[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 2005

[[Page 421]]

 
                 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 Public Law 
107-188; [$1,673,441,000] $1,820,849,000: Provided, That of the amount 
provided under this heading, [$249,825,000] $284,394,000 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 further, That this amount shall not include any fees 
pursuant to 21 U.S.C. 379h(a)(2) and (a)(3) assessed for fiscal year 
2006 but collected in fiscal year 2005; [$31,654,000] $33,938,000 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; and [$5,000,000] $8,000,000 shall be derived from animal drug 
user fees [(subject to enactment of legislation authorizing such 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, medical device, and animal drug assessments 
received during fiscal year [2004] 2005, including any such fees 
assessed prior to the current fiscal year but credited during the 
current year, shall be subject to the fiscal year [2004] 2005 limitation 
[Provided further, That none of these funds shall be used to develop, 
establish, or operate any program of user fees authorized by 31 U.S.C. 
9701: Provided further, That of the total amount appropriated: (1) 
$413,112,000 shall be for the Center for Food Safety and Applied 
Nutrition and related field activities in the Office of Regulatory 
Affairs; (2) $477,966,000 shall be for the Center for Drug Evaluation 
and Research and related field activities in the Office of Regulatory 
Affairs; (3) $169,429,000 shall be for the Center for Biologics 
Evaluation and Research and for related field activities in the Office 
of Regulatory Affairs; (4) $89,396,000 shall be for the Center for 
Veterinary Medicine and for related field activities in the Office of 
Regulatory Affairs; (5) $209,420,000 shall be for the Center for Devices 
and Radiological Health and for related field activities in the Office 
of Regulatory Affairs; (6) $39,887,000 shall be for the National Center 
for Toxicological Research; (7) $39,276,000 shall be for Rent and 
Related activities, other than the amounts paid to the General Services 
Administration for rent; (8) $119,594,000 shall be for payments to the 
General Services Administration for rent; and (9) $115,361,000 shall be 
for other activities, including the Office of the Commissioner; the 
Office of Management and Systems; the Office of External Relations; the 
Office of Policy and Planning; and central services for these offices: 
Provided further, That funds may be transferred from one specified 
activity to another with the prior approval of the Committees on 
Appropriations of both Houses of Congress.]
    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, 
$7,000,000, to remain available until expended.] (Division A, H.R. 2673, 
Consolidated Appropriations Bill, FY 2004.)

                Unavailable Receipts (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-9911-0-1-554      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
01.99 Balance, start of year............
    Receipts:
02.20 Cooperative research and 
        development agreements, FDA.....           2           2           2
                                           ---------   ---------  ----------
04.00 Total: Balances and collections...           2           2           2
    Appropriations:
05.00 Salaries and expenses.............          -2          -2          -2
                                           ---------   ---------  ----------
07.99 Balance, end of year..............
---------------------------------------------------------------------------

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-9911-0-1-554      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Foods.............................         425         411         470
00.02 Drugs.............................         514         501         511
00.03 Devices and radiological products.         193         191         217
00.04 National Center for Toxicological 
        Research........................          45          40          41
00.05 Other activities..................          84          90          89
00.06 Other rent and rent related 
        activities......................          42          38          59
00.07 Rental payments...................         105         108         108
00.08 Buildings and facilities..........          17           7
00.09 CRADAs............................           2           2           2
09.01 Reimbursable program..............         255         322         371
                                           ---------   ---------  ----------
10.00   Total new obligations...........       1,682       1,710       1,868
    Budgetary resources available for obligation:
21.40 Unobligated balance carried 
        forward, start of year..........         202          65          65
22.00 New budget authority (gross)......       1,534       1,710       1,868
22.10 Resources available from 
        recoveries of prior year 
        obligations.....................           6
22.22 Unobligated balance transferred 
        from other accounts.............           5
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......       1,747       1,775       1,933
23.95 Total new obligations.............      -1,682      -1,710      -1,868
24.40 Unobligated balance carried 
        forward, end of year............          65          65          65
    New budget authority (gross), detail:
      Discretionary:

40.00   Appropriation...................       1,390       1,394       1,495
40.35   Appropriation permanently 
          reduced.......................          -9          -8
                                           ---------   ---------  ----------
43.00     Appropriation (total 
            discretionary)..............       1,381       1,386       1,495
      Mandatory:

