Head Start: Information on Federal Funds Unspent by Program Grantees
Published: 1995-12-29T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: Pursuant to a congressional request, GAO reviewed the: (1) amount of Head Start funding unspent by program grantees at the end of budget years 1992 to 1994 and the reasons for these unspent funds; (2) proportion of carryover funds that were added to grantee awards and that are 1 or more budget years old; and (3) grantees' intended use of carryover funds.
section_title: What GAO Found
paragraphs: GAO found that: (1) about two-thirds of the grantees reviewed had unspent balances of $69,000 to $177,000 during budget years 1992 through 1994; (2) most of the unspent balances resulted from small differences between grantees' budget estimates and actual expenditures, problems related to building Head Start centers, and grantees' inability to spend their awards because of the Department of Health and Human Services (HHS) disbursement problems; (3) one-half of all the carryover funds in budget year 1993 and about three-fourths of the carryover funds in budget year 1994 were added to grantee awards in subsequent budget years; (4) about one-half and one-fourth of carryover funds in grantee budget years 1993 and 1994 offset grantee awards; (5) Head Start offset 70 to 90 percent of its grantee awards with carryover funds within 2 budget years of an unspent balance; and (6) carryover funds added to grantee awards were used to expand Head Start enrollments, build new facilities, purchase capital equipment and train staff.

section_title: Letter
paragraphs: In fiscal year 1995, Head Start—the centerpiece of federal early childhood programs—was appropriated $3.5 billion to provide a range of services to eligible, preschool-aged children from low-income families. Currently, about 1,400 local agencies, known as grantees, sponsor these programs and serve 752,000 children. Local programs provide education, nutrition, health, and social services to low-income children and opportunities for parental involvement and enrichment.
Since 1990, the Congress has increased funding for Head Start 135 percent (in current dollars) to allow more children the opportunity to participate and to improve the quality of Head Start services. During this period of growth, virtually all program funds were awarded to grantees. However, some Head Start grantees, as expected, (1) did not spend all of the program funds awarded them each year to conduct local program activities and (2) carried these unspent funds forward for use in subsequent years.
This report responds to your request for us to determine the amount of Head Start funding unspent by program grantees at the end of grantee budget years 1992, 1993, and 1994 and the reasons for these unspent funds;the proportion of carryover funds that was added to grantee awards or that offset grantee awards in subsequent years; the proportion of carryover funds that are 1 or more grantee budget years old; and the grantees’ intended use of carryover funds.
To gather information about the extent and intended use of Head Start grantees’ carryover funds in grantee budget years ending 1992 through 1995, we drew a nationally representative sample of 108 grantee files. We subsequently examined key documents in these grantees’ files maintained at Head Start’s Atlanta, Chicago, Dallas, Denver, and New York regional offices. We discussed the information we collected with Department of Health and Human Services (HHS) officials at headquarters and the field offices. We did not independently verify the accuracy of the data in the grantee files. Finally, we analyzed and weighted the data from 107 grantees and projected the results to a universe of 1,197 Head Start grantees in 1994.
Our universe of 1,197 grantees did not include 135 grantees that operate programs for Native American and migrant children; 69 grantees in existence less than 3 years; and 4 grantees with fiscal year 1994 awards of $60 million or greater. Our review was not designed to (1) determine whether program grantees actually used carryover funds for the purposes intended or (2) uncover program abuses, such as fraud or mismanagement. (See app. I for a full description of our methodology.)
subsections: section_title: Background
paragraphs: Head Start is administered by HHS’ Administration for Children and Families (ACF). Services are provided at the local level by public and private nonprofit agencies that receive their funding directly from HHS. These agencies include public and private school systems, community action agencies, government agencies, and Indian tribes. Grantees may contract with one or more other public or private nonprofit organizations—commonly referred to as delegate agencies—in the community to run all or part of their local Head Start programs. Grantees may choose to provide center-based programs, home-based programs, or a combination of both.
Once approved for funding as a result of a competitive application process, Head Start grantees do not compete for funding in succeeding years. However, they are required to submit applications for continuation awards (hereafter called awards) to support their programs beyond the initial grantee budget year. After Head Start receives its annual appropriation from the Congress, the respective HHS regional offices make awards to grantees in their administrative service areas at the beginning of each grantee’s budget year as shown in table 1.
