The GAO determined that more children have likely died from maltreatment than are counted in the Federal National Child Abuse and Neglect Data System (NCANDS), which is based on voluntary State reports to HHS. NCANDS estimated that 1,770 children in the United States died from maltreatment in fiscal year 2009; however, nearly half of the States included data only from child welfare agencies in reporting child maltreatment fatalities to NCANDS. This is a flawed measurement, because not all children who die from maltreatment have had contact with these agencies. HHS also collects, but does not report, some information on the circumstances surrounding child maltreatment fatalities that could be useful for prevention. The National Center for Child Death Reviews (NCCDR), a nongovernmental organization funded by HHS, collects more detailed data on circumstances from 39 States; however, these data on child maltreatment deaths have not yet been synthesized or published. In the GAO survey of the States, State officials indicate a need for additional information on how to coordinate among State agencies to collect more complete information on child maltreatment fatalities. GAO recommends that the HHS Secretary further strengthen data quality, expand available information on child fatalities, improve information sharing, and estimate the costs and benefits of collecting national data on near fatalities. HHS agreed with GAO's findings and recommendations and provided technical comments. 4 tables and 8 figures