Federal Disability Assistance: Wide Array of Programs Needs to be Examined in Light of 21st Century Challenges
Published: 2005-06-02T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: In 2003, GAO designated modernizing federal disability programs as a high-risk area requiring urgent attention and organizational transformation to ensure that programs function as efficiently and effectively as possible. GAO found that although social attitudes have changed and medical advancements afford greater opportunities for people with disabilities to work, the Social Security Administration and the Department of Veterans Affairs have maintained an outmoded approach that equated disability with inability to work. We have prepared this report under the Comptroller General's authority as part of a continued effort to help policymakers better understand the extent of support provided by federal programs to people with disabilities and to assist them in determining how these programs could be better aligned to more effectively meet the needs of individuals with disabilities in the 21st century. This report identifies (1) the wide array of federal programs that serve people with disabilities, and (2) the major challenges these federal programs face in the 21st century. In addition, GAO presents factors policy makers and program administrators should address in assessing whether, and how, they could be transformed to better meet 21st century challenges.
section_title: What GAO Found
paragraphs: More than 20 federal agencies and almost 200 programs provide a wide range of assistance to people with disabilities, including employment-related services, medical care, and monetary support. About half of these programs serve only people with disabilities while the rest serve people both with and without disabilities. In fiscal year 2003, more than $120 billion in federal funds was spent on programs that only serve people with disabilities, with over 80 percent of these funds spent on monetary support. In addition, considerable funds are spent on people with disabilities by programs that also serve people without disabilities, like Medicare and Medicaid. The program challenges cited most frequently in our recent survey of nearly 200 programs serving people with disabilities are largely consistent with several of the key findings from past reports that led GAO to place federal programs supporting people with disabilities on its high-risk list. Both our recent survey and our past work have identified challenges in (1) ensuring timely and consistent processing of applications; (2) ensuring timely provision of services and benefits; (3) interpreting complex eligibility requirements;( 4) planning for growth in the demand for benefits and services; (5) making beneficiaries or clients aware of benefits and services; and (6) communicating or coordinating with other federal disability programs. In light of the vital role federal programs play in providing assistance to people with disabilities and in helping to ensure an adequate national labor force, we have identified a number of factors that are important to consider in assessing the need for, and nature of, program transformations including (1) program design issues; (2) fiscal implications of proposed program changes; and (3) feasibility of implementing program changes.

section_title: Letter
paragraphs: In 2003, GAO designated modernizing federal disability programs as a  high-risk area—one that requires urgent attention and organizational  transformation to ensure that programs function in the most economical,  efficient, and effective manner possible. This designation was based on  more than a decade of research focusing primarily on the nation’s largest  disability programs, which are administered by the Social Security  Administration (SSA) and the Department of Veterans Affairs (VA). GAO’s  work has found that these programs are neither well aligned with 21st  century realities nor are they well-positioned to provide meaningful and  timely support for Americans with disabilities. For example, despite  opportunities afforded by medical and technological advancements and  the growing expectations that people with disabilities can and want to  work, federal disability programs remain grounded in an approach that  equates medical conditions with the incapacity to work. Given the  projected slowdown in the growth of the nation’s labor force, it is  imperative that those who can work are supported in their efforts to do so.  Yet federal disability programs are not well-positioned to provide this  support. Solutions to these problems are likely to require fundamental  changes, including regulatory and legislative action.
In addition to disability programs operated within SSA and VA, there are a  number of other federal programs that provide various levels of support to  individuals with disabilities. We have prepared this report under the  Comptroller General’s authority as part of a continued effort to help policy  makers better understand the extent of support provided by federal  programs to people with disabilities and to assist them in determining how  these programs could more effectively meet the needs of individuals with  disabilities in the 21st century. In this report, we (1) identify the many  federal programs that play a role in supporting people with disabilities and  (2) identify some of the major challenges that federal programs face in  supporting people with disabilities in the 21st century. We also present  factors that we believe are important for programs to consider in assessing  whether, and how, they could be transformed to better meet 21st century  challenges. As this report may prove helpful in the deliberations of  committees with oversight responsibilities or jurisdiction over disability  issues, we have addressed this report to each of these committees.
