    [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 2004

    [[Page 401]]

                     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 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; for rental of special purpose space in the
    District of Columbia or elsewhere; 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; and notwithstanding section 521 of P.L. 107-188;
    $1,673,632,000, of which not to exceed $249,825,000 shall be derived
    from prescription drug user fees authorized by 21 U.S.C. 379h and shall
    be credited to this account and remain available until expended:
    Provided, That of the amount provided under this heading, $29,190,000
    shall be derived from medical device user fees authorized by 21 U.S.C.
    379j and shall be credited to this account and remain available until
    expended: Provided further, That fees derived from prescription drug and
    medical device applications received during fiscal year 2004 shall be
    subject to the fiscal year 2004 limitation: Provided further, That any
    prescription drug or medical device user fee collected in fiscal year
    2004 that exceed this limitation shall be credited to this account and
    remain available until expended, in accordance with 21 U.S.C. 379h(g)(4)
    and 379j(h)(4).
        In addition, mammography user fees authorized by 42 U.S.C. 263b may
    be credited to this account, to remain available until expended.
        In addition, export certification user fees authorized by 21 U.S.C.
    381 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, $11,500,000, to
    remain available until expended (7 U.S.C. 2209b).

        Note.--A regular 2003 appropriation for this account had not been
    enacted at the time the budget was prepared; therefore, this account is
    operating under a continuing resolution (P.L. 107-229, as amended). The
    amounts included for 2003 in this budget reflect the Administration's
    2003 policy proposals.

                  Unavailable Collections (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9911-0-1-554      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
    01.99 Balance, start of year............
        Receipts:
    02.20 Cooperative research and
            development agreements..........           2           2           2
        Appropriations:
    05.00 Salaries and expenses.............          -2          -2          -1
                                               ---------   ---------  ----------
    07.99 Balance, end of year..............
    ---------------------------------------------------------------------------

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9911-0-1-554      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Foods.............................         393         412         413
    00.02 Drugs.............................         479         513         513
    00.03 Devices and radiological products.         180         191         185
    00.04 National Center for Toxicological
            Research........................          39          41          40
    00.05 Other activities..................          82          85          92
    00.06 Other rent and rent related
            activities......................          38          36          42
    00.07 Rental payments...................          99          99         109
    00.08 Buildings and facilities..........          44           8          12
    00.09 CRADAs............................           1           2           2
    09.01 Reimbursable program..............         214         291         334
                                               ---------   ---------  ----------
    10.00   Total new obligations...........       1,569       1,678       1,742
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance carried
            forward, start of year..........          69         203         203
    22.00 New budget authority (gross)......       1,698       1,678       1,741
    22.10 Resources available from
            recoveries of prior year
            obligations.....................           5
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......       1,772       1,881       1,944
    23.95 Total new obligations.............      -1,569      -1,678      -1,742
    24.40 Unobligated balance carried
            forward, end of year............         203         203         203
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Discretionary:

    40.00   Appropriation...................       1,369       1,385       1,406
    40.73   Reduction pursuant to P.L. 107-
              206...........................          -1
                                               ---------   ---------  ----------
    43.00     Appropriation (total
                discretionary)..............       1,368       1,385       1,406
          Mandatory:

    60.20   Appropriation (special fund)....           2           2           1
          Spending authority from offsetting
              collections:

            Discretionary:
    68.00     Offsetting collections (cash).         306         291         334
    68.10     Change in uncollected customer
                payments from Federal
                sources (unexpired).........          22
                                               ---------   ---------  ----------
    68.90       Spending authority from
                  offsetting collections
                  (total discretionary).....         328         291         334
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................       1,698       1,678       1,741
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..         393         488         503
    73.10 Total new obligations.............       1,569       1,678       1,742
    73.20 Total outlays (gross).............      -1,450      -1,663      -1,735
    73.40 Adjustments in expired accounts
            (net)...........................          -5
    73.45 Recoveries of prior year
            obligations.....................          -5
    74.00 Change in uncollected customer
            payments from Federal sources
            (unexpired).....................         -22
    74.10 Change in uncollected customer
            payments from Federal sources
            (expired).......................           7
    74.40 Obligated balance, end of year....         488         503         510
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new discretionary
            authority.......................       1,182       1,326       1,384
    86.93 Outlays from discretionary
            balances........................         267         335         350
    86.97 Outlays from new mandatory
            authority.......................           1           2           1
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........       1,450       1,663       1,735
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

            Offsetting collections (cash)
                from:
    88.00     Federal sources...............         -32         -25         -37
    88.40     Non-Federal sources...........        -291        -266        -297
                                               ---------   ---------  ----------
    88.90       Total, offsetting
                  collections (cash)........        -323        -291        -334
          Against gross budget authority only:

    88.95   Change in uncollected customer
              payments from Federal sources
              (unexpired)...................         -22
    88.96   Portion of offsetting
              collections (cash) credited to
              expired accounts..............          17
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................       1,370       1,387       1,407
    90.00 Outlays...........................       1,127       1,372       1,401
    ----------------------------------------------------------------------------

    Additional net budget authority and outlays to cover cost of fully accruing
                                     retirement:
    99.00 Budget authority..................          56          60          67
    99.01 Outlays...........................          56          60          67
    ---------------------------------------------------------------------------

                            [In millions of dollars]

                                            2002         2003        2004
    Distribution of budget authority by
        account:
      Salaries and expenses.............       1,336       1,379       1,395
      Buildings and facilities..........          34           8          12
    Distribution of outlays by account:
      Salaries and expenses.............       1,085       1,356       1,388
      Buildings and facilities..........          42          16          13

    [[Page 402]]

                     Summary of Budget Authority and Outlays

                            (in millions of dollars)

                                         2002 actual  2003 est.   2004 est.
    Enacted/requested:
      Budget Authority..................       1,370       1,387       1,407
      Outlays...........................       1,127       1,372       1,401
    Legislative proposal, not subject to
        PAYGO:
      Budget Authority..................
      Outlays...........................
                                        ------------------------------------
    Total:
      Budget Authority..................       1,370       1,387       1,407
      Outlays...........................       1,127       1,372       1,401
                                        ====================================

        The Food and Drug Administration assures the safety of the nation's
    foods, medicines, medical devices and other products through
    regulations, pre-market product and manufacturer reviews and post-market
    inspections. The budget includes funding for counter terrorism
    activities that specifically deal with the protection of products
    regulated by the FDA (such as drugs, vaccines, foods, and animal feed),
    and the availability of medical products for public health preparedness
    in the event of an attack. The budget also requests funding for food
    safety, improved access to generic drugs, and implementation of the Best
    Pharmaceuticals for Children Act.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9911-0-1-554      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

          Direct obligations:

            Personnel compensation:
    11.1      Full-time permanent...........         497         584         612
    11.3      Other than full-time permanent          41          35          37
    11.5      Other personnel compensation..          18          20          21
    11.7      Military personnel............          33          32          36
                                               ---------   ---------  ----------
    11.9        Total personnel compensation         589         671         706
    12.1    Civilian personnel benefits.....         134         142         147
    12.2    Military personnel benefits.....          17          15          18
    21.0    Travel and transportation of
              persons.......................          26          28          27
    22.0    Transportation of things........           4           7           7
    23.1    Rental payments to GSA..........          99          99         109
    23.2    Rental payments to others.......           5           6           6
    23.3    Communications, utilities, and
              miscellaneous charges.........          20          29          29
    24.0    Printing and reproduction.......           3           3           3
    25.1    Advisory and assistance services          41          19          16
    25.2    Other services..................          67          85          76
    25.3    Other purchases of goods and
              services from Government
              accounts......................          61          55          48
    25.4    Operation and maintenance of
              facilities....................          52          38          33
    25.5    Research and development
              contracts.....................          28          43          43
    25.7    Operation and maintenance of
              equipment.....................          37          31          27
    26.0    Supplies and materials..........          22          25          24
    31.0    Equipment.......................          80          62          59
    32.0    Land and structures.............          38                       2
    41.0    Grants, subsidies, and
              contributions.................          30          27          26
    42.0    Insurance claims and indemnities           2           2           2
                                               ---------   ---------  ----------
    99.0      Direct obligations............       1,355       1,387       1,408
    99.0  Reimbursable obligations..........         214         291         334
                                               ---------   ---------  ----------
    99.9    Total new obligations...........       1,569       1,678       1,742
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-9911-0-1-554      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
        Direct:
          Total compensable workyears:

    1001    Civilian full-time equivalent
              employment....................       7,748       8,402       8,485
    1101    Military full-time equivalent
              employment....................         564         577         587
        Reimbursable:
          Total compensable workyears:

    2001    Civilian full-time equivalent
              employment....................       1,107       1,378       1,588
    2101    Military full-time equivalent
              employment....................          76          84         103
    ---------------------------------------------------------------------------

                              Salaries and Expenses

                  (Legislative proposal, not subject to PAYGO)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9911-2-1-554      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    09.01 Reimbursable program..............                                   5
                                               ---------   ---------  ----------
    10.00   Total new obligations...........                                   5
    ----------------------------------------------------------------------------

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

        New budget authority (gross), detail:
          Discretionary:

    68.00   Spending authority from
              offsetting collections
              (gross): Offsetting
              collections (cash)............                                   5
    ----------------------------------------------------------------------------

        Change in obligated balances:
    73.10 Total new obligations.............                                   5
    73.20 Total outlays (gross).............                                  -5
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new discretionary
            authority.......................                                   5
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

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

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

        The budget includes a total of $5,000,000 in animal drug user fees.
    Authorizing language for these fees will be proposed to authorize the
    collection and spending of the fees subject to appropriations language.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9911-2-1-554      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
    99.0  Reimbursable obligations:
            Reimbursable obligations........                                   5
                                               ---------   ---------  ----------
    99.9    Total new obligations...........                                   5
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-9911-2-1-554      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
        Reimbursable:
          Total compensable workyears:

    2001    Civilian full-time equivalent
              employment....................                                  40
    ---------------------------------------------------------------------------

    Public enterprise funds:

               Revolving Fund for Certification and Other Services

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-4309-0-3-554      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    09.01 Reimbursable program..............           5           8           6
                                               ---------   ---------  ----------
    10.00   Total new obligations...........           5           8           6
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance carried
            forward, start of year..........           4           4           1
    22.00 New budget authority (gross)......           5           5           6
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......           9           9           7
    23.95 Total new obligations.............          -5          -8          -6
    24.40 Unobligated balance carried
            forward, end of year............           4           1           1
    ----------------------------------------------------------------------------

    [[Page 403]]

        New budget authority (gross), detail:
          Mandatory:

    69.00   Offsetting collections (cash)...           5           5           6
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..           1           1           1
    73.10 Total new obligations.............           5           8           6
    73.20 Total outlays (gross).............          -5          -8          -6
    74.40 Obligated balance, end of year....           1           1           1
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new mandatory
            authority.......................           5           5           6
    86.98 Outlays from mandatory balances...                       3
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........           5           8           6
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.40   Offsetting collections (cash)
              from: Non-Federal sources.....          -5          -5          -6
    ----------------------------------------------------------------------------

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

        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      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
    11.1  Personnel compensation: Full-time
            permanent.......................           2           2           2
    12.1  Civilian personnel benefits.......           1           1           1
    23.3  Communications, utilities, and
            miscellaneous charges...........                       2           2
    25.2  Other services....................           1           3           1
    31.0  Equipment.........................           1
                                               ---------   ---------  ----------
    99.9    Total new obligations...........           5           8           6
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-4309-0-3-554      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
        Reimbursable:
          Total compensable workyears:

    2001    Civilian full-time equivalent
              employment....................          33          38          38
    ---------------------------------------------------------------------------

                  HEALTH RESOURCES AND SERVICES ADMINISTRATION

                                  Federal Funds

    General and special funds:

                          Health Resources and Services

        For carrying out titles II, III, IV, 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 (including section 510), and
    sections 711, 1128E, and 1820 of the Social Security Act, the Health
    Care Quality Improvement Act of 1986, as amended, the Native Hawaiian
    Health Care Act of 1988, as amended, the Cardiac Arrest Survival Act of
    2000, and the Poison Control Center Enhancement and Awareness Act,
    $5,665,996,000, of which $25,000,000 from general revenues,
    notwithstanding section 1820(j) of the Social Security Act, shall be
    available for carrying out the Medicare rural hospital flexibility
    grants program under section 1820 of such Act: Provided, That of the
    funds made available under this heading, $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 fees collected for the full
    disclosure of information under the ``Health Care Fraud and Abuse Data
    Collection Program'', authorized by section 1128E(d)(2) of the Social
    Security Act, shall be sufficient to recover the full costs of operating
    the program, and shall remain available until expended to carry out that
    Act: Provided further, That no more than $45,000,000 is available for
    carrying out the provisions of Public Law 104-73: Provided further, That
    an award for compensation under said provisions for actual and projected
    pain and suffering and emotional distress shall not exceed $250,000:
    Provided further, That of the funds made available under this heading,
    $264,808,000 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 $739,000,000 shall be for State AIDS Drug Assistance Programs
    authorized by section 2616 of the Public Health Service Act: Provided
    further, That, notwithstanding section 502(a)(1) of the Social Security
    Act, not to exceed $109,132,000 is for carrying out special projects of
    regional and national significance pursuant to section 501(a)(2):
    Provided further, That $73,044,000 is available for special projects of
    regional and national significance under section 501(a)(2) of the Social
    Security Act, which shall not be counted toward compliance with the
    allocation required in section 502(a)(1) of such Act, and which shall be
    used only for making competitive grants to provide abstinence education
    (as defined in section 510(b)(2) of such Act) to adolescents and for
    evaluations (including longitudinal evaluations) of activities under the
    grants and for Federal costs of administering the grants: Provided
    further, That grants under the immediately preceding proviso shall be
    made only to public and private entities which agree that, with respect
    to an adolescent to whom the entities provide abstinence education under
    such grant, the entities will not provide to that adolescent any other
    education regarding sexual conduct, except that, in the case of an
    entity expressly required by law to provide health information or
    services the adolescent shall not be precluded from seeking health
    information or services from the entity in a different setting than the
    setting in which the abstinence education was provided: Provided
    further, That the funds expended for such evaluations may not exceed 3.5
    percent of such amount.

        Note.--A regular 2003 appropriation for this account had not been
    enacted at the time the budget was prepared; therefore, this account is
    operating under a continuing resolution (P.L. 107-229, as amended). The
    amounts included for 2003 in this budget reflect the Administration's
    2003 policy proposals.

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0350-0-1-550      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.02 Loan guarantee subsidy............           1           1           1
    00.10 Health centers....................       1,328       1,433       1,582
    00.11 National Health Service Corps.....          46          46          45
    00.12 National Health Service Corps
            recruitment.....................          99         143         167
    00.13 Hansen's disease center...........          18          18          18
    00.14 Payment to Hawaii for the
            treatment of Hansen's disease...           2           2           2
    00.15 Black lung clinics................           6           6           6
    00.16 Nursing loan repayment............          10          15          27
    00.17 Health professions................         377          94          81
    00.18 Maternal and child health block
            grant...........................         731         732         751
    00.19 Healthy start.....................          99          99          99
    00.20 Universal newborn hearing.........          10
    00.21 Emergency medical services for
            children........................          19
    00.22 Poison control centers............          21
    00.23 HIV/AIDS..........................       1,911       1,911       2,010
    00.24 Organ transplantation.............          20          25          25
    00.25 Health care facilities............         315
    00.26 Bone marrow donor registry........          22          22          22
    00.27 Rural health policy development...          15           6           6
    00.28 Rural health outreach grants......          52          38          38
    00.29 Rural health flexibility grants...          40          25          30
    00.30 Telehealth........................          37           6           6
    00.31 Program management................         149         147         151
    00.32 Family planning...................         265         265         265
    00.33 Abstinence education..............          44          25
    00.34 State access program..............          15
    00.35 Community access program..........         105
    00.36 Health centers tort claim fund....          16          25          45
    00.37 Trauma EMS........................           3

    [[Page 404]]

    00.39 Childrens' GME....................         285         200         199
    00.40 Denali commission.................          20
    00.41 Community based abstinence grants.          40          73          73
    00.42 State offices of rural health.....           8           4           4
    00.44 Rural access to emergency devices.          12           2           2
    00.45 Radiation Exposure Compensation
            Act.............................           4           4           4
    00.46 Traumatic brain injury............           7           7           7
    00.47 Healthy communities innovation
            initiative......................                      20
    00.48 Buildings and facilities..........           1
                                               ---------   ---------  ----------
    03.00   Total direct programs...........       6,153       5,394       5,666
    09.01 Reimbursable program..............         140         156         160
                                               ---------   ---------  ----------
    10.00   Total new obligations...........       6,293       5,550       5,826
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance carried
            forward, start of year..........          33          39          43
    22.00 New budget authority (gross)......       6,304       5,555       5,831
    22.10 Resources available from
            recoveries of prior year
            obligations.....................           1
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......       6,338       5,594       5,874
    23.95 Total new obligations.............      -6,293      -5,550      -5,826
    23.98 Unobligated balance expiring or
            withdrawn.......................          -7
    24.40 Unobligated balance carried
            forward, end of year............          39          43          48
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Discretionary:

    40.00   Appropriation...................       6,081       5,369       5,666
    40.71   Reduction pursuant to P.L. Labor
              HHS 107-116...................          -1
    40.73   Reduction pursuant to P.L. 107-
              206...........................          -2
                                               ---------   ---------  ----------
    43.00     Appropriation (total
                discretionary)..............       6,078       5,369       5,666
    55.00   Advance appropriation...........          30
          Mandatory:

    60.00   Appropriation...................          50          25
          Spending authority from offsetting
              collections:

            Discretionary:
    68.00     Offsetting collections (cash).         122         130         130
    68.10     Change in uncollected customer
                payments from Federal
                sources (unexpired).........           1
                                               ---------   ---------  ----------
    68.90       Spending authority from
                  offsetting collections
                  (total discretionary).....         123         130         130
          Mandatory:

    69.00   Offsetting collections
              (cash)(HPSL&NSL)..............          23          31          35
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................       6,304       5,555       5,831
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..       4,557       5,054       4,697
    73.10 Total new obligations.............       6,293       5,550       5,826
    73.20 Total outlays (gross).............      -5,753      -5,907      -5,953
    73.40 Adjustments in expired accounts
            (net)...........................         -41
    73.45 Recoveries of prior year
            obligations.....................          -1
    74.00 Change in uncollected customer
            payments from Federal sources
            (unexpired).....................          -1
    74.40 Obligated balance, end of year....       5,054       4,697       4,570
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new discretionary
            authority.......................       2,328       2,072       2,201
    86.93 Outlays from discretionary
            balances........................       3,354       3,760       3,691
    86.97 Outlays from new mandatory
            authority.......................          35          38          35
    86.98 Outlays from mandatory balances...          36          37          26
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........       5,753       5,907       5,953
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

            Offsetting collections (cash)
                from:
    88.00     Federal sources...............        -102        -110        -110
    88.40     Non-Federal sources...........         -20         -20         -20
    88.45     Offsetting governmental
                collections (from non-
                Federal sources)............         -23         -31         -35
                                               ---------   ---------  ----------
    88.90       Total, offsetting
                  collections (cash)........        -145        -161        -165
          Against gross budget authority only:

    88.95   Change in uncollected customer
              payments from Federal sources
              (unexpired)...................          -1
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................       6,158       5,394       5,666
    90.00 Outlays...........................       5,608       5,746       5,788
    ----------------------------------------------------------------------------

    Additional net budget authority and outlays to cover cost of fully accruing
                                     retirement:
    99.00 Budget authority..................          14          15          17
    99.01 Outlays...........................          14          15          17
    ---------------------------------------------------------------------------

                     Summary of Budget Authority and Outlays

                            (in millions of dollars)

                                         2002 actual  2003 est.   2004 est.
    Enacted/requested:
      Budget Authority..................       6,158       5,394       5,666
      Outlays...........................       5,608       5,746       5,788
    Legislative proposal, subject to
        PAYGO:
      Budget Authority..................                      25          50
      Outlays...........................                       7          37
                                        ------------------------------------
    Total:
      Budget Authority..................       6,158       5,419       5,716
      Outlays...........................       5,608       5,753       5,825
                                        ====================================

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

    ----------------------------------------------------------------------------
    Identification code 75-0350-0-1-550      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
        Guaranteed loan levels supportable by subsidy
                    budget authority:
    215001Health centers: Facilities
            renovation loan guarantee levels           1          10          10
    215002Health centers: Managed care
            network development loan
            guarantee levels................                       2           2
    215003Health centers: Managed care plan
            loan guarantee levels...........                       5           5
                                               ---------   ---------  ----------
    215901Total loan guarantee levels.......           1          17          17
        Guaranteed loan subsidy (in percent):
    232001Health centers: Facilities
            renovation loan guarantee levels        8.71        3.49        3.52
    232002Health centers: Managed care
            network development loan
            guarantee levels................        9.27        9.02        9.28
    232003Health centers: Managed care plan
            loan guarantee levels...........        5.00        7.65        7.77
                                               ---------   ---------  ----------
    232901Weighted average subsidy rate.....        8.71        5.88        5.88
        Guaranteed loan subsidy budget authority:
    233001Health centers: Facilities
            renovation loan guarantee levels                       1           1
    233002Health centers: Managed care
            network development loan
            guarantee levels................
    233003Health centers: Managed care plan
            loan guarantee levels...........
                                               ---------   ---------  ----------
    233901Total subsidy budget authority....                       1           1
        Guaranteed loan subsidy outlays:
    234001Health centers: Facilities
            renovation loan guarantee levels                       1           1
    234002Health centers: Managed care
            network development loan
            guarantee levels................
    234003Health centers: Managed care plan
            loan guarantee levels...........
                                               ---------   ---------  ----------
    234901Total subsidy outlays.............                       1           1
    ----------------------------------------------------------------------------

        Administrative expense data:
    351001Administrative expenses...........           1           1           1
    358001Outlays from balances.............
    359001Outlays for administrative
            expenses........................           1           1           1
    ---------------------------------------------------------------------------

        Activities displayed here support categorical health resources and
    services grants, treatment and care for those living with HIV/AIDS, 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      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

          Direct obligations:

            Personnel compensation:
    11.1      Full-time permanent...........          95         103         107
    11.3      Other than full-time permanent           4           4           4
    11.5      Other personnel compensation..           3           3           3

    [[Page 405]]

    11.7      Military personnel............          21          22          23
                                               ---------   ---------  ----------
    11.9        Total personnel compensation         123         132         137
    12.1    Civilian personnel benefits.....          22          24          25
    12.2    Military personnel benefits.....          11          14          17
    13.0    Benefits for former personnel...           3           3           3
    21.0    Travel and transportation of
              persons.......................           4           4           4
    23.1    Rental payments to GSA..........          12          13          13
    23.3    Communications, utilities, and
              miscellaneous charges.........           4           5           5
    24.0    Printing and reproduction.......           1           2           2
    25.1    Advisory and assistance services          52          48          48
    25.2    Other services..................          80          87          96
    25.3    Other purchases of goods and
              services from Government
              accounts......................         118          94          97
    25.4    Operation and maintenance of
              facilities....................           1           1           1
    25.6    Medical care....................           1           1           1
    25.7    Operation and maintenance of
              equipment.....................           4           5           5
    26.0    Supplies and materials..........           2           2           2
    31.0    Equipment.......................           5           5           5
    41.0    Grants, subsidies, and
              contributions.................       5,694       4,929       5,158
    42.0    Insurance claims and indemnities          16          25          46
                                               ---------   ---------  ----------
    99.0      Direct obligations............       6,153       5,394       5,665
    99.0  Reimbursable obligations..........         140         156         161
                                               ---------   ---------  ----------
    99.9    Total new obligations...........       6,293       5,550       5,826
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-0350-0-1-550      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
        Direct:
          Total compensable workyears:

    1001    Civilian full-time equivalent
              employment....................       1,438       1,472       1,445
    1101    Military full-time equivalent
              employment....................         267         270         278
        Reimbursable:
          Total compensable workyears:

    2001    Civilian full-time equivalent
              employment....................          85         128         128
    2101    Military full-time equivalent
              employment....................           5           5           5
        Allocation account:
          Total compensable workyears:

    3001    Civilian full-time equivalent
              employment....................                      12          12
    3101    Military full-time equivalent
              employment....................           8          21          21
    ---------------------------------------------------------------------------

                          Health Resources and Services

                    (Legislative proposal, subject to PAYGO)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0350-4-1-550      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.33 Abstinence education..............                      25          50
                                               ---------   ---------  ----------
    10.00   Total new obligations (object
              class 41.0)...................                      25          50
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......                      25          50
    23.95 Total new obligations.............                     -25         -50
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Mandatory:

    60.00   Appropriation...................                      25          50
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..                                  18
    73.10 Total new obligations.............                      25          50
    73.20 Total outlays (gross).............                      -7         -37
    74.40 Obligated balance, end of year....                      18          31
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new mandatory
            authority.......................                       7          14
    86.98 Outlays from mandatory balances...                                  23
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........                       7          37
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................                      25          50
    90.00 Outlays...........................                       7          37
    ---------------------------------------------------------------------------

        The budget extends funding for state-based abstinence education
    activities for five years.

                          Vaccine Injury Compensation

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0320-0-1-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Direct program activity...........           4           8
                                               ---------   ---------  ----------
    10.00   Total new obligations...........           4           8
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance carried
            forward, start of year..........          11           8
    22.00 New budget authority (gross)......           1
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......          12           8
    23.95 Total new obligations.............          -4          -8
    24.40 Unobligated balance carried
            forward, end of year............           8
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Mandatory:

    69.00   Offsetting collections (cash)...           1
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..           3           3
    73.10 Total new obligations.............           4           8
    73.20 Total outlays (gross).............          -5         -11
    74.40 Obligated balance, end of year....           3
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new mandatory
            authority.......................           1
    86.98 Outlays from mandatory balances...           4          11
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........           5          11
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.00   Offsetting collections (cash)
              from: Federal sources.........          -1
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................
    90.00 Outlays...........................           3          11
    ---------------------------------------------------------------------------

        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 2004 to
    cover payment of pre-1988 claims. By statute, no new claims are accepted
    for this account. Payment of claims associated with vaccine related
    injury or death occurring after October 1, 1988 are reflected in the
    Vaccine improvement trust fund account.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0320-0-1-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
    42.0  Direct obligations: Insurance
            claims and indemnities..........           3           8
    99.0  Reimbursable obligations:
            Reimbursable obligations........           1
                                               ---------   ---------  ----------
    99.9    Total new obligations...........           4           8
    ---------------------------------------------------------------------------

    Credit accounts:

                 Health Center Guaranteed Loan Financing Account

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-4442-0-3-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance carried
            forward, start of year..........                       1           1
    22.00 New financing authority (gross)...                       1           1
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......                       2           2

    [[Page 406]]

    24.40 Unobligated balance carried
            forward, end of year............           1           1           1
    ----------------------------------------------------------------------------

        New financing authority (gross), detail:
          Discretionary:

    68.00   Spending authority from
              offsetting collections
              (gross): (Federal sources:
              From program account).........                       1           1
    ----------------------------------------------------------------------------

        Change in obligated balances:
    73.20 Total financing disbursements
            (gross).........................                       1           1
    87.00 Total financing disbursements
            (gross).........................                      -1          -1
    ----------------------------------------------------------------------------

        Offsets:
          Against gross financing authority and
              financing disbursements:

    88.00   Offsetting collections (cash)
              from: Federal sources.........                      -1          -1
    ----------------------------------------------------------------------------

        Net financing authority and financing
            disbursements:
    89.00 Financing authority...............
    90.00 Financing disbursements...........                      -2          -2
    ---------------------------------------------------------------------------

                 Status of Guaranteed Loans (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-4442-0-3-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
        Position with respect to appropriations act
                    limitation on commitments:
    2111  Limitation on guaranteed loans
            made by private lenders.........
    2121  Limitation available from carry-
            forward.........................         139         138         121
    2143  Uncommitted limitation carried
            forward.........................        -138        -121         -99
                                               ---------   ---------  ----------
    2150    Total guaranteed loan
              commitments...................           1          17          22
    2199  Guaranteed amount of guaranteed
            loan commitments................           1          14          18
    ----------------------------------------------------------------------------

        Cumulative balance of guaranteed loans
                    outstanding:
    2210  Outstanding, start of year........          12          13          30
    2231  Disbursements of new guaranteed
            loans...........................           1          17          22
    2251  Repayments and prepayments........
    2263  Adjustments: Terminations for
            default that result in claim
            payments........................
                                               ---------   ---------  ----------
    2290    Outstanding, end of year........          13          30          52
    ----------------------------------------------------------------------------

        Memorandum:
    2299  Guaranteed amount of guaranteed
            loans outstanding, end of year..          10          24          42
    ---------------------------------------------------------------------------

        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. This program has
    used $0.5 million of its available $139 million in loan guarantee
    authority, HRSA plans to use approximately $39 million of the remaining
    existing loan guarantee limit over 2003 and 2004. 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    2001 actual    2002 actual     2003 est.      2004 est.
    -----------------------------------------------------------------------------------------------
        ASSETS:
    1101  Federal assets: Fund balances with
            Treasury........................           4              1             1              1
                                            ------------ --------------  ------------  -------------
    1999    Total assets....................           4              1             1              1
        LIABILITIES:
    2204  Non-Federal liabilities:
            Liabilities for loan guarantees.           4              1             1              1
                                            ------------ --------------  ------------  -------------
    2999    Total liabilities...............           4              1             1              1
        NET POSITION:
    3300  Cumulative results of operations..
                                            ------------ --------------  ------------  -------------
    3999    Total net position..............
                                            ------------ --------------  ------------  -------------
    4999  Total liabilities and net position           4              1             1              1
    -----------------------------------------------------------------------------------------------

                Health Education Assistance Loans Program Account

        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. For administrative expenses to carry out the guaranteed loan
    program, including section 709 of the Public Health Service Act,
    $3,389,000.