Grantees use their awards for the following purposes, among others, to: purchase or rent a facility if providing a center-based program; hire qualified teachers, aides, and support staff; coordinate or contract with Public Health agencies and local health providers to deliver medical and dental services; buy or lease vehicles to transport children to Head Start centers; purchase utilities, services, and supplies needed to operate a center and administer the program; and comply with program standards and local building and health codes that ensure quality and safety.
During a grantee budget year, grantees may also receive supplemental awards for specific purposes (such as expanding enrollment) or to cover normal, though sometimes unexpected, expenses such as repairing a roof or purchasing a new heating system. In addition, grantee accounts may be adjusted as the result of a routine financial audit or Head Start regional office review of grantees’ files. These activities sometimes identify unspent funds that the grantee did not report due to an error or oversight. HHS requires grantees to get their Head Start accounts audited every 2 years, though many grantees hire accountants to perform an audit every year.
As shown in figure 1, grantees, as expected, may not necessarily spend all of their award by the end of their budget year. HHS permits grantees to carry over unspent funds into the next grantee budget year to complete any program objectives that remain unmet from the previous year. HHS regional offices generally handle carryover funds in two ways: 1. Carryover balances from a previous year or years are added to an award that a grantee receives in a subsequent year. This procedure is known as “reprogramming” funds, and the amount of carryover funds added to a grantee’s award is called total obligating authority (TOA). 2. Carryover balances from a previous year or years offset or reduce the award that a grantee receives in a subsequent year. This procedure is known as “offsetting” funds, and the amount of carryover deducted from the award is called new obligating authority (NOA).
New $ (TOA)
New $ (NOA)
subsections: section_title: Funding Increases Had No Impact on HHS’ Ability to Disburse Awards
paragraphs: The growth in Head Start funding since 1990 (see fig. 2) reflects the federal government’s commitment to expanding the number of children in the program and to ensuring program quality. Overall program funding increased from about $1.5 billion in fiscal year 1990 to about $3.5 billion in fiscal year 1995. Twice in fiscal year 1990 and once each in fiscal years 1991, 1992, and 1993, the Congress appropriated additional funding for Head Start to, among other things, increase local enrollments, strengthen the program’s social, health, and parent involvement components; improve services for disabled children; initiate and improve literacy programs; and enhance salaries, benefits, training, and technical assistance for program staff. ACF allocated these expansion funds on the basis of a formula as required by statute.
Despite this dramatic growth in Head Start appropriations, HHS awarded virtually all program funding to eligible grantees. Head Start’s program obligation rates for each of these years stayed at or above 99 percent, while the total number of grantees increased from 1,321 in fiscal year 1990 to about 1,400 in fiscal year 1994. Overall program outlay rates (that is, the ratio of outlays to budget authority) during this period indicate that outlays remained stable as grantees received infusions of Head Start expansion or quality improvement funding. However, at the grantee level, this funding growth increased grantee awards and unspent balances for the grantees included in our universe during the grantee budget years we examined.
section_title: Grantee Awards and Unspent Balances Increased in Recent Years
paragraphs: We found that total grantee awards for the 1,197 Head Start grantees covered by our review increased from $1.4 billion to $2.3 billion from grantee budget years 1992 through 1994, while mean awards rose from $1.2 million to $1.9 million in these same years. (See table 2.)
During grantee budget years 1992, 1993, and 1994—a period of intense growth—about two-thirds of the 1,197 grantees had unspent balances at the end of each budget year. Almost 40 percent of these 1,197 grantees had unspent balances every year. As shown in table 2, these balances totaled approximately $54 million, $101 million, and $130 million, in grantee budget years 1992, 1993, and 1994, respectively, and varied greatly by grantee.
However, these unspent balances were a small part of grantees’ total awards. On the basis of our analysis, unspent balances represented from about 5 to 8 percent of the award for those grantees with unspent balances and from 4 to 6 percent of total awards for all grantees in the aggregate. (See app. II for the reported unspent balances of the 108 grantees included in our sample.)
section_title: Why Do Unspent Balances Occur?
paragraphs: Unspent balances resulted from (1) small differences between the amount of a grantee’s annual award and its actual expenditures at the end of its grantee budget year, (2) situations that delay a grantee’s expenditure of funds or that hamper a grantee’s ability to spend funds before the year’s end, and (3) a combination of these and other reasons.