To obtain information on federal disability programs and the challenges  they face, we (1) reviewed the Catalog of Federal Domestic Assistance  (CFDA) and agency Web sites to identify federal programs that provide  assistance to people with disabilities; (2) conducted a Web-based survey of  the programs we identified to obtain descriptive information on these  programs and the challenges they face; (3) interviewed selected agency  officials and officials from disability advocacy organizations to obtain  additional information on the challenges federal programs face; and   (4) reviewed pertinent agency documents, GAO reports, and academic  research on disability issues. We conducted our work between March 2004  and March 2005 in accordance with generally accepted government  auditing standards. For more details about our scope and methodology,  see appendix I.
subsections: section_title: Background
paragraphs: Recent economic, medical, technological, and social changes have  increased opportunities for individuals with disabilities to live with greater  independence and more fully participate in the workforce. For example,  over the past several decades, the economy has shifted towards service-  and knowledge-based jobs that may allow greater participation for some  persons with physical limitations. Also, advances in medicine and assistive  technologies—such as improved treatments for mental illnesses and  advanced wheelchair design—afford greater opportunities for some  people with disabilities. In addition, social and legal changes have  promoted the goal of greater inclusion of people with disabilities in the  mainstream of society, including adults at work. For example, the  Americans with Disabilities Act supports the full participation of people  with disabilities in society and fosters the expectation that people with  disabilities can work and have the right to work. More recently, the  President announced the New Freedom Initiative, a set of guiding  principles and initiatives aimed at improving the integration of people with  disabilities in all aspects of society, including employment.
Public concern and congressional action have produced a broad array of  federal programs designed to help people with disabilities. However, our  prior reviews of the largest federal disability programs indicate that such  programs have not evolved in line with these larger societal changes and  therefore, are poorly positioned to provide meaningful and timely support  for people with disabilities. Furthermore, program enrollment and costs  for the largest federal disability programs have been growing and are  poised to grow even more rapidly in the future, further contributing to the  federal government’s large and growing long-term structural deficit. For  example, from 1982 to 2002, the number of disabled workers receiving  benefits under SSA’s Disability Insurance (DI) program doubled from 2.6  million to 5.5 million, while payments quadrupled from about $14.8 billion  to $60 billion. Moreover, these disability programs are poised to grow even  more as baby boomers reach their disability-prone years. This program  growth is exacerbated by the low rate of return to work for individuals  with disabilities receiving cash and medical benefits. In addition, the  projected slowdown in the growth of the nation’s labor force has made it  more imperative that those who can work are supported in their efforts to  do so.
section_title: Over 20 Different Agencies Administer Almost 200 Programs That Provide a Wide Range of Assistance
paragraphs: We identified over 20 federal agencies and almost 200 federal programs  that are either wholly or partially targeted to serving people with  disabilities. These programs provide a wide range of assistance such as  employment-related services, medical care, and monetary support.  Multiple agencies run programs that provide similar types of assistance,  but these programs often serve different populations of people with  disabilities because of varying eligibility criteria. About 59 percent of the  programs we identified provide indirect support to people with disabilities  through means such as grants to states, while the rest provide support  directly to people with disabilities. In fiscal year 2003, over $120 billion in  federal funds were spent on programs that serve only people with  disabilities. Although there were insufficient data available to estimate the  total additional funds spent on people with disabilities by programs that  also serve people without disabilities, benefit payments for people with  disabilities for two such programs alone—Medicare and Medicaid— amounted to about $132 billion in fiscal year 2002.
