In 2007, GAO reported on issues associated with the proliferation of biosafety laboratories in the United States. In 2009, we noted that while proliferation of these laboratories was taking place in the federal, academic, and private sectors across the United States, the federal oversight of these laboratories was fragmented—there was not a single federal agency to provide oversight. As a result, numerous federal agencies could be involved in separate and independent inspections of these entities and their associated laboratories. The various agencies that have a role in the oversight of select agent entities and can conduct inspections are shown in figure 1. CDC and APHIS have regulatory authority to assess compliance with biosafety, biosecurity, and biocontainment requirements. Under the current SAR, entity registration must be renewed every 3 years, and CDC or APHIS may conduct an on-site inspection before the award of a new certificate of registration or the renewal of an existing registration. These inspections generally cover all aspects of the SAR. As a matter of policy, to ensure that the entity is compliant with the SAR, CDC or APHIS inspects the premises and records of applicants, including a review of all required plans, before issuing the initial certificate of registration. In addition, CDC or APHIS may conduct inspections to (1) respond to concerns about an entity’s compliance, (2) verify corrections of deficiencies identified through inspections or accomplishment of Performance Improvement Plan goals; or when (3) modifications are made to the entity’s registration, (4) a new building or laboratory is added, (5) a higher-risk agent or toxin is added, (6) a change is made in security infrastructure or policy and procedures, (7) a theft, loss, or release incident occurs, or (8) a violation is reported. Any entity where select agents are possessed, used, or transferred must allow CDC and APHIS to inspect, with or without prior notification. In addition to CDC or APHIS inspections, the SAR requires each registered entity to conduct annual self-inspections under the direction of the entity’s RO. DOT has the primary authority to regulate the safe and secure transport of all hazardous materials shipped intrastate, interstate, and in foreign commerce. Infectious substances, which include select agents, are regulated as hazardous materials by DOT. DOT regulates select agents in commercial transportation to, from, and within the United States, and its oversight extends to all parts of the hazardous materials transportation system, including classification of materials, packaging, handling, moving, loading, and unloading of hazardous materials shipments in commerce. PHMSA is the component of DOT responsible for this oversight. As its authority is limited to transportation, its focus is on the shipping and packaging aspects of biosafety and biosecurity requirements. Consequently, entities that are active in the transfer of select agents may have their shipping and handling facilities inspected by PHMSA. DHS and DOD own or fund research at select agent entities, and these entities may undergo additional inspections from these agencies as part of the conditions of funding or based on the safety and security policies of the parent agency. For example, entities that receive funds from DHS to conduct laboratory work involving select agents are subject to on-site compliance reviews and inspections by the DHS Regulatory Compliance Office. In addition, select agent laboratories operated by DOD are subject to inspections by the service IGs and other commands. DHS established a regulatory compliance program to facilitate department-wide implementation of and compliance with DHS policies for biosafety, select agent security, and the care and use of animals in research. DHS’s select agent research is subject to regulatory oversight by CDC and APHIS. In addition, entities that receive funding from DHS to conduct laboratory work involving select agents are subject to on-site compliance reviews and inspections based on DHS Management Directives. According to DHS, it “conducts significant additional oversight because of unique sensitivities related to biodefense research, as distinct from conventional public health research, and a desire to ensure complete transparency for senior management of the department about all ongoing biodefense efforts.” DHS also has responsibility for ensuring biosecurity compliance of DHS funded research under biodefense weapon treaties. Through its long-standing Chemical and Biological Defense Program, the DOD supports research on detection, identification, and characterization of biological threats and the development of countermeasures against those threats. DOD research activities take place at numerous facilities, including military-owned entities as well as entities in academia and private industry supported by contracts. DOD entities that are registered with CDC or APHIS are required to follow SAR requirements as well as service-specific requirements derived from DOD requirements. DOD- related select agent entities can therefore be subject to inspections from CDC, APHIS, the service IGs, and other commands. Specifically, the Department of the Army Inspector General (DAIG) conducts inspections of five Army and contractor-owned entities, the Navy Medical IG (MEDIG) conducts inspections of two Navy laboratories located in the United States and three overseas, and the Air Force Materiel Command IG conducts inspections of one Air Force select agent facility. In addition to DAIG inspections, Army facilities are also subject to command/program office (PEO) reviews by (1) Army Material Command Surety Management Review Team, (2) Army Test and Evaluation Command (ATEC) Surety Management Review Team, (3) Army Medical Command (MEDCOM) Surety Management Review Team, and (4) Joint Program Office for Chemical and Biological Defense (JPEO-CBD) Surety Management Review Team. The DAIG and command/PEO teams each have a 2-year inspection cycle and stagger the inspections so that each entity is inspected once per year. Other federal agencies, such as the NIH and USDA’s Agriculture Research Service, have their own internal offices that may perform inspections in addition to those performed by CDC or APHIS as part of the SAP. In many cases, these agencies have internal regulations or policies that are more prescriptive than the CDC or APHIS regulations, according to the Trans-Federal Task Force. In addition, as the agency responsible for the general oversight of workplace safety in the United States, OSHA has oversight authority for the safety and health of workers in all workplaces that fall under its jurisdiction, including individuals who work with hazardous biological agents or toxins in high- and maximum- containment research facilities. This includes jurisdiction over the safety and health of workers employed by privately owned entities and, under certain circumstances, federal high-containment facilities. Inspection activities are generally conducted in three phases: (1) preparation, (2) execution (the actual inspection), and (3) closeout (postinspection activities). In order to prepare for an inspection, entities conduct a variety of activities, such as responding to requests for documents related to the SAR; reviewing and updating guidance, records, and plans; and checking security and medical certifications of inspectors. In the execution phase, inspection activities include, for example, tours of the facility, document reviews, inventory audits, interviews of laboratory staff, equipment tests, and examinations of physical security and shipping and receiving of select agents. The closeout phase includes activities such as discussing the inspection findings and report, developing corrective action plans, and providing verification of corrective actions. (For a detailed list of inspection activities included in the survey, see app. II.) Inspections consist of an extensive review of laboratory safety and security. CDC and APHIS use specific checklists, which they developed from the SAR, OSHA regulations, NIH guidelines for recombinant DNA research, and the Biosafety in Microbiological and Biomedical Laboratories (BMBL) manual, to guide their inspections. The BMBL provides guidance for standards of practice for laboratory principles, practices, and procedures. Other inspecting agencies also use the same or similar checklists for their inspections. DOT inspections, for example, are derived from PHMSA’s regulations for hazardous materials shipping, packaging, testing, certification, safety and security, and record keeping. The scope of a DOD inspection covers a wide range of functional areas, such as security, safety and occupational health, surety management, emergency response, occupational medical requirements, and transportation. The number of federal agencies involved in inspections of select agent entities increases the potential for overlap and duplication. Further adding to the potential for overlap is the increase in the number of inspections. These inspections have increased for a variety of reasons, such as heightened security concern in response to the events of September 2001, as well as an increase in select agent research and the number of agencies funding the research. For example, in addition to announced inspections that generally take place with registration certification and renewal, the number of unannounced CDC inspections substantially increased from fewer than 5 in 2006–07 to nearly 80 in 2012, according to estimates from CDC. And while some federal agencies have increased the use of joint inspections, in which two agencies are on-site for an inspection at the same time, it is unclear whether this will address all of the negative aspects of duplication if compliance is still assessed separately. About 15 percent of the 374 entities that were registered to work with select agents between fiscal years 2009 and 2011 were subject to inspection overlap. This means that in a 2-year period, these entities were inspected by more than one federal agency for biosafety, biosecurity, and biocontainment compliance. In addition, specific inspection activities were often duplicative, according to our survey of the 55 entities that were subject to overlapping inspections. While the percentage of entities affected by inspection overlap was relatively small, the entities affected tended to be larger ones that work with a greater variety of agents and with more laboratories, principal investigators, and laboratory