[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.)