subsections: section_title: Multiple Federal Agencies Administer Programs Serving People with Disabilities
paragraphs: Twenty-one federal agencies—under the jurisdiction of more than 10  Congressional committees—administer 192 programs that target or give  priority to people with disabilities (see table 1). However, four agencies— the departments of Health and Human Services (HHS), Education,  Veterans Affairs, and Labor—are responsible for over 65 percent of these  programs. About half of the programs that we identified are wholly  targeted (targeted exclusively) to people with disabilities. The rest of the  programs are partially targeted to people with disabilities—they serve  people with and without disabilities. Specifically, of the 192 programs we  identified, 95 reported being wholly targeted, and 97 reported being  partially targeted. The wholly targeted programs reported that they served  over 34 million beneficiaries or clients in fiscal year 2003, with the largest  among these—SSA’s DI program and VA’s Veterans Compensation for  Service-Connected Disability program—serving about 10 million of these  beneficiaries. Although some of the partially targeted programs we  surveyed could not provide data on the number of people with disabilities  they serve, our survey data indicate that these programs served at least   15 million beneficiaries or clients with disabilities in fiscal year 2003, with  the largest of these programs—SSA’s Supplemental Security Income  Program—serving about 5.7 million of these beneficiaries.
section_title: Federal Programs Provide a Wide Range of Assistance to People with Disabilities
paragraphs: Federal programs provide a wide range of assistance to people with  disabilities (see fig. 1). The most common primary types of assistance  provided are employment-related services and medical care, although a  number of programs provide civil protections or legal services, education,  and monetary support as well as other benefits or services (see fig. 2).
Most of the federal programs provide more than one type of assistance and  over one-quarter of the programs provide three or more types of  assistance to people with disabilities (see fig. 3). For example, the  Developmental Disabilities Basic Support and Advocacy Grants program  run by HHS provides multiple types of assistance to people with  disabilities including housing, education, transportation, and information  dissemination services.
About 59 percent of the programs we identified provide support indirectly  through other entities such as state agencies or private organizations,  while the rest provide it directly to people with disabilities. For example,  the Department of Education’s Preschool Grants program provides special  education to preschool children with disabilities via funding to state  education agencies, whereas the Department of Labor’s Coal Mine  Workers’ Compensation program provides monetary support directly to  eligible coal mine workers with disabilities. Of the programs that provide  assistance indirectly to people with disabilities, the most common means  is through nonfederal government entities (e.g., state or local agencies).
section_title: Multiple Federal Agencies Provide Similar Types of Assistance
paragraphs: Multiple federal agencies administer programs that provide similar types  of assistance to people with disabilities (see table 2). For example, seven  agencies—including the Social Security Administration, the Committee for  the Purchase from People who are Blind or Severely Disabled, the Office  of Personnel Management, and the departments of Agriculture, Education,  Labor, and Veterans Affairs—administer 28 programs that primarily  provide employment-related services to people with disabilities.
Although programs from multiple agencies provide the same primary type  of assistance, these programs often have varying eligibility criteria that  may limit the populations served to distinct groups of people with  disabilities. For example, the American Indian Vocational Rehabilitation  Services program run by the Department of Education and the Department  of Veterans Affairs’ Vocational Rehabilitation for Disabled Veterans  program each provide employment-related assistance, but to distinct  groups of people. Furthermore, the 28 programs that primarily provide  employment-related services often have distinct eligibility criteria beyond  the specific populations served.
section_title: Billions Are Spent on Programs for People with Disabilities
paragraphs: The programs that provide assistance only to people with disabilities spent  over $120 billion in fiscal year 2003. SSA and VA accounted for about 88  percent of this amount (see fig. 4). In particular, SSA’s DI program  accounted for about 64 percent of the total spending for wholly targeted  programs, and the VA’s Veterans Compensation for Service-Connected  Disability program accounted for approximately 17 percent of this total.  Approximately 86 percent of the wholly targeted program spending was  for programs that primarily provided monetary support to people with  disabilities (see fig. 5).
In addition to the billions of dollars spent on programs that serve only  people with disabilities, additional amounts are spent on individuals with  disabilities by partially targeted programs whose beneficiaries also include  people without disabilities. While we were not provided with sufficient  data to determine the total amount spent by all of these partially targeted  programs on benefits or services for individuals with disabilities, these  costs are certainly significant given that they include such programs as  Supplemental Security Income (SSI), Medicaid, and Medicare. In 2002, SSI  paid about $26 billion in cash benefits to people with disabilities and  Medicaid and Medicare together paid about $132 billion in benefits for  such individuals.
