Both of the programs are designed to strengthen State and local bioterrorism preparedness. The two programs require participants to complete specific activities designed to build public health and health-care capacities. To determine the extent to which States had completed program requirements, the GAO study relied primarily on the progress reports under the cooperative agreements. Program officials were also interviewed, and relevant documents were reviewed. Interviews were conducted with officials from 10 States, local health departments within each of these States, and two metropolitan areas funded by CDC and HRSA. Of the 10 critical benchmarks set under the CDC agreement, 2 critical benchmarks were met by only a few of the States: development of a statewide response plan and development of a regional response plan. The remaining eight critical benchmarks were met by about half of the States. These benchmarks included assessment of emergency preparedness and response capabilities, development of a system that can receive and evaluate urgent disease reports at all times, and development of an interim Strategic National Stockpile plan. In addition, State and local officials reported factors that have impeded their ability to complete all of the CDC's requirements. Although no State has completed all of HRSA's requirements regarding the strengthening of hospital preparedness for a biological weapon attack, almost all the States reported meeting two of the three critical benchmarks: designation of a coordinator for hospital preparedness planning, and establishment of a hospital preparedness planning committee. The GAO concludes that although much remains to be done to meet the goals of the two cooperative agreements, States are more prepared now than they were prior to the creation of these programs. 1 table