    [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 1999

    [[Page 395]]

                     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; [$948,705,000]
    $878,884,000. In addition, fees collected for fiscal year 1999 [of which
    not to exceed $91,204,000 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 [1998] 1999 shall
    be subject to the fiscal year [1998] 1999 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].
        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]
    $8,350,000, 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] $88,294,000, including not
    to exceed $5,428,000 to be transferred to this appropriation from fees
    collected pursuant to section 736 of the Federal Food, Drug, and
    Cosmetic Act and credited to the Food and Drug Administration Salaries
    and Expenses appropriation: 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, 1998.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9911-0-1-554      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
          Direct program:

    00.01   Foods...........................         191         204         198
    00.02   Drugs...........................         334         337         300
    00.03   Devices and radiological
              products......................         147         142         103
    00.04   National center for
              toxicological research........          32          31          32
    00.05   Tobacco.........................           5          34         134
    00.06   Other activities................          87          83          84
    00.07   Other rent and rent related
              activities....................          24          26          28
    00.08   Rental payments.................          46          46          83
    00.09   Buildings and facilities........          15          48           8
    00.10   CRADAs..........................                       1           1
    09.01 Reimbursable program..............         111         141         161
                                               ---------   ---------  ----------
    10.00   Total obligations...............         992       1,093       1,132
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested.......          54          68          42
    22.00 New budget authority (gross)......       1,006       1,067       1,132
    22.22 Unobligated balance transferred
            from other accounts.............                       1
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......       1,060       1,136       1,174
    23.95 New obligations...................        -992      -1,093      -1,132
    24.40 Unobligated balance available, end
            of year: Uninvested.............          68          42          42
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................         888         925         970
          Permanent:

    60.00   Appropriation...................                       1           1
    68.00   Spending authority from
              offsetting collections:
              Offsetting collections (cash).         118         141         161
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................       1,006       1,067       1,132
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Uninvested...         293         277         253
    73.10 New obligations...................         992       1,093       1,132
    73.20 Total outlays (gross).............        -993      -1,116      -1,157
    73.40 Adjustments in expired accounts...         -17
    74.40 Unpaid obligations, end of year:
            Obligated balance: Uninvested...         277         253         228
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority         703         735         785
    86.93 Outlays from current balances.....         172         239         209
    86.97 Outlays from new permanent
            authority.......................         118         141         161
    86.98 Outlays from permanent balances...                       1           1
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........         993       1,116       1,157
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

            Offsetting collections (cash)
                from:
    88.40     Non-Federal sources...........        -107        -130        -150
    88.45     Offsetting governmental
                collections.................         -11         -11         -11
                                               ---------   ---------  ----------
    88.90       Total, offsetting
                  collections (cash)........        -118        -141        -161
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................         888         926         971
    90.00 Outlays...........................         874         975         996
    ---------------------------------------------------------------------------

                     Summary of Budget Authority and Outlays

                            (in millions of dollars)

                                         1997 actual  1998 est.   1999 est.
    Enacted/requested:
      Budget Authority..................         888         926         971
      Outlays...........................         875         975         995
    Supplemental proposal:
      Budget Authority..................
      Outlays...........................
    Legislative proposal, not subject to
        PAYGO:
      Budget Authority..................
      Outlays...........................
                                        ------------------------------------
    Total:
      Budget Authority..................         888         926         971
      Outlays...........................         875         975         995
                                        ====================================

                            [In millions of dollars]

                                            1997         1998        1999
    Distribution of budget authority by
        account:
      Salaries and expenses.............         820         858         879
      Rental payments (FDA).............          46          46          83
      Buildings and facilities..........          21          21           8
    Distribution of outlays by account:
      Salaries and expenses.............         818         897         886
      Rental payments (FDA).............          47          48          83
      Buildings and facilities..........           9          29          27

    [[Page 396]]

        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 $878.9 million for Salaries and Expenses, which includes
    funding for new food safety initiatives and tobacco regulation. In
    addition, the Budget includes $280.9 million for user fees, an increase
    of $142.4 million in user fees over FY 1998, which will be used to
    finance FDA activities. Of the $280.9 million in user fees, $127.7
    million consists of new user fees, which are represented in the
    legislative proposal schedule. The buildings and facilities
    appropriation of $8.3 million provides funds for projects related to the
    repair, construction, alteration, and improvement of all buildings and
    facilities of FDA. The rental payments appropriation of $88.3 million,
    which consists of $82.9 million in budget authority and up to $5.4
    million from user fees, provides funds for payments of GSA space rental
    and related costs.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9911-0-1-554      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

          Direct obligations:

            Personnel compensation:
    11.1      Full-time permanent...........         416         442         411
    11.3      Other than full-time permanent          30          28          26
    11.5      Other personnel compensation..          16          15          14
                                               ---------   ---------  ----------
    11.9        Total personnel compensation         462         485         451
    12.1    Civilian personnel benefits.....         104         108         101
    21.0    Travel and transportation of
              persons.......................          17          17          17
    22.0    Transportation of things........           2           2           2
    23.1    Rental payments to GSA..........          42          42          79
    23.2    Rental payments to others.......           5           5           5
    23.3    Communications, utilities, and
              miscellaneous charges.........          24          24          24
    24.0    Printing and reproduction.......           3           3           3
    25.1    Advisory and assistance services          10           9           9
    25.2    Other services..................          25          40         100
    25.3    Purchases of goods and services
              from Government accounts......          42          41          41
    25.4    Operation and maintenance of
              facilities....................          26          38          37
    25.5    Research and development
              contracts.....................          18          18          18
    25.7    Operation and maintenance of
              equipment.....................          22          21          21
    26.0    Supplies and materials..........          17          17          18
    31.0    Equipment.......................          26          26          26
    32.0    Land and structures.............          17          37
    41.0    Grants, subsidies, and
              contributions.................          18          18          18
    42.0    Insurance claims and indemnities           1           1           1
                                               ---------   ---------  ----------
    99.0      Subtotal, direct obligations..         881         952         971
    99.0  Reimbursable obligations..........         111         141         161
                                               ---------   ---------  ----------
    99.9    Total obligations...............         992       1,093       1,132
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-9911-0-1-554      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
        Direct:
    1001  Total compensable workyears: Full-
            time equivalent employment......       8,353       8,319       7,402
        Reimbursable:
    2001  Total compensable workyears: Full-
            time equivalent employment......         776         789         909
    ---------------------------------------------------------------------------

                              Salaries and Expenses

                  (Legislative proposal, not subject to PAYGO)

        Upon enactment of authorization to establish fees to cover the costs
    of regulation of products under the jurisdiction of the Food and Drug
    Administration, such fees may be collected and credited to this account
    as offsetting collections: Provided, That not to exceed $127,717,000 of
    such fees shall be available until expended for authorized purposes.

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9911-2-1-554      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    10.00 Total obligations.................                                 128
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......                                 128
    23.95 New obligations...................                                -128
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    68.00 Spending authority from offsetting
            collections (gross): Offsetting
            collections (cash)..............                                 128
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    73.10 New obligations...................                                 128
    73.20 Total outlays (gross).............                                -128
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new permanent
            authority.......................                                 128
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.40   Offsetting collections (cash)
              from: Non-Federal sources.....                                -128
    ----------------------------------------------------------------------------

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

        The Budget includes $280.9 million in user fees, of which $127.7
    million are new user fees to finance FDA activities as reflected in the
    legislative proposal schedule. Additional appropriations language is
    being proposed contingent upon the enactment of authorizing legislation.
    The authorizing legislation will be proposed to authorize the collection
    and spending of the fee subject to appropriations action.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9911-2-1-554      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
    99.0  Reimbursable obligations:
            Subtotal, reimbursable
            obligations.....................                                 128
                                               ---------   ---------  ----------
    99.9    Total obligations...............                                 128
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-9911-2-1-554      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
        Direct:
    1001  Total compensable workyears: Full-
            time equivalent employment......
        Reimbursable:
    2001  Total compensable workyears: Full-
            time equivalent employment......                               1,183
    ---------------------------------------------------------------------------

    Public enterprise funds:

               Revolving Fund for Certification and Other Services

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-4309-0-3-554      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

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

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

    [[Page 397]]

    24.40 Unobligated balance available, end
            of year: Uninvested.............           4           5           5
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    68.00 Spending authority from offsetting
            collections (gross): Offsetting
            collections (cash)..............           5           4           4
    ----------------------------------------------------------------------------

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

        Outlays (gross), detail:
    86.97 Outlays from new permanent
            authority.......................           4           3           4
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.40   Offsetting collections (cash)
              from: Non-Federal sources.....          -5          -4          -4
    ----------------------------------------------------------------------------

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

        FDA certifies 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      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
    11.1  Personnel compensation: Full-time
            permanent.......................           2           2           2
    23.1  Rental payments to GSA............           1           1           1
    26.0  Supplies and materials............           1           1           1
                                               ---------   ---------  ----------
    99.9    Total obligations...............           4           4           4
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-4309-0-3-554      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
    2001  Total compensable workyears: Full-
            time equivalent employment......          42          36          36
    ---------------------------------------------------------------------------

                  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, 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, [$3,618,137,000]
    $3,773,338,000, of which [$225,000] $150,000 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 [and of which $28,000,000 shall be available for the construction
    and renovation of health care and other facilities]: 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, [$2,500,000] $250,000 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, [$203,452,000] $218,452,000 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 [$285,500,000] $385,500,000 shall
    be for State AIDS Drug Assistance Programs authorized by section 2616 of
    the Public Health Service Act, and for providing AIDS drugs in the most
    inexpensive manner possible: 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
    $6,000,000 shall be made available and shall remain available until
    expended for loan guarantees for loans funded under part A of title XVI
    of the Public Health Service Act as amended, made by non-Federal lenders
    for the construction, renovation, and modernization of medical
    facilities that are owned and operated by health centers, and for loans
    made to health centers under section 330(d) of the Public Health Service
    Act as amended by Public Law 104-299, 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 $103,863,000 is
    available for carrying out special projects of regional and national
    significance pursuant to section 501(a)(2) of such Act. (Department of
    Health and Human Services Appropriations Act, 1998.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0350-0-1-550      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
          Direct program:

    00.01   Health centers..................         791         815         836
    00.02   National Health Service Corps...          37          37          37
    00.03   National Health Service Corps
              recruitment...................          78          78          78
    00.04   Hansen's disease center.........          17          17          17
    00.05   Payment to Hawaii for the
              treatment of Hansen's disease.           2           2           2
    00.06   Buildings and facilities........           1           3
    00.07   Black lung clinics..............           4           5           5
    00.08   Alzheimer's demonstration grants           6           6
    00.09   Nursing loan repayment..........           2           2
    00.10   Health professions..............         290         291         291
    00.11   Maternal and child health block
              grant.........................         681         683         683
    00.12   Emergency medical services for
              children......................          13          13          11
    00.13   Healthy start...................          96          96          96
    00.14   HIV/AIDS........................         996       1,150       1,315
    00.15   Organ transplantation...........           2           3           4
    00.16   Health care facilities..........          13          28
    00.17   Bone marrow donor registry......          15          15          15
    00.18   Rural health policy development.           9          12          12
    00.19   Rural health outreach grants....          28          33          33
    00.20   Program management..............         113         114         114
    00.21   Family planning.................         198         203         219
    00.22   Abstinence education............                      50          50
    00.23   Health centers tort claims fund.           1           2           2
    00.24   Health centers loan guarantee
              program account...............                       6           6
    00.25   Other HRSA programs.............           1           1
                                               ---------   ---------  ----------
    00.91     Total direct program..........       3,394       3,665       3,826
    09.01 Reimbursable program..............          65          82          85
                                               ---------   ---------  ----------
    10.00   Total obligations...............       3,459       3,747       3,911
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested.......          29          39          42
    22.00 New budget authority (gross)......       3,470       3,750       3,906
    22.10 Resources available from
            recoveries of prior year
            obligations.....................           1
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......       3,500       3,789       3,948
    23.95 New obligations...................      -3,459      -3,747      -3,911

    [[Page 398]]

    24.40 Unobligated balance available, end
            of year: Uninvested.............          39          42          37
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................       3,405       3,618       3,773
          Permanent:

    60.00   Appropriation...................                      50          50
    68.00   Spending authority from
              offsetting collections:
              Offsetting collections (cash).          65          82          83
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................       3,470       3,750       3,906
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Uninvested...       2,299       2,397       2,553
    73.10 New obligations...................       3,459       3,747       3,911
    73.20 Total outlays (gross).............      -3,433      -3,591      -3,822
    73.40 Adjustments in expired accounts...          73
    73.45 Adjustments in unexpired accounts.          -1
    74.40 Unpaid obligations, end of year:
            Obligated balance: Uninvested...       2,397       2,553       2,642
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority       1,349       1,423       1,484
    86.93 Outlays from current balances.....       2,019       2,066       2,208
    86.97 Outlays from new permanent
            authority.......................          65         102         103
    86.98 Outlays from permanent balances...                                  26
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........       3,433       3,591       3,822
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

            Offsetting collections (cash)
                from:
    88.00     Federal sources...............         -55         -71         -71
    88.40     Non-Federal sources...........         -10         -11         -12
                                               ---------   ---------  ----------
    88.90       Total, offsetting
                  collections (cash)........         -65         -82         -83
    88.95 Change in orders on hand from
            Federal sources.................
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................       3,405       3,668       3,823
    90.00 Outlays...........................       3,368       3,509       3,739
    ---------------------------------------------------------------------------

                              [Dollars in millions]

                                            1997         1998        1999
    Distribution of budget authority by
        account:
      Health resources and services.....       3,400       3,663       3,818
      Health centers malpractice claims.           5           5           5
    Distribution of outlays by account:
      Health resources and services.....       3,367       3,507       3,737
      Health centers malpractice claims.           1           2           2

                   Status of Direct Loans (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0350-0-1-550      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
        Cumulative balance of direct loans
                    outstanding:
    1210  Outstanding, start of year........         800         797         773
    1231  Disbursements: Direct loan
            disbursements...................          21
    1251  Repayments: Repayments and
            prepayments.....................         -22         -22         -22
    1263  Write-offs for default: Direct
            loans...........................          -2          -2          -2
                                               ---------   ---------  ----------
    1290    Outstanding, end of year........         797         773         749
    ---------------------------------------------------------------------------

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

    ----------------------------------------------------------------------------
    Identification code 75-0350-0-1-550      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
        Guaranteed loan levels supportable by subsidy
                    budget authority:
    2150  Loan guarantee levels.............                      26          26
    2150  Loan guarantee levels.............                      27          27
    2150  Loan guarantee levels.............                      27          27
                                               ---------   ---------  ----------
    2159    Total loan guarantee levels.....                      80          80
        Guaranteed loan subsidy (in percent):
    2320  Subsidy rate......................                    2.21        2.26
    2320  Subsidy rate......................                    8.40        8.59
    2320  Subsidy rate......................                    5.03        5.11
                                               ---------   ---------  ----------
    2329    Weighted average subsidy rate...                    5.11        5.32
        Guaranteed loan subsidy budget authority:
    2330  Subsidy budget authority..........                       1           1
    2330  Subsidy budget authority..........                       2           2
    2330  Subsidy budget authority..........                       1           1
                                               ---------   ---------  ----------
    2339    Total subsidy budget authority..                       4           4
        Guaranteed loan subsidy outlays:
    2340  Subsidy outlays...................                       1           1
    2340  Subsidy outlays...................                       2           2
    2340  Subsidy outlays...................                       1           1
                                               ---------   ---------  ----------
    2349    Total subsidy outlays...........                       4           4
    ---------------------------------------------------------------------------

        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      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

          Direct obligations:

            Personnel compensation:
    11.1      Full-time permanent...........          87          94          98
    11.3      Other than full-time permanent           2           2           2
    11.5      Other personnel compensation..           4           4           5
                                               ---------   ---------  ----------
    11.9        Total personnel compensation          93         100         105
    12.1    Civilian personnel benefits.....          22          24          25
    13.0    Benefits for former personnel...           1
    21.0    Travel and transportation of
              persons.......................           3           3           3
    23.1    Rental payments to GSA..........           7           8           8
    23.3    Communications, utilities, and
              miscellaneous charges.........           4           4           4
    24.0    Printing and reproduction.......           1           1           1
    25.1    Advisory and assistance services          32          37          37
    25.2    Other services..................          41          36          34
    25.3    Purchases of goods and services
              from Government accounts......          55          53          61
    25.6    Medical care....................           2           2           2
    25.7    Operation and maintenance of
              equipment.....................           1           1           1
    26.0    Supplies and materials..........           2           3           2
    31.0    Equipment.......................           5           2           2
    41.0    Grants, subsidies, and
              contributions.................       3,124       3,389       3,539
    42.0    Insurance claims and indemnities           1           2           2
                                               ---------   ---------  ----------
    99.0      Subtotal, direct obligations..       3,394       3,665       3,826
    99.0  Reimbursable obligations..........          65          82          85
                                               ---------   ---------  ----------
    99.9    Total obligations...............       3,459       3,747       3,911
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-0350-0-1-550      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
        Direct:
          Total compensable workyears:

    1001    Full-time equivalent employment.       1,477       1,588       1,588
    1011    Exempt Full-time equivalent
              employment....................         126         146         146
        Reimbursable:
    2001  Total compensable workyears: Full-
            time equivalent employment......         188         216         216
        Allocation account:
    3001  Total compensable workyears: Full-
            time equivalent employment......           1           1           1
    ---------------------------------------------------------------------------

                           Vaccine Injury Compensation

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0320-0-1-551      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    10.00 Total obligations (object class
            42.0)...........................          71          75          19
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested.......         106         145          70

    [[Page 399]]

    22.00 New budget authority (gross)......         110
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......         216         145          70
    23.95 New obligations...................         -71         -75         -19
    24.40 Unobligated balance available, end
            of year: Uninvested.............         145          70          51
    ----------------------------------------------------------------------------

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

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Uninvested...                       3           3
    73.10 New obligations...................          71          75          19
    73.20 Total outlays (gross).............         -67         -75         -22
    74.40 Unpaid obligations, end of year:
            Obligated balance: Uninvested...           3           3
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.93 Outlays from current balances.....          67          75          22
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................         110
    90.00 Outlays...........................          67          75          22
    ---------------------------------------------------------------------------

        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 1999
    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      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
        Position with respect to appropriations act
                    limitation on commitments:
    2111  Limitation on guaranteed loans
            made by private lenders.........                     160
                                               ---------   ---------  ----------
    2150    Total guaranteed loan
              commitments...................                     160
    ----------------------------------------------------------------------------

        Cumulative balance of guaranteed loans
                    outstanding:
    2210  Outstanding, start of year........                                  67
    2231  Disbursements of new guaranteed
            loans...........................                      67          74
    2251  Repayments and prepayments........                                  -3
    2261  Adjustments: Terminations for
            default that result in loans
            receivable......................
                                               ---------   ---------  ----------
    2290    Outstanding, end of year........                      67         138
    ----------------------------------------------------------------------------

        Memorandum:
    2299  Guaranteed amount of guaranteed
            loans outstanding, end of year..                      67         138
    ----------------------------------------------------------------------------

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

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

        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 program
    has not yet used any of its current $160 million in loan guarantee
    authority, HRSA will use this existing loan guarantee limit over FY 1998
    and FY 1999. 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.

                                 Balance Sheet (in millions of dollars)

    -----------------------------------------------------------------------------------------------
    Identification code   75-4442-0-3-551    1996 actual    1997 actual     1998 est.      1999 est.
    -----------------------------------------------------------------------------------------------
        ASSETS:
          Investments in US securities:

    1106    Federal assets: Receivables, net                                       80             80
                                            ------------ --------------  ------------  -------------
    1999    Total assets....................                                       80             80
        LIABILITIES:
    2204  Non-Federal liabilities:
            Liabilities for loan guarantees.                                       80             80
                                            ------------ --------------  ------------  -------------
    2999    Total liabilities...............                                       80             80
                                            ------------ --------------  ------------  -------------
    4999  Total liabilities and net position                                       80             80
    -----------------------------------------------------------------------------------------------

                    Health Education Assistance Loans Program

                          (including transfer of funds)

        [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 $85,000,000: Provided further, That the Secretary may use up to
    $1,000,000 derived by transfer from insurance premiums collected from
    guaranteed loans made under title VII of the Public Health Service Act
    for the purpose of carrying out section 709 of that Act. In addition,
    for] For administrative expenses to carry out the guaranteed loan
    program, including section 709 of the Public Health Service Act,
    [$2,688,000] $3,688,000. (Department of Health and Human Services
    Appropriations Act, 1998.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0340-0-1-552      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

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

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

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................           3           3           4
    42.00   Transferred from other accounts.                       1
                                               ---------   ---------  ----------
    43.00     Appropriation (total).........           3           4           4
          Permanent:

    60.05   Appropriation (indefinite)......                       1
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................           3           5           4
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Uninvested...           2           1
    73.10 New obligations...................           3           5           4
    73.20 Total outlays (gross).............          -4          -6          -4
    74.40 Unpaid obligations, end of year:
            Obligated balance: Uninvested...           1
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority           3           4           4

    [[Page 400]]

    86.97 Outlays from new permanent
            authority.......................                       1
    86.98 Outlays from permanent balances...           1           1
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........           4           6           4
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................           3           5           4
    90.00 Outlays...........................           4           6           4
    ---------------------------------------------------------------------------

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

    ----------------------------------------------------------------------------
    Identification code 75-0340-0-1-552      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
        Guaranteed loan levels supportable by subsidy
                    budget authority:
    2150  Loan guarantee levels.............         140          85
                                               ---------   ---------  ----------
    2159    Total loan guarantee levels.....         140          85
        Guaranteed loan subsidy (in percent):
    2320  Subsidy rate......................        0.34        1.09
                                               ---------   ---------  ----------
    2329    Weighted average subsidy rate...        0.34        1.09
        Guaranteed loan subsidy budget authority:
    2330  Subsidy budget authority..........                       1
                                               ---------   ---------  ----------
    2339    Total subsidy budget authority..                       1
        Guaranteed loan subsidy outlays:
    2340  Subsidy outlays...................                       1
                                               ---------   ---------  ----------
    2349    Total subsidy outlays...........                       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      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
    11.1  Personnel compensation: Full-time
            permanent.......................           2           2           2
    25.2  Other services....................           1           1           1
    41.0  Grants, subsidies, and
            contributions...................                       1
                                               ---------   ---------  ----------
    99.0      Subtotal, direct obligations..           3           4           3
    99.5  Below reporting threshold.........                       1           1
                                               ---------   ---------  ----------
    99.9    Total obligations...............           3           5           4
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-0340-0-1-552      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
        Total compensable workyears:
    1001  Full-time equivalent employment...          20          20          20
    1011  Exempt Full-time equivalent
            employment......................           6           6           6
    ---------------------------------------------------------------------------

           Health Education Assistance Loans Program Financing Account

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-4304-0-3-552      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    10.00 Total obligations.................          12          11          16
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested.......         226         247         266
    22.00 New financing authority (gross)...          33          30          26
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......         259         277         292
    23.95 New obligations...................         -12         -11         -16
    24.40 Unobligated balance available, end
            of year: Uninvested.............         247         266         276
    ----------------------------------------------------------------------------

        New financing authority (gross), detail:
          Current:

    41.00   Transferred to other accounts...                      -1
          Permanent:

    68.00   Spending authority from
              offsetting collections:
              Offsetting collections (cash).          33          31          26
                                               ---------   ---------  ----------
    70.00   Total new financing authority
              (gross).......................          33          30          26
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    73.10 New obligations...................          12          11          16
    73.20 Total financing disbursements
            (gross).........................         -12         -11         -16
    87.00 Total financing disbursements
            (gross).........................          12          11          16
    ----------------------------------------------------------------------------

        Offsets:
          Against gross financing authority and
              financing disbursements:

            Offsetting collections (cash)
                from:
    88.00     Federal sources...............                      -1
    88.25     Interest on uninvested funds..         -19         -24         -25
              Non-Federal sources:
    88.40       Premium income..............         -14          -5
    88.40       Recoveries of defaulted
                  loans.....................                      -1          -1
                                               ---------   ---------  ----------
    88.90       Total, offsetting
                  collections (cash)........         -33         -31         -26
    ----------------------------------------------------------------------------

        Net financing authority and financing
            disbursements:
    89.00 Financing authority...............                      -1
    90.00 Financing disbursements...........         -21         -20         -10
    ---------------------------------------------------------------------------

                 Status of Guaranteed Loans (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-4304-0-3-552      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
        Position with respect to appropriations act
                    limitation on commitments:
    2111  Limitation on guaranteed loans
            made by private lenders.........         140          85
                                               ---------   ---------  ----------
    2150    Total guaranteed loan
              commitments...................         140          85
    ----------------------------------------------------------------------------

        Cumulative balance of guaranteed loans
                    outstanding:
    2210  Outstanding, start of year........       1,366       1,494       1,568
    2231  Disbursements of new guaranteed
            loans...........................         140          85
          Adjustments:

    2261    Terminations for default that
              result in loans receivable....         -11         -10         -15
    2263    Terminations for default that
              result in claim payments......          -1          -1          -1
                                               ---------   ---------  ----------
    2290    Outstanding, end of year........       1,494       1,568       1,552
    ----------------------------------------------------------------------------

        Memorandum:
    2299  Guaranteed amount of guaranteed
            loans outstanding, end of year..       1,494       1,568       1,552
    ----------------------------------------------------------------------------

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

    2310    Outstanding, start of year......           7          18          27
    2331    Disbursements for guaranteed
              loan claims...................          11          10          15
    2351    Repayments of loans receivable..                      -1          -1
                                               ---------   ---------  ----------
    2390      Outstanding, end of year......          18          27          41
    ---------------------------------------------------------------------------

    [[Page 401]]

        This account records all cash flows to and from the Government
    resulting from (HEAL) loan guarantees committed between 1992 and 1998.