section_title: Federal Programs That Support People with Disabilities Face an Array of Challenges
paragraphs: Both our past work and our recent survey of federal programs supporting  people with disabilities indicate that these programs face a number of  challenges. Among these are challenges in ensuring timely and consistent  processing of applications for assistance, ensuring timely provision of  services and benefits, interpreting complex eligibility requirements,  planning for growth in the demand for program benefits and services,  making beneficiaries or clients aware of program services or benefits, and  communicating or coordinating with other federal programs.
subsections: section_title: Timely and Consistent Processing of Applications for Assistance
paragraphs: Our past work examining disability programs administered by SSA and VA  highlighted the challenges that federal programs face in ensuring timely  and consistent processing of applications for assistance. Both SSA and VA  have experienced lengthy processing times for disability claims over the  past several years, with claimants waiting, on average, more than 4 months  for an initial decision and for more than 1 year for a decision on appeal of  a denied claim. In addition, we have also pointed out that inconsistencies  in these agencies’ disability claim decisions across adjudicative levels and  locations have raised questions about the fairness, integrity, and cost of  these programs. Our survey provides further evidence of such challenges  facing programs that provide monetary support. Almost half of these  programs reported that ensuring timely processing of applications was a  major or moderate challenge, and more than one-quarter of monetary  support programs reported that consistent processing of applications was  a major or moderate challenge.
section_title: Timely Provision of Services and Benefits
paragraphs: Our past work also identified the challenges encountered by federal  programs in ensuring timely provision of services and benefits. For  example, we noted that structural weaknesses in SSA’s DI and SSI  programs have prevented the agency from offering return-to-work services  when it may help most—soon after a person becomes disabled. Our survey  indicates that some other federal programs also face the challenge of  providing services in a timely fashion. For example, 38 percent of the  programs that provide employment-related assistance to people with  disabilities reported that ensuring timely provision of services and benefits  was a challenge. Officials from the Department of Education, for  instance, told us that of the 80 Vocational Rehabilitation (VR) agencies  they are responsible for overseeing, about half of these agencies operate  under a special procedure for prioritizing services because the demand  for VR services outweighs the available resources.
section_title: Interpreting Complex Eligibility Requirements
paragraphs: Our past work indicated that SSA and VA’s eligibility requirements are  complex and difficult to interpret. For example, we have reported that the  high costs of administering SSA’s DI program reflects the complex and  demanding nature of making disability decisions. Our survey provides  further evidence of such challenges for federal disability programs. For  example, 53 percent of programs providing monetary support to people  with disabilities reported that interpreting complex eligibility requirements  was a challenge.
section_title: Planning for Growth in the Demand for Services and Benefits
paragraphs: Our past work noted that federal disability programs are facing challenges  in planning for the anticipated increase in demand for their benefits and  services. For example, by the year 2010, SSA expects the number of Social  Security DI beneficiaries to increase by more than one-third over 2001  levels. However, our past work found that most of the state Disability  Determination Services agencies responsible for processing DI claims face  significant challenges in ensuring there are enough trained staff to handle  DI as well as SSI claims. Similarly, in our prior work we reported that  despite VA’s recent progress in reducing its disability claims workload, it  will be difficult for the agency to cope with future workload increases due  to several factors, including increased demand for services as a result of  military conflicts and legislative mandates. Our survey of federal disability  programs indicates that planning for growth in the demand for benefits or  services is also a challenge for other programs that support people with  disabilities. For example, 54 percent of the programs that provide medical  care and almost half of the programs that provide employment-related  assistance reported that planning for growth in the demand for assistance  was a challenge. Our discussions with responsible agency officials  reinforced the challenges posed by potential growth in demand for  program services or benefits. For example, officials from the Department  of Labor’s one-stop center program told us they are not sure if the  program has sufficient resources to meet any increased demand for  services that might result from the outreach they are conducting to people  with disabilities.
section_title: Making Beneficiaries or Clients Aware of Program Services and Benefits
paragraphs: Our past work highlighted challenges in making beneficiaries aware of  services offered under federal disability programs. For example, we  reported that SSA’s work incentives are ineffective in motivating people to  work, in part, because many beneficiaries are unaware that the work  incentives even exist. Our survey indicated that 69 percent of programs  that disseminate information to people with disabilities reported that  making beneficiaries or clients aware of their programs’ services was a  challenge. The need to make people more aware of disability program  services has also been noted by other entities. For example, in 1999, the  Presidential Task Force on Employment of Adults with Disabilities  suggested that the White House take more action to make people aware of  programs that support people with disabilities.