        Note.--A regular 2003 appropriation for this account had not been
    enacted at the time the budget was prepared; therefore, this account is
    operating under a continuing resolution (P.L. 107-229, as amended). The
    amounts included for 2003 in this budget reflect the Administration's
    2003 policy proposals.

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0340-0-1-552      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.02 Guarantee loan subsidy............          18          20          18
    00.09 Administrative expenses...........           4           4           3
                                               ---------   ---------  ----------
    10.00   Total new obligations...........          22          24          21
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......          22          24          21
    23.95 Total new obligations.............         -22         -24         -21
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Discretionary:

    40.00   Appropriation...................           4           4           3
          Mandatory:

    60.00   Appropriation...................          18          20          18
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................          22          24          21
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..           1           1
    73.10 Total new obligations.............          22          24          21
    73.20 Total outlays (gross).............         -22         -24         -21
    74.40 Obligated balance, end of year....           1
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new discretionary
            authority.......................           4           4           3
    86.97 Outlays from new mandatory
            authority.......................          18          20          18
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........          22          24          21
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................          22          24          21
    90.00 Outlays...........................          23          24          21
    ---------------------------------------------------------------------------

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

    ----------------------------------------------------------------------------
    Identification code 75-0340-0-1-552      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
        Guaranteed loan levels supportable by subsidy
                    budget authority:
    215001HEAL Loan guarantee...............         165         160         150
                                               ---------   ---------  ----------
    215901Total loan guarantee levels.......         165         160         150
        Guaranteed loan subsidy (in percent):
    232001HEAL Loan guarantee...............       12.43       12.43       12.19
                                               ---------   ---------  ----------
    232901Weighted average subsidy rate.....       12.43       12.43       12.19
        Guaranteed loan subsidy budget authority:
    233001HEAL Loan guarantee...............          21          20          18
                                               ---------   ---------  ----------
    233901Total subsidy budget authority....          21          20          18
        Guaranteed loan subsidy outlays:
    234001HEAL Loan guarantee...............          18          20          18
                                               ---------   ---------  ----------
    234901Total subsidy outlays.............          18          20          18
    ----------------------------------------------------------------------------

    [[Page 407]]

        Administrative expense data:
    351001Budget authority..................           4           4           3
    359001Outlays from new authority........           4           4           3
    ---------------------------------------------------------------------------

        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 administrative expenses are estimated on a
    cash basis.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0340-0-1-552      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
    11.1  Personnel compensation: Full-time
            permanent.......................           2           2           1
    25.3  Other purchases of goods and
            services from Government
            accounts........................           2           2           2
    41.0  Grants, subsidies, and
            contributions...................          18          20          18
                                               ---------   ---------  ----------
    99.9    Total new obligations...........          22          24          21
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-0340-0-1-552      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
        Direct:
          Total compensable workyears:

    1001    Civilian full-time equivalent
              employment....................          22          22          17
    ---------------------------------------------------------------------------

               Health Education Assistance Loans Financing Account

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-4304-0-3-552      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Death and disability claims.......           4           2           2
    00.02 Default claims....................          24          37          41
                                               ---------   ---------  ----------
    10.00   Total new obligations...........          28          39          43
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance carried
            forward, start of year..........         321         345         334
    22.00 New financing authority (gross)...          52          28          27
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......         373         373         361
    23.95 Total new obligations.............         -28         -39         -43
    24.40 Unobligated balance carried
            forward, end of year............         345         334         318
    ----------------------------------------------------------------------------

        New financing authority (gross), detail:
          Discretionary:

    68.00   Spending authority from
              offsetting collections
              (gross): Offsetting
              collections (cash)............          52          28          27
    ----------------------------------------------------------------------------

        Change in obligated balances:
    73.10 Total new obligations.............          28          39          43
    73.20 Total financing disbursements
            (gross).........................         -28         -39         -43
    87.00 Total financing disbursements
            (gross).........................          28          39          43
    ----------------------------------------------------------------------------

        Offsets:
          Against gross financing authority and
              financing disbursements:

            Offsetting collections (cash)
                from:
    88.00     Federal sources...............         -18         -20         -18
    88.25     Interest on uninvested funds..                      -2          -3
    88.40     Recoveries of defaulted loans.         -34          -6          -6
                                               ---------   ---------  ----------
    88.90       Total, offsetting
                  collections (cash)........         -52         -28         -27
    ----------------------------------------------------------------------------

        Net financing authority and financing
            disbursements:
    89.00 Financing authority...............
    90.00 Financing disbursements...........         -24          11          16
    ---------------------------------------------------------------------------

                 Status of Guaranteed Loans (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-4304-0-3-552      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
        Position with respect to appropriations act
                    limitation on commitments:
    2111  Limitation on guaranteed loans
            made by private lenders.........         165         160         150
                                               ---------   ---------  ----------
    2150    Total guaranteed loan
              commitments...................         165         160         150
    2199  Guaranteed amount of guaranteed
            loan commitments................         165         160         150
    ----------------------------------------------------------------------------

        Cumulative balance of guaranteed loans
                    outstanding:
    2210  Outstanding, start of year........       1,513       1,646       1,760
    2231  Disbursements of new guaranteed
            loans...........................         165         160         150
    2251  Repayments and prepayments........          -5          -6          -6
          Adjustments:

    2261    Terminations for default that
              result in loans receivable....         -23         -38         -41
    2263    Terminations for default that
              result in claim payments......          -4          -2          -2
                                               ---------   ---------  ----------
    2290    Outstanding, end of year........       1,646       1,760       1,861
    ----------------------------------------------------------------------------

        Memorandum:
    2299  Guaranteed amount of guaranteed
            loans outstanding, end of year..       1,646       1,760       1,861
    ----------------------------------------------------------------------------

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

    2310    Outstanding, start of year......         373         391         423
    2331    Disbursements for guaranteed
              loan claims...................          23          38          41
    2351    Repayments of loans receivable..          -5          -6          -6
                                               ---------   ---------  ----------
    2390      Outstanding, end of year......         391         423         458
    ---------------------------------------------------------------------------

        This account records all cash flows to and from the Government
    resulting from HEAL loan guarantees committed between 1992 and 2004.

                                 Balance Sheet (in millions of dollars)

    -----------------------------------------------------------------------------------------------
    Identification code   75-4304-0-3-552    2001 actual    2002 actual     2003 est.      2004 est.
    -----------------------------------------------------------------------------------------------
        ASSETS:
    1101  Federal assets: Fund balances with
            Treasury........................         321            345           340            331
    1206  Non-Federal assets: Receivables,
            net.............................          51             67            67             67
                                            ------------ --------------  ------------  -------------
    1999    Total assets....................         372            412           407            398
        LIABILITIES:
    2204  Non-Federal liabilities:
            Liabilities for loan guarantees.         372            412           407            398
                                            ------------ --------------  ------------  -------------
    2999    Total liabilities...............         372            412           407            398
        NET POSITION:
    3300  Cumulative results of operations..
                                            ------------ --------------  ------------  -------------
    3999    Total net position..............
                                            ------------ --------------  ------------  -------------
    4999  Total liabilities and net position         372            412           407            398
    -----------------------------------------------------------------------------------------------

              Health Education Assistance Loans Liquidating Account

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-4305-0-3-552      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Death and disability claims.......           3           3           3
    00.02 Defaulted loans...................          17          19          15
    00.03 Debt collection...................           5           6           6
                                               ---------   ---------  ----------
    10.00   Total new obligations...........          25          28          24
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......          31          28          24
    22.10 Resources available from
            recoveries of prior year
            obligations.....................          17
    22.40 Capital transfer to general fund..         -23
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......          25          28          24
    23.95 Total new obligations.............         -25         -28         -24
    ----------------------------------------------------------------------------

    [[Page 408]]

        New budget authority (gross), detail:
          Mandatory:

    60.00   Appropriation...................          10           7           4
    69.00 Offsetting collections (cash).....          21          21          20
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................          31          28          24
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..          21           4           3
    73.10 Total new obligations.............          25          28          24
    73.20 Total outlays (gross).............         -25         -28         -24
    73.45 Recoveries of prior year
            obligations.....................         -17
    74.40 Obligated balance, end of year....           4           3           3
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new mandatory
            authority.......................          25          28          24
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

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

        Net budget authority and outlays:
    89.00 Budget authority..................          10           7           4
    90.00 Outlays...........................           4           7           4
    ---------------------------------------------------------------------------

                 Status of Guaranteed Loans (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-4305-0-3-552      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
        Cumulative balance of guaranteed loans
                    outstanding:
    2210  Outstanding, start of year........         668         619         566
    2251  Repayments and prepayments........         -39         -42         -35
          Adjustments:

    2261    Terminations for default that
              result in loans receivable....          -8          -9          -7
    2263    Terminations for default that
              result in claim payments......          -2          -2          -2
                                               ---------   ---------  ----------
    2290    Outstanding, end of year........         619         566         522
    ----------------------------------------------------------------------------

        Memorandum:
    2299  Guaranteed amount of guaranteed
            loans outstanding, end of year..         619         566         522
    ----------------------------------------------------------------------------

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

    2310    Outstanding, start of year......         497         488         458
    2331    Disbursements for guaranteed
              loan claims...................           8           9           7
    2351    Repayments of loans receivable..         -15         -15         -15
    2361    Write-offs of loans receivable..         -24         -24         -24
    2364    Other adjustments, net..........          22
                                               ---------   ---------  ----------
    2390      Outstanding, end of year......         488         458         426
    ---------------------------------------------------------------------------
        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.

                            Statement of Operations (in millions of dollars)

    -----------------------------------------------------------------------------------------------
    Identification code   75-4305-0-3-552    2001 actual    2002 actual     2003 est.      2004 est.
    -----------------------------------------------------------------------------------------------
    0101  Revenue...........................          14             25            28             24
    0102  Expense...........................         -14            -25           -28            -24
                                            ------------ --------------  ------------  -------------
    0105  Net income or loss (-)............
    -----------------------------------------------------------------------------------------------

                                 Balance Sheet (in millions of dollars)

    -----------------------------------------------------------------------------------------------
    Identification code   75-4305-0-3-552    2001 actual    2002 actual     2003 est.      2004 est.
    -----------------------------------------------------------------------------------------------
        ASSETS:
    1101  Federal assets: Fund balances with
            Treasury........................          21              4             4              4
    1206  Non-Federal assets: Receivables,
            net.............................         376            303           376            376
                                            ------------ --------------  ------------  -------------
    1999    Total assets....................         397            307           380            380
        LIABILITIES:
    2204  Non-Federal liabilities:
            Liabilities for loan guarantees.         397            307           380            380
                                            ------------ --------------  ------------  -------------
    2999    Total liabilities...............         397            307           380            380
        NET POSITION:
    3300  Cumulative results of operations..
                                            ------------ --------------  ------------  -------------
    3999    Total net position..............
                                            ------------ --------------  ------------  -------------
    4999  Total liabilities and net position         397            307           380            380
    -----------------------------------------------------------------------------------------------

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-4305-0-3-552      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
    25.2  Other services....................           5           6           6
    42.0  Insurance claims and indemnities..          20          22          18
                                               ---------   ---------  ----------
    99.9    Total new obligations...........          25          28          24
    ---------------------------------------------------------------------------

                   Medical Facilities Guarantee and Loan Fund

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9931-0-3-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance carried
            forward, start of year..........          67          68          69
    22.00 New budget authority (gross)......           1           1           1
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......          68          69          70
    24.40 Unobligated balance carried
            forward, end of year............          68          69          70
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Mandatory:

    69.00   Offsetting collections (cash)...           1           1           1
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..           1           1           1
    73.20 Total outlays (gross).............           1
    74.40 Obligated balance, end of year....           1           1           1
    ----------------------------------------------------------------------------

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

        Offsets:
          Against gross budget authority and outlays:

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

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

                   Status of Direct Loans (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9931-0-3-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
        Cumulative balance of direct loans
                    outstanding:
    1210  Outstanding, start of year........           9           8           7
    1251  Repayments: Repayments and
            prepayments.....................          -1          -1          -1
                                               ---------   ---------  ----------
    1290    Outstanding, end of year........           8           7           6
    ---------------------------------------------------------------------------

                 Status of Guaranteed Loans (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9931-0-3-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
        Cumulative balance of guaranteed loans
                    outstanding:
    2210  Outstanding, start of year........          19          16          13
    2251  Repayments and prepayments........          -3          -3          -3
                                               ---------   ---------  ----------
    2290    Outstanding, end of year........          16          13          10
    ----------------------------------------------------------------------------

    [[Page 409]]

        Memorandum:
    2299  Guaranteed amount of guaranteed
            loans outstanding, end of year..          16          13          10
    ---------------------------------------------------------------------------

        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. Unobligated balances will be used to pay defaults and interest
    subsidy payments.

                                   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 $2,991,000 shall be
    available from the Trust Fund to the Secretary of Health and Human
    Services.

        Note.--A regular 2003 appropriation for this account had not been
    enacted at the time the budget was prepared; therefore, this account is
    operating under a continuing resolution (P.L. 107-229, as amended). The
    amounts included for 2003 in this budget reflect the Administration's
    2003 policy proposals.

                  Unavailable Collections (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8175-0-7-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
    01.99 Balance, start of year............       1,627       1,759       1,907
        Receipts:
    02.00 Deposits..........................         109         124         124
    02.40 Interest income...................          90          97         105
                                               ---------   ---------  ----------
    02.99   Total receipts and collections..         199         221         229
                                               ---------   ---------  ----------
    04.00 Total: Balances and collections...       1,826       1,980       2,136
        Appropriations:
    05.00 Vaccine injury compensation
            program trust fund..............         -67         -73         -76
                                               ---------   ---------  ----------
    05.99   Total appropriations............         -67         -73         -76
                                               ---------   ---------  ----------
    07.99 Balance, end of year..............       1,759       1,907       2,060
    ---------------------------------------------------------------------------

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8175-0-7-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Compensation: Claims for post-FY
            1989 injuries...................          57          63          66
          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)......................           4           4           4
                                               ---------   ---------  ----------
    01.91     Total, administrative expenses          10          10          10
                                               ---------   ---------  ----------
    10.00   Total new obligations...........          67          73          76
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance carried
            forward, start of year..........           1           1
    22.00 New budget authority (gross)......          67          73          76
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......          68          74          76
    23.95 Total new obligations.............         -67         -73         -76
    24.40 Unobligated balance carried
            forward, end of year............           1
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Discretionary:

    40.26   Appropriation (trust fund)......          10          10          10
          Mandatory:

    60.26   Appropriation (trust fund)......          57          63          66
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................          67          73          76
    ----------------------------------------------------------------------------

        Change in obligated balances:
    73.10 Total new obligations.............          67          73          76
    73.20 Total outlays (gross).............         -67         -73         -76
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new discretionary
            authority.......................          10          10          10
    86.97 Outlays from new mandatory
            authority.......................          57          63          66
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........          67          73          76
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................          67          73          76
    90.00 Outlays...........................          66          73          76
    ----------------------------------------------------------------------------

        Memorandum (non-add) entries:
    92.01 Total investments, start of year:
            Federal securities: Par value...       1,628       1,758       1,980
    92.02 Total investments, end of year:
            Federal securities: Par value...       1,758       1,980       2,060
    ---------------------------------------------------------------------------

        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      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
    25.2  Other services....................           3           3           3
    25.3  Other purchases of goods and
            services from Government
            accounts........................           7           7           7
    42.0  Insurance claims and indemnities..          57          63          66
                                               ---------   ---------  ----------
    99.9    Total new obligations...........          67          73          76
    ---------------------------------------------------------------------------

                        Ricky Ray Hemophilia Relief Fund

                  Unavailable Collections (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-8074-0-7-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
    01.99 Balance, start of year............
        Receipts:
    02.41 Interest on investments, Ricky....           2           2
        Appropriations:
    05.00 Ricky Ray hemophilia relief fund..          -2          -2
                                               ---------   ---------  ----------
    07.99 Balance, end of year..............
    ---------------------------------------------------------------------------

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-8074-0-7-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Compensation--claims..............          48           4           1
    00.02 Administrative expenses subject to
            limitation......................           2           3           2
                                               ---------   ---------  ----------
    10.00   Total new obligations...........          50           7           3
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance carried
            forward, start of year..........         145          97          92
    22.00 New budget authority (gross)......           2           2
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......         147          99          92
    23.95 Total new obligations.............         -50          -7          -3

    [[Page 410]]

    24.40 Unobligated balance carried
            forward, end of year............          97          92          89
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Mandatory:

    60.26   Appropriation (trust fund)......           2           2
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..           3           1
    73.10 Total new obligations.............          50           7           3
    73.20 Total outlays (gross).............         -53          -8          -3
    74.40 Obligated balance, end of year....           1
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.98 Outlays from mandatory balances...          53           8           3
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................           2           2
    90.00 Outlays...........................          53           8           3
    ----------------------------------------------------------------------------

        Memorandum (non-add) entries:
    92.01 Total investments, start of year:
            Federal securities: Par value...         130          91
    92.02 Total investments, end of year:
            Federal securities: Par value...          91
    ---------------------------------------------------------------------------

        The Ricky Ray hemophilia relief fund was established pursuant to
    Public Law 105-369 and serves as a source of funds to pay claims to
    eligible individuals on behalf of persons with HIV and a blood clotting
    disorder, who were treated with an anti-hemophiliac factor between July
    1982 and December 1987.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-8074-0-7-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
    11.1  Personnel compensation: Full-time
            permanent.......................           2           1           1
    25.2  Other services....................                       2           1
                                               ---------   ---------  ----------
    99.0      Limitation acct--direct
                obligations.................           2           3           2
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-8074-0-7-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
        Total compensable workyears:
    6001  Civilian full-time equivalent
            employment......................          19          12           6
    ---------------------------------------------------------------------------

                              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, $2,502,393,000, 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 up to $18,000,000 shall remain available until expended,
    for the Indian Catastrophic Health Emergency Fund: Provided further,
    That $493,046,000 for contract medical care shall remain available for
    obligation until September 30, 2005: Provided further, That of the funds
    provided, up to $27,000,000 to remain available until expended, 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 1-year contracts and grants which
    are to be performed in 2 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
    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 until expended: 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, notwithstanding
    any other provision of law, of the amounts provided herein, not to
    exceed $270,734,000 shall be for payments to tribes and tribal
    organizations for contract or grant support costs associated with
    contracts, grants, self-governance compacts or annual funding agreements
    between the Indian Health Service and a tribe or tribal organization
    pursuant to the Indian Self-Determination Act of 1975, as amended, prior
    to or during fiscal year 2004, of which not to exceed $2,500,000 may be
    used for contract support costs associated with new or expanded self-
    determination contracts, grants, self-governance compacts or annual
    funding agreements: Provided further, That funds available for the
    Indian Health Care Improvement Fund may be used, as needed, to carry out
    activities typically funded under the Indian Health Facilities account.

        Note.--A regular 2003 appropriation for this account had not been
    enacted at the time the budget was prepared; therefore, this account is
    operating under a continuing resolution (P.L. 107-229, as amended). The
    amounts included for 2003 in this budget reflect the Administration's
    2003 policy proposals.

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0390-0-1-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
          Direct program:

    00.01   Clinical services...............       1,802       1,945       1,987
    00.02   Preventive health...............         100         103         108
    00.03   Urban health....................          31          32          32
    00.04   Indian health professions.......          34          35          35
    00.05   Tribal management...............           2           2           2
    00.06   Direct operations...............          54          55          57
    00.07   Self-governance.................           9          10          10
    00.08   Contract support costs..........         268         271         271
    00.09   Diabetes funds..................         100         100         150
    09.01 Reimbursable program..............         767         805         812
                                               ---------   ---------  ----------
    10.00   Total new obligations...........       3,167       3,358       3,464
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance carried
            forward, start of year..........         185         241         243
    22.00 New budget authority (gross)......       3,214       3,359       3,464
    22.10 Resources available from
            recoveries of prior year
            obligations.....................          11
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......       3,410       3,600       3,707
    23.95 Total new obligations.............      -3,167      -3,358      -3,464
    23.98 Unobligated balance expiring or
            withdrawn.......................          -2
    24.40 Unobligated balance carried
            forward, end of year............         241         243         243
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Discretionary:

    40.00   Appropriation...................       2,390       2,454       2,502
    40.73   Reduction pursuant to P.L. 107-
              206...........................          -1
                                               ---------   ---------  ----------
    43.00     Appropriation (total
                discretionary)..............       2,389       2,454       2,502
          Mandatory:

    60.00   Appropriation...................          70         100         150
    62.00   Transferred from CMS for
              diabetes......................          30
                                               ---------   ---------  ----------
    62.50     Appropriation (total
                mandatory)..................         100         100         150
          Spending authority from offsetting
              collections:

            Discretionary:
    68.00     Offsetting collections (cash).         692         805         812
    68.10     Change in uncollected customer
                payments from Federal
                sources (unexpired).........          33
                                               ---------   ---------  ----------

    [[Page 411]]

    68.90       Spending authority from
                  offsetting collections
                  (total discretionary).....         725         805         812
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................       3,214       3,359       3,464
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..         604         605         728
    73.10 Total new obligations.............       3,167       3,358       3,464
    73.20 Total outlays (gross).............      -3,212      -3,325      -3,463
    73.40 Adjustments in expired accounts
            (net)...........................           9           9
    73.45 Recoveries of prior year
            obligations.....................         -11
    74.00 Change in uncollected customer
            payments from Federal sources
            (unexpired).....................         -33
    74.10 Change in uncollected customer
            payments from Federal sources
            (expired).......................          81          81
    74.40 Obligated balance, end of year....         605         728         729
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new discretionary
            authority.......................       2,869       2,964       3,013
    86.93 Outlays from discretionary
            balances........................         243         281         341
    86.97 Outlays from new mandatory
            authority.......................          20          20          30
    86.98 Outlays from mandatory balances...          80          60          79
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........       3,212       3,325       3,463
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

            Offsetting collections (cash)
                from:
    88.00     Federal sources...............        -381        -410        -448
    88.40     Non-Federal sources...........        -386        -395        -364
                                               ---------   ---------  ----------
    88.90       Total, offsetting
                  collections (cash)........        -767        -805        -812
          Against gross budget authority only:

    88.95   Change in uncollected customer
              payments from Federal sources
              (unexpired)...................         -33
    88.96   Portion of offsetting
              collections (cash) credited to
              expired accounts..............          75
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................       2,489       2,554       2,652
    90.00 Outlays...........................       2,445       2,520       2,651
    ----------------------------------------------------------------------------

    Additional net budget authority and outlays to cover cost of fully accruing
                                     retirement:
    99.00 Budget authority..................          59          62          67
    99.01 Outlays...........................          59          62          67
    ---------------------------------------------------------------------------

        The Indian health services account provides medical care, public
    health services, and health professions training opportunities to
    American Indians and Alaska Natives. An estimated $1,445 million will be
    administered by tribal governments under self-determination contracts
    and self-governance compacts in 2004.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0390-0-1-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

          Direct obligations:

            Personnel compensation:
    11.1      Full-time permanent...........         312         333         346
    11.3      Other than full-time permanent          17          18          19
    11.5      Other personnel compensation..          29          22          35
    11.7      Military personnel............          72          77          81
                                               ---------   ---------  ----------
    11.9        Total personnel compensation         430         450         481
    12.1    Civilian personnel benefits.....          86          91          97
    12.2    Military personnel benefits.....          30          33          38
    13.0    Benefits for former personnel...           7           8          10
            Travel and transportation of
                persons:
    21.0      Travel and transportation of
                persons.....................          29          27          29
    21.0      Patient Travel................           8           8          10
    22.0    Transportation of things........           8           8          10
    23.1    Rental payments to GSA..........          11          11          13
    23.2    Rental payments to others.......           2           2           4
    23.3    Communications, utilities, and
              miscellaneous charges.........          18          19          21
    24.0    Printing and reproduction.......           1           1           3
    25.1    Advisory and assistance services           5           5           7
    25.2    Other services..................          91          87          89
    25.4    Operation and maintenance of
              facilities....................           6           6           8
    25.6    Medical care....................         215         215         251
    25.7    Operation and maintenance of
              equipment.....................           4           4           6
    25.8    Subsistence and support of
              persons.......................           1           2           4
    26.0    Supplies and materials..........         126         126         128
    31.0    Equipment.......................           9           9          11
    32.0    Land and structures.............           3           3           5
    41.0    Grants, subsidies, and
              contributions.................       1,310       1,438       1,427
                                               ---------   ---------  ----------
    99.0      Direct obligations............       2,400       2,553       2,652
    99.0  Reimbursable obligations..........         767         805         812
                                               ---------   ---------  ----------
    99.9    Total new obligations...........       3,167       3,358       3,464
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-0390-0-1-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
        Direct:
          Total compensable workyears:

    1001    Civilian full-time equivalent
              employment....................       7,454       7,498       7,528
    1101    Military full-time equivalent
              employment....................       1,071       1,071       1,073
        Reimbursable:
          Total compensable workyears:

    2001    Civilian full-time equivalent
              employment....................       4,415       4,416       4,420
    2101    Military full-time equivalent
              employment....................         619         618         614
    ---------------------------------------------------------------------------

                            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, $387,269,000, 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: Provided
    further, That not to exceed $500,000 shall be used by the Indian Health
    Service to purchase TRANSAM equipment from the Department of Defense for
    distribution to the Indian Health Service and tribal facilities:
    Provided further, That not to exceed $500,000 shall be used by the
    Indian Health Service to obtain ambulances for the Indian Health Service
    and tribal facilities in conjunction with an existing interagency
    agreement between the Indian Health Service and the General Services
    Administration: Provided further, That not to exceed $500,000 shall be
    placed in a Demolition Fund, available until expended, to be used by the
    Indian Health Service for demolition of Federal buildings.

        Note.--A regular 2003 appropriation for this account had not been
    enacted at the time the budget was prepared; therefore, this account is
    operating under a continuing resolution (P.L. 107-229, as amended). The
    amounts included for 2003 in this budget reflect the Administration's
    2003 policy proposals.

                  Unavailable Collections (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0391-0-1-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
    01.99 Balance, start of year............
        Receipts:
    02.20 Rent and charges for quarters,
            Indian health service, HHS......           6           6           6
        Appropriations:
    05.00 Indian health facilities..........          -6          -6          -6
                                               ---------   ---------  ----------
    07.99 Balance, end of year..............
    ---------------------------------------------------------------------------

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0391-0-1-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
          Direct program:

    00.01   Sanitation and health facilities         190         166         184
    00.02   Maintenance.....................          48          53          53
    00.03   Facilities and environmental
              health........................         127         134         140
    00.04   Equipment.......................          13          16          16
                                               ---------   ---------  ----------
    01.00     Total direct program..........         378         369         393
    09.01 Reimbursable program..............           2           2           2
                                               ---------   ---------  ----------

    [[Page 412]]

    10.00   Total new obligations...........         380         371         395
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance carried
            forward, start of year..........         138         142         145
    22.00 New budget authority (gross)......         382         376         400
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......         520         518         545
    23.95 Total new obligations.............        -380        -371        -395
    24.40 Unobligated balance carried
            forward, end of year............         142         145         150
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Discretionary:

    40.00   Appropriation...................         369         363         387
          Mandatory:

    60.20   Appropriation (special fund)....           6           6           6
          Discretionary:

    68.00   Spending authority from
              offsetting collections:
              Offsetting collections (cash).           7           7           7
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................         382         376         400
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..         323         323         354
    73.10 Total new obligations.............         380         371         395
    73.20 Total outlays (gross).............        -379        -339        -385
    74.40 Obligated balance, end of year....         323         354         364
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new discretionary
            authority.......................         155         116         123
    86.93 Outlays from discretionary
            balances........................         218         217         256
    86.97 Outlays from new mandatory
            authority.......................           6           6           6
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........         379         339         385
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.00   Offsetting collections (cash)
              from: Federal sources.........          -7          -7          -7
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................         375         369         393
    90.00 Outlays...........................         372         332         378
    ----------------------------------------------------------------------------

    Additional net budget authority and outlays to cover cost of fully accruing
                                     retirement:
    99.00 Budget authority..................           9           9          10
    99.01 Outlays...........................           9           9          10
    ---------------------------------------------------------------------------

        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      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

          Direct obligations:

            Personnel compensation:
    11.1      Full-time permanent...........          35          38          40
    11.3      Other than full-time permanent           6           6           7
    11.5      Other personnel compensation..           1           1           1
    11.7      Military personnel............          17          18          20
                                               ---------   ---------  ----------
    11.9        Total personnel compensation          59          63          68
    12.1    Civilian personnel benefits.....           9          10          11
    12.2    Military personnel benefits.....           6           6           7
    21.0    Travel and transportation of
              persons.......................           3           3           3
    22.0    Transportation of things........           2           3           3
    23.1    Rental payments to GSA..........           1           1           1
    23.3    Communications, utilities, and
              miscellaneous charges.........          11          11          12
    25.1    Advisory and assistance services           2           2           4
    25.2    Other services..................         150         134         151
    25.3    Other purchases of goods and
              services from Government
              accounts......................           1           1           1
    25.4    Operation and maintenance of
              facilities....................           9           8           3
    25.7    Operation and maintenance of
              equipment.....................           1           1           1
    26.0    Supplies and materials..........          10          10          11
    31.0    Equipment.......................           3           3           3
    32.0    Land and structures.............          15          15          15
    41.0    Grants, subsidies, and
              contributions.................          96          98          99
                                               ---------   ---------  ----------
    99.0      Direct obligations............         378         369         393
    99.0  Reimbursable obligations..........           2           2           2
                                               ---------   ---------  ----------
    99.9    Total new obligations...........         380         371         395
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-0391-0-1-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
        Direct:
          Total compensable workyears:

    1001    Civilian full-time equivalent
              employment....................       1,162       1,179       1,205
    1101    Military full-time equivalent
              employment....................         168         169         171
    ---------------------------------------------------------------------------

                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 therefor 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.
        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. 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.
        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.
        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.
        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.
        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. 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. Such amounts shall remain available until
    expended.
        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.

