government report gao 10 702

• Politics & Social Sciences
• Politics & Government

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Homelessness: A Common Vocabulary Could Help Agencies Collaborate and Collect More Consistent Data: Gao-10-702 Paperback – May 16, 2013

• Print length 88 pages
• Language English
• Publisher BiblioGov
• Publication date May 16, 2013
• Dimensions 7.44 x 0.18 x 9.69 inches
• ISBN-10 1287201857
• ISBN-13 978-1287201854
• See all details

Product details

• Publisher ‏ : ‎ BiblioGov (May 16, 2013)
• Language ‏ : ‎ English
• Paperback ‏ : ‎ 88 pages
• ISBN-10 ‏ : ‎ 1287201857
• ISBN-13 ‏ : ‎ 978-1287201854
• Item Weight ‏ : ‎ 6.1 ounces
• Dimensions ‏ : ‎ 7.44 x 0.18 x 9.69 inches

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U.S. Government Accountability Office

Updating the Standards for Government Auditing

Financial benefits for congress and the american people, identifies billions of dollars in potential savings, our list of “high risk” federal programs, gao ranked #1 in best places to work, recent reports & testimonies.

Southwest Border: CBP Could Take Additional Steps to Strengthen Its Response to Incidents Involving Its Personnel

Cyber Personnel: Navy Needs to Address Accuracy of Workforce Data

GAOverview: Understanding Waste in Federal Programs

Federal Housing Finance Agency: Improvements Needed in Controls over Management Reviews and Information Systems Access

U.s. territories: coordinated federal approach needed to better address data gaps, federal housing finance agency office of inspector general: improvements needed in review procedures for payroll accounting, legal decisions, american eagle protection services corporation, department of labor, employee benefits security administration: amendment to prohibited transaction exemption 84-24, department of energy: energy conservation program: energy conservation standards for dishwashers, quadrant training solutions, jv, department of labor, employee benefits security administration: amendment to prohibited transaction exemptions 75-1, 77-4, 80-83, 83-1, and 86-128, department of labor, employee benefits security administration: amendment to prohibited transaction exemption 2020-02, featured topics.

Duplication & Cost Savings

High Risk List

Tracking the Funds

Cybersecurity

Coronavirus Oversight

America's Fiscal Future

Race in America

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Meet The U.S. Comptroller General

Gene L. Dodaro is the eighth Comptroller General of the United States and head of GAO. As Comptroller General, Mr. Dodaro leads GAO and helps oversee the hundreds of reports and testimonies that GAO provides each year to various committees and individual Members of Congress. The U.S. Comptroller General is appointed to a 15-year term.

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Significant Improvements Are Needed for Overseeing Relief Funds and Leading Responses to Public Health Emergencies

Gao-22-105291;  published: jan 27, 2022.  publicly released: jan 27, 2022..

• Executive Summary

Recommendations

What gao found.

Note: CDC counts individuals as being fully vaccinated if they received two doses on different days of the two-dose vaccines or received one dose of the single-dose vaccine.

Note: Amounts shown reflect amounts appropriated specifically for COVID-19 response and relief and do not include annual appropriations. SNAP received both specific amounts of funding, as well as an indefinite appropriation—an appropriation that, at the time of enactment, is for an unspecified amount—for certain purposes, including a SNAP benefit increase of 15 percent through September 2021.

• Average Monthly Processing Times for Carryback Applications and Claims Filed with the Internal Revenue Service (IRS), Apr. 2020–Nov. 2021

Why GAO Did This Study

What gao recommends, recommendations for executive action, introduction  .

• Figure 1: Report Enclosures by Topic Area
• Figure 2: Status of Prior GAO Recommendations from COVID-19-Related Work, by Federal Department or Agency, as of Dec. 31, 2021

Background  

In this section, public health and economic effects of the covid-19 pandemic, federal covid-19 funding and spending.

• Figure 3: 7-Day Averages of Reported COVID-19 Cases in the U.S., Mar. 1, 2020–Jan. 3, 2022
• Figure 4: Reported Daily Hospitalizations and 7-Day Averages of Patients with Confirmed COVID-19 in the U.S., Aug. 1, 2020–Jan. 6, 2022

Note: See CDC, “COVID Data Tracker: COVID-19 Vaccinations in the United States,” accessed January 10, 2022, https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-total-admin-rate-total . a As of January 8, 2022, CDC counts individuals as being fully vaccinated if they received two doses on different days (regardless of time interval) of the two-dose vaccines or received one dose of the single-dose vaccine. FDA authorized Pfizer’s two-dose COVID-19 vaccine for emergency use for individuals aged 16 and older on December 11, 2020. FDA amended the emergency use authorization to authorize use for individuals aged 12 to 15 on May 10, 2021, and to authorize a lower dose for individuals aged 5 to 11 on October 29, 2021. b The count of people who received a booster dose includes anyone who is fully vaccinated and has received a third dose of the two-dose COVID-19 vaccine or a second dose of the one-dose vaccine since August 13, 2021. c On December 9, 2021 and January 3, 2022, FDA amended the Pfizer emergency use authorization to allow booster doses for individuals 16 and 17 years of age, and for individuals aged 12 to 15, respectively. CDC recommended Pfizer booster doses for those aged 12 to 15 on January 5, 2022; data on the percentage of the population under 18 years of age who received a booster dose is therefore not available as this population was not eligible as of January 3, 2022.

• Figure 5: Percent of People Fully Vaccinated by Jurisdiction, as Reported to the CDC, as of Jan. 3, 2022
• Figure 6: Employment-to-Population Ratio, January 2019–December 2021
• Figure 7: Percentage of COVID-19 Relief Funding Obligated and Expended, July 31, 2020–Nov. 30, 2021

Note: Total budgetary resources, obligations, and expenditure data shown for the major spending areas are based on data reported by applicable agencies to Treasury’s Governmentwide Treasury Account Symbol Adjusted Trial Balance System. Each spending area may include multiple programs. Total budgetary resources reflect the amount of funding made available for the COVID-19 response under the American Rescue Plan Act of 2021 (ARPA), Pub. L. No. 117-2, 135 Stat. 4; Consolidated Appropriations Act, 2021, Pub. L. No. 116-260, 134 Stat. 1182 (2020); Paycheck Protection Program and Health Care Enhancement Act, Pub. L. No. 116-139, 134 Stat. 620 (2020); CARES Act, Pub. L. No. 116-136, 134 Stat. 281 (2020); Families First Coronavirus Response Act, Pub. L. No. 116-127, 134 Stat. 178 (2020); and Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020, Pub. L. No. 116-123, 134 Stat. 146. In our October 2021 report, we reported that, as of August 31, 2021, $4.8 trillion in COVID-19 relief funds were provided by the six relief laws based on appropriation warrant information provided by Treasury. The total amount we are reporting as of November 30, 2021 decreased from the amount we reported as of August 31, 2021 mostly due to the return of unused indefinite appropriations to the Treasury at the end of fiscal year 2021 by the Internal Revenue Service and the Department of Labor. To account for this and other actions affecting funding amounts for each activity, we used total budgetary resources reported to Treasury’s Governmentwide Treasury Account Symbol Adjusted Trial Balance System for this report. Total budgetary resources, as opposed to the previously reported appropriation warrant information provided by Treasury, reflect appropriations, as well as transfers, adjustments, recoveries, rescissions, and returns of unused indefinite appropriations at the end of fiscal year 2021. An obligation is a definite commitment that creates a legal liability of the U.S. government for the payment of goods and services ordered or received, or a legal duty on the part of the U.S. government that could mature into a legal liability by virtue of actions on the part of another party that are beyond the control of the U.S. government. An expenditure is the actual spending of money, or an outlay. Expenditures shown include some estimates, such as estimated subsidy costs for direct loans and loan guarantees. a The Small Business Administration’s Business Loan Program account includes activity for the Paycheck Protection Program loan guarantees and certain other loan subsidies. These expenditures relate mostly to the loan subsidy costs (i.e., the loan’s estimated long-term costs to the U.S. government). b Funding provided to the Disaster Relief Fund is generally not specific to individual disasters. Therefore, Treasury’s methodology for determining COVID-19-related obligations and expenditures does not capture obligations and expenditures for the COVID-19 response based on funding other than what was provided in the COVID-19 relief laws. Further, Treasury’s methodology includes all obligations and expenditures based on funding in the COVID-19 relief laws, including those for other disasters. In its Disaster Relief Fund Monthly Report dated December 7, 2021, the Department of Homeland Security reported COVID-19-related obligations totaling $84.0 billion and expenditures totaling $65.9 billion as of November 30, 2021. c Several provisions in the Families First Coronavirus Response Act and ARPA authorized increases in Medicaid payments to states and U.S. territories. The Congressional Budget Office estimated that federal expenditures from these provisions would be approximately $76.9 billion through fiscal year 2030. The largest increase to federal Medicaid spending is based on a temporary formula change rather than a specific appropriated amount. Some of the estimated costs in this total are for the Children’s Health Insurance Program, permanent changes to Medicaid, and changes not specifically related to COVID-19. This increased spending is not accounted for in the funding provided by the COVID-19 relief laws and therefore not included in this table. d Because of rounding, amounts shown in columns may not sum to the totals.

Notes: The COVID-19 relief laws providing the appropriations shown are the American Rescue Plan Act of 2021 (ARPA), Pub. L. No. 117-2, 135 Stat. 4 (2021), the Consolidated Appropriations Act, 2021, Pub. L. No. 116-260, div. M and N, 134 Stat. 1182 (2020), the Paycheck Protection Program and Health Care Enhancement Act, Pub. L. No. 116-139, 134 Stat. 620 (2020), the CARES Act, Pub. L. No. 116-136, 134 Stat. 281 (2020), and the Families First Coronavirus Response Act, Pub. L. No. 116-127, 134 Stat. 178 (2020). The Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020, Pub. L. No. 116-123, 134 Stat. 146, did not provide any specified amounts for these programs or funds for states, D.C., localities, territories, or tribes. The amounts shown are the cumulative amounts for each program or fund under the other five laws. Some appropriation amounts include an amount available for administration expenses or for the relevant inspectors general. Numbers are rounded to the nearest hundred million. We did not independently verify obligations and expenditures amounts. a Funding provided to the Disaster Relief Fund is generally not specific to individual disasters and may be used for various disaster assistance programs, including the Public Assistance program, which provides assistance to state, local, territorial, and tribal governments. b The obligations and expenditures listed in the table are for the Public Assistance program for the COVID-19 response. c Several provisions in the Families First Coronavirus Response Act and ARPA authorized increases in Medicaid payments to states and U.S. territories. The Congressional Budget Office estimated that federal expenditures from these provisions would be approximately $76.9 billion through fiscal year 2030. The largest increase to federal Medicaid spending is based on a temporary funding formula change rather than a specific appropriated amount. Some of the estimated costs in this total are for the Children’s Health Insurance Program, permanent changes to Medicaid, and changes not specifically related to the COVID-19 pandemic. d Medicaid obligations and expenditures are as of September 30, 2021. COVID-19 related obligation and expenditure amounts for Medicaid only reflect provisions in the Families First Coronavirus Response Act. Obligation and expenditure amounts for COVID-19 related Medicaid provisions in ARPA are not currently available from the Centers for Medicare & Medicaid Services. e The Child Care and Development Fund is made up of two funding streams: mandatory and matching funding authorized under section 418 of the Social Security Act, and discretionary funding authorized under the Child Care and Development Block Grant Act of 1990, as amended. See 42 U.S.C. §§ 618 and 9858m. f Expenditures represent funding disbursed to grantees by Treasury for distribution to renters, landlords, and utility providers, as well as associated administrative costs and certain housing stability services. g Funds are available to eligible sponsors of airports. Nearly all of these airports are under city, state, county, or public-authority ownership. h Obligations and expenditures for these funds are as of November 29, 2021. i Treasury issued implementing guidance in September 2021 that provides that the application deadline for requesting allocations of the Coronavirus Capital Projects Fund from Treasury was (1) December 27, 2021, for states, D.C., and U.S. territories; and is (2) June 1, 2022, for tribal governments. j States, D.C., territories, and tribal governments were required to initiate applications for the State Small Business Credit Initiative program with Treasury by December 11, 2021. Eligible jurisdictions must submit completed applications by February 11, 2022.

Executive Summary  

Emergency rental assistance, nutrition assistance, tax relief for businesses, hhs covid-19 funding, designation of new high-risk area: hhs’s leadership and coordination of public health emergencies.

• establishing clear roles and responsibilities for the wide range of key federal, state, local, tribal, territorial, and nongovernmental partners;
• collecting and analyzing complete and consistent data to inform decision-making—including any midcourse changes necessary—as well as future preparedness;
• providing clear and consistent communication to key partners and the public;
• establishing transparency and accountability to help ensure program integrity and build public trust; and
• understanding key partners’ capabilities and limitations.

Conclusions  

Closing  , congressional addressees.

The Honorable Patrick Leahy Chairman The Honorable Richard Shelby Vice Chairman Committee on Appropriations United States Senate

The Honorable Ron Wyden Chairman The Honorable Mike Crapo Ranking Member Committee on Finance United States Senate

The Honorable Patty Murray Chair The Honorable Richard Burr Ranking Member Committee on Health, Education, Labor, and Pensions United States Senate

The Honorable Gary C. Peters Chairman The Honorable Rob Portman Ranking Member Committee on Homeland Security and Governmental Affairs United States Senate

The Honorable Rosa L. DeLauro Chair The Honorable Kay Granger Ranking Member Committee on Appropriations House of Representatives

The Honorable Frank Pallone, Jr. Chairman The Honorable Cathy McMorris Rodgers Republican Leader Committee on Energy and Commerce House of Representatives

The Honorable Bennie G. Thompson Chairman The Honorable John Katko Ranking Member Committee on Homeland Security House of Representatives

The Honorable Carolyn B. Maloney Chairwoman The Honorable James Comer Ranking Member Committee on Oversight and Reform House of Representatives

The Honorable Richard Neal Chairman The Honorable Kevin Brady Republican Leader Committee on Ways and Means House of Representatives

Appendixes and Enclosures  

Appendix i: enclosures, economic indicators, enhanced medicaid funding, unemployment insurance programs, student loan repayment, economic injury disaster loan program, paycheck protection program, state small business credit initiative, federal office space, coronavirus state and local fiscal recovery funds, federal contracts and agreements for covid-19, international trade, federal fraud-related cases, appendix ii: new high-risk designation: hhs and public health emergencies, appendix iii: highlights pages from recently issued gao covid-19 products, aviation industry recovery, federal workplace reentry, hiring authorities, emergency relief to tribes, state department repatriation effort, vaccine distribution and communication, election assistance commission grants, vaccine development, defense production act loans, va supply chain, behavioral health and covid-19, services for older adults, improving usaspending.gov, defense production act authorities, housing finance vulnerabilities, hhs-dod covid-19 countermeasures acceleration group, international humanitarian assistance, appendix iv: list of ongoing gao work related to covid-19 as of december 28, 2021, appendix v: comments from the internal revenue service, appendix vi: comments from the department of the treasury.

• Indicators for Areas of the Economy Supported by the Federal COVID-19 Pandemic Response, Sept.–Dec. 2021, Cumulative Changes since Feb. 2020
• Employment-to-Population Ratio, Jan. 2019–Dec. 2021
• Indicators of Inflation, Feb.–Nov. 2021, and Average Inflation Rates, 2000–2019
• Percentage Change in Inflation Indicators from the Previous Month, Jan. 2019-Nov. 2021

Methodology

Agency comments, gao’s ongoing work, overview of key issues.

• HHS-Reported COVID-19 Relief Appropriations, Obligations, and Expenditures from COVID-19 Relief Laws, as of Nov. 30, 2021

Note: The Department of Health and Human Services (HHS) reported that, of its total appropriations for COVID-19 relief, the agency transferred $289 million to the Department of Homeland Security that is not included in the reported obligations or expenditures, and that $300 million in appropriations are not available until HHS has taken certain actions. a HHS reported that it transferred $289 million from CARES Act appropriations to the Department of Homeland Security; this amount is not included in HHS’s reported obligations or expenditures. b This amount reflects appropriations provided in Divisions M and N of the Consolidated Appropriations Act, 2021 that are specifically designated for COVID-19 relief. An additional $638 million in COVID-19 relief funds were appropriated under Division H to the Administration for Children and Families, an agency within HHS, to prevent, prepare for, and respond to the coronavirus, for necessary expenses for grants to carry out a low-income household drinking water and wastewater emergency assistance program. These funds were not included in the HHS-reported data on HHS COVID-19 relief appropriations, obligations, and expenditures, as HHS noted that the funds were not considered COVID-19 relief funding for USAspending.gov reporting purposes. c The percent obligated was 99.6 percent, which we show as 100 percent due to rounding.

Note: For the purpose of this table, the term allocation includes both direct appropriations and transfers between HHS agencies. For example, according to HHS, the agency transferred $1,063.5 million to the Administration for Children and Families’ Unaccompanied Children Program from National Institutes of Health appropriations provided in the Consolidated Appropriations Act, 2021, Pub. L. No. 116-260, 134 Stat. 1182, 1913 (2020), citing the Secretary’s authorities under that act. HHS reported that of its total appropriation for COVID-19 relief, the agency transferred $289 million to the Department of Homeland Security that is not included in the reported obligations or expenditures, and that $300 million in appropriations are not available until HHS takes certain actions. With respect to the Consolidated Appropriations Act, 2021, the amounts reflect appropriations specifically designated for COVID-19 in Divisions M and N of the act. a These amounts do not reflect Medicaid and Medicare expenditures that resulted from statutory changes to these programs under the COVID-19 relief laws. b PHSSEF is an account through which funding is provided to certain HHS offices, such as the Office of the Assistant Secretary for Preparedness and Response. Amounts have been appropriated to this fund for the COVID-19 response to support certain HHS agencies and response activities. Amounts appropriated to the PHSSEF and transferred to agencies within HHS listed in the table are included in the allocation amounts for the specified receiving agencies. For example, the National Institutes of Health (NIH) received transfers from the PHSSEF and this amount is included in the NIH allocation rather than in the PHSSEF total. c The italicized amounts are subtotals of the PHSSEF and are already reflected in amounts listed for the PHSSEF. d The Provider Relief Fund reimburses eligible health care providers for health care-related expenses or lost revenues that are attributable to COVID-19. Provider Relief Fund expenditures also may be referred to as disbursements.

Notes: The selected response activities represent examples of certain targeted activities that fall within particular HHS agencies, such as funding for health centers or Head Start, as well as broader categories of response activities that may span HHS agencies, such as testing-, vaccine-, and therapeutics-related response activities. HHS reported allocations, obligations, and expenditures for these activities based on the primary programmatic recipient organization of the funds, although some activities apply to multiple categories. For example, certain funds in the “support to state, local, territorial, and tribal organizations for preparedness” category were provided for testing but are not reflected in the “testing” category. However, HHS also noted that testing-related funding awarded to states or localities that was appropriated under the American Rescue Plan Act of 2021 (ARPA) was included in the “testing” category. HHS officials explained that the activity names align with how funds were appropriated under different COVID-19 relief laws. According to HHS officials, the allocations reported for the key activities above are based on amounts appropriated for these activities in the COVID-19 relief laws, HHS transfers of funds, and approved spend plan decisions made by HHS in coordination with the Office of Management and Budget. According to HHS, the agency used about $1.7 billion in appropriations provided under ARPA, including $1.2 billion appropriated for COVID-19 testing, contact tracing, and mitigation activities, for the Administration for Children and Families’ Unaccompanied Children Program, citing the Secretary’s authorities under the Public Health Service Act and the Consolidated Appropriations Act, 2021. See Pub. L. No. 116-260, div. H, tit. II, § 204, 134 Stat. 1182, 1589 (2020); 42 U.S.C. 238j(a). With respect to the Consolidated Appropriations Act, 2021, the amounts reflect appropriations specifically designated for COVID-19 in Divisions M and N of the act. HHS reported that, of its total appropriation for COVID-19 relief, the agency transferred $289 million to the Department of Homeland Security that is not included in the reported obligations or expenditures. a The Child Care and Development Fund is made up of two funding streams: mandatory and matching funding authorized under section 418 of the Social Security Act, and discretionary funding authorized under the Child Care and Development Block Grant Act of 1990, as amended. See 42 U.S.C. §§ 618 and 9858m. b According to HHS officials, HHS has allocated an additional $4.8 billion to the testing for the uninsured program from section 2401 of ARPA, which HHS included in the “testing” response activity category. c According to HHS officials, the agency transferred $1,063.5 million from NIH appropriations for research and clinical trials related to long-term studies of COVID-19 and $850 million from the Public Health and Social Services Emergency Fund, Strategic National Stockpile, to the Administration for Children and Families’ Unaccompanied Children Program citing authority provided in section 304 of the Consolidated Appropriations Act, 2021 for both transfers. See Pub. L. No. 116-260, div. M, tit. III, § 304, 134 Stat. at 1913, 1916, 1923 (2020).