section_title: Communication and Coordination among Programs Serving Individuals with Disabilities
paragraphs: Both our work and the work of others suggests some weaknesses in  communication and coordination among various federal disability  programs. In a 1996 report, we noted that programs helping people with  disabilities do not work together as efficiently as they could to share  information about their programs and to overcome obstacles posed by  differing eligibility criteria and numerous service providers. We said that  the lack of coordination among programs could result in duplication or  gaps in services provided to people with disabilities. Others have also  identified the need for greater coordination among federal disability  programs. For example, in announcing the New Freedom Initiative—a  federal effort to remove barriers and promote community integration for  people with disabilities—the President identified policy areas, such as the  provision of assistive technology, where better federal coordination was  needed. Also, in a review of programs for low-income adults with  disabilities, Urban Institute researchers described the safety net  supporting such individuals as “a tangled web of conflicting goals and gaps  in needed services.” In addition, officials at the National Council on  Disability told us that although various interagency commissions exist to  address issues faced by people with disabilities, most of these  commissions have weak authority or have never met as a group. Our  survey provides further evidence of the coordination and communication  challenges facing federal programs serving individuals with disabilities.  About one-third of these programs indicated that, in their efforts to  support people with disabilities, they experienced challenges in obtaining  information from or coordinating with other federal or nonfederal  programs.
section_title: Key Factors to Consider in Transforming Programs for the 21st Century
paragraphs: Over the past several years, GAO, in reporting that the largest federal  disability programs were mired in outdated concepts of disability, has  identified the need to reexamine and transform these programs to better  position the government to meet the challenges and expectations of the  21st century. In identifying the wide range of federal programs serving  individuals with disabilities and some of the major challenges these  programs face, this report raises several questions about whether other  federal disability programs may also need to be reoriented and  transformed. In particular, are the nearly two hundred programs that  provide assistance to people with disabilities well-suited to address these  challenges, and are they structured in a manner that collectively allows  them to provide coherent and seamless support to people with  disabilities? Also, in light of the nation’s large and growing structural  deficit, do these programs represent the most cost-effective approaches to  serving individuals with disabilities?
On the basis of more than a decade of research focusing on the nation’s  largest disability programs and our review of prior GAO reports examining  efforts to reform federal programs and transform agencies, we have  identified several key factors that are important to consider in assessing  the need for, and nature of, program transformations. In particular, our  prior work identifying shortcomings in the work incentives and supports  provided by the largest federal disability programs indicates that these  basic program design issues need to be addressed. Second, given the tight  fiscal constraints facing both federal and state governments, programs will  need to carefully consider the sustainability of current costs and the  potential costs associated with transformation initiatives. Finally,  programs will need to evaluate the feasibility of any transformation  efforts, considering whether appropriate processes and systems— including those related to the planning and management of human capital  and information technology—are in place to effectively carry out current  operations or proposed changes. Figure 6 presents a list of questions that  may serve as a guide for addressing these factors.
In addition to addressing these questions, which will provide a basic  framework for individually assessing existing programs and proposals for  transforming them, it is also important that some mechanism be  established for looking across programs to assess their overall  effectiveness and integration and whether they are designed to achieve  similar or complimentary goals. The diffusion of responsibility for federal  programs serving people with disabilities across multiple agencies and the  absence of any clear central authority for guiding a fundamental  reassessment of federal disability policy will likely pose significant  impediments to such action. However, a reexamination could serve to  identify programs and policies that are outdated or ineffective while  improving the targeting and efficiency of remaining programs through  such actions as redesigning allocation and cost-sharing provisions and  consolidating facilities and programs. Our recently issued report  concerning “21st Century Challenges” identifies approaches—such as the  use of special temporary commissions to develop policy proposals and the  exercise of congressional oversight through hearings on the activities of  federal agencies—that may be used for such a reexamination should the  Congress choose to pursue this course of action. Addressing the  individual program transformation questions we identify above in  conjunction with a reexamination of how these programs work  collectively represent key steps in efforts to meet 21st century social and  economic expectations of individuals with disabilities and the general  public.