subsections: section_title: Small Budget Variances
paragraphs: We found that almost two-thirds of grantees in grantee budget year 1992 and about half in grantee budget years 1993 and 1994 had small differences between their total award approved at the beginning of a grantee budget year and the amount spent at year’s end. We considered these spending variances small if the amount of unspent funds was 5 percent or less of a grantee’s award in a given year. These small budget variances could have occurred because, for example, (1) grantees’ projected budgets—upon which grant awards are based—did not equal their actual expenditures or (2) grantees did not purchase an item or service as originally planned. For example, a grantee in Ohio had ordered two buses and playground equipment for its Head Start center. However, these items were not delivered nor paid for before the grantee’s budget year ended, resulting in an unspent balance of $84,762.
section_title: Timing Issues
paragraphs: We found that from 10 to 24 percent of grantees with unspent balances in grantee budget years 1992 through 1994 (1) had problems renovating or building a center, which delayed planned expenditures until subsequent years, or (2) received additional funding late in a grantee budget year, making it difficult for grantees to spend all of their funds before year’s end. For example, a Head Start grantee in Colorado received funding to increase its program enrollment in early September 1991—about 2 months before the grantee’s budget year was to end on October 30. Due to the short time remaining, the grantee could not spend $89,980 of the amount awarded for expanding program enrollment. This same grantee had agreed verbally with a private company to prepare a site so that the grantee could place a modular unit on it to serve as a Head Start center. Site preparation would have involved establishing water, sewer, gas, and electrical hookups at the site. Before any work began, however, new owners took over the company and did not honor the verbal agreement between the grantee and the previous owner. It took the grantee 2 years to find another site suitable for the center, and that facility required extensive renovations.
HHS’ Office of Inspector General reported in 1991 and 1993 that acquiring adequate, affordable space was a major problem for Head Start grantees attempting to expand program enrollments. Grantees told the Inspector General’s office that it can take up to a year to find suitable space that then may have to be renovated. Strict construction licensing requirements and delays in license approval could also slow spending for center construction or renovation. The Inspector General reported that space problems were most prevalent among grantees funded to increase enrollment by more than 200 children. The grantees believed that being notified at least 6 months in advance of funding disbursements would help to alleviate this problem.
Head Start grantees interviewed by the Inspector General’s staff also said that receiving expansion funding late in the budget year results in carryover fund balances. After expansion, more than twice as many grantees interviewed had carryover balances of over $50,000. Many grantees believe that even with adequate lead time large expansions should not occur annually.
section_title: Other Reasons
paragraphs: According to the grantee files we reviewed, unspent balances sometimes occurred for reasons other than small budget variances or timing issues. On the basis of information included in grantee files and discussions with regional office program officials, we found, for example, that unspent balances occurred because grantees experienced accounting or management problems during 1 or more years, depended on large government bureaucracies, such as New York City’s, to provide certain goods and services, which often slowed program expenditures; or assumed the program operations and accounts of a former grantee.
Also, unspent balances may have occurred for a combination of reasons described above. In other cases we could not determine the reason for grantees’ unspent balances on the basis of file information or discussions with Head Start regional office officials.
section_title: Larger Proportion of Carryover Funds Added to Grantee Awards in Grantee Budget Year 1994
paragraphs: Unspent balances occur when a grantee’s total award differs from the amount the grantee spent during its budget year. As previously stated, these unspent funds may be carried over into a subsequent grantee budget year. For our analysis, we defined carryover funds as any unspent funds used to either offset or add to a grantee’s award during a subsequent budget year. Carryover funds are not always added to or offset in the year immediately following the year the unspent funds occurred. For example, a grantee in Florida with $45,913 in unspent funds in grantee budget year 1992 did not have this amount totally added to or offset as carryover funds in grantee budget year 1993. In fact, $45,759 was added to its budget year 1993 award and the remaining $154 was used to offset the grantee’s budget year 1994 award. A grantee in Minnesota, on the other hand, had $3,840 from grantee budget year 1993 added to its budget year 1995 award. Yet, a Michigan grantee had its entire grantee budget year 1992 unspent balance of $1,568 offset as carryover funds in 1993.
On the basis of our analysis of grantee files, we found that in grantee budget year 1993 HHS added about half of all carryover funds to grantees’ awards as TOA and the remaining proportion of carryover funds was offset as NOA. Of the grantees in our sample with TOA in grantee budget year 1993, the unspent funds added to grantee awards ranged from $10,900 to $533,500 and averaged approximately $96,000. If we had included the grantee representing New York City in our calculation, the upper end of this range would have been about $4.2 million. NOA for the same period ranged from $59 to $664,700 and averaged about $39,000.