staff. For example, entities with five or more laboratories are more likely to be subject to overlap than entities with fewer than five laboratories, controlling for biosafety level (BSL) and the number of agents. Similarly, entities working with five or more select agents are more likely to be subject to overlap than entities working with fewer than four select agents, controlling for the number of laboratories and BSL. As a result, the overlap affected roughly a third of all laboratories, principal investigators, and lab staff. Moreover, DOD-owned select agent entities are also subject to inspections from internal inspecting entities. These inspections can overlap with inspections from CDC, APHIS, and the service IGs. Concerning duplication, the entities often prepare the same documents for inspectors to review; conduct the same facility tours, inventory inspections, and personnel interviews; and go through the same exit conference and corrective action plan processes, according to survey results. Inspections conducted by DOT, however, were generally not duplicative of CDC and APHIS inspections because specific inspection activities tended to differ. According to surveyed entities, DOT inspections tended to focus narrowly on transportation issues—such as (1) checking hazardous material and transportation security plans and (2) verifying the labeling, testing, and assembly of United Nations (UN) certified packagings—rather than general biosafety and biosecurity compliance. DHS and DOD’s DAIG inspections tended to be more duplicative with those of CDC and APHIS, in that numerous activities were the same across these inspections, according to survey results. Fifty-five, or 15 percent, of entities registered between fiscal years 2009 and 2011 were subject to overlapping inspections. Although the overlap appears to affect only a small portion of registered entities, these entities are home to 645 laboratories—roughly a third of all laboratories involved in select agent work (see fig. 2 for details). On the basis of logistic regression analysis, we found that the likelihood that an entity was subject to overlap in federal inspections depends on the number of laboratories, the highest BSL of its laboratories, and the number of select agents. Specifically, entities with five or more laboratories are more likely to be subject to overlap than entities with fewer than five, controlling for BSL and the number of agents. In addition, entities with at least one BSL-4 lab are more likely to be subject to overlap than entities without a BSL-4 lab, controlling for the number of laboratories and the number of select agents. In addition, entities working with five or more select agents are more likely to be subject to overlap than entities working with fewer than four select agents, controlling for the number of laboratories and BSL. Finally, entities subject to overlap have, on average, more staff and more principal investigators (see fig. 3). Overlap in inspections occurred most frequently between CDC or APHIS and (1) DOT (34 overlapping inspections), (2) DAIG (13 overlapping inspections), and (3) DHS (8 overlapping inspections). Considering only CDC inspections, overlap occurred with 29 DOT inspections, 13 DAIG inspections, and 3 DHS inspections. However, overlapping inspections do not necessarily result in duplication. While the overlap in inspections occurs most frequently between CDC or APHIS and DOT, these inspections are not necessarily duplicative because the specific inspection activities tend to differ. The activities are likely to differ because the purpose of DOT inspections is narrowly focused on issues and areas related to the transport of select agents, whereas CDC and APHIS inspections are more-broadly focused. While there is less-frequent overlap between CDC or APHIS inspections and those of DHS or DOD, these inspections tend to be more duplicative, in that the inspection activities are similar, according to survey results. According to DOT inspection data, DOT’s PHSMA conducted 83 inspections of select agent entities between fiscal years 2009 and 2011. DOT coordinates its inspections with CDC and APHIS under a working Memorandum of Understanding (MOU), which spells out the framework and responsibilities for the exchange and protection of information on transfer of select agents. Under the MOU, CDC and APHIS annually provide DOT with a list of registered entities that have transferred select agents during the 12 preceding months. DOT, in turn, notifies CDC and APHIS of any anticipated inspection of an entity 30 days before the inspection and also provides them with the inspection results. According to DOT officials, they try to coordinate joint inspections whenever possible. After CDC provides a list of scheduled inspections, DOT informs CDC about which inspections it will join. According to DOT officials, where possible, they coordinate joint inspections with CDC because (1) they learn things from each other, (2) with both agencies there at the same time it is more encompassing view of the process, and (3) it brings greater sophistication to inspections. Such coordination appears effective, given survey results of entities that experienced DOT inspections that overlapped with CDC or APHIS inspections. These entities reported little duplication in specific activities in the preparation, execution, and closeout phases of inspections (see table 2). Among the activities that tended to be duplicative were verifying the medical, security, or other credentials of inspectors in the preparation phase; participating in interviews with inspectors in the execution phase; and holding exit conferences with the inspecting agency in the closeout phase. Among the activities that tended to be DOT-specific were checking hazardous materials and transportation security plans and verifying the labeling, testing, and assembly of UN- certified packagings. DHS identified 42 government, university, private, and not-for-profit entities that were receiving DHS funding for work involving select agents. DHS’s Regulatory Compliance Office conducted or participated in 19 on- site inspections of 13 of these entities between fiscal years 2009 and 2011. Of those 19 inspections, 8 were joint inspections, including: 5 joint inspections with CDC; 1 joint inspection with APHIS; and 2 joint inspections with both CDC and APHIS. According to DHS officials, there are numerous reasons for DHS to visit a select agent entity that has also been inspected by CDC or APHIS. These reasons include, for example, CDC or APHIS placing the entity on a Performance Improvement Plan or making substantial recommendations to correct regulatory noncompliance. If it appears that the compliance issues identified by CDC or APHIS could affect the DHS program, DHS may also make a site visit to understand the effect on DHS research and to assist the entity in mitigating the effect through appropriate corrective action. According to DHS officials, their inspections are fundamentally different from CDC and APHIS inspections. DHS describes its compliance inspections as broader in some ways than those of CDC or APHIS, because they are designed to ensure that DHS-sponsored research activities not only comply with select agent requirements, but with other relevant regulations and guidelines as well. According to DHS officials, CDC and APHIS, as regulatory agencies, conduct more comprehensive inspections at the institutional level. DHS compliance inspections, however, go beyond compliance with select agent regulations to include general biosafety, animal care and use, research protocols and procedures, institutional review and oversight (for example, Institutional Biosafety Committees), and adherence to best practices. Nevertheless, survey responses from entities that experienced DHS inspections that overlapped with CDC or APHIS inspections reported some duplication in specific activities in the preparation, execution, and closeout phases of inspections (see table 3). Among the activities that tended to be duplicative were verifying medical, security, or other credentials of inspectors and arranging staff availability in the preparation phase; participating in interviews with inspectors in the execution phase; and holding exit conferences and developing and implementing corrective action plans in the closeout phase. According to DOD inspection data, the DAIG conducted 16 biosurety inspections of its Army and contractor-owned entities between fiscal years 2009 and 2011, 5 of which were conducted jointly with CDC. Of the 16 DAIG inspections, 13 overlapped with an inspection from another federal agency. The Navy IG conducted one inspection and the Air Force IG conducted two inspections between 2009 and 2011. These inspections did not overlap with an inspection from another federal agency. With respect to specific activities in the preparation, execution, and closeout phases of inspections, entities that experienced DAIG inspections that overlapped with CDC or APHIS inspections also reported substantial duplication in inspection activities (see table 4). Among the inspection activities that tended to be duplicative were arranging staff availability in the preparation phase, holding entry meetings and escorting inspectors in the execution phase, and holding exit conferences in the closeout phase. However, according to DAIG officials, as required by Army directives and regulations, its biosurety inspections are more- comprehensive than CDC and APHIS inspections, covering biosafety, biosecurity, biocontainment, personnel reliability program (PRP), transportation, occupational medical requirements, and emergency response exercises. While DAIG officials acknowledge a level of overlap with CDC and APHIS inspections in terms of verifying compliance with standards, DOD and the Department of the Army have developed specific requirements to implement those standards. In addition, until recently, CDC and APHIS inspections did not look at facility or department-specific requirements such as PRP. DOD-related select agent entities are also subject to inspections and reviews from internal organizations, which can overlap with inspections from CDC, APHIS, and the service IGs. For example, in addition to service IG inspections, DOD entities undergo Biosurety Management Reviews (SMR) and Biosurety Staff Assistance Visits (SAV). The SMRs are meant to verify the entity is managing its biosurety program according to standards. They allow the command to see how the surety program is being managed and where there may be