The roles of certain key federal officials initially involved in the advisory board's review of the dose reconstructions may not have been sufficiently independent and actions were taken to replace these officials. Nonetheless, continued diligence by HHS is required to prevent such problems from recurring as new candidates are considered for these roles. Initially, the project officer assigned responsibility for reviewing the monthly progress reports and monitoring the technical performance of the contractor was also a manager of the NIOSH dose reconstruction program being reviewed. In addition, the designated federal officer for the advisory board, who is responsible for scheduling and attending board meetings, was the director of the dose reconstruction program being reviewed. In response to concerns about the appearance of conflicting roles, the director of NIOSH replaced both of these officials in December 2004 with a senior NIOSH official not involved in the NIOSH program under review. The contractor and members of the board told us that implementation of the contract improved after these replacements were made. With regard to structural independence, we found it appropriate that the contracting officers, who are responsible for managing the contract on behalf of the advisory board, have been federal officials with the Centers for Disease Control and Prevention (CDC), NIOSH's parent agency. The contracting officers do not have responsibilities for the NIOSH program under review and are not accountable to its managers. Members of the advisory board helped facilitate the independence of the contractor's work by playing the leading role in developing and approving the initial statement of work for the contractor and the independent cost estimate for the contract. The progress of the contracted review of NIOSH's site profiles and dose reconstructions has been hindered by the complexity of the work. Specifically, in the first 2 years, the contractor spent almost 90 percent of the $3 million that had been allocated to the contract for a 5-year undertaking. Various adjustments have been made in the review approach in light of the identified complexities, which were not initially understood. However, further improvements could be made in the oversight and planning of the review process. First, the contractor's expenditure levels were not adequately monitored by the agency in the initial months and the contractor's monthly progress reports did not provide sufficient details on the level of work completed compared to funds expended. The monthly report for each individual task order was subsequently revised to provide more details but developing more integrated data across the various tasks could further improve the board's ability to track the progress of the overall review. Second, while the advisory board has made mid-course adjustments to the contractor's task orders and review procedures, the board has not comprehensively reexamined its long-term plan for the overall project. The board revised the task orders for the contractor several times, in part to reflect adjustments made as the board gained a deeper understanding of the needs of the project. Nonetheless, the board has not reexamined its original plan for the total number of site profile and dose reconstruction reviews needed, and the time frames and funding levels for completing them. Third, there is still a gap with regard to management controls for the resolution of the findings and recommendations that emerge from SC&A's review. The advisory board developed a six-step resolution process to help resolve technical issues between the contractor and NIOSH, and this process uses matrices to track the findings and recommendations of the contractor and advisory board. However, NIOSH currently lacks a system for documenting that changes it agrees to make as part of this resolution process are implemented. With regard to reviewing special exposure cohort petitions, the advisory board has asked for and received the contractor's assistance, expanded its charge, and acknowledged the need for the board to review the petitions in a timely manner. The board has reviewed eight petitions as of October 2005, and the contractor assisted with six of these by reviewing the site profiles associated with the facilities. The contractor will play an expanded role by reviewing some of the other submitted petitions and NIOSH's evaluation of those petitions and recommending to the advisory board whether the petitioning group should be added to the special exposure cohort. The contractor will also develop procedures for the advisory board to use when reviewing petitions. While NIOSH is generally required by law to complete its review of a petition within 180 days of determining that the petition has met certain initial qualification requirements, the advisory board has no specified deadline for its review of petitions. However, the board has discussed the fact that special exposure cohort petition reviews have required more time and effort than originally estimated and that the advisory board needs to manage its workload in order to reach timely decisions. Credibility is essential to the work of the advisory board and the contractor, and actions were taken in response to initial concerns about the independence of federal officials in certain key roles. Nonetheless, it is important for HHS to continue to be diligent in avoiding actual or perceived conflicts of roles as new candidates are considered for these roles over the life of the advisory board. The advisory board's review of site profiles and dose reconstructions has presented a steep learning curve for the various parties involved. These experiences