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COVID-19: Current and Future Federal Preparedness Requires Fixes to Improve Health Data and Address Improper Payments

GAO-22-105397 Published: Apr 27, 2022. Publicly Released: Apr 27, 2022.
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Fast Facts

Although hospitalizations and deaths associated with COVID-19 have recently decreased, the pandemic continues to challenge U.S. response and recovery efforts. The federal response continues to focus on vaccinations, testing, and treatment.

As of March 2022, we have made 279 recommendations to improve the federal response, such as collecting data on long-term COVID-19 effects. Agencies have fully or partially addressed 39% of our recommendations.

In this report, we make a suggestion for Congress to consider and 15 new recommendations to address payment oversight, data collection, critical manufacturing and supply chain issues, and more.

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Highlights

What GAO Found

By late March 2022, daily COVID-19 cases in the U.S. had fallen substantially since the Omicron-related peak in January 2022. Though COVID-19-associated hospitalizations and deaths have also decreased, the effects of the Omicron variant—and the rising prevalence of its new BA.2 sublineage—underscore enduring challenges and the importance of a continued, agile federal response.

This response has included a focus on COVID-19 vaccinations. As of March 26, 2022, about 70 percent of the eligible U.S. population had been fully vaccinated. According to the Centers for Disease Control and Prevention (CDC), getting vaccinated and staying up to date with vaccines—including a booster dose—is the best way to protect against COVID-19. Data show that vaccinated adults experienced lower COVID-19-associated hospitalization rates (see figure).

Age-Adjusted Rates of COVID-19-Associated Hospitalizations by Vaccination Status in Adults Aged 18 Years and Older, Oct. 2021–Feb. 2022

Figure described in preceding paragraph. For additional information about this figure, refer to contacts listed at http://www.gao.gov/products/GAO-22-105397

Since June 2020, GAO has made 279 total recommendations for improving federal pandemic operations. These recommendations include improvements in such areas as publicly reporting COVID-19 nursing home vaccination data and targeting vaccine outreach to veterans. Agencies have fully or partially addressed 39 percent of these recommendations as of March 2022, fully addressing 22 percent (61 recommendations) and partially addressing another 17 percent (48 recommendations). Fully addressing GAO’s recommendations will enhance federal COVID-19 pandemic response and recovery efforts, and help prepare for future public health emergencies.

In this report, GAO makes 15 new recommendations and raises one matter for congressional consideration in the areas of COVID-19 payment oversight, public health data collection, and critical manufacturing, among others.

Payment Integrity: COVID-19 Spending

The Payment Integrity Information Act of 2019 defines improper payments as any payment that should not have been made or that was made in an incorrect amount (including overpayments and underpayments) under statutory, contractual, administrative, or other legally applicable requirements. Improper payments are a pervasive and growing problem in regular programs across the federal government. They also have been a significant concern in pandemic spending, especially among the largest programs such as unemployment insurance.

Under guidance from the Office of Management and Budget (OMB), agencies are to complete a risk assessment to determine a new program’s susceptibility to significant improper payments after the first 12 months of program operations and, if susceptible, develop corrective actions and report on improper payments the following fiscal year. This means that improper payment information for new COVID-19 programs may not be reported until November 2022. By that time, agencies may have disbursed most or even all COVID-19 funds before assessing risk or developing corrective actions to address potential improper payment issues.

GAO therefore suggested in its November 2020 report that Congress consider in any future legislation appropriating COVID-19 relief funds designating all executive agency programs and activities making more than $100 million in payments from COVID-19 relief funds as “susceptible to significant improper payment.”

GAO continues to believe that expeditiously estimating and reporting improper payments and developing corrective actions to reduce such payments is critical to agency accountability, particularly for new programs that receive large outlays in a given year. GAO reiterates the November 2020 matter, as well as a matter GAO made in a March 2022 testimony suggesting that Congress consider amending the Payment Integrity Information Act of 2019 to designate all new executive agency programs—such as those created specifically to respond to the COVID-19 pandemic—making more than $100 million annually in payments as “susceptible to significant improper payments” for their initial years of operation.

GAO also recommends that OMB require agencies to certify the reliability of submitted improper payment data. OMB neither agreed nor disagreed with this recommendation.