                                 Balance Sheet (in millions of dollars)

    -----------------------------------------------------------------------------------------------
    Identification code   75-4304-0-3-552    1996 actual    1997 actual     1998 est.      1999 est.
    -----------------------------------------------------------------------------------------------
        ASSETS:
          Federal assets:

    1101    Fund balances with Treasury.....         202            226           247            266
            Investments in US securities:
    1106      Receivables, net..............                                        1
          Non-Federal assets:

    1201    Investments in non-Federal
              securities, net...............          15             19            24             25
    1206    Receivables, net................          15             14             5              1
                                            ------------ --------------  ------------  -------------
    1999    Total assets....................         232            259           277            292
        LIABILITIES:
    2204  Non-Federal liabilities:
            Liabilities for loan guarantees.       1,366          1,494         1,568          1,552
                                            ------------ --------------  ------------  -------------
    2999    Total liabilities...............       1,366          1,494         1,568          1,552
        NET POSITION:
    3300  Cumulative results of operations..      -1,134         -1,235        -1,291         -1,260
                                            ------------ --------------  ------------  -------------
    3999    Total net position..............      -1,134         -1,235        -1,291         -1,260
                                            ------------ --------------  ------------  -------------
    4999  Total liabilities and net position         232            259           277            292
    -----------------------------------------------------------------------------------------------

          Health Education Assistance Loans Program Liquidating Account

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-4305-0-3-552      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Operating expenses: death and
            disability......................           5           8           9
    00.02 Capital investment................          47          42          40
    00.03 Collection costs..................           5           5           8
                                               ---------   ---------  ----------
    10.00   Total obligations...............          57          55          57
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested.......          12           5
    22.00 New budget authority (gross)......          51          50          57
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......          63          55          57
    23.95 New obligations...................         -57         -55         -57
    24.40 Unobligated balance available, end
            of year: Uninvested.............           5
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    60.05 Appropriation (indefinite)........          38          30          37
    68.00 Spending authority from offsetting
            collections: Offsetting
            collections (cash)..............          13          20          20
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................          51          50          57
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Uninvested...           1           6
    73.10 New obligations...................          57          55          57
    73.20 Total outlays (gross).............         -51         -61         -57
    74.40 Unpaid obligations, end of year:
            Obligated balance: Uninvested...           6
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new permanent
            authority.......................          38          50          57
    86.98 Outlays from permanent balances...          13          11
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........          51          61          57
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.40   Offsetting collections (cash)
              from: Non-Federal sources.....         -13         -20         -20
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................          38          30          37
    90.00 Outlays...........................          38          41          37
    ---------------------------------------------------------------------------

                 Status of Guaranteed Loans (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-4305-0-3-552      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
        Cumulative balance of guaranteed loans
                    outstanding:
    2210  Outstanding, start of year........       1,559       1,475       1,387
    2251  Repayments and prepayments........         -48         -52         -58
          Adjustments:

    2261    Terminations for default that
              result in loans receivable....         -29         -23         -28
    2263    Terminations for default that
              result in claim payments......          -3          -8          -5
    2264    Other adjustments, net..........          -4          -5          -8
                                               ---------   ---------  ----------
    2290    Outstanding, end of year........       1,475       1,387       1,288
    ----------------------------------------------------------------------------

        Memorandum:
    2299  Guaranteed amount of guaranteed
            loans outstanding, end of year..       1,475       1,387       1,288
    ----------------------------------------------------------------------------

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

    2310    Outstanding, start of year......         422         470         489
    2331    Disbursements for guaranteed
              loan claims...................          47          42          40
    2351    Repayments of loans receivable..         -13         -13         -13
    2361    Write-offs of loans receivable..         -10         -10         -10
    2364    Other adjustments, net..........          24
                                               ---------   ---------  ----------
    2390      Outstanding, end of year......         470         489         506
    ---------------------------------------------------------------------------

        Note.--Includes carryover commitments from prior years.
        Note.--The adjustment to loans receivable represents interest, which
    had not previously been reflected in cumulative outstanding balances.

        This account records all cash flows to and from the Government
    resulting from HEAL loan guarantees committed prior to 1992.

                                  DATA ON LOANS

                                         1997 actual  1998 est.   1999 est.
    Dollar volume of loans insured ($ in
    millions)...........................         140          85
    Number of students..................      12,035       7,727
    Average value of loans..............      11,602      11,000

                            Statement of Operations (in millions of dollars)

    -----------------------------------------------------------------------------------------------
    Identification code   75-4305-0-3-552    1996 actual    1997 actual     1998 est.      1999 est.
    -----------------------------------------------------------------------------------------------
    0101  Revenue...........................          80             74            60             57
    0102  Expense...........................         -44            -57           -55            -57
                                            ------------ --------------  ------------  -------------
    0109  Net loss..........................          36             17             5
    -----------------------------------------------------------------------------------------------

                                 Balance Sheet (in millions of dollars)

    -----------------------------------------------------------------------------------------------
    Identification code   75-4305-0-3-552    1996 actual    1997 actual     1998 est.      1999 est.
    -----------------------------------------------------------------------------------------------
        ASSETS:
    1101  Federal assets: Fund balances with
            Treasury........................          12
          Net value of assets related to
              pre-1992 direct loans
              receivable and acquired
              defaulted guaranteed loans
              receivable:

    1701    Defaulted guaranteed loans,
              gross.........................         422            470           489            506
    1702    Interest receivable.............           6              6             6              6
    1703    Allowance for estimated
              uncollectible loans and
              interest (-)..................          -7
    1704    Defaulted guaranteed loans and
              interest receivable, net......         421            476           495            512
                                            ------------ --------------  ------------  -------------
    1799      Value of assets related to
                loan guarantees.............         421            476           495            512
    1801  Other Federal assets: Cash and
            other monetary assets...........          44             57            55             57
                                            ------------ --------------  ------------  -------------
    1999    Total assets....................         477            533           550            569
        LIABILITIES:
    2104  Federal liabilities: Resources
            payable to Treasury.............           5              3             8              5
    2201  Non-Federal liabilities: Accounts
            payable.........................          38             47            42             40
                                            ------------ --------------  ------------  -------------
    2999    Total liabilities...............          43             50            50             45
        NET POSITION:
    3300  Cumulative results of operations..         434            483           500            524
                                            ------------ --------------  ------------  -------------
    3999    Total net position..............         434            483           500            524
                                            ------------ --------------  ------------  -------------

    [[Page 402]]

    4999  Total liabilities and net position         477            533           550            569
    -----------------------------------------------------------------------------------------------

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-4305-0-3-552      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
    25.2  Other services....................           6           5           5
    42.0  Insurance claims and indemnities..          51          50          52
                                               ---------   ---------  ----------
    99.9    Total obligations...............          57          55          57
    ---------------------------------------------------------------------------

                   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, [$6,000,000] $1,000,000, 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, 1998.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9931-0-3-550      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Operating expenses: Interest
            subsidies, private..............           4           4           4
    01.01 Capital investment: Direct loans..                       1           1
                                               ---------   ---------  ----------
    10.00   Total obligations...............           4           5           5
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested.......          58          66          63
    22.00 New budget authority (gross)......          18          14           9
    22.60 Redemption of debt................          -6         -12         -12
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......          70          68          60
    23.95 New obligations...................          -4          -5          -5
    24.40 Unobligated balance available, end
            of year: Uninvested.............          66          63          55
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................           7           6           1
          Permanent:

    68.00   Spending authority from
              offsetting collections:
              Offsetting collections (cash).          11           8           8
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................          18          14           9
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Uninvested...           8           7           4
    73.10 New obligations...................           4           5           5
    73.20 Total outlays (gross).............          -5          -6          -6
    74.40 Unpaid obligations, end of year:
            Obligated balance: Uninvested...           7           4           3
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority           4           6           1
    86.93 Outlays from current balances.....           1                       5
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........           5           6           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.......................          -6          -6          -6
    88.40       Default collections,
                  principal.................          -3
    88.40       Interest collections from
                  FFB.......................          -1          -1          -1
                                               ---------   ---------  ----------
    88.90       Total, offsetting
                  collections (cash)........         -11          -8          -8
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................           7           6           1
    90.00 Outlays...........................          -6          -2          -2
    ---------------------------------------------------------------------------

                   Status of Direct Loans (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9931-0-3-550      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
        Cumulative balance of direct loans
                    outstanding:
    1210  Outstanding, start of year........          34          24          17
    1251  Repayments: Repayments and
            prepayments.....................         -10          -5          -5
    1264  Write-offs for default: Other
            adjustments, net................                      -2          -2
                                               ---------   ---------  ----------
    1290    Outstanding, end of year........          24          17          10
    ---------------------------------------------------------------------------

                 Status of Guaranteed Loans (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9931-0-3-550      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
        Cumulative balance of guaranteed loans
                    outstanding:
    2210  Outstanding, start of year........         188         142          98
    2251  Repayments and prepayments........         -46         -44         -40
                                               ---------   ---------  ----------
    2290    Outstanding, end of year........         142          98          58
    ----------------------------------------------------------------------------

        Memorandum:
    2299  Guaranteed amount of guaranteed
            loans outstanding, end of year..         142          98          58
    ---------------------------------------------------------------------------

        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      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
    33.0  Investments and loans.............                       1           1
    41.0  Grants, subsidies, and
            contributions...................           4           3           3
    43.0  Interest and dividends............                       1           1
                                               ---------   ---------  ----------
    99.9    Total obligations...............           4           5           5
    ---------------------------------------------------------------------------

                                   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,
    1998.)

    [[Page 403]]

                  Unavailable Collections (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8175-0-7-551      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
        Balance, start of year:
    01.99 Balance, start of year............       1,047       1,193       1,336
        Receipts:
    02.01 Deposits..........................         123         111         111
    02.03 Interest income...................          81          93         104
                                               ---------   ---------  ----------
    02.99   Total receipts..................         204         204         215
                                               ---------   ---------  ----------
    04.00 Total: Balances and collections...       1,251       1,397       1,551
        Appropriation:
    05.01 Vaccine injury compensation
            program trust fund..............         -58         -61         -61
                                               ---------   ---------  ----------
    05.99 Subtotal appropriation............         -58         -61         -61
    07.99 Total balance, end of year........       1,193       1,336       1,490
    ---------------------------------------------------------------------------

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8175-0-7-551      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Compensation: Claims for post--FY
            1989 injuries...................          49          52          52
          Administrative expenses:

    01.03   Claims processing (Claims Court)           3           3           3
    01.04   Claims processing (Public Health
              Service)......................           3           3           3
    01.05   Claims processing (Dept. of
              Justice)......................                       6           3
                                               ---------   ---------  ----------
    01.91     Total, administrative expenses           6          12           9
                                               ---------   ---------  ----------
    10.00   Total obligations...............          55          64          61
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested.......                       3
    22.00 New budget authority (gross)......          58          61          61
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......          58          64          61
    23.95 New obligations...................         -55         -64         -61
    24.40 Unobligated balance available, end
            of year: Uninvested.............           3
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    40.26 Appropriation (trust fund,
            definite).......................           9           9           9
    40.27 Appropriation (trust fund,
            indefinite).....................          49          52          52
                                               ---------   ---------  ----------
    43.00   Appropriation (total)...........          58          61          61
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................          58          61          61
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Uninvested...                       1
    73.10 New obligations...................          55          64          61
    73.20 Total outlays (gross).............         -54         -65         -61
    74.40 Unpaid obligations, end of year:
            Obligated balance: Uninvested...           1
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority          54          61          61
    86.93 Outlays from current balances.....                       4
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........          54          65          61
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................          58          61          61
    90.00 Outlays...........................          54          65          61
    ---------------------------------------------------------------------------

        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.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8175-0-7-551      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
    25.2  Other services....................           3           3           3
    25.3  Purchases of goods and services
            from Government accounts........           3           9           6
    42.0  Insurance claims and indemnities..          49          52          52
                                               ---------   ---------  ----------
    99.9    Total obligations...............          55          64          61
    ---------------------------------------------------------------------------

                              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, [$1,841,074,000]
    $1,843,873,000, 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 $361,375,000 for contract medical care
    shall remain available for obligation until September 30, [1999] 2000:
    Provided further, That of the funds provided, not less than $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 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, [1999] 2000: 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: Provided
    further, That not to exceed $168,702,000 shall be for payments to tribes
    and tribal organizations for contract support costs associated with
    ongoing contracts or grants or compacts entered into with the Indian
    Health Service prior to fiscal year [1998] 1999, as authorized by the
    Indian Self-Determination Act of 1975, as amended. (Department of the
    Interior and Related Agencies Appropriations Act, 1998.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0390-0-1-551      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
          Direct program:

    00.01   Clinical services...............       1,485       1,477       1,479
    00.02   Preventive health...............          81          83          83
    00.03   Urban health....................          25          25          26
    00.04   Indian health professions.......          28          29          29
    00.05   Tribal management...............           2           2           2
    00.06   Direct operations...............          43          47          47
    00.07   Self-governance.................           7           9           9
    00.08   Contract support costs..........         155         169         169
    00.09   Diabetes funds..................                      30          30
                                               ---------   ---------  ----------
    00.91     Total direct program..........       1,826       1,871       1,874
    09.01 Reimbursable program..............         308         298         323
                                               ---------   ---------  ----------
    10.00   Total obligations...............       2,134       2,169       2,197
    ----------------------------------------------------------------------------

    [[Page 404]]

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested.......          77          98          98
    22.00 New budget authority (gross)......       2,158       2,169       2,197
    22.30 Unobligated balance expiring......          -3
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......       2,232       2,267       2,295
    23.95 New obligations...................      -2,134      -2,169      -2,197
    24.40 Unobligated balance available, end
            of year: Uninvested.............          98          98          98
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................       1,806       1,841       1,844
    40.15   Appropriation (emergency).......           1
                                               ---------   ---------  ----------
    43.00     Appropriation (total).........       1,807       1,841       1,844
          Permanent:

    62.00   Transferred from HCFA for
              Diabetes......................                      30          30
    68.00   Spending authority from
              offsetting collections:
              Offsetting collections (cash).         351         298         323
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................       2,158       2,169       2,197
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Uninvested...         565         481         509
    73.10 New obligations...................       2,134       2,169       2,197
    73.20 Total outlays (gross).............      -2,271      -2,141      -2,146
    73.40 Adjustments in expired accounts...          53
    74.40 Unpaid obligations, end of year:
            Obligated balance: Uninvested...         481         509         560
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority       1,409       1,437       1,438
    86.93 Outlays from current balances.....         511         397         358
    86.97 Outlays from new permanent
            authority.......................         351         307         332
    86.98 Outlays from permanent balances...                                  18
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........       2,271       2,141       2,146
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

            Offsetting collections (cash)
                from:
    88.00     Federal sources...............         -74         -74         -78
    88.40     Non-Federal sources...........        -277        -224        -245
                                               ---------   ---------  ----------
    88.90       Total, offsetting
                  collections (cash)........        -351        -298        -323
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................       1,807       1,871       1,874
    90.00 Outlays...........................       1,920       1,843       1,823
    ---------------------------------------------------------------------------

        The Indian Health Services account provides medical care, public
    health services, and health professions training opportunities to
    American Indians and Alaska Natives. An estimated $444 million will be
    administered by tribal governments under self-governance compacts in FY
    1999.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0390-0-1-551      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

          Direct obligations:

            Personnel compensation:
    11.1      Full-time permanent...........         368         364         381
    11.3      Other than full-time permanent          18          16          17
    11.5      Other personnel compensation..          12          31          32
                                               ---------   ---------  ----------
    11.9        Total personnel compensation         398         411         430
    12.1    Civilian personnel benefits.....         116         119         125
    13.0    Benefits for former personnel...           6           6           6
    21.0    Travel and transportation of
              persons.......................          28          29          29
    22.0    Transportation of things........          11          11          11
    23.1    Rental payments to GSA..........           8           8           8
    23.2    Rental payments to others.......           2
    23.3    Communications, utilities, and
              miscellaneous charges.........          26          20          20
    24.0    Printing and reproduction.......           2           2           2
    25.1    Advisory and assistance services           1           4           4
    25.2    Other services..................         120         161         132
    25.3    Purchases of goods and services
              from Government accounts......           4           5           8
    25.4    Operation and maintenance of
              facilities....................           8          14          15
    25.6    Medical care....................         187         243         248
    25.7    Operation and maintenance of
              equipment.....................          15          21          20
    25.8    Subsistence and support of
              persons.......................          22          30          30
    26.0    Supplies and materials..........         103          88          87
    31.0    Equipment.......................          22          22          22
    32.0    Land and structures.............           2           2           2
    41.0    Grants, subsidies, and
              contributions.................         745         675         675
                                               ---------   ---------  ----------
    99.0      Subtotal, direct obligations..       1,826       1,871       1,874
    99.0  Reimbursable obligations..........         308         298         323
                                               ---------   ---------  ----------
    99.9    Total obligations...............       2,134       2,169       2,197
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-0390-0-1-551      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
        Direct:
          Total compensable workyears:

    1001    Full-time equivalent employment.      10,271      10,085      10,071
    1011    Exempt Full-time equivalent
              employment....................                       5           5
        Reimbursable:
    2001  Total compensable workyears: Full-
            time equivalent employment......       2,691       2,691       2,691
    ---------------------------------------------------------------------------

                            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, [$257,538,000] $235,576,000, 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 1999, up to $25,000,000 for fiscal year 2000, and up to
    $28,000,000 for fiscal year 2001; for construction of the health
    facility at Keams Canyon, Arizona, 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, 1998.)

                  Unavailable Collections (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0391-0-1-551      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
        Balance, start of year:
    01.99 Balance, start of year............
        Receipts:
    02.01 Rent and charges for quarters,
            Indian Health Service, HHS......           5           5           5
        Appropriation:
    05.01 Indian health facilities..........          -5          -5          -5
    07.99 Total balance, end of year........
    ---------------------------------------------------------------------------

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0391-0-1-551      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
          Direct program:

    00.01   Sanitation and health facilities
              construction..................         104         103         123
    00.02   Maintenance.....................          53          45          40
    00.03   Facilities and environmental
              health........................          95         102         103
    00.04   Equipment.......................          10          13          13
                                               ---------   ---------  ----------

    [[Page 405]]

    01.00     Total direct program..........         262         263         279
    09.01 Reimbursable program..............          18          12          12
                                               ---------   ---------  ----------
    10.00   Total obligations...............         280         275         291
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested.......          25          11          11
    22.00 New budget authority (gross)......         267         275         291
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......         292         286         302
    23.95 New obligations...................        -280        -275        -291
    24.40 Unobligated balance available, end
            of year: Uninvested.............          11          11          11
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................         250         258         274
          Permanent:

    60.25   Appropriation (special fund,
              indefinite)...................           5           5           5
    68.00   Spending authority from
              offsetting collections:
              Offsetting collections (cash).          12          12          12
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................         267         275         291
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Uninvested...         380         392         382
    73.10 New obligations...................         280         275         291
    73.20 Total outlays (gross).............        -266        -285        -314
    74.40 Unpaid obligations, end of year:
            Obligated balance: Uninvested...         392         382         359
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority          57          64          69
    86.93 Outlays from current balances.....         204         204         228
    86.97 Outlays from new permanent
            authority.......................           5          17          17
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........         266         285         314
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.45   Offsetting collections (cash)
              from: Offsetting governmental
              collections...................         -12         -12         -12
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................         255         263         279
    90.00 Outlays...........................         256         273         302
    ---------------------------------------------------------------------------

        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      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

          Direct obligations:

            Personnel compensation:
    11.1      Full-time permanent...........          44          45          48
    11.3      Other than full-time permanent           5           5           6
    11.5      Other personnel compensation..           2           2           2
                                               ---------   ---------  ----------
    11.9        Total personnel compensation          51          52          56
    12.1    Civilian personnel benefits.....          14          16          16
    21.0    Travel and transportation of
              persons.......................           4           4           4
    22.0    Transportation of things........           5           5           5
    23.3    Communications, utilities, and
              miscellaneous charges.........           7          15          15
    25.1    Advisory and assistance services           3           2           3
    25.2    Other services..................          57          52          53
    25.3    Purchases of goods and services
              from Government accounts......           2           7           6
    25.4    Operation and maintenance of
              facilities....................          32          21          28
    25.6    Medical care....................           8           4           7
    26.0    Supplies and materials..........          10          10          10
    31.0    Equipment.......................           4           4           4
    32.0    Land and structures.............          27          45          45
    41.0    Grants, subsidies, and
              contributions.................          38          26          27
                                               ---------   ---------  ----------
    99.0      Subtotal, direct obligations..         262         263         279
    99.0  Reimbursable obligations..........          18          12          12
                                               ---------   ---------  ----------
    99.9    Total obligations...............         280         275         291
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-0391-0-1-551      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
    1001  Total compensable workyears: Full-
            time equivalent employment......       1,437       1,456       1,470
    ---------------------------------------------------------------------------

                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 passenger 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. 2651-2653) 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 with respect to functions transferred by the Indian Health Service
    to tribes or tribal organizations, the Indian Health Service is
    authorized to provide goods and services to those entities, on a
    reimbursable basis, including payment in advance with subsequent
    adjustment, and the reimbursements received therefrom, along with the
    funds received from those entities pursuant to the Indian Self-
    Determination Act, may be credited to the same or subsequent
    appropriation account which provided the funding, said amounts to remain
    available until expended: 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, 1998.)

    [[Page 406]]

                   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, [$2,327,552,000] $2,414,197,000, of which [$21,504,000]
    $6,800,000 shall remain available until expended for equipment and
    construction and renovation of facilities, 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 [$59,232,000] $86,012,000 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.
         In addition, $[51,000,000,] $43,000,000 to be derived from the
    Violent Crime Reduction Trust Fund, for carrying out sections 40151 and
    40261 of Public Law 103-322. (Department of Health and Human Services
    Appropriations Act, 1998.)