In grantee budget year 1994, we found that about three-fourths of carryover funding was added to awards as TOA, and the remainder was offset as NOA. Of the grantees in our sample with TOA in grantee budget year 1994, the amount of unspent funds added to grantee awards ranged from $3,200 to $2.4 million and averaged about $197,400. NOA for the same period ranged from $17 to $621,000 and averaged approximately $58,600. This trend appears to continue in grantee budget year 1995, though data for this year were incomplete when we performed our final calculations in October 1995.
subsections: section_title: Most Carryover Funds Are Reprogrammed or Offset Within 2 Grantee Budget Years
paragraphs: We found that HHS generally adds to or offsets grantee carryover funds within 2 grantee budget years after an unspent balance occurs. For example, for both grantee budget years 1993 and 1994, we found that about 90 percent of carryover funds added to grantee awards was 1 year old, and the remainder was from 2 to 3 years old; and from about 70 to 90 percent of carryover funds offsetting grantee awards was from 1 to 2 years old, and the remainder was 3 or more years old.
Because Head Start carryover funds are generally spent in 2 grantee budget years but are available for up to 5 fiscal years following the fiscal year in which they are initially awarded (31 U.S.C., sec. 1552(a)), we asked Head Start regional office officials why certain carryover balances were reprogrammed or offset as long as 3 or more years after an unspent balance occurred. Regional office officials gave the following administrative and grantee-specific reasons:
Regional office staff may not process grantee files in a timely manner due to grantee or staff errors, delays in data entry, staff turnover, large workloads, and differences in staff competence.
Final forms documenting carryover balances are not due from grantees until 90 days after the budget year’s end. Incorrect carryover balances may not be caught immediately because independent auditors may take up to 13 months to complete an audit of a grantee’s program accounts for a given year.
Actions, such as reprogramming or offsetting carryover balances, could be suspended if a grantee appeals an HHS decision to disallow funding.
A grantee’s bankruptcy proceedings delayed a regional office from offsetting certain carryover funds.
section_title: Intended Use of Carryover Balances Reportedly for Expansion and Facilities
paragraphs: For grantee budget years 1993 and 1994 combined, we estimated that carryover funds totaled $139 million. Of this amount, carryover funds added to grantee awards (TOA) totaled $97 million and those offsetting grantee awards (NOA) totaled $42 million. We focused our analysis of intended use on the TOA portion because NOA has no identifiable intended purpose.
On the basis of our review of Head Start grantee files, the intended use of a large proportion of Head Start carryover funds from grantee budget years 1993 and 1994 combined was to be used for expanding program enrollments and renovating or buying facilities. Of the $97 million of TOA carryover funds, the intended use of 40 percent of these funds was for expansion and 37 percent was for facilities. Data from the files indicated that about 23 percent of the total TOA for these years was reportedly to be used for capital equipment, supplies, and other purposes such as staff training and moving expenses. Data were incomplete for grantee budget year 1995.
We found that grantees in our sample with TOA in grantee budget years 1993 and 1994 combined to be used for facilities ranged from $901 to $611,000 and averaged approximately $116,000. TOA reportedly to be used for expansion ranged from $4,200 to $2.4 million and averaged about $296,000.
In summary, although overall program outlay rates remained stable during a period of intense program growth (fiscal years 1990-95), Head Start grantees accrued increasingly larger average unspent balances in grantee budget years 1992 through 1994. Depending on the size of grantees’ awards, their reported unspent balances in those years ranged from as little as $2 to about $2 million. On the basis of Head Start files, we determined in most cases that these unspent balances resulted from (1) small differences between grantees’ budget estimates and actual expenditures; (2) grantee problems renovating or constructing facilities, which delayed planned expenditures; and (3) the receipt of supplemental funding by grantees late in their budget year, which made it difficult for grantees to spend their funds before year’s end. Of the unspent funds added to grantee awards in budget years 1993 and 1994 combined, we found that grantees planned to use these dollars for increasing local program enrollments and buying or improving program facilities—activities that grantees often do not complete in a single year.
As arranged with your office, we will make copies available to the Secretary of Health and Human Services and other interested parties. We will also make copies available to others on request.
