    [Appendix]
    [Detailed Budget Estimates by Agency]
    [Department of Health and Human Services, except Social Security]
    [From the U.S. Government Printing Office, www.gpo.gov]

                         THE BUDGET FOR FISCAL YEAR 1998

    [[Page 491]]

                     DEPARTMENT OF HEALTH AND HUMAN SERVICES

                          FOOD AND DRUG ADMINISTRATION

                                  Federal Funds

    General and special funds:

                              Salaries and Expenses

        For necessary expenses of the Food and Drug Administration,
    including hire and purchase of passenger motor vehicles; for rental of
    special purpose space in the District of Columbia or elsewhere; and for
    miscellaneous and emergency expenses of enforcement activities,
    authorized and approved by the Secretary and to be accounted for solely
    on the Secretary's certificate, not to exceed $25,000; [$907,499,000, of
    which not to exceed $87,528,000 in fees pursuant to section 736 of the
    Federal Food, Drug, and Cosmetic Act may be credited to this
    appropriation and remain available until expended: Provided, That fees
    derived from applications received during fiscal year 1997 shall be
    subject to the fiscal year 1997 limitation: Provided further, That none
    of these funds shall be used to develop, establish, or operate any
    program of user fees authorized by 31 U.S.C. 9701] $750,922,000.
        [In addition, fees pursuant to section 354 of the Public Health
    Service Act may be credited to this account, to remain available until
    expended.]
        In addition, fees pursuant to section 801 of the Federal Food, Drug,
    and Cosmetic Act may be credited to this account, to remain available
    until expended.

                            Buildings and Facilities

        For plans, construction, repair, improvement, extension, alteration,
    and purchase of fixed equipment or facilities of or used by the Food and
    Drug Administration, where not otherwise provided, [$21,350,000]
    $22,900,000, to remain available until expended (7 U.S.C. 2209b).

                              Rental Payments (FDA)

                         (including transfers of funds)

        For payment of space rental and related costs pursuant to Public Law
    92-313 for programs and activities of the Food and Drug Administration
    which are included in this Act, $46,294,000: Provided, That in the event
    the Food and Drug Administration should require modification of space
    needs, a share of the salaries and expenses appropriation may be
    transferred to this appropriation, or a share of this appropriation may
    be transferred to the salaries and expenses appropriation, but such
    transfers shall not exceed 5 percent of the funds made available for
    rental payments (FDA) to or from this account. (Agriculture, Rural
    Development, Food and Drug Administration, and Related Agencies
    Appropriations Act, 1997.)

                  Unavailable Collections (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9911-0-1-554      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
        Balance, start of year:
    01.99 Balance, start of year............
        Receipts:
    02.01 User fees, FDA, legislative
            proposal........................                                 237
        Appropriation:
    05.01 Salaries and expenses, legislative
            proposal........................                                -237
    07.99 Total balance, end of year........
    ---------------------------------------------------------------------------

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9911-0-1-554      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
          Direct program:

    00.01   Foods...........................         201         200         174
    00.02   Drugs...........................         326         329         296
    00.03   Devices and radiological
              products......................         144         147         107
    00.04   National center for
              toxicological research........          31          31          31
    00.05   Tobacco.........................           5           5          34
    00.06   Other activities................          90          86          86
    00.07   Other rent and rent related
              activities....................          22          23          23
    00.08   Rental payments.................          46          46          46
    00.09   Buildings and facilities........          25          40          23
                                               ---------   ---------  ----------
    00.91     Total direct program..........         890         907         820
    01.01 Reimbursable program..............         109         114          13
                                               ---------   ---------  ----------
    10.00   Total obligations...............         999       1,021         833
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested
            balance.........................          67          58          39
    22.00 New budget authority (gross)......         986       1,002         833
    22.22 Unobligated balance transferred
            from other accounts.............           4           1
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......       1,057       1,061         872
    23.95 New obligations...................        -999      -1,021        -833
    24.40 Unobligated balance available, end
            of year: Uninvested balance.....          58          39          39
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................         877         888         820
          Permanent:

    68.00   Spending authority from
              offsetting collections:
              Offsetting collections (cash).         109         114          13
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................         986       1,002         833
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Appropriation         279         290         273
    73.10 New obligations...................         999       1,021         833
    73.20 Total outlays (gross).............        -975      -1,032        -865
    73.40 Adjustments in expired accounts...         -13          -6
    74.40 Unpaid obligations, end of year:
            Obligated balance: Appropriation         290         273         241
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority         682         684         631
    86.93 Outlays from current balances.....         184         234         221
    86.97 Outlays from new permanent
            authority.......................         109         114          13
    86.98 Outlays from permanent balances...
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........         975       1,032         865
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

            Offsetting collections (cash)
                from:
    88.00     Federal sources...............         -14         -11         -11
    88.40     Non-Federal sources...........         -95        -103          -2
                                               ---------   ---------  ----------
    88.90       Total, offsetting
                  collections (cash)........        -109        -114         -13
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................         877         888         820
    90.00 Outlays...........................         866         918         852
    ---------------------------------------------------------------------------

                            [In millions of dollars]

                                            1996         1997        1998
    Distribution of budget authority by
        account:
      Salaries and expenses.............         818         820         751
      Rental payments (FDA).............          46          46          46
      Buildings and facilities..........          12          21          23
    Distribution of outlays by account:
      Salaries and expenses.............         788         852         785
      Rental payments (FDA).............          66          49          46
      Buildings and facilities..........          12          17          21

                     Summary of Budget Authority and Outlays

                            (in millions of dollars)

                                         1996 actual  1997 est.   1998 est.
    Enacted/requested:
      Budget Authority..................         877         888         820
      Outlays...........................         866         918         852
    Legislative proposal, subject to
        PAYGO:
      Budget Authority..................                                 237
      Outlays...........................                                 237
                                        ------------------------------------

    [[Page 492]]

    Total:
      Budget Authority..................         877         888       1,057
      Outlays...........................         866         918       1,089
                                        ====================================

        The Food and Drug Administration (FDA) administers laws concerning
    misbranded and adulterated foods, drugs, human biologics, medical
    devices, cosmetics, and human-made sources of radiation. The Budget
    includes $750.9 million for Salaries and Expenses, which includes
    funding for new food safety initiatives and tobacco regulation. In
    addition, the Budget includes $244 million for user fees, an increase of
    $136 million in user fees over FY 1997, which will be used to finance
    FDA activities. Of the $244 million in user fees, $237 million consists
    of reauthorized and new user fees, which are represented in the
    legislative proposal schedule. The buildings and facilities
    appropriation of $22.9 million provides funds for projects related to
    the repair, construction, alteration, and improvement of all buildings
    and facilities of FDA, while the rental payments appropriation of $46.3
    million provides funds for payment of GSA space rental and related
    costs.

      Comparable Presentation of Budget Authority Under New User Fee Policy

                            (in millions of dollars)

                                         1996 actual  1997 est.   1998 est.
    Enacted/requested:
      Budget Authority..................         877         888         820
    User Fees collected/requested:
      Budget Authority..................         103         108         244
          Total:
      Budget Authority..................         980         996       1,064

        As shown in the table above, the total resources (budget authority
    plus user fees) available to FDA increase from $996 million in FY 1997
    to $1.06 billion in FY 1998, a six percent increase.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9911-0-1-554      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

          Direct obligations:

            Personnel compensation:
    11.1      Full-time permanent...........         405         423         379
    11.3      Other than full-time permanent          28          30          27
    11.5      Other personnel compensation..          16          17          15
                                               ---------   ---------  ----------
    11.9        Total personnel compensation         449         470         421
    12.1    Civilian personnel benefits.....          98         102          91
    21.0    Travel and transportation of
              persons.......................          17          16          12
    22.0    Transportation of things........           1           1           1
    23.1    Rental payments to GSA..........          42          42          42
    23.2    Rental payments to others.......           6           6           4
    23.3    Communications, utilities, and
              miscellaneous charges.........          23          21          16
    24.0    Printing and reproduction.......           3           3           2
    25.1    Advisory and assistance services          10           7           5
    25.2    Other services..................          28          51          83
    25.3    Purchases of goods and services
              from Government accounts......          49          35          25
    25.4    Operation and maintenance of
              facilities....................          24          21          16
    25.5    Research and development
              contracts.....................          30          28          20
    25.7    Operation and maintenance of
              equipment.....................          34          25          17
    26.0    Supplies and materials..........          19          18          13
    31.0    Equipment.......................          34          32          23
    32.0    Land and structures.............           1          10          15
    41.0    Grants, subsidies, and
              contributions.................          20          18          13
    42.0    Insurance claims and indemnities           2           1           1
                                               ---------   ---------  ----------
    99.0      Subtotal, direct obligations..         890         907         820
    99.0  Reimbursable obligations..........         109         114          13
                                               ---------   ---------  ----------
    99.9    Total obligations...............         999       1,021         833
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-9911-0-1-554      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
        Direct:
          Total compensable workyears:

    1001    Full-time equivalent employment.       8,459       8,475       7,353
    1005    Full-time equivalent of overtime
              and holiday hours.............          87          87          87
        Reimbursable:
    2001  Total compensable workyears: Full-
            time equivalent employment......         671         663          28
    ---------------------------------------------------------------------------

                              Salaries and Expenses

                    (Legislative proposal, subject to PAYGO)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9911-4-1-554      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
          Direct program:

    00.01   Foods...........................                                  47
    00.02   Drugs...........................                                 131
    00.03   Devices and radiological
              products......................                                  59
                                               ---------   ---------  ----------
    10.00   Total obligations...............                                 237
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......                                 237
    23.95 New obligations...................                                -237
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    40.25 Appropriation (special fund,
            indefinite).....................                                 237
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    73.10 New obligations...................                                 237
    73.20 Total outlays (gross).............                                -237
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority                                 237
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................                                 237
    90.00 Outlays...........................                                 237
    ---------------------------------------------------------------------------

        This legislative proposal seeks $237 million in user fees to finance
    FDA activities. These user fees build upon the successful implementation
    of the Prescription Drug User Fee Act (PDUFA) of 1992, which authorized
    the collection of fees paid by the pharmaceutical industry to expedite
    FDA's review of human drug applications and the Mammography Quality
    Standards Act (MQSA), which authorized the collection of fees for the
    inspection of mammography facilities. The Budget includes continued
    collection of PDUFA and MQSA fees, as well as fees for medical device
    reviews, animal drug approvals, import inspections, food additive
    petition reviews, generic/over-the-counter drug applications, and fees
    for postmarket surveillance of products.

        This is one of several proposals in the budget to charge fees to
    users directly availing themselves of, or subject to, a government
    service, program, or activity, in order to cover the government's costs.
    Legislation will be proposed to authorize the fees and, upon enactment
    of the authorization, a budget amendment to the current appropriations
    language will be proposed to make the fees available for expenditure.
    Because the current requirements of the Budget Enforcement Act of 1990
    make it difficult to fund discretionary programs with receipts that are
    not authorized in appropriations acts, the Administration is proposing a
    change in the requirements to facilitate the enactment of proposals such
    as this one.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9911-4-1-554      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

          Personnel compensation:

    11.1    Full-time permanent.............                                 128

    [[Page 493]]

    11.3    Other than full-time permanent..                                   5
                                               ---------   ---------  ----------
    11.9      Total personnel compensation..                                 133
    12.1  Civilian personnel benefits.......                                  28
    21.0  Travel and transportation of
            persons.........................                                   4
    23.1  Rental payments to GSA............                                   1
    23.3  Communications, utilities, and
            miscellaneous charges...........                                   4
    24.0  Printing and reproduction.........                                   1
    25.1  Advisory and assistance services..                                   3
    25.2  Other services....................                                  18
    25.3  Purchases of goods and services
            from Government accounts........                                   7
    25.4  Operation and maintenance of
            facilities......................                                   4
    25.5  Research and development contracts                                  11
    25.7  Operation and maintenance of
            equipment.......................                                   9
    26.0  Supplies and materials............                                   4
    31.0  Equipment.........................                                  10
                                               ---------   ---------  ----------
    99.9    Total obligations...............                                 237
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-9911-4-1-554      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
    1001  Total compensable workyears: Full-
            time equivalent employment......                               1,757
    ---------------------------------------------------------------------------

    Public enterprise funds:

               Revolving Fund for Certification and Other Services

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-4309-0-3-554      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Color additives...................           3           3           3
    00.02 Insulin...........................           1           1           1
                                               ---------   ---------  ----------
    10.00   Total obligations...............           4           4           4
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.90 Unobligated balance available,
            start of year: Fund balance.....           3           4           4
    22.00 New budget authority (gross)......           5           5           5
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......           8           9           9
    23.95 New obligations...................          -4          -4          -4
    24.90 Unobligated balance available, end
            of year: Fund balance...........           4           4           5
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    68.00 Spending authority from offsetting
            collections (gross): Offsetting
            collections (cash)..............           5           5           5
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.90 Unpaid obligations, start of year:
            Obligated balance: Fund balance.           1           1
    73.10 New obligations...................           4           4           4
    73.20 Total outlays (gross).............          -4          -5          -5
    74.90 Unpaid obligations, end of year:
            Obligated balance: Fund balance.           1
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new permanent
            authority.......................           4           5           5
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.40   Offsetting collections (cash)
              from: Non-Federal sources.....          -5          -5          -5
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................
    90.00 Outlays...........................
    ---------------------------------------------------------------------------

        FDA certifies batches of insulin and color additives for use in
    foods, drugs, and cosmetics. It also lists color additives for use in
    foods, drugs, medical devices, and cosmetics (21 U.S.C. 346a, 356, 357,
    376). These services are financed wholly by fees paid by the industries
    affected.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-4309-0-3-554      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
    11.1  Personnel compensation: Full-time
            permanent.......................           2           2           2
    12.1  Civilian personnel benefits.......           1           1           1
    23.1  Rental payments to GSA............           1           1           1
    99.0  Subtotal, reimbursable obligations           4           4           4
                                               ---------   ---------  ----------
    99.9    Total obligations...............           4           4           4
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-4309-0-3-554      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
    2001  Total compensable workyears: Full-
            time equivalent employment......          42          42          42
    ---------------------------------------------------------------------------

                  HEALTH RESOURCES AND SERVICES ADMINISTRATION

                                  Federal Funds

    General and special funds:

                          Health Resources and Services

        For carrying out titles II, III, VII, VIII, X, XII, XVI, XIX, and
    XXVI of the Public Health Service Act, section 427(a) of the Federal
    Coal Mine Health and Safety Act, title V of the Social Security Act, the
    Health Care Quality Improvement Act of 1986, as amended, and the Native
    Hawaiian Health Care Act of 1988, as amended, [$3,405,019,000]
    $3,266,479,000, of which [$297,000] $225,000 shall remain available
    until expended for interest subsidies on loan guarantees made prior to
    fiscal year 1981 under part B of title VII of the Public Health Service
    Act: Provided, That the Division of Federal Occupational Health may
    utilize personal services contracting to employ professional management/
    administrative and occupational health professionals: Provided further,
    That of the funds made available under this heading, [$828,000] $500,000
    shall be available until expended for facilities renovations at the
    Gillis W. Long Hansen's Disease Center: Provided further, That in
    addition to fees authorized by section 427(b) of the Health Care Quality
    Improvement Act of 1986, fees shall be collected for the full disclosure
    of information under the Act sufficient to recover the full costs of
    operating the National Practitioner Data Bank, and shall remain
    available until expended to carry out that Act: Provided further, That
    no more than $5,000,000 is available for carrying out the provisions of
    Public Law 104-73: [Provided further, That of the funds made available
    under this heading, $198,452,000 shall be for the program under title X
    of the Public Health Service Act to provide for voluntary family
    planning projects: Provided further, That amounts provided to said
    projects under such title shall not be expended for abortions, that all
    pregnancy counseling shall be nondirective, and that such amounts shall
    not be expended for any activity (including the publication or
    distribution of literature) that in any way tends to promote public
    support or opposition to any legislative proposal or candidate for
    public office:] Provided further, That $167,000,000 shall be for State
    AIDS Drug Assistance Programs authorized by section 2616 of the Public
    Health Service Act [and shall be distributed to States as authorized by
    section 2618(b)(2) of such Act]: Provided further, That notwithstanding
    any other provision of law, funds made available under this heading may
    be used to continue operating the Council on Graduate Medical Education
    established by section 301 of Public law 102-408: Provided further,
    That[, of the funds made available under this heading, not more than
    $8,000,000 shall be made available and shall remain available until
    expended for loan guarantees for loans made by non-Federal lenders for
    the construction, renovation, and modernization of medical facilities
    that are owned and operated by health centers funded under part A of
    title XVI of the Public Health Service Act as amended, and, subject to
    authorization, for loans made to health centers for the costs of
    developing and operating managed care networks or plans, and that such
    funds be available to subsidize guarantees of total loan principal in an
    amount not to exceed $80,000,000: Provided further, That notwithstanding
    section 502(a)(1) of the Social Security Act, not to exceed $103,609,000
    is available for carrying out special projects of regional and national
    significance pursuant to section 501(a)(2) of such Act] user fees to be
    collected by the Secretary pursuant to 31 U.S.C. 9701 related to

    [[Page 494]]

    activities authorized by section 340B(a)(8) of the Public Health Service
    Act shall be available to fund such activities and shall remain
    available until expended. (Department of Health and Human Services
    Appropriations Act, 1997.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0350-0-1-550      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
          Direct program:

    00.01   Consolidated health centers.....         753         791         805
    00.02   National Health Service Corps...          37          37          37
    00.03   National Health Service Corps
              recruitment...................          75          78          78
    00.04   Hansen's disease center.........          17          17
    00.05   Payment to Hawaii for the
              treatment of Hansen's disease.           2           2
    00.06   Buildings and facilities........           1           1
    00.07   Hansen's disease services
              cluster.......................                                  17
    00.08   Black lung clinics..............           4           4           2
    00.09   Alzheimer's demonstration grants           4           6
    00.10   Nursing loan repayment..........           2           2
    00.11   Health professions curriculum
              assistance....................         257         290
    00.12   Health professions clusters.....                                 130
    00.13   Maternal and child health block
              grant.........................         678         681         681
    00.14   Healthy start...................          93          96          96
    00.15   Emergency medical services for
              children......................          11          13          12
    00.16   Organ transplantation...........           2           2           4
    00.17   Bone marrow donor registry......          15          15          15
    00.18   Health care facilities..........          18          13
    00.19   Family planning.................         193         198         203
    00.20   Program management..............         112         113         111
    00.21   Rural health policy development.          11           9           9
    00.22   Rural health outreach...........          28          28          25
    00.23   HIV.............................         757         996       1,036
    00.24   Malpractice claims fund.........                       1           1
    00.25   LA emergency funds..............           4
    00.26   Abstinence education............                                  50
    00.27   Other HRSA programs.............           1           2
    00.28   CHC loan guarantee program
              account.......................                       5           1
                                               ---------   ---------  ----------
    00.91     Total direct program..........       3,075       3,400       3,313
    01.01 Reimbursable obligations (cash)...         140          81          79
                                               ---------   ---------  ----------
    10.00   Total obligations...............       3,215       3,481       3,392
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested
            balance.........................          22          29          27
    22.00 New budget authority (gross)......       3,218       3,479       3,392
    22.22 Unobligated balance transferred
            from other accounts.............           4
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......       3,244       3,508       3,419
    23.95 New obligations...................      -3,215      -3,481      -3,392
    24.40 Unobligated balance available, end
            of year: Uninvested balance.....          29          27          28
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................       3,077       3,405       3,266
          Permanent:

    60.00   Appropriation...................                                  50
    68.00   Spending authority from
              offsetting collections:
              Offsetting collections (cash).         141          74          76
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................       3,218       3,479       3,392
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Appropriation       3,053       2,299       2,454
    73.10 New obligations...................       3,215       3,481       3,392
    73.20 Total outlays (gross).............      -3,966      -3,326      -3,413
    73.40 Adjustments in expired accounts...          -3
    74.40 Unpaid obligations, end of year:
            Obligated balance: Appropriation       2,299       2,454       2,431
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority       1,271       1,362       1,306
    86.93 Outlays from current balances.....       2,554       1,890       2,011
    86.97 Outlays from new permanent
            authority.......................         141          74          96
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........       3,966       3,326       3,413
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

            Offsetting collections (cash)
                from:
    88.00     Federal sources...............        -133         -68         -68
    88.40     Non-Federal sources...........          -8          -6          -8
                                               ---------   ---------  ----------
    88.90       Total, offsetting
                  collections (cash)........        -141         -74         -76
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................       3,077       3,405       3,316
    90.00 Outlays...........................       3,825       3,252       3,337
    ---------------------------------------------------------------------------

                              [Dollars in millions]

                                            1996         1997        1998
    Distribution of budget authority by
        account:
      Health resources and services.....       3,072       3,400       3,311
      Health centers malpractice claims.           5           5           5
    Distribution of outlays by account:
      Health resources and services.....       3,820       3,247       3,332
      Health centers malpractice claims.           5           5           5

                   Status of Direct Loans (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0350-0-1-550      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
        Cumulative balance of direct loans
                    outstanding:
    1210  Outstanding, start of year........         798         800         800
    1231  Disbursements: Direct loan
            disbursements...................          25          20
    1251  Repayments: Repayments and
            prepayments.....................         -18         -18         -18
          Write-offs for default:

    1263    Direct loans....................          -1          -1          -1
    1264    Other adjustments, net..........          -4          -1          -1
                                               ---------   ---------  ----------
    1290    Outstanding, end of year........         800         800         780
    ---------------------------------------------------------------------------

                 Status of Guaranteed Loans (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0350-0-1-550      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
        Position with respect to appropriations act
                    limitation on commitments:
    2111  Limitation on guaranteed loans
            made by private lenders.........                      80
                                               ---------   ---------  ----------
    2150    Total guaranteed loan
              commitments...................                      80
    ----------------------------------------------------------------------------

        Cumulative balance of guaranteed loans
                    outstanding:
    2210  Outstanding, start of year........          10          10          76
    2231  Disbursements of new guaranteed
            loans...........................                      67          13
    2251  Repayments and prepayments........                      -1
                                               ---------   ---------  ----------
    2290    Outstanding, end of year........          10          76          89
    ----------------------------------------------------------------------------

        Memorandum:
    2299  Guaranteed amount of guaranteed
            loans outstanding, end of year..          10          76          89
    ---------------------------------------------------------------------------

    Summary of Loan Levels, Subsidy Budget Authority and Outlays by Program (in
                                millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0350-0-1-550      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
        Guaranteed loan levels supportable by subsidy
                    budget authority:
    2150  Loan guarantee levels.............                      23           5
    2150  Loan guarantee levels.............                      22           4
    2150  Loan guarantee levels.............                      22           4
                                               ---------   ---------  ----------
    2159    Total loan guarantee levels.....                      67          13
        Guaranteed loan subsidy (in percent):
    2320  Subsidy rate......................                    5.41        5.41
    2320  Subsidy rate......................                   13.26       13.26
    2320  Subsidy rate......................                    4.35        4.35
                                               ---------   ---------  ----------
    2329    Weighted average subsidy rate...                    7.67        7.67
        Guaranteed loan subsidy budget authority:
    2330  Subsidy budget authority..........                       2           1
    2330  Subsidy budget authority..........                       1
    2330  Subsidy budget authority..........                       2
                                               ---------   ---------  ----------
    2339    Total subsidy budget authority..                       5           1
        Guaranteed loan subsidy outlays:
    2340  Subsidy outlays...................                       2           1
    2340  Subsidy outlays...................                       1
    2340  Subsidy outlays...................                       2
                                               ---------   ---------  ----------
    2349    Total subsidy outlays...........                       5           1
    ---------------------------------------------------------------------------

    [[Page 495]]

        Activities displayed here support categorical health resources and
    services grants and the Medical Malpractice Claims Fund, which pays
    malpractice claims filed against employees of federally-supported health
    centers.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0350-0-1-550      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

          Direct obligations:

            Personnel compensation:
    11.1      Full-time permanent...........          87          91          93
    11.3      Other than full-time permanent           2           2           2
    11.5      Other personnel compensation..           4           3           3
                                               ---------   ---------  ----------
    11.9        Total personnel compensation          93          96          98
    12.1    Civilian personnel benefits.....          22          22          23
    13.0    Benefits for former personnel...           1           1
    21.0    Travel and transportation of
              persons.......................           2           2           2
    23.1    Rental payments to GSA..........           7           8           9
    23.3    Communications, utilities, and
              miscellaneous charges.........           4           4           4
    24.0    Printing and reproduction.......           1           1           1
    25.1    Advisory and assistance services          10          11          14
    25.2    Other services..................          39          37          36
    25.3    Purchases of goods and services
              from Government accounts......          67          73          62
    26.0    Supplies and materials..........           2           2           2
    31.0    Equipment.......................           2           3           3
    41.0    Grants, subsidies, and
              contributions.................       2,825       3,139       3,058
    42.0    Insurance claims and indemnities                       1           1
                                               ---------   ---------  ----------
    99.0      Subtotal, direct obligations..       3,075       3,400       3,313
    99.0  Reimbursable obligations..........         140          81          79
                                               ---------   ---------  ----------
    99.9    Total obligations...............       3,215       3,481       3,392
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-0350-0-1-550      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
        Direct:
          Total compensable workyears:

    1001    Full-time equivalent employment.       1,534       1,563       1,563
    1005    Full-time equivalent of overtime
              and holiday hours.............          10          10          10
    1011    Exempt Full-time equivalent
              employment....................         145         137         137
        Reimbursable:
    2001  Total compensable workyears: Full-
            time equivalent employment......         304         170         170
        Allocation account:
    3001  Total compensable workyears: Full-
            time equivalent employment......           3           3           3
    ---------------------------------------------------------------------------

                           Vaccine Injury Compensation

        [For payment of claims resolved by the United States Court of
    Federal Claims related to the administration of vaccines before October
    1, 1988, $110,000,000, to remain available until expended.] (Department
    of Health and Human Services Appropriations Act, 1997.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0320-0-1-551      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    10.00 Total obligations (object class
            42.0)...........................          74          75          75
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested
            balance.........................          69         106         141
    22.00 New budget authority (gross)......         110         110
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......         179         216         141
    23.95 New obligations...................         -74         -75         -75
    24.40 Unobligated balance available, end
            of year: Uninvested balance.....         106         141          68
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    40.05 Appropriation (indefinite)........         110         110
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Appropriation           2                       7
    73.10 New obligations...................          74          75          75
    73.20 Total outlays (gross).............         -76         -68         -68
    74.40 Unpaid obligations, end of year:
            Obligated balance: Appropriation                       7          14
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority           5
    86.93 Outlays from current balances.....          71          68          68
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........          76          68          68
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................         110         110
    90.00 Outlays...........................          76          68          68
    ---------------------------------------------------------------------------

        The Vaccine Improvement Program was established pursuant to Public
    Law 99-660 and Public Law 100-203, and serves as a source of funds to
    pay claims for compensation for vaccine related injury or death. Payment
    of claims associated with vaccine related injury or death occurring
    before October 1, 1988 are financed from the General Fund and are
    reflected in this account. Given sufficient carry-over funds from prior
    years' appropriations to pay for the balance of the pre-1988 backlog of
    claims yet to be adjudicated, no appropriation is requested in FY 1998
    to cover payment of pre-1988 claims. Payment of claims associated with
    vaccine related injury or death occurring after October 1, 1988 are
    reflected in the Vaccine Improvement Trust Fund account.