GAO’s Prior Recommendation

a See Families First Coronavirus Response Act, Pub. L. No. 116-127, div. F, §§ 6004(a)(3), 6008, 134 Stat. 178, 205, 208 (2020) (“FFCRA”); American Rescue Plan Act of 2021, Pub. L. No. 117-2, tit. IX, subtit. J, §§ 9811, 9817, 135 Stat 4, 208, 216 (“ARPA”). b In general, a state may not receive this FMAP increase if it 1) restricts eligibility standards, methodologies, or procedures, 2) increases premiums, 3) fails to provide continuous enrollment through the last day of the month in which the PHE ends, or 4) imposes cost sharing for certain COVID-19-related services. c This column refers to the optional COVID-19 group for otherwise uninsured individuals described at section 1902(a)(10)(A)(ii)(XXIII) of the Social Security Act. Coverage for this group is generally limited to COVID-19 vaccines, vaccine administration, testing, and treatment, as well as treatment of any condition that may seriously complicate the treatment of an individual with COVID-19, if otherwise covered by the state. See 42 U.S.C. § 1396a(a)(10)(XVIII) (in the matter following subsection (G)). d No state receiving the HCBS FMAP increase may receive a total FMAP greater than 95 percent for HCBS expenditures. In order to receive the FMAP increase for eligible HCBS expenditures, states must meet certain programmatic requirements, including submitting a spending plan to the Centers for Medicare & Medicaid Services (CMS) and obtaining CMS approval. As of December 15, 2021, CMS officials said they had given conditional approval to nine states, meaning the state is fully approved to claim the HCBS FMAP increase conditional upon its continued compliance with program requirements, and partial approval to 42 states, meaning the state is approved to claim the HCBS FMAP increase but CMS requested additional information about one or more of the states’ planned activities. No territories had submitted a spending plan as of that date. e Unless otherwise noted, the term “state” refers to the 50 states, the District of Columbia, and the five U.S. territories that have Medicaid programs. f The CBO estimate does not account for additional Medicaid costs associated with evaluation and treatment of COVID-19, nor any increased Medicaid enrollment resulting from the economic disruption brought about by COVID-19. Thus, CBO notes that actual federal spending on Medicaid is likely to be greater.

• The 6.2 percentage point FMAP increase . In general, this increase applies to allowable Medicaid expenditures for which a state receives its standard FMAP rate and that are made from January 1, 2020, through the end of the quarter in which the PHE ends. All states qualify for the increased FMAP provided they meet certain conditions, such as maintaining Medicaid enrollment for beneficiaries through the end of the month in which the PHE ends. [ 65 ]
• The 10 percentage point FMAP increase for HCBS expenditures . This increase applies to certain expenditures for HCBS provided from April 1, 2021 to March 31, 2022. [ 66 ] To qualify for the increase, states must (1) use federal funds attributable to the increased FMAP to supplement, not supplant, existing state HCBS spending and (2) invest state funds equivalent to the amount of federal funding they receive from the increase into activities that will “enhance, expand, or strengthen” their HCBS programs. Each state was to submit an HCBS spending plan to CMS that estimated its expected amount of additional federal funding from the FMAP increase and described its planned activities in order to qualify. [ 67 ]
• officials from four selected states said the funding helped them respond to COVID-19, for example, by expanding telehealth and making supplemental payments to retain providers.
• officials from six selected states said the increased FMAP provided general economic relief to their states in light of revenue declines and budget uncertainty, with officials from three states noting it freed up state funds to address other needs.
• Timeline of COVID-19 PHE, 6.2 Percentage Point FMAP Increase, and Medicaid Enrollment Requirements
• New Hampshire officials estimated it will cost the state $3.8 million per 10,000 enrollees each month as they work to remove coverage for those who are no longer eligible.
• New Jersey officials said that a phase out of the increased FMAP would help the state normalize operations as it returns to pre-PHE enrollment levels, because enrollment will not drop immediately when the PHE ends.
• Selected States’ Estimates of Additional Federal Funding Attributable to Increased HCBS Federal Medicaid Assistance Percentage, July 2021

a Selected states submitted plans to the Centers for Medicare & Medicaid Services (CMS) estimating the amount of additional federal funding they expect to receive for HCBS and describing how the state will reinvest state funds equivalent to the amount of federal funds attributable to the increased FMAP into proposed HCBS activities. Proposed activities are subject to CMS approval, which was in process for all eight selected states as of October 21, 2021. As of this date, CMS had given partial approval to the plans submitted by six selected states, but had requested additional information on one or more of their proposed activities. For the other two selected states, CMS was awaiting on additional information from the states to complete its initial review. On October 21, 2021, CMS launched a webpage on Medicaid.gov that includes all states’ HCBS spending plans and a summary of related activities. b We did not include Ohio in the count of states because the state did not indicate specific proposed activities in its HCBS spending plan submitted to CMS in July 2021.

• Washington officials said they needed additional clarification from CMS on what types of behavioral health services are considered eligible HCBS activities.
• Officials from three selected states also expressed uncertainty about how to apply the FMAP increase to managed care payments, which CMS had not issued guidance on as of November 9, 2021. [ 77 ]
• New Mexico officials were concerned about increasing the number of individuals receiving HCBS, knowing that the state would be responsible for funding the increased costs associated with their coverage after the increase in funding ends.
• Likewise, Iowa officials said their plan focused on infrastructure proposals that would support HCBS but require minimal state funding over time, while Ohio officials reported collaborating with their state legislature to develop proposed activities that would later be authorized.

GAO’s Prior Recommendations

Related gao product, recommendation for executive action.

Note: This table provides information about selected programs and is not intended to provide comprehensive information about all federal nutrition assistance funding provided during the COVID-19 pandemic. For example, the Nutrition Assistance Program (not shown in the table above) provides block grants to Puerto Rico, American Samoa, and the Commonwealth of the Northern Mariana Islands to provide food assistance to low-income households and has expended $1.3 billion in COVID-19 funding through November 2021. a Amounts shown from the Consolidated Appropriations Act, 2021 reflect amounts appropriated in Division N, pertaining to COVID-19 response and relief. b The $16.8 billion shown reflects total funding for SNAP provisions in COVID-19 relief laws that included a specific amount of funding. It does not include SNAP provisions from COVID-19 relief laws that included an indefinite appropriation. It also does not include SNAP emergency allotments, which are included in the regular annual SNAP appropriation, according to FNS. c The Consolidated Appropriations Act, 2021 provided an indefinite appropriation for certain provisions, including a SNAP benefit increase of 15 percent through June 2021. The American Rescue Plan Act of 2021 extended the increase through September 2021. d The Families First Coronavirus Response Act provided an indefinite appropriation for Pandemic EBT.

• Pandemic EBT: Officials from all five states we interviewed said FNS had not yet solicited feedback on Pandemic EBT lessons learned. FNS officials confirmed that the agency had not conducted formal data collection on lessons learned for the program, though officials noted they have collected some information on lessons learned through listening sessions, conference calls with regional groups of states, and working with states to develop their Pandemic EBT plans.
• SNAP: Officials in four states said FNS had not yet solicited feedback on SNAP lessons learned, though FNS officials told us they have collected some anecdotal information from states on lessons learned and expect to learn more when states submit reports to FNS on the SNAP adjustments they used during the pandemic.
• TEFAP: Feeding America and the American Commodity Distribution Association officials said they were not aware of FNS efforts to identify lessons learned for TEFAP during the pandemic, and FNS officials confirmed that the agency did not institute a formal process to gather information from TEFAP stakeholders.
• Challenges to data timeliness . SNAP officials we interviewed in selected states said that obtaining data from their state’s educational agency was a challenge that impeded their efforts to issue Pandemic EBT in a timely manner. For example, officials in one state said that, at the onset of the pandemic, a state law prohibited data sharing between the state educational agency and the state SNAP agency. FNS officials said challenges collecting eligibility data have led to delays in states issuing Pandemic EBT benefits to students—an issue that has led to students receiving Pandemic EBT benefits several months after they missed the school meals that those benefits were intended to replace. Code for America officials, who provided Pandemic EBT technical assistance to several states, said that delays in benefit issuance or challenges with incomplete data may disproportionately affect the most vulnerable, highest need families.
• Challenges to data reliability. FNS officials said state SNAP agencies encountered challenges to obtaining reliable and comprehensive NSLP eligibility data and school operating status information from state educational agencies. Prior to the pandemic, state educational agencies did not track whether students were learning in-person, remotely, or via a hybrid model. State SNAP agencies needed this information to determine students’ eligibility and benefit amounts for Pandemic EBT accurately. [ 88 ]

Related GAO Products

• Pandemic Unemployment Assistance (PUA), which authorized UI benefits for individuals not otherwise eligible for UI benefits, such as self-employed and certain gig economy workers, who were unable to work as a result of specified COVID-19-related reasons. [ 99 ]
• Federal Pandemic Unemployment Compensation (FPUC), which generally authorized an additional weekly benefit for individuals who were eligible for weekly benefits under the regular UI or CARES Act UI programs. [ 100 ]
• Pandemic Emergency Unemployment Compensation (PEUC), which generally authorized additional weeks of UI benefits for those who had exhausted their regular UI benefits. [ 101 ]
• Weekly Continued Claims Submitted Nationwide for Regular UI, PEUC, and Extended Benefits, Mar. 1, 2020–Dec.18, 2021
• Timeliness of First Payments of Regular Unemployment Insurance (UI) Benefits, Jan. 2020–Nov. 2021
• $10.4 billion in PUA overpayments, [ 116 ]
• $8.5 billion in FPUC overpayments, [ 117 ]
• $6.9 billion in regular UI and Extended Benefits overpayments, and
• $1.3 billion in PEUC overpayments. [ 118 ]
• Deployed expert teams to six states, and began deploying expert teams to six others. According to DOL officials, as of the end of October 2021, teams of experts in fraud, timeliness, technology, and equity had finished gathering information from the first six states that volunteered to participate—Colorado, Kansas, Nevada, Virginia, Washington, and Wisconsin—and were working with DOL and the states to finalize recommendations. Officials said that expert teams had also held initial meetings with four of six additional states that had volunteered to participate: Alabama, Connecticut, Iowa, Kentucky, Nebraska, and Pennsylvania. As this work continues, officials said they plan to use the expert teams’ findings to identify best practices and solutions for common challenges, and make them available as a resource for all states. In November 2021, DOL announced the availability of up to $200 million in grant funding to support states in improving UI systems and processes by implementing the expert teams’ recommendations following a consultative assessment. [ 130 ]
• Awarded grants to states to strengthen their efforts to address potential fraud and recover overpayments, and solicited grant applications from states to address equity issues . As we previously reported, DOL announced grant opportunities for states to address potential fraud and recover overpayments in their UI programs. [ 131 ] According to DOL officials, DOL awarded a total of about $94 million in these grants in 2021, including grants to 55 states, territories, and the District of Columbia for PUA and to 50 states, territories, and the District of Columbia for PEUC. [ 132 ] In addition, DOL announced that it had awarded a total of nearly $134 million to 50 states, territories, and the District of Columbia to combat potential fraud in all UI programs. DOL also solicited grant applications from states to address equity issues, such as by improving access to the regular UI program for individuals with disabilities or individuals who have limited or no internet access, and eliminating administrative barriers to benefit applications. [ 133 ] States seeking these grants were required to identify the equity gaps they planned to address and the metrics they planned to use to measure improvement in equitable access. In October 2021, DOL officials said they planned to review states’ applications to ensure that states planned to use these funds for allowable purposes and had identified sufficient metrics before they awarded these grants.
• Began developing modular technology solutions and a UI customer service blueprint. In November 2021, DOL officials said they had begun working with OMB’s U.S. Digital Service to develop modular technology solutions that can be integrated with state IT systems. Officials said they planned to begin pilot testing the first module, which is focused on the claimant experience, with states in February or March of 2022. In December 2021, DOL announced that Arkansas and New Jersey would be the first two states to participate in the pilot project. [ 134 ] Officials noted that they are also working with the U.S. Digital Service to develop a blueprint for the UI customer experience.
• Addressed identity-related fraud by issuing instructions to states on accessing identity verification and fraud protection services and working with the Social Security Administration to establish a secure incarceration data exchange . As we previously reported, DOL officials told us that they had awarded purchase agreements to three vendors that states can use to combat identity-related fraud. In September 2021, DOL issued instructions to states on how to use DOL’s blanket purchase agreements to order the identity verification and fraud protection services provided by these vendors. [ 135 ] As a separate action, DOL officials said they signed a Memorandum of Understanding with the Social Security Administration in October 2021 to establish a secure incarceration data exchange that will allow states to cross-match UI claims data with incarceration records when determining the eligibility of UI claimants. That month, DOL announced the establishment and availability of this secure incarceration data exchange, and provided guidance for states on how to access it. [ 136 ]
• the implementation and administration of the CARES Act UI programs and the implications of high claims volumes during the pandemic on the timeliness of benefit payments and on overall program integrity;
• selected claimants’ experiences during the pandemic, including their experiences with accessing the CARES Act UI programs;
• selected states’ data on PUA benefit receipt, by race and ethnicity;
• programmatic risks and challenges for the regular UI program as well as options for program transformation; and
• UI IT systems modernization.

Note: The amounts disbursed are through November 30, 2021. For ERA1, the funding remains available until September 30, 2022, and the amount spent includes expenditures for financial assistance to households through November 30, 2021, as well as payments for administrative costs, housing stability services, Indian tribes or their tribally designated housing entities, and the Department of Hawaiian Home Lands through September 30, 2021. For ERA2, the funding remains available until September 30, 2025, and the amount spent includes total expenditures through November 30, 2021. As required by law, Treasury has made available 40 percent of the ERA2 allocations to grantees and is disbursing additional ERA2 funds to grantees that have both substantially expended their ERA1 allocation and obligated at least 75 percent of their initial ERA2 allocation.

• Number and Type of Borrowers Affected by the Expiration of COVID-19 Emergency Relief for Federal Student Loans, as of November 2021
• increased the amount of funding that can be borrowed from $500,000 to $2 million;
• created a 1-month exclusivity window for businesses requesting loans of $500,000 or less;
• authorized funds to be used to prepay commercial debt and make payments on federal business debt;
• deferred repayments for 2 years after loan origination date;
• created additional ways to meet program size standards for businesses in industries uniquely affected by COVID-19;
• established more simplified requirements for affiliated businesses to model those of the Restaurant Revitalization Fund; and
• added a $10 million limit on maximum aggregate loans to a single corporate group.
• develop and execute a review plan for the EIDL loans and advances portfolios and determine which transactions were made to ineligible recipients;
• implement controls to prevent or detect loans and advances that are not in conformance with related legislation and program eligibility terms;
• design and implement controls to continue accumulating relevant, complete, and accurate data on which to base the subsidy reestimate model for the EIDL portfolio; and
• enhance its review and evaluation of service organization controls.
• Average Monthly Processing Times for Taxpayer Carryback Applications and Claims Filed with the Internal Revenue Service (IRS), Apr. 2020–Nov. 2021
• Weekly reports . IRS headquarters staff produce weekly carryback reports that they share with IRS processing sites to alert them of older cases and to help ensure that processing timeframes are met, particularly for higher dollar value cases. [ 201 ] They also generate reports that track the weekly processing times for applications for tentative refund. In late 2020 through early 2021, neither of these efforts resulted in immediate action to reduce the overall processing times for these applications, but rather focused on specific aged cases that IRS prioritized based on refund amount.
• The auditor could not verify existence and accuracy for 32 of 383 sampled items from the PPP loan guarantees approved in fiscal year 2021 because lenders did not respond to confirmation requests.
• As of September 30, 2021, SBA had flagged over 27,000 approved PPP loan guarantees (with an approximate value of $488 million) in its loan repository system as potentially not in conformance with the CARES Act and related legislation.
• As of September 30, 2021, SBA had reported approximately $2 billion of PPP loans that were approved but not disbursed due to unsubmitted or unprocessed loan status reports from lenders.
• An analysis of the results of the PPP loan review process and forgiveness payments showed $49 billion was paid to lenders for forgiveness of PPP loans that were still being reviewed by SBA to address alerts and flags indicative of eligibility concerns.
• perform a thorough review of PPP loan guarantees approved in fiscal year 2021;
• develop and enforce a policy and controls that require the adequate training and monitoring of lenders to execute their responsibilities in the PPP loan servicing process;
• develop and enforce a policy and controls to monitor the results of its contractor’s loan review processes;
• design adequate controls and processes to ensure forgiveness payments are not processed for loan guarantees that have not been sufficiently reviewed;
• design and implement controls to continue accumulating relevant, complete, and accurate data on which to base the subsidy reestimate models for the PPP portfolio; and
• assess the risk posed by service organizations’ control environments, and obtain sufficient assurance of the operating effectiveness of relevant and significant service organization controls.
• document its internal control system and processes related to the implementation of new or expanded programs from new legislation;
• develop and implement monitoring controls to ensure implementation of an effective internal control environment; and
• develop and implement a sufficient plan to test and monitor the design, implementation, and operating effectiveness of key, relevant controls that affect financial reporting and compliance with relevant laws and regulations.
• Status of SBA Loan Forgiveness Determinations on Paycheck Protection Program Loans, as of Sept. 30, 2021
• Number of Paycheck Protection Program Loan Forgiveness Decisions Submitted by Lenders to SBA, Aug. 2020–Sept. 2021
• In our July 2021 report, we found that SBA had not documented policies and procedures for some elevated reviews conducted when SBA determines that the borrower is ineligible for a PPP loan or for the loan amount or loan forgiveness amount claimed by the borrower. Consequently, we recommended that SBA establish time frames for finalizing and issuing these procedures. SBA agreed with the recommendation, and the agency issued a Federal Register notice on November 16, 2021, that delegated certain authorities related to SBA's review of PPP loans and final SBA loan review decisions to two entities within SBA—a Higher Authority Review Team and the Office of Capital Access Committee. [ 218 ] We are reviewing the notice to determine whether it fully addresses our recommendation.
• We also found in July 2021 that although SBA developed tools such as a web portal and lender hotline, its system for responding to lender inquiries was ad hoc. Some lenders, lender associations, and state banking associations also noted that SBA was not responsive to lender inquiries, including on loan reviews and the status of loan forgiveness determinations. Consequently, we recommended that SBA develop and implement a process to help ensure it responds in a timely manner to PPP lender inquiries on loan reviews. SBA agreed with the recommendation, and SBA officials told us in October 2021 that they had taken steps to improve communication with lenders, such as having a customer service team handle all the lender inquiries from the lender platform and communicate to lenders reasons for delays or issues with loan reviews. In late December 2021, SBA provided us with documentation on procedures its customer service staff are to follow. We are reviewing the documentation to determine whether it fully addresses our recommendation.
• Lastly, we found in July 2021 that SBA had not yet implemented the CARES Act requirement that SBA purchase loans prior to loan forgiveness upon submission of reports by lenders concerning the amount expected to be forgiven. Consequently, we recommended that SBA implement this statutory provision or report to Congress why it has not complied, including seeking statutory flexibilities or exceptions that the agency believes appropriate. In response, SBA stated that it would notify Congress of its request to seek statutory flexibility on this matter or would request that Congress repeal the advance purchase requirement. In December 2021, SBA officials said they planned to send a letter to Congress in the second quarter of fiscal year 2022.
• State Small Business Credit Initiative Funding Allocations, 2010 and 2021
• State Small Business Credit Initiative 2021 Preliminary Allocations to States and Territories
• Meeting the overall program leverage ratio . ARPA increased total funding for states and territories by over $5 billion, creating a larger pool of money for lending and investing. Many states were unable to meet the 10:1 leverage ratio requirement for the original program, and state officials expressed some concerns about meeting the same leverage ratio for the current program. For example, one state official said meeting the leverage ratio requirement will be a challenge given the amount of money the state will receive for the current program. Representatives from a financial organization we interviewed noted that participants have a better understanding of opportunities to leverage funds and which types of programs result in higher leverage ratios for the current program.
• Managing allocations related to very small businesses and businesses owned and controlled by socially and economically disadvantaged individuals. ARPA included $1.5 billion to be expended for businesses owned and controlled by socially and economically disadvantaged individuals (as well as $1 billion to be provided to jurisdictions that demonstrate robust support for these businesses), and $500 million to be expended for very small businesses. State officials we interviewed said assisting these businesses can be difficult. For example, officials from one state said it may be difficult to incentivize banks to take on the level of risk necessary to serve these businesses and that they plan to address this by working closely with community development financial institutions.
• Managing funds for tribal governments. ARPA included a $500 million set-aside for tribal governments, who as first-time participants will likely require additional guidance and technical assistance from Treasury, according to representatives from a financial organization that helped states set up their programs during the original SSBCI round. Tribal governments may also receive additional SSBCI funding from the allocations related to very small businesses and businesses owned and controlled by socially and economically disadvantaged individuals. We reported in October 2021 that Treasury faced various challenges that slowed distribution of funds from the Coronavirus Relief Fund to tribes.
• Managing technical assistance funds. ARPA included a $500 million set-aside for technical assistance to very small businesses and businesses owned by socially and economically disadvantaged individuals. Treasury may provide these funds to participating jurisdictions, transfer them to the Minority Business Development Agency, or use them to directly contract with technical assistance providers. State officials we interviewed said the technical assistance component would be an important component of the current program and receiving additional guidance from Treasury in this area will help them plan how to use the SSBCI funds. One official noted that allowing participating jurisdictions to administer these funds may improve access for underserved businesses. As previously noted, Treasury officials plan to release guidance for this component in early 2022.
• The Department of Veterans Affairs reduced its leased office space by approximately 237,000 square feet across 18 leases nationwide—through lease terminations and allowing leases to expire—because of teleworking personnel.
• The Environmental Protection Agency delayed its office relocation to a federal building in Washington, D.C. due to the challenges of moving almost 1,000 employees and equipment while the federal government was operating under a maximum telework status. As a result, the agency had to extend its lease in Arlington, Virginia (326,057 square feet) until March 2022 at an annual cost of approximately $14 million.
• Number of Leases in the Federal Leasing Inventory, July 2011–July 2021
• Department of Education officials said they are canceling plans for several new leases because of the pandemic and will reduce square footage between 27 and 50 percent for future leases.
• Department of Defense officials reported plans to reduce their reliance on leased workspace because, in some offices, almost 90 percent of personnel were able to telework.
• On June 10, 2021, the Office of Personnel Management (OPM), GSA, and the Office of Management and Budget (OMB) jointly issued a memorandum providing guidance to agencies for reentry and post-reentry work environment and personnel policies. This memorandum included high-level guidance to agencies on telework, remote work, hours of work, labor relations, and performance management.
• On July 23, 2021, OPM issued further guidance for agencies on workforce reentry issues. It covered many topics addressed in the previous guidance but also included information on pay administration, evacuation pay, labor, and employee relations.
• On November 12, 2021, OPM released additional guidance which provides resources and information to help agencies conceptualize the continued evolution of telework, including a new section providing agencies with policy guidance on remote work.
• Examples of General Services Administration’s (GSA) Return to Workplace Planning Services for Federal Agencies
• Coronavirus State and Local Fiscal Recovery Funds Allocations and Treasury Distributions as of Nov. 30, 2021, by Recipient Type
• All recipients—except NEUs—were required to submit an interim report that provided an initial overview of the status and use of their funding.
• All recipients, including NEUs, are required to submit project and expenditure reports on a quarterly or annual basis—depending on the type of recipient—that provide information on their use of the funding and projects undertaken with the funding, among other things.
• States, U.S. territories, and metropolitan cities and counties with a population that exceeds 250,000 residents are also required to submit to Treasury annually, and post on their public websites, a recovery plan performance report (recovery plan). These recovery plans are to discuss planned uses of spending and include, among other things, descriptions of the projects funded.
• Treasury’s Reporting Requirements for the Coronavirus State and Local Fiscal Recovery Funds, by Recipient Type, as of Nov. 15, 2021
• Public Health . Recipients may address the effects of the COVID-19 public health emergency. Examples include funds for COVID-19 testing and vaccination efforts, procuring personal protective equipment, and providing mental health services.
• Negative Economic Impacts . Recipients may address the negative economic impacts that the COVID-19 pandemic had on individuals, households, and businesses, among other groups. Examples include funds for food programs, job training assistance, and aid to tourism, travel, and hospitality industries.
• Services to Disproportionately Impacted Communities . Recipients may provide services to communities disproportionately impacted by the COVID-19 pandemic. Examples include funds for education assistance to high-poverty school districts, affordable housing, and services for unhoused persons.
• Premium Pay . Recipients may use funds to provide premium pay to eligible public and private sector workers performing essential work during the COVID–19 pandemic.
• Infrastructure . Recipients may use funds for necessary investments in water, sewer, and broadband infrastructure. Examples include funds for wastewater treatment services, managing and treating stormwater, and providing broadband to unserved or underserved users.
• Revenue Replacement . Recipients may use funds for the provision of government services to the extent of the reduction in revenue experienced due to the COVID–19 pandemic.
• Administrative and Other . Recipients may use funds to cover the administrative expenses of managing their CSLFRF award. Examples include costs of consultants to ensure compliance with program requirements and costs of facilities or administrative functions (e.g., a director’s office). [ 254 ]
• Percentage of States’ Planned Uses of Coronavirus State and Local Fiscal Recovery Funds (CSLFRF) by Spending Category, Based on States’ Recovery Plan Performance Reports that Were Publicly Available as of Dec. 3, 2021
• Contract Obligations in Response to COVID-19 by Federal Agency, as of Dec. 15, 2021
• Government-wide COVID-19-Related Contract Obligations and Confirmed COVID-19 Cases by Month, Feb. 2020–Dec. 15, 2021
• Contract Obligation Amounts for Top Five Goods and Services Procured in Response to COVID-19 by month, Feb. 2020–Dec. 15, 2021
• Monthly Trends in U.S. Import Charges Relative to Value Imported from Jan. 2018–Aug. 2021
• Monthly U.S. Imports of COVID-19-Related Products, by Product Type, Jan. 2019–Aug. 2021
• Value of U.S. Exports of Vaccines for Human Use, Overall and to EU Member Countries and the United Kingdom, January 2019 through August 2021
• Number of Individuals or Entities That Have Pleaded Guilty to Federal Fraud-Related Charges by COVID-19 Relief Program, as of Oct. 31, 2021
• Number of Individuals Who Have Pleaded Guilty to Federal Fraud-Related Charges and Have Been Sentenced, as of Oct. 31, 2021
• The first person in the country charged with fraudulently seeking SBA loans was sentenced to 56 months in prison followed by 3 years supervised release in connection with a PPP loan scheme. This individual and a co-conspirator pleaded guilty to conspiracy to commit bank fraud after filing four fraudulent PPP loan applications in the names of businesses they falsely claimed to own. In total, these individuals sought over $500,000. In fact, this individual had no ownership interest in three of the businesses and the fourth business had no employees and did not pay any wages. [ 288 ] See the enclosure on the Paycheck Protection Program in appendix I for more information on the program.
• In another case, an individual pleaded guilty to wire fraud and aggravated identity theft associated with a scheme to defraud SBA’s EIDL program. This individual created multiple fictitious businesses and submitted three fraudulent EIDL applications for the businesses, providing false statements on the loan applications using the stolen identification of another person. As a result of these applications, this individual received over $110,000 and spent the funds on unauthorized personal expenses and to make money transfers to individuals in another country. As of October 31, 2021, this individual had not yet been sentenced. See the enclosure on the Economic Injury Disaster Loan Program in appendix I for more information on the program.
• One individual pleaded guilty to wire fraud, conspiracy to commit wire fraud, and identity theft associated with a scheme to defraud UI. This individual was hired by the state unemployment agency shortly after being released from prison following a conviction for aggravated identity theft. Using this position with the agency, this individual submitted fraudulent UI claims for personal benefit and for the benefit of a co-conspirator. The co-conspirator—who was also the individual’s spouse and was incarcerated at the time of the application and therefore ineligible for UI—also pleaded guilty to wire fraud. As of October 31, 2021, neither individual had yet been sentenced. For more information on the UI programs, including information on state and territory reporting of overpayments that are due to fraud and DOL’s efforts to address potential fraud in the UI programs, see the enclosure on Unemployment Insurance Programs in appendix I .
• One individual was sentenced to 70 months in prison followed by 5 years supervised release and ordered to pay over $50,000 in restitution after pleading guilty to bank fraud and aggravated identity theft in connection with a mail theft and EIP fraud scheme. This individual admitted, among other things, to stealing mail, including bank statements, credit cards, credit card statements, W-2 forms, and more than $700,000 in checks, including an EIP check. This individual used the stolen EIP check to create six counterfeit EIP checks, ranging from $1,200 to $2,400. Further, this individual admitted to attempting to deposit his own EIP check through an online banking platform after having already cashed it the prior day.
• As part of another case, one individual pleaded guilty to theft of government money associated with a scheme to defraud the Coronavirus Food Assistance Program. This individual submitted an application to the program, falsely claiming that this individual’s livestock business sustained significant losses because of the COVID-19 pandemic, and received over $70,000 in benefits as a result. As of October 31, 2021, this individual had not yet been sentenced.
• Number of Individuals or Entities That Have Pleaded Guilty to, Faced Federal Charges for, or Were Convicted for Consumer Fraud, as of Oct. 31, 2021
• In one case, an individual pleaded guilty to participating in a felony conspiracy associated with a vaccine-related Medicaid fraud scheme. Specifically, this individual illegally vaccinated minors who were ineligible to receive a COVID-19 vaccine and submitted corresponding claims to Medicaid.
• In another case, DOJ announced charges against two individuals in two separate cases for allegedly selling or attempting to sell COVID-19 vaccination record cards via social media. In one of the cases, the individual is alleged to have stolen authentic COVID-19 vaccination record cards from a Department of Veterans Affairs hospital, while the second individual is alleged to have imported fraudulent cards.
• In October 2021, the FTC warned the public about scams related to the Federal Communications Commission’s Emergency Broadband Benefit Program—a program designed to help qualified households afford internet service during the COVID-19 pandemic by providing a one-time discount on an internet-connected device and monthly discounts for internet service. Specifically, the FTC warned the public about impersonators offering to help individuals sign up for a “free” device and internet service in exchange for money or personal information and offered tips to avoid such scams.
• In August 2021, the FTC warned the public about schemes in which identity thieves use text messages to gather personal information necessary to steal UI benefits or file fraudulent UI benefits claims.
• Also in August 2021, the Department of Health and Human Services Office of Inspector General alerted the public about COVID-19-related scams in which fraudsters offer unapproved and illegitimate COVID-19 tests, federal grants, and Medicare prescription cards in exchange for personal information.
• In addition, federal officials have continued to warn the public against making or buying fake COVID-19 vaccination cards.