deficiencies. According to Army lab officials, however, these inspections tend to be identical to service IG biological surety inspections. SAVs are an opportunity for the command to assist in fixing deficiencies or other lacking areas, and usually take place before another major inspection. SAVs are not biosurety inspections, nor are they required under DOD regulations. However, SAVs tend to be treated similarly to service IG inspections, according to Army lab officials. While SMRs and SAVs may be handled like an inspection with written reports of perceived deficiencies for which the entity makes a formal response and corrections for the identified deficiencies, DOD officials noted that entities may be self-imposing requirements or practices not required by regulation or the inspecting agency. As a result, these internal reviews can represent an additional area of overlap for DOD-owned and DOD-operated entities. For example, as shown in table 5, an Army entity underwent eight inspections or reviews, five of which were for compliance with select agent regulations between fiscal years 2009 and 2011. According to an official of this particular Army entity, many of the major command reviews and visits use up time and resources, fixing issues that are not value-added, or that are not looked at by other major inspections. In many cases, inspectors are focusing on minor issues, leaving the laboratory open for larger deficiencies on the major inspection. According to the DAIG Chief of Technical Inspections, a major cause of overlapping internal inspections is that there is no single entity within the DOD overseeing or coordinating inspections and that each service validates compliance very differently. The Army requires each major command to have its own internal biosurety team and, because the entities feel they should be prepared for higher-level reviews, the teams conduct inspections in preparation for higher-level inspections. For Army labs, the DAIG inspects an entity every 2 years, an internal command surety team, such as ATEC, conducts an SMR every 2 years (alternating with the DAIG inspection), and SAV reviews may be conducted before any inspection (DOD or otherwise). In an example of an extreme case, an Army select agent laboratory that conducts recombinant DNA research for DHS-funded projects and frequently transfers select agent materials to collaborators could theoretically be inspected by CDC/APHIS, DAIG, NIH, DHS, and DOT all within the same year. This could significantly hinder critical research productivity at the inspected laboratory because of the time dedicated to inspections, according to the report of the Working Group on Strengthening the Biosecurity of the United States. This is somewhat in contrast with inspections of the two Navy and one Air Force entities. For example, while the Navy can perform SAVs prior to inspections, they are not required like Army’s SMRs. In addition, rather than conducting its own inspection, the Air Force accepts the CDC inspection results and adds its own PRP review. This limited coordination among the inspection agencies was noted in the Working Group report. The costs of overlapping federal inspections and effects on lab operations are difficult to quantify because (1) agencies and entities generally do not track the costs or effects of inspections and (2) some costs are not quantifiable. Nevertheless, the costs and effects on lab operations are significant when considering (1) the cost of inspections to federal agencies, (2) both the quantifiable and nonquantifiable costs to the entity, and (3) surveyed entities’ perceptions of the negative effects of overlapping inspections on lab operations. Although we could not quantify the portion of federal and entity costs directly attributable to overlap, we could quantify the costs of inspections in general. For example, we estimate that for fiscal years 2010 through August 2011, individual agencies’ total inspection costs ranged from approximately $22,400 to over $900,000, according to agency data on the hours spent on inspection activities, inspector compensation (salaries and benefits) per labor hour, and travel. The approximate overall federal cost for fiscal year 2010 and 2011 inspections was over $2.1 million dollars. On average, the entity costs per inspection were nearly $15,000 and 380 hours in staff time, according to our survey. The quantifiable cost of an inspection to a select agent entity depends on the number of laboratories and select agents, the complexity of the entity’s mission, its location, and whether it has a history of problems or violations of select agent regulations. In inspections of larger entities, there are higher inspection costs and a greater likelihood for overlap. The costs of overlap are therefore most likely higher as well. Entities also reported moderate to significant nonquantifiable costs of inspections when it comes to loss of productivity and delays in research. While inspections can help entities correct deficiencies, improve inventory management and accountability, and justify the need for resources to improve operations, most surveyed entities reported that overlapping inspections have negative effects on lab operations. According to surveyed entities, overlapping inspections negatively affected lab productivity, staff morale, available time to complete research, and the research schedule. And according to at least one-fifth of surveyed entities, overlapping inspections negatively affected the physical viability of inventory, staff retention, and competitiveness for research funds. Because many of these entities are federal laboratories or are funded through federal grants, these quantifiable and nonquantifiable costs are passed on to the federal government. Obtaining an accurate and complete picture of the costs of multiple inspections is difficult because entities generally do not track the costs of inspections and some of those costs are nonquantifiable. Nonetheless, federal agencies do incur quantifiable costs, including salaries, travel, and training of inspectors, and must purchase inspection equipment and pay staff to engage in inspection activities as opposed to research or other routine activities. Entities may also incur nonquantifiable costs of multiple inspections, such as loss of productivity, delays, and decreased time available to complete research. In addition, because many of these entities are federally owned or funded, some portion of this cost is passed on to the federal government. These costs are affected by the number of inspectors, the time spent on an inspection, and the size of the entity being inspected. The larger the entity—in terms of laboratories, staff, and select agent research—the greater the cost of inspections. Given that inspections cost more for larger entities and overlap occurs more often for larger entities, the cost of overlap is greater than it would be if it were evenly distributed across entities of various sizes. The approximate direct federal cost for fiscal years 2010 and 2011 inspections was over $2.1 million, ranging from approximately $22,400 at DOT to over $900,000 at CDC, according to agency data on the hours spent on inspection activities, inspector compensation (salaries and benefits) per labor hour, and travel. Specifically, APHIS’s total labor, travel, and other costs for inspections were $265,792; DOD’s costs were $697,744; DOT’s costs in 2010 were approximately $22, 444; and CDC’s costs were $903,475 (see table 6 for agency inspection costs). DHS estimates their inspection costs at about $250,000 for the 2-year period. Although we did not estimate indirect costs, the federal government also incurs costs from inspections because many select agent entities are either federally owned or funded. Consequently, the costs to entities, described in the sections below, also accrue to the federal government. The cost of inspections to entities is also difficult to accurately determine because entities generally do not track inspection cost. However, according to focus group participants and entities we surveyed, entities do incur quantifiable and nonquantifiable costs with each inspection, some of which can be significant. Focus group participants and surveyed entities reported quantifiable costs, such as purchasing inspection equipment and salaries for staff involved in preparing for, carrying out, and responding to an inspection. Entities also reported less-easily measured, nonquantifiable costs, such as loss of productivity, delays, and decreased time to complete research, as well as loss of specimen viability from repeated thawing and freezing. Staff time and lab resources are required for inspections, and that burden is increased with overlapping inspections. The actual cost of an inspection to a select agent entity will depend on the number of laboratories and select agents, the complexity of the entity’s mission, its location, and whether it has a history of problems or violations of select agent regulations. However, because overlap in inspections tends to occur more often for larger entities, the overall costs of overlap for these laboratories are likely higher as well. Entities that experienced an overlapping inspection spent, on average, 380 hours and nearly $15,000 in staff time to engage in a federal inspection, according to survey data on the number of hours spent to prepare for, carry out, and close out inspections and the hourly salaries of laboratory staff involved (see table 7 for average costs across occupational groups). See app. I for an explanation of how we calculated these costs. Much of the time spent on inspections takes place in the preparation phase, according to focus groups of lab staff. For example, staff from Army laboratories noted that there is a period of 3 to 4 months of intense preparation for DAIG inspections and months of follow-up. During the preparation phase, lab staff perform numerous activities, including updating standard operating procedures and other documents and records; verifying inspectors’ health records and clearances; turning in unused equipment; holding meetings to prepare for the inspection; checking chemicals and agents in inventory; checking lab equipment; and inspecting, cleaning and painting floors, walls, and desk space. According to some focus group participants, in the weeks preceding an inspection, research is suspended and all staff time is directed toward inspection efforts. Scheduling for inspections can also create conflicts because experiments must be scheduled around the