                  Unavailable Collections (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0943-0-1-999      1997 actual   1998 est.   1999 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      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
          Direct program:

    00.01   Preventive health block grant...         154         150         150
    00.02   Prevention centers..............           8           8           8
    00.03   Sexually transmitted diseases...         106         114         124
    00.04   Immunization....................         468         407         407
    00.05   Infectious diseases.............         207         234         259
    00.06   Other chronic and environmental
              diseases......................         367         403         419
    00.07   Tobacco.........................          21          28          74
    00.08   Occupational safety and health..         141         153         153
    00.09   Mine safety and health..........          30          36          36
    00.10   Epidemic services...............          70          89          89
    00.11   Health statistics...............          38          27
    00.12   HIV.............................         616         634         634
    00.13   Research for America............                                  25
    00.14   Buildings and facilities........          44          94           7
    00.15   Program management..............           3           2           2
    00.16   Violent crime reduction programs          41          51          51
    00.17   Office of the Director savings..                                 -11
    00.18   Demonstrations to address health
              disparities...................                                  30
                                               ---------   ---------  ----------
    00.91     Total direct program..........       2,314       2,430       2,457
    09.01 Reimbursable program..............         147         150         182
                                               ---------   ---------  ----------
    10.00   Total obligations...............       2,461       2,580       2,639
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested.......          51          52
    22.00 New budget authority (gross)......       2,455       2,530       2,640
    22.10 Resources available from
            recoveries of prior year
            obligations.....................           1
    22.22 Unobligated balance transferred
            from other accounts.............           5
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......       2,512       2,582       2,640
    23.95 New obligations...................      -2,461      -2,580      -2,639
    24.40 Unobligated balance available, end
            of year: Uninvested.............          52
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................       2,261       2,327       2,414
    42.00   Transferred from other accounts.          41          52          43
                                               ---------   ---------  ----------
    43.00     Appropriation (total).........       2,302       2,379       2,457
          Permanent:

    60.25   Appropriation (special fund,
              indefinite)...................           1           1           1
            Spending authority from
                offsetting collections:
    68.00     Offsetting collections (cash).         147         150         182
    68.10     Change in orders on hand from
                Federal sources.............           5
                                               ---------   ---------  ----------
    68.90       Spending authority from
                  offsetting collections
                  (total)...................         152         150         182
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................       2,455       2,530       2,640
    ----------------------------------------------------------------------------

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

    72.40   Obligated balance: Uninvested...       2,061       2,070       2,230
    72.95   Orders on hand from Federal
              sources.......................                       5           5
                                               ---------   ---------  ----------
    72.99     Total unpaid obligations,
                start of year...............       2,061       2,075       2,235
    73.10 New obligations...................       2,461       2,580       2,639
    73.20 Total outlays (gross).............      -2,396      -2,420      -2,533
    73.40 Adjustments in expired accounts...         -50
    73.45 Adjustments in unexpired accounts.          -1
          Unpaid obligations, end of year:

    74.40   Obligated balance: Uninvested...       2,070       2,230       2,336
    74.95   Orders on hand from Federal
              sources.......................           5           5           5
                                               ---------   ---------  ----------
    74.99     Total unpaid obligations, end
                of year.....................       2,075       2,235       2,341
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority         801         804         829
    86.93 Outlays from current balances.....       1,447       1,465       1,521
    86.97 Outlays from new permanent
            authority.......................         147         150         182
    86.98 Outlays from permanent balances...           1           1           1
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........       2,396       2,420       2,533
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.00   Offsetting collections (cash)
              from: Federal sources.........        -147        -150        -182
    88.95 Change in orders on hand from
            Federal sources.................          -5
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................       2,303       2,380       2,458
    90.00 Outlays...........................       2,249       2,270       2,351
    ---------------------------------------------------------------------------

                              [Dollars in millions]

                                            1997         1998        1999
    Distribution of budget authority by
        account:
      Disease control, research and
        training........................       2,262       2,328       2,414
      Violent crime reduction programs..          41          51          43
    Distribution of outlays by account:
      Disease control, research and
        training........................       2,219       2,220       2,310
      Violent crime reduction programs..          30          50          41

        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.

        A portion of the funding for the Centers for Disease Control's
    Prevention Research is proposed as part of the Research Fund for
    America. This proposal highlights the Administration's priority to
    providing needed and sustained investments in important Federal research
    programs on a deficit neutral basis. A discussion of the Research Fund
    for America, and two other funds for the environment and transportation,
    can be found in Section II of the Budget volume.

    [[Page 407]]

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0943-0-1-999      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

          Direct obligations:

            Personnel compensation:
    11.1      Full-time permanent...........         256         290         298
    11.3      Other than full-time permanent          14          15          16
    11.5      Other personnel compensation..          14          15          16
                                               ---------   ---------  ----------
    11.9        Total personnel compensation         284         320         330
    12.1    Civilian personnel benefits.....          82          87          90
    21.0    Travel and transportation of
              persons.......................          22          23          23
    22.0    Transportation of things........           4           4           4
    23.1    Rental payments to GSA..........          15          20          20
    23.3    Communications, utilities, and
              miscellaneous charges.........          26          27          27
    24.0    Printing and reproduction.......           7           7           7
    25.1    Advisory and assistance services          10          11          11
    25.2    Other services..................          83          75          78
    25.5    Research and development
              contracts.....................         196         200         206
    25.7    Operation and maintenance of
              equipment.....................          13          13          13
    26.0    Supplies and materials..........         164         164         166
    31.0    Equipment.......................          42          38          38
    32.0    Land and structures.............          16          72           7
    41.0    Grants, subsidies, and
              contributions.................       1,348       1,367       1,435
    43.0    Interest and dividends..........           2           2           2
                                               ---------   ---------  ----------
    99.0      Subtotal, direct obligations..       2,314       2,430       2,457
    99.0  Reimbursable obligations..........         147         150         182
                                               ---------   ---------  ----------
    99.9    Total obligations...............       2,461       2,580       2,639
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-0943-0-1-999      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
        Direct:
          Total compensable workyears:

    1001    Full-time equivalent employment.       5,583       5,987       5,958
    1011    Exempt Full-time equivalent
              employment....................          37          60          60
        Reimbursable:
    2001  Total compensable workyears: Full-
            time equivalent employment......       1,000       1,000       1,097
    ---------------------------------------------------------------------------

                    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 of the Public Health
    Service Act with respect to cancer, [$2,547,314,000] $2,536,061,000.
    (Department of Health and Human Services Appropriations Act, 1998.)

                    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, [$1,531,061,000] $1,646,479,000.
    (Department of Health and Human Services Appropriations Act, 1998.)

                      National Institute of Dental Research

        For carrying out section 301 and title IV of the Public Health
    Service Act with respect to dental disease, [$209,415,000] $214,559,000.
    (Department of Health and Human Services Appropriations Act, 1998.)

        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,
    [$873,860,000] $927,492,000. (Department of Health and Human Services
    Appropriations Act, 1998.)

             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,
    [$780,713,000] $815,649,000. (Department of Health and Human Services
    Appropriations Act, 1998.)

              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,
    [$1,351,655,000] $702,040,000. (Department of Health and Human Services
    Appropriations Act, 1998.)

                 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, [$1,065,947,000]
    $1,114,886,000. (Department of Health and Human Services Appropriations
    Act, 1998.)

            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,
    [$674,766,000] $654,716,000. (Department of Health and Human Services
    Appropriations Act, 1998.)

                             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,
    [$355,691,000] $374,356,000. (Department of Health and Human Services
    Appropriations Act, 1998.)

               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,
    [$330,108,000] $348,090,000. (Department of Health and Human Services
    Appropriations Act, 1998.)

                           National Institute on Aging

        For carrying out section 301 and title IV of the Public Health
    Service Act with respect to aging, [$519,279,000] $556,070,000.
    (Department of Health and Human Services Appropriations Act, 1998.)

      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, [$274,760,000] $291,053,000. (Department of Health and Human
    Services Appropriations Act, 1998.)

        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,
    [$200,695,000] $213,834,000. (Department of Health and Human Services
    Appropriations Act, 1998.)

                     National Institute of Nursing Research

        For carrying out section 301 and title IV of the Public Health
    Service Act with respect to nursing research, [$63,597,000] $62,416,000.
    (Department of Health and Human Services Appropriations Act, 1998.)

               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, [$227,175,000]
    $230,243,000. (Department of Health and Human Services Appropriations
    Act, 1998.)

                        National Institute on Drug Abuse

        For carrying out section 301 and title IV of the Public Health
    Service Act with respect to drug abuse, [$527,175,000] $395,129,000.
    (Department of Health and Human Services Appropriations Act, 1998.)

                       National Institute of Mental Health

        For carrying out section 301 and title IV of the Public Health
    Service Act with respect to mental health, [$750,241,000] $701,790,000.
    (Department of Health and Human Services Appropriations Act, 1998.)

    [[Page 408]]

                    National Human Genome Research Institute

        For carrying out section 301 and title IV of the Public Health
    Service Act with respect to human genome research, [$217,704,000]
    $236,996,000. (Department of Health and Human Services Appropriations
    Act, 1998.)

                     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, [$453,883,000] $422,995,000: 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] $20,000,000 shall
    be for extramural facilities construction grants. (Department of Health
    and Human Services Appropriations Act, 1998.)

                      John E. Fogarty International Center

        For carrying out the activities at the John E. Fogarty International
    Center, [$28,289,000] $19,105,000. (Department of Health and Human
    Services Appropriations Act, 1998.)

                          National Library of Medicine

        For carrying out section 301 and title IV of the Public Health
    Service Act with respect to health information communications,
    [$161,185,000] $171,253,000, of which $4,000,000 shall be available
    until expended for improvement of information systems: Provided, That in
    fiscal year [1998] 1999, 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,
    1998.)

                             Office of the Director

                          (including transfer of funds)

        For carrying out the responsibilities of the Office of the Director,
    National Institutes of Health, [$296,373,000, of which $40,536,000 shall
    be for the Office of AIDS Research] $212,949,000: 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 or
    any other Act to all National Institutes of Health appropriations to
    activities the Director may so designate: Provided further, That no such
    appropriation shall be 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 third party payments
    for the cost of clinical services that are incurred in National
    Institutes of Health research facilities 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 [$500,000] $300,000 shall be
    available to carry out section 499 of the Public Health Service Act for
    the final year of Federal support for the National Foundation for
    Biomedical Research and that these funds shall be available for
    obligation only after the Secretary of Health and Human Services
    certifies a plan for the self-sufficiency of the Foundation after fiscal
    year 1999: Provided further, That, notwithstanding section 499(k)(10) of
    the Public Health Service Act, funds from the National Foundation for
    Biomedical Research may be transferred to the National Institutes of
    Health[: Provided further, That $20,000,000 shall be available to carry
    out section 404E of the Public Health Service Act: Provided further,
    That of the funds available to carry out section 404E of the Public
    Health Service Act, not less than $7,000,000 shall be for peer reviewed
    complementary and alternative medicine research grants and contracts
    that respond to program announcements and requests for proposals issued
    by the Office of Alternative Medicine]. (Department of Health and Human
    Services Appropriations Act, 1998.)

                             Office of AIDS Research

                        (including the transfer of funds)

        For carrying out part D of title XXIII of the Public Health Service
    Act, $1,730,796,000, of which $6,100,000 shall be transferred to
    Buildings and Facilities and remain available until expended: 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, [$206,957,000] $128,886,000, to remain
    available until expended[, of which $90,000,000 shall be for the
    clinical research center and $16,957,000 for the Vaccine Facility:
    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: Provided further, That notwithstanding any other
    provision of law, a single contract or related contracts for the
    development and construction of the Vaccine Facility 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 in 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 Mark O. Hatfield
    Clinical Research Center: $90,000,000 for fiscal year 1999, and
    $40,000,000 for fiscal year 2000. (Department of Health and Human
    Services Appropriations Act, 1998.)

                  Unavailable Collections (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9915-0-1-552      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
        Balance, start of year:
    01.99 Balance, start of year............
        Receipts:
    02.01 Cooperative research and
            development agreements, NIH.....          28          28          28
        Appropriation:
    05.01 National Institutes of Health.....         -28         -28         -28
    07.99 Total balance, end of year........
    ---------------------------------------------------------------------------

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9915-0-1-552      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
          Direct program:

    00.01   National Cancer Institute.......       2,389       2,547       2,536
    00.02   National Heart, Lung, and Blood
              Institute.....................       1,432       1,531       1,647
    00.03   National Institute of Dental
              Research......................         197         209         215
    00.04   National Institute of Diabetes
              and Digestive and Kidney
              Disease.......................         813         874         927
    00.05   National Institute of
              Neurological Disorders and
              Stroke........................         729         781         816
    00.06   National Institute of Allergy
              and Infectious Diseases.......       1,258       1,352         702
    00.07   National Institute of General
              Medical Sciences..............         995       1,066       1,115
    00.08   National Institute of Child
              Health and Human Development..         631         675         655
    00.09   National Eye Institute..........         332         356         374
    00.10   National Institute of
              Environmental Health Sciences.         308         330         348
    00.11   National Institute on Aging.....         484         519         556
    00.12   National Institute of Arthritis
              and Musculoskeletal and Skin
              Disease.......................         256         275         291
    00.13   National Institute on Deafness
              and Other Communication
              Disorder......................         188         201         214
    00.14   National Institute of Nursing
              Research......................          60          64          62
    00.15   National Institute of Alcohol
              Abuse and Alcoholism..........         211         227         230
    00.16   National Institute on Drug Abuse         499         527         395
    00.17   National Institute of Mental
              Health........................         701         750         702
    00.18   National Center for Research
              Resources.....................         414         454         423
    00.19   National Human Genome Research
              Institute.....................         189         218         237
    00.20   John E. Fogarty International
              Center........................          27          28          19
    00.21   National Library of Medicine....         150         161         171
    00.22   Office of the Director..........         286         296         213
    00.23   Office of AIDS Research.........                               1,731
    00.24   Buildings and facilities........         222         207         219
    00.25   Cooperative research and
              development agreements........          17          17          17
    00.26   Royalities......................          29          29          29
                                               ---------   ---------  ----------
    00.91     Total direct program..........      12,817      13,694      14,844
    09.00 Reimbursable program..............       1,052       1,159       1,145
                                               ---------   ---------  ----------
    10.00   Total obligations...............      13,869      14,853      15,989
    ----------------------------------------------------------------------------

    [[Page 409]]

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested.......         221         197         179
    22.00 New budget authority (gross)......      13,848      14,835      15,971
    22.30 Unobligated balance expiring......          -1
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......      14,068      15,032      16,150
    23.95 New obligations...................     -13,869     -14,853     -15,989
    24.40 Unobligated balance available, end
            of year: Uninvested.............         197         179         161
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................      12,741      13,648      14,798
    42.00   Transferred from other accounts.          10
                                               ---------   ---------  ----------
    43.00     Appropriation (total).........      12,751      13,648      14,798
          Permanent:

    60.25   Appropriation (special fund,
              indefinite)...................          28          28          28
            Spending authority from
                offsetting collections:
    68.00     Offsetting collections (cash).       1,052       1,159       1,145
    68.10     Change in orders on hand from
                Federal sources.............          17
                                               ---------   ---------  ----------
    68.90       Spending authority from
                  offsetting collections
                  (total)...................       1,069       1,159       1,145
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................      13,848      14,835      15,971
    ----------------------------------------------------------------------------

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

    72.40   Obligated balance: Uninvested...       9,247      10,973      11,746
    72.95   Orders on hand from Federal
              sources.......................       4,422       4,439       4,439
                                               ---------   ---------  ----------
    72.99     Total unpaid obligations,
                start of year...............      13,669      15,412      16,185
    73.10 New obligations...................      13,869      14,853      15,989
    73.20 Total outlays (gross).............     -12,251     -14,080     -15,071
    73.40 Adjustments in expired accounts...         125
          Unpaid obligations, end of year:

    74.40   Obligated balance: Uninvested...      10,973      11,746      12,664
    74.95   Orders on hand from Federal
              sources.......................       4,439       4,439       4,439
                                               ---------   ---------  ----------
    74.99     Total unpaid obligations, end
                of year.....................      15,412      16,185      17,103
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority       3,973       4,251       4,618
    86.93 Outlays from current balances.....       7,293       8,642       9,280
    86.97 Outlays from new permanent
            authority.......................         985       1,187       1,173
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........      12,251      14,080      15,071
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.00   Offsetting collections (cash)
              from: Federal sources.........      -1,052      -1,159      -1,145
    88.95 Change in orders on hand from
            Federal sources.................         -17
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................      12,779      13,676      14,826
    90.00 Outlays...........................      11,199      12,921      13,926
    ---------------------------------------------------------------------------

                              [Dollars in millions]

                                            1997         1998        1999
    Distribution of budget authority by
        account:
      National Cancer Institute.........       2,389       2,547       2,536
      National Heart, Lung, and Blood
        Institute.......................       1,432       1,531       1,646
      National Institute of Dental
        Research........................         197         209         215
      National Institute of Diabetes and
        Digestive and Kidney Diseases...         813         874         927
      National Institute of Neurological
        Disorder and Stroke.............         729         781         816
      National Institute of Allergy and
        Infectious Diseases.............       1,258       1,352         702
      National Institute of General
        Medical Sciences................         995       1,066       1,115
      National Institute of Child Health
        and Human Development...........         632         675         655
      National Eye Institute............         332         356         374
      National Institute of
        Environmental Health Sciences...         308         330         348
      National Institute on Aging.......         484         519         556
      National Institute of Arthritis
        and Musculoskeletal and Skin
        Diseases........................         256         275         291
      National Institute on Deafness and
        Other Communication Disorders...         188         201         214
      National Institute of Nursing
        Research........................          60          64          62
      National Institute on Alcohol
        Abuse and Alcoholism............         211         227         230
      National Institute on Drug Abuse..         500         527         395
      National Institute of Mental
        Health..........................         701         750         702
      National Center for Research
        Resources.......................         414         454         423
      National Human Genome Research
        Institute.......................         189         218         237
      John E. Fogarty International
        Center..........................          27          28          19
      National Library of Medicine......         150         161         171
      Office of the Director............         286         298         213
      Office of AIDS Research...........                               1,731
      Buildings and Facilities..........         200         207         219
                                        ------------------------------------
          Subtotal......................      12,751      13,650      14,797
      Cooperative Research and
        Development Agreements..........          26          28          28
                                        ------------------------------------
          Total Budget Authority, NIH...      12,777      13,678      14,825
                                        ====================================

                              [Dollars in millions]

                                            1997         1998        1999
    Distribution of outlays by account:
      National Cancer Institute.........       2,148       2,423       2,382
      National Heart, Lung, and Blood
        Institute.......................       1,083       1,442       1,503
      National Institute of Dental
        Research........................         168         199         200
      National Institute of Diabetes and
        Digestive and Kidney Diseases...         627         823         870
      National Institute of Neurological
        Disorders and Stroke............         701         742         767
      National Institute of Allergy and
        Infectious Diseases.............       1,216       1,266         655
      National Institute of General
        Medical Sciences................         882       1,002       1,051
      National Institute of Child Health
        and Human Development...........         566         638         620
      National Eye Institute............         337         338         351
      National Institute of
        Environmental Health Sciences...         286         308         332
      National Institute on Aging.......         426         490         522
      National Institute of Arthritis
        and Musculoskeletal and Skin
        Diseases........................         230         258         274
      National Institute on Deafness and
        Other Communication Disorders...         177         190         202
      National Institute of Nursing
        Research........................          48          59          58
      National Institute on Alcohol
        Abuse and Alcoholism............         171         215         216
      National Institute on Drug Abuse..         437         496         364
      National Institute of Mental
        Health..........................         638         710         658
      National Center for Research
        Resources.......................         302         432         385
      National Human Genome Research
        Institute.......................         165         197         220
      John E. Fogarty International
        Center..........................          15          25          18
      National Library of Medicine......         144         155         163
      Office of the Director............         315         277         237
      Office of AIDS Research...........                               1,609
      Buildings and Facilities..........          94         208         241
      Service and Supply Fund/Management
        Fund............................          17
                                        ------------------------------------
          Subtotal Outlays..............      11,193      12,893      13,898
      Cooperative Research and
        Development Agreements..........           6          28          28
                                        ------------------------------------
          Total Outlays, NIH............      11,199      12,921      13,926
                                        ====================================
        Note: The total amount for FY 1998 AIDS research was $1,607,053, which
    was jointly determined by the Director of NIH and the Director of the Office
    of AIDS Research pursuant to section 209 of P.L. 105-78. $1,566,517,000 was
    made available to OAR. This amount is net of the $40,536,000 in AIDS funds
    earmarked in P.L. 105-78 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.

        The funding for the National Institutes of Health is proposed as
    part of the Research Fund for America. This proposal highlights the
    Administration's priority to providing needed and sustained investments
    in important Federal research programs on a deficit neutral basis. A
    discussion of the Research Fund for America, and two other funds for the
    environment and transportation, can be found in Section II of the Budget
    volume.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9915-0-1-552      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

          Direct obligations:

            Personnel compensation:
    11.1      Full-time permanent...........         477         507         548
    11.3      Other than full-time permanent         101         107         115
    11.5      Other personnel compensation..          32          34          34
    11.8      Special personal services
                payments....................          82          92          97
                                               ---------   ---------  ----------
    11.9        Total personnel compensation         692         740         794
    12.1    Civilian personnel benefits.....         144         152         165
    21.0    Travel and transportation of
              persons.......................          22          22          23
    22.0    Transportation of things........           4           4           4
    23.1    Rental payments to GSA..........           5           5           5
    23.2    Rental payments to others.......           7           7           8
    23.3    Communications, utilities, and
              miscellaneous charges.........          36          39          40
    24.0    Printing and reproduction.......          13          13          14

    [[Page 410]]

    25.1    Advisory and assistance services          26          29          30
    25.2    Other services..................         234         442         479
    25.3    Purchases of goods and services
              from Government accounts......         992         789         822
    25.4    Operation and maintenance of
              facilities....................         228         104         107
    25.5    Research and development
              contracts.....................         742         809         878
    25.6    Medical care....................          11          11          12
    25.7    Operation and maintenance of
              equipment.....................          34          25          26
    26.0    Supplies and materials..........         133         137         143
    31.0    Equipment.......................         113         120         127
    41.0    Grants, subsidies, and
              contributions.................       9,378      10,243      11,164
    42.0    Insurance claims and indemnities           3           3           3
                                               ---------   ---------  ----------
    99.0      Subtotal, direct obligations..      12,817      13,694      14,844
    99.0  Reimbursable obligations..........       1,052       1,159       1,145
                                               ---------   ---------  ----------
    99.9    Total obligations...............      13,869      14,853      15,989
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-9915-0-1-552      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
        Direct:
          Total compensable workyears:

    1001    Full-time equivalent employment.      10,785      11,012      11,462
    1011    Exempt Full-time equivalent
              employment....................                      29          33
        Reimbursable:
    2001  Total compensable workyears: Full-
            time equivalent employment......       4,347       4,421       4,515
    ---------------------------------------------------------------------------

            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, and
    section 301 of the Public Health Service Act with respect to program
    management, [$2,146,743,000, of which $10,000,000 shall be for grants to
    rural and Native American projects: Provided, That notwithstanding any
    other provision of law, each State's allotment for fiscal year 1998 for
    each of the programs under subparts I and II of part B of title XIX of
    the Public Health Service Act shall be equal to such State's allotment
    for such programs for fiscal year 1997.] $2,279,643,000. (Department of
    Health and Human Services Appropriations Act, 1998.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1362-0-1-550      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
          Direct program:

    00.01   Mental health and substance
              abuse activities..............         506         507         442
    00.02   Mental health partnership.......         275         275         275
    00.03   Substance abuse partnership.....       1,310       1,310       1,510
    00.04   Substance abuse partnership
              temporary supplement
              (mandatory)...................          50          50
    00.05   Program management..............          54          55          53
                                               ---------   ---------  ----------
    00.91   Total, direct program...........       2,195       2,197       2,280
    09.01 Reimbursable program..............          22          22          22
                                               ---------   ---------  ----------
    10.00   Total obligations...............       2,217       2,219       2,302
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested.......           2
    22.00 New budget authority (gross)......       2,216       2,219       2,302
    22.30 Unobligated balance expiring......          -1
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......       2,217       2,219       2,302
    23.95 New obligations...................      -2,217      -2,219      -2,302
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................       2,134       2,147       2,280
    42.00   Transferred from other accounts.          11
                                               ---------   ---------  ----------
    43.00     Appropriation (total).........       2,145       2,147       2,280
          Permanent:

    65.00   Advance appropriation (definite)          50          50
    68.00   Spending authority from
              offsetting collections:
              Offsetting collections (cash).          22          22          22
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................       2,217       2,219       2,302
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Uninvested...       1,048       1,642       1,675
    73.10 New obligations...................       2,217       2,219       2,302
    73.20 Total outlays (gross).............      -1,644      -2,186      -2,215
    73.40 Adjustments in expired accounts...          21
    74.40 Unpaid obligations, end of year:
            Obligated balance: Uninvested...       1,642       1,675       1,762
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority         842         859         912
    86.93 Outlays from current balances.....         759       1,280       1,281
    86.97 Outlays from new permanent
            authority.......................          43          47          22
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........       1,644       2,186       2,215
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.00   Offsetting collections (cash)
              from: Federal sources.........         -22         -22         -22
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................       2,195       2,197       2,280
    90.00 Outlays...........................       1,622       2,164       2,193
    ---------------------------------------------------------------------------

        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      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

          Direct obligations:

            Personnel compensation:
    11.1      Full-time permanent...........          31          35          38
    11.3      Other than full-time permanent           1           1           1
    11.5      Other personnel compensation..           1           1           1
                                               ---------   ---------  ----------
    11.9        Total personnel compensation          33          37          40
    12.1    Civilian personnel benefits.....           6           7           8
    21.0    Travel and transportation of
              persons.......................           1           1           1
    23.1    Rental payments to GSA..........           3           4           4
    23.3    Communications, utilities, and
              miscellaneous charges.........           1           1           1
    24.0    Printing and reproduction.......           2           2           1
    25.1    Advisory and assistance services          48          76          82
    25.2    Other services..................          96          97          94
    25.3    Purchases of goods and services
              from Government accounts......          14          16          12
    31.0    Equipment.......................           2           1           1
    41.0    Grants, subsidies, and
              contributions.................       1,987       1,953       2,034
    42.0    Insurance claims and indemnities           2           2           2
                                               ---------   ---------  ----------
    99.0      Subtotal, direct obligations..       2,195       2,197       2,280
    99.0  Reimbursable obligations..........          22          22          22
                                               ---------   ---------  ----------
    99.9    Total obligations...............       2,217       2,219       2,302
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-1362-0-1-550      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
        Direct:
    1001  Total compensable workyears: Full-
            time equivalent employment......         535         559         593
        Reimbursable:
          Total compensable workyears:

