[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.
