Census      1990  Functional--having a    16-64
                                                      work disability or a
                                                      mobility limitation or
                                                      a self-care limitation

16.8                          10.1  CPS         1994  CPS definition--        16-64
                                                      either unable to work
                                                      or receiving
                                                      disability benefits
                                                      from government income
                                                      maintenance program

17.0                          10.9  NHIS        1993  Work disability--       18-64
                                                      either unable to work
                                                      or limited in work

18.0                          12.5  SIPP        1991  Functional--            21-64
                                                      limitation in major
                                                      activity

19.4                          13.1  SIPP        1993  Functional--            21-64
                                                      limitation in major
                                                      activity

19.5                          11.6  SIPP     1990-91  Work disability--       16-67
                                                      either unable to work
                                                      or limited in work

22.7                          14.6  NHIS        1993  Functional--limited in  18-64
                                                      either work or in some
                                                      other activity

25.8                          10.3  NHIS        1992  Functional--limited in  All ages
                                                      major activity

27.0                          10.6  NHIS        1993  Functional--limited in  All ages
                                                      major activity

27.4                          19.0  SIPP        1991  Functional--limited in  21-64
                                                      any activity

28.8                          19.4  SIPP        1993  Functional--limited in  21-64
                                                      any activity

37.7                          15.0  NHIS        1992  Functional--limited in  All ages
                                                      any activity

39.3                          15.5  NHIS        1993  Functional--limited in  All ages
                                                      any activity

48.9                          19.4  SIPP     1990-91  Composite--limited in   All ages
                                                      any activity or in
                                                      self-care or has
                                                      difficulty with one of
                                                      listed tasks
-----------------------------------------------------------------------------------------
\a The NHIS question has a peculiar skip pattern--the ADL question
was asked to anyone under 60 who reported an activity limitation and
to all people over 60. 

Notes:  All data are self-reported and represent estimates for the
noninstitutionalized population unless noted otherwise.

No sources predating 1990 were included.  The Survey of Disability
and Work (1972 and 1978), the National Long-Term Care Survey
(1982-84), the Epidemiological Catchment Area survey (1981), and the
SSA New Beneficiary Survey (1982) also provide some disability
information.

Some information on specific disabling conditions is available from
the National Comorbidity Survey administered between 1990 and 1992,
the 1990-1991 SIPP, and the 1993 NHIS.  The Epidemiological Catchment
Area survey (1981) also provides data on specific conditions. 




(See figure in printed edition.)Appendix VI
COMMENTS FROM THE DEPARTMENT OF
LABOR
=========================================================== Appendix V



(See figure in printed edition.)



(See figure in printed edition.)



(See figure in printed edition.)


GAO CONTACTS AND STAFF
ACKNOWLEDGMENTS
========================================================= Appendix VII

GAO CONTACTS

Charles Jeszeck, Assistant Director, (202) 512-7036
Sarah L.  Glavin, Senior Economist, (202) 512-7180
Valerie S.  Dumas, Analyst, (202) 512-9817

STAFF ACKNOWLEDGMENTS

The following individuals also contributed to this report:  Richard
Kelley, Steven Machlin, and Mary Reich. 


BIBLIOGRAPHY
=========================================================== Appendix 0

Anderson, K., J.  Mitchell, and J.S.  Butler.  "Effect of Deviance
During Adolescence on Choice of Jobs." Southern Economics Journal,
Vol.  60,
No.  2 (1993), pp.  341-56. 

Barker, P., et al.  "Serious Mental Illness and Disability in the
Adult Household Population:  United States, 1989." Advance Data, No. 
218, Centers for Disease Control and Prevention:  National Center for
Health Statistics.  Washington, D.C.:  1992, p.  11. 

Baldwin, M., and W.  Johnson.  "Labor Market Discrimination Against
Men With Disabilities." Journal of Human Resources, Vol.  29, No.  1
(1994),
pp.  1-19. 

Berkowitz, Edward D.  Disabled Policy:  America's Programs for the
Handicapped (A Twentieth Century Fund Report) Cambridge, U.K.: 
Cambridge University Press, 1987. 

Bound, J.  "Health and Earnings of Rejected Disability Insurance
Applicants:  Reply." American Economic Review, Vol.  81, No.  5
(1991),
pp.  1427-34. 

_____.  "The Health and Earnings of Rejected Disability Insurance
Applicants." American Economic Review, Vol.  79, No.  3 (1989), pp. 
482-503. 

_____ and T.  Waidman.  "Disability Transfers, Self-Reported Health,
and Labor Force Attachment of Older Men:  Evidence from the
Historical Record." The Quarterly Journal of Economics (1992), pp. 
1393-1419. 

Burkhauser, R.V., and P.  Hirvonen.  "United States Disability Policy
in a Time of Economic Crisis:  A Comparison with Sweden and the
Federal Republic of Germany." Millibank Quarterly, Vol.  67, Suppl. 
2, Pt.  1 (1989), pp.  166-95. 

Chirikos, T.  "Accounting for the Historical Rise in Work-Disability
Prevalence." Millibank Quarterly, Vol.  64, No.  2 (1986), pp. 
271-301. 

DeJong, G., A.  Batavia, and R.  Griss.  "America's Neglected Health
Minority:  Working-age Persons with Disabilities." Millibank
Quarterly, Vol.  67,
Suppl.  2, Pt.  2 (1989), pp.  311-51. 

Haveman, R., and B.  Wolfe.  "The Economic Well-Being of the Disabled
1962-84." Journal of Human Resources, Vol.  25, No.  1 (1990), pp. 
32-54. 