    2001    Full-time equivalent employment.           2          13           6
    2011    Exempt Full-time equivalent
              employment....................          58          92          92
    ---------------------------------------------------------------------------

    [[Page 411]]

                   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, [$90,229,000]
    $100,788,000; 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
    [$56,206,000] $70,647,000. (Department of Health and Human Services
    Appropriations Act, 1998.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1700-0-1-552      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
          Direct program:

    01.01   Research on health costs,
              quality, and outcomes.........          95          88          99
    01.04   Program support.................           2           2           2
    09.00 Reimbursable program..............          57          65          80
                                               ---------   ---------  ----------
    10.00   Total obligations...............         154         155         181
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested.......           1
    22.00 New budget authority (gross)......         154         155         181
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......         155         155         181
    23.95 New obligations...................        -154        -155        -181
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................          96          90         101
    42.00   Transferred from other accounts.           1
                                               ---------   ---------  ----------
    43.00     Appropriation (total).........          97          90         101
          Permanent:

            Spending authority from
                offsetting collections:
    68.00     Offsetting collections (cash).          55          65          80
    68.10     Change in orders on hand from
                Federal sources.............           2
                                               ---------   ---------  ----------
    68.90       Spending authority from
                  offsetting collections
                  (total)...................          57          65          80
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................         154         155         181
    ----------------------------------------------------------------------------

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

    72.40   Obligated balance: Uninvested...         142         129         126
    72.95   Orders on hand from Federal
              sources.......................           4           6           6
                                               ---------   ---------  ----------
    72.99     Total unpaid obligations,
                start of year...............         146         135         132
    73.10 New obligations...................         154         155         181
    73.20 Total outlays (gross).............        -165        -158        -173
          Unpaid obligations, end of year:

    74.40   Obligated balance: Uninvested...         129         126         134
    74.95   Orders on hand from Federal
              sources.......................           6           6           6
                                               ---------   ---------  ----------
    74.99     Total unpaid obligations, end
                of year.....................         135         132         140
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority           9          14          15
    86.93 Outlays from current balances.....         101          79          79
    86.97 Outlays from new permanent
            authority.......................          55          65          80
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........         165         158         173
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.00   Offsetting collections (cash)
              from: Federal sources.........         -55         -65         -80
    88.95 Change in orders on hand from
            Federal sources.................          -2
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................          97          90         101
    90.00 Outlays...........................         110          93          93
    ---------------------------------------------------------------------------

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

        A portion of the funding for the Agency for Health Care Policy and
    Research is proposed as part of the Research Fund for America. This
    proposal highlights the Administration's priority of providing needed
    and sustained investments in important Federal research programs on a
    deficit neutral basis. A discussion of the Research Fund for America,
    and two other funds for the environment and transportation, can be found
    in Section II of the Budget volume.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1700-0-1-552      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

          Direct obligations:

            Personnel compensation:
    11.1      Full-time permanent...........          11          13          14
    11.3      Other than full-time permanent           2           2           2
                                               ---------   ---------  ----------
    11.9        Total personnel compensation          13          15          16
    12.1    Civilian personnel benefits.....           3           4           4
    21.0    Travel and transportation of
              persons.......................                       1           1
    23.1    Rental payments to GSA..........           2           2           3
    23.3    Communications, utilities, and
              miscellaneous charges.........           1           1           1
    24.0    Printing and reproduction.......           1           1           1
    25.2    Other services..................           5           4           5
    25.3    Purchases of goods and services
              from Government accounts......           2           2           1
    25.5    Research and development
              contracts.....................           9          19          16
    31.0    Equipment.......................           1           1           1
    41.0    Grants, subsidies, and
              contributions.................          60          40          52
                                               ---------   ---------  ----------
    99.0      Subtotal, direct obligations..          97          90         101
    99.0  Reimbursable obligations..........          57          65          80
                                               ---------   ---------  ----------
    99.9    Total obligations...............         154         155         181
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-1700-0-1-552      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
        Direct:
    1001  Total compensable workyears: Full-
            time equivalent employment......         198         203         211
        Reimbursable:
    2001  Total compensable workyears: Full-
            time equivalent employment......          59          64          64
    ---------------------------------------------------------------------------

                      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, [$71,602,429,000] $74,593,733,000, to remain
    available until expended.
         For making, after May 31, [1998] 1999, payments to States under
    title XIX of the Social Security Act for the last quarter of fiscal year
    [1998] 1999 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 [1999,
    $27,800,689,000] 2000, $28,733,605,000, 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, 1998.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0512-0-1-551      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Medicaid vendor payments..........      91,744      95,263     101,711
    00.02 State and local administration....       4,340       5,210       5,640

    [[Page 412]]

    00.03 Vaccine purchases.................         393         487         566
    09.00 Medicare Part B premium transfer..                     200         250
                                               ---------   ---------  ----------
    10.00   Total obligations...............      96,477     101,160     108,167
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested.......       2,155       6,890       5,522
    22.00 New budget authority (gross)......     101,212      99,791     102,644
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......     103,367     106,681     108,167
    23.95 New obligations...................     -96,477    -101,160    -108,167
    24.40 Unobligated balance available, end
            of year: Uninvested.............       6,890       5,522
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................      75,057      71,602      74,594
          Permanent:

    65.00   Advance appropriation (definite)      26,155      27,989      27,801
    68.00   Spending authority from
              offsetting collections:
              Offsetting collections (cash).                     200         250
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................     101,212      99,791     102,644
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Uninvested...       5,344       6,268       6,268
    73.10 New obligations...................      96,477     101,160     108,167
    73.20 Total outlays (gross).............     -95,552    -101,160    -108,167
    74.40 Unpaid obligations, end of year:
            Obligated balance: Uninvested...       6,268       6,268       6,268
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority      61,898      59,813      68,326
    86.93 Outlays from current balances.....       7,499      13,158      11,790
    86.97 Outlays from new permanent
            authority.......................      26,155      28,189      28,051
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........      95,552     101,160     108,167
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.00   Offsetting collections (cash)
              from: Federal sources.........                    -200        -250
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................     101,212      99,591     102,394
    90.00 Outlays...........................      95,552     100,960     107,917
    ---------------------------------------------------------------------------

                     Summary of Budget Authority and Outlays

                            (in millions of dollars)

                                         1997 actual  1998 est.   1999 est.
    Enacted/requested:
      Budget Authority..................     101,212      99,591     102,395
      Outlays...........................      95,552     100,960     107,917
    Legislative proposal, subject to
        PAYGO:
      Budget Authority..................                                -210
      Outlays...........................                                -210
                                        ------------------------------------
    Total:
      Budget Authority..................     101,212      99,591     102,185
      Outlays...........................      95,552     100,960     107,707
                                        ====================================

        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.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0512-0-1-551      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
    41.0  Direct obligations: Grants,
            subsidies, and contributions....      96,477     100,960     107,917
    99.0  Reimbursable obligations:
            Subtotal, reimbursable
            obligations.....................                     200         250
                                               ---------   ---------  ----------
    99.9    Total obligations...............      96,477     101,160     108,167
    ---------------------------------------------------------------------------

                          Grants to States for Medicaid

                    (Legislative proposal, subject to PAYGO)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0512-4-1-551      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    10.00 Total obligations (object class
            41.0)...........................                                -210
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......                                -210
    23.95 New obligations...................                                 210
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    40.00 Appropriation.....................                                -210
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    73.10 New obligations...................                                -210
    73.20 Total outlays (gross).............                                 210
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority                                -210
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................                                -210
    90.00 Outlays...........................                                -210
    ---------------------------------------------------------------------------

        This schedule reflects the effects of Medicaid, Medicare, and
    welfare proposals included in the Budget on the Grants to States for
    Medicaid account. Medicaid costs associated with children's health
    outreach proposals will be financed by receipts from tobacco
    legislation.

                       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, [$60,904,000,000] $62,953,000,000.
    (Department of Health and Human Services Appropriations Act, 1998.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0580-0-1-571      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Supplementary medical insurance
            (SMI)...........................      59,456      59,773      62,171
    00.02 Hospital insurance for uninsured
            (HI)............................         405         -52         555
    00.03 Federal uninsured payment (HI)....          76          86          97
    00.04 Program management (HI)...........         116         131         130
    00.06 Federal payments from taxation of
            OASDI benefits (HI).............       3,558       5,193       5,173
    00.08 Fraud and abuse control, FBI......          47          56          66
    00.10 Fraud and abuse control, criminal
            fines...........................          46          15          16
    00.11 Fraud and abuse control, civil
            monetary penalties..............           1           1           1
                                               ---------   ---------  ----------
    10.00   Total obligations...............      63,705      65,203      68,209
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......      63,731      66,169      68,209
    22.30 Unobligated balance expiring......         -26        -966
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......      63,705      65,203      68,209
    23.95 New obligations...................     -63,705     -65,203     -68,209
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................      60,079      60,904      62,953
          Permanent:

    60.00   Appropriation...................          47          56          66
    60.05   Appropriation (indefinite)......       3,605       5,209       5,190
                                               ---------   ---------  ----------
    63.00     Appropriation (total).........       3,652       5,265       5,256
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................      63,731      66,169      68,209
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    73.10 New obligations...................      63,705      65,203      68,209

    [[Page 413]]

    73.20 Total outlays (gross).............     -63,720     -65,203     -68,209
    73.40 Adjustments in expired accounts...          15
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority      60,053      59,938      62,953
    86.93 Outlays from current balances.....          15
    86.97 Outlays from new permanent
            authority.......................       3,652       5,265       5,256
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........      63,720      65,203      68,209
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................      63,731      66,169      68,209
    90.00 Outlays...........................      63,722      65,203      68,209
    ---------------------------------------------------------------------------

                     Summary of Budget Authority and Outlays

                            (in millions of dollars)

                                         1997 actual  1998 est.   1999 est.
    Enacted/requested:
      Budget Authority..................      63,731      66,169      68,209
      Outlays...........................      63,720      65,203      68,209
    Legislative proposal, subject to
        PAYGO:
      Budget Authority..................                                -135
      Outlays...........................                                -135
                                        ------------------------------------
    Total:
      Budget Authority..................      63,731      66,169      68,074
      Outlays...........................      63,720      65,203      68,074
                                        ====================================

        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. Since
    1992, amounts have been included for non-Medicare activities of HCFA
    Program Management.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0580-0-1-571      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
    41.0  Grants, subsidies, and
            contributions...................      63,108      65,038      67,427
    42.0  Insurance claims and indemnities..         481          34         652
    92.0  Undistributed.....................         116         131         130
                                               ---------   ---------  ----------
    99.9    Total obligations...............      63,705      65,203      68,209
    ---------------------------------------------------------------------------

                       Payments to Health Care Trust Funds

                    (Legislative proposal, subject to PAYGO)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0580-4-1-571      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Supplementary medical insurance
            (SMI)...........................                                -135
                                               ---------   ---------  ----------
    10.00   Total obligations (object class
              41.0).........................                                -135
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......                                -135
    23.95 New obligations...................                                 135
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    40.00 Appropriation.....................                                -135
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    73.10 New obligations...................                                -135
    73.20 Total outlays (gross).............                                 135
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority                                -135
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................                                -135
    90.00 Outlays...........................                                -135
    ---------------------------------------------------------------------------

        This schedule reflects the effects of the Medicare proposals
    contained in the Budget on the Payments to Health Care Trust Funds
    account.

                               Program Management

        For carrying out, except as otherwise provided, titles XI, XVIII,
    XIX and XXI of the Social Security Act, titles XIII and XXVII of the
    Public Health Service Act, and the Clinical Laboratory Improvement
    Amendments of 1988, not to exceed [$1,743,066,000] $1,678,000,000 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 and such
    sums as may be collected from authorized user fees and the sale of data,
    which shall remain available until expended, and together with
    administrative fees collected relative to Medicare overpayment recovery
    activities, which shall be transferred to the Health Care Fraud and
    Abuse Control (HCFAC) account and 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 shall be credited to and available for carrying out the purposes of
    this appropriation: [Provided further, That $900,000 shall be for
    carrying out section 4021 of Public Law 105-33: Provided further, That
    in carrying out its legislative mandate, the National Bipartisan
    Commission on the Future of Medicare shall examine the impact of
    increased investments in health research on future Medicare costs, and
    the potential for coordinating Medicare with cost-effective long-term
    care services:] Provided further, That [$40,000,000] $45,000,000
    appropriated under this heading for the transition to a single Part A
    and Part B processing system shall remain available until expended:
    [Provided further, That funds appropriated under this heading may be
    obligated to increase Medicare provider audits and implement the
    Department's corrective action plan to the Chief Financial Officer's
    audit of the Health Care Financing Administration's oversight of
    Medicare:] Provided further, That the Secretary of Health and Human
    Services is directed to collect, in aggregate, [$95,000,000]
    $150,000,000 in fees in fiscal year [1998] 1999 from Medicare+Choice
    organizations pursuant to section 1857(e)(2) of the Social Security Act
    and from eligible organizations with risk-sharing contracts under
    section 1876 of that Act pursuant to section 1876(k)(4)(D) of that Act.
    (Department of Health and Human Services Appropriations Act, 1998.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0511-0-1-550      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
          Direct program:

    00.01   Research, demonstrations, and
              evaluation projects...........          44          50          50
    00.02   Medicare contractors............       1,176       1,174       1,104
    00.04   State certification.............         156         154         105
    00.05   Administrative costs............         334         365         419
                                               ---------   ---------  ----------
    00.91     Total direct program..........       1,710       1,743       1,678
          Reimbursable program:

    08.01   CLIA............................          29          43          43
    08.02   Other reimbursements............           6          97         152
                                               ---------   ---------  ----------
    08.91     Total reimbursable program....          35         140         195
                                               ---------   ---------  ----------
    10.00   Total obligations...............       1,745       1,883       1,873
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested.......          99          18          18
    22.00 New budget authority (gross)......       1,687       1,883       1,873
    22.10 Resources available from
            recoveries of prior year
            obligations.....................           1
    22.30 Unobligated balance expiring......         -24
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......       1,763       1,901       1,891
    23.95 New obligations...................      -1,745      -1,883      -1,873
    24.40 Unobligated balance available, end
            of year: Uninvested.............          18          18          17
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    68.00 Spending authority from offsetting
            collections (gross): Offsetting
            collections (cash)..............       1,687       1,883       1,873
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Uninvested...         452         495         495
    73.10 New obligations...................       1,745       1,883       1,873
    73.20 Total outlays (gross).............      -1,691      -1,883      -1,873
    73.40 Adjustments in expired accounts...         -10

    [[Page 414]]

    73.45 Adjustments in unexpired accounts.          -1
    74.40 Unpaid obligations, end of year:
            Obligated balance: Uninvested...         495         495         495
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new permanent
            authority.......................       1,687       1,883       1,873
    86.98 Outlays from permanent balances...           4
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........       1,691       1,883       1,873
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

            Offsetting collections (cash)
                from:
    88.00     Federal sources...............      -1,653      -1,743      -1,678
    88.40     Non-Federal sources...........         -34        -140        -195
                                               ---------   ---------  ----------
    88.90       Total, offsetting
                  collections (cash)........      -1,687      -1,883      -1,873
    ----------------------------------------------------------------------------

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

                     Summary of Budget Authority and Outlays

                            (in millions of dollars)

                                         1997 actual  1998 est.   1999 est.
    Enacted/requested:
      Budget Authority..................
      Outlays...........................           4
    Legislative proposal, not subject to
        PAYGO:
      Budget Authority..................
      Outlays...........................
    Legislative proposal, subject to
        PAYGO:
      Budget Authority..................                                 220
      Outlays...........................                                 220
                                        ------------------------------------
    Total:
      Budget Authority..................                                 220
      Outlays...........................           4                     220
                                        ====================================

        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      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

          Personnel compensation:

    11.1    Full-time permanent.............         222         242         270
    11.3    Other than full-time permanent..           5           5           5
    11.5    Other personnel compensation....           1           2           2
                                               ---------   ---------  ----------
    11.9      Total personnel compensation..         228         249         277
    12.1  Civilian personnel benefits.......          40          45          51
    21.0  Travel and transportation of
            persons.........................           5           2           7
    23.1  Rental payments to GSA............          29          24          25
    23.3  Communications, utilities, and
            miscellaneous charges...........          16           3           7
    24.0  Printing and reproduction.........           6           2           5
    25.1  Advisory and assistance services..           1           2           2
    25.2  Other services....................         332         368         373
    25.6  Medical care......................       1,045       1,172       1,102
    26.0  Supplies and materials............           2           1           1
    31.0  Equipment.........................          16           7           7
    32.0  Land and structures...............                                  10
    41.0  Grants, subsidies, and
            contributions...................          25           8           6
                                               ---------   ---------  ----------
    99.9    Total obligations...............       1,745       1,883       1,873
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-0511-0-1-550      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
    1001  Total compensable workyears: Full-
            time equivalent employment......       3,979       4,002       4,217
    ---------------------------------------------------------------------------

                               Program Management

                  (Legislative proposal, not subject to PAYGO)

        Upon enactment of authorization to establish fees to cover
    administrative costs of the Health Care Financing Administration and its
    contractors, such fees may be collected and credited to this account as
    offsetting collections: Provided, That not to exceed $264,500,000 of
    such fees shall be available until expended for authorized purposes.

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0511-2-1-550      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    08.03 Survey and certification initial
            fee.............................                                  10
    08.04 Survey and certification
            recertification fee.............                                  52
    08.05 Duplicate claim fee...............                                  36
    08.06 Paper claim fee...................                                 110
    08.07 Provider enrollment registration
            fee.............................                                  20
    08.08 Health plan initial application
            fee.............................                                  37
                                               ---------   ---------  ----------
    10.00   Total obligations...............                                 265
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......                                 265
    23.95 New obligations...................                                -265
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    68.00 Spending authority from offsetting
            collections (gross): Offsetting
            collections (cash)..............                                 265
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    73.10 New obligations...................                                 265
    73.20 Total outlays (gross).............                                -265
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new permanent
            authority.......................                                 265
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.40   Offsetting collections (cash)
              from: Non-Federal sources.....                                -265
    ----------------------------------------------------------------------------

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

        The Budget includes $264.5 million in new user fees to finance HCFA
    activities as reflected in the legislative proposal schedule. Proposed
    user fees include: a duplicate or unprocessable claims fee; a paper
    claims fee; a physician, provider, and supplier enrollment registration
    fee; a managed care organization application and renewal fee; an initial
    survey and certification fee; and a recertification fee. Additional
    appropriations language is being proposed contingent upon the enactment
    of authorizing legislation. The authorizing legislation will be proposed
    to authorize the collection and spending of the fee subject to
    appropriations action.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0511-2-1-550      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
    25.2  Other services....................                                  99
    25.6  Medical care......................                                 166
                                               ---------   ---------  ----------
    99.9    Total obligations...............                                 265
    ---------------------------------------------------------------------------

                               Program Management

                    (Legislative proposal, subject to PAYGO)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0511-4-1-550      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Voluntary insurance cooperatives..                                  20
    00.02 Medicare cancer clinical trials
            demonstration...................                                 200
                                               ---------   ---------  ----------

    [[Page 415]]

    10.00   Total obligations (object class
              41.0).........................                                 220
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......                                 220
    23.95 New obligations...................                                -220
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    60.00 Appropriation.....................                                 220
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    73.10 New obligations...................                                 220
    73.20 Total outlays (gross).............                                -220
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new permanent
            authority.......................                                 220
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................                                 220
    90.00 Outlays...........................                                 220
    ---------------------------------------------------------------------------

        This schedule reflects the effects on the Program Management account
    of the Administration's proposals to: (1) provide competitive grants
    designed to facilitate the development of state-based health insurance
    purchasing cooperatives; and (2) create a time-limited demonstration of
    Medicare coverage of patient care costs associated with Medicare
    beneficiary participation in NIH sponsored clinical trials for cancer.
    The demonstration's costs will be financed by receipts from tobacco
    legislation.

                     State Children's Health Insurance Fund

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0515-0-1-551      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    10.00 Total obligations (object class
            41.0)...........................                   4,235       4,215
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......                   4,235       4,215
    23.95 New obligations...................                  -4,235      -4,215
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    60.00 Appropriation.....................                   4,295       4,275
    61.00 Transferred to other accounts.....                     -60         -60
                                               ---------   ---------  ----------
    63.00   Appropriation (total)...........                   4,235       4,215
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................                   4,235       4,215
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Uninvested...                               3,856
    73.10 New obligations...................                   4,235       4,215
    73.20 Total outlays (gross).............                    -379      -1,834
    74.40 Unpaid obligations, end of year:
            Obligated balance: Uninvested...                   3,856       6,237
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new permanent
            authority.......................                     379       1,834
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................                   4,235       4,215
    90.00 Outlays...........................                     379       1,834
    ---------------------------------------------------------------------------

                     Summary of Budget Authority and Outlays

                            (in millions of dollars)

                                         1997 actual  1998 est.   1999 est.
    Enacted/requested:
      Budget Authority..................                   4,235       4,215
      Outlays...........................                     379       1,834
    Legislative proposal, subject to
        PAYGO:
      Budget Authority..................                                  34
      Outlays...........................                                  34
                                        ------------------------------------
    Total:
      Budget Authority..................                   4,235       4,249
      Outlays...........................                     379       1,868
                                        ====================================

        The Balanced Budget Act of 1997 established the Children's Health
    Insurance Program (CHIP) under Title XXI of the Social Security Act.
    This new Title provides Federal matching funds to States to enable them
    to extend coverage to uninsured children from low-income families.
    States are able to use Title XXI funds for obtaining health benefit
    coverage for uninsured children through a CHIP State program, a CHIP
    Medicaid expansion program, or a combination of both.

                     State Children's Health Insurance Fund

                    (Legislative proposal, subject to PAYGO)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0515-4-1-551      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    10.00 Total obligations (object class
            41.0)...........................                                  34
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......                                  34
    23.95 New obligations...................                                 -34
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    60.00 Appropriation.....................                                  34
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    73.10 New obligations...................                                  34
    73.20 Total outlays (gross).............                                 -34
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new permanent
            authority.......................                                  34
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................                                  34
    90.00 Outlays...........................                                  34
    ---------------------------------------------------------------------------

        This schedule reflects the effects of the proposed increase in CHIP
    payments to the territories.