    Credit accounts:

                 Health Center Guaranteed Loan Financing Account

                 Status of Guaranteed Loans (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-4442-0-3-551      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
        Position with respect to appropriations act
                    limitation on commitments:
    2111  Limitation on guaranteed loans
            made by private lenders.........                      80
                                               ---------   ---------  ----------
    2150    Total guaranteed loan
              commitments...................                      80
    ----------------------------------------------------------------------------

        Cumulative balance of guaranteed loans
                    outstanding:
    2210  Outstanding, start of year........                                  67
    2231  Disbursements of new guaranteed
            loans...........................                      67           7
    2261  Adjustments: Terminations for
            default that result in loans
            receivable......................                                  -1
                                               ---------   ---------  ----------
    2290    Outstanding, end of year........                      67          73
    ----------------------------------------------------------------------------

        Memorandum:
    2299  Guaranteed amount of guaranteed
            loans outstanding, end of year..                      67          73
    ----------------------------------------------------------------------------

        Addendum:
          Cumulative balance of defaulted guaranteed
              loans that result in loans receivable:

    2310    Outstanding, start of year......
    2331    Disbursements for guaranteed
              loan claims...................                                   1
    2351    Repayments of loans receivable..
                                               ---------   ---------  ----------
    2390      Outstanding, end of year......                                   1
    ---------------------------------------------------------------------------

        P.L. 104-299 and P.L. 104-208 authorize HRSA to guarantee up to $80
    million in private loans to Health Centers for the costs of developing
    and operating managed care networks or plans and for the construction,
    renovation and modernization of medical facilities. Since this new
    program will not begin to operate until late into FY 1997, HRSA will use
    this $80 million loan guarantee limit over FY 1997 and FY 1998. As
    required by the Federal Credit Reform Act of 1990, this Financing
    Account records all cash flows to and from the Government resulting from
    the Health Center Loan Guarantee Program. The Program Account for this
    activity is displayed in the Health Resources and Services account (75-
    0350) as a line in the Program and Financing Schedule.

    [[Page 496]]

                                 Balance Sheet (in millions of dollars)

    -----------------------------------------------------------------------------------------------
    Identification code   75-4442-0-3-551    1995 actual    1996 actual     1997 est.      1998 est.
    -----------------------------------------------------------------------------------------------
        ASSETS:
          Investments in US securities:

    1106    Federal assets: Receivables, net                                       80
          Net value of assets related to
              post-1991 acquired defaulted
              guaranteed loans receivable:

    1501    Defaulted guaranteed loans
              receivable, gross.............                                                       1
                                            ------------ --------------  ------------  -------------
    1599      Net present value of assets
                related to defaulted
                guaranteed loans............                                                       1
                                            ------------ --------------  ------------  -------------
    1999    Total assets....................                                       80              1
        LIABILITIES:
    2204  Non-Federal liabilities:
            Liabilities for loan guarantees.                                       80
                                            ------------ --------------  ------------  -------------
    2999    Total liabilities...............                                       80
                                            ------------ --------------  ------------  -------------
    4999  Total liabilities and net position                                       80
    -----------------------------------------------------------------------------------------------

    Health [Education Assistance Loans Program] Professions Graduate Student
                         Loan Insurance Program Account

        For the cost of guaranteed loans, such sums as may be necessary to
    carry out the purpose of the program, as authorized by title VII of the
    Public Health Service Act, as amended: Provided, That such costs,
    including the cost of modifying such loans, shall be as defined in
    section 502 of the Congressional Budget Act of 1974: Provided further,
    That these funds are available to subsidize gross obligations for the
    total loan principal any part of which is to be guaranteed at not to
    exceed [$140,000,000] $85,000,000. In addition, for administrative
    expenses to carry out the guaranteed loan program, $2,688,000.

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0340-0-1-552      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.02 Guaranteed loan subsidy...........                                   1
    00.09 Administrative expenses subject to
            limitation......................           4           3           4
                                               ---------   ---------  ----------
    10.00   Total obligations...............           4           3           5
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......           4           3           5
    23.95 New obligations...................          -4          -3          -5
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................           3           3           3
          Permanent:

    60.05   Appropriation (indefinite)......                                   1
    62.00   Transferred from other accounts.           1                       1
                                               ---------   ---------  ----------
    63.00     Appropriation (total).........           1                       2
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................           4           3           5
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Appropriation           1           2
    73.10 New obligations...................           4           3           5
    73.20 Total outlays (gross).............          -3          -5          -5
    74.40 Unpaid obligations, end of year:
            Obligated balance: Appropriation           2
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority           3           3           3
    86.97 Outlays from new permanent
            authority.......................                                   2
    86.98 Outlays from permanent balances...                       2
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........           3           5           5
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................           4           3           5
    90.00 Outlays...........................           3           5           5
    ---------------------------------------------------------------------------

    Summary of Loan Levels, Subsidy Budget Authority and Outlays by Program (in
                                millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0340-0-1-552      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
        Guaranteed loan levels supportable by subsidy
                    budget authority:
    2150  Loan guarantee levels.............         210         140          85
                                               ---------   ---------  ----------
    2159    Total loan guarantee levels.....         210         140          85
        Guaranteed loan subsidy (in percent):
    2320  Subsidy rate......................        0.34        0.34        1.09
                                               ---------   ---------  ----------
    2329    Weighted average subsidy rate...        0.34        0.34        1.09
        Guaranteed loan subsidy budget authority:
    2330  Subsidy budget authority..........           1                       1
                                               ---------   ---------  ----------
    2339    Total subsidy budget authority..           1                       1
        Guaranteed loan subsidy outlays:
    2340  Subsidy outlays...................           1                       1
                                               ---------   ---------  ----------
    2349    Total subsidy outlays...........           1                       1
    ---------------------------------------------------------------------------

        The Health Education Assistance Loan (HEAL) program guarantees loans
    from private lenders to health professions students to help pay for the
    costs of their training. As required by the Federal Credit Reform Act of
    1990, this account records, for the HEAL program, the subsidy costs
    associated with HEAL loan guarantees committed in 1992 and beyond
    (including modifications of HEAL loan guarantees that resulted from
    obligations or commitments in any year), as well as administrative
    expenses of the program. The subsidy amounts are estimated on a present
    value basis; the administrative expenses are estimated on a cash basis.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0340-0-1-552      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
    11.1  Personnel compensation: Full-time
            permanent.......................           2           2           2
    25.2  Other services....................           2           1           2
    41.0  Grants, subsidies, and
            contributions...................                                   1
                                               ---------   ---------  ----------
    99.9    Total obligations...............           4           3           5
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-0340-0-1-552      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
        Total compensable workyears:
    1001  Full-time equivalent employment...          20          20          20
    1011  Exempt Full-time equivalent
            employment......................           6           6           6
    ---------------------------------------------------------------------------

       Health Professions Graduate Student Loan Guaranteed Loan Financing
                                     Account

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-4304-0-3-552      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    10.00 Total obligations.................           6           7          11
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.90 Unobligated balance available,
            start of year: Fund balance.....         202         226         250
    22.00 New financing authority (gross)...          30          31          27
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......         232         257         277
    23.95 New obligations...................          -6          -7         -11
    24.90 Unobligated balance available, end
            of year: Fund balance...........         226         250         268
    ----------------------------------------------------------------------------

        New financing authority (gross), detail:
    61.00 Transferred to other accounts.....          -1                      -1
    68.00 Spending authority from offsetting
            collections: Offsetting
            collections (cash)..............          31          31          28
                                               ---------   ---------  ----------

    [[Page 497]]

    70.00   Total new financing authority
              (gross).......................          30          31          27
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    73.10 New obligations...................           6           7          11
    73.20 Total financing disbursements
            (gross).........................          -6          -7         -11
    87.00 Total financing disbursements
            (gross).........................           6           7          11
    ----------------------------------------------------------------------------

        Offsets:
          Against gross financing authority and
              financing disbursements:

            Offsetting collections (cash)
                from:
    88.00     Federal sources...............                                  -1
    88.25     Interest on uninvested funds..         -15         -20         -21
              Non-Federal sources:
    88.40       Premium income..............         -16         -10          -5
    88.40       Recoveries of defaulted
                  loans.....................                                  -1
    88.40       Below threshold.............                      -1
                                               ---------   ---------  ----------
    88.90       Total, offsetting
                  collections (cash)........         -31         -31         -28
    ----------------------------------------------------------------------------

        Net financing authority and financing
            disbursements:
    89.00 Financing authority...............          -1                      -1
    90.00 Financing disbursements...........         -25         -24         -17
    ---------------------------------------------------------------------------

                 Status of Guaranteed Loans (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-4304-0-3-552      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
        Position with respect to appropriations act
                    limitation on commitments:
    2111  Limitation on guaranteed loans
            made by private lenders.........         210         140          85
                                               ---------   ---------  ----------
    2150    Total guaranteed loan
              commitments...................         210         140          85
    ----------------------------------------------------------------------------

        Cumulative balance of guaranteed loans
                    outstanding:
    2210  Outstanding, start of year........       1,163       1,366       1,498
    2231  Disbursements of new guaranteed
            loans...........................         210         140          85
          Adjustments:

    2261    Terminations for default that
              result in loans receivable....          -6          -7         -11
    2263    Terminations for default that
              result in claim payments......          -1          -1          -1
                                               ---------   ---------  ----------
    2290    Outstanding, end of year........       1,366       1,498       1,571
    ----------------------------------------------------------------------------

        Memorandum:
    2299  Guaranteed amount of guaranteed
            loans outstanding, end of year..       1,366       1,498       1,571
    ----------------------------------------------------------------------------

        Addendum:
          Cumulative balance of defaulted guaranteed
              loans that result in loans receivable:

    2310    Outstanding, start of year......           1           7          14
    2331    Disbursements for guaranteed
              loan claims...................           6           7          11
    2351    Repayments of loans receivable..                                  -1
                                               ---------   ---------  ----------
    2390      Outstanding, end of year......           7          14          24
    ---------------------------------------------------------------------------

        As required by the Federal Credit Reform Act of 1990, this non-
    budgetary account records all cash flows to and from the Government
    resulting from Health Education Assistance Loan (HEAL) guarantees
    committed in 1992 and beyond (including modifications of loan guarantees
    that resulted from commitments in any year). The amounts in this account
    are a means of financing and are not included in the budget totals.

                                 Balance Sheet (in millions of dollars)

    -----------------------------------------------------------------------------------------------
    Identification code   75-4304-0-3-552    1995 actual    1996 actual     1997 est.      1998 est.
    -----------------------------------------------------------------------------------------------
        ASSETS:
          Federal assets:

    1101    Fund balances with Treasury.....         153            202           226            250
            Investments in US securities:
    1106      Receivables, net..............          22                                           1
          Non-Federal assets:

    1201    Investments in non-Federal
              securities, net...............          11             15            20             21
    1206    Receivables, net................          19             15            11              5
                                            ------------ --------------  ------------  -------------
    1999    Total assets....................         205            232           257            277
        LIABILITIES:
    2204  Non-Federal liabilities:
            Liabilities for loan guarantees.       1,163          1,366         1,498          1,571
                                            ------------ --------------  ------------  -------------
    2999    Total liabilities...............       1,163          1,366         1,498          1,571
        NET POSITION:
    3300  Cumulative results of operations..        -958         -1,134        -1,241         -1,294
                                            ------------ --------------  ------------  -------------
    3999    Total net position..............        -958         -1,134        -1,241         -1,294
                                            ------------ --------------  ------------  -------------
    4999  Total liabilities and net position         205            232           257            277
    -----------------------------------------------------------------------------------------------

      Health Professions Graduate Student Loan Insurance Fund Liquidating
                                     Account

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-4305-0-3-552      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Operating expenses: death and
            disability......................           5           7           8
    00.02 Capital investment................          38          55          39
    00.03 Collection costs..................           1           2           2
    00.04 Consolidation transfers...........                       6           1
                                               ---------   ---------  ----------
    10.00   Total obligations...............          44          70          50
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.90 Unobligated balance available,
            start of year: Fund balance.....          24          12
    22.00 New budget authority (gross)......          33          58          51
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......          57          70          51
    23.95 New obligations...................         -44         -70         -50
    24.90 Unobligated balance available, end
            of year: Fund balance...........          12
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    60.05 Appropriation (indefinite)........          13          38          30
    68.00 Spending authority from offsetting
            collections: Offsetting
            collections (cash)..............          20          20          21
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................          33          58          51
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Appropriation           4           8
    73.10 New obligations...................          44          70          50
    73.20 Total outlays (gross).............         -40         -78         -51
    74.40 Unpaid obligations, end of year:
            Obligated balance: Appropriation           8
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new permanent
            authority.......................          13          58          51
    86.98 Outlays from permanent balances...          27          20
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........          40          78          51
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.40   Offsetting collections (cash)
              from: Non-Federal sources.....         -20         -20         -21
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................          13          38          30
    90.00 Outlays...........................          20          58          30
    ---------------------------------------------------------------------------

                 Status of Guaranteed Loans (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-4305-0-3-552      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
        Cumulative balance of guaranteed loans
                    outstanding:
    2210  Outstanding, start of year........       1,620       1,549       1,454
    2251  Repayments and prepayments........         -43         -48         -52
          Adjustments:

    2261    Terminations for default that
              result in loans receivable....         -24         -35         -25
    2263    Terminations for default that
              result in claim payments......          -3          -4          -5
    2264    Other adjustments, net..........          -1          -8          -3
                                               ---------   ---------  ----------
    2290    Outstanding, end of year........       1,549       1,454       1,369
    ----------------------------------------------------------------------------

    [[Page 498]]

        Memorandum:
    2299  Guaranteed amount of guaranteed
            loans outstanding, end of year..       1,549       1,454       1,368
    ----------------------------------------------------------------------------

        Addendum:
          Cumulative balance of defaulted guaranteed
              loans that result in loans receivable:

    2310    Outstanding, start of year......         388         422         480
    2331    Disbursements for guaranteed
              loan claims...................          38          55          39
    2351    Repayments of loans receivable..          -6          -6          -6
    2361    Write-offs of loans receivable..           9           9           9
    2364    Other adjustments, net..........          -7
                                               ---------   ---------  ----------
    2390      Outstanding, end of year......         422         480         522
    ---------------------------------------------------------------------------
        \1\ Includes carryover commitments from prior years.

        Note.--The adjustment to loans receivable represents interest, which
    had not previously been reflected in cumulative outstanding balances.

        As required by the Federal Credit Reform Act of 1990, this account
    records, for the Health Education Assistance Loan program (HEAL), all
    cash flows to and from the Government resulting from HEAL loan
    guarantees committed prior to 1992. This account is shown on a cash
    basis. All new activity in this program in 1992 and beyond (including
    modifications of loan guarantees that resulted from obligations or
    commitments in any year) is recorded in corresponding program and
    financing accounts.

                                  DATA ON LOANS

                                         1996 actual  1997 est.   1998 est.
    Dollar volume of loans insured ($ in
    millions)...........................         209         140          85
    Number of students..................      18,422      12,727       7,727
    Average value of loans..............      11,324      11,000      11,000

                            Statement of Operations (in millions of dollars)

    -----------------------------------------------------------------------------------------------
    Identification code   75-4305-0-3-552    1995 actual    1996 actual     1997 est.      1998 est.
    -----------------------------------------------------------------------------------------------
    0101  Revenue...........................          87             80            82             50
    0102  Expense...........................         -36            -44           -70            -50
                                            ------------ --------------  ------------  -------------
    0109  Net loss..........................          51             36            12
    -----------------------------------------------------------------------------------------------

                                 Balance Sheet (in millions of dollars)

    -----------------------------------------------------------------------------------------------
    Identification code   75-4305-0-3-552    1995 actual    1996 actual     1997 est.      1998 est.
    -----------------------------------------------------------------------------------------------
        ASSETS:
    1101  Federal assets: Fund balances with
            Treasury........................          20             12
          Net value of assets related to
              pre-1992 direct loans
              receivable and acquired
              defaulted guaranteed loans
              receivable:

    1701    Defaulted guaranteed loans,
              gross.........................         388            422           480            522
    1702    Interest receivable.............           5              6             6              6
    1703    Allowance for estimated
              uncollectible loans and
              interest (-)..................          -3             -7
    1704    Defaulted guaranteed loans and
              interest receivable, net......         390            421           486            528
                                            ------------ --------------  ------------  -------------
    1799      Value of assets related to
                loan guarantees.............         390            421           486            528
    1801  Other Federal assets: Cash and
            other monetary assets...........          37             44            70             50
                                            ------------ --------------  ------------  -------------
    1999    Total assets....................         447            477           556            578
        LIABILITIES:
    2104  Federal liabilities: Resources
            payable to Treasury.............           4              5             6              6
    2201  Non-Federal liabilities: Accounts
            payable.........................          33             38            55             39
                                            ------------ --------------  ------------  -------------
    2999    Total liabilities...............          37             43            61             45
        NET POSITION:
    3300  Cumulative results of operations..         410            434           495            533
                                            ------------ --------------  ------------  -------------
    3999    Total net position..............         410            434           495            533
                                            ------------ --------------  ------------  -------------
    4999  Total liabilities and net position         447            477           556            578
    -----------------------------------------------------------------------------------------------

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-4305-0-3-552      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
    25.2  Other services....................           1           8           3
    42.0  Insurance claims and indemnities..          43          62          47
                                               ---------   ---------  ----------
    99.9    Total obligations...............          44          70          50
    ---------------------------------------------------------------------------

                                Health Loan Funds

                   Medical Facilities Guarantee and Loan Fund

                federal interest subsidies for medical facilities

        For carrying out subsections (d) and (e) of section 1602 of the
    Public Health Service Act, [$7,000,000] $6,000,000, together with any
    amounts received by the Secretary in connection with loans and loan
    guarantees under title VI of the Public Health Service Act, to be
    available without fiscal year limitation for the payment of interest
    subsidies. During the fiscal year, no commitments for direct loans or
    loan guarantees shall be made. (Department of Health and Human Services
    Appropriations Act, 1997.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9931-0-3-550      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Operating expenses: Interest
            subsidies, private..............           8           8           8
    01.01 Capital investment: Direct loans..                       1           1
                                               ---------   ---------  ----------
    10.00   Total obligations...............           8           9           9
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.90 Unobligated balance available,
            start of year: Fund balance.....          55          58          52
    22.00 New budget authority (gross)......          16          15          15
    22.60 Redemption of debt................          -5         -12         -12
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......          66          61          55
    23.95 New obligations...................          -8          -9          -9
    24.90 Unobligated balance available, end
            of year: Fund balance...........          58          52          46
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................           8           7           6
          Permanent:

    68.00   Spending authority from
              offsetting collections:
              Offsetting collections (cash).           8           8           8
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................          16          15          14
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Appropriation           8           8          10
    73.10 New obligations...................           8           9           9
    73.20 Total outlays (gross).............          -7          -8          -6
    74.40 Unpaid obligations, end of year:
            Obligated balance: Appropriation           8          10          13
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority           7           7           6
    86.93 Outlays from current balances.....                       1
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........           7           8           6
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

            Offsetting collections (cash)
                from:
              Non-Federal sources:
    88.40       Interest repaid on loans not
                  sold......................          -1          -1          -1
    88.40       Principal collections from
                  FFB.......................          -5          -6          -6
    88.40       Default collections,
                  principal.................          -1
    88.40       Interest collections from
                  FFB.......................          -1          -1          -1
                                               ---------   ---------  ----------
    88.90       Total, offsetting
                  collections (cash)........          -8          -8          -8
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................           8           7           7

    [[Page 499]]

    90.00 Outlays...........................          -1                      -2
    ---------------------------------------------------------------------------

                   Status of Direct Loans (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9931-0-3-550      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
        Cumulative balance of direct loans
                    outstanding:
    1210  Outstanding, start of year........          45          34          23
    1251  Repayments: Repayments and
            prepayments.....................          -7          -7          -5
    1264  Write-offs for default: Other
            adjustments, net................          -4          -4          -2
                                               ---------   ---------  ----------
    1290    Outstanding, end of year........          34          23          16
    ---------------------------------------------------------------------------

                 Status of Guaranteed Loans (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9931-0-3-550      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
        Cumulative balance of guaranteed loans
                    outstanding:
    2210  Outstanding, start of year........         261         188         138
    2251  Repayments and prepayments........         -73         -50         -40
                                               ---------   ---------  ----------
    2290    Outstanding, end of year........         188         138          98
    ----------------------------------------------------------------------------

        Memorandum:
    2299  Guaranteed amount of guaranteed
            loans outstanding, end of year..         188         138          98
    ---------------------------------------------------------------------------

        Title VII, part C of the Public Health Service Act established a
    revolving fund from which health professions schools could borrow in
    order to provide loans to their students.

        Public Law 89-751, the Allied Health Professions Personnel Training
    Act of 1966, amended the Public Health Service Act to authorize the
    Federal Government to pay the difference between the interest paid by
    students to the schools and the interest payable by the schools to the
    Government National Mortgage Association (GNMA) and the Treasury.

        Title VI and subsequently title XVI of the Public Health Service Act
    established a loan and loan guarantee fund for medical facilities with a
    maximum amount allowable for the Government's liability. Direct loans
    were made available for public facilities and guaranteed loans for
    private, nonprofit facilities. Funds under this authority were
    established in the amount of $50 million for use in fulfilling
    guarantees in event of default, $30 million as a revolving fund for
    direct loans and an amount for interest subsidy payments on guaranteed
    loans. Default and interest subsidy funds are replenished as necessary
    through the annual appropriation process.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9931-0-3-550      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
    33.0  Investments and loans.............                       1           1
    41.0  Grants, subsidies, and
            contributions...................           7           7           7
    43.0  Interest and dividends............           1           1           1
                                               ---------   ---------  ----------
    99.9    Total obligations...............           8           9           9
    ---------------------------------------------------------------------------

                                   Trust Funds

                 Vaccine Injury Compensation Program Trust Fund

        For payments from the Vaccine Injury Compensation Program Trust
    Fund, such sums as may be necessary for claims associated with vaccine-
    related injury or death with respect to vaccines administered after
    September 30, 1988, pursuant to subtitle 2 of title XXI of the Public
    Health Service Act, to remain available until expended: Provided, That
    for necessary administrative expenses, not to exceed $3,000,000 shall be
    available from the Trust Fund to the Secretary of Health and Human
    Services. (Department of Health and Human Services Appropriations Act,
    1997.)

                  Unavailable Collections (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8175-0-7-551      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
        Balance, start of year:
    01.99 Balance, start of year............         912       1,047       1,179
        Receipts:
    02.01 Deposits..........................         115         125          52
    02.03 Interest income...................          58          66          74
                                               ---------   ---------  ----------
    02.99   Total receipts..................         173         191         126
                                               ---------   ---------  ----------
    04.00 Total: Balances and collections...       1,085       1,238       1,305
        Appropriation:
    05.01 Vaccine injury compensation
            program trust fund..............         -38         -59         -51
                                               ---------   ---------  ----------
    05.99 Subtotal appropriation............         -38         -59         -51
    07.99 Total balance, end of year........       1,047       1,179       1,254
    ---------------------------------------------------------------------------

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8175-0-7-551      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Compensation: Claims for post--FY
            1989 injuries...................          30          50          42
          Administrative expenses:

    01.03   Claims processing (Claims Court)           2           2           2
    01.04   Claims processing (Public Health
              Service)......................           3           3           3
    01.05   Claims processing (Dept. of
              Justice)......................           3           4           4
                                               ---------   ---------  ----------
    01.91     Total, administrative expenses           8           9           9
                                               ---------   ---------  ----------
    10.00   Total obligations...............          38          59          51
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......          38          59          51
    23.95 New obligations...................         -38         -59         -51
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    40.26 Appropriation (trust fund,
            definite).......................           8           9           9
    40.27 Appropriation (trust fund,
            indefinite).....................          30          50          42
                                               ---------   ---------  ----------
    43.00   Appropriation (total)...........          38          59          51
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................          38          59          51
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Appropriation           1           2
    73.10 New obligations...................          38          59          51
    73.20 Total outlays (gross).............         -37         -61         -51
    74.40 Unpaid obligations, end of year:
            Obligated balance: Appropriation           2
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority          36          59          51
    86.93 Outlays from current balances.....           1           2
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........          37          61          51
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................          38          59          51
    90.00 Outlays...........................          37          61          51
    ---------------------------------------------------------------------------

        The Vaccine Improvement Program was established pursuant to Public
    Law 99-660 and Public Law 100-203, and serves as a source of funds to
    pay claims for compensation for vaccine related injury or death. This
    account reflects payments for claims for vaccine related injury or death
    occurring after October 1, 1988.