    [[Page 413]]

        The appropriation structure for the Indian Health Service may not be
    altered without advance notice submitted to the House and Senate
    Committees on Appropriations.

                   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, XIX, XXI, and XXVI
    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, 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, $4,267,330,000, of which $114,000,000 shall
    remain available until expended for equipment and construction and
    renovation of facilities; of which $293,763,000 for international HIV/
    AIDS shall remain available until September 30, 2005, including not less
    than $150,000,000, to remain available until expended, for the
    ``International Mother and Child HIV Prevention Initiative.'' 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 $51,982,000 shall be available from amounts
    available under section 241 of the Public Health Service Act to carry
    out the National Center for Health Statistics surveys: Provided further,
    That none of the funds made available for injury prevention and control
    at the Centers for Disease Control and Prevention may be used to
    advocate or promote gun control: Provided further, That the Director may
    redirect the total amount made available under authority of Public Law
    101-502, section 3, dated November 3, 1990, to activities the Director
    may so designate: Provided further, That the Congress is to be notified
    promptly of any such transfer: Provided further, That not to exceed
    $10,000,000 may be available for making grants under section 1509 of the
    Public Health Service Act to not more than 15 States.

        Note.--A regular 2003 appropriations for this account had not been
    enacted at the time the budget was prepared; therefore, this account is
    operating under a continuing resolution (P.L. 107-229, as amended). The
    amounts included for 2003 in this budget reflect the Administration's
    2003 policy proposals.

                  Unavailable Collections (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0943-0-1-999      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
    01.99 Balance, start of year............
        Receipts:
    02.20 Cooperative research and
            development agreements, Centers
            for Disease Contr...............           1           1           1
        Appropriations:
    05.00 Disease control, research, and
            training........................          -1          -1          -1
                                               ---------   ---------  ----------
    07.99 Balance, end of year..............
    ---------------------------------------------------------------------------

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0943-0-1-999      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
          Direct program:

    00.19   Birth defects/developmental
              disabilities/disability and
              health........................          90          89          87
    00.20   Chronic disease prev & health
              promotion.....................         747         690         834
    00.21   Environmental health............         157         152         150
    00.22   Epidemic services and response..          81          78          76
    00.23   Health statistics...............         103          79          73
    00.24   HIV/AIDS, STD and TB prevention.       1,148       1,235       1,281
    00.25   Immunization....................         627         628         621
    00.26   Infectious disease control......         348         335         331
    00.27   Injury prevention and control...         149         145         145
    00.28   Occupational safety and health..         281         248         246
    00.29   Preventive health and heath
              service block grant...........         135         135         135
    00.30   Public health improvement.......         148         117         114
    00.31   Building and facilities.........         236         184         114
    00.32   Office of the Director..........          49          51          60
    00.33   Response and recovery...........          12
    09.01 Reimbursable program..............         224         207         212
                                               ---------   ---------  ----------
    10.00   Total new obligations...........       4,535       4,373       4,479
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance carried
            forward, start of year..........          47          66          67
    22.00 New budget authority (gross)......       4,554       4,374       4,480
    22.10 Resources available from
            recoveries of prior year
            obligations.....................           1
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......       4,602       4,440       4,547
    23.95 Total new obligations.............      -4,535      -4,373      -4,479
    23.98 Unobligated balance expiring or
            withdrawn.......................          -1
    24.40 Unobligated balance carried
            forward, end of year............          66          67          68
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Discretionary:

    40.00   Appropriation...................       4,306       4,166       4,267
    40.71   Reduction pursuant to P.L. 107-
              116 (Labor/HHS)...............          -2
    40.73   Reduction pursuant to P.L. 107-
              206...........................          -3
    42.00   Transferred from other accounts.          25
                                               ---------   ---------  ----------
    43.00     Appropriation (total
                discretionary)..............       4,326       4,166       4,267
          Mandatory:

    60.20   Appropriation (special fund)....           1           1           1
    62.00   Transferred from other accounts.           3
                                               ---------   ---------  ----------
    62.50     Appropriation (total
                mandatory)..................           4           1           1
          Spending authority from offsetting
              collections:

            Discretionary:
    68.00     Offsetting collections (cash).          71         207         212
    68.10     Change in uncollected customer
                payments from Federal
                sources (unexpired).........         153
                                               ---------   ---------  ----------
    68.90       Spending authority from
                  offsetting collections
                  (total discretionary).....         224         207         212
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................       4,554       4,374       4,480
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..       3,246       3,972       4,032
    73.10 Total new obligations.............       4,535       4,373       4,479
    73.20 Total outlays (gross).............      -3,708      -4,313      -4,396
    73.40 Adjustments in expired accounts
            (net)...........................         -20
    73.45 Recoveries of prior year
            obligations.....................          -1
    74.00 Change in uncollected customer
            payments from Federal sources
            (unexpired).....................        -153
    74.10 Change in uncollected customer
            payments from Federal sources
            (expired).......................          75
    74.40 Obligated balance, end of year....       3,972       4,032       4,115
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new discretionary
            authority.......................       1,597       1,582       1,620
    86.93 Outlays from discretionary
            balances........................       2,110       2,730       2,775
    86.97 Outlays from new mandatory
            authority.......................           1           1           1
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........       3,708       4,313       4,396
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

            Offsetting collections (cash)
                from:
    88.00     Federal sources...............        -145        -205        -210
    88.40     Non-Federal sources...........                      -2          -2
                                               ---------   ---------  ----------
    88.90       Total, offsetting
                  collections (cash)........        -145        -207        -212
          Against gross budget authority only:

    88.95   Change in uncollected customer
              payments from Federal sources
              (unexpired)...................        -153
    88.96   Portion of offsetting
              collections (cash) credited to
              expired accounts..............          74
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................       4,330       4,167       4,268
    90.00 Outlays...........................       3,565       4,106       4,184
    ----------------------------------------------------------------------------

    Additional net budget authority and outlays to cover cost of fully accruing
                                     retirement:
    99.00 Budget authority..................          52          55          63
    99.01 Outlays...........................          52          55          63
    ---------------------------------------------------------------------------

                     Summary of Budget Authority and Outlays

                            (in millions of dollars)

                                         2002 actual  2003 est.   2004 est.
    Enacted/requested:
      Budget Authority..................       4,330       4,167       4,268
      Outlays...........................       3,563       4,106       4,184
    Legislative proposal, not subject to
        PAYGO:
      Budget Authority..................                                -110
      Outlays...........................                                 -48
                                        ------------------------------------

    [[Page 414]]

    Total:
      Budget Authority..................       4,330       4,167       4,158
      Outlays...........................       3,563       4,106       4,136
                                        ====================================

        The Centers for Disease Control and Prevention (CDC) supports a
    number of categorical programs designed to improve the health, safety,
    and protection of all Americans. These programs include immunization,
    HIV prevention, chronic disease prevention and health promotion,
    infectious disease control, occupational safety and health, injury
    prevention and control, environmental health, and programs that reduce
    the occurrence of birth defects and developmental disabilities. CDC also
    supports bioterrorism and emergency response activities. Funding for
    these activities is included in the Public Health and Social Services
    Emergency Fund provided to CDC from the Office of the Secretary of
    Health and Human Services. The budget request for the 317 immunization
    program assumes enactment of a legislative proposal that reduces the
    discretionary request by $110 million.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0943-0-1-999      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

          Direct obligations:

            Personnel compensation:
    11.1      Full-time permanent...........         354         372         379
    11.3      Other than full-time permanent          41          41          42
    11.5      Other personnel compensation..          23          23          24
    11.7      Military personnel............          50          59          60
    11.8      Special personal services
                payments....................           1           1           1
                                               ---------   ---------  ----------
    11.9        Total personnel compensation         469         496         506
    12.1    Civilian personnel benefits.....         106         115         117
    12.2    Military personnel benefits.....          31          37          38
    21.0    Travel and transportation of
              persons.......................          35          35          36
    22.0    Transportation of things........           8           6           6
    23.1    Rental payments to GSA..........          38          40          42
    23.2    Rental payments to others.......           2           2           2
    23.3    Communications, utilities, and
              miscellaneous charges.........          21          28          28
    24.0    Printing and reproduction.......           7           7           7
    25.1    Advisory and assistance services         104          93          95
    25.2    Other services..................          79          44          22
    25.3    Other purchases of goods and
              services from Government
              accounts......................         265         125         129
    25.4    Operation and maintenance of
              facilities....................          47          43          44
    25.5    Research and development
              contracts.....................         270         241         261
    25.6    Medical care....................           2           2           2
    25.7    Operation and maintenance of
              equipment.....................          19          17          19
    26.0    Supplies and materials..........          32          21          21
    31.0    Equipment.......................          64          43          39
    32.0    Land and structures.............         221         180         110
    41.0    Grants, subsidies, and
              contributions.................       2,491       2,591       2,743
                                               ---------   ---------  ----------
    99.0      Direct obligations............       4,311       4,166       4,267
    99.0  Reimbursable obligations..........         224         207         212
                                               ---------   ---------  ----------
    99.9    Total new obligations...........       4,535       4,373       4,479
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-0943-0-1-999      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
        Direct:
          Total compensable workyears:

    1001    Civilian full-time equivalent
              employment....................       6,599       6,559       6,558
    1101    Military full-time equivalent
              employment....................         796         797         796
        Reimbursable:
          Total compensable workyears:

    2001    Civilian full-time equivalent
              employment....................         352         347         356
    2101    Military full-time equivalent
              employment....................          32          31          32
        Allocation account:
          Total compensable workyears:

    3001    Civilian full-time equivalent
              employment....................         420         497         497
    ---------------------------------------------------------------------------

                     Disease Control, Research, and Training

                  (Legislative proposal, not subject to PAYGO)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0943-2-1-999      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
          Direct program:

    00.25   Immunization....................                                -110
                                               ---------   ---------  ----------
    10.00   Total new obligations (object
              class 41.0)...................                                -110
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......                                -110
    23.95 Total new obligations.............                                 110
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Discretionary:

    40.00   Appropriation...................                                -110
    ----------------------------------------------------------------------------

        Change in obligated balances:
    73.10 Total new obligations.............                                -110
    73.20 Total outlays (gross).............                                  48
    74.40 Obligated balance, end of year....                                 -62
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new discretionary
            authority.......................                                 -48
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................                                -110
    90.00 Outlays...........................                                 -48
    ---------------------------------------------------------------------------

        The budget includes legislative proposals for the Vaccines for
    Children (VFC) program to expand access to immunizations for VFC-
    eligible children. Legislation amending the Vaccines for Children
    program will be proposed to allow underinsured children to receive
    immunizations at state and local public health clinics and to lift the
    price cap on the tetanus-diphtheria booster. These proposals will result
    in approximately $110 million in savings from the CDC discretionary 317
    immunization program. The budget request for the 317 program assumes
    enactment of this proposal.

                Agency for Toxic Substances and Disease Registry

                toxic substances and environmental public health

        For necessary expenses for the Agency for Toxic Substances and
    Disease Registry (ATSDR) in carrying out activities set forth in
    sections 104(i), 111(c)(4), and 111(c)(14) of the Comprehensive
    Environmental Response, Compensation, and Liability Act of 1980
    (CERCLA), as amended; section 118(f) of the Superfund Amendments and
    Reauthorization Act of 1986 (SARA), as amended; and section 3019 of the
    Solid Waste Disposal Act, as amended, $73,467,000, to be derived from
    the Hazardous Substance Superfund Trust Fund pursuant to section 517(a)
    of SARA (26 U.S.C. 9507): Provided, That notwithstanding any other
    provision of law, in lieu of performing a health assessment under
    section 104(i)(6) of CERCLA, the Administrator of ATSDR may conduct
    other appropriate health studies, evaluations, or activities, including,
    without limitation, biomedical testing, clinical evaluations, medical
    monitoring, and referral to accredited health care providers: Provided
    further, That in performing any such health assessment or health study,
    evaluation, or activity, the Administrator of ATSDR shall not be bound
    by the deadlines in section 104(i)(6)(A) of CERCLA: Provided further,
    That none of the funds appropriated under this heading shall be
    available for ATSDR to issue in excess of 40 toxicological profiles
    pursuant to section 104(i) of CERCLA during fiscal year 2004, and
    existing profiles may be updated as necessary.

        Note.--A regular 2003 appropriation for this account had not been
    enacted at the time the budget was prepared; therefore, this account is
    operating under a continuing resolution (P.L. 107-229, as amended). The
    amounts included for 2003 in this budget reflect the Administration's
    2003 policy proposals.

    [[Page 415]]

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-8252-0-7-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Direct program....................          78          77          73
    09.01 Reimbursable program..............          31          25          25
                                               ---------   ---------  ----------
    10.00   Total new obligations...........         109         102          98
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......         109         102          98
    23.95 Total new obligations.............        -109        -102         -98
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Discretionary:

    40.26   Appropriation (trust fund)......          78          77          73
          Spending authority from offsetting
              collections:

    68.00   Offsetting collections (cash)...           7          25          25
    68.10   Change in uncollected customer
              payments from Federal sources
              (unexpired)...................          24
                                               ---------   ---------  ----------
    68.90     Spending authority from
                offsetting collections
                (total discretionary).......          31          25          25
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................         109         102          98
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..          30          44          32
    73.10 Total new obligations.............         109         102          98
    73.20 Total outlays (gross).............         -77        -114        -100
    74.00 Change in uncollected customer
            payments from Federal sources
            (unexpired).....................         -24
    74.10 Change in uncollected customer
            payments from Federal sources
            (expired).......................           6
    74.40 Obligated balance, end of year....          44          32          30
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new discretionary
            authority.......................          60          77          75
    86.93 Outlays from discretionary
            balances........................          17          37          25
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........          77         114         100
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.00   Offsetting collections (cash)
              from: Federal sources.........         -13         -25         -25
          Against gross budget authority only:

    88.95   Change in uncollected customer
              payments from Federal sources
              (unexpired)...................         -24
    88.96   Portion of offsetting
              collections (cash) credited to
              expired accounts..............           6
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................          78          77          73
    90.00 Outlays...........................          65          89          75
    ----------------------------------------------------------------------------

    Additional net budget authority and outlays to cover cost of fully accruing
                                     retirement:
    99.00 Budget authority..................           3           3           4
    99.01 Outlays...........................           3           3           4
    ---------------------------------------------------------------------------

        The Agency for Toxic Substances and Disease Registry (ATSDR) is
    authorized under the Comprehensive Environmental Response, Compensation,
    and Liability Act of 1980 (CERCLA). ATSDR assesses health hazards at
    specific hazardous waste sites helping to prevent or reduce exposure and
    illnesses that result, and increasing knowledge and understanding of the
    health effects that may result from exposure to hazardous substances.
    ATSDR is financed through the EPA Superfund.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-8252-0-7-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

          Direct obligations:

            Personnel compensation:
    11.1      Full-time permanent...........          20          20          21
    11.3      Other than full-time permanent           1           1           1
    11.5      Other personnel compensation..           1           1           1
    11.7      Military personnel............           4           4           4
                                               ---------   ---------  ----------
    11.9        Total personnel compensation          26          26          27
    12.1    Civilian personnel benefits.....           5           6           5
    12.2    Military personnel benefits.....           2           2           2
    21.0    Travel and transportation of
              persons.......................           2           2           2
    23.3    Communications, utilities, and
              miscellaneous charges.........           1           1           1
    25.1    Advisory and assistance services           5           4           4
    25.2    Other services..................           2           2           1
    25.3    Other purchases of goods and
              services from Government
              accounts......................           9           7           5
    25.5    Research and development
              contracts.....................           3           7           6
    31.0    Equipment.......................           3           2           2
    41.0    Grants, subsidies, and
              contributions.................          20          18          18
                                               ---------   ---------  ----------
    99.0      Direct obligations............          78          77          73
    99.0  Reimbursable obligations..........          31          25          25
                                               ---------   ---------  ----------
    99.9    Total new obligations...........         109         102          98
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-8252-0-7-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
        Direct:
          Total compensable workyears:

    1001    Civilian full-time equivalent
              employment....................         308         301         301
    1101    Military full-time equivalent
              employment....................          63          63          63
        Reimbursable:
          Total compensable workyears:

    2001    Civilian full-time equivalent
              employment....................          57          57          57
    2101    Military full-time equivalent
              employment....................           8           8           8
    ---------------------------------------------------------------------------

                          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, $4,770,519,000.

                    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, $2,867,995,000.

             National Institute of Dental and Craniofacial Research

        For carrying out section 301 and title IV of the Public Health
    Service Act with respect to dental disease, $382,396,000.

        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,
    $1,670,007,000.

             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,
    $1,468,926,000.

              National Institute of Allergy and Infectious Diseases

                          (including transfer of funds)

        For carrying out section 301 and title IV of the Public Health
    Service Act with respect to allergy and infectious diseases,
    $4,335,255,000: Provided, That $100,000,000 may be made available to
    International Assistance Programs, ``Global Fund to Fight HIV/AIDS,
    Malaria, and Tuberculosis'', to remain available until expended, to
    further the Institute's efforts to prevent and alleviate these diseases.

                 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, $1,923,133,000.

            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,
    $1,245,371,000.

                             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,
    $648,299,000.

    [[Page 416]]

               National Institute of Environmental Health Sciences

        For necessary expenses for the National Institute of Environmental
    Health Sciences in carrying out activities set forth in section 311(a)
    of the Comprehensive Environmental Response, Compensation, and Liability
    Act of 1980, as amended, and section 126(g) of the Superfund Amendments
    and Reauthorization Act of 1986, $78,774,000.
        For carrying out sections 301 and 311 and title IV of the Public
    Health Service Act with respect to environmental health sciences,
    $630,774,000.

                           National Institute on Aging

        For carrying out section 301 and title IV of the Public Health
    Service Act with respect to aging, $994,411,000.

      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, $502,778,000.

        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,
    $380,377,000.

                     National Institute of Nursing Research

        For carrying out section 301 and title IV of the Public Health
    Service Act with respect to nursing research, $134,579,000.

               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, $430,121,000.

                        National Institute on Drug Abuse

        For carrying out section 301 and title IV of the Public Health
    Service Act with respect to drug abuse, $995,614,000.

                       National Institute of Mental Health

        For carrying out section 301 and title IV of the Public Health
    Service Act with respect to mental health, $1,382,114,000.

                    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, $478,072,000.

           National Institute of Biomedical Imaging and Bioengineering

        For carrying out section 301 and title IV of the Public Health
    Service Act with respect to biomedical imaging and bioengineering
    research, $282,109,000.

                     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, $1,053,926,000: 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.

           National Center for Complementary and Alternative Medicine

        For carrying out section 301 and title IV of the Public Health
    Service Act with respect to complementary and alternative medicine,
    $116,202,000.

            National Center on Minority Health and Health Disparities

        For carrying out section 301 and title IV of the Public Health
    Service Act with respect to minority health and health disparities
    research, $192,724,000.

                      John E. Fogarty International Center

        For carrying out the activities at the John E. Fogarty International
    Center, $64,266,000.

                          National Library of Medicine

        For carrying out section 301 and title IV of the Public Health
    Service Act with respect to health information communications,
    $316,040,000, of which $4,000,000 shall be available until expended for
    improvement of information systems: Provided, That in fiscal year 2004,
    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.

                             Office of the Director

                          (including transfer of funds)

        For carrying out the responsibilities of the Office of the Director,
    National Institutes of Health, $317,983,000, of which $60,942,000 shall
    be for the Office of AIDS Research: Provided, That funding shall be
    available for the purchase of not to exceed 29 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 the National Institutes of Health 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 National Institutes of
    Health Management Fund shall remain available for one fiscal year after
    the fiscal year in which they are deposited.

                            buildings and facilities

        For the study of, construction of, renovation of, and acquisition of
    equipment for, facilities of or used by the National Institutes of
    Health, including the acquisition of real property, $80,000,000, to
    remain available until expended.

        Note.--A regular 2003 appropriation for this account had not been
    enacted at the time the budget was prepared; therefore, this account is
    operating under a continuing resolution (P.L. 107-229, as amended). The
    amounts included for 2003 in this budget reflect the Administration's
    2003 policy proposals.

                  Unavailable Collections (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9915-0-1-552      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
    01.99 Balance, start of year............
        Receipts:
    02.20 Cooperative research and
            development agreements, NIH.....          15          15          15
        Appropriations:
    05.00 National Institutes of Health.....         -15         -15         -15
                                               ---------   ---------  ----------
    07.99 Balance, end of year..............
    ---------------------------------------------------------------------------

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9915-0-1-552      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
          Direct program:

    00.01   National Cancer Institute.......       4,178       4,673       4,771
    00.02   National Heart, Lung, and Blood
              Institute.....................       2,570       2,779       2,868
    00.03   National Institute of Dental and
              Craniofacial Research.........         342         370         382
    00.04   National Institute of Diabetes
              and Digestive and Kidney
              Disease.......................       1,560       1,704       1,820
    00.05   National Institute of
              Neurological Disorders and
              Stroke........................       1,325       1,432       1,469
    00.06   National Institute of Allergy
              and Infectious Diseases.......       2,340       3,984       4,335
    00.07   National Institute of General
              Medical Sciences..............       1,723       1,874       1,923
    00.08   National Institute of Child
              Health and Human Development..       1,111       1,196       1,245
    00.09   National Eye Institute..........         580         626         648
    00.10   National Institute of
              Environmental Health Sciences.         645         685         710
    00.11   National Institute on Aging.....         891         958         994
    00.12   National Institute of Arthritis
              and Musculoskeletal and Skin
              Disease.......................         448         486         503
    00.13   National Institute on Deafness
              and Other Communication
              Disorder......................         341         366         380
    00.14   National Institute of Mental
              Health........................       1,245       1,344       1,382
    00.15   National Institute on Drug Abuse         892         961         996
    00.16   Natinal Institute on Alcohol
              Abuse and Alcoholism..........         383         415         430
    00.17   National Institute of Nursing
              Research......................         120         130         135
    00.18   National Human Genome Research
              Institute.....................         428         458         478
    00.19   National Institute of Biomedical
              Imaging and Bioengineering....         111         120         282

    [[Page 417]]

    00.20   National Center for Research
              Resources.....................       1,010       1,090       1,054
    00.21   National Center for
              Complementary and Alternative
              Medicine......................         104         113         116
    00.22   National Center on Minority
              Health and Health Disparities.         158         186         193
    00.23   John E. Fogarty International
              Center........................          57          63          64
    00.24   National Library of Medicine....         276         308         316
    00.25   Office of the Director..........         235         254         318
    00.26   Buildings and facilities........         115         769          80
    00.27   Cooperative Research and
              Development Agreements........           9          15          15
    00.28   Royalities......................          28
    09.00 Reimbursable program..............       1,628       1,855       1,887
                                               ---------   ---------  ----------
    10.00   Total new obligations...........      24,853      29,214      29,794
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance carried
            forward, start of year..........         209         466         464
    22.00 New budget authority (gross)......      25,119      29,214      29,794
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......      25,328      29,680      30,258
    23.95 Total new obligations.............     -24,853     -29,214     -29,794
    23.98 Unobligated balance expiring or
            withdrawn.......................          -8
    24.40 Unobligated balance carried
            forward, end of year............         466         464         464
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Discretionary:

    40.00   Appropriation...................      23,366      27,244      27,742
    40.35   Appropriation rescinded.........         -30
    40.71   Reduction pursuant to P.L. 107-
              116 (Labor/HHS)...............          -9
    40.73   Reduction pursuant to P.L. 107-
              206...........................         -27
    41.00   Transferred to other accounts...        -125
    42.00   Transferred from other accounts.           7
                                               ---------   ---------  ----------
    43.00     Appropriation (total
                discretionary)..............      23,182      27,244      27,742
          Mandatory:

    60.00   Appropriation...................          70         100         150
    60.20   Appropriation (special fund)....          15          15          15
    62.00   Transferred from other accounts.          27
                                               ---------   ---------  ----------
    62.50     Appropriation (total
                mandatory)..................         112         115         165
          Spending authority from offsetting
              collections:

            Discretionary:
    68.00     Offsetting collections (cash).       1,533       1,855       1,887
    68.10     Change in uncollected customer
                payments from Federal
                sources (unexpired).........         292
                                               ---------   ---------  ----------
    68.90       Spending authority from
                  offsetting collections
                  (total discretionary).....       1,825       1,855       1,887
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................      25,119      29,214      29,794
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..      19,238      21,692      25,810
    73.10 Total new obligations.............      24,853      29,214      29,794
    73.20 Total outlays (gross).............     -22,201     -25,098     -28,386
    73.40 Adjustments in expired accounts
            (net)...........................        -134
    74.00 Change in uncollected customer
            payments from Federal sources
            (unexpired).....................        -292
    74.10 Change in uncollected customer
            payments from Federal sources
            (expired).......................         228
    74.40 Obligated balance, end of year....      21,692      25,810      27,218
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new discretionary
            authority.......................       7,095       8,829       8,989
    86.93 Outlays from discretionary
            balances........................      15,022      16,166      19,267
    86.97 Outlays from new mandatory
            authority.......................          33          34          51
    86.98 Outlays from mandatory balances...          51          69          79
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........      22,201      25,098      28,386
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

            Offsetting collections (cash)
                from:
    88.00     Federal sources...............      -1,688      -1,855      -1,887
    88.40     Non-Federal sources...........         -63
                                               ---------   ---------  ----------
    88.90       Total, offsetting
                  collections (cash)........      -1,751      -1,855      -1,887
          Against gross budget authority only:

    88.95   Change in uncollected customer
              payments from Federal sources
              (unexpired)...................        -292
    88.96   Portion of offsetting
              collections (cash) credited to
              expired accounts..............         218
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................      23,294      27,359      27,907
    90.00 Outlays...........................      20,450      23,243      26,499
    ----------------------------------------------------------------------------

    Additional net budget authority and outlays to cover cost of fully accruing
                                     retirement:
    99.00 Budget authority..................          86          92         104
    99.01 Outlays...........................          86          92         104
    ---------------------------------------------------------------------------

             DISTRIBUTION OF BUDGET AUTHORITY AND OUTLAYS BY ACCOUNT

                              [Dollars in millions]

                                            2002         2003        2004
    Distribution of budget authority by
        account:
      National Cancer Institute.........       4,177       4,673       4,771
      National Heart, Lung, and Blood
        Institute.......................       2,570       2,779       2,868
      National Institute of Dental and
        Craniofacial Research...........         342         370         382
      National Institute of Diabetes and
        Digestive and Kidney Diseases...       1,561       1,704       1,820
      National Institute of Neurological
        Disorder and Stroke.............       1,325       1,432       1,469
      National Institute of Allergy and
        Infectious Diseases.............       2,340       3,984       4,335
      National Institute of General
        Medical Sciences................       1,723       1,874       1,923
      National Institute of Child Health
        and Human Development...........       1,111       1,196       1,245
      National Eye Institute............         580         626         648
      National Institute of
        Environmental Health Sciences...         645         685         710
      National Institute on Aging.......         891         958         994
      National Institute of Arthritis
        and Musculoskeletal and Skin
        Diseases........................         448         486         503
      National Institute on Deafness and
        Other Communication Disorders...         341         366         380
      National Institute of Nursing
        Research........................         120         130         135
      National Institute on Alcohol
        Abuse and Alcoholism............         383         415         430
      National Institute on Drug Abuse..         893         961         996
      National Institute of Mental
        Health..........................       1,245       1,344       1,382
      National Center for Research
        Resources.......................       1,010       1,090       1,054
      National Human Genome Research
        Institute.......................         428         458         478
      National Institute of Biomedical
        Imaging and Bioengineering......         112         120         282
      National Center for Complementary
        and Alternative Medicine........         104         113         116
      National Center for Minority
        Health and Health Disparities...         158         186         193
      John E. Fogarty International
        Center..........................          57          63          64
      National Library of Medicine......         276         308         316
      Office of the Director............         235         254         318
      Buildings and facilities..........         204         769          80
                                        ------------------------------------
          Subtotal......................      23,279      27,344      27,892
      Cooperative Research and
        Development Agreements..........          15          15          15
                                        ------------------------------------
          Total Budget Authority, NIH...      23,294      27,359      27,907
                                        ====================================