          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 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 [1998] 1999,
    no commitments for direct loans or loan guarantees shall be made.
    (Department of Health and Human Services Appropriations Act, 1998.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-4420-0-3-551      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

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

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested.......          11          10          10
    22.00 New budget authority (gross)......           2           2           2
    22.60 Redemption of debt................          -2          -1          -1
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......          11          11          11
    23.95 New obligations...................          -1
    24.40 Unobligated balance available, end
            of year: Uninvested.............          10          10          10
    ----------------------------------------------------------------------------

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

        Change in unpaid obligations:
    73.10 New obligations...................           1

    [[Page 416]]

    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:

    88.40   Offsetting collections (cash)
              from: Other...................          -2          -2          -2
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................
    90.00 Outlays...........................          -2          -1          -1
    ---------------------------------------------------------------------------

                                   Trust Funds

                      Federal Hospital Insurance Trust Fund

                  Unavailable Collections (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8005-0-7-571      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
        Balance, start of year:
    01.99 Balance, start of year............     106,230      96,931      92,149
        Receipts:
    02.01 Transfers from general fund (FICA
            taxes)..........................     103,500     109,125     113,632
    02.02 Receipts from Railroad Retirement
            Board...........................         380         393         394
    02.03 Transfers from general fund (SECA
            taxes)..........................       6,844       8,511       8,600
    02.04 Federal employer contributions
            (FICA)..........................       1,790       1,835       1,905
    02.05 Postal service employer
            contributions (FICA)............         605         597         620
    02.06 Refunds...........................           3
    02.07 Interest received by trust funds..       9,718       9,153       8,765
    02.09 Premium receipts from displaced
            workers and early retirees,
            legislative proposal subject to
            PAYGO...........................                                  87
    02.10 Taxation on OASDI benefits........       3,558       5,193       5,173
    02.11 Deposits by States................         -17
    02.12 Interest payments by Railroad
            Retirement Board................          39          38          36
    02.13 Payments from the general fund
            (uninsured and program
            management).....................         597         165         782
    02.14 Payments for military service
            credits.........................          70          67          71
    02.15 Premiums collected for uninsured
            individuals not otherwise
            eligible........................       1,279       1,310       1,323
    02.16 FBI, Payment from the general fund          47          56          66
    02.17 Criminal fines, transfers from the
            general fund....................          46          15          16
    02.18 Civil monetary penalties,
            transfers from the general fund.           1           1           1
    02.20 Civil penalties and damages.......          89          50          53
                                               ---------   ---------  ----------
    02.99   Total receipts..................     128,549     136,509     141,524
                                               ---------   ---------  ----------
    04.00 Total: Balances and collections...     234,779     233,440     233,673
        Appropriation:
    05.01 Federal hospital insurance trust
            fund............................    -137,259    -140,615    -144,074
    05.02 Health care fraud and abuse
            control account.................        -591        -676        -764
    05.04 Federal hospital insurance trust
            fund, legislative proposal
            subject to PAYGO................                                 -93
                                               ---------   ---------  ----------
    05.99 Subtotal appropriation............    -137,850    -141,291    -144,931
    06.10 Unobligated balance returned to
            receipts........................           2
    07.99 Total balance, end of year........      96,931      92,149      88,742
    ---------------------------------------------------------------------------

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8005-0-7-571      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Benefit payments, HI..............     135,991     131,595     131,856
    00.02 Administration, HI................       1,183       1,231       1,209
    00.03 Peer review organizations, HI.....          58          67         553
    00.04 Research, HI......................          28          32          32
    00.05 HI partial transfer of home health
            to SMI..........................                   7,690      10,424
                                               ---------   ---------  ----------
    10.00   Total obligations...............     137,259     140,615     144,074
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......     137,259     140,615     144,074
    23.95 New obligations...................    -137,259    -140,615    -144,074
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.26   Appropriation (trust fund,
              definite).....................       1,169       1,218       1,196
          Permanent:

    60.27   Appropriation (trust fund,
              indefinite)...................     126,922     135,291     140,241
    60.28   Appropriation (unavailable
              balances).....................       9,168       4,106       2,637
                                               ---------   ---------  ----------
    63.00     Appropriation (total).........     136,090     139,397     142,878
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................     137,259     140,615     144,074
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.41 Unpaid obligations, start of year:
            Obligated balance: U.S.
            Securities: Par value...........      19,107      18,988      18,816
    73.10 New obligations...................     137,259     140,615     144,074
    73.20 Total outlays (gross).............    -137,378    -140,787    -143,762
    74.41 Unpaid obligations, end of year:
            Obligated balance: U.S.
            Securities: Par value...........      18,988      18,816      19,128
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority       1,084       1,128       1,114
    86.93 Outlays from current balances.....         119         136         132
    86.97 Outlays from new permanent
            authority.......................     117,187     120,671     123,833
    86.98 Outlays from permanent balances...      18,988      18,852      18,684
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........     137,378     140,787     143,762
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................     137,259     140,615     144,074
    90.00 Outlays...........................     137,378     140,787     143,762
    ---------------------------------------------------------------------------

                     Summary of Budget Authority and Outlays

                            (in millions of dollars)

                                         1997 actual  1998 est.   1999 est.
    Enacted/requested:
      Budget Authority..................     137,259     140,615     144,074
      Outlays...........................     137,378     140,787     143,763
    Legislative proposal, subject to
        PAYGO:
      Budget Authority..................                                  93
      Outlays...........................                                  93
                                        ------------------------------------
    Total:
      Budget Authority..................     137,259     140,615     144,167
      Outlays...........................     137,378     140,787     143,856
                                        ====================================

        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 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 transmitting the required report to
    Congress.

        The status of the trust fund is as follows:

                      Status of Funds (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8005-0-7-571      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
        Unexpended balance, start of year:
    0100  Treasury balance..................        -467        -619           1
    0101  U.S. Securities: Par value........     125,805     116,621     110,990
                                               ---------   ---------  ----------
    0199    Total balance, start of year....     125,337     116,002     110,991

    [[Page 417]]

        Cash income during the year:
          Governmental receipts:

    0200    FHI trust fund, transfers from
              general fund (FICA taxes).....     103,500     109,125     113,632
    0201    FHI trust fund, transfers from
              general fund (SECA taxes).....       6,844       8,511       8,600
    0202    Refunds.........................           3
    0205    FHI trust fund, receipts from
              Railroad Retirement Board.....         380         393         394
    0206    HCFAC: Civil penalties and
              damages.......................          89          50          53
    0207    FHI trust fund, deposits by
              States........................         -17
          Proprietary receipts:

    0221    FHI trust fund, premiums
              collected for uninsured
              individuals not otherwise
              eligible......................       1,279       1,310       1,323
    0223    Other proprietary receipts......
    0224    Premiums from aged 62-64 &
              displaced workers, proposed
              legislation...................                                  87
          Intragovernmental transactions:

    0240    FHI trust fund, Federal employer
              contributions (FICA)..........       1,790       1,835       1,905
    0241    FHI trust fund, Postal Service
              employer contributions (FICA).         605         597         620
    0242    FHI trust fund, Federal payment
              for transitional coverage for
              uninsured Federal employees...          76          86          97
    0243    FHI trust fund, Federal payment
              for transitional coverage for
              the uninsured.................         405         -52         555
    0244    FHI trust fund, Federal payment
              for SECA tax credits..........
    0245    FHI trust fund, general fund
              transfer, Program management
              (HI)..........................         116         131         130
    0246    FHI trust fund, Federal payments
              for OASDI taxes...............       3,558       5,193       5,173
    0248    FHI trust fund, interest payment
              from Railroad Retirement Board          39          38          36
    0249    FHI trust fund, interest on
              investments...................       9,718       9,153       8,765
    0250    FHI trust fund, interest on
              investments...................
    0251    FHI trust fund, transfer from
              Department of Defense for
              military service credits......          70          67          71
    0252    HCFAC: FBI......................          47          56          66
    0253    HCFAC: Criminal fines...........          46          15          16
    0254    HCFAC: Civil monetary penalties.           1           1           1
          Offsetting collections:

    0281    HCFAC user fees, proposed.......                                 395
    0297  Income under present law..........     128,548     136,509     141,437
    0298  Income under proposed legislation.                                 482
                                               ---------   ---------  ----------
    0299    Total cash income...............     128,548     136,509     141,919
        Cash outgo during year:
    0500  Benefit payments..................    -136,010    -131,595    -131,856
    0501  Benefit payments (proposed
            legislation)....................                                 -93
    0502  Administration....................      -1,161      -1,235      -1,213
    0504  Peer review organizations.........        -165        -238        -236
    0505  Research..........................         -42         -29         -32
    0506  HCFAC.............................        -506        -733        -764
    0507  HI partial transfer of home health
            to SMI..........................                  -7,690     -10,424
    0508  HCFAC, proposed (-)...............                                -395
    0597  Outgo under present law (-).......    -137,884    -141,520    -144,526
    0598  Outgo under proposed legislation
            (-).............................                                -488
                                               ---------   ---------  ----------
    0599  Total cash outgo (-)..............    -137,884    -141,520    -145,014
        Unexpended balance, end of year:
    0700  Treasury Balance..................        -619           1           1
    0701  U.S. Securities: Par value........     116,621     110,990     107,895
                                               ---------   ---------  ----------
    0799    Total balance, end of year......     116,002     110,991     107,896
    ---------------------------------------------------------------------------

                    Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8005-0-7-571      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

          Grants, subsidies, and contributions:

    41.0    Payment for health insurance
              experiments and demonstration
              projects......................          28          32          32
    41.0    Payment for peer review
              organization (PRO) activities.          58          67         553
    42.0  Insurance claims and indemnities..     135,990     131,595     131,856
          Undistributed:

    92.0    HI Partial Transfer of Home
              Health to SMI.................                   7,690      10,424
    92.0    Reimbursement for administrative
              expenses for other than SSA
              LAE...........................          42          45          45
    92.0    Purchases of goods and services.         611         625         605
    93.0  Administrative expenses: Portion
            of limitation on salaries and
            expenses: Social Security
            Administration..................         531         561         559
                                               ---------   ---------  ----------
    99.9    Total obligations...............     137,259     140,615     144,074
    ---------------------------------------------------------------------------

                      Federal Hospital Insurance Trust Fund

                    (Legislative proposal, subject to PAYGO)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8005-4-7-571      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    10.00 Total obligations (object class
            42.0)...........................                                  93
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......                                  93
    23.95 New obligations...................                                 -93
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    60.27 Appropriation (trust fund,
            indefinite).....................                                  87
    60.28 Appropriation (unavailable
            balances).......................                                   6
                                               ---------   ---------  ----------
    63.00   Appropriation (total)...........                                  93
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................                                  93
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    73.10 New obligations...................                                  93
    73.20 Total outlays (gross).............                                 -93
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new permanent
            authority.......................                                  93
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................                                  93
    90.00 Outlays...........................                                  93
    ---------------------------------------------------------------------------

        This schedule reflects the effects of the Medicare proposals
    contained in the Budget 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      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Medicare integrity program........         439         500         560
    00.02 FBI fraud and abuse control.......          47          56          66
    00.03 Other fraud and abuse control.....         103         120         138
                                               ---------   ---------  ----------
    10.00   Total obligations...............         589         676         764
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......         591         676         764
    22.30 Unobligated balance expiring......          -2
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......         589         676         764
    23.95 New obligations...................        -589        -676        -764
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    60.26 Appropriation (trust fund,
            definite).......................         591         676         764
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Uninvested...                      83          26
    73.10 New obligations...................         589         676         764
    73.20 Total outlays (gross).............        -506        -733        -764
    74.40 Unpaid obligations, end of year:
            Obligated balance: Uninvested...          83          26          26
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new permanent
            authority.......................         506         676         764
    86.98 Outlays from permanent balances...                      57
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........         506         733         764
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................         591         676         764
    90.00 Outlays...........................         506         733         764
    ---------------------------------------------------------------------------

    [[Page 418]]

                     Summary of Budget Authority and Outlays

                            (in millions of dollars)

                                         1997 actual  1998 est.   1999 est.
    Enacted/requested:
      Budget Authority..................         591         676         764
      Outlays...........................         506         733         764
    Legislative proposal, subject to
        PAYGO:
      Budget Authority..................
      Outlays...........................
                                        ------------------------------------
    Total:
      Budget Authority..................         591         676         764
      Outlays...........................         506         733         764
                                        ====================================

        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      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

          Direct obligations:

    25.6    Medical care (HCFA).............         439         500         560
    92.0    Undistributed (FBI).............          47          56          66
                                               ---------   ---------  ----------
    99.0      Subtotal, direct obligations..         486         556         626
          Allocation Account:

            Personnel compensation:
              Full-time permanent:
    11.1        Full-time permanent (OIG)...          38          50          58
    11.1        Full-time permanent (DoJ)...           2          16          17
    11.1        Full-time permanent (OGC)...           1           1           2
    11.3      Other than full-time permanent
                (DoJ).......................           1
    11.5      Other personnel compensation
                (OIG).......................           1           1           1
                                               ---------   ---------  ----------
    11.9        Total personnel compensation          43          68          78
            Civilian personnel benefits:
    12.1      Civilian personnel benefits
                (OIG).......................           8          11          13
    12.1      Civilian personnel benefits
                (DoJ).......................           1           4           4
            Travel and transportation of
                persons:
    21.0      Travel and transportation of
                persons (OIG)...............           2           3           4
    21.0      Travel and transportation of
                persons (DoJ)...............           1           1           1
            Rental payments to GSA:
    23.1      Rental payments to GSA (OIG)..           4           5           6
    23.1      Rental payments to GSA (DoJ)..                       3           3
    23.1      Rental payments to GSA (OGC)..           1           1           1
    23.2    Rental payments to others (HCFA)                       1           1
    23.3    Communications, utilities, and
              miscellaneous charges (OIG)...           1           1           1
            Advisory and assistance
                services:
    25.1      Advisory and assistance
                services (OIG)..............           1
    25.1      Advisory and assistance
                services (HCFA).............           2
            Other services:
    25.2      Other services (OIG)..........           1           1           1
    25.2      Other services (DoJ)..........          10           6           9
    25.2      Other services (HCFA).........           1
    25.2      Other services (AoA)..........                                   1
    25.2      Other services (HRSA).........           2
            Purchases of goods and services
                from Government accounts:
    25.3      Purchases of goods and
                services from Government
                accounts (OIG)..............           8           9           9
    25.3      Purchases of goods and
                services from Government
                accounts (DoJ)..............           1
    25.7    Operation and maintenance of
              equipment (OIG)...............                       1           1
    26.0    Supplies and materials (OIG)....           1           1           1
            Equipment:
    31.0      Equipment (OIG)...............           4           2           2
    31.0      Equipment (DoJ)...............           6
    31.0      Equipment (HCFA)..............           2
            Grants, subsidies, and
                contributions:
    41.0      Grants, subsidies, and
                contributions (AoA).........           1           1           1
    41.0      Grants, subsidies, and
                contributions (Non-HHS/DoJ).           2           1           1
                                               ---------   ---------  ----------
    99.0      Subtotal, allocation account..         103         120         138
                                               ---------   ---------  ----------
    99.9    Total obligations...............         589         676         764
    ---------------------------------------------------------------------------

        This schedule reflects estimated distribution of the Allocation
    Account. Actual FY 1999 distribution will be determined by the Secretary
    of HHS and the Attorney General. Contingent on their agreement, the
    amount shown under ``Other non-HHS/DOJ'' would fund incentive grants for
    States to develop Medicaid fraud and abuse performance measures.

                                         1997 actual  1998 est.   1999 est.
    Department of Justice (DOJ).........          22          30          27
    Office of the Inspector General, HHS          70          85         100
    Health Care Financing Administration           5           1           1
    Office of General Counsel, HHS......           2           2           2
    Administration on Aging.............           1           1           1
    Other HHS...........................           2                       2
    Other non-HHS/DOJ...................           2           1           5
                                        ------------------------------------
        Total...........................         104         120         138
                                        ====================================

                       Health Care Fraud and Abuse Account

                     (federal hospital insurance trust fund)

                    (Legislative proposal, subject to PAYGO)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-8393-4-7-571      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Medicare integrity program........                                 395
                                               ---------   ---------  ----------
    10.00   Total obligations (object class
              25.6).........................                                 395
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......                                 395
    23.95 New obligations...................                                -395
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    68.00 Spending authority from offsetting
            collections (gross): Offsetting
            collections (cash)..............                                 395
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    73.10 New obligations...................                                 395
    73.20 Total outlays (gross).............                                -395
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new permanent
            authority.......................                                 395
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.40   Offsetting collections (cash)
              from: Non-Federal sources.....                                -395
    ----------------------------------------------------------------------------

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

        This schedule reflects the Administration's policies related to the
    Medicare Integrity Program.

               Federal Supplementary Medical Insurance Trust Fund

                  Unavailable Collections (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8004-0-7-571      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
        Balance, start of year:
    01.99 Balance, start of year............      21,963      30,210      34,548
        Receipts:
    02.01 Federal contributions.............      59,471      59,773      62,171
    02.02 Interest received by trust fund...       2,192       2,451       2,565
    02.03 Other proprietary receipts from
            the public......................           1
    02.05 Premiums collected for the aged...      16,984      17,008      17,547

    [[Page 419]]

    02.06 Premiums collected for the
            disabled........................       2,158       2,354       2,514
    02.07 Federal contributions, proposed
            legislation subject to PAYGO....                                -135
    02.09 Premiums collected for the aged,
            proposed legislation............                                 -39
    02.10 Premiums collected for the
            disabled, proposed legislation..                                  -6
    02.11 Premium receipts from displaced
            workers and early retirees,
            legislative proposal subject to
            PAYGO...........................                                  85
                                               ---------   ---------  ----------
    02.99   Total receipts..................      80,806      81,586      84,702
                                               ---------   ---------  ----------
    04.00 Total: Balances and collections...     102,769     111,796     119,250
        Appropriation:
    05.01 Federal supplementary medical
            insurance trust fund............     -72,559     -77,248     -84,296
    05.03 Federal supplementary medical
            insurance trust fund, proposed
            legislation.....................                                  45
                                               ---------   ---------  ----------
    05.99 Subtotal appropriation............     -72,559     -77,248     -84,251
    07.99 Total balance, end of year........      30,210      34,548      34,999
    ---------------------------------------------------------------------------

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8004-0-7-571      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Benefit payments, SMI.............      71,093      75,521      82,452
    00.02 Administration, SMI...............       1,444       1,492       1,438
    00.03 Peer review organizations, SMI....           6          17         138
    00.04 Research, SMI.....................          16          18          18
    00.06 Transfer to Medicaid for payment
            of SMI premiums.................                     200         250
    09.01 HI partial transfer of home health                   7,690      10,424
                                               ---------   ---------  ----------
    10.00   Total obligations...............      72,559      84,938      94,720
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......      72,559      84,938      94,720
    23.95 New obligations...................     -72,559     -84,938     -94,720
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.26   Appropriation (trust fund,
              definite).....................       1,454       1,506       1,452
          Permanent:

    60.27   Appropriation (trust fund,
              indefinite)...................      79,352      80,080      83,345
    60.45   Portion precluded from
              obligation....................      -8,247      -4,338        -501
                                               ---------   ---------  ----------
    63.00     Appropriation (total).........      71,105      75,742      82,844
    68.00   Spending authority from
              offsetting collections:
              Offsetting collections (cash).                   7,690      10,424
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................      72,559      84,938      94,720
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.41 Unpaid obligations, start of year:
            Obligated balance: U.S.
            Securities: Par value...........       4,990       4,996       4,956
    73.10 New obligations...................      72,559      84,938      94,720
    73.20 Total outlays (gross).............     -72,553     -84,978     -94,631
    74.41 Unpaid obligations, end of year:
            Obligated balance: U.S.
            Securities: Par value...........       4,996       4,956       5,045
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority       1,268       1,320       1,274
    86.93 Outlays from current balances.....         152         217         188
    86.97 Outlays from new permanent
            authority.......................      66,295      78,661      88,401
    86.98 Outlays from permanent balances...       4,838       4,779       4,768
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........      72,553      84,978      94,631
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.00   Offsetting collections (cash)
              from: Federal sources.........                  -7,690     -10,424
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................      72,559      77,248      84,296
    90.00 Outlays...........................      72,553      77,288      84,207
    ---------------------------------------------------------------------------

                     Summary of Budget Authority and Outlays

                            (in millions of dollars)

                                         1997 actual  1998 est.   1999 est.
    Enacted/requested:
      Budget Authority..................      72,559      77,248      84,296
      Outlays...........................      72,553      77,287      84,207
    Legislative proposal, subject to
        PAYGO:
      Budget Authority..................                                 -45
      Outlays...........................                                 -45
                                        ------------------------------------
    Total:
      Budget Authority..................      72,559      77,248      84,251
      Outlays...........................      72,553      77,287      84,162
                                        ====================================

        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 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 transmitting the required report to
    Congress.

        The status of the trust fund is as follows:

                      Status of Funds (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8004-0-7-571      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
        Unexpended balance, start of year:
    0100  Treasury balance..................        -222         742
    0101  U.S. Securities: Par value........      27,175      34,464      39,504
                                               ---------   ---------  ----------
    0199    Total balance, start of year....      26,953      35,206      39,504
        Cash income during the year:
          Proprietary receipts:

    0221    Premiums collected for the aged,
              FSMI Fund.....................      16,984      17,008      17,547
    0222    Premiums collected for the aged,
              FSMI Fund, proposed
              legislation...................                                 -39
            Proprietary receipts:
    0223      Premiums collected for the
                disabled, FSMI Fund.........       2,158       2,354       2,514
    0223      Premiums collected for the
                disabled, FSMI Fund,
                proposed legislation........                                  -6
    0224    Premiums for aged 62-64 and
              Displaced Workers, proposed
              legislation...................                                  85
    0225    Other Proprietary receipts......           1
          Intragovernmental transactions:

    0240    Federal contributions, FSMI Fund      59,471      59,773      62,171
    0241    Federal contributions, FSMI
              Fund, proposed legislation....                                -135
    0242    Interest received by trust fund,
              FSMI Fund.....................       2,192       2,451       2,565
          Offsetting collections:

    0280    HI Partial Transfer of Home
              Health........................                   7,690      10,424
    0297  Income under present law..........      80,806      89,276      95,221
    0298  Income under proposed legislation.                                 -95
                                               ---------   ---------  ----------
    0299    Total cash income...............      80,806      89,276      95,126
        Cash outgo during year:
          Cash outgo during the year (-):

    0501    Benefit payments & ESRD.........     -71,115     -75,521     -82,452
    0501    Benefit payments, proposed
              legislation...................                                  45
    0502  Administration....................      -1,396      -1,520      -1,443
    0504  Peer review organizations.........         -18         -29         -43
    0505  Research..........................         -24         -17         -19
    0506  HI Partial Transfer of Home Health                  -7,690     -10,424
    0507  Transfer to Medicaid for payment
            of SMI premiums.................                    -200        -250
    0597  Outgo under present law (-).......     -72,553     -84,977     -94,631
    0598  Outgo under proposed legislation
            (-).............................                                  45
                                               ---------   ---------  ----------
    0599  Total cash outgo (-)..............     -72,553     -84,977     -94,586
        Unexpended balance, end of year:
    0700  Treasury balance..................         742
    0701  U.S. Securities: Par value........      34,464      39,504      40,044
                                               ---------   ---------  ----------
    0799    Total balance, end of year......      35,206      39,504      40,044
    ---------------------------------------------------------------------------

        Note.--This status of funds table displays the gross outlay and
    income effect on the SMI trust fund of the administrative mechanism used
    to implement the home health transfer policy authorized in PL 105-33.
    Showing

    [[Page 420]]

    the net outlay and income effect of this administrative mechanism
    requires the following substitutions to the table above:

                                                         FY 1998    FY 1999

      line 0280: HI partial transfer of Home Health...
    (1)line deleted
      line 0501: Benefit payments and ESRD............    -83,211    -92,876
      line 0506: HI partial transfer of Home Health...     +7,690    +10,424

        The totals would also be decreased in FYs 1998 and 1999 by 7,690 and
    10,424 respectively, so as to leave end of year balances unchanged.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8004-0-7-571      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

          Direct obligations:

            Grants, subsidies, and
                contributions:
    41.0      Payment for peer review
                organization (PRO) activity.           6          17         138
    41.0      Payment for health insurance
                experiments and
                demonstration projects......          16          18          18
    42.0    Insurance claims and indemnities      71,093      75,721      82,702
    92.0    Undistributed...................       1,072       1,088       1,045
    93.0    Administrative expenses: Portion
              of limitation on salaries and
              expenses: Social Security
              Administration................         372         404         393
                                               ---------   ---------  ----------
    99.0      Subtotal, direct obligations..      72,559      77,248      84,296
    99.0  Reimbursable obligations..........                   7,690      10,424
                                               ---------   ---------  ----------
    99.9    Total obligations...............      72,559      84,938      94,720
    ---------------------------------------------------------------------------

               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      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Benefit payments, SMI.............                                 -45
                                               ---------   ---------  ----------
    10.00   Total obligations (object class
              42.0).........................                                 -45
    ----------------------------------------------------------------------------

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

        New budget authority (gross), detail:
    60.27 Appropriation (trust fund,
            indefinite).....................                                 -95
    60.45 Portion precluded from obligation.                                  50
                                               ---------   ---------  ----------
    63.00   Appropriation (total)...........                                 -45
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................                                 -45
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    73.10 New obligations...................                                 -45
    73.20 Total outlays (gross).............                                  45
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new permanent
            authority.......................                                 -45
    ----------------------------------------------------------------------------

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

        This schedule reflects the effects of the Medicare proposals
    contained in the Budget 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.''