Why the Area Is High Risk

• The Office of the Assistant Secretary for Preparedness and Response (ASPR) serves as the principal advisor to the Secretary of Health and Human Services on all matters related to federal public health and medical preparedness and response to public health emergencies.
• The Centers for Disease Control and Prevention (CDC) supports public health preparedness efforts to prevent, detect, and respond to new and emerging disease threats. For example, during infectious disease outbreaks, CDC conducts studies to learn about the link between infection and health outcomes, monitors and reports cases of infection, and provides guidance to travelers and health care providers, among other activities. Additionally, CDC typically develops a diagnostic test for an emerging pathogen when no diagnostic test has been approved, cleared, or authorized by the Food and Drug Administration (FDA) and no adequate alternative is available, such as during H1N1 and Zika.
• FDA plays a critical role in protecting the U.S. from biological threats, including intentional acts and naturally occurring infectious diseases. For example, FDA is responsible for ensuring that medical countermeasures—including drugs, vaccines, diagnostic tests, and personal protective equipment—against these threats are safe and effective. [ 296 ] FDA may also issue emergency use authorizations to allow the temporary use of unapproved medical products to diagnose, prevent, or treat disease. [ 297 ]
• 72 recommendations have not been fully implemented—49 stemming from the COVID-19 pandemic (HHS generally concurred with 62 of these 72 recommendations);
• 10 recommendations—all made prior to the COVID-19 pandemic, in fiscal year 2012 or earlier—have been closed as unimplemented as the department does not plan to address them, though we believe these recommendations are still relevant; [ 298 ] and
• 33 recommendations—nine made during, and the rest prior to the COVID-19 pandemic—have been implemented.
• providing clear, consistent communication to key partners and the public;
• understanding key partners’ capabilities and limitations .
• In September 2020, we reported that many responsibilities for medical supply chain management—the process for obtaining and delivering goods and services—that had been shared between multiple agencies for the COVID-19 response were transitioning to HHS. We recommended that HHS document roles and responsibilities for supply chain management functions transitioning to HHS, including continued support from other federal partners, to ensure sufficient resources exist to sustain and make the necessary progress in stabilizing the supply chain. As of January 2022, HHS has not addressed this recommendation, which we reiterate as important, especially during a time of ongoing shortages of medical supplies, including testing material and personal protective equipment for the COVID-19 response.
• In January 2021, we reported on challenges facing HHS’s Strategic National Stockpile (SNS), among them, its appropriate role and responsibilities during future pandemics. We cited confusion among stakeholders and experts regarding the role of the SNS in the COVID-19 response. The SNS is part of the federal medical infrastructure that can supplement state and other jurisdictional medical countermeasure needs during public health emergencies. [ 300 ] However, as of January 2022, HHS has not developed a formal process for engaging with key stakeholders on a supply strategy for pandemic preparedness. These stakeholders, including state, local, tribal, and territorial partners and the private sector, have a shared role for providing supplies during a pandemic.
• COVID-19 testing, case counts, and hospital capacity data. We reported in January 2021 that interpreting these data has proven challenging because the data HHS collects are often incomplete and inconsistent. Test positivity rates may be incomplete and inconsistent due, in part, to whether and how states report on certain types of COVID-19 tests. Case counts may be incomplete and inconsistent due, in part, to differences in how states count cases. Available hospital capacity may be inconsistent due, in part, to how hospital staff interpret which data must be reported.
• Race and ethnicity data for COVID-19 cases, hospitalizations, and deaths. We reported in September 2020 that persistent gaps in these data limited the nation’s ability to effectively target pandemic response efforts for various racial and ethnic groups that available data suggest may be disproportionately affected.
• Nursing home data for COVID-19 cases and deaths. We reported in September 2020 that HHS’s Centers for Medicare & Medicaid Services began requiring nursing homes to report COVID-19 data to CDC starting with information as of May 8, 2020, but made reporting prior to May 8, 2020, optional. By not requiring nursing homes to submit data from the first 4 months of 2020, HHS limited the usefulness of the data in helping to understand the effects of COVID-19 in nursing homes during the initial stage of the response.
• In April 2021, we reported that some stakeholders said states often did not have information critical to COVID-19 vaccine distribution at the local level, such as how many doses they would receive and when. We reemphasized findings from a prior September 2020 report that a clearly communicated plan for coordination with key federal and non-federal partners remains imperative for effective distribution and administration planning, as well as for effective management of the public’s expectations, including to help ensure public acceptance and uptake of the vaccine.
• In March 2021, we reported that there was inconsistent communication to health care providers about the use of certain personal protective equipment, according to association officials. Specifically, there was inconsistent information on the recommended use of decontamination systems for respirators between FDA and CDC, which led to confusion and hesitancy among providers about using such devices, according to some associations we interviewed.
• In January 2021, we reported that HHS had not issued a publicly available and comprehensive national COVID-19 testing strategy, creating the risk of key partners and the public lacking crucial information to support an informed and coordinated testing response. An effective national strategy not only aids coordination, but is also an important tool to help determine resources required to meet future needs and measure progress on national goals. As of January 2022, HHS has not made public a comprehensive national strategy on COVID-19 testing.
• Vaccine responsibilities. In January 2022, we reported that federal efforts to accelerate the development, manufacturing, and distribution of COVID-19 vaccines transitioned to a new office within ASPR, when they previously had been led by a partnership between HHS and DOD—known as the HHS-DOD Countermeasures Acceleration Group (and formerly known as Operation Warp Speed). We reported that the partnership and HHS had not completed all tasks necessary to ensure that ASPR could fully assume all of its new responsibilities by the transition date of January 1, 2022. For example, documentation that we reviewed did not indicate that HHS had developed and implemented strategies to resolve identified workforce gaps—such as communication and logistic expertise—resulting from DOD’s departure.
• Domestic manufacturing of medical products. In December 2021, we reported that HHS created an office in September 2020 in response to ASPR’s new responsibility to manage the expansion of domestic manufacturing of critical medical supplies, according to officials. One year later as the pandemic continues and ASPR has already assumed new responsibilities, ASPR has yet to reveal how it will staff this office.
• Medical supply acquisition. In September 2020, we reported that ASPR was expected to take over medical supply acquisition responsibilities from DOD, which would require knowledge of certain legal authorities, according to officials. However, only three of ASPR’s 20 contracting officers had experience using these authorities prior to the COVID-19 pandemic and hiring was expected to be a challenge, according to ASPR officials. [ 307 ]
• Emergency responder workforce. In June 2020, we reported that when determining the size of its emergency responder workforce, ASPR did not consider the number of responders projected to be needed to respond to multiple or concurrent events, and officials could not tell us why their planning did not take such scenarios into account. This lack of planning was notable given that we had previously reported that during the 2017 hurricane season, ASPR experienced a shortage of these responders, which contributed to a reliance on DOD to provide essential public health and medical service functions.

What Remains to Be Done

• Cleary defined roles and responsibilities. HHS should direct the Biodefense Coordination Team to document agreed upon processes, roles, and responsibilities for making and enforcing joint decisions across federal agencies and their partners involved in protecting the nation against catastrophic biological threats.
• Complete and consistent data. HHS should establish the nationwide public health situational awareness network capability, as required by statute, to help ensure timely and complete collection of public health data to aid a response, and use an expert committee to systematically review, and help standardize, the ongoing collection and reporting of public health data.
• Clear, consistent communication. FDA and CDC should develop a process to ensure consistent guidance for health care providers on the appropriate use of personal protective equipment during future public health emergencies.
• Transparency and accountability. ASPR should develop plans to ensure a transparent and deliberative process for making recommendations on the procurement of vaccines, supplies, and other materials for the SNS and maintain related documentation, including the rationale and outcomes for decisions made.
• Understanding key partners’ capabilities and limitations. ASPR should work with key federal response partners to develop and finalize memorandums of agreement that include information on the capabilities and limitations of these agencies to meet public health and medical services core capabilities during public health emergencies.

Selected Related GAO Products

• Reported COVID-19 Vaccinations by Age Group in U.S., as of Jan. 3, 2022
• COVID-19 Funding and Expenditures for Selected Federal Nutrition Assistance Programs as of Nov. 30, 2021
• Table 1: Reported COVID-19 Vaccinations by Age Group in the U.S., as of Jan. 3, 2022
• Table 2: COVID-19 Relief Funding and Spending as of Nov. 30, 2021
• Table 3: COVID-19 Relief Funding for Federal Programs and Funds Receiving $10 Billion or More in Aid for States, the District of Columbia, Localities, U.S. Territories, and Tribes, as of Nov. 30, 2021
• HHS-Reported COVID-19 Relief Appropriations, Obligations, and Expenditures, by Relief Law, as of Nov. 30, 2021
• HHS-Reported Allocations, Obligations, and Expenditures of COVID-19 Relief Funding, by Agency or Key Fund, as of Nov. 30, 2021
• HHS-Reported Allocations, Obligations, and Expenditures by Selected COVID-19 Response Activity, as of Nov. 30, 2021
• Prior GAO Recommendation Related to Department of Health and Human Services (HHS) COVID-19 Funding
• Overview of Selected Changes to the Federal Medical Assistance Percentage (FMAP) during the COVID-19 Public Health Emergency (PHE), as of Oct. 2021
• Examples of Selected States’ Proposed Home and Community-Based Services (HCBS) Activities, July 2021
• Prior GAO Matter for Congressional Consideration Related to Medicaid Funding
• COVID-19 Funding and Expenditures for Selected Federal Nutrition Assistance Programs as of Nov. 2021
• Prior GAO Recommendation Related to COVID-19 Nutrition Assistance
• Prior GAO Recommendations Related to Unemployment Insurance (UI) Programs
• Summary of Funding for Emergency Rental Assistance (ERA) Appropriated, Disbursed, and Spent as of November 30, 2021 (dollars in billions)
• Prior GAO Recommendations Related to the Economic Injury Disaster Loan Program
• Prior GAO Recommendations Related to Tax Relief for Business
• Prior GAO Recommendations Related to the Paycheck Protection Program
• Number of States Receiving One or More 30-Day Extensions from Treasury for Distributing Coronavirus State and Local Fiscal Recovery Funds Payments to Non-Entitlement Units of Local Government, as of Jan. 3, 2022
• Prior GAO Recommendations Related to Single Audits and Coronavirus State and Local Fiscal Recovery Funds (CSLFRF)
• Prior GAO Recommendations Related to Federal Contracts and Agreements for COVID-19

Abbreviations

[ 1 ]   HHS, “COVID-19 Reported Patient Impact and Hospital Capacity by State Timeseries,” accessed January 6, 2022, https://healthdata.gov/Hospital/COVID-19-Reported-Patient-Impact-and-Hospital-Capa/g62h-syeh .

[ 2 ]   According to CDC, viruses, such as COVID-19, constantly change through mutation, and new variants are expected to occur. Sometimes, new variants emerge and disappear, while at other times, new variants persist. First identified in the U.S. on December 1, 2021, the Omicron variant has superseded the Delta variant to become the dominant strain circulating in the U.S. Both the Omicron and Delta variants spread faster than previous variants. As of December 20, 2021, CDC reported that more research is needed to determine if Omicron causes more severe illness or death than infections caused by other variants and how well available vaccines and medications work against it.

[ 3 ]   As of January 8, 2022, CDC counts individuals as being fully vaccinated if they received two doses on different days (regardless of time interval) of the two-dose vaccines or received one dose of a single-dose vaccine. See CDC, “COVID Data Tracker: COVID-19 Vaccinations in the United States,” accessed January 10, 2022, https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-total-admin-rate-total .

[ 4 ]   CDC recommended use of the Pfizer COVID-19 vaccine for children aged 5 to 11 on November 2, 2021. We calculated the population aged 5 to 11 who received at least one COVID-19 vaccine dose by subtracting the population aged 5 and over from the population aged 12 and over who received at least one dose. These data do not include numbers from Idaho for vaccine recipients under age 18. Please see https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-total-admin-rate-total , accessed January 10, 2022, for additional technical notes.

[ 5 ]   According to the Department of Labor’s consumer price index, which measures the prices of consumer goods and services, prices increased 6.8 percent between November 2020 and November 2021, with larger increases recorded in the prices for certain items, such as energy commodities and services as well as used vehicles.

[ 6 ]   The White House noted in an October 13, 2021, press briefing that the COVID-19 pandemic contributed to key transportation and logistics disruptions domestically and abroad, such as congestion at ports, further disrupting supply chains.

[ 7 ]   The White House, Building Resilient Supply Chains, Revitalizing American Manufacturing, and Fostering Broad-Based Growth (Washington, D.C.: June 2021) . This report specifically examined the supply chains of four critical products: semiconductor manufacturing and advanced packaging, large capacity batteries, critical minerals and materials, and pharmaceuticals and active pharmaceutical ingredients.

[ 8 ]   Department of Health and Human Services, National Strategy for a Resilient Public Health Supply Chain (Washington, D.C.: July 2021). This strategy aims to build a more resilient supply chain that would support the U.S.’s preparedness and response for future pandemics and biological threats. We plan to report on the strategy and its implementation in a future CARES Act report. A Sustainable Public Health Supply Chain, Exec. Order No. 14001, § 4, 86 Fed. Reg. 7,219, 7,220-21 (Jan. 26, 2021).

[ 9 ]   The Strategic National Stockpile contains a multibillion dollar inventory of medical countermeasures—drugs, vaccines, and other medical supplies and materials—to respond to a broad range of public health emergencies.

[ 10 ]   For the purposes of our review, we consider COVID-19 relief laws to include the six laws providing comprehensive relief across federal agencies and programs. These six laws are the American Rescue Plan Act of 2021 (ARPA), Pub. L. No. 117-2, 135 Stat. 4; Consolidated Appropriations Act, 2021, Pub. L. No. 116-260, 134 Stat. 1182 (2020); Paycheck Protection Program and Health Care Enhancement Act, Pub. L. No. 116-139, 134 Stat. 620 (2020); CARES Act, Pub. L. No. 116-136, 134 Stat. 281 (2020); Families First Coronavirus Response Act, Pub. L. No. 116-127, 134 Stat. 178 (2020); and the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020, Pub. L. No. 116-123, 134 Stat. 146. In our October 2021 report, we reported that, as of August 31, 2021, $4.8 trillion in COVID-19 relief funds were provided by the six relief laws based on appropriation warrant information provided by Treasury. The total amount we are reporting as of November 30, 2021 decreased from the amount we reported as of August 31, 2021 mostly due to the return of unused indefinite appropriations to the Treasury at the end of fiscal year 2021 by the Internal Revenue Service and the Department of Labor. To account for this and other actions affecting funding amounts for each activity, we used total budgetary resources reported to Treasury’s Governmentwide Treasury Account Symbol Adjusted Trial Balance System for this report. Total budgetary resources, as opposed to the previously reported appropriation warrant information provided by Treasury, reflect appropriations, as well as transfers, adjustments, recoveries, rescissions, and returns of unused indefinite appropriations at the end of fiscal year 2021.

