United States General Accounting Office

GAO Report to the Chairman, Subcommittee

on Employer-Employee Relations,

Committee on Economic and

Educational Opportunities, 

House of Representatives

September 1996 PEOPLE WITH

DISABILITIES

Federal Programs

Could Work Together

More Efficiently to

Promote Employment

G O A

years

1921 - 1996

GAO/HEHS-96-126

GAO United States

General Accounting Office

Washington, D.C. 20548

Health, Education, and

Human Services Division

B-266310 

September 3, 1996

The Honorable Harris W. Fawell

Chairman, Subcommittee on

 Employer-Employee Relations

Committee on Economic and

 Educational Opportunities

House of Representatives

Dear Mr. Chairman:

Over the past decade in the United States, attitudes about people with

disabilities have changed significantly. A growth in public awareness of

the capabilities of people with disabilities, a new emphasis on their

inclusion in society, and a movement toward strategies promoting their

economic self-sufficiency reflect this changed view. These changes in

attitudes have influenced several recent major legislative initiatives: the

Supported Employment program in 1986, the Americans With Disabilities

Act (ADA) in 1990, and the amendments to the Rehabilitation Act. Although

these initiatives are designed to help promote the employment of people

with disabilities, they have not represented a substantial overhaul of U.S.

disability policy. Instead, as experts have noted, they have added to or

expanded an already existing program structure, parts of which have been

in place for many decades.

Because these legislative initiatives have raised concerns about the ability

of federal programs that target people with disabilities to work together,

you asked us to examine and describe these programs, emphasizing those

that relate to employment. Specifically, we focused on the following

questions:

1. Which federal programs target people with disabilities, and how many of

these programs provide employment-related services?

2. To what extent are information, eligibility, and services coordinated

under these programs?

3. What does available evidence suggest about the effectiveness of federal

programs in promoting employment among people with disabilities?

To accomplish these objectives, we integrated evidence from the

literature, from analyses of the most current available databases, and from

Page 1 GAO/HEHS-96-126 Disability Programs
B-266310 

interviews with consumers and public and private organizations. We

identified the range of federal programs, their funding levels, and the

services they provide through a review of federal statutes and regulations,

consultations with agency officials, and information from a variety of

sources—agency reports, budget documents, the Catalog of Federal

Domestic Assistance, the most current expenditure data (fiscal year

1994) available from the Consolidated Federal Funds Report, and our

previous reports. Using the economics and social science literature,

combined with evidence from available databases, including the 1990

census and the 1993 National Health Interview Survey, for example, we

identified characteristics of the population of people with disabilities and

gathered information on employment barriers posed by their special

needs. However, we did not independently verify data that we received

from public or private databases. We also interviewed disability experts,

consumers, service providers, and public officials at the federal, state, and

local levels to help determine how federal programs address these barriers

to employment. Our work was completed between April 1995 and

July 1996 in accordance with generally accepted government auditing

standards. For more detailed information on our scope and methodology,

see appendix I.

Results in Brief The federal government funds a broad range of services to assist the

millions of people with disabilities. This effort is diffuse, however, with

federal assistance provided through 130 programs in 19 federal agencies.

For many of these programs, service delivery filters down to numerous

public and private agencies at the state and local level. In fiscal year 1994,

the federal government spent over $60 billion on 69 programs targeted

exclusively to people with disabilities. In addition, people with disabilities

benefited from between $81 billion and $184 billion in spending through 61

partially targeted programs. These partially targeted programs gave special

consideration to people with disabilities, even though they serve a much

broader clientele.1

The majority of federal expenditures were associated with income

maintenance and health care programs. In 1994, programs that focused

specifically on employment assistance constituted a relatively small

proportion of all disability programs (26 of 130) and received a relatively

small proportion of total federal funding for such programs (from 2.5 to

1

Because the agencies responsible for many of these partially targeted programs could not separate

program expenditures into disability-related and nondisability-related categories, our estimated range

reflects the substantial uncertainty surrounding federal expenditures to help people with disabilities.

See app. I.

Page 2 GAO/HEHS-96-126 Disability Programs
B-266310 

4 percent). A larger number of programs and a greater share of federal

dollars, however, were devoted to programs that provide employmentrelated services such as transportation, accessible housing, and

independent living services.

Our review suggests that programs helping people with disabilities do not

work together as efficiently as they could to share information about their

programs and overcome obstacles posed by differing eligibility criteria and

numerous service providers. Because people with disabilities often face

multiple barriers to employment, including insufficient job training, lack of

transportation, and employer discrimination, they may require services

from more than one program to make employment feasible. However,

each program has its own eligibility requirements and applicants must

often establish eligibility separately because no effective mechanism exists

to promote or ensure coordination. Similarly, because services are often

not coordinated among programs, people with disabilities may receive

duplicate services or face service gaps.

Although the general lack of coordination suggests that program efficiency

could be improved, scant evidence exists for evaluating the effectiveness

of these programs either individually or collectively. Despite the size of the

federal commitment, few programs are required to gather the outcome

data necessary for reliable program evaluation. Many of the 26

employment-focused programs that we identified have had little or no

formal evaluation in recent years. The difficulties associated with

comparing data from different programs also hinder evaluation efforts. In

many instances, service providers track different consumer information,

use different eligibility criteria, and have different rules on confidentiality.

Therefore, without improving coordination, imposing requirements on

data collection may not necessarily facilitate evaluation.

Past federal efforts to reorganize and restructure service delivery have

succeeded only marginally compared with more modest, local initiatives.

Federal agencies have an opportunity to learn from some recent state and

local efforts to improve the coordination of programs helping people with

disabilities. Some state and local programs reported improved service

delivery along with reduced program costs, thus providing resources that

could be redirected toward improving services or evaluating program

performance.

Page 3 GAO/HEHS-96-126 Disability Programs
B-266310 

Background In the last 10 years, the Congress has expanded federal efforts to promote

employment for people with more severe disabilities by creating new

programs, expanding existing programs, and providing employment

protections. In the past, social attitudes toward people with mental

retardation or psychiatric conditions often labeled them as unemployable

outside of institutions or sheltered workshops and thus unable to benefit

from job training or vocational rehabilitation. However, recent advances in

assistive technology, particularly in computers, have made many personal

limitations less prohibitive barriers to work. Voice recognition software,

for example, allows those who do not have use of their hands to produce

documents on a computer. In addition, the development of supported

employment, in which ongoing on-the-job support is provided to people

with disabilities through a job coach, has demonstrated that many people

previously considered unemployable could work alongside people without

disabilities. In response to these developments, the Congress has created

new programs to promote the increased use of assistive technology and to

provide states with funding specifically designated for supported

employment. In addition, the Congress has amended the Rehabilitation Act

to strengthen the requirement that states serve individuals with severe

disabilities.

In 1990, the Congress provided educational and employment protections

to people with disabilities. For example, ADA prohibited employment

discrimination on the basis of disability by state and local governments

and many private-sector employers, as long as the person was qualified

and able to perform the essential job functions “with or without

reasonable accommodation.”2

 Similarly, in the Individuals With Disabilities

Education Act (IDEA), the Congress mandated that all children with

disabilities be provided a “free, appropriate public education,” and courts

interpreting the law have required that this education be provided in “the

least restrictive environment.” This provision emphasized a clear

presumption that children with disabilities should be mainstreamed—that

is, taught in regular classrooms when possible.

2

This provision requires employers to provide what is necessary (for example, equipment,

modifications to work station, and the like) for the individual to do the job as long as accommodating

the disability is not an undue hardship for the employer.

Page 4 GAO/HEHS-96-126 Disability Programs
B-266310 

130 Federal Programs

Target People With

Disabilities

Over many years, public concern and congressional action have produced

a broad continuum of services and policies designed to help people with

disabilities. We identified 19 different federal departments or agencies that

administered 130 programs targeting people with disabilities in 1994.3

These programs ranged from those for toddlers with disabilities, for

example, Early Intervention State Grants for Infants and Toddlers With

Disabilities—to those for the elderly with disabilities, for example,

Independent Living Services for Older Blind Individuals. These many

programs provided education, health care, and books and assisted with

employment. (For a list of these programs, as well as targeting and funding

information, see app. II.)

Of the 130 programs, 69 were wholly targeted (targeted exclusively) to

people with disabilities; the others were partially targeted—that is, they

provided services to a wider clientele but nonetheless gave some priority

or preference to people with disabilities. In 1994, the federal government

spent over $60 billion through these 69 wholly targeted programs,

including efforts such as the Disabled Veterans’ Outreach program, which

helps disabled veterans. In addition, people with disabilities benefited

from between $81 billion and $184 billion in federal spending through 61

partially targeted programs in areas such as income support, housing, and

transportation.4

The federal commitment to helping people with disabilities has also

attempted to facilitate their employment both directly and indirectly. Of

the 130 programs available in 1994, 26 provided direct employment

services such as skills training and job search assistance. For example, the

Supported Employment program established by the Rehabilitation Act is

employment focused because it provided training and placement services

to people with severe disabilities. (Apps. II and III provide details about

these programs.) Employment-focused programs in 1994 provided

between $2.5 billion and $6.1 billion in services targeted to people with

disabilities.

3

We defined a program as targeted to people with disabilities if either people with disabilities were the

ultimate beneficiary of this assistance, if disability was a criterion for eligibility, or if the program gave

priority or preference to people with disabilities. We excluded those programs that may serve some

people with disabilities but were not specifically intended to address disability. For example, people

with disabilities may receive Aid to Families With Dependent Children but their eligibility for this

program does not arise from their disability. We also omitted programs that exclusively fund research

related to specific medical conditions. See app. I.

4

This broad range reflects the fact that many partially targeted programs do not track expenditure by

target or recipient group. See app. I.

Page 5 GAO/HEHS-96-126 Disability Programs
B-266310 

In addition, we identified 57 of 130 programs as related to

employment—that is, although not directed specifically at employment,

these programs may have indirectly affected employment outcomes. These

include federal programs that help finance purchases of assistive

technology, such as specially designed wheelchairs or computer software,

which are employment related because they can enable an individual with

a disability to enter the workplace. In 1994, employment-related programs

provided between $62 billion and $156 billion in services targeted to

people with disabilities.

The remaining 47 of the 130 federal programs were unrelated to

employment. Federal efforts to promote early intervention services for

toddlers with disabilities are an example of these types of programs. (See

fig. 1.)

Figure 1: Employment Focus of

Federal Disability Programs in 1994

20% • Employment Focused

44% • Employment Related

•36%

Unrelated to Employment

Notes: Employment-focused programs provide services that directly facilitate finding and

maintaining employment such as job training and placement assistance.

Employment-related programs indirectly facilitate work through services such as assistive

technology, transportation, health insurances, and the like.

Page 6 GAO/HEHS-96-126 Disability Programs
B-266310 

Many of these employment-focused and -related programs provided a

specific service rather than a broad range of services to people with

disabilities. For example, the Department of Transportation (DOT) funds

capital improvements for local transit systems and also provides funds for

paratransit services.5

 The Job Training Partnership Act (JTPA) program,

although only partially targeted to people with disabilities, emphasizes

shorter term skill training and provides only a limited range and amount of

support services. Important exceptions to this are the vocational

rehabilitation programs; both the federal-state Vocational Rehabilitation

program and the Veterans’ Vocational Rehabilitation program can provide

a wide variety of services designed to promote employment.

Degree of Federal

Financing and

Responsibility Varies

Among Disability

Programs and States

Although the federal government provides funds for all 130 programs, the

extent of the federal role in their administration varies considerably.

Federal programs provide assistance directly to the individual or indirectly

through other public or private service providers at the state and local

levels. Programs that provide assistance indirectly often involve limited

responsibilities for the federal government in administering services.

For some programs, assistance or services flow directly from the federal

government to the individual with a disability. For example, income

support payments under the Social Security Disability Insurance (DI)

program flow directly to beneficiaries, and phone calls requesting

information from the Education Department’s Information Clearinghouse

are a direct service from the federal government. The largest federal

programs in terms of spending—the income maintenance and health care

programs—generally deliver assistance directly to individuals; however, if

these programs are excluded, states receive a substantial amount of the

funds provided through disability programs.

For many programs, assistance or services flow indirectly from the federal

government through state governments, which are responsible for

delivering services to individuals with disabilities. For example, under the

federal-state Vocational Rehabilitation program, the federal government

allocates program funds to the states, which have authority to deliver

services.6

 For some programs, the states may provide funds to other

5

Paratransit is a service specifically designed for individuals unable to use regular fixed-route

transportation. Other federal agencies (such as the Department of Health and Human Services) also

provide funding for paratransit.

6

The Vocational Rehabilitation program distributes funds to states through formula allocations, with

each state program generally establishing its own funding formula or grant criteria for local providers

that deliver services directly.

Page 7 GAO/HEHS-96-126 Disability Programs
B-266310 

entities, such as local governments or nonprofit or private agencies, to

administer services. In the states we visited, funds from federal disability

programs were further distributed to a wide range of state agencies—

departments of rehabilitation services, employment and training,

developmental disabilities, mental health, education, and those for the

deaf and hard of hearing, or the blind, for example.

For many other programs, assistance or services flow indirectly from the

federal government to other organizations such as state or local agencies

or nonprofit or private organizations. For example, the Projects With

Industry (PWI) program may be administered through other public, private,

or nonprofit agencies.7

 Under these programs, federal agencies allocate

grants on the basis of the application or proposal submitted by an

organization or agency, which is then responsible for providing services.

Federal funds allocated through these programs provide support for

special projects in delivering disability services; others support research

or train state or local professionals to work more effectively with people

with disabilities. (See fig. 2.)

7

See app. III for details on this program.

Page 8 GAO/HEHS-96-126 Disability Programs
B-266310 

Figure 2: Distribution of Disability

Programs Providing Services—Directly

or Indirectly—to People With

Disabilities

25% • Direct - Individuals

23% • Indirect - Government Agencies

Only (Nonfederal)

48%•

Indirect - Any Nonfederal

Organization

•

4%

Other

Variety of Program

Funding Mechanisms

Influences the Distribution

of Funds to States

Although many federal programs have decentralized the provision of

services to state governments, the programs have adopted a variety of

funding mechanisms to do so, including funding formulas based on

different criteria as well as varying procedures for awarding grants. The

variation in these funding mechanisms affects the distribution of federal

funds to states. States may receive more or less money depending on the

size and characteristics of their targeted population as well as their

success in pursuing grants and other awarded monies. In our analysis of

statewide 1990 funding data for the eight wholly targeted employmentfocused programs and statewide 1990 census data, we found that the

disabled working-age population8

 as a percentage of the total working-age

population varied between 7 and 15 percent. Federal programs distributed

to states between $200 and $1,100 per working-age person with a

disability. Some states like Florida, Georgia, and South Carolina received

between $200 and $350 per working-age person with a disability; sparsely

populated states like Wyoming and Alaska received between $800 and

$1,100 per working-age person with a disability. (See app. IV.)

8

Includes any noninstitutionalized person between the ages of 16 and 64 who reported a work,

mobility, or personal care limitation.

Page 9 GAO/HEHS-96-126 Disability Programs
B-266310 

Federal Disability

Programs Confront

Extensive

Employment Needs of

People With

Disabilities

Promoting employment is one of the most important challenges

confronting federal assistance to people with disabilities. People with

disabilities constitute an underutilized workforce and a potential resource

to the U.S. economy. Surveys have estimated that 18 to 40 percent of

people with disabilities have jobs—far below the 73 percent of people

without impairments.9

 Yet in these surveys, most individuals with

disabilities indicated that their disability did not prevent them from

working. For example, although 8.2 percent of individuals were identified

as having a work disability in the 1990 census, only a little over half of

those said that they could not work.10

Increased employment would alleviate the poor economic condition of

people with disabilities, many of whom struggle to get by on marginal

resources. According to 1990 census estimates, 22 percent of working-age

people with disabilities live on or below the poverty line, and an additional

12 percent can be classified as “near poor” (with incomes between 101 and

150 percent of the poverty line).11 Not surprisingly, many people with

disabilities turn to public assistance. In 1992, approximately 3.5 million

disabled workers participated in the Social Security Administration’s (SSA)

DI program, and approximately 4 million people with disabilities

participated in the Supplemental Security Income (SSI) program. Aside

from Social Security income, census figures indicate that people with

disabilities were also more likely to receive other forms of public

assistance. Only 2 percent of working-age people without disabilities—

those aged 16 to 64—reported receiving public assistance income,

compared with 15 percent of working-age people with disabilities.12

9

Calculating the employment rate of people with disabilities depends on the particular survey and the

definition of disability that survey uses. For example, the 1990 census found that 18 percent of

individuals who identified themselves as having a mobility limitation were employed, and 33 percent of

those who said they are limited in the kind or amount of work they can do were employed. In a 1994

Louis Harris poll of 1,021 people who identified themselves as having a disability, 31 percent said they

were employed. For a discussion of the definitions of disability, see app. V.

10Many jobless people with disabilities also appear to want to work. When the 1994 Louis Harris survey

asked people with disabilities without jobs whether they would prefer to work, 42 percent said they

would prefer to work and would be able to do so.

11In comparison, the 1990 census reported that 10 percent of working-age people without disabilities

were living in poverty, and an additional 6 percent were near poor.

12Although the census asked separate questions about Social Security income and public assistance

income, some respondents may have confused the two and reported SSI or DI benefits as public

assistance. For this reason, these figures should be interpreted cautiously.

Page 10 GAO/HEHS-96-126 Disability Programs
B-266310 

Federal Government

Finances a Wide Range of

Services to Address Major

Employment Barriers

Our discussions with disability experts, consumers, and officials from

public and private agencies identified multiple barriers that contribute to

the relatively low employment rates for people with disabilities. Some of

the major employment barriers they identified are listed in table 1, which

also includes examples of federal efforts addressing each barrier.