                    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      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 State family assistance grant.....      13,403      16,489      16,489
    00.02 State penalties...................                                 -50
    00.03 Territories--family assistance
            grants..........................                      78          78
    00.04 Matching grants to territories....                      20          20
    00.05 Bonus to reward decrease in
            illegitimacy....................                                  75
    00.06 Supplemental grants for population
            increases.......................                      79         161
    00.07 Bonus to reward high performance
            States..........................                                 200
    00.08 Tribal work programs..............           8           8           8
                                               ---------   ---------  ----------
    00.91   Subtotal........................      13,411      16,674      16,981
          Loan program:

    01.01   Loan fund disbursements.........                      32          48
    01.02   Loan fund repayments............                      -6         -31
                                               ---------   ---------  ----------
    01.91   Total loan program..............                      26          17
                                               ---------   ---------  ----------
    10.00   Total obligations (object class
              41.0).........................      13,411      16,700      16,998
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......      13,411      16,700      16,998
    23.95 New obligations...................     -13,411     -16,700     -16,998
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    60.05 Appropriation (indefinite)........      13,411      16,700      16,998
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Uninvested...         111       3,807       6,705
    73.10 New obligations...................      13,411      16,700      16,998
    73.20 Total outlays (gross).............      -9,726     -13,802     -15,933
    73.40 Adjustments in expired accounts...          12
    74.40 Unpaid obligations, end of year:
            Obligated balance: Uninvested...       3,807       6,705       7,770
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new permanent
            authority.......................       9,641      12,027      12,240
    86.98 Outlays from permanent balances...          85       1,775       3,693
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........       9,726      13,802      15,933
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................      13,411      16,700      16,998
    90.00 Outlays...........................       9,726      13,802      15,933
    ---------------------------------------------------------------------------

        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.

                                Contingency Fund

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1522-0-1-609      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    10.00 Total obligations (object class
            41.0)...........................                      20          28
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......                      20          28
    23.95 New obligations...................                     -20         -28
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    60.00 Appropriation.....................                      20          28
    ----------------------------------------------------------------------------

    [[Page 421]]

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Uninvested...                                   6
    73.10 New obligations...................                      20          28
    73.20 Total outlays (gross).............                     -14         -23
    74.40 Unpaid obligations, end of year:
            Obligated balance: Uninvested...                       6          11
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new permanent
            authority.......................                      14          20
    86.98 Outlays from permanent balances...                                   3
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........                      14          23
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................                      20          28
    90.00 Outlays...........................                      14          23
    ---------------------------------------------------------------------------

        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 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), to remain available until
    expended, $1,989,000,000; and for such purposes for the first quarter of
    fiscal year [1999, $660,000,000, to remain available until expended]
    2000, $750,000,000.
        For making payments to each State for carrying out the program of
    Aid to Families with Dependent Children under title IV-A of the Social
    Security Act before the effective date of the program of Temporary
    Assistance to Needy Families (TANF) with respect to such State, such
    sums as may be necessary: 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[: Provided further, That, notwithstanding
    section 418(a) of the Social Security Act, for fiscal year 1997 only,
    the amount of payment under section 418(a)(1) to which each State is
    entitled shall equal the amount specified as mandatory funds with
    respect to such State for such fiscal year in the table transmitted by
    the Administration for Children and Families to State Child Care and
    Development Block Grant Lead Agencies on August 27, 1996, and the amount
    of State expenditures in fiscal year 1994 or 1995 (whichever is greater)
    that equals the non-Federal share for the programs described in section
    418(a)(1)(A) shall be deemed to equal the amount specified as
    maintenance of effort with respect to such State for fiscal year 1997 in
    such table].
         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 and the Act of July 5, 1960 (24
    U.S.C. ch. 9), for the last three months of the current year for
    unanticipated costs, incurred for the current fiscal year, such sums as
    may be necessary. (Department of Health and Human Services
    Appropriations Act, 1998.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1501-0-1-609      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
          Child support Enforcement (CSE):

            Benefit payments:
    00.01     State child support
                administrative costs........       2,445       2,255       2,749
    00.02     Federal incentive/hold
                harmless payments to States.         401         423         469
    00.03     Access and visitation grants..          10          10          10
                                               ---------   ---------  ----------
    00.91   Subtotal, child support
              enforcement...................       2,856       2,688       3,228
    01.02 Payments to territories...........          11          21          21
    01.03 Repatriation......................           1           1           1
                                               ---------   ---------  ----------
    01.91   Subtotal, other payments........          12          22          22
          Aid to families with dependent children (AFDC)
              payments:

    02.01   AFDC benefit payments...........       3,206         300          35
    02.02   Emergency assistance............         854         200          65
    02.03   State and local welfare
              administration................         425         146
    02.04   AFDC/JOBS child care............           1           5
    02.05   At-risk child care..............                      10
    02.06   Collection of excess State
              errors........................                     -15         -25
                                               ---------   ---------  ----------
    02.91     Subtotal, AFDC Programs.......       4,486         646          75
                                               ---------   ---------  ----------
    10.00   Total obligations (object class
              41.0).........................       7,354       3,356       3,325
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested.......       1,343       2,046         207
    22.00 New budget authority (gross)......       8,057       1,030       3,118
    22.10 Resources available from
            recoveries of prior year
            obligations.....................                     487
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......       9,400       3,563       3,325
    23.95 New obligations...................      -7,354      -3,356      -3,325
    24.40 Unobligated balance available, end
            of year: Uninvested.............       2,046         207
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................       2,158                   1,989
          Permanent:

    65.00   Advance appropriation (definite)       4,800         607         660
    68.00   Spending authority from
              offsetting collections:
              Offsetting collections (cash).       1,099         423         469
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................       8,057       1,030       3,118
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Uninvested...       1,691       2,603         673
    73.10 New obligations...................       7,354       3,356       3,325
    73.20 Total outlays (gross).............      -6,442      -4,799      -3,645
    73.45 Adjustments in unexpired accounts.                    -487
    74.40 Unpaid obligations, end of year:
            Obligated balance: Uninvested...       2,603         673         353
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority       1,074                   1,651
    86.93 Outlays from current balances.....         813       2,823         645
    86.97 Outlays from new permanent
            authority.......................       4,555       1,030       1,129
    86.98 Outlays from permanent balances...                     946         220
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........       6,442       4,799       3,645
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.40   Offsetting collections (cash)
              from: Non-Federal sources.....      -1,099        -423        -469
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................       6,958         607       2,649
    90.00 Outlays...........................       5,345       4,376       3,176
    ---------------------------------------------------------------------------

                     Summary of Budget Authority and Outlays

                            (in millions of dollars)

                                         1997 actual  1998 est.   1999 est.
    Enacted/requested:
      Budget Authority..................       6,958         607       2,649
      Outlays...........................       5,343       4,376       3,176
    Legislative proposal, subject to
        PAYGO:
      Budget Authority..................                                  -8
      Outlays...........................                                  -8
                                        ------------------------------------
    Total:
      Budget Authority..................       6,958         607       2,641
      Outlays...........................       5,343       4,376       3,168
                                        ====================================

        P.L. 104-93 modified the treatment of child support collections so
    that once a State enters TANF, collections are no longer used to reduce
    the budget authority requested. Instead, spending authority from
    offsetting collections is limited to incentive and hold harmless
    payments. The net federal share of collections remaininng after
    incentive and hold harmless payments are made to States is returned to
    the treasury in a receipt account. The text table below shows the
    traditional display of child support enforcement costs:

    [[Page 422]]

                 Net Federal Costs of Child Support Enforcement

                            (In millions of dollars)

                                            1997         1998        1999
    Gross Federal share of collections..      -1,424      -1,445      -1,530
    Federal incentive payments to States         401         406         429
    Hold harmless payments..............                      17          40
    State child support administrative
    costs...............................       2,334       2,430       2,651
    Access and visitation grants........          10          10          10
                                        ------------------------------------
        Subtotal........................       1,321       1,418       1,600

                        Family Support Payments to States

                    (Legislative proposal, subject to PAYGO)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1501-4-1-609      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
          Benefit payments:

    00.01   State child support
              administrative costs..........                                  -8
    00.02   Federal incentive/hold harmless
              payments to States............                                 -40
                                               ---------   ---------  ----------
    10.00   Total obligations (object class
              41.0).........................                                 -48
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......                                 -48
    23.95 New obligations...................                                  48
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................                                  -8
          Permanent:

    68.00   Spending authority from
              offsetting collections:
              Offsetting collections (cash).                                 -40
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................                                 -48
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    73.10 New obligations...................                                 -48
    73.20 Total outlays (gross).............                                  48
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority                                  -8
    86.97 Outlays from new permanent
            authority.......................                                 -40
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........                                 -48
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.40   Offsetting collections (cash)
              from: Non-Federal sources.....                                  40
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................                                  -8
    90.00 Outlays...........................                                  -8
    ---------------------------------------------------------------------------

        This proposal simplifies the child support funding structure by: (1)
    conforming the match rate for paternity testing with the base
    administrative match rate; and, (2) repealing the hold harmless
    provision established in welfare reform.

                        Low Income Home Energy Assistance

        For making payments under title XXVI of the Omnibus Budget
    Reconciliation Act of 1981, $1,100,000,000, to be available for
    obligation in the period October 1, [1998] 1999 through September 30,
    [1999] 2000.
         For making payments under title XXVI of such Act, $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. (Department of
    Health and Human Services Appropriations Act, 1998.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1502-0-1-609      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    10.00 Total obligations (object class
            41.0)...........................       1,215       1,000       1,100
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......       1,215       1,000       1,100
    23.95 New obligations...................      -1,215      -1,000      -1,100
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................       1,000
    40.15   Appropriation (emergency).......                     300         300
    40.60   Contingent emergency
              appropriation not available
              for obligations...............                    -300        -300
                                               ---------   ---------  ----------
    43.00     Appropriation (total).........       1,000
          Permanent:

    60.65   Contingent emergency
              appropriation released........         215
    65.00   Advance appropriation (definite)                   1,000       1,100
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................       1,215       1,000       1,100
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Uninvested...         358         352         278
    73.10 New obligations...................       1,215       1,000       1,100
    73.20 Total outlays (gross).............      -1,221      -1,074      -1,077
    74.40 Unpaid obligations, end of year:
            Obligated balance: Uninvested...         352         278         301
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority         897
    86.93 Outlays from current balances.....                     318
    86.97 Outlays from new permanent
            authority.......................                     740         814
    86.98 Outlays from permanent balances...         324          16         263
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........       1,221       1,074       1,077
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................       1,215       1,000       1,100
    90.00 Outlays...........................       1,221       1,074       1,077
    ---------------------------------------------------------------------------

           Status of Contingent Emergency Funding (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1502-0-1-609      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
    0199  Balance of contingent emergency
            funding, start of year..........         420
    0300  New emergency funding not
            available for obligation........                     300         300
    0400  Releases of contingent emergency
            appropriations..................        -215
    0599  Adjustments.......................        -205        -300        -300
                                               ---------   ---------  ----------
    0799  Balance of contingent emergency
            funding, end of year............
    ---------------------------------------------------------------------------

        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), $415,000,000 [Provided, That funds appropriated pursuant to
    section 414(a) of the Immigration and Nationality Act under Public Law
    104-134 for fiscal year 1996 shall be available for the costs of
    assistance provided and other activities conducted in such year and in
    fiscal years 1997 and 1998]. (Department of Health and Human Services
    Appropriations Act, 1998.)

                        [Refugee Resettlement Assistance]

        [For necessary expenses for the targeted assistance program
    authorized by title IV of the Immigration and Nationality Act and

    [[Page 423]]

    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, 1998.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1503-0-1-609      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    10.00 Total obligations.................         404         423         415
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested.......           2           2           2
    22.00 New budget authority (gross)......         425         423         415
    22.30 Unobligated balance expiring......         -20
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......         407         425         417
    23.95 New obligations...................        -404        -423        -415
    24.40 Unobligated balance available, end
            of year: Uninvested.............           2           2           2
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    40.00 Appropriation.....................         417         420         415
    41.00 Transferred to other accounts.....          -2
                                               ---------   ---------  ----------
    43.00   Appropriation (total)...........         415         420         415
    50.00 Reappropriation...................          10           3
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................         425         423         415
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Uninvested...         337         436         449
    73.10 New obligations...................         404         423         415
    73.20 Total outlays (gross).............        -323        -410        -408
    73.40 Adjustments in expired accounts...          18
    74.40 Unpaid obligations, end of year:
            Obligated balance: Uninvested...         436         449         456
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority         136         148         145
    86.93 Outlays from current balances.....         187         262         263
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........         323         410         408
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................         425         423         415
    90.00 Outlays...........................         323         410         408
    ---------------------------------------------------------------------------

        States are subsidized for administering the refugee assistance
    program.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1503-0-1-609      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
    25.1  Advisory and assistance services..           2           2           2
    25.3  Purchases of goods and services
            from Government accounts........           6
    41.0  Grants, subsidies, and
            contributions...................         396         421         413
                                               ---------   ---------  ----------
    99.9    Total obligations...............         404         423         415
    ---------------------------------------------------------------------------

                         Family Preservation and Support

        For carrying out section 430 of the Social Security Act,
    [$255,000,000] $275,000,000. (Department of Health and Human Services
    Appropriations Act, 1998.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1512-0-1-506      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Grants to States and Tribes.......         224         239         259
    00.02 Training and technical assistance.           6           6           6
    00.03 State court assessment activities.          10          10          10
                                               ---------   ---------  ----------
    10.00   Total obligations...............         240         255         275
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......         240         255         275
    23.95 New obligations...................        -240        -255        -275
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    40.00 Appropriation.....................         240         255         275
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Uninvested...         270         293         312
    73.10 New obligations...................         240         255         275
    73.20 Total outlays (gross).............        -216        -236        -252
    74.40 Unpaid obligations, end of year:
            Obligated balance: Uninvested...         293         312         335
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority          41          44          48
    86.93 Outlays from current balances.....         175         192         204
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........         216         236         252
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................         240         255         275
    90.00 Outlays...........................         216         236         252
    ---------------------------------------------------------------------------

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1512-0-1-506      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
    25.1  Advisory and assistance services..           6           6           6
    41.0  Grants, subsidies, and
            contributions...................         234         249         269
                                               ---------   ---------  ----------
    99.9    Total obligations...............         240         255         275
    ---------------------------------------------------------------------------

                       Job Opportunities and Basic Skills

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1509-0-1-504      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    10.00 Total obligations (object class
            41.0)...........................         283
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......       1,000
    22.30 Unobligated balance expiring......        -717
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......         283
    23.95 New obligations...................        -283
    ----------------------------------------------------------------------------

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

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Uninvested...         254         158           6
    73.10 New obligations...................         283
    73.20 Total outlays (gross).............        -445        -152          -6
    73.40 Adjustments in expired accounts...          66
    74.40 Unpaid obligations, end of year:
            Obligated balance: Uninvested...         158           6
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority         211
    86.93 Outlays from current balances.....         234         152           6
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........         445         152           6
    88.95 Change in orders on hand from
            Federal sources.................
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................       1,000
    90.00 Outlays...........................         445         152           6
    ---------------------------------------------------------------------------

        This activity is replaced by Temporary Assistance for Needy
    Families.

    [[Page 424]]

                   State Legalization Impact-Assistance Grants

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1508-0-1-506      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Uninvested...           2           7           7
    73.20 Total outlays (gross).............           5
    73.40 Adjustments in expired accounts...          -1
    74.40 Unpaid obligations, end of year:
            Obligated balance: Uninvested...           7           7           7
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.93 Outlays from current balances.....          -5
    ----------------------------------------------------------------------------

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

                        Child Care Entitlement to States

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1550-0-1-609      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Mandatory child care..............       1,238       1,219       1,221
    00.02 Matching child care...............         724         847         941
    00.03 Training and technical assistance.           5           5           5
                                               ---------   ---------  ----------
    10.00   Total obligations...............       1,967       2,071       2,167
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......       1,967       2,071       2,167
    23.95 New obligations...................      -1,967      -2,071      -2,167
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    50.00   Reappropriation.................                       4
          Permanent:

    60.00   Appropriation...................       1,967       2,067       2,167
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................       1,967       2,071       2,167
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Uninvested...                     569         801
    73.10 New obligations...................       1,967       2,071       2,167
    73.20 Total outlays (gross).............      -1,398      -1,835      -2,056
    73.40 Adjustments in expired accounts...                      -4
    74.40 Unpaid obligations, end of year:
            Obligated balance: Uninvested...         569         801         912
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new permanent
            authority.......................       1,398       1,468       1,534
    86.98 Outlays from permanent balances...                     367         522
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........       1,398       1,835       2,056
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................       1,967       2,071       2,167
    90.00 Outlays...........................       1,398       1,835       2,056
    ---------------------------------------------------------------------------

                     Summary of Budget Authority and Outlays

                            (in millions of dollars)

                                         1997 actual  1998 est.   1999 est.
    Enacted/requested:
      Budget Authority..................       1,967       2,071       2,167
      Outlays...........................       1,398       1,835       2,056
    Legislative proposal, subject to
        PAYGO:
      Budget Authority..................                               1,755
      Outlays...........................                               1,170
                                        ------------------------------------
    Total:
      Budget Authority..................       1,967       2,071       3,922
      Outlays...........................       1,398       1,835       3,226
                                        ====================================

        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).

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1550-0-1-609      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
    25.1  Advisory and assistance services..           5           5           5
    41.0  Grants, subsidies, and
            contributions...................       1,962       2,066       2,162
                                               ---------   ---------  ----------
    99.9    Total obligations...............       1,967       2,071       2,167
    ---------------------------------------------------------------------------

                        Child Care Entitlement to States

                    (Legislative proposal, subject to PAYGO)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1550-4-1-609      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Early learning fund...............                                 600
    00.02 Matching funds to States..........                               1,129
    00.03 Tribal mandatory funds............                                  23
    00.04 Training and technical assistance.                                   3
                                               ---------   ---------  ----------
    10.00   Total obligations...............                               1,755
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......                               1,755
    23.95 New obligations...................                              -1,755
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    60.00 Appropriation.....................                               1,755
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    73.10 New obligations...................                               1,755
    73.20 Total outlays (gross).............                              -1,170
    74.40 Unpaid obligations, end of year:
            Obligated balance: Uninvested...                                 585
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new permanent
            authority.......................                               1,170
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................                               1,755
    90.00 Outlays...........................                               1,170
    ---------------------------------------------------------------------------

        This legislative proposal will provide child care funding for low-
    income working families and provide challenge grants to communities to
    support programs to improve early learning and the quality and safety of
    child care for children ages zero to five.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1550-4-1-609      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
    25.1  Advisory and assistance services..                                   3
    41.0  Grants, subsidies, and
            contributions...................                               1,752
                                               ---------   ---------  ----------
    99.9    Total obligations...............                               1,755
    ---------------------------------------------------------------------------
                                                 -------

        Payments to States for the 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), in addition to amounts already appropriated for fiscal
    year [1998, $65,672,000] 1999, $2,672,000; and to become available on
    October 1, [1998] 1999 and remain available through September 30, [1999,
    $1,000,000,000: Provided, That of funds appropriated for each of fiscal
    years 1998 and 1999, $19,120,000 shall be available for child care
    resource and referral and school-aged child

    [[Page 425]]

    care activities, of which for fiscal year 1998 $3,000,000 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 1997 and remaining available for expenditure:
    Provided further, That of the funds provided for fiscal year 1998,
    $50,000,000 shall be reserved by the States for activities authorized
    under section 658G of the Omnibus Budget Reconciliation Act of 1981 (The
    Child Care and Development Block Grant Act of 1990), such funds to be in
    addition to the amounts required to be reserved by States under such
    section 658G] 2000, $1,002,672,000. (Department of Health and Human
    Services Appropriations Act, 1998.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1515-0-1-609      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Block grant payments to States....          19       1,000       1,000
    00.02 Advisory and assistance services..                       3           3
                                               ---------   ---------  ----------
    10.00   Total obligations...............          19       1,003       1,003
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......          19       1,003       1,003
    23.95 New obligations...................         -19      -1,003      -1,003
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................          13          63           3
    42.00   Transferred from other accounts.           6           3
                                               ---------   ---------  ----------
    43.00     Appropriation (total).........          19          66           3
          Permanent:

    65.00   Advance appropriation (definite)                     937       1,000
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................          19       1,003       1,003
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Uninvested...       1,413         521         546
    73.10 New obligations...................          19       1,003       1,003
    73.20 Total outlays (gross).............        -909        -978        -993
    73.40 Adjustments in expired accounts...          -2
    74.40 Unpaid obligations, end of year:
            Obligated balance: Uninvested...         521         546         556
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority          13          41           2
    86.93 Outlays from current balances.....         896         356         166
    86.97 Outlays from new permanent
            authority.......................                     581         620
    86.98 Outlays from permanent balances...                                 206
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........         909         978         993
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................          19       1,003       1,003
    90.00 Outlays...........................         909         978         993
    ---------------------------------------------------------------------------

                     Summary of Budget Authority and Outlays

                            (in millions of dollars)

                                         1997 actual  1998 est.   1999 est.
    Enacted/requested:
      Budget Authority..................          19       1,003       1,003
      Outlays...........................         909         978         994
    Legislative proposal, not subject to
        PAYGO:
      Budget Authority..................                                 180
      Outlays...........................                                  75
                                        ------------------------------------
    Total:
      Budget Authority..................          19       1,003       1,183
      Outlays...........................         909         978       1,069
                                        ====================================

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

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1515-0-1-609      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
    25.1  Advisory and assistance services..                       3           3
    41.0  Grants, subsidies, and
            contributions...................          19       1,000       1,000
                                               ---------   ---------  ----------
    99.9    Total obligations...............          19       1,003       1,003
    ---------------------------------------------------------------------------

                     Child Care and Development Block Grant

                  (Legislative proposal, not subject to PAYGO)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1515-2-1-609      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Standards enforcement fund........                                 100
    00.02 Child care provider scholarship
            fund............................                                  50
    00.03 Research and evaluation fund......                                  30
                                               ---------   ---------  ----------
    10.00   Total obligations (object class
              41.0).........................                                 180
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......                                 180
    23.95 New obligations...................                                -180
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    40.00 Appropriation.....................                                 180
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    73.10 New obligations...................                                 180
    73.20 Total outlays (gross).............                                 -75
    74.40 Unpaid obligations, end of year:
            Obligated balance: Uninvested...                                 105
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority                                  75
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................                                 180
    90.00 Outlays...........................                                  75
    ---------------------------------------------------------------------------

        This legislative proposal will provide funds: (1) to States to
    improve licensing systems and enforce State child care health and safety
    standards; (2) for scholarships to students working toward a child care
    credential; and (3) to support a National Center on Child Care
    Statistics, a child care hotline, and research and demonstration
    projects.

                           Social Services Block Grant

        For making grants to States pursuant to section 2002 of the Social
    Security Act, [$2,299,000,000] $1,909,000,000: Provided, That
    notwithstanding section 2003(c) of such Act, as amended, the amount
    specified for allocation under such section for fiscal year [1998] 1999
    shall be [$2,299,000,000] $1,909,000,000. (Department of Health and
    Human Services Appropriations Act, 1998.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1534-0-1-506      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    10.00 Total obligations (object class
            41.0)...........................       2,500       2,299       1,909
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......       2,500       2,299       1,909
    23.95 New obligations...................      -2,500      -2,299      -1,909
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    40.00 Appropriation.....................       2,500       2,299       1,909
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Uninvested...       1,217       1,149       1,005
    73.10 New obligations...................       2,500       2,299       1,909
    73.20 Total outlays (gross).............      -2,571      -2,443      -2,049
    73.40 Adjustments in expired accounts...           3
    74.40 Unpaid obligations, end of year:
            Obligated balance: Uninvested...       1,149       1,005         865
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority       2,233       2,069       1,718
    86.93 Outlays from current balances.....         338         374         331
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........       2,571       2,443       2,049
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................       2,500       2,299       1,909

    [[Page 426]]

    90.00 Outlays...........................       2,572       2,443       2,049
    ---------------------------------------------------------------------------

        Social services block grant.--The proposed level will support grants
    to States for social services.