[ 11 ]   According to CDC’s January 1, 2022, weekly influenza surveillance report, although the flu season is just beginning, data—including indicators that track hospitalizations—reflect increasing flu activity in the United States. In addition, these early data show lower flu vaccine uptake compared with last season. For additional information from CDC’s weekly influenza surveillance report, see https://www.cdc.gov/flu/weekly/index.htm .

[ 12 ]   Pub. L. No. 116-136, § 19010, 134 Stat. at 579–81.

[ 13 ]   Our recurring oversight reports are GAO, COVID-19: Additional Actions Needed to Improve Accountability and Program Effectiveness of Federal Response, GAO-22-105051 (Washington, D.C.: Oct. 27, 2021); COVID-19: Continued Attention Needed to Enhance Federal Preparedness, Response, Service Delivery, and Program Integrity , GAO-21-551 (Washington, D.C.: July 19, 2021); COVID-19: Sustained Federal Action Is Crucial as Pandemic Enters Its Second Year, GAO-21-387 (Washington, D.C.: Mar. 31, 2021); COVID-19: Critical Vaccine Distribution, Supply Chain, Program Integrity, and Other Challenges Require Focused Federal Attention , GAO-21-265 (Washington, D.C.: Jan. 28, 2021); COVID-19: Urgent Actions Needed to Better Ensure an Effective Federal Response , GAO-21-191 (Washington, D.C.: Nov. 30, 2020); COVID-19: Federal Efforts Could Be Strengthened by Timely and Concerted Actions , GAO-20-701 (Washington, D.C.: Sept. 21, 2020); COVID-19: Brief Update on Initial Federal Response to the Pandemic , GAO-20-708 (Washington, D.C.: Aug. 31, 2020); and COVID-19: Opportunities to Improve Federal Response and Recovery Efforts , GAO-20-625 (Washington, D.C.: June 25, 2020).

[ 14 ]   We consider a recommendation to be addressed when the target agency has completed the implementation of the recommendation. We consider a recommendation to be partially addressed when the agency is in the process of developing an action, has started but not yet completed or has partially implemented an action, or has taken steps toward implementation.

[ 15 ]   In March 2021, we recommended that, as FDA developed a transition plan for devices with emergency use authorizations, the agency specify a reasonable timeline and process for transitioning authorized devices to clearance, approval, or appropriate disposition that takes into account input from stakeholders. FDA’s actions fulfill the intent of our recommendation.

[ 16 ]   Data on COVID-19 cases in the U.S. are based on aggregate case reporting to CDC and include probable and confirmed cases as reported by states and jurisdictions. CDC COVID-19 counts are subject to change due to delays or updates in reported data from states and jurisdictions. According to CDC, the actual number of COVID-19 cases is unknown for a variety of reasons, including that people who have been infected may have not been tested or may have not sought medical care. See CDC, “COVID Data Tracker: Trends in Number of COVID-19 Cases and Deaths in the US reported to CDC, by State/Territory,” accessed January 10, 2022, https://covid.cdc.gov/covid-data-tracker/#trends_dailycases .

[ 17 ]   CDC’s National Center for Health Statistics COVID-19 death counts in the U.S. are based on provisional counts from death certificate data, which do not distinguish between laboratory-confirmed and probable COVID-19 deaths. Data are provisional and subject to updates. In more recent weeks, the data are more likely to be incomplete due to an average delay of 2 weeks (a range of 1–8 weeks or longer) for death certificate processing. See CDC, National Center for Health Statistics, “Provisional Death Counts for Coronavirus Disease 2019 (COVID-19),” accessed January 10, 2022, https://www.cdc.gov/nchs/nvss/vsrr/covid19/index.htm .

[ 18 ]   CDC COVID-19 case counts are subject to change based on any delays or updates in reported data from states and territories. We compared the relative difference between the average of new cases per day between December 21, 2020, and January 3, 2021, and the average of new cases per day between December 21, 2021, and January 3, 2022.

[ 19 ]   The 52 states and jurisdictions include all 50 states; Washington, D.C.; and New York, N.Y. COVID-19 case counts for New York, N.Y., are reported separately from the state of New York. We defined states as holding steady if they had less than a 1 percent increase or decrease in average daily new cases over the time frame. The average percentage change in daily new cases was calculated as the average of the daily rates of change of the 7-day moving average between December 18 and December 31, 2021. CDC, “United States COVID-19 Cases and Deaths by State Over Time,” accessed on January 10, 2022, https://data.cdc.gov/Case-Surveillance/United-States-COVID-19-Cases-and-Deaths-by-State-o/9mfq-cb36 . These COVID-19 case counts may change as new or updated data are reported by states.

[ 20 ]   HHS, “COVID-19 Reported Patient Impact and Hospital Capacity by State Timeseries,” accessed January 6, 2022, https://healthdata.gov/Hospital/COVID-19-Reported-Patient-Impact-and-Hospital-Capa/g62h-syeh .

[ 21 ]   CDC, “Percentage of Emergency Department visits with Diagnosed COVID-19 in United States, All Ages,” accessed January 10, 2022, https://covid.cdc.gov/covid-data-tracker/#ed-visits . Data are from the National Syndromic Surveillance Program (NSSP). For insights into COVID-19 trends, CDC monitors a subset of emergency department in 50 states to identify visits that have a COVID-19 diagnosis associated with them.

[ 22 ]   For example, in response to the rapid increases in hospitalizations due to COVID-19, on January 4, 2022, the Governor of Maryland declared a 30-day state of emergency to take actions to help health care providers in the state manage the surge in cases and hospitalizations by expanding the potential health care workforce, allowing new hospital-adjacent facilities to act as alternate sites of care, and mobilizing National Guard troops to help with testing and other pandemic response actions.

[ 23 ]   This number represents the number of deaths from all causes reported in the U.S. in a given week from February 2020 through December 18, 2021, that exceeded the upper-bound threshold of expected deaths calculated by CDC’s National Center for Health Statistics on the basis of variation in mortality in prior years. Since our October report, the National Center for Health Statistics has updated the methodology used to estimate the number of excess deaths, using 6 years instead of 4 years of prior data on which to base these estimates. As in prior reports, GAO continues to report excess deaths based on the more conservative upper bound estimate of expected deaths. For further details of CDC’s methodology, see CDC, National Center for Health Statistics, “Excess Deaths Associated with COVID-19,” accessed January 10, 2022, https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm .

[ 24 ]   On December 29, 2021, FDA authorized the 13th over-the-counter COVID-19 test.

[ 25 ]   In addition to plans to increase access to free testing, the White House also outlined its plans to support vaccinations and increase hospital capacity, such as by sending military medical professionals to hospitals throughout the U.S.

[ 26 ]   In our October 2021 recurring report, we reported that if rapid antigen testing continues to expand, especially with the increasing availability of over-the-counter tests, the ongoing limited reporting of antigen test results could reduce the ability of public health officials to more comprehensively monitor and effectively respond to the COVID-19 pandemic. These issues highlight the importance of HHS and CDC efforts aimed at improving reporting and surveillance.

[ 27 ]   Pfizer’s two-dose COVID-19 vaccine was first authorized for emergency use for individuals aged 16 and older on December 11, 2020. FDA has amended the emergency use authorization multiple times, including to authorize use for individuals aged 12 through 15 on May 10, 2021, and to authorize a lower dose for individuals aged 5 through 11 on October 29, 2021. Pfizer’s COVID-19 vaccine was developed in collaboration with BioNTech.

[ 28 ]   Moderna’s two-dose COVID-19 vaccine was authorized for emergency use on December 18, 2020, and Janssen’s one-dose COVID-19 vaccine was authorized on February 27, 2021. Both vaccines were authorized for individuals aged 18 and older. Janssen Pharmaceutical Companies are a part of Johnson & Johnson.

[ 29 ]   As of January 7, 2022, the Pfizer and Moderna booster doses were authorized to be administered at least 5 months after completion of the two-dose primary regimen, and the Janssen booster dose was authorized to be administered at least 2 months after administration of the one-dose regimen. FDA also authorized a “mix and match” booster approach for eligible individuals following completion of primary vaccination with a different available COVID-19 vaccine. For additional information on vaccine distribution, see GAO, COVID-19: HHS Agencies’ Planned Reviews of Vaccine Distribution and Communication Efforts Should Include Stakeholder Perspectives , GAO-22-104457 (Washington, D.C.: Nov. 4, 2021).

[ 30 ]   On December 22 and 23, 2021, FDA authorized two antiviral drugs for use in individuals aged 18 and older that meet certain health criteria: molnupiravir, developed by Merck and Ridgeback Biotherapeutics, and Paxlovid, developed by Pfizer, which can reduce the risk of hospitalization and death in high-risk adults with COVID-19.

[ 31 ]   Requiring Coronavirus Disease 2019 Vaccination for Federal Employees, Exec. Order No. 14043, 86 Fed. Reg. 50,989 (Sept. 14, 2021). Federal guidance implementing the order required federal executive branch employees to be fully vaccinated against COVID-19 by November 22, 2021, with some exceptions. The executive order applicable to federal contractors calls for covered contracts to include a clause that requires compliance with all guidance for contractor or subcontractor workplace locations published by the Safer Federal Workforce Task Force for which the Director of the Office of Management and Budget has determined that adherence “will promote economy and efficiency in Federal contracting.” Ensuring Adequate COVID Safety Protocols for Federal Contractors, Exec. Order No. 14,042, 86 Fed. Reg. 50,985 (Sept. 14, 2021). A federal district court issued a nationwide injunction to prohibit enforcement of “the vaccine mandate for federal contractors and subcontractors in all covered contracts.” Georgia v. Biden, No. 1:21-cv-163, 2021 WL 5779939, at *12 (S.D. Ga. Dec. 7, 2021).

[ 32 ]   COVID-19 Vaccination and Testing; Emergency Temporary Standard, 86 Fed. Reg. 61,402 (Nov. 5, 2021). The Secretary of Labor shall issue an “emergency temporary standard” without going through the normal rulemaking process if the Secretary determines that “employees are exposed to grave danger from exposure to substances or agents determined to be toxic or physically harmful or from new hazards,” and that such a standard “is necessary to protect employees from such danger.” 29 U.S.C. § 655(c)(1).

[ 33 ]   On January 13, 2022, agreeing that challenges to the emergency temporary standard were likely to prevail, the U.S. Supreme Court stayed the emergency temporary standard until final disposition is reached on the petitions for review of the emergency temporary standard that were consolidated in the 6 th Circuit Court of Appeals. Nat'l Fed'n of Indep. Bus. v. Dep't of Lab., Occupational Safety & Health Admin., No. 21A244, 2022 WL 120952, at *1, *5 (U.S. Jan. 13, 2022).

[ 34 ]   In March 2021, we identified HHS’s leadership and coordination of public health emergencies as an emerging issue meriting close attention. High-Risk Series: Dedicated Leadership Needed to Address Limited Progress in Most High-Risk Areas , GAO-21-119SP (Washington, D.C.: Mar. 2, 2021).

[ 35 ]   While HHS is the lead agency for the public health and medical response, the Federal Emergency Management Agency leads the overall federal response during emergencies and disasters. The Federal Emergency Management Agency began assisting with vaccine distribution efforts in February 2021, in line with the White House’s COVID-19 response strategy.

[ 36 ]   The employment-to-population ratio represents the number of employed people as a percentage of the civilian noninstitutional population 16 years and older. The ratio is subject to misclassification errors with respect to consistently identifying workers as employed and absent from work or unemployed on temporary layoff.

[ 37 ]   The Port of Long Beach expanded operations in mid-September 2021. Containers at these ports contain such consumer goods as toys, appliances, bicycles, and furniture . Biden Administration Efforts to Address Bottlenecks at Ports of Los Angeles and Long Beach, Moving Goods from Ship to Shelf, Fact Sheet (Oct. 13, 2021), https://www.whitehouse.gov/briefing-room/statements-releases/2021/10/13/fact-sheet-biden-administration-efforts-to-address-bottlenecks-at-ports-of-los-angeles-and-long-beach-moving-goods-from-ship-to-shelf/ .

[ 38 ]   Pub. L. No. 117-58, 135 Stat. 429 (2021).

[ 39 ]   In our October 2021 report, we reported that, as of August 31, 2021, $4.8 trillion in COVID-19 relief funds were provided by the six relief laws based on appropriation warrant information provided by Treasury. The total amount we are reporting as of November 30, 2021 decreased from the amount we reported as of August 31, 2021 mostly due to the return of unused indefinite appropriations to the Treasury at the end of fiscal year 2021 by the Internal Revenue Service and the Department of Labor. To account for this and other actions affecting funding amounts for each activity, we used total budgetary resources reported to Treasury’s Governmentwide Treasury Account Symbol Adjusted Trial Balance System for this report. Total budgetary resources, as opposed to the previously reported appropriation warrant information provided by Treasury, reflect appropriations, as well as transfers, adjustments, recoveries, rescissions, and returns of unused indefinite appropriations at the end of fiscal year 2021.

[ 40 ]   An obligation is a definite commitment that creates a legal liability of the U.S. government for the payment of goods and services ordered or received, or a legal duty on the part of the U.S. government that could mature into a legal liability by virtue of actions on the part of another party that are beyond the control of the U.S. government. An expenditure is the actual spending of money, or an outlay. Expenditures include some estimates, such as estimated subsidy costs for direct loans and loan guarantees. Increased spending in Medicaid and Medicare is not accounted for in the funding provided by the COVID-19 relief laws. Federal agencies use the Governmentwide Treasury Account Symbol Adjusted Trial Balance System to report proprietary financial reporting and budgetary execution information to Treasury.

[ 41 ]   This total is based on (1) an analysis of the appropriated amounts in ARPA, Divisions M and N of the Consolidated Appropriations Act, 2021, the Paycheck Protection Program and Health Care Enhancement Act, the CARES Act, the Families First Coronavirus Response Act, and the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 that are available to agencies for assistance to states, the District of Columbia., localities, U.S. territories, and tribes; and (2) the Congressional Budget Office’s estimated outlays for Medicaid resulting from authorized increases in payments to states and U.S. territories under those laws.

[ 42 ]   Since the early 1990s, our high-risk program has focused attention on government operations with greater vulnerabilities to fraud, waste, abuse, and mismanagement, or that are in need of transformation to address economy, efficiency, or effectiveness challenges. Every 2 years, we report on our High-Risk List. We issued our most recent high-risk report in March 2021, in which we listed HHS’s leadership and coordination of public health emergencies as an emerging issue but did not designate it as a high-risk area at that time because we had ongoing work that had not yet been completed.

[ 43 ]   This number includes recommendations from our June 2020, September 2020, November 2020, January 2021, March 2021, July 2021, and October 2021 CARES Act reports as well as other targeted COVID-19-related reports in areas such as Department of State’s repatriation of U.S. citizens during the pandemic and federal vaccine distribution and communication efforts. For a complete list of our COVID-related products, see https://www.gao.gov/coronavirus .

[ 44 ]   These appropriations to Treasury consisted of about $25 billion in December 2020, provided under the Consolidated Appropriations Act, 2021, and about $21.55 billion in additional funding in March 2021, provided under ARPA. Under the first appropriation, the other housing-related expenses, as defined by the Secretary of the Treasury, must have been incurred due, directly or indirectly, to the COVID-19 pandemic.

[ 45 ]   The additional ERA funding from ARPA did not include additional funds for Indian tribes or the Department of Hawaiian Home Lands. Treasury guidance provides that grantees, in disbursing assistance, may make payments directly to utility providers. Grantees are required to make reasonable efforts to obtain the cooperation of landlords and utility providers to accept certain ERA payments before they can be made directly to renter households. For other ERA funds, grantees can make payments directly to renter households.

[ 46 ]   The Single Audit Act is codified, as amended, at 31 U.S.C. §§ 7501-06, and implementing OMB guidance is reprinted in 2 C.F.R. part 200. Non-federal entities (states, the District of Columbia, U.S. territories, Indian tribes, local governments, or nonprofit organizations) that expend $750,000 or more in federal awards in their fiscal year are required to undergo a single audit, which is an audit of an entity’s financial statements and federal awards (or a program-specific audit, in limited circumstances), for the fiscal year. 31 U.S.C. § 7502; 2 C.F.R. § 200.501.

[ 47 ]   Pub. L. No. 116-136, §§ 2301–2307, 134 Stat. at 347–359 (2020). The other COVID-19 relief laws include theConsolidated Appropriations Act, 2021, and ARPA. Pub. L. No. 116-260, 134 Stat. 1182 (2020); Pub. L. No. 117-2, 135 Stat. 4 (2021).

[ 48 ]   A net operating loss occurs when a taxpayer's allowable deductions exceed its gross income for a tax year. The CARES Act generally requires, unless waived, carrybacks for 5 years for net operating losses arising in tax years beginning in 2018, 2019, and 2020, which may provide a cash refund for certain taxpayers. Tax years prior to 2018 generally had a higher tax rate, so the ability of businesses to carryback post-2018 net operating losses to earlier tax years tends to increase the relative value of the carryback amounts. In general, the AMT was an alternative tax regime which applied a lower tax rate to a broader tax base by limiting the use of tax preferences and disallowing credits and deductions. The corporate AMT was repealed in 2017, but most corporations could claim their remaining unused minimum tax credits as a refundable credit for tax years 2018 through 2021. Under the CARES Act, corporations with AMT credits may claim a refund for tax years beginning in 2018 and 2019.

[ 49 ]   IRS is generally required to issue certain refunds within a period of 90 days from the date on which a complete application for a tentative carryback adjustment is filed, or 90 days from the last day of the month in which the return is due, whichever is later. 26 U.S.C. § 6411(b), (d)(2); Pub. L. No. 116-136, § 2305(d)(1), 134 Stat. at 357.

[ 50 ]   26 U.S.C. § 6611(e), (f). Interest is owed when the refund is not issued within 45 days of the later of the: loss year return due date, delinquent loss year return received date, loss year return processable date, date the application is received by the IRS, or date the application is received by the IRS in processable form. IRS considers applications unprocessable for a number of reasons, including an incorrect taxpayer name or missing documentation.

[ 51 ]   We designate federal programs and operations as “high risk” due to their vulnerabilities to fraud, waste, abuse, and mismanagement, or because they need transformation. We consider qualitative factors, such as whether the risk involves public health or safety. For information on how we determine which federal government programs and functions should be designated high risk, see GAO, Determining Performance and Accountability Challenges and High Risks, GAO-01-159SP (Washington, D.C.: November 2000). For more information on programs and operations on our High-Risk List, see https://www.gao.gov/high-risk-list .

[ 52 ]   Of the 115 recommendations we have made to HHS since fiscal year 2007, 58 recommendations were made in our recurring CARES and standalone COVID-19 reports, and the remaining 57 were made in reports that were issued either prior to the pandemic or did not focus on the pandemic response.

[ 53 ]   In previous work, we identified a number of economic indicators to facilitate ongoing and consistent monitoring of areas of the economy supported by the federal pandemic response, including labor markets, household finances, and small business credit and financial conditions. To the extent that federal pandemic responses are effective, we would expect to see improvements in outcomes related to these indicators. However, while trends in these indicators may be suggestive of the effect of provisions of the COVID-19 relief laws over time, those trends will not on their own provide definitive evidence of effectiveness.

[ 54 ]   See The Effects of Pandemic-Related Legislation on Output , Congressional Budget Office, September 2020 and An Update to the Budget and Economic Outlook: 2021 to 2031 , Congressional Budget Office, July 2021.

[ 55 ]   See Cox et al., “Initial Impacts of the Pandemic on Consumer Behavior: Evidence from Linked Income, Spending, and Saving Data,” Brookings Papers on Economic Activity , Summer 2020 and Gilchrist et al, “The Fed Takes on Corporate Credit Risk: An Analysis of the Efficacy of the SMCCF,” National Bureau of Economic Research Working Paper No. 27809 , September 2020.

[ 56 ]   In fiscal year 2021, 32.8 percent of all FHA purchase and refinance borrowers were minorities, 52.6 percent of FHA forward mortgage borrowers were of low-to-moderate income, and 84.6 percent of home purchasers under the FHA forward mortgage insurance program were first-time homebuyers. See Department of Housing and Urban Development, FHA Annual Management Report Fiscal Year 2021 . The CARES Act provided temporary protections for millions of households against foreclosure and eviction, as well as temporary forbearance, suspending mortgage payments for up to 360 days. In addition, FHA allowed mortgage servicers to initiate new forbearance through September 30, 2021, and it allowed borrowers who requested an initial forbearance on or before June 30, 2020, to request up to 6 months of forbearance extensions. Moreover, on July 23, 2021, FHA introduced additional COVID-19 recovery options to help borrowers transitioning out of forbearance to permanent sustainable payments. For example, FHA will require mortgage servicers to offer a no-cost option to eligible homeowners and enhance servicers’ ability to provide all eligible borrowers that cannot resume their monthly mortgage with a 25 percent monthly principal and interest reduction.

[ 57 ]   Inflation is the increase in the price of goods and services over time, and is typically measured as the percentage change in those prices over a set period, often 1 year. For example, an inflation rate of 2 percent would mean that the prices of goods and services, on average, increased 2 percent over the last year.

[ 58 ]   See the FOMC’s 2020 Statement on Longer-Run Goals and Monetary Policy Strategy .

[ 59 ]   Higher levels of inflation over short periods—described as transitory—are not unusual and are less cause for concern. The prices of goods and services regularly shift in response to economic changes, and any impact on household finances is more limited because prices increase more rapidly for only a short period of time. In contrast, high levels of inflation that persist for long periods are more cause for concern, and can reduce the pace of economic growth.

