This section provides information on water infrastructure in Indian country, federal programs that provide drinking water and wastewater infrastructure assistance to Indian tribes, and our prior work on interagency collaboration. The 573 federally recognized Indian tribes in the United States vary greatly in terms of their culture, language, population size, land base, location, and economic status. Many are located in remote and often environmentally challenging areas. According to the U.S. Census Bureau’s American Community Survey, in 2016, about 26 percent of American Indians and Alaska Natives were living below the poverty line, compared with 14 percent for the nation as a whole. According to EPA databases, tribes operate about 950 public drinking water systems and about 340 public wastewater systems. Drinking water systems often include groundwater wells, water treatment plants, and pipelines to deliver water to homes. A regulated, centralized wastewater system may include sewer lines, tanks, and wastewater treatment plants or lagoons, but small, rural communities are more likely to have decentralized wastewater systems, such as individual septic systems. Once centralized water or wastewater systems are constructed in Indian country, ownership is typically transferred to the tribe. A tribally owned utility, tribal government, or a separate entity operates and maintains the system on behalf of the tribe. Some tribal utilities charge user fees to help offset operations and maintenance costs, but other tribal utilities do not charge these fees because of users’ low income levels or for cultural reasons, according to IHS and tribal officials. According to EPA, thousands of Indian homes are not currently served by a regulated, centralized drinking water or wastewater system, due in part to the logistical and other challenges associated with Indian water systems that must serve widely dispersed populations in remote locations. Instead, as we reported in September 2017, homes that are not served by water systems may have private wells and septic systems, or they may be entirely unserved. According to EPA and IHS documents, some tribal members may haul drinking water from a regulated drinking water source. However, containers used to haul and store the water can introduce bacteria and other contaminants. Also, because the regulated water source in some communities may be many miles away, residents may haul drinking water from nearby unregulated water sources, such as streams or livestock wells. For homes without access to a wastewater disposal system, residents may use a privy, use honeybuckets, or discharge waste directly to the ground. According to researchers with the Centers for Disease Control and Prevention, restricted access to clean water for hand washing and hygiene, along with manually disposing of waste, exposes people— especially infants and the elderly—to higher rates of illness and hospitalization. We reported in January 2017 that such health concerns underscore the importance of quality health care—including preventative care, such as providing safe sanitation facilities—for American Indian and Alaska Native people. Further, according to IHS, American Indian and Alaska Native families living in homes with satisfactory environmental conditions, which include safe water and sewer systems, require appreciably fewer medical services and place fewer demands on primary health care delivery systems. Seven federal agencies administer a number of programs that provide assistance to tribes for drinking water and wastewater infrastructure projects. Each agency has its own programs and processes for providing this assistance, with some similarities. Tribes can apply to one or more federal programs for financial assistance. In some cases, federal agencies coordinate to jointly fund the same project if the project is too large for one agency to fund. In other cases, agencies may work together by separately funding different parts of a large project or different phases of a multi-year project. Of these agencies, IHS, EPA, and USDA administer drinking water and wastewater infrastructure programs that are specific to Indian tribes. IHS’s mission is to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level. To fulfill this mission, IHS provides primary health care and disease prevention services. IHS’s Office of Environmental Health and Engineering’s Sanitation Facilities Construction program, established in 1959, contributes to IHS’s disease prevention efforts. This program provides technical and financial assistance to Indian tribes for the cooperative development and construction of drinking water and wastewater systems and support facilities. According to the Indian Health Care Amendments of 1988, it is the policy of the United States that all Indian communities and Indian homes, new and existing, be provided with safe and adequate water supply systems and sanitary wastewater disposal systems as soon as possible. IHS’s 12 regional offices, called Areas, are responsible for working with tribes when administering the Sanitation Facilities Construction program. The Indian Health Care Amendments of 1988 require that IHS report annually to Congress on the sanitation deficiency levels for Indian tribes and communities, including, among other things, the amount of funds necessary to raise all Indian tribes and communities to zero sanitation deficiency. The act identifies five deficiency levels, and IHS uses a deficiency level of 0 to represent the absence of a deficiency in its data systems (see table 1). To develop its annual report to Congress and identify sanitation deficiencies in Indian communities and homes, IHS maintains two data systems: (1) the Sanitation Deficiency System (SDS), which contains proposed drinking water and wastewater infrastructure projects to address identified sanitation deficiencies; and (2) the Home Inventory Tracking System (HITS), which contains home-specific information that complements the SDS’s project-specific information. According to IHS program documentation, the project descriptions in the SDS are to include information about the sanitation deficiency level that each project will address, the project’s estimated cost, and the number of Indian homes that the project will serve. According to IHS documents, HITS is to include information about each Indian home that may have a sanitation deficiency that is eligible to receive Sanitation Facilities Construction program assistance, including the home’s geographic location and deficiency level. Eligible homes can be located on or off reservations, but according to IHS officials, the agency typically does not collect information about Indian homes located in large urban areas. According to IHS program documentation, IHS uses information in HITS to track the status of and plan for the provision of sanitation facilities for Indian homes. To address tribes’ identified sanitation facility needs, IHS is authorized to construct essential sanitation facilities, including domestic and community water supplies and facilities, as well as wastewater disposal facilities for Indian homes, communities, and lands. Under the Sanitation Facilities Construction program, IHS administers two primary drinking water and wastewater infrastructure activities: one to address sanitation deficiencies in existing homes and communities based on needs identified in the SDS, and one to provide water infrastructure for newly constructed or recently renovated Indian homes—these needs are not included in the SDS. According to IHS policy, the agency selects projects to fund that address deficiencies in existing homes based on ranked project lists contained in the SDS, by area. According to IHS policy, the agency can manage sanitation projects on behalf of a tribe (direct service), or a tribe or tribal entity can elect to manage projects. According to this policy, to implement a project under direct service, a tribe formally requests IHS assistance, and IHS engineers typically develop projects to include in the SDS. When IHS selects the project to fund, the tribe decides whether it will complete the project design and manage the construction contract or have IHS engineers do so. EPA provides annual grants to states to help finance drinking water and wastewater infrastructure through its Drinking Water and Clean Water State Revolving Fund programs, respectively. EPA sets aside a certain percentage of the appropriations it receives for these programs to make grants directly to Indian tribes for drinking water and wastewater infrastructure. Nine EPA regions administer the Drinking Water Infrastructure Grants Tribal Set-Aside and the Clean Water Indian Set- Aside programs, while states administer the State Revolving Funds. Under the drinking water set-aside program, EPA funds projects for community water systems that serve tribal populations, as well as for non- profit, non-community water systems owned by a tribal government that serve a tribal population. Under the clean water set-aside program, EPA provides funding for the planning, design, and construction of wastewater treatment plant facilities that serve federally recognized Indian tribes, Alaska Native villages, and certain tribes in Oklahoma. According to EPA officials, tribes are among those eligible to receive loans from the states’ State Revolving Fund programs. In addition, EPA administers the separate Alaska Native Villages and Rural Community Water Grant program that awards grants to the State of Alaska to, among other things, improve sanitation in rural and Alaska Native villages. USDA’s Rural Utilities Service allocates a portion of its appropriation for rural water and wastewater disposal programs to make drinking water and wastewater infrastructure grants to Indian tribes; this is referred to as the Native American program. USDA administers the Native American program at the national level and works with tribes at the state office and local level to conduct outreach and assist with the application process, among other things. The Native American program provides grants for water and wastewater facilities and services to rural and low-income tribal communities “whose residents face significant health risks … due to the fact that a significant proportion of the community’s residents do not have access to, or are not served by, adequate affordable water supply systems or waste disposal facilities.” In addition, USDA administers the Rural Alaska Village Grant program, which provides grants to the State of Alaska for development and construction of water and wastewater systems that address dire sanitation conditions in rural or Alaska Native villages with 10,000 or fewer people. Tribes are also eligible to receive loans and grants for infrastructure investments from the agency’s Water and Waste Disposal Program, which is administered by USDA’s state offices. Tribes that are located close to the U.S.-Mexico border and that meet the definition of a colonia are eligible for assistance from USDA’s Colonias program, a water infrastructure grant program to serve state- designated, low-income, unincorporated areas along the border. Finally, USDA administers a grant program to provide technical assistance and training, and the agency makes pre-planning grants available to tribes, organizations that serve tribes, and other recipients through multiple programs to assist with the development of application components, such as preliminary engineering or environmental reports. Four additional agencies may provide drinking water or wastewater assistance to Indian tribes through other programs not specific to drinking water or wastewater or as authorized by statute: HUD. HUD administers the Indian Community Development Block Grant program, a set-aside from the agency’s Community Development Block Grant program that is specific to Indian tribes. Indian Community Development Block grants can be used for construction of public facilities, provision of public services, housing, and certain economic development projects, among other things. HUD also awards Indian Housing Block Grants to tribes for affordable housing activities, which may include the development and rehabilitation of utilities, necessary infrastructure, and utility services. Reclamation. As authorized by statute, Reclamation provides assistance for drinking water infrastructure in the 17 western states, including rural water supply projects for tribes. Some of the statutes that direct Reclamation to construct rural water supply projects for tribes are enacted Indian water rights settlements. In addition, until September 2016, Reclamation’s rural water supply program was authorized to conduct appraisal investigations and feasibility studies for proposed rural water supply projects, including those that serve Indian tribes, but the program was not authorized to construct rural water supply projects. Corps. As authorized by statute, the Corps may provide designated communities, counties, and states with design and construction assistance for drinking water and wastewater infrastructure. For example, Congress has authorized and made appropriations for the Corps to provide assistance to Indian tribes for water-related environmental infrastructure projects—including wastewater treatment facilities and water supply, storage, treatment, and distribution facilities—through the Corps’ Section 219 Environmental Infrastructure Program. EDA. EDA’s Public Works Program provides grants to economically distressed areas to, among other things, help rehabilitate, expand, and improve their public works facilities, including drinking water and wastewater facilities. The Economic Adjustment Assistance Program provides grants for, among other things, development of public facilities, including drinking water and wastewater facilities. EDA’s Planning Program provides grants to various entities, including tribes, to pay the costs of economic development planning, which can include planning for water infrastructure. As part of our body of work on interagency collaboration, our September 2012 report discussed a variety of mechanisms to implement interagency collaborative efforts and identified key features that all efforts benefit from. Mechanisms to implement interagency collaborative efforts include establishing interagency task forces or signing memorandums of understanding. Key features, many of which are related to practices to enhance and sustain collaboration identified in our previous work, fall into the following categories: outcomes and accountability, bridging organizational cultures, leadership, clarity of roles and responsibilities, participants, resources, and written guidance and agreements. IHS and EPA estimated costs for tribal water infrastructure needs, with IHS identifying at least $3.2 billion in estimated costs for infrastructure projects to address existing drinking water and wastewater infrastructure needs for fiscal year 2016 and EPA estimating the costs of future tribal drinking water infrastructure needs at an additional $2.4 billion over the following 20 years. However, IHS’s estimate of existing needs is likely too low because IHS has not identified all eligible Indian homes that may have existing sanitation deficiencies—drinking water or wastewater infrastructure needs—and some data in the system that IHS uses to track home-specific infrastructure