Copies of this report are being sent to: the Secretaries of Agriculture,  Commerce, Defense, Education, Energy, Health and Human Services,  Housing and Urban Development, Interior, Justice, Labor, Transportation,  Treasury, and Veterans Affairs; the Commissioner of  SSA; the Director of  the Office of Personnel Management; the Administrator of the Small  Business Administration; the Chairman of the Railroad Retirement Board;  the Chairperson of the Committee for Purchase from People who are Blind  or Severely Disabled; the Chair of the Access Board; the Chair of the Equal  Employment Opportunity Commission; the Librarian of Congress;  appropriate congressional committees; and other interested parties. The  report is also available at no charge on GAO’s Web site at  http://www.gao.gov.
If you or your staff have any questions about this report, please contact me  at (202) 512-7215 or RobertsonR@gao.gov. Contact points for our Offices  of Congressional Relations and Public Affairs may be found on the last  page of this report. GAO staff who made major contributions to this report  are listed in appendix III.
section_title: Appendix I: Scope and Methodology
paragraphs: For our review, we defined a federal program as a function of a federal  agency that provides assistance or benefits 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 federal programs  meeting one of more of the following criteria: (1) people with disabilities  are specifically mentioned in a program’s authorizing legislation as a  targeted group, (2) people are eligible for the program wholly because of a  disability, (3) people are eligible for the program partially because of a  disability, (4) people with disabilities are given special consideration in  eligibility determinations, or (5) people with disabilities are given priority  in being served. Programs that serve individuals without respect to  disability (i.e., disability is not an explicit criteria for program eligibility)  but that serve some individuals with disabilities (such as Temporary  Assistance for Needy Families) are beyond the scope of our review. In  addition, we excluded programs whose principal focus is research,  demonstrations, training for professionals who work with people with  disabilities, technical assistance, or special transportation, as well as  disability retirement programs for federal workers.
To develop a list of programs that met these criteria, we first conducted a  systematic search in the Catalog of Federal Domestic Assistance (CFDA)  to identify programs that have some role in serving people with disabilities  and the respective agencies responsible for administering each of these  programs. In addition, we reviewed federal agency Web sites to identify  additional programs that were not included in the CFDA. We then  submitted the list of programs administered by each agency to that agency  for verification. (The final list of programs along with some descriptive  information on each program can be found in app. II.) In developing our  list, we included federal programs regardless of how the benefit, service,  or assistance is ultimately delivered to the individual (e.g., directly by the  federal agency or indirectly by another entity, such as a state agency).
To obtain information on federal programs supporting people with  disabilities and the challenges they face, we conducted a Web-based  survey, which collected basic information on each program, including the  types of assistance provided, whether the assistance is provided directly to  beneficiaries or indirectly through other entities, whether the program is  partially or wholly targeted to people with disabilities, the number of  beneficiaries served, program spending, and the challenges faced by these  programs (i.e., obstacles that hindered a program’s ability to effectively  and efficiently support people with disabilities). (A more complete  tabulation of the survey results related to program challenges is available  on the GAO Web site at www.gao.gov/cgi-bin/getrpt?GAO-05-695SP.) To  identify the appropriate program officials to respond to the survey, we  submitted the list of programs that we compiled to liaisons at each agency.  These liaisons then identified the appropriate respondents at their  respective agencies. We pretested the content and format of our survey  with officials from eight programs to determine if it was understandable  and if the information was feasible to collect, and we refined the survey as  appropriate. We then sent e-mail notifications to the identified officials of  299 programs beginning on June 15, 2004, asking them to complete the  survey by June 28, 2004. To encourage respondents to complete the  survey, we sent e-mail messages to prompt each nonrespondent 1 and 2  weeks after the initial e-mail message. We closed the survey on August 16,  2004. We obtained survey responses from 258 programs, for an overall  response rate of 86 percent. In addition, for 11 of the 41 programs that did  not submit survey responses, we obtained descriptive information from  the CFDA to answer a limited number of survey questions to the extent  that such information was available. Based on responses to survey  questions asking programs to identify the criteria they apply in serving  people with disabilities and the primary type of assistance they provide,  we identified 192 programs (comprising 64 percent of all programs  surveyed) that met our criteria for defining programs as either wholly or  partially targeted towards serving individuals with disabilities.