FEMA’s COVID-19 Funeral Assistance and Public Assistance Program

As of February 28, 2022, the Federal Emergency Management Agency (FEMA) had received and was processing more than 444,000 applications for funeral assistance since April 2021—when it began accepting applications—and awarded more than $1.92 billion for more than 296,000 approved applications. (See figure for obligations made for COVID-19 Funeral Assistance from May 10, 2021, through February 22, 2022.)

Cumulative Obligations for FEMA Funeral Assistance over Time, May 10, 2021–Feb. 22, 2022

Figure described in preceding paragraph. For additional information about this figure, refer to contacts listed at http://www.gao.gov/products/GAO-22-105397

However, GAO identified several gaps in FEMA’s internal controls meant to prevent improper or potentially fraudulent payments, such as cases in which these controls did not prevent duplicate applications for funeral assistance or assistance issued to ineligible recipients. For example, GAO identified 374 deceased individuals that were listed on more than one award-receiving application; in total, these applications received about $4.8 million in assistance. Without adequate controls in place, COVID-19 Funeral Assistance is at risk of improper payments and potential fraud.

GAO recommends that the FEMA Administrator take action to identify the causes of the gaps in internal control in COVID-19 Funeral Assistance and design and implement additional control activities, where needed, to prevent and detect improper payments and potential fraud.

GAO recommends that the FEMA Administrator address deficiencies in the COVID-19 Funeral Assistance data by updating data records as data are verified, and adding data fields where necessary, to ensure that consistent and accurate data are available for monitoring of potential fraud trends and identifying control deficiencies. The Department of Homeland Security (DHS) agreed with both recommendations.

COVID-19 Surveillance

CDC could be better positioned to lead and coordinate the national efforts to detect and monitor COVID-19 by including in the agency’s existing surveillance approach specific objectives for how it will achieve its goals and a description of how it will assess progress toward meeting them.

CDC’s COVID-19 surveillance approach outlines goals and activities for what the agency wants to achieve, but it does not detail how it will achieve its stated goals or how it will measure its progress—two components of an effective strategy GAO has noted in its past work. By including specific objectives that detail how CDC’s actions will allow it to meet its goals and describing measures to assess its progress towards reaching its goals, CDC could better ensure it is able to effectively monitor COVID-19 nationwide.

GAO recommends that the Director of CDC, in coordination with state, tribal, local, and territorial jurisdictions and public health partner organizations, ensure the agency builds upon its existing COVID-19 surveillance approach by detailing specific objectives for how it will achieve its COVID-19 surveillance goals and describing how it will assess progress toward meeting them. HHS agreed with our recommendation.

Public Health Data Collection and Standardization

CDC has made progress in modernizing the U.S. public health data collection and surveillance infrastructure through its Data Modernization Initiative, which aims to improve data collection and sharing, strengthen data reporting and analytics, and advance surveillance of future public health threats, among other goals.

However, CDC’s strategic implementation plan for the Data Modernization Initiative does not articulate the specific actions, time frames, and allocation of roles and responsibilities needed to achieve its objectives. In addition, CDC has not fully developed plans for how it will allocate certain funds for data modernization. Without more specific, actionable plans, CDC may not be able to gauge its progress on the initiative or achieve key results in a timely manner. In addition, such lack of progress to implement enhanced surveillance systems could affect the quality and timeliness of data needed to respond to future public health emergencies.

GAO recommends that the Director of CDC define specific action steps and time frames for the agency’s data modernization efforts. HHS agreed with this recommendation.

Critical Manufacturing Sector

The pandemic has impacted the Critical Manufacturing Sector by causing worker shortages, delays in shipments of goods, and increased cybersecurity vulnerability in critical infrastructure systems and assets. The Cybersecurity and Infrastructure Security Agency (CISA)—in its role as the lead federal agency for coordinating security and resilience efforts with the Critical Manufacturing Sector on behalf of DHS—took steps to respond to the pandemic’s impacts in the sector. For example, CISA developed voluntary guidance to help jurisdictions and critical infrastructure owners and operators identify essential work functions and ensure that the workers who performed those functions could continue to access their workplaces when restrictions, such as stay-at-home orders, were in place in their communities.