Table 1: Examples of Employment

Barriers for People With Disabilities

and Federal Efforts Addressing These

Needs

Employment barriers

Examples of federal efforts addressing

this employment barrier

Low education levels IDEA and related programs, vocational

education, funding for Gallaudet

University, Department of Veterans Affairs

(VA) Vocational Rehabilitation

Limited skill training Vocational Rehabilitation, VA Vocational

Rehabilitation, JTPA

Lack of access to assistive technology Technology assistance programs,

Medicare and Medicaid, Vocational

Rehabilitation

Lack of access to employer-based health

insurance

No direct effortsa

Negative attitudes and employer

discrimination

Prohibition against discrimination by

federal contractors, state and local

governments, and private employers and

enforcement efforts

Lack of accessible transportation ADA, DOT funds for capital improvements,

VA funding for auto modifications

Work disincentives of income maintenance

programs

Plan to Achieve Self-Support (PASS)

program under SSA

Other employment barriers for specific

disability groups, for example,

communication issues for the deaf

Programs such as library services for the

blind and funding for higher education for

the deaf at Gallaudet University

Note: For more detailed descriptions of employment-focused programs, see app. III.

aADA does not allow employers to discriminate in hiring on the basis of individual employee

health insurance costs.

Employment Barriers Can

Limit Job Opportunities for

People With Disabilities

For many individuals with disabilities, employment barriers can restrict

the range of employment opportunities available. For example, the

40 percent of people with disabilities who have less than a high school

education may find the job market particularly difficult, especially with the

general decline in the number of lower skill jobs available in many

industries. According to 1990 census figures, people with disabilities were

nearly twice as likely to have less than a high school education (40 to

Page 11 GAO/HEHS-96-126 Disability Programs
B-266310 

21 percent); similarly, individuals without impairments were more than

twice as likely to have a college degree or more (21 to 9 percent).

In contrast, although a lack of skill training can limit employment

opportunities, access to appropriate technology can expand the range of

possibilities. In a National Council on Disability (NCD) report, users of

assistive technology reported that such equipment enabled them to work

more productively for more hours, increase their earnings, and either keep

their jobs or obtain employment.13 Obtaining access to supportive

technologies, however, is often difficult for many people with disabilities.

The Council reported that a person with severe disabilities may be

considered eligible for, and benefit from, more than 20 federal programs in

the area of assistive technology. Yet the report cites that the many

inconsistencies between and within these programs lead to an

extraordinary amount of confusion and frustration for individuals with

disabilities and their families. Moreover, even if a person is clearly eligible

for all services, he or she must negotiate multiple eligibility requirements—

perhaps including medical examinations, additional documentation, and

interviews with officials from multiple agencies—to get access to services

under several narrowly focused programs.

People with disabilities also face problems with accessing

nongovernment-supported health care due to preexisting conditions. For

example, while ADA does not allow employers to discriminate on the basis

of health care costs, the President’s Committee on Employment of Persons

With Disabilities cited employer discrimination in accessing

nongovernment-supported health insurance as a major employment

barrier. For example, employers, especially small businesses, may find

that sometimes the premiums for employee group health insurance will

increase significantly if an employee with a disability is included in the

policy. Although measuring the extent of discrimination is difficult, several

research studies have found that wages and hiring rates are lower for

individuals with disabilities than for those without impairments, even after

differences in education, experience, and other factors are accounted for.14

13Study on the Financing of Assistive Technology Devices and Services for Individuals with

Disabilities, National Council on Disability (Washington, D.C.: 1993).

14See Marjorie Baldwin and W. Johnson, “Labor Market Discrimination Against Men With Disabilities,”

Journal of Human Resources, Vol. 223, No. 1 (1994), pp. 1-19; Jean-Francois Ravaud, Beatrice Madiot,

and Isabelle Ville, “Discrimination Towards Disabled People Seeking Employment,” Social Science and

Medicine, Vol. 35, No. 8 (1992), pp. 951-58; and William G. Johnson and James Lambrinos, “Wage

Discrimination Against Handicapped Men and Women,” Journal of Human Resources, Vol. 20, No. 2

(1985) pp. 264-77.

Page 12 GAO/HEHS-96-126 Disability Programs
B-266310 

In addition to these barriers, people with disabilities face other obstacles

in taking advantage of available employment opportunities. For example,

many of the federal and state officials we spoke with, along with other

experts, identified the lack of accessible transportation as especially

problematic. The U.S. transportation system is heavily automobile based,

but people with disabilities are less able to rely on cars than individuals

without impairments. According to census data, 14 percent of people with

disabilities did not have an automobile in the household, compared with 6

percent of people without disabilities. Some disabilities (such as

blindness) make driving impractical; others require costly adjustments,

such as hand controls or a lift, to a standard automobile. In addition,

financial considerations may limit access to automobiles for many people

with disabilities, especially for the over 10 million people with disabilities

who reported incomes of less than $10,000 in 1990. The need to rely on

public transportation may especially restrict employment options for

people with disabilities who live in rural areas.

People with disabilities who rely on income support programs such as

Social Security DI or SSI may also be discouraged from attempting to work

by the prospect of losing their benefits, particularly their health insurance

coverage. Disability advocates and rehabilitation counselors believe that

the fear of losing medical coverage is one of the most significant barriers

to the participation of SSI and DI beneficiaries in the Vocational

Rehabilitation program, their return to work, or both.15 In recent years,

other initiatives have adopted additional procedures to mitigate these

work disincentives, but relatively few beneficiaries have taken advantage

of these provisions.

Despite Its

Importance,

Coordination Has

Been Difficult to

Achieve

Because people with disabilities may need a variety of services to seek or

retain employment, and with federal assistance dispersed among many

programs and agencies, coordination of these activities is especially

important. Programs and agencies may coordinate in different ways, from

sharing basic program information to establishing compatible eligibility

criteria to cooperating in service provision. (See table 2.)

15SSA Disability: Program Redesign Necessary to Encourage Return to Work (GAO/HEHS-96-62,

Apr. 24, 1996).

Page 13 GAO/HEHS-96-126 Disability Programs
B-266310 

Table 2: Types of Program

Coordination Type Definition

Informational Ensuring that program administrators are knowledgeable about the

requirements and services of related programs, enabling them to

better plan their activities, share information, overcome institutional

barriers, and help beneficiaries access appropriate resources from

other programs.

Eligibility Establishing similar, compatible eligibility requirements for programs

with overlapping target populations. Eligibility coordination and

streamlining documentation not only reduce the administrative burden

on participants, but also reduce the amount of program time required

to make assessments and process applications.

Service Enabling beneficiaries to have easy access to the services they need

to avoid duplication or service gaps. Interagency service linkages

enable agencies to ensure that individual programs support each

other.

Our review raised questions about the extent to which federal disability

programs achieve coordination in any of these areas. Many of the agencies

responsible for federal disability programs did not engage, or engaged very

little, in basic informational coordination either with each other, state and

local agencies, the private sector, or the disability community. Eligibility

coordination was also lacking; similarly, service coordination appeared to

be uncommon.

Coordination in any of these areas appeared to be a formidable task for

several reasons. First, many of the recent initiatives targeted to people

with disabilities added to or expanded an already existing program

structure organized to address the needs of nondisabled people. As a

result, administrators, particularly those who manage partially targeted

programs, often do not fully understand the needs of people with

disabilities16 and do not place a high priority on coordinating with

organizations serving their special needs. Second, many federal programs

rely on service providers at the state and local levels for direct service

delivery. In addition to the 130 federal programs overseen by 19 agencies

in 1994, states distributed program administration and authority to a

variety of agencies: state departments of employment and training; state

rehabilitation departments; state education departments; state

departments for the blind, deaf, or developmentally disabled; state health

departments; and others. Many of these different agencies also apply their

own eligibility criteria, creating even greater variation. One disability

researcher reported that when he surveyed states and asked which

departments provided disability-related services, he received almost as

16PASS Program: SSA Work Incentive for Disabled Beneficiaries Poorly Managed (GAO/HEHS-96-51,

Feb. 28, 1996).

Page 14 GAO/HEHS-96-126 Disability Programs
B-266310 

many different responses as there were respondents. Finally, federal and

state officials also identified turf battles, different orientations and

approaches, and competing program objectives as other impediments to

coordination.

Limited Communication

Exists Among Agencies

Serving People With

Disabilities

Although federal assistance to people with disabilities is dispersed among

many programs and service delivery agencies at the state and local level,

limited informational coordination exists among agencies about these

programs and how they fit together. Federal officials did not

systematically share program information and ongoing developments with

their counterparts at other federal, state, local, and nonprofit agencies or

with the private sector or the disability community. Some federal officials

we interviewed did not know of the existence of other federal programs

helping people with disabilities. Although others knew of these programs,

they seldom or never talked with agency officials from other programs nor

did they keep up with ongoing program developments.

Limited informational coordination by federal administrators was

common, particularly among those who manage partially targeted

programs. For example, one Labor official, commenting on the

department’s lack of outreach to the disability community, said that the

Department “does not even talk to its [disabled] customers.”17 Similarly,

we consistently heard from disability advocates, state and local officials,

service providers, and private employers that JTPA does not effectively

serve the needs of people with disabilities. State officials told us that, in

fact, some JTPA offices were situated in locations that were inaccessible to

people with mobility limitations.

One consequence of this limited informational coordination was the

difficulty people with disabilities experienced in getting reliable

information about federal services. In particular, although the majority of

SSI field offices and their staff reported that they spent time providing

program information, according to our 1991 study,18 state and local

officials told us that consumers often received inconsistent answers to

commonly asked questions about SSI, work, and rehabilitation. The lack of

consistent, accurate information about SSI, work, and rehabilitation could

17This observation is supported by the 1994 results of the Louis Harris survey. When asked how much

they knew about state or local job counseling and employment services for people with disabilities,

67 percent of the full-time students or job trainees with disabilities said they were either “not too

familiar” or “not familiar at all” with these services.

18Social Security: District Managers’ Views on Outreach for Supplemental Security Income Programs

(GAO/HRD 91-19FS, Oct. 30, 1990).

Page 15 GAO/HEHS-96-126 Disability Programs
B-266310 

magnify some of the work disincentives created by provisions of income

support programs. One consumer we interviewed stated that getting

answers to questions about work and rehabilitation was difficult because

SSI/DI administrators did not understand the needs that were specific to her

disability.19 She also told us that getting incomplete information made

employment a risky proposition because she could lose her health benefits

and not have the earning power to replace them.20

Lack of informational coordination also has negative consequences for

employers and service providers, both public and private. For example, in

some states, counselors from vocational rehabilitation programs do not

have access to job listings from agencies that administer employment and

training programs. The absence of such linkages for sharing information

can present undue burdens on employers. For example, without such

information sharing, counselors from separate agencies may

independently contact the same employer to develop employment

opportunities for people with disabilities. Having different service

providers—a vocational rehabilitation counselor, an employment training

specialist, a supported employment job developer, or a representative

from PWI—contact one employer can undermine the relationship between

service providers, employers, and the disability community.

Federal and State Agencies

Apply a Wide Range of

Eligibility Criteria

Eligibility coordination is similarly limited among federal programs and

agencies. Each federal program has congressionally authorized eligibility

and scope-of-service requirements. Differences in eligibility criteria can

make access to services a complex process, however, and could confuse

people with disabilities as well as those who serve them. We identified at

least 14 different definitions of disability used by federal programs alone,

and many of these definitions provided considerable agency and state

discretion in eligibility determination. For example, in assessing eligibility

for services, one program permitted each of its 300 field offices

considerable discretion in defining disability. State officials who serve

people with disabilities told us that the requirements for participating in

this program are very strenuous and a paper chase is required to apply.

19These statements were consistent with findings from another GAO study citing lack of awareness

and understanding about disability and rehabilitation issues among SSI staff (GAO/HEHS-96-51,

Feb. 28, 1996, pp. 22-23).

20For example, people with disabilities often cannot get health insurance through an employer because

of exclusions based on pre-existing conditions. To replace the lost health care and income support

from federal programs, a person with a disability would have to earn as much as $50,000 per year,

according to the President’s Committee on Employment of Persons With Disabilities.

Page 16 GAO/HEHS-96-126 Disability Programs
B-266310 

Even when programs may have well-defined criteria within their own

departments, these criteria may differ from those used by other agencies.

For example, programs administered through the Department of

Education, such as Vocational Education and Vocational Rehabilitation,

defined eligibility in terms of physical or mental impairments, whereas the

programs administered through Social Security (DI and SSI) defined

disability in terms of the inability to work. (See app. V.)

In addition to the federal eligibility definitions, many states have the

flexibility to develop and apply additional eligibility criteria and standards.

For example, according to federal officials, theoretically, each state can

have its own definition of developmental disabilities. State agencies may

use the federal definition of developmental disabilities or the state’s

definition. For someone to be eligible for services in one state, mental

retardation has to be the primary disability. Other states define

developmental disability in terms of intelligence quotient with differing

thresholds. A 1988 report from the Training and Research Institute for

People With Disabilities cited that among state agencies serving the

mentally retarded or developmentally disabled population, only 40 percent

evaluated their consumers using the relevant federal definitions and

standards and none of the state vocational rehabilitation agencies

evaluated their consumers according to federal criteria.21 We also found in

a recent study that state vocational rehabilitation agencies used criteria

that were more restrictive than federal standards in screening SSI/DI

participants.22 Restrictive standards allowed state rehabilitation agencies

to limit the referrals they receive from the Social Security offices to those

they considered to be the best rehabilitation candidates.

The wide variation in eligibility standards limits the possibilities for

linkages among programs, such as reciprocal referrals or eligibility

agreements, in which agencies or programs can establish that eligibility for

one program would expedite service provision from another. Such

linkages could reduce confusion and service delays to consumers, despite

the variation in eligibility, yet we found few examples of such reciprocal

agreements. For example, few linkages exist between state vocational

rehabilitation programs and federal or state employment and training

agencies. In our 1992 study of support services under JTPA, only 24 percent

21National Perspectives on Integrated Employment: State MR/DD Agency Trends, Training and

Research Institute for People With Disabilities, 1993.

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

Page 17 GAO/HEHS-96-126 Disability Programs
B-266310 

(131 of 557) of local organizations surveyed said that they had

coordination agreements with the state rehabilitation agencies.23

Although in many cases variation in eligibility requirements may be

appropriate or necessary, collectively these differences make federal

programs difficult for consumers to use. For example, in the area of

assistive technology, consumers testified at public forums convened by

NCD that one device or piece of equipment has to be defined in different

ways to meet eligibility requirements under different programs, each with

its own funding limitations. Different rules are further complicated by

differences in interpretating guidelines in an agency within a state and

across states. Even if a person is clearly eligible for all services, he or she

must negotiate multiple eligibility requirements—perhaps including

medical examinations, documentation, and interviews with officials from

multiple programs—to access services under several narrowly focused

programs. Routinely, people with disabilities must go to several different

offices to get services.

Similarly, different standards and criteria also increase costs for service

providers and can limit their participation. For example, an international

nonprofit organization that provides a variety of employment and

rehabilitation services for the disabled told us that some local chapters of

the organization choose not to participate in some programs that have a

federal and state component. These local chapters would prefer to spend

their resources on delivering services instead of negotiating different

processes in a variety of agencies.

Many Agencies Have Not

Coordinated Services for

People With Disabilities

Established, well-maintained service coordination among programs also

appears uncommon, resulting in inefficiencies and limiting private-sector

participation and support. For example, many experts believe that

increased access to regular fixed-route transportation facilitates the

employment of people with disabilities. Transportation continues to be

problematic, however, particularly in rural areas. Although different

federal and state programs provided separate transportation funding for

the elderly and the disabled, these services were not required to be

coordinated at the local level. Thus, federal and state officials told us that,

for example, in one county a half-empty van providing transportation for

the elderly and another half-empty van providing transportation for the

disabled may be traveling the same routes at the same time.

23Job Training Partnership Act: Actions Needed to Improve Participant Support Services

(GAO/HEHS-92-124, June 12, 1992).

Page 18 GAO/HEHS-96-126 Disability Programs
B-266310 

Poor service coordination can also discourage employer efforts to work

with programs and help people with disabilities. Private-sector partners

involved with government programs told us that service coordination is

essential for them. Officials from one corporate partner told us that having

a single point of contact—rather than having to deal with multiple

programs and administrators—is crucial to the company’s ability to

participate in a program employing individuals with psychiatric

disabilities. Another corporate official explained that lack of

responsiveness and service coordination among multiple employment

programs—along with reductions in financial incentives—contributed to

her company’s decision to discontinue its efforts to participate in job

training programs for the disadvantaged and for people with disabilities.

Broad-Based Efforts to

Reduce Fragmentation in

Federal Programs Have

Fallen Short

The diffusion of federal assistance to people with disabilities is not unique

to these programs, and efforts to address the resulting problems are not

new. For more than 30 years, the Congress, federal agencies, and others

have recognized that most public and private human service agencies are

organized to address a narrow range of issues and individuals.

Nevertheless, their periodic attempts to reorganize and reshape the way

human services are delivered have met with only marginal success.

Public and private officials from all levels of government and service

delivery have tried different approaches to change the way human services

are planned, funded, and administered. As we identified in a previous

study, however, broad-based efforts to eliminate fragmentation by creating

a new service delivery system have faced many obstacles and met with

limited success.24 Mandates alone are unlikely to secure the significant

time and resource commitments needed from officials to initiate and

sustain systemwide reform. In contrast, less ambitious efforts to improve

coordination among service providers have succeeded somewhat in

enhancing services. These efforts did not try to reorganize agencies’

administrative structures; they improved services by taking a more

modest, practical approach, focusing on the point of delivery and adapting

to local conditions. Specifically, they linked individuals, services, and

programs by (1) convincing service providers and officials of the need to

cooperate and developing incentives for them to participate in the effort,

(2) getting key participants to agree to the goals of the initiative and the

role of each party in implementing changes, and (3) establishing a forum

to institutionalize changes and continue ongoing communication.

24Integrating Human Services: Linking At-Risk Families With Services More Successful Than System

Reform Efforts (GAO/HRD-92-108, Sept. 24, 1992).

Page 19 GAO/HEHS-96-126 Disability Programs
B-266310 

Some State and Local

Initiatives Show Promise in

Improving Coordination

Some states have developed strategies that use the practical and modest

approach that we had previously identified as improving coordination. For

example, in California, one rural county we visited appeared to be

improving services and reducing program costs. Despite significant

barriers to coordination, state and local officials were improving

communication among service providers and linking people with

disabilities to the services they need in a comprehensive manner. Officials

reported that their coordination efforts had reduced time and expense for

administrators and consumers by 40 to 50 percent.

