	Background

NLS operates a program that provides free reading materials for residents  and citizens of the United States and its territories as well as U.S. citizens  residing abroad who are generally unable to read standard print because  of a visual or physical disability. 1). Administration of the NLS program is shared between NLS headquarters  and a national network of libraries and outreach centers. NLS Users Are Primarily Older Adults with Visual Disabilities, but NLS Efforts Are Not Ensuring Full Access and Awareness

		Older Adults with Visual Disabilities Make Up the Majority of Users, though an Eligibility Requirement May Limit Access of Potential Users with Reading Disabilities

In fiscal year 2014, about 430,000 individuals used the NLS program, with  the majority being older individuals who were blind or had other visual  disabilities. 2). The number of NLS users remained stable from fiscal year 2010 through  fiscal year 2014, according to NLS data. This eligibility requirement, which originated in 1974 and has remained  largely unchanged since, creates additional steps and costs for applicants  with reading disabilities in comparison to other groups, and may hinder  some individuals’ access to services. NLS officials said that changing the eligibility  requirement for reading disabilities may lead to more users and increased  costs. Staff at 6 of the 8 network libraries told us they wanted more  guidance and assistance from NLS on outreach efforts such as these. However, NLS has not developed a plan for  assessing its outreach efforts, also a best practice we previously  identified. NLS Offers Materials in a Range of Formats, but Statutory and Other Limitations Impede Adoption of Potentially Cost- Saving Technologies

		NLS Provides a Range of Reading Formats, but Most Users Choose to Receive Audio Materials Through the Mail

NLS offers its users several options for receiving both audio and braille  reading materials, and the vast majority of NLS users choose to receive  audio materials, primarily in the form of digital cartridges sent through the  mail. According to NLS administrative data, almost 90  percent of NLS users received digital cartridges during fiscal year 2014,  with the majority playing these cartridges on specialized audio devices  provided by NLS, and a much smaller number using other, commercially- available devices. The precise number of blind and visually impaired people who use  braille in the United States is not known, according to a study on braille by  LOC’s Federal Research Division, as well as officials from two national  organizations that produce braille materials and an assistive technology  company we contacted. NLS’s Efforts to Adopt New Technologies Are Hampered by Limitations in Its Statutory Authority and Analyses of Alternative Approaches

NLS is considering whether to adopt several new technologies for  delivering braille and audio content to its users which have the potential to  improve services and reduce costs. However, the  statute does not allow NLS to use such funds to provide users with  devices for reading electronic braille files. The resulting report, delivered in July 2015, found that the total  annual cost of NLS’s current approach—including the costs for NLS to  produce hard copy braille documents, for network libraries to store them,  and for USPS to deliver them—is about $17 million. Conclusions

The NLS program provides accessible reading materials to those who  cannot read standard print due to visual, physical, and other disabilities. Eighty-five years after the program was established, NLS is providing an  important service to many older and visually-disabled adults, but it is also  missing opportunities to meet the needs of all groups eligible for services. Looking ahead, NLS is considering emerging technologies to meet user  needs. Similarly, absent a comprehensive comparison of adding  text-to-speech materials to its audio collection versus continuing to rely  only on human narration, NLS may not make an informed decision about  whether to move forward with a technology that has the potential to  decrease the time and costs of providing new materials to users. Matter for Congressional Consideration

To give NLS the opportunity to provide braille in a modernized format and  potentially achieve cost savings, Congress should consider amending the  law to allow the agency to use federal funds to provide its users playback  equipment for electronic braille files (i.e., refreshable braille devices). To ensure that it provides all eligible populations access to its services  and that its eligibility requirements are consistent with currently  accepted practices, the Library of Congress should re-examine and  potentially revise its requirement that medical doctors must certify  eligibility for the NLS program for those with a reading disability  caused by organic dysfunction. To ensure funds are directed to the most cost-effective outreach  efforts, NLS should evaluate the effectiveness of its outreach efforts,  including the extent to which different outreach efforts have resulted in  new users. For  example, LOC agreed to reexamine and potentially revise its requirement  that only medical doctors may certify NLS eligibility for people with  reading disabilities to authorize other qualified persons to make such a  certification. LOC also indicated that NLS is exploring the use of text- to-speech technology as a way to expand its offerings, and NLS will  introduce this technology through a pilot program and solicit feedback  from users and network libraries to assess their acceptance of this  approach. In addition, this report will also be available at no  charge on GAO’s website at http://www.gao.gov.
Why GAO Did This Study