                              [Dollars in millions]

                                            2002         2003        2004
    Distribution of outlays by account:
      National Cancer Institute.........       3,934       4,089       4,615
      National Heart, Lung, and Blood
        Institute.......................       2,341       2,513       2,744
      National Institute of Dental and
        Craniofacial Research...........         296         340         367
      National Institute of Diabetes and
        Digestive and Kidney Diseases...       1,327       1,544       1,697
      National Institute of Neurological
        Disorders and Stroke............       1,145       1.297       1,415
      National Institute of Allergy and
        Infectious Diseases.............       2,075       2,680       3,766
      National Institute of General
        Medical Sciences................       1,544       1,710       1,861
      National Institute of Child Health
        and Human Development...........         974       1,099       1,192
      National Eye Institute............         509         572         623
      National Institute of
        Environmental Health Sciences...         551         635         685
      National Institute on Aging.......         782         869         948
      National Institute of Arthritis
        and Musculoskeletal and Skin
        Diseases........................         394         440         481
      National Institute on Deafness and
        Other Communication Disorders...         298         336         364
      National Institute of Nursing
        Research........................          99         114         127
      National Institute on Alcohol
        Abuse and Alcoholism............         331         377         410
      National Institute on Drug Abuse..         765         864         942
      National Institute of Mental
        Health..........................       1,101       1,222       1,326
      National Center for Research
        Resources.......................         781         962       1,041
      National Human Genome Research
        Institute.......................         360         433         465
      National Institute of Biomedical
        Imaging and Bioengineering......          20          66         135
      National Center for Complementary
        and Alternative Medicine........          82          99         112
      National Center for Minority
        Health and Health Disparities...          86         136         165
      John E. Fogarty International
        Center..........................          51          54          61
      National Library of Medicine......         252         282         307
      Office of the Director............         263         232         272
      Buildings and Facilities..........         231         268         368
      Service and Supply Fund/Management
        Fund............................        -152           0           0
                                        ------------------------------------
          Subtotal Outlays..............      20,440      23,233      26,489
      Cooperative Research and
        Development Agreements..........          10          10          10
                                        ------------------------------------
          Total Outlays, NIH............      20,450      23,243      26,499
                                        ====================================

    [[Page 418]]

        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 National Institutes of Health (NIH) is working to meet the
    management challenges that can arise when an agency receives a
    substantial infusion of resources over a short period of time. NIH is in
    the process of identifying strategies and policies that could be
    implemented in 2004 and beyond to maximize budgetary and management
    flexibility in the future. Such strategies include funding the total
    costs of an increasing number of new grants in the grant's first year
    and managing grant average cost increases.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9915-0-1-552      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

          Direct obligations:

            Personnel compensation:
    11.1      Full-time permanent...........         600         636         657
    11.3      Other than full-time permanent         267         285         294
    11.5      Other personnel compensation..          37          31          32
    11.7      Military personnel............          24          25          26
    11.8      Special personal services
                payments....................         117         130         133
                                               ---------   ---------  ----------
    11.9        Total personnel compensation       1,045       1,107       1,142
    12.1    Civilian personnel benefits.....         227         241         250
    12.2    Military personnel benefits.....          13          14          15
    21.0    Travel and transportation of
              persons.......................          44          51          53
    22.0    Transportation of things........           6           7           7
    23.1    Rental payments to GSA..........           5           6           7
    23.2    Rental payments to others.......          18          23          30
    23.3    Communications, utilities, and
              miscellaneous charges.........          31          38          39
    24.0    Printing and reproduction.......          16          19          19
    25.1    Advisory and assistance services          93          90          92
    25.2    Other services..................         432         527         550
    25.3    Other purchases of goods and
              services from Government
              accounts......................       1,698       1,906       1,989
    25.4    Operation and maintenance of
              facilities....................         294         989         306
    25.5    Research and development
              contracts.....................       1,245       2,190       2,329
    25.6    Medical care....................          14          16          17
    25.7    Operation and maintenance of
              equipment.....................          57          59          61
    26.0    Supplies and materials..........         203         239         247
    31.0    Equipment.......................         177         206         209
    41.0    Grants, subsidies, and
              contributions.................      17,606      19,631      20,545
    42.0    Insurance claims and indemnities           1
                                               ---------   ---------  ----------
    99.0      Direct obligations............      23,225      27,359      27,907
    99.0  Reimbursable obligations..........       1,628       1,855       1,887
                                               ---------   ---------  ----------
    99.9    Total new obligations...........      24,853      29,214      29,794
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-9915-0-1-552      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
        Direct:
          Total compensable workyears:

    1001    Civilian full-time equivalent
              employment....................      12,259      12,528      12,352
    1101    Military full-time equivalent
              employment....................         379         387         382
        Reimbursable:
          Total compensable workyears:

    2001    Civilian full-time equivalent
              employment....................       4,465       4,626       4,640
    2101    Military full-time equivalent
              employment....................         138         143         143
    ---------------------------------------------------------------------------

            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, $3,393,315,000: Provided, That in addition to amounts
    provided herein, $16,000,000 shall be available from amounts available
    under section 241 of the Public Health Service Act to carry out national
    surveys on drug abuse.

        Note.--A regular 2003 appropriation for this account had not been
    enacted at the time the budget was prepared; therefore, this account is
    operating under a continuing resolution (P.L. 107-229, as amended). The
    amounts included for 2003 in this budget reflect the Administration's
    2003 policy proposals.

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1362-0-1-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
          Direct program:

    00.01   Mental health and substance
              abuse activities..............         884         900       1,106
    00.02   Mental health partnership.......         433         433         433
    00.03   Substance abuse partnership.....       1,725       1,785       1,785
    00.05   Program management..............          91          77          69
    09.01 Reimbursable program..............          73          75          75
                                               ---------   ---------  ----------
    10.00   Total new obligations...........       3,206       3,270       3,468
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance carried
            forward, start of year..........           7           6           6
    22.00 New budget authority (gross)......       3,209       3,270       3,468
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......       3,215       3,276       3,474
    23.95 Total new obligations.............      -3,206      -3,270      -3,468
    23.98 Unobligated balance expiring or
            withdrawn.......................          -3
    24.40 Unobligated balance carried
            forward, end of year............           6           6           6
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Discretionary:

    40.00   Appropriation...................       3,139       3,195       3,393
    40.71   Reduction pursuant to P.L. 107-
              116...........................          -1
    40.73   Reduction pursuant to P.L. 107-
              206...........................          -2
                                               ---------   ---------  ----------
    43.00     Appropriation (total
                discretionary)..............       3,136       3,195       3,393
          Spending authority from offsetting
              collections:

    68.00   Offsetting collections (cash)...          70          75          75
    68.10   Change in uncollected customer
              payments from Federal sources
              (unexpired)...................           3
                                               ---------   ---------  ----------
    68.90     Spending authority from
                offsetting collections
                (total discretionary).......          73          75          75
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................       3,209       3,270       3,468
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..       2,156       2,385       2,524
    73.10 Total new obligations.............       3,206       3,270       3,468
    73.20 Total outlays (gross).............      -2,957      -3,131      -3,349
    73.40 Adjustments in expired accounts
            (net)...........................         -19
    74.00 Change in uncollected customer
            payments from Federal sources
            (unexpired).....................          -3
    74.10 Change in uncollected customer
            payments from Federal sources
            (expired).......................           2
    74.40 Obligated balance, end of year....       2,385       2,524       2,643
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new discretionary
            authority.......................       1,314       1,327       1,405
    86.93 Outlays from discretionary
            balances........................       1,643       1,803       1,944
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........       2,957       3,131       3,349
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.00   Offsetting collections (cash)
              from: Federal sources.........         -72         -75         -75
          Against gross budget authority only:

    88.95   Change in uncollected customer
              payments from Federal sources
              (unexpired)...................          -3

    [[Page 419]]

    88.96   Portion of offsetting
              collections (cash) credited to
              expired accounts..............           2
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................       3,136       3,195       3,393
    90.00 Outlays...........................       2,885       3,056       3,274
    ----------------------------------------------------------------------------

    Additional net budget authority and outlays to cover cost of fully accruing
                                     retirement:
    99.00 Budget authority..................           5           5           6
    99.01 Outlays...........................           5           5           6
    ---------------------------------------------------------------------------

        This program provides Federal support for treatment and prevention
    in the areas of alcoholism, drug abuse, and mental health. The
    Administration has proposed to retain the language of the HHS General
    Provisions dealing with the penalty in Sec. 1926 of the Public Health
    Service Act, known as the Synar Amendment. The only penalty allowed
    under the current law is disproportionally severe, and could penalize
    those needing substance abuse services. The Administration looks forward
    to working with Congress to achieve a permanent statutory change that
    would establish a more fair and sustainable penalty structure.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1362-0-1-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

          Direct obligations:

            Personnel compensation:
    11.1      Full-time permanent...........          36          37          38
    11.3      Other than full-time permanent           2           2           2
    11.5      Other personnel compensation..           1           1           1
    11.7      Military personnel............           2           2           2
                                               ---------   ---------  ----------
    11.9        Total personnel compensation          41          42          43
    12.1    Civilian personnel benefits.....           9           9           9
    12.2    Military personnel benefits.....           1           1           1
    21.0    Travel and transportation of
              persons.......................           2           2           2
    23.1    Rental payments to GSA..........           4           6           7
    23.3    Communications, utilities, and
              miscellaneous charges.........           2           2           2
    24.0    Printing and reproduction.......           4           6           6
    25.1    Advisory and assistance services          19          19          18
    25.2    Other services..................         221         221         204
    25.3    Other purchases of goods and
              services from Government
              accounts......................         124         124         122
    31.0    Equipment.......................           1           1           1
    41.0    Grants, subsidies, and
              contributions.................       2,703       2,760       2,976
    42.0    Insurance claims and indemnities           2           2           2
                                               ---------   ---------  ----------
    99.0      Direct obligations............       3,133       3,195       3,393
    99.0  Reimbursable obligations..........          73          75          75
                                               ---------   ---------  ----------
    99.9    Total new obligations...........       3,206       3,270       3,468
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-1362-0-1-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
        Direct:
          Total compensable workyears:

    1001    Civilian full-time equivalent
              employment....................         490         499         483
    1101    Military full-time equivalent
              employment....................          36          33          33
        Reimbursable:
          Total compensable workyears:

    2101    Military full-time equivalent
              employment....................          56          56          56
    ---------------------------------------------------------------------------

                   AGENCY FOR HEALTHCARE RESEARCH AND QUALITY

                                  Federal Funds

    General and special funds:

                         Healthcare Research and Quality

        For carrying out titles III and IX of the Public Health Service Act,
    and part A of title XI of the Social Security Act, amounts received from
    Freedom of Information Act fees, reimbursable and interagency
    agreements, and the sale of data shall be credited to this appropriation
    and shall remain available until expended: Provided, That the amount
    made available pursuant to section 927(c) of the Public Health Service
    Act shall not exceed $279,000,000.

        Note.--A regular 2003 appropriation for this account had not been
    enacted at the time the budget was prepared; therefore, this account is
    operating under a continuing resolution (P.L. 107-229, as amended). The
    amounts included for 2003 in this budget reflect the Administration's
    2003 policy proposals.

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1700-0-1-552      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
          Direct program:

    01.04   Program support.................           3
    09.00 Reimbursable program..............         320         275         304
                                               ---------   ---------  ----------
    10.00   Total new obligations...........         323         275         304
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance carried
            forward, start of year..........           7          15          15
    22.00 New budget authority (gross)......         333         275         304
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......         340         290         319
    23.95 Total new obligations.............        -323        -275        -304
    23.98 Unobligated balance expiring or
            withdrawn.......................          -1
    24.40 Unobligated balance carried
            forward, end of year............          15          15          15
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Discretionary:

    40.00   Appropriation...................           3
          Spending authority from offsetting
              collections:

    68.00   Offsetting collections (cash)...         329         275         304
    68.10   Change in uncollected customer
              payments from Federal sources
              (unexpired)...................           1
                                               ---------   ---------  ----------
    68.90     Spending authority from
                offsetting collections
                (total discretionary).......         330         275         304
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................         333         275         304
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..         278         337         337
    73.10 Total new obligations.............         323         275         304
    73.20 Total outlays (gross).............        -263        -275        -304
    73.40 Adjustments in expired accounts
            (net)...........................          -1
    74.00 Change in uncollected customer
            payments from Federal sources
            (unexpired).....................          -1
    74.40 Obligated balance, end of year....         337         337         337
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new discretionary
            authority.......................          87         275         304
    86.93 Outlays from discretionary
            balances........................         176
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........         263         275         304
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.00   Offsetting collections (cash)
              from: Federal sources.........        -329        -275        -304
          Against gross budget authority only:

    88.95   Change in uncollected customer
              payments from Federal sources
              (unexpired)...................          -1
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................           3
    90.00 Outlays...........................         -66
    ---------------------------------------------------------------------------

        This activity supports the development of scientific evidence and
    tools to improve the quality, safety, and effectiveness of all aspects
    of the health care system, and initiatives to disseminate and translate
    scientific findings into health care practice.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1700-0-1-552      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

          Direct obligations:

    11.1    Personnel compensation: Full-
              time permanent................           2
    12.1    Civilian personnel benefits.....           1
                                               ---------   ---------  ----------
    99.0      Direct obligations............           3
    99.0  Reimbursable obligations..........         320         275         304
                                               ---------   ---------  ----------
    99.9    Total new obligations...........         323         275         304
    ---------------------------------------------------------------------------

    [[Page 420]]

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-1700-0-1-552      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
        Direct:
          Total compensable workyears:

    1001    Civilian full-time equivalent
              employment....................          22
        Reimbursable:
          Total compensable workyears:

    2001    Civilian full-time equivalent
              employment....................         246         284         284
    2101    Military full-time equivalent
              employment....................          10          10          10
    ---------------------------------------------------------------------------

                   CENTERS FOR MEDICARE AND MEDICAID SERVICES

                                  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, $124,892,197,000, to remain available until
    expended.
        For making, after May 31, 2004, payments to States under title XIX
    of the Social Security Act for the last quarter of fiscal year 2004 for
    unanticipated costs, incurred for the current fiscal year, such sums as
    may be necessary.
        For making payments to States or in the case of section 1928 on
    behalf of States under title XIX of the Social Security Act for the
    first quarter of fiscal year 2005, $58,416,275,000, 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.

        Note.--A regular 2003 appropriation for this account had not been
    enacted at the time the budget was prepared; therefore, this account is
    operating under a continuing resolution (P.L. 107-229, as amended). The
    amounts included for 2003 in this budget reflect the Administration's
    2003 policy proposals.

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0512-0-1-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Medicaid vendor payments..........     142,585     152,485     166,706
    00.02 State and local administration....       8,076       8,902       9,067
    00.03 Vaccine purchases.................         983       1,056         980
    09.01 Medicare Part B premiums..........                      50
                                               ---------   ---------  ----------
    10.00   Total new obligations...........     151,644     162,493     176,754
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance carried
            forward, start of year..........         110           7
    22.00 New budget authority (gross)......     147,342     162,486     176,754
    22.10 Resources available from
            recoveries of prior year
            obligations.....................       4,198
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......     151,650     162,493     176,754
    23.95 Total new obligations.............    -151,644    -162,493    -176,754
    24.40 Unobligated balance carried
            forward, end of year............           7
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Mandatory:

            Appropriation:
    60.00     Appropriation.................     106,822     112,090     124,892
    60.00     Appropriation.................       4,311       3,667
                                               ---------   ---------  ----------
    62.50     Appropriation (total
                mandatory)..................     111,133     115,757     124,892
    65.00   Advance appropriation...........      36,208      46,602      51,861
    69.00 Offsetting collections (cash).....         138         127
    69.10 Change in uncollected customer
            payments from Federal sources
            (unexpired).....................        -136
                                               ---------   ---------  ----------
    69.90   Spending authority from
              offsetting collections (total
              mandatory)....................           2         127
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................     147,343     162,486     176,754
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..       5,626       5,557       5,557
    73.10 Total new obligations.............     151,644     162,493     176,754
    73.20 Total outlays (gross).............    -147,650    -162,493    -176,754
    73.45 Recoveries of prior year
            obligations.....................      -4,198
    74.00 Change in uncollected customer
            payments from Federal sources
            (unexpired).....................         136
    74.40 Obligated balance, end of year....       5,557       5,557       5,557
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new mandatory
            authority.......................     146,652     161,493     175,754
    86.98 Outlays from mandatory balances...         998       1,000       1,000
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........     147,650     162,493     176,754
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.00   Offsetting collections (cash)
              from: Federal sources.........        -138        -127
          Against gross budget authority only:

    88.95   Change in uncollected customer
              payments from Federal sources
              (unexpired)...................         136
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................     147,340     162,359     176,754
    90.00 Outlays...........................     147,512     162,366     176,754
    ---------------------------------------------------------------------------

                     Summary of Budget Authority and Outlays

                            (in millions of dollars)

                                         2002 actual  2003 est.   2004 est.
    Enacted/requested:
      Budget Authority..................     147,341     162,359     176,753
      Outlays...........................     147,512     162,366     176,754
    Legislative proposal, not subject to
        PAYGO:
      Budget Authority..................                     -50         -55
      Outlays...........................                     -50         -55
    Legislative proposal, subject to
        PAYGO:
      Budget Authority..................                     225       5,844
      Outlays...........................                     225       5,844
                                        ------------------------------------
    Total:
      Budget Authority..................     147,341     162,534     182,542
      Outlays...........................     147,512     162,541     182,543
                                        ====================================

        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      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
    41.0  Direct obligations: Grants,
            subsidies, and contributions....     151,642     162,443     176,754
    99.0  Reimbursable obligations:
            Reimbursable obligations........           2          50
                                               ---------   ---------  ----------
    99.9    Total new obligations...........     151,644     162,493     176,754
    ---------------------------------------------------------------------------

                          Grants to States for Medicaid

                  (Legislative proposal, not subject to PAYGO)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0512-2-1-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.00   Offsetting collections (cash)
              from: Federal sources.........                     -50         -55
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................                     -50         -55
    90.00 Outlays...........................                     -50         -55
    ---------------------------------------------------------------------------

        This schedule reflects the Administration's Medicaid proposals.

    [[Page 421]]

                          Grants to States for Medicaid

                    (Legislative proposal, subject to PAYGO)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0512-4-1-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Targeted reforms..................                     175       3,356
    09.00 Reimbursable program--Medicare
            Part B premium..................                      50          55
    09.21 Reimbursable program from SCHIP...                               2,433
                                               ---------   ---------  ----------
    10.00   Total new obligations...........                     225       5,844
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......                     225       5,844
    23.95 Total new obligations.............                    -225      -5,844
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Mandatory:

    60.00   Appropriation...................                     175       3,356
    62.00   Transferred from other accounts.                               2,433
                                               ---------   ---------  ----------
    62.50     Appropriation (total
                mandatory)..................                     175       5,789
    69.00 Offsetting collections (cash).....                      50          55
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................                     225       5,844
    ----------------------------------------------------------------------------

        Change in obligated balances:
    73.10 Total new obligations.............                     225       5,844
    73.20 Total outlays (gross).............                    -225      -5,844
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new mandatory
            authority.......................                     225       5,844
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................                     225       5,844
    90.00 Outlays...........................                     225       5,844
    ---------------------------------------------------------------------------

        This schedule reflects the Administration's Medicaid proposals.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0512-4-1-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
    41.0  Direct obligations: Grants,
            subsidies, and contributions....                     175       3,356
    99.0  Reimbursable obligations:
            Reimbursable obligations........                      50       2,488
                                               ---------   ---------  ----------
    99.9    Total new obligations...........                     225       5,844
    ---------------------------------------------------------------------------

                         State Grants and Demonstrations

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0516-0-1-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 TWWIIA--infrastructure grants.....          21          24          27
    00.02 TWWIIA--demo grants...............           4           9          18
    00.03 High Risk Pools--seed grants......                      10          10
    00.04 High Risk Pools--operations grants                      30          40
                                               ---------   ---------  ----------
    10.00   Total new obligations...........          25          73          95
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance carried
            forward, start of year..........          40          83         142
    22.00 New budget authority (gross)......          67         132         117
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......         107         215         259
    23.95 Total new obligations.............         -25         -73         -95
    24.40 Unobligated balance carried
            forward, end of year............          83         142         164
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Mandatory:

            Appropriation:
    60.00     Appropriation.................          67          72          77
    60.00     Appropriation.................                      60          40
                                               ---------   ---------  ----------
    62.50     Appropriation (total
                mandatory)..................          67         132         117
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..          20          35          71
    73.10 Total new obligations.............          25          73          95
    73.20 Total outlays (gross).............         -10         -37         -65
    74.40 Obligated balance, end of year....          35          71         101
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new mandatory
            authority.......................           2          14          29
    86.98 Outlays from mandatory balances...           8          23          36
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........          10          37          65
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................          67         132         117
    90.00 Outlays...........................          10          37          65
    ---------------------------------------------------------------------------

        State Grants and Demonstrations provides funding for grant programs
    established under the Ticket to Work and Work Incentives Improvement Act
    and Title II of the Trade Act of 2002. The Ticket to Work and Work
    Incentives Improvement Act of 1999 (P.L. 106-170), Title II, established
    two grant programs. Section 203 provides funding for Medicaid
    infrastructure grants to support the design, establishment and operation
    of State infrastructures to help working people with disabilities
    purchase health coverage through Medicaid. Section 204 provides funding
    for States to establish Demonstrations to Maintain Independence and
    Employment, which will provide Medicaid benefits and services to working
    individuals who have a condition that, without medical assistance, will
    result in disability. Part of Title II of the Trade Act of 2002 (P.L.
    107-210) amends the Public Health Service Act by adding section 2745,
    which addresses promotion of qualified high-risk pools for assisting
    ``high-risk'' individuals who may find private health insurance
    unavailable, unaffordable, or undesirable. This section establishes: (1)
    seed grants to states for the creation and initial operation of a
    qualified high-risk pool for those states that do not have one as of the
    legislative enactment, and (2) grants to states for operation of
    qualified high-risk pools.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0516-0-1-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

          Grants, subsidies, and contributions:

    41.0    Grants, subsidies, and
              contributions.................          25          33          45
    41.0    Grants, subsidies, and
              contributions.................                      40          50
                                               ---------   ---------  ----------
    99.9    Total new obligations...........          25          73          95
    ---------------------------------------------------------------------------

                       Payments to Health Care Trust Funds

        For payment to the Federal Hospital Insurance and the Federal
    Supplementary Medical Insurance Trust Funds, as provided under section
    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, $95,084,100,000.
        Note.--A regular 2003 appropriation for this account had not been
    enacted at the time the budget was prepared; therefore, this account is
    operating under a continuing resolution (P.L. 107-229, as amended). The
    amounts included for 2003 in this budget reflect the Administration's
    2003 policy proposals.

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0580-0-1-571      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Supplementary medical insurance
            (SMI)...........................      78,318      80,905      94,518
    00.02 Hospital insurance for uninsured
            (HI)............................         292         225         197
    00.03 Federal uninsured payment (HI)....         150         168         168
    00.04 Program management (HI)...........         202         173         201
    00.05 FHI trust fund, Transfers from
            general fund (civil monetary
            penalties)......................                       7           7
    00.06 Federal payments from taxation of
            OASDI benefits (HI).............      10,946       7,780       8,348
    00.07 Fraud and abuse control, FBI......         101         114         114
    00.08 Fraud and abuse control, criminal
            fines...........................         440           4           4
                                               ---------   ---------  ----------
    10.00   Total new obligations...........      90,449      89,376     103,557
    ----------------------------------------------------------------------------

    [[Page 422]]

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......      93,467      89,376     103,557
    23.95 Total new obligations.............     -90,449     -89,376    -103,557
    23.98 Unobligated balance expiring or
            withdrawn.......................      -3,017
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Mandatory:

            Appropriation:
    60.00     Appropriation.................      10,946       7,780       8,348
    60.00     Appropriation.................         440          11          11
    60.00     Appropriation.................      81,980      81,471      95,084
    60.00     Appropriation.................         101         114         114
                                               ---------   ---------  ----------
    62.50     Appropriation (total
                mandatory)..................      93,467      89,376     103,557
    ----------------------------------------------------------------------------

        Change in obligated balances:
    73.10 Total new obligations.............      90,449      89,376     103,557
    73.20 Total outlays (gross).............     -90,450     -89,376    -103,557
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new mandatory
            authority.......................      90,450      89,376     103,557
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................      93,467      89,376     103,557
    90.00 Outlays...........................      90,450      89,376     103,557
    ----------------------------------------------------------------------------

    Additional net budget authority and outlays to cover cost of fully accruing
                                     retirement:
    99.00 Budget authority..................           7           7           8
    99.01 Outlays...........................           7           7           8
    ---------------------------------------------------------------------------

                     Summary of Budget Authority and Outlays

                            (in millions of dollars)

                                         2002 actual  2003 est.   2004 est.
    Enacted/requested:
      Budget Authority..................      93,467      89,376     103,557
      Outlays...........................      90,450      89,376     103,557
    Legislative proposal, not subject to
        PAYGO:
      Budget Authority..................                                 150
      Outlays...........................                                 150
                                        ------------------------------------
    Total:
      Budget Authority..................      93,467      89,376     103,707
      Outlays...........................      90,450      89,376     103,707
                                        ====================================

        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 CMS
    program management.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0580-0-1-571      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
    41.0  Grants, subsidies, and
            contributions...................      89,805      88,810     102,991
    42.0  Insurance claims and indemnities..         442         393         365
    94.0  Financial transfers...............         202         173         201
                                               ---------   ---------  ----------
    99.0      Direct obligations............      90,449      89,376     103,557
                                               ---------   ---------  ----------
    99.9    Total new obligations...........      90,449      89,376     103,557
    ---------------------------------------------------------------------------

                       Payments to Health Care Trust Funds

                  (Legislative proposal, not subject to PAYGO)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0580-2-1-571      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.09 Military Service Credits (HI).....                                 150
                                               ---------   ---------  ----------
    10.00   Total new obligations (object
              class 42.0)...................                                 150
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......                                 150
    23.95 Total new obligations.............                                -150
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Mandatory:

    60.00   Appropriation...................                                 150
    ----------------------------------------------------------------------------

        Change in obligated balances:
    73.10 Total new obligations.............                                 150
    73.20 Total outlays (gross).............                                -150
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new mandatory
            authority.......................                                 150
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................                                 150
    90.00 Outlays...........................                                 150
    ---------------------------------------------------------------------------

        The budget proposes to compensate HI for the equivalent of payroll
    taxes on deemed wages posted to the Social Security earnings records of
    uniformed services personnel in 2000 and 2001.

                               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 $2,733,507,000, 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 section 1857(e)(2) of
    the Social Security 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 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
    $65,000,000, to remain available until September 30, 2005, is for
    contract costs for CMS' Systems Revitalization Plan: Provided further,
    That $56,991,000, to remain available until September 30, 2005, is for
    contract costs for the Healthcare Integrated General Ledger Accounting
    System: Provided further, That not less than $129,000,000 shall be for
    processing Medicare appeals: Provided further, That the Secretary of
    Health and Human Services may use alternate mechanisms in lieu of
    Administrative Law Judge review: Provided further, That the Secretaryis
    directed to collect fees in fiscal year 2004 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.
        Note.--A regular 2003 appropriation for this account had not been
    enacted at the time the budget was prepared; therefore, this account is
    operating under a continuing resolution (P.L. 107-229, as amended). The
    amounts included for 2003 in this budget reflect the Administration's
    2003 policy proposals.