needs are not accurate. In fiscal year 2016, IHS identified about $3.2 billion in estimated costs for projects to address existing tribal drinking water and wastewater infrastructure needs. This estimate represented more than 2,000 projects in the SDS to address 373 tribes’ existing drinking water and wastewater infrastructure needs. To develop these projects, IHS policy directs area staff to invite all federally recognized tribes to identify existing drinking water and wastewater infrastructure needs each year. IHS staff then work with interested tribes to develop projects, including cost estimates, to include in the SDS. In fiscal year 2016, projects to address deficiency levels 4 and 5—homes or communities that lack a safe drinking water supply or wastewater disposal system, or both—accounted for $1.6 billion, or about half, of the total estimated costs of tribal infrastructure needs in the SDS. More than 80 percent of the deficiency level 4 and 5 project costs were located in the IHS Alaska and Navajo areas. In addition, in fiscal year 2016, IHS determined that more than 60 percent of the total existing drinking water and wastewater infrastructure needs in the SDS were infeasible, mostly due to the significant costs associated with infeasible deficiency level 5 projects. EPA collects and reports data on the drinking water infrastructure needs of the nation’s public water systems, including the future needs of tribally owned or operated drinking water systems. Specifically, EPA is required to assess capital improvement needs of all eligible public water systems every 4 years, and EPA has conducted its Drinking Water Infrastructure Needs Survey and Assessment to obtain this information every 4 years from 1995 through 2015. EPA last reported in 2013 on the estimated costs of capital improvement projects needed to repair, replace, and upgrade existing tribal and other public drinking water systems over the following 20 years. In its 2013 report, EPA estimated the costs of future tribal drinking water needs of public systems at approximately $2.4 billion. EPA does not, and is not required to collect information about future tribal wastewater infrastructure needs. Other agencies that provide tribes with assistance for drinking water or wastewater infrastructure projects do not—and are not required to— systematically identify tribal drinking water or wastewater infrastructure needs. For example, USDA officials explained that tribes identify needs through the applications they submit to the agency’s programs. These officials stated that they also identify tribal needs through outreach to tribes and coordination with other agencies, such as IHS. In addition, HUD officials said that they do not collect information specifically about tribal water infrastructure needs because they rely on the tribes to propose or identify projects to meet any needs based on the tribes’ priorities. IHS area staff work with tribes each year to (1) identify Indian homes eligible for and in need of IHS drinking water or wastewater infrastructure assistance to include in IHS’s home-specific tracking system, HITS; and (2) develop projects aimed at correcting any identified sanitation deficiencies in these homes to include in the SDS. Through this process, IHS has entered information about hundreds of thousands of eligible Indian homes in HITS and developed thousands of projects in the SDS. According to agency documents, HITS is to include information about each Indian home that is eligible to be served by the Sanitation Facilities Construction program and that may have an existing sanitation deficiency. However, based on our review of IHS documentation and interviews with IHS officials, HITS does not contain all eligible Indian homes that may have existing sanitation deficiencies, and some data in the system are not accurate. According to IHS officials, as of February 2018, HITS contained information for about 406,000 Indian homes. However, according to IHS area officials, the system does not contain information about all Indian homes eligible to be served by the Sanitation Facilities Construction program. For example, Oklahoma City Area officials we interviewed estimated that, based on Census data and their professional experience, more than 100,000 Indian homes in their area may be eligible for IHS program assistance but are not included in the system, and an unknown number of those homes likely have existing drinking water and wastewater infrastructure needs. These officials, as well as tribal officials administering the Sanitation Facilities Construction program for their tribes in Oklahoma, said that the system does not contain all eligible Indian homes, in part because it is difficult to identify where tribal members are living since most of the communities in the state are a mixture of tribal and non-tribal residents and are not located on reservations. In addition, Portland Area officials stated that they believe the system is missing an unknown number of eligible Indian homes in their area because it is challenging to identify eligible homes that are in scattered locations away from tribal community facilities. In contrast, Navajo Area officials said they believe the system is more than 95 percent complete for their area, in part because the area aligns with the Navajo Nation’s lands. IHS headquarters officials stated that they do not expect HITS to capture all eligible Indian homes, in large part because some tribes have chosen to not provide such information to IHS for cultural or other reasons. These officials said they are focused on working collaboratively with tribes to identify homes that have existing deficiencies rather than all homes eligible for services but added that IHS areas are expected to identify such homes during the normal course of their work. IHS area officials and tribal officials we interviewed stated that identifying eligible Indian homes not located on reservations is resource intensive, and they do not have sufficient resources to locate these homes. IHS Oklahoma City Area officials said it would be helpful to find efficient ways to identify additional eligible homes that may have sanitation deficiencies. For example, these officials said they have started using EPA data to target communities with water systems that do not meet EPA’s water quality standards and identify eligible homes within those communities, but they have made limited progress with their existing resources. Standards for Internal Control in the Federal Government calls for management to use quality information to achieve the entity’s objectives; such information is appropriate, current, complete, accurate, accessible, and provided on a timely basis. We recognize that it would be resource intensive for IHS to locate every eligible Indian home to include in HITS, but because the system may not contain roughly 20 percent of eligible Indian homes, opportunities exist for IHS to identify in a targeted, efficient way additional homes with existing deficiencies to include in HITS. By implementing a targeted, resource-efficient method to identify additional eligible Indian homes that may have existing sanitation deficiencies to include in HITS, IHS could have better assurance that it has more complete information to help improve its estimate of the number of eligible Indian homes that may need sanitation facilities assistance. Deficiency levels for thousands of homes may not be accurately captured in HITS. IHS headquarters officials stated that, as of February 2018, of the roughly 406,000 total tribal homes in HITS, about 229,400 homes had a deficiency level of 0. Therefore, the remaining approximately 176,600 tribal homes had deficiency levels 1 through 5. HITS automatically assigns a deficiency level 0 to each home when IHS enters it into the system, and homes remain at a deficiency level 0 until IHS develops projects in the SDS to serve those homes. HITS does not provide IHS with the option of recording a home’s deficiency level as unassessed, so a deficiency level 0 could indicate that there is no deficiency or that the home has not yet been assessed to determine a deficiency. IHS area officials we interviewed stated that they were aware of homes with sanitation deficiencies that were not accurately reflected in HITS. For example, Phoenix Area staff said they knew of homes with a deficiency level 4 or 5 that had a deficiency level 0 in HITS because these homes were not yet included within the scope of an SDS project. Also, California Area officials estimated that they had not assessed deficiency levels for about 20,000 eligible homes in their area, and Oklahoma City Area officials said they had not assessed more than 100,000 homes in their area—these homes’ deficiency levels all appeared as deficiency level 0 in HITS, but their actual deficiencies were unknown. According to IHS officials, there are multiple ways to assess homes’ deficiency levels. For homes that are not connected to a public water system, such as homes with private wells, IHS staff may need to visit homes to identify any existing deficiencies, with permission of the tribe. For homes connected to a public water system, staff can assign the homes the deficiency level associated with the water system but may need to visit the community to assess the system’s overall deficiency level. IHS officials from the California and Oklahoma City areas said they did not have the staff resources to begin the process of identifying whether the deficiency level 0 homes in their areas had deficiencies and developing projects for the SDS to serve them. IHS headquarters officials stated that they have identified homes that the Sanitation Facilities Construction program has served since implementing HITS in 2015. For example, IHS officials stated that of the about 229,400 homes with a deficiency level 0 in HITS, they had determined that about 90,700 correctly show that deficiency level because they have been included in a project in the SDS since 2015. IHS had not included the remaining approximately 138,700 homes with a deficiency level 0 in a project in the SDS. Therefore, using HITS, IHS could not determine if these homes had (1) no deficiency, (2) a deficiency that IHS addressed prior to 2015, or (3) an unknown deficiency because the homes had not been assessed. IHS officials stated that in the future they will be able to use HITS to better track the agency’s service and project history at the individual home level. However, IHS officials did not explain what steps they would take to identify deficiencies for the approximately 138,700 homes in HITS that had not been included in an SDS project. Standards for Internal Control in the Federal Government calls for management to use quality information to achieve the entity’s objectives; such information is appropriate, current, complete, accurate, accessible, and provided on a timely basis. IHS officials said that improving the system’s accuracy would be beneficial. By implementing a mechanism to indicate in HITS whether each home with a deficiency level of 0 has been assessed, IHS could also have more efficient ways to take steps to address the deficiencies of the homes contained in HITS. In fiscal year 2016, federal agencies obligated approximately $370 million for tribal drinking water or wastewater infrastructure projects. The agencies with tribal-specific programs for drinking water and wastewater infrastructure—IHS, EPA, and USDA—funded some projects to address what they identified as the most severe sanitation deficiencies— communities and homes that do not have safe drinking water or wastewater disposal facilities. However, the agencies’ processes may not always prioritize projects that address the most severe sanitation deficiencies. In addition, during the course of our review, we identified issues with how USDA awarded grants under its Rural Alaska Village Grant program. In fiscal year 2016, federal agencies provided about $370 million to develop, construct, or repair tribal drinking water and wastewater infrastructure projects to address tribes’ needs. This amount represents about 11 percent of the more than $3 billion in total existing tribal drinking water and wastewater infrastructure needs that IHS identified in 2016. Appendix III contains additional detail about agency obligations for tribal drinking water and wastewater infrastructure projects for fiscal years 2012 through 2016. Federal agency obligations were used to address a variety of tribal drinking water and wastewater infrastructure needs. For example, IHS, EPA, USDA, and the State of Alaska provided approximately $15.9 million for multiple, phased projects to bring first-time, in-home piped drinking water and wastewater service to approximately 90 homes in the Native Village of Eek in Alaska (see fig. 1). The residents of Eek obtain their drinking water by hauling water from the village washeteria, a building that contains toilets, washing machines, and a spigot for purchasing water for use in the home. Most homes in the community do not have piped water or sewer service to kitchens or bathrooms, and residents use washbasins for handwashing and food preparation and honeybuckets for wastewater disposal. As of April 2017, construction was ongoing, and officials estimated that the entire community of about 300 people would be served by the fall of 2018. See appendix IV for other examples of tribal drinking water and wastewater infrastructure projects that we visited. In addition to providing financial assistance for projects to design or construct water infrastructure, federal programs provided grants for technical assistance and training for tribal utilities and staff. For example, in fiscal year 2016, USDA awarded a $130,000 grant from its Technical Assistance and Training program to one organization that works with tribes. USDA also awarded a contract to the National Rural Water Association for it to employ a network of technical consultants who can provide on-site technical assistance to eligible systems, including tribally operated systems experiencing day-to-day operational issues, among other challenges. Federal programs mostly did not provide financial assistance for routine operations and maintenance of installed community or individual infrastructure. Tribal officials we interviewed, however, said that paying for operations and maintenance is often the tribe’s biggest challenge once a system is constructed or upgraded. For example, officials from one tribe said that the tribe did not have sufficient resources to operate and maintain a newly constructed water treatment system. Tribal officials we interviewed stated that their members are often unable to afford the utility fees needed to support the water system. For private systems, officials from two tribes said some of their members have trouble maintaining new drinking water filtration and septic systems because, for example, the systems are technically complex and costly to maintain. Officials from another tribe said homeowners who have difficulty operating and maintaining a system may return to using an unsafe drinking water source they previously used, for example. According to IHS officials, the agency has been collaborating with EPA, USDA, and tribes to improve collection of information about the cause of some systems’ premature failure and to analyze best practices for operations and maintenance