Members of the Critical Manufacturing Sector have identified a lessons-learned analysis as a high-priority need, and CISA has collected some information on the impact of the pandemic in the sector that could be leveraged in a lessons-learned analysis. However, as of February 2022, CISA had not finalized a plan for developing the analysis.

GAO recommends that the Director of CISA assess and document lessons learned from the COVID-19 pandemic’s impacts on the Critical Manufacturing Sector. DHS agreed with this recommendation and stated it plans to issue a lessons-learned report by December 2022.

Advance Child Tax Credit and Economic Impact Payments

During 2021, the Internal Revenue Service (IRS) and the Department of Treasury issued advance payments of the child tax credit (CTC) and a third round of Economic Impact Payments (EIP 3) to eligible individuals, totaling over $500 billion. Both payments could have had implications for individuals as they filed their 2021 taxes.

Information on Advance Child Tax Credit Payments, July 2021–Dec. 2021, as of April 6, 2022

Figure described in preceding paragraph. For additional information about this figure, refer to contacts listed at http://www.gao.gov/products/GAO-22-105397

To help individuals file accurate 2021 tax returns during the 2022 filing season, Treasury and IRS took several steps to reach out to individuals that received the advance CTC payments and EIP 3. However, Treasury and IRS missed opportunities to collaborate on these outreach efforts.

Relatedly, the communications plans and strategies IRS developed for several programs, including the advance CTC and EIP, do not include metrics for assessing the usefulness and accessibility of these outreach efforts. Such metrics would inform management of these efforts and help focus resources on what works. Without sufficient, relevant, timely, and comparable data on its outreach efforts, IRS is missing information it could use to develop performance metrics and to assess which aspects of their communications and outreach strategy were effective in reaching different audiences.

GAO is making three recommendations for Treasury and IRS to enhance communication and outreach efforts concerning the refundable tax credit. These recommendations focus on improving collaboration between the agencies and within IRS and on using data to assess the effectiveness of their efforts. Treasury and IRS neither agreed nor disagreed with the recommendations.

This report contains additional recommendations related to the Single Audit Compliance Supplement, the Capital Projects Fund, the Homeowner Assistance Fund, and Public Health Industrial Base Expansion. For example, GAO recommends that the Assistant Secretary for Preparedness and Response within HHS conduct a workforce assessment of its Innovation and Industrial Base Expansion Program Office to determine the critical skills and competencies needed to support and sustain the office, and develop corresponding workforce strategies to address those needs. HHS agreed with this recommendation.

Why GAO Did This Study

By the end of March 2022, the U.S. had about 80 million reported cases of COVID-19 and over 980,000 reported deaths, according to CDC. The country also experiences lingering economic repercussions related to the pandemic, including rising inflation and ongoing supply chain disruptions.

As of February 28, 2022 (the most recent date for which data were available), the federal government had obligated $4.2 trillion and expended $3.6 trillion for pandemic relief. These amounts reflect 91 and 79 percent, respectively, of the total amount of COVID-19 relief funds provided by the CARES Act and five other relief laws.

The CARES Act includes a provision for GAO to report on its ongoing monitoring and oversight efforts related to the COVID-19 pandemic. This report—GAO’s 10th comprehensive report—examines the federal government’s continued efforts to respond to, and recover from, the COVID-19 pandemic. In addition, GAO’s March 17, 2022 testimony included 10 new legislative suggestions to enhance the transparency and accountability of federal spending, which we reiterate here.

GAO reviewed federal data and documents and interviewed federal and state officials and other stakeholders.

Recommendations

GAO is making 15 new recommendations for agencies and one matter for consideration by Congress that are detailed in this Highlights and in the report.

Matter for Congressional Consideration

Matter Status Comments
Congress should consider providing the Department of Health and Human Services the authority to require states to report the data necessary for the Secretary to estimate and report on improper payments for the Temporary Assistance for Needy Families program in accordance with 31 U.S.C. § 3352. See the Payment Integrity: COVID-19 Spending enclosure.
Open
No new legislation has been enacted as of May 2023 which would provide the Department of Health and Human Services the authority to require states to report the data necessary for the Secretary to estimate and report on improper payments for the Temporary Assistance for Needy Families program.