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0511-0-1-550      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
          Direct program:

    00.01   Medicare operations.............       1,521       1,709       1,777

    [[Page 423]]

    00.02   Federal administration..........         530         562         581
    00.03   State survey and certification..         253         248         248
    00.04   Research, demonstrations, and
              evaluation projects...........         117          28          63
    00.05   Revitalization plan.............                                  65
                                               ---------   ---------  ----------
    01.00   Total direct program............       2,421       2,547       2,734
    09.01 CLIA..............................          35          43          43
    09.03 Other reimbursements..............          28           2           2
    09.06 Medicare+Choice...................          21          16          14
                                               ---------   ---------  ----------
    09.09   Total reimbursable program......          84          61          59
                                               ---------   ---------  ----------
    10.00   Total new obligations...........       2,505       2,608       2,793
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance carried
            forward, start of year..........          80          99          99
    22.00 New budget authority (gross)......       2,498       2,608       2,793
    22.10 Resources available from
            recoveries of prior year
            obligations.....................          31
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......       2,609       2,707       2,892
    23.95 Total new obligations.............      -2,505      -2,608      -2,793
    23.98 Unobligated balance expiring or
            withdrawn.......................          -5
    24.40 Unobligated balance carried
            forward, end of year............          99          99          99
    ----------------------------------------------------------------------------

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

            Discretionary:
    68.00     Offsetting collections (cash).       1,748       2,608       2,793
    68.10     Change in uncollected customer
                payments from Federal
                sources (unexpired).........         758
    68.73     Reduction pursuant to P.L.
                107-116.....................          -4
    68.76     Reduction pursuant to P.L.
                107-206.....................          -4
                                               ---------   ---------  ----------
    68.90       Spending authority from
                  offsetting collections
                  (total discretionary).....       2,498       2,608       2,793
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..         175        -219        -219
    73.10 Total new obligations.............       2,505       2,608       2,793
    73.20 Total outlays (gross).............      -2,403      -2,608      -2,793
    73.40 Adjustments in expired accounts
            (net)...........................         -33
    73.45 Recoveries of prior year
            obligations.....................         -31
    74.00 Change in uncollected customer
            payments from Federal sources
            (unexpired).....................        -758
    74.10 Change in uncollected customer
            payments from Federal sources
            (expired).......................         326
    74.40 Obligated balance, end of year....        -219        -219        -219
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new discretionary
            authority.......................       1,818       2,608       2,793
    86.93 Outlays from discretionary
            balances........................         585
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........       2,403       2,608       2,793
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

            Offsetting collections (cash)
                from:
    88.00     Federal sources...............      -1,959      -2,547      -2,734
    88.40     Non-Federal sources...........         -60         -61         -59
                                               ---------   ---------  ----------
    88.90       Total, offsetting
                  collections (cash)........      -2,019      -2,608      -2,793
          Against gross budget authority only:

    88.95   Change in uncollected customer
              payments from Federal sources
              (unexpired)...................        -758
    88.96   Portion of offsetting
              collections (cash) credited to
              expired accounts..............         271
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................          -8
    90.00 Outlays...........................         384
    ---------------------------------------------------------------------------

                     Summary of Budget Authority and Outlays

                            (in millions of dollars)

                                         2002 actual  2003 est.   2004 est.
    Enacted/requested:
      Budget Authority..................          -8
      Outlays...........................         384
    Legislative proposal, not subject to
        PAYGO:
      Budget Authority..................
      Outlays...........................
                                        ------------------------------------
    Total:
      Budget Authority..................          -8
      Outlays...........................         384
                                        ====================================

        Program management activities include funding for research, Medicare
    operations, survey and certification, CLIA, Medicare+Choice, the CMS
    systems revitalization plan, and administrative costs.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0511-0-1-550      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

          Direct obligations:

            Personnel compensation:
    11.1      Full-time permanent...........         302         332         333
    11.3      Other than full-time permanent           6          10          10
    11.5      Other personnel compensation..           6           5           4
    11.7      Military personnel............           7           7           8
                                               ---------   ---------  ----------
    11.9        Total personnel compensation         321         354         355
    12.1    Civilian personnel benefits.....          68          71          72
    12.2    Military personnel benefits.....           2           2           3
    21.0    Travel and transportation of
              persons.......................          10           9          10
    22.0    Transportation of things........           1
    23.1    Rental payments to GSA..........          28          16          16
    23.3    Communications, utilities, and
              miscellaneous charges.........          26           3           3
    24.0    Printing and reproduction.......          19           4           3
    25.1    Advisory and assistance services           3
    25.2    Other services..................         707         359         384
    25.3    Other purchases of goods and
              services from Government
              accounts......................           8           2           2
    25.6    Medical care....................       1,134       1,709       1,834
    26.0    Supplies and materials..........           3           2           2
    31.0    Equipment.......................           6
    32.0    Land and structures.............                      10          10
    41.0    Grants, subsidies, and
              contributions.................          85           6          40
                                               ---------   ---------  ----------
    99.0      Direct obligations............       2,421       2,547       2,734
    99.0  Reimbursable obligations..........          84          61          59
                                               ---------   ---------  ----------
    99.9    Total new obligations...........       2,505       2,608       2,793
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-0511-0-1-550      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
        Direct:
          Total compensable workyears:

    1001    Civilian full-time equivalent
              employment....................       4,333       4,498       4,325
    1101    Military full-time equivalent
              employment....................          84          83          83
        Reimbursable:
          Total compensable workyears:

    2001    Civilian full-time equivalent
              employment....................          80          80          78
    ---------------------------------------------------------------------------

                               Program Management

                  (Legislative proposal, not subject to PAYGO)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0511-2-1-550      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Medicare operations...............                    -130        -201
    09.01 Proposed user fees................                     130         201
                                               ---------   ---------  ----------
    10.00   Total new obligations...........
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

            Offsetting collections (cash)
                from:
    88.00     Federal sources...............                     130         201
    88.40     Non-Federal sources...........                    -130        -201
                                               ---------   ---------  ----------
    88.90       Total, offsetting
                  collections (cash)........
    ----------------------------------------------------------------------------

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

        The budget includes $201 million in new user fees to finance CMS
    activities. Proposed fees include: a duplicate or unprocessable claims
    fee and a Medicare appeals filing fee. Authorizing legislation for these
    fees will be proposed to au

    [[Page 424]]

    thorize the collection and spending of the fees subject to
    appropriations language. If authorizing legislation is enacted, the
    amount appropriated from the Federal hospital insurance and Federal
    supplementary medical insurance trust funds will be reduced by $201
    million.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0511-2-1-550      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
    25.6  Direct obligations: Medical care..                    -130        -201
    99.0  Reimbursable obligations:
            Reimbursable obligations........                     130         201
                                               ---------   ---------  ----------
    99.9    Total new obligations...........
    ---------------------------------------------------------------------------

                     State Children's Health Insurance Fund

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0515-0-1-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Grants, subsidies, and
            contributions...................       5,934       5,382       3,175
                                               ---------   ---------  ----------
    10.00   Total new obligations (object
              class 41.0)...................       5,934       5,382       3,175
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......       5,934       5,382       3,175
    23.95 Total new obligations.............      -5,934      -5,382      -3,175
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Mandatory:

            Appropriation:
    60.00     Appropriation, BBA............       3,150       3,150       3,150
    60.00     Appropriation, BBRA for
                territories.................          25          25          25
    61.00   Transferred to other accounts...         -60
                                               ---------   ---------  ----------
    62.50     Appropriation (total
                mandatory)..................       3,115       3,175       3,175
    63.00   Reappropriation.................       2,819       2,207
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................       5,934       5,382       3,175
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..      11,501      10,934       8,099
    73.10 Total new obligations.............       5,934       5,382       3,175
    73.20 Total outlays (gross).............      -3,682      -4,751      -5,090
    73.40 Adjustments in expired accounts
            (net)...........................      -2,819      -3,466        -831
    74.40 Obligated balance, end of year....      10,934       8,099       5,353
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new mandatory
            authority.......................         413          12         381
    86.98 Outlays from mandatory balances...       3,269       4,739       4,709
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........       3,682       4,751       5,090
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................       5,934       5,382       3,175
    90.00 Outlays...........................       3,682       4,751       5,090
    ---------------------------------------------------------------------------

                     Summary of Budget Authority and Outlays

                            (in millions of dollars)

                                         2002 actual  2003 est.   2004 est.
    Enacted/requested:
      Budget Authority..................       5,934       5,382       3,175
      Outlays...........................       3,682       4,751       5,090
    Legislative proposal, subject to
        PAYGO:
      Budget Authority..................                              -2,433
      Outlays...........................                              -2,433
                                        ------------------------------------
    Total:
      Budget Authority..................       5,934       5,382         742
      Outlays...........................       3,682       4,751       2,657
                                        ====================================

        The Balanced Budget Act of 1997 established the State Children's
    Health Insurance Program (SCHIP) under Title XXI of the Social Security
    Act. Title XXI 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 SCHIP program, a SCHIP
    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      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Grants, subsidies, and
            contributions...................                              -2,433
                                               ---------   ---------  ----------
    10.00   Total new obligations (object
              class 41.0)...................                              -2,433
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......                              -2,433
    23.95 Total new obligations.............                               2,433
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Mandatory:

    61.00   Transferred to other accounts...                              -2,433
    ----------------------------------------------------------------------------

        Change in obligated balances:
    73.10 Total new obligations.............                              -2,433
    73.20 Total outlays (gross).............                               2,433
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new mandatory
            authority.......................                              -2,433
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................                              -2,433
    90.00 Outlays...........................                              -2,433
    ---------------------------------------------------------------------------

        This schedule reflects SCHIP legislative proposals, including
    Medicaid/SCHIP reform.

          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 2004, no
    commitments for direct loans or loan guarantees shall be made.
        Note.--A regular 2003 appropriation for this account had not been
    enacted at the time the budget was prepared; therefore, this account is
    operating under a continuing resolution (P.L. 107-229, as amended). The
    amounts included in 2003 in this budget reflect the Administration's
    2003 policy proposals.

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-4420-0-3-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance carried
            forward, start of year..........          10          10          10
    23.98 Unobligated balance expiring or
            withdrawn.......................                                 -10
    24.40 Unobligated balance carried
            forward, end of year............          10          10
    ----------------------------------------------------------------------------

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

        The last loan commitments from the HMO loan fund were made in 1983.

    [[Page 425]]

                                   Trust Funds

                      Federal Hospital Insurance Trust Fund

                  Unavailable Collections (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8005-0-7-571      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
    01.99 Balance, start of year............     196,791     227,932     254,489
        Receipts:
    02.00 Transfers from general fund (FICA
            taxes)..........................     138,876     141,866     148,900
    02.01 Transfers from general fund (SECA
            taxes)..........................       9,785      10,011      10,487
    02.02 Receipts from Railroad Retirement
            Board...........................         388         398         397
    02.03 Civil penalties and damages.......         330         363         363
    02.20 Premiums collected for uninsured
            individuals not otherwise
            eligible........................       1,525       1,568       1,681
    02.21 Other proprietary receipts from
            the public......................           1
    02.40 Federal employer contributions
            (FICA)..........................       2,191       2,333       2,402
    02.41 Postal service employer
            contributions (FICA)............         722         684         683
    02.42 Payments from the general fund
            (uninsured and program
            management).....................         646         566         566
    02.43 Taxation on OASDI benefits........      10,946       7,780       8,348
    02.44 Interest payments by Railroad
            Retirement Board................          36          31          28
    02.45 Interest received by trust funds..      13,738      14,006      15,331
    02.47 FBI, Payment from the general fund         101         114         114
    02.48 Criminal fines, transfers from the
            general fund....................         431           4           4
    02.49 Civil monetary penalties,
            transfers from the general fund.           7           7           7
    02.50 Transfers from DOD, HI............          16           4
    02.52 Transfer from general fund (in
            lieu of DOD payments for
            military service credits).......                                 150
    02.81 Health care fraud and abuse
            control, offsetting collections.           7
                                               ---------   ---------  ----------
    02.99   Total receipts and collections..     179,746     179,735     189,461
                                               ---------   ---------  ----------
    04.00 Total: Balances and collections...     376,537     407,667     443,950
        Appropriations:
          Appropriations:

    05.00   Federal hospital insurance trust
              fund..........................    -147,198    -152,128    -161,113
    05.00   Proposed legislation not subject
              to PAYGO......................                      25          38
    05.01 Health care fraud and abuse
            control account.................      -1,018      -1,075      -1,075
                                               ---------   ---------  ----------
    05.99   Total appropriations............    -148,216    -153,178    -162,150
    06.10 Unobligated balance returned to
            receipts........................        -389
                                               ---------   ---------  ----------
    07.99 Balance, end of year..............     227,932     254,489     281,800
    ---------------------------------------------------------------------------

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8005-0-7-571      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Benefit payments, HI..............     144,139     150,001     159,418
    00.02 Administration, HI................       1,552       1,532       1,563
    00.03 Quality improvement organizations,
            HI..............................         244         572          80
    00.04 Research, HI......................          95          23          52
    00.05 HI partial transfer of home health
            to SMI..........................       1,168
                                               ---------   ---------  ----------
    10.00   Total new obligations...........     147,198     152,128     161,113
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......     147,198     152,128     161,113
    23.95 Total new obligations.............    -147,198    -152,128    -161,113
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Discretionary:

    40.26   Appropriation (trust fund)......       1,607       1,515       1,574
          Mandatory:

    60.26   Appropriation (trust fund)......     178,139     178,220     187,737
    60.45   Portion precluded from
              obligation....................     -32,548     -27,607     -28,198
                                               ---------   ---------  ----------
    62.50     Appropriation (total
                mandatory)..................     145,591     150,613     159,538
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................     147,198     152,128     161,113
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..         408         966       1,219
    73.10 Total new obligations.............     147,198     152,128     161,113
    73.20 Total outlays (gross).............    -147,050    -151,875    -161,322
    73.40 Adjustments in expired accounts
            (net)...........................         410
    74.40 Obligated balance, end of year....         966       1,219       1,009
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new discretionary
            authority.......................       1,444       1,506       1,556
    86.93 Outlays from discretionary
            balances........................                      60          15
    86.97 Outlays from new mandatory
            authority.......................     145,606     150,155     159,475
    86.98 Outlays from mandatory balances...                     154         275
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........     147,050     151,875     161,322
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................     147,198     152,128     161,113
    90.00 Outlays...........................     147,050     151,875     161,322
    ----------------------------------------------------------------------------

        Memorandum (non-add) entries:
    92.01 Total investments, start of year:
            Federal securities: Par value...     197,137     228,908     255,896
    92.02 Total investments, end of year:
            Federal securities: Par value...     228,908     255,896     282,960
    ----------------------------------------------------------------------------

    Additional net budget authority and outlays to cover cost of fully accruing
                                     retirement:
    99.00 Budget authority..................          38          43          46
    99.01 Outlays...........................          38          43          46
    ---------------------------------------------------------------------------

                     Summary of Budget Authority and Outlays

                            (in millions of dollars)

                                         2002 actual  2003 est.   2004 est.
    Enacted/requested:
      Budget Authority..................     147,198     152,128     161,112
      Outlays...........................     147,050     151,875     161,321
    Legislative proposal, not subject to
        PAYGO:
      Budget Authority..................                     -25         -38
      Outlays...........................                     -25         -38
                                        ------------------------------------
    Total:
      Budget Authority..................     147,198     152,103     161,074
      Outlays...........................     147,050     151,850     161,283
                                        ====================================

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

        The status of the trust fund is as follows:

                      Status of Funds (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8005-0-7-571      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
        Unexpended balance, start of year:
    0100  Treasury balance..................         247         202
    0101  Federal securities: Par value.....     197,137     228,908     255,921
                                               ---------   ---------  ----------
    0199    Total balance, start of year....     197,385     229,111     255,921
        Cash income during the year:
          Current law:

            Receipts:
    1200      FHI trust fund, transfers from
                general fund (FICA taxes)...     138,876     141,866     148,900
    1201      FHI trust fund, transfers from
                general fund (SECA taxes)...       9,785      10,011      10,487
    1202      FHI trust fund, receipts from
                Railroad Retirement Board...         388         398         397
    1203      HCFAC: Civil penalties and
                damages.....................         330         363         363
            Offsetting receipts
                (proprietary):
    1220      FHI trust fund, premiums
                collected for uninsured
                individuals not otherwise
                eligible....................       1,525       1,568       1,681
    1221      Other proprietary receipts....           1
            Offsetting receipts
                (intragovernmental):
    1240      FHI trust fund, Federal
                employer contributions
                (FICA)......................       2,191       2,333       2,402
    1241      FHI trust fund, Postal Service
                employer contributions
                (FICA)......................         722         684         683
              Offsetting receipts
                  (intragovernmental):
    1242        FHI trust fund, Federal
                  payment for transitional
                  coverage for uninsured
                  Federal employees.........         150         168         168
    1242        FHI trust fund, Federal
                  payment for transitional
                  coverage for the uninsured         292         225         197
    1242        FHI trust fund, general fund
                  transfer, program
                  management (HI)...........         205         173         201
    1243      FHI trust fund, Federal
                payments for OASDI taxes....      10,946       7,780       8,348
    1244      FHI trust fund, interest
                payment from Railroad
                Retirement Board............          36          31          28
    1245      FHI trust fund, interest on
                investments.................      13,738      14,006      15,331
    1247      HCFAC: FBI....................         101         114         114
    1248      HCFAC: Criminal fines.........         431           4           4
    1249      HCFAC: Civil monetary
                penalties...................           7           7           7
    1250      Other intragovernmental
                transactions................          16           4
            Offsetting collections:
    1281      HCFAC user fees...............           7
                                               ---------   ---------  ----------
    1299      Income under present law......     179,746     179,735     189,311

    [[Page 426]]

          Proposed legislation:

            Offsetting receipts
                (intragovernmental):
    2252      Transfer from the general fund
                in lieu of DOD payments for
                military service credits....                                 150
                                               ---------   ---------  ----------
    3299    Total cash income...............     179,746     179,735     189,461
        Cash outgo during year:
          Current law:

            Cash outgo during the year (-):
    4500      Benefit Payments..............    -144,140    -150,001    -159,418
    4500      Administration................      -1,425      -1,519      -1,555
    4500      Quality Improvement
                Organizations...............        -258        -268        -291
    4500      Research......................         -59         -87         -59
    4500      HI Partial Transfer of Home
                Health to SMI...............      -1,168
    4501    HCFAC...........................        -970      -1,075      -1,075
                                               ---------   ---------  ----------
    4599      Outgo under current law (-)...    -148,020    -152,950    -162,397
          Proposed legislation:

    5500    Administration, legislative
              proposal not subject to PAYGO.                      25          38
                                               ---------   ---------  ----------
    6599    Total cash outgo (-)............    -148,020    -152,925    -162,359
        Unexpended balance, end of year:
    8700  Uninvested balance................         202
    8701  Federal securities: Par value.....     228,906     255,921     283,023
                                               ---------   ---------  ----------
    8799    Total balance, end of year......     229,111     255,921     283,022
    ---------------------------------------------------------------------------

                    Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8005-0-7-571      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
    41.0  Payment for Quality Improvement
            Organization (QIO) activities...         244         572          80
    42.0  Insurance claims and indemnities
            (benefits)......................     144,139     150,001     159,418
    94.0  Financial transfers...............       2,815       1,555       1,615
                                               ---------   ---------  ----------
    99.0      Direct obligations............     147,198     152,128     161,113
                                               ---------   ---------  ----------
    99.9    Total new obligations...........     147,198     152,128     161,113
    ---------------------------------------------------------------------------

                         Federal Hospital Insurance Fund

                  (Legislative proposal, not subject to PAYGO)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8005-2-7-571      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.02 Administration, HI................                     -25         -38
                                               ---------   ---------  ----------
    10.00   Total new obligations (object
              class 94.0)...................                     -25         -38
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......                     -25         -38
    23.95 Total new obligations.............                      25          38
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Discretionary:

    40.26   Appropriation (trust fund)......                     -25         -38
          Mandatory:

    60.26   Appropriation (trust fund)......                      25          38
    60.45   Portion precluded from
              obligation....................                     -25         -38
                                               ---------   ---------  ----------
    62.50     Appropriation (total
                mandatory)..................
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................                     -25         -38
    ----------------------------------------------------------------------------

        Change in obligated balances:
    73.10 Total new obligations.............                     -25         -38
    73.20 Total outlays (gross).............                      25          38
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new discretionary
            authority.......................                     -25         -38
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................                     -25         -38
    90.00 Outlays...........................                     -25         -38
    ----------------------------------------------------------------------------

        Memorandum (non-add) entries:
    92.01 Total investments, start of year:
            Federal securities: Par value...                                  25
    92.02 Total investments, end of year:
            Federal securities: Par value...                      25          63
    ---------------------------------------------------------------------------

        The budget proposes new discretionary user fees paid by providers
    who file a Medicare claims appeal or submit duplicate or unprocessable
    claims. This account reflects the reduction in payments to HI as a
    result of this user fee proposal.

                   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      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Medicare integrity program........         700         720         720
    00.02 FBI fraud and abuse control.......         101         114         114
    00.03 Other fraud and abuse control.....         202         241         241
    09.01 Reimbursables.....................           8
                                               ---------   ---------  ----------
    10.00   Total new obligations...........       1,011       1,075       1,075
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......       1,018       1,075       1,075
    23.95 Total new obligations.............      -1,011      -1,075      -1,075
    23.98 Unobligated balance expiring or
            withdrawn.......................          -7
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Mandatory:

    60.28   Appropriation (unavailable
              balances).....................       1,011       1,075       1,075
    69.00 Offsetting collections (cash).....           7
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................       1,018       1,075       1,075
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..         186         213         213
    73.10 Total new obligations.............       1,011       1,075       1,075
    73.20 Total outlays (gross).............        -970      -1,075      -1,075
    73.40 Adjustments in expired accounts
            (net)...........................         -14
    74.40 Obligated balance, end of year....         213         213         213
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new mandatory
            authority.......................         846       1,075       1,075
    86.98 Outlays from mandatory balances...         124
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........         970       1,075       1,075
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.00   Offsetting collections (cash)
              from: Federal sources.........          -7
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................       1,011       1,075       1,075
    90.00 Outlays...........................         963       1,075       1,075
    ---------------------------------------------------------------------------

        P.L. 104-191 established the Health Care Fraud and Abuse Control
    (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.

        This schedule reflects the estimated distribution of the account for
    2003 and 2004. Actual 2003 and 2004 distributions will be determined by
    the Secretary of HHS and the Attorney General consistent with the
    Administration's priorities, including augmenting existing program
    integrity activities for Medicaid and the State Children's Health
    Insurance Program (SCHIP).

                                         2002 actual  2003 est.   2004 est.
    Department of Justice, DOJ..........          55          50          45

    [[Page 427]]

    Office of the Inspector General, HHS         139         160         160
    Centers for Medicare and Medicaid
    Services, Medicaid/SCHIP Program
    Integrity, HHS......................           0          10          20
    Centers for Medicare and Medicaid
    Services, Other HHS.................           3          12           9
    Office of the General Counsel, HHS..           3           6           5
    Other HHS...........................           2           3           2
                                        ------------------------------------
          Total.........................         202         241         241
                                        ====================================

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-8393-0-7-571      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

          Direct obligations:

    11.1    Personnel compensation: Full-
              time permanent (CMS 100 FTEs).                                   8
    12.1    Civilian personnel benefits
              (CMS).........................                                   2
    25.1    Advisory and assistance services
              (CMS).........................                      12           5
    25.2    Other services (CMS)............                       5           9
            Other purchases of goods and
                services from Government
                accounts:
    25.3      Other purchases of goods and
                services from Government
                accounts (DoJ)..............                      50          45
    25.3      Other purchases of goods and
                services from Government
                accounts (HHS/OIG)..........                     160         160
    25.3      Other purchases of goods and
                services from Government
                accounts (HHS/AoA)..........                       3           2
    25.3      Other purchases of goods and
                services from Government
                accounts (HHS/OGC)..........                       6           5
    25.6    Medical care (CMS)..............         700         720         720
    41.0    Grants, subsidies, and
              contributions (CMS)...........                       5           5
    94.0    Financial transfers.............         101         114         114
                                               ---------   ---------  ----------
    99.0      Direct obligations............         801       1,075       1,075
    99.0  Reimbursable obligations..........           8
          Allocation Account:

            Travel and transportation of
                persons:
    21.0      Travel and transportation of
                persons (OIG)...............           7
    21.0      Travel and transportation of
                persons (DoJ)...............           1
    22.0    Transportation of things (OIG)..           1
            Rental payments to GSA:
    23.1      Rental payments to GSA (OIG)..           9
    23.1      Rental payments to GSA (DoJ)..           3
    23.1      Rental payments to GSA (OGC)..           1
    23.3    Communications, utilities, and
              miscellaneous charges (OIG)...           2
    24.0    Printing and reproduction [DOJ].           1
            Advisory and assistance
                services:
    25.1      Advisory and assistance
                services [DOJ]..............           1
    25.1      Advisory and assistance
                services (CMS)..............           1
            Other services:
    25.2      Other services (DoJ)..........          25
    25.2      Other services [OIG]..........           2
            Other purchases of goods and
                services from Government
                accounts:
    25.3      Purchases of goods and
                services from Government
                accounts (DoJ)..............           2
    25.3      Purchases of goods and
                services from Government
                accounts [OIG]..............          10
    25.7    Operation and maintenance of
              equipment (OIG)...............           1
    26.0    Supplies and materials (OIG)....           2
            Equipment:
    31.0      Equipment (OIG)...............           4
    31.0      Equipment [DOJ]...............           1
            Grants, subsidies, and
                contributions:
    41.0      Grants, subsidies, and
                contributions (AoA).........           1
    41.0      Grants, subsidies, and
                contributions (CMS).........           2
            Financial transfers:
    94.0      OIG full-time permanent.......          75
    94.0      DoJ full-time permanent.......          15
    94.0      OGC full-time permanent.......           2
    94.0      AoA full-time permanent.......           1
    94.0      Undistributed (DoJ other than
                full-time permanent)........           1
    94.0      Undistributed (OIG other than
                full-time permanent)........           1
    94.0      Undistributed (OIG other
                personnel compensation).....           2
    94.0      Undistributed (DoJ special
                personal services payments).           1
    94.0      Undistributed (OIG personnel
                benefits)...................          23
    94.0      Undistributed (DoJ personnel
                benefits)...................           4
                                               ---------   ---------  ----------
    99.0      Allocation account............         202
                                               ---------   ---------  ----------
    99.9    Total new obligations...........       1,011       1,075       1,075
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-8393-0-7-571      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
        Direct:
          Total compensable workyears:

    1001    Civilian full-time equivalent
              employment....................                                 100
    ---------------------------------------------------------------------------

               Federal Supplementary Medical Insurance Trust Fund

                  Unavailable Collections (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8004-0-7-571      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
    01.99 Balance, start of year............      41,663      37,744      27,608
        Receipts:
    02.20 Premiums collected for the aged...      21,173      23,009      25,145
    02.21 Premiums collected for the
            disabled........................       3,254       3,692       4,172
    02.22 Other proprietary receipts from
            the public......................           3
    02.40 Federal contributions.............      78,318      80,905      94,518
          Offsetting receipts (intragovernmental):

    02.41   Interest received by trust fund.       2,916       2,374       1,966
    02.41   Interest received by trust fund,
              legislative proposal not
              subject to PAYGO..............                                  -6
    02.42 Transfers from DOD, SMI...........          15           4
    02.45 Miscellaneous Federal payments....           1
    02.80 Federal supplementary medical
            insurance trust fund, offsetting
            collections.....................       1,168
                                               ---------   ---------  ----------
    02.99   Total receipts and collections..     106,848     109,984     125,795
                                               ---------   ---------  ----------
    04.00 Total: Balances and collections...     148,511     147,728     153,403
        Appropriations:
          Appropriations:

    05.00   Federal supplementary medical
              insurance trust fund..........    -110,353    -120,175    -121,599
    05.00   Legislative proposal not subject
              to PAYGO......................                      55         108
                                               ---------   ---------  ----------
    05.99   Total appropriations............    -110,353    -120,120    -121,491
    06.10 Unobligated balance returned to
            receipts........................        -414
                                               ---------   ---------  ----------
    07.99 Balance, end of year..............      37,744      27,608      31,912
    ---------------------------------------------------------------------------

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8004-0-7-571      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Benefit payments, SMI.............     106,909     117,627     119,214
    00.02 Administration, SMI...............       2,181       2,273       2,353
    00.03 Quality improvement organizations,
            SMI.............................          71         143          20
    00.04 Research, SMI.....................          22           5          12
    00.06 Transfer to Medicaid for payment
            of SMI premiums.................           2         127
    09.01 HI partial transfer of home health       1,168
                                               ---------   ---------  ----------
    10.00   Total new obligations...........     110,353     120,175     121,599
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......     110,353     120,175     121,599
    23.95 Total new obligations.............    -110,353    -120,175    -121,599
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Discretionary:

    40.26   Appropriation (trust fund)......       2,198       2,273       2,360
          Mandatory:

    60.26   Appropriation (trust fund)......     103,482     107,711     123,441
    60.28   Appropriation (unavailable
              balances).....................       3,505      10,191      -4,202
                                               ---------   ---------  ----------
    62.50     Appropriation (total
                mandatory)..................     106,987     117,902     119,239
    69.00 Offsetting collections (cash).....       1,168
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................     110,353     120,175     121,599
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..         142         916       1,017
    73.10 Total new obligations.............     110,353     120,175     121,599
    73.20 Total outlays (gross).............    -109,993    -120,074    -121,626
    73.40 Adjustments in expired accounts
            (net)...........................         414
    74.40 Obligated balance, end of year....         916       1,017         990
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new discretionary
            authority.......................       1,712       2,238       2,328
    86.97 Outlays from new mandatory
            authority.......................     108,155     117,788     119,223
    86.98 Outlays from mandatory balances...         126          48          75
                                               ---------   ---------  ----------

    [[Page 428]]

    87.00   Total outlays (gross)...........     109,993     120,074     121,626
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.00   Offsetting collections (cash)
              from: Federal sources.........      -1,168
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................     109,185     120,175     121,599
    90.00 Outlays...........................     108,825     120,074     121,626
    ----------------------------------------------------------------------------

        Memorandum (non-add) entries:
    92.01 Total investments, start of year:
            Federal securities: Par value...      41,978      38,804      28,570
    92.02 Total investments, end of year:
            Federal securities: Par value...      38,804      28,570      32,695
    ----------------------------------------------------------------------------