NLS, within the Library of Congress (LOC), provides free audio and braille materials for U.S. citizens and residents who cannot read standard print due to visual and other disabilities. In fiscal year 2016, the NLS program received about $50 million in federal funds to provide these materials through a national network of libraries. The House report accompanying the fiscal year 2016 legislative branch appropriations bill included a provision for GAO to review NLS's users and the technology it employs to meet their needs.
GAO examined (1) the characteristics of NLS users and the steps NLS is taking to ensure eligible individuals' access and awareness, and (2) how NLS provides materials and the extent to which it is considering emerging trends in technology. GAO reviewed relevant federal laws and regulations, NLS documents, and administrative data; interviewed NLS officials, librarians from 8 of the 101 network libraries selected for geographic diversity and a range in the number of users, and officials from research and advocacy groups and assistive technology companies; and reviewed literature on NLS-eligible populations and trends in assistive technologies.

What GAO Found

The National Library Service for the Blind and Physically Handicapped (NLS) is primarily used by older adults with visual disabilities, and NLS has taken some steps to ensure eligible users' access to and awareness of available services. In fiscal year 2014, about 70 percent of the program's 430,000 users were age 60 and older and almost 85 percent had visual disabilities, according to the most recent NLS data available at the time of GAO's review. Federal regulations establish eligibility for NLS services for people with a range of disabilities. However, medical doctors must certify eligibility for people with reading disabilities such as dyslexia, which is not required for those with visual or physical disabilities. According to officials from network libraries and other stakeholder groups, the requirement for a doctor's certification is an obstacle to accessing services because of additional steps and costs to the individual. These officials and stakeholders said other professionals, such as special education teachers, are also positioned to certify eligibility for applicants with reading disabilities. GAO has previously noted the importance of disability programs keeping pace with scientific and medical advances. However, the certification requirement has remained largely unchanged for more than 40 years. NLS has taken steps to inform eligible groups about its services, such as partnering with other organizations that serve these groups, developing a new website, and distributing an outreach toolkit to network libraries. However, NLS has no plans to evaluate which outreach efforts have resulted in new users in order to ensure resources are used effectively—a key practice identified previously by GAO.
NLS offers materials to its users in a range of formats, but its efforts to adopt new, potentially cost-saving technologies are hampered by limitations in both its statutory authority and its analyses of alternatives. Users may choose to receive, through the mail, audio materials on digital cartridges or hard copy braille documents. Users may also choose to download audio and braille files from an NLS-supported website. During fiscal year 2014, 86 percent of users chose to receive audio materials on digital cartridges, according to NLS data. NLS officials said they would like to provide users with devices for reading electronic braille files, a faster and less bulky approach than braille documents, and per the agency's July 2015 analysis, could become more cost effective with technological advances. However, federal statute does not authorize NLS to use program funds to acquire and provide braille devices as it does for audio devices, which prevents the agency from taking advantage of technology that has the potential to reduce costs. NLS is also examining new technologies for audio materials but has not fully assessed available alternatives. For example, NLS is considering supplementing its collection of human-narrated audio materials with text-to-speech (i.e., synthetic speech) materials, which some evidence suggests could be produced more quickly and at a lower cost. However, NLS has not comprehensively compared the text-to-speech option to its current approach in order to make a decision on whether to move forward, as called for by GAO best practices for alternatives analysis. Without this analysis, NLS may miss an opportunity to meet its users' needs more efficiently and cost effectively.

What GAO Recommends

Congress should consider authorizing NLS to provide its users devices for reading electronic braille files. In addition, GAO recommends that NLS re-examine its eligibility certification requirements, evaluate its outreach, and assess alternative approaches to delivering audio content. LOC generally agreed with these recommendations.