        Current and projected vaccine excise tax receipts to the Vaccine
    Injury Compensation Program Trust Fund far exceed current and projected
    claims on the Trust Fund. The Budget proposes lowering revenue to the
    Trust Fund by exempting Federal programs (which provide free vaccine to
    low-income, uninsured and underinsured children) from payment of the
    vaccine excise tax in FY 1998. Exempting these programs will result in
    Federal savings in mandatory (HCFA Grants to States for Medicaid) and
    discretionary (Centers for Disease Control and Prevention) programs
    displayed in those accounts. The estimated reduction in receipts to the
    Trust Fund is $73 million.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8175-0-7-551      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
    25.2  Other services....................           3           3           3
    25.3  Purchases of goods and services
            from Government accounts........           5           6           6

    [[Page 500]]

    42.0  Insurance claims and indemnities..          30          50          42
                                               ---------   ---------  ----------
    99.9    Total obligations...............          38          59          51
    ---------------------------------------------------------------------------

                              INDIAN HEALTH SERVICE

                                  Federal Funds

    General and special funds:

                             Indian Health Services

        For expenses necessary to carry out the Act of August 5, 1954 (68
    Stat. 674), the Indian Self-Determination Act, the Indian Health Care
    Improvement Act, and titles II and III of the Public Health Service Act
    with respect to the Indian Health Service, [$1,806,269,000],
    $1,835,465,000 together with payments received during the fiscal year
    pursuant to 42 U.S.C. 238(b) for services furnished by the Indian Health
    Service: Provided, That funds made available to tribes and tribal
    organizations through contracts, grant agreements, or any other
    agreements or compacts authorized by the Indian Self-Determination and
    Education Assistance Act of 1975 (25 U.S.C. 450), shall be deemed to be
    obligated at the time of the grant or contract award and thereafter
    shall remain available to the tribe or tribal organization without
    fiscal year limitation: Provided further, That $12,000,000 shall remain
    available until expended, for the Indian Catastrophic Health Emergency
    Fund: Provided further, That [$356,325,000] $362,348,000 for contract
    medical care shall remain available for obligation until September 30,
    [1998] 1999: Provided further, That of the funds provided, not less than
    [$11,706,000] $11,889,000 shall be used to carry out the loan repayment
    program under section 108 of the Indian Health Care Improvement Act:
    Provided further, That funds provided in this Act may be used for one-
    year contracts and grants which are to be performed in two fiscal years,
    so long as the total obligation is recorded in the year for which the
    funds are appropriated: Provided further, That the amounts collected by
    the Secretary of Health and Human Services under the authority of title
    IV of the Indian Health Care Improvement Act shall remain available
    until expended for the purpose of achieving compliance with the
    applicable conditions and requirements of titles XVIII and XIX of the
    Social Security Act (exclusive of planning, design, or construction of
    new facilities): Provided further, That of the funds provided,
    [$7,500,000] $12,000,000 shall remain available until expended, for the
    Indian Self-Determination Fund, which shall be available for the
    transitional costs of initial or expanded tribal contracts, compacts,
    grants or cooperative agreements with the Indian Health Service under
    the provisions of the Indian Self-Determination Act: Provided further,
    That funding contained herein, and in any earlier appropriations Acts
    for scholarship programs under the Indian Health Care Improvement Act
    (25 U.S.C. 1613) shall remain available for obligation until September
    30, [1998] 1999: Provided further, That amounts received by tribes and
    tribal organizations under title IV of the Indian Health Care
    Improvement Act shall be reported and accounted for and available to the
    receiving tribes and tribal organizations until expended. (Department of
    the Interior and Related Agencies Appropriations Act, 1997.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0390-0-1-551      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
          Direct program:

    00.01   Clinical services...............       1,412       1,451       1,468
    00.02   Preventive health...............          78          81          82
    00.03   Urban health....................          24          25          26
    00.04   Indian health professions.......          26          28          28
    00.05   Tribal management...............           2           2           2
    00.06   Direct operations...............          48          49          47
    00.07   Self-governance.................          13           9           9
    00.08   Contract support costs..........         146         161         173
                                               ---------   ---------  ----------
    00.91     Total direct program..........       1,749       1,806       1,835
    04.01 Reimbursable program..............         245         283         285
                                               ---------   ---------  ----------
    10.00   Total obligations...............       1,994       2,089       2,120
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested
            balance.........................          60          76          76
    22.00 New budget authority (gross)......       2,012       2,089       2,120
    22.30 Unobligated balance expiring......          -2
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......       2,070       2,165       2,196
    23.95 New obligations...................      -1,994      -2,089      -2,120
    24.40 Unobligated balance available, end
            of year: Uninvested balance.....          76          76          76
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................       1,745       1,806       1,835
          Permanent:

    68.00   Spending authority from
              offsetting collections:
              Offsetting collections (cash).         267         283         285
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................       2,012       2,089       2,120
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Appropriation         602         565         540
    73.10 New obligations...................       1,994       2,089       2,120
    73.20 Total outlays (gross).............      -2,012      -2,114      -2,109
    73.40 Adjustments in expired accounts...         -19
    74.40 Unpaid obligations, end of year:
            Obligated balance: Appropriation         565         540         551
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority       1,287       1,319       1,340
    86.93 Outlays from current balances.....         458         512         484
    86.97 Outlays from new permanent
            authority.......................         267         283         285
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........       2,012       2,114       2,109
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

            Offsetting collections (cash)
                from:
    88.00     Federal sources...............         -60         -64         -64
    88.40     Non-Federal sources...........        -207        -219        -221
                                               ---------   ---------  ----------
    88.90       Total, offsetting
                  collections (cash)........        -267        -283        -285
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................       1,745       1,806       1,835
    90.00 Outlays...........................       1,746       1,831       1,824
    ---------------------------------------------------------------------------

        The Indian Health Services account provides medical care, public
    health services, and health professions training opportunities to
    American Indians and Alaska Natives. An estimated $390,000,000 will be
    administered by tribal governments under self-governance compacts in FY
    1998.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0390-0-1-551      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

          Direct obligations:

            Personnel compensation:
    11.1      Full-time permanent...........         365         391         404
    11.3      Other than full-time permanent          16          16          16
    11.5      Other personnel compensation..          26          27          28
                                               ---------   ---------  ----------
    11.9        Total personnel compensation         407         434         448
    12.1    Civilian personnel benefits.....         117         122         125
    13.0    Benefits for former personnel...           3           3           3
    21.0    Travel and transportation of
              persons.......................          27          28          28
    22.0    Transportation of things........          10          13          14
    23.1    Rental payments to GSA..........          10          10          10
    23.3    Communications, utilities, and
              miscellaneous charges.........          25          26          14
    24.0    Printing and reproduction.......           1           1           1
    25.1    Advisory and assistance services           1           1           1
    25.2    Other services..................         463         465         472
    25.3    Purchases of goods and services
              from Government accounts......           2           1           2
    25.4    Operation and maintenance of
              facilities....................           8           7           8
    25.6    Medical care....................         211         214         223
    25.7    Operation and maintenance of
              equipment.....................           7           7           8
    25.8    Subsistence and support of
              persons.......................           5           5           5
    26.0    Supplies and materials..........          97          99         100
    31.0    Equipment.......................          18          18          18

    [[Page 501]]

    32.0    Land and structures.............           2
    41.0    Grants, subsidies, and
              contributions.................         335         352         355
                                               ---------   ---------  ----------
    99.0      Subtotal, direct obligations..       1,749       1,806       1,835
    99.0  Reimbursable obligations..........         245         283         285
                                               ---------   ---------  ----------
    99.9    Total obligations...............       1,994       2,089       2,120
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-0390-0-1-551      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
        Direct:
          Total compensable workyears:

    1001    Full-time equivalent employment.      10,331      10,345      10,345
    1005    Full-time equivalent of overtime
              and holiday hours.............         183         191         191
    1011    Exempt Full-time equivalent
              employment....................           6           5           5
        Reimbursable:
          Total compensable workyears:

    2001    Full-time equivalent employment.       2,517       2,517       2,517
    2005    Full-time equivalent of overtime
              and holiday hours.............          57          57          57
    ---------------------------------------------------------------------------

                            Indian Health Facilities

        For construction, repair, maintenance, improvement, and equipment of
    health and related auxiliary facilities, including quarters for
    personnel; preparation of plans, specifications, and drawings;
    acquisition of sites, purchase and erection of modular buildings, and
    purchases of trailers; and for provision of domestic and community
    sanitation facilities for Indians, as authorized by section 7 of the Act
    of August 5, 1954 (42 U.S.C. 2004a), the Indian Self-Determination Act,
    and the Indian Health Care Improvement Act, and for expenses necessary
    to carry out such Acts and titles II and III of the Public Health
    Service Act with respect to environmental health and facilities support
    activities of the Indian Health Service, [$247,731,000] $247,635,000, to
    remain available until expended: Provided, That notwithstanding any
    other provision of law, funds appropriated for the planning, design,
    construction or renovation of health facilities for the benefit of an
    Indian tribe or tribes may be used to purchase land for sites to
    construct, improve, or enlarge health or related facilities.
        In addition, to become available on October 1 of the fiscal year
    specified and remain available until expended: for construction of a
    replacement of the health facility at Fort Defiance, Arizona, up to
    $25,000,000 for fiscal year 1998, up to $25,000,000 for fiscal year
    1999, and up to $28,000,000 for fiscal year 2000; for construction of a
    replacement of the health facility at Keams Canyon, Arizona, up to
    $13,900,000 for fiscal year 1998, up to $13,900,000 for fiscal year
    1999, and up to $3,200,000 for fiscal year 2000. (Department of the
    Interior and Related Agencies Appropriations Act, 1997.)

                  Unavailable Collections (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0391-0-1-551      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
        Balance, start of year:
    01.99 Balance, start of year............
        Receipts:
    02.01 Rent and charges for quarters,
            Indian Health Service, HRSA, HHS           4           5           5
        Appropriation:
    05.01 Indian health facilities..........          -4          -5          -5
    07.99 Total balance, end of year........
    ---------------------------------------------------------------------------

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0391-0-1-551      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Construction......................         110         112         129
    01.01 Maintenance.......................          47          45          44
    02.01 Facilities and environmental
            health..........................          93         100         105
    05.01 Equipment.........................          15          16          13
                                               ---------   ---------  ----------
    10.00   Total obligations...............         265         273         291
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested
            balance.........................          36          25          16
    22.00 New budget authority (gross)......         254         264         303
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......         290         289         319
    23.95 New obligations...................        -265        -273        -291
    24.40 Unobligated balance available, end
            of year: Uninvested balance.....          25          16          28
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................         239         248         287
          Permanent:

    60.25   Appropriation (special fund,
              indefinite)...................           4           5           5
    68.00   Spending authority from
              offsetting collections:
              Offsetting collections (cash).          11          11          11
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................         254         264         303
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Appropriation         412         380         351
    73.10 New obligations...................         265         273         291
    73.20 Total outlays (gross).............        -297        -302        -283
    74.40 Unpaid obligations, end of year:
            Obligated balance: Appropriation         380         351         360
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority          65          62          72
    86.93 Outlays from current balances.....         217         224         195
    86.97 Outlays from new permanent
            authority.......................          15          16          16
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........         297         302         283
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.45   Offsetting collections (cash)
              from: Offsetting governmental
              collections...................         -11         -11         -11
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................         243         253         292
    90.00 Outlays...........................         286         291         272
    ---------------------------------------------------------------------------

        The Indian health facilities account supports construction, repair
    and improvement, equipment, and environmental health and facilities
    support for the Indian health services.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0391-0-1-551      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

          Personnel compensation:

    11.1    Full-time permanent.............          45          45          45
    11.3    Other than full-time permanent..           6           6           6
    11.5    Other personnel compensation....           2           2           2
                                               ---------   ---------  ----------
    11.9      Total personnel compensation..          53          53          53
    12.1  Civilian personnel benefits.......          15          15          15
    21.0  Travel and transportation of
            persons.........................           4           5           4
    22.0  Transportation of things..........           4           4           4
    23.3  Communications, utilities, and
            miscellaneous charges...........           6           8          19
    25.1  Advisory and assistance services..           2           2           3
    25.2  Other services....................          41          37          56
    25.4  Operation and maintenance of
            facilities......................          37          19          18
    25.7  Operation and maintenance of
            equipment.......................          10           3           3
    25.8  Subsistence and support of persons          10          10          10
    26.0  Supplies and materials............          11          12          11
    31.0  Equipment.........................          12           5           4
    32.0  Land and structures...............          38          60          54
    41.0  Grants, subsidies, and
            contributions...................          22          28          27
    43.0  Interest and dividends............                      12          10
                                               ---------   ---------  ----------
    99.9    Total obligations...............         265         273         291
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-0391-0-1-551      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
        Total compensable workyears:
    1001  Full-time equivalent employment...       1,454       1,454       1,454
    1005  Full-time equivalent of overtime
            and holiday hours...............          21          21          21
    ---------------------------------------------------------------------------

                Administrative Provisions, Indian Health Service

        Appropriations in this Act to the Indian Health Service shall be
    available for services as authorized by 5 U.S.C. 3109 but at rates not
    to exceed the per diem rate equivalent to the maximum rate payable for
    senior-level positions under 5 U.S.C. 5376; hire of pas-

    [[Page 502]]

    senger motor vehicles and aircraft; purchase of medical equipment;
    purchase of reprints; purchase, renovation and erection of modular
    buildings and renovation of existing facilities; payments for telephone
    service in private residences in the field, when authorized under
    regulations approved by the Secretary; and for uniforms or allowances
    therefore as authorized by 5 U.S.C. 5901-5902; and for expenses of
    attendance at meetings which are concerned with the functions or
    activities for which the appropriation is made or which will contribute
    to improved conduct, supervision, or management of those functions or
    activities: Provided, That in accordance with the provisions of the
    Indian Health Care Improvement Act, non-Indian patients may be extended
    health care at all tribally administered or Indian Health Service
    facilities, subject to charges, and the proceeds along with funds
    recovered under the Federal Medical Care Recovery Act (42 U.S.C. 2651-
    53) shall be credited to the account of the facility providing the
    service and shall be available without fiscal year limitation: Provided
    further, That notwithstanding any other law or regulation, funds
    transferred from the Department of Housing and Urban Development to the
    Indian Health Service shall be administered under Public Law 86-121 (the
    Indian Sanitation Facilities Act) and Public Law 93-638, as amended:
    Provided further, That funds appropriated to the Indian Health Service
    in this Act, except those used for administrative and program direction
    purposes, shall not be subject to limitations directed at curtailing
    Federal travel and transportation: Provided further, That
    notwithstanding any other provision of law, funds previously or herein
    made available to a tribe or tribal organization through a contract,
    grant, or agreement authorized by title I or title III of the Indian
    Self-Determination and Education Assistance Act of 1975 (25 U.S.C. 450),
    may be deobligated and reobligated to a self-determination contract
    under title I, or a self-governance agreement under title III of such
    Act and thereafter shall remain available to the tribe or tribal
    organization without fiscal year limitation: Provided further, That none
    of the funds made available to the Indian Health Service in this Act
    shall be used to implement the final rule published in the Federal
    Register on September 16, 1987, by the Department of Health and Human
    Services, relating to the eligibility for the health care services of
    the Indian Health Service until the Indian Health Service has submitted
    a budget request reflecting the increased costs associated with the
    proposed final rule, and such request has been included in an
    appropriations Act and enacted into law: Provided further, That funds
    made available in this Act are to be apportioned to the Indian Health
    Service as appropriated in this Act, and accounted for in the
    appropriation structure set forth in this Act: Provided further, That
    funds received from any source, including tribal contractors and
    compactors for previously transferred functions which tribal contractors
    and compactors no longer wish to retain, for services, goods, or
    training and technical assistance, shall be retained by the Indian
    Health Service and shall remain available until expended by the Indian
    Health Service: Provided further, That reimbursements for training,
    technical assistance, or services provided by the Indian Health Service
    will contain total costs, including direct, administrative, and overhead
    associated with the provision of goods, services, or technical
    assistance: Provided further, That the appropriation structure for the
    Indian Health Service may not be altered without advance [approval of]
    notice submitted to the House and Senate Committees on Appropriations.
    (Department of the Interior and Related Agencies Appropriations Act,
    1997.)

                   CENTERS FOR DISEASE CONTROL AND PREVENTION

                                  Federal Funds

    General and special funds:

                     Disease Control, Research, and Training

        To carry out titles II, III, VII, XI, XV, XVII, and XIX of the
    Public Health Service Act, sections 101, 102, 103, 201, 202, 203, 301,
    and 501 of the Federal Mine Safety and Health Act of 1977, and sections
    20, 21 and 22 of the Occupational Safety and Health Act of 1970, title
    IV of the Immigration and Nationality Act and section 501 of the Refugee
    Education Assistance Act of 1980; including insurance of official motor
    vehicles in foreign countries; and hire, maintenance, and operation of
    aircraft, [$2,262,698,000] $2,252,900,000, of which [$30,553,000]
    $23,007,000 shall remain available until expended for equipment and
    construction and renovation of facilities, and of which $32,000,000
    shall remain available until September 30, [1998] 1999 for mine safety
    and health activities, and in addition, such sums as may be derived from
    authorized user fees, which shall be credited to this account: Provided,
    That in addition to amounts provided herein, up to [$48,400,000]
    $70,063,000 shall be available from amounts available under section 241
    of the Public Health Service Act, to carry out the National Center for
    Health Statistics surveys: [Provided further, That none of the funds
    made available for injury prevention and control at the Centers for
    Disease Control and Prevention may be used to advocate or promote gun
    control: Provided further, That the Director may redirect the total
    amount made available under authority of Public Law 101-502, section 3,
    dated November 3, 1990, to activities the Director may so designate:
    Provided further, That the Congress is to be notified promptly of any
    such transfer: Provided further, That the functions described in clause
    (1) of the first proviso under the subheading ``mines and minerals''
    under the heading ``Bureau of Mines'' in the text of title I of the
    Department of the Interior and Related Agencies Appropriations Act,
    1996, as enacted by section 101 (c) of the Omnibus Consolidated
    Rescissions and Appropriations Act of 1996 (Public Law 104-134), are
    hereby transferred to, and vested in, the Secretary of Health and Human
    Services, subject to section 1531 of title 31, United States Code:
    Provided further, That of the amount provided, $23,000,000 is designated
    by Congress as an emergency requirement pursuant to section
    251(b)(2)(D)(i) of the Balanced Budget and Emergency Deficit Control Act
    of 1985, as amended.]
        In addition, not to exceed $17,895,000 to carry out Title III of the
    Public Health Service Act: Provided, That all purchases of vaccine with
    grants from appropriations for fiscal year 1998 authorized by section
    317(j) of the Public Health Act or section 1928 of the Social Security
    Act shall be exempt from the payment of excise tax on vaccine.
        In addition, [$41,000,000] $45,000,000, to be derived from the
    Violent Crime Reduction Trust Fund, for carrying out [sections] section
    40151 [and 40261] of Public Law 103-322. (Department of Health and Human
    Services Appropriations Act, 1997.)

                  Unavailable Collections (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0943-0-1-999      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
        Balance, start of year:
    01.99 Balance, start of year............
        Receipts:
    02.01 Cooperative Research and
            Development Agreements, Centers
            for Disease Control.............           1           1           1
        Appropriation:
    05.01 Disease control, research, and
            training........................          -1          -1          -1
    07.99 Total balance, end of year........
    ---------------------------------------------------------------------------

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0943-0-1-999      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
          Direct program:

    00.01   Preventive health block grant...         145         154         144
    00.02   Prevention centers..............           8           8           8
    00.03   Sexually transmitted diseases...         105         106         111
    00.04   Immunization....................         468         468         429
    00.05   Infectious diseases.............         181         207         232
    00.06   Chronic and environmental
              diseases......................         348         388         421
    00.07   Occupational safety and health..         129         141         149
    00.08   Mine safety and health..........                      32          32
    00.09   Epidemic services...............          67          70          70
    00.10   Health statistics...............          37          38          19
    00.11   HIV.............................         585         617         637
    00.12   Buildings and facilities........          17          79          24
    00.13   Program management..............           3           3           3
    00.14   Violent crime reduction programs          32          41          45
    00.15   Office of the Director savings..                                  -8
                                               ---------   ---------  ----------
    00.91     Total direct program..........       2,125       2,352       2,316
    01.01 Reimbursable program..............         134         134         134
                                               ---------   ---------  ----------
    10.00   Total obligations...............       2,259       2,486       2,450
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested
            balance.........................          46          51
    22.00 New budget authority (gross)......       2,248       2,437       2,451

    [[Page 503]]

    22.10 Resources available from
            recoveries of prior year
            obligations.....................          18
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......       2,312       2,488       2,451
    23.95 New obligations...................      -2,259      -2,486      -2,450
    24.40 Unobligated balance available, end
            of year: Uninvested balance.....          51
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................       2,081       2,263       2,271
    40.75   Reduction pursuant to P.L. 104-
              208...........................                      -2
    42.00   Transferred from other accounts.          32          41          45
                                               ---------   ---------  ----------
    43.00     Appropriation (total).........       2,113       2,302       2,316
          Permanent:

    60.25   Appropriation (special fund,
              indefinite)...................           1           1           1
    68.00   Spending authority from
              offsetting collections:
              Offsetting collections (cash).         134         134         134
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................       2,248       2,437       2,451
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Appropriation       2,124       2,061       2,223
    73.10 New obligations...................       2,259       2,486       2,450
    73.20 Total outlays (gross).............      -2,301      -2,324      -2,406
    73.40 Adjustments in expired accounts...          -4
    73.45 Adjustments in unexpired accounts.         -18
    74.40 Unpaid obligations, end of year:
            Obligated balance: Appropriation       2,061       2,223       2,267
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority         684         721         726
    86.93 Outlays from current balances.....       1,482       1,468       1,545
    86.97 Outlays from new permanent
            authority.......................         134         134         134
    86.98 Outlays from permanent balances...           1           1           1
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........       2,301       2,324       2,406
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.00   Offsetting collections (cash)
              from: Federal sources.........        -134        -134        -134
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................       2,114       2,303       2,317
    90.00 Outlays...........................       2,167       2,190       2,272
    ---------------------------------------------------------------------------

                              [Dollars in millions]

                                            1996         1997        1998
    Distribution of budget authority by
        account:
      Disease control, research and
        training........................       2,075       2,263       2,271
      Violent crime reduction programs..          32          41          45
    Distribution of outlays by account:
      Disease control, research and
        training........................                   2,163       2,233
      Violent crime reduction programs..                      27          39

        The Centers for Disease Control and Prevention (CDC) supports a
    number of categorical programs including grants for immunizations,
    control of sexually transmitted diseases, HIV prevention, and control of
    other infectious and chronic diseases. CDC also supports the Preventive
    Health Block Grant.

        This display also includes amounts derived from the Violent Crime
    Reduction Trust Fund.

        Current and projected vaccine excise tax receipts to the Vaccine
    Injury Compensation Program Trust Fund far exceed current and projected
    claims on the Trust Fund. The Budget exempts Federal programs which
    provide free vaccine to low-income, uninsured and underinsured children
    from payment of vaccine excise tax for FY 1998, lowering the cost to the
    Government of providing vaccine to these children. The savings to CDC's
    discretionary immunization program and the funding provided above will
    allow CDC to purchase as much vaccine in FY 1998 as in FY 1997. The $18
    million in the savings resulting from the combined effects of the
    exemption of the mandatory Vaccines for Children from the excise tax on
    mandatory costs and tax receipts will offset some of the cost of CDC's
    prevention activities. Funds carried-over by States from prior-year
    appropriations permit additional immunization savings.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0943-0-1-999      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

          Direct obligations:

            Personnel compensation:
    11.1      Full-time permanent...........         223         255         258
    11.3      Other than full-time permanent          10          10          10
    11.5      Other personnel compensation..          11          11          11
                                               ---------   ---------  ----------
    11.9        Total personnel compensation         244         276         279
    12.1    Civilian personnel benefits.....          72          80          81
    13.0    Benefits for former personnel...           2
    21.0    Travel and transportation of
              persons.......................          16          16          17
    22.0    Transportation of things........           3           4           4
    23.1    Rental payments to GSA..........          15          16          16
    23.3    Communications, utilities, and
              miscellaneous charges.........          19          20          20
    24.0    Printing and reproduction.......           5           4           5
    25.1    Advisory and assistance services           2           2           2
    25.2    Other services..................          71          76          72
    25.5    Research and development
              contracts.....................         179         232         225
    25.7    Operation and maintenance of
              equipment.....................                       1           1
    26.0    Supplies and materials..........         145         167         162
    31.0    Equipment.......................          40          96          75
    32.0    Land and structures.............           3          31          18
    41.0    Grants, subsidies, and
              contributions.................       1,309       1,331       1,339
                                               ---------   ---------  ----------
    99.0      Subtotal, direct obligations..       2,125       2,352       2,316
    99.0  Reimbursable obligations..........         134         134         134
                                               ---------   ---------  ----------
    99.9    Total obligations...............       2,259       2,486       2,450
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-0943-0-1-999      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
        Direct:
          Total compensable workyears:

    1001    Full-time equivalent employment.       5,109       5,351       5,351
    1005    Full-time equivalent of overtime
              and holiday hours.............          29          29          29
    1011    Exempt Full-time equivalent
              employment....................          48          45          45
        Reimbursable:
          Total compensable workyears:

    2001    Full-time equivalent employment.         875       1,052       1,052
    2005    Full-time equivalent of overtime
              and holiday hours.............           2           2           2
    ---------------------------------------------------------------------------

                    Allocations Received From Other Accounts

        Note.--Obligations incurred under allocations from other accounts
    are included in the schedules of the parent appropriation as follows:
        Environmental Protection Agency: ``Hazardous substance response
    trust fund.''

                          NATIONAL INSTITUTES OF HEALTH

                                  Federal Funds

    General and special funds:

                            National Cancer Institute

        For carrying out section 301 and title IV (except section 417B(d))
    of the Public Health Service Act with respect to cancer,
    [$2,382,532,000] $2,217,482,000. (Department of Health and Human
    Services Appropriations Act, 1997.)

                    National Heart, Lung, and Blood Institute

        For carrying out section 301 and title IV of the Public Health
    Service Act with respect to cardiovascular, lung, and blood diseases,
    and blood and blood products, [$1,433,001,000] $1,404,770,000.
    (Department of Health and Human Services Appropriations Act, 1997.)

                      National Institute of Dental Research

        For carrying out section 301 and title IV of the Public Health
    Service Act with respect to dental disease, [$195,997,000] $190,081,000.
    (Department of Health and Human Services Appropriations Act, 1997.)

        National Institute of Diabetes and Digestive and Kidney Diseases

        For carrying out section 301 and title IV of the Public Health
    Service Act with respect to diabetes and digestive and kidney disease,
    [$815,982,000] $821,164,000. (Department of Health and Human Services
    Appropriations Act, 1997.)

    [[Page 504]]

             National Institute of Neurological Disorders and Stroke

        For carrying out section 301 and title IV of the Public Health
    Service Act with respect to neurological disorders and stroke,
    [$726,746,000] $722,712,000. (Department of Health and Human Services
    Appropriations Act, 1997.)

              National Institute of Allergy and Infectious Diseases

        For carrying out section 301 and title IV of the Public Health
    Service Act with respect to allergy and infectious diseases,
    [$1,257,234,000] $634,272,000. (Department of Health and Human Services
    Appropriations Act, 1997.)

                 National Institute of General Medical Sciences

        For carrying out section 301 and title IV of the Public Health
    Service Act with respect to general medical sciences, [$998,470,000]
    $992,032,000. (Department of Health and Human Services Appropriations
    Act, 1997.)

            National Institute of Child Health and Human Development

        For carrying out section 301 and title IV of the Public Health
    Service Act with respect to child health and human development,
    [$631,703,000] $582,032,000. (Department of Health and Human Services
    Appropriations Act, 1997.)

                             National Eye Institute

        For carrying out section 301 and title IV of the Public Health
    Service Act with respect to eye diseases and visual disorders,
    [$332,735,000] $330,955,000. (Department of Health and Human Services
    Appropriations Act, 1997.)

               National Institute of Environmental Health Sciences

        For carrying out sections 301 and 311 and title IV of the Public
    Health Service Act with respect to environmental health sciences,
    [$308,819,000] $313,583,000. (Department of Health and Human Services
    Appropriations Act, 1997.)

                           National Institute on Aging

        For carrying out section 301 and title IV of the Public Health
    Service Act with respect to aging, [$486,047,000] $495,202,000.
    (Department of Health and Human Services Appropriations Act, 1997.)