inspection, and key staff must be available during the inspection, regardless of personal plans or schedule. During the inspection, lab staff are involved in activities that take time and resources. For example, staff conduct safety training for inspectors (how to wear safety suits and respirators and blood-borne pathogen and internal requirement training), issue safety equipment to the inspectors, clear inspectors through security, and provide escorts for inspectors. Safety equipment, such as personal protective equipment (PPE), gowns, and footies are provided to inspectors at the entities’ expense, and these costs increase with larger inspection parties and when there is overlap because the equipment can not be shared or reused. Staff time for escorts can be significant in some cases. For example, Army lab inspection teams can have as many as 20 personnel and stay as long as 2 weeks. According to one Army laboratory, it spent more than 7,305 labor hours in activities related to preparing for, executing, and responding to six inspections during 2009 at a cost of $350,640. During 2010, the laboratory estimated it spent 4,082 hours on these activities for three inspections, at a cost of $195,456. In addition, when joint inspections take place, the size of the inspection team may be too large for some entities to manage. For example, according to one survey respondent, the entity requested DHS and CDC not conduct a joint inspection because the inspection teams are too large to handle at one time. According to another survey respondent, the respondent’s laboratory had to arrange for additional personnel to escort large teams of inspectors for multiple inspections. Laboratories also spend time and resources in the closeout phase of the inspection. For example, upper- level staff attend meetings to discuss inspection results, and staff time and effort are required to respond to oral and written findings that may change or be added to even after the completion of the inspection. Of particular concern was that frequent inspections keep lab staff in a constant mode of preparing for the next inspection while responding to the last one, inhibiting their ability to respond to inspection findings and conduct research. Laboratories also incur nonquantifiable costs from inspections, which can be exacerbated by overlapping inspections. While these costs tend to be small, according to most surveyed entities, for some they can be moderate to significant when it comes to loss of productivity, decreased time available to complete research, and delays (see table 8). Other costs noted by surveyed entities include stress and anxiety for lab staff, contractor and overtime costs, HVAC and equipment testing costs, and loss of focus and manufacturing time. Focus group participants noted a variety of nonquantifiable costs, such as the loss of productivity, recertifying equipment or bringing it offline for inspection, and loss of agent viability from repeated thawing and freezing of agents. Although only 5 (11 percent) of surveyed entities reported that reduced viability of inventory was a moderate to significant cost, a preliminary study at the Dugway Army Proving Ground on the viability of agent vials that had undergone multiple inspections found reductions in agent viability, with a 100 percent loss of viability in a few cases. While the costs of reduced or lost viability are difficult to determine, a strain that existed in only a single vial would be impossible to replace. Furthermore, loss of agent viability can damage research opportunities and experimental findings. Focus group participants also noted that multiple inspections reduce an entity’s competitiveness for grant money, although most surveyed entities found this a negligible cost. In addition, inspection time must be factored into grant proposals. And because inspections affect the research cycle, the time it takes to complete research and the overall costs of the research increase when entities experience multiple inspections. For example, some participants noted the costs of their entity’s grant proposals are higher than others’ because of the “overhead” costs they must build in for their multiple biosafety and biosecurity inspections. In addition, the time to conduct research is affected when laboratories have to suspend research for inspections. Undergoing multiple inspections exacerbates this problem. Some participants noted that the granting community knows that if laboratories are frequently inspected, the work will not get done by the desired deadlines, affecting the communities’ willingness to award grants to these entities. Inspections are essential in ensuring biosafety and biosecurity requirements are met and SAR regulations are followed. Most surveyed entities reported that multiple inspections positively affect (1) actions to correct deficiencies, (2) coverage in helping to identify problems, (3) the strength of inventory management and accountability, and (4) justification for additional resources to improve operations. However, many entities also noted multiple inspections negatively affect lab operations. In particular, most surveyed entities reported that multiple inspections negatively affect (1) lab productivity, (2) staff morale, (3) the time to complete research, and (4) the research schedule. While some entities reported negative effects to (1) the physical viability of inventory, (2) staff retention, and (3) staff recruitment, a greater majority of entities reported these issues were unaffected by multiple inspections (see table 9 for effects of multiple inspections). Focus group participants also noted some positive aspects of multiple inspections, among them having an “extra set of eyes” or a layer of oversight on laboratory operations to identify areas of need. In addition, inspection report findings, can provide funding justification for resources and staff, validate good laboratory practices, and identify needed quality assurance improvements. However, some focus groups participants also noted that the amount of time spent on inspections slows down the science and that while inspections may help get the laboratory renovated, they do not actually improve the science. Others participants noted that oversight functions in laboratories, such as quality assurance, are growing faster than the research community. Finally, one survey respondent noted that multiple inspections do not allow the laboratory to have the time necessary to implement lessons learned in a meaningful time frame. Actions to reduce the costs and negative effects of overlapping and duplicative inspections include better coordination and greater consistency in the application of standards, according to various experts and surveyed entities. Both the HHS-USDA Trans-Federal Task Force and the Executive Order Working Group on Strengthening the Biosecurity of the United States recommended enhancing the coordination of biosafety oversight activities, including inspections. In addition, our earlier work on select agent laboratories recommended a single coordinating agency as a means to improve coordination. Accordingly, CDC and APHIS have taken steps to better coordinate inspections with other agencies, for example, by increasing the use of joint inspections, signing MOUs for sharing inspection information with other agencies, establishing an inspector training program for federal partners, and developing a common “playbook” for inspection of registered entities. Such coordination efforts are important steps in reducing overlap and duplication. However, MOUs and joint inspections may not fully address the negative effects of overlap and duplication if inspectors are still applying standards inconsistently and preparing separate reports of findings. Specifically, according to surveyed entities, standards must be applied more consistently between agencies and from one inspection to another. It is this inconsistent application of standards that exacerbates the negative effects, including costs, of overlapping inspections. According to surveyed entities, the most effective actions for greater consistency in the application of standards include (1) ensuring inspectors are well trained and experienced, (2) establishing a single set of inspection standards that all agencies accept, (3) providing an opportunity to discuss, clarify, and rebut inspection findings, and (4) training inspectors to one set of standards with requirements for noncompliance findings (see table 10). Well-trained inspectors, who are able to apply consistent standards, would reduce the negative effects of overlapping inspections. In particular, they might reduce overlap by allowing federal agencies to accept each other’s inspection results. Such a result is facilitated by joint training, according to DOD officials. Without a consistent standard, however, highly trained inspectors would not be effective, according to some surveyed entities. In addition, according to most surveyed entities, a 3-year federal inspection cycle for select agent entities was reasonable. Focus group participants also suggested options for minimizing the potential for overlapping or duplicative inspections and the associated burden, such as having a single inspecting agency whose findings are accepted by all other agencies and improving the knowledge and skills of inspectors. In addition to scaled responses, surveyed entities provided written suggestions for reducing the negative effects of multiple inspections. While several entities expressed support for a single inspecting agency or joint inspections, others felt that addressing overlap alone would be insufficient when the same agency applies different standards in each inspection. In support of inspections being conducted by a single agency, entities noted that at least the inconsistent application of standards across agencies and frustration over trying to comply with two different agency regulations would be minimized. Surveyed entities highlighted the inherent conflict that arises when agencies come to different conclusions about an entity’s compliance. For example, one noted that because there is no agency “in complete control,” entities cannot determine which agency is correct when there is conflict in inspection reports. And a DOD entity wondered about the implication for CDC—which approved the SAP registration—if DAIG recommends the shutdown of a lab. While some thought an independent agency or an inspection czar would be a useful neutral party, others expressed concern that such an entity would just add