We recommend that the Indian Health Service enhance Single Audit Compliance Supplement, part 4: "Agency Program Requirements," for Tribes receiving ISDEAA funds from IHS by: establishing special tests and audit procedures in the annual Single Audit Compliance Supplement for all its ISDEAA programs to ensure that the ICPFVPA's requirements are tested during a review of a Tribal health program as part of the single audit, and reviewing the results of those special tests and audit procedures in the annual single audits for Tribal health programs to help assess whether Tribes are complying with ICPFVPA requirements to conduct background investigations and meet minimum standards of character.