of tribal water systems. Agencies with tribal-specific programs for water infrastructure—IHS, EPA, and USDA—selected and funded projects that address the most severe sanitation deficiencies. Three of these agencies’ programs—IHS’s Sanitation Facilities Construction, EPA’s clean water set-aside, and USDA’s Native American program—documented in regulation or policy their goal of funding projects to address these needs. Specifically, according to IHS’s Sanitation Facilities Construction program policy, the program’s goal includes providing funding first and in greater degree to homes and communities with the greatest needs, that is, those that lack safe drinking water or wastewater disposal, or both. EPA’s clean water set-aside program policy states the program’s goal is to protect public health in Indian country by addressing the lack of access to sanitation facilities (i.e., deficiency levels 4 and 5 for IHS and EPA). Finally, under the applicable requirements and policy, USDA’s Native American program’s objective is to provide water and waste disposal facilities and services to low-income rural communities whose residents face significant health risks. The program’s goal includes funding the neediest projects, giving priority to areas that lack running water, flushing toilets, and modern sewage disposal systems. According to agency policy, IHS’s Sanitation Facilities Construction program and EPA’s clean water set-aside program prioritize and select projects to fund according to the projects’ rankings in each IHS area’s SDS list. To create the ranked lists, IHS staff assign scores to each project based on a set of eight scoring factors, each with a different number of points that may be assigned to a project (see table 2). USDA prioritizes and selects projects to fund from its Native American program using a different process than IHS and EPA. USDA’s process involves tribes, working with USDA state offices, submitting project grant applications to the headquarters office. USDA state offices score project applications before submitting them to the headquarters office. USDA policy directs the program to make funds available according to priority, and the agency accepts and evaluates applications and awards grants throughout the year. USDA officials said the program maintains a wait list for eligible applications received after all available funds have been obligated each year. According to USDA’s scoring sheet for the Native American program, the agency evaluates project applications based on a set of five scoring factors, each with a different number of points to award. These scoring factor categories include population, income, joint financing, and discretionary points that can be awarded at state offices and headquarters (see table 3). USDA officials said that they also take SDS deficiency levels into account when reviewing project applications, but that the statute authorizing the Native American program does not specifically reference IHS’s deficiency level definitions. Using their respective processes to prioritize and select projects for funding, IHS’s Sanitation Facilities Construction program, EPA’s clean water set-aside program, and USDA’s Native American program obligated a total of nearly $110 million in fiscal year 2016 for projects to meet a mixture of needs. For example, for approximately 190 projects from the SDS that IHS, EPA, and others funded in fiscal year 2016, about 40 percent were projects to address deficiency levels 2 and 3, and about 60 percent were projects to address deficiency levels 4 and 5. Further, in fiscal year 2016, USDA reported that its Native American program funded four projects that provided new drinking water and wastewater service to some tribal communities and funded nine projects that replaced, renovated, or expanded existing infrastructure. Based on our review of IHS and USDA documents, deficiency level 2 and 3 projects as well as replacement and renovation projects can address important water quality and other problems, but they generally do not address the most severe deficiencies or the most significant health risks. Based on our review of IHS and EPA documents and interviews with these agencies’ officials, we found that their process for prioritizing and selecting projects to fund from the SDS can discourage funding some deficiency level 4 and 5 projects, especially those with a relatively high cost per home. According to some IHS area officials we interviewed, applying IHS’s scoring factors and the points associated with each factor means that deficiency level 3 projects may score higher than—and therefore receive funding before—deficiency level 4 or 5 projects. For example, a project’s cost per home is a significant contributor to its score because IHS assigns as low as minus 20 points for projects that have a relatively high cost to implement per home. IHS officials said that, typically, deficiency level 3 projects replace existing community infrastructure and serve more homes, which makes those projects’ relative cost per home lower than deficiency level 4 and 5 projects. IHS headquarters officials explained that they developed the SDS scoring system in consultation with tribes so the system could balance the need to fund deficiency level 4 and 5 projects with the need to fund projects with lower deficiencies that address health needs and serve a larger number of homes. However, because deficiency level 4 and 5 projects may rank lower than some projects that address less severe deficiencies and rank too low to be funded in a given year, hundreds of feasible projects to address the most severe sanitation deficiencies have remained on SDS lists for 5 years or more, based on our review of these lists. As of the end of fiscal year 2016, many of these projects had not been selected for funding from IHS or EPA. IHS headquarters officials said that the agency is working to improve the extent to which it funds feasible projects to address the highest sanitation deficiencies. For example, these officials said that they are updating the 2003 Sanitation Facilities Construction program guidelines to incorporate subsequently issued guidance, and this update should also more directly align the guidelines with the program’s original focus—to prioritize service to Indian homes and communities that lack access to piped water and sewer systems. However, a senior IHS official said that changing the SDS scoring factors is not part of this effort because the current scoring factors balance a number of interests in addition to projects’ deficiency levels. The official said that higher deficiency level projects ranking lower than other projects on the SDS list in a given year does not mean that public health needs are going unaddressed. Yet, our analysis shows that projects to address the highest deficiency levels have remained in the SDS for many years. We recognize that IHS faces trade-offs when selecting tribal infrastructure projects to fund. By reassessing the point distribution across the SDS scoring factors as part of IHS’s program guidelines update, in light of trade-offs between funding projects that address the most severe sanitation deficiencies and projects that meet other needs, IHS may have better assurance that its projects address the most severe sanitation deficiencies in Indian communities. Regarding USDA’s Native American program, based on our review of agency documents and interviews with USDA officials, we found that the agency’s process for prioritizing and selecting projects may not provide USDA with reasonable assurance that it is selecting projects to fund that address the most severe sanitation deficiencies. Specifically, USDA’s scoring factors for its Native American program do not include a scoring factor category to evaluate the extent to which projects will address health risks that stem from tribes’ lack of drinking water and wastewater infrastructure. In contrast, USDA prioritizes projects to fund under its Colonias grant program using an additional scoring factor that awards points based on the extent to which a proposed project will address health risks stemming from lack of safe drinking water and wastewater disposal in a colonia. For example, USDA awards 50 points for projects in colonias where a lack of access to safe drinking water and wastewater disposal results in a significant health risk. We recommended in December 2009 that USDA take steps to better target its limited funds for the Colonias program, and USDA responded in part by creating the additional scoring factor for colonias to ensure that the neediest colonias receive funding. To prioritize Native American program applications that address significant health risks, USDA officials said they use discretionary points. However, according to program policy, USDA state office and headquarters officials may award discretionary points to meet other purposes that are not related to addressing health risks, such as encouraging projects with green infrastructure or promoting geographic diversity among grantees, or they may not award these points at all. As a result, USDA may not have reasonable assurance that it is consistently evaluating or funding project applications in a way that aligns with the Native American program’s goal. USDA policy states that both the Native American and Colonias programs are to prioritize areas that lack running water, flushing toilets, and modern sewage disposal systems. By implementing a scoring factor similar to the one in the Colonias program—that is, one that awards points for proposed projects that address health risks from a lack of access to safe drinking water and wastewater disposal—for the Native American program, USDA would have more assurance that it is evaluating project applications consistently and funding projects to address the most severe sanitation deficiencies in Indian communities, consistent with the program’s goal. During the course of reviewing funding for tribal drinking water and wastewater infrastructure projects, we encountered several issues with one of USDA’s tribal drinking water and wastewater infrastructure programs, the Rural Alaska Village Grant program. Specifically, section 306D of the Consolidated Farm and Rural Development Act authorizes USDA to make grants to the State of Alaska for the benefit of rural or Native villages to provide for the development and construction of drinking water and wastewater systems. According to USDA reports, these grants are used for projects that have provided, for example, rural Alaska Native residents with access to safe drinking water and flush toilets in their homes. From the program’s beginning in fiscal year 1997 through fiscal year 2016, USDA awarded 455 grants totaling more than $444 million to provide safe drinking water and wastewater disposal to thousands of Alaska Natives in remote communities. We found that from fiscal year 1997 through fiscal year 2016, USDA awarded 159 Rural Alaska Village grants totaling about $157 million to recipients not authorized by section 306D. These recipients were Alaska Native villages, municipalities, and the Alaska Native Tribal Health Consortium, which is the tribal organization that administers IHS’s Sanitation Facilities Construction program in Alaska. USDA’s appropriations acts for fiscal years 2012 through 2017, however, authorized USDA to provide Rural Alaska Village grants to the Consortium. Of the 159 grants, USDA awarded 127 grants (about $121 million) to municipalities and Alaska Native villages from 1997 through 2016, and it awarded 32 grants (about $36 million) to the Consortium in 2011 before first receiving authority to do so in fiscal year 2012. Based on our review of a list of USDA grant agreements, selected agreements, and according to agency officials, in 2011, USDA signed 32 such agreements with the Consortium and the communities on whose behalf the Consortium administered the grants. USDA officials stated that the agency made seven total obligations to the Consortium in 2011 for these grants. USDA officials stated that they did not agree that the agency had awarded Rural Alaska Village grants to ineligible entities because the program’s authorizing statute gives the State of Alaska control over the use of the grants, and the state concurred with USDA making some grants directly to other parties. For example, the USDA officials stated that a 2011 memorandum of agreement between USDA, the State of Alaska, IHS, and the Consortium was a vehicle for the state to direct a portion of the Rural Alaska Village grants to other parties. These officials stated that since the statute does not prevent the state from redirecting portions of the grant to other parties, it is not improper for USDA to enter into an agreement with the state to award the grants directly to other parties so that the state does not have to redirect them. In commenting on a draft of this report, USDA noted that the agency has awarded two grants to municipalities since signing the 2011 agreement. In addition, USDA officials said that they entered into the memorandum of agreement and began awarding grants to the Consortium in 2011 to address problems with the program’s administration, which resulted in projects that were delayed or halted. For example, USDA stated in a 2010 report that the State of Alaska had not adequately documented project costs and that USDA staff were concerned that the state had not applied the obligations it received from USDA to the intended communities. According to USDA officials, they have seen a significant improvement in the state’s grant administration and more timely delivery of projects since the 2011 agreement. In addition, the Rural Alaska Village Grant program manager said the agency awards grants directly to Native villages that have the capacity to administer them. In commenting on a draft of this report, USDA stated that the agency has made all grants to the Consortium pursuant to the 2011 memorandum of agreement. The State of Alaska can choose to make subgrants once it receives the Rural Alaska Village grant, but section 306D of the Consolidated Farm and Rural Development Act only authorizes USDA to award grants to the State of Alaska. Moreover, the 2011 memorandum of agreement cannot authorize USDA to award grants to recipients that are not authorized by statute. By ensuring that all Rural Alaska Village grants are awarded only to recipients identified as eligible in section 306D or USDA appropriations acts, USDA will have assurance that it is complying with the law. If USDA wants to award Rural Alaska Village grants to municipalities and Alaska Native villages, it should seek authority to do so, as it did to award such grants to the Consortium. In addition, the regulations governing the Rural Alaska Village Grant program identify rural or native villages in Alaska as eligible grant recipients. USDA officials explained that the agency amended the Rural Alaska Village Grant program regulations in 2015 to codify the 2011 memorandum of agreement. However, this regulation identifying rural and Alaska Native villages as eligible grant recipients expands USDA’s authority to award grants beyond the existing statutory authorities, which do not list rural or Alaska Native villages as eligible recipients. Until USDA amends the Rural Alaska Village Grant program regulations to be consistent with USDA’s authority, the agency’s regulations