    Additional net budget authority and outlays to cover cost of fully accruing
                                     retirement:
    99.00 Budget authority..................          35          38          42
    99.01 Outlays...........................          35          38          42
    ---------------------------------------------------------------------------

                     Summary of Budget Authority and Outlays

                            (in millions of dollars)

                                         2002 actual  2003 est.   2004 est.
    Enacted/requested:
      Budget Authority..................     109,185     120,175     121,599
      Outlays...........................     108,825     120,074     121,626
    Legislative proposal, not subject to
        PAYGO:
      Budget Authority..................                     -55        -108
      Outlays...........................                     -55        -108
                                        ------------------------------------
    Total:
      Budget Authority..................     109,185     120,120     121,491
      Outlays...........................     108,825     120,019     121,518
                                        ====================================

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

        The status of the trust fund is as follows:

                      Status of Funds (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8004-0-7-571      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
        Unexpended balance, start of year:
    0100  Treasury balance..................        -174        -145
    0101  Federal securities: Par value.....      41,978      38,804      28,625
                                               ---------   ---------  ----------
    0199    Total balance, start of year....      41,805      38,660      28,625
        Cash income during the year:
          Current law:

            Offsetting receipts
                (proprietary):
    1220      Premiums collected for the
                aged, FSMI fund.............      21,173      23,009      25,145
    1221      Premiums collected for the
                disabled, FSMI fund.........       3,254       3,692       4,172
    1222      Other proprietary receipts....           3
            Offsetting receipts
                (intragovernmental):
    1240      Federal contributions, FSMI
                fund........................      78,318      80,905      94,518
    1241      Interest received by trust
                fund, FSMI fund.............       2,916       2,374       1,966
    1242      Intragovernmental transactions          15           4
    1245      Offsetting receipts
                (intragovernmental).........           1
            Offsetting collections:
    1280      HI partial transfer of home
                health......................       1,168
                                               ---------   ---------  ----------
    1299      Income under present law......     106,848     109,984     125,801
          Proposed legislation:

            Offsetting receipts
                (intragovernmental):
    2241      Interest received by trust
                fund, legislative proposal
                not subject to PAYGO........                                  -6
                                               ---------   ---------  ----------
    3299    Total cash income...............     106,848     109,984     125,795
        Cash outgo during year:
          Current law:

            Cash outgo during the year (-):
    4500      Benefit payments & ESRD.......    -106,901    -117,627    -119,214
    4500      Administration................      -1,704      -2,223      -2,320
    4500      Quality Improvement
                Organizations...............         -95         -77         -79
    4500      Research......................         -13         -20         -13
    4500      HI partial transfer of home
                health......................      -1,168
    4500      Transfer to Medicaid for
                payment of SMI premiums.....        -112        -127
                                               ---------   ---------  ----------
    4599      Outgo under current law (-)...    -109,993    -120,074    -121,626
          Proposed legislation:

    5500    Administration, legislative
              proposal not subject to PAYGO.                      55         108
                                               ---------   ---------  ----------
    6599    Total cash outgo (-)............    -109,993    -120,019    -121,518
        Unexpended balance, end of year:
    8700  Uninvested balance................        -145
    8701  Federal securities: Par value.....      38,804      28,625      32,902
                                               ---------   ---------  ----------
    8799    Total balance, end of year......      38,660      28,625      32,902
    ---------------------------------------------------------------------------

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8004-0-7-571      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

          Direct obligations:

    41.0    Payment for Quality Improvement
              Organization (QIO) activity...          71         143          20
    42.0    Insurance claims and indemnities     106,911     117,754     119,214
    94.0    Financial transfers.............       2,203       2,278       2,365
                                               ---------   ---------  ----------
    99.0      Direct obligations............     109,185     120,175     121,599
    99.0  Reimbursable obligations..........       1,168
                                               ---------   ---------  ----------
    99.9    Total new obligations...........     110,353     120,175     121,599
    ---------------------------------------------------------------------------

               Federal Supplementary Medical Insurance Trust Fund

                  (Legislative proposal, not subject to PAYGO)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8004-2-7-571      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.02 Administration, SMI...............                    -105        -163
    00.06 Transfer to Medicaid for payment
            of SMI premiums.................                      50          55
                                               ---------   ---------  ----------
    10.00   Total new obligations...........                     -55        -108
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......                     -55        -108
    23.95 Total new obligations.............                      55         108
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Discretionary:

    40.26   Appropriation (trust fund)......                    -105        -163
          Mandatory:

    60.26   Appropriation (trust fund)......                     105         157
    60.28   Appropriation (unavailable
              balances).....................                      50        -102
    60.45   Portion precluded from
              obligation....................                    -105
                                               ---------   ---------  ----------
    62.50     Appropriation (total
                mandatory)..................                      50          55
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................                     -55        -108
    ----------------------------------------------------------------------------

        Change in obligated balances:
    73.10 Total new obligations.............                     -55        -108
    73.20 Total outlays (gross).............                      55         108
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new discretionary
            authority.......................                    -105        -163
    86.97 Outlays from new mandatory
            authority.......................                      50          55
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........                     -55        -108
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................                     -55        -108
    90.00 Outlays...........................                     -55        -108
    ----------------------------------------------------------------------------

        Memorandum (non-add) entries:
    92.01 Total investments, start of year:
            Federal securities: Par value...                                  55
    92.02 Total investments, end of year:
            Federal securities: Par value...                      55         207
    ---------------------------------------------------------------------------

    [[Page 429]]

        The budget proposes new discretionary user fees paid by providers
    who file a Medicare claims appeal or submit duplicate or unprocessable
    claims. This account reflects the reduction in payments to SMI as a
    result of this user fee proposal.

        The budget proposes to extend the subsidy of Medicare cost sharing
    for certain qualified individuals.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 20-8004-2-7-571      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
    42.0  Insurance claims and indemnities..                      50          55
    94.0  Financial transfers...............                    -105        -163
                                               ---------   ---------  ----------
    99.9    Total new obligations...........                     -55        -108
    ---------------------------------------------------------------------------

                     Allocation Received From Other Accounts

        Note.--Obligations incurred under allocations from other accounts
    are included in the schedule of the parent appropriation as follows:
    Centers for Medicare and Medicaid Services ``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      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 State family assistance grant.....      16,489      16,489      16,489
    00.03 Territories--family assistance
            grants..........................          73          78          78
    00.04 Matching grants to territories....           6          15          15
    00.05 Bonus to reward decrease in
            illegitimacy....................         100         100         100
    00.06 Supplemental grants for population
            increases.......................         319         192
    00.07 Bonus to reward high performance
            States..........................         200         400         200
    00.08 Tribal work programs..............           8           8           8
                                               ---------   ---------  ----------
    10.00   Total new obligations (object
              class 41.0)...................      17,195      17,282      16,890
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance carried
            forward, start of year..........         600         400
    22.00 New budget authority (gross)......      17,009      16,882      17,690
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......      17,609      17,282      17,690
    23.95 Total new obligations.............     -17,195     -17,282     -16,890
    23.98 Unobligated balance expiring or
            withdrawn.......................         -14
    24.40 Unobligated balance carried
            forward, end of year............         400                     800
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Mandatory:

    60.00   Appropriation...................      17,009      16,882      17,690
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..      10,543       8,884       6,952
    73.10 Total new obligations.............      17,195      17,282      16,890
    73.20 Total outlays (gross).............     -18,749     -19,214     -18,567
    73.40 Adjustments in expired accounts
            (net)...........................        -105
    74.40 Obligated balance, end of year....       8,884       6,952       5,275
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new mandatory
            authority.......................      12,442      12,816      13,028
    86.98 Outlays from mandatory balances...       6,307       6,398       5,539
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........      18,749      19,214      18,567
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................      17,009      16,882      17,690
    90.00 Outlays...........................      18,749      19,214      18,567
    ---------------------------------------------------------------------------

                     Summary of Budget Authority and Outlays

                            (in millions of dollars)

                                         2002 actual  2003 est.   2004 est.
    Enacted/requested:
      Budget Authority..................      17,009      16,882      17,690
      Outlays...........................      18,749      19,214      18,567
    Legislative proposal, subject to
        PAYGO:
      Budget Authority..................                     127         -81
      Outlays...........................                      -5         146
                                        ------------------------------------
    Total:
      Budget Authority..................      17,009      17,009      17,609
      Outlays...........................      18,749      19,209      18,713
                                        ====================================

        This account provides continued 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 low-income families
    with children.

                     Temporary Assistance for Needy Families

                    (Legislative proposal, subject to PAYGO)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1552-4-1-609      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Promotion of healthy marriage and
            family formation grants.........                     100         100
    00.02 Family formation, research,
            demonstration, and technical
            assistance......................                     100         100
    00.03 Supplemental grants for population
            increases.......................                     127         319
    00.04 Elimination of illegitimacy bonus.                    -100        -100
    00.05 Redirect high performance bonus...                    -100        -500
                                               ---------   ---------  ----------
    10.00   Total new obligations...........                     127         -81
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......                     127         -81
    23.95 Total new obligations.............                    -127          81
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Mandatory:

    60.00   Appropriation...................                     127         -81
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..                                 132
    73.10 Total new obligations.............                     127         -81
    73.20 Total outlays (gross).............                       5        -146
    74.40 Obligated balance, end of year....                     132         -95
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new mandatory
            authority.......................                      -5          96
    86.98 Outlays from mandatory balances...                                  50
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........                      -5         146
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................                     127         -81
    90.00 Outlays...........................                      -5         146
    ---------------------------------------------------------------------------

        This schedule reflects additional proposals to be included in the
    reauthorization of the Temporary Assistance for Needy Families program.
    These include funding for Supplemental Grants and initiatives to promote
    healthy marriages and family formation.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1552-4-1-609      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
    25.1  Advisory and assistance services..                      20
    41.0  Grants, subsidies, and
            contributions...................                     107         -81
                                               ---------   ---------  ----------
    99.9    Total new obligations...........                     127         -81
    ---------------------------------------------------------------------------

    [[Page 430]]

                                Contingency Fund

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1522-0-1-609      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Program activity..................                                   2
                                               ---------   ---------  ----------
    10.00   Total new obligations (object
              class 41.0)...................                                   2
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance carried
            forward, start of year..........                               1,958
    22.00 New budget authority (gross)......       1,958       1,958
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......       1,958       1,958       1,958
    23.95 Total new obligations.............                                  -2
    23.98 Unobligated balance expiring or
            withdrawn.......................      -1,958
    24.40 Unobligated balance carried
            forward, end of year............                   1,958       1,956
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Mandatory:

    60.00   Appropriation...................                   1,958
    63.00   Reappropriation.................       1,958
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................       1,958       1,958
    ----------------------------------------------------------------------------

        Change in obligated balances:
    73.10 Total new obligations.............                                   2
    73.20 Total outlays (gross).............                                  -1
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.98 Outlays from mandatory balances...                                   1
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................       1,958       1,958
    90.00 Outlays...........................                                   1
    ---------------------------------------------------------------------------

                     Summary of Budget Authority and Outlays

                            (in millions of dollars)

                                         2002 actual  2003 est.   2004 est.
    Enacted/requested:
      Budget Authority..................       1,958       1,958
      Outlays...........................                                   1
    Legislative proposal, subject to
        PAYGO:
      Budget Authority..................                      42
      Outlays...........................                       1           1
                                        ------------------------------------
    Total:
      Budget Authority..................       1,958       2,000
      Outlays...........................                       1           2
                                        ====================================

                                Contingency Fund

                    (Legislative proposal, subject to PAYGO)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1522-4-1-609      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance carried
            forward, start of year..........                                  42
    22.00 New budget authority (gross)......                      42
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......                      42          42
    24.40 Unobligated balance carried
            forward, end of year............                      42          42
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Mandatory:

    60.00   Appropriation...................                      42
    ----------------------------------------------------------------------------

        Change in obligated balances:
    73.20 Total outlays (gross).............                      -1          -1
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.98 Outlays from mandatory balances...                       1           1
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................                      42
    90.00 Outlays...........................                       1           1
    ---------------------------------------------------------------------------

        This schedule reflects a proposal to authorize a more accessible
    Contingency Fund.

      Payments to States for Child Support Enforcement and Family Support
                                    Programs

        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), $3,292,970,000, to remain
    available until expended; and for such purposes for the first quarter of
    fiscal year 2005, $1,200,000,000, to remain available until expended.
        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.
        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 3 months of the current fiscal year for
    unanticipated costs, incurred for the current fiscal year, such sums as
    may be necessary.

        Note.--A regular 2003 appropriation for this account had not been
    enacted at the time the budget was prepared; therefore, this account is
    operating under a continuing resolution (P.L. 107-229, as amended). The
    amounts included for 2003 in this budget reflect the Administration's
    2003 policy proposals.

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1501-0-1-609      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

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

            Benefit payments:
    00.01     State child support
                administrative costs........       3,324       3,532       3,905
    00.02     Child support incentive
                payments....................         450         461         454
    00.03     Access and visitation grants..          10          10          10
                                               ---------   ---------  ----------
    00.91   Subtotal, child support
              enforcement...................       3,784       4,003       4,369
    01.02 Payments to territories...........          23          23          23
    01.03 Repatriation......................           1           1           1
                                               ---------   ---------  ----------
    01.91   Subtotal, other payments........          24          24          24
          Aid to families with dependent children (AFDC)
              payments:

    02.01   AFDC benefit payments...........         124          10
    02.03   State and local welfare
              administration................           3
                                               ---------   ---------  ----------
    02.91     Subtotal, AFDC programs.......         127          10
    09.01 Offset obligations (cse grants to
            states).........................         157         189         179
                                               ---------   ---------  ----------
    10.00   Total new obligations...........       4,092       4,226       4,572
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance carried
            forward, start of year..........          89
    22.00 New budget authority (gross)......       4,003       4,226       4,572
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......       4,092       4,226       4,572
    23.95 Total new obligations.............      -4,092      -4,226      -4,572
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Mandatory:

    60.00   Appropriation...................       2,846       2,937       3,293
    65.00   Advance appropriation...........       1,000       1,100       1,100
    69.00 Offsetting collections (cash).....         157         189         179
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................       4,003       4,226       4,572
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..         803         740         603
    73.10 Total new obligations.............       4,092       4,226       4,572
    73.20 Total outlays (gross).............      -4,155      -4,363      -4,517
    74.40 Obligated balance, end of year....         740         603         658
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new mandatory
            authority.......................       3,641       3,817       4,102

    [[Page 431]]

    86.98 Outlays from mandatory balances...         514         546         415
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........       4,155       4,363       4,517
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.45   Offsetting collections (cash)
              from: Offsetting governmental
              collections (from non-Federal
              sources)......................        -157        -189        -179
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................       3,846       4,037       4,393
    90.00 Outlays...........................       3,998       4,174       4,338
    ---------------------------------------------------------------------------

                     Summary of Budget Authority and Outlays

                            (in millions of dollars)

                                         2002 actual  2003 est.   2004 est.
    Enacted/requested:
      Budget Authority..................       3,846       4,037       4,393
      Outlays...........................       3,998       4,174       4,338
    Legislative proposal, subject to
        PAYGO:
      Budget Authority..................                                 -47
      Outlays...........................                                 -47
                                        ------------------------------------
    Total:
      Budget Authority..................       3,846       4,037       4,346
      Outlays...........................       3,998       4,174       4,291
                                        ====================================

        This account provides for payments to States for child support
    enforcement and other family support programs, including access and
    visitation programs for families. Spending authority from the Federal
    share of child support collections is used to pay incentive payments.
    The remaining net Federal share of collections is returned to the
    Treasury in a receipt account. The text table below shows the net
    Federal costs of child support enforcement:

                 Net Federal Costs of Child Support Enforcement

                            (In millions of dollars)

                                            2002         2003        2004
    Gross Federal share of collections..      -1,235      -1,127      -1,151
    Federal incentive payments to States         450         461         454
    Hold harmless payments..............                      10
    State child support administrative
    costs...............................       3,481       3,711       4,035
    Access and visitation grants........          10          10          10
                                        ------------------------------------
        Total...........................       2,706       3,065       3,348
                                        ====================================

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1501-0-1-609      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
    41.0  Direct obligations: Grants,
            subsidies, and contributions....       3,935       4,037       4,393
    99.0  Reimbursable obligations:
            Reimbursable obligations........         157         189         179
                                               ---------   ---------  ----------
    99.9    Total new obligations...........       4,092       4,226       4,572
    ---------------------------------------------------------------------------

      Payments to States for Child Support Enforcement and Family Support
                                    Programs

                    (Legislative proposal, subject to PAYGO)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1501-4-1-609      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

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

            Benefit payments:
    00.01     State child support
                administrative costs........                                 -49
    00.03     Access and visitation grants..                                   2
                                               ---------   ---------  ----------
    10.00   Total new obligations (object
              class 41.0)...................                                 -47
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......                                 -47
    23.95 Total new obligations.............                                  47
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Mandatory:

    60.00   Appropriation...................                                 -47
    ----------------------------------------------------------------------------

        Change in obligated balances:
    73.10 Total new obligations.............                                 -47
    73.20 Total outlays (gross).............                                  47
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new mandatory
            authority.......................                                 -47
    ----------------------------------------------------------------------------

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

        This legislative package reproposes provisions in the TANF
    reauthorization plan, including proposals to increase child support
    collections and to direct more of these payments to families. Also
    included are provisions to streamline current and introduce new data
    matching efforts to more effectively seize child support payments
    through state, tribal, and private industry participation.

                        Low Income Home Energy Assistance

        For making payments under title XXVI of the Omnibus Budget
    Reconciliation Act of 1981, $1,700,000,000.
        For making payments under title XXVI of the Omnibus Budget
    Reconciliation Act of 1981, $300,000,000: Provided, That these funds are
    for the unanticipated home energy assistance needs of one or more
    States, as authorized by section 2604(e) of the Act, and notwithstanding
    the designation requirement of section 2602(e).

        Note.--A regular 2003 appropriation for this account had not been
    enacted at the time the budget was prepared; therefore, this account is
    operating under a continuing resolution (P.L. 107-229, as amended). The
    amounts included for 2003 in this budget reflect the Administration's
    2003 policy proposals.

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1502-0-1-609      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Direct program activity...........       1,800       1,550       1,850
                                               ---------   ---------  ----------
    10.00   Total new obligations (object
              class 41.0)...................       1,800       1,550       1,850
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance carried
            forward, start of year..........         300         300         300
    22.00 New budget authority (gross)......       2,000       1,700       2,000
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......       2,300       2,000       2,300
    23.95 Total new obligations.............      -1,800      -1,550      -1,850
    23.98 Unobligated balance expiring or
            withdrawn.......................        -200        -150        -150
    24.40 Unobligated balance carried
            forward, end of year............         300         300         300
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Discretionary:

            Appropriation:
    40.00     Appropriation [Base Program]..       1,700       1,400       1,700
    40.00     Appropriation [Emergency].....         300         300         300
                                               ---------   ---------  ----------
    43.00     Appropriation (total
                discretionary)..............       2,000       1,700       2,000
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..         512         536         459
    73.10 Total new obligations.............       1,800       1,550       1,850
    73.20 Total outlays (gross).............      -1,773      -1,628      -1,774
    73.40 Adjustments in expired accounts
            (net)...........................          -3                      -5
    74.40 Obligated balance, end of year....         536         459         530
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new discretionary
            authority.......................       1,329       1,147       1,369
    86.93 Outlays from discretionary
            balances........................         444         481         405
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........       1,773       1,628       1,774
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................       2,000       1,700       2,000
    90.00 Outlays...........................       1,773       1,628       1,774
    ---------------------------------------------------------------------------

    [[Page 432]]

        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. Obligation
    estimates for the contingency fund are based on average historical
    obligation rates.

                         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), $417,626,000: Provided, That funds appropriated pursuant to
    section 414(a) of the Immigration and Nationality Act for fiscal year
    2004 shall be available for the costs of assistance provided and other
    activities through September 30, 2006: Provided further, That up to
    $10,000,000 is available to carry out the Trafficking Victims Protection
    Act of 2000.
        For carrying out section 5 of the Torture Victims Relief Act of 1998
    (Public Law 105-320), $10,000,000. For carrying out section 462 of the
    Homeland Security Act of 2002 (P.L. 107-296), $34,000,000.

        Note.--A regular 2003 appropriation for this account had not been
    enacted at the time the budget was prepared; therefore, this account is
    operating under a continuing resolution (P.L. 107-229, as amended). The
    amounts included for 2003 in this budget reflect the Administration's
    2003 policy proposals.

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1503-0-1-609      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Refugee and entrant assistance....         468         490         462
    00.02 Assistance for treatment of
            torture victims.................          10          10          10
                                               ---------   ---------  ----------
    10.00   Total new obligations...........         478         500         472
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance carried
            forward, start of year..........          24          24          10
    22.00 New budget authority (gross)......         460         486         462
    22.10 Resources available from
            recoveries of prior year
            obligations.....................          19
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......         503         510         472
    23.95 Total new obligations.............        -478        -500        -472
    23.98 Unobligated balance expiring or
            withdrawn.......................          -2
    24.40 Unobligated balance carried
            forward, end of year............          24          10
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Discretionary:

    40.00   Appropriation...................         460         453         462
    42.00   Transferred from other accounts.                      33
                                               ---------   ---------  ----------
    43.00     Appropriation (total
                discretionary)..............         460         486         462
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..         570         544         559
    73.10 Total new obligations.............         478         500         472
    73.20 Total outlays (gross).............        -480        -483        -476
    73.40 Adjustments in expired accounts
            (net)...........................          -2
    73.45 Recoveries of prior year
            obligations.....................         -19
    74.10 Change in uncollected customer
            payments from Federal sources
            (expired).......................          -3
    74.40 Obligated balance, end of year....         544         559         555
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new discretionary
            authority.......................         138         146         139
    86.93 Outlays from discretionary
            balances........................         342         337         337
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........         480         483         476
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................         460         486         462
    90.00 Outlays...........................         480         483         476
    ---------------------------------------------------------------------------

        States are subsidized for administering the refugee assistance
    program. Funds are also provided to assist in the rehabilitation of
    victims of torture. The transferred amounts from the Department of
    Homeland Security to HHS in 2003 relating to the care and placement of
    unaccompanied alien children are estimates. Final amounts transferred
    will be included in a determination order issued by the Director of the
    Office of Management and Budget.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1503-0-1-609      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
    25.1  Advisory and assistance services..           1           1           1
    25.2  Other services....................           2           2           2
    25.3  Other purchases of goods and
            services from Government
            accounts........................           2           2           2
    41.0  Grants, subsidies, and
            contributions...................         473         495         467
                                               ---------   ---------  ----------
    99.9    Total new obligations...........         478         500         472
    ---------------------------------------------------------------------------

                       Promoting Safe and Stable Families

        For carrying out section 436 of the Social Security Act,
    $305,000,000; for section 437, $199,978,000; and for section 439,
    $50,000,000.
        Note.--A regular 2003 appropriation for this account had not been
    enacted at the time the budget was prepared; therefore, this account is
    operating under a continuing resolution (P.L. 107-229, as amended). The
    amounts included for 2003 in this budget reflect the Administration's
    2003 policy proposals.

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1512-0-1-506      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Grants to States and Tribes.......         353         475         475
    00.02 Research, training and technical
            assistance......................           9          13          13
    00.03 State court assessment activities.          13          17          17
    00.04 Mentoring children of prisoners...                      25          50
                                               ---------   ---------  ----------
    10.00   Total new obligations...........         375         530         555
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......         375         530         555
    23.95 Total new obligations.............        -375        -530        -555
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Discretionary:

            Appropriation:
    40.00     Appropriation.................          70         200         200
    40.00     Appropriation.................                      25          50
                                               ---------   ---------  ----------
    43.00     Appropriation (total
                discretionary)..............          70         225         250
          Mandatory:

    60.00   Appropriation...................         305         305         305
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................         375         530         555
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..         339         402         541
    73.10 Total new obligations.............         375         530         555
    73.20 Total outlays (gross).............        -301        -391        -507
    73.40 Adjustments in expired accounts
            (net)...........................         -11
    74.40 Obligated balance, end of year....         402         541         591
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new discretionary
            authority.......................          12          37          39
    86.93 Outlays from discretionary
            balances........................                      45         150
    86.97 Outlays from new mandatory
            authority.......................          56          55          55
    86.98 Outlays from mandatory balances...         233         254         263
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........         301         391         507
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................         375         530         555
    90.00 Outlays...........................         301         391         507
    ---------------------------------------------------------------------------

        This program provides funds for a broad range of child welfare
    services, including family preservation and family support services. It
    also includes funding for competitive grants to mentor the children of
    prisoners.

    [[Page 433]]

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1512-0-1-506      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
    25.1  Advisory and assistance services..           3           4           4
    25.3  Other purchases of goods and
            services from Government
            accounts........................           2           2           2
    41.0  Grants, subsidies, and
            contributions...................         370         524         549
                                               ---------   ---------  ----------
    99.9    Total new obligations...........         375         530         555
    ---------------------------------------------------------------------------

               Job Opportunities and Basic Skills Training Program

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1509-0-1-504      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..           8
    73.20 Total outlays (gross).............         -23
    73.40 Adjustments in expired accounts
            (net)...........................          15
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.98 Outlays from mandatory balances...          23
    ----------------------------------------------------------------------------

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

        This activity was replaced by Temporary Assistance for Needy
    Families.

                        Child Care Entitlement to States

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1550-0-1-609      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Mandatory child care..............       1,178       1,178       1,178
    00.02 Matching child care...............       1,519       1,478       1,478
    00.03 Training and technical assistance.           7           7           7
    00.04 Child care tribal grants..........          54          54          54
                                               ---------   ---------  ----------
    10.00   Total new obligations...........       2,758       2,717       2,717
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......       2,758       2,717       2,717
    23.95 Total new obligations.............      -2,758      -2,717      -2,717
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Mandatory:

    60.00   Appropriation...................       2,717       2,717       2,717
    63.00   Reappropriation.................          41
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................       2,758       2,717       2,717
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..         814       1,144       1,171
    73.10 Total new obligations.............       2,758       2,717       2,717
    73.20 Total outlays (gross).............      -2,365      -2,690      -2,813
    73.40 Adjustments in expired accounts
            (net)...........................         -63
    74.40 Obligated balance, end of year....       1,144       1,171       1,075
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new mandatory
            authority.......................       1,774       1,842       1,926
    86.98 Outlays from mandatory balances...         591         848         887
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........       2,365       2,690       2,813
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................       2,758       2,717       2,717
    90.00 Outlays...........................       2,365       2,690       2,813
    ---------------------------------------------------------------------------

        This account provides child care funding for welfare recipients and
    low-income working families and was 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      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
    25.1  Advisory and assistance services..           6           6           6
    25.2  Other services....................           1           1           1
    41.0  Grants, subsidies, and
            contributions...................       2,751       2,710       2,710
                                               ---------   ---------  ----------
    99.9    Total new obligations...........       2,758       2,717       2,717
    ---------------------------------------------------------------------------

        Payments to States for the Child Care and Development Block Grant

        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), $2,099,729,000 shall be used to supplement, not supplant
    state general revenue funds for child care assistance for low-income
    families: Provided, That $19,120,000 shall be available for child care
    resource and referral and school-aged child care activities, of which
    $1,000,000 shall be for the Child Care Aware toll free hotline: Provided
    further, That in addition to the amounts required to be reserved by the
    States under section 658G, $272,672,000 shall be reserved by the States
    for activities authorized under section 658G, of which $100,000,000
    shall be for activities that improve the quality of infant and toddler
    care: Provided further, That $9,864,000 shall be for use by the
    Secretary for child care research, demonstration, and evaluation
    activities.

        Note.--A regular 2003 appropriation for this account had not been
    enacted at the time the budget was prepared; therefore, this account is
    operating under a continuing resolution (P.L. 107-229, as amended). The
    amounts included for 2003 in this budget reflect the Administration's
    2003 policy proposals.

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1515-0-1-609      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Block grant payments to States....       2,090       2,090       2,090
    00.04 Research and evaluation fund......          10          10          10
                                               ---------   ---------  ----------
    10.00   Total new obligations...........       2,100       2,100       2,100
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......       2,100       2,100       2,100
    23.95 Total new obligations.............      -2,100      -2,100      -2,100
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Discretionary:

    40.00   Appropriation...................       2,100       2,100       2,100
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..       1,121       1,044       1,064
    73.10 Total new obligations.............       2,100       2,100       2,100
    73.20 Total outlays (gross).............      -2,174      -2,080      -2,093
    73.40 Adjustments in expired accounts
            (net)...........................          -3
    74.40 Obligated balance, end of year....       1,044       1,064       1,071
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new discretionary
            authority.......................       1,349       1,344       1,344
    86.93 Outlays from discretionary
            balances........................         825         736         749
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........       2,174       2,080       2,093
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................       2,100       2,100       2,100
    90.00 Outlays...........................       2,174       2,080       2,093
    ---------------------------------------------------------------------------

        This appropriation helps low-income families pay for child care and
    related services and supports grants to States for child care quality
    activities.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1515-0-1-609      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
    25.1  Advisory and assistance services..           6           6           6
    25.3  Other purchases of goods and
            services from Government
            accounts........................           1           1           1
    41.0  Grants, subsidies, and
            contributions...................       2,093       2,093       2,093
                                               ---------   ---------  ----------
    99.9    Total new obligations...........       2,100       2,100       2,100
    ---------------------------------------------------------------------------

    [[Page 434]]

                           Social Services Block Grant

        For making grants to States pursuant to section 2002 of the Social
    Security Act, $1,700,000,000.

