This is the third annual report to Congress on Public Law 109-95, the Assistance for Orphans and Other Vulnerable Children in Developing Countries Act of 2005. Public Law 109-95 was signed into law four years ago to respond to the global orphans and vulnerable children crisis. It calls for the U.S. Government (USG) response to the crisis to be comprehensive, coordinated and effective. This report provides: global estimates of the number of highly vulnerable children; a summary of USG assistance programs for highly vulnerable children; a summary of progress coordinating the response among USG agencies; key strategic issues and opportunities; priorities for 2009-2010 - and beyond; and a summary of the results and achievements of USG assistance.