will continue to recognize recipients not authorized by statute. Most of the seven federal agencies that administer programs to provide drinking water and wastewater infrastructure assistance to Indian tribes have taken actions to collaborate at the national level, and the agencies have identified additional opportunities to collaborate. At the regional level, seven federal agencies we surveyed reported collaborating on a range of activities within six selected states—with some agencies frequently working together and others rarely collaborating—and the agencies identified opportunities to increase collaboration at the regional level to better serve tribes. Most of the seven federal agencies we reviewed have taken actions to collaborate at the national level and identified additional opportunities to collaborate that they have not yet taken. In our previous work, we found that achieving important national outcomes—such as providing access to safe drinking water and wastewater disposal—often requires coordinated and collaborative efforts of a number of programs spread across the federal government. For example, IHS, EPA, USDA, HUD, and Reclamation have formed a national tribal infrastructure task force to facilitate the agencies’ collaborative efforts when providing services, support, and technical assistance to tribes. The tribal infrastructure task force’s efforts reflect some of the key features that we have found all collaborative mechanisms benefit from in our previous work: Written guidance and agreements. We have previously reported that agencies that articulate their agreements in documents can strengthen their commitment to working collaboratively. The members of the tribal infrastructure task force first documented their agreement in a memorandum of understanding in 2007, the year the task force was created. The agencies updated the memorandum most recently in 2013, and they use the document to formally agree on the group’s common goal and purposes and to clarify and define roles and responsibilities. Having participating agencies document their agreements on how they will be collaborating, and continually updating and monitoring these agreements, are practices that are consistent with our prior work. Outcomes and accountability. In our previous work, we have reported on the importance of groups having clear goals. In its 2013 memorandum of understanding, the tribal infrastructure task force identified a common goal of improving access to safe drinking water and basic sanitation for American Indians and Alaska Natives. In the memorandum, the member agencies also agreed on the task force’s stated purposes, one of which is to enhance the efficient leveraging of funds. Leadership. We have found that identifying one agency as the leader of a collaborative group is often beneficial because it centralizes accountability and can speed decision making. EPA has served as the federal focal point for the task force; this has included hosting the task force’s website that serves as a common source for documents the group has produced. According to an official involved with the task force, EPA’s role has provided continuity in leadership. The task force’s efforts have yielded some specific results. For example, in 2013, tribal infrastructure task force members agreed to adopt a uniform preliminary engineering report template, a key supporting document that multiple agencies require in their project application and evaluation processes. Task force members created this template in part in response to our October 2012 recommendation that EPA and USDA develop such a document. According to agency officials we interviewed, the report template has been helpful for tribes since they no longer have to produce different versions of the same document when submitting multiple applications to different agencies. USDA officials said they have since worked with other agencies to develop an online version of the preliminary engineering report that is accessible to task force members and others to further improve collaboration. However, according to agency officials involved with the task force, there may be additional opportunities to improve the efficiency of their collaboration at the national level. For example, in 2011, a workgroup of the task force identified a series of 10 options to increase the efficiency of collaboration by streamlining their application processes. As of November 2017, according to agency officials, the task force had not acted on most of the options. One such option was for agencies to better align their different funding and application cycles where possible. Several tribal officials and representatives from a tribal organization we interviewed cited challenges with complying with the agencies’ different application requirements. For example, they said that doing so can be resource intensive and can make it difficult to obtain funds for one project. Other tribal officials we interviewed also identified ways that agencies could improve their collaboration that would benefit tribal applicants and that the task force did not identify in its 2011 report. For example, various tribal officials suggested that agencies standardize federal program application processes and coordinate their outreach to tribes to discuss agency programs and their requirements. According to an agency official involved with the task force, when the group considered which options from the 2011 report to implement, member agencies focused their efforts on implementing those that were most achievable given the agencies’ limited resources. Other officials also said that it would be worthwhile to reconsider some of the options identified in the report. As stated in the task force’s 2013 memorandum of understanding, one of its purposes is to enhance the member agencies’ efficient leveraging of funds. By reviewing the 2011 task force report and identifying and implementing additional actions to help increase their collaboration, the task force member agencies could improve their ability to leverage limited program funds. The regional offices of the seven federal agencies we surveyed collaborated with each other to varying extents in the six selected states (Alaska, Arizona, California, New York, Oklahoma, and South Dakota). In the 2013 memorandum of understanding, the tribal infrastructure task force member agencies—IHS, EPA, USDA, HUD, and Reclamation— agreed that they are expected to collaborate at the regional level to achieve a common goal of providing safe drinking water and basic sanitation for tribes. However, based on our review of agency survey responses, these agencies did not always collaborate in each of the six states. We measured agency collaboration in terms of the number of instances in which one agency regional office reported using a collaborative mechanism with another agency. These collaborative mechanisms include state- or project-level working groups, memorandums of understanding, and shared databases, among others. In responses to our survey, we found that the number of instances of agency regional offices reporting that they used one or more collaborative mechanism with other agencies varied across the six states. For example, the agencies’ regional offices collaborated the most in Alaska and the least in New York and Oklahoma. Figure 2 shows the percentage of instances where an agency reported using a collaborative mechanism with another agency when jointly working on tribal drinking water and wastewater activities in the six states, out of the total possible instances. Appendix II contains additional details about our survey and agency responses. In responses to our survey, certain agencies’ regional offices reported collaborating with each other in some states but not in other states. For example, EPA and USDA regional offices both reported working together in Alaska, Arizona, and California, but not in New York, Oklahoma, or South Dakota. IHS and HUD reported collaborating with each other in three states but not in the other states. Not all agencies work with tribes in every state. For example, Reclamation does not operate in Alaska or New York, so we did not survey the agency in those states. The Corps’ regional offices responded that they are not authorized to work on drinking water or wastewater infrastructure with tribes in two of the six states. In contrast, IHS and EPA regional offices reported collaborating with each other in all six states, the most of any agency pair. In their responses to our survey and in interviews, the seven federal agencies’ regional offices most frequently identified three key factors that limited how much they collaborated in the six states. Specifically: Incompatibility of agency policies and missions. Agencies’ regional offices reported that having incompatible policies or agency missions was a factor that had hindered their collaboration with other agencies. For example, IHS and HUD regional offices in four states reported that a restriction on IHS’s ability to serve new homes constructed with grants from HUD’s housing programs limited their collaboration. Several agencies’ regional offices reported that having compatible policies helped their collaboration. For example, IHS and USDA regional offices in Alaska responded that multiple agencies’ use of IHS’s SDS list as a common source for identifying potential projects to fund has helped collaboration. We previously found that adopting compatible policies and procedures is one way for agencies to establish means of operating across agency boundaries. Insufficient resources. An additional factor that hindered agencies’ collaboration was insufficient staff and financial resources. For example, HUD and IHS regional officials we interviewed in Arizona said that a state-level tribal infrastructure working group they were involved in became inactive in 2016, after the lead agency determined it was unable to continue dedicating staff resources to that role and none of the other agencies picked up the lead. In contrast, several IHS and EPA regional offices reported that the existence of standard interagency agreements that facilitate transferring EPA funds to IHS helped them collaborate and leverage funding for projects that each agency would not have funded on its own. Identifying and leveraging the resources needed to initiate or sustain a collaborative effort is a key consideration for implementing the interagency collaborative mechanisms we previously identified. Absence of personal relationships. Agencies’ regional offices also reported that the absence of relationships with staff from other agencies hindered their collaboration. In contrast, agencies’ regional offices reported that having good working relationships with staff from other agencies helped their collaboration. For example, USDA’s regional office and the State of Alaska reported that their strong relationships with each other and other agencies in Alaska helped their collaboration, and that these relationships were enhanced by agency staff’s frequent communication through regular meetings. We previously found that having positive working relationships can bridge organizational cultures and build trust. In their responses to the survey and in interviews, several agencies’ regional offices identified examples of inefficiencies that have occurred when they did not collaborate, including inefficient use of their limited resources. For example, officials from one EPA region we interviewed said that there have been years when EPA staff spent time developing a project only to learn that USDA had already funded the same project. The officials stated that this inefficiency could have been avoided if they had been communicating with their USDA counterparts about the projects that each agency was considering to fund. Also, in two states, EPA’s regional office reported that EPA and USDA may be missing opportunities to leverage funding for individual projects by not sharing information about projects. In all six states, nearly all of the federal agency regional offices responded that it would be beneficial to increase their collaboration. Specifically, more than 90 percent of the federal agency respondents identified at least one collaborative mechanism that would be beneficial for them to begin using with another agency. The specific mechanisms that the agencies identified appeared to relate to the amount of collaboration in which they had already engaged. For example, agency regional offices that reported not having collaborated with another agency most frequently said that it would be beneficial to begin having informal communications with their counterparts in other agencies and to start sharing project-specific documents such as preliminary engineering reports. Alternatively, agency regional offices that reported having collaborated with another agency most frequently responded that it would be beneficial to begin using a memorandum of understanding as an additional mechanism for collaborating where they had not already done so. In the tribal infrastructure task force’s 2013 memorandum of understanding, the member agencies—IHS, EPA, USDA, HUD, and Reclamation—agreed that they are expected to collaborate at the regional level to provide safe drinking water and basic sanitation for tribes and to more efficiently leverage program funds. By directing their regional offices to identify and pursue additional mechanisms to increase their collaboration, the task force member agencies would have better assurance that their regional offices are efficiently leveraging limited program funds and following through on the commitment to collaborate. Identifying and addressing drinking water and wastewater infrastructure needs in Indian country is a difficult undertaking. IHS dedicates a significant effort each year to working with tribes to identify their existing drinking water and wastewater infrastructure needs. However, one of IHS’s systems—HITS—may be missing tens of thousands of eligible Indian homes, an unknown number of which may have existing sanitation deficiencies. Additionally, some homes’ deficiency levels in HITS are inaccurate. By implementing a targeted, resource-efficient method to identify additional eligible Indian homes that may have existing sanitation deficiencies to include in HITS, IHS could have better assurance that it has more complete information to help improve its estimate of the number of eligible Indian homes that may need sanitation facilities assistance. Also, IHS officials said that improving the system’s accuracy would be beneficial. By implementing a mechanism to indicate in HITS whether each home with a deficiency level of 0 has been assessed, IHS could also have more efficient ways to take steps to address the deficiencies of the homes contained in HITS. IHS and USDA funded some projects to address the most severe sanitation deficiencies, but residents of many Indian homes remain without safe drinking water or wastewater disposal as the agencies also prioritized and funded projects that addressed other needs. We recognize that IHS faces trade-offs when selecting tribal infrastructure projects to fund. By reassessing the point distribution across the SDS scoring factors as part of IHS’s program guidelines update, in light of trade-offs between funding projects that address the most severe sanitation deficiencies and projects that meet