                     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 Families of Children with Disabilities Support Act
    under part I of the Individuals with Disabilities Education Act (20
    U.S.C. 149 et seq.), notwithstanding section 203(a) of the Individuals
    with Disabilities Education Act Amendments of 1997 (P.L. 105-17), the
    Head Start Act, the Child Abuse Prevention and Treatment Act[ (including
    section 105(a)(2) of the Child Abuse Prevention and Treatment 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 Adoption and Safe Families Act of 1997 (Public Law
    105-89), the Abandoned Infants Assistance Act of 1988, part B(1) of
    title IV and sections 413, 429A and 1110 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, sections 40155, 40211, and
    40241 of Public Law 103-322, and section 126 and titles IV and V of
    Public Law 100-485, [$5,682,916,000] $5,944,100,000, of which
    [$542,165,000] $20,000,000, to remain available until September 30,
    2003, for grants to States for adoption incentive payments, as
    authorized by section 473A of title IV of the Social Security Act (42
    U.S.C. 670-679); of which $490,600,000 shall be for making payments
    under the Community Services Block Grant Act[,] ; and of which
    [$4,355,000,000] $4,660,000,000 shall be for making payments under the
    Head Start Act, of which up to $90,000,000 may be used for making
    payments under section 640(g)(1) of Public Law 103-252, and up to
    $56,000,000 may be used for making payments under section 640(a)(3) of
    such law: Provided, That, notwithstanding section 640(a)(6) of Public
    Law 103-252, of the funds made available for the Head Start Act,
    [$279,250,000] $350,000,000 shall be set aside for the Head Start
    Program for Families with Infants and Toddlers (Early Head Start):
    Provided further, 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],
    notwithstanding section 203(d)(3)(A) of Public Law 95-266, up to
    $5,000,000 shall be available for improving State efforts to increase
    the placement of foster care children.
        [In addition, $93,000,000, 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 1998 under section 429A(e), part
    B of title IV of the Social Security Act shall be reduced by $6,000,000.
         Funds appropriated for fiscal year 1998 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, 1998.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1536-0-1-506      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Head Start........................       3,981       4,355       4,660
          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.....................          33          33          33
    01.11     Abandoned infants assistance..          12          12          12
    01.14     Child welfare services........         292         292         292
    01.15     Child welfare training........           4           6           6
    01.17     Adoption opportunities........          13          23          27
    01.19     Family violence grants........          62          10
    01.20     Social services and income
                maintenance research........          44          26          10
            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     States support systems........                                   5
    01.28   Native American programs........          35          35          35
    01.29   Adoption incentive payments.....                                  20
                                               ---------   ---------  ----------
    01.91     Subtotal social services
                programs....................         703         645         648
    02.01 ACF Federal administration........         143         141         145
                                               ---------   ---------  ----------
    02.93   Total direct program............       4,827       5,141       5,453
          Community services programs:

    03.01   Community services block grants.         490         491         491
    03.03   Community food and nutrition....           4           4
    03.04   Community services discretionary          31          33
    03.05   National youth sports...........          12          14
                                               ---------   ---------  ----------
    03.91   Subtotal, community services....         537         542         491
    09.01 Reimbursable program..............          13          11          11
                                               ---------   ---------  ----------
    10.00   Total obligations...............       5,377       5,694       5,955
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested.......           7           3           3
    22.00 New budget authority (gross)......       5,373       5,694       5,955
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......       5,380       5,697       5,958
    23.95 New obligations...................      -5,377      -5,694      -5,955
    24.40 Unobligated balance available, end
            of year: Uninvested.............           3           3           3
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................       5,364       5,683       5,944
          Permanent:

            Spending authority from
                offsetting collections:
    68.00     Offsetting collections (cash).           7          30          11
    68.10     Change in orders on hand from
                Federal sources.............           3         -19
                                               ---------   ---------  ----------
    68.90       Spending authority from
                  offsetting collections
                  (total)...................          10          11          11
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................       5,374       5,694       5,955
    ----------------------------------------------------------------------------

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

    72.40   Obligated balance: Uninvested...       3,225       3,605       3,788
    72.95   Orders on hand from Federal
              sources.......................          16          19
                                               ---------   ---------  ----------
    72.99     Total unpaid obligations,
                start of year...............       3,241       3,624       3,788
    73.10 New obligations...................       5,377       5,694       5,955
    73.20 Total outlays (gross).............      -5,129      -5,530      -5,795
    73.40 Adjustments in expired accounts...         135
          Unpaid obligations, end of year:

    74.40   Obligated balance: Uninvested...       3,605       3,788       3,948
    74.95   Orders on hand from Federal
              sources.......................          19
                                               ---------   ---------  ----------
    74.99     Total unpaid obligations, end
                of year.....................       3,624       3,788       3,948
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority       2,257       2,410       2,523
    86.93 Outlays from current balances.....       2,865       3,109       3,263
    86.97 Outlays from new permanent
            authority.......................           7          11          11
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........       5,129       5,530       5,795
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.00   Offsetting collections (cash)
              from: Federal sources.........          -7         -30         -11
    88.95 Change in orders on hand from
            Federal sources.................          -3          19
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................       5,364       5,683       5,944

    [[Page 427]]

    90.00 Outlays...........................       5,122       5,500       5,784
    ---------------------------------------------------------------------------

        Head Start.--The proposed level will enable Head Start projects to
    continue comprehensive early childhood development services and is
    consistent with the President's goal to serve 1 million children by
    2002, including a doubling of the number of infants and toddlers in
    Early Head Start to 80,000.

        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.

        Adoption Incentive Payments.--The proposed level includes $20
    million for bonus payments to States that increase the number of
    children adopted from the foster care system.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1536-0-1-506      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

          Direct obligations:

            Personnel compensation:
    11.1      Full-time permanent...........          91          91          92
    11.3      Other than full-time permanent           1           1           1
    11.5      Other personnel compensation..           1
                                               ---------   ---------  ----------
    11.9        Total personnel compensation          93          92          93
    12.1    Civilian personnel benefits.....          16          16          17
    21.0    Travel and transportation of
              persons.......................           2           2           3
    22.0    Transportation of things........           1
    23.1    Rental payments to GSA..........          12          12          12
    23.2    Rental payments to others.......           6
    23.3    Communications, utilities, and
              miscellaneous charges.........           2           2           2
    24.0    Printing and reproduction.......           1           1           1
    25.1    Advisory and assistance services          54          61          61
    25.2    Other services..................           2           1           1
    25.3    Purchases of goods and services
              from Government accounts......          20          16          16
    25.7    Operation and maintenance of
              equipment.....................           3           2           2
    31.0    Equipment.......................           2           2           2
    41.0    Grants, subsidies, and
              contributions.................       5,156       5,476       5,734
    43.0    Interest and dividends..........          -6
                                               ---------   ---------  ----------
    99.0      Subtotal, direct obligations..       5,364       5,683       5,944
    99.0  Reimbursable obligations..........          13          11          11
                                               ---------   ---------  ----------
    99.9    Total obligations...............       5,377       5,694       5,955
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-1536-0-1-506      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
    1001  Total compensable workyears: Full-
            time equivalent employment......       1,657       1,588       1,562
    ---------------------------------------------------------------------------

                        Violent Crime Reduction Programs

        For activities authorized by sections 40155, 40211, and 40241 of
    Public Law 103-322, $105,000,000, to remain available until expended, of
    which $101,000,000 shall be derived from the Violent Crime Reduction
    Trust Fund: Provided, That $88,800,000 shall be for Family Violence
    (including 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      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Family violence/battered women's
            shelters and domestic violence
            hotline.........................          12          78          90
    00.02 Education and prevention grants to
            reduce sexual abuse of runaway,
            homeless and street youth.......           8          15          15
    09.01 Community schools.................          11
                                               ---------   ---------  ----------
    10.00   Total obligations...............          31          93         105
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......          31          93         105
    23.95 New obligations...................         -31         -93        -105
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................                                   4
    42.00   Transferred from other accounts.          20          93         101
                                               ---------   ---------  ----------
    43.00     Appropriation (total).........          20          93         105
          Permanent:

    68.00   Spending authority from
              offsetting collections:
              Offsetting collections (cash).          11
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................          31          93         105
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Uninvested...          21          28          68
    73.10 New obligations...................          31          93         105
    73.20 Total outlays (gross).............         -23         -53         -84
    74.40 Unpaid obligations, end of year:
            Obligated balance: Uninvested...          28          68          89
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority          -3          37          42
    86.93 Outlays from current balances.....          15          16          42
    86.97 Outlays from new permanent
            authority.......................          11
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........          23          53          84
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.00   Offsetting collections (cash)
              from: Federal sources.........         -11
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................          20          93         105
    90.00 Outlays...........................          12          53          84
    ---------------------------------------------------------------------------

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-8605-0-1-754      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

          Direct obligations:

    25.1    Advisory and assistance services           1           1           1
    41.0    Grants, subsidies, and
              contributions.................          19          92         104
                                               ---------   ---------  ----------
    99.0      Subtotal, direct obligations..          20          93         105
    99.0  Reimbursable obligations..........          11
                                               ---------   ---------  ----------
    99.9    Total obligations...............          31          93         105
    ---------------------------------------------------------------------------

                  Children's Research and Technical Assistance

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1553-0-1-609      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Training and technical assistance.          17          15          15
    00.02 Federal parent locator service....          17          39          30
    00.03 Child welfare study...............                                   6
    00.04 Welfare research..................                                  15
    00.05 Evaluation of welfare to work.....                       9           9
    00.06 Evaluation of abstinence education                       3           3
                                               ---------   ---------  ----------
    10.00   Total obligations...............          34          66          78
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested.......          12          12
    22.00 New budget authority (gross)......          34          54          78
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......          46          66          78
    23.95 New obligations...................         -34         -66         -78
    24.40 Unobligated balance available, end
            of year: Uninvested.............          12
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    41.00   Transferred to other accounts...          -6          -3

    [[Page 428]]

          Permanent:

    60.00   Appropriation...................          39          55          76
    68.00   Spending authority from
              offsetting collections:
              Offsetting collections (cash).           1           2           2
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................          34          54          78
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Uninvested...          24          40          55
    73.10 New obligations...................          34          66          78
    73.20 Total outlays (gross).............         -18         -51         -56
    74.40 Unpaid obligations, end of year:
            Obligated balance: Uninvested...          40          55          77
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new permanent
            authority.......................          12          21          19
    86.98 Outlays from permanent balances...           6          30          37
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........          18          51          56
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.40   Offsetting collections (cash)
              from: Non-Federal sources.....          -1          -2          -2
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................          33          52          76
    90.00 Outlays...........................          17          49          54
    ---------------------------------------------------------------------------

        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.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1553-0-1-609      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
    21.0  Travel and transportation of
            persons.........................           2           1           1
    23.3  Communications, utilities, and
            miscellaneous charges...........           1           1           1
    25.1  Advisory and assistance services..           2          12          19
    25.2  Other services....................          10          22           9
    25.3  Purchases of goods and services
            from Government accounts........          13          21          27
    25.5  Research and development contracts           1           1           1
    25.7  Operation and maintenance of
            equipment.......................           3           5           5
    31.0  Equipment.........................           1           1           1
    41.0  Grants, subsidies, and
            contributions...................           1           2          14
                                               ---------   ---------  ----------
    99.9    Total obligations...............          34          66          78
    ---------------------------------------------------------------------------

           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, [$3,200,000,000] $3,984,000,000,
    of which $200,000,000 shall be placed in reserve for use only in such
    amounts and 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 [1999] 2000, [$1,157,500,000] $1,355,300,000. (Department of Health
    and Human Services Appropriations Act, 1998.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1545-0-1-506      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Foster care.......................       3,292       3,340       3,983
    00.02 Independent living................          70          70          70
    00.03 Adoption assistance...............         590         701         869
    00.04 Adoption incentives...............                                  20
                                               ---------   ---------  ----------
    10.00   Total obligations (object class
              41.0).........................       3,952       4,111       4,942
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......       4,445       4,311       5,142
    22.30 Unobligated balance expiring......        -493        -200        -200
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......       3,952       4,111       4,942
    23.95 New obligations...................      -3,952      -4,111      -4,942
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................       4,445       3,200       3,984
          Permanent:

    65.00   Advance appropriation (definite)                   1,111       1,158
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................       4,445       4,311       5,142
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Uninvested...         870         829         716
    73.10 New obligations...................       3,952       4,111       4,942
    73.20 Total outlays (gross).............      -4,047      -4,224      -4,803
          Adjustments in expired accounts:

    73.40   Adjustments in expired accounts.                                  -5
    73.40   Adjustments in expired accounts.          54
    74.40 Unpaid obligations, end of year:
            Obligated balance: Uninvested...         829         716         850
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority       3,331       2,526       3,181
    86.93 Outlays from current balances.....         716         763         647
    86.97 Outlays from new permanent
            authority.......................                     935         975
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........       4,047       4,224       4,803
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................       4,445       4,311       5,142
    90.00 Outlays...........................       4,047       4,224       4,803
    ---------------------------------------------------------------------------

        Foster care.--The proposed level will support eligible low-income
    children who must be placed outside the home. An average of 323,000
    children per month will be served in 1999.

        Adoption assistance.--The proposed funding level will support
    subsidies for families adopting eligible low-income children with
    special needs. An average of 197,100 children per month will be served
    in 1999.

                             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, [$865,050,000] $871,050,000:
    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 of the funds appropriated to
    carry out section 303(a)(1) of such Act, $4,449,000 shall be available
    for carrying out section 702(a) of such Act and $4,732,000 shall be
    available for carrying out section 702(b) of such Act:] 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, Alaska and Hawaiian Native communities to be
    served. (Department of Health and Human Services Appropriations Act,
    1998.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0142-0-1-506      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    01.01 Supportive services and centers...         302         310         301
    01.02 Preventive health.................          16          16          16

    [[Page 429]]

    01.05 Congregate meals..................         365         374         374
    01.06 Home-delivered meals..............         105         112         112
    01.07 In-home services..................           9          10          10
    01.08 Grants to Indian tribes...........          16          18          18
    01.09 Research, training and
            discretionary projects..........           4          10          10
    01.10 Federal administration............          15          15          15
    01.13 Alzheimer's disease demonstration
            grants to States................                                   6
    01.14 Grants for protection of
            vulnerable older Americans......                                   9
                                               ---------   ---------  ----------
    10.00   Total obligations...............         832         865         871
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......         832         865         871
    23.95 New obligations...................        -832        -865        -871
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    40.00 Appropriation.....................         832         865         871
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Uninvested...         222         226         240
    73.10 New obligations...................         832         865         871
    73.20 Total outlays (gross).............        -828        -851        -860
    74.40 Unpaid obligations, end of year:
            Obligated balance: Uninvested...         226         240         251
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority         626         672         679
    86.93 Outlays from current balances.....         202         179         181
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........         828         851         860
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................         832         865         871
    90.00 Outlays...........................         828         851         860
    ---------------------------------------------------------------------------

        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      1997 actual   1998 est.   1999 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............           1           1           1
    25.2  Other services....................           3           3           3
    41.0  Grants, subsidies, and
            contributions...................         817         850         856
                                               ---------   ---------  ----------
    99.9    Total obligations...............         832         865         871
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-0142-0-1-506      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
        Direct:
    1001  Total compensable workyears: Full-
            time equivalent employment......         130         139         141
        Allocation account:
    3001  Total compensable workyears: Full-
            time equivalent employment......           1           1           1
    ---------------------------------------------------------------------------

                             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 the
    United States-Mexico Border Health Commission Act, $171,631,000, of
    which $500,000 shall remain available until expended] $154,092,000,
    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, $1,500,000
    shall be available until expended for extramural construction].
    (Department of Health and Human Services Appropriations Act, 1998.)

                             Office for Civil Rights

        For expenses necessary for the Office for Civil Rights,
    [$16,345,000] $17,345,000, 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, 1998.)

                                 Policy Research

        For carrying out, to the extent not otherwise provided, research
    studies under section 1110 of the Social Security Act, $14,000,000.
    (Department of Health and Human Services Appropriations Act, 1998.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9912-0-1-551      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
          Direct activities:

    00.01   General departmental management.         181         177         160
    00.02   U.S. Office of Consumer Affairs.           2
    00.03   Office for Civil Rights.........          20          20          21
    00.04   Policy research.................          18          14          14
    00.05   Emergency supplement............           1          15
    00.06   Diabetes funds..................                      30          30
    09.01 Reimbursable program..............          84          89          89
                                               ---------   ---------  ----------
    10.00   Total obligations...............         306         345         314
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested.......          13          25          10
    22.00 New budget authority (gross)......         320         329         312
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......         333         354         322
    23.95 New obligations...................        -306        -345        -314
    24.40 Unobligated balance available, end
            of year: Uninvested.............          25          10           8
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................         211         202         185
    40.15   Appropriation (emergency).......          15
    42.00   Transferred from other accounts.           1
                                               ---------   ---------  ----------
    43.00     Appropriation (total).........         227         202         185
          Permanent:

    62.00   Transferred from other accounts.                      30          30
    68.00   Spending authority from
              offsetting collections:
              Offsetting collections (cash).          93          97          97
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................         320         329         312
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Uninvested...         210         249         269
    73.10 New obligations...................         306         345         314
    73.20 Total outlays (gross).............        -270        -325        -337
    73.40 Adjustments in expired accounts...           3
    74.40 Unpaid obligations, end of year:
            Obligated balance: Uninvested...         249         269         246
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority         111         100          92
    86.93 Outlays from current balances.....          66         119         121
    86.97 Outlays from new permanent
            authority.......................          93         106         106
    86.98 Outlays from permanent balances...                                  18
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........         270         325         337
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.00   Offsetting collections (cash)
              from: Federal sources.........         -93         -97         -97
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................         227         232         215
    90.00 Outlays...........................         177         228         240
    ---------------------------------------------------------------------------

    [[Page 430]]

                              [Dollars in millions]

                                         1997 actual  1998 est.   1999 est.
    Distribution of budget authority by
        account:
      General departmental management...         175         172         154
      Office of Consumer Affairs........           2
      Office for Civil Rights...........          17          16          17
      Policy research...................          18          14          14
      Diabetes funds....................                      30          30
    Distribution of outlays by account:
      General departmental management...         132         172         180
      Office of Consumer Affairs........           2
      Office for Civil Rights...........          15          16          18
      Policy research...................          21           8           8
      Emergency supplemental............           7          23           7
      Diabetes funds....................                       9          27

        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; 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.

        The Balanced Budget Act of 1997 appropriated mandatory funds of $30
    million per year in FY 1998-FY 2002 for research into the prevention and
    cure of type 1 diabetes, to be transferred from the Children's Health
    Insurance Program in the Health Care Financing Administration. These
    funds are temporarily reflected within Departmental Management; once the
    selection of specific research initiatives has been completed, the funds
    will be allocated to the National Institutes of Health and the Centers
    for Disease Control and Prevention.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9912-0-1-551      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

          Direct obligations:

            Personnel compensation:
    11.1      Full-time permanent...........          77          81          83
    11.3      Other than full-time permanent           3           3           3
    11.5      Other personnel compensation..           1           1           2
                                               ---------   ---------  ----------
    11.9        Total personnel compensation          81          85          88
    12.1    Civilian personnel benefits.....          15          16          17
    21.0    Travel and transportation of
              persons.......................           1           2           2
    23.1    Rental payments to GSA..........          11          12          12
    23.3    Communications, utilities, and
              miscellaneous charges.........           4           4           4
    24.0    Printing and reproduction.......                       1           1
    25.1    Advisory and assistance services           4           2           2
    25.2    Other services..................          16          13          13
    25.3    Purchases of goods and services
              from Government accounts......          33          21          21
    25.4    Operation and maintenance of
              facilities....................           4           4           2
    25.5    Research and development
              contracts.....................           1          20           4
    25.7    Operation and maintenance of
              equipment.....................           4           2           3
    26.0    Supplies and materials..........           3           1
    31.0    Equipment.......................           3           4           4
    41.0    Grants, subsidies, and
              contributions.................          42          69          52
                                               ---------   ---------  ----------
    99.0      Subtotal, direct obligations..         222         256         225
    99.0  Reimbursable obligations..........          84          89          89
                                               ---------   ---------  ----------
    99.9    Total obligations...............         306         345         314
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-9912-0-1-551      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
        Direct:
    1001  Total compensable workyears: Full-
            time equivalent employment......       1,332       1,302       1,316
        Reimbursable:
    2001  Total compensable workyears: Full-
            time equivalent employment......         139         141         143
        Allocation account:
    3001  Total compensable workyears: Full-
            time equivalent employment......          14          20          22
    ---------------------------------------------------------------------------

                    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, 1998.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0379-0-1-551      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Retirement payments...............         139         149         159
    00.02 Survivors' benefits...............          11          12          12
    00.03 Medical care......................          26          28          29
    00.04 Military service credits..........           3           2           2
                                               ---------   ---------  ----------
    10.00   Total obligations...............         179         191         202
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......         180         191         202
    22.30 Unobligated balance expiring......          -1
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......         179         191         202
    23.95 New obligations...................        -179        -191        -202
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    40.05 Appropriation (indefinite)........         180         191         202
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Uninvested...           8          19          18
    73.10 New obligations...................         179         191         202
    73.20 Total outlays (gross).............        -180        -192        -201
    73.40 Adjustments in expired accounts...          12
    74.40 Unpaid obligations, end of year:
            Obligated balance: Uninvested...          19          18          19
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new current authority         162         173         183
    86.93 Outlays from current balances.....          18          19          18
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........         180         192         201
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................         180         191         202
    90.00 Outlays...........................         180         192         201
    ---------------------------------------------------------------------------

        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, retir

    [[Page 431]]

    ees, and dependents of members and retirees of the PHS Commissioned
    Corps.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0379-0-1-551      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
    13.0  Benefits for former personnel.....         150         161         171
    25.2  Other services....................          26          28          29
    25.3  Purchases of goods and services
            from Government accounts........           3           2           2
                                               ---------   ---------  ----------
    99.9    Total obligations...............         179         191         202
    ---------------------------------------------------------------------------

                             Health Activities Funds

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9913-0-1-550      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Uninvested...          11          10           9
    73.20 Total outlays (gross).............          -1          -1          -1
    74.40 Unpaid obligations, end of year:
            Obligated balance: Uninvested...          10           9           8
    ----------------------------------------------------------------------------

        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
    ---------------------------------------------------------------------------

        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      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    09.01 Program support center............         236         258         257
    09.02 Federal employee occupational
            health..........................          79         104         143
    09.03 OS activities.....................           7           7           6
                                               ---------   ---------  ----------
    10.00   Total obligations...............         322         369         406
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested.......          32          42          42
    22.00 New budget authority (gross)......         279         369         406
    22.10 Resources available from
            recoveries of prior year
            obligations.....................          53
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......         364         411         448
    23.95 New obligations...................        -322        -369        -406
    24.40 Unobligated balance available, end
            of year: Uninvested.............          42          42          42
    ----------------------------------------------------------------------------

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

    68.00   Offsetting collections (cash)...         297         369         406
    68.10   Change in orders on hand from
              Federal sources...............         -18
                                               ---------   ---------  ----------
    68.90     Spending authority from
                offsetting collections
                (total).....................         279         369         406
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................         279         369         406
    ----------------------------------------------------------------------------

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

    72.40   Obligated balance: Uninvested...          -9         -14
    72.95   Orders on hand from Federal
              sources.......................         149         131         131
                                               ---------   ---------  ----------
    72.99     Total unpaid obligations,
                start of year...............         140         117         131
    73.10 New obligations...................         322         369         406
    73.20 Total outlays (gross).............        -292        -355        -406
    73.45 Adjustments in unexpired accounts.         -53
          Unpaid obligations, end of year:

    74.40   Obligated balance: Uninvested...         -14
    74.95   Orders on hand from Federal
              sources.......................         131         131         131
                                               ---------   ---------  ----------
    74.99     Total unpaid obligations, end
                of year.....................         117         131         131
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new permanent
            authority.......................         279         369         406
    86.98 Outlays from permanent balances...          13         -14
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........         292         355         406
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.00   Offsetting collections (cash)
              from: Federal sources.........        -297        -369        -406
    88.95 Change in orders on hand from
            Federal sources.................          18
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................
    90.00 Outlays...........................          -5         -14
    ---------------------------------------------------------------------------

        The HHS Service and Supply Fund (SSF) provides common centralized
    services to HHS components. The Program Support Center (PSC) line
    includes activities such as personnel and payroll administration,
    financial management operations, and a wide array of administrative
    services, including acquisitions management, building and property
    management, and technical support. The Office of the Secretary (OS)
    activities line includes the fund manager, departmental contracts and
    grants, audit resolution, OS graphics, and the regional health
    administrators. The Federal Employee Occupational Health (FOH) program
    is also funded through the SSF. FOH includes clinical services,
    environmental health services and employee assistance programs.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9941-0-4-551      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

          Personnel compensation:

    11.1    Full-time permanent.............          63          54          56
    11.3    Other than full-time permanent..           2           9           9
    11.5    Other personnel compensation....           6           3           3
                                               ---------   ---------  ----------
    11.9      Total personnel compensation..          71          66          68
    12.1  Civilian personnel benefits.......          13          14          14
    21.0  Travel and transportation of
            persons.........................           2           4           5
    22.0  Transportation of things..........           2           2           3
    23.1  Rental payments to GSA............          10           9           9
    23.3  Communications, utilities, and
            miscellaneous charges...........          48          49          54
    24.0  Printing and reproduction.........           1           1           1
    25.1  Advisory and assistance services..           4           2           2
    25.2  Other services....................          77         101         115
    25.3  Purchases of goods and services
            from Government accounts........          34          35          35
    26.0  Supplies and materials............          53          81          93
    31.0  Equipment.........................           7           5           7
                                               ---------   ---------  ----------
    99.9    Total obligations...............         322         369         406
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-9941-0-4-551      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
    2001  Total compensable workyears: Full-
            time equivalent employment......       1,241       1,256       1,261
    ---------------------------------------------------------------------------

                                   Trust Funds

                            Miscellaneous Trust Funds

                  Unavailable Collections (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9971-0-7-551      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
        Balance, start of year:
    01.99 Balance, start of year............