[ 60 ]   Department of Health and Human Services, Centers for Medicare & Medicaid Services, 2018 Actuarial Report on the Financial Outlook on Medicaid (Baltimore, Md.).

[ 61 ]   For the purposes of this enclosure, the term “state” refers to the 50 states, the District of Columbia, and the U.S. territories, unless otherwise noted.

[ 62 ]   For the District of Columbia and U.S. territories, the FMAP is set by statute regardless of their per capita incomes. Additionally, federal law specifies a maximum amount, or allotment for federal contributions to Medicaid spending in U.S. territories, in contrast to the states and the District of Columbia, for which federal Medicaid spending is open-ended.There are exceptions to the regular FMAP for certain populations and services. For example, states receive a 90 percent FMAP for services provided to the newly eligible adult population, and for family planning services and supplies. Additionally, in general, the federal government matches states’ spending on Medicaid administrative costs at a 50 percent FMAP.

[ 63 ]   For example, the American Recovery and Reinvestment Act of 2009 was enacted in response to the 2007 national recession and included a provision that increased eligible states’ FMAP for nine quarters, which was later extended for two additional quarters, but at a lower level. American Recovery and Reinvestment Act of 2009, Pub. L. No. 111-5, div. B, tit. V, § 5001, 123 Stat. 115, 496 (as amended by Pub. L. No. 111-226, tit. II, subtit. A, § 201, 124 Stat. 2389, 2393 (2010)).

[ 64 ]   See Families First Coronavirus Response Act, Pub. L. No. 116-127, div. F, §§ 6004(a)(3), 6008, 134 Stat. 178, 205, 208 (2020); American Rescue Plan Act of 2021, Pub. L. No. 117-2, tit. IX, subtit. J, §§ 9811, 9817, 135 Stat 4, 208, 216.

[ 65 ]   States must maintain enrollment for all beneficiaries enrolled as of or after March 18, 2020, except for any beneficiary who requests to terminate their eligibility or no longer resides in that state. In general, states must also maintain Medicaid eligibility standards that are no more restrictive than what was in place as of January 1, 2020; not charge premiums that exceed those that were in place as of January 1, 2020; cover COVID-19 testing, services, and treatments without cost sharing; and ensure local governments are not required to contribute a larger percentage of the state’s share than what was in place on March 11, 2020. FFCRA, § 6008(b), 134 Stat. at 208; 42 C.F.R. § 433.400 (2020).

[ 66 ]   American Rescue Plan Act of 2021, Pub. L. No. 117-2, § 9817, 135 Stat 4, 216.

[ 67 ]   See Centers for Medicare & Medicaid Services, State Medicaid Director Letter #21-003 , Implementation of American Rescue Plan Act of 2021 Section 9817: Additional Support for Medicaid Home and Community-Based Services during the COVID-19 Emergency (Baltimore, Md.: May 13, 2021.) All states and the District of Columbia submitted such a plan by July 2021. As of December 15, 2021, CMS officials said they had given conditional approval to nine states, meaning the state is fully approved to claim the HCBS FMAP increase conditional upon its continued compliance with program requirements, and partial approval to 42 states, meaning the state is approved to claim the HCBS FMAP increase but CMS requested additional information about one or more of the states’ planned activities. No territories had submitted a spending plan as of that date.

[ 68 ]   The most recent available information is for the quarter which ended September 30, 2021. States generally report their expenditures to CMS within 30 days of the end of each quarter, but may adjust their past reporting for up to 2 years after a quarter ends. Virginia had not reported COVID-19 expenditures for the fourth quarter of fiscal year 2021 as of November 30, 2021.

[ 69 ]   We interviewed Medicaid officials from Georgia, Iowa, Louisiana, New Hampshire, New Jersey, New Mexico, Ohio, and Washington.

[ 70 ]   CMS, May 2021 Medicaid and CHIP Enrollment Trends Snapshot. These data represent Medicaid enrollment from February 2020 to May 2021.In order to receive the 6.2 percentage point FMAP increase, states must meet certain requirements, including maintaining enrollment of all beneficiaries who were enrolled as of or after March 18, 2020, except for any beneficiary who requests to terminate their eligibility or no longer resides in that state. See FFCRA, § 6008(b), 134 Stat. at 208; 42 C.F.R. § 433.400 (2020).

[ 71 ]   See Centers for Medicare & Medicaid Services, State Health Official Letter #21-002 . Updated Guidance Related to Planning for the Resumption of Normal State Medicaid, Children’s Health Insurance Program (CHIP), and Basic Health Program (BHP) Operations Upon Conclusion of the COVID-19 Public Health Emergency (Baltimore, Md.: Aug. 13, 2021.)

[ 72 ]   On January 14, 2022, the Secretary of HHS renewed the PHE through April 16, 2022.

[ 73 ]   CMS officials said the agency does not have authority to extend the FMAP increase because the increase and its termination are specified in statute. The House of Representatives recently passed legislation proposing to phase out FFCRA’s FMAP increase and amend the requirement that states maintain Medicaid enrollment for most beneficiaries through the end of the PHE. See H.R. 5376, 117th Cong. § 30741 (2021) (as passed by House, Nov. 19, 2021).

[ 74 ]   Improper payments are those that did not meet statutory, regulatory, or administrative requirements. CMS computes an annual rolling average of improper payment rates across all states based on a 3-year rotation cycle of 17 states each year. We designated Medicaid a high risk program in 2003, due in part to its susceptibility to improper payments. GAO’s High-Risk Series identifies government operations with vulnerabilities to fraud, waste, abuse, and mismanagement, or in need of transformation to address economy, efficiency, or effectiveness challenges.

[ 75 ]   In November 2021, CMS released policy and operational strategies states can adopt to support their efforts to resume normal eligibility and enrollment operations.

[ 76 ]   States began reporting expenditure data for ARPA in October 2021; thus, complete data were not available at the time of our analysis.

[ 77 ]   Under managed care, states contract with managed care plans to provide a specific set of covered services in return for a fixed periodic payment per beneficiary. According to CMS guidance, states should report the portion of their managed care payment that is attributable to HCBS to receive the increased FMAP on that portion.

[ 78 ]   States have until March 31, 2024, to reinvest the additional funding into HCBS but can only receive the additional match once, on approved expenditures made by March 31, 2022. See Centers for Medicare & Medicaid Services, State Medicaid Director Letter #21-003. Implementation of American Rescue Plan Act of 2021 Section 9817: Additional Support for Medicaid Home and Community-Based Services during the COVID-19 Emergency (Baltimore, MD.: May 13, 2021)

[ 79 ]   The House of Representatives recently passed legislation that would provide a permanent 6 percentage point FMAP increase for a state that implements an HCBS improvement program and a 6 quarter increase to the FMAP of 2 percentage points if a state adopts an HCBS model that promotes self-direction of care and meets certain other requirements. It would also provide an 80 percent FMAP for administrative costs associated with improving HCBS. See H.R. 5376, 117th Cong. § 30712 (2021) (as passed by House, Nov. 19, 2021).

[ 80 ]   The eight states in which we interviewed state Medicaid officials are Georgia, Iowa, Louisiana, New Hampshire, New Jersey, New Mexico, Ohio, and Washington.

[ 81 ]   In nominal terms, SNAP benefits previously peaked at $76.1 billion in fiscal year 2013. FNS released data on participation and expenditures for fiscal year 2021 in December 2021. The data are preliminary and subject to significant revision, as states finalize their data submissions to FNS.

[ 82 ]   Pub. L. No. 116-127, § 2302(a), 134 Stat. 178, 188 (2020). As of November 2021, 42 states continued to issue emergency allotments, according to FNS officials. Provisions in the Consolidated Appropriations Act, 2021 and the American Rescue Plan Act of 2021 (ARPA) led to an additional 15 percent increase in SNAP benefits from January through September 2021. Pub. L. No. 117-2, § 1101(a), 134 Stat. 4, 15; Pub. L. No. 116-260, div. N, tit. VII, § 702(a), 134 Stat. 1182, 2092. In August 2021, FNS released its reevaluation of the Thrifty Food Plan—the basis for determining SNAP benefit amounts—which was required by the Agriculture Improvement Act of 2018. See Pub. L. No. 115-334, § 4002, 132 Stat. 4490, 4624. Effective October 1, 2021, FNS’s reevaluation led to about a 21 percent increase in SNAP benefits for a family of four. Thus, the benefit increase resulting from FNS’s reevaluation of the Thrifty Food Plan, generally, more than offset the expiration of the 15 percent increase in SNAP benefits on September 30, 2021.

[ 83 ]   In October 2021, we recommended that USDA document its plan to analyze lessons learned during the pandemic for its child nutrition programs, such as the National School Lunch Program and the Summer Food Service Program. USDA generally agreed with this recommendation.

[ 84 ]   Department of Agriculture, USDA Strategic Plan: FY 2018-2022 (Washington, D.C.: May 2018).

[ 85 ]   Department of Homeland Security, National Response Framework, Fourth Edition (Washington, D.C.: Oct. 2019) and Third Edition (Washington, D.C.: June 2016).

[ 86 ]   States, school districts, and schools identify children who are eligible to receive free or reduced-price meals through the NSLP, and determine Pandemic EBT benefit levels based on the number of days that eligible students did not receive meals at school due to the COVID-19 public health emergency. State SNAP agencies identify SNAP-enrolled children who are eligible for Pandemic EBT’s childcare benefit.

[ 87 ]   For additional information on challenges states experienced implementing Pandemic EBT, see Urban Institute and American Public Human Services Association, Documenting Pandemic EBT for the 2020-21 School Year: State Perspectives on Implementation Challenges and Lessons for the Future (Washington, D.C.: Oct. 2021).

[ 88 ]   FNS officials noted that these data challenges are somewhat mitigated during the summer, when state agencies do not need to track school operating status.

[ 89 ]   In response to a Consolidated Appropriations Act, 2021 requirement, FNS established a WIC Task Force in March 2021 to study how to streamline and promote convenient, safe, and equitable access to WIC benefits. For the report, see USDA Task Force on Supplemental Foods Delivery, Task Force on Supplemental Foods Delivery in the WIC Program: Recommendations Report , (Washington, D.C.: Sept. 2021).

[ 90 ]   The Consolidated Appropriations Act, 2021 required (1) the WIC Task Force to submit a report to USDA on the study results and related recommendations by September 30, 2021, and (2) USDA to submit a report to Congress within 45 days of receiving the Task Force report.

[ 91 ]   In addition to convening the WIC Task Force, in fall 2020, FNS awarded a $2.5 million, 3-year competitive grant to the Gretchen Swanson Center for Nutrition to develop and test a safe and secure model for online ordering in WIC. In December 2021, the center issued subgrants to states and was in the process of developing guidance and best practices for WIC online ordering.

[ 92 ]   ARPA provided $490 million to USDA to offer a temporary increase of up to $35 per month to the WIC cash-value voucher for fruits and vegetables during the pandemic. Pub. L. No. 117-2, § 1105(e), 135 Stat. 4, 17. The WIC cash-value voucher allows participants to purchase fruits and vegetables at grocery stores and farmers markets.

[ 93 ]   The Extending Government Funding and Delivering Emergency Assistance Act increased the WIC cash-value voucher for fruits and vegetable to an amount recommended by the National Academies of Science, Engineering and Medicine and adjusted for inflation. Pub. L. No. 117-43, § 118, 135 Stat. 344, 348 (2021). According to USDA officials, for the first quarter of fiscal year 2022, the value was $24 for children, $43 for pregnant and postpartum women, and $47 for fully and partially breastfeeding women.

[ 94 ]   ARPA provided $390 million to USDA to remain available through fiscal year 2024, for WIC outreach, innovation, and program modernization efforts, including offering waivers and flexibilities to states, to increase participation and benefit redemption. Pub. L. No. 117-2, § 1106, 135 Stat. 4, 17.

[ 95 ]   WIC state agencies include 50 states, the District of Columbia, five territories, and 33 Indian Tribal Organizations.

[ 96 ]   As we reported previously, canceled TEFAP orders result from a variety of supply chain issues reported by vendors that affect product availability, including shortages of raw materials and transportation challenges.

[ 97 ]   In August 2021, USDA offered states up to $100 million of the $500 million in food funds to support state administrative expenses; the remaining funds were used to purchase additional food for TEFAP through the end of fiscal year 2021. USDA is currently approving implementation plans and proposal documents to allocate the $100 million in infrastructure funds and $400 million for cooperative agreements.

[ 98 ]   To be eligible for regular UI benefits, applicants generally must be able and available to work and actively seeking work. 42 U.S.C. § 503(a)(12). Administration of the regular UI program is financed by a federal tax on employers, according to DOL.

[ 99 ]   Pub. L. No. 116-136, § 2102, 134 Stat. 281, 313 (2020), as amended.

[ 100 ]   Pub. L. No. 116-136, § 2104, 134 Stat. at 318, as amended.

[ 101 ]   Pub. L. No. 116-136, § 2107, 134 Stat. at 323, as amended.

[ 102 ]   The MEUC program, which was voluntary for states, authorized an additional $100 weekly benefit for certain UI claimants who received at least $5,000 of self-employment income in the most recent tax year prior to their application for UI benefits. Pub. L. No. 117-2, § 9013(a), 135 Stat. 4, 119; Pub. L. No. 116-260, div. N, tit. II, § 261(a)(1), 134 Stat. 1182, 1961.

[ 103 ]   According to DOL, 51 states and territories elected to participate in the MEUC program, with Idaho and South Dakota opting not to participate, but 23 states terminated their participation in June or July 2021. The remaining 28 states and territories continued participating in the MEUC program until it expired in September 2021, including Maryland, which intended to terminate participation but did not because of litigation at the state level, according to DOL. As of November 2021, not all participating states and territories had begun paying MEUC benefits, according to DOL.

[ 104 ]   After the PEUC program ended, Extended Benefits were available to claimants who exhausted their regular UI benefits in certain states.DOL reported that as of January 9, 2022, the Extended Benefits program was activated in two states and territories because of high levels of unemployment. The Extended Benefits program was activated in all states except South Dakota at some point during the pandemic, according to DOL.

[ 105 ]   While the CARES Act UI programs were federally funded, regular UI is funded primarily through state and federal taxes on employers. When a state exhausts the funds available for regular UI benefits, it may borrow from the federal government. According to DOL data, even before the pandemic, many states were not collecting enough UI tax revenue to satisfy the solvency standard specified in DOL regulations providing for interest-free loans to states. See 20 C.F.R. § 606.32.

[ 106 ]   Under federal law, the accrual of interest was suspended through early September 2021. As we previously reported, the number of states holding federal loans to pay UI benefits, and the total amount of these loans, decreased slightly in late summer 2021. According to DOL officials, this decrease likely occurred because some states repaid these loans in full before they began accruing interest, and others repaid part of their loan balances to reduce the amount that would be subject to ongoing interest.

[ 107 ]   The CARES Act established the $150 billion Coronavirus Relief Fund to provide payments to state, local, territorial, and tribal governments to cover the costs of necessary expenditures incurred because of the COVID-19 pandemic. Pub. L. No. 116-136, § 5001, 134 Stat. 281, 501-504. In its guidance on the Coronavirus Relief Fund, Treasury reported that states may use this funding to make payments to their state UI trust funds to prevent expenses related to the COVID-19 public health emergency from causing these UI trust funds to become insolvent. The Consolidated Appropriations Act, 2021 extended the period for states and other entities to use these funds through December 31, 2021. Pub. L. No. 116-260, div. N, tit. X, § 1001, 134 Stat. 1182, 2145.

[ 108 ]   Coronavirus State and Local Fiscal Recovery Funds, 86 Fed. Reg. 26,786, 26,822 (May 17, 2021). Funds may be used to restore a state’s unemployment trust fund to its balance on January 27, 2020, or to pay back advances received for the payment of benefits between January 27, 2020, and May 17, 2021. 31 C.F.R. § 35.6(b)(5).

[ 109 ]   Interim reports were not publicly available for all states.

[ 110 ]   Claims counts are for the weeks ending on August 28, 2021, and September 25, 2021, and are not seasonally adjusted. An initial claim is the first claim filed by an individual to determine eligibility for UI benefits after separating from an employer. According to DOL, after filing an initial claim to establish eligibility for UI benefits, individuals then generally file a continued claim on a weekly basis to claim benefits for the preceding week of unemployment. States continued to receive some PUA and PEUC claims after the programs expired. For 30 days after the PUA program ended, DOL required states to continue accepting new PUA applications for weeks of unemployment before the program ended. States were also required to accept new PEUC and MEUC applications for weeks of unemployment before those programs ended, if state law allowed claims to be backdated.

[ 111 ]   During the week ending on December 18, 2021, states also reported that 87,850 continued claims were submitted in other programs, including those for Extended Benefits, federal employees and former service members, state additional benefit programs, and Short-Time Compensation or work-sharing. In addition, states reported continued claims submitted that week for the PUA and PEUC programs, which had expired on September 6, 2021. According to DOL, these continued claims were for weeks of unemployment before the programs expired.

[ 112 ]   DOL monitors timeliness of benefit payments in the regular UI program. One of DOL’s core performance measures is the percentage of all regular UI first payments made within either 14 or 21 days of the first week of benefits for which claimants are eligible; DOL considers 87 percent to be an acceptable level of performance. DOL uses 14 days as the timeliness goal for states with a waiting week requirement and uses 21 days for states without a waiting week requirement. According to DOL, some states require individuals who are otherwise eligible for benefits to serve a waiting period—generally 1 week—before receiving benefits. In its guidance released at the start of the pandemic, DOL recommended that states consider temporarily waiving their waiting week requirements. Thus, we focus on payments made within 21 days. We analyzed first-payment timeliness data that states had reported to DOL as of January 3, 2022. At that point, all 53 states and territories had reported data for November 2021 and prior months.

[ 113 ]   The extension of the CARES Act UI programs at the end of 2020, according to DOL officials, may have affected payment timeliness because states had to reassign staff and focus resources on implementing new program requirements. According to officials, states also cited the need for additional time to process backlogs of claims requiring adjudication and appeals, decreased numbers of staff, and an increase in adjudication issues following the implementation of enhanced fraud prevention efforts.

[ 114 ]   While states do not report the actual amount of underpayments to DOL, they estimate underpayments based on representative samples of paid and denied regular UI claims and report these estimates to DOL. In calendar year 2020, states estimated about $696 million in regular UI underpayments, although this estimate does not include the second quarter (April 1, 2020, through June 30, 2020). According to DOL officials, DOL provided operational flexibilities to states in response to the pandemic by temporarily suspending this sampling process during the second quarter of 2020 to allow states to implement the CARES Act UI programs.

[ 115 ]   While some overpayments may be caused by unintentional error, fraud involves obtaining something of value through willful misrepresentation. Whether an act is fraudulent is determined through the judicial or other adjudicative systems. According to DOL, in the case of these payments made by states, whether an act is fraudulent is defined by states and must be determined through the appropriate adjudication process.

[ 116 ]   States and territories report PUA overpayments data to DOL on a monthly basis, and the total amount shown includes overpayments related to identity theft. We accessed the PUA overpayments data on January 3, 2022; these data are subject to change as more states report data and as states revise previously reported data. For consistency with the regular UI overpayment data, which states and territories report on a quarterly basis, the PUA overpayment amount shown is for April 2020 through September 2021. As of January 3, 2022, 40 states and territories had reported approximately $1.8 billion of additional PUA overpayments. The number of states and territories that have reported PUA overpayments data varies by month; for example, 45 reported overpayment amounts in August 2021, and 44 reported overpayment amounts in September 2021.

[ 117 ]   FPUC benefits were paid in addition to other UI benefits. About 92 percent of reported FPUC overpayment amounts were paid on regular UI or PUA claims.

[ 118 ]   States and territories report regular UI, Extended Benefits, PEUC, and FPUC overpayments data to DOL on a quarterly basis. We accessed the data on January 3, 2022. At that point, not all states and territories had reported overpayment amounts for all programs in all quarters. States and territories may revise the amount of overpayments they have identified for 3 years after the reporting quarter, according to DOL.

[ 119 ]   We accessed the recovered overpayments data on January 3, 2022; these data are subject to change as more states and territories report data and as states and territories revise previously reported data.

[ 120 ]   As of January 3, 2022, 33 states and territories had reported approximately $32 million of additional PUA overpayments recovered. As of January 3, 2022, states and territories had also reported recovering about $1.9 billion in the regular UI and Extended Benefits programs during the first 6 quarters of the pandemic combined (April 2020 through September 2021). However, the amounts recovered for any quarter may be from overpayments established in many previous periods. Thus, the total amount does not measure the extent to which overpayments made during the pandemic have been recovered.

[ 121 ]   According to DOL, states generally may waive a nonfraud overpayment, in accordance with state law and an established waiver policy, if the overpayment was not the fault of the claimant and if requiring repayment would be against equity and good conscience or would otherwise defeat the purpose of the UI law. States were authorized to waive PUA overpayments under the Consolidated Appropriations Act, 2021. According to this act, if an individual receives PUA benefits they were not entitled to, the state must generally require such individuals to repay the amount; however, the state can waive that requirement if the individual was without fault and repayment would be contrary to equity and good conscience. Pub. L. No. 116-260, div. N, tit. II, § 201(d), 134 Stat. 1182, 1952. According to DOL, states are able to retroactively waive PUA overpayments from the beginning of the program onward.

[ 122 ]   We accessed the waived overpayments data on January 3, 2022; these data are subject to change as more states and territories report data and as states and territories revise previously reported data.

[ 123 ]   Department of Labor, Pandemic Unemployment Assistance (PUA) Program: Updated Operating Instructions and Reporting Changes, UIPL 16-20, Change 6 (Washington, D.C.: Sept. 3, 2021).

[ 124 ]   As of January 3, 2022, 19 states and territories had reported approximately $71 million of additional PUA overpayments waived.