Recommendations for Executive Action

Agency Affected Recommendation Status
Office of Management and Budget The Director of the Office of Management and Budget should require agencies to certify the reliability of data submitted to PaymentAccuracy.gov. See the Payment Integrity: COVID-19 Spending enclosure. (Recommendation 1)
Closed – Implemented
The Office of Management and Budget (OMB) neither agreed nor disagreed with this recommendation. On August 26, 2022, OMB stated that it was planning on adding a new certification requirement for agency submissions to paymentaccuracy.gov, consistent with this GAO recommendation. In September 2022, OMB updated its fiscal year 2022 Payment integrity Annual Data Call Instructions. In this updated document, OMB instructs agencies on how to submit their annual data calls for PaymentAccuracy.gov and directs agencies to certify with their submission that the information provided "is complete and reliable and that the submission has been reviewed and approved by appropriate Agency senior leadership, e.g., the Chief Financial Officer or equivalent." We believe that OMB has addressed our recommendation. Therefore, we are closing this recommendation as implemented.
Federal Emergency Management Agency The Federal Emergency Management Agency Administrator should take action to identify the causes of the gaps in internal control in COVID-19 Funeral Assistance and design and implement additional control activities, where needed, to prevent and detect improper payments and potential fraud. See FEMA's COVID-19 Funeral Assistance and Public Assistance Program enclosure. (Recommendation 2)
Closed – Implemented
In April 2023, FEMA officials provided information showing that the agency had taken action to help prevent and detect improper payments and potential fraud. For example, based on our findings, FEMA now manually reviews any applications with pending awards over $9,000 on a daily basis to help avoid improper payments. In addition, FEMA implemented refresher training for staff, to be completed by April 2023, to help clarify how to process potential duplicate applications and verify that assistance does not exceed the maximum allowed. Further, officials reported that in October 2022 FEMA established a new payment integrity and fraud prevention section tasked with review and analysis of potentially fraudulent funeral assistance cases. Officials also reported that as of April 2023 FEMA was performing an audit of a random sample of awarded funeral assistance applications from 2021 and 2022, intended to assess the implementation of FEMA's fraud prevention and other controls. FEMA expects to complete the audit by the end of September 2023.
Federal Emergency Management Agency The Federal Emergency Management Agency Administrator should address deficiencies in the COVID-19 Funeral Assistance data by updating data records as data are verified, and adding data fields where necessary, to ensure that consistent and accurate data are available for monitoring of potential fraud trends and identifying control deficiencies. See FEMA's COVID-19 Funeral Assistance and Public Assistance Program enclosure. (Recommendation 3)
Open – Partially Addressed
FEMA agreed with our recommendation and has taken steps to address it. However, as of April 2023, FEMA did not have plans to change how data are recorded. Officials reported that as of October 2022, FEMA had established a new payment integrity and fraud prevention section tasked with review and analysis of potentially fraudulent funeral assistance cases. In addition, as of April 2023, FEMA was performing an audit of a random sample of applications with an expected completion date by the end of September 2023. While intended to assess FEMA's controls more broadly, these efforts could help identify inconsistent data elements and lead to improvements. However, we continue to believe that the agency should make targeted efforts to improve the consistency and accuracy of the COVID-19 funeral assistance data to facilitate oversight and prevent and detect fraud, particularly given that FEMA officials reported the program will extend through September 30, 2025.
Department of Education The Secretary of Education should document policies and procedures for providing information to the Office of Management and Budget to better enable it to annually update the Compliance Supplement that include steps for (1) establishing management's expectations of staff competence for key roles (e.g., relevant knowledge, skills and abilities) and providing ongoing training, and (2) agency officials proactively involving internal stakeholders (e.g., the inspector general, general counsel and chief financial officer) and external stakeholders (e.g., the audit community) when developing audit procedures, prior to submitting drafts to the Office of Management and Budget, in order to ensure the guidance meets users' needs. See the Single Audit Compliance Supplement enclosure. (Recommendation 4)
Open