    [[Page 432]]

        Receipts:
    02.01 Contributions, Indian health
            facilities, Health Services
            Administration..................          32          32          32
    02.02 Gifts and contributions,
            Miscellaneous trust funds.......          11          11          11
    02.03 Interest, Miscellaneous trust
            funds...........................           1           1           1
                                               ---------   ---------  ----------
    02.99   Total receipts..................          44          44          44
        Appropriation:
    05.01 Miscellaneous trust funds.........         -44         -44         -44
    07.99 Total balance, end of year........
    ---------------------------------------------------------------------------

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9971-0-7-551      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.02 Gifts.............................          13          12          12
    00.03 Contributions, Indian health
            facilities......................          39          32          32
                                               ---------   ---------  ----------
    10.00   Total obligations...............          52          44          44
    ----------------------------------------------------------------------------

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

    21.40   Uninvested......................          25          23          23
    21.41   U.S. Securities: Par value......           9          14          14
                                               ---------   ---------  ----------
    21.99     Total unobligated balance,
                start of year...............          34          37          37
    22.00 New budget authority (gross)......          46          44          44
    22.10 Resources available from
            recoveries of prior year
            obligations.....................           9
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......          89          81          81
    23.95 New obligations...................         -52         -44         -44
          Unobligated balance available, end of year:

    24.40   Uninvested......................          23          23          23
    24.41   U.S. Securities: Par value......          14          14          14
                                               ---------   ---------  ----------
    24.99   Total unobligated balance, end
              of year.......................          37          37          37
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
    60.27 Appropriation (trust fund,
            indefinite).....................          44          44          44
    68.00 Spending authority from offsetting
            collections: Offsetting
            collections (cash)..............           2
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................          46          44          44
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Uninvested...          96          88          83
    73.10 New obligations...................          52          44          44
    73.20 Total outlays (gross).............         -51         -49         -47
    73.45 Adjustments in unexpired accounts.          -9
    74.40 Unpaid obligations, end of year:
            Obligated balance: Uninvested...          88          83          80
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new permanent
            authority.......................          12          10           9
    86.98 Outlays from permanent balances...          39          39          38
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........          51          49          47
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.00   Offsetting collections (cash)
              from: Federal sources.........          -2
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................          44          44          44
    90.00 Outlays...........................          49          49          47
    ---------------------------------------------------------------------------

                              [Dollars in millions]

                                            1997         1998        1999
    Distribution of budget authority by
        account:
      Gifts.............................          12          12          12
      Contributions, Indian health
        facilities......................          32          32          32
    Distribution of outlays by account:
      Gifts.............................          18          18          16
      Contributions, Indian health
        facilities......................          31          31          31

        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      1997 actual   1998 est.   1999 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..........           2           2           2
    25.2  Other services....................           2           1           1
    25.3  Purchases of goods and services
            from Government accounts........           5           2           2
    25.7  Operation and maintenance of
            equipment.......................          12          12          12
    26.0  Supplies and materials............           5           3           3
    31.0  Equipment.........................           1
    32.0  Land and structures...............          15          15          15
    41.0  Grants, subsidies, and
            contributions...................           3           2           2
                                               ---------   ---------  ----------
    99.9    Total obligations...............          52          44          44
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-9971-0-7-551      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
    1001  Total compensable workyears: Full-
            time equivalent employment......          67          67          67
    ---------------------------------------------------------------------------

                         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, [$31,921,000] $29,000,000. (Department of Health and Human
    Services Appropriations Act, 1998.)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0128-0-1-551      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Direct program....................          33          32          29
    09.01 Reimbursable program..............          11          11          12
                                               ---------   ---------  ----------
    10.00   Total obligations...............          44          43          41
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance available,
            start of year: Uninvested.......           1           1           1
    22.00 New budget authority (gross)......          44          43          41
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......          45          44          42
    23.95 New obligations...................         -44         -43         -41
    24.40 Unobligated balance available, end
            of year: Uninvested.............           1           1           1
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Current:

    40.00   Appropriation...................          33          32          29
          Permanent:

    68.00   Spending authority from
              offsetting collections:
              Offsetting collections (cash).          11          11          12
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................          44          43          41
    ----------------------------------------------------------------------------

        Change in unpaid obligations:
    72.40 Unpaid obligations, start of year:
            Obligated balance: Uninvested...           9          13           9
    73.10 New obligations...................          44          43          41
    73.20 Total outlays (gross).............         -39         -47         -46
    73.40 Adjustments in expired accounts...          -1
    74.40 Unpaid obligations, end of year:
            Obligated balance: Uninvested...          13           9           4
    ----------------------------------------------------------------------------

    [[Page 433]]

        Outlays (gross), detail:
    86.90 Outlays from new current authority          25          28          26
    86.93 Outlays from current balances.....           3           8           8
    86.97 Outlays from new permanent
            authority.......................          11          11          12
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........          39          47          46
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.00   Offsetting collections (cash)
              from: Federal sources.........         -11         -11         -12
    88.95 Change in orders on hand from
            Federal sources.................
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................          33          32          29
    90.00 Outlays...........................          28          36          34
    ---------------------------------------------------------------------------

        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 (OIG), the Health Insurance Portability
    and Accountability Act of 1996 makes available mandatory funding for use
    by the OIG 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
    OIG:

                              (In millions of dollars)

                                             1997 actual   1998 est.   1999 est.
    Budget Authority:
      Discretionary appropriations..........          33          32          29
      Mandatory (HCFAC Account).............          70          85          97
                                               ---------   ---------  ----------
          Total.............................         103         117         126
    Outlays:
      Discretionary appropriations..........          28          36          34
      Mandatory (HCFAC Account).............          70          85          97
                                               ---------   ---------  ----------
          Total.............................          98         121         131

        This schedule reflects estimated distribution of mandatory funds
    from the HCFAC Account in FY 1999. Actual FY 1999 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      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------

          Direct obligations:

    11.1    Personnel compensation: Full-
              time permanent................          19          20          17
    12.1    Civilian personnel benefits.....           4           4           4
    21.0    Travel and transportation of
              persons.......................           2           1           1
    23.1    Rental payments to GSA..........           2           2           2
    23.3    Communications, utilities, and
              miscellaneous charges.........           1           1           1
    25.3    Purchases of goods and services
              from Government accounts......           4           3           3
    31.0    Equipment.......................           1           1           1
                                               ---------   ---------  ----------
    99.0      Subtotal, direct obligations..          33          32          29
    99.0  Reimbursable obligations..........          11          11          12
                                               ---------   ---------  ----------
    99.9    Total obligations...............          44          43          41
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-0128-0-1-551      1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
        Direct:
    1001  Total compensable workyears: Full-
            time equivalent employment......         327         328         286
        Reimbursable:
    2001  Total compensable workyears: Full-
            time equivalent employment......          33          24          23
        Allocation account:
    3001  Total compensable workyears: Full-
            time equivalent employment......         658         851         966
    ---------------------------------------------------------------------------

                    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 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)

    ----------------------------------------------------------------------------
                                             1997 actual   1998 est.   1999 est.
    ----------------------------------------------------------------------------
    Offsetting receipts from the public:
      75-310700  Federal share of child
        support collections.................         325       1,022       1,063
        Legislative proposal, subject to
          PAYGO.............................                                  40
                                               ---------   ---------  ----------
    General Fund Offsetting receipts from
     the public.............................         325       1,022       1,103
    ---------------------------------------------------------------------------

                               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 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. 205. 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.]
        [Sec. 206. 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. [207] 205. 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 except the Public Health and
    Social Services Emergency Fund, which shall be subject to no such
    limitation: Provided, That the Appropriations Committees of both Houses
    of Congress are notified at least fifteen days in advance of any
    transfer.
        Sec. [208] 206. The Director of the National Institutes of Health,
    jointly with the Director of the Office of AIDS Research, may transfer

    [[Page 434]]

    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.
        [Sec. 209. 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. [210] 207. Funds appropriated in this Act for the National
    Institutes of Health may be used to provide transit subsidies in amounts
    consistent with the transportation subsidy programs authorized under
    section 629 of Public Law 101-509 to non-FTE bearing positions including
    trainees, visiting fellows and volunteers.
        [Sec. 211. (a) The Secretary of Health and Human Services may in
    accordance with this section provide for the relocation of the Federal
    facility known as the Gillis W. Long Hansen's Disease Center (located in
    the vicinity of Carville, in the State of Louisiana), including the
    relocation of the patients of the Center.
         (b)(1) Subject to paragraph (2), in relocating the Center the
    Secretary may on behalf of the United States transfer to the State of
    Louisiana, without charge, title to the real property and improvements
    that as of the date of the enactment of this Act constitute the Center.
    Such real property is a parcel consisting of approximately 330 acres.
    The exact acreage and legal description used for purposes of the
    transfer shall be in accordance with a survey satisfactory to the
    Secretary.
         (2) Any conveyance under paragraph (1) is not effective unless the
    deed or other instrument of conveyance contains the conditions specified
    in subsection (d); the instrument specifies that the United States and
    the State of Louisiana agree to such conditions; and the instrument
    specifies that, if the State engages in a material breach of the
    conditions, title to the real property and improvements involved reverts
    to the United States at the election of the Secretary.
         (c)(1) With respect to Federal equipment and other items of Federal
    personal property that are in use at the Center as of the date of the
    enactment of this Act, the Secretary may, subject to paragraph (2),
    transfer to the State such items as the Secretary determines to be
    appropriate, if the Secretary makes the transfer under subsection (b).
         (2) A transfer of equipment or other items may be made under
    paragraph (1) only if the State agrees that, during the 30-year period
    beginning on the date on which the transfer under subsection (b) is
    made, the items will be used exclusively for purposes that promote the
    health or education of the public, except that the Secretary may
    authorize such exceptions as the Secretary determines to be appropriate.
         (d) For purposes of subsection (b)(2), the conditions specified in
    this subsection with respect to a transfer of title are the following:
             (1) During the 30-year period beginning on the date on which
        the transfer is made, the real property and improvements referred to
        in subsection (b)(1) (referred to in this subsection as the
        ``transferred property'') will be used exclusively for purposes that
        promote the health or education of the public, with such incidental
        exceptions as the Secretary may approve.
             (2) For purposes of monitoring the extent to which the
        transferred property is being used in accordance with paragraph (1),
        the Secretary will have access to such documents as the Secretary
        determines to be necessary, and the Secretary may require the
        advance approval of the Secretary for such contracts, conveyances of
        real or personal property, or other transactions as the Secretary
        determines to be necessary.
             (3) The relocation of patients from the transferred property
        will be completed not later than 3 years after the date on which the
        transfer is made, except to the extent the Secretary determines that
        relocating particular patients is not feasible. During the period of
        relocation, the Secretary will have unrestricted access to the
        transferred property, and after such period will have such access as
        may be necessary with respect to the patients who pursuant to the
        preceding sentence are not relocated.
             (4)(A) With respect to projects to make repairs and energy-
        related improvements at the transferred property, the Secretary will
        provide for the completion of all such projects for which contracts
        have been awarded and appropriations have been made as of the date
        on which the transfer is made.
             (B) If upon completion of the projects referred to in
        subparagraph (A) there are any unobligated balances of amounts
        appropriated for the projects, and the sum of such balances is in
        excess of $100,000--
                 (i) the Secretary will transfer the amount of such excess
            to the State; and
                 (ii) the State will expend such amount for the purposes
            referred to in paragraph (1), which may include the renovation
            of facilities at the transferred property.
             (5)(A) The State will maintain the cemetery located on the
        transferred property, will permit individuals who were long-term-
        care patients of the Center to be buried at the cemetery, and will
        permit members of the public to visit the cemetery.
             (B) The State will permit the Center to maintain a museum on
        the transferred property, and will permit members of the public to
        visit the museum.
             (C) In the case of any waste products stored at the transferred
        property as of the date of the transfer, the Federal Government will
        after the transfer retain title to and responsibility for the
        products, and the State will not require that the Federal Government
        remove the products from the transferred property.
             (6) In the case of each individual who as of the date of the
        enactment of this Act is a Federal employee at the transferred
        property with facilities management or dietary duties:
                 (A) The State will offer the individual an employment
            position with the State, the position with the State will have
            duties similar to the duties the individual performed in his or
            her most recent position at the transferred property, and the
            position with the State will provide compensation and benefits
            that are similar to the compensation and benefits provided for
            such most recent position, subject to the concurrence of the
            Governor of the State.
                 (B) If the individual becomes an employee of the State
            pursuant to subparagraph (A), the State will make payments in
            accordance with subsection (e)(2)(B) (relating to disability),
            as applicable with respect to the individual.
             (7) The Federal Government may, consistent with the intended
        uses by the State of the transferred property, carry out at such
        property activities regarding at-risk youth.
             (8) Such additional conditions as the Secretary determines to
        be necessary to protect the interests of the United States.
         (e)(1) This subsection applies if the transfer under subsection (b)
    is made.
         (2) In the case of each individual who as of the date of the
    enactment of this Act is a Federal employee at the Center with
    facilities management or dietary duties, and who becomes an employee of
    the State pursuant to subsection (d)(6)(A):
             (A) The provisions of subchapter III of chapter 83 of title 5,
        United States Code, or of chapter 84 of such title, whichever are
        applicable, that relate to disability shall be considered to remain
        in effect with respect to the individual (subject to subparagraph
        (C)) until the earlier of--
                 (i) the expiration of the 2-year period beginning on the
            date on which the transfer under subsection (b) is made; or
                 (ii) the date on which the individual first meets all
            conditions for coverage under a State program for payments
            during retirement by reason of disability.
             (B) The payments to be made by the State pursuant to subsection
        (d)(6)(B) with respect to the individual are payments to the Civil
        Service Retirement and Disability Fund, if the individual is
        receiving Federal disability coverage pursuant to subparagraph (A).
        Such payments are to be made in a total amount equal to that portion
        of the normal-cost percentage (determined through the use of dynamic
        assumptions) of the basic pay of the individual that is allocable to
        such coverage and is paid for service performed during the period
        for which such coverage is in effect. Such amount is to be
        determined in accordance with chapter 84 of such title 5, is to be
        paid at such time and in such manner as mutually agreed by the State
        and the Office of Personnel Management, and is in lieu of individual
        or agency contributions otherwise required.
             (C) In the determination pursuant to subparagraph (A) of
        whether the individual is eligible for Federal disability coverage
        (during the applicable period of time under such subparagraph),
        service as an employee of the State after the date of the transfer
        under subsection (b) shall be counted toward the service requirement
        specified in the first sentence of section 8337(a) or 8451(a)(1)(A)
        of such title 5 (whichever is applicable).

    [[Page 435]]

         (3) In the case of each individual who as of the date of the
    enactment of this Act is a Federal employee with a position at the
    Center and is, for duty at the Center, receiving the pay differential
    under section 208(e) of the Public Health Service Act or under section
    5545(d) of title 5, United States Code:
             (A) If as of the date of the transfer under subsection (b) the
        individual is eligible for an annuity under section 8336 or 8412 of
        title 5, United States Code, then once the individual separates from
        the service and thereby becomes entitled to receive the annuity, the
        pay differential shall be included in the computation of the annuity
        if the individual separated from the service not later than the
        expiration of the 90-day period beginning on the date of the
        transfer.
             (B) If the individual is not eligible for such an annuity as of
        the date of the transfer under subsection (b) but subsequently does
        become eligible, then once the individual separates from the service
        and thereby becomes entitled to receive the annuity, the pay
        differential shall be included in the computation of the annuity if
        the individual separated from the service not later than the
        expiration of the 90-day period beginning on the date on which the
        individual first became eligible for the annuity.
             (C) For purposes of this paragraph, the individual is eligible
        for the annuity if the individual meets all conditions under such
        section 8336 or 8412 to be entitled to the annuity, except the
        condition that the individual be separated from the service.
         (4) With respect to individuals who as of the date of the enactment
    of this Act are Federal employees with positions at the Center and are
    not, for duty at the center, receiving the pay differential under
    section 208(e) of the Public Health Service Act or under section 5545(d)
    of title 5, United States Code:
             (A) During the calendar years 1997 and 1998, the Secretary may
        in accordance with this paragraph provide to any such individual a
        voluntary separation incentive payment. The purpose of such payments
        is to avoid or minimize the need for involuntary separations under a
        reduction in force with respect to the Center.
             (B) During calendar year 1997, any payment under subparagraph
        (A) shall be made under section 663 of the Treasury, Postal Service,
        and General Government Appropriations Act, 1997 (as contained in
        section 101(f) of division A of Public Law 104-208), except that,
        for purposes of this subparagraph, subsection (b) of such section
        663 does not apply.
             (C) During calendar year 1998, such section 663 applies with
        respect to payments under subparagraph (A) to the same extent and in
        the same manner as such section applied with respect to the payments
        during fiscal year 1997, and for purposes of this subparagraph, the
        reference in subsection (c)(2)(D) of such section 663 to December
        31, 1997, is deemed to be a reference to December 31, 1998.
         (f) The following provisions apply if under subsection (a) the
    Secretary makes the decision to relocate the Center:
             (1) The site to which the Center is relocated shall be in the
        vicinity of Baton Rouge, in the State of Louisiana.
             (2) The facility involved shall continue to be designated as
        the Gillis W. Long Hansen's Disease Center.
             (3) The Secretary shall make reasonable efforts to inform the
        patients of the Center with respect to the planning and carrying out
        of the relocation.
             (4) In the case of each individual who as of October 1, 1996,
        was a patient of the Center and is considered by the Director of the
        Center to be a long-term-care patient (referred to in this
        subsection as an ``eligible patient''), the Secretary shall continue
        to provide for the long-term care of the eligible patient, without
        charge, for the remainder of the life of the patient.
             (5)(A) For purposes of paragraph (4), an eligible patient who
        is legally competent has the following options with respect to
        support and maintenance and other nonmedical expenses:
                 (i) For the remainder of his or her life, the patient may
            reside at the Center.
                 (ii) For the remainder of his or her life, the patient may
            receive payments each year at an annual rate of $33,000
            (adjusted in accordance with subparagraphs (C) and (D)), and may
            not reside at the Center. Payments under this clause are in
            complete discharge of the obligation of the Federal Government
            under paragraph (4) for support and maintenance and other
            nonmedical expenses of the patient.
             (B) The choice by an eligible patient of the option under
        clause (i) of subparagraph (A) may at any time be revoked by the
        patient, and the patient may instead choose the option under clause
        (ii) of such subparagraph. The choice by an eligible patient of the
        option under such clause (ii) is irrevocable.
             (C) Payments under subparagraph (A)(ii) shall be made on a
        monthly basis, and shall be pro rated as applicable. In 1999 and
        each subsequent year, the monthly amount of such payments shall be
        increased by a percentage equal to any percentage increase taking
        effect under section 215(i) of the Social Security Act (relating to
        a cost-of-living increase) for benefits under title II of such Act
        (relating to Federal old-age, survivors, and disability insurance
        benefits). Any such percentage increase in monthly payments under
        subparagraph (A)(ii) shall take effect in the same month as the
        percentage increase under such section 215(i) takes effect.
             (D) With respect to the provision of outpatient and inpatient
        medical care for Hansen's disease and related complications to an
        eligible patient:
                 (i) The choice the patient makes under subparagraph (A)
            does not affect the responsibility of the Secretary for
            providing to the patient such care at or through the Center.
                 (ii) If the patient chooses the option under subparagraph
            (A)(ii) and receives inpatient care at or through the Center,
            the Secretary may reduce the amount of payments under such
            subparagraph, except to the extent that reimbursement for the
            expenses of such care is available to the provider of the care
            through the program under title XVIII of the Social Security Act
            or the program under title XIX of such Act. Any such reduction
            shall be made on the basis of the number of days for which the
            patient received the inpatient care.
             (6) The Secretary shall provide to each eligible patient such
        information and time as may be necessary for the patient to make an
        informed decision regarding the options under paragraph (5)(A).
             (7) After the date of the enactment of this Act, the Center may
        not provide long-term care for any individual who as of such date
        was not receiving such care as a patient of the Center.
             (8) If upon completion of the projects referred to in
        subsection (d)(4)(A) there are unobligated balances of amounts
        appropriated for the projects, such balances are available to the
        Secretary for expenses relating to the relocation of the Center,
        except that, if the sum of such balances is in excess of $100,000,
        such excess is available to the State in accordance with subsection
        (d)(4)(B). The amounts available to the Secretary pursuant to the
        preceding sentence are available until expended.
         (g) For purposes of this section:
             (1) The term ``Center'' means the Gillis W. Long Hansen's
        Disease Center.
             (2) The term ``Secretary'' means the Secretary of Health and
        Human Services.
             (3) The term ``State'' means the State of Louisiana.
         (h) Section 320 of the Public Health Service Act (42 U.S.C. 247e)
    is amended by striking the section designation and all that follows and
    inserting the following:
         ``Sec. 320. (a)(1) At or through the Gillis W. Long Hansen's
    Disease Center (located in the State of Louisiana), the Secretary shall
    without charge provide short-term care and treatment, including
    outpatient care, for Hansen's disease and related complications to any
    person determined by the Secretary to be in need of such care and
    treatment. The Secretary may not at or through such Center provide long-
    term care for any such disease or complication.
         ``(2) The Center referred to in paragraph (1) shall conduct
    training in the diagnosis and management of Hansen's disease and related
    complications, and shall conduct and promote the coordination of
    research (including clinical research), investigations, demonstrations,
    and studies relating to the causes, diagnosis, treatment, control, and
    prevention of Hansen's disease and other mycobacterial diseases and
    complications related to such diseases.
         ``(3) Paragraph (1) is subject to section 211 of the Department of
    Health and Human Services Appropriations Act, 1998.
         ``(b) In addition to the Center referred to in subsection (a), the
    Secretary may establish sites regarding persons with Hansen's disease.
    Each such site shall provide for the outpatient care and treatment for
    Hansen's disease and related complications to any person determined by
    the Secretary to be in need of such care and treatment.
         ``(c) The Secretary shall carry out subsections (a) and (b) acting
    through an agency of the Service. For purposes of the preceding
    sentence, the agency designated by the Secretary shall carry out both
    activities relating to the provision of health services and activities
    relating to the conduct of research.
         ``(d) The Secretary shall make payments to the Board of Health of
    the State of Hawaii for the care and treatment (including out

    [[Page 436]]

    patient care) in its facilities of persons suffering from Hansen's
    disease at a rate determined by the Secretary. The rate shall be
    approximately equal to the operating cost per patient of such
    facilities, except that the rate may not exceed the comparable costs per
    patient with Hansen's disease for care and treatment provided by the
    Center referred to in subsection (a). Payments under this subsection are
    subject to the availability of appropriations for such purpose.''.]
        Sec. [212] 208. None of the funds appropriated in the Act may be
    made available to any entity under title X of the Public Health Service
    Act unless the applicant for the award certifies to the Secretary that
    it encourages family participation in the decision of minors to seek
    family planning services and that it provides counseling to minors on
    how to resist attempts to coerce minors into engaging in sexual
    activities.

       [comprehensive independent study of nih research priority setting]

        [Sec. 213. (a) Study by the Institute of Medicine.--Not later than
    30 days after the date of enactment of this Act, the Secretary of Health
    and Human Services shall enter into a contract with the Institute of
    Medicine to conduct a comprehensive study of the policies and process
    used by the National Institutes of Health to determine funding
    allocations for biomedical research.
         (b) Matters To Be Assessed.--The study under subsection (a) shall
    assess--
             (1) the factors or criteria used by the National Institutes of
        Health to determine funding allocations for disease research;
             (2) the process by which research funding decisions are made;
             (3) the mechanisms for public input into the priority setting
        process; and
             (4) the impact of statutory directives on research funding
        decisions.
         (c) Report.--
             (1) In general.--Not later than 6 months after the date on
        which the Secretary of Health and Human Services enters into the
        contract under subsection (a), the Institute of Medicine shall
        submit a report concerning the study to the Committee on Labor and
        Human Resources and the Committee on Appropriations of the Senate,
        and the Committee on Commerce and the Committee on Appropriations of
        the House of Representatives.
             (2) Requirement.--The report under paragraph (1) shall set
        forth the findings, conclusions, and recommendations of the
        Institute of Medicine for improvements in the National Institutes of
        Health research funding policies and processes and for any necessary
        congressional action.] (Department of Health and Human Services
        Appropriations Act, 1998.)