other needs, IHS may have better assurance that its projects address the most severe sanitation deficiencies in Indian communities. Also, by USDA implementing a scoring factor similar to the one in its Colonias program—that is, one that awards points for proposed projects that address health risks from a lack of access to safe drinking water and wastewater disposal—for the Native American program, USDA would have more assurance that it is evaluating project applications consistently and funding projects to address the most severe sanitation deficiencies in Indian communities, consistent with the program’s goal. USDA has provided thousands of Alaska Natives with safe drinking water and wastewater infrastructure through its Rural Alaska Village Grant program. However, USDA awarded some grants to recipients not authorized by statute. By ensuring that all Rural Alaska Village grants are awarded only to recipients authorized by statute, USDA will have assurance that it is complying with the law. If USDA wants to award Rural Alaska Village grants to municipalities and Alaska Native villages, it should seek authority to do so as it did to award these grants to the Alaska Native Tribal Health Consortium. Also, until USDA amends the Rural Alaska Village Grant program regulations to be consistent with USDA’s authority, the agency’s regulations will continue to recognize recipients not authorized by statute. The five agencies that participate in the national tribal infrastructure task force have committed to working together at the national and regional levels to increase tribes’ access to safe drinking water and basic sanitation. In our previous work, we have found that achieving important national outcomes, such as providing access to safe drinking water and wastewater disposal, often requires collaborative efforts by a number of programs across the federal government. At the national level, the task force has not acted on most of the options it previously identified to improve member agencies’ collaboration. By reviewing the 2011 task force report and identifying and implementing additional actions to help increase their collaboration, the task force member agencies could improve their ability to leverage limited program funds. At the regional level, we found that the task force member agencies had not fulfilled their commitment to collaborate in all of the six states we reviewed. Responses to our survey also indicated that there is unrealized potential for the task force member agencies’ regional offices to increase the extent of their collaboration. By directing their regional offices to identify and pursue additional mechanisms to increase their collaboration, the task force member agencies would have better assurance that their regional offices are leveraging limited program funds and following through on their commitment to collaborate. We are making 16 recommendations—two to IHS to improve information in HITS; one each to IHS and USDA to review their project selection processes; two to USDA to address issues with its Rural Alaska Village Grant program; and two each to IHS, USDA, EPA, HUD, and Reclamation to increase collaboration at the national and regional levels. The Director of IHS should implement a targeted, resource-efficient method to identify additional eligible Indian homes that may have existing deficiencies to include in HITS. (Recommendation 1) The Director of IHS should implement a mechanism to indicate in HITS whether each home with a deficiency level of 0 has been assessed. (Recommendation 2) The Director of IHS should reassess the point distribution across the SDS scoring factors as part of its program guidelines update, in light of trade-offs between funding projects that address the most severe sanitation deficiencies and projects that meet other needs. (Recommendation 3) The Assistant to the Secretary of Agriculture for Rural Development should implement a scoring factor that awards points for proposed Native American program grant projects that address health risks from a lack of access to safe drinking water and wastewater disposal, as it does with the Colonias grant program. (Recommendation 4) The Assistant to the Secretary of Agriculture for Rural Development should ensure that all Rural Alaska Village grants are awarded only to recipients authorized by law or seek authority to award grants to municipalities and Alaska Native villages. (Recommendation 5) The Assistant to the Secretary of Agriculture for Rural Development should amend the Rural Alaska Village Grant program regulations so that they are consistent with USDA’s authority. (Recommendation 6) The Director of IHS, in cooperation with other members of the tribal infrastructure task force, should review the 2011 task force report and identify and implement additional actions to help increase the task force’s collaboration at the national level. (Recommendation 7) The Administrator of EPA, in cooperation with other members of the tribal infrastructure task force, should review the 2011 task force report and identify and implement additional actions to help increase the task force’s collaboration at the national level. (Recommendation 8) The Assistant to the Secretary of Agriculture for Rural Development, in cooperation with other members of the tribal infrastructure task force, should review the 2011 task force report and identify and implement additional actions to help increase the task force’s collaboration at the national level. (Recommendation 9) The Deputy Assistant Secretary of the Department of Housing and Urban Development’s Office of Native American Programs, in cooperation with other members of the tribal infrastructure task force, should review the 2011 task force report and identify and implement additional actions to help increase the task force’s collaboration at the national level. (Recommendation 10) The Commissioner of Reclamation, in cooperation with other members of the tribal infrastructure task force, should review the 2011 task force report and identify and implement additional actions to help increase the task force’s collaboration at the national level. (Recommendation 11) The Director of IHS, in cooperation with other members of the tribal infrastructure task force, should direct IHS area offices to identify and pursue additional mechanisms to increase their collaboration. (Recommendation 12) The Assistant to the Secretary of Agriculture for Rural Development, in cooperation with other members of the tribal infrastructure task force, should direct USDA state offices to identify and pursue additional mechanisms to increase their collaboration. (Recommendation 13) The Administrator of EPA, in cooperation with other members of the tribal infrastructure task force, should direct EPA regional offices to identify and pursue additional mechanisms to increase their collaboration. (Recommendation 14) The Deputy Assistant Secretary of the Department of Housing and Urban Development’s Office of Native American Programs, in cooperation with other members of the tribal infrastructure task force, should direct HUD regional offices to identify and pursue additional mechanisms to increase their collaboration. (Recommendation 15) The Commissioner of Reclamation, in cooperation with other members of the tribal infrastructure task force, should direct Reclamation regional offices to identify and pursue additional mechanisms to increase their collaboration. (Recommendation 16) We provided a draft of this report for review and comment to the Department of Health and Human Services (for IHS), HUD, the Department of the Interior (for Reclamation), EPA, USDA, the Department of Defense (for the Corps), and the Department of Commerce (for EDA). Of the five agencies to which we directed recommendations, three— Health and Human Services, HUD, and Interior—agreed with the recommendations directed to them. The fourth agency, EPA, agreed with one of the recommendations and agreed with the intent of the second recommendation but proposed revised language, as discussed below. The Acting Director of Grants Evaluation for HUD’s Office of Native American Programs provided comments by e-mail, and Health and Human Services, Interior, and EPA provided written comments that are reproduced in appendixes V, VI, and VII, respectively. The fifth agency to which we directed recommendations, USDA, disagreed with the two recommendations regarding the Rural Alaska Village Grant program and neither agreed nor disagreed with the other three recommendations directed to it, although the agency proposed alternative language for two of these recommendations in its written comments, reproduced in appendix VIII. Of the two agencies to which we did not direct recommendations, Defense provided a letter, reproduced in appendix IX, in which it indicated the agency had no comments on the report, and Commerce’s Audit Liaison stated in an e-mail that Commerce would not send a formal comment letter. In addition, Health and Human Services, USDA, and EDA (for Commerce) provided technical comments, which we incorporated in the report as appropriate. In its written comments, EPA requested that we revise the language of the recommendation that the members of the tribal infrastructure task force direct their regional, state, or area offices to identify and pursue additional mechanisms to increase their collaboration. EPA stated that it agreed with the intent of the recommendation but that it was concerned that, as worded, the recommendation may not achieve the intended goal. Instead, EPA stated that it can accomplish increased regional collaboration through multiple avenues and as such, provided revised language that would remove reference to its regional offices taking the recommended action. We encourage EPA to take advantage of increasing regional collaboration through all avenues it sees fit. However, because EPA’s regional offices are the entities that collaborate with other agencies in the various regions, we continue to believe it is important for these offices to participate in identifying and implementing the means for increasing collaboration in their respective regions. As a result, we did not modify the recommendation language in response to EPA’s comment. In its written comments, USDA stated it disagreed with our statements concerning the Rural Alaska Village Grant program and asked that we remove the two corresponding recommendations from our report. Specifically, USDA stated that our recommendations are unnecessary because the agency is operating within its authorities. USDA stated that it believes providing grants directly to parties other than the state— including Alaska Native villages and municipalities—under the 2011 memorandum of agreement is consistent with the purpose of section 306D of the Consolidated Farm and Rural Development Act and appropriations made for the program. As we state in the report, we agree that the State of Alaska can choose to make subgrants once it receives the Rural Alaska Village grant. We also state in the report that we did not see any evidence of grants being used for other than their intended purposes during the course of our review. However, the language of section 306D only authorizes USDA to award grants to the State of Alaska and not directly to other entities. Therefore, we believe that our recommendations are necessary. If USDA wants to make Rural Alaska Village grants to municipalities and Alaska Native villages, it should seek authority to do so as it did to award such grants to the Alaska Native Tribal Health Consortium. Regarding our fourth recommendation that USDA implement a scoring factor that awards points for proposed Native American program projects that address health risks, USDA stated that it would like clarification as to what form of scoring factor would be acceptable to address this recommendation. USDA stated that it would prefer to use its discretionary points under the program’s existing regulations to award additional points to give a higher priority to projects that address a lack of access to safe drinking water and wastewater disposal, and that the agency could implement this change at the start of fiscal year 2019 or sooner. In contrast, USDA stated that changing the program’s regulations to implement the scoring factor could take 18 months or longer. USDA also stated that this approach would only have a programmatic effect in fiscal years when demand for Native American program grant funds exceeds the available funding. Our intent for the recommendation as written is to provide USDA with the flexibility to best determine how to implement it. If USDA has determined that using its discretionary points under the program’s existing regulations gives greater priority to addressing health risks faced by Native American communities, and that such an approach is consistent with applicable law, such an approach could meet the intent of our recommendation. USDA also requested in its written comments that we modify the language of the ninth recommendation aimed at increasing collaboration at the national level by removing reference to increasing national collaboration and that we modify the thirteenth recommendation aimed at increasing regional collaboration by removing reference to the agency’s state offices and regional level collaboration. USDA did not provide a clear rationale for its requested change for either recommendation. We continue to believe that implementing these recommendations, as worded, would help improve collaboration at the national and regional levels. Therefore, we did not modify the language in response to USDA’s comments. In several places in its written comments, USDA stated that our draft either omitted information or contained inaccurate information and requested that we make modifications. Specifically, USDA stated that we omitted statutory language for the Native American program in a few places in the report. In response, we added additional language from and about the Native American program’s authorizing statute in several places. USDA also stated the report is missing information about the scope of some of its programs, including its Technical Assistance and Training program. In response, we added more information about this program, including obligations made to non-profit organizations that work on behalf of tribes. Further, USDA stated that we did not accurately characterize certain activities that USDA conducts under some of its programs, including identifying tribal needs and conducting operations and maintenance. In response, we modified language to reflect additional information about how USDA identifies tribal needs and to indicate that the Native American program is not authorized to fund operations and maintenance. Regarding the Rural Alaska Village Grant program, USDA stated that we did not accurately represent information shared by a USDA official and information about the number of grants made to the Consortium. We revised language attributed to the official and clarified information about the number of grants awarded based on additional information that USDA provided by e-mail after submitting its written comments. In other cases where USDA requested revisions to the draft in its written comments, we did not make suggested changes because they did not align with the scope of our review. Specifically, in addition to its Technical Assistance and Training program, USDA asked that we add information about tribal obligations under its Solid Waste Management program. Since federal agency efforts to fund solid waste management projects are outside the scope of this review, we did not make this revision. In addition, USDA requested that we limit our discussion of Rural Alaska Village Grant awards to fiscal year 2011 and forward. We did not make this change because USDA’s grants to municipalities and Native villages prior to 2011 are directly relevant to our findings and are within the scope of this review. Finally, USDA asked that we edit our description of the findings of a 2010 report to Congress by citing a different report instead. We did not make this change because the original report contained relevant information for our findings. 