have prompted the board to make various adjustments to the contractor's work that are intended to better meet the needs of the review, such as the establishment of a formal six-step resolution process that increases transparency. Nonetheless, further improvements could be made to the oversight and planning of the contracted review. Even though the advisory board has made numerous midcourse adjustments to the work of the contractor, the board has not comprehensively reexamined its long- term plan for the project to determine whether the plan needs to be modified in light of the knowledge gained over the past few years. In addition, while the contractor's monthly reports were modified to provide more detailed expenditure data, the lack of integrated and comprehensive data across the various tasks makes it more difficult for the advisory board to track the progress of the overall review or make adjustments to funding or deliverables across tasks. Finally, without a system to track the actions taken by NIOSH in response to the findings and recommendations of the advisory board and contractor, there is no assurance that any needed improvements are being made. We are making three recommendations to the Secretary of HHS. To assist the advisory board meet its statutory responsibilities, we recommend that the Secretary of HHS (1) direct the contracting and project officers to develop and share with the advisory board more integrated and comprehensive data on contractor spending levels compared to work completed and (2) consider the need for providing HHS staff to collect and analyze pertinent information that would help the advisory board comprehensively reexamine its long-term plan for assessing the NIOSH site profiles and dose reconstructions. To ensure that the findings and recommendations of the advisory board and the contractor are promptly resolved, we recommend that the Secretary of HHS direct the Director of NIOSH to establish a system to track the actions taken by the agency in response to these findings and recommendations and update the advisory board periodically on the status of such actions. We provided a draft of this report to HHS, the contractor, and all the members of the advisory board for comment. We received comments from HHS, the contractor, and four individual members of the advisory board. The comments from the four members of the board represent the views of these individuals and not an official position of the advisory board. HHS agreed with GAO's recommendations to provide more integrated and comprehensive data to the advisory board and said that it will consider the need to provide staff to help the advisory board reexamine its overall plan for assessing NIOSH site profiles and dose reconstructions. With regard to the third recommendation, HHS stated that a system is already in place to track actions taken by the agency in response to advisory board recommendations in letters from the board to the Secretary of HHS. HHS added that matrices used in conjunction with the six-step resolution process outline the contractor's concerns, NIOSH's response, and the actions to be taken. However, we believe that these matrices do not provide sufficient closure with regard to tracking the actions NIOSH has actually implemented in response to advisory board and contractor findings and recommendations. For example, in some of the matrices, the advisory board has made numerous recommendations that NIOSH perform certain actions to resolve various issues, but there is no system in place to provide assurance that these actions have in fact been taken. Thus, we continue to see a need for this recommendation. Some individual advisory board members who provided comments expressed concerns about our recommendations, although differing in their reasons. One individual board member expressed concern about the recommendations to provide more integrated and comprehensive data to the advisory board or to provide staff to help in reexamining the overall review plan, suggesting that these changes might not be very helpful. We still believe that these recommendations are necessary to ensure that the advisory board has more complete information to better oversee the review as well as a long-term plan for completing the review; hence we did not revise the recommendation. Another individual board member suggested that a system be established to track the advisory board's recommendations rather than the contractor's recommendations since it is these that should be of greater concern. While GAO believes it is important to track the resolution of the board's recommendations, it also important to track the resolution of the contractor's recommendations, and we therefore revised the wording of our recommendation to reflect this position. HHS, the contractor, and individual advisory board members took issue with statements in the report about the contractor being over budget and behind schedule. While they agreed with GAO's assessment that the review process got off to a slow start, they thought that the report did not provide sufficient information about the various factors that complicated or led to an expansion of work for the contractor, the revisions to the contractor's task orders, and the performance of the contractor with respect to the revised task orders. For example, commenters pointed out that in some instances, the contractor had to review a site profile more than once after NIOSH had revised the site profile to include additional information. Commenters added that the contractor's work also had to shift to accommodate changing priorities. For instance, NIOSH's increased reliance on using the site profiles to complete dose reconstructions