[ 125 ]   According to DOL guidance, an overpayment is established when a formal notice of determination has been issued. Whether an act is fraudulent is determined through the judicial or other adjudicative systems. According to DOL, because states may use different definitions for categorizing an overpayment as fraudulent, an overpayment that is classified as fraudulent in one state might not be classified as fraudulent in another state.

[ 126 ]   We accessed the fraud overpayments data on January 3, 2022; these data are subject to change as more states and territories report data and as states and territories revise previously reported data.

[ 127 ]   An improper payment is defined as any payment that should not have been made or that was made in an incorrect amount (including overpayments and underpayments) under statutory, contractual, administrative, or other legally applicable requirements. 31 U.S.C. § 3351(4). For the purpose of producing an improper payment estimate, when the executive agency cannot determine, due to lacking or insufficient documentation, whether a payment is proper or not, the payment shall be treated as an improper payment. 31 U.S.C. § 3352(c)(2).

[ 128 ]   According to OMB guidance, OMB does not formally approve improper payment estimation methodologies submitted by agencies prior to implementation. See Office of Management and Budget, Appendix C to OMB Circular A-123, Requirements for Payment Integrity Improvement , OMB Memorandum M-21-19 (Washington, D.C.: Mar. 5, 2021).

[ 129 ]   See Department of Labor, “Fact Sheet: Unemployment Insurance Modernization: American Rescue Plan Act Funding for Timely, Accurate and Equitable Payment in Unemployment Compensation Programs,” Aug. 11, 2021, https://oui.doleta.gov/unemploy/pdf/FactSheet_UImodernization.pdf .

[ 130 ]   See Department of Labor, Grant Opportunity to Support States Following a Consultative Assessment for Fraud Detection and Prevention, Promoting Equitable Access, and Ensuring the Timely Payment of Benefits, including Backlog Reduction, for all Unemployment Compensation (UC) Programs , UIPL 2-22 (Washington, D.C.: Nov. 2, 2021).

[ 131 ]   For more information about these fraud-related grants, see Department of Labor, Additional Funding to Assist with Strengthening Fraud Detection and Prevention Efforts and the Recovery of Overpayments in the Pandemic Unemployment Assistance (PUA) and Pandemic Emergency Unemployment Compensation (PEUC) Programs, as well as Guidance on Processes for Combatting Identity Fraud , UIPL 28-20, Change 2 (Washington, D.C.: Aug. 11, 2021). Also see Department of Labor, Grant Opportunity to Support States with Fraud Detection and Prevention, Including Identity Verification and Overpayment Recovery Activities, in All Unemployment Compensation (UC) Programs , UIPL 22-21 (Washington, D.C.: Aug. 11, 2021).

[ 132 ]   These PUA grants were available to 6 territories that administered the PUA program under the CARES Act but do not administer regular UI programs: Guam, American Samoa, the Commonwealth of the Northern Mariana Islands, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau.

[ 133 ]   For more information about these equity grants, including other allowable uses of these funds, see Department of Labor, Grant Opportunity for Promoting Equitable Access to Unemployment Compensation (UC) Programs , UIPL 23-21 (Washington, D.C.: Aug. 17, 2021). State grant applications were due on December 31, 2021.

[ 134 ]   See Department of Labor, Announcing Grant Awards Made to States Selected to Participate in the Unemployment Insurance (UI) Information Technology (IT) Modernization Project - Claimant Experience Pilot , TEN No. 16-21 (Washington, D.C.: Dec. 2, 2021).

[ 135 ]   See Department of Labor, Accessing Unemployment Insurance (UI) Identity Verification and Fraud Protection (Identity Proofing) Services using the U.S. Department of Labor’s (Department) Blanket Purchase Agreements (BPA) , TEN 6-21 (Washington, D.C.: Sept. 15, 2021).

[ 136 ]   For more information about this data exchange, see Department of Labor, Announcing the Availability of an Incarceration Data Exchange and Instructions to Access the Data Exchange between the Unemployment Insurance (UI) Interstate Connection Network (ICON) and the Social Security Administration (SSA) Prisoner Update Processing System (PUPS) , UIPL 01-22 (Washington, D.C.: Oct. 29, 2021).

[ 137 ]   Pub. L. No. 116-260, div. N, tit. V, § 501, 134 Stat. 1182, 2069-2079 (2020) (codified at 15 U.S.C. § 9058a), as amended by Pub. L. No. 117-2, tit. III, § 3201(h), 135 Stat. 4, 58. The American Rescue Plan Act of 2021 extended the period of availability from December 30, 2021, to September 30, 2022. The Consolidated Appropriations Act, 2021 reserved $15 million of the ERA1 appropriation for administrative expenses of the Secretary of the Treasury. 15 U.S.C. § 9058a(a)(2)(C), (h).

[ 138 ]   Pub. L. No. 117-2, tit. III, § 3201(a)(1), (f)-(g), 135 Stat. 4, 58, (codified at 15 U.S.C. §§ 9058c(a)(1), (f)-(g)). The statute directs ERA2 allocations to similar grantees as ERA1, except that ERA2 does not include allocations for Indian tribes or the Department of Hawaiian Home Lands.

[ 139 ]   See Consolidated Appropriations Act, 2021, § 501(c)(2)(A) (codified at 15 U.S.C. § 9058a(c)(2)(A)); American Rescue Plan Act of 2021, §3201(d)(1)(A)(i) (codified at 15 U.S.C. § 9058c(d)(1)(A)(i)). For ERA1, the other expenses related to housing, as defined by the Secretary of the Treasury, must have been incurred due, directly or indirectly, to the COVID-19 pandemic. According to Treasury guidance, other expenses related to housing include relocation expenses (including prospective relocation expenses), such as rental security deposits, and rental fees, which may include application or screening fees. It can also include reasonable accrued late fees (if not included in rental or utility arrears), and Internet service provided to the rental unit.

[ 140 ]   Consolidated Appropriations Act, 2021, § 501(b)(1) (codified at 15 U.S.C. § 9058a(b)(1)); American Rescue Plan Act of 2021, §3201(b) (codified at 15 U.S.C. § 9058c(b)).

[ 141 ]   Treasury guidance provides that grantees, in disbursing assistance, may make payments directly to utility providers. Grantees are required to make reasonable efforts to obtain the cooperation of landlords and utility providers to accept ERA1 payments before they can be made directly to renter households. For ERA2 funds, grantees can make payments directly to renter households.

[ 142 ]   “Pay-and-chase” refers to the practice of detecting overpayments and attempting to recover funds after payments have been made.

[ 143 ]   Office of Management and Budget, Appendix C to OMB Circular A-123, Requirements for Payment Integrity Improvement, OMB Memorandum M-21-19 (Washington, D.C.: March 5, 2021).

[ 144 ]   Both the Consolidated Appropriations Act, 2021 and the American Rescue Plan Act of 2021 include provisions addressing the Treasury OIG’s oversight of ERA1 and ERA 2, respectively. However, these provisions differ in that the Consolidated Appropriations Act, 2021 includes specific direction for OIG monitoring, oversight, and recoupment related to ERA1, while the American Rescue Plan Act of 2021 requires Treasury to reserve funds for the OIG’s ERA2 oversight without further direction. Treasury officials indicated that they functionally manage ERA1 and ERA2 together. Therefore, Treasury officials are planning to consult with the OIG about performing the oversight and recoupment functions for ERA2 as well.

[ 145 ]   The Single Audit Act is codified, as amended, at 31 U.S.C. §§ 7501-06, and implementing OMB guidance is reprinted in 2 C.F.R. part 200. Non-federal entities (states, the District of Columbia, U.S. territories, Indian tribes, local governments, or nonprofit organizations) that expend $750,000 or more in federal awards in their fiscal year are required to undergo a single audit, which is an audit of an entity’s financial statements and federal awards (or a program-specific audit, in limited circumstances), for the fiscal year. 31 U.S.C. § 7502; 2 C.F.R. § 200.501.

[ 146 ]   At the time of publication of the 2021 Compliance Supplement, several federal agencies were working to stand up and develop program sections for new COVID-19 programs, as well as revise existing program sections to address implications from the American Rescue Plan Act of 2021. Therefore, OMB will be posting addendums to the 2021 Compliance Supplement to include audit guidance for such programs.

[ 147 ]   OMB’s guidance implementing the Single Audit Act states that for those federal programs not included in the Compliance Supplement, the auditor must follow the Supplement’s guidance for auditing programs not included in the Supplement. See 2 C.F.R. § 200.514(d)(3). For the 2021 Compliance Supplement, Part 7 provides guidance both in identifying the compliance requirements and designing tests of compliance for programs such as ERA that are not included in the Supplement.

[ 148 ]   Some older federal student loans made under the Federal Family Education Loan and Federal Perkins Loan programs may not be owned by Education.

[ 149 ]   On March 27, 2020, the CARES Act was enacted, which suspended payments due, interest accrual, and involuntary collections for Direct Loans and Federal Family Education Loans held by Education. See Pub. L. No. 116-136, § 3513(a), (b), (e), 134 Stat. 281, 404-05 (2020). Involuntary collections may include wage garnishments and offsets of tax refunds or federal benefit payments. In addition, Education has taken several actions, including some prior to the enactment of the CARES Act, to provide similar relief to borrowers, including those with other federal loans held by Education, such as Perkins loans. The CARES Act required Education to grant relief to borrowers through September 30, 2020. The period of relief has been extended by Education five times, with the most recent announcement extending relief through May 1, 2022. In this enclosure, we do not differentiate between actions Education took independently of the CARES Act and actions Education took under the CARES Act. We refer to all such relief as COVID-19 emergency relief for federal student loans.

[ 150 ]   Most of the audit work for this enclosure was completed before the extension to May 1, 2022, was announced on December 22, 2021. The Education documents we reviewed reflected Education’s plan to resume repayment in February 2022. We did not assess how Education’s plans have changed since the most recent extension was announced.

[ 151 ]   Some borrowers opted to make payments on their student loans during the payment suspension. Education estimates that approximately 8.4 million borrowers made at least one payment during April 2020–September 2021. Borrowers who made payments during this time are included in the 26.6 million borrowers whose loans are entering repayment in May 2022.

[ 152 ]   Some borrowers may be double-counted if they have multiple loans in different payment statuses (e.g., one loan in repayment and one loan in default).

[ 153 ]   The CARES Act required Education, beginning on August 1, 2020, to carry out a program to provide not less than six notices by postal mail, telephone, or electronic communication to borrowers indicating 1) when the borrower’s normal payment obligations will resume; and 2) that the borrower has the option to enroll in an Income-Driven Repayment plan, including a brief description of such options. Pub. L. No. 116-136, § 3513(g)(2), 134 Stat. at 405.

[ 154 ]   Prior to the extension of payment relief announced in December 2021, Education’s earlier outreach efforts had been informing borrowers that payments would resume in February 2022. Income-Driven Repayment plans base monthly payments on a borrower’s income and family size. Loan consolidation allows borrowers to combine multiple federal education loans into one Direct Consolidation Loan, resulting in one single monthly payment instead of multiple payments. Loan consolidation can also give borrowers access to additional loan repayment plans and forgiveness programs.

[ 155 ]   Education’s communication plan acknowledged that borrower communication preferences vary by age group, but there was a consensus of email as the preferred method based on customer interviews and usability studies.

[ 156 ]   See https://studentaid.gov/mystudentaid-mobile-app for more information about Education’s mobile phone application for federal student loan borrowers.

[ 157 ]   Education instructed loan servicers to identify borrowers as at-risk who, as of the end of the payment suspension: 1) had not graduated and entered repayment in the last 60 months; 2) entered repayment for the first time within the last 36 months; 3) exited hardship, unemployment, or natural disaster deferment or forbearance—a temporary suspension of monthly loan payments—in the last 48 months; or 4) were ever 90 days delinquent or more in the year prior to the payment suspension.

[ 158 ]   Defaulted borrowers who enter into a loan rehabilitation agreement can restore their eligibility for federal student aid and remove the record of default from their credit history after making nine on-time monthly payments within 10 months. The borrower’s credit history will still show late payments that were reported before the loan went into default.

[ 159 ]   Borrowers with auto-debit have payments automatically deducted from their bank accounts. Loan servicers are not required to reconfirm the auto-debit enrollment for the 571,000 borrowers who signed up for auto-debit after March 13, 2020, or the 280,000 borrowers who have been continuing to make payments via auto-debit during the payment suspension, as of October 2021. These borrowers will not need to take any action to remain in auto-debit status.

[ 160 ]   The borrower will need to re-sign up for auto-debit if they choose to participate at a later time.

[ 161 ]   Of the remaining borrowers who previously had auto-debit accounts prior to the payment freeze, 106,000 have elected to opt out of auto-debit going forward and 1.7 million had not responded as of December 2021. Generally, borrowers have until 15 days before their first bill is due to opt back into automatic payment status, according to Education officials.

[ 162 ]   If a borrower’s income has decreased or their family size has changed, recertifying their Income-Driven Repayment plan with this information may result in a lower monthly payment.

[ 163 ]   During the payment suspension, borrowers in an Income-Driven Repayment plan did not have to recertify their income annually.

[ 164 ]   Education officials noted that while borrowers do have the option to self-certify their income, many borrowers applying for Income-Driven Repayment plans through Education’s website choose to validate their income with IRS data. For example, in early December 2021 the majority of borrowers who applied for an Income-Driven Repayment plan online used the IRS income verification process.

[ 165 ]   Navient transferred its federal student loan servicing contract to another loan servicer, Maximus, in October 2021. Maximus’s Aidvantage servicing unit will administer student loans owned by the federal government. While all student accounts for Granite State Management and Resources have been transferred, the servicer will answer calls from borrowers until January 28, 2022. Pennsylvania Higher Education Assistance Agency’s FedLoan Servicing unit administers student loans owned by the federal government, and plans to end its servicing activities by December 2022.

[ 166 ]   As of January 12, 2022, approximately 3.2 million of the approximately 8.5 million FedLoan Servicing borrowers had been transferred. Education anticipates that at least 1.8 million more borrowers will be transferred through March/April 2022.

[ 167 ]   In contrast, loan servicers reported that call volume generally decreased during the payment suspension. We did not include responses from an eighth servicer—Granite State Management and Resources—in this report because their servicing contract ends in March 2022, meaning they will not be assisting borrowers once payments resume in May 2022. Although FedLoan Servicing and Navient are also ending their servicing contracts with Education, we included responses from both because their staff will still be servicing student loans in some capacity after repayment resumes. Education does not plan to complete the transfer of borrowers from FedLoan Servicing until the summer of 2022, and Education confirmed that Navient transitioned about 800 of its staff to Maximus’s Aidvantage servicing unit in December 2021. We obtained responses from all servicers in October 2021, before Education announced that the payment suspension will be extended from January 31, 2022, to May 1, 2022.

[ 168 ]   Federal clearances generally take about two weeks to process, according to Education officials.

[ 169 ]   We also sent questions to an eighth servicer, Granite State Management and Resources. They did not provide responses to the majority of our questions as their servicing contract ends in March 2022, meaning they will not be assisting borrowers once payments resume in May 2022.

[ 170 ]   All references to the EIDL program in this report refer to the program administered in response to the COVID-19 pandemic.

[ 171 ]   EIDL loans are limited by statute to a maximum of $2 million. However, SBA set lower maximum amounts for periods in 2020 and 2021. From March 16, 2020 through May 3, 2020, SBA limited the maximum loan amount to $500,000, even if the calculated economic injury exceeded that amount. From May 4, 2020, through April 5, 2021, SBA limited the maximum loan amount to $150,000. Beginning on April 6, 2021, SBA increased the loan limit back to $500,000.

[ 172 ]   When implementing the advances under the CARES Act, SBA provided advances in the amount of $1,000 per employee up to a maximum of $10,000.

[ 173 ]   The Consolidated Appropriations Act, 2021, defines economic loss as the amount by which the gross receipts of the covered entity declined during an 8-week period between March 2, 2020, and December 31, 2021, relative to a comparable 8-week period immediately preceding March 2, 2020, or during 2019 or for seasonal businesses, as the SBA defined as appropriate.

[ 174 ]   These eligible entities qualify for the full amount of $10,000 in targeted advances—regardless of their number of employees—minus the amount they received under the CARES Act advances, which SBA based on employee numbers.

[ 175 ]   In March 2021, the American Rescue Plan Act of 2021 established the Restaurant Revitalization Fund and appropriated $28.6 billion for SBA to provide support to eligible entities that suffered revenue losses related to the pandemic. SBA provides grants of up to $10 million per entity.

[ 176 ]   No personal real estate is required as collateral.

[ 177 ]   The CARES Act restricted SBA from obtaining federal tax transcripts—typically a component of SBA’s review of a disaster loan application—as part of the EIDL application process. The Consolidated Appropriations Act, 2021 removed this restriction.

[ 178 ]   The auditor also reported that it identified a material weakness in internal control related to SBA’s Shuttered Venues Operators Grant program and Restaurant Revitalization Fund program. Specifically, the auditor stated that SBA did not adequately design and implement monitoring controls over program awards to ensure accurate financial reporting as of the fiscal year-end, and to ensure that funds were used in accordance with related legislation. For example, SBA disbursed numerous awards to restaurants that had a Paycheck Protection Program loan guarantee with an alert or flag prior to approval of the award. SBA officials told us in December 2021 that SBA plans to provide details to the auditor that it believes will remedy the finding for the Restaurant Revitalization Fund. They also noted that since the completion of the audit SBA had implemented a process to monitor the use of recipients’ funds. We will continue to monitor SBA’s efforts to address the deficiencies identified in its financial statement audit. The Consolidated Appropriations Act, 2021, enacted in December 2020, authorized and appropriated $15 billion to SBA for the shuttered venues program to assist businesses in the performing arts and entertainment industries experiencing economic hardship due to the COVID-19 pandemic. Pub. L, No. 116-260, div. N, tit. III, §§ 323(d)(1)(H), 324, 134 Stat. 1182, 2021, 2022-32 (2020). The American Rescue Plan Act of 2021, enacted in March 2021, appropriated an additional $1.25 billion for shuttered venues and modified certain eligibility requirements. Pub. L. No. 117-2, tit. V, § 5005, 135 Stat. 4, 91-92 (2021). The American Rescue Plan Act of 2021 also established the restaurant revitalization program and appropriated $28.6 billion to SBA for eligible entities that suffered revenue losses related to the COVID-19 pandemic. Pub. L. No. 117-2, tit. V, § 5003, 135 Stat. 4, 85-90 (2021).

[ 179 ]   A material weakness is a deficiency, or combination of deficiencies, in internal control over financial reporting, such that there is a reasonable possibility that a material misstatement of the entity’s financial statements will not be prevented, or detected and corrected, on a timely basis. A deficiency in internal control exists when the design or operation of a control does not allow management or employees, in the normal course of performing their assigned functions, to prevent, or detect and correct, misstatements on a timely basis.

[ 180 ]   The Federal Credit Reform Act of 1990 (FCRA) requires that agencies have budget authority to cover a program’s subsidy cost to the government in advance—before new loan guarantee commitments are made. The data used for budgetary subsidy cost estimates are generally updated—or reestimated—annually after the end of the fiscal year to reflect actual loan performance and to incorporate any changes in assumptions about future loan performance. Reestimates that increase subsidy costs are referred to as upward reestimates (an agency would need additional funds), while reestimates that decrease subsidy costs are referred to as downward reestimates (an agency would return funds to the Department of the Treasury).

[ 181 ]   Pub. L. No. 116-136, §§ 2301–2307, 134 Stat. 281, 347–359 (2020). Other COVID-19 relief laws include the Consolidated Appropriations Act, 2021, and the American Rescue Plan Act of 2021. Pub. L. No. 116-260, 134 Stat. 1182 (2020); Pub. L. No. 117-2, 135 Stat. 4 (2021). The measures can also help other types of entities, such as estates and trusts.

[ 182 ]   Pub. L. No. 115-97, 131 Stat. 2054 (2017).

[ 183 ]   This is lower than our July 2021 CARES Act report estimate because it only includes the estimate for Net Operating Loss and Alternative Minimum Tax.

[ 184 ]   26 U.S.C. § 172(a), (b)(2). TCJA generally repealed NOL carrybacks and required NOLs to be carried forward indefinitely. Pub. L. No. 115-97, § 13302(b), 131 Stat. at 2122. The amount allowed as an NOL and the amount allowed as a net operating loss deduction in another year may be subject to certain modifications. 26 U.S.C. § 172(d). For ease of reporting, we use the term “taxpayer” to refer to an entity that may use the CARES Act tax relief provisions described in this enclosure.

[ 185 ]   Pub. L. No. 116-136, § 2303, 134 Stat. at 352–356. Taxpayers who have amounts included in their income because of the one-time repatriation tax established in the TCJA (referred to as the “section 965 tax” or “transition tax”), can elect to exclude those inclusion years from the carryback period to produce an NOL refund in other years. 26 U.S.C. § 965.

[ 186 ]   Pub. L. No. 115-97, § 13302(a)(1), 131 Stat. at 2121. Specifically, for NOLs arising in tax years beginning after 2017, the TCJA’s 80-percent limitation limited the deduction of NOL carrybacks and carryforwards to an amount equal to the lesser of (1) the aggregate of the NOL carryforwards and carrybacks to that taxable year, or (2) 80 percent of taxable income of the taxpayer computed without regard to any NOL deduction.

[ 187 ]   Pub. L. No. 116-136, § 2303(a)(1), 134 Stat. at 353.

[ 188 ]   An S corporation is a corporation meeting certain requirements that elects to be taxed under subchapter S of the Internal Revenue Code. Corporations, other than S corporations, file Form 1139, Corporation Application for Tentative Refund . Individuals, including sole proprietors, estates, and trusts file Form 1045, Application for Tentative Refund. For ease of reporting, we use the term “application for tentative refund” to refer to Form 1139 and Form 1045. IRS uses “claim” to refer to the carrybacks filed on amended returns, according to agency officials.