another level of bureaucracy or require unnecessary new legislation. Because of entities’ familiarity with CDC, one noted that they would not want to have a single agency unless it was CDC. However, another noted it was uncertain how useful a single agency with authority to audit would be because there would be a period of mixed messages while each agency has its say. And so far, the entity had not seen government agencies “play well together as a team.” In addition, while some thought joint inspections might address the negative effects of overlap, others thought they would exacerbate the problem because agency coordination—in terms of consistent interpretations and applications of standards—was still a concern. In support of joint inspections, some felt they facilitated agency coordination and reduced duplication. Others noted that joint inspections are a better use of time and resources, reducing disruption and burden. In addition, joint inspections could help bring more uniformity and clarity for the inspection agencies and entities. For example, according to DAIG officials, they have taken steps to address these issues in joint inspections with CDC and APHIS. During joint inspections, the agencies discuss and resolve differences of interpretation so there is one “inspector” face to the inspected facility, and except for major findings, DAIG does not duplicate the findings of the other agency. However, noting recent inspections by two different agencies, one entity reported that having them at the same time would have made the inspection longer and more grueling. Joint inspections also require the entity to provide escorts and enough PPE for everyone entering the facility, a large expense when considering how many PPEs and escorts are needed for some joint inspections. In addition, (1) combined inspections may still result in multiple reports the entity must respond to and (2) having two teams do what a single team can do is still an additional burden on the taxpayer. Nonetheless, the burden that results from inconsistent application of standards could be minimized if agencies (1) conducting joint inspections issued a single report of findings or (2) instead of conducting a separate or joint inspection, accepted each others’ inspection findings in lieu of conducting their own inspections. Regardless of whether a single agency is responsible or joint inspections are conducted, numerous respondents focused on the need for consistent application of standards by well-trained inspectors. Respondents’ concerns focused on the inconsistent application of standards that can occur, not only between agencies, but from one inspection to another. While the problem may be exacerbated by overlapping inspections, the burden results from inconsistency, not overlap per se. For example, one entity noted that the biggest problem with multiple inspections by different agencies is that each has its own agenda, so establishing inspection standards that are accepted by all agencies would have the greatest effect on reducing the negative effects of multiple inspections. Another noted that a common set of requirements and interpretations would significantly reduce variation in compliance assessments. Reflecting on the additional burden to Army laboratories, one entity noted, “Ideally the set of standards that would be accepted would be the same federal standard that all organizations, not only DOD organizations, would be held to. This would not only reduce the burden of multiple inspections but also level the playing field between DOD and academia which would increase collaboration between laboratories.” Some noted that this might facilitate sufficient trust for agencies to accept each other’s inspection results. If all inspections were based on the same standard, with a checklist to keep them consistent, and all inspectors were trained together and required to use the published standard and checklist, the need for multiple inspections would be decreased or eliminated. Despite the support for greater consistency, some cautioned against the application of a “checklist mentality.” For example, one surveyed entity noted that too many inspectors for their select agent program had been rigid and unbending, sticking to a checklist rather than common sense. Training can support efforts to consistently apply standards, while still allowing the flexibility for inspectors to have essential discussions with entities to establish rapport, exchange information, and understand why certain procedures and policies are in place in any given facility. Surveyed entities offered a variety of other suggestions, such as (1) limiting the number of inspectors and days for inspections; (2) streamlining inspections, including the number of inspectors on the team, and coordinating areas of focus within the team to lessen the burden on the laboratories; (3) having an advisory group of ROs to give feedback to the inspection agency, regulatory agency, or GAO; (4) dividing inspection elements among the inspecting agencies, on the basis of their strengths; (5) staffing inspection teams for consistency and historical knowledge; (6) training all inspectors together to help ensure consistent inspections; and (7) giving entities credit for moving in the right direction. While none of the written comments suggested reducing the inspection cycle, almost half of surveyed entities noted that a 3-year federal inspection cycle for select agent laboratories was reasonable. The agencies have taken some steps to address these concerns. For example, after we had initiated our work, CDC and APHIS convened an Interagency Working Group that includes representatives from DHS and DOD, as well as other federal agencies. So that effective oversight can be achieved with minimal disruption, the working group is developing procedures and policies to better coordinate the inspections of entities that are federally owned or funded, improve information sharing between agencies, and implement other activities. For example, the working group has initiated a joint inspection program through which it has, so far, conducted 24 joint inspections. In addition, it has MOUs with DHS and DOD to share inspection data and an inspector- training program to provide the knowledge, skills, and experience to federal agencies to enable them to conduct “internal” inspections of registered entities they own or fund or to conduct joint inspections with CDC or APHIS. Inspections are important for safety and compliance and can help improve laboratory procedures, infrastructure, and security. However, the value of inspections may be diminished when federal agencies are (1) expending resources to conduct the same or similar work and (2) burdening entities with overlapping or duplicative inspections. While one could argue that more-frequent inspections might be necessary to better ensure safety—in particular for larger entities—there is no apparent value-added when specific inspection activities are duplicative and occur, in some cases, before entities have had time to respond to findings from a previous inspection. In addition, most surveyed entities reported a federal inspection schedule of once every 3 years was reasonable; more frequent—especially duplicative—inspections waste federal dollars and can negatively affect lab operations. This effect on lab operations also wastes federal dollars because many of the laboratories are federally funded through grants or appropriations. To improve interagency coordination and reduce the potential for overlap and unnecessary duplication, a single coordinating agency could be helpful. Such a coordinating agency need not be responsible for conducting all inspections. Rather, where agencies can demonstrate that they meet SAR standards for their inspections, their inspections could be used in lieu of other agency inspections. Currently, the primary agencies with regulatory authority, CDC and APHIS, have taken steps toward better coordination through the interagency working group. However, CDC and APHIS have not been officially charged with overseeing or coordinating all inspection efforts and the other federal agencies may still inspect an entity regardless of how recently another agency has conducted an inspection. Moreover, consistent application of inspection standards— both across and within the agencies—is needed to reduce the negative effects of multiple inspections on lab operations. Further, cross-agency training efforts could facilitate consistent learning and application of such standards. Agencies could then better target their inspection time and resources, and entities could better prepare for and respond to federal inspections. In order to eliminate overlapping and potentially duplicative inspections, as well as reduce the burden of such overlap and duplication on select agent entities, we recommend that CDC and APHIS, as the primary agencies with regulatory authority, work with DHS and DOD to (1) coordinate inspections of select agent entities and (2) where possible, use mechanisms such as (a) joint inspections with a single report of findings, (b) acceptance of each other’s inspection results rather than independent inspections, and (c) cross-agency training opportunities to ensure consistent application of biosafety, biosecurity, and biocontainment inspection standards. We provided a draft of this report to HHS, USDA, DOT, DHS, and DOD for review and comment. DOT did not provide any comments. In its written comments, reproduced in appendix III, HHS agreed with our recommendations. HHS noted that DOT, DHS, and DOD have different authorities than the federal select agent program (SAP), as we had outlined in the background section of this report. HHS stated that it already has a number of activities underway related to reducing overlap and duplication in inspections. Specifically, through the working group for Optimizing the Security of Biological Select Agents and Toxins in the United States, HHS’s Federal Select Agent Program has developed procedures and policies to better coordinate inspections of federally owned or funded entities and to improve information sharing between departments and agencies. HHS initiated three programs to accomplish these goals: (1) a joint inspection program, (2) inspection information sharing MOUs, and (3) an inspector training program. HHS has so far conducted 24 joint inspections, signed inspection information sharing MOUs with five agencies, and trained five individuals from DHS and four individuals from DOD. HHS also plans another training