        Note.--A regular 2003 appropriation for this account had not been
    enacted at the time the budget was prepared; therefore, this account is
    operating under a continuing resolution (P.L. 107-229, as amended). The
    amounts included for 2003 in this budget reflect the Administration's
    2003 policy proposals.

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1534-0-1-506      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Direct program activity...........       1,700       1,700       1,700
                                               ---------   ---------  ----------
    10.00   Total new obligations (object
              class 41.0)...................       1,700       1,700       1,700
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance carried
            forward, start of year..........           1           1           1
    22.00 New budget authority (gross)......       1,700       1,700       1,700
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......       1,701       1,701       1,701
    23.95 Total new obligations.............      -1,700      -1,700      -1,700
    24.40 Unobligated balance carried
            forward, end of year............           1           1           1
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Mandatory:

    60.00   Appropriation...................       1,700       1,700       1,700
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..         746         666         574
    73.10 Total new obligations.............       1,700       1,700       1,700
    73.20 Total outlays (gross).............      -1,780      -1,792      -1,790
    73.40 Adjustments in expired accounts
            (net)...........................                                  -4
    74.40 Obligated balance, end of year....         666         574         480
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new mandatory
            authority.......................       1,452       1,445       1,445
    86.98 Outlays from mandatory balances...         328         347         345
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........       1,780       1,792       1,790
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................       1,700       1,700       1,700
    90.00 Outlays...........................       1,780       1,792       1,790
    ---------------------------------------------------------------------------

                     Children and Families Services Programs

        For carrying out, except as otherwise provided, the Runaway and
    Homeless Youth Act, the Developmental Disabilities Assistance and Bill
    of Rights Act, the Head Start Act, the Child Abuse Prevention and
    Treatment Act, sections 310 and 316 of the Family Violence Prevention
    and Services Act, as amended, 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), sections 1201 and 1211 of
    the Children's Health Act of 2000, the Abandoned Infants Assistance Act
    of 1988, sections 413, 429A, 1110, and 1115 of the Social Security Act,
    and sections 40155, 40211, and 40241 of Public Law 103-322; for making
    payments under the Community Services Block Grant Act, section 473A of
    the Social Security Act, and title IV of Public Law 105-285, 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, section 5 of the Torture
    Victims Relief Act of 1998 (Public Law 105-320), sections 40155, 40211,
    and 40241 of Public Law 103-322, and section 126 and titles IV and V of
    Public Law 100-485, $8,547,382,000, of which $43,000,000, to remain
    available until September 30, 2005, shall be 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) and may be made for
    adoptions completed before September 30, 2004; of which $552,312,000
    shall be for making payments under the Community Services Block Grant
    Act; and of which $6,815,570,000 shall be for making payments under the
    Head Start Act, of which $1,400,000,000 shall become available October
    1, 2004 and remain available through September 30, 2005: Provided, That
    to the extent Community Services Block Grant funds are distributed as
    grant funds by a State to an eligible entity as provided under the Act,
    and have not been expended by such entity, they shall remain with such
    entity for carryover into the next fiscal year for expenditure by such
    entity consistent with program purposes: Provided further, That all
    eligible entities currently in good standing in the Community Services
    Block Grant program shall receive an increase in funding proportionate
    to the increase provided in this Act for the Community Services Block
    Grant: Provided further, That $100,000,000 is for a compassion capital
    fund to provide grants to charitable organizations to emulate model
    social service programs and to encourage research on the best practices
    of social service organizations: Provided further, That the Secretary
    shall establish procedures regarding the disposition of intangible
    property which permits grant funds, or intangible assets acquired with
    funds authorized under section 680 of the Community Services Block Grant
    Act, as amended, to become the sole property of such grantees after a
    period of not more than 12 years after the end of the grant for purposes
    and uses consistent with the original grant: Provided further, That
    funds appropriated for section 680(a)(2) of the Community Services Block
    Grant Act, as amended, shall be available for financing construction and
    rehabilitation and loans or investments in private business enterprises
    owned by community development corporations.

        Note.--A regular 2003 appropriation for this account had not been
    enacted at the time the budget was prepared; therefore, this account is
    operating under a continuing resolution (P.L. 107-229, as amended). The
    amounts included for 2003 in this budget reflect the Administration's
    2003 policy proposals.

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1536-0-1-506      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Head start........................       6,537       6,667       6,816
          Runaway and homeless youth:

    01.03   Runaway and homeless youth......          48          48          62
    01.04   Transitional living.............          40          40          26
    01.05   Education grants to reduce
              sexual abuse of runaway youth.          15          15          15
          Child abuse programs:

    01.07   Child abuse State grants........          22          22          22
    01.08   Child abuse discretionary grants          26          26          26
    01.09   Community based resource centers          33          33          33
          Child welfare programs:

    01.11   Child welfare services..........         292         292         292
    01.12   Child welfare training..........           8           8           7
    01.15   Abandoned infants...............          12          12          13
    01.16   Adoption incentives.............          40          43          43
    01.17   Adoption opportunities..........          27          27          27
    01.18 Children's health act programs....          13          13          13
    01.19 Social services and income
            maintenance research............          31           6           6
    01.20 Native American programs..........          46          45          45
    01.21 Compassion capital fund...........          30         100         100
    01.23 Early learning fund...............          25
          Developmental disabilities programs:

    01.24   Protection and advocacy.........          35          35          35
    01.25   Projects of national
              significance..................          12          12          12
    01.26   Centers for excellence..........          24          24          24
    01.27   State grants....................          70          70          70
    01.28 Federal administration............         171         171         180
    01.29 Faith-based center................           2           2           1
                                               ---------   ---------  ----------
    01.91   Subtotal........................       1,022       1,044       1,052
          Community services programs:

    03.01   Community services block grants.         649         570         495
    03.03   Community food and nutrition....           7           7
    03.04   Community services discretionary          39          39          32
    03.05   National youth sports...........          17
    03.06 Individual development accounts...          25          25          25
    03.08 Domestic violence hotline.........           2           2           3
    03.09 Grants for battered women's
            shelters........................         125         125         124
                                               ---------   ---------  ----------
    03.91   Subtotal........................         864         768         679
                                               ---------   ---------  ----------
    04.00   Total, direct program...........       8,423       8,479       8,547
    09.01 Reimbursable program..............          18          15          15
                                               ---------   ---------  ----------
    10.00   Total new obligations...........       8,441       8,494       8,562
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance carried
            forward, start of year..........           3           4           1
    22.00 New budget authority (gross)......       8,445       8,494       8,562
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......       8,448       8,498       8,563
    23.95 Total new obligations.............      -8,441      -8,494      -8,562

    [[Page 435]]

    23.98 Unobligated balance expiring or
            withdrawn.......................          -1          -3
    24.40 Unobligated balance carried
            forward, end of year............           4           1           1
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Discretionary:

    40.00   Appropriation...................       7,030       7,079       7,147
    40.71   Reduction pursuant to P.L. 107-
              116...........................          -1
    40.73   Reduction pursuant to P.L. 107-
              206...........................          -2
                                               ---------   ---------  ----------
    43.00     Appropriation (total
                discretionary)..............       7,027       7,079       7,147
    55.00   Advance appropriation...........       1,400       1,400       1,400
          Spending authority from offsetting
              collections:

    68.00   Offsetting collections (cash)...          15          15          15
    68.10   Change in uncollected customer
              payments from Federal sources
              (unexpired)...................           3
                                               ---------   ---------  ----------
    68.90     Spending authority from
                offsetting collections
                (total discretionary).......          18          15          15
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................       8,445       8,494       8,562
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..       4,374       4,693       4,771
    73.10 Total new obligations.............       8,441       8,494       8,562
    73.20 Total outlays (gross).............      -8,084      -8,416      -8,464
    73.40 Adjustments in expired accounts
            (net)...........................         -35
    74.00 Change in uncollected customer
            payments from Federal sources
            (unexpired).....................          -3
    74.10 Change in uncollected customer
            payments from Federal sources
            (expired).......................           1
    74.40 Obligated balance, end of year....       4,693       4,771       4,869
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new discretionary
            authority.......................       4,412       4,391       4,429
    86.93 Outlays from discretionary
            balances........................       3,672       4,025       4,035
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........       8,084       8,416       8,464
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.00   Offsetting collections (cash)
              from: Federal sources.........         -15         -15         -15
          Against gross budget authority only:

    88.95   Change in uncollected customer
              payments from Federal sources
              (unexpired)...................          -3
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................       8,427       8,479       8,547
    90.00 Outlays...........................       8,071       8,401       8,449
    ----------------------------------------------------------------------------

    Additional net budget authority and outlays to cover cost of fully accruing
                                     retirement:
    99.00 Budget authority..................          11          11          13
    99.01 Outlays...........................          11          11          13
    ---------------------------------------------------------------------------

                     Summary of Budget Authority and Outlays

                            (in millions of dollars)

                                         2002 actual  2003 est.   2004 est.
    Enacted/requested:
      Budget Authority..................       8,427       8,479       8,547
      Outlays...........................       8,069       8,401       8,449
    Legislative proposal, not subject to
        PAYGO:
      Budget Authority..................                      30          30
      Outlays...........................                       5          18
                                        ------------------------------------
    Total:
      Budget Authority..................       8,427       8,509       8,577
      Outlays...........................       8,069       8,406       8,467
                                        ====================================

        Provides funding for a Compassion Capital Fund to support public and
    private partnerships in funding community and faith-based charitable
    organizations that expand upon or emulate model social service programs.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1536-0-1-506      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

          Direct obligations:

            Personnel compensation:
    11.1      Full-time permanent...........         111         113         113
    11.3      Other than full-time permanent           2           1           1
    11.5      Other personnel compensation..           1           1           1
                                               ---------   ---------  ----------
    11.9        Total personnel compensation         114         115         115
    12.1    Civilian personnel benefits.....          21          22          22
    21.0    Travel and transportation of
              persons.......................           4           5           5
    23.1    Rental payments to GSA..........          14          16          16
    23.3    Communications, utilities, and
              miscellaneous charges.........           4           2           2
    24.0    Printing and reproduction.......           2           3           3
    25.1    Advisory and assistance services         105         124         124
    25.2    Other services..................           5          41          41
    25.3    Other purchases of goods and
              services from Government
              accounts......................          55          30          30
    25.7    Operation and maintenance of
              equipment.....................           3           1           1
    26.0    Supplies and materials..........           1           2           2
    31.0    Equipment.......................           1           1           1
    41.0    Grants, subsidies, and
              contributions.................       8,094       8,117       8,185
                                               ---------   ---------  ----------
    99.0      Direct obligations............       8,423       8,479       8,547
    99.0  Reimbursable obligations..........          18          15          15
                                               ---------   ---------  ----------
    99.9    Total new obligations...........       8,441       8,494       8,562
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-1536-0-1-506      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
        Direct:
          Total compensable workyears:

    1001    Civilian full-time equivalent
              employment....................       1,448       1,512       1,472
    ---------------------------------------------------------------------------

                      Children and Family Services Programs

                  (Legislative proposal, not subject to PAYGO)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1536-2-1-506      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    01.19 Maternity group homes.............                      10          10
    01.20 Strengthening fatherhood and
            healthy marriages...............                      20          20
                                               ---------   ---------  ----------
    04.00   Total, direct program...........                      30          30
                                               ---------   ---------  ----------
    10.00   Total new obligations...........                      30          30
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......                      30          30
    23.95 Total new obligations.............                     -30         -30
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Discretionary:

    40.00   Appropriation...................                      30          30
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..                                  25
    73.10 Total new obligations.............                      30          30
    73.20 Total outlays (gross).............                      -5         -18
    74.40 Obligated balance, end of year....                      25          37
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new discretionary
            authority.......................                       5           5
    86.93 Outlays from discretionary
            balances........................                                  13
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........                       5          18
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................                      30          30
    90.00 Outlays...........................                       5          18
    ---------------------------------------------------------------------------

        This legislative proposal establishes the Responsible Fatherhood and
    Healthy Marriages Program. The budget provides grants to faith-based and
    community organizations to assist non-custodial fathers in becoming more
    involved in the lives of their children. In addition, the Administration
    includes funding for grants to provide young, pregnant and parenting
    women with access to maternity group homes.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1536-2-1-506      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
    25.3  Other purchases of goods and
            services from Government
            accounts........................                       7           7
    41.0  Grants, subsidies, and
            contributions...................                      23          23
                                               ---------   ---------  ----------
    99.9    Total new obligations...........                      30          30
    ---------------------------------------------------------------------------

    [[Page 436]]

                        Violent Crime Reduction Programs

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-8605-0-1-754      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..          29          15           6
    73.20 Total outlays (gross).............         -13          -9          -3
    73.40 Adjustments in expired accounts
            (net)...........................          -1
    74.40 Obligated balance, end of year....          15           6           3
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.93 Outlays from discretionary
            balances........................          13           9           3
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................
    90.00 Outlays...........................          13           9           3
    ---------------------------------------------------------------------------

                  Children's Research and Technical Assistance

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1553-0-1-609      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Training and technical assistance.          12          12          12
    00.02 Federal parent locator service....          25          23          23
    00.04 Welfare research..................                      15          15
    09.01 Reimbursable program..............           9           9           9
                                               ---------   ---------  ----------
    10.00   Total new obligations...........          46          59          59
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance carried
            forward, start of year..........           1           1
    22.00 New budget authority (gross)......          46          59          59
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......          47          60          59
    23.95 Total new obligations.............         -46         -59         -59
    24.40 Unobligated balance carried
            forward, end of year............           1
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Mandatory:

    60.00   Appropriation...................          58          50          50
    60.35   Appropriation rescinded.........         -21
                                               ---------   ---------  ----------
    62.50     Appropriation (total
                mandatory)..................          37          50          50
    69.00 Offsetting collections (cash).....           9           9           9
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................          46          59          59
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..          34          31          44
    73.10 Total new obligations.............          46          59          59
    73.20 Total outlays (gross).............         -48         -47         -53
    74.40 Obligated balance, end of year....          31          44          50
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new mandatory
            authority.......................          24          25          24
    86.98 Outlays from mandatory balances...          24          22          29
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........          48          47          53
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

            Offsetting collections (cash)
                from:
    88.00     Federal sources...............          -4          -4          -4
    88.40     Non-Federal sources...........          -5          -5          -5
                                               ---------   ---------  ----------
    88.90       Total, offsetting
                  collections (cash)........          -9          -9          -9
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................          37          50          50
    90.00 Outlays...........................          40          38          44
    ---------------------------------------------------------------------------

        This account provides funding for research and technical assistance
    activities established in P.L. 104-193. Amounts for welfare research are
    in addition to research amounts in the Children and families services
    program account and the Temporary Assistance to Needy Families account
    under Illegitimacy Reduction and Family Formation activities.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1553-0-1-609      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

          Direct obligations:

    21.0    Travel and transportation of
              persons.......................           1           1           1
    23.1    Rental payments to GSA..........           1           1           1
    23.3    Communications, utilities, and
              miscellaneous charges.........           1           1           1
    25.1    Advisory and assistance services          14          20          20
    25.2    Other services..................           5           5           5
    25.3    Other purchases of goods and
              services from Government
              accounts......................          13          13          13
    41.0    Grants, subsidies, and
              contributions.................           2           9           9
                                               ---------   ---------  ----------
    99.0      Direct obligations............          37          50          50
    99.0  Reimbursable obligations..........           9           9           9
                                               ---------   ---------  ----------
    99.9    Total new obligations...........          46          59          59
    ---------------------------------------------------------------------------

           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, $5,043,200,000. In addition, for
    carrying out section 477(i), $60,000,000.
        For making payments to States or other non-Federal entities under
    title IV-E of the Act, for the first quarter of fiscal year 2005,
    $1,767,700,000.
        For making, after May 31 of the current fiscal year, payments to
    States or other non-Federal entities under section 474 of title IV-E,
    for the last 3 months of the current fiscal year for unanticipated
    costs, incurred for the current fiscal year, such sums as may be
    necessary.

        Note.--A regular 2003 appropriation for this account had not been
    enacted at the time the budget was prepared; therefore, this account is
    operating under a continuing resolution (P.L. 107-229, as amended). The
    amounts included for 2003 in this budget reflect the Administration's
    2003 policy proposals.

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1545-0-1-609      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Foster care.......................       4,536       4,666       4,939
    00.02 Independent living................         140         140         140
    00.03 Education and training vouchers...                      60          60
    00.04 Adoption assistance...............       1,393       1,539       1,700
                                               ---------   ---------  ----------
    10.00   Total new obligations...........       6,069       6,405       6,839
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......       6,622       6,556       6,839
    23.95 Total new obligations.............      -6,069      -6,405      -6,839
    23.98 Unobligated balance expiring or
            withdrawn.......................        -552        -151
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Discretionary:

    40.00   Appropriation...................                      60          60
          Mandatory:

    60.00   Appropriation...................       4,886       4,742       5,043
    65.00   Advance appropriation...........       1,736       1,754       1,736
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................       6,622       6,556       6,839
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..         934       1,117       1,216
    73.10 Total new obligations.............       6,069       6,405       6,839
    73.20 Total outlays (gross).............      -5,885      -6,306      -6,736
    73.40 Adjustments in expired accounts
            (net)...........................          -2
    74.40 Obligated balance, end of year....       1,117       1,216       1,320
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new discretionary
            authority.......................                       9           9
    86.93 Outlays from discretionary
            balances........................                                  40
    86.97 Outlays from new mandatory
            authority.......................       5,235       5,412       5,831
    86.98 Outlays from mandatory balances...         650         885         856
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........       5,885       6,306       6,736
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................       6,622       6,556       6,839

    [[Page 437]]

    90.00 Outlays...........................       5,885       6,306       6,736
    ---------------------------------------------------------------------------

                     Summary of Budget Authority and Outlays

                            (in millions of dollars)

                                         2002 actual  2003 est.   2004 est.
    Enacted/requested:
      Budget Authority..................       6,622       6,556       6,839
      Outlays...........................       5,885       6,306       6,736
    Legislative proposal, subject to
        PAYGO:
      Budget Authority..................                                  35
      Outlays...........................                                  31
                                        ------------------------------------
    Total:
      Budget Authority..................       6,622       6,556       6,874
      Outlays...........................       5,885       6,306       6,767
                                        ====================================

        Foster care.--The proposed level will support eligible low-income
    children who must be placed outside the home. An average of 240,600
    children per month will be served in 2004.

        Adoption assistance.--The proposed funding level will support
    subsidies for families adopting eligible low-income children with
    special needs. An average of 348,700 children per month will be served
    in 2004.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1545-0-1-609      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
    25.1  Advisory and assistance services..           9          12          17
    25.5  Research and development contracts                       2           2
    41.0  Grants, subsidies, and
            contributions...................       6,060       6,391       6,820
                                               ---------   ---------  ----------
    99.9    Total new obligations...........       6,069       6,405       6,839
    ---------------------------------------------------------------------------

            Payments to States for Foster Care and Adoption Assistance

                    (Legislative proposal, subject to PAYGO)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-1545-4-1-609      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Foster care.......................                                  35
                                               ---------   ---------  ----------
    10.00   Total new obligations (object
              class 41.0)...................                                  35
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......                                  35
    23.95 Total new obligations.............                                 -35
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Mandatory:

    60.00   Appropriation...................                                  35
    ----------------------------------------------------------------------------

        Change in obligated balances:
    73.10 Total new obligations.............                                  35
    73.20 Total outlays (gross).............                                 -31
    74.40 Obligated balance, end of year....                                   5
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new mandatory
            authority.......................                                  31
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................                                  35
    90.00 Outlays...........................                                  31
    ---------------------------------------------------------------------------

        This legislative proposal includes provisions to introduce an option
    available to all states to participate in an alternative financing
    system for child welfare that will better meet the needs of each state's
    foster care population. States choosing to participate will face fewer
    administrative burdens and will receive funds in the form of flexible
    grants.

                             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, and section 398 of the Public Health
    Service Act, $1,343,701,000 of which $5,000,000 shall be available for
    activities regarding medication management, screening, and education to
    prevent incorrect medication and adverse drug reactions; of which
    $2,842,000 shall remain available until September 30, 2006 for the White
    House Conference on Aging; and of which $149,670,000 shall be for making
    payments to or on behalf of States and other eligible grantees,
    consistent with section 311 of the Older Americans Act of 1965:
    Provided, That references to the Secretary of Agriculture in section
    311(b) and (d)(1) shall be deemed to be references to the Secretary of
    Health and Human Services: Provided further, That in those instances in
    which the eligible entity elects to receive its allotment, in part or in
    total, in the form of commodities, the Secretary of Agriculture shall
    supply such commodities and be reimbursed for the costs thereof from
    amounts provided herein.

        Note.--A regular 2003 appropriation for this account had not been
    enacted at the time the budget was prepared; therefore, this account is
    operating under a continuing resolution (P.L. 107-229, as amended). The
    amounts included for 2003 in this budget reflect the Administration's
    2003 policy proposals.

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0142-0-1-506      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    01.01 Home and community-based
            supportive services.............         357         357         357
    01.02 Preventive health.................          21          21          21
    01.03 National family caregiver support
            program.........................         142         142         142
    01.05 Congregate meals..................         390         492         390
    01.06 Home-delivered meals..............         176         224         178
    01.07 Nutrition services incentive
            program.........................                                 150
    01.08 Grants to Indian tribes...........          26          28          26
    01.09 Program innovations...............          39          28          28
    01.10 Aging network support activities..           2           2           2
    01.11 Federal administration............          18          18          18
    01.13 Alzheimer's disease demonstration
            grants to States................          11          11          11
    01.14 Grants to States for the
            protection of vulnerable older
            Americans.......................          18          18          18
    01.15 White House Conference on Aging...                                   3
                                               ---------   ---------  ----------
    02.00   Total, Direct Program...........       1,200       1,341       1,344
    09.01 Reimbursable program (HCFAC)......                       3           3
                                               ---------   ---------  ----------
    10.00   Total new obligations...........       1,200       1,344       1,347
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance carried
            forward, start of year..........           2           1           1
    22.00 New budget authority (gross)......       1,200       1,344       1,347
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......       1,202       1,345       1,348
    23.95 Total new obligations.............      -1,200      -1,344      -1,347
    24.40 Unobligated balance carried
            forward, end of year............           1           1           1
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Discretionary:

    40.00   Appropriation...................       1,200       1,341       1,344
          Mandatory:

    69.00   Offsetting collections (cash)...                       3           3
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................       1,200       1,344       1,347
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..         456         548         601
    73.10 Total new obligations.............       1,200       1,344       1,347
    73.20 Total outlays (gross).............      -1,105      -1,291      -1,344
    73.40 Adjustments in expired accounts
            (net)...........................          -3
    74.40 Obligated balance, end of year....         548         601         603
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new discretionary
            authority.......................         727         832         834
    86.93 Outlays from discretionary
            balances........................         378         456         507
    86.97 Outlays from new mandatory
            authority.......................                       3           3
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........       1,105       1,291       1,344
    ----------------------------------------------------------------------------

    [[Page 438]]

        Offsets:
          Against gross budget authority and outlays:

    88.00   Offsetting collections (cash)
              from: Federal sources.........                      -3          -3
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................       1,200       1,341       1,344
    90.00 Outlays...........................       1,105       1,288       1,341
    ----------------------------------------------------------------------------

    Additional net budget authority and outlays to cover cost of fully accruing
                                     retirement:
    99.00 Budget authority..................           1           1           1
    99.01 Outlays...........................           1           1           1
    ---------------------------------------------------------------------------
        Note.--The reimbursable program (HCFAC) in the Administration on
    Aging (AoA) reflects the estimated distribution of the allocation
    account for fiscal years 2003 and 2004. Actual 2003 and 2004
    distributions will be determined by the Secretary of HHS and the
    Attorney General.

        Administration on Aging.--The proposed level will provide continued
    funding for core formula grant programs that provide nutrition,
    supportive services and caregiver support services through the aging
    network. AoA programs are part of a comprehensive system of support for
    older people and their families. The proposed level also includes
    funding for the White House Conference on Aging.

        In order to improve program management, the budget proposes to
    transfer the smaller Department of Agriculture nutrition program for the
    elderly to AoA, while preserving State access to commodities and
    ensuring that the funds continue to be dedicated exclusively to the
    provision of meals. Although both Departments currently fund these
    services, HHS is the lead agency and has greater interaction with
    service providers. This transfer will improve program oversight and
    streamline reporting requirements.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0142-0-1-506      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

          Direct obligations:

    11.1    Personnel compensation: Full-
              time permanent................           9           9          10
    12.1    Civilian personnel benefits.....           2           2           2
    23.1    Rental payments to GSA..........           1           2           2
    25.1    Advisory and assistance services           5           6           6
    25.2    Other services..................           1           1           1
    25.3    Other purchases of goods and
              services from Government
              accounts......................           6           4           6
    41.0    Grants, subsidies, and
              contributions.................       1,176       1,317       1,317
                                               ---------   ---------  ----------
    99.0      Direct obligations............       1,200       1,341       1,344
    99.0  Reimbursable obligations..........                       3           3
                                               ---------   ---------  ----------
    99.9    Total new obligations...........       1,200       1,344       1,347
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-0142-0-1-506      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
        Direct:
          Total compensable workyears:

    1001    Civilian full-time equivalent
              employment....................         112         112         112
        Reimbursable:
          Total compensable workyears:

    2001    Civilian full-time equivalent
              employment....................                       8           8
        Allocation account:
          Total compensable workyears:

    3001    Civilian full-time equivalent
              employment....................           8
    ---------------------------------------------------------------------------

                             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, $348,100,000 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 XX
    of the Public Health Service Act, $11,885,000 shall be for activities
    specified under section 2003(b)(2), of which $10,157,000 shall be for
    prevention service demonstration grants under section 510(b)(2) of title
    V of the Social Security Act, as amended, without application of the
    limitation of section 2010(c) of said title XX: Provided further, That
    of this amount, $50,000,000 is for minority AIDS prevention and
    treatment activities; and $18,400,000 is for an Information Technology
    Security and Innovation Fund for Department-wide activities involving
    cybersecurity, information technology security, and related innovation
    projects, and $5,000,000 is to assist Afghanistan in the development of
    maternal and child health clinics, consistent with section 103(a)(4)(H)
    of the Afghanistan Freedom Support Act of 2002.

                             office for civil rights

        For expenses necessary for the Office for Civil Rights, $30,936,000,
    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.

                                 policy research

        For carrying out, to the extent not otherwise provided, research
    studies under section 1110 of the Social Security Act and title III of
    the Public Health Service Act, $2,499,000: Provided, That in addition to
    amounts provided herein, $21,000,000 shall be available from amounts
    available under section 241 of the Public Health Service Act to carry
    out national health or human services research and evaluation
    activities: Provided further, That the expenditure of any funds
    available under section 241 of the Public Health Service Act are subject
    to the requirements of section 205 of this Act.

                public health and social services emergency fund

        For expenses necessary to support activities related to countering
    potential biological, disease and chemical threats to civilian
    populations, $1,896,149,000, of which $100,000,000 shall be for
    activities to ensure a year-round influenza vaccine production capacity
    and the development and implementation of rapidly expandable production
    technologies: Provided, That the Secretary of Health and Human Services
    may increase funding for such pandemic influenza activities by transfer
    of up to $150,000,000 from available unobligated amounts in
    discretionary accounts (pursuant to the Balanced Budget and Emergency
    Deficit Control Act of 1985, as amended) of the Department of Health and
    Human Services funded in this or prior appropriations Acts: Provided
    further, That funding for pandemic influenza activities shall remain
    available until expended.

        Note.--A regular 2003 appropriation for this account had not been
    enacted at the time the budget was prepared; therefore, this account is
    operating under a continuing resolution (P.L. 107-229, as amended). The
    amounts included for 2003 in this budget reflect the Administration's
    2003 policy proposals.