[ 189 ]   See: IRS, Temporary procedures to fax certain Forms 1139 and 1045 due to COVID-19, accessed November 16, 2021, https://www.irs.gov/newsroom/temporary-procedures-to-fax-certain-forms-1139-and-1045-due-to-covid-19 . The IRS has marked this webpage as “historical content,” providing that the webpage “is an archival or historical document and may not reflect current law, policies or procedures.”

[ 190 ]   Pub. L. No. 115-97, § 12001(a), 131 Stat. at 2092.

[ 191 ]   Pub. L. No. 116-136, § 2305, 134 Stat. at 357. Under the CARES Act, corporations with AMT credits in excess of the credit allowed to offset regular tax liability (excess credit) may claim 50 percent of the excess credit as a refundable credit for the first tax year beginning in 2018 and then claim any remaining excess credit as a refundable credit in 2019. Alternatively, a taxpayer may elect to claim the entire excess credit as a refundable credit in its first tax year beginning in 2018. If a corporation elects to claim all of the excess credit as a refundable credit in 2018, the corporation may use Form 1139 to claim a refund for this refundable credit. If a corporation does not file Form 1139 to make this election, it may file a Form 1120-X to make the election and claim a refund for this refundable credit. See: IRS, Questions and Answers about NOL Carrybacks of C Corporations to Taxable Years in which the Alternative Minimum Tax Applies, Question 5, accessed December 18, 2021, https://www.irs.gov/newsroom/questions-and-answers-about-nol-carrybacks-of-c-corporations-to-taxable-years-in-which-the-alternative-minimum-tax-applies .

[ 192 ]   26 U.S.C. § 6411(b), (d)(2); Pub. L. No. 116-136, § 2305(d)(1), 134 Stat. at 357.

[ 193 ]   Individuals that file applications for tentative refund include sole proprietors.

[ 194 ]   IRS considers applications unprocessable for a number of reasons, including an incorrect taxpayer name or missing documentation. According to IRS officials, if an Application for Tentative Refund is deemed unprocessable, IRS does not start counting the 90-day timeline until the application is considered complete.

[ 195 ]   26 U.S.C. § 6611(e), (f). Interest is owed when the refund is not issued within 45 days of the later of the: loss year return due date (without regard to any extension), delinquent loss year return received date (used when the loss year return is filed after its due date, without regard to any extension), loss year return processable date, date the application is received by the IRS, or date the application is received by the IRS in processable form.

[ 196 ]   This number includes the total interest for all carrybacks, including applications and claims via both applications for tentative refund and amended returns. This enclosure focuses on “applications” filed via applications for tentative refund. The 2021 fiscal year ended on September 30, 2021.

[ 197 ]   Officials explained that the staffing changes required IRS to provide its Accounts Management employees with the equipment needed to work from home, which limited the available staff to complete work and added to the processing backlog.

[ 198 ]   This includes all of IRS’s Business Master File pipeline, and not just carryback cases. This is down from roughly 4,500 business filings that they reported unprocessed in October 2021. We are reviewing challenges of the filing season as part of our annual review of the tax filing season and expect to issue a report in 2022.

[ 199 ]   New legislation includes the CARES Act, the Consolidated Appropriations Act, 2021, and the American Rescue Plan Act of 2021. Pub. L. No. 116-136,134 Stat. 281, (2020); Pub. L. No. 116-260, 134 Stat. 1182 (2020); Pub. L. No. 117-2, 135 Stat. 4 (2021).

[ 200 ]   We use the word inventory to refer to the number of taxpayer filings that the IRS has in house.

[ 201 ]   IRS creates weekly reports with the 15 oldest carryback cases and the 15 oldest that have not shown any activity in the last 30 days. A case stays on these reports until it is closed.

[ 202 ]   National Taxpayer Advocate, Objectives Report to Congress, Fiscal Year 2022, https://www.taxpayeradvocate.irs.gov/reports/2022-objectives-report-to-congress/full-report/ (Washington, D.C.: June 2021. The Treasury Inspector General for Tax Administration also issued a report in June 2021 that identified IRS internal control issues within the process to verify tentative carryback refund eligibility. This report did not directly address processing issues because at the time of the review, IRS was processing carryback applications within the 90-day statutory requirement.

[ 203 ]   IRS has an internal Lean Six Sigma Organization whose mission is to support the IRS Wage and Investment Division's strategy of improving service to the taxpayer by leading accelerated process improvement initiatives utilizing the Lean Six Sigma Methodology. LSSO employs experienced process improvement individuals who are specifically trained and certified in the Lean Six Sigma Methodology. To accomplish the mission, the LSSO methodology focuses on eliminating waste and non-value-added activities and improving process effectiveness and efficiency by reducing variation and increasing quality. LSSO is guided by a structured problem-solving approach called Define-Measure-Analyze-Improve-Control.

[ 204 ]   The National Taxpayer Advocate Service 2022 Objectives Report to Congress proposed four activities for improving the timeliness of tentative refunds during national emergencies: (1) Work with the IRS to identify issues causing delays, expedite relief to taxpayers, propose recommendations, and collaborate on improved timely payments. (2) Advocate for a dedicated fax line or other means of delivery to expedite the processing of paper forms. (3) Recommend the IRS assign a specific employee unit dedicated to processing Forms 1139 and 1045. (4) Work with the IRS to develop a communication strategy to ensure the IRS is transparent and keeps taxpayers informed about the status of their application for refund and the anticipated delays. IRS officials said any decisions they make will be based on subsequent reviews along with any final TAS recommendations.

[ 205 ]   See Pub. L. No. 116-136, § 1102(b), 134 Stat. 281, 293-294 (2020); Pub. L. No. 116-139, § 101(a), 134 Stat. 620, 620 (2020); Pub. L No. 116-260, div. N, tit. III, §323(a) 134 Stat. 1182, 2018-19 (2020); Pub. L. No. 117-2, § 5001(d) 135 Stat. 4, 85 (2021). The program also paid fees to lenders for their participation in the program.

[ 206 ]   As originally implemented by SBA, at least 75 percent of the loan forgiveness amount must have been for payroll costs. In addition, the CARES Act required loans to be used within an 8-week period in order for the loans to be fully forgiven. However, the Paycheck Protection Program Flexibility Act of 2020 modified this to at least 60 percent and allowed borrowers to pay or incur those expenses over a 24-week period. Pub. L. No. 116-142, § 3, 134 Stat. 641, 641-42 (2020). Under the Paycheck Protection Program Flexibility Act of 2020, the loan forgiveness covered period for PPP loans was to end the earlier of 24 weeks after origination or December 31, 2020. The Consolidated Appropriations Act, 2021 further modified the covered period for forgiveness to allow the borrower to choose a covered period ending on any date between 8 and 24 weeks after origination. Pub. L. No. 116-260, div. N, tit. III, § 306, 134 Stat. 1182, 1997 (2020).

[ 207 ]   New applications were accepted through May 31, 2021, and SBA had until June 30, 2021, to process submitted applications.

[ 208 ]   The Consolidated Appropriations Act, 2021 expanded the categories of forgivable nonpayroll costs to include certain operations, property damage, supplier, and worker protection expenditures. PPP borrowers were eligible to receive a second PPP loan of up to $2 million provided that they met certain criteria, such as having not more than 300 employees, having used the full amount of their initial PPP loan, and having experienced revenue reductions of at least 25 percent in a quarter of 2020 when compared to the same quarter in 2019. Pub. L No. 116-260, div. N, tit. III, § 311, 134 Stat. 1182, 2001-2007 (2020); see also 86 Fed. Reg. 3712 (Jan. 14, 2021).

[ 209 ]   SBA worked with the Department of the Treasury (Treasury) to implement PPP.

[ 210 ]   For more information on the auditor’s findings related to the Economic Injury Disaster Loan program, see the enclosure on the Economic Injury Disaster Loan Program in app. I . The auditor also reported that it identified a material weakness in internal control related to SBA’s Shuttered Venues Operators Grant program and Restaurant Revitalization Fund program. Specifically, the auditor stated that SBA did not adequately design and implement monitoring controls over program awards to ensure accurate financial reporting as of the fiscal year-end, and to ensure that funds were used in accordance with the CARES Act and related legislation. For example, SBA disbursed numerous awards to restaurants that had a PPP loan guarantee with an alert or flag prior to approval of the award. SBA officials told us in December 2021 that SBA plans to provide details to the auditor that it believes will remedy the finding for the Restaurant Revitalization Fund. They also noted that since the completion of the audit SBA had implemented a process to monitor the use of recipients’ funds. We will continue to monitor SBA’s efforts to address the deficiencies identified in its financial statement audit. The Consolidated Appropriations Act, 2021, enacted in December 2020, authorized and appropriated $15 billion to SBA for the shuttered venues program to assist businesses in the performing arts and entertainment industries experiencing economic hardship due to the COVID-19 pandemic. Pub. L, No. 116-260, div. N, tit. III, §§ 323(d)(1)(H), 324, 134 Stat. 1182, 2021, 2022-32 (2020). The American Rescue Plan Act of 2021, enacted in March 2021, appropriated an additional $1.25 billion for shuttered venues and modified certain eligibility requirements. Pub. L. No. 117-2, tit. V, § 5005, 135 Stat. 4, 91-92 (2021). The American Rescue Plan Act of 2021 also established the restaurant revitalization program and appropriated $28.6 billion for eligible entities that suffered revenue losses related to the COVID-19 pandemic. Pub. L. No. 117-2, tit. V, § 5003, 135 Stat. 4, 85-90 (2021).

[ 211 ]   A material weakness is a deficiency, or combination of deficiencies, in internal control over financial reporting, such that there is a reasonable possibility that a material misstatement of the entity’s financial statements will not be prevented, or detected and corrected, on a timely basis. A deficiency in internal control exists when the design or operation of a control does not allow management or employees, in the normal course of performing their assigned functions, to prevent, or detect and correct, misstatements on a timely basis.

[ 212 ]   The Federal Credit Reform Act of 1990 (FCRA) requires that agencies have budget authority to cover a program’s subsidy cost to the government in advance—before new loan guarantee commitments are made. The data used for budgetary subsidy cost estimates are generally updated—or reestimated—annually after the end of the fiscal year to reflect actual loan performance and to incorporate any changes in assumptions about future loan performance. Reestimates that increase subsidy costs are referred to as upward reestimates (an agency would need additional funds), while reestimates that decrease subsidy costs are referred to as downward reestimates (an agency would return funds to the Department of the Treasury).

[ 213 ]   Under SBA rules and guidance, the borrower submits the forgiveness application to the lender. The lender then has 60 days from receipt of the application to review and submit its forgiveness decision (approved in full, approved in part, or denied) to SBA. SBA reviews the lender decision, makes a final forgiveness determination, and remits the appropriate forgiveness amount to the lender. In general, SBA must remit the forgiveness amount to the lender within 90 days of that amount being determined. SBA and Treasury officials told us they interpreted the CARES Act requirement to remit funds within 90 days to be subject to SBA’s review of loans. Of the approximately 8.6 million loan forgiveness decisions submitted to SBA by lenders as of November 14, 2021, 4,782,390 were for loans made in 2020 and 3,855,083 were for loans made in 2021.

[ 214 ]   According to SBA officials, lenders have recommended that about 7,500 of the approximately 115,000 loans still under SBA review not receive any forgiveness.

[ 215 ]   According to Treasury officials, there could be a variety of reasons for this increase. For example, the officials noted that the covered period was extended to a maximum of 24 weeks, and borrowers can apply for forgiveness after they have used all the proceeds for which they are seeking forgiveness. See 86 Fed. Reg. 8283 at 8288 (Feb. 5, 2021). Consequently, it would have been reasonable for Round 1 borrowers to wait for the full 24 weeks to elapse before applying for forgiveness. The officials also suggested that another potential reason could be that the Consolidated Appropriations Act, 2021 was passed around the time when many Round 1 borrowers would have been preparing to apply for forgiveness, and resources at lenders were likely diverted to implementing Round 2. As a result, lender processing of forgiveness applications likely picked back up after Round 2 closed in May 2021.

[ 216 ]   For a discussion of potential fraud in PPP, see the enclosure on Federal Fraud-Related Cases in app. I .

[ 217 ]   The contractor referred an additional approximately 3,300 loans to SBA automatically and without manual review based on agreed parameters.

[ 218 ]   86 Fed. Reg. 63437 (Nov. 16, 2021).

[ 219 ]   For purposes of the SSBCI program, tribal government is defined as the recognized governing body of any Indian or Alaska Native tribe, band, nation, pueblo, village, community, component band, or component reservation, individually identified (including parenthetically) in the list published most recently as of March 11, 2021 pursuant to 25 U.S.C. § 5131. 12 U.S.C. § 5701(19).

[ 220 ]   Eligible businesses may have no more than 500 employees.

[ 221 ]   Other credit support programs are required to target an average borrower or investee size of 500 employees or fewer and are not permitted to extend credit support to borrowers that have more than 750 employees.

[ 222 ]   Very small businesses are defined as businesses with fewer than 10 employees and may include independent contractors and sole proprietors. 12 U.S.C. § 5702(f)(2). Business enterprises owned and controlled by socially and economically disadvantaged individuals are defined as businesses that, if privately or publically owned, are at least 51 percent owned by one or more socially and economically disadvantaged individuals or in the case of a mutual institution, a majority of the Board of Directors, account holders, and the community which the institution services is predominately comprised of socially and economically disadvantaged individuals. 12 U.S.C § 5701(15).

[ 223 ]   Treasury published initial preliminary allocation amounts, including main allocations and allocations for very small businesses, for states, territories, and the District of Columbia in April 2021 and communicated preliminary allocation amounts to tribal governments in June 2021. In November 2021, Treasury published updated preliminary allocation amounts and communicated individual amounts to tribal governments.

[ 224 ]   Each state, territory, and the District of Columbia was guaranteed a minimum allocation amount.

[ 225 ]   Community Development Financial Institution Investment Areas, as defined in 12 C.F.R. § 1805.201(b)(3)(ii), are generally low-income, high-poverty areas that receive neither sufficient access to capital nor support for the needs of small businesses.

[ 226 ]   The preliminary minimum allocation amount for each tribal government was $432,000, according to Treasury’s methodology for allocating funds to tribal governments.

[ 227 ]   According to Treasury officials, Treasury identified 582 tribal governments—574 federally recognized tribes and 8 component bands of those tribes that had submitted tribal enrollment data to the Bureau of Indian Affairs—as eligible to apply to the program. Multiple tribal governments may apply jointly to the SSBCI program.

[ 228 ]   These agencies include the Departments of Agriculture, Commerce, Defense, Education, Energy, Health and Human Services, Homeland Security, Housing and Urban Development, Interior, Justice, Labor, State, Transportation, the Treasury, and Veterans Affairs; National Aeronautics and Space Administration; Environmental Protection Agency; U.S. Agency for International Development; General Services Administration; National Science Foundation; Nuclear Regulatory Commission; Office of Personnel Management; Small Business Administration; and Social Security Administration.

[ 229 ]   Office of Personnel Management , Federal Employee Viewpoint Survey 2020: Governmentwide Management Report (Washington, D.C.: 2020).

[ 230 ]   According to GSA officials, the Lease Cost Avoidance program, which aggregates cost savings from several efforts, including the Freeze the Footprint and Reduce the Footprint initiatives, has achieved $4.5 billion in cost avoidance from fiscal year 2018 through fiscal year 2021. However, in prior GAO work issued in March 2020, we raised concerns regarding the reliability of the information used to calculate these cost savings.

[ 231 ]   Pub. L. No. 117-2, tit. IX, subtit. M, § 9901, 135 Stat. 4, 223 (2021) (codified at 42 U.S.C. §§ 802-803) (ARPA). Sections 602 and 603 of the Social Security Act as added by section 9901 of ARPA appropriated $350 billion in total funding for two funds—the Coronavirus State Fiscal Recovery Fund and the Coronavirus Local Fiscal Recovery Fund. For purposes of this report, we discuss these two funds as one—the Coronavirus State and Local Fiscal Recovery Funds (CSLFRF). 42 U.S.C. §§ 802-803. For purposes of the CSLFRF, ARPA establishes that the District of Columbia is considered to be a state. 42 U.S.C. §§ 802(g)(5), 803(g)(9).

[ 232 ]   42 U.S.C. §§ 803(g), 5302(a).

[ 233 ]   42 U.S.C. § 803(b)(2). Territories also allocate and distribute payments to NEUs. For purposes of payments to NEUs, ARPA defines “states” to include territories (i.e., Commonwealth of Puerto Rico, the United States Virgin Islands, the Commonwealth of the Northern Mariana Islands, and American Samoa). 42 U.S.C. § 803(g)(9). However, for purposes of this report we excluded territories from our analysis.

[ 234 ]   Treasury considers state governments that request their own allocations also to have requested allocations for NEUs within their states. Treasury will make payments to states from the Coronavirus Local Fiscal Recovery Fund for distribution to NEUs in two tranches, with the second tranche payment to be made no earlier than 12 months after the date on which the first tranche payment is paid to the state.

[ 235 ]   Department of the Treasury. Coronavirus Local Fiscal Recovery Fund: Guidance on Distribution of Funds to Non-entitlement Units of Local Government , accessed Oct. 25, 2021. https://home.treasury.gov/system/files/136/NEU_Guidance.pdf .

[ 236 ]   ARPA requires states to allocate and distribute to NEUs an amount that is the same proportion to the amount of payment as the population in the NEU as a share of the total population of all NEUs in the state. 42 U.S.C. § 803(b)(2)(C).

[ 237 ]   Section 603(b)(2)(C)(iii), as added by section 9901 of ARPA (codified at 42 U.S.C. § 803(b)(2)(C)(iii)), provides that each NEU’s total allocation and distribution (i.e., the total of distributions under both the first and second tranche) is capped at 75 percent of its most recent budget, in effect as of January 27, 2020. The supplemental information accompanying Treasury’s interim final rule that implements CSLFRF defined a NEU’s most recent budget for purposes of the cap to mean the NEU’s most recent annual total operating budget, including its general fund and other funds, as of January 27, 2020. Coronavirus State and Local Fiscal Recovery Funds , 86 Fed. Reg. 26,786, 26,814 (May 17, 2021). Treasury’s final rule specifies that the NEU’s total annual budget includes both operating and capital expenditure budgets. See Department of the Treasury, Coronavirus State and Local Fiscal Recovery Funds, Final Rule (Jan. 6, 2022), https://home.treasury.gov/system/files/136/SLFRF-Final-Rule.pdf . While the final rule does not go into effect until April 1, 2022, recipients may take actions consistent with the final rule prior to the effective date. See, Treasury’s Statement Regarding Compliance with the Coronavirus State and Local Fiscal Recovery Funds Interim Final Rule and Final Rule .

[ 238 ]   In some states, the boundaries of some NEUs overlap with or encompass other NEUs within the state, typically resulting in overlapping populations between the larger “parent” NEU and the subsidiary NEU (e.g., a township that encompasses a city).

[ 239 ]   The Single Audit Act is codified, as amended, at 31 U.S.C. §§ 7501-06, and implementing Office of Management and Budget (OMB) guidance is reprinted in 2 C.F.R. part 200. The single audit that the statute generally requires covers both the entity’s financial statements and its federal awards for the fiscal year. The nonfederal entities covered by the act are states, the District of Columbia, U.S. territories, Indian tribes, local governments, and nonprofit organizations. 31 U.S.C. § 7502; 2 C.F.R. § 200.501.

[ 240 ]   Subsequently, on May 17, 2021, Treasury published the interim final rule in the Federal Register. See Coronavirus State and Local Fiscal Recovery Funds, 86 Fed. Reg. 26,786. Treasury provided initial guidance on reporting requirements for all recipients in the supplemental information section of the interim final rule. The text of the rule in the interim final rule did not contain specific reporting requirements, but rather established recipients’ obligation to provide regular detailed reporting and other information as Treasury requires. This general provision was retained in the final rule which Treasury released on January 6, 2022. See Department of the Treasury, Coronavirus State and Local Fiscal Recovery Funds, Final Rule (Jan. 6, 2022), https://home.treasury.gov/system/files/136/SLFRF-Final-Rule.pdf .

[ 241 ]   Department of the Treasury. Compliance and Reporting Guidance: State and Local Fiscal Recovery Funds, ver. 2.1 (Nov. 15, 2021), accessed Dec. 2, 2021, https://home.treasury.gov/system/files/136/SLFRF-Compliance-and-Reporting-Guidance.pdf .

[ 242 ]   Pub. L. No. 117-2, § 9901, 135 Stat. at 229 (codified at 42 U.S.C. § 803(b)(2)(C)).

[ 243 ]   The other related identifying information includes Data Universal Numbering System (DUNS) numbers, which are unique nine-digit identifiers used to identify an organization. By April 2022, the federal government will transition from the DUNS number to the new Unique Entity ID (SAM) assigned by SAM.gov. Treasury requires all CSLFRF recipients to have an active SAM registration.

[ 244 ]   In December 2021, Treasury released a user guide for NEUs to confirm their accounts in Treasury’s online reporting portal and upload required documents, among other things. Department of the Treasury. NEU and Non-UGLGs Agreements and Supporting Documents User Guide: State and Local Fiscal Recovery Funds , ver. 1 (Dec. 14, 2021), accessed Dec. 14, 2021. https://home.treasury.gov/system/files/136/SLFRF_Recipient-Reporting-User-Guide-NEU_Non-UGLG.pdf .

[ 245 ]   An authorized state officer must certify that CSLFRF distributions to NEUs would constitute an “excessive administrative burden” for the state with respect to one or more of those distributions. After the initial extension, any additional extensions may only be granted by Treasury if (1) the state provides a written plan specifying when it expects to make such distribution and the actions the state has taken and will take in order to make all such distributions before the end of the distribution period (as extended), and (2) Treasury determines such plan is reasonably designed to distribute all such funds to NEUs by the end of the extended period. 42 U.S.C. § 803(b)(2)(C)(ii).

[ 246 ]   Department of the Treasury. Frequently Asked Questions on Distribution of Funds to Non-entitlement Units of Local Government , (June 30, 2021), accessed Nov. 2, 2021, https://home.treasury.gov/system/files/136/NEU-FAQs.pdf .