In March 2023, Education officials stated, "the Grants Risk Management Services Division (GRMSD) will take the lead in working with the various program offices to update and/or document policies and procedures for providing information to OMB to better enable OMB to annually update the Compliance Supplement in a manner that meets the needs of its users. GRMSD will work with program offices to review and enhance, where necessary, its current methodology for training and establishing management expectations of staff competencies for key Compliance Supplement roles at the program office level. GRMSD will enhance its policies and procedures to examine and improve its current engagement with internal (e.g., general counsel and chief financial officer) and external (e.g., inspector general and the audit community) stakeholders and where necessary, enhance its policies and procedures to ensure consistency and efficient collaboration is maximized during the Supplement review process. The planned completion date for the action item is: 30 June 2024." We will continue to monitor Education's steps to address this recommendation.
Department of Health and Human Services The Secretary of Health and Human Services should document policies and procedures for providing information to the Office of Management and Budget to better enable it to annually update the Compliance Supplement, that include steps for (1) establishing management's expectations of staff competence for key roles (e.g., relevant knowledge, skills and abilities) and providing ongoing training, and (2) agency officials proactively involving internal stakeholders (e.g., the inspector general, general counsel and chief financial officer) and external stakeholders (e.g., the audit community) when developing audit procedures, prior to submitting drafts to the Office of Management and Budget, in order to ensure the guidance meets users' needs. See the Single Audit Compliance Supplement enclosure. (Recommendation 5)
Open
In April 2023, HHS officials stated, "HHS Office of Grants has drafted the Standard Operating Procedure (SOP) and, in coordination with the HHS Office of Finance, is in the process of finalizing the SOP. The SOP serves to document existing practice in writing. HHS plans to issue the SOP to HHS awarding agencies by June 2023. Once HHS issues the SOP in final to HHS awarding agencies, HHS will conduct training on the SOP." We will continue to monitor HHS' steps to address this recommendation.
Department of the Treasury The Secretary of the Treasury should document policies and procedures for providing information to the Office of Management and Budget to better enable it to annually update the Compliance Supplement, that include steps for (1) establishing management's expectations of staff competence for key roles (e.g., relevant knowledge, skills and abilities) and providing ongoing training, and (2) agency officials proactively involving internal stakeholders (e.g., the inspector general, general counsel and chief financial officer) and external stakeholders (e.g., the audit community) when developing audit procedures, prior to submitting drafts to the Office of Management and Budget, in order to ensure the guidance meets users' needs. See the Single Audit Compliance Supplement enclosure. (Recommendation 6)
Open
In April 2023, Treasury generally agreed with the report's recommendation that Treasury document policies and procedures for providing information to OMB. To address the recommendation, Treasury provided its recently completed Federal Financial Assistance Award Policy and related Guide. We are in the process of reviewing the documentation.
Department of the Treasury The Secretary of the Treasury should document a comprehensive plan that includes timely and sufficient policies and procedures for monitoring recipients of the CPF to provide assurance that funds are being used in compliance with laws, regulations, agency guidance, and award terms and conditions, including ensuring that funds are being used for allowable purposes. See the Capital Projects Fund enclosure . (Recommendation 7)
Open – Partially Addressed
The Department of the Treasury (Treasury) agreed with the recommendation. As of September 2022, Treasury had taken steps to address this recommendation by issuing several documents detailing internal controls over monitoring recipients of Coronavirus Capital Projects Fund (CPF) awards, including the Office of Recovery Programs' (ORP) Awards Management Policy. Treasury also issued Compliance Testing Procedures for its programs including CPF. Following these actions, Treasury has finalized and issued various compliance and recipient monitoring documents responsive to the recommendation. First, Treasury issued CPF business rules and implemented testing on CPF reports. The first reports for CPF were due on October 30, 2022 and covered all CPF expenditures made by the recipient up until September 30, 2022. Business rules were developed and used to test these reports. Second, in October 2022, Treasury issued the CPF Project and Expenditure Report User Guide for States, available at https://home.treasury.gov/system/files/136/CPF-PE-Report-User-Guide.pdf to help CPF recipients fulfill their quarterly reporting requirements. Third, in December 2022, Treasury issued an updated version of the CPF Compliance and Reporting Guidance for States, Territories, and Freely Associated States, available at https://home.treasury.gov/system/files/136/CPF-Reporting-Guidance-for-States.pdf. Treasury expects to continue issuing updates to this guidance document as necessary. Fourth, in January 2023, ORP issued its "Single Audit Responsibility Policy" and "Standard Remedies: Non-Submission of Required Compliance Reports and Failure to Register or Lapse of Registration at SAM.gov", and finalized updated policies and procedures for award management and compliance testing that apply to all programs administered by Treasury's ORP, including CPF. In April 2023, ORP further updated its Compliance Testing Procedures to reflect the business rules that ORP's recipient monitoring utilizes in its CPF testing process. Treasury is planning to publish Compliance and Reporting Guidance for Tribal governments and a user guide for states, territories, and freely associated states for completing their annual performance reports in May 2023. CPF continues to provide support to applicants through office hours, ongoing outreach, and dedicated points of contact for each state. We commend Treasury for the corrective actions taken to date and will continue to monitor Treasury's actions in response to our recommendation.
Department of the Treasury The Secretary of the Treasury should develop and implement written procedures to monitor Homeowner Assistance Fund participants' programs and uses of funds for compliance with program requirements and improper payments. See the Homeowner Assistance Fund enclosure. (Recommendation 8)
Open – Partially Addressed
In September 2022, Treasury told us its Office of Recovery Programs had finalized policies and procedures for award management and compliance testing that applied to all recovery programs administered by the office, including the Homeowner Assistance Fund. Treasury shared these policies and procedures, which described an overall framework for award management and compliance testing but lacked procedures that were specific to the fund. According to Treasury, the agency is still working to develop and implement such procedures but did not provide an expected completion date. As of April 2023, Treasury provided information that GAO is in the process of reviewing.
Centers for Disease Control and Prevention The Director of the Centers for Disease Control and Prevention should define specific action steps and time frames for the agency's data modernization efforts. See the Public Health Data Collection and Standardization enclosure. (Recommendation 9)
Open – Partially Addressed
As of April 2023, CDC has taken steps to address this recommendation. Specifically, CDC has developed a Public Health Data Strategy (Strategy), and has established the Office of Public Health Data, Surveillance, and Technology (Office). The Office was created as an accountability mechanism for public health data and will implement the Strategy within the next 2 years. According to CDC, the Office will be responsible for core public health data systems and technology solutions to support critical public health missions and data policy. Although CDC has identified a 2 year time frame to implement its Strategy, it has not defined the specific action steps it will take to implement the Strategy. In its Strategy, CDC outlines broad actions it plans to take, but does not define the steps needed to achieve these actions. That is, the mechanisms through which CDC plans to increase engagement, collaboration, and continual feedback are unclear. GAO will continue to monitor CDC's progress on any updates to the Strategy and its implementation.
Centers for Disease Control and Prevention The Director of the Centers for Disease Control and Prevention, in coordination with state, tribal, local, and territorial jurisdiction and public health organization partners, should ensure the agency builds upon its existing surveillance approach by detailing specific objectives for how it will achieve its COVID-19 surveillance goals and describing how it will assess progress toward meeting them. See the COVID-19 Surveillance enclosure. (Recommendation 10)
Open
The Department of Health and Human Services (HHS) agreed with our recommendation, and the Centers for Disease Control and Prevention (CDC) noted that it will continue efforts to develop a document summarizing its COVID-19 surveillance goals and how it will assess progress towards meeting them. As of April 2023, CDC stated that it is preparing a report for publication that will describe COVID-19 Surveillance in the United States after the expiration of the Public Health Emergency (PHE) on May 11, 2023. CDC also stated that it is finalizing a document that summarizes the national COVID-19 surveillance framework during the emergency response phase of the pandemic that is expected to be cleared for release after the expiration of the PHE. CDC stated that it will provide supporting documentation in May 2023. Once CDC provides these documents, we will review them to determine the extent they were developed in coordination with partners and the extent they detail specific objectives for how it will achieve its COVID-19 surveillance goals and measure progress.
Cybersecurity and Infrastructure Security Agency The Director of the Cybersecurity and Infrastructure Security Agency should assess and document lessons learned from the COVID-19 pandemic's impacts on the Critical Manufacturing Sector. See the Critical Manufacturing Sector enclosure. (Recommendation 11)
Open – Partially Addressed