prompted a shift in contractor priorities to devote more time and resources to site profile reviews than originally anticipated. The commenters added that since the task orders were revised, the contractor has been meeting the time frames and budgets specified in the task orders. We therefore revised the report to incorporate additional information on factors that complicated or led to an expansion in the work of the contractor, the revisions that were made to the task orders, and the contractor's progress in meeting the terms of the revised task orders. HHS, the contractor, and some of the individual members of the advisory board maintained that the advisory board has taken actions to reexamine and adjust its strategy for reviewing site profiles and dose reconstruction cases. For instance, HHS stated that during the advisory board's meetings in 2005, the board regularly discussed the future of contract activities and altered the review schedule and scope of work several times. For example, the contractor was asked to perform site profile reviews for sites not originally anticipated in order to facilitate the advisory board's review of related special exposure cohort petitions. Other commenters pointed out the board's development of a six-step resolution process for use by NIOSH and the contractor to resolve differences on technical issues. We revised the report to more fully reflect actions taken by the advisory board to reexamine and adjust its strategy for the review. We also changed the report title to reflect changes made in the report in this regard. However, we continue to see a need for the advisory board to build on its actions by comprehensively reexamining whether its original long-term plan for the overall project is still appropriate. Several individual advisory board members commented that they remain concerned about the independence of the board and its contractor. Although acknowledging that replacement of the original officials appointed as the designated federal officer and project officer has helped reduce possible challenges to independence, the members pointed out that NIOSH officials remain involved in managing the contract and could still potentially influence the work of the contractor. These individual board members also emphasized that the board has no independent budgetary authority and that it relies on NIOSH to obtain funding. Our review suggests that the contractor has been able to demonstrate its independence during the review. For instance, our report notes that the contractor's reports have criticized numerous aspects of NIOSH site profiles and dose reconstructions. Further, contractor officials told us that they believe relations with NIOSH are thoroughly professional and board members told us that they are satisfied with the information provided by the contractor. We acknowledge that the potential for impairment of the contractor's efforts remains. In fact, our draft report concluded that there is a need for continued diligence in avoiding actual or perceived conflicts of roles as new candidates are considered for certain positions over the life of the advisory board. We have further highlighted this point in the final report. HHS's comments are provided in appendix II, and the contractor's comments are provided in appendix III. HHS, the contractor, and individual board members also provided technical comments, which we have incorporated as appropriate. As arranged with your office, unless you publicly announce its contents earlier, we plan no further distribution of this report until 30 days from the issue date. At that time, we will send copies of this report to the Secretary of Health and Human Services, interested congressional committees, and other interested parties. We are also sending copies to the Chair and members of the advisory board. We will make copies available to others upon request. In addition, the report will be available at no charge on GAO's Web site at http://www.gao.gov. If you have any questions about this report, please contact me at (202) 512- 7215. Contact points for our Offices of Congressional Relations and Public Affairs may be found on the last page of this report. GAO staff that made major contributions to this report are listed in appendix III. predecessor agencies and contractors have employed thousands of individuals in secret and dangerous work in the atomic weapons industry. The Energy Employees Occupational Illness Compensation Program Act (EEOICPA) of 2000 compensates individuals who have developed cancer or other specified diseases related to on-the-job exposure to radiation and other hazards at these work sites. Under Subtitle B, determining a claimant's eligibility for compensation involves developing estimates of the likely radiation levels a worker was exposed to based on information such as exposure records. These estimates are referred to as "dose reconstructions" and are developed by the National Institute for Occupational Safety and Health (NIOSH) under the Department of Health and Human Services (HHS). NIOSH also compiles information in "site profiles" about the radiation protection practices and hazardous materials used at various plants and facilities, which assist NIOSH in completing the dose reconstructions. Employees at certain facilities were designated under the law as members of a "special exposure cohort" because it was believed that exposure records were insufficient and the reasonable likelihood was that the workers' radiation exposure caused their cancers. Their claims are paid without completing exposure estimates. The law also allows the Secretary, HHS, to designate additional groups of employees as members of the special exposure cohort. claims