[ 247 ]   31 U.S.C. § 7502(c). GAGAS provides standards and guidance for auditors and audit organizations, outlining the requirements for audit reports, professional qualifications for auditors, and audit organization quality control. Auditors of federal, state, and local government programs use these standards to perform their audits and produce their reports.

[ 248 ]   Because NEUs qualify as nonfederal entities under the Single Audit Act, any NEU that meets the $750,000 expenditure threshold in a given fiscal year will need to comply with the act. 31 U.S.C. §§ 7501, 7502.

[ 249 ]   As a nonfederal entity subject to the Single Audit Act, each NEU meeting the act’s expenditure threshold in a given fiscal year is responsible for obtaining an independent auditor to conduct its single audit. 31 U.S.C. § 7502; 2 C.F.R. § 200.501.

[ 250 ]   Pursuant to OMB guidance implementing the Single Audit Act, certain single audit costs may be charged to the recipient’s federal award. 2 C.F.R. § 200.425.

[ 251 ]   OMB’s Compliance Supplement provides guidance for performing single audits, including information about programs’ objectives, procedures, and compliance requirements. Each year, OMB works with agencies to compile this information and issues the information in the supplement. In December 2021, OMB published single audit guidance for the CSLFRF in an addendum to the 2021 Compliance Supplement.

[ 252 ]   Our review of 47 state recovery plans included the recovery plan for the District of Columbia, which is considered a state under ARPA. 42 U.S.C. § 802(g)(5). The recovery plans we analyzed described the states’ planned uses of funds, which includes intended and actual uses, at the time the reports were filed. Our analysis is based only on those states with recovery plans available as of December 3, 2021 and on information that was presented in the state’s recovery plan report. A number of states’ plans noted that the information contained in their plans is subject to further deliberation and development. We did not assess whether the planned uses were in accordance with statute or Treasury guidance on permissible uses of these funds. In addition, our review did not include U.S. territories’ and local governments’ recovery plans or their planned uses of funds.

[ 253 ]   According to Treasury guidance, each of these seven spending categories is comprised of one or more sub-categories that recipients use to group their specific projects. See Department of the Treasury, Recovery Plan Template , accessed Nov. 30, 2021. https://home.treasury.gov/system/files/136/SLFRF-Recovery-Plan-Performance-Report-Template.docx . We excluded from our analysis of recovery plans any dollar amounts that were not identified within one of the seven spending categories.

[ 254 ]   Recipients may also report on distributions to NEUs and other units of government. We excluded distributions to NEUs from our analysis because they are distributions of payments from the Coronavirus Local Fiscal Recovery Fund. As previously mentioned, Treasury is in the process of validating state provided data on distributions to NEUs.

[ 255 ]   The metropolitan cities and counties required to submit the first quarterly project and expenditure reports by January 31, 2022 are (1) metropolitan cities and counties with populations that exceed 250,000 residents and (2) metropolitan cities and counties with populations below 250,000 residents that are allocated more than $10 million in CSLFRF funding. Department of the Treasury. Compliance and Reporting Guidance: State and Local Fiscal Recovery Funds, ver. 2.1 (Nov. 15, 2021), accessed Dec. 2, 2021, https://home.treasury.gov/system/files/136/SLFRF-Compliance-and-Reporting-Guidance.pdf .

[ 256 ]   The metropolitan cities and counties required to submit the first annual project and expenditure reports by April 30, 2022 are metropolitan cities and counties with populations below 250,000 residents that are allocated less than $10 million in CSLFRF funding.

[ 257 ]   In an October 2021 report, we described various challenges taxpayers faced using ID.me to access the Internal Revenue Service’s Child Tax Credit Update Portal. This online portal allows qualified individuals to check their eligibility for the advance payments, opt out of receiving the payments, update their bank account information, and change their mailing address. We also reported that applicants to the Coronavirus Economic Relief for Transportation Services (CERTS) Program faced challenges using ID.me, which Treasury required applicants to use to verify their identity before they could complete a CERTS Program application.

[ 258 ]   Department of the Treasury, Project and Expenditure Report User Guide: State and Local Fiscal Recovery Funds , ver. 1 (Jan. 7, 2022), accessed Jan. 7, 2022, https://home.treasury.gov/system/files/136/Project-and-Expenditure-Report-User-Guide.pdf .

[ 259 ]   The CARES Act includes a provision for GAO to provide a comprehensive audit and review of federal contracting pursuant to the authorities provided in the Act. In addition to specific contracting reviews, we have reported on federal contracting in response to the pandemic as part of regularly issued government-wide reports on the federal response to COVID-19.

[ 260 ]   For the purposes of this report, “contract obligations” refers to obligations on procurement contracts that are subject to the Federal Acquisition Regulation and does not include, for example, grants, cooperative agreements, loans, other transactions for research, real property leases, or requisitions from federal stock.

[ 261 ]   Other transaction authorities allow certain agencies to enter into agreements “other than” standard government contracts or other traditional mechanisms. Agreements under these authorities are generally not subject to federal laws and regulations applicable to federal contracts or financial assistance, allowing agencies to customize their other transaction agreements to help meet project requirements and mission needs.

[ 262 ]   Pub. L. No. 116-136, §§ 3301, 13006, 134 Stat. 281, 383, 522 (2020).

[ 263 ]   The memorandum of agreement guiding the use of NIA codes does not address tracking of other transaction agreements. Our prior work has identified challenges with how the Departments of Defense, Health and Human Services, and Homeland Security tracked other transaction agreements in response to COVID-19.

[ 264 ]   According to the memorandum of agreement guiding the management of the NIA code, DHS and DOD are responsible for making determinations about whether to establish or close a code, based on a variety of considerations. The General Services Administration (GSA)—the agency that operates and maintains FPDS—is responsible for adding or updating the NIA code in the system based on DHS’s and DOD’s decisions. The extensions of the code are consistent with our prior recommendations to DHS, DOD, and GSA related to the importance of ensuring federal agencies, the public, and Congress have visibility into contract actions and associated obligations related to emergency response efforts.

[ 265 ]   Emergency use authorizations allow for the temporary use of unapproved medical products. Janssen Pharmaceutical Companies are a part of Johnson & Johnson.

[ 266 ]   Our methodology for identifying noncompetitive contracts is explained in detail at the end of this enclosure.

[ 267 ]   For the purposes of this report, obligations on contracts identified as using the unusual and compelling urgency exception include those associated with contracts subject to Federal Acquisition Regulation 6.302-2, as well as orders under multiple award contracts, which are subject to separate requirements under Federal Acquisition Regulation subpart 16.5. Specifically, under Federal Acquisition Regulation 16.505(b)(2), orders on multiple award contracts require contracting officers to give every awardee a fair opportunity to be considered for a delivery order or task order exceeding $3,500, with exceptions, including if the agency need for the supplies or services is so urgent that providing a fair opportunity would result in unacceptable delays. When using the unusual and compelling urgency exception to full and open competition, agencies still must request offers from as many potential sources as is practicable under the circumstances.

[ 268 ]   Undefinitized contracts include letter contracts, as well as other undefinitized actions. Letter contracts are a preliminary contract that authorizes the contractor to begin work immediately, and undefinitized contract actions include any contract action for which the contract terms, specifications, or price are not agreed upon before performance has begun under the action. Federal Acquisition Regulation 16.603 and Defense Federal Acquisition Regulation Supplement 217.74.

[ 269 ]   FPDS data from SAM.gov accessed through December 15, 2021. For purposes of this report, “competition rate” is the percentage of total obligations associated with contracts awarded competitively. We calculated competition rates as the percentages of obligations on competitive contracts and orders over all obligations on contracts and orders. Competitive contracts included contracts and orders coded in the FPDS as “full and open competition,” “full and open after exclusion of sources,” and “competed under simplified acquisition procedures” as well as orders coded as “subject to fair opportunity,” “fair opportunity given,” and “competitive set aside.” Noncompetitive contracts included contracts and orders coded in the FPDS as “not competed,” “not available for competition,” and “not competed under simplified acquisition procedures,” as well as orders coded as an exception to “subject to fair opportunity,” including “urgency,” “only one source,” “minimum guarantee,” “follow-on action following competitive initial action,” “other statutory authority,” and “sole source.” Even for contracts identified as noncompetitive, agencies may have solicited more than one source.

[ 270 ]   In November 2019 we identified some inconsistencies in the information agencies report in the contract description field in the FPDS. Data on DOD contract obligations based on information in the description field were available only through September 15, 2021, due to differences in the time frames for which DOD data are made publicly available.

[ 271 ]   The overall trade deficit is calculated as total imports in goods and services subtracted from exports in goods and services.

[ 272 ]   U.S. Census import data contains information on total monthly import charges paid on all imported shipments. Census cannot reliably account for shipments valued below $2,000. As such, Census implements statistical methodologies to account for imported shipments below $2,000 to improve coverage, timeliness and relevance of the international merchandise trade statistics. Import charges include cost of freight; insurance; and other charges, excluding duties.

[ 273 ]   The TEU is a measure of volume in units of 20-foot long shipping containers.

[ 274 ]   For the purposes of our analysis, U.S. import values refer to the value of imports for consumption, which is a measure of the total of merchandise that has physically cleared through customs.

[ 275 ]   U.S. Census Bureau trade statistics—a widely used source analyzing U.S. international trade—do not contain precise data on imports of COVID-19-related products. As a result, we estimated the import value of all product types and categories within those types using Harmonized Tariff Schedule of the United States (HTS) statistical reporting numbers and associated product groupings listed by the U.S. International Trade Commission (USITC) in COVID-19 Related Goods: U.S. Imports and Tariffs , Investigation No. 332-576, USITC Publication 5073 (Washington, D.C.: June 2020). Revisions to the HTS on July 1, 2020, January 1, 2021, and July 1, 2021, provided several new HTS-10 statistical reporting numbers for previously identified COVID-19-related product categories. We identified these product categories and included them in our analysis.

[ 276 ]   As an example, the number of imported N-95 respirators increased by 15 percent from June 2021 through August 2021 while the unit values of these products declined by 42 percent in the same time period. Overall, U.S. import values for N-95 respirators fell by 33 percent from June 2021 through August 2021. Unit values equal the total import value of the product divided by the quantity imported. Trends in this measure serve as a proxy for understanding fluctuations in import price.

[ 277 ]   In April 2020, WHO and seven other global health organizations created the Access to COVID-19 Tools Accelerator (ACT-Accelerator), an effort to rapidly develop and provide equitable access to vaccines, diagnostics, and therapeutics. The vaccine-related component of the ACT-Accelerator is known as COVID-19 Vaccines Global Access (COVAX).

[ 278 ]   The Census uses Schedule B product categories, a systematic grouping of commodities used by the Census Bureau to track exports of different products, which is based the headings and subheadings in the International Harmonized System used by WTO members. As of October 2021, Schedule B product categories do not contain more granular information required to identify exports of COVID-19 vaccines specifically.

[ 279 ]   We compared COVID-19-related HTS-10 statistical reporting numbers before and after July 1, 2020, before and after January 1, 2021, and before and after July 2021. If no data existed for an HTS-10 statistical reporting number, we checked USITC guidance to determine whether the original reporting number had been annotated or discontinued. If it had been annotated or discontinued, we included import values of those codes after July 1, 2020, January 1, 2021 or July 1, 2021 in our analysis. For instance, on July 1, 2020, according to guidance provided by the USITC, the HTS statistical reporting number 4818.50.0000 split into two new HTS-10 statistical reporting numbers, 4818.50.0080 and 4818.50.0020. Therefore, we included imports for products contained in 4818.50.0080 and 4818.50.0020 after July 1, 2020, in our calculations. As such, we may overestimate the value of imports for COVID-19 related products. Nevertheless, the values shown are useful indicators for tracking import trends for such products. August 2021 was the latest month of trade data available at the time of our analysis.

[ 280 ]   Fraud and “fraud risk” are distinct concepts. Fraud—obtaining something of value through willful misrepresentation—is challenging to detect because of its deceptive nature. Fraud risk (which is a function of likelihood and impact) exists when individuals have an opportunity to engage in fraudulent activity, have an incentive or are under pressure to commit fraud, or are able to rationalize committing fraud. Fraud risk management is a process for ensuring program integrity by continuously and strategically mitigating the likelihood and impact of fraud. When fraud risks can be identified and mitigated, fraud may be less likely to occur. Although the occurrence of fraud indicates there is a fraud risk, a fraud risk can exist even if actual fraud has not yet been identified or occurred.

[ 281 ]   In July 2021, we reported that SBA’s initial implementation of PPP contributed to increased risk of improper payments and extensive fraud. Also in July 2021, we reported on efforts SBA has taken to address risks of fraud in the EIDL program and provision of funds to ineligible applicants. Further, in our October 2021 quarterly report, we reported on fraud risks in UI programs and strategies DOL is implementing to address potential fraud in UI programs.

[ 282 ]   We consider convictions to be cases where an individual was convicted of a fraud-related charge at trial.

[ 283 ]   The remainder of the complaints relate to a variety of other programs and issues, including other federal programs, such as the Restaurant Revitalization Fund Grant program and Higher Education Emergency Relief fund; COVID-19-related mortgage fraud; and testing and vaccines. While not all of the complaints received involve allegations of potential fraud, many of them do.

[ 284 ]   According to FTC, the fraud reports reflect complaints in the Consumer Sentinel Network that mention COVID, stimulus, N95, and related terms. The identity theft reports reflect complaints that mention COVID, stimulus, or related terms in the following identity theft subtypes: tax, employment and wage, government benefits, and government documents.

[ 285 ]   A charge is merely an allegation, and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.

[ 286 ]   The federal government may enforce laws through civil or criminal action. Such action may be resolved through a trial, a permanent injunction, a civil settlement, or a guilty plea. Since March 2020, DOJ has resolved an EIDL fraud-related case against one individual and PPP fraud-related cases against eight individuals or entities through civil settlements. For example, in one case, an individual agreed to pay over $280,000 to settle allegations brought by a former employee that this individual misappropriated PPP loan proceeds obtained on behalf of this individual’s company for personal expenses. In addition to the federal government, state governments have brought COVID-19-related unemployment insurance fraud charges.

[ 287 ]   The statute of limitations for mail fraud and wire fraud prosecutions is 5 years (18 U.S.C. § 3282), except for mail and wire fraud schemes that affect a financial institution, in which case the statute is 10 years (18 U.S.C. § 3293). Also, based on our analysis, these cases can take many years to resolve. For example, the Department of Housing and Urban Development OIG closed cases in 2017–2020 resulting from Hurricane Sandy in 2012.

[ 288 ]   This individual also pleaded guilty to failure to appear in court after removing an electronic monitoring device while released to home detention and staging suicide.

[ 289 ]   Two of these individuals had been sentenced as of October 31, 2021. One of these individuals was sentenced to 37 months in federal prison and 3 years of supervised release and ordered to pay restitution of over $2 million for PPP-related fraud. The other individual was sentenced to one year and one day in federal prison and 3 years of supervised released and ordered to pay restitution of over $10.7 million for PPP- and EIDL-related fraud. As of October 31, 2021, there had not been any convictions related to UI, EIP, or other federal COVID-19 relief programs.

[ 290 ]   The majority of these individuals were charged with attempting to defraud SBA’s PPP and EIDL program and DOL’s UI programs, or fraudulently accessing EIPs. Eight individuals were charged with attempting to defraud only other federal COVID-19 relief programs, including the Higher Education Emergency Relief Fund and the Provider Relief Fund. Seventy-eight of the 499 individuals faced charges related to more than one federal COVID-19 relief program. For example, 60 individuals faced federal charges related to both PPP and EIDL, 10 individuals faced federal charges related to both EIDL and UI, and one individual faced federal charges related to PPP, the Accelerated and Advance Payments Program, and the Provider Relief Fund as of October 31, 2021. Some of these individuals also faced federal charges related to consumer fraud or other types of COVID-19-related fraud.

[ 291 ]   One of the 18 individuals or entities has also pleaded guilty to federal charges of defrauding a COVID-19 relief program. Also, 11 of the 18 individuals or entities had been sentenced as of October 31, 2021. Sentences for individuals ranged from 6 months of probation and almost $5,000 of restitution to more than 5 years in prison followed by 5 years of supervised release. In addition to these 18 individuals or entities, since March 2020, DOJ resolved a civil complaint of consumer fraud against one entity through a civil settlement.

[ 292 ]   The Food and Drug Administration approved the use of hydroxychloroquine sulfate on an emergency basis forhospitalized COVID-19 patients in March 2020 and revoked this emergency use authorization in June 2020 after finding, based on clinical research data, that hydroxychloroquine sulfate may not be effective in the treatment of COVID-19 and that the drug’s potential benefits for such use do not outweigh its known and potential risks.

[ 293 ]   Twelve individuals had been sentenced as of October 31, 2021. Sentences ranged from 2 years of probation and a $75,000 fine to almost 4 years in prison, 3 years of supervised release, and an order to pay over $530,000 in restitution and to forfeit $527,000, among other things, in the case of an individual who also pleaded guilty to an additional fraud scheme that was not related to COVID-19. In addition to these 12 individuals, since March 2020, DOJ resolved complaints against three individuals or entities for activities such as hoarding and price gouging through settlements.

[ 294 ]   In September 2021, DOJ announced charges against numerous individuals as part of a national health care fraud enforcement action. The action resulted in charges against five defendants who allegedly engaged in the misuse of Provider Relief Fund monies and nine defendants, including these two individuals, who allegedly engaged in various health care fraud schemes designed to exploit the COVID-19 pandemic, resulting in the submission of over $29 million in false billings.

[ 295 ]   While HHS is the lead for the public health and medical response, the Federal Emergency Management Agency, an agency within the Department of Homeland Security, leads the overall federal response during emergencies and disasters.

[ 296 ]   Medical countermeasures are drugs, biologics, and devices used to diagnose, treat, prevent, or mitigate harm from any chemical, biological, radiological, or nuclear agent.

[ 297 ]   The Secretary of Health and Human Services may declare that circumstances, prescribed by statute, exist justifying the emergency use of certain medical products. Once such declaration has been made, FDA may temporarily allow the use of an unapproved product through an emergency use authorization. For FDA to issue an emergency use authorization, it must be reasonable to believe that the product may be effective and that the known and potential benefits of the product outweigh the known and potential risks, among other statutory criteria. See 21 U.S.C. § 360bbb-3.

[ 298 ]   For example, in 2007, we recommended that the Secretary of Health and Human Services work with the Secretary of Homeland Security to develop and conduct rigorous testing, training, and exercises to ensure that federal leadership roles are clearly defined and understood and to ensure that leaders are able to effectively execute their shared responsibilities. We also made a similar recommendation to HHS with regard to involving state, local, and tribal governments to ensure their leadership roles and responsibilities are clearly defined. These recommendations were not implemented and HHS acknowledged in fiscal year 2012 that while it continued to exercise its pandemic response capabilities, its exercises would not specifically address our recommendation to test leadership roles and responsibilities.

[ 299 ]   The National Biodefense Strategy outlines a national vision for addressing challenges arising from naturally occurring, deliberate, or accidental biological threats and explains how the federal government can manage its activities more effectively to assess, prevent, prepare for, respond to, and recover from biological threats like the COVID-19 pandemic. HHS chairs the two coordination bodies responsible for facilitating joint decision-making to implement the National Biodefense Strategy. The Secretary of Health and Human Services chairs the cabinet-level Biodefense Steering Committee and a senior HHS official chairs the Biodefense Coordination Team, which consists of subject matter experts from multiple departments and agencies with biodefense responsibilities.

[ 300 ]   See 42 U.S.C. § 247d-6b. The SNS contains a multibillion dollar inventory of medical countermeasures to respond to a broad range of public health emergencies resulting from exposure to chemical, biological, radiological, and nuclear agents, as well as emerging infectious diseases, including pandemic influenza.

[ 301 ]   The Pandemic and All-Hazards Preparedness Act required the Secretary of Health and Human Services to establish a near real-time electronic nationwide public health situational awareness capability through an interoperable network of systems to enhance early detection of, rapid response to, and management of public health emergencies. Pub. L. No. 109-417, § 202, 120 Stat. 2831, 2845-48 (2006) (codified, as amended, at 42 U.S.C. § 247d-4(c)).

[ 302 ]   As of our September 2017 report, these health entities included about 59 state and territorial health departments; 3,000 county, city, and tribal health departments; and 180,000 public and private laboratories, as well as multiple federal agencies.

[ 303 ]   See Pandemic and All-Hazards Preparedness Reauthorization Act of 2013, Pub. L. No. 113-5, § 204(a)(4), 127 Stat. 161, 177 (codified, as amended, at 42 U.S.C. § 247d-4(c)). We have ongoing work examining HHS’s efforts in establishing this network.

[ 304 ]   Crimson Contagion was a multi-state, whole-of-government exercise on the nation’s ability to respond to a large-scale outbreak of a novel influenza virus strain, which quickly spreads via human-to-human transmission around the world and across the continental U.S. with high rates of morbidity and mortality.

[ 305 ]   Agencies use after-action reports to summarize the agency’s performance during an exercise or real-world event, including strengths and areas for improvement. The after-action report for the Crimson Contagion exercise identified a number of areas for improvement related to planning and other response functions, including that the organization of the federal government response when HHS is the lead federal agency was not sufficiently outlined in documents.

[ 306 ]   See 42 U.S.C. § 247d-6b(a)(2).

[ 307 ]   HHS signed a memorandum of understanding with DOD in May 2021 to establish a framework whereby the departments will identify a path to enhance HHS’s own capabilities while incrementally reducing DOD’s support.

[ 308 ]   For example, see White House, American Pandemic Preparedness: Transforming Our Capabilities (Washington, D.C.: Sept. 2, 2021) and National Strategy for the COVID-⁠19 Response and Pandemic Preparedness (Washington, D.C.: Jan. 21, 2021).

Jessica Farb

Congressional relations, public affairs, strategic planning and external liaison, obtaining copies of gao reports and testimony, order by phone, to report fraud, waste, and abuse in federal programs, connect with gao, gao’s mission.

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