This federal Public Expenditure Review (PER) analyzes the key drivers of Pakistan's fiscal deficits and explores how the Federal Government can regain fiscal and debt sustainability, in accordance with the fiscal rules set forth in the FRDLA 2005. The report builds upon previous studies, provides new and updated analysis, and suggests policy measures for fiscal consolidation that could bring the fiscal deficit to under 3.5 percent of GDP and public debt below 60 percent of GDP, as stipulated by the FRDLA 2005. This is the first PER report since 2010 and it is the first federal-level PER since the implementation of the 18th Constitutional Amendment and the 7th National Finance Commission (NFC) Award in 2010, which represented a major shift in the country's national fiscal architecture. While there have been three provincial PERs since 2010, there has not been a federal-level PER released since then, presenting a substantial knowledge gap.