process, EEOICPA created a citizen's advisory board of scientists, physicians, and employee representatives--the President's Advisory Board on Radiation and Worker Health (advisory board). Members of board serve part-time, and the board has limited staff support. The advisory board is tasked with reviewing the scientific validity and quality of NIOSH's dose reconstructions and advising the Secretary of HHS. The board has the flexibility to determine the scope and methodology for this review. In addition, the advisory board is tasked with reviewing NIOSH's evaluation of petitions for special exposure cohort status and recommending whether such status should be granted. To facilitate the advisory board's review, HHS awarded a 5-year, $3-million contract to Sanford Cohen & Associates (SC&A) in October 2003 to examine a sample of dose reconstructions and particular site profiles and to perform a variety of other tasks. assist NIOSH in developing site profiles and in performing dose reconstructions. Originally, about $70 million was allocated to the contract, but this figure had increased to over $200 million by 2004. We focused our work on three questions: Are the roles of key federal officials involved in the review of NIOSH's dose reconstructions sufficiently independent to assure the objectivity of the review? Have the agency's management controls and the advisory board's oversight been sufficient to ensure that the contract to review site profiles and dose reconstructions is adequately carried out? Is the advisory board using the contractor's expertise in reviewing special exposure cohort petitions? key officials and interviewed these officials to document their roles. We used the broad principles specified in various criteria, including those specified in the Federal Acquisition Regulation and Government Auditing Standards, to assess the independence of key officials' roles. We analyzed the contract provisions, including the specific task orders and monthly progress reports as well as the actions taken by officials to manage the contract. We assessed whether the management controls were adequate, considering criteria such as the Federal Acquisition Regulation. meeting minutes as well as interviewed key officials and attended advisory board meetings, to determine the process the advisory board has used and plans to use to evaluate petitions. The scope of our work did not include examining the contract NIOSH awarded to Oak Ridge Associated Universities. We conducted this review from March 2005 through November 2005 in accordance with generally accepted government auditing standards. The roles of certain key federal officials initially involved in the review of dose reconstructions may not have been sufficiently independent and these officials were replaced. However, continued diligence by HHS is required to prevent such problems from recurring as new candidates are considered for these roles. The progress of the contracted review of site profiles and dose reconstructions has been hindered, largely by the complexity of the work. Some adjustments have been made, but further improvements could be made to the oversight and planning of the review. The advisory board is using the contractor's work in reviewing special exposure cohort petitions and has acknowledged the need to review the petitions in a timely manner. (HHS) (CDC) National Institute for Occupational Safety and Health (PGO) Designated federal officer (since 12/04) Project officer (since 12/04) Office of Compensation Analysis and Support (OCAS) Project officer (prior to 12/04) (SC&A) delegated by the President, and is tasked by executive order with providing administrative services, funds, facilities, staff, and other necessary support services to assist the advisory board in carrying out its responsibilities. CDC NIOSH's parent agency awarded the contract on behalf of the advisory board. A CDC Procurement and Grants Office (PGO) official serves as the contracting officer. The contracting officer is responsible for administering and providing management of the contract on the advisory board's behalf. This includes reviewing the monthly progress reports and paying the contractor for its approved costs. for preparing the site profiles and completing the dose reconstructions. NIOSH officials serve as the project officer for the contract and the designated federal officer for the advisory board. The project officer is responsible for reviewing the monthly progress reports and monitoring the technical performance of the contractor. The designated federal officer schedules and attends meetings of the advisory board. reconstructions and (2) review NIOSH's evaluation of special exposure cohort petitions and recommend whether such status should be granted. Operates under Federal Advisory Committee Act (FACA) requirements such as conducting its meetings in public. Contractor - SC&A Under contract, assists the advisory board in meeting its statutory responsibilities by reviewing a sample of dose reconstructions and their associated site profiles and providing assistance with special exposure cohort petitions. Provides monthly progress reviews to the contracting officer, project officer, and advisory board. Task 1: Review selected NIOSH-developed site profiles. Task 2: Develop automated system to track NIOSH dose reconstruction cases. Task 3: Review NIOSH dose reconstruction procedures. Task 4: Review a sample of NIOSH dose reconstruction cases. Review NIOSH's special exposure cohort petition procedures and individual petitions. Provide administrative (logistical) support to advisory board (monthly progress reports, attendance at advisory board meetings, etc.). The contracting officer