In this case, state and local officials created a collaborative forum—the

School-to-Work Interagency Transition Partnership (SWITP)—that uses

interagency linkages at the local level to help students with disabilities

successfully transition from school to work. Officials formed a transition

team composed of the student, parents, school counselors, representatives

from the local JTPA program, and the state vocational rehabilitation agency.

The team meets to identify a student’s employment goals and devises a

plan to tailor available services to the student’s aspirations for achieving

independent living. Representatives from almost all of the necessary

services usually attend the meeting, and they work with the student and

his family to identify priorities and overcome barriers. For example, one

student could not take needed computer classes because of a lack of

access to public transportation, but buying a car would have jeopardized

the student’s income maintenance and health care benefits. Because the

agencies were working together in a team format to coordinate services,

they quickly identified and implemented a solution.

Transition team members said that students liked being part of the team

because it gave them greater personal independence. One of the students

who participated in the transition team told us it had been indispensable in

guiding him from high school to independent living. The student had only

work experience as a janitor, but the team helped him to identify his skill

strengths and weaknesses as well as his own aspirations for other

vocations. School counselors provided insights about the student’s

disability, and the JTPA staff identified relevant training the student needed.

The end product of the meeting was a strategic plan, which gave the

employment specialist a basis on which to approach employers,

emphasizing the student’s skills and their benefits to employers. Despite

initial employer reluctance, the team placed the student temporarily for

on-the-job training and continued to support both the employer and the

student after the placement. The student’s enthusiasm and willingness to

learn impressed the employer, and, 4 years later, the student was still

Page 20 GAO/HEHS-96-126 Disability Programs
B-266310 

employed there as a custom upholsterer—at well above the minimum

wage.

Although SWITP’s comprehensive team assessment and planning process is

targeted to youth with disabilities, it mirrors the challenges and strategies

that have faced other programmatic efforts to improve services.25 Like

administrators of adolescent drug prevention programs, SWITP service

providers faced tasks of coordinating diverse external agency procedures,

documentation, and personalities. SWITP service providers noted that they

often need conflict management skills, a strong focus on the student’s

needs, and patience to overcome the turf concerns of specialized

professionals and their agencies to provide the full range of services

necessary for their participants. SWITP providers also found that

coordination was enhanced by using a master document containing the

information necessary for each agency to meet each program’s data

requirements. Although the master document does not replace all other

documentation, it condenses the multiple intake documents previously

required from students. In addition, service providers regularly consult

each other about changes in their programs and consumers, which has

enhanced their ability to follow up with their students long after they have

left the program. SWITP service providers reported strong support for the

process because it fosters trust (“we don’t feel threatened by one

another”), noting that this trust has given them greater flexibility in

helping their students achieve their goals.

States are also exploring other strategies to improve communication and

overcome organizational barriers. For example, Massachusetts has created

interagency agreements establishing forums in which state agency

personnel can discuss and systematically train each other about their

respective missions, procedures, standards, and target populations.

Nevada and Massachusetts have also reported arrangements for

exchanging electronic information between vocational rehabilitation and

employment and training agencies, which has facilitated reciprocal

referrals.

25Adolescent Drug Use Prevention: Common Features of Promising Community Programs

(GAO/PEMD-92-2, Jan. 16, 1992).

Page 21 GAO/HEHS-96-126 Disability Programs
B-266310 

Agencies Generally

Do Not Know If

Employment-Focused

Programs Are

Working Effectively

While the variety of programs and agencies engaged in serving people with

disabilities raises questions about the efficiency of federal efforts, the

effectiveness of these efforts is also unclear. Most of the 26 employmentfocused programs we examined have not been formally evaluated. For

many of the employment-focused programs, no statutory or agency data

collection requirements exist. Federal officials explained that few formal

evaluations have been conducted because of the lack of data collection,

limited resources, and in many instances the data collection problems

posed by federal and state program flexibility.

The absence of legislative and agency data collection requirements,

coupled with limited available resources, precludes effectiveness studies

for many of the programs we visited. Many of the agencies administering

these 26 employment-focused programs did not require or collect data on

program outcomes—specifically, data on whether participants got jobs

and kept them, what wages they received, and whether they received

employee benefits such as health insurance. For example, JTPA has no

statutory requirement for service delivery areas to report the

characteristics of the services delivered to people with disabilities or how

they are delivered. Program officials told us that, with the limited

resources of most agencies, they lack the capabilities to initiate data

collection efforts.

For some of the programs that did collect outcome data, the information

collected was not sufficient to adequately link outcomes to the services

provided. For example, although service providers for the Supported

Employment program provided detailed information on program

participant performance and initial placement, they were not required to

track consumers after an 18-month period, making any long-term

assessment of the linkage between training and employment difficult.

Without a concurrent effort to improve coordination at all service levels,

however, imposing reporting or assessment requirements may not improve

the basis for evaluation. Given the flexibility each state has in choosing its

own standards and definitions, outcome tracking can be a formidable task.

In many instances, service providers, both public and private, use different

intake data, eligibility criteria, paperwork requirements, software, and

confidentiality rules. Consequently, “people aren’t talking the same

language,” as one state official summarized, and considerable investments

would be required to develop more uniform documentation and data to

accommodate the many definitions and standards used. For example,

different agencies and organizations at the state level provide funds for

Page 22 GAO/HEHS-96-126 Disability Programs
B-266310 

supported employment services. Federal officials told us, however, that

mental health agencies have a different definition of services that

constitute supported employment than do the vocational rehabilitation

agencies. Without better coordination, data collection and tracking will

remain a costly endeavor, and program administrators will lack

confidence that their programs are effective, either individually or in

combination with other services.

The Congress has in the past directed agencies involved in research and

evaluation of programs serving people with disabilities to improve their

coordination. For example, according to a report from the Office of

Technology Assessment (OTA), Education’s Rehabilitation Services

Administration signed a memorandum of understanding in 1993 with other

agencies involved in similar research and evaluation.26 The memorandum

was intended to initiate collaboration of service delivery, staff training,

and evaluation activities for the rehabilitation and employment of people

with psychiatric disabilities. Similarly, the National Task Force on

Rehabilitation and Employment of Psychiatric Disabilities tried to

promote collaboration in the research and evaluation of federal

rehabilitation and employment efforts. The task force met quarterly for 3

years, but attendance declined significantly, with many members

complaining about its voluntary nature and limited impact on policies. The

OTA report stated that experts and advocates commented to them that such

efforts had achieved only mixed success, leading to OTA’s conclusion that

“while mechanisms for communicating across agencies have or do exist,

they lie moribund at the present time.”

Conclusion Our review raises questions about the efficiency of federal efforts to help

people with disabilities. In 1994, the federal government provided a broad

range of services to people with disabilities through 130 different

programs, 19 federal agencies, and a multitude of public and private

agencies at the state and local levels. Although research groups and

independent panels have stressed the need to simplify and streamline

programs serving people with disabilities, suggestions for creating a new

system to deliver services may be difficult to implement. In 1992, we urged

caution when the Congress considered initiatives for federal, state, and

local organizations to make fundamental changes in human service

delivery systems, and we also urge caution for programs serving people

with disabilities. Although the potential benefits of creating a new system

26Psychiatric Disabilities, Employment, and the Americans With Disabilities Act, Office of Technology

Assessment (Washington, D.C.: Mar. 1994).

Page 23 GAO/HEHS-96-126 Disability Programs
B-266310 

to deliver services more comprehensively to people with disabilities may

be great, so are the barriers and the risks of failure. Obstacles preventing

officials from reorganizing service agencies, creating new funding and

service agreements, and divesting authority from their own agencies are

difficult to overcome. Mandates alone are unlikely to secure the significant

time and resource commitments needed from officials—whether they are

charged with directing reforms or have responsibility for administering

services.

In the current fiscal environment, a renewed focus by federal agencies on

improving coordination would be a useful step toward improving services

and enhancing the customer orientation of their programs. Given the

multifaceted federal effort, better coordination is crucial to any strategy to

eliminate duplication and service gaps and to enhance the efficiency of

programs administered by the many public agencies at all levels of

government. Without such an effort, assessing the impact of the federal

commitment to people with disabilities and the relevance of improvement

measures, such as program consolidation, becomes virtually impossible.

We have identified several state and local initiatives that have shown

promise in meeting the challenges of coordination; other initiatives most

likely exist throughout the nation. These efforts appear to have succeeded

somewhat in reducing duplication and service gaps, while saving agencies

money. In light of these initiatives, the major Departments serving people

with disabilities—Education, Labor, and Health and Human Services

(HHS)—have an opportunity to identify, encourage, support, and learn from

the innovative solutions being developed at the state and local levels.

Agency Comments The Departments of Labor, Education, and Transportation provided

comments on our draft report, agreeing with our findings and conclusions.

(See app. VI for a copy of written comments from the Department of

Labor.) Each of these agencies also provided technical comments, which

we incorporated in the report as appropriate. HHS did not provide

comments on the report within the time available.

Page 24 GAO/HEHS-96-126 Disability Programs
B-266310 

As arranged with your office, we are sending copies of this report to the

Secretaries of Labor, Education, and Health and Human Services. GAO

contacts and staff acknowledgments for this report appear in appendix

VII. Please call me on (202) 512-7014 if you or your staff have any

questions.

Sincerely yours,

Carlotta C. Joyner

Director, Education and

 Employment Issues

Page 25 GAO/HEHS-96-126 Disability Programs
Contents

Letter 1

Appendix I 

Objectives, Scope,

and Methodology

30

Identifying Federal Programs That Target People With

Disabilities

31

Identifying Information on Program Expenditures 32

Appendix II 

Federal Programs

Targeting People With

Disabilities

34

Appendix III 

Federal Employment

Initiatives Targeted to

People With

Disabilities

61

Federal Efforts to Promote Competitive Employment Include

Legislative Mandates and Partially and Fully Targeted Programs

61

Federal Financing for Supported Employment Is Limited 67

Federal Government Provides Indirect Support for Sheltered

Workshops

68

Appendix IV 

Geographic

Distribution of

Expenditures for

Selected Wholly

Targeted,

Employment-Focused

Programs

70

Many Wholly Targeted, Employment-Focused Programs

Distribute Benefits Through State or Nonprofit Agencies

72

People With Disabilities as a Percentage of the Working-Age

Population Generally Highest in Southern States

73

Distribution of Federal Funds for Employment-Focused

Programs Differs From That of Working-Age People With

Disabilities

75

Data Limitations of This Analysis 77

Page 26 GAO/HEHS-96-126 Disability Programs
Contents

Appendix V 

Definitions of

Disability and

Population Estimates

of People With

Disabilities

78

Disability Is Difficult to Define and Measure 78

Disability Is Most Commonly Defined by Measures of Functional

Limitation

79

Disability Sometimes Defined as the Presence of Specific

Conditions

81

Other Disability Definitions Are Less Commonly Used 82

Appendix VI 

Comments From the

Department of Labor

87

Appendix VII 

GAO Contacts and

Staff

Acknowledgments

91

Bibliography 92

Related GAO Products 96

Tables Table 1: Examples of Employment Barriers for People With

Disabilities and Federal Efforts Addressing These Needs

11

Table 2: Types of Program Coordination 14

Table II.1: Federal Programs Targeting People With Disabilities 36

Table IV.1: Federal Expenditures of Eight Wholly Targeted,

Employment-Focused Programs, in 1990

71

Table V.1: Examples of Different Definitions of Disability, by

Source and Type

83

Table V.2: Estimated Disability Prevalence in the United States,

1990-93

85

Figures Figure 1: Employment Focus of Federal Disability Programs in

1994

6

Figure 2: Distribution of Disability Programs Providing

Services—Directly or Indirectly—to People With Disabilities

9

Page 27 GAO/HEHS-96-126 Disability Programs
Contents

Figure IV.1: People With Disabilities as a Percentage of the

Working-Age Population

74

Figure IV.2: Expenditures on Employment-Focused Programs per

Working-Age Person With a Disability

76

Abbreviations

ADA Americans With Disabilities Act

ADL activities of daily living

CFDA Catalog of Federal Domestic Assistance

CFFR Consolidated Federal Funds Report

CPS Current Population Survey

DI Disability Insurance

DOT Department of Transportation

ES employment service

HHS Department of Health and Human Services

HUD Department of Housing and Urban Development

IADL independent activities of daily living

IDEA Individuals With Disabilities Education Act

JAN Job Accommodation Network

JTPA Job Training Partnership Act

NCD National Council on Disability

NHIS National Health Interview Survey

OTA Office of Technology Assessment

PASS Plan to Achieve Self-Support

PWI Projects With Industry

SBA Small Business Administration

SIPP Survey of Income and Program Participation

SSA Social Security Administration

SSI Supplemental Security Income

SWITP School-to-Work Interagency Transition Partnership

TJTC Targeted Jobs Tax Credit

VA Department of Veterans Affairs

WHO World Health Organization

Page 28 GAO/HEHS-96-126 Disability Programs
Page 29 GAO/HEHS-96-126 Disability Programs
Appendix I 

Objectives, Scope, and Methodology

This report identifies and describes federal programs designed to assist

people with disabilities, with a special emphasis on programs promoting

employment. Specifically, we focused on the following questions:

(1) Which federal programs target people with disabilities, and how many

of these programs provide employment-related services? (2) To what

extent are information, eligibility, and services coordinated under these

programs? (3) What does available evidence suggest about the efficiency

or effectiveness of federal programs in promoting employment among

people with disabilities?

To accomplish these objectives, we integrated evidence from the

literature, from analyses of available databases, and from interviews with

consumers and public and private organizations. We interviewed officials

of federal agencies that administer programs targeted to people with

disabilities. We also interviewed disability advocates; officials of nonprofit

groups; and state and local officials in Massachusetts, California, Virginia,

and Nevada. We chose these states on the basis of expert opinions and

agency officials to obtain a variety of geographic locations, program sizes,

and administrative structures. In addition, we interviewed consumers and

several private-sector participants in several of these states to obtain their

perspectives on how these programs promote employment of people with

disabilities. We reviewed the literature on labor economics and

employment programs, generally, and on people with disabilities, in

particular, to obtain information on the problems and employment

barriers such individuals face and on federal efforts to surmount these

barriers. We also reviewed agency documents and legislation to help

determine the purpose, eligibility requirements, and services authorized

under these programs.

To profile the population of people with disabilities, we used several

databases. In addition to relying on previously published results from the

Current Population Survey (CPS), the Survey of Income and Program

Participation (SIPP), and the 1995 National Organization on Disability/Louis

Harris Survey on Employment of Persons With Disabilities, we analyzed

information from the 1990 census and from the 1993 National Health

Interview Survey (NHIS). Our estimates from the 1990 census were based

on a 5-percent subset of the full census sample—approximately 15.9

percent of all U.S. housing units consisting of over 12 million people and

5 million housing units. These households received the long form of the

census questionnaire, which collects detailed information on many

variables, including several different ways of measuring disability status.

The 1993 NHIS is a personal interview household survey using a nationwide

Page 30 GAO/HEHS-96-126 Disability Programs
Appendix I 

Objectives, Scope, and Methodology

sample of 109,671 civilian noninstitutionalized people in the United States.

The two surveys differ in the content of their disability-related questions

as well as in the other information gathered. For example, NHIS was useful

in estimating the prevalence of chronic conditions, information the census

does not gather. The census database provided more precise information

on the geographic distribution of people with disabilities.

Identifying Federal

Programs That Target

People With

Disabilities

The major sources used to identify federal programs were the Catalog of

Federal Domestic Assistance (CFDA), agency documents, and interviews

with federal officials. We defined a federal program as a function of a

federal agency that provides assistance or benefits27 to a state or states,

territorial possession, county, city, other political subdivision, or grouping

or instrumentality thereof; or to any domestic profit or nonprofit

corporation, institution, or individual, other than an agency of the federal

government. We defined the scope of our review to include those

programs meeting one or more of the following criteria: (1) people with

disabilities are specifically mentioned in the legislation as a targeted

group; (2) people are eligible for the program wholly or partially because

of a disability; (3) people with disabilities are given special consideration

in eligibility assessments; or (4) program officials are directed to give

priority to serving people with disabilities. In general, we included all

programs that explicitly recognized disability or handicap, regardless of

how (or whether) the program or legislation defined disability.

Programs that serve individuals without respect to disability but that serve

some individuals with disabilities (for example, Aid to Families With

Dependent Children) are beyond the scope of this report. We also omitted

those programs that exclusively funded medical research. Our definition

of federal programs also excluded federal legislation that does not

authorize the direct expenditure of federal funds but instead provides

indirect support or imposes mandates on federal or nonfederal entities.

For example, the Javits-Wagner-O’Day Act of 1971 authorizes federal

agencies to procure selected goods and services from sheltered

workshops for blind or severely disabled individuals.28 Although we

excluded these types of federal efforts from our analysis of federal

27Our definition of a program is consistent with that of the CFDA, which states that assistance or

benefits includes any activity, service, or anything of value, the principal purpose of which is to

accomplish a public purpose authorized by federal statute.

28This act was an amendment to the Wagner-O’Day Act of 1938, which authorized purchases from

sheltered workshops for blind individuals.

Page 31 GAO/HEHS-96-126 Disability Programs
Appendix I 

Objectives, Scope, and Methodology

programs, we described some of the most important of these efforts in the

report.

To analyze in more detail those programs that affect employment issues,

we divided these federal programs into three groups: (1) employmentfocused programs that provide services such as job training, supported

employment, job placement, and employment counseling;

(2) employment-related programs that provide services that could reduce

barriers to employment—such as transportation, health care, or assistive

technology; (3) programs unrelated to employment that provide services

that are unconnected (or could have only a remote connection) to

employment—such as services to infants and toddlers.

Identifying

Information on

Program

Expenditures

We gathered information on 1990 and 1994 expenditures using the

Consolidated Federal Funds Report (CFFR) compiled by the Bureau of the

Census. The CFFR tracks the majority of federal domestic outlays and is the

best information available on expenditures or obligations. For some

programs, agencies had not reported information to the Census Bureau;

we attempted to gather the information from the agencies. In other cases,

this information was not available. For many of these cases, the agency

performed the program’s activity in conjunction with other agency

activities, and we could not distinguish funds spent for one activity from

funds spent for the other. For this reason, our estimates of total

expenditures on disability-related programs are likely to be

underestimated. In addition, our estimates reflect federal outlays only and

exclude any supplements from states and localities. (These estimates,

which appear in table II.1 in app. II, reflect the federal

expenditures/obligation for the entire program unless noted otherwise.)