CISA agreed with GAO's recommendation and, in September 2022, shared with us the Critical Manufacturing Pandemic Planning Guide (published July 2022), which provides suggested guidelines and best practices for Sector members to follow during a pandemic or other similar crisis. According to CISA officials, these best practices were identified through a series of facilitated discussions with representatives from the Critical Manufacturing Government and Sector Coordinating Councils, and shared with CISA. CISA's Guide is a positive step in providing the Sector with guidance and best practices for navigating a pandemic or similar crisis, but the Guide does not document the lessons CISA learned from assessing the COVID-19 pandemic's impacts on the Sector. To fully address this recommendation, CISA officials should assess and document, either as part of the Guide or separately, lessons learned from the pandemic's impacts on the Critical Manufacturing Sector. This would help show how the Guide's best practices, or separately identified lessons learned, could mitigate the effects of similar, future crises. We will continue to monitor CISA's efforts to fully address this recommendation.
Office of the Assistant Secretary for Preparedness and Response The Assistant Secretary for Preparedness and Response within the Department of Health and Human Services should conduct a workforce assessment of its Innovation and Industrial Base Expansion Program Office to determine the critical skills and competencies needed to support and sustain the office, and develop corresponding workforce strategies to address those needs. See the Public Health Industrial Base Expansion enclosure. (Recommendation 12)
Open – Partially Addressed
The Administration for Strategic Preparedness and Response (ASPR) agreed with GAO's recommendation. In October 2023, ASPR provided information on efforts taken to address the recommendation. Specifically, ASPR provided an assessment of the workforce needs of its new Office of Industrial Base Management and Supply Chain (formerly known as the Innovation and Industrial Base Expansion Office). The assessment included detailed information on the critical skills and competencies needed to support and sustain the office, such as information on the number and types of permanent positions needed, and those that would need to be hired. The assessment determined that 38 additional staff are needed. Of these 38, ASPR plans to covert 10 existing staff currently working for the agency under term positions to permanent positions and plans to hire the remaining 28 staff. In January 2024, ASPR provided general information on the recruiting and hiring strategies they are employing to hire the 28 staff. ASPR's assessment of its workforce needs for this Office are a positive step forward and partially address our recommendation. However, GAO is keeping this recommendation open until we obtain further information on the recruiting and hiring strategies ASPR is employing to hire the additional 28 staff, including actions ASPR is taking to monitor the effectiveness of these strategies.
Department of the Treasury The Secretary of the Treasury, in coordination with the Commissioner of Internal Revenue, should enhance collaboration among departmental components for refundable tax credit communication and outreach efforts by including relevant participants and clearly defining participant outcomes, roles, and responsibilities. See the Advance Child Tax Credit and Economic Impact Payments enclosure. (Recommendation 13)
Open
As of April 2023, Treasury did not provide any updates.
Internal Revenue Service The Commissioner of Internal Revenue should enhance internal collaboration among its stakeholder outreach and education offices for refundable tax credit communications and outreach efforts by clearly establishing outcomes, roles and responsibilities, and developing resources to facilitate joint interactions and methods to document information sharing. See the Advance Child Tax Credit and Economic Impact Payments enclosure. (Recommendation 14)
Open – Partially Addressed
IRS officials stated that they fully addressed this recommendation on February 3, 2023. We concur that they have taken some actions to implement this recommendation, such as developing resources to facilitate joint interactions and methods to document information sharing among the different offices that provide communications and outreach to taxpayers. However, IRS has not yet established outcomes, or roles and responsibilities among these different offices. GAO maintains that taking these steps could enhance future communications and outreach efforts and reduce the risk of the fragmentation and duplication that we had observed related to identifying and reaching out to new community partners.
Internal Revenue Service The Commissioner of Internal Revenue should collect sufficient, relevant, and comparable data on the usefulness and accessibility of its communications and outreach efforts for refundable tax credits and use these data to develop performance metrics to assess the effectiveness of ongoing efforts. See the Advance Child Tax Credit and Economic Impact Payments enclosure. (Recommendation 15)
Open
As of April 2023, IRS did not provide additional information.

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Data collectionDisease surveillanceImproper paymentspandemicsPublic assistance programsPublic healthPublic health emergenciesTax creditManufacturingCompliance oversight