Despite the general perception that it is no longer an important public health problem, lead poisoning remains a serious, preventable environmental health threat to young children that affects neurodevelopmental, intellectual, and cognitive outcomes. One of the key goals of current U.S. public health policy is the elimination of childhood lead poisoning, which will require improvements in lead poisoning prevention; screening, reporting, and surveillance of childhood blood lead levels; and treatment of childhood lead poisoning. The focus of this report is on screening, reporting, and surveillance, which are critical for eliminating lead poisoning, as well as for its prevention and treatment. In pursuit of this goal at the community level, Healthy Home Resources commissioned the RAND Corporation and the University of Pittsburgh Office of Child Development to examine the current status of childhood blood lead level screening, reporting, and surveillance in Allegheny County, Pennsylvania, and to offer recommendations for improving these processes. The findings and recommendations presented in this report are the result of a background study of the relevant literature, a review of existing blood lead level reporting and surveillance databases for Pennsylvania and Allegheny County, and interviews and focus groups.