Although our survey asked programs to provide spending data, because of  limitations or inconsistencies in the spending information reported by  survey respondents, we obtained spending data from the Consolidated  Federal Funds Report (CFFR)—a database compiled by the Bureau of the  Census—for all of the relevant programs listed in this database. For  programs that did not have data reported in the CFFR, we used spending  information from the survey data. In a few cases where spending data was  not available from either the CFFR or survey data, we obtained this  information from the CFDA. To verify the spending data that we present in  this report, we sent each program an e-mail message asking them to  confirm the amounts we had identified. While many programs confirmed  the spending amounts that we listed in our message, others identified  different amounts. The spending data we present in this report are based  on the final verified spending amounts identified by programs in their  response to our e-mail. These data are not entirely consistent across  programs. For example, while most of these data represent spending for  fiscal year 2003, some programs instead provided data for other fiscal  years. Also, some programs included administrative costs in their spending  figures while others did not include such costs. In addition, while the  majority of the spending data we report represent program obligations,  some of the data instead represent outlays. Of the 95 wholly targeted  programs in our analysis, we were able to obtain some type of spending  data for 85 programs. However, many partially targeted programs were  unable to provide us with data pertaining to their programs’ spending on  people with disabilities because they do not separately track or collect  such data for these individuals. As a result, we do not present spending  data in this report for partially targeted programs except for three  programs (Supplemental Security Income, Medicare, and Medicaid) for  which we were able to obtain a breakdown of spending on people with  disabilities from agency documents.
Because we relied extensively on program spending data derived from the  2003 CFFR data that are available on-line from the CFFR Web site  (http://www.census.gov/govs/www/cffr.html), we conducted limited tests  of the reliability of these data, including frequency analyses of critical data  fields. We restricted our reliability assessment to the specific variables  that were pertinent to our analysis. These tests indicated that the critical  data fields were sufficiently complete and accurate for the purposes of our  analysis.
To obtain additional information on the challenges faced by programs, we  conducted interviews with federal agency officials and officials from  disability advocacy organizations, and reviewed pertinent agency  documents, GAO reports, and academic research on disability issues.
To identify questions that should be addressed in transforming federal  disability programs, we reviewed the major findings and recommendations  that have resulted from the substantial body of GAO research on federal  disability programs over the past decade. We also examined past GAO  reports on program reform and organizational transformation throughout  the federal government.
Because our questionnaire was not a sample survey, there are no sampling  errors. However, the practical difficulties of conducting any survey may  introduce errors, commonly referred to as nonsampling errors. For  example, difficulties in how a particular question is interpreted, in the  sources of information that are available to respondents, or in how the  data are entered into a database or were analyzed, can introduce  unwanted variability into the survey results. We took steps in the  development of the questionnaire, the data collection, and the data  analysis to minimize these nonsampling errors. For example, social  science survey specialists designed the questionnaire in collaboration with  GAO staff with subject matter expertise. Then, as mentioned earlier, the  draft questionnaire was pretested with program officials to ensure that the  questions were relevant, clearly stated, and easy to comprehend. When the  data were analyzed, a second, independent analyst checked all computer  programs. Since this was a Web-based survey, respondents entered their  answers directly into the electronic questionnaire. This eliminated the  need to have the data keyed into a database, thus removing an additional  source of error.