Iams, H.M.  "Characteristics of the Longest Job for New Disabled
Workers:  Findings from the New Beneficiary Survey." Social Security
Bulletin,
Vol.  49, No.  12 (1986), pp.  13-18. 

Johnson, W., and J.  Lambrinos.  "Wage Discrimination Against
Handicapped Men and Women." Journal of Human Resources, Vol.  20,
No.  2 (1985), pp.  264-77. 

Maki, D.R.  "The Economic Implications of Disability Insurance in
Canada." Journal of Labor Economics, Vol.  11, No.  1 (1993), pp. 
S148-S169. 

Manton, K.  "Epidemiological, Demographic, and Social Correlates of
Disability Among the Elderly." Millibank Quarterly, Vol.  67, Suppl. 
2, Pt.  1 (1989), pp.  13-58. 

Mitchell, J.M., and R.  Burkhauser.  "Disentangling the Effect of
Arthritis on Earnings:  A Simultaneous Estimate of Wage Rates and
Hours Worked." Applied Economics, Vol.  22 (1990), pp.  1291-1309. 

Oi, Walter Y.  "Disability and a Workfare-Welfare Dilemma," in
Disability and Work:  Incentives, Rights and Opportunities, ed. 
Carolyn Weaver.  Washington, D.C.:  American Enterprise Institute,
1991. 

Oliver, Michael.  The Politics of Disablement:  A Sociological
Approach, New York:  St.  Martin's Press, 1990. 

Parsons, Donald.  "The Decline in Male Labor Force Participation,"
Journal of Political Economy, Vol.  88, No.  1 (1988), pp.  117-34. 

Ravaud, J.F., B.  Madiot, and I.  Ville.  "Discriminiation Towards
Disabled People Seeking Employment." Social Science Medicine, Vol. 
35, No.  8 (1992), pp.  951-58. 

Reisine, S., J.  Fifield.  "Expanding the Definition of Disability: 
Implications for Planning, Policy, and Research." Millibank
Quarterly, Vol.  70, No.  3 (1992), pp.  491-508. 

Rones, P.  "Can the Current Population Survey Be Used to Identify the
Disabled." Monthly Labor Review, June (1981), pp.  37-39. 

Stern, S.  "Measuring the Effect of Disability." Journal of Human
Resources, Vol.  24, No.  3 (1989), pp.  361-95. 

Wolfe, B.L.  "How the Disabled Fare in the Labor Market." Monthly
Labor Review, (1980), pp.  48-52. 

Yelin, E.  "Displaced Concern:  The Social Context of the Work
Disability Problem." The Millibank Quarterly, Vol.  67, No.  2
(1989), pp.  114-65. 

_____, and P.  Katz.  "Labor Force Participation Among Persons With
Musculoskeletal Conditions, 1970-1987." Arthritis and Rheumatism,
Vol.  34, No.  11 (1991), pp.  1361-70. 

Zeitzer, I.R.  "Recent European Trends in Disability and Related
Programs." Social Security Bulletin, Vol.  57, No.  2 (1994), pp. 
21-26. 

_____.  "The Role of Assistive Technology in Promoting Return to Work
for People with Disabilities:  The U.S.  and the Swedish Systems."
Social Security Bulletin, Vol.  54, No.  7 (1991), pp.  24-29. 



RELATED GAO PRODUCTS
============================================================ Chapter 1

SSA Disability:  Program Redesign Necessary to Encourage Return to
Work (GAO/HEHS-96-62, Apr.  24, 1996). 

PASS Program:  SSA Work Incentive for Disabled Beneficiaries Poorly
Managed (GAO/HEHS-96-51, Feb.  28, 1996). 

Americans With Disabilities Act:  Effect of the Law on Access to
Goods and Services (GAO/PEMD-94-14, June 21, 1994). 

Social Security:  Disability Rolls Keep Growing, While Explanations
Remain Elusive (GAO/HEHS-94-34, Feb.  8, 1994). 

Vocational Rehabilitation:  Evidence for Federal Program's
Effectiveness Is Mixed (GAO/PEMD-93-19, Aug.  27, 1993). 

Social Security:  Disability:  SSA Needs to Improve Continuing
Disability Review Program (GAO/HRD-93-109, July 8, 1993). 

Americans With Disabilities Act:  Initial Accessibility Good But
Important Barriers Remain (GAO/PEMD-93-16, May 19, 1993). 

Vocational Rehabilitation:  VA Needs to Emphasize Serving Veterans
With Severe Employment Handicaps (GAO/HRD-92-133, Sept.  28, 1992). 

Integrating Human Services:  Linking At-Risk Families With Services
More Successful Than System Reform Efforts (GAO/HRD-92-108, Sept. 
24, 1992). 

Vocational Rehabilitation:  Better VA Management Needed to Help
Disabled Veterans Find Jobs (GAO/HRD-92-100, Sept.  4, 1992). 

Job Training Partnership Act:  Actions Needed to Improve Participant
Support Services (GAO/HEHS-92-124, June 12, 1992). 

Adolescent Drug Use Prevention:  Common Features of Promising
Community Programs (GAO/PEMD-92-2, Jan.  16, 1992). 

Vocational Rehabilitation:  Clearer Guidance Could Help Focus
Services on Those With Severe Disabilities (GAO/HRD-92-12, Nov.  26,
1991). 

Social Security:  District Managers' Views on Outreach for
Supplemental Security Income Programs (GAO/HRD-91-19FS, Oct.  30,
1990). 


*** End of document. ***