Many federal programs are partially targeted toward people with

disabilities—that is, the programs target multiple groups of individuals,

with people with disabilities being only one and not necessarily the most

important one. For some of these programs, agency officials track

program expenditures by target group. For example, the Health Care

Financing Administration tracks Medicare expenditures for the aged and

for the disabled. Many partially targeted programs, however, do not track

expenditures by targeted group. For example, the Transportation

Department’s Federal Transit Administration finances public transit

systems, along with capital improvement funds to make mass transit more

accessible to people with disabilities. Agency officials have found it

impractical to track disability-related expenditures under this program,

Page 32 GAO/HEHS-96-126 Disability Programs
Appendix I 

Objectives, Scope, and Methodology

particularly since it is impossible to know riders’ disability status and

whether or not they are using public transportation for work or some

other activity. Because we could not distinguish expenditures under many

partially targeted programs, we created an interval estimate of disabilityrelated expenditures. At the lower bound, none of the expenditures for

these programs were included; at the upper bound, all expenditures for

these programs were included.

Page 33 GAO/HEHS-96-126 Disability Programs
Appendix II 

Federal Programs Targeting People With

Disabilities

This appendix presents an overview in table II.1 of the 130 federal

programs that we identified as targeted to people with disabilities.29 Each

program’s administering department or agency, services, and the

individuals or groups who ultimately benefit from these services are

included. Each program’s 1994 funding, the degree of targeting, and the

type of applicant are also included. The order we used to list programs

corresponds to the five-digit program identification number assigned by

the Catalog of Federal Domestic Assistance (CFDA).

The first column of table II.1 contains the CFDA five-digit program

identification number. The first two digits identify the federal department

or agency that administers the program, and the last three digits are

unique codes identifying a program. For example, programs starting with

“14” are administered by the Department of Housing and Urban

Development (HUD) and those starting with “96” by the Social Security

Administration (SSA). For programs not listed in the CFDA, the table uses

the alphanumeric code the Bureau of the Census has assigned. For

example, Funding for the American Printing House for the Blind is

allocated through the Department of Education. All Education programs

start with “84” as a program identification, and the additional alpha codes

“JJJ” or “JAW” are assigned by the Bureau of the Census. Column 2

identifies the descriptive title listed in the CFDA. Column 3 shows the

federal department, agency, commission, council, or instrumentality of the

government with direct responsibility for program management.

Column 4 provides the most prominent services authorized under each

program. Although other services may also be available, the table cites

those services relevant to people with disabilities.

Column 5 describes the ultimate beneficiaries of federal assistance.

Although other groups or individuals may benefit from a program, the

table only describes characteristics relevant to people with disabilities.

Column 6 shows information about targeting: All programs that are

partially targeted have a “P” in column 6. A partially targeted program is

one that serves people with disabilities and others; a wholly targeted

program provides assistance only to people with disabilities. Programs

with a “W” in this column are considered wholly targeted.

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

Page 34 GAO/HEHS-96-126 Disability Programs
Appendix II 

Federal Programs Targeting People With

Disabilities

Column 7 shows federal expenditures and/or obligations for the entire

program in 1994, unless noted otherwise.30 Broadly, the CFDA specifies

three categories of federal assistance: financial, nonfinancial, or a

combination of both. For programs that provide any financial assistance,

the table shows the total amount spent or obligated in 1994 as identified

through the Bureau of the Census. Programs that provide nonfinancial

assistance have “NF” in column 7 because the census only tracks financial

assistance for each program. Some programs have “NA” in column 7

because expenditure information was unavailable.31

Column 8 identifies the applicant for each program. The CFDA defines

applicants as any entity or individual eligible to receive funds from a

federal program. Generally, the applicant and the beneficiary will be the

same individual or group for programs that provide assistance directly

from a federal agency. However, financial assistance that passes through

state or local governments will have different applicants and beneficiaries.

We classified applicants into the following five groups: individuals,

nonfederal governmental entities, nongovernmental entities, other, and the

general public.

30Agencies responsible for many of the partially targeted programs could not separate programs

expenditures/obligations into disability-related and nondisability-related categories.

31See app. I for details about this database.

Page 35 GAO/HEHS-96-126 Disability Programs
Appendix II 

Federal Programs Targeting People With

Disabilities

Table II.1: Federal Programs Targeting

People With Disabilities

Program number Program title

Department or

agencya Services

B

e

10.415 Rural Rental Housing Loans USDA Housing L

f

a

d

a

14.135 Mortgage

Insurance—Rental and

Cooperative Housing for

Moderate Income Families,

Elderly, Market Interest Rate

HUD Housing T

p

d

14.138 Mortgage

Insurance—Rental Housing

for the Elderly

HUD Housing T

p

d

14.170 Congregate Housing

Services

HUD Housing, food, and

other

T

p

d

14.181 Supportive Housing for

People With Disabilities

HUD Housing V

a

d

d

c

i

14.182 Section 8 New Construction HUD Housing V

f

i

p

d

14.235 Supportive Housing

Demonstration Program

HUD Housing H

i

f

t

14.238 Shelter Plus Care HUD Housing and

support services

H

e

d

14.407 Architectural Barriers Act

Enforcement

HUD Investigation of

complaints

I

a

c

14.414 Non-Discrimination on the

Basis of Disability by Public

Entities

HUD Investigation of

complaints

I

d

a

c

c

h

Page 36 GAO/HEHS-96-126 Disability Programs
Appendix II 

Federal Programs Targeting People With

Disabilities

Applicant

Beneficiary

eligibilityb

Targeting

P=partial

W=wholly

Expenditures or

obligations for

1994 (in dollars) Individuals

Nonfederal

government

entitiesc

Nongovernmental

entitiesd Othere

General

publicf

Low-income

families, the elderly,

and people with

disabilities in rural

areas

P 512,374,225 X X X

The elderly and

people with

disabilities

P 396,179,600 X X

The elderly and

people with

disabilities

P 3,913,500 X X

The elderly and

people with

disabilities

P 6,059,000 X X

Very low income

and physically or

developmentally

disabled or

chronically mentally

ill

W 26,230,293 X

Very low-income

families and lower

income single

persons with a

disability

P 199,107 X

Homeless

individuals and

families, especially

those with disabilities

P 103,056,242 X X

Homeless people,

especially those with

disabilities

P 1,665,292 X

Individuals with

accessibility

complaints

W NFg X

Individuals with

discrimination or

accessibility

complaints

concerning public

housing

W NF X

(continued)

Page 37 GAO/HEHS-96-126 Disability Programs
Appendix II 

Federal Programs Targeting People With

Disabilities

Program number Program title

Department or

agencya Services

B

e

16.101 Equal Employment

Opportunity

Justice Investigation of

complaints

information

I

d

c

16.105 Civil Rights of

Institutionalized Persons

Justice Investigation of

complaints

information

I

i

16.108 Americans With Disabilities

Act Technical Assistance

Program

Justice Information P

d

a

g

p

o

17.207 Employment Service Labor Job training and/or

placement

assistance

J

p

w

17.248 Employment and Training

Research and

Demonstration Projects

Labor Research R

17.249 Employment Services and

Job Training—Pilot and

Demonstration Programs

Labor Job training and

other related

services

J

i

l

d

i

17.250 Job Training Partnership Act Labor Job training and

other related

services

J

i

l

d

i

17.301 Non-Discrimination and

Affirmative Action by

Federal Contractors and

Federally Assisted

Construction Contractors

Labor Legal assistance I

d

c

f

17.302 Longshore and Harbor

Workers’ Compensation

Labor Income support L

h

i

o

17.307 Coal Mine Workers’

Compensation

Labor Income support D

m

o

d

17.801 Disabled Veterans

Outreach Program

Labor Job training and/or

placement

assistance

D

s

Page 38 GAO/HEHS-96-126 Disability Programs
Appendix II 

Federal Programs Targeting People With

Disabilities

Applicant

Beneficiary

eligibilityb

Targeting

P=partial

W=wholly

Expenditures or

obligations for

1994 (in dollars) Individuals

Nonfederal

government

entitiesc

Nongovernmental

entitiesd Othere

General

publicf

Individuals with

discrimination

complaints

P NF X

Institutionalized

individuals

P NF X

People with

disabilities, state

and local

governments, and

profit and nonprofit

organizations

W 1,611,240 X X

Job seekers, with

priority to people

with disabilities

P 905,562,244 X

Researchers P 7,292,013 X X

Job seekers with low

income and/or other

labor market

disadvantages,

including disability

P NA X X X

Job seekers with low

income and/or other

labor market

disadvantages,

including disability

P 2,617,524,315 X

Individuals with

discrimination

complaints involving

federal contractors

P NF X

Longshore and

harbor workers

injured or disabled

on the job

W 7,279,539 X

Disabled coal

miners, widows, and

other surviving

dependents

W 534,304,493 X

Disabled veterans

seeking jobs

W 85,100,000 X

(continued)

Page 39 GAO/HEHS-96-126 Disability Programs
Appendix II 

Federal Programs Targeting People With

Disabilities

Program number Program title

Department or

agencya Services

B

e

17.802 Veterans Employment

Program

Labor Job training and

other related

services

V

s

d

o

r

v

20.106 Airport Improvement

Program

DOT Transportation A

o

a

c

20.500 Federal Transit Capital

Improvement Grants

DOT Transportation P

a

t

c

20.513 Capital Assistance Program

for Elderly Persons and

Persons With Disabilities

DOT Transportation E

w

27.005 Federal Employment for

Individuals With Disabilities

OPM Placement

assistance;

information

P

d

30.011 Employment

Discrimination—Title 1 of

the Americans With

Disabilities Act (ADA)

EEOC Investigation of

complaints

P

d

d

c

30.012 Employment

Discrimination— Title 1 of

the ADA Technical

Assistance

EEOC Information P

d

a

g

p

o

42.001 Books for the Blind and

Physically Handicapped

LC Books on tape,

braille, large type,

etc.

B

p

p

47.041 Engineering Grants NSF Research R

s

w

a

d

53.001 Employment Promotion of

People With Disabilities

PCEPD Technical

assistance and

training

P

d

a

o

59.021 Handicapped Assistance

Loans

SBA Business loans to

individuals and

sheltered

workshops

N

w

h

o

Page 40 GAO/HEHS-96-126 Disability Programs
Appendix II 

Federal Programs Targeting People With

Disabilities

Applicant

Beneficiary

eligibilityb

Targeting

P=partial

W=wholly

Expenditures or

obligations for

1994 (in dollars) Individuals

Nonfederal

government

entitiesc

Nongovernmental

entitiesd Othere

General

publicf

Veterans with

service-connected

disability, veterans

of Vietnam era, or

recently separated

veterans

P 11,965,306 X X

Airport authorities or

organizations;

airport users to

comply with ADA

P 1,686,906,685 X X

Public transit

agencies; public

transit users to

comply with ADA

P 2,000,959,999 X X

Elderly and people

with disabilities

P NA X

People with

disabilities

W NF X

People with

disabilities who have

discrimination

complaints

W NF X

People with

disabilities, state

and local

governments, and

profit and nonprofit

organizations

W NF X X X X

Blind and other

physically disabled

people

W NF X

Researchers, with

some preference to

women, minorities,

and people with

disabilities

P 352,933,495 X X X X

People with

disabilities, public

and private

organizations

W 1,068,000 X X X X

Nonprofit sheltered

workshops or

handicappedowned businesses

W 9,784,823 X

(continued)

Page 41 GAO/HEHS-96-126 Disability Programs
Appendix II 

Federal Programs Targeting People With

Disabilities

Program number Program title

Department or

agencya Services

B

e

59.038h Veterans Loan Program SBA Business loans S

o

V

v

w

64.007 Blind Rehabilitation Centers

and Clinics

VA Medical and

support services

B

64.008 Veterans Domiciliary Care VA Medical and

support services

L

v

d

64.009 Veterans Hospitalization VA Medical and

support services

L

v

v

n

c

d

64.010 Veterans Nursing Home

Care

VA Medical and

support services

L

v

v

s

d

64.011 Veterans Outpatient Care VA Medical care C

w

64.013 Veterans Prosthetic

Appliances

VA Medical care V

d

64.014 Veterans State Domiciliary

Care

VA Medical care V

d

64.015 Veterans State Nursing

Home Care

VA Medical care V

d

64.016 Veterans State Hospital

Care

VA Medical care V

d

64.100 Autos and Adaptive

Equipment for Certain

Disabled Vets and

Members of Armed Forces

VA Transportation S

a

d

64.104 Pension for

NonService-Connected

Disability for Veterans

VA Income support V

d

64.106 Specially Adapted Housing

for Disabled Veterans

VA Housing V

d

64.109 Veterans Compensation for

Service-Connected

Disability

VA Income support V

s

d

Page 42 GAO/HEHS-96-126 Disability Programs
Appendix II 

Federal Programs Targeting People With

Disabilities

Applicant

Beneficiary

eligibilityb

Targeting

P=partial

W=wholly

Expenditures or

obligations for

1994 (in dollars) Individuals

Nonfederal

government

entitiesc

Nongovernmental

entitiesd Othere

General

publicf

Small businesses

owned by

Vietnam-era

veterans or veterans

with disability

P 12,613,135 X

Blind veterans W NF X

Low-income

veterans with

disabilities

W NF X

Low-income

veterans and

veterans with

nonserviceconnected

disabilities

P NF X

Low-income

veterans and

veterans with

service-connected

disabilities

P NF X

Certain veterans

with disabilities

P NF X

Veterans with

disabilities

W NF X

Veterans with

disabilities

W 17,544,609 X

Veterans with

disabilities

W 136,206,330 X

Veterans with

disabilities

W 4,338,955 X

Service members

and veterans with

disabilities

W 24,990,946 X

Veterans with

disabilities

W 2,225,579,347 X

Veterans with

disabilities

W 8,044,137 X

Veterans with

service-connected

disabilities

W 10,976,393,239 X

(continued)

Page 43 GAO/HEHS-96-126 Disability Programs
Appendix II 

Federal Programs Targeting People With

Disabilities

Program number Program title

Department or

agencya Services

B

e

64.116 Vocational Rehabilitation for

Disabled Veterans

VA Job training and/or

placement

assistance

C

w

s

d

64.118 Veterans Housing—Direct

Loans for Disabled Veterans

VA Adapted housing

loans

C

w

p

d

64.123 Vocational Training for

Certain Veterans Receiving

VA Pensions

VA Job training and/or

placement

assistance

C

V

p

81.042 Weatherization Assistance

for Lower-Income Persons

Energy Financial

assistance to

weatherize homes

L

h

s

t

p

d

84.009i Chapter 1 Assistance to

States for Children With

Disabilities

Education Education C

d

a

o

-

84.023 Special

Education—Innovation and

Development

Education Education C

w

84.024 Early Education for Children

With Disabilities

Education Education C

d

a

84.025 Services for Children With

Deaf-Blindness

Education Education D

a

84.026 Media and Captioning

Services for Individuals With

Disabilities

Education Media and

captioning

I

d

84.027 Special Education—Grants

to States

Education Education C

d

84.028 Special

Education—Regional

Resource Centers

Education Information C

w

i

i

84.029 Special

Education—Personnel

Development and Parent

Training

Education Training for

disability

professionals

S

p

a

d

p

Page 44 GAO/HEHS-96-126 Disability Programs
Appendix II 

Federal Programs Targeting People With

Disabilities

Applicant

Beneficiary

eligibilityb

Targeting

P=partial

W=wholly

Expenditures or

obligations for

1994 (in dollars) Individuals

Nonfederal

government

entitiesc

Nongovernmental

entitiesd Othere

General

publicf

Certain veterans

with

service-connected

disabilities

W 2,690,171,145 X

Certain veterans

with specific

permanent and total

disabilities

W NA X

Certain recipients of

VA disability

pensions

P NA X

Low-income

households, with

special emphasis on

the elderly and

people with

disabilities

P 206,552,044 X X

Children with

disabilities through

age 21 in stateoperated or

-supported schools

W 113,432,639 X

Children and youth

with disabilities

W 18,856,693 X X

Children with

disabilities aged 8

and under

W 19,010,910 X X

Deaf-blind children

and young adults

W 12,312,577 X X

Individuals with

disabilities

W 12,366,277 X X

Children with

disabilities

W 2,659,361,647 X

Children and youth

with disabilities;

individuals seeking

information

W 6,778,000 X X

Special education

personnel; children

and youth with

disabilities and their

parents

W 104,492,784 X X

(continued)

Page 45 GAO/HEHS-96-126 Disability Programs
Appendix II 

Federal Programs Targeting People With

Disabilities

Program number Program title

Department or

agencya Services

B

e

84.030 Clearinghouses for

Individuals With Disabilities

Education Information I

d

i

i

84.034 Library Services Education Library materials

and related

support

I

d

o

i

s

84.048 Vocational

Education—Basic Grants to

States

Education Education I

v

p

s

s

i

w

84.078 Post-Secondary Education

Programs for Persons With

Disabilities

Education Education I

d

s

p

e

84.086 Special

Education—Program for

Severely Disabled Children

Education Education C

w

d

84.125 Clearinghouse on Disability

Information

Education Information I

o

s

a

i

84.126 Rehabilitation

Services—Vocational

Rehabilitation Grants to

States

Education Job training and/or

placement

assistance

P

d

84.128 Rehabilitation

Services—Service Projects

Education Job training and/or

placement

assistance

P

d

84.129 Rehabilitation Long-Term

Training

Education Job training and/or

placement

assistance

R

p

84.132 Centers for Independent

Living

Education Independent living I

s

84.133 National Institute on

Disability and Rehabilitation

Research

Education Research R

i

d

Page 46 GAO/HEHS-96-126 Disability Programs
Appendix II 

Federal Programs Targeting People With

Disabilities

Applicant

Beneficiary

eligibilityb

Targeting

P=partial

W=wholly

Expenditures or

obligations for

1994 (in dollars) Individuals

Nonfederal

government

entitiesc

Nongovernmental

entitiesd Othere

General

publicf

Individuals with

disabilities;

individuals seeking

information

W 2,149,639 X X

Individuals with

disabilities and

others with

inadequate library

service

P 82,056,525 X

Individuals in

vocational education

programs, with

special priority to

several groups,

including individuals

with disabilities

P 941,065,735 X

Individuals with

disabilities in

selected

postsecondary

education programs

W 8,701,278 X X

Children and youths

with severe

disabilities

W 8,945,872 X X

Individuals and

organizations

seeking information

about disability

issues

W NF X

People with

disabilities

W 2,029,629,738 X

People with

disabilities

W 20,918,755 X X

Rehabilitation

professionals

W 25,133,000 X X

Individuals with

significant disabilities

W 36,483,522 X X

Researchers;

individuals with

disabilities

W 66,552,586 X X X

(continued)

