Responding to Congress’s concerns about the adequacy of the country’s stockpiles of medical supplies to combat a chemical or biological terrorist attack, the GAO reviewed the accuracy and currency of the inventory tracking systems and examined internal controls in place to manage the stockpiles. In reviewing all the stockpiles, the GAO found the U.S. ability to respond to chemical or biological terrorist incidents as compromised by poor management controls and the lack of required items. A physical inventory of the Office of Emergency Preparedness stockpiles compared with its required list showed a discrepancy of more than 11 percent. A review of inventory found excess supplies, shortages and expired items. For example, investigators found 600 more amyl nitrate inhalants than recorded and shortages of 100 vials of diazepam. Systems cannot be relied upon to consistently and accurately account for the items required to be in stockpiles because they lacked good record keeping, such as documentation of back orders, replacements and shipment, and receipt of all pharmaceutical and medical supplies. Emergency agencies did not implement five internal control standards for managing stockpiles: effective control environment, risk assessments, control activities, information and communications, and monitoring. The GAO concludes that agencies cannot provide reasonable assurance that the required medical supplies will be available if needed. To improve internal controls, the GAO recommended the agencies: conduct risk assessments and organize program activities to identify and mitigate risks; arrange for periodic, independent inventories; implement a tracking system that retains complete documentation for all supplies that have been ordered, received and destroyed; and rotate supplies properly. Appendices, glossary