is a CDC employee whose organization is independent of the NIOSH program under review. In 2003-2004, the project officer also served as a NIOSH program manager of the program under review. In December, 2004, a senior NIOSH official, who does not have responsibilities for the program under review, took over this role. In 2002-2004, the designated federal officer also served as the NIOSH director of the program under review. In December 2004, a senior NIOSH official, who does not have responsibilities for the program, took over this role. approving the initial statement of work for the contractor and the independent government cost estimate for the contract, actions which helped facilitate the independence of the contractor's work. overall project performance in the initial months. More detailed expenditure data were subsequently provided to facilitate monitoring but developing more comprehensive data would be useful. While the advisory board has made various adjustments to the contractor's task orders and work processes after the contractor encountered initial difficulties, the board has not comprehensively reexamined its long-term plan for the project. Additionally, NIOSH lacks a process for documenting actions it has taken in response to the contractor's findings that are reported to the advisory board and the advisory board's recommendations to HHS. The contractor's expenditure levels were not adequately monitored in the initial months. Although the contractor's reports indicated that costs were higher than anticipated, the project officer was caught by surprise in October 2004 when the contractor announced a need for work stoppage because expenditures on a specific task order had approached budget ceilings. The contracting officer noted that during this period the contractor's reports did not reflect the actual percent of work completed, making it very difficult to identify the actual cost of performance. Work was suspended on the site profile review task and a smaller task for several days in November until additional funds were authorized. Separate monthly progress reports are submitted for each task order. However, there is no single comprehensive report on overall contract performance, which could facilitate tracking the progress of the overall review or making strategic adjustments where needed. Initial task orders called for the contractor to complete: 12 to 16 site profile reviews by February 2005 for $426,000 60 dose reconstruction reviews by August 2004 for $467,000 These tasks cost more or took longer to complete than originally estimated. At the end of January 2005, the contractor had completed 2 site profile reviews and partially completed 2 others while spending $481,000. The contractor completed the first 60 dose reconstruction reviews by September 2005 while spending about $1.0 million. (According to SC&A, the cost increase consisted of costs related to overall contract management, not to increased dose reconstruction review costs.) Overall, in the first 2 years, the contractor spent almost 90 percent of the $3 million allocated for a 5-year undertaking. anticipated. Both the contractor and NIOSH officials involved in the review reported that reviews of site profiles and dose reconstructions have proven considerably more complex than originally anticipated; thus the original cost estimates for the project (based on very limited information and experience) were not realistic. Contractor encountered initial delays in obtaining information. The contractor's progress was initially hindered by substantial delays it encountered in obtaining necessary security clearances and access from NIOSH to various technical documents. These early implementation issues have generally been resolved, according to the contractor. Contractor has met these revised task order requirements. to NIOSH's increased reliance on site profiles. Site profiles were originally seen as one of numerous resources to be used in developing dose reconstructions. However, as site profiles became the primary resource used by NIOSH, the advisory board wanted assurance that these site profiles were credible. NIOSH revisions to site profiles required the contractor to complete multiple reviews in some instances. For example, the contractor completed four reviews of the Mallinckrodt site profile as a result of NIOSH's changes. NIOSH views the site profiles as "living documents" that can be added to as new information is identified or changes need to be made. In addition, as NIOSH worked to complete many of the site profiles within an 18-month time frame, many "loose ends" remained in the site profiles, according to the contractor. and contractor to resolve their differences of views on technical issues. This process expanded the time and resources needed for reviews. Unanticipated site profile reviews (e.g., Iowa Army Ammunition Plant) were needed to facilitate the advisory board's review of special exposure cohort petitions. use by, or in support of, the advisory board. The advisory board has authorized a new set of contractor reviews for fiscal year 2006. An additional 6 site profile reviews, 60 dose reconstruction case reviews, and 6 special exposure cohort petition reviews. In August 2005, the designated federal officer pointed out that at the current rate of progress, the original plan to review a total of 600 dose reconstructions would require about 10 years to complete. But the advisory board has not comprehensively reexamined its original long-term plan for the project to determine if it needs to be modified. Total number of site profile reviews needed? Total number of dose reconstruction case reviews needed? Time frames for completion and funding levels