      National Institute of Arthritis and Musculoskeletal and Skin Diseases

        For carrying out section 301 and title IV of the Public Health
    Service Act with respect to arthritis and musculoskeletal and skin
    diseases, [$257,111,000] $258,932,000. (Department of Health and Human
    Services Appropriations Act, 1997.)

        National Institute on Deafness and Other Communication Disorders

        For carrying out section 301 and title IV of the Public Health
    Service Act with respect to deafness and other communication disorders,
    [$188,422,000] $192,447,000. (Department of Health and Human Services
    Appropriations Act, 1997.)

                     National Institute of Nursing Research

        For carrying out section 301 and title IV of the Public Health
    Service Act with respect to nursing research, [$59,743,000] $55,692,000.
    (Department of Health and Human Services Appropriations Act, 1997.)

               National Institute on Alcohol Abuse and Alcoholism

        For carrying out section 301 and title IV of the Public Health
    Service Act with respect to alcohol abuse and alcoholism, [$212,004,000]
    $208,112,000. (Department of Health and Human Services Appropriations
    Act, 1997.)

                        National Institute on Drug Abuse

        For carrying out section 301 and title IV of the Public Health
    Service Act with respect to drug abuse, [$489,375,000] $358,475,000.
    (Department of Health and Human Services Appropriations Act, 1997.)

                       National Institute of Mental Health

        For carrying out section 301 and title IV of the Public Health
    Service Act with respect to mental health, [$701,585,000] $629,739,000.
    (Department of Health and Human Services Appropriations Act, 1997.)

                     National Center for Research Resources

        For carrying out section 301 and title IV of the Public Health
    Service Act with respect to research resources and general research
    support grants, [$415,145,000] $333,868,000: Provided, That none of
    these funds shall be used to pay recipients of the general research
    support grants program any amount for indirect expenses in connection
    with such grants: Provided further, That [$20,000,000] $4,000,000 shall
    be for extramural facilities construction grants. (Department of Health
    and Human Services Appropriations Act, 1997.)

              National [Center for] Human Genome Research Institute

        For carrying out section 301 and title IV of the Public Health
    Service Act with respect to human genome research, [$189,657,000]
    $202,197,000. (Department of Health and Human Services Appropriations
    Act, 1997.)

                      John E. Fogarty International Center

        For carrying out the activities at the John E. Fogarty International
    Center, [$26,586,000] $16,755,000. (Department of Health and Human
    Services Appropriations Act, 1997.)

                          National Library of Medicine

        For carrying out section 301 and title IV of the Public Health
    Service Act with respect to health information communications,
    [$151,103,000] $152,689,000, of which $4,000,000 shall be available
    until expended for improvement of information systems: Provided, That in
    fiscal year [1997] 1998, the Library may enter into personal services
    contracts for the provision of services in facilities owned, operated,
    or constructed under the jurisdiction of the National Institutes of
    Health. (Department of Health and Human Services Appropriations Act,
    1997.)

                             Office of the Director

                          (including transfer of funds)

        For carrying out the responsibilities of the Office of the Director,
    National Institutes of Health, [$287,206,000, of which $35,589,000 shall
    be for the Office of AIDS Research] $234,247,000: Provided, That funding
    shall be available for the purchase of not to exceed five passenger
    motor vehicles for replacement only: Provided further, That the Director
    may direct up to 1 percent of the total amount made available in this
    Act to all National Institutes of Health appropriations to activities
    the Director may so designate: Provided further, That no such
    appropriation shall be increased or decreased by more than 1 percent by
    any such transfers and that the Congress is promptly notified of the
    transfer: Provided further, That NIH is authorized to collect
    $15,000,000 in third party payments for the cost of clinical services
    that are incurred in National Institutes of Health research facilities
    in FY 1998 and that such payments shall be credited to the National
    Institutes of Health Management Fund: Provided further, That all funds
    credited to the NIH Management Fund shall remain available for one
    fiscal year after the fiscal year in which they are deposited[: Provided
    further, That up to $200,000 shall be available to carry out section 499
    of the Public Health Service Act]. (Department of Health and Human
    Services Appropriations Act, 1997.)

                             Office of AIDS Research

                          (including transfer of funds)

        For carrying out part D of title XXIII of the Public Health Service
    Act, $1,540,765,000: Provided, That the Director of the Office of AIDS
    Research shall transfer from this appropriation the amounts necessary to
    carry out subsection 2353(d) of the Act.

                            Buildings and Facilities

        For the study of, construction of, and acquisition of equipment for,
    facilities of or used by the National Institutes of Health, including
    the acquisition of real property, [$200,000,000] $100,000,000, to remain
    available until expended[, of which $90,000,000 shall be for the
    clinical research center: Provided, That, notwithstanding any other
    provision of law, a single contract or related contracts for the
    development and construction of the clinical research center may be
    employed which collectively include the full scope of the project:
    Provided further, That the solicitation and contract shall contain the
    clause ``availability of funds'' found at 48 CFR 52.232-18]. In
    addition, to become available on October 1 of the fiscal year specified
    and remain available until expended, for the clinical research center,
    $90,000,000 for each of fiscal years 1998 and 1999, and $40,000,000

    [[Page 505]]

    for fiscal year 2000. (Department of Health and Human Services
    Appropriations Act, 1997.)

                  Unavailable Collections (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9915-0-1-552      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
        Balance, start of year:
    01.99 Balance, start of year............
        Receipts:
    02.01 Cooperative Research and
            Development Agreements, NIH.....           7          12          15
        Appropriation:
    05.01 National Institutes of Health.....          -7         -12         -15
    07.99 Total balance, end of year........
    ---------------------------------------------------------------------------

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9915-0-1-552      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 National Cancer Institute.........       2,255       2,381       2,217
    00.02 National Heart, Lung, and Blood
            Institute.......................       1,351       1,433       1,405
    00.03 National Institute of Dental
            Research........................         184         196         190
    00.04 National Institute of Diabetes and
            Digestive and Kidney Disease....         768         816         821
    00.05 National Institute of Neurological
            Disorders and Stroke............         684         726         723
    00.06 National Institute of Allergy and
            Infectious Diseases.............       1,171       1,257         634
    00.07 National Institute of General
            Medical Sciences................         944         998         992
    00.08 National Institute of Child Health
            and Human Development...........         593         631         582
    00.09 National Eye Institute............         313         333         331
    00.10 National Institute of
            Environmental Health Sciences...         288         308         314
    00.11 National Institute on Aging.......         454         486         495
    00.12 National Institute of Arthritis
            and Musculoskeletal and Skin
            Disease.........................         243         257         259
    00.13 National Institute on Deafness and
            Other Communication Disorder....         176         188         192
    00.14 National Institute of Nursing
            Research........................          56          60          56
    00.15 National Institute of Alcohol
            Abuse and Alcoholism............         199         212         208
    00.16 National Institute on Drug Abuse..         458         489         358
    00.17 National Institute of Mental
            Health..........................         660         701         630
    00.18 National Center for Research
            Resources.......................         390         415         334
    00.19 National Human Genome Research
            Institute.......................         169         190         202
    00.20 John E. Fogarty International
            Center..........................          25          27          17
    00.21 National Library of Medicine......         139         152         153
    00.22 Office of the Director............         260         287         234
    00.23 Office of AIDS Research...........                               1,541
    00.24 Buildings and facilities..........         101         387         190
    00.25 Cooperative research and
            development agreements..........           6          24          15
    00.26 Royalities........................          13          20          20
                                               ---------   ---------  ----------
    00.91   Total direct program............      11,900      12,974      13,113
    01.01 Reimbursable program..............         330         360         384
                                               ---------   ---------  ----------
    10.00   Total obligations...............      12,230      13,334      13,497
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested
            balance.........................         164         221
    22.00 New budget authority (gross)......      12,285      13,113      13,497
    22.30 Unobligated balance expiring......           2
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......      12,451      13,334      13,497
    23.95 New obligations...................     -12,230     -13,334     -13,497
    24.40 Unobligated balance available, end
            of year: Uninvested balance.....         221
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................      11,928      12,747      13,078
    40.75   Reduction pursuant to P.L. 104-
              208...........................                      -6
                                               ---------   ---------  ----------
    43.00     Appropriation (total).........      11,928      12,741      13,078
          Permanent:

    60.25   Appropriation (special fund,
              indefinite)...................           7          12          15
            Spending authority from
                offsetting collections:
    68.00     Offsetting collections (cash).         250         360         404
    68.10     Change in orders on hand from
                Federal sources.............         100
                                               ---------   ---------  ----------
    68.90       Spending authority from
                  offsetting collections
                  (total)...................         350         360         404
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................      12,285      13,113      13,497
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
          Unpaid obligations, start of year:

    72.40   Obligated balance: Appropriation       7,647       9,247      10,063
    72.95   Orders on hand from Federal
              sources.......................       4,322       4,422       4,422
                                               ---------   ---------  ----------
    72.99     Total unpaid obligations,
                start of year...............      11,969      13,669      14,485
    73.10 New obligations...................      12,230      13,334      13,497
    73.20 Total outlays (gross).............     -10,467     -12,518     -13,205
    73.40 Adjustments in expired accounts...         -63
          Unpaid obligations, end of year:

    74.40   Obligated balance: Appropriation       9,247      10,063      10,355
    74.95   Orders on hand from Federal
              sources.......................       4,422       4,422       4,422
                                               ---------   ---------  ----------
    74.99     Total unpaid obligations, end
                of year.....................      13,669      14,485      14,777
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority       4,489       4,935       5,067
    86.93 Outlays from current balances.....       5,723       7,211       7,719
    86.97 Outlays from new permanent
            authority.......................         255         372         419
    86.98 Outlays from permanent balances...
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........      10,467      12,518      13,205
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.00   Offsetting collections (cash)
              from: Federal sources.........        -250        -360        -404
    88.95 Change in orders on hand from
            Federal sources.................        -100
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................      11,935      12,753      13,093
    90.00 Outlays...........................      10,217      12,158      12,801
    ---------------------------------------------------------------------------

                              [Dollars in millions]

                                            1996         1997        1998
    Distribution of budget authority by
        account:
      National Cancer Institute.........       2,255       2,381       2,217
      National Heart, Lung, and Blood
        Institute.......................       1,351       1,432       1,405
      National Institute of Dental
        Research........................         184         196         190
      National Institute of Diabetes and
        Digestive and Kidney Diseases...         769         816         821
      National Institute of Neurological
        Disorder and Stroke.............         684         726         723
      National Institute of Allergy and
        Infectious Diseases.............       1,171       1,257         634
      National Institute of General
        Medical Sciences................         944         998         992
      National Institute of Child Health
        and Human Development...........         593         631         582
      National Eye Institute............         313         333         331
      National Institute of
        Environmental Health Sciences...         288         308         314
      National Institute on Aging.......         454         486         495
      National Institute of Arthritis
        and Musculoskeletal and Skin
        Diseases........................         243         257         259
      National Institute on Deafness and
        Other Communication Disorders...         176         188         192
      National Institute of Nursing
        Research........................          56          60          56
      National Institute on Alcohol
        Abuse and Alcoholism............         199         212         208
      National Institute on Drug Abuse..         458         489         358
      National Institute of Mental
        Health..........................         660         701         630
      National Center for Research
        Resources.......................         389         415         334
      National Human Genome Research
        Institute.......................         169         190         202
      John E. Fogarty International
        Center..........................          25          27          17
      National Library of Medicine......         141         151         153
      Office of the Director............         260         287         234
      Office of AIDS Research...........                               1,541
      Buildings and Facilities..........         146         200         190
                                        ------------------------------------
          Subtotal......................      11,928      12,741      13,078
      Cooperative Research and
        Development Agreements..........           7          12          15
                                        ------------------------------------
          Total Budget Authority, NIH...      11,935      12,753      13,093
                                        ====================================

                              [Dollars in millions]

                                            1996         1997        1998
    Distribution of outlays by account:
      National Cancer Institute.........       2,011       2,299       2,178
      National Heart, Lung, and Blood
        Institute.......................       1,214       1,387       1,391
      National Institute of Dental
        Research........................         126         187         184
      National Institute of Diabetes and
        Digestive and Kidney Diseases...         794         790         811
      National Institute of Neurological
        Disorders and Stroke............         501         693         709
      National Institute of Allergy and
        Infectious Diseases.............         893       1,185         608
      National Institute of General
        Medical Sciences................         803         957         979
      National Institute of Child Health
        and Human Development...........         542         607         571
      National Eye Institute............         229         318         322
      National Institute of
        Environmental Health Sciences...         212         296         310
      National Institute on Aging.......         359         461         484
      National Institute of Arthritis
        and Musculoskeletal and Skin
        Diseases........................         208         247         253
      National Institute on Deafness and
        Other Communication Disorders...         152         179         187
      National Institute of Nursing
        Research........................          37          56          55
      National Institute on Alcohol
        Abuse and Alcoholism............         222         204         203

    [[Page 506]]

      National Institute on Drug Abuse..         407         461         339
      National Institute of Mental
        Health..........................         617         669         608
      National Center for Research
        Resources.......................         289         400         344
      National Human Genome Research
        Institute.......................         145         176         191
      John E. Fogarty International
        Center..........................          28          23          17
      National Library of Medicine......         117         145         152
      Office of the Director............         195         245         224
      Office of AIDS Research...........                               1,478
      Buildings and Facilities..........         118         161         188
                                        ------------------------------------
          Subtotal Outlays..............      10,212      12,146      12,786
      Cooperative Research and
        Development Agreements..........           5          12          15
                                        ------------------------------------
          Total Outlays, NIH............      10,217      12,158      12,801
                                        ====================================
        Note: The total amount for FY 1997 AIDS research was $1,501,720,000,
    which was jointly determined by the Director of NIH and the Director of the
    Office of AIDS Research pursuant to section 211 of P.L. 104-208.
    $1,466,131,000 was made available to OAR. This amount is net of the
    $35,589,000 in AIDS funds earmarked in P.L. 104-208 in the Office of the
    Director account.

        This program funds biomedical research and research training. These
    accounts will continue to be appropriated separately, and are displayed
    in a consolidated format to improve the readability of the presentation.
    Detailed information is available through the Department of Health and
    Human Services.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9915-0-1-552      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

          Direct obligations:

            Personnel compensation:
    11.1      Full-time permanent...........         457         476         496
    11.3      Other than full-time permanent          96         106         108
    11.5      Other personnel compensation..          24          26          23
    11.8      Special personal services
                payments....................          81          88          92
                                               ---------   ---------  ----------
    11.9        Total personnel compensation         658         696         719
    12.1    Civilian personnel benefits.....         138         145         151
    21.0    Travel and transportation of
              persons.......................          18          19          19
    22.0    Transportation of things........           3           4           4
    23.1    Rental payments to GSA..........           4           5           5
    23.2    Rental payments to others.......           7           6           6
    23.3    Communications, utilities, and
              miscellaneous charges.........          44          45          45
    24.0    Printing and reproduction.......          14          12          12
    25.1    Advisory and assistance services          19          21          27
    25.2    Other services..................         342         631         416
    25.3    Purchases of goods and services
              from Government accounts......         857         764         764
    25.4    Operation and maintenance of
              facilities....................          97         166         164
    25.5    Research and development
              contracts.....................         710         688         705
    25.6    Medical care....................           5           5           5
    25.7    Operation and maintenance of
              equipment.....................          34          33          33
    25.8    Subsistence and support of
              persons.......................           8          11
    26.0    Supplies and materials..........         120         124         123
    31.0    Equipment.......................         105         102          98
    41.0    Grants, subsidies, and
              contributions.................       8,714       9,494       9,794
    42.0    Insurance claims and indemnities           3           3           3
                                               ---------   ---------  ----------
    99.0      Subtotal, direct obligations..      11,900      12,974      13,093
    99.0  Reimbursable obligations..........         330         360         404
                                               ---------   ---------  ----------
    99.9    Total obligations...............      12,230      13,334      13,497
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-9915-0-1-552      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
        Direct:
          Total compensable workyears:

    1001    Full-time equivalent employment.      15,050      15,047      15,088
    1005    Full-time equivalent of overtime
              and holiday hours.............         196         196         196
    1011    Exempt Full-time equivalent
              employment....................                      14          14
        Reimbursable:
    2001  Total compensable workyears: Full-
            time equivalent employment......          65          66          65
    ---------------------------------------------------------------------------

            SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION

                                  Federal Funds

    General and special funds:

                   Substance Abuse and Mental Health Services

        For carrying out [titles V and XIX of] the Public Health Service Act
    with respect to substance abuse and mental health services, the
    Protection and Advocacy for Mentally Ill Individuals Act of 1986,
    [section 30401 of Public Law 103-322 and section 301 of the Public
    Health Service Act with respect to program management, $2,134,743,000,
    of which $5,000,000 shall be for grants to rural and Native American
    projects and $12,800,000 shall be for activities authorized by section
    30401 of Public Law 103-322] $2,155,943,000, of which $1,000,000,
    together with unobligated balances for facilities renovation, shall be
    available for sealing off and preserving the Federally-owned unoccupied
    facilities at St. Elizabeths Hospital and shall remain available until
    September 30, 1999. (Department of Health and Human Services
    Appropriations Act, 1997.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1362-0-1-550      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Mental health and substance abuse
            activities......................         320         494         505
    00.02 Mental health partnership.........         275         275         275
    00.03 Substance abuse partnership.......       1,234       1,310       1,320
    00.04 Substance abuse partnership--
            temporary supplement (mandatory)                      50          50
    00.05 Program management................          56          55          55
    00.06 Building and facilities...........                                   1
                                               ---------   ---------  ----------
    00.91   Total direct program............       1,885       2,184       2,206
    01.01 Reimbursable program..............          20          20          20
                                               ---------   ---------  ----------
    10.00   Total obligations...............       1,905       2,204       2,226
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested
            balance.........................           2           2           2
    22.00 New budget authority (gross)......       1,905       2,204       2,226
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......       1,907       2,206       2,228
    23.95 New obligations...................      -1,905      -2,204      -2,226
    24.40 Unobligated balance available, end
            of year: Uninvested balance.....           2           2           2
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................       1,883       2,134       2,156
    42.00   Transferred from other accounts.           2
                                               ---------   ---------  ----------
    43.00     Appropriation (total).........       1,885       2,134       2,156
          Permanent:

    65.00   Advance appropriation (definite)                      50          50
    68.00   Spending authority from
              offsetting collections:
              Offsetting collections (cash).          20          20          20
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................       1,905       2,204       2,226
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Appropriation       1,250       1,048       1,327
    73.10 New obligations...................       1,905       2,204       2,226
    73.20 Total outlays (gross).............      -2,104      -1,925      -2,109
    73.40 Adjustments in expired accounts...          -3
    74.40 Unpaid obligations, end of year:
            Obligated balance: Appropriation       1,048       1,327       1,444
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority         905       1,067       1,078
    86.93 Outlays from current balances.....       1,179         813         986
    86.97 Outlays from new permanent
            authority.......................          20          45          45
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........       2,104       1,925       2,109
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.00   Offsetting collections (cash)
              from: Federal sources.........         -20         -20         -20
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................       1,885       2,184       2,206

    [[Page 507]]

    90.00 Outlays...........................       2,083       1,905       2,089
    ---------------------------------------------------------------------------

        This program provides Federal support for treatment and prevention
    in the areas of alcoholism, drug abuse, and mental health.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1362-0-1-550      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

          Direct obligations:

            Personnel compensation:
    11.1      Full-time permanent...........          31          32          32
    11.3      Other than full-time permanent           1           1           1
    11.5      Other personnel compensation..           1           1           1
                                               ---------   ---------  ----------
    11.9        Total personnel compensation          33          34          34
    12.1    Civilian personnel benefits.....           7           7           7
    21.0    Travel and transportation of
              persons.......................           1           1           1
    23.1    Rental payments to GSA..........           3           3           3
    23.3    Communications, utilities, and
              miscellaneous charges.........           2           1           1
    24.0    Printing and reproduction.......           2           2           1
    25.1    Advisory and assistance services          33          38          70
    25.2    Other services..................          64         102         125
    25.3    Purchases of goods and services
              from Government accounts......          14          13          11
    31.0    Equipment.......................           1           1           1
    41.0    Grants, subsidies, and
              contributions.................       1,723       1,980       1,950
    42.0    Insurance claims and indemnities           2           2           2
                                               ---------   ---------  ----------
    99.0      Subtotal, direct obligations..       1,885       2,184       2,206
    99.0  Reimbursable obligations..........          20          20          20
                                               ---------   ---------  ----------
    99.9    Total obligations...............       1,905       2,204       2,226
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-1362-0-1-550      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
        Direct:
          Total compensable workyears:

    1001    Full-time equivalent employment.         590         590         590
    1005    Full-time equivalent of overtime
              and holiday hours.............           2           2           2
        Reimbursable:
          Total compensable workyears:

    2001    Full-time equivalent employment.           2           2           2
    2011    Exempt Full-time equivalent
              employment....................          64          61          61
    ---------------------------------------------------------------------------

                   AGENCY FOR HEALTH CARE POLICY AND RESEARCH

                                  Federal Funds

    General and special funds:

                         Health Care Policy and Research

        For carrying out titles III and IX of the Public Health Service Act,
    and part A of title XI of the Social Security Act, [$96,175,000]
    $87,000,000; in addition, amounts received from Freedom of Information
    Act fees, reimbursable and interagency agreements, and the sale of data
    tapes shall be credited to this appropriation and shall remain available
    until expended: Provided, That the amount made available pursuant to
    section 926(b) of the Public Health Service Act shall not exceed
    [$47,412,000] $62,000,000. (Department of Health and Human Services
    Appropriations Act, 1997.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1700-0-1-552      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
          Direct program:

    01.01   Research on health care systems
              cost and access...............           7          36          17
    01.02   Health insurance and expenditure
              surveys.......................                      10          10
    01.03   Research on health care outcomes
              and quality...................          56          48          58
    01.04   Program support.................           2           2           2
                                               ---------   ---------  ----------
    01.91     Total direct program..........          65          96          87
    04.01 Reimbursable program..............          69          57          71
                                               ---------   ---------  ----------
    10.00   Total obligations...............         134         153         158
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......         134         153         158
    23.95 New obligations...................        -134        -153        -158
    24.40 Unobligated balance available, end
            of year: Uninvested balance.....           1
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................          65          96          87
          Permanent:

    68.00   Spending authority from
              offsetting collections:
              Offsetting collections (cash).          69          57          71
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................         134         153         158
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Appropriation         159         142         143
    73.10 New obligations...................         134         153         158
    73.20 Total outlays (gross).............        -150        -152        -159
    73.40 Adjustments in expired accounts...          -1
    74.40 Unpaid obligations, end of year:
            Obligated balance: Appropriation         142         143         142
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority         -25          16          15
    86.93 Outlays from current balances.....         106          79          73
    86.97 Outlays from new permanent
            authority.......................          69          57          71
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........         150         152         159
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.00   Offsetting collections (cash)
              from: Federal sources.........         -69         -57         -71
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................          65          96          87
    90.00 Outlays...........................          81          95          88
    ---------------------------------------------------------------------------

        This activity supports research and information dissemination on
    health care services and technology, medical effectiveness, and patient
    outcomes.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1700-0-1-552      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

          Direct obligations:

            Personnel compensation:
    11.1      Full-time permanent...........           6          12          13
    11.3      Other than full-time permanent           1           1           2
    11.5      Other personnel compensation..                       1
                                               ---------   ---------  ----------
    11.9        Total personnel compensation           7          14          15
    12.1    Civilian personnel benefits.....           1           4           4
    23.1    Rental payments to GSA..........           1           3           3
    23.3    Communications, utilities, and
              miscellaneous charges.........           1           1           1
    24.0    Printing and reproduction.......           1           2           2
    25.2    Other services..................           2           4           4
    25.3    Purchases of goods and services
              from Government accounts......           1           2           2
    25.5    Research and development
              contracts.....................          11          11          30
    31.0    Equipment.......................                       1           1
    41.0    Grants, subsidies, and
              contributions.................          40          54          25
                                               ---------   ---------  ----------
    99.0      Subtotal, direct obligations..          65          96          87
    99.0  Reimbursable obligations..........          69          57          71
                                               ---------   ---------  ----------
    99.9    Total obligations...............         134         153         158
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-1700-0-1-552      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
        Direct:
          Total compensable workyears:

    1001    Full-time equivalent employment.         104         197         197
    1005    Full-time equivalent of overtime
              and holiday hours.............           1           1           1
        Reimbursable:
    2001  Total compensable workyears: Full-
            time equivalent employment......         148          55          55
    ---------------------------------------------------------------------------

    [[Page 508]]

                      HEALTH CARE FINANCING ADMINISTRATION

                                  Federal Funds

    General and special funds:

                          Grants to States for Medicaid

        For carrying out, except as otherwise provided, titles XI and XIX of
    the Social Security Act, [$75,056,618,000] $71,530,429,000, to remain
    available until expended.
        For making, after May 31, [1997] 1998, payments to States under
    title XIX of the Social Security Act for the last quarter of fiscal year
    [1997] 1998 for unanticipated costs, incurred for the current fiscal
    year, such sums as may be necessary.
        For making payments to States under title XIX of the Social Security
    Act for the first quarter of fiscal year [1998, $27,988,993,000] 1999,
    $27,800,689,000, to remain available until expended.
        Payment under title XIX may be made for any quarter with respect to
    a State plan or plan amendment in effect during such quarter, if
    submitted in or prior to such quarter and approved in that or any
    subsequent quarter. (Department of Health and Human Services
    Appropriations Act, 1997.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0512-0-1-551      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Medicaid vendor payments..........      88,642      93,346      99,144
    00.02 State and local administration....       3,881       4,634       4,875
    00.03 Vaccine purchases.................         204         523         365
                                               ---------   ---------  ----------
    10.00   Total obligations (object class
              41.0).........................      92,728      98,503     104,384
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested
            balance.........................      12,740       2,155       4,864
    22.00 New budget authority (gross)......      82,142     101,212      99,519
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......      94,882     103,367     104,384
    23.95 New obligations...................     -92,728     -98,503    -104,384
    24.40 Unobligated balance available, end
            of year: Uninvested balance.....       2,155       4,864
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................      55,094      75,057      71,530
          Permanent:

    65.00   Advance appropriation (definite)      27,048      26,155      27,989
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................      82,142     101,212      99,519
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Appropriation       4,606       5,344       5,344
    73.10 New obligations...................      92,728      98,503     104,384
    73.20 Total outlays (gross).............     -91,990     -98,503    -104,384
    74.40 Unpaid obligations, end of year:
            Obligated balance: Appropriation       5,344       5,344       5,344
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority      47,596      64,849      66,187
    86.93 Outlays from current balances.....      17,346       7,499      10,208
    86.97 Outlays from new permanent
            authority.......................      27,048      26,155      27,989
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........      91,990      98,503     104,384
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................      82,142     101,212      99,519
    90.00 Outlays...........................      91,990      98,503     104,384
    ---------------------------------------------------------------------------

                     Summary of Budget Authority and Outlays

                            (in millions of dollars)

                                         1996 actual  1997 est.   1998 est.
    Enacted/requested:
      Budget Authority..................      82,142     101,212      99,519
      Outlays...........................      91,990      98,503     104,384
    Legislative proposal, subject to
        PAYGO:
      Budget Authority..................                               1,456
      Outlays...........................                      39       1,417
                                        ------------------------------------
    Total:
      Budget Authority..................      82,142     101,212     100,975
      Outlays...........................      91,990      98,542     105,801
                                        ====================================

        Medicaid assists States in providing medical care to their low-
    income population by granting Federal matching payments under title XIX
    of the Social Security Act to States with approved plans.