Page 47 GAO/HEHS-96-126 Disability Programs
Appendix II 

Federal Programs Targeting People With

Disabilities

Program number Program title

Department or

agencya Services

B

e

84.158 Secondary Education and

Transitional Services for

Youth With Disabilities

Education Education Y

d

84.159 Special Education—Special

Studies for Persons With

Disabilities

Education Research R

i

d

e

a

84.160 Training Interpreters for

Individuals Who Are Deaf

and Individuals Who Are

Deaf-Blind

Education Training for

disability

professionals

I

o

a

i

84.161 Rehabilitation

Services—Client Assistance

Program

Education Information,

independent living

I

d

84.169 Independent Living—State

Grants

Education Independent living I

d

84.173 Special

Education—Preschool

Grants

Education Education P

d

84.174 Vocational Education—

Community Based

Organizations

Education Education I

d

i

o

p

e

84.177 Rehabilitation Services—

Independent Living

Services for Older

Individuals Who Are Blind

Education Independent living I

o

v

84.180 Technology Applications for

Individuals With Disabilities

Education Assistive

technology,

education

C

w

84.181 Special Education—Grants

for Infants and Families With

Disabilities

Education State planning I

w

84.187 Supported Employment

Services for Individuals With

Severe Disabilities

Education Job training and/or

placement

assistance

I

s

84.224 State Grants for Assistive

Technology

Education Assistive

technology

I

d

84.231j Demonstration and

Innovation Projects

Education Assistive

technology

I

d

Page 48 GAO/HEHS-96-126 Disability Programs
Appendix II 

Federal Programs Targeting People With

Disabilities

Applicant

Beneficiary

eligibilityb

Targeting

P=partial

W=wholly

Expenditures or

obligations for

1994 (in dollars) Individuals

Nonfederal

government

entitiesc

Nongovernmental

entitiesd Othere

General

publicf

Youths with

disabilities

W 21,588,505 X X

Researchers;

individuals with

disabilities,

especially children

and youths

W 2,012,603 X X

Interpreters for deaf

or deaf-blind; deaf

and deaf-blind

individuals

W 1,510,000 X X

Individuals with

disabilities

W 9,502,000 X

Individuals with

disabilities

W 17,882,970 X

Preschoolers with

disabilities

W 406,103,320 X

Individuals with

disabilities and other

individuals in need

of special

prevocational

education

P 11,528,750 X

Individuals 55 and

older with severe

visual impairments

W 8,025,915 X

Children and youths

with disabilities

W 10,077,164 X X

Infants and toddlers

with disabilities

W 228,380,473 X

Individuals with

severe disabilities

W 34,170,640 X X

Individuals with

disabilities

W 36,148,396 X

Individuals with

disabilities

W NA X X

(continued)

Page 49 GAO/HEHS-96-126 Disability Programs
Appendix II 

Federal Programs Targeting People With

Disabilities

Program number Program title

Department or

agencya Services

B

e

84.234 Projects With Industry Education Job training and/or

placement

assistance

I

d

84.235 Special Projects and

Demos for Providing

Vocational Rehab. Services

to Individuals With Severe

Disabilities

Education Job training and/or

placement

assistance

I

d

m

i

s

A

84.236k Training and Public

Awareness Projects in

Tech. Related Assist. for

Individuals With Disabilities

Education Information,

assistive

technology

P

d

84.237 Special

Education—Program for

Children With Serious

Emotional Disturbance

Education Education C

w

e

d

84.240 Program of Protection and

Advocacy of Individual

Rights

Education Protection of legal

and human rights

P

d

84.246 Rehabilitation Short-Term

Training

Education Training for

disability

professionals

P

w

i

d

84.250 Rehabilitation

Services—American

Indians With Disabilities

Education Job training and/or

placement

assistance

A

w

r

r

84.263 Rehabilitation Training—

Experimental and

Innovative Training

Education Training for

disability

professionals

P

w

i

d

84.264 Rehabilitation Training—

Continuing Education

Education Training for

disability

professionals

P

w

i

d

84.265 Rehabilitation

Training—State Vocational

Rehab. Unit In-Service

Training

Education Training for

disability

professionals

I

f

r

a

84.JAV Funding for Gallaudet

University

Education Education D

c

p

p

84.JAW Funding for American

Printing House for the Blind

Education Education B

Page 50 GAO/HEHS-96-126 Disability Programs
Appendix II 

Federal Programs Targeting People With

Disabilities

Applicant

Beneficiary

eligibilityb

Targeting

P=partial

W=wholly

Expenditures or

obligations for

1994 (in dollars) Individuals

Nonfederal

government

entitiesc

Nongovernmental

entitiesd Othere

General

publicf

Individuals with

disabilities

W 21,850,110 X X

Individuals who are

deaf, blind, or

mobility impaired in

isolated populations

such as Native

Americans

W 20,599,717 X X

People with

disabilities

W NA X X

Children and youths

with serious

emotional

disturbances

W 3,873,888 X X

People with

disabilities

W 5,400,000 X

Professionals

working with

individuals with

disabilities

W 738,543 X X

American Indians

with disabilities

residing on

reservations

W 6,508,329 X

Professionals

working with

individuals with

disabilities

W 1,052,732 X X

Professionals

working with

individuals with

disabilities

W 6,290,552 X X

Individuals working

for state vocational

rehabilitation

agencies

W 5,924,555 X

Deaf individuals in

certain

postsecondary

programs

W 52,715,000 X

Blind persons W 6,643,000 X

(continued)

Page 51 GAO/HEHS-96-126 Disability Programs
Appendix II 

Federal Programs Targeting People With

Disabilities

Program number Program title

Department or

agencya Services

B

e

84.JCN Funding for Construction at

National Technical Institute

for the Deaf

Education Education D

c

p

p

84.JKZ Disabled Infants and

Toddlers

Education Education I

w

84.JJF Model Secondary Schools

for the Deaf

Education Education D

88.001 Architectural and

Transportation Barriers

Compliance Board (ATBCB)

ATBCB Information,

enforce federal

laws

I

a

c

s

92.001 National Council on

Disability (NCD)

NCD Information,

research,

monitoring public

laws

I

i

93.001 Civil Rights Compliance

Activities

HHS Enforce federal

laws

I

d

c

s

93.132 Managed Care Demo

Models for SSI Beneficiaries

Disabled Due to Addiction

to Alcohol and Other Drugs

HHS Referral and

monitoring medical

care

S

m

93.138 Protection and Advocacy

for Individuals with Mental

Illness

HHS Protection and

advocacy

I

a

o

a

93.150 Projects for Assistance in

Transition from

Homelessness

HHS Rehabilitation and

housing

I

h

h

s

s

93.173 Research Related to

Deafness and

Communication Disorders

HHS Research R

i

d

c

d

93.184 Disabilities Prevention HHS State planning P

d

f

g

Page 52 GAO/HEHS-96-126 Disability Programs
Appendix II 

Federal Programs Targeting People With

Disabilities

Applicant

Beneficiary

eligibilityb

Targeting

P=partial

W=wholly

Expenditures or

obligations for

1994 (in dollars) Individuals

Nonfederal

government

entitiesc

Nongovernmental

entitiesd Othere

General

publicf

Deaf individuals in

certain

postsecondary

programs

W 193,000 X

Infants and toddlers

with disabilities

W NA X

Deaf youths W (4,020) X

Individuals with

accessibility

complaints or

seeking information

W NA X

Individuals seeking

information

W NA X X

Individuals with

discrimination

complaints or

seeking information

P NF X

SSI referral and

monitoring agencies

W 14,271,645 X

Individuals who are

admitted, residing,

or discharged from

a treatment facility

W 21,378,618 X X

Individuals at risk for

homelessness or

homeless and

suffering from

serious mental illness

P 28,874,000 X

Researchers;

individuals with

deafness or

communication

disorders

W 147,391,280 X X

People with

disabilities and their

families and the

general public

W 9,722,813 X X

(continued)

Page 53 GAO/HEHS-96-126 Disability Programs
Appendix II 

Federal Programs Targeting People With

Disabilities

Program number Program title

Department or

agencya Services

B

e

93.572 Emergency Community

Services for the Homeless

HHS Housing and

support services

H

i

s

h

i

d

e

93.600 Head Start HHS Education, health,

and other support

services

L

c

c

d

93.613 Mental Retardation

President’s Committee on

Mental Retardation

HHS Assistance in

coordinating

federal activities

and information

M

i

93.630 Developmental Disabilities

Basic Support and

Advocacy Grants

HHS Information, legal

assistance

P

d

d

93.631 Developmental Disabilities

Projects of National

Significance

HHS Information,

research

P

d

d

93.632 Developmental Disabilities

University Affiliated

Programs

HHS Training for

disability

professionals

P

d

d

93.647 Social Services Research

and Demonstration

HHS Research,

information

R

l

d

d

A

93.656 Temporary Child Care and

Crisis Nurseries

HHS Temporary child

care

C

d

a

n

93.659 Adoption Assistance HHS Assistance with

adoption costs

C

d

a

93.673 Grants to States for

Planning and Development

of Dependent Care

Programs

HHS State planning C

d

t

e

d

d

93.674 Independent Living HHS Skill development,

education, training

Y

w

r

p

Page 54 GAO/HEHS-96-126 Disability Programs
Appendix II 

Federal Programs Targeting People With

Disabilities

Applicant

Beneficiary

eligibilityb

Targeting

P=partial

W=wholly

Expenditures or

obligations for

1994 (in dollars) Individuals

Nonfederal

government

entitiesc

Nongovernmental

entitiesd Othere

General

publicf

Homeless

individuals, with

special emphasis on

homeless

individuals with

disabilities, and

elderly

P 19,822,356 X X

Low-income

children, especially

children with

disabilities

P 3,288,875,858 X X

Mentally retarded

individuals

W NF X

People with

developmental

disabilities

W 92,374,368 X

People with

developmental

disabilities

W 4,965,620 X X

People with

developmental

disabilities

W 18,271,614 X X

Researchers;

low-income,

developmentally

disabled, and Native

American individuals

P 13,711,262 X

Children with

disabilities and

abused or

neglected children

P 11,712,432 X

Children with

disabilities and their

adoptive parents

P 317,396,990 X

Children and elderly

dependents and

their families,

especially those with

developmental

disabilities

W 12,938,241 X

Youths 16 and over

who receive or have

received foster care

payments

W 70,834,870 X

(continued)

Page 55 GAO/HEHS-96-126 Disability Programs
Appendix II 

Federal Programs Targeting People With

Disabilities

Program number Program title

Department or

agencya Services

B

e

93.773 Medicare Hospital Insurance HHS Medical care P

a

d

93.774 Medicare Supplementary

Medical Insurance

HHS Medical care P

a

q

i

93.778 Medical Assistance Program HHS Medical care L

o

d

93.929 Center for Medical

Rehabilitation Research

HHS Research and

training

R

p

d

93.955 Health and Safety Programs

for Construction Workers

HHS Information,

prevention

C

93.956 Centers for Agricultural

Research, Disease, Injury

Prevention

HHS Research, injury

prevention

R

g

93.965 Coal Miners Respiratory

Impairment Treatment

Clinics and Services

HHS Medical care C

r

i

t

94.011l Foster Grandparents CNS Physical,

emotional, and

mental care

E

c

n

c

d

96.001m Social Security—Disability

Insurance

SSA Income support P

u

a

g

r

m

i

e

h

m

d

96.002n Social Security—Retirement

Insurance

SSA Income support P

d

“

w

b

s

d

Page 56 GAO/HEHS-96-126 Disability Programs
Appendix II 

Federal Programs Targeting People With

Disabilities

Applicant

Beneficiary

eligibilityb

Targeting

P=partial

W=wholly

Expenditures or

obligations for

1994 (in dollars) Individuals

Nonfederal

government

entitiesc

Nongovernmental

entitiesd Othere

General

publicf

People 65 and over

and other qualified

disabled

P 11,700,000,000

(disabled only)

X

People 65 and over

and those who

qualify for hospital

insurance benefits

P 7,800,000,000

(disabled only)

X

Low-income people

over 65, blind or

disabled

P 42,231,000,000

(disabled only)

X

Researchers,

people with

disabilities

W 11,913,915 X X

Construction workers P 15,348,905 X X

Researchers,

general public

W 2,109,625 X

Coal workers with

respiratory

impairments and

their families

P 4,142,000 X X

Elderly; also

children with special

needs, including

children with

disabilities

P 65,863,323 X X

People who are

unable to engage in

any substantial

gainful activity by

reason of a

medical/mental

impairment that is

expected to last or

has lasted for 12

months and eligible

dependents

P 38,458,439,713 X

People with

disabilities who

“can’t work” and

were disabled

before age 22 and

some of their

dependents

P 18,900,000,000

(disabled only)

X

(continued)

Page 57 GAO/HEHS-96-126 Disability Programs
Appendix II 

Federal Programs Targeting People With

Disabilities

Program number Program title

Department or

agencya Services

B

e

96.004o Social Security—Survivors

Insurance

SSA Income support S

S

i

s

p

d

96.005p Special Benefits for

Disabled Coal Miners

SSA Income support I

f

o

d

c

e

96.006q SSI SSA Income support L

a

d

“

96.007r Social Security—Research

and Demonstration

SSA Research and

client assistance

C

b

Page 58 GAO/HEHS-96-126 Disability Programs
Appendix II 

Federal Programs Targeting People With

Disabilities

Applicant

Beneficiary

eligibilityb

Targeting

P=partial

W=wholly

Expenditures or

obligations for

1994 (in dollars) Individuals

Nonfederal

government

entitiesc

Nongovernmental

entitiesd Othere

General

publicf

Survivors of Social

Security-insured

individuals, with

special provisions to

people with

disabilities

P 63,247,942,288 X

Individuals disabled

from black lung or

other lung disease

directly caused by

coal mine

employment

W 759,710,101 X

Low-income elderly

and people with

disabilities who

“can’t work”

P 26,010,116,116 X

Certain SSI

beneficiaries

NA NA X X

Page 59 GAO/HEHS-96-126 Disability Programs
Appendix II 

Federal Programs Targeting People With

Disabilities

aCNS=Corporation for National Service; DOT=Department of Transportation;

Education=Department of Education; EEOC=Equal Employment Opportunity Commission;

Energy=Department of Energy; HHS=Department of Health and Human Services;

HUD=Department of Housing and Urban Development; Justice=Department of Justice;

Labor=Department of Labor; LC=Library of Congress; NSF=National Science Foundation;

OPM=Office of Personnel Management; PCEPD=President’s Committee on the Employment of

Persons With Disabilities; SBA=Small Business Administration; SSA=Social Security

Administration; USDA=Agriculture; VA=Department of Veterans Affairs.

bSee introduction to this app. for explanation of beneficiary.

cThis includes a state agency, county, parish, municipality, city, town, township, village, local

public authority, school or special district, council of government, or any other instrumentality of a

state, local, or regional government.

dThis includes a private institution or other quasi-public, nonprofit organization such as a

community action agency, private agency, cooperative, or any other entity that is

nongovernmental.

eIncludes federal agencies.

f

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

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

hProgram officials told us that 59.038 was eliminated in 1995; however, the program still appeared

in the 1995 CFDA.

i

Program 84.009 was deleted in 1995.

j

Program 84.231 was deleted in 1995.

k

Program 84.236 was deleted in 1995.

l

Before 1995, program 94.011 was identified as 72.001.

mBefore 1995, program 96.001 was identified as 93.802.

nBefore 1995, program 96.002 was identified as 93.803.

oBefore 1995, program 96.004 was identified as 93.805.

pBefore 1995, program 96.005 was identified as 93.806.

qBefore 1995, program 96.006 was identified as 93.807.

r

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

Page 60 GAO/HEHS-96-126 Disability Programs
Appendix III 

Federal Employment Initiatives Targeted to

People With Disabilities

Over several decades, congressional concern about employment

opportunities for people with disabilities has led to more than two dozen

federal employment-focused programs.32 In addition, the Congress has

provided certain employment protections to people with disabilities, for

example, by barring discrimination in employment on the basis of

disability. Finally, several laws also provide a variety of mechanisms that

indirectly support the employment of people with disabilities, for example,

by authorizing federal purchases from nonprofit organizations that employ

people with disabilities. These federal employment initiatives incorporate

three approaches toward employing individuals with disabilities:

• In sheltered employment, individuals with disabilities work in a “sheltered

workshop,” which is a controlled environment providing job operations

involving a limited set of tasks. Sheltered employment is most frequently

used with individuals with severe functional limitations, although the blind

have a long history of working in sheltered employment operations.

• Under supported employment, individuals with disabilities are integrated

into a work setting but are provided postemployment services, frequently

including job coaches or on-the-job training, to help facilitate the

transition to employment. Federal initiatives for supported employment

are intended for individuals with relatively severe disabilities.

• Competitive employment most often refers to a regular job, in which an

individual does not receive postemployment services. The majority of

federal placement initiatives for people with disabilities are aimed at

placing individuals with disabilities in competitive employment. Services

provided under such federal efforts include job training, educational

support, counseling, assessment, and placement.

Federal Efforts to

Promote Competitive

Employment Include

Legislative Mandates

and Partially and Fully

Targeted Programs

Federal efforts to promote the employment of people with disabilities are

largely aimed at competitive employment. Some of the federal programs

with a goal of competitive employment are designed exclusively for people

with disabilities. Others, however, are part of the wider federal effort to

promote job opportunities for people who are disadvantaged in the labor

market. For example, the Job Training Partnership Act (JTPA) provides job

training services mainly to the economically disadvantaged, but people

with disabilities who are not economically disadvantaged may also qualify.