required? profiles and dose reconstructions, such as NIOSH's failure to consider information provided by site experts in its site profiles and certain assumptions NIOSH used to calculate dose reconstructions. As part of the six-step resolution process, the contractor and NIOSH develop matrices that specify NIOSH's response and any planned actions for each of the contractor's findings and recommendations. In some matrices, space is provided for the board to recommend that NIOSH take certain actions to resolve issues. However, there is no system in place to track NIOSH's implementation of these actions or advisory board recommendations. Procedures for prompt resolution and implementation of audit findings and other reviews should be part of all federal agencies' internal controls. exposure cohort petitions. A recent task order expands the contractor's role for this facet of the board's work. A potentially large increase in the board's petition review workload did not occur because many petitions did not meet initial qualification requirements. The advisory board has acknowledged the need to review the petitions in a timely manner. For six of these petitions, the contractor reviewed the site profiles (though not the actual petitions associated with the named facilities). For the other two petitions, the advisory board did not request the contractor's assistance. evaluations of these petitions to recommend to the advisory board whether the petitioning group should be added to the special exposure cohort. The contractor will also develop the procedures for the advisory board to use when reviewing petitions. thus did not need to be reviewed by the board. As of October 2005, NIOSH had determined that 18 of the submitted petitions did not meet the qualification requirements. filed as of October 2005: One petition is ready for the advisory board to review. NIOSH is completing its evaluation of four more petitions that will be sent to the board for review. NIOSH is assessing three other petitions to determine if they meet the qualification requirements. for evaluation is unknown. While NIOSH is generally required by law to complete its review of a petition within 180 days of the petition's being qualified, there is no specified time frame for the advisory board's review of petitions. Nonetheless, the advisory board has discussed the fact that special exposure cohort petition reviews have required more time and effort to reach a recommended decision than originally estimated and that the advisory board needs to manage its workload in order to reach timely decisions. performing key roles, actions were taken to replace these officials. Credibility is essential to the work of the advisory board and the contractor. Thus, it is important to continue to be diligent in avoiding actual or perceived conflicts of roles as new candidates are considered for certain positions over the life of the advisory board. Management and Oversight of the Review of Site Profiles and Dose The advisory board's review has presented a steep learning curve for the various parties involved. Despite some adjustments, further improvements could be made: reassessing the long-term plan for the project integrating data on contractor expenditures tracking resolution of board and contractor findings and recommendations. Reassessing the long-term plan for the project The advisory board has made numerous midcourse adjustments to the work of the contractor as operations have matured. It would thus be appropriate for the advisory board to comprehensively reexamine its long-term plan for the overall project to determine whether this plan needs to be modified. Integrated data on contractor expenditures Contractor's monthly reports were modified to provide more detailed data for individual tasks on expenditures compared to work completed. However, the lack of integrated and comprehensive data across the various tasks makes it more difficult for the advisory board to track the progress of the overall review or make strategic adjustments to funding or deliverables across tasks. Tracking resolution of findings and recommendations The advisory board developed a six-step resolution process that uses matrices to track the findings and recommendations of the contractor and board. However, without a system for documenting the actions NIOSH has taken in response, there is no assurance that any needed improvements are being made. direct the contracting and project officers to develop and share with the advisory board more integrated and comprehensive data on contractor's spending levels compared to work completed and consider the need for providing HHS staff to collect and analyze pertinent information that would help the advisory board comprehensively reexamine its long-term plan for assessing the NIOSH site profiles and dose reconstructions. direct the Director of NIOSH to establish a system to track the actions taken by the agency in response to these findings and recommendations and update the advisory board periodically on the status of such actions. Processing, Program Structure May Result in Inconsistent Benefit Outcomes. GAO- 04-516. Washington, DC: May 28, 2004. Energy Employees Compensation: Many Claims Have Been Processed, but Action Is Needed to Expedite Processing of Claims Requiring Radiation Exposure Estimates. GAO-04-958. Washington, DC: Sept.10, 2004. Andy Sherrill, Assistant Director; Margaret Armen, Richard Burkard, Susan Bernstein, Sandra Chefitz, Mary Nugent, and Robert Sampson made significant contributions to this report. Energy Employees Compensation: Many Claims Have Been Processed, but Action Is Needed to Expedite Processing of Claims Requiring Radiation Exposure Estimates. GAO-04-958. Washington, D.C.: Sept. 10, 2004. Energy Employees Compensation: Even with Needed Improvements in Case Processing, Program Structure May Result in Inconsistent Benefit Outcomes. GAO-04-516. Washington, D.C.: May 28, 2004.