session for spring 2013 to educate federal agencies about recent revisions to select agent regulations. HHS also provided technical comments, which we incorporated as appropriate. In its written comments, reproduced in appendix IV, USDA agreed with our recommendations. Although USDA noted that it did not believe its activities were overlapping with DOD and DHS because of differences in inspection authorities and agency missions, it noted that it had a number of activities underway to reduce overlap and duplication in inspections. Along with CDC—USDA’s partner in overseeing the select agent program—USDA noted that it is conducting joint inspections to minimize the number of select agent inspections, signing information sharing MOUs with several agencies to share inspection data, and conducting inspector training programs to provide knowledge, skills, and experience to federal partners. USDA also provided technical comments, which we incorporated as appropriate. In its written comments, reproduced in appendix V, DHS agreed with our recommendations. DHS notes that its Regulatory Compliance Office collaborates with officials and inspectors at CDC and APHIS to plan joint inspections, share information, and consult on inspection findings in order to reduce the burden on inspected institutions. Specifically, DHS signed an MOU with CDC and APHIS that outlines how the parties will coordinate joint inspections in order to reduce the burden on entities and to facilitate coordination of oversight efforts between the agencies. In line with our recommendations, DHS now accepts the results of inspections conducted jointly with CDC or APHIS instead of conducting independent inspections or generating a DHS-specific report of findings. DHS has also taken advantage of cross-agency training to ensure consistent application of biosafety, biosecurity, and biocontainment inspection standards. In its written comments, reproduced in appendix VI, DOD agreed with our recommendations. DOD noted that certain DOD regulations require compliance inspections for areas, such as the personnel reliability program (PRP), that are in addition to the SAR. We recognize some requirements are agency-specific and do not suggest that they be eliminated. We do recommend, however, that the burden on entities be reduced through coordination with other SAR inspection activities. In line with our recommendations, we are encouraged that DOD has several initiatives to coordinate with CDC and APHIS to reduce overlap and duplication of inspections. For example, the Army and Navy have signed information sharing memorandums of agreement and understanding with CDC and APHIS to coordinate inspections of select agent agencies, through which they conducted the first CDC, DOD, and Army joint inspection in spring 2011. Although the Air Force does not have an MOU with CDC or APHIS for its one facility, it accepts the CDC inspection results and performs its own PRP inspection. During joint inspections, DOD notes that it develops an inspection plan with CDC, APHIS, and the entity, and coordinates with the agencies to minimize entries into inspected areas by inspecting an area together. While two separate reports are written, the DAIG notes that it generally does not replicate CDC findings of noncompliance with SAR standards. Findings are discussed to ensure a common understanding of the standards and what was observed, and to delineate between what is required by the SAR, DOD, and DAIG. While DOD notes that it is unclear whether it would or could accept a CDC or APHIS inspection report in lieu of its own inspection, these joint efforts are still new and the issue will evolve with further collaboration. Additionally, DOD is revising its biological and chemical agent security policies in order to harmonize them with the recently revised SAR. DOD also noted other steps it has taken to coordinate oversight efforts though the Working Group, such as developing the charter and implementation plan for the current federal “joint” inspections process, and developing tools, such as the inspector training program and playbook, to administer the joint inspection process. DOD also made some technical comments, which we incorporated as appropriate. As agreed with your offices, unless you publicly announce the contents of this report earlier, we plan no further distribution until 30 days from the report date. At that time, we will send copies to the Secretaries of Health and Human Services, Agriculture, Transportation, Homeland Security, and Defense, the appropriate congressional committees, and other interested parties. In addition, the report will be available at no charge on the GAO website at http://www.gao.gov. If you or your staff have any questions about this report, please contact me at (202) 512-2700 or kingsburyn@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 key contributions to this report are listed in appendix VII. To assess (1) the extent of overlap and potential duplication in federal agencies’ inspections of entities that work with select agents, (2) the costs of overlapping federal inspections and effects on laboratory operations, and (3) actions to reduce the costs and negative effects of overlapping inspections, we interviewed agency officials, reviewed pertinent legislation, regulations, and agency documents. Specifically, we spoke with officials from the Center for Disease Control and Prevention (CDC) Division of Select Agents and Toxins, the Department of Agriculture’s Animal and Plant Health Inspection Service (APHIS), the Department of Transportation’s (DOT) Pipeline and Hazardous Materials Safety Administration (PHMSA), the Department of Defense (DOD) military service Inspector General’s offices, including the Department of the Army Inspector General (DAIG), Navy Inspector General, and Air Force Inspector General offices. We also spoke with interest groups, such as the American Biological Safety Association (ABSA), and officials at various Army, private, academic, and federal select agent entities. To assess the extent of overlap and potential duplication in federal agencies’ inspections of entities that work with select agents, we (1) identified 374 entities registered to work with select agents between fiscal years 2009 and 2011, (2) analyzed inspection data to identify registered entities that had been inspected by more than one agency on separate occasions in a 2-year period (at any point between fiscal years 2009 and 2011), and (3) surveyed those entities to assess the extent of duplication in inspection activities. In order to operationalize overlap, we relied on our 2011 duplication report, in which we define overlap as multiple agencies or programs having similar goals, engaging in similar activities or strategies to achieve them, or targeting similar beneficiaries. CDC, APHIS, DHS, DOD, and DOT inspections are directed toward a similar goal—assessing biosafety and biosecurity compliance—and are accomplished through a similar strategy, the inspection process. When these inspections targeted the same entities, we counted the inspection as overlapping. Specifically, we analyzed fiscal year 2009 through July 2011 inspection data from CDC, APHIS, DHS, DOD, and DOT, and identified any instances where two different agencies had inspected the same entity on separate occasions within 2 years of each other. We counted joint inspections as a single inspection in our analysis, regardless of the agencies involved. For example, joint APHIS/DHS inspections or CDC/DAIG inspections were counted as one inspection. We chose the 2- year time frame because the Select Agent Regulations (SAR) require certification renewal every 3 years and it is the policy of CDC and APHIS to inspect the entity before recertifying, this represents a somewhat conservative measure of overlap. Because CDC and APHIS manage the Select Agent Program (SAP) jointly and conduct joint inspections, where applicable, we collapse these agencies in reporting on overlap to show where DOT, DHS, or DOD inspections overlapped with either a CDC or APHIS inspection. We also relied on our 2011 report for our definition of duplication—when two or more agencies or programs are engaged in the same activities or provide the same services to the same beneficiaries. The entities experiencing overlap were identified from the population of 374 entities registered with CDC or APHIS at any point in the 3-year period. Some entities register and de-register each year, so the number of entities registered at any point in the 3-year period will differ from a single point-in-time number of registered entities. Using the number of entities registered at any point in the 3-year period, the extent of overlap as we have defined it is 15 percent. To estimate the likelihood that an entity would experience overlap in federal inspections, we developed a logistic regression model, using the following entity characteristics: the number of laboratories, the highest biosafety level (BSL) of laboratories within an entity, and the number of different select agents the entity works with. The model did not include the number of staff or the number of principal investigators, both of which are strongly correlated with the number of laboratories. We chose to include the number of laboratories in the model because it was a stronger predictor of the likelihood, on the basis of the Wald chi-squared test, than these two characteristics. To assess the extent of duplication in the overlapping inspections, we surveyed the 55 entities that had been inspected by more than one agency in a 2-year period (that is, the population experiencing overlap). The web-based survey of all such entities gathered information on the (1) extent to which there was duplication in specific inspection activities related to the preparation, execution, and close-out phases of the two inspections the entities had undergone, (2) costs and operational effects of inspections, (3) solutions for mitigating the negative effects of multiple inspections, and (4) positive and negative aspects of joint inspections (see app. II for a copy of the survey).The survey was sent to the RO of each entity, and we received an 86 percent response rate, with 47 of the 55 entities responding. To gather preliminary information and develop our survey, we conducted focus groups with about 50 laboratory workers from entities that have experienced federal inspections, including responsible officials, biosafety officers, principal investigators, and technical staff from federal, academic, and private entities that work