        Current and projected vaccine excise tax receipts to the Vaccine
    Injury Compensation Program Trust Fund far exceed current and projected
    claims to the Trust Fund. The Budget proposes lowering revenue to the
    Trust Fund by exempting Federal programs (which provide free vaccine to
    low-income, uninsured, and underinsured children) from payment of the
    vaccine excise tax in FY 1998. Exempting these programs will result in
    Federal savings to the Grants to States for Medicaid account.

                          Grants to States for Medicaid

                    (Legislative proposal, subject to PAYGO)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0512-4-1-551      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    10.00 Total obligations (object class
            41.0)...........................                      39       1,417
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested
            balance.........................                                 -39
    22.00 New budget authority (gross)......                               1,456
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......                               1,417
    23.95 New obligations...................                     -39      -1,417
    24.40 Unobligated balance available, end
            of year: Uninvested balance.....                     -39
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    40.00 Appropriation.....................                               1,456
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    73.10 New obligations...................                      39       1,417
    73.20 Total outlays (gross).............                     -39      -1,417
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority                      39       1,456
    86.93 Outlays from current balances.....                                 -39
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........                      39       1,417
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................                               1,456
    90.00 Outlays...........................                      39       1,417
    ---------------------------------------------------------------------------

        This schedule reflects the effects of Medicaid, Medicare, welfare,
    children's health, and other mandatory proposals included in the Budget
    on the Grants to States for Medicaid account.

                       Payments to Health Care Trust Funds

        For payment to the Federal Hospital Insurance and the Federal
    Supplementary Medical Insurance Trust Funds, as provided under sections
    217(g) and 1844 of the Social Security Act, sections 103(c) and 111(d)
    of the Social Security Amendments of 1965, section 278(d) of Public Law
    97-248, and for administrative expenses incurred pursuant to section
    201(g) of the Social Security Act, [$60,079,000,000] $63,581,000,000.
    (Department of Health and Human Services Appropriations Act, 1997.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0580-0-1-571      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Supplementary medical insurance
            (SMI)...........................      61,702      59,354      63,416
    00.02 Hospital insurance for uninsured
            (HI)............................         358         405         -52
    00.03 Federal uninsured payment (HI)....          61          76          86
    00.04 Program management (HI)...........         145         142         131

    [[Page 509]]

    00.06 Federal payments from taxation of
            OASDI benefits (HI).............       4,069       4,163       4,351
    00.07 SECA tax credits (HI).............         -10
    00.08 Fraud and abuse control, FBI......                      47          56
    00.10 Fraud and abuse control, criminal
            fines...........................                      15          15
    00.11 Fraud and abuse control, civil
            monetary penalties..............                     218         237
                                               ---------   ---------  ----------
    10.00   Total obligations...............      66,325      64,420      68,240
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......      67,372      64,522      68,240
    22.30 Unobligated balance expiring......      -1,047        -102
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......      66,325      64,420      68,240
    23.95 New obligations...................     -66,325     -64,420     -68,240
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................      63,313      60,079      63,581
          Permanent:

    60.05   Appropriation (indefinite)......       4,059       4,443       4,659
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................      67,372      64,522      68,240
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    73.10 New obligations...................      66,325      64,420      68,240
    73.20 Total outlays (gross).............     -66,325     -64,420     -68,240
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority      62,266      59,977      63,581
    86.97 Outlays from new permanent
            authority.......................       4,059       4,443       4,659
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........      66,325      64,420      68,240
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................      67,372      64,522      68,240
    90.00 Outlays...........................      66,325      64,420      68,240
    ---------------------------------------------------------------------------

                     Summary of Budget Authority and Outlays

                            (in millions of dollars)

                                         1996 actual  1997 est.   1998 est.
    Enacted/requested:
      Budget Authority..................      67,372      64,522      68,240
      Outlays...........................      66,325      64,420      68,240
    Legislative proposal, not subject to
        PAYGO:
      Budget Authority..................                              14,668
      Outlays...........................                              14,668
                                        ------------------------------------
    Total:
      Budget Authority..................      67,372      64,522      82,908
      Outlays...........................      66,325      64,420      82,908
                                        ====================================

        Payments are made (1) to the Federal Supplementary Medical Insurance
    Trust Fund; and (2) to the Federal Hospital Insurance Trust Fund for
    individuals aged 65 and over who meet certain transitional insured
    status requirements, and for civil service employees and annuitants who
    worked before 1983 and who were employed during January 1983. Beginning
    in 1992, amounts are included for non-Medicare activities of HCFA
    Program Management.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0580-0-1-571      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
    41.0  Grants, subsidies, and
            contributions...................      65,761      63,797      68,075
    42.0  Insurance claims and indemnities..         419         481          34
    92.0  Undistributed.....................         145         142         131
                                               ---------   ---------  ----------
    99.9    Total obligations...............      66,325      64,420      68,240
    ---------------------------------------------------------------------------

                       Payments to Health Care Trust Funds

                  (Legislative proposal, not subject to PAYGO)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0580-2-1-571      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    10.00 Total obligations (object class
            41.0)...........................                              14,668
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......                              14,668
    23.95 New obligations...................                             -14,668
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    40.00 Appropriation.....................                              14,668
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    73.10 New obligations...................                              14,668
    73.20 Total outlays (gross).............                             -14,668
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority                              14,668
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................                              14,668
    90.00 Outlays...........................                              14,668
    ---------------------------------------------------------------------------

        This schedule reflects the effects of the Medicare reform proposals
    contained in the Administration's balanced budget proposal on the
    Payments to Health Care Trust Funds account.

                               Program Management

        For carrying out, except as otherwise provided, titles XI, XVIII,
    and XIX of the Social Security Act, title XIII of the Public Health
    Service Act, and the Clinical Laboratory Improvement Amendments of 1988,
    not to exceed [$1,735,125,000] $1,774,500,000, to be transferred from
    the Federal Hospital Insurance and the Federal Supplementary Medical
    Insurance Trust Funds, as authorized by section 201(g) of the Social
    Security Act; together with all funds collected in accordance with
    section 353 of the Public Health Service Act, the latter funds to remain
    available until expended, together with such sums as may be collected
    from authorized user fees and the sale of data, which shall remain
    available until expended: Provided, That all funds derived in accordance
    with 31 U.S.C. 9701 from organizations established under title XIII of
    the Public Health Service Act are to be credited to and available for
    carrying out the purposes of this appropriation. (Department of Health
    and Human Services Appropriations Act, 1997.)

                  Unavailable Collections (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0511-0-1-550      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
        Balance, start of year:
    01.99 Balance, start of year............
        Receipts:
    02.01 Survey and certification fees,
            HCFA, legislative proposal......                                  10
        Appropriation:
    05.01 Program management, legislative
            proposal........................                                 -10
    07.99 Total balance, end of year........
    ---------------------------------------------------------------------------

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0511-0-1-550      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
          Direct program:

    00.01   Research, demonstrations, and
              evaluation projects...........          53          44          45
    00.02   Medicare contractors............       1,555       1,207       1,223
    00.04   State certification.............         145         158         148
    00.05   Administrative costs............         325         325         359
                                               ---------   ---------  ----------
    00.91   Total direct program............       2,078       1,734       1,775
          Reimbursable program:

    08.01   CLIA............................          29          43          43
    08.02   Other reimbursements............           4           2           2
                                               ---------   ---------  ----------
    08.91   Total reimbursable program......          33          45          45
                                               ---------   ---------  ----------
    10.00   Total obligations...............       2,111       1,779       1,820
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested
            balance.........................          15          17          17
    22.00 New budget authority (gross)......       2,159       1,779       1,820
    22.30 Unobligated balance expiring......         -46
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......       2,128       1,796       1,837

    [[Page 510]]

    23.95 New obligations...................      -2,111      -1,779      -1,820
    24.40 Unobligated balance available, end
            of year: Uninvested balance.....          17          17          17
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    68.00 Spending authority from offsetting
            collections (gross): Offsetting
            collections (cash)..............       2,159       1,779       1,820
                                                   2,159       1,779       1,820
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Appropriation         445         452         452
    73.10 New obligations...................       2,111       1,779       1,820
    73.20 Total outlays (gross).............      -2,116      -1,779      -1,820
    73.40 Adjustments in expired accounts...          12
    74.40 Unpaid obligations, end of year:
            Obligated balance: Appropriation         452         452         452
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new permanent
            authority.......................       2,116       1,779       1,820
    86.98 Outlays from permanent balances...
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........       2,116       1,779       1,820
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

            Offsetting collections (cash)
                from:
    88.00     Federal sources...............      -2,124      -1,734      -1,775
    88.40     Non-Federal sources...........         -35         -45         -45
                                               ---------   ---------  ----------
    88.90       Total, offsetting
                  collections (cash)........      -2,159      -1,779      -1,820
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................
    90.00 Outlays...........................         -43
    ---------------------------------------------------------------------------

                     Summary of Budget Authority and Outlays

                            (in millions of dollars)

                                         1996 actual  1997 est.   1998 est.
    Enacted/requested:
      Budget Authority..................
      Outlays...........................         -43
    Legislative proposal, subject to
        PAYGO:
      Budget Authority..................                               2,610
      Outlays...........................                               2,523
                                        ------------------------------------
    Total:
      Budget Authority..................                               2,610
      Outlays...........................         -43                   2,523
                                        ====================================

        Program management activities include funding for research, Medicare
    contractors, survey and certification, CLIA, and administrative costs.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0511-0-1-550      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

          Personnel compensation:

    11.1    Full-time permanent.............         216         228         239
    11.3    Other than full-time permanent..           5           5           5
    11.5    Other personnel compensation....           1           2           2
                                               ---------   ---------  ----------
    11.9      Total personnel compensation..         222         235         246
    12.1  Civilian personnel benefits.......          38          41          47
    21.0  Travel and transportation of
            persons.........................           5           3           5
    23.1  Rental payments to GSA............          16          23          31
    23.3  Communications, utilities, and
            miscellaneous charges...........           7           4           8
    24.0  Printing and reproduction.........           5           3           6
    25.1  Advisory and assistance services..          34          27          29
    25.2  Other services....................         274         225         213
    25.6  Medical care......................       1,466       1,205       1,221
    26.0  Supplies and materials............           3           1           1
    31.0  Equipment.........................          13                       6
    41.0  Grants, subsidies, and
            contributions...................          28          12           6
    99.5  Below reporting threshold.........                                   1
                                               ---------   ---------  ----------
    99.9    Total obligations...............       2,111       1,779       1,820
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-0511-0-1-550      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
        Total compensable workyears:
    1001  Full-time equivalent employment...       4,081       4,085       4,085
    1005  Full-time equivalent of overtime
            and holiday hours...............           9           9           9
    ---------------------------------------------------------------------------

                               Program Management

                    (Legislative proposal, subject to PAYGO)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0511-4-1-550      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Healthy working families grants...                               1,738
    00.02 Grants for health insurance
            cooperatives....................                                  25
    00.03 Healthy kids State partnership
            grants..........................                                 750
    00.04 Survey and certification user fee.                                  10
                                               ---------   ---------  ----------
    10.00   Total obligations...............                               2,523
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested
            balance.........................
    22.00 New budget authority (gross)......                               2,610
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......                               2,610
    23.95 New obligations...................                              -2,523
    24.40 Unobligated balance available, end
            of year: Uninvested balance.....                                  87
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    60.00 Appropriation.....................                               2,600
    60.25 Appropriation (special fund,
            indefinite).....................                                  10
                                               ---------   ---------  ----------
    63.00   Appropriation (total)...........                               2,610
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................                               2,610
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    73.10 New obligations...................                               2,523
    73.20 Total outlays (gross).............                              -2,523
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new permanent
            authority.......................                               2,523
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................                               2,610
    90.00 Outlays...........................                               2,523
    ---------------------------------------------------------------------------

        This schedule reflects the effects on the Program Management account
    of the Administration's proposals to: (1) create a four year
    demonstration called ``Healthy Working Families'' to finance health
    insurance for the temporarily unemployed, (2) create a State grant
    program to foster the development of purchasing cooperatives, (3) create
    a State grant demonstration program called ``Healthy Kids'' to support
    State efforts to expand insurance options for uninsured children, and
    (4) require States to collect and retain fees from providers to cover
    the cost of initial surveys required for participation in the Medicare
    program.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0511-4-1-550      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
    25.2  Other services....................                                  10
    41.0  Grants, subsidies, and
            contributions...................                               2,513
                                               ---------   ---------  ----------
    99.9    Total obligations...............                               2,523
    ---------------------------------------------------------------------------

          Health Maintenance Organization Loan and Loan Guarantee Fund

        For carrying out subsections (d) and (e) of section 1308 of the
    Public Health Service Act, any amounts received by the Secretary

    [[Page 511]]

    in connection with loans and loan guarantees under title XIII of the
    Public Health Service Act, to be available without fiscal year
    limitation for the payment of outstanding obligations. During fiscal
    year [1997] 1998, no commitments for direct loans or loan guarantees
    shall be made. (Department of Health and Human Services Appropriations
    Act, 1997.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-4420-0-3-551      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.05 Interest payments to FFB..........           1           1
                                               ---------   ---------  ----------
    10.00   Total obligations (object class
              43.0).........................           1           1
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.90 Unobligated balance available,
            start of year: Fund balance.....          11          11          10
    22.00 New budget authority (gross)......           4           2           2
    22.60 Redemption of debt................          -3          -2          -2
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......          12          11          10
    23.95 New obligations...................          -1          -1
    24.90 Unobligated balance available, end
            of year: Fund balance...........          11          10          10
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    68.00 Spending authority from offsetting
            collections (gross): Offsetting
            collections (cash)..............           4           2           2
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    73.10 New obligations...................           1           1
    73.20 Total outlays (gross).............          -1          -1          -1
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.93 Outlays from current balances.....           1           1           1
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

            Offsetting collections (cash)
                from:
              Non-Federal sources:
    88.40       Interest....................          -1
    88.40       Other.......................          -3          -2          -2
                                               ---------   ---------  ----------
    88.90       Total, offsetting
                  collections (cash)........          -4          -2          -2
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................
    90.00 Outlays...........................          -3          -1          -1
    ---------------------------------------------------------------------------

                                   Trust Funds

                      Federal Hospital Insurance Trust Fund

                  Unavailable Collections (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8005-0-7-571      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
        Balance, start of year:
    01.99 Balance, start of year............     114,830     106,229      96,363
        Receipts:
    02.01 Transfers from general fund (FICA
            taxes)..........................      97,866     102,064     105,744
    02.02 Receipts from Railroad Retirement
            Board...........................         362         366         367
    02.03 Transfers from general fund (SECA
            taxes)..........................       6,752       6,750       8,056
    02.04 Federal employer contributions
            (FICA)..........................       1,787       1,805       1,943
    02.05 Postal service employer
            contributions (FICA)............         522         595         618
    02.06 Refunds...........................          17
    02.07 Interest received by trust funds..      10,350       9,914       8,855
    02.08 Other proprietary receipts from
            the public......................           1
    02.09 Interest received by trust funds,
            legislative proposal............                                 302
    02.10 Taxation on OASDI benefits........       4,069       4,163       4,351
    02.11 Premiums collected for uninsured
            individuals not otherwise
            eligible, legislative proposal..                                -180
    02.12 Interest payments by Railroad
            Retirement Board................          39          35          35
    02.13 Payments from the general fund
            (uninsured and program
            management).....................         554         623         165
    02.14 Payments for military service
            credits.........................          73          70          64
    02.15 Premiums collected for uninsured
            individuals not otherwise
            eligible........................       1,107       1,265       1,385
    02.16 Payment from the general fund.....                      47          56
    02.17 Criminal fines, transfers from the
            general fund....................                      15          15
    02.18 Civil monetary penalties,
            transfers from the general fund.                     218         237
    02.20 Civil penalties and damages.......                      50          50
                                               ---------   ---------  ----------
    02.99   Total receipts..................     123,499     127,980     132,063
                                               ---------   ---------  ----------
    04.00 Total: Balances and collections...     238,329     234,209     228,426
        Appropriation:
    05.01 Federal hospital insurance trust
            fund............................    -132,100    -137,259    -148,484
    05.02 Health care fraud and abuse
            control account.................                    -591        -676
    05.04 Federal hospital insurance trust
            fund, legislative proposal
            subject to PAYGO................                              19,410
                                               ---------   ---------  ----------
    05.99 Subtotal appropriation............    -132,100    -137,850    -129,750
    06.20 Reduction pursuant to Public Law
            104-208.........................                       4
    07.99 Total balance, end of year........     106,229      96,363      98,676
    ---------------------------------------------------------------------------

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8005-0-7-571      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Benefit payments, HI..............     128,003     136,021     147,171
    00.02 Administration, HI................       1,172       1,123       1,218
    00.03 Peer review organizations, HI.....         521          80          63
    00.04 Research, HI......................          38          31          31
    00.05 Quinquennial adjustment for
            military service credits........       2,366
                                               ---------   ---------  ----------
    10.00   Total obligations...............     132,100     137,255     148,484
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......     132,100     137,255     148,484
    23.95 New obligations...................    -132,100    -137,255    -148,484
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.26   Appropriation (trust fund,
              definite).....................       1,169       1,114       1,209
          Permanent:

    60.27   Appropriation (trust fund,
              indefinite)...................     122,330     126,866     130,732
    60.28   Appropriation (unavailable
              balances).....................       8,601       9,279      16,543
    60.75   Reduction pursuant to P.L. 104-
              208...........................                      -4
                                               ---------   ---------  ----------
    63.00     Appropriation (total).........     130,931     136,141     147,274
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................     132,100     137,255     148,484
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.41 Unpaid obligations, start of year:
            Obligated balance: U.S.
            Securities: Par value...........      14,691      19,107      18,890
    73.10 New obligations...................     132,100     137,255     148,484
    73.20 Total outlays (gross).............    -127,683    -137,471    -148,686
    74.41 Unpaid obligations, end of year:
            Obligated balance: U.S.
            Securities: Par value...........      19,107      18,890      18,688
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority       1,098       1,045       1,140
    86.93 Outlays from current balances.....         130         148         113
    86.97 Outlays from new permanent
            authority.......................     111,894     117,319     128,656
    86.98 Outlays from permanent balances...      14,561      18,959      18,777
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........     127,683     137,471     148,686
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................     132,100     137,255     148,484
    90.00 Outlays...........................     127,683     137,471     148,686
    ---------------------------------------------------------------------------

                     Summary of Budget Authority and Outlays

                            (in millions of dollars)

                                         1996 actual  1997 est.   1998 est.
    Enacted/requested:
      Budget Authority..................     132,100     137,255     148,483
      Outlays...........................     127,683     137,471     148,686
    Legislative proposal, subject to
        PAYGO:
      Budget Authority..................                             -19,410
      Outlays...........................                             -19,410
                                        ------------------------------------
    Total:
      Budget Authority..................     132,100     137,255     129,073
      Outlays...........................     127,683     137,471     129,276
                                        ====================================

        The Hospital Insurance (HI) program funds the costs of hospital and
    related care for individuals age 65 or older and for eligible disabled
    people.

        The status of the trust fund is as follows:

    [[Page 512]]

                      Status of Funds (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8005-0-7-571      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
        Unexpended balance, start of year:
    0100  Treasury balance..................        -344        -467           1
    0101  U.S. Securities: Par value........     129,864     125,803     115,253
                                               ---------   ---------  ----------
    0199    Total balance, start of year....     129,520     125,336     115,254
        Cash income during the year:
          Governmental receipts:

    0200    FHI Trust Fund, Transfers from
              general fund (FICA taxes).....      97,865     102,064     105,744
    0201    FHI Trust Fund, Transfers from
              general fund (SECA taxes).....       6,752       6,750       8,056
    0202    Refunds.........................          17
    0205    FHI Trust Fund, Receipts from
              Railroad Retirement Board.....         362         366         367
    0206    HCFAC: Civil Penalties and
              Damages.......................                      50          50
          Proprietary receipts:

    0221    FHI Trust Fund, Premiums
              collected for uninsured
              individuals not otherwise
              eligible......................       1,107       1,265       1,385
    0222    FHI Trust Fund, Premiums
              collected for uninsured
              individuals not otherwise
              eligible, proposed legislation                                -180
    0223    Other proprietary receipts......           1
          Intragovernmental transactions:

    0240    FHI Trust Fund, Federal employer
              contributions (FICA)..........       1,787       1,805       1,943
    0241    FHI Trust Fund, Postal service
              employer contributions (FICA).         522         595         618
    0242    FHI Trust Fund, Federal payment
              for transitional coverage for
              uninsured Federal employees...          61          76          86
    0243    FHI Trust Fund, Federal payment
              for transitional coverage for
              the uninsured.................         358         405         -52
    0244    FHI Trust Fund, Federal payment
              for SECA tax credits..........         -10
    0245    FHI Trust Fund, General Fund
              transfer, Program management
              (HI)..........................         145         142         131
    0246    FHI Trust Fund, Federal payments
              for OASDI taxes...............       4,069       4,163       4,351
    0248    FHI Trust fund, Interest payment
              from Railroad Retirement Board          39          35          35
    0249    FHI Trust Fund, Interest on
              investments...................      10,350       9,914       8,855
    0250    FHI Trust Fund, Interest on
              investments...................                                 302
    0251    FHI Trust Fund, Transfer from
              Department of Defense for
              military service credits......          73          70          64
    0252    HCFAC: FBI......................                      47          56
    0253    HCFAC: Criminal Fines...........                      15          15
    0254    HCFAC: Civil Monetary Penalties.                     218         237
    0297  Income under present law..........     123,499     127,980     131,941
    0298  Income under proposed legislation.                                 122
                                               ---------   ---------  ----------
    0299    Total cash income...............     123,499     127,980     132,063
        Cash outgo during year:
    0500  Benefit payments..................    -123,908    -136,022    -147,171
    0501  Benefit payments (proposed
            legislation)....................                              19,410
    0502  Administration....................      -1,178      -1,139      -1,215
    0504  Peer review organizations.........        -181        -257        -262
    0505  Research..........................         -50         -54         -38
    0506  HCFAC.............................                    -591        -676
    0507  Quinquennial Adjustment for
            Military Service Credits........      -2,366
    0597  Outgo under present law (-).......    -127,683    -138,062    -149,362
    0598  Outgo under proposed legislation
            (-).............................                              19,410
                                               ---------   ---------  ----------
    0599  Total cash outgo (-)..............    -127,683    -138,062    -129,952
        Unexpended balance, end of year:
    0700  Uninvested balance................        -467           1           1
    0701  U.S. Securities: Par value........     125,803     115,253     117,364
                                               ---------   ---------  ----------
    0799    Total balance, end of year......     125,336     115,254     117,365
    ---------------------------------------------------------------------------

                    Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8005-0-7-571      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
    25.3  Purchases of goods and services
            from Government accounts........         673         603         618
          Grants, subsidies, and contributions:

    41.0    Payment for health insurance
              experiments and demonstration
              projects......................          38          31          31
    41.0    Payment for peer review
              organization (PRO) activities.         521          80          63
    42.0  Insurance claims and indemnities..     128,003     136,021     147,171
          Undistributed:

    92.0    Quinquennial Adjustment for
              Military Service Credits......       2,366
    92.0    Reimbursement for administrative
              expenses for other than SSA
              LAE...........................          41          40          40
    93.0  Administrative expenses: Portion
            of limitation on salaries and
            expenses: Social Security
            Administration..................         458         481         560
    99.5  Below reporting threshold.........                      -1           1
                                               ---------   ---------  ----------
    99.9    Total obligations...............     132,100     137,255     148,484
    ---------------------------------------------------------------------------

        The estimate of administrative expenses borne by each of the
    financing sources, including the Hospital Insurance (HI) and
    Supplemental Medical Insurance (SMI) trust funds for Medicare-related
    activities performed by the Social Security Administration (SSA), has
    been made by SSA based on the current cost allocation methodology.
    Pursuant to section 201(g) of the Social Security Act, a final
    accounting of actual payments is made after the close of each fiscal
    year. In the Conference Committee Report for Public Law 103-296, The
    Social Security Independence and Program Improvements Act of 1994, the
    conferees requested that the Secretary of Health and Human Services and
    the Commissioner of Social Security make a joint examination of the most
    appropriate cost allocation methodology and report their joint findings
    to the Congress within 36 months of enactment. The Secretary and the
    Commissioner are in the process of designing and carrying out this study
    and preparing the required report to Congress.

                      Federal Hospital Insurance Trust Fund

                    (Legislative proposal, subject to PAYGO)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8005-4-7-571      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Benefit payments, HI..............                             -19,410
                                               ---------   ---------  ----------
    10.00   Total obligations (object class
              42.0).........................                             -19,410
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......                             -19,410
    23.95 New obligations...................                              19,410
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    60.28 Appropriation (unavailable
            balances).......................                             -19,410
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    73.10 New obligations...................                             -19,410
    73.20 Total outlays (gross).............                              19,410
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new permanent
            authority.......................                             -19,410
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................                             -19,410
    90.00 Outlays...........................                             -19,410
    ---------------------------------------------------------------------------

        This schedule reflects the effects of the Medicare reform proposals
    contained in the Administration's balanced budget proposal on the
    Hospital Insurance Trust Fund.