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9912-0-1-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
          Direct activities:

    00.01   General departmental management.         343         341         353
    00.02   Office for Civil Rights.........          28          30          31
    00.03   Policy research.................           2           2           2
    00.04   Public health and social
              services emergency fund.......       1,625       1,807       1,896
    09.01 Reimbursable program..............         141         168         186
    09.02 Reimbursable program (HCFAC)......                       6           5
                                               ---------   ---------  ----------
    10.00   Total new obligations...........       2,139       2,354       2,473
    ----------------------------------------------------------------------------

    [[Page 439]]

        Budgetary resources available for obligation:
    21.40 Unobligated balance carried
            forward, start of year..........         109         147         149
    22.00 New budget authority (gross)......       2,182       2,356       2,475
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......       2,291       2,503       2,624
    23.95 Total new obligations.............      -2,139      -2,354      -2,473
    23.98 Unobligated balance expiring or
            withdrawn.......................          -4
    24.40 Unobligated balance carried
            forward, end of year............         147         149         151
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Discretionary:

    40.00   Appropriation...................       2,029       2,176       2,278
    40.73   Reduction pursuant to P.L. 107-
              206...........................          -3
    42.00   Transferred from other accounts.           9
                                               ---------   ---------  ----------
    43.00     Appropriation (total
                discretionary)..............       2,035       2,176       2,278
          Spending authority from offsetting
              collections:

            Offsetting collections (cash):
    68.00     Offsetting collections (cash).          81         174         192
    68.00     Offsetting collections (cash)
                HCFAC.......................                       6           5
    68.10   Change in uncollected customer
              payments from Federal sources
              (unexpired)...................          66
                                               ---------   ---------  ----------
    68.90     Spending authority from
                offsetting collections
                (total discretionary).......         147         180         197
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................       2,182       2,356       2,475
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..         562       1,555       1,996
    73.10 Total new obligations.............       2,139       2,354       2,473
    73.20 Total outlays (gross).............      -1,092      -1,913      -2,432
    73.40 Adjustments in expired accounts
            (net)...........................         -17
    74.00 Change in uncollected customer
            payments from Federal sources
            (unexpired).....................         -66
    74.10 Change in uncollected customer
            payments from Federal sources
            (expired).......................          28
    74.40 Obligated balance, end of year....       1,555       1,996       2,037
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new discretionary
            authority.......................         760         806         851
    86.93 Outlays from discretionary
            balances........................         332       1,107       1,581
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........       1,092       1,913       2,432
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.00   Offsetting collections (cash)
              from: Federal sources.........        -108        -180        -197
          Against gross budget authority only:

    88.95   Change in uncollected customer
              payments from Federal sources
              (unexpired)...................         -66
    88.96   Portion of offsetting
              collections (cash) credited to
              expired accounts..............          27
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................       2,035       2,176       2,278
    90.00 Outlays...........................         982       1,733       2,235
    ----------------------------------------------------------------------------

    Additional net budget authority and outlays to cover cost of fully accruing
                                     retirement:
    99.00 Budget authority..................          10          10          12
    99.01 Outlays...........................          10          10          12
    ---------------------------------------------------------------------------
        Note.--The reimbursable program (HCFAC) in Departmental Management
    reflects the estimated distribution from the allocation account for
    fiscal year 2003 and 2004. Actual 2003 and 2004 distributions will be
    determined by the Secretary of HHS and the Attorney General.

                              (Dollars in millions)

                                         2002 actual  2003 est.   2004 est.
    Distribution of budget authority by
        account:
      General Departmental Management...         334         337         349
      Office for Civil Rights...........          28          30          31
      Policy Research...................           2           2           2
      Public Health and Social Services
        Emergency Fund..................       1,671       1,807       1,896
    Distribution of outlays by account:
      General Departmental Management...         319         324         341
      Office for Civil Rights...........          25          30          32
      Policy research...................          11           2           2
      Public Health and Social Services
        Emergency Fund..................         627       1,377       1,860

        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 and health information privacy
    compliance 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, as well as programs to counter bioterrorist threats.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9912-0-1-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

          Direct obligations:

            Personnel compensation:
    11.1      Full-time permanent...........         106         113         115
    11.3      Other than full-time permanent           4           6           6
    11.5      Other personnel compensation..           3           2           2
    11.7      Military personnel............           2           3           3
                                               ---------   ---------  ----------
    11.9        Total personnel compensation         115         124         126
    12.1    Civilian personnel benefits.....          24          26          27
    12.2    Military personnel benefits.....           1           1           1
    21.0    Travel and transportation of
              persons.......................           6           6           4
    23.1    Rental payments to GSA..........          15          18          24
    23.3    Communications, utilities, and
              miscellaneous charges.........           4           6           4
    24.0    Printing and reproduction.......           2           2           2
    25.1    Advisory and assistance services           7           1           1
    25.2    Other services..................          24          37          41
    25.3    Other purchases of goods and
              services from Government
              accounts......................          48          43          41
    25.4    Operation and maintenance of
              facilities....................           9           8           9
    25.7    Operation and maintenance of
              equipment.....................          18          25          28
    26.0    Supplies and materials..........           5           8           3
    31.0    Equipment.......................           7           7           3
    41.0    Grants, subsidies, and
              contributions.................         111         127         134
                                               ---------   ---------  ----------
    99.0      Direct obligations............         396         439         448
    99.0  Reimbursable obligations..........         142         174         191
          Allocation Account:

            Personnel compensation:
    11.1      Full-time permanent...........          29          13          13
    11.3      Other than full-time permanent           3           2           2
    11.5      Other personnel compensation..           2           2           2
    11.8      Special personal services
                payments....................           1
                                               ---------   ---------  ----------
    11.9        Total personnel compensation          35          17          17
    12.1    Civilian personnel benefits.....          10           9           9
    21.0    Travel and transportation of
              persons.......................           4           3           3
    23.1    Rental payments to GSA..........                       5           5
    23.3    Communications, utilities, and
              miscellaneous charges.........           7           3           3
    25.1    Advisory and assistance services          51          11          11
    25.2    Other services..................          36          12          12
    25.3    Other purchases of goods and
              services from Government
              accounts......................          63          22          22
    25.4    Operation and maintenance of
              facilities....................          39          52          52
    25.5    Research and development
              contracts.....................          22          22          22
    25.6    Medical care....................           6
    25.7    Operation and maintenance of
              equipment.....................           1           1           1
    26.0    Supplies and materials..........           6          20          20
    31.0    Equipment.......................          20          14          14
    41.0    Grants, subsidies, and
              contributions.................       1,301       1,549       1,642
    42.0    Insurance claims and indemnities                       1           1
                                               ---------   ---------  ----------
    99.0      Allocation account............       1,601       1,741       1,834
                                               ---------   ---------  ----------
    99.9    Total new obligations...........       2,139       2,354       2,473
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-9912-0-1-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
        Direct:
          Total compensable workyears:

    1001    Civilian full-time equivalent
              employment....................       1,300       1,424       1,419
    1101    Military full-time equivalent
              employment....................          61          61          61
        Reimbursable:
          Total compensable workyears:

    2001    Civilian full-time equivalent
              employment....................         257         277         278
    ---------------------------------------------------------------------------

                    Allocations Received From Other Accounts

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

    [[Page 440]]

                             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, 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 56), such amounts as
    may be required during the current fiscal year.

        Note.--A regular 2003 appropriation for this account had not been
    enacted at the time the budget was prepared; therefore, this account is
    operating under a continuing resolution (P.L. 107-229, as amended). The
    amounts included for 2003 in this budget reflect the Administration's
    2003 policy proposals.

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0379-0-1-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Retirement payments...............         204         219         234
    00.02 Survivors' benefits...............          13          14          15
    00.03 Medical care......................          56          52          54
                                               ---------   ---------  ----------
    10.00   Total new obligations...........         273         285         303
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......         278         285         303
    23.95 Total new obligations.............        -273        -285        -303
    23.98 Unobligated balance expiring or
            withdrawn.......................          -5
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Mandatory:

    60.00   Appropriation...................         278         285         303
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..          20          45          49
    73.10 Total new obligations.............         273         285         303
    73.20 Total outlays (gross).............        -253        -281        -301
    73.40 Adjustments in expired accounts
            (net)...........................           5
    74.40 Obligated balance, end of year....          45          49          51
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new mandatory
            authority.......................         234         242         258
    86.98 Outlays from mandatory balances...          19          39          43
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........         253         281         301
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................         278         285         303
    90.00 Outlays...........................         253         281         301
    ----------------------------------------------------------------------------

    Additional net budget authority and outlays to cover cost of fully accruing
                                     retirement:
    99.00 Budget authority..................                                  27
    99.01 Outlays...........................                                  27
    ---------------------------------------------------------------------------

                     Summary of Budget Authority and Outlays

                            (in millions of dollars)

                                         2002 actual  2003 est.   2004 est.
    Enacted/requested:
      Budget Authority..................         278         285         303
      Outlays...........................         253         281         301
    Legislative proposal, not subject to
        PAYGO:
      Budget Authority..................                                  13
      Outlays...........................                                  13
                                        ------------------------------------
    Total:
      Budget Authority..................         278         285         316
      Outlays...........................         253         281         314
                                        ====================================

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

        The estimates in the following table support the President's Budget
    proposal to extend accrual financing for health care provided to non-
    Medicare-eligible uniformed services retirees.

     Uniformed Services Non-Medicare Eligible Retiree Health Care Accrual
              Proposal Effects on Public Health Accounts in 2004

                             (Dollars in millions)
                                               Mandatory     Discretionary
    Mandatory Offsetting Collection through
      the Defense Health Account from the
      Uniformed Services Retiree Health Care
      Fund for Non-Medicare Eligible Retiree
      Health Care:
    Public Health Service...................            54
    Adjustments to Public Health
     Discretionary Appropriation Payments to
     the Uniformed Services Retiree Health
     Care Fund Ret. Pay and Med. Benefits
     for Commissioned Officers Account......                            27
    Adj. to Ret. Pay and Med. Benefits for
     Commissioned Officers Account..........                           -54
                                                            --------------

    Change to Public Health Discretionary
     Appropriation..........................                           -27

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0379-0-1-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
    13.0  Benefits for former personnel.....         217         233         249
    25.6  Medical care......................          56          52          54
                                               ---------   ---------  ----------
    99.9    Total new obligations...........         273         285         303
    ---------------------------------------------------------------------------

          Retirement Pay and Medical Benefits for Commissioned Officers

                  (Legislative proposal, not subject to PAYGO)

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0379-2-1-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.03 Medical care......................                                  13
                                               ---------   ---------  ----------
    10.00   Total new obligations (object
              class 12.2)...................                                  13
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    22.00 New budget authority (gross)......                                  13
    23.95 Total new obligations.............                                 -13
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Discretionary:

    40.00   Appropriation...................                                  13
    ----------------------------------------------------------------------------

        Change in obligated balances:
    73.10 Total new obligations.............                                  13
    73.20 Total outlays (gross).............                                 -13
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new discretionary
            authority.......................                                  13
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................                                  13
    90.00 Outlays...........................                                  13
    ---------------------------------------------------------------------------

        A Department of Defense legislative proposal will change the accrual
    amount that HHS pays into the Uniformed Services Retiree Health Care
    Fund for health benefits for Medicare-eligible Public Health Service
    Commissioned Corps officers. The new accrual rate more accurately
    reflects the all-officer nature of the Commissioned Corps.

                             Health Activities Funds

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9913-0-1-552      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance carried
            forward, start of year..........           7           7           7
    24.40 Unobligated balance carried
            forward, end of year............           7           7           7
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..           2           2           2
    74.40 Obligated balance, end of year....           2           2           2
    ----------------------------------------------------------------------------

    [[Page 441]]

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

        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      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    09.01 Program support center............         287         320         321
    09.02 Federal employee occupational
            health..........................         110         129         138
    09.03 OS activities.....................           8           7           7
                                               ---------   ---------  ----------
    10.00   Total new obligations...........         405         456         466
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance carried
            forward, start of year..........          69          89          89
    22.00 New budget authority (gross)......         417         456         466
    22.10 Resources available from
            recoveries of prior year
            obligations.....................           8
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......         494         545         555
    23.95 Total new obligations.............        -405        -456        -466
    24.40 Unobligated balance carried
            forward, end of year............          89          89          89
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Mandatory:

    69.00   Offsetting collections (cash)...         385         456         466
    69.10   Change in uncollected customer
              payments from Federal sources
              (unexpired)...................          32
                                               ---------   ---------  ----------
    69.90     Spending authority from
                offsetting collections
                (total mandatory)...........         417         456         466
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..         -15         -46         -46
    73.10 Total new obligations.............         405         456         466
    73.20 Total outlays (gross).............        -397        -456        -466
    73.45 Recoveries of prior year
            obligations.....................          -8
    74.00 Change in uncollected customer
            payments from Federal sources
            (unexpired).....................         -32
    74.40 Obligated balance, end of year....         -46         -46         -46
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new mandatory
            authority.......................         397         456         466
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.00   Offsetting collections (cash)
              from: Federal sources.........        -385        -456        -466
          Against gross budget authority only:

    88.95   Change in uncollected customer
              payments from Federal sources
              (unexpired)...................         -32
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................
    90.00 Outlays...........................          11
    ---------------------------------------------------------------------------

        HHS Service and Supply Fund (SSF) provides a wide range of
    logistical and support services to components of the Department and
    other Federal agencies. The Program Support Center line includes
    activities such as personnel and payroll administration, financial
    management operations, and administrative services, including
    acquisitions management, building and property management, information
    technology and telecommunication services, and medical supplies
    repackaging and distribution services. The Federal Occupational Health
    program is also financed by the SSF, and provides clinical health
    services, environmental and industrial hygiene-related services, and
    employee assistance programs. The Office of Secretary activities line
    includes the fund manager, departmental contracts, audit resolutions,
    and the regional health administrators.

                   Object Classification (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9941-0-4-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

          Personnel compensation:

    11.1    Full-time permanent.............          67          73          77
    11.3    Other than full-time permanent..           2           2           2
    11.5    Other personnel compensation....           2           2           2
    11.7    Military personnel..............           7           8           8
                                               ---------   ---------  ----------
    11.9      Total personnel compensation..          78          85          89
    12.1  Civilian personnel benefits.......          19          18          19
    12.2  Military personnel benefits.......           4           3           4
    21.0  Travel and transportation of
            persons.........................           3           3           3
    22.0  Transportation of things..........           2           2           3
    23.1  Rental payments to GSA............          11          13          13
    23.3  Communications, utilities, and
            miscellaneous charges...........           8           8           8
    24.0  Printing and reproduction.........           1           1           2
    25.1  Advisory and assistance services..          13          15          15
    25.2  Other services....................         100         119         109
    25.3  Other purchases of goods and
            services from Government
            accounts........................          27          31          32
    25.4  Operation and maintenance of
            facilities......................          18          21          21
    25.6  Medical care......................          34          39          40
    26.0  Supplies and materials............          80          86          94
    31.0  Equipment.........................           7          12          14
                                               ---------   ---------  ----------
    99.9    Total new obligations...........         405         456         466
    ---------------------------------------------------------------------------

        This year's budget includes an improved display for Public Health
    Service Commissioned Corps Officers. Most Commissioned Corps officers
    work for agencies in the Department of Health and Human Services.
    However, some of these officers are detailed to perform work in other
    Federal agencies. The allocation account section in the table below
    shows the total number of these detailed FTE.

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-9941-0-4-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
        Reimbursable:
          Total compensable workyears:

    2001    Civilian full-time equivalent
              employment....................       1,122       1,122       1,122
    2101    Military full-time equivalent
              employment....................          71          71          71
        Allocation account:
          Total compensable workyears:

    3101    Military full-time equivalent
              employment....................       1,131       1,281       1,281
    ---------------------------------------------------------------------------

                                   Trust Funds

                            Miscellaneous Trust Funds

                  Unavailable Collections (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9971-0-7-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
    01.99 Balance, start of year............
        Receipts:
    02.00 Gifts and contributions,
            miscellaneous trust funds.......          47          47          47
    02.20 Contributions, Indian health
            facilities, Health Services
            Administration..................          60          60          60
    02.40 Interest, Miscellaneous trust
            funds...........................           1           1           1
                                               ---------   ---------  ----------
    02.99   Total receipts and collections..         108         108         108
        Appropriations:
    05.00 Miscellaneous trust funds.........        -108        -108        -108
                                               ---------   ---------  ----------
    07.99 Balance, end of year..............
    ---------------------------------------------------------------------------

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-9971-0-7-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.02 Gifts.............................          38          48          48
    00.03 Contributions, Indian health
            facilities......................          42          60          60
                                               ---------   ---------  ----------
    10.00   Total new obligations...........          80         108         108
    ----------------------------------------------------------------------------

    [[Page 442]]

        Budgetary resources available for obligation:
    21.40 Unobligated balance carried
            forward, start of year..........          74         101         101
    22.00 New budget authority (gross)......         108         108         108
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......         182         209         209
    23.95 Total new obligations.............         -80        -108        -108
    24.40 Unobligated balance carried
            forward, end of year............         101         101         101
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Mandatory:

    60.26   Appropriation (trust fund)......         108         108         108
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..          76          99         129
    73.10 Total new obligations.............          80         108         108
    73.20 Total outlays (gross).............         -57         -78         -96
    74.40 Obligated balance, end of year....          99         129         141
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.97 Outlays from new mandatory
            authority.......................          24          32          32
    86.98 Outlays from mandatory balances...          33          46          64
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........          57          78          96
    ----------------------------------------------------------------------------

        Net budget authority and outlays:
    89.00 Budget authority..................         108         108         108
    90.00 Outlays...........................          57          78          96
    ----------------------------------------------------------------------------

        Memorandum (non-add) entries:
    92.01 Total investments, start of year:
            Federal securities: Par value...          25          30          30
    92.02 Total investments, end of year:
            Federal securities: Par value...          30          30          30
    ---------------------------------------------------------------------------

                              [Dollars in millions]

                                            2002         2003        2004
    Distribution of budget authority by
        account:
      Gifts.............................          48          48          48
      Contributions, Indian health
        facilities......................          60          60          60
    Distribution of outlays by account:
      Gifts.............................          26          35          43
      Contributions, Indian health
        facilities......................          31          43          53

        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      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

          Personnel compensation:

    11.1    Full-time permanent.............           1           1           1
    11.3    Other than full-time permanent..           1           1           1
                                               ---------   ---------  ----------
    11.9      Total personnel compensation..           2           2           2
    21.0  Travel and transportation of
            persons.........................           1           1           1
    22.0  Transportation of things..........                       1           1
    25.1  Advisory and assistance services..           1           1           1
    25.2  Other services....................          11          15          15
    25.3  Other purchases of goods and
            services from Government
            accounts........................           1           1           1
    25.4  Operation and maintenance of
            facilities......................                       1           1
    25.5  Research and development contracts           8          11          11
    25.7  Operation and maintenance of
            equipment.......................          22          30          30
    26.0  Supplies and materials............           1           1           1
    31.0  Equipment.........................           1           1           1
    32.0  Land and structures...............           5           7           7
    41.0  Grants, subsidies, and
            contributions...................          27          36          36
                                               ---------   ---------  ----------
    99.9    Total new obligations...........          80         108         108
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-9971-0-7-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
        Direct:
          Total compensable workyears:

    1001    Civilian full-time equivalent
              employment....................          22          22          22
    ---------------------------------------------------------------------------

                         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, $39,497,000: Provided, That, of such amount, necessary sums are
    available for providing protective services to the Secretary and
    investigating non-payment of child support cases for which non-payment
    is a Federal offense under 18 U.S.C. 228.
        Note.--A regular 2003 appropriation for this account had not been
    enacted at the time the budget was prepared; therefore, this account is
    operating under a continuing resolution (P.L. 107-229, as amended). The
    amounts included for 2003 in this budget reflect the Administration's
    2003 policy proposals.

                   Program and Financing (in millions of dollars)

    ----------------------------------------------------------------------------
    Identification code 75-0128-0-1-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

        Obligations by program activity:
    00.01 Direct program....................          36          40          39
    09.01 HCFAC reimbursable program........                     166         166
    09.02 Reimbursable program..............          17          12          12
                                               ---------   ---------  ----------
    10.00   Total new obligations...........          53         218         217
    ----------------------------------------------------------------------------

        Budgetary resources available for obligation:
    21.40 Unobligated balance carried
            forward, start of year..........           1           1           1
    22.00 New budget authority (gross)......          52         218         217
                                               ---------   ---------  ----------
    23.90   Total budgetary resources
              available for obligation......          53         219         218
    23.95 Total new obligations.............         -53        -218        -217
    24.40 Unobligated balance carried
            forward, end of year............           1           1           1
    ----------------------------------------------------------------------------

        New budget authority (gross), detail:
          Discretionary:

    40.00   Appropriation...................          36          40          39
          Spending authority from offsetting
              collections:

    68.00   Offsetting collections (cash)...           6          12          12
    68.10   Change in uncollected customer
              payments from Federal sources
              (unexpired)...................          10
                                               ---------   ---------  ----------
    68.90     Spending authority from
                offsetting collections
                (total discretionary).......          16          12          12
          Mandatory:

    69.00   Offsetting collections (cash)...                     166         166
                                               ---------   ---------  ----------
    70.00   Total new budget authority
              (gross).......................          52         218         217
    ----------------------------------------------------------------------------

        Change in obligated balances:
    72.40 Obligated balance, start of year..           1                       4
    73.10 Total new obligations.............          53         218         217
    73.20 Total outlays (gross).............         -54        -214        -217
    74.00 Change in uncollected customer
            payments from Federal sources
            (unexpired).....................         -10
    74.10 Change in uncollected customer
            payments from Federal sources
            (expired).......................          11
    74.40 Obligated balance, end of year....                       4           4
    ----------------------------------------------------------------------------

        Outlays (gross), detail:
    86.90 Outlays from new discretionary
            authority.......................          32          48          47
    86.93 Outlays from discretionary
            balances........................          22                       4
    86.97 Outlays from new mandatory
            authority.......................                     166         166
                                               ---------   ---------  ----------
    87.00   Total outlays (gross)...........          54         214         217
    ----------------------------------------------------------------------------

        Offsets:
          Against gross budget authority and outlays:

    88.00   Offsetting collections (cash)
              from: Federal sources.........         -18        -178        -178
          Against gross budget authority only:

    88.95   Change in uncollected customer
              payments from Federal sources
              (unexpired)...................         -10
    88.96   Portion of offsetting
              collections (cash) credited to
              expired accounts..............          12
    ----------------------------------------------------------------------------

    [[Page 443]]

        Net budget authority and outlays:
    89.00 Budget authority..................          36          40          39
    90.00 Outlays...........................          36          36          39
    ----------------------------------------------------------------------------

    Additional net budget authority and outlays to cover cost of fully accruing
                                     retirement:
    99.00 Budget authority..................           9           9          10
    99.01 Outlays...........................           9           9          10
    ---------------------------------------------------------------------------

        The Office of Inspector General (OIG) 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 OIG,
    the Health Insurance Portability and Accountability Act of 1996 makes
    available mandatory funding for use by the OIG. These funds are used to
    combat Medicare, Medicaid, and State Children's Health Insurance Program
    (SCHIP) 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)

                                             2002 actual   2003 est.   2004 est.
    Budget Authority:
      Discretionary appropriations..........          36          40          39
      Mandatory (HCFAC Account).............         139         160         160
                                               ---------   ---------  ----------
          Total.............................         175         200         199
        Note.--The reimbursable program (HCFAC) in Office of the Inspector
    General reflects the estimated distrubiton of the allocation account for
    fiscal years 2003 and 2004. Actual 2003 and 2004 distributions 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      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------

          Direct obligations:

    11.1    Personnel compensation: Full-
              time permanent................          20          24          24
    12.1    Civilian personnel benefits.....           6           6           6
    21.0    Travel and transportation of
              persons.......................           2           2           2
    23.1    Rental payments to GSA..........           3           3           3
    25.3    Other purchases of goods and
              services from Government
              accounts......................           4           4           4
    31.0    Equipment.......................           1           1
                                               ---------   ---------  ----------
    99.0      Direct obligations............          36          40          39
    99.0  Reimbursable obligations..........          17         178         178
                                               ---------   ---------  ----------
    99.9    Total new obligations...........          53         218         217
    ---------------------------------------------------------------------------

                                  Personnel Summary

    ----------------------------------------------------------------------------
    Identification code 75-0128-0-1-551      2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
        Direct:
          Total compensable workyears:

    1001    Civilian full-time equivalent
              employment....................         296         320         307
        Reimbursable:
          Total compensable workyears:

    2001    Civilian full-time equivalent
              employment....................          56       1,320       1,252
        Allocation account:
          Total compensable workyears:

    3001    Civilian full-time equivalent
              employment....................       1,217
    ---------------------------------------------------------------------------

                    Allocations Received From Other Accounts

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

                          GENERAL FUND RECEIPT ACCOUNTS

                               (in millions of dollars)

    ----------------------------------------------------------------------------
                                             2002 actual   2003 est.   2004 est.
    ----------------------------------------------------------------------------
    Offsetting receipts from the public:
      75-310700  Federal share of child
        support collections.................       1,235       1,117       1,137
        Legislative proposal, subject to
          PAYGO.............................                                  14
                                               ---------   ---------  ----------
    General Fund Offsetting receipts from
     the public.............................       1,235       1,117       1,151
    ---------------------------------------------------------------------------

                               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 399F(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, the Agency for Healthcare Research and
    Quality, 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 Executive
    Level II.
        Sec. 205. Notwithstanding section 241(a) of the Public Health
    Service Act, such portion as the Secretary shall determine, but not more
    than 1.25 percent, of any amounts appropriated for programs authorized
    under said Act shall be made available for the evaluation (directly, or
    by grants or contracts) of the implementation and effectiveness of such
    programs.

                               (transfer of funds)

        Sec. 206. Not to exceed 3 percent of any discretionary funds
    (pursuant to the Balanced Budget and Emergency Deficit Control Act of
    1985, as amended) which are appropriated for the current fiscal year for
    the Department of Health and Human Services in this or any other Act may
    be transferred between appropriations, but no such appropriation shall
    be increased by more than 10 percent by any such transfer: Provided,
    That the Appropriations Committees of both Houses of Congress are
    notified at least 15 days in advance of any transfer.
        Sec. 207. The Director of the National Institutes of Health, jointly
    with the Director of the Office of AIDS Research, may transfer up to 3
    percent among institutes, centers, and divisions from the total amounts
    identified by these two Directors as funding for research pertaining to
    the human immunodeficiency virus: Provided, That the Congress is
    promptly notified of the transfer.
        Sec. 208. 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 the
    National Institutes of Health 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. 209. None of the funds appropriated in this 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.
        Sec. 210. None of the funds appropriated by this Act (including
    funds appropriated to any trust fund) may be used to carry out the
    Medicare+Choice program if the Secretary denies participation in such
    program to an otherwise eligible entity (including a Provider Sponsored
    Organization) because the entity informs the Secretary that it will not
    provide, pay for, provide coverage of, or provide referrals for
    abortions: Provided, That the Secretary shall make appropriate
    prospective adjustments to the capitation payment to such an entity
    (based on an actuarially sound estimate of the expected costs of
    providing the service to such entity's enrollees): Provided further,
    That nothing in this section shall be construed to change the Medicare
    program's coverage for such services and a Medicare+Choice organization
    described in this section shall be responsible for informing enrollees
    where to obtain information about all Medicare covered services.

    [[Page 444]]

        Sec. 211. Notwithstanding any other provision of law, no provider of
    services under title X of the Public Health Service Act shall be exempt
    from any State law requiring notification or the reporting of child
    abuse, child molestation, sexual abuse, rape, or incest.
        Sec. 212. (a) Except as provided by subsection (e) none of the funds
    appropriated by this Act may be used to withhold substance abuse funding
    from a State pursuant to section 1926 of the Public Health Service Act
    (42 U.S.C. 300x-26) if such State certifies to the Secretary of Health
    and Human Services by May 1, 2004 that the State will commit additional
    State funds, in accordance with subsection (b), to ensure compliance
    with State laws prohibiting the sale of tobacco products to individuals
    under 18 years of age.
        (b) The amount of funds to be committed by a State under subsection
    (a) shall be equal to 1 percent of such State's substance abuse block
    grant allocation for each percentage point by which the State misses the
    retailer compliance rate goal established by the Secretary of Health and
    Human Services under section 1926 of such Act.
        (c) The State is to maintain State expenditures in fiscal year 2004
    for tobacco prevention programs and for compliance activities at a level
    that is not less than the level of such expenditures maintained by the
    State for fiscal year 2003, and adding to that level the additional
    funds for tobacco compliance activities required under subsection (a).
    The State is to submit a report to the Secretary on all fiscal year 2003
    State expenditures and all fiscal year 2004 obligations for tobacco
    prevention and compliance activities by program activity by July 31,
    2004.
        (d) The Secretary shall exercise discretion in enforcing the timing
    of the State obligation of the additional funds required by the
    certification in subsection (a) as late as July 31, 2004.
        (e) None of the funds appropriated by this Act may be used to
    withhold substance abuse funding pursuant to section 1926 from a
    territory that receives less than $1,000,000.
        Sec. 213. In order for the Centers for Disease Control and
    Prevention to carry out international health activities, including HIV/
    AIDS and other infectious disease, chronic and environmental disease,
    and other health activities abroad during fiscal year 2004, the
    Secretary of Health and Human Services is authorized to--
        (1) utilize the authorities contained in subsection 2(c) of the
    State Department Basic Authorities Act of 1956, as amended; and
        (2) utilize the authorities contained in 22 U.S.C. 291 and 292 and
    directly or through contract or cooperative agreement to lease, alter or
    renovate facilities in foreign countries, to carry out programs
    supported by this appropriation notwithstanding PHS Act section 307.
        In exercising the authority set forth in paragraphs (1) and (2), the
    Secretary of Health and Human Services shall consult with the Department
    of State to assure that planned activities are within the legal
    strictures of the State Department Basic Authorities Act of 1956, as
    amended, and other applicable parts of title 22, United States Code.
        Sec. 214. The Division of Federal Occupational Health may utilize
    personal services contracting to employ professional management/
    administrative and occupational health professionals.
        Sec. 215. With the funds appropriated to the National Institutes of
    Health in this Act, NIH is authorized to obligate in fiscal year 2004
    the full multi-year cost of a grant or contract that is awarded in that
    year, and any funds which may be deobligated subsequently shall remain
    available until expended for the same purposes.