with select agents. To understand general and agency specific inspection activities, we interviewed inspectors with CDC, APHIS, DHS, DOD service IGs, and DOT and examined inspection files. We also spoke with professional organizations such as the ABSA and the American Society for Microbiology and experts in the safety of select agent laboratories. We took several steps to ensure the reliability of survey responses and the analytical process. To ensure the content and wording of the survey were clear, accurate, unbiased, and nonburdensome, we solicited subject-matter expert reviews from affected agencies (CDC, APHIS, DAIG, and PHMSA), an interest group (ABSA), and an internal (GAO) survey expert. We also pretested the survey with lab staff from a variety of laboratories, including an Army lab, an academic lab, a private lab, and a large federal lab. The survey was deployed through the web, and each respondent had a unique user identification and password. To increase the response rate, follow-up e-mail and telephone calls were made to nonrespondents. Once we had reached an 80 percent response rate, we reviewed responses for (1) item nonresponse, (2) obvious errors or outliers in responses, and (3) “no” answers to question 1. We then followed up with respondents, as necessary, to get additional information and clarification. Changes identified through this process were recorded, and appropriate response cleaning was conducted in the analysis. To eliminate data-processing errors, the computer program that generated the survey results was independently verified by an internal SAS expert who was not involved in the engagement. To assess the costs of overlapping federal inspections and the effects on laboratory operations, we (1) analyzed agency budget data and (2) gathered data from focus groups and our survey of entities on the costs and effects of inspections. Specifically, to assess the costs to the federal government, we requested information on the government and contracted staff involved in inspections and their total compensation (salary and benefits), the number of hours spent on inspection activities, and the associated travel costs for inspections for fiscal years 2010 and 2011. DHS was unable to provide detailed cost data as requested because their inspections of select agent laboratories are provided under a contract that does not identify labor hours, hourly contract rates, salaries, and benefits. But DHS did provide an estimate of the cost of inspections for fiscal years 2010 and 2011. This estimate was based on assumptions about typical staffing levels and costs for the most-common types of inspections, multiplied by the number of inspections conducted in each fiscal year. While DHS believes these estimations include travel costs, they do not include training costs. DOT was not able to provide cost data that include travel, because their system does not distinguish between inspection travel and other travel. As a result, DOT inspection amounts reflect only compensation costs. To assess the reliability of agency data on the costs of inspections, we provided the agencies with a detailed data-collection instrument with specific data requests and precalculated formulas. We reviewed the data for obvious errors, compared these data with cost data from earlier fiscal years, and followed up with officials to discuss data reliability, significant changes across fiscal years, obvious errors, or omissions. We determined these data were sufficiently reliable for our purposes, which was to provide the approximate aggregate federal costs of inspections for the four agencies. To assess the costs to entities, we asked surveyed entities to provide labor and cost information about the most recent inspection identified in our overlap analysis (see app. II, question 6, for specific wording). Specifically, we requested data for five occupational groups that tend to be involved in federal inspections, including (1) ROs and Alternate Responsible Officials, (2) Principal Investigators, (3) owners or controllers, (4) laboratory staff, and (5) support staff (security, administrative, maintenance, and information technology). We asked entities to provide the number of staff involved and the total labor hours spent by each occupational group, as well as the average salary for each group. We used these data to develop overall averages of the personnel and labor costs entities experience as a result of inspections by each one of the five federal agencies in our review. For data reliability purposes, we checked for outliers or obvious errors and followed up where such issues were identified. We calculated the average cost of an inspection by dividing the average (yearly) salary by 2080 to get an hourly rate, and then multiplied that by the number of labor hours provided. We also surveyed entities about nonquanitifable costs and the operational effects of multiple inspections and analyzed comments related to costs from our focus groups of lab staff. To assess actions to reduce the costs and negative effects of overlapping inspections, we interviewed agency officials and interest groups, reviewed key reports addressing the issue, and analyzed comments related to solutions from our focus groups of lab staff. In addition, in our survey, we sought entities’ opinions about solutions for overlapping inspections, including their experiences with joint inspections, which have been proposed as a solution for minimizing inspection duplication. We conducted our work from March 2011 through January 2013 in accordance with generally accepted government auditing standards. Those standards require that we plan and perform the audit to obtain sufficient, appropriate evidence to provide a reasonable basis for our findings and conclusions based on our audit objectives. We believe that the evidence obtained provides a reasonable basis for our findings and conclusions based on our audit objectives. Welcome to the GAO survey on inspections of Select Agent (SA) entities. To complete this survey, you may consult with others in your lab, as necessary. Your responses to this web-based survey are essential in order for us to provide complete and accurate information on these issues to Congress. We will use your responses, together with the responses of other recipients, to develop aggregate statistics, observations, and findings. The identities of individual respondents will not be disclosed in our final report. For questions, contact Jason Fong at fongj@gao.gov or 202-512-xxxx. If you experience technical problems with this web questionnaire, please contact Rebecca Shea at shear@gao.gov or 202-512-xxxx. Important! JavaScript must be enabled on your browser in order to use this web questionnaire. This survey has 7 main sections covering the following key issues: 1. Inspecting Agencies 2. Inspection Activities: a. Preparation b. Execution c. Close-out/response 3. Quantifiable Costs of Inspections 4. Non-quantifiable Costs of Inspections 5 Effects of Multiple Inspections 6. Solutions 7. Joint Inspections Click on "Menu" to the left of this screen to display a navigation panel that can be used to move from section to section. Click on the "Summary" to the left of this screen to print a copy of the survey. AAALAC Association for Assessment and Accreditation of Laboratory Animal Care APHIS Department of Agriculture's Animal and Plant Health Inspection Service BSC Biosafety cabinet BSO Biosafety Officer CDC Department Health and Human Services' Centers for Disease Control and Prevention DAIG Department of the Army's Inspector General DHS Department of Homeland Security DOE Department of Energy DOT Department of Transportation EPA Environmental Protection Agency NIH National Institutes of Health OSHA Occupational Safety and Health Administration PI Principle investigator RO Responsible official (CDC designated) SA Select Agent UN certified packaging designed/tested in accordance with specifications of the United Nations Committee of Experts on the Transport of Dangerous Goods Unless otherwise specified, the questions in this survey apply only to inspections for biosafety and biosecurity as required under Select Agent regulations or by those agencies that own or fund your entities' Select Agent research. Please check the following information for accuracy. If you need to make changes, please do so in the appropriate editable field(s) below. Respondent telephone 1. GAO received inspection data from CDC, APHIS, DHS, DOT, and DAIG, and identified your entity (lab) as one that has been inspected by more than one of these agencies within the past 2 years. Specifically, these data indicate your lab was inspected by the following agencies in the past 2 years: ______ in ______ and ______ in ______. Is this correct? 1a. If the information above is not correct, please note the necessary corrections in the space below. 2. States, local governments, accrediting bodies (such as AAALAC and the Joint Commission), military organizations (such as the Medical Command and Army Material Command), and other federal entities such as NIH, OSHA, EPA, and DOE might also inspect SA registered labs. If your lab was inspected in the past 2 years by any other entities (for SA compliance or other reasons), please provide the name of the inspecting entity and inspection date. 2a. Other inspecting entity and date of inspection: 2b. Other inspecting entity and date of inspection: 2c. Other inspecting entity and date of inspection: 2d. Other inspecting entity and date of inspection: 2e. If you would like to describe any areas of overlap between these "other" inspections and the inspections your lab has received from CDC, APHIS, DAIG, DHS or DOT, please do so in the space below. Inspections can be seen as taking place in 3 broad phases--(1) preparation, (2) execution, and (3) closeout/response-- with specific activities occurring in each phase. 3. Thinking about your lab's inspections by ______ in ______ and ______ in ______, please indicate whether you performed the following preparation activities as part of your routine activities, specifically for each inspection, or not at all. Please note: not all listed activities are required as part of routine activities or for inspections. 