It mostly feeds into other negotiations and trade agreements. It is not actionable itself but provides political pressure during almost any other trade agreement.
I don't have first hand knowledge but am led to believe that this report is often used during trade talks to apply pressure to favour USA in negotiations. (as suggested by the above Howard Knopf and Michael Geist)
It mentions the DMCA, however fails to mention a connection between the Special 301 list and DMCAs.