Both wholly and partially targeted federal employment programs rely

heavily on leveraging support from the private sector to place individuals

in jobs and move them toward economic self-sufficiency.

32Employment-focused programs provide services, such as job training, supported employment, job

placement, and employment counseling, that directly facilitate employment. (See app. I.)

Page 61 GAO/HEHS-96-126 Disability Programs
Appendix III 

Federal Employment Initiatives Targeted to

People With Disabilities

Vocational Rehabilitation The largest federal effort focused exclusively on facilitating employment

of people with disabilities is the Vocational Rehabilitation program.

Vocational rehabilitation formula grants are provided to a state on the

basis of the state’s per capita income and overall population.33 States are

required to submit a plan for providing services to the Commissioner of

Rehabilitation Services Administration and to match 21.3 percent of

federal funds. Services that can be provided with these grant funds include

job training, assessment, counseling, maintenance during rehabilitation,

personal assistance, placement or rehabilitation technology, and

assistance in operating a business. Vocational rehabilitation counselors

must draw up an Individual Employment Plan for each client to specify

what that client needs to move toward employability. The program

provides services as specified in the plan; these services can include

virtually anything deemed necessary to facilitate a positive employment

outcome. The emphasis of the program remains on competitive

employment, but it can place individuals in supported or sheltered

employment as well.

A number of other programs support the Basic State Grants for Vocational

Education.34 For example, several programs provide funding to train

vocational rehabilitation personnel through state agencies or other public

or private organizations.35 An estimated 44,034 people participated in

training (including continuing education programs) in fiscal year 1993.

Another support program for the vocational rehabilitation system provides

funding for special projects and demonstration efforts.36 In fiscal year

1994, this program funded 11 new grants and 87 continuation projects in

supported employment. These efforts emphasized (among other areas)

services to individuals with specific learning disabilities, for example,

individuals with long-term mental illness and transition services for youths

with special needs. In addition, other federal programs provide grants to

Native American tribes for vocational rehabilitation services to individuals

33See app. II for more information on Rehabilitation Services—Vocational Rehabilitation Grants to

States (84.126).

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

35See app. II for more information on the following programs: Rehabilitation Long-Term Training

(84.129); Rehabilitation Short-Term Training (84.246); Rehabilitation Short-Term—Experimental and

Innovative Training (84.263); Rehabilitation Training—Continuing Education (84.264); and

Rehabilitation Training—State Vocational Rehabilitation Unit In-Service Training (84.265).

36See app. II for more information on Special Projects and Demonstrations for Providing Vocational

Rehabilitation Services to Individuals With Severe Disabilities (84.235).

Page 62 GAO/HEHS-96-126 Disability Programs
Appendix III 

Federal Employment Initiatives Targeted to

People With Disabilities

living on reservations; another provides vocational rehabilitation services

to migrant and seasonal farmworkers.37

Projects With Industry The Projects With Industry (PWI) program is one of the few federal efforts

that engages the private sector as a partner in expanding employment

opportunities for people with disabilities.38 Services provided to

individuals with disabilities vary with different projects but generally

include evaluation, counseling, training, job development, and job

placement. Services may also be provided to employers, sometimes

including job-site or equipment modification. The PWI program may involve

grants or contracts with individual employers, state vocational

rehabilitation units, or other public or private organizations. Each grantee

must develop and work with a Business Advisory Council, with

representatives from private industry and organized labor, and individuals

with disabilities.

Vocational Rehabilitation

for Veterans

The Department of Veterans Affairs (VA) has established two programs to

provide vocational rehabilitation services to veterans with disabilities.39 VA

generally provides services to honorably discharged veterans who have

received a 20-percent or higher VA disability rating40 for a serviceconnected disability. Under a second program, veterans who are receiving

a VA pension may also qualify for vocational rehabilitation services. Case

managers in these programs can provide whatever services the veteran

needs to facilitate employment. Some of these services include evaluation,

counseling, education, training, and job placement assistance; many

veterans with disabilities receive financing for higher education. However,

these vocational services are time limited. Veterans must generally

complete the training portion of their vocational rehabilitation plan within

48 months; participants generally cannot receive services after 12 years

from the date on which their eligibility was established.41 In program year

37See app. II for more information on Rehabilitation Services—American Indians With Disabilities

(84.250) and Rehabilitation Services—Services Projects (84.128).

38The PWI program was authorized under the Rehabilitation Act of 1973. See app. II for more

information on the program (84.234).

39See app. II for more information on Vocational Rehabilitation for Disabled Veterans (64.116) and

Vocational Training for Certain Veterans Receiving VA Pensions (64.123).

40To assess eligibility for this and other VA programs, VA assesses disability on a percentage scale

based on the kind and the severity of impairment. A veteran may receive a disability score of up to

100 percent (in 10-percent increments) for VA eligibility purposes.

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

Page 63 GAO/HEHS-96-126 Disability Programs
Appendix III 

Federal Employment Initiatives Targeted to

People With Disabilities

1995, approximately 48,000 veterans with disabilities received vocational

rehabilitation services.

JTPA Programs JTPA provides job training and employment-seeking skills. It is primarily

directed to economically disadvantaged people but also includes others

who face employment barriers. JTPA features a unique partnership of the

federal government, the states, and the private sector.42 Although JTPA does

provide support services such as child care and transportation, local JTPA

providers are restricted in the amount they can spend and they often

spend less than permitted. Thus, people with disabilities who require more

extensive support services may need to access other programs to

supplement JTPA services. In addition to its primary training program, JTPA

also encompasses the residential Job Corps program and research, pilot,

and demonstration efforts.43 Individuals with disabilities can be served

under all these JTPA programs, and the needs of individuals with

disabilities receive special consideration in the awarding of discretionary

JTPA projects. For example, in 1995, special project grants were awarded to

organizations, such as Goodwill Industries and the American

Rehabilitation Association, to provide job search assistance and job

placement to people with disabilities. In addition, people with disabilities

can sometimes qualify for JTPA without meeting income guidelines because

they face a barrier to employment. JTPA’s focus for its clients with

disabilities remains competitive employment, although JTPA funds can be

used for supported employment efforts as well.

Employment Service Established by the Depression-era Wagner-Peyser Act,44 the state-federal

employment service (ES) provides employment offices to assist individuals

looking for jobs and employers looking for workers. Through many local

offices, the ES program offers an array of services, including job

counseling, skills assessment and testing, job search workshops, job

opening identification, and referrals to employers.45 Services provided by

ES, however, are frequently limited to job listings and some counseling.

Although these services are available to everyone, states are required to

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

43See app. II for more information on Employment and Training Research and Demonstration Projects

(17.248) and Employment Services and Job Training—Pilot and Demonstration Programs (17.249).

44The Congress passed the Wagner-Peyser Act in 1933. Subsequent amendments to the act, especially

the 1954 amendments, strengthened the priority placed on serving people with disabilities.

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

Page 64 GAO/HEHS-96-126 Disability Programs
Appendix III 

Federal Employment Initiatives Targeted to

People With Disabilities

give special consideration to people with disabilities by requiring every

local ES office to designate at least one staff member to help individuals

with disabilities locate employment or training. In program year 1994, ES

provided assistance to an estimated 625,133 people with disabilities, which

accounted for approximately 3.3 percent of ES’ total clientele.

School-to-Work Transition

Grants

With a joint Education/Vocational Rehabilitation plan approved by the

Department of Education, states can receive project grants to provide

school-to-work transition services to secondary students (14 and older)

with disabilities.46 Many of these projects implement the Individuals With

Disabilities Education Act’s (IDEA) requirement to provide transition

services. Other institutions, such as colleges and universities and other

nonprofit organizations, are also eligible for project grants to improve the

school-to-work transition for students with disabilities.

Small Business Loans Although vocational rehabilitation programs can also provide financing for

small businesses, competitive employment remains that program’s primary

emphasis. The Handicapped Assistance Loan program awards loans to

small businesses that are 100-percent owned by individuals with

disabilities to provide construction or working capital. Under this

program, the Small Business Administration (SBA) guarantees commercial

loans with extended repayment periods to businesses. This program can

also be used for sheltered workshops, as described in more detail later.47

President’s Committee on

Employment of Persons

With Disabilities

Since 1947, the President’s Committee on Employment of Persons With

Disabilities has made efforts to develop public-private partnerships and

encourage businesses to hire individuals with disabilities.48 The

committee’s activities include information dissemination and coordination

as well as operating the Job Accommodation Network (JAN). JAN provides

information on workplace accommodations to employers, rehabilitation

professionals, and individuals through a toll-free number.

46This program is authorized under the Individuals With Disabilities Education Act Part C. See app. II

for more information on Secondary Education and Transitional Services for Youth With Disabilities

(84.158).

47Until 1995, SBA operated a similar program that guaranteed some loans and also provided direct

lending to disabled and Vietnam-era veterans. This program was discontinued for lack of funding. See

app. II for more information on the Handicapped Assistance Loan (59.021) and the Veterans Loan

programs (59.038).

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

Page 65 GAO/HEHS-96-126 Disability Programs
Appendix III 

Federal Employment Initiatives Targeted to

People With Disabilities

Federal Employment for

People With Disabilities

The Office of Personnel Management operates the federal Selective

Placement Program, which provides federal agencies with assistance in

placing federal employees who have become disabled and in recruiting

employees with disabilities to federal service. Under this program, people

with disabilities can apply for federal employment without going through

the normal competitive process.49

Americans With

Disabilities Act

The Americans With Disabilities Act (ADA) of 1990 established a clear and

comprehensive prohibition against discrimination on the basis of

disability. Among other protections, ADA established regulations focused

on removing architectural, communications, and transportation barriers.

Regarding employment, ADA essentially prohibits organizations employing

15 or more employees from discriminating against a qualified individual

with a disability because of the disability in the job application or hiring

process, in advancement or discharge of employees, employee

compensation, job training, or other conditions of employment. ADA

protects individual applicants or employees as long as they can perform all

essential functions of the job with or without reasonable accommodation.

To be reasonable, an accommodation must not impose an undue hardship

on the employer and must enable the individual with a disability to

perform the necessary work. For example, a reasonable accommodation

for an individual in a wheelchair might be to raise his or her desk so that

the wheelchair can fit comfortably beneath it. ADA is a mandate and not a

federal program as such, although programs have been set up to enforce

the provisions of the law.50 Nonetheless, the ADA remains a key part of the

federal commitment to promote employment of people with disabilities.

Nondiscrimination in

Employment

Through several different legislative actions, the federal government has

prohibited employment discrimination solely on the basis of disability for

federal contractors, state and local governments, and private businesses

with 15 or more employees. Several programs have been set up to enforce

these provisions. The Office of Federal Contract Compliance Programs is

responsible for investigating complaints against federal contractors.51 The

Department of Justice is responsible for investigating and prosecuting

cases of employment discrimination under ADA against state and local

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

50See app. II for more information on Equal Employment Opportunity (16.101), Civil Rights of

Institutionalized Persons (16.105), and the ADA Technical Assistance program (16.108).

51See app. II for more information on Non-Discrimination and Affirmative Action by Federal

Contractors and Federally Assisted Construction Contractors (17.301).

Page 66 GAO/HEHS-96-126 Disability Programs
Appendix III 

Federal Employment Initiatives Targeted to

People With Disabilities

governments, and the Equal Employment Opportunity Commission is

responsible for ADA cases involving private-sector employees. These

bodies may prosecute a case, decide that no cause for suit exists, or give

clearance for an individual to file the case in federal court on his or her

own.

Randolph-Sheppard

Vending Program

The Randolph-Sheppard Act in 1936 set up a program for blind individuals

that gives organizations working with the blind preference in operating

vending facilities on federal property. Under this program, these

organizations may be granted rights to place vending machines or sell

other items in federal buildings. The gross receipts of Randolph-Sheppard

vending facilities totaled $388.8 million during fiscal year 1990.

Targeted Jobs Tax Credit The Targeted Jobs Tax Credit (TJTC), which expired in 1994, was

established by the Congress to promote employment for disadvantaged

people. The Congress authorized this special tax credit to induce private

businesses to employ people who were chronically unemployed,

disadvantaged youth, welfare recipients, and people with disabilities. The

tax credit amounted to 40 percent of the first $6,000 in wages during the

first year of employment. For an employer to qualify for the tax credit, the

worker must have been employed for at least 90 days or have completed at

least 120 hours of work. Approximately 8 percent of the individuals

benefiting from the TJTC were people with disabilities.

Federal Financing for

Supported

Employment Is

Limited

Two federal programs provide financing for supported employment

programs: one program provides aid to state programs, the other finances

projects directly.52 In addition, many states finance some supported

employment services through state grant programs that receive funds from

HHS to provide services to individuals with developmental disabilities.

These programs provide ongoing (although generally time-limited)

postemployment support to individuals with disabilities to help them

maintain community employment.

52Both supported employment programs derive their authorization from the 1986 amendments to the

Rehabilitation Act of 1973. See app. II for more information on Supported Employment Services for

Individuals With Severe Disabilities (84.187) and Rehabilitation Services—Service Projects (84.128).

Page 67 GAO/HEHS-96-126 Disability Programs
Appendix III 

Federal Employment Initiatives Targeted to

People With Disabilities

Supported Employment

Grants to States

Under this program, states are given formula grants to provide supported

employment services. This program is intended to provide services to

individuals with severe disabilities to allow them to get jobs.53 These

services can include job coaches, ongoing supports, training for

coworkers, and a variety of other services designed to enable individuals

to adjust to the workplace. Services provided under this program are

generally limited to 18 months; after this time, states must either find

additional funds to pay for continuing services or discontinue the services

and see if the individual can continue without the additional support.

Supported Employment

Special Projects

This program awards grants to public and nonprofit agencies, including

states, to conduct special projects and demonstrations to expand or assist

supported employment services to individuals with the most severe

disabilities.54 In fiscal year 1993, this program supported 13 new

community-based projects, 14 continuing community-based projects, and

16 grants to states for systems-change projects. Services under this

program are like services provided under the state grant and can include

assistance to employers in training coworkers, assistive technology, and

job coaches. Like the formula grants to states program, this program

allows recipients to use these funds to build community capacity to

provide these services.

Federal Government

Provides Indirect

Support for Sheltered

Workshops

Federal financial help also supports sheltered workshop employment for

people with disabilities. This support, however, is generally somewhat

indirect, coming from federal purchases, exemptions from federal wage

laws, and some business loans.55

Federal Purchases

(Javits-Wagner-O’Day Act)

The Javits-Wagner-O’Day Act established an initiative under which federal

agencies may purchase selected goods and services from sheltered

53See app. II for more information on Supported Employment Services for Individuals With Severe

Disabilities (84.187).

54This program also supports recreational activities for individuals with disabilities to aid in their

employment, mobility, socialization, independence, and community integration. An estimated 20,346

people were served under this portion of the program. See app. II for more information on Special

Projects and Demonstrations for Providing Vocational Rehabilitation Services to Individuals With

Severe Disabilities (84.235).

55As with supported employment, some states choose to use their funding under developmental

disabilities programs to support sheltered workshops.

Page 68 GAO/HEHS-96-126 Disability Programs
Appendix III 

Federal Employment Initiatives Targeted to

People With Disabilities

workshop providers. In fiscal year 1991, $431.55 million in contracts were

awarded to 497 such workshops.

Relief From Minimum

Wage Laws

Under the Fair Labor Standards Act, sheltered workshops may apply to

the Secretary of Labor for exemptions from the minimum wage law.

Small Business Loans SBA may award handicapped assistance loans to sheltered workshops for

construction or working capital. For workshops to be eligible, at least

75 percent of the work hours for the direct production must be performed

by people with disabilities. The Handicapped Assistance Loan program

also provides loans to small businesses wholly owned by people with

disabilities.

Page 69 GAO/HEHS-96-126 Disability Programs
Appendix IV 

Geographic Distribution of Expenditures for

Selected Wholly Targeted,

Employment-Focused Programs

The disability programs we examined differ in their services, objectives,

size and scope, and in how they distribute program dollars. Although many

of these federal programs allocate their funding to state governments or

local providers, the programs generally have established different

mechanisms for doing so. For example, the federal-state Vocational

Rehabilitation program allocates its funding to state governments on the

basis of a formula that includes state population and per capita income. By

contrast, the Labor Department’s Special Projects for Employment of

Persons With Disabilities program awards grants to states or local

providers on the basis of applications and proposals. Thus, the aggregate

distribution of funds among states and geographic areas reflects these

different allocation mechanisms in combination and may not resemble the

distribution that would result from any one mechanism in particular. In

addition, the aggregate distribution of funds among states under a multiple

program structure may not represent the distribution that would have

been chosen under a more integrated system.

To illustrate the distribution effects of the allocation mechanisms

currently used by disability programs, we examined the state distribution

of funds for those wholly targeted, employment-focused programs that

channel funds to locations nationwide. We compared this distribution with

the distribution of people with disabilities by state and then looked at the

per capita amounts available to each state under these programs.

Our analysis focused on eight programs that represent the majority of

funds distributed under employment-focused programs.56 We chose to

limit our illustration to wholly targeted programs because people with

disabilities represent a relatively small portion of clients served by many

of the partially targeted programs. Without reliable data on state-by-state

spending on people with disabilities only, we could not incorporate

partially targeted programs without distorting the analysis. Of the 26

employment-focused programs that we identified, 9 were partially targeted

and thus excluded from our analysis. An additional four programs

provided advice to people with disabilities and their employers from

central locations, and five programs did not report state-by-state spending

information. Thus, eight programs remained for our analysis. Table IV.1

shows 1990 federal expenditures of eight wholly targeted,

employment-focused programs.

56A wholly targeted program is one that only serves the needs of people with disabilities.

Employment-focused programs are those that directly facilitate employment through services such as

job training and placement and employment counseling. See app. I.