                   Health Care Fraud and Abuse Control Account

                     (federal hospital insurance trust fund)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-8393-0-7-571      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Medicare integrity program........                     440         500
    00.02 FBI fraud and abuse control.......                      47          56
    00.03 Other fraud and abuse control.....                     104         120
                                               ---------   ---------  ----------
    10.00   Total obligations...............                     591         676
    ----------------------------------------------------------------------------

    [[Page 513]]

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......                     591         676
    23.95 New obligations...................                    -591        -676
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    60.26 Appropriation (trust fund,
            definite).......................                     591         676
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    73.10 New obligations...................                     591         676
    73.20 Total outlays (gross).............                    -591        -676
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new permanent
            authority.......................                     591         676
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................                     591         676
    90.00 Outlays...........................                     591         676
    ---------------------------------------------------------------------------

        The Health Care Fraud and Abuse Control (HCFAC) Account was
    established by Sec. 201 of Public Law 104-191, the Health Insurance
    Portability and Accountability Act of 1996. P.L. 104-191 established the
    HCFAC Account within the Federal Hospital Insurance Trust Fund and
    appropriated funds, to be available without further appropriation, from
    the Trust Fund to the HCFAC Account for specified health care fraud and
    abuse control activities of the Department of Health and Human Services
    (HHS), the Department of Justice, and other agencies.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-8393-0-7-571      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

          Direct obligations:

    25.6    Medical care (HCFA).............                     440         500
    92.0    Undistributed (FBI).............                      47          56
                                               ---------   ---------  ----------
    99.0      Subtotal, direct obligations..                     487         556
          Allocation Account:

            Personnel compensation:
              Full-time permanent:
    11.1        Full-time permanent (OIG)...                      43          50
    11.1        Full-time permanent (DoJ)...                       7           9
    11.1        Full-time permanent (OGC)...                       1           1
                                               ---------   ---------  ----------
    11.9        Total personnel compensation                      51          60
            Civilian personnel benefits:
    12.1      Civilian personnel benefits
                (OIG).......................                       9          10
    12.1      Civilian personnel benefits
                (DoJ).......................                       2           3
            Travel and transportation of
                persons:
    21.0      Travel and transportation of
                persons (OIG)...............                       3           3
    21.0      Travel and transportation of
                persons (DoJ)...............                       1           1
    21.0      Travel and transportation of
                persons (OGC)...............                       1           1
            Rental payments to GSA:
    23.1      Rental payments to GSA (OIG)..                       4           5
    23.1      Rental payments to GSA (DoJ)..                       1           1
            Communications, utilities, and
                miscellaneous charges:
    23.3      Communications, utilities, and
                miscellaneous charges (OIG).                       1           1
    23.3      Communications, utilities, and
                miscellaneous charges (DoJ).                       1           1
            Advisory and assistance
                services:
    25.1      Advisory and assistance
                services (OIG)..............                       1           1
    25.1      Advisory and assistance
                services (HCFA).............                       2           2
            Other services:
    25.2      Other services (OIG)..........                       1           2
    25.2      Other services (DoJ)..........                       9          10
    25.2      Other services (AoA)..........                       1           1
    25.2      Other services (Adverse Action
                Data Bank)..................                       2           2
    25.2      Other services (Other non-HHS,
                non-DoJ)....................                       3           4
    25.3    Purchases of goods and services
              from Government accounts (OIG)                       6           7
            Supplies and materials:
    26.0      Supplies and materials (OIG)..                       1           1
    26.0      Supplies and materials (DoJ)..                       1           1
            Equipment:
    31.0      Equipment (OIG)...............                       1           1
    31.0      Equipment (DoJ)...............                       2           2
                                               ---------   ---------  ----------
    99.0      Subtotal, allocation account..                     104         120
                                               ---------   ---------  ----------
    99.9    Total obligations...............                     591         676
    ---------------------------------------------------------------------------

        This schedule reflects estimated distribution of the Allocation
    Account. Actual FY 1998 distribution will be determined by the Secretary
    of HHS and the Attorney General.

                                         1996 actual  1997 est.   1998 est.
    Department of Justice (DOJ).........                      24          28
    Office of the Inspector General, HHS                      70          81
    Health Care Financing Administration                       2           2
    Office of General Counsel, HHS......                       2           2
    Administration on Aging.............                       1           1
    Other HHS...........................                       2           2
    Other non-HHS/DOJ...................                       3           4
                                        ------------------------------------
        Total...........................                     104         120
                                        ====================================

               Federal Supplementary Medical Insurance Trust Fund

                  Unavailable Collections (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8004-0-7-571      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
        Balance, start of year:
    01.99 Balance, start of year............       8,848      21,963      25,369
        Receipts:
    02.01 Federal contributions.............      61,702      59,354      63,416
    02.02 Interest received by trust fund...       1,388       1,440       1,424
    02.03 Other proprietary receipts from
            the public......................           4
    02.05 Premiums collected for the aged...      16,858      16,779      18,060
    02.06 Premiums collected for the
            disabled........................       2,073       2,249       2,538
    02.07 Federal contributions, proposed
            legislation.....................                              14,668
    02.09 Premiums collected for the aged,
            proposed legislation............                                 -30
    02.10 Premiums collected for the
            disabled, proposed legislation..                                  -1
                                               ---------   ---------  ----------
    02.99   Total receipts..................      82,025      79,822     100,075
                                               ---------   ---------  ----------
    04.00 Total: Balances and collections...      90,873     101,785     125,444
        Appropriation:
    05.01 Federal supplementary medical
            insurance trust fund............     -68,910     -76,416     -84,010
    05.03 Federal supplementary medical
            insurance trust fund, proposed
            legislation.....................                             -14,889
                                               ---------   ---------  ----------
    05.99 Subtotal appropriation............     -68,910     -76,416     -98,899
    07.99 Total balance, end of year........      21,963      25,369      26,545
    ---------------------------------------------------------------------------

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8004-0-7-571      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Benefit payments, SMI.............      67,107      74,923      82,456
    00.02 Administration, SMI...............       1,759       1,476       1,537
    00.03 Peer review organizations, SMI....          27           4           3
    00.04 Research, SMI.....................          17          13          14
                                               ---------   ---------  ----------
    10.00   Total obligations...............      68,910      76,416      84,010
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......      68,910      76,416      84,010
    23.95 New obligations...................     -68,910     -76,416     -84,010
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.26   Appropriation (trust fund,
              definite).....................       1,770       1,484       1,546
          Permanent:

    60.27   Appropriation (trust fund,
              indefinite)...................      80,255      78,338      83,892
    60.28   Appropriation (unavailable
              balances).....................     -13,115      -3,406      -1,428
                                               ---------   ---------  ----------
    63.00     Appropriation (total).........      67,139      74,931      82,463
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................      68,910      76,416      84,010
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.41 Unpaid obligations, start of year:
            Obligated balance: U.S.
            Securities: Par value...........       5,027       4,991       4,919
    73.10 New obligations...................      68,910      76,416      84,010
    73.20 Total outlays (gross).............     -68,946     -76,487     -84,015
    74.41 Unpaid obligations, end of year:
            Obligated balance: U.S.
            Securities: Par value...........       4,991       4,919       4,914
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority       1,647       1,361       1,420
    86.93 Outlays from current balances.....         123         189         124
    86.97 Outlays from new permanent
            authority.......................      62,272      70,135      77,676

    [[Page 514]]

    86.98 Outlays from permanent balances...       4,904       4,802       4,795
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........      68,946      76,487      84,015
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................      68,910      76,416      84,010
    90.00 Outlays...........................      68,946      76,487      84,015
    ---------------------------------------------------------------------------

                     Summary of Budget Authority and Outlays

                            (in millions of dollars)

                                         1996 actual  1997 est.   1998 est.
    Enacted/requested:
      Budget Authority..................      68,909      76,415      84,009
      Outlays...........................      68,946      76,487      84,015
    Legislative proposal, subject to
        PAYGO:
      Budget Authority..................                              14,889
      Outlays...........................                              14,889
                                        ------------------------------------
    Total:
      Budget Authority..................      68,909      76,415      98,898
      Outlays...........................      68,946      76,487      98,904
                                        ====================================

        The Supplementary Medical Insurance (SMI) program is a voluntary
    program which affords protection against the costs of physician and
    certain other medical services. The program also covers treatment of
    end-stage renal disease for eligible enrollees. SMI costs are financed
    by premium payments from enrollees and contributions from the general
    revenues.

        The status of the trust fund is as follows:

                       Status of Funds (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8004-0-7-571      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
        Unexpended balance, start of year:
    0100  Treasury balance..................         361        -222           1
    0101  U.S. Securities: Par value........      13,513      27,175      30,287
                                               ---------   ---------  ----------
    0199    Total balance, start of year....      13,874      26,953      30,288
        Cash income during the year:
          Proprietary receipts:

    0221    Premiums collected for the aged,
              FSMI Fund.....................      16,858      16,779      18,060
    0222    Premiums collected for the aged,
              FSMI Fund, proposed
              legislation...................                                 -30
            Proprietary receipts:
    0223      Premiums collected for the
                disabled, FSMI Fund.........       2,073       2,249       2,538
    0223      Premiums collected for the
                disabled, FSMI Fund,
                proposed legislation........                                  -1
    0224    Proprietary receipts............           4
          Intragovernmental transactions:

    0240    Federal contributions, FSMI Fund      61,702      59,354      63,416
    0241    Federal contributions, FSMI
              Fund, proposed legislation....                              14,668
    0242    Interest received by trust fund,
              FSMI Fund.....................       1,388       1,440       1,424
    0297  Income under present law..........      82,025      79,822      85,438
    0298  Income under proposed legislation.                              14,637
                                               ---------   ---------  ----------
    0299    Total cash income...............      82,025      79,822     100,075
        Cash outgo during year:
          Cash outgo during the year (-):

    0501    Benefit payments & ESRD.........     -67,167     -74,924     -82,457
    0501    Benefit payments, proposed
              legislation...................                             -14,889
    0502  Administration....................      -1,747      -1,526      -1,527
    0504  Peer review organizations.........         -10         -14         -14
    0505  Research..........................         -23         -24         -17
    0597  Outgo under present law (-).......     -68,946     -76,487     -84,015
    0598  Outgo under proposed legislation
            (-).............................                             -14,889
                                               ---------   ---------  ----------
    0599  Total cash outgo (-)..............     -68,946     -76,487     -98,904
        Unexpended balance, end of year:
    0700  Treasury balance..................        -222           1           1
    0701  U.S. Securities: Par value........      27,175      30,287      31,458
                                               ---------   ---------  ----------
    0799    Total balance, end of year......      26,953      30,288      31,459
    ---------------------------------------------------------------------------

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8004-0-7-571      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
    25.3  Purchases of goods and services
            from Government accounts........       1,405       1,110       1,133
          Grants, subsidies, and contributions:

    41.0    Payment for peer review
              organization (PRO) activity...          27           4           3
    41.0    Payment for health insurance
              experiments and demonstration
              projects......................          17          13          14
    42.0  Insurance claims and indemnities..      67,107      74,923      82,456
    93.0  Administrative expenses: Portion
            of limitation on salaries and
            expenses: Social Security
            Administration..................         354         365         404
                                               ---------   ---------  ----------
    99.9    Total obligations...............      68,910      76,416      84,010
    ---------------------------------------------------------------------------

        The estimate of administrative expenses borne by each of the
    financing sources, including the Hospital Insurance (HI) and
    Supplemental Medical Insurance (SMI) trust funds for Medicare-related
    activities performed by the Social Security Administration (SSA), has
    been made by SSA based on the current cost allocation methodology.
    Pursuant to section 201(g) of the Social Security Act, a final
    accounting of actual payments is made after the close of each fiscal
    year. In the Conference Committee Report for Public Law 103-296, The
    Social Security Independence and Program Improvements Act of 1994, the
    conferees requested that the Secretary of Health and Human Services and
    the Commissioner of Social Security make a joint examination of the most
    appropriate cost allocation methodology and report their joint findings
    to the Congress within 36 months of enactment. The Secretary and the
    Commissioner are in the process of designing and carrying out this study
    and preparing the required report to Congress.

               Federal Supplementary Medical Insurance Trust Fund

                    (Legislative proposal, subject to PAYGO)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8004-4-7-571      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Benefit payments, SMI.............                              14,889
                                               ---------   ---------  ----------
    10.00   Total obligations (object class
              42.0).........................                              14,889
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......                              14,889
    23.95 New obligations...................                             -14,889
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    60.27 Appropriation (trust fund,
            indefinite).....................                              14,889
                                                                          14,889
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    73.10 New obligations...................                              14,889
    73.20 Total outlays (gross).............                             -14,889
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new permanent
            authority.......................                              14,889
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................                              14,889
    90.00 Outlays...........................                              14,889
    ---------------------------------------------------------------------------

        This schedule reflects the effects of the Medicare reform proposals
    contained in the Administration's balanced budget proposal on the
    Supplementary Medical Insurance Trust Fund.

                    Allocations Received From Other Accounts

        Note.--Obligations incurred under allocations from other accounts
    are included in the schedules of the parent appropriation as follows:
    Health Care Financing Administration: ``Health Care Fraud and Abuse
    Control Account.''

    [[Page 515]]

                    ADMINISTRATION FOR CHILDREN AND FAMILIES

                                  Federal Funds

    General and special funds:

                     Temporary Assistance for Needy Families

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1552-0-1-609      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 State family assistance grant.....         111      13,535      16,489
    00.02 Territories--family assistance
            grants..........................                      78          78
    00.03 Matching grants to territories....                      11          11
    00.05 Supplemental grants for population
            increases.......................                                  87
    00.07 Tribal work programs..............                       8           8
                                               ---------   ---------  ----------
    00.91   Subtotal........................         111      13,632      16,673
          Loan program:

    01.01   Loan fund disbursements.........                      26         121
    01.02   Loan fund repayments............                                 -38
                                               ---------   ---------  ----------
    01.91   Total loan program..............                      26          83
                                               ---------   ---------  ----------
    10.00   Total obligations (object class
              41.0).........................         111      13,658      16,756
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......         111      13,658      16,756
    23.95 New obligations...................        -111     -13,658     -16,756
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    60.05 Appropriation (indefinite)........         111      13,658      16,756
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Appropriation                     111       1,369
    73.10 New obligations...................         111      13,658      16,756
    73.20 Total outlays (gross).............                 -12,365     -16,586
    73.40 Adjustments in expired accounts...                     -35
    74.40 Unpaid obligations, end of year:
            Obligated balance: Appropriation         111       1,369       1,539
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new permanent
            authority.......................                  12,295      15,422
    86.98 Outlays from permanent balances...                      70       1,164
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........                  12,365      16,586
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................         111      13,658      16,756
    90.00 Outlays...........................                  12,365      16,586
    ---------------------------------------------------------------------------

        This account provides funding for activities established by the
    Personal Responsibility and Work Opportunity Reconciliation Act of 1996
    (P.L. 104-193). The Temporary Assistance for Needy Families block grant
    provides funding to States for aid to poor families with children.

        This account also includes Federal loans for State welfare programs,
    established by section 406 of the Social Security Act as amended.
    Administrative expenses for this activity are estimated to be $300,000
    in fiscal year 1998 and are funded through ACF Federal administration in
    the Children and Families Services Programs account.

                                Contingency Fund

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1522-0-1-609      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    10.00 Total obligations (object class
            41.0)...........................                      45          80
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......                      45          80
    23.95 New obligations...................                     -45         -80
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    60.00 Appropriation.....................                      45          80
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.90 Unpaid obligations, start of year:
            Obligated balance: Fund balance.                                  22
    73.10 New obligations...................                      45          80
    73.20 Total outlays (gross).............                     -23         -96
    74.90 Unpaid obligations, end of year:
            Obligated balance: Fund balance.                      22           6
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new permanent
            authority.......................                      23          74
    86.98 Outlays from permanent balances...                                  22
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........                      23          96
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................                      45          80
    90.00 Outlays...........................                      23          96
    ---------------------------------------------------------------------------

        The Contingency Fund for State Welfare Programs supplements the
    Temporary Assistance for Needy Families block grant by providing
    matching amounts to States that reach certain unemployment or Food Stamp
    caseload thresholds and maintain 100 percent of historical State
    spending on block-granted programs.

                        Family Support Payments to States

        [For making payments of such sums as necessary to each State for
    carrying out the program of Aid to Families with Dependent Children
    under title IV-A of the Social Security Act in fiscal year 1997 before
    the effective date of the program of Temporary Assistance to Needy
    Families (TANF) with respect to such State: Provided, That the sum of
    the amounts available to a State with respect to expenditures under such
    title IV-A in fiscal year 1997 under this appropriation and under such
    title IV-A as amended by the Personal Responsibility and Work
    Opportunity Reconciliation Act of 1996 shall not exceed the limitations
    under section 116(b) of such Act.]
        [For making payments to States for carrying out title IV-A (other
    than section 402(g)(6)) of the Social Security Act in calendar quarters
    prior to October 1, 1996, such sums as may be necessary.]
        [For making payments to States or other non-Federal entities under
    titles I, IV-D, X, XI, XIV, and XVI of the Social Security Act and the
    Act of July 5, 1960 (24 U.S.C. ch. 9), $2,158,000,000 to remain
    available until expended.]
        [For making, after May 31 of the current fiscal year, payments to
    States or other non-Federal entities under titles I, IV-D, X, XI, XIV,
    and XVI of the Social Security Act, for the last three months of the
    current year for unanticipated costs, incurred for the current fiscal
    year, such sums as may be necessary.]
        [For making payments to States or other non-Federal entities under
    titles I, IV-D, X, XI, XIV, and XVI of the Social Security Act and the
    Act of July 5, 1960 (24 U.S.C. ch. 9) for the first quarter of fiscal
    year 1998, $607,000,000 to remain available until expended.] (Department
    of Health and Human Services Appropriations Act, 1997.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1501-0-1-609      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
          Aid to families with dependent children (AFDC)
              payments:

            Benefit payments:
    00.01     Properly issued payments......      10,420       2,054          28
    00.02     Erroneously issued payments...         665
    00.03     Collection of excess State
                errors......................                                 -15
                                               ---------   ---------  ----------
    00.91   Subtotal, benefit payments......      11,085       2,054          13
    01.02 Payments to territories...........          27          27          27
    01.03 Emergency assistance..............       1,546         743         233
    01.04 Repatriation......................                       1           1
    01.05 AFDC day care.....................         761          26          13
    01.06 Transitional day care.............         303          11           5
    01.07 At-risk day care..................         291
    01.08 State welfare administrative costs       1,531         235           8
                                               ---------   ---------  ----------
    01.91   Subtotal, other payments........       4,459       1,043         287
                                               ---------   ---------  ----------

    [[Page 516]]

    02.00   Subtotal, AFDC..................      15,544       3,097         300
          Child support enforcement (CSE):

    02.01   Gross Federal share of
              collections...................      -1,263
    02.02   Federal incentive payments to
              States........................         406         437         437
    02.03   State child support
              administrative costs..........       1,984       2,335       2,386
    02.04   Access and Visitation Grants....                      10          10
                                               ---------   ---------  ----------
    02.91     Subtotal, CSE.................       1,127       2,782       2,833
                                               ---------   ---------  ----------
    10.00   Total obligations (object class
              41.0).........................      16,671       5,879       3,133
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested
            balance.........................         105       1,343       3,089
    22.00 New budget authority (gross)......      18,014       7,625       1,044
    22.30 Unobligated balance expiring......        -105
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......      18,014       8,968       4,133
    23.95 New obligations...................     -16,671      -5,879      -3,133
    24.40 Unobligated balance available, end
            of year: Uninvested balance.....       1,343       3,089       1,000
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................      13,614       2,158
          Permanent:

    65.00   Advance appropriation (definite)       4,400       4,800         607
    68.00   Spending authority from
              offsetting collections:
              Offsetting collections (cash).                     667         437
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................      18,014       7,625       1,044
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Appropriation       1,690       1,691         475
    73.10 New obligations...................      16,671       5,879       3,133
    73.20 Total outlays (gross).............     -16,670      -7,093      -3,461
    74.40 Unpaid obligations, end of year:
            Obligated balance: Appropriation       1,691         475         147
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority      10,592       1,158
    86.93 Outlays from current balances.....       1,678       2,754         519
    86.97 Outlays from new permanent
            authority.......................       4,400       3,181       1,044
    86.98 Outlays from permanent balances...                               1,898
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........      16,670       7,093       3,461
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.40   Offsetting collections (cash)
              from: Non-Federal sources.....                    -667        -437
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................      18,014       6,958         607
    90.00 Outlays...........................      16,670       6,426       3,024
    ---------------------------------------------------------------------------

        States have transitioned to the new Temporary Assistance for Needy
    Families program more quickly than anticipated. As a result, unobligated
    balances remain in this account which are sufficient to cover expected
    State needs for child support enforcement activities through the first
    quarter of fiscal year 1999. It is anticipated that this account will
    return to its traditional appropriations cycle after then.

        P.L. 104-193 modified the treatment of child support collections,
    making it a combination of offsetting collections and receipts rather
    than a reduction in obligations to States. The text table below shows
    the traditional display of child support enforcement costs:

                     Net Costs of Child Support Enforcement

                            (In millions of dollars)

                                            1996         1997        1998
    Gross Federal share of collections..      -1,263      -1,506      -1,469
    Federal incentive payments to States         406         437         437
    State child support administrative
    costs...............................       1,984       2,335       2,386
    Access and visitation grants........                      10          10
                                        ------------------------------------
        Subtotal........................       1,126       1,276       1,364

                        Low Income Home Energy Assistance

        For making payments under title XXVI of the Omnibus Budget
    Reconciliation Act of 1981, [$1,000,000,000.] $300,000,000: Provided,
    That these funds are hereby designated by Congress to be emergency
    requirements pursuant to section 251(b)(2)(D) of the Balanced Budget and
    Emergency Deficit Control Act of 1985: Provided further, That these
    funds shall be made available only after submission to Congress of a
    formal budget request by the President that includes designation of the
    entire amount of the request as an emergency requirement as defined in
    the Balanced Budget and Emergency Deficit Control Act.
        For making payments under title XXVI of [the Omnibus Budget
    Reconciliation] such Act [of 1981], $1,000,000,000, to be available for
    obligation in the period October 1, [1997] 1998 through September 30,
    [1998] 1999. (Department of Health and Human Services Appropriations
    Act, 1997.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1502-0-1-609      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    10.00 Total obligations (object class
            41.0)...........................       1,080       1,005       1,000
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......       1,080       1,005       1,000
    23.95 New obligations...................      -1,080      -1,005      -1,000
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................         180       1,415         300
    40.79   Contingent appropriation not
              available.....................                    -415        -300
                                               ---------   ---------  ----------
    43.00     Appropriation (total).........         180       1,000
          Permanent:

    65.00   Advance appropriation (definite)         900           5       1,000
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................       1,080       1,005       1,000
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Appropriation         346         358         267
    73.10 New obligations...................       1,080       1,005       1,000
    73.20 Total outlays (gross).............      -1,067      -1,097        -996
    73.40 Adjustments in expired accounts...          -1
    74.40 Unpaid obligations, end of year:
            Obligated balance: Appropriation         358         267         271
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority         135         750
    86.93 Outlays from current balances.....                                 230
    86.97 Outlays from new permanent
            authority.......................         627           5         750
    86.98 Outlays from permanent balances...         305         342          16
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........       1,067       1,097         996
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................       1,080       1,005       1,000
    90.00 Outlays...........................       1,067       1,097         996
    ---------------------------------------------------------------------------

        This program makes grants to States and Indian tribes to aid low-
    income households with high energy costs through payments to eligible
    households, energy suppliers, and weatherization providers.

                         Refugee and Entrant Assistance

        For making payments for refugee and entrant assistance activities
    authorized by title IV of the Immigration and Nationality Act and
    section 501 of the Refugee Education Assistance Act of 1980 (Public Law
    96-422), [$412,076,000] $392,332,000: Provided, That funds appropriated
    pursuant to section 414(a) of the Immigration and Nationality Act under
    Public Law [103-333] 104-134 for fiscal year [1995]

    [[Page 517]]

    1996 shall be available for the costs of assistance provided and other
    activities conducted in [such year and in] fiscal years [1996 and 1997]
    1997 and 1998. (Department of Health and Human Services Appropriations
    Act, 1997.)

                        [Refugee Resettlement Assistance]

        [For necessary expenses for the targeted assistance program
    authorized by title IV of the Immigration and Nationality Act and
    section 501 of the Refugee Education Assistance Act of 1980 and
    administered by the Office of Refugee Resettlement of the Department of
    Health and Human Services, in addition to amounts otherwise available
    for such purposes, $5,000,000]. (Foreign Operations, Export Financing,
    and Related Appropriations Act, 1997.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1503-0-1-609      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    10.00 Total obligations.................         408         427         396
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested
            balance.........................           2           2           2
    22.00 New budget authority (gross)......         413         427         396
    22.30 Unobligated balance expiring......          -5
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......         410         429         398
    23.95 New obligations...................        -408        -427        -396
    24.40 Unobligated balance available, end
            of year: Uninvested balance.....           2           2           2
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    40.00 Appropriation.....................         407         417         392
    41.00 Transferred to other accounts.....          -4
                                               ---------   ---------  ----------
    43.00   Appropriation (total)...........         403         417         392
    50.00 Reappropriation...................          10          10           4
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................         413         427         396
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Appropriation         297         337         335
    73.10 New obligations...................         408         427         396
    73.20 Total outlays (gross).............        -361        -429        -405
    73.40 Adjustments in expired accounts...          -7
    74.40 Unpaid obligations, end of year:
            Obligated balance: Appropriation         337         335         326
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority         171         205         190
    86.93 Outlays from current balances.....         190         224         215
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........         361         429         405
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................         413         427         396
    90.00 Outlays...........................         361         427         404
    ---------------------------------------------------------------------------

        States are subsidized for administering the refugee assistance
    program.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1503-0-1-609      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
    25.1  Advisory and assistance services..           2           2           2
    25.3  Purchases of goods and services
            from Government accounts........           4
    25.6  Medical care......................           3
    41.0  Grants, subsidies, and
            contributions...................         399         425         394
                                               ---------   ---------  ----------
    99.9    Total obligations...............         408         427         396
    ---------------------------------------------------------------------------

                         Family Preservation and Support

        For carrying out Section 430 of the Social Security Act,
    [$240,000,000] $255,000,000. (Department of Health and Human Services
    Appropriations Act, 1997.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1512-0-1-506      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Grants to States and Tribes.......         209         224         239
    00.02 Training and technical assistance.           6           6           6
    00.03 State court assessment activities.          10          10          10
                                               ---------   ---------  ----------
    10.00   Total obligations...............         225         240         255
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......         225         240         255
    23.95 New obligations...................        -225        -240        -255
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    40.00 Appropriation.....................         225         240         255
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Appropriation         171         270         324
    73.10 New obligations...................         225         240         255
    73.20 Total outlays (gross).............        -126        -186        -227
    74.40 Unpaid obligations, end of year:
            Obligated balance: Appropriation         270         324         352
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority          18          19          20
    86.93 Outlays from current balances.....         108         167         207
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........         126         186         227
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................         225         240         255
    90.00 Outlays...........................         126         186         227
    ---------------------------------------------------------------------------

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1512-0-1-506      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
    25.1  Advisory and assistance services..           6           6           6
    41.0  Grants, subsidies, and
            contributions...................         219         234         249
                                               ---------   ---------  ----------
    99.9    Total obligations...............         225         240         255
    ---------------------------------------------------------------------------

                      [Job Opportunities and Basic Skills]

        [For carrying out aid to families with dependent children work
    programs, as authorized by part F of title IV of the Social Security
    Act, $1,000,000,000.] (Department of Health and Human Services
    Appropriations Act, 1997.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1509-0-1-504      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    10.00 Total obligations (object class
            41.0)...........................         879         169
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......       1,000       1,000
    22.30 Unobligated balance expiring......        -121        -831
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......         879         169
    23.95 New obligations...................        -879        -169
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    40.00 Appropriation.....................       1,000       1,000
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Appropriation         314         254          99
    73.10 New obligations...................         879         169
    73.20 Total outlays (gross).............        -931        -324         -89
    73.40 Adjustments in expired accounts...          -7
    74.40 Unpaid obligations, end of year:
            Obligated balance: Appropriation         254          99          10
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority         695         133
    86.93 Outlays from current balances.....         236         191          89
                                               ---------   ---------  ----------

    [[Page 518]]

    87.00   Total outlays (gross)...........         931         324          89
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................       1,000       1,000
    90.00 Outlays...........................         931         324          89
    ---------------------------------------------------------------------------

        This activity is replaced by Temporary Assistance for Needy
    Families.

