The Office for Victims of Crime (OVC) established the National Coordination Committee on the American Indian/Alaska Native (AI/AN) Sexual Assault Nurse Examiner-Sexual Assault Response Team (SANE-SART) Initiative Committee in 2011 to advise the U.S. Attorney General of potential solutions to complex issues that arise when federal, tribal, state, and local providers attempt to coordinate a response to victims of sexual violence, including women, children, and men. The 14 Committee members include representatives from diverse national tribal organizations; experts in forensic nursing, tribal courts, Alaska Native issues, and child sexual abuse; and representatives from five federal agencies with responsibility for law enforcement, prosecution, health care, and victim services. The Committee worked for 16 months to consider and develop the recommendations in this document. The recommendations focus on problems and issues and provide suggested actions that will change the way the Federal Government responds to sexual violence in tribal nations. The recommendations address four critical areas: 1) Federal agency coordination and collaboration at the local level; 2) Department of Justice personnel policy changes; 3) Department of Justice grant solicitations and funding; and 4) Public safety and public health. These recommendations will improve the effectiveness and efficiency of the Federal system's response to adult and child victims of sexual violence in tribal nations and ensure that the progress made on this issue will be institutionalized throughout U.S. Department of Justice and lead to lasting, systemic change that will survive transitions between administrations.