We performed our work at various locations in Washington, D.C. We  conducted our work between March 2004 and March 2005 in accordance  with generally accepted government auditing standards.
section_title: Appendix II: Federal Programs Serving People with Disabilities
paragraphs: The following table presents an overview of the 192 federal programs that  we identified as targeted to people with disabilities. The information  presented in this table is based mostly on the programs’ survey responses,  although it also presents data obtained from other sources. In particular,  the spending information is derived from multiple sources, including  programs’ survey responses and federal government reports on program  spending. The spending data we present below represent either  obligations, expenditures, or appropriations, as indicated by the table  notes accompanying each reported amount. Due to the various sources  that we used to identify program spending and possible inconsistencies in  these data (e.g., differences in the fiscal years for which spending was  reported by programs), we advise caution in efforts to compare or sum  spending figures across programs. Also, given the significant limitations in  the spending data available for partially targeted programs, we do not  present such data in this table. (See app. 1 for a more detailed discussion  of our methodology for collecting spending data and other information on  these programs.)
Spending (for  fiscal year 2003  unless  otherwise  indicated)
Committee for Purchase From People Who Are Blind or  Severely Disabled  Javits-Wagner-O Day Program (Committee for Purchase From  People Who Are Blind or Severely Disabled)
Assistive & Ergonomic Technology (Target Center, USDA,  Washington, D.C.)
Assistive and Ergonomic Technology (Midwest Target Center,  St. Louis, Missouri)
Spending (for  fiscal year 2003  unless  otherwise  indicated)
Spending (for  fiscal year 2003  unless  otherwise  indicated)
Spending (for  fiscal year 2003  unless  otherwise  indicated)
Disabilities Prevention (Disability and Health)
Family Support Payments to States Assistance Payments  (Adult Programs in the Territories)
Spending (for  fiscal year 2003  unless  otherwise  indicated)
Maternal and Child Health Services Block Grant to the States  (Title V)
Other:  Infrastructure and  coordination   Other: Multifaceted  support systems  Other: Outreach  and case  management.
Special Programs for the Aging Title III, Part C Nutrition  Services  Special Projects of National Significance (Ryan White CARE  Act)
Spending (for  fiscal year 2003  unless  otherwise  indicated)
Housing Opportunities for Persons with AIDS  Lower Income Housing Assistance Program Section 8  Moderate Rehabilitation  Mortgage Insurance Rental Housing for the Elderly  Non-Discrimination in Federally Assisted and Conducted  Programs (on the Basis of Disability)
Spending (for  fiscal year 2003  unless  otherwise  indicated)
Spending (for  fiscal year 2003  unless  otherwise  indicated)
Assistance for Indian Children with Severe Disabilities  Capital and Training Assistance Program for Over-the-Road  Bus Accessibility  Capital Assistance Program for Elderly Persons and Persons  with Disabilities  FTA general activities and technical assistance related to  disability issues  Tax Deduction to remove barriers for the Elderly and Disabled  Other: Tax  Automobiles and Adaptive Equipment for Certain Disabled  Veterans and Members of the Armed Forces  Compensation for Service-Connected Deaths for Veterans’  Dependents  Montgomery GI Bill Educational Assistance (Chapter 30)
Spending (for  fiscal year 2003  unless  otherwise  indicated)
Pension to Veterans Surviving Spouses, and Children  Post-Vietnam Era Veterans’ Educational Assistance  Specially Adapted Housing for Disabled Veterans  Survivors and Dependents Educational Assistance  Veterans Compensation for Service-Connected Disability  Veterans Dependency and Indemnity Compensation for  Service-Connected Death; Compensation for Service  Veterans Housing—Guaranteed and Insured Loans  Vocational and Educational Counseling for Separating Service  Members (Chapter 36)
Vocational Rehabilitation for Disabled Veterans  Vocational Training and Rehabilitation for Vietnam Veterans’  Children with Spina Bifida or Other Covered Birth Defects   Employment Discrimination Section 501 of the Rehabilitation  Act (federal employees)
Spending (for  fiscal year 2003  unless  otherwise  indicated)
Other: Library  service.
section_title: Appendix III: GAO Contact and Staff Acknowledgments
subsections: section_title: GAO Contact
section_title: Staff Acknowledgments
paragraphs: The following individuals made important contributions to this report:  Shelia D. Drake, Erin M. Godtland, Joel A. Green, Mark de la Rosa, David  J. Forgosh, Mark Trapani, Stuart M. Kaufman, and Daniel A. Schwimer.