                   State Legalization Impact-Assistance Grants

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1508-0-1-506      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Appropriation                       2
    73.20 Total outlays (gross).............           2          -2
    73.40 Adjustments in expired accounts...           1
    74.40 Unpaid obligations, end of year:
            Obligated balance: Appropriation           2
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.93 Outlays from current balances.....                       2
    86.98 Outlays from permanent balances...          -2
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........          -2           2
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................
    90.00 Outlays...........................          -2           2
    ---------------------------------------------------------------------------

                        Child Care Entitlement to States

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1550-0-1-609      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Mandatory child care..............                   1,238       1,240
    00.02 Matching child care...............                     717         896
    00.03 Training and technical assistance.                       5           5
                                               ---------   ---------  ----------
    10.00   Total obligations (object class
              41.0).........................                   1,960       2,141
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......                   1,967       2,175
    22.30 Unobligated balance expiring......                      -7         -34
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......                   1,960       2,141
    23.95 New obligations...................                  -1,960      -2,141
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    50.00   Reappropriation.................                                 108
          Permanent:

    60.00   Appropriation...................                   1,967       2,067
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................                   1,967       2,175
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Appropriation                                 368
    73.10 New obligations...................                   1,960       2,141
    73.20 Total outlays (gross).............                  -1,592      -1,922
    73.40 Adjustments in expired accounts...                                -108
    74.40 Unpaid obligations, end of year:
            Obligated balance: Appropriation                     368         479
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new permanent
            authority.......................                   1,592       1,666
    86.98 Outlays from permanent balances...                                 256
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........                   1,592       1,922
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................                   1,967       2,175
    90.00 Outlays...........................                   1,592       1,922
    ---------------------------------------------------------------------------

        This account provides child care funding for welfare recipients and
    low-income working families established by the Personal Responsibility
    and Work Opportunity Reconciliation Act of 1996 (P.L. 104-193).

                     Child Care and Development Block Grant

                         [(including transfer of funds)]

        For carrying out sections 658A through 658R of the Omnibus Budget
    Reconciliation Act of 1981 (The Child Care and Development Block Grant
    Act of 1990), [$956,120,000, of which $937,000,000 shall become
    available on October 1, 1997 and shall remain available through
    September 30, 1998] in addition to amounts already appropriated for
    fiscal year 1998, $63,000,000; and to become available on October 1,
    1998 and remain available until September 30, 1999, $1,000,000,000:
    Provided, That of funds appropriated for each of fiscal years 1998 and
    1999, $19,120,000 shall [become] be available [for obligation on October
    1, 1996] for child care resource and referral and school-aged child care
    activities[, of which $6,120,000 shall be derived from an amount that
    shall be transferred from the amount appropriated under section 452(j)
    of the Social Security Act (42 U.S.C. 652(j)) for fiscal year 1996 and
    remaining available for expenditure]. (Department of Health and Human
    Services Appropriations Act, 1997.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1515-0-1-609      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Block grant payments to States....         932          19         997
    00.02 Advisory and assistance services..           3                       3
                                               ---------   ---------  ----------
    10.00   Total obligations...............         935          19       1,000
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......         935          19       1,000
    23.95 New obligations...................        -935         -19      -1,000
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................         935          13          63
    42.00   Transferred from other accounts.                       6
                                               ---------   ---------  ----------
    43.00     Appropriation (total).........         935          19          63
          Permanent:

    65.00   Advance appropriation (definite)                                 937
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................         935          19       1,000
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Appropriation       1,415       1,413         473
    73.10 New obligations...................         935          19       1,000
    73.20 Total outlays (gross).............        -933        -959        -998
    73.40 Adjustments in expired accounts...          -4
    74.40 Unpaid obligations, end of year:
            Obligated balance: Appropriation       1,413         473         475
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority                      13          42
    86.93 Outlays from current balances.....         933         946         328
    86.97 Outlays from new permanent
            authority.......................                                 628
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........         933         959         998
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................         935          19       1,000
    90.00 Outlays...........................         933         959         998
    ---------------------------------------------------------------------------

        This appropriation helps low-income families pay for child care and
    related services.

    [[Page 519]]

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1515-0-1-609      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
    25.1  Advisory and assistance services..           2                       3
    41.0  Grants, subsidies, and
            contributions...................         932          19         997
    99.5  Below reporting threshold.........           1
                                               ---------   ---------  ----------
    99.9    Total obligations...............         935          19       1,000
    ---------------------------------------------------------------------------

                           Social Services Block Grant

        For making grants to States pursuant to section 2002 of the Social
    Security Act, [$2,500,000,000: Provided, That notwithstanding section
    2003(c) of such Act, as amended, the amount specified for allocation
    under such section for fiscal year 1997 shall be $2,500,000,000]
    $2,380,000,000. (Department of Health and Human Services Appropriations
    Act, 1997.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1534-0-1-506      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Block grant.......................       2,381       2,500       2,380
    00.02 Empowerment zone..................         360
                                               ---------   ---------  ----------
    10.00   Total obligations (object class
              41.0).........................       2,741       2,500       2,380
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested
            balance.........................         360
    22.00 New budget authority (gross)......       2,381       2,500       2,380
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......       2,741       2,500       2,380
    23.95 New obligations...................      -2,741      -2,500      -2,380
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    40.00 Appropriation.....................       2,381       2,500       2,380
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Appropriation         962       1,217       1,023
    73.10 New obligations...................       2,741       2,500       2,380
    73.20 Total outlays (gross).............      -2,484      -2,694      -2,621
    73.40 Adjustments in expired accounts...          -2
    74.40 Unpaid obligations, end of year:
            Obligated balance: Appropriation       1,217       1,023         782
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority       2,203       2,250       2,142
    86.93 Outlays from current balances.....         281         261         249
    86.98 Outlays from permanent balances...                     183         230
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........       2,484       2,694       2,621
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................       2,381       2,500       2,380
    90.00 Outlays...........................       2,484       2,694       2,621
    ---------------------------------------------------------------------------

        Social services block grant.--The proposed level will support grants
    to States for social services to: (1) prevent, reduce, or eliminate
    dependency; (2) prevent neglect, abuse, or exploitation of children and
    adults; (3) prevent or reduce inappropriate institutional care; (4)
    secure admission or referral for institutional care when other forms of
    care are not appropriate; and (5) provide services to individuals in
    institutions.

                     Children and Families Services Programs

                            [(including rescissions)]

        For carrying out, except as otherwise provided, the Runaway and
    Homeless Youth Act, the Developmental Disabilities Assistance and Bill
    of Rights Act, the Head Start Act, the Child Abuse Prevention and
    Treatment Act, [the Temporary Child Care for Children with Disabilities
    and Crisis Nurseries Act of 1986,] Adoption Initiative activities under
    title IV-E and IV-B of the Social Security Act, section 429A, part B of
    title IV of the Social Security Act, section 413 of the Social Security
    Act, [the Family Violence Prevention and Services Act,] the Native
    American Programs Act of 1974, title II of Public Law 95-266 (adoption
    opportunities), the Abandoned Infants Assistance Act of 1988, and part
    B(1) of title IV of the Social Security Act; for making payments under
    the Community Services Block Grant Act; and for necessary administrative
    expenses to carry out said Acts and titles I, IV, X, XI, XIV, XVI, and
    XX of the Social Security Act, the Act of July 5, 1960 (24 U.S.C. ch.
    9), the Omnibus Budget Reconciliation Act of 1981, title IV of the
    Immigration and Nationality Act, section 501 of the Refugee Education
    Assistance Act of 1980, and section 126 and titles IV and V of Public
    Law 100-485, [$5,363,569,000], $5,498,900,000 of which [$536,432,000]
    $414,720,000 shall be for making payments under the Community Services
    Block Grant Act[: Provided, That to the extent Community Services Block
    Grant funds are distributed as grant funds by a State to an eligible
    entity as provided under the Act, and have not been expended by such
    entity, they shall remain with such entity for carryover into the next
    fiscal year for expenditure by such entity consistent with program
    purposes: Provided further, That of the amount appropriated for fiscal
    year 1997 under section 672(a) of the Community Services Block Grant
    Act, the Secretary shall use up to one percent of the funds available to
    correct allocation errors that occurred in fiscal year 1995 and fiscal
    year 1996 to ensure that the minimum allotment to each State for each of
    fiscal years 1995 and 1996 would be $2,222,460: Provided further, That
    no more than one-half of one percent of the funds available under
    section 672(a) shall be used for the purposes of section 674(a) of the
    Community Services Block Grant Act].
        [In addition, $20,000,000, to be derived from the Violent Crime
    Reduction Trust Fund, for carrying out sections 40155, 40211 and 40241
    of Public Law 103-322.]
        [Funds appropriated for fiscal year 1996 and fiscal year 1997 under
    section 429A(e), part B of title IV of the Social Security Act shall be
    reduced by $6,000,000 in each such year.]
        [Funds appropriated for fiscal year 1997 under section 413(h)(1) of
    the Social Security Act shall be reduced by $15,000,000.] (Department of
    Health and Human Services Appropriations Act, 1997.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1536-0-1-506      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Head Start........................       3,569       3,981       4,305
          Social services programs:

            Children, youth, and families:
    01.03     Runaway and homeless youth....          44          44          44
    01.04     Runaway youth transitional
                living......................          15          15          15
    01.07     Child abuse state grants......          21          21          21
    01.08     Child abuse discretionary
                grants......................          14          14          14
    01.09     Community based resource
                centers.....................          23          33          33
    01.11     Abandoned infants assistance..          12          12          12
    01.13     Temporary child care and
                crisis nurseries............          10
    01.14     Child welfare services........         277         292         292
    01.15     Child welfare training........           2           4           4
    01.17     Adoption opportunities........          11          13          13
    01.18     Adoption Initiative...........                                  21
    01.19     Family violence grants........          33          62
    01.20     Social services and income
                maintenance research........                      44          18
            Developmental disabilities:
    01.23     State grants..................          65          65          65
    01.24     Protection and advocacy.......          27          27          27
    01.25     Special projects..............           5           5           5
    01.26   University affiliated projects..          17          17          17
    01.27   Native american programs........          35          35          35
                                               ---------   ---------  ----------
    01.91     Subtotal social services
                programs....................         611         703         636
    02.01 ACF Federal administration........         150         143         143
                                               ---------   ---------  ----------
    02.93   Total direct program............       4,330       4,827       5,084
          Community services programs:

    03.01   Community services block grants.         390         490         415
    03.03   Community food and nutrition....           4           4
    03.04   Community services discretionary          41          43
                                               ---------   ---------  ----------
    03.91   Subtotal, community services....         435         537         415
    04.01 Reimbursable program..............           7          11          11
                                               ---------   ---------  ----------
    10.00   Total obligations...............       4,772       5,375       5,510
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested
            balance.........................          13           7           7

    [[Page 520]]

    22.00 New budget authority (gross)......       4,768       5,375       5,510
    22.30 Unobligated balance expiring......          -2
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......       4,779       5,382       5,517
    23.95 New obligations...................      -4,772      -5,375      -5,510
    24.40 Unobligated balance available, end
            of year: Uninvested balance.....           7           7           7
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................       4,766       5,364       5,499
          Permanent:

            Spending authority from
                offsetting collections:
    68.00     Offsetting collections (cash).           1          11          11
    68.10     Change in orders on hand from
                Federal sources.............           1
                                               ---------   ---------  ----------
    68.90       Spending authority from
                  offsetting collections
                  (total)...................           2          11          11
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................       4,768       5,375       5,510
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
          Unpaid obligations, start of year:

    72.40   Obligated balance: Appropriation       3,308       3,225       3,523
    72.95   Orders on hand from Federal
              sources.......................                       1           1
                                               ---------   ---------  ----------
    72.99     Total unpaid obligations,
                start of year...............       3,308       3,226       3,524
    73.10 New obligations...................       4,772       5,375       5,510
    73.20 Total outlays (gross).............      -4,752      -5,078      -5,403
    73.40 Adjustments in expired accounts...        -103
          Unpaid obligations, end of year:

    74.40   Obligated balance: Appropriation       3,225       3,523       3,630
    74.95   Orders on hand from Federal
              sources.......................           1           1           1
                                               ---------   ---------  ----------
    74.99     Total unpaid obligations, end
                of year.....................       3,226       3,524       3,631
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority       2,073       2,335       2,392
    86.93 Outlays from current balances.....       2,678       2,732       3,000
    86.97 Outlays from new permanent
            authority.......................           1          11          11
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........       4,752       5,078       5,403
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.00   Offsetting collections (cash)
              from: Federal sources.........          -1         -11         -11
    88.95 Change in orders on hand from
            Federal sources.................          -1
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................       4,766       5,364       5,499
    90.00 Outlays...........................       4,750       5,067       5,392
    ---------------------------------------------------------------------------

        Head Start.--The proposed level is consistent with the President's
    goal to serve 1 million children by 2002, and will enable Head Start
    projects to continue comprehensive early childhood development services.

        Social Services.--The proposed level will continue to support State,
    local, and private efforts to provide developmental and other services
    for children and youth, grants to improve support networks for persons
    with developmental disabilities, and economic development assistance to
    Native American populations.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1536-0-1-506      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

          Direct obligations:

            Personnel compensation:
    11.1      Full-time permanent...........          96          93          93
    11.3      Other than full-time permanent           1           1           1
                                               ---------   ---------  ----------
    11.9        Total personnel compensation          97          94          94
    12.1    Civilian personnel benefits.....          17          16          17
    21.0    Travel and transportation of
              persons.......................           3           3           1
    23.1    Rental payments to GSA..........          13          12          12
    23.3    Communications, utilities, and
              miscellaneous charges.........           2           2           2
    24.0    Printing and reproduction.......           1           2           1
    25.1    Advisory and assistance services          69          77          85
    25.2    Other services..................           2           2           2
    25.3    Purchases of goods and services
              from Government accounts......          12          13          13
    25.7    Operation and maintenance of
              equipment.....................           4           3           3
    26.0    Supplies and materials..........           1
    31.0    Equipment.......................           2           1           1
    41.0    Grants, subsidies, and
              contributions.................       4,543       5,139       5,268
                                               ---------   ---------  ----------
    99.0      Subtotal, direct obligations..       4,766       5,364       5,499
    99.0  Reimbursable obligations..........           6          11          11
                                               ---------   ---------  ----------
    99.9    Total obligations...............       4,772       5,375       5,510
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-1536-0-1-506      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
        Total compensable workyears:
    1001  Full-time equivalent employment...       1,732       1,669       1,627
    1005  Full-time equivalent of overtime
            and holiday hours...............           2           2           2
    ---------------------------------------------------------------------------

                        Violent Crime Reduction Programs

        For activities authorized by sections 30401, 40155, 40211, and 40241
    of Public Law 103-322, $99,000,000, to remain available until expended,
    which shall be derived from the Violent Crime Reduction Trust Fund, of
    which $12,800,000 shall be for the Community Schools Youth Services and
    Supervision Grant Program; $70,000,000 for Family Violence (including
    grants for Battered Women's Shelters); $15,000,000 for Education and
    Prevention Grants to Reduce Sexual Abuse of Runaway, Homeless, and
    Street Youth; and $1,200,000 for the National Domestic Violence Hotline.

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-8605-0-1-754      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Family violence/battered women's
            shelters and domestic violence
            hotline.........................          15          12          71
    00.02 Education and prevention grants to
            reduce sexual abuse of runaway,
            homeless and street youth.......           6           8          15
    00.03 Community schools program.........                                  13
                                               ---------   ---------  ----------
    10.00   Total obligations...............          21          20          99
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......          21          20          99
    23.95 New obligations...................         -21         -20         -99
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    42.00 Transferred from other accounts...          21          20          99
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Appropriation          11          21          24
    73.10 New obligations...................          21          20          99
    73.20 Total outlays (gross).............         -11         -17         -35
    74.40 Unpaid obligations, end of year:
            Obligated balance: Appropriation          21          24          88
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority           4           4          20
    86.93 Outlays from current balances.....           7          13          15
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........          11          17          35
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................          21          20          99
    90.00 Outlays...........................          11          17          35
    ---------------------------------------------------------------------------

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-8605-0-1-754      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
    25.1  Advisory and assistance services..                       1           4
    41.0  Grants, subsidies, and
            contributions...................          21          19          95
                                               ---------   ---------  ----------

    [[Page 521]]

    99.9    Total obligations...............          21          20          99
    ---------------------------------------------------------------------------

                  Children's Research and Technical Assistance

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1553-0-1-609      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Training and technical assistance.                      19          15
    00.02 Federal parent locator service....          24          25          30
    00.03 Child welfare study...............                                   6
    00.04 Welfare research..................                                  15
                                               ---------   ---------  ----------
    10.00   Total obligations (object class
              41.0).........................          24          44          66
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested
            balance.........................                      12
    22.00 New budget authority (gross)......          37          32          66
    22.30 Unobligated balance expiring......          -1
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......          36          44          66
    23.95 New obligations...................         -24         -44         -66
    24.40 Unobligated balance available, end
            of year: Uninvested balance.....          12
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    41.00   Transferred to other accounts...                      -6
          Permanent:

    60.00   Appropriation...................          37          38          66
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................          37          32          66
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Appropriation                      24          27
    73.10 New obligations...................          24          44          66
    73.20 Total outlays (gross).............                     -41         -59
    74.40 Unpaid obligations, end of year:
            Obligated balance: Appropriation          24          27          34
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new permanent
            authority.......................                      29          35
    86.98 Outlays from permanent balances...                      12          24
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........                      41          59
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................          37          32          66
    90.00 Outlays...........................                      41          59
    ---------------------------------------------------------------------------

        This provides funding for research and technical assistance
    activities established in P.L. 104-193. Amounts for child welfare study
    and welfare research are in addition to research amounts in the Children
    and Families Services Program account.

           Payments to States for Foster Care and Adoption Assistance

        For making payments to States or other non-Federal entities, under
    title IV-E of the Social Security Act, [$4,445,031,000] $3,200,000,000
    of which $200,000,000 shall be placed in reserve for use only in such
    amounts and in such times as may become necessary to make payments to
    States.
        For making payments to States or other non-Federal entities, under
    title IV-E of the Social Security Act, for the first quarter of fiscal
    year [1998, $1,111,000,000] 1999, $1,157,500,000. (Department of Health
    and Human Services Appropriations Act, 1997.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1545-0-1-506      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Foster care.......................       3,148       3,319       3,340
    00.02 Independent living................          70          70          70
    00.03 Adoption assistance...............         486         568         701
                                               ---------   ---------  ----------
    10.00   Total obligations (object class
              41.0).........................       3,704       3,957       4,111
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......       4,322       4,445       4,311
    22.30 Unobligated balance expiring......        -618        -488        -200
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......       3,704       3,957       4,111
    23.95 New obligations...................      -3,704      -3,957      -4,111
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................       4,322       4,445       3,200
          Permanent:

    65.00   Advance appropriation (definite)                               1,111
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................       4,322       4,445       4,311
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Appropriation         919         870       1,038
    73.10 New obligations...................       3,704       3,957       4,111
    73.20 Total outlays (gross).............      -3,691      -3,789      -4,071
    73.40 Adjustments in expired accounts...         -62
    74.40 Unpaid obligations, end of year:
            Obligated balance: Appropriation         870       1,038       1,078
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority       2,993       3,117       2,408
    86.93 Outlays from current balances.....         698         672         796
    86.97 Outlays from new permanent
            authority.......................                                 867
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........       3,691       3,789       4,071
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................       4,322       4,445       4,311
    90.00 Outlays...........................       3,691       3,789       4,071
    ---------------------------------------------------------------------------

        Foster care.--The proposed level will support eligible low-income
    children who must be placed outside the home. An average of 300,000
    children per month will be served in 1998.

        Adoption assistance.--The proposed funding level will support
    subsidies for families adopting eligible low-income children with
    special needs. An average of 153,000 children per month will be served
    in 1998.

        The budget includes funding for the adoption initiative that seeks
    to double by 2002 the number of children adopted or permanently placed
    from the foster care system each year. Incentive payments to States
    increasing adoptions would begin in 1999. Discretionary resources to
    support the initiative are included in the Children and Families
    Services Programs account.

                             ADMINISTRATION ON AGING

                                  Federal Funds

    General and special funds:

                             Aging Services Programs

        For carrying out, to the extent not otherwise provided, the Older
    Americans Act of 1965, as amended, [$830,168,000] $838,168,000:
    Provided, That notwithstanding section 308(b)(1) of such Act, the
    amounts available to each State for administration of the State plan
    under title III of such Act shall be reduced not more than 5 percent
    below the amount that was available to such State for such purpose for
    fiscal year 1995: Provided further, That in considering grant
    applications for nutrition services for elder Indian recipients, the
    Assistant Secretary shall provide maximum flexibility to applicants who
    seek to take into account subsistence, local customs and other
    characteristics that are appropriate to the unique cultural, regional
    and geographic needs of the American Indian, Alaskan and Hawaiian native
    communities to be served. (Department of Health and Human Services
    Appropriations Act, 1997.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0142-0-1-506      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    01.01 Supportive services and centers...         301         301         292

    [[Page 522]]

    01.02 Preventive health.................          15          15          15
    01.03 Grants for protection of
            vulnerable older Americans......                                   9
    01.05 Congregate meals..................         365         365         360
    01.06 Home-delivered meals..............         105         105         110
    01.07 In-home services..................           9           9           9
    01.08 Grants to Indian tribes...........          16          16          16
    01.09 Research, training and
            discretionary projects..........           3           4           4
    01.10 Federal administration............          15          15          15
    01.13 Alzheimer's Initiative............                                   8
    01.15 DOL transfer for senior community
            service employment program......                                 440
                                               ---------   ---------  ----------
    10.00   Total obligations...............         829         830       1,278
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......         829         830       1,278
    23.95 New obligations...................        -829        -830      -1,278
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    40.00 Appropriation.....................         829         830         838
    42.00 Transferred from other accounts...                                 440
                                               ---------   ---------  ----------
    43.00   Appropriation (total)...........         829         830       1,278
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................         829         830       1,278
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Appropriation         215         223         201
    73.10 New obligations...................         829         830       1,278
    73.20 Total outlays (gross).............        -818        -851        -914
    73.40 Adjustments in expired accounts...          -3
    74.40 Unpaid obligations, end of year:
            Obligated balance: Appropriation         223         201         564
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority         647         645         732
    86.93 Outlays from current balances.....         171         206         182
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........         818         851         914
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................         829         830       1,278
    90.00 Outlays...........................         818         851         914
    ---------------------------------------------------------------------------

        Administration on Aging.--The proposed level will continue to
    provide supportive and nutrition services, research, training and
    demonstration projects for the elderly.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0142-0-1-506      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
    11.1  Personnel compensation: Full-time
            permanent.......................           9           9           9
    12.1  Civilian personnel benefits.......           2           2           2
    23.1  Rental payments to GSA............           2           1           1
    25.2  Other services....................           2           2           2
    41.0  Grants, subsidies, and
            contributions...................         814         816       1,264
                                               ---------   ---------  ----------
    99.9    Total obligations...............         829         830       1,278
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-0142-0-1-506      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
        Total compensable workyears:
    1001  Full-time equivalent employment...         149         150         150
    1005  Full-time equivalent of overtime
            and holiday hours...............           1           1           1
    ---------------------------------------------------------------------------

                    Allocations Received From Other Accounts

        Note.--Obligations incurred under allocations from other accounts
    are included in the schedules of the parent appropriation as follows:
    Health Care Financing Administration: ``Health Care Fraud and Abuse
    Control Account.''

                             DEPARTMENTAL MANAGEMENT

                                  Federal Funds

    General and special funds:

                         General Departmental Management

        For necessary expenses, not otherwise provided, for general
    departmental management, including hire of six sedans, and for carrying
    out titles III, XVII, and XX of the Public Health Service Act, and
    research studies under section 1110 of the Social Security Act,
    [$174,523,000] $166,326,000, together with $5,851,000, to be transferred
    and expended as authorized by section 201(g)(1) of the Social Security
    Act from the Hospital Insurance Trust Fund and the Supplemental Medical
    Insurance Trust Fund[: Provided, That of the funds made available under
    this heading for carrying out title XVII of the Public Health Service
    Act, $11,500,000 shall be available until expended for extramural
    construction: Provided further, That notwithstanding section 2010 (b)
    and (c) under title XX of the Public Health Service Act, as amended, of
    the funds made available under this heading, $10,879,000 shall be for
    activities specified under section 2003(b)(2) of title XX of the Public
    Health Service Act, as amended, and of which $9,011,000 shall be for
    prevention grants under section 510(b)(2) of title V of the Social
    Security Act, as amended: Provided further, That of the amount provided,
    $5,775,000 is designated by Congress as an emergency requirement
    pursuant to section 251(b)(2)(D)(i) of the Balanced Budget and Emergency
    Deficit Control Act of 1985, as amended]. (Department of Health and
    Human Services Appropriations Act, 1997.)

                           Office of Consumer Affairs

        For necessary expenses of the Office of Consumer Affairs, including
    services authorized by 5 U.S.C. 3109[, but at rates for individuals not
    to exceed the per diem rate equivalent to the rate for GS-18,
    $1,500,000] $1,800,000: Provided, That the Office may accept and deposit
    to this account, during fiscal year 1998, gifts for the purpose of
    defraying its costs of printing, publishing, and distributing consumer
    information and educational materials; not to exceed $1,110,000 of total
    gift fund balances are available for those purposes, in addition to any
    amounts appropriated herein; and any balance shall remain available for
    such purposes to the extent provided in subsequent appropriations Acts:
    Provided further, That none of the funds provided under this heading may
    be made available for any other activities within the Department of
    Health and Human Services. (Omnibus Consolidated Appropriations Act,
    1997.)

                             Office for Civil Rights

        For expenses necessary for the Office for Civil Rights,
    [$16,216,000] $17,216,000, together with not to exceed $3,314,000, to be
    transferred and expended as authorized by section 201(g)(1) of the
    Social Security Act from the Hospital Insurance Trust Fund and the
    Supplemental Medical Insurance Trust Fund. (Department of Health and
    Human Services Appropriations Act, 1997.)