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 appropriate congressional committees, the Secretary of Agriculture, the Secretary of Commerce, the Secretary of Defense, the Secretary of Health and Human Services, the Secretary of Housing and Urban Development, the Secretary of the Interior, the Administrator of the Environmental Protection Agency, 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 Anne-Marie Fennell at (202) 512-3841 or fennella@gao.gov or J. Alfredo Gómez at (202) 512-3841 or gomezj@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 X. The objectives of our review were to examine the extent to which the seven federal agencies, as applicable, (1) identified Indian tribes’ drinking water and wastewater infrastructure needs; (2) funded tribal drinking water and wastewater infrastructure projects, including projects to address the most severe sanitation deficiencies; and (3) collaborated to meet Indian tribes’ drinking water and wastewater infrastructure needs. To address these objectives, we reviewed our previous reports, other agency reports, and agency obligations to identify the federal agencies that provide financial or other assistance to Indian tribes for drinking water and wastewater infrastructure. We identified seven agencies, as shown in table 4. We identified the Indian Health Service (IHS), Environmental Protection Agency (EPA), and U.S. Department of Agriculture (USDA) as federal agencies that have drinking water and wastewater infrastructure programs specifically targeted to provide financial assistance for planning and construction to address Indian tribes’ needs. According to IHS documentation, such needs arise from a sanitation deficiency in existing drinking water or wastewater infrastructure (or lack thereof) that can negatively affect public health. In addition, the Department of Housing and Urban Development (HUD), the Department of the Interior’s Bureau of Reclamation, the Department of Commerce’s Economic Development Administration (EDA), and the U.S. Army Corps of Engineers administer programs that may assist tribes with drinking water and wastewater infrastructure planning and construction. The types of assistance these agencies provide vary by program, and each program has its own eligibility requirements and authorities. To determine the extent to which these federal agencies identified Indian tribes’ drinking water and wastewater infrastructure needs, we identified requirements for IHS and EPA to collect and report information on needs, but we did not identify such requirements for the other agencies. We reviewed IHS’s project-level tribal drinking water and wastewater infrastructure needs data from the Sanitation Deficiency System (SDS) for fiscal year 2016, the most recent year of data available at the time of our review. The SDS contains information about proposed drinking water and wastewater infrastructure projects, including each project’s estimated cost. IHS policy directs area staff to invite all federally recognized tribes to identify potential projects each year. Area staff then work with interested tribes to develop projects and enter project information into standard fields in the SDS. As of the end of fiscal year 2016, the SDS included more than 2,000 projects for 373 tribes. We also reviewed IHS’s most recent reports describing tribal drinking water and wastewater needs. In addition, we reviewed information about tribal public drinking water systems reported in EPA’s 2013 Drinking Water Infrastructure Needs Survey and Assessment report. EPA assesses and reports on the nation’s public water systems’ capital improvement needs every 4 years, including needs of tribally owned or operated drinking water systems. For its 2013 report, EPA assessed tribal water system needs by administering a survey to a statistical sample of 306 tribal water systems out of 956 identified tribal public drinking water systems. We assessed the reliability of SDS project-level needs data and information from EPA’s 2013 Drinking Water Infrastructure Needs Survey and Assessment report by reviewing our previous related work regarding the use of these data and documentation from IHS and EPA. We also interviewed IHS and EPA officials involved with identifying tribal water needs from headquarters and all 12 IHS areas and 9 EPA regions that administered the drinking water and clean water set-aside programs, discussing the data and any of its limitations. We tested the data for accuracy and completeness by identifying any duplicate, missing, or invalid records and cross-referencing with relevant datasets. We determined that IHS’s SDS project-level needs data and information from EPA’s 2013 report were sufficiently reliable to provide descriptive information on tribes’ needs for drinking water and wastewater infrastructure projects for this report. Further, we reviewed documentation on the Home Inventory Tracking System (HITS)—IHS’s database containing home-specific information that the agency also uses in administering the Sanitation Facilities Construction program. The information in HITS includes each home’s geographic location and individual sanitation deficiency, and IHS officials said in February 2018 that the system contained a total of 405,986 homes. We also interviewed IHS headquarters and area officials about this system’s contents, uses, and limitations, and we compared this information to the agency’s implementation plan and other documentation for HITS. We identified issues with the information contained in the system related to its completeness (whether it contains the correct number of homes in light of its purpose) and related to the accuracy of homes identified as having no deficiency, as we discuss in the report. These issues were sufficient for us to determine that the number of homes in the system was incomplete and that deficiency level information was not accurate for all homes in the system. As a result, we did not assess the reliability of other information in HITS that was not relevant to our review. We also interviewed officials from the other five agencies regarding any efforts to collect information on tribal drinking water and wastewater infrastructure needs. To determine the extent to which the agencies funded tribal drinking water and wastewater infrastructure projects, we analyzed data from the seven agencies administering programs that provide assistance to tribes for drinking water and wastewater infrastructure—IHS, EPA, USDA, HUD, Reclamation, EDA, and Corps. Specifically, we obtained and analyzed obligations data for drinking water and wastewater projects under programs that are specifically for or available to tribes. Generally, we reviewed each agency’s obligations data for fiscal years 2012 through 2016, the most recent 5 years of data available at the time of our review. Corps provided us with information on obligations for projects that involved tribal drinking water or wastewater infrastructure, but none of these obligations were in fiscal years 2012 through 2016. We assessed the reliability of the other agencies’ data by reviewing our previous related work regarding the use of these data and any available documentation from each agency; interviewing knowledgeable agency officials involved with collecting or analyzing these data; and testing data for accuracy and completeness by identifying any duplicate, missing, or invalid records. We present more details about each agency’s data, any limitations, and how we addressed those limitations below. On the basis of these efforts, we determined that the data obtained from these agencies were sufficiently reliable for our descriptive purposes unless otherwise noted below. IHS. IHS provided us with project-level obligations data from fiscal years 2012 through 2016 for tribal drinking water and wastewater infrastructure projects from its Project Data System. In reviewing these data, we found data reliability issues that posed challenges to accurately reporting IHS’s project obligations separate from other agencies’ contributions to projects, which IHS also tracks in the system. We determined that the project-level obligations data from the Project Data System were not sufficiently reliable for the purposes of this objective. However, we determined that using IHS’s information on allocations to areas for the same time frame would introduce fewer limitations to our reporting. IHS provided us with information from fiscal years 2012 through 2016 on allocations to each of its 12 areas by Sanitation Facilities Program activity (i.e., sanitation deficiencies, new housing, and emergency and special projects). IHS officials stated that the IHS Director of the Division of Sanitation Facilities Construction determines the area allocations amounts annually, and that IHS obligated all of its area allocations each fiscal year. IHS did not separate the area allocations information by drinking water, wastewater, or solid waste projects; therefore, we report total obligations with solid waste projects included. EPA. EPA provided us with project-level obligations data from fiscal years 2012 through 2016 from each of its three tribal-specific programs listed in table 4. EPA uses its Tribal Direct Implementation Nexus system to track project obligations for the Clean Water Indian Set-Aside and Drinking Water Infrastructure Grants Tribal Set-Aside programs, but the agency relies on the State of Alaska to provide similar project-level information for its Alaska Native Villages and Rural Community Water Grant program. In reviewing EPA’s data, we found several duplicate project records. We confirmed the issue with EPA officials and deleted those duplicate records to accurately aggregate EPA’s obligations by fiscal year for our report. USDA. USDA provided us with grant and loan obligations data from fiscal years 2012 through 2016 for all of its programs specifically for or available to tribes from its Community Program Application Processing system. First, we removed solid waste and landfill projects that were indicated as such in the project name. To determine the project obligations for programs specifically for tribes, we included all obligations from USDA’s Native American and Rural Alaska Village Grant programs. USDA also awarded grants and loans to tribes or non-profit organizations working on behalf of tribes from non-tribal specific programs such as from its Water and Waste Disposal program as well as the Section 306C Colonias, Emergency Community Water Assistance Grant, Predevelopment Planning Grants, Special Evaluation Assistance for Rural Communities and Households, and Technical Assistance and Training programs. To determine the project obligations for those programs, we included projects that had an applicant or customer type as a tribe or tribal entity (e.g., an organization working on behalf of a tribe or tribes such as tribal health consortia or tribal utility authorities) and projects that served a population of at least 50 percent tribal users. For these awards, we included the full amount of the award regardless of the percent of tribal users served. HUD. HUD provided us with project-level obligations data from fiscal years 2012 through 2016 for its Indian Community Development Block Grant program from its Performance Tracking Database. We worked with HUD officials to identify projects that included drinking water and wastewater infrastructure and to identify the amount of the obligations used for those purposes to determine HUD’s overall fiscal year project obligations for tribal water infrastructure. Reclamation. Reclamation provided us with project-level obligations data from fiscal years 2012 through 2016 for the tribal portions of authorized water system projects, including projects authorized by enacted Indian water rights settlements. For the Indian water rights settlement project obligations, Reclamation provided both mandatory and discretionary amounts. We included both rural water system projects and Indian water rights settlements projects in reporting Reclamation’s overall fiscal year obligations. EDA. EDA provided us with project-level obligations data from fiscal years 2012 through 2016 for tribal projects funded by its Public Works, Economic Adjustment Assistance, and Planning programs from its Operations Planning and Control System. To determine whether the EDA projects included drinking water or wastewater infrastructure, we reviewed each project’s description or scope of work for mention of a drinking water or wastewater infrastructure component. If we determined that the project included water infrastructure, we included the entire project’s obligation amount for each fiscal year we report. In addition, to determine the extent to which agencies’ funding addressed the most severe sanitation deficiencies, we identified programs that have documented goals in regulation and policy to fund projects that meet these needs, which the programs identify as the absence of safe drinking water or wastewater disposal facilities. These selected programs included IHS’s Sanitation Facilities Construction program, EPA’s clean water set- aside program, and USDA’s Native American program. For these programs, we compared the number of funded projects to address the most severe sanitation deficiencies with the number of funded projects that met other needs for fiscal year 2016. Specifically, for IHS and EPA, we calculated the percentage of projects for each deficiency level that the agencies and other entities selected to fund from the fiscal year 2016 SDS list. For USDA, we reviewed the list of Native American program project obligations in fiscal year 2016 and determined the number of projects where USDA reported the purpose as new, replacement, renovation, or expansion. We also reviewed documentation of the agencies’ project identification and selection methods to determine whether these methods aligned with stated goals. We interviewed IHS and EPA officials from headquarters and all area and regional offices that administer these programs, and USDA officials from headquarters and six state-level offices (see below for state selection information), regarding their administration of these programs. Additionally, we analyzed IHS’s data from the SDS from fiscal years 2005 through 2016 to identify projects that remained unfunded and that were in the SDS for more than 5 years. We did not review the extent to which EPA’s drinking water set- aside program addressed the most severe sanitation deficiencies because EPA regions implement the program using a variety of different processes. During the course of evaluating