3a. Update and/or confirm records related to Select Agents and Toxins are current and accurate (e.g., records for inventory, training, security, biosafety, etc.) Did not perform Not applicable Don't know 3b. Prepare and send requested documents to inspecting agency (hardcopy or electronic) Don't know 3c. Prepare all needed documentation for inspectors to review during visit (hardcopy or electronic) Did not perform Not applicable Don't know 3d. Revise and update written safety and security plans (e.g., biosafety, incident response plans, cyber, personnel and physical security) Don't know 3i. Decontaminate and prepare labs (i.e., go from a hot lab to a cold lab) Did not perform Not applicable Don't know 3j. Check equipment calibration, and operation (e.g., pressure monitors, autoclaves, BSCs, etc.) Did not perform Not applicable Don't know 3p. Check Hazmat training records/documents concerning transportation responsibilities are current and available (e.g., general security and safety awareness, function specific) Don't know 3r. Other (describe below) Don't know 4b. Train inspectors on the use of Personal Protective Equipment (PPE) Did not perform Not applicable Don't know 4c. Train inspectors on other issues (e.g., entry/exit, lab hazards, decontamination requirements, emergency procedures, alarm sounds, etc.) Did not perform Not applicable Don't know 4g. Participate in interviews with inspectors (to answer inspector questions and explain lab procedures and operations) Did not perform Not applicable Don't know 4h. Perform safety or security demonstrations (e.g., emergency response walk-through) Did not perform Not applicable Don't know 4i. Other (describe below) 5. Thinking about your lab's inspections by ______ in ______ and ______ in ______, please indicate whether you performed the following close- out/response activities specifically for each inspection. Please note: not all listed activities are required for all inspections. 5a. Hold close out/exit conference with inspecting agency (where agency tells the entity the results of the inspection in broad terms) Don't know 5g. Bring equipment back online (e.g., HVAC, biosafety cabinets) Did not perform Not applicable Don't know 5h. Other (describe below) 6a. Responsible Official (RO) and Alternate Responsible Official (ARO) following areas as a result of the inspection by ______ in ______? 7a. Loss of productivity 7b. Delays in funded research 7c. Dollars lost in funded research 7d. Decreased time to complete research 7e. Reduced viability of inventory 7f. Reduced competitiveness for research 7g. Other costs 1 (describe below) 7h. Other costs 2 (describe below) 7i. Other costs 3 (describe below) Other costs of inspections #1 Other costs of inspections #2 Other costs of inspections #3 8. If you would like to provide additional information about the costs of inspections, or context for your responses, please do so in the space provided below. 9. Thinking about the overall impact of having more than one federal inspection within the past 2 years, has having multiple federal inspections positively or negatively affected your lab operations in the following areas? 9a. Competitiveness for research funding 9c. Time to complete research 9e. Physical viability of inventory (i.e., resilience of the biological sample) 9i. Strength of inventory management and 9j. Actions to correct deficiencies 9k. Justification for additional resources to 9l. Ability to have specialized inspections in which agencies focus on different areas (e.g., biosafety, security, animal husbandry, SA transport) 9m. "Coverage" in helping to identify problems (i.e., more than one set of "eyes on the problem") 9n. Other effect (describe below) 9o. Other--describe 10. If you would like to provide context for your responses or additional information about the positive or negative effects of multiple federal inspections, please do so in the space provided below. 11. In your opinion, what is a reasonable federal inspection cycle for select agent laboratories? 1. 2. 3. 4. 5. 6. More than once per year Once per year Every other year Every three years As needed Other 11a. Please explain your response. 12. In your opinion, how effective would the following actions be in reducing the negative effects of multiple federal inspections? 12a. Conducting joint inspections 12b. Establishing an inspection czar (i.e., an individual who directs and coordinates SA inspection programs and strategy) 12c. Designating a single agency with 12d. Establishing a single set of inspection standards that all agencies accept (in areas where authorities overlap) 12e. Inspecting to requirements rather than 12f. Training inspectors to one set of standards with requirements for non- compliance findings 12g. Ensuring inspectors are well 12h. Training lab staff about the different agency missions and purposes for inspecting 12i. Providing an opportunity to discuss, clarify, and rebut inspection findings 12j. Other (describe) 12k. Other--describe 13. Please explain why you think the actions above would or would not be effective at reducing the negative effects of multiple federal inspections. 14. If you would like to provide additional information about solutions for reducing the costs of multiple inspections, please do so in the space provided below. 15. Has your lab received a joint inspection (e.g., CDC/APHIS, CDC/DAIG, CDC/DHS, APHIS/DHS inspect concurrently)? 1. 2. 3. Yes No (GO TO QUESTION 16) Don't know (GO TO QUESTION 16) single agency inspections? 15b. What are the negative aspects of joint inspections compared to single agency inspections? 16. If you would like to clarify any of your responses to this survey, or comment on any other related topic, please do so in the space below. 17. If you have completed the questions in this survey, please move the check to the "Completed" button below. (Your answers will not be used until you have checked "Completed." 1. 2. You may view and print your completed survey by clicking on the Summary link in the menu to the left. When you are done, click on the "Exit" button below to exit the survey and send your responses to GAO. Thank you for your help. In addition to the contact named above, Sushil Sharma, Assistant Director; Rebecca Shea; Jason Fong; Elaine Vaurio; Jim Ashley; and Laurel Rabin made key contributions to this report.

Summary: Between 2009 and 2011, there were roughly 374 entities across the United States conducting research with select agents such as anthrax, which have the potential to threaten health and safety. Inspections are one means of ensuring safety and compliance with regulations. However, several federal agencies--CDC, APHIS, DOT, DHS, and DOD--conduct such inspections, creating significant potential for overlap and duplication of effort. In this context, GAO was asked to assess (1) the extent of overlap and potential duplication in federal inspections of select agent entities, (2) the costs of such overlap and effects on laboratory operations, and (3) actions to reduce the costs and negative effects of any overlap. To answer these objectives, GAO analyzed agency data, surveyed entities, held focus groups with lab staff, and interviewed agency officials. About 15 percent of entities registered to work with select agents were subject to inspection overlap (multiple federal agencies inspecting within a 2-year period). Entities experiencing overlap tended to be larger ones, with more laboratories, principal investigators, and staff. Although there was overlap between Department of Transportation (DOT) inspections and those of the Centers for Disease Control and Prevention (CDC) and the Animal and Plant Health Inspection Service (APHIS), they were generally not duplicative because specific inspection activities tended to differ, according to GAO's survey of entities experiencing overlap. For example, DOT inspections tended to focus on transportation issues, such as checking hazardous materials and transportation security plans, rather than general biosafety issues. The Department of Homeland Security (DHS) and Department of Defense (DOD) inspections, however, tended to be more duplicative with those of CDC and APHIS. For example, both review the same documents, require safety and security demonstrations, conduct inventory inspections and personnel interviews, and provide corrective action plans. While inspections are important for safety and compliance, there is no value added when federal agencies are expending resources to conduct the same work and, in some cases, reinspecting before entities have had time to respond to findings from a previous inspection. The costs of overlapping federal inspections and effects on lab operations are difficult to quantify because agencies and entities generally do not track them and some costs are not quantifiable. Although GAO could not quantify the portion of federal and entity costs directly attributable to overlap, it could quantify the costs of inspections in general. According to agency data, the approximate overall federal cost for fiscal years 2010 and 2011 inspections was $2.1 million dollars. On average, the entity costs per inspection were nearly $15,000, and staff time per inspection was 380 hours, according to the GAO survey. While surveyed entities reported that inspections can help correct deficiencies and improve accountability, most reported moderate to significant nonquantifiable costs of inspections due to loss of productivity and delays in research. In addition, according to surveyed entities, overlapping inspections negatively affected lab productivity, staff morale, available time to complete research, and the research schedule. Because many of these entities are federal laboratories or are funded through federal grants, these costs are passed on to the federal government. Actions to reduce the costs of overlapping and duplicative inspections include better coordination among federal agencies and greater consistency in the application of standards, according to various experts and surveyed entities. CDC has taken actions to better coordinate inspections with other agencies, for example, by increasing the use of joint inspections. But such actions, including joint inspections, do not fully address the negative effects of multiple inspections if agencies apply inconsistent standards and develop separate reports of findings. Well-trained inspectors, who apply consistent standards, are also needed. Collectively, these actions would reduce the negative effects of overlap and duplication and could increase agencies' acceptance of each other's inspection results. GAO recommends that CDC and APHIS work with DHS and DOD to coordinate inspections and ensure consistent application of inspection standards. HHS, USDA, DHS, and DOD generally agreed with our recommendations and noted various actions they have already taken, or plan to take, to coordinate inspection efforts.