                                [Policy Research]

        [For carrying out, to the extent not otherwise provided, research
    studies under section 1110 of the Social Security Act and section 301(l)
    of Public Law 104-191, $18,500,000: Provided, That $9,500,000, to remain
    available until September 30, 1998, shall be for carrying out section
    301(l) of Public Law 104-191]. (Department of Health and Human Services
    Appropriations Act, 1997.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9912-0-1-551      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
          Direct activities:

    00.01   General Departmental Management.         139         180         172
    00.02   U.S.Office of Consumer Affairs..           2           2           2
    00.03   Office for Civil Rights.........          20          19          21
    00.04   Policy Research.................           9          19
    00.05   Emergency Supplement............          25
                                               ---------   ---------  ----------
    00.91     Total direct activities.......         195         220         195
    01.01 Reimbursable activities...........          61          67          67
                                               ---------   ---------  ----------
    10.00   Total obligations...............         256         287         262
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested
            balance.........................          16          26          26

    [[Page 523]]

    22.00 New budget authority (gross)......         267         287         262
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......         283         313         288
    23.95 New obligations...................        -256        -287        -262
    24.40 Unobligated balance available, end
            of year: Uninvested balance.....          26          26          26
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................         188         210         185
    42.00   Transferred from other accounts.           2
                                               ---------   ---------  ----------
    43.00     Appropriation (total).........         190         210         185
          Permanent:

    68.00   Spending authority from
              offsetting collections:
              Offsetting collections (cash).          77          77          77
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................         267         287         262
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Appropriation         108         153         139
    73.10 New obligations...................         256         287         262
    73.20 Total outlays (gross).............        -223        -300        -270
    73.40 Adjustments in expired accounts...          12
    74.40 Unpaid obligations, end of year:
            Obligated balance: Appropriation         153         139         131
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority         101         106         100
    86.93 Outlays from current balances.....          45         117          93
    86.97 Outlays from new permanent
            authority.......................          77          77          77
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........         223         300         270
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.00   Offsetting collections (cash)
              from: Federal sources.........         -77         -77         -77
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................         190         210         185
    90.00 Outlays...........................         145         223         193
    ---------------------------------------------------------------------------

                              [Dollars in millions]

                                         1996 actual  1997 est.   1998 est.
    Distribution of budget authority by
        account:
      General departmental management...         140         174         166
      Office of Consumer Affairs........           2           2           2
      Office for Civil Rights...........          16          16          17
      Policy research...................           9          19
    Distribution of outlays by account:
      General departmental management...         106         153         175
      Office of Consumer Affairs........           3           2           2
      Office for Civil Rights...........          15          17          17
      Policy research...................          15          12
      Emergency supplemental............           6          40

        Departmental Management (DM) is a consolidated display of accounts
    that fund activities which provide leadership, policy, legal, and
    administrative guidance to HHS components; carry out the Department's
    civil rights and nondiscrimination enforcement programs; present
    consumer needs and viewpoints in the Federal government; and support
    research to develop policy initiatives and improve existing HHS
    programs. DM also includes the activities of the Office of Public Health
    and Science, including adolescent family life, disease prevention and
    health promotion, physical fitness and sports, minority health, research
    integrity, women's health, and emergency preparedness. These accounts
    will continue to be appropriated separately, and are being displayed in
    a consolidated format to improve the readability of the presentation.
    Detailed information will continue to be available through the
    Department of Health and Human Services.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9912-0-1-551      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

          Direct obligations:

            Personnel compensation:
    11.1      Full-time permanent...........          76          82          83
    11.3      Other than full-time permanent           3           3           3
    11.5      Other personnel compensation..           1           1           1
                                               ---------   ---------  ----------
    11.9        Total personnel compensation          80          86          87
    12.1    Civilian personnel benefits.....          12          16          17
    21.0    Travel and transportation of
              persons.......................           2           1           1
    23.1    Rental payments to GSA..........          13          13          12
    23.3    Communications, utilities, and
              miscellaneous charges.........           3           4           4
    24.0    Printing and reproduction.......           1           2           1
    25.1    Advisory and assistance services           1
    25.2    Other services..................           9          18           9
    25.3    Purchases of goods and services
              from Government accounts......          24          25          23
    25.5    Research and development
              contracts.....................           5           6           6
    25.6    Medical care....................           2
    25.7    Operation and maintenance of
              equipment.....................           5           5
    26.0    Supplies and materials..........           4           1           2
    31.0    Equipment.......................           3           2           3
    41.0    Grants, subsidies, and
              contributions.................          31          41          30
                                               ---------   ---------  ----------
    99.0      Subtotal, direct obligations..         195         220         195
    99.0  Reimbursable obligations..........          61          67          67
                                               ---------   ---------  ----------
    99.9    Total obligations...............         256         287         262
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-9912-0-1-551      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
        Direct:
          Total compensable workyears:

    1001    Full-time equivalent employment.       1,326       1,352       1,331
    1005    Full-time equivalent of overtime
              and holiday hours.............           8           8           8
        Reimbursable:
    2001  Total compensable workyears: Full-
            time equivalent employment......         118          83          83
    ---------------------------------------------------------------------------

                    Allocations Received From Other Accounts

        Note.--Obligations incurred under allocations from other accounts
    are included in the schedules of the parent appropriation as follows:
    Health Care Financing Administration: ``Health Care Fraud and Abuse
    Control Account.''

                             PROGRAM SUPPORT CENTER

    General and special funds:

          Retirement Pay and Medical Benefits for Commissioned Officers

        For retirement pay and medical benefits of Public Health Service
    Commissioned Officers as authorized by law, and for payments under the
    Retired Serviceman's Family Protection Plan and Survivor Benefit Plan
    and for medical care of dependents and retired personnel under the
    Dependents' Medical Care Act (10 U.S.C. ch. 55), and for payments
    pursuant to section 229(b) of the Social Security Act (42 U.S.C.
    429(b)), such amounts as may be required during the current fiscal year.
    (Department of Health and Human Services Appropriations Act, 1997.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0379-0-1-551      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Retirement payments...............         119         139         149
    00.02 Survivors' benefits...............           9          11          12
    00.03 Medical care......................          24          26          28
    00.04 Military service credits..........           3           3           2
                                               ---------   ---------  ----------
    10.00   Total obligations...............         155         179         191
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......         167         179         191
    22.30 Unobligated balance expiring......         -12
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......         155         179         193
    23.95 New obligations...................        -155        -179        -191
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    40.05 Appropriation (indefinite)........         167         179         191
    ----------------------------------------------------------------------------

    [[Page 524]]

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Appropriation          14           8           7
    73.10 New obligations...................         155         179         191
    73.20 Total outlays (gross).............        -170        -180        -190
    73.40 Adjustments in expired accounts...           9
    74.40 Unpaid obligations, end of year:
            Obligated balance: Appropriation           8           7           8
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority         148         172         183
    86.93 Outlays from current balances.....          22           8           7
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........         170         180         190
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................         167         179         191
    90.00 Outlays...........................         170         180         190
    ---------------------------------------------------------------------------

        This activity funds annuities of retired Public Health Service (PHS)
    commissioned officers and survivors of retirees, and medical care to
    active duty PHS commissioned officers, retirees, and dependents of
    members and retirees of the PHS Commissioned Corps.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0379-0-1-551      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
    13.0  Benefits for former personnel.....         128         150         161
    25.2  Other services....................          24          26          28
    25.3  Purchases of goods and services
            from Government accounts........           3           3           2
                                               ---------   ---------  ----------
    99.9    Total obligations...............         155         179         191
    ---------------------------------------------------------------------------

                             Health Activities Funds

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9913-0-1-550      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Appropriation          12          11          10
    73.20 Total outlays (gross).............          -1          -1          -1
    74.40 Unpaid obligations, end of year:
            Obligated balance: Appropriation          11          10           9
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.93 Outlays from current balances.....           1           1           1
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................
    90.00 Outlays...........................           1           1           1
    ---------------------------------------------------------------------------

        This display shows activities in support of St. Elizabeths Hospital
    and scientific activities overseas that were supported by foreign
    currencies by the United States abroad.

    Intragovernmental funds:

                          HHS Service and Supply Fund

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9941-0-4-551      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Program support center............         218         238         237
    00.02 Federal employee occupational
            health..........................                      95         104
    00.03 OS activities.....................           7           6           7
                                               ---------   ---------  ----------
    10.00   Total obligations...............         225         339         348
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.90 Unobligated balance available,
            start of year: Fund balance.....          30          32          32
    22.00 New budget authority (gross)......         221         339         348
    22.10 Resources available from
            recoveries of prior year
            obligations.....................           6
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......         257         371         380
    23.95 New obligations...................        -225        -339        -348
    24.90 Unobligated balance available, end
            of year: Fund balance...........          32          32          32
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Spending authority from offsetting
              collections:

    68.00   Offsetting collections (cash)...         179         339         348
    68.10   Change in orders on hand from
              Federal sources...............          42
                                               ---------   ---------  ----------
    68.90     Spending authority from
                offsetting collections
                (total).....................         221         339         348
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................         221         339         348
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
          Unpaid obligations, start of year:

    72.90   Obligated balance: Fund balance.          10          -9
    72.95   Orders on hand from Federal
              sources.......................         107         149         149
                                               ---------   ---------  ----------
    72.99     Total unpaid obligations,
                start of year...............         117         140         149
    73.10 New obligations...................         225         339         348
    73.20 Total outlays (gross).............        -196        -330        -348
    73.45 Adjustments in unexpired accounts.          -6
          Unpaid obligations, end of year:

    74.90   Obligated balance: Fund balance.          -9
    74.95   Orders on hand from Federal
              sources.......................         149         149         149
                                               ---------   ---------  ----------
    74.99     Total unpaid obligations, end
                of year.....................         140         149         149
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new permanent
            authority.......................         178         339         348
    86.98 Outlays from permanent balances...          18          -9
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........         196         330         348
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.00   Offsetting collections (cash)
              from: Federal sources.........        -179        -339        -348
    88.95 Change in orders on hand from
            Federal sources.................         -42
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................
    90.00 Outlays...........................          18          -9
    ---------------------------------------------------------------------------

        The HHS Service and Supply Fund (SSF) provides common centralized
    services to HHS components. The Program Support Center (PSC) line
    includes activities funded through the SSF and the OS Working Capital
    Fund (WCF) in FY 1996. The WCF terminated in FY 1997 and the PSC and OS
    activities are funded solely through the SSF. The OS activities line
    includes the Fund Manager, Departmental Contracts Information System,
    Audit Resolution, OS Graphics, and the Regional Health Administrators.
    For FY 1996, Federal Employee Occupational Health funds operated through
    the Health Resources and Services Administration general fund account,
    but are funded through the SSF beginning in FY 1997.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9941-0-4-551      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

          Personnel compensation:

    11.1    Full-time permanent.............          58          66          67
    11.3    Other than full-time permanent..           3           2           2
    11.5    Other personnel compensation....           1           2           2
                                               ---------   ---------  ----------
    11.9      Total personnel compensation..          62          70          71
    12.1  Civilian personnel benefits.......          12          14          14
    21.0  Travel and transportation of
            persons.........................           1           3           3

    [[Page 525]]

    22.0  Transportation of things..........           2           2           2
    23.1  Rental payments to GSA............          12          12          10
    23.3  Communications, utilities, and
            miscellaneous charges...........          11          15          16
    24.0  Printing and reproduction.........           1           1           1
    25.1  Advisory and assistance services..                       1           1
    25.2  Other services....................          63         140         144
    25.3  Purchases of goods and services
            from Government accounts........          28          29          27
    26.0  Supplies and materials............          28          47          53
    31.0  Equipment.........................           5           5           6
    99.0  Subtotal, reimbursable obligations         225         339         348
                                               ---------   ---------  ----------
    99.9    Total obligations...............         225         339         348
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-9941-0-4-551      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
        Total compensable workyears:
    2001  Full-time equivalent employment...       1,236       1,319       1,279
    2005  Full-time equivalent of overtime
            and holiday hours...............          15          22          22
    ---------------------------------------------------------------------------

                            Miscellaneous Trust Funds

                  Unavailable Collections (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9971-0-7-551      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
        Balance, start of year:
    01.99 Balance, start of year............
        Receipts:
    02.01 Contributions, Indian health
            facilities, Health Services
            Administration..................          31          31          31
    02.02 Gifts and contributions,
            Miscellaneous trust funds.......          13          13          13
    02.03 Interest, Miscellaneous trust
            funds...........................           1           1           1
                                               ---------   ---------  ----------
    02.99   Total receipts..................          45          45          45
        Appropriation:
    05.01 Miscellaneous trust funds.........         -45         -45         -45
    07.99 Total balance, end of year........
    ---------------------------------------------------------------------------

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9971-0-7-551      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.02 Gifts.............................          22          14          14
    00.03 Contributions, Indian health
            facilities......................          32          31          31
                                               ---------   ---------  ----------
    10.00   Total obligations...............          54          45          45
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
          Unobligated balance available, start of year:

    21.40   Uninvested balance..............          20          25          25
            U.S. Securities:
    21.41     Par value.....................          23           9           9
    21.42     Unrealized discounts..........          -1
                                               ---------   ---------  ----------
    21.99     Total unobligated balance,
                start of year...............          42          34          34
    22.00 New budget authority (gross)......          45          45          45
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......          87          79          79
    23.95 New obligations...................         -54         -45         -45
          Unobligated balance available, end of year:

    24.40   Uninvested balance..............          25          25          25
    24.41   U.S. Securities: Par value......           9           9           9
                                               ---------   ---------  ----------
    24.99   Total unobligated balance, end
              of year.......................          34          34          34
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    60.27 Appropriation (trust fund,
            indefinite).....................          45          45          45
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Appropriation          95          96          90
    73.10 New obligations...................          54          45          45
    73.20 Total outlays (gross).............         -53         -51         -48
    74.40 Unpaid obligations, end of year:
            Obligated balance: Appropriation          96          90          87
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new permanent
            authority.......................          15          12          12
    86.98 Outlays from permanent balances...          38          39          36
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........          53          51          48
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................          45          45          45
    90.00 Outlays...........................          53          51          48
    ---------------------------------------------------------------------------

                              [Dollars in millions]

                                            1996         1997        1998
    Distribution of budget authority by
        account:
      Gifts.............................          14          14          14
      Contributions, Indian health
        facilities......................          31          31          31
    Distribution of outlays by account:
      Gifts.............................          24          23          22
      Contributions, Indian health
        facilities......................          29          28          26

        Gifts to the Public Health Service are for the benefit of patients
    and for research. Contributions are made for the construction,
    improvement, extension, and provision of sanitation facilities.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9971-0-7-551      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

          Personnel compensation:

    11.3    Other than full-time permanent..           3           3           3
    11.5    Other personnel compensation....           1           1           1
    11.8    Special personal services
              payments......................           1           1           1
                                               ---------   ---------  ----------
    11.9      Total personnel compensation..           5           5           5
    12.1  Civilian personnel benefits.......           1           1           1
    21.0  Travel and transportation of
            persons.........................           1           1           1
    22.0  Transportation of things..........           1           1           1
    25.2  Other services....................           2           2           2
    25.3  Purchases of goods and services
            from Government accounts........           2           1           1
    25.5  Research and development contracts          11           7           7
    25.7  Operation and maintenance of
            equipment.......................           5           3           3
    26.0  Supplies and materials............           3           3           3
    31.0  Equipment.........................           1           1           1
    32.0  Land and structures...............          19          19          19
    41.0  Grants, subsidies, and
            contributions...................           3           1           1
                                               ---------   ---------  ----------
    99.9    Total obligations...............          54          45          45
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-9971-0-7-551      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
        Total compensable workyears:
    1001  Full-time equivalent employment...         100         100         100
    1005  Full-time equivalent of overtime
            and holiday hours...............          20          20          20
    ---------------------------------------------------------------------------

                         OFFICE OF THE INSPECTOR GENERAL

    General and special funds:

                           Office of Inspector General

        For expenses necessary for the Office of Inspector General in
    carrying out the provisions of the Inspector General Act of 1978, as
    amended, [$32,999,000, together with any funds, to remain available
    until expended, that represent the equitable share from the forfeiture
    of property in investigations in which the Office of Inspector General
    participated, and which are transferred to the Office of Inspector
    General by the Department of Justice, the Department of the Treasury, or
    the United States Postal Service] $31,921,000. (Department of Health and
    Human Services Appropriations Act, 1997.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0128-0-1-551      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Direct program....................          79          33          32
    01.01 Reimbursable program..............          10          13          12
                                               ---------   ---------  ----------
    10.00   Total obligations...............          89          46          44
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested
            balance.........................           1           1           1

    [[Page 526]]

    22.00 New budget authority (gross)......          89          46          44
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......          90          47          45
    23.95 New obligations...................         -89         -46         -44
    24.40 Unobligated balance available, end
            of year: Uninvested balance.....           1           1           1
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................          58          33          32
          Permanent:

    68.00   Spending authority from
              offsetting collections:
              Offsetting collections (cash).          31          13          12
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................          89          46          44
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Appropriation                       9           5
    73.10 New obligations...................          89          46          44
    73.20 Total outlays (gross).............         -80         -50         -45
    74.40 Unpaid obligations, end of year:
            Obligated balance: Appropriation           9           5           4
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority          52          30          29
    86.93 Outlays from current balances.....          -3           7           4
    86.97 Outlays from new permanent
            authority.......................          31          13          12
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........          80          50          45
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.00   Offsetting collections (cash)
              from: Federal sources.........         -31         -13         -12
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................          58          33          32
    90.00 Outlays...........................          49          37          33
    ---------------------------------------------------------------------------

        The Office of Inspector General identifies and recommends actions to
    correct fraud, waste, and abuse in HHS administered and assisted
    programs and operations through audits and investigations.

        In addition to the discretionary resources appropriated to the
    Office of the Inspector General (IG), the Health Insurance Portability
    and Accountability Act of 1996 makes available mandatory funding for use
    by the IG to combat Medicare fraud and abuse through a coordinated
    Health Care Fraud and Abuse Control (HCFAC) Program with the Department
    of Justice. The following table shows total funding resources for the
    IG:
                                             1966 actual   1997 est.   1998 est.
    Budget Authority:
      Discretionary Appropriations..........          58          33          32
      Medicare Trust Fund Transfers.........          21           0           0
      Mandatory (HCFAC Account).............           0          70          81
                                               ---------   ---------  ----------
          Total.............................          79         103         113
    Outlays:
      Discretionary Appropriations..........          49          37          33
      Medicare Trust Fund Transfers.........          21           0           0
      Mandatory (HCFAC Account).............           0          70          81
                                               ---------   ---------  ----------
          Total.............................          70         107         114

        This schedule reflects estimated distribution of mandatory funds
    from the HCFAC Account in FY 1998. Actual FY 1998 distribution will be
    determined by the Secretary of HHS and the Attorney General.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0128-0-1-551      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------

          Direct obligations:

            Personnel compensation:
    11.1      Full-time permanent...........          48          21          21
    11.5      Other personnel compensation..           1
                                               ---------   ---------  ----------
    11.9        Total personnel compensation          49          21          21
    12.1    Civilian personnel benefits.....          10           4           4
    21.0    Travel and transportation of
              persons.......................           2           1           1
    23.1    Rental payments to GSA..........           5           2           2
    23.3    Communications, utilities, and
              miscellaneous charges.........           1           1           1
    25.1    Advisory and assistance services           1
    25.2    Other services..................           1           1
    25.3    Purchases of goods and services
              from Government accounts......           7           3           3
    26.0    Supplies and materials..........           1
    31.0    Equipment.......................           2
                                               ---------   ---------  ----------
    99.0      Subtotal, direct obligations..          79          33          32
    99.0  Reimbursable obligations..........          10          13          12
                                               ---------   ---------  ----------
    99.9    Total obligations...............          89          46          44
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-0128-0-1-551      1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
        Direct:
          Total compensable workyears:

    1001    Full-time equivalent employment.         839         348         330
    1005    Full-time equivalent of overtime
              and holiday hours.............           5           2           2
        Reimbursable:
    2001  Total compensable workyears: Full-
            time equivalent employment......          87          33          32
        Allocation account:
    3001  Total compensable workyears: Full-
            time equivalent employment......                     610         691
    ---------------------------------------------------------------------------

                    Allocations Received From Other Accounts

        Note.--Obligations incurred under allocations from other accounts
    are included in the schedules of the parent appropriations as follows:
    Health Care Financing Administration: ``Health Care Fraud and Abuse
    Control Account.''

        Note for Entire HHS Chapter.--The personnel summaries for all HHS
    accounts reflect current estimates and add to the HHS totals shown in
    the Federal Employment in the Executive Branch table of the Budget.
    Within the HHS totals, account-by-account estimates may be subject to
    change as staffing plans are implemented. The HHS FTE totals reflect
    compliance with section 416 of the Social Security Act, as amended by
    Public Law 104-193, the Personal Responsibility and Work Opportunity Act
    of 1996, which requires a reduction of FTE consistent with the
    replacement of Aid to Families with Dependent Children and Job
    Opportunities and Basic Skills training program with Temporary
    Assistance for Needy Families.

                          GENERAL FUND RECEIPT ACCOUNTS

                               (in millions of dollars)

    ----------------------------------------------------------------------------
                                             1996 actual   1997 est.   1998 est.
    ----------------------------------------------------------------------------
    Offsetting receipts from the public:
      75-310700  Federal share of child
        support collections.................                     839       1,032
                                               ---------   ---------  ----------
    General Fund Offsetting receipts from
     the public.............................                     839       1,032
    ----------------------------------------------------------------------------
    Intragovernmental payments:
      20-310530  Quinquennial adjustment for
        military service credits, Federal
        hospital insurance..................       2,366
                                               ---------   ---------  ----------
    General Fund Intragovernmental payments.       2,366
    ---------------------------------------------------------------------------

    [[Page 527]]

                               GENERAL PROVISIONS

        Sec. 201. Funds appropriated in this title shall be available for
    not to exceed $37,000 for official reception and representation expenses
    when specifically approved by the Secretary.
        Sec. 202. The Secretary shall make available through assignment not
    more than 60 employees of the Public Health Service to assist in child
    survival activities and to work in AIDS programs through and with funds
    provided by the Agency for International Development, the United Nations
    International Children's Emergency Fund or the World Health
    Organization.
        Sec. 203. None of the funds appropriated under this Act may be used
    to implement section 399L(b) of the Public Health Service Act or section
    1503 of the National Institutes of Health Revitalization Act of 1993,
    Public Law 103-43.
        [Sec. 204. None of the funds made available by this Act may be used
    to withhold payment to any State under the Child Abuse Prevention and
    Treatment Act by reason of a determination that the State is not in
    compliance with section 1340.2(d)(2)(ii) of title 45 of the Code of
    Federal Regulations. This provision expires upon the date of enactment
    of the reauthorization of the Child Abuse Prevention and Treatment Act.]
        Sec. [205] 204. None of the funds appropriated in this Act for the
    National Institutes of Health and the Substance Abuse and Mental Health
    Services Administration shall be used to pay the salary of an
    individual, through a grant or other extramural mechanism, at a rate in
    excess of $125,000 per year.
        [Sec. 206. None of the funds appropriated in this Act may be
    expended pursuant to section 241 of the Public Health Service Act,
    except for funds specifically provided for in this Act, or for other
    taps and assessments made by any office located in the Department of
    Health and Human Services, prior to the Secretary's preparation and
    submission of a report to the Committee on Appropriations of the Senate
    and of the House detailing the planned uses of such funds.]

                              [(transfer of funds)]

        [Sec. 207. Of the funds appropriated or otherwise made available for
    the Department of Health and Human Services, General Departmental
    Management, for fiscal year 1997, the Secretary of Health and Human
    Services shall transfer to the Office of the Inspector General such sums
    as may be necessary for any expenses with respect to the provision of
    security protection for the Secretary of Health and Human Services.]
        [Sec. 208. None of the funds appropriated in this Act may be
    obligated or expended for the Federal Council on Aging under the Older
    Americans Act or the Advisory Board on Child Abuse and Neglect under the
    Child Abuse Prevention and Treatment Act.]

                              [(transfer of funds)]

        [Sec. 209. Not to exceed 1 percent of any discretionary funds
    (pursuant to the Balanced Budget and Emergency Deficit Control Act, as
    amended) which are appropriated for the current fiscal year for the
    Department of Health and Human Services in this Act may be transferred
    between appropriations, but no such appropriation shall be increased by
    more than 3 percent by any such transfer: Provided, That the
    Appropriations Committees of both House of Congress are notified at
    least fifteen days in advance of any transfer.]

                               (transfer of funds)

        Sec. [210] 205. The Director of the National Institutes of Health,
    jointly with the Director of the Office of AIDS Research, may transfer
    up to 3 percent among institutes, centers, and divisions from the total
    amounts identified by these two Directors as funding for research
    pertaining to the human immunodeficiency virus: Provided, That the
    Congress is promptly notified of the transfer.

                              [(transfer of funds)]

        [Sec. 211. Of the amounts made available in this Act for the
    National Institutes of Health, the amount for research related to the
    human immunodeficiency virus, as jointly determined by the Director of
    NIH and the Director of the Office of AIDS Research, shall be made
    available to the ``Office of AIDS Research'' account. The Director of
    the Office of AIDS Research shall transfer from such account amounts
    necessary to carry out section 2353(d)(3) of the Public Health Service
    Act.]
        [Sec. 212. Not later than January 1, 1997, the Administrator of the
    Health Care Financing Administration, with the advice and technical
    assistance of the Agency for Health Care Policy and Research, shall
    transmit to the appropriate committees of the Congress a report
    including--
            (1) a review of all available studies and research data on the
        treatment of end-stage emphysema and chronic obstructive pulmonary
        disease by both unilateral and bilateral lung volume reduction
        surgery, involving both invasive and noninvasive surgery and
        supplemental surgical methods, including laser applications; and
            (2) a recommendation, based on such review, as to the
        appropriateness of Medicare coverage of such procedures and the
        conditions, if necessary, that facilities and physicians should be
        required to meet, to ensure the efficacy of such procedures, as more
        detailed clinical studies are conducted.]
        [Sec. 213. Section 304(a)(1) of the Family Violence Prevention and
    Services Act (42 U.S.C. 10403(a)(1)) is amended by striking ``$200,000''
    and inserting ``$400,000''.]
        [Sec. 214. The new clinical research center at the National
    Institutes of Health is hereby named the Mark O. Hatfield Clinical
    Research Center.]
        [Sec. 215. Section 345 of Public Law 104-193 is amended by replacing
    ``section 457(a)'' wherever it appears with ``a plan approved under this
    part''. Amounts available under such section shall be calculated as
    though such section were effective October 1, 1995.] (Department of
    Health and Human Services Appropriations Act, 1997.)