the extent to which federal agencies have provided funding for tribal drinking water and wastewater infrastructure projects, we identified issues with USDA’s Rural Alaska Village Grant program. We reviewed obligations data in light of the program’s authorizing statute, implementing regulations, and relevant provisions in USDA appropriations acts. USDA provided us with the Rural Alaska Village Grant program’s award amounts for fiscal years 1997 through 2016, and we determined whether the grant recipients were eligible or ineligible at the time of the award. We interviewed agency officials who manage the program and from USDA’s Office of the General Counsel. To determine the extent to which the federal agencies collaborated to meet tribal water needs, we reviewed documentation of national-level collaboration, including federal program and interagency documents, such as national-level memorandums of understanding and interagency agreements. We interviewed headquarters officials from the seven agencies about their interagency collaboration. We compared the agencies’ actions to the key features of interagency collaboration that we have previously identified. We reviewed agencies’ collaboration at the regional level by surveying the seven agencies about their joint actions on activities related to tribal drinking water and wastewater in six states— Alaska, Arizona, California, New York, Oklahoma, and South Dakota— and by conducting a network analysis using the survey responses. We selected agency regional offices within these six states as the unit of analysis because the federal agencies organize their field structures differently, with some using region, district, area, or state offices to work with tribes—we refer to all of these office types as regional offices. We selected the nonprobability sample of six states to include a large percentage of the number of federally recognized tribes, to obtain a range in the total federal obligations to tribes and identified needs of tribes in the SDS, and for geographic diversity. The sample of states is not generalizable, and the results of our work do not apply to all states where Indian tribes are located. However, reviewing federal agency collaboration in these states provides illustrative examples of interagency collaboration within the six selected states, which include about 70 percent of the 573 federally recognized tribes. We compared the agencies’ reported collaboration with a national-level memorandum of understanding that contained commitments for collaborating at the regional level. For a detailed description of our survey methodology and the analysis of our results, see appendix II. We also interviewed federal agency and State of Alaska officials to discuss the extent to which their drinking water and wastewater assistance programs collaborate with other agencies to meet tribal needs in the six selected states. We interviewed, either in person or by telephone, officials from the eight IHS areas, five EPA regions, and six USDA state offices that work with tribes and other agencies in the six states. We conducted site visits from February through April 2017 to three of the six states—Alaska, Arizona, and Oklahoma. During these visits, we met with tribal officials and staff and federal agency officials, and we visited tribal water infrastructure project sites. We selected these states for site visits based on geographic diversity and to obtain a range in the amount of tribal water infrastructure needs identified in the SDS. We met with or interviewed by telephone officials from 22 Indian tribes and representatives from 8 intertribal organizations that represent and work with tribes on water infrastructure issues to obtain their views about the water and wastewater infrastructure assistance that they receive from federal agencies. We judgmentally selected these tribes and organizations to obtain a range in their geographic locations and the amount and variety of federal drinking water and wastewater infrastructure assistance they have received. Our findings are not generalizable to all tribes but provide illustrative examples of input provided by tribal officials. We conducted this performance audit from August 2016 to May 2018 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. This appendix describes how we selected the sample and administered the survey, designed the survey questionnaire, and conducted the network analysis for our survey on interagency collaboration regarding tribal drinking water and wastewater infrastructure projects. To determine the extent to which the selected federal agencies have collaborated to meet tribal water needs, we surveyed officials at seven federal agencies: Indian Health Service (IHS), Environmental Protection Agency (EPA), U.S. Department of Agriculture (USDA), Department of Housing and Urban Development (HUD), Economic Development Administration (EDA), Bureau of Reclamation, and the U.S. Army Corps of Engineers. Specifically, we surveyed agency officials in six states: Alaska, Arizona, California, New York, Oklahoma, and South Dakota. Appendix I describes how we selected these agencies and states. The results of this survey are not generalizable beyond these agencies in these states. We reviewed maps of each agency’s regional or state offices and identified and confirmed the offices that work with tribes and other agencies in the six selected states. If one state included multiple regions from the same agency, we administered the survey to officials in all relevant regional offices. In addition, if one agency’s region covered more than one of the selected states, we administered a survey to the agency’s regional office for each state. The federal agencies and regional offices we included in our survey were: Corps divisions: Great Lakes & Ohio River, Northwestern, Pacific Ocean, South Pacific, Southwestern; EDA regions: Austin, Denver, Philadelphia, Seattle; EPA regions: 2, 6, 8, 9, 10 (Alaska Operations Office); HUD regions: Alaska, Eastern Woodlands, Northern Plains, Southern IHS areas: Alaska, California, Great Plains, Nashville, Navajo, Oklahoma City, Phoenix, Tucson; Reclamation regions: Great Plains, Lower Colorado, Mid-Pacific; and USDA state offices: Alaska, Arizona, California, New York, Oklahoma, South Dakota. In Alaska, we also included the Alaska Department of Environmental Conservation as a respondent because the state provides a 25 percent match for two federal water infrastructure programs. We did not include other state agencies because they do not provide a similar match. We also included the Alaska Native Tribal Health Consortium because it administers IHS’s Sanitation Facilities Construction program in Alaska. The practical difficulties of conducting any survey may introduce errors, commonly referred to as non-sampling errors. For example, respondents may have difficulty interpreting a question, they may have limited information to respond to a question, or officials from different agencies may have different recollections regarding the extent of collaboration on a particular project. We sought to minimize the impact of non-sampling error by conducting six pretests of the draft questionnaire with agency officials; five pretests were conducted by telephone and one pretest was conducted in person. We selected officials to cover a range of agencies and locations. During these pretests, we sought to determine whether (1) the questions were clear and unambiguous, (2) terminology was used correctly, (3) the questionnaire did not place an undue burden on agency officials, (4) the information could feasibly be obtained, and (5) the survey was comprehensive and unbiased. We modified the questionnaire in response to these pretests. To further minimize the impact of non- sampling error, we conducted a sensitivity analysis. We customized the questionnaire for each agency regional office so that we asked each office to respond about its collaboration only with the other agencies located in its state. We e-mailed these questionnaires to 46 respondents from May 15 through May 17, 2017, and conducted follow-up as necessary. We received a 100 percent response rate. In the survey, we asked each agency regional office whether it had jointly conducted activities related to tribal drinking water or wastewater projects during the past 3 years with each of the other agencies’ regional offices within the same state. If an agency regional office responded “yes,” we then provided a list of tribal drinking water and wastewater activities and asked the agency regional office if it had jointly conducted any of the listed activities related to tribal drinking water and wastewater infrastructure projects in collaboration with the other agency. The activities included: identifying infrastructure needs, communicating information to tribes about programs that fund projects, planning and designing proposed projects, evaluating proposed projects according to eligibility and scoring criteria, selecting projects to fund, constructing projects, providing technical assistance for operating and maintaining water infrastructure, and negotiating or implementing Indian water rights settlements. We developed the list of activities based on our initial interviews and pretests with agency officials. We next provided a list of collaborative mechanisms. For each of these collaborative mechanisms, we asked the agency regional office if it had used the mechanism when jointly conducting activities in collaboration with the other agency related to tribal drinking water and wastewater infrastructure projects within the same state during the past 3 years. The mechanisms included: state-, regional-, or project-level memorandum of understanding or agreement; interagency agreement to transfer funding; working group, task force, or committee; consulting on project selection; sharing project documents; geographic co-location; shared database or other data sharing; conferences or forums; informal or ad hoc communication; and personnel detailing or sharing. If the agency regional office responded that it had not used one of the listed mechanisms, we asked if it would be beneficial to use that mechanism to collaborate in the future. We identified the list of mechanisms based on our prior work on interagency collaboration and pretests with agency officials. We also asked the agency regional office what factors, if any, helped it to collaborate with the other agency on tribal drinking water and wastewater infrastructure projects in the state and what factors, if any, hindered it from collaborating with the other agency. For both questions, we asked the agency regional office to consider agency policies and procedures, available resources, leadership, personalities, presence of written agreements, and accountability measures. If an agency regional office responded “no” to the initial question of whether it had jointly conducted activities related to tribal drinking water or wastewater projects during the past 3 years with another agency’s regional office, we asked a shorter set of follow-up questions. We provided the list of collaborative mechanisms and asked if it would be beneficial for the agency regional office to use any of the listed mechanisms to collaborate with the other agency on activities related to tribal drinking water and wastewater infrastructure projects in the future in the state. We also asked the agency regional office to describe the factors, if any, that hindered its collaboration with the other agency. To quantify the extent of interagency collaboration during the past 3 years and the potential for future collaboration among the federal agencies we surveyed, we conducted a Network Analysis—a method of analyzing the patterns of interaction among multiple entities. Specifically, we aggregated the survey responses to our questions about drinking water and wastewater activities and collaborative mechanisms for each pair of agencies in all six states. We configured these aggregated data into networks representing the pattern of collaboration among the agencies. We then analyzed these networks to determine how extensively the agencies have collaborated and the extent to which additional future collaboration could be beneficial for them. We also analyzed these networks to assess how the pattern of collaboration varied by state. We describe the steps of our analysis and agency survey responses below. To quantify the extent of collaboration among the federal agencies across the six states during the past 3 years, we aggregated the responses to our survey by agency pair. The seven federal agencies form 21 possible agency pairs. For each agency pair, we combined the first agency’s responses regarding its collaboration with the second agency and the second agency’s responses regarding its collaboration with the first agency. We aggregated the agency pair responses in this way for each of the three measures of collaboration for all six states, specifically: Drinking water and wastewater activities. We calculated the total number of instances in which each agency in a pair reported having worked on an activity with the other agency in that pair during the past 3 years (see column 2 in table 5). We examined this measure to identify the pairs of agencies that collaborated most and least extensively. For example, IHS and EPA reported the highest number of instances of jointly conducting tribal drinking water and wastewater activities across the six states. In contrast, EDA and IHS reported no such instances of collaboration. Use of collaborative mechanisms. We calculated the total number of instances in which each agency in a pair reported having used a mechanism to collaborate with the other agency in that pair during the past 3 years (see column 3 in table 5). We examined this measure to identify the pairs of agencies that collaborated most and least extensively. The pattern of collaboration based on this measure is similar to the pattern based on drinking water and wastewater activities. For example, IHS and EPA also reported the highest number of instances of using specific collaborative mechanisms across the six states. Potential future collaboration. We calculated the total number of instances in which each agency in a pair reported that it would be beneficial to use a mechanism to collaborate with the other agency in that pair in the future (see column 4 in table 5). We compared this measure to the number of mechanisms the agency pairs reported having used during the past 3 years. Each of the agency pairs reported that it would be beneficial to use additional collaborative mechanisms in the future, including those pairs that had reported not collaborating. For example, the agency pairs of EDA-IHS and EDA- Reclamation both reported no instances of using a mechanism to collaborate with each other and both reported multiple instances in which use of a collaborative mechanism would be beneficial in the future. To quantify the potential to increase collaboration among the federal agencies, we configured the agency pair data into two networks. The first network represented recent collaboration among the agencies—the instances in which agencies reported having used a mechanism to collaborate during the past 3 years (based on column 3 in table 5). The second network represented potential future collaboration among the agencies (based on the sum of