Page 70 GAO/HEHS-96-126 Disability Programs
Appendix IV 

Geographic Distribution of Expenditures for

Selected Wholly Targeted,

Employment-Focused Programs

Table IV.1: Federal Expenditures of

Eight Wholly Targeted,

Employment-Focused Programs, in

1990

Program

number Program title Applicanta

Funding

mechanism/

cost sharing

or matching 

(Y/N)b

Expenditures in

1990

17.801 Disabled Veterans’

Outreach

State

employment

agencies

Formula

grants (N)

$964,852

59.021 Handicapped

Assistance Loans

Nonprofit

agencies

and

individuals

Direct loans

(N)

12,508,329

64.116 Vocational Rehabilitation

for Disabled Veterans

Individual

veterans

Direct

payments (N) 129,062,141

84.126 Rehabilitation Services—

Vocational Rehabilitation

Grants to States

State

agencies

Formula

grants (Y)

2,028,193,744

84.128 Rehabilitation Services—

Service Projects

State and

nonprofit

agencies

Project

grants (Y)

69,114,000

84.129 Rehabilitation Long-Term

Training

State and

nonprofit

agencies

Project

grants (Y)

29,507,158

84.158 Secondary Education

and Transitional Services

for Youth With Disabilities

State and

nonprofit

agencies

Project

grants (N)

7,922,550

84.187 Supported Employment

Services for Individuals

With Severe Disabilities

State

agencies

and other

private or

nonprofit

agencies

Formula

grants (N)

34,220,912

Total $2,311,493,686

aThe Catalog of Federal Domestic Assistance (CFDA) states that applicants and beneficiaries are

generally the same for programs that provide assistance directly from a federal agency. However,

financial assistance from state or local governments or other entities has different applicants and

beneficiaries. Applicants are those individuals or entities that can apply for federal assistance.

Beneficiaries are those individuals or entities that ultimately benefit from federal assistance.

bSome programs—those designated as “Y” in table IV.1—have a cost-sharing component or may

require a matching amount. For example, the Vocational Rehabilitation program is 80-percent

federal, and the states provide an additional 20 percent. Our expenditure estimates only reflect

federal outlays.

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

We obtained the information in this appendix from publicly available data

through the Bureau of the Census. Specifically, we derived summary

Page 71 GAO/HEHS-96-126 Disability Programs
Appendix IV 

Geographic Distribution of Expenditures for

Selected Wholly Targeted,

Employment-Focused Programs

statistics from the Census of Population and Housing, 1990, and we

derived expenditure data from the Consolidated Federal Funds Report

(CFFR). Our selection of employment programs was based on the

availability of expenditure data for wholly targeted programs.

Many Wholly

Targeted,

Employment-Focused

Programs Distribute

Benefits Through

State or Nonprofit

Agencies

As shown in table IV.1, approximately $2.3 billion was distributed in 1990

through eight employment programs that were wholly targeted to people

with disabilities. Many of these programs funded state, local, private, or

nonprofit entities that administered services in their area. These

organizations included institutions of higher learning, state vocational

rehabilitation agencies, job training councils, local educational agencies,

or other appropriate public or private nonprofit institutions. No single

agency or department had both the responsibility and authority to

administer these employment programs. Of the eight we selected, the

Department of Labor, the Small Business Administration (SBA), and the

Department of Veterans Affairs (VA) administered one program each. The

remaining five programs were administered through the Department of

Education, including the largest, Vocational Rehabilitation (see table IV.1).

Programs that used a decentralized program structure distribute funds

through a formula or project proposals (see table IV.1). The largest

program, Rehabilitation Services—Vocational Rehabilitation Grants to

States, distributes funds through a formula and accounts for over

80 percent of the total amount available for people with disabilities in

employment assistance. Formulas are also used by the Supported

Employment and the Disabled Veterans’ Outreach programs. Under these

programs, the states’ annual allotment is based on population

characteristics such as per capita income, total population, or the number

of disabled veterans in the state. Programs that used project grants to

make allotments include Rehabilitation Services—Service Projects,

Rehabilitation Long-Term Training, and Secondary Education and

Transitional Services for Youth With Disabilities. For each of these, the

state or service provider must apply for funding. Consequently, the

variation in expenditures may relate to the population characteristics as

well as the success of these local organizations in pursuing additional

funds.

Page 72 GAO/HEHS-96-126 Disability Programs
Appendix IV 

Geographic Distribution of Expenditures for

Selected Wholly Targeted,

Employment-Focused Programs

People With

Disabilities as a

Percentage of the

Working-Age

Population Generally

Highest in Southern

States

As shown in figure IV.1, in 1990, the disabled working-age population as a

percentage of the total working-age population across states varied

between 7 and 15 percent.57 Southern states had the highest concentration

of the disabled. For example, the percentage of working-age disabled

people in West Virginia was around 15 percent of the total working-age

population. Other southern states were also in the higher end of the

distribution. States such as Kentucky and Alabama registered a disabled

working-age population around 13 percent. In highly populated states like

California, New York, Texas, Florida, and Illinois, the disabled workingage population was generally between 10 and 11 percent. In contrast,

sparsely populated states, such as Wyoming, and states in the High Plains,

such as North Dakota and South Dakota, had disabled working-age

populations of less than 10 percent.

57These figures reflect a composite of individuals 16 to 64 who reported a work, mobility, or personal

care limitation to the 1990 census. The size of the disability population is extremely sensitive to how

disability is defined. Our estimates are derived using data from the Bureau of the Census (see apps. I

and V for additional details).

Page 73 GAO/HEHS-96-126 Disability Programs
Appendix IV 

Geographic Distribution of Expenditures for

Selected Wholly Targeted,

Employment-Focused Programs

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

14 – 15 Percent (4)

12 – 13 Percent (8)

10 – 11 Percent (22)

7 – 9 Percent (17)

Page 74 GAO/HEHS-96-126 Disability Programs
Appendix IV 

Geographic Distribution of Expenditures for

Selected Wholly Targeted,

Employment-Focused Programs

Distribution of

Federal Funds for

Employment-Focused

Programs Differs

From That of

Working-Age People

With Disabilities

As shown in figure IV.2, in 1990, these programs distributed to states

between $200 and $1,100 per working-age person with a disability.

Approximately 40 states have less than $500 available per person in the

working-age disabled population. Although southern states have higher

percentages of people with disabilities in their working-age population,

these states were in the lower end of the expenditure distribution. Florida,

Georgia, and South Carolina, for example, have between $200 and $350

available per disabled person. Large, highly populated states such as

California and New York, were also in the lower end of the distribution,

although sparsely populated states, such as Wyoming and North Dakota,

were in the higher end.

Page 75 GAO/HEHS-96-126 Disability Programs
Appendix IV 

Geographic Distribution of Expenditures for

Selected Wholly Targeted,

Employment-Focused Programs

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

801 – 1,100 (3)

651 – 800 (1)

501 – 650 (7)

351 – 500 (19)

200 – 350 (21)

Expenditures in Dollars

Page 76 GAO/HEHS-96-126 Disability Programs
Appendix IV 

Geographic Distribution of Expenditures for

Selected Wholly Targeted,

Employment-Focused Programs

Data Limitations of

This Analysis

The distribution of federal dollars must be interpreted cautiously due to

limitations in the availability of data for several reasons. First, data derived

from the CFFR are the best estimates of federal obligations or outlays

available.58 Because these data are estimates, however, in any given year,

actual outlays may be higher or lower because program funds may be

deobligated at any time. Similarly, although this analysis accounts for the

majority of federal expenditures on employment-focused programs, we

could not obtain sufficiently reliable data to allow us to analyze

expenditures on partially targeted programs.

Moreover, per capita amounts may conceal reasonable underlying factors

not captured by our data sets such as money that states or local

jurisdictions raise. For example, the largest employment program,

Vocational Rehabilitation, requires state and local jurisdictions to provide

a matching component. While these funds increase the overall

expenditures available, our estimates reflect only federal outlays.

58The outlays include grants, direct loans, guaranteed loans, indemnity claims, retirement and disability

claims, federal insurance coverage as well as some data on procurement contracts.

Page 77 GAO/HEHS-96-126 Disability Programs
Appendix V 

Definitions of Disability and Population

Estimates of People With Disabilities

Disability Is Difficult

to Define and Measure

One of the most contentious aspects of disability research is also the most

basic—the definition of disability. Different federal programs use different

operational definitions of disability, as do researchers, advocacy groups,

and other interested parties. Some of this variation occurs because many

groups define disability for different purposes and thus use different

criteria for evaluating a definition. For example, a relatively broad

definition of disability would encompass a wide array of people with

disabilities; however, some broader definitions can be quite subjective.

Researchers may prefer a definition that can be used with existing data

sources; program officials must be concerned with definitions that can be

measured and verified. Three fundamental issues about the nature of

disability contribute to these definition and measurement differences:

• Scope of definition—Defining disability involves distinguishing between

normal variations among individuals and conditions that are disabling.

• Duration of a condition—Because a person’s disability status may change

over time, some researchers argue that disability should be continually

re-evaluated and remeasured and that temporary or sporadic conditions

should be considered in evaluating disability. Others contend that only

permanent conditions should be considered. A condition (such as

rheumatoid arthritis) may be limiting but may have only sporadic impact

on an individual’s ability to function—so even differentiating between

permanent and temporary disabilities can be difficult.

• Variation in application—Even with the most clear-cut definitions of

disability, applying the criteria involves an inherent judgment. Two parties

may agree on a definition of disability but may then apply different

classifications of who is disabled. For example, a significant difference

exists in the number of people identified as eligible for disability insurance

by the state disability determination services and by administrative law

judges.59

Not only is disability hard to determine under any given definition, but

definitions of disability vary widely. We identified many different

definitions used by programs, researchers, and advocacy groups. (Table

V.1, at the end of this appendix, lists some examples of these definitions

and their sources.) Relying on functional assessment, medical criteria, or

individual perception, these definitions emphasize different aspects of

disability—from the individual’s ability to work, for example, to the role of

the person’s physical environment in shaping the degree of disability.

59Social Security: Disability Rolls Keep Growing, While Explanations Remain Elusive

(GAO/HEHS-94-34, Feb. 11, 1994), pp. 26-27.

Page 78 GAO/HEHS-96-126 Disability Programs
Appendix V 

Definitions of Disability and Population

Estimates of People With Disabilities

The number of disability definitions combined with differences in

measurement techniques have resulted in estimates of the number of

people with disabilities that range from 3.5 million to 49 million. Although

many definitions are similar, even subtle differences in the population

included, the survey used, or the definition of disability can have

far-reaching effects on how many individuals are counted as having a

disability. For example, estimates from the 1990 Survey of Income and

Program Participation (SIPP) indicated that 8.6 million Americans aged 16

to 67 were “unable to work” due to disability; the 1990 census estimated

that 6.6 million Americans aged 16 to 64 were “unable to work” due to

disability—a difference of nearly one-third. When the definition of

disability is widened to include individuals who are “limited in work,” 1990

to 1993 estimates range from 12.9 million to 19.5 million. Table V.2, at the

end of this appendix, shows the differences in the estimated disability

prevalence in the United States using different definitions and sources.

Disability Is Most

Commonly Defined by

Measures of

Functional Limitation

The most common method of defining disability—both for researchers and

under federal programs—is based on functional limitation. Under this type

of definition, an individual is considered to have a disability if he or she is

limited in, or unable to perform, a certain activity or activities. The

definition can be broad or narrow, depending on whether activities are

specified narrowly or widely and on whether the individual must be unable

to do the activity or must only be limited. The term “limited” may refer to

the type or amount of activity. For instance, a person with arthritis may be

unable to perform some types of household chores (such as sewing) but

may be able to do other tasks (like laundry) without any problem.

Similarly, a person with another condition may be able to do any chore for

a short period of time but may need to rest before attempting to complete

the task. Activities can also be specified widely or narrowly. For example,

some survey questions leave the term “activities” to be defined by the

respondent. Other instruments confine the definition of activities to a

specific list, like the activities of daily living (ADL) or the independent

activities of daily living (IADL).60 As an example, a broader definition of

disability could characterize individuals with a disability as “limited in

performing any of their usual activities;” a narrower definition could

characterize individuals with a disability as being “unable to work at a

full-time job.”

60ADLs include such activities as feeding and dressing oneself, bathing, and the like. IADLs include

household chores such as grocery shopping, meal preparation, and the like.

Page 79 GAO/HEHS-96-126 Disability Programs
Appendix V 

Definitions of Disability and Population

Estimates of People With Disabilities

Widely Ranging Functional

Definitions Are More

Inclusive, but Can Be

Harder to Measure

Some disability advocates find a wide-ranging functional approach to

disability definition appealing because it measures the impact on an

individual’s condition without regard to the cause of that condition. Others

have criticized many of these definitions, however, as being too general to

make effective distinctions among individual cases. Although narrowing

the scope of the activities considered would make the definition more

specific, it would also increase the probability that individuals would be

arbitrarily excluded. In addition, even when the activities are defined fairly

narrowly—with ADLs or IADLs, for example—measuring or verifying

disability can be difficult.

Survey evidence demonstrates the effect of adopting a widely ranging

functional definition as opposed to a narrower one. For example, when the

1990 census asked individuals if they were limited in their mobility (for

example, going out of the house or to a store by themselves), an estimated

3.5 million individuals aged 16 to 64 were identified as disabled. However,

in the 1991 SIPP, an estimated 27 million individuals aged 21 to 64 were

identified as disabled when the definition included having a functional

limitation in any activity; and an estimated 49 million individuals of all

ages were considered disabled when the definition included having a

functional limitation in any activity and when examples were provided.

“Can’t Work” Definitions

Are More Specific but Still

Difficult to Apply

Several disability definitions take a narrow view of activity limitation, with

employment as the only activity. For example, income maintenance and

pension programs often define disability to include only those individuals

who cannot work because of their impairment.61 These definitions allow

programs to focus on individuals for whom employment is deemed

unfeasible and thus may be in greater need. A “can’t work” definition,

however, requires judgment not only of an individual’s physical conditions,

but also of his or her capabilities in a wide variety of potential employment

situations. This makes implementing the definition problematic, especially

in recent years because improvements in information technology, an

increased emphasis on accommodation in the workplace, and new models

of working with individuals with disabilities (such as supported

employment) have complicated assessments of the ability to work.

Medical and legal determination of the ability to work is thus labor

intensive. The emphasis on ability to work has also been criticized by

analysts who believe that this definition creates a strong disincentive to

employment. Because applicants must prove that they cannot work to

61The major U.S. income maintenance programs (Social Security’s Supplemental Security Income (SSI)

and Disability Insurance (DI)) define disability this way.

Page 80 GAO/HEHS-96-126 Disability Programs
Appendix V 

Definitions of Disability and Population

Estimates of People With Disabilities

receive benefits and may risk losing these benefits if they become

employed, they may be reluctant to look for a job. In addition, having

proved to the authorities that they are unable to work, disability

beneficiaries may agree with this assessment and thus not try to enter the

labor force.

Many household surveys include questions that reflect this kind of broad

“can’t work” definition, for example, “Do you have a health condition that

limits your ability to work?” or “Are you unable to work because of a

disability?” or “Do you have a condition that limits the type or amount of

work you can do?” In 1990, the number of working-age individuals who

reported they were unable to work or limited in work ranged from

12.9 million to 19.5 million; the number reported as unable to work ranged

from 6.6 million to 14.2 million.62

Disability Sometimes

Defined as the

Presence of Specific

Conditions

Some definitions consider an individual disabled if he or she has one or

more of a specified list of medical conditions. For example, vocational

education programs define students as having a disability if they are

“mentally retarded, hard of hearing, deaf, speech impaired, visually

handicapped, seriously emotionally disturbed, orthopedically impaired,

other health impaired, deaf-blind, multihandicapped, or have specific

learning disabilities, who because of these impairments, need special

education and related services, and cannot succeed in the regular

vocational education program without special education assistance.” In

addition, some functional definitions of disability specifically exclude

certain conditions. For example, the definition of disability in the

Americans With Disabilities Act (ADA) excludes psychoactive substance

abuse, transsexualism, pedophilia, compulsive gambling, and kleptomania

(among other disorders).

These definitions are presumably relatively straightforward because they

require only an assessment of a medical condition, not an evaluation of an

individual’s ability to function with this impairment. However, a medical

definition generally contains no information on the severity of the

condition and ignores potentially debilitating conditions not included on

the list. Thus, a medically based approach may sometimes be as arbitrary

as a more subjective definition. In addition, medically based definitions

would presumably require certification and may be expensive to verify.

62Survey results on this particular question may suffer from response bias, that is, respondents who are

not in the labor force—whether they receive government benefits or not—may prefer to tell the

interviewer that they cannot work rather than say they choose not to work. For this reason, all these

estimates should be interpreted cautiously.

Page 81 GAO/HEHS-96-126 Disability Programs
Appendix V 

Definitions of Disability and Population

Estimates of People With Disabilities

Relatively little up-to-date information on the prevalence of specific

medical disorders exists in the United States. The data that are available,

however, suggest that definitions of disability based on medical conditions

may be quite distinct from definitions based on an individual’s functional

ability, and may classify large numbers of individuals as having a disability.

For example, the 1993 National Health Interview Survey (NHIS) reported

that, of Americans aged 18 to 64, 13.2 million were hearing impaired;

5.8 million were visually impaired; and 0.9 million had palsy, cerebral

palsy, or mental retardation. Fully 61 percent of the visually impaired and

65 percent of the hearing impaired reported no limitation in the kind or

amount of work they could do—indicating that medical condition and

self-perception of ability to work are distinct concepts. Results from the

National Comorbidity Survey administered between 1990 and 1992

indicated that during the previous 12 months as many as 29 percent of

individuals may have had at least 1 of 14 psychiatric disorders, including

major depression, anxiety disorders, and substance abuse.63

Other Disability

Definitions Are Less

Commonly Used

Researchers have used two other types of disability definitions that are

less practical for programmatic purposes. For example, individually

defined disability is used in some survey data. This measure classifies an

individual as disabled on the basis of self-assessment or on the opinions of

others. No explicit definition of disability is used, so each individual

answers the question using his or her own concept of what it means to be

disabled. An individually defined concept of disability could capture some

people who would not be included under more restrictive definitions, but

this definition is likely to be inconsistent and thus unreliable to distinguish

among individual cases. A second type of definition is an environmental/

societal-based definition of disability, which emphasizes the role of the

surrounding environment in determining the extent of an individual’s

limitations; that is, it assesses whether the person can function

independently given the environment he or she must face. These

definitions require consideration of both the individual’s physical or

mental condition and the surrounding environment. For example, under

such a definition, an individual in a wheelchair may be considered

disabled if he or she lives in a city with no public transportation and no

curb cuts but might not be considered disabled in a city that had these

features. Assessing functional ability in the context of both the individual

and the environment or society is not only subjective but extremely

difficult—the environment is all encompassing and frequently changing.