Please contact Fred E. Yohey, Assistant Director, on (202) 512-7218 or Karen A. Whiten, Evaluator-in-Charge, if you or your staff have any questions. Other GAO contributors to this report are listed in appendix III.
section_title: Scope and Methodology
paragraphs: We designed our study to collect information about the extent and nature of Head Start carryover funds. To do so, we visited a sample of Head Start regional offices and examined key documents in selected grantee files. Results are generalizable to Head Start grantees that (1) were at least 3 years old in 1994, (2) had at least some but less than $60 million in new funding in 1994, and (3) were located in 10 of the 12 Head Start regions. Our work was performed between June and October 1995 in accordance with generally accepted government auditing standards.
subsections: section_title: Data Collection Strategy
paragraphs: We reviewed grantee files for a nationally representative sample of Head Start grantees. We focused our efforts on grantee budget years that ended in 1992 through 1995, examining file documents at selected Head Start regional offices.
subsections: section_title: Sample Design
paragraphs: To generate national estimates, we employed a two-stage cluster sampling strategy. The Head Start regions constituted the first stage of the sample. Of the 12 Head Start regions, 2 are operated from the Department of Health and Human Services headquarters in Washington, D.C.—1 for Native Americans and the other for migrant workers. Because these regional offices share a unique relationship with headquarters, they were not included in the regions to be sampled. We organized the 10 remaining regions by the amount of grantee new funding received in federal fiscal year 1994, separating them into three groups or strata: regions with new funding of $500 million or more; regions with new funding of $200 to $499 million; and regions with new funding of less than $200 million. Table I.1 shows our population of regions.
Total fiscal year 1994 new funding (dollars in millions)
We then selected a sample of regions in each strata using a random number generator program. Table I.2 shows the regions selected in our sample.
Total fiscal year 1994 new funding (dollars in millions)
Stage two of the sample consisted of individual Head Start grantees. Head Start had 1,270 grantees in the 10 regions in fiscal year 1994. Because we were reviewing 2 to 3 years of data, we excluded any grantee not in existence at least 3 years. We also excluded all grantees with no new funding in fiscal year 1994. This reduced the number of grantees in our population to 1,201.
We organized grantees in our sample regions by fiscal year 1994 new funding and put them into four strata: those with fiscal year 1994 new funding of less than $1 million; those with $1 million or more but less than $3 million; those with $3 million or more but less than $5 million; and those with $5 million or more. We then selected a random sample of grantees in each strata. Table I.3 shows the distribution of grantees by strata of our population and sample.
Once the fieldwork was completed and records evaluated, we determined that one very large grantee with fiscal year 1994 new funding of $60 million or more was, because of its complexity, unique and required special handling. Therefore, we set aside this one grantee—The City of New York Human Resources Administration, Agency for Child Development. We did not include data collected from this site in our overall estimates but used the data as a case study of a very large grantee. By eliminating the very large grantees, we reduced our population further by 4 grantees to 1,197, thereby reducing our sample from 108 to 107 grantees. Our findings, therefore, are representative of grantees in the 10 Head Start regions that are at least 3 years old with at least some but less than $60 million in fiscal year 1994 new funding.
section_title: Fieldwork
paragraphs: We provided the list of sample grantees to each selected regional office, which collected records for our review. We examined key documents from the files and summarized the information using a data collection instrument. Data elements we collected included the number of service years for a selected grantee; total federal funds authorized for specific funding periods; the unspent balance of federal funds for specific funding periods and its intended usage; and the amount of carryover funds added to or offsetting grantee awards in grantee budget years 1993, 1994, and 1995 by type and source year. To link source year with carryover funds, we gathered information from the Financial Assistance Award form, which identifies the grantee service year in which the unspent funds occurred.
Once data collection was complete, we compiled and merged the data. Data elements were verified and traced to documents maintained in the grantee files for 91 percent of the cases. We then computed weights to produce national estimates from our sample and calculated analytic variables. To calculate the age of carryover funds, we subtracted the source year from the grantee’s current service year.
The Head Start grantee funding process presented unique data collection challenges. We made no attempt to capture the fiscal year funding. Rather, we used each grantee’s budget year ending date to guide our compilation of financial data.
section_title: Sampling Errors
paragraphs: Because our analysis is based on data from a sample of grantees, each reported estimate has an associated sampling error. The size of the sampling error reflects the estimate’s precision; the smaller the error, the more precise the estimate. The magnitude of the sampling error depends largely on the size of the obtained sample and the amount of data variability. Our sampling errors for the estimates were calculated at the 95-percent confidence level. This means that in 95 out of 100 instances, the sampling procedure we used would produce a confidence intervalcontaining the population value we are estimating.