columns 3 and 4 in table 5). As such, it captures the instances in which agencies reported having used a mechanism to collaborate during the past 3 years plus the instances in which they reported it would be beneficial to use an additional mechanism in the future. Figure 3 shows a graphical illustration of these two networks. In this figure, the circles represent agencies and the lines represent collaboration between the agencies. Specifically, the darkness of the lines indicates the number of mechanisms used by the corresponding pair of agencies. The left side of figure 3 illustrates reported use of collaborative mechanisms during the past 3 years, and the right side of figure 3 illustrates potential future collaboration. The figure shows that overall collaboration would increase if the agencies began using the additional mechanisms that they reported would be beneficial. We quantified the difference between these networks in two ways. First, we calculated the increase in overall collaboration that would occur if agencies began using the additional mechanisms that they reported would be beneficial. Based on this calculation, the number of instances of agencies using collaborative mechanisms would approximately triple. Specifically, agencies reported 403 instances of having used a specific mechanism to collaborate with another agency—this number would increase to 1,249 if agencies began using all of the identified mechanisms that they reported would be beneficial. This difference is shown in figure 3, in which the right side of the figure (potential future collaboration) has a greater number of darker lines connecting the agencies compared with the left side of the figure (recent collaboration). Second, we measured how the relative amount of collaboration for each agency would change if the agencies began using additional mechanisms they reported would be beneficial. To do this, we aggregated the agency pair data for each of the agencies. For the network of recent collaboration, for example, we added (1) the number of instances that each agency reported using a collaborative mechanism with any of the other agencies and (2) the number of instances that any of the other agencies reported using a collaborative mechanism with the first agency. We performed a similar calculation using the agency pair data for the network of potential future collaboration. The analysis shows that the use of collaborative mechanisms during the past 3 years was primarily centered on three agencies (IHS, EPA, and USDA). If all of the agencies began using the additional mechanisms that they reported would be beneficial, however, collaboration would be distributed more evenly across the entire network of agencies. This difference is also shown in figure 3, in which agencies such as HUD, Reclamation, and Corps are connected to other agencies with dashed lines on the left side of the figure (representing less extensive recent collaboration), but with thick lines on the right side of the figure (representing more extensive potential future collaboration). To quantify the extent of variation in collaboration by state, we disaggregated the agency pair data reported in table 5 by each of the states for the three measures of collaboration we asked about in our survey. In particular, tables 6, 7, and 8 show the number of instances in which an agency reported collaborating on drinking water and wastewater infrastructure activities with another agency during the past 3 years (table 6), using collaborative mechanisms with another agency during the past 3 years (table 7), and collaborative mechanisms that would be beneficial to use with another agency in the future (table 8). The totals in the bottom rows of these tables show the extent of collaboration based on these measures by state. Specifically, tables 6 and 7 show that agencies worked together on activities and used collaborative mechanisms most extensively in Alaska and least extensively in New York and Oklahoma. Table 8 shows that agencies in New York and Oklahoma reported the greatest potential for using additional collaborative mechanisms. The totals in the far right columns of these tables show the extent of reported collaboration by activity (table 6), collaborative mechanism (table 7), and the extent of potential future collaboration by collaborative mechanism (table 8). Appendix III: Federal Agency Obligations for Tribal Drinking Water and Wastewater Infrastructure Projects, Fiscal Years 2012 through 2016 According to Environmental Protection Agency officials, obligations listed may not match annual appropriations because the agency may have de-obligated and re-obligated any unexpended obligations to other projects. We determined that the U.S. Department of Agriculture awarded a grant or loan from its non-tribal specific programs for a tribal drinking water or wastewater infrastructure project if the recipient was a tribe or tribal entity (for example, an organization working on behalf of a tribe or tribes such as tribal health consortia or tribal utility authorities) and if the project was to serve a population of at least 50 percent American Indian or Alaska Native. The Economic Development Administration obligated approximately $34,000 for one project in fiscal year 2012, which is not reflected in the table due to rounding. We determined that the Economic Development Administration awarded a grant for a tribal drinking water or wastewater infrastructure project if the project’s description or scope of work mentioned a drinking water or wastewater infrastructure component. Obligations are combined from three programs: Public Works, Economic Adjustment Assistance, and Planning. This appendix contains summaries and photographs of selected tribal drinking water and wastewater infrastructure projects we visited from February through April 2017 in Alaska, Arizona, and Oklahoma. The Native Village of Kivalina, located on a barrier island above the Arctic Circle, is one of approximately 30 communities in Alaska where residents do not have access to safe drinking water and wastewater disposal facilities in their homes. Kivalina, a community of 469 residents, has a community washeteria with washing machines, dryers, and drinking water available for purchase. Like many Alaska Native villages, the harsh winter climate, limited revenue, and isolation create challenges for installing and operating water infrastructure. Erosion due to diminishing sea ice and other factors threaten Kivalina, and the community is considering relocation. As such, infrastructure improvements are limited to small projects consisting of moveable, low-water use infrastructure to provide interim sanitation improvements. In 2015, the Alaska Native Tribal Health Consortium installed a pilot sanitation system in nine homes. This system is called the Portable Alternative Sanitation System and consists of a bathroom sink, rainwater catchment, in-home water treatment, and a separating toilet, where liquid waste is collected separate from solid waste. According to a Consortium report, the system is a low-cost alternative to traditional piped infrastructure. The total cost was $633,000 to design, install, and monitor the system, with the Indian Health Service (IHS) and the Consortium contributing to the project. The Consortium recommended expanding the pilot system to the rest of Kivalina, and a Consortium official said it is working with IHS to test the system in several homes in three other unserved communities in Alaska. As of 2015, more than 30 percent of the nearly 80 homes in the Hopi Village of Shungopavi did not have adequate wastewater disposal. The Sewer Line Q and Dump Stations construction project included installing a sewer main to connect nine homes to sewer service. Previously, some of these homes had discharged wastewater directly onto the ground, and one had a septic system. The project also involved installing three honeybucket dump stations in the village and connecting them to the existing sewer system so that an additional 19 homes could dispose of raw sewage in an environmentally safe manner. According to IHS officials, solid rock a few feet beneath the surface made it challenging and expensive to lay the sewer pipes. The total estimated cost was $666,000, with the Environmental Protection Agency (EPA), the Village of Shungopavi, and IHS contributing to the project. According to IHS officials, the project is expected to be fully constructed in 2018. The Cherokee Nation’s Oaks Wastewater Lagoons project serves an estimated 85 Indian-owned homes in the community of Oaks, Oklahoma. The project consisted of constructing three wastewater lagoons and a spray irrigation field. According to a tribal official, because the previous lagoons leaked into the adjacent creek, local residents who used the creek for swimming, fishing, and other traditional purposes were at high risk of coming in contact with lagoon leakage. The total cost of the project was an estimated $1.22 million, and the U.S. Department of Agriculture, EPA, IHS, the Department of Housing and Urban Development, and the Oklahoma Water Resources Board made contributions to the project. The Cherokee Nation completed the project in 2012 under the provisions of its self-governance compact with IHS. The Sasakwa Rural Water District is owned and operated by the Seminole Nation of Oklahoma and serves 61 households—about 60 percent of which are Indian homes, according to tribal officials. The Drinking Water Pump Station Replacement project involved drilling new wells and constructing a new pump station and treatment system. IHS constructed the original Sasakwa water treatment plant in 1972. According to an IHS project summary, the problems with the prior system included (1) recurring leaks in the water transmission line and distribution system and (2) deterioration of the pump and treatment building and equipment due to weather, vandalism, and poor water quality. The project cost approximately $700,000, with EPA funding the project. According to tribal officials, the replacement water treatment plant became operational in 2014. In addition to the contacts named above, Jeffery D. Malcolm (Assistant Director, in memoriam), Leslie Kaas Pollock (Analyst in Charge), Carolyn S. Blocker, Mark Braza, John Delicath, David Dornisch, Cynthia Grant, Susan Iott, Serena Lo, Elizabeth Luke, Micah McMillan, Jon Melhus, Jeanette Soares, Sara Sullivan, Kiki Theodoropoulos, and Sarah Veale made key contributions to this report.

Summary: Tens of thousands of American Indians and Alaska Natives do not have safe drinking water or wastewater disposal in their home—referred to as needs arising from a sanitation deficiency—at a higher percentage than the general population, according to IHS. Among other things, IHS assesses homes, either individually or by reviewing public water systems, to determine any deficiencies. Seven agencies, including IHS, EPA, and USDA, have programs that provide drinking water and wastewater infrastructure assistance to Indian tribes. GAO was asked to review federal efforts to provide water infrastructure assistance to Indian tribes. This report examines, among other objectives, the extent to which selected federal agencies (1) identified tribes' drinking water and wastewater infrastructure needs and (2) funded tribal water infrastructure projects, including tribes' most severe sanitation deficiencies. GAO reviewed agency data on tribal needs, analyzed agency funding data for tribal water infrastructure projects, reviewed agency policy documents, and interviewed agency officials and officials from 22 tribes representing different geographic locations. Federal agencies have identified several billion dollars in existing and future tribal drinking water and wastewater infrastructure needs. Specifically, the Indian Health Service (IHS) worked with tribes to identify, in fiscal year 2016, an estimated $3.2 billion in water infrastructure projects to address existing sanitation deficiencies in Indian homes, and the Environmental Protection Agency (EPA) identified an additional $2.4 billion in future tribal drinking water infrastructure needs over the next 20 years. However, IHS could enhance the accuracy of its information about the water infrastructure needs of some Indian homes. In February 2018, the database that IHS uses to track Indian homes' sanitation deficiencies showed that about one-third of the homes (138,700) had no deficiency. However, because the database does not provide IHS with a way to record if a home's deficiency has been assessed, IHS could not determine whether these homes had no deficiency or if they had not yet been assessed to identify a deficiency. IHS officials stated that improving the database's accuracy would be beneficial. By implementing a way to indicate in its database whether these homes' deficiencies have been assessed, IHS could also more efficiently address any deficiencies in these homes. Federal agencies provided about $370 million for tribal drinking water and wastewater infrastructure projects in fiscal year 2016, including some projects to address what the agencies identified as the most severe sanitation deficiencies (i.e., communities that lack safe drinking water or wastewater disposal). IHS and U.S. Department of Agriculture (USDA) policies direct the agencies to fund tribal projects that address these deficiencies. However, agency scoring processes may not always prioritize the projects that address them: IHS assigns points to projects using eight scoring factors, including sanitation deficiency and cost. Based on GAO's review of IHS documents and interviews with agency officials, IHS's process for selecting projects can discourage funding some projects that address the most severe sanitation deficiencies, especially those with a relatively high cost per home. As a result, some projects to serve homes without water infrastructure can remain unfunded for many years. IHS officials said the scoring factors balance a number of interests, and the agency is looking to improve the extent to which it funds projects that address these deficiencies. USDA uses a different set of scoring factors to assign points when evaluating project applications for its tribal water program, including rural population and income levels. However, USDA does not have a scoring factor to assign points to a project based on whether it will serve homes that lack safe drinking water or wastewater disposal, as it does with another program with similar goals. Instead, USDA officials said they use discretionary points to score projects on this basis, but these points may not be awarded at all. As a result, USDA may not have reasonable assurance that it consistently evaluates project applications in a way that aligns with agency policy to fund projects that address the most severe sanitation deficiencies. By IHS reviewing and USDA updating their scoring processes, the agencies could have more assurance that the projects they fund address the most severe sanitation deficiencies in Indian communities. GAO is making 16 recommendations, including that (1) IHS develop a way to indicate in its database if homes' deficiencies have been assessed and (2) IHS and USDA review and update project scoring processes. IHS agreed with these recommendations, and USDA proposed an approach for addressing the recommendation on scoring, as discussed in the report.