In this study, we examined relationships between the use of test results and US students' math, reading, and science performance in the Programme for International Student Assessment (PISA) 2009. Based on a literature review, we hypothesized that the 16 items in the PISA school questionnaire, which are related to the use of test results, can be categorized according to 4 factors. We validated this hypothesized factor structure using a confirmatory factor analysis and then obtained composite scores for each factor. As revealed by a multilevel analysis, when student and school demographic variables were controlled for, using test results to hold schools accountable to authority and the public was significantly positively related to students' performance across all 3 subjects. No statistically significant relationship, however, was detected between students' performance and the following uses of test scores: informing parents of their children's performance, providing information for instructional purposes, and evaluating teachers and principals.