63Ronald C. Kessler, et al., “Lifetime and 12-Month Prevalence of DSM-III-R Psychiatric Disorders in the

United States: Results from the National Comorbidity Survey,” June 1993.

Page 82 GAO/HEHS-96-126 Disability Programs
Appendix V 

Definitions of Disability and Population

Estimates of People With Disabilities

However, this type of definition does raise the public’s awareness of the

role of the environment in determining individuals’ capabilities.

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

Definition Sourcea Type

“. . . a limitation that affects an individual’s ability to perform certain

functions.”

Disability community/

advocacy group

Functional

“Had a disability or health problem that prevented him or her from

participating fully in work, school, or other activities.”

Louis Harris Survey and DeJong Functional

“Individuals with significant physical or mental impairments whose abilities

to function independently in the families or communities or whose ability to

obtain, maintain, or advance in employment is substantially limited.

Eligibility shall not be based on the presence or absence of any one or

more specific severe disabilities.”

Centers for Independent Living

Program (84.132)

Functional

“. . . departure from normal role functioning attributable to a health-related

condition.”

Nagi as quoted in Chirikos Functional

Unable to perform at least three ADLs or IADLs without assistance.b HUD Congregate Housing

(14.170)

Functional/ADL or IADL

“. . . any restriction or lack (resulting from an impairment) to perform an

activity in the manner or within the range considered normal.” (Note: WHO

also defines an “impairment” as “a psychological, anatomical, or mental

loss, or some other abnormality.”)

World Health Organization (WHO) Functional

“. . . a physical or mental impairment which substantially limits one or more

of the major life activities of such individual; a record of having such an

impairment; or being regarded as having such an impairment.” (excluding

specific conditions, especially current substance abuse)

ADA Functional

“. . . are incapable of regularly pursuing any substantially gainful

employment due to a disability that is likely to be of long or indefinite

duration or is likely to result in death.” Also, “. . . unable to perform their

usual occupation due to a disability that is likely to be of long or indefinite

duration or is likely to result in death.”

Canadian disability

insurance/income maintenance

program as reported in Maki

Functional/can’t work

“. . . individuals with mental or physical impairments that reduce their

capacity to work by at least 50 percent; individuals who are at least 30

percent impaired and unemployed are also considered handicapped.”

German disability agency as

reported in Burkahauser

Functional/can’t work

Either (a) receives benefits from a government disability program or (b)

reports a limitation on his or her ability to work.

Haveman and Wolfe Functional/can’t work

Limited in the type or amount of work (or housekeeping if housekeeping is

considered to be the “primary occupation”).

Reisine and Fifield; Chirikos;

DeJong; Stern

Functional/can’t work

The inability to engage in substantial gainful activity, by any medically

determinable physical or mental impairment which can be expected to

result in death or has lasted or is expected to last for a continuous period

of not less than 12 months.

DI and SSI Functional/can’t work

Having one or more of the following physical conditions—“weakness/lack

of strength; trouble with fingers; trouble walking, standing, or with stairs; in

a wheelchair; trouble seeing/blind; trouble with leaving bed or leaving

home; trouble lifting; deaf; trouble with stiffness or pain; trouble with

seizures or spasms; mental illness; mental retardation.”

Stern Medical

(continued)

Page 83 GAO/HEHS-96-126 Disability Programs
Appendix V 

Definitions of Disability and Population

Estimates of People With Disabilities

Definition Sourcea Type

“Mentally retarded, hard of hearing, deaf, speech impaired, visually

handicapped, seriously emotionally disturbed, orthopedically impaired,

other health impaired, deaf-blind, multihandicapped, or have specific

learning disabilities, who because of these impairments, need special

education and related services and cannot succeed in the regular

vocational education program without special education assistance.”

Vocational education programs;

also other Education programs

Medical

Having one or more of the following physical conditions—“major

amputations, cerebral palsy, major head injury, Friedreich’s ataxia,

muscular dystrophy, spina bifida, amyotrophic lateral sclerosis, cystic

fibrosis, spinal cord injury, multiple sclerosis, post-polio, stroke.”

DeJong Medical

Individuals with “mental retardation; hearing impairments; speech, or

language impairments; visual impairments; serious emotional disturbance;

orthopedic impairments; autism; traumatic brain injury; other health

impairments; specific learning disabilities; . . . that need special education

and related services.”

Special education programs Medical

“A person was defined as having a disability if he or she considered

himself or herself to have a disability or said that other people would

consider him or her to be a person with a disability.”

National Organization on

Disability - Louis Harris Survey

Individually defined

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

Disability is “. . . the expression of a physical or mental limitation in a social

context—the gap between a person’s capabilities and the demands of the

environment. People with such functional limitations are not inherently

disabled, that is, incapable of carrying out their personal, familial, and

social responsibilities. It is this interaction of their physical or mental

limitations with social and environmental factors that determines whether

they have a disability.”

Institute of Medicine Societal based

“The disadvantage or restriction of activity caused by a contemporary

social organization which takes no or little account of people who have

physical impairments and thus excludes them from the mainstream of

social activities.”

Advocacy group Societal based

aSee Bibligraphy for full citations.

bSee footnote 60 for definitions of ADL and IADL.

Page 84 GAO/HEHS-96-126 Disability Programs
Appendix V 

Definitions of Disability and Population

Estimates of People With Disabilities

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

Estimate of number of people

with disabilities (in millions)

Percent of

relevant

population

Data

source

Year of

estimate Definition of disability

Ages of

population

included in

estimate

3.5 2.2 Census 1990 Functional—having a mobility

limitation

16-64

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

5.3 3.4 Census 1990 Functional—having a self-care

limitation

16-64

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

7.2 4.6 Census 1990 Functional—having a mobility

limitation or a self-care limitation

16-64

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

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

11.5 4.5 NHIS 1993 Functional—unable to carry out

major activity

All ages

12.9 8.2 Census 1990 Work disability—either unable to

work or limited in work

16-64

14.2 9.0 Current

Population

Survey

(CPS)

1990 CPS definition—either unable to

work or receiving disability

benefits from government income

maintenance program

16-64

15.6 9.5 CPS 1993 CPS definition—either unable to

work or receiving disability

benefits from government income

maintenance program

16-64

16.4 10.4 Census 1990 Functional—having a work

disability or a mobility limitation or

a self-care limitation

16-64

16.8 10.1 CPS 1994 CPS definition—either unable to

work or receiving disability

benefits from government income

maintenance program

16-64

17.0 10.9 NHIS 1993 Work disability—either unable to

work or limited in work

18-64

18.0 12.5 SIPP 1991 Functional—limitation in major

activity

21-64

19.4 13.1 SIPP 1993 Functional—limitation in major

activity

21-64

19.5 11.6 SIPP 1990-91 Work disability—either unable to

work or limited in work

16-67

22.7 14.6 NHIS 1993 Functional—limited in either work

or in some other activity

18-64

(continued)

Page 85 GAO/HEHS-96-126 Disability Programs
Appendix V 

Definitions of Disability and Population

Estimates of People With Disabilities

Estimate of number of people

with disabilities (in millions)

Percent of

relevant

population

Data

source

Year of

estimate Definition of disability

Ages of

population

included in

estimate

25.8 10.3 NHIS 1992 Functional—limited in major

activity

All ages

27.0 10.6 NHIS 1993 Functional—limited in major

activity

All ages

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

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

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

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

48.9 19.4 SIPP 1990-91 Composite—limited in any activity

or in self-care or has difficulty with

one of listed tasks

All ages

aThe NHIS question has a peculiar skip pattern—the ADL question was asked to anyone under 60

who reported an activity limitation and to all people over 60.

Notes: All data are self-reported and represent estimates for the noninstitutionalized population

unless noted otherwise.

No sources predating 1990 were included. The Survey of Disability and Work (1972 and 1978),

the National Long-Term Care Survey (1982-84), the Epidemiological Catchment Area survey

(1981), and the SSA New Beneficiary Survey (1982) also provide some disability information.

Some information on specific disabling conditions is available from the National Comorbidity

Survey administered between 1990 and 1992, the 1990-1991 SIPP, and the 1993 NHIS. The

Epidemiological Catchment Area survey (1981) also provides data on specific conditions.

Page 86 GAO/HEHS-96-126 Disability Programs
Appendix VI 

Comments From the Department of Labor

Page 87 GAO/HEHS-96-126 Disability Programs
Appendix VI 

Comments From the Department of Labor

Page 88 GAO/HEHS-96-126 Disability Programs
Appendix VI 

Comments From the Department of Labor

Page 89 GAO/HEHS-96-126 Disability Programs
Appendix VI 

Comments From the Department of Labor

Page 90 GAO/HEHS-96-126 Disability Programs
Appendix VII 

GAO Contacts and Staff Acknowledgments

GAO Contacts Charles Jeszeck, Assistant Director, (202) 512-7036

Sarah L. Glavin, Senior Economist, (202) 512-7180

Valerie S. Dumas, Analyst, (202) 512-9817

Staff

Acknowledgments

The following individuals also contributed to this report: Richard Kelley,

Steven Machlin, and Mary Reich.

Page 91 GAO/HEHS-96-126 Disability Programs
Bibliography

Anderson, K., J. Mitchell, and J.S. Butler. “Effect of Deviance During

Adolescence on Choice of Jobs.” Southern Economics Journal, Vol. 60, 

No. 2 (1993), pp. 341-56.

Barker, P., et al. “Serious Mental Illness and Disability in the Adult

Household Population: United States, 1989.” Advance Data, No. 218,

Centers for Disease Control and Prevention: National Center for Health

Statistics. Washington, D.C.: 1992, p. 11.

Baldwin, M., and W. Johnson. “Labor Market Discrimination Against Men

With Disabilities.” Journal of Human Resources, Vol. 29, No. 1 (1994), 

pp. 1-19.

Berkowitz, Edward D. Disabled Policy: America’s Programs for the

Handicapped (A Twentieth Century Fund Report) Cambridge, U.K.:

Cambridge University Press, 1987.

Bound, J. “Health and Earnings of Rejected Disability Insurance

Applicants: Reply.” American Economic Review, Vol. 81, No. 5 (1991), 

pp. 1427-34.

_____. “The Health and Earnings of Rejected Disability Insurance

Applicants.” American Economic Review, Vol. 79, No. 3 (1989), pp.

482-503.

_____ and T. Waidman. “Disability Transfers, Self-Reported Health, and

Labor Force Attachment of Older Men: Evidence from the Historical

Record.” The Quarterly Journal of Economics (1992), pp. 1393-1419.

Burkhauser, R.V., and P. Hirvonen. “United States Disability Policy in a

Time of Economic Crisis: A Comparison with Sweden and the Federal

Republic of Germany.” Millibank Quarterly, Vol. 67, Suppl. 2, Pt. 1 (1989),

pp. 166-95.

Chirikos, T. “Accounting for the Historical Rise in Work-Disability

Prevalence.” Millibank Quarterly, Vol. 64, No. 2 (1986), pp. 271-301.

DeJong, G., A. Batavia, and R. Griss. “America’s Neglected Health Minority:

Working-age Persons with Disabilities.” Millibank Quarterly, Vol. 67, 

Suppl. 2, Pt. 2 (1989), pp. 311-51.

Page 92 GAO/HEHS-96-126 Disability Programs
Bibliography

Haveman, R., and B. Wolfe. “The Economic Well-Being of the Disabled

1962-84.” Journal of Human Resources, Vol. 25, No. 1 (1990), pp. 32-54.

Iams, H.M. “Characteristics of the Longest Job for New Disabled Workers:

Findings from the New Beneficiary Survey.” Social Security Bulletin, 

Vol. 49, No. 12 (1986), pp. 13-18.

Johnson, W., and J. Lambrinos. “Wage Discrimination Against

Handicapped Men and Women.” Journal of Human Resources, Vol. 20, 

No. 2 (1985), pp. 264-77.

Maki, D.R. “The Economic Implications of Disability Insurance in Canada.”

Journal of Labor Economics, Vol. 11, No. 1 (1993), pp. S148-S169.

Manton, K. “Epidemiological, Demographic, and Social Correlates of

Disability Among the Elderly.” Millibank Quarterly, Vol. 67, Suppl. 2, Pt. 1

(1989), pp. 13-58.

Mitchell, J.M., and R. Burkhauser. “Disentangling the Effect of Arthritis on

Earnings: A Simultaneous Estimate of Wage Rates and Hours Worked.”

Applied Economics, Vol. 22 (1990), pp. 1291-1309.

Oi, Walter Y. “Disability and a Workfare-Welfare Dilemma,” in Disability

and Work: Incentives, Rights and Opportunities, ed. Carolyn Weaver.

Washington, D.C.: American Enterprise Institute, 1991.

Oliver, Michael. The Politics of Disablement: A Sociological Approach,

New York: St. Martin’s Press, 1990.

Parsons, Donald. “The Decline in Male Labor Force Participation,” Journal

of Political Economy, Vol. 88, No. 1 (1988), pp. 117-34.

Ravaud, J.F., B. Madiot, and I. Ville. “Discriminiation Towards Disabled

People Seeking Employment.” Social Science Medicine, Vol. 35, No. 8

(1992), pp. 951-58.

Reisine, S., J. Fifield. “Expanding the Definition of Disability: Implications

for Planning, Policy, and Research.” Millibank Quarterly, Vol. 70, No. 3

(1992), pp. 491-508.

Rones, P. “Can the Current Population Survey Be Used to Identify the

Disabled.” Monthly Labor Review, June (1981), pp. 37-39.

Page 93 GAO/HEHS-96-126 Disability Programs
Bibliography

Stern, S. “Measuring the Effect of Disability.” Journal of Human Resources,

Vol. 24, No. 3 (1989), pp. 361-95.

Wolfe, B.L. “How the Disabled Fare in the Labor Market.” Monthly Labor

Review, (1980), pp. 48-52.

Yelin, E. “Displaced Concern: The Social Context of the Work Disability

Problem.” The Millibank Quarterly, Vol. 67, No. 2 (1989), pp. 114-65.

_____, and P. Katz. “Labor Force Participation Among Persons With

Musculoskeletal Conditions, 1970-1987.” Arthritis and Rheumatism, 

Vol. 34, No. 11 (1991), pp. 1361-70.

Zeitzer, I.R. “Recent European Trends in Disability and Related Programs.”

Social Security Bulletin, Vol. 57, No. 2 (1994), pp. 21-26.

_____. “The Role of Assistive Technology in Promoting Return to Work for

People with Disabilities: The U.S. and the Swedish Systems.” Social

Security Bulletin, Vol. 54, No. 7 (1991), pp. 24-29.

Page 94 GAO/HEHS-96-126 Disability Programs
Bibliography

Page 95 GAO/HEHS-96-126 Disability Programs
Related GAO Products

SSA Disability: Program Redesign Necessary to Encourage Return to Work

(GAO/HEHS-96-62, Apr. 24, 1996).

PASS Program: SSA Work Incentive for Disabled Beneficiaries Poorly

Managed (GAO/HEHS-96-51, Feb. 28, 1996).

Americans With Disabilities Act: Effect of the Law on Access to Goods and

Services (GAO/PEMD-94-14, June 21, 1994).

Social Security: Disability Rolls Keep Growing, While Explanations

Remain Elusive (GAO/HEHS-94-34, Feb. 8, 1994).

Vocational Rehabilitation: Evidence for Federal Program’s Effectiveness Is

Mixed (GAO/PEMD-93-19, Aug. 27, 1993).

Social Security: Disability: SSA Needs to Improve Continuing Disability

Review Program (GAO/HRD-93-109, July 8, 1993).

Americans With Disabilities Act: Initial Accessibility Good But Important

Barriers Remain (GAO/PEMD-93-16, May 19, 1993).

Vocational Rehabilitation: VA Needs to Emphasize Serving Veterans With

Severe Employment Handicaps (GAO/HRD-92-133, Sept. 28, 1992).

Integrating Human Services: Linking At-Risk Families With Services More

Successful Than System Reform Efforts (GAO/HRD-92-108, Sept. 24, 1992).

Vocational Rehabilitation: Better VA Management Needed to Help Disabled

Veterans Find Jobs (GAO/HRD-92-100, Sept. 4, 1992).

Job Training Partnership Act: Actions Needed to Improve Participant

Support Services (GAO/HEHS-92-124, June 12, 1992).

Adolescent Drug Use Prevention: Common Features of Promising

Community Programs (GAO/PEMD-92-2, Jan. 16, 1992).

Vocational Rehabilitation: Clearer Guidance Could Help Focus Services on

Those With Severe Disabilities (GAO/HRD-92-12, Nov. 26, 1991).

Social Security: District Managers’ Views on Outreach for Supplemental

Security Income Programs (GAO/HRD-91-19FS, Oct. 30, 1990).

(205295) Page 96 GAO/HEHS-96-126 Disability Programs
Ordering Information

The first copy of each GAO report and testimony is free.

Additional copies are $2 each. Orders should be sent to the

following address, accompanied by a check or money order

made out to the Superintendent of Documents, when

necessary. VISA and MasterCard credit cards are accepted, also.

Orders for 100 or more copies to be mailed to a single address

are discounted 25 percent.

Orders by mail:

U.S. General Accounting Office

P.O. Box 6015

Gaithersburg, MD 20884-6015

or visit:

Room 1100

700 4th St. NW (corner of 4th and G Sts. NW)

U.S. General Accounting Office

Washington, DC

Orders may also be placed by calling (202) 512-6000 

or by using fax number (301) 258-4066, or TDD (301) 413-0006.

Each day, GAO issues a list of newly available reports and

testimony. To receive facsimile copies of the daily list or any

list from the past 30 days, please call (202) 512-6000 using a

touchtone phone. A recorded menu will provide information on

how to obtain these lists.

For information on how to access GAO reports on the INTERNET,

send an e-mail message with "info" in the body to:

info@www.gao.gov

or visit GAO’s World Wide Web Home Page at:

http://www.gao.gov

PRINTED ON RECYCLED PAPER
United States

General Accounting Office

Washington, D.C. 20548-0001

Official Business

Penalty for Private Use $300

Address Correction Requested

Bulk Rate

Postage & Fees Paid

GAO

Permit No. G100