Some sampling errors for our dollar estimates are relatively high because dollar amounts vary substantially. Sampling errors also tend to be higher for those estimates based on a subset of sample cases. For example, estimates of the mean and total amounts of grantee unspent balances are based on fewer than the 107 grantees in our sample and have large sampling errors. Therefore, these estimates must be used with extreme caution. For a complete list of sampling errors for dollar estimates and proportions in this report, see tables I.4 and I.5, respectively.
Number of sample grantees contributing to estimate +/-$82,904103 +/-$98,912,337 +/-$102,334 +/-$123,885,671 +/-$102,618 +/-$122,810,684 +/-$19,304 +/-$15,412,760 +/-$41,297 +/-$32,225,320 +/-$36,568 +/-$27,732,575 1993/1994 Carryover funds offsetting grantee awards (NOA) +/-$25,705 +/-$18,371,913 1993/1994 Carryover funds added to grantee awards (TOA)
Estimated proportion (percent)
Sampling error (percentage points)
Grantees with unspent balances all 3 years Unspent balances as a percent of total Amount of unspent as a percent of award Unspent balances due to small budget variances Unspent balances due to timing issues Unspent balances due to other reasons Unspent balances due to unknown reasons (continued)
Estimated proportion (percent)
Sampling error (percentage points)
section_title: Methodology Limitations
paragraphs: Because we wanted to obtain general information about the extent and frequency of Head Start carryover funds, we limited our investigation to reviewing grantee records maintained at HHS’ Atlanta, Chicago, Dallas, Denver, and New York regional offices. We gave officials at these regional offices an opportunity to review the accuracy of the data we collected and subsequently used to develop our estimates. We did not contact individual grantees to verify records nor did we visit grantee sites. We did not follow the flow of funds to determine if program abuses had occurred nor did we make any attempt to determine whether program grantees actually used the funds for the purposes intended.
section_title: Head Start Grantees Included in Our Representative Sample
paragraphs: North Wilkesboro, N.C.
Hardinsburg, Ky.
Fort Lauderdale, Fla.
Huntsville, Ala.
Cheraw, S.C.
Chattanooga, Tenn.
Tuscaloosa, Ala.
Jacksonville, N.C.
Savannah, Ga.
Monticello, Ga.
Williamston, N.C.
Brooksville, Fla.
Montgomery, Ala.
Jacksonville, Fla.
La Grange, Ky.
Florence, S.C. (continued)
Eatonton, Ga.
Lucedale, Miss.
Cartersville, Ga.
Ashland, Miss.
Logansport, Ind.
Coldwater, Mich.
Washington Court House, Ohio Stevens Point, Wis. (continued)
Rockford, Ill.
Greenville, Mich.
Scottville, Mich.
Oklee, Minn.
Grand Rapids, Mich.
Alpena, Mich.
Janesville, Wis.
Port Huron, Mich.
Rushford, Minn.
East St. Louis, Ill.
Zumbrota, Minn.
Rock Falls, Ill.
NA - Information not available.
subsections: section_title: Levelland, Tex.
paragraphs: (continued)
Stonewall, Tex.
Winnsboro, La.
Bay City, Tex.
NA - Information not available.
section_title: Loveland, Colo.
paragraphs: NA - Information not available.
section_title: Brooklyn, N.Y.
paragraphs: (continued)
Kingston, N.Y.
Brooklyn, N.Y.
NA - Information not available.
section_title: GAO Contacts and Staff Acknowledgments
subsections: section_title: GAO Contacts
section_title: Acknowledgments
paragraphs: The following individuals made important contributions to this report: Robert Rogers and Karen Barry planned this review, and Karen managed the data collection. David Porter and Lawrence Kubiak collected much of the data from the HHS regional offices. Patricia Bundy also helped to collect data, conducted follow-up discussions with HHS headquarters and regional office officials, and assisted with report processing. Dianne Murphy drew the sample and performed the analysis. Steve Machlin calculated sampling errors. Harry Conley and Michael Curro provided technical assistance, and Demaris Delgado-Vega provided legal advice.
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