Summary:
For the last several decades, the Department of Energy and its predecessor agencies and contractors have employed thousands of individuals in secret and dangerous work in the atomic weapons industry. In 2000, Congress enacted the Energy Employees Occupational Illness Compensation Program Act to compensate those individuals who have developed cancer or other specified diseases related to on-the-job exposure to radiation and other hazards at these work sites. Under Subtitle B, determining the eligibility of claimants for compensation is a complex process, involving several federal agencies and a reconstruction of the historical evidence available. The Department of Labor must consider a claimant's case based on records of his or her employment and work activities, which are provided by the Department of Energy. Labor considers the compensability of certain claims by relying on estimates of the likely radiation levels to which particular workers were exposed. These "dose reconstructions" are developed by the National Institute for Occupational Safety and Health (NIOSH) under the Department of Health and Human Services (HHS). NIOSH also compiles information in "site profiles" about the radiation protection practices and hazardous materials used at various plants and facilities, which helps complete the dose reconstructions. Because certain facilities are known to have exposed employees to radiation while keeping few records of individuals' exposure, their employees have been designated under the law as members of a "special exposure cohort," and their claims may be paid without individual dose reconstructions. The law also allows the Secretary of HHS to add additional groups of employees to the special exposure cohort. For quality control and to raise public confidence in the fairness of the claims process, the compensation act also created a citizen's advisory board of scientists, physicians, and employee representatives--the President's Advisory Board on Radiation and Worker Health. Members of the board serve part-time and the board has limited staff support. The advisory board is tasked to review the scientific validity and quality of NIOSH's dose reconstructions and advise the Secretary of HHS. The board has the flexibility to determine the scope and methodology for this review. We assessed how well the advisory board's review and the contracted work with SC&A are proceeding. We focused on three questions: (1) Are the roles of key federal officials involved in the review of NIOSH's dose reconstructions sufficiently independent to assure the objectivity of the review? (2) Have the agency's management controls and the advisory board's oversight been sufficient to ensure that the contract to review site profiles and dose reconstructions is adequately carried out? and (3) Is the advisory board using the contractor's expertise in reviewing special exposure cohort petitions? The roles of certain key federal officials initially involved in the advisory board's review of the dose reconstructions may not have been sufficiently independent and actions were taken to replace these officials. Nonetheless, continued diligence by HHS is required to prevent such problems from recurring as new candidates are considered for these roles. Initially, the project officer assigned responsibility for reviewing the monthly progress reports and monitoring the technical performance of the contractor was also a manager of the NIOSH dose reconstruction program being reviewed. In addition, the designated federal officer for the advisory board, who is responsible for scheduling and attending board meetings, was the director of the dose reconstruction program being reviewed. The progress of the contracted review of NIOSH's site profiles and dose reconstructions has been hindered by the complexity of the work. Specifically, in the first 2 years, the contractor spent almost 90 percent of the $3 million that had been allocated to the contract for a 5-year undertaking. Various adjustments have been made in the review approach in light of the identified complexities, which were not initially understood. However, further improvements could be made in the oversight and planning of the review process. With regard to reviewing special exposure cohort petitions, the advisory board has asked for and received the contractor's assistance, expanded its charge, and acknowledged the need for the board to review the petitions in a timely manner. The board has reviewed eight petitions as of October 2005, and the contractor assisted with six of these by reviewing the site profiles associated with the facilities. The contractor will play an expanded role by reviewing some of the other submitted petitions and NIOSH's evaluation of those petitions and recommending to the advisory board whether the petitioning group should be added to the special exposure cohort. The contractor will also develop procedures for the advisory board to use when reviewing petitions. While NIOSH is generally required by law to complete its review of a petition within 180 days of determining that the petition has met certain initial qualification requirements, the advisory board has no specified deadline for its review of petitions. However, the board has discussed the fact that special exposure cohort petition reviews have required more time and effort than originally estimated and that the advisory board needs to manage its workload in order to reach timely decisions.