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

        Discretionary:
68.00     Offsetting collections (cash).         282         322         371
68.10     Change in uncollected customer 
            payments from Federal 
            sources (unexpired).........           8
68.45     Portion precluded from 
            obligation (limitation on 
            obligations)................        -139
                                           ---------   ---------  ----------
68.90       Spending authority from 
              offsetting collections 
              (total discretionary).....         151         322         371
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................       1,534       1,710       1,868
    Change in obligated balances:
72.40 Obligated balance, start of year..         488         460         514
73.10 Total new obligations.............       1,682       1,710       1,868
73.20 Total outlays (gross).............      -1,730      -1,656      -1,838
73.40 Adjustments in expired accounts 
        (net)...........................          27
73.45 Recoveries of prior year 
        obligations.....................          -6
74.00 Change in uncollected customer 
        payments from Federal sources 
        (unexpired).....................          -8
74.10 Change in uncollected customer 
        payments from Federal sources 
        (expired).......................           8
74.40 Obligated balance, end of year....         460         514         543
    Outlays (gross), detail:
86.90 Outlays from new discretionary 
        authority.......................       1,398       1,358       1,487
86.93 Outlays from discretionary 
        balances........................         331         296         349
86.97 Outlays from new mandatory 
        authority.......................           1           2           2
                                           ---------   ---------  ----------

[[Page 422]]


87.00   Total outlays (gross)...........       1,730       1,656       1,838
    Offsets:
      Against gross budget authority and outlays:

        Offsetting collections (cash) 
            from:
88.00     Federal sources...............         -77         -25         -26
88.40     Non-Federal sources...........        -258        -297        -345
                                           ---------   ---------  ----------
88.90       Total, offsetting 
              collections (cash)........        -335        -322        -371
      Against gross budget authority only:

88.95   Change in uncollected customer 
          payments from Federal sources 
          (unexpired)...................          -8
88.96   Portion of offsetting 
          collections (cash) credited to 
          expired accounts..............          53
    Net budget authority and outlays:
89.00 Budget authority..................       1,244       1,388       1,497
90.00 Outlays...........................       1,396       1,334       1,467
---------------------------------------------------------------------------

                        [In millions of dollars]

                                        2003         2004        2005
Distribution of budget authority by 
    account:
  Salaries and expenses.............       1,364       1,379       1,495
  Buildings and facilities..........          17           7
Distribution of outlays by account:
  Salaries and expenses.............       1,371       1,325       1,460
  Buildings and facilities..........          25           9           8

    The FDA is responsible for protecting the public health by assuring 
the safety, efficacy, and security of human and veterinary drugs, 
biological products, medical devices, our nation's food supply, 
cosmetics, and products that emit radiation. The FDA is also responsible 
for advancing the public health by helping to speed innovations that 
make medicines and foods more effective, safer, and more affordable; and 
helping the public get the accurate, science-based information they need 
to use medicines and foods to improve their health. The budget includes 
funding for counterterrorism activities that specifically relate to the 
protection of products or therapies 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. 
Specifically, the budget requests increased funding for food defense, 
medical counter measures related to terrorism or other related threats 
to public health, medical device reviews, protecting the safety of the 
U.S. food and feed supply from Bovine Spongiform Encephalopathy (BSE), 
and moving expenses for a new Human Drugs facility in White Oak, 
Maryland.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-9911-0-1-554      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

      Direct obligations:

        Personnel compensation:
11.1      Full-time permanent...........         548         613         635
11.3      Other than full-time permanent          55          37          40
11.5      Other personnel compensation..          21          21          22
11.7      Military personnel............          33          35          36
                                           ---------   ---------  ----------
11.9        Total personnel compensation         657         706         733
12.1    Civilian personnel benefits.....         156         150         156
12.2    Military personnel benefits.....          17          16          17
21.0    Travel and transportation of 
          persons.......................          28          25          30
22.0    Transportation of things........           5           7           5
23.1    Rental payments to GSA..........         104         108         108
23.2    Rental payments to others.......           4           5           5
23.3    Communications, utilities, and 
          miscellaneous charges.........          21          27          23
24.0    Printing and reproduction.......           3           3           3
25.1    Advisory and assistance services          48          13          52
25.2    Other services..................          70          72          71
25.3    Other purchases of goods and 
          services from Government 
          accounts......................          77          54          80
25.4    Operation and maintenance of 
          facilities....................          52          30          47
25.5    Research and development 
          contracts.....................          23          41          25
25.7    Operation and maintenance of 
          equipment.....................          32          25          33
26.0    Supplies and materials..........          22          22          23
31.0    Equipment.......................          62          57          53
32.0    Land and structures.............          14                       1
41.0    Grants, subsidies, and 
          contributions.................          29          25          29
42.0    Insurance claims and indemnities           3           2           3
                                           ---------   ---------  ----------
99.0      Direct obligations............       1,427       1,388       1,497
99.0  Reimbursable obligations..........         255         322         371
                                           ---------   ---------  ----------
99.9    Total new obligations...........       1,682       1,710       1,868
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-9911-0-1-554      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
    Direct:
      Total compensable workyears:

1001    Civilian full-time equivalent 
          employment....................       8,324       8,345       8,371
1101    Military full-time equivalent 
          employment....................         617         611         612
    Reimbursable:
      Total compensable workyears:

2001    Civilian full-time equivalent 
          employment....................       1,251       1,617       1,735
2101    Military full-time equivalent 
          employment....................          94         118         126
---------------------------------------------------------------------------

                                

Public enterprise funds:

           Revolving Fund for Certification and Other Services

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-4309-0-3-554      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
09.01 Reimbursable program..............           8           6           6
                                           ---------   ---------  ----------
10.00   Total new obligations...........           8           6           6
    Budgetary resources available for obligation:
21.40 Unobligated balance carried 
        forward, start of year..........           4           2           1
22.00 New budget authority (gross)......           5           5           5
22.10 Resources available from 
        recoveries of prior year 
        obligations.....................           1
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......          10           7           6
23.95 Total new obligations.............          -8          -6          -6
24.40 Unobligated balance carried 
        forward, end of year............           2           1
    New budget authority (gross), detail:
      Mandatory:

69.00   Offsetting collections (cash)...           5           5           5
    Change in obligated balances:
72.40 Obligated balance, start of year..           1           2           2
73.10 Total new obligations.............           8           6           6
73.20 Total outlays (gross).............          -6          -6          -6
73.45 Recoveries of prior year 
        obligations.....................          -1
74.40 Obligated balance, end of year....           2           2           2
    Outlays (gross), detail:
86.97 Outlays from new mandatory 
        authority.......................           5           5           5
86.98 Outlays from mandatory balances...           1           1           1
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........           6           6           6
    Offsets:
      Against gross budget authority and outlays:

88.40   Offsetting collections (cash) 
          from: Non-Federal sources.....          -5          -5          -5
    Net budget authority and outlays:
89.00 Budget authority..................
90.00 Outlays...........................           1           1           1
---------------------------------------------------------------------------

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

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-4309-0-3-554      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
11.1  Personnel compensation: Full-time 
        permanent.......................           2           2           2
12.1  Civilian personnel benefits.......           1           1           1

[[Page 423]]

25.2  Other services....................           3           2           2
31.0  Equipment.........................           1           1           1
32.0  Land and structures...............           1
                                           ---------   ---------  ----------
99.9    Total new obligations...........           8           6           6
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-4309-0-3-554      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
    Reimbursable:
2001  Total compensable workyears: 
        Civilian full-time equivalent 
        employment......................          32          32          32
---------------------------------------------------------------------------

                                


 
              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 1128E[,] and 711 [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, [$6,698,437,000, of which $367,563,000 shall be available 
for construction and renovation (including equipment) of health care and 
other facilities, abstinence education and related services, and other 
health-related activities as specified in the statement of the managers 
on the conference report accompanying this Act, and of which $39,740,000 
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] 
$6,022,833,000: Provided, That of the funds made available under this 
heading, [$250,000] $249,000 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 $25,000,000 of the funding provided for 
community health centers shall be used for base grant adjustments for 
existing centers:] Provided further, That no more than [$4,850,000 is 
available] $4,821,000 is available until expended for carrying out the 
provisions of U.S.C. Title 42 Section 233(o) including associated 
administrative expenses: Provided further, That no more than $45,000,000 
is available until expended for carrying out the provisions of Public 
Law 104-73: Provided further, That [$10,000,000] $9,941,000 is available 
until expended [to establish a] for the National Cord Blood Stem Cell 
Bank Program [as described in the statement of the managers on the 
conference report accompanying this Act]: Provided further, That of the 
funds made available under this heading, [$280,000,000] $278,283,000 
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 [$753,317,000] $783,872,000 shall be for State AIDS Drug Assistance 
Programs authorized by section 2616 of the Public Health Service Act: 
Provided further, That the Secretary may use a portion of the funds 
under this heading for carrying out section 338A-L of the Public Health 
Service Act to establish and administer a reserve commitment program for 
the Reserve Corps of the Service for section 338A-L loan and scholarship 
recipients, to be defined by the Secretary: Provided further, $9,998,000 
shall be for carrying out section 340 of the Public Health Service Act: 
Provided further, That grants made under the immediately preceding 
proviso shall be made only to entities receiving a grant under section 
330 and that a consortium of such entities shall fulfill the 
requirements of section 340(b): Provided further, That in addition to 
amounts provided herein, $25,000,000 shall be available from amounts 
available under section 241 of the Public Health Service Act to carry 
out Parts A, B, C, and D of title XXVI of the Public Health Service Act 
to fund section 2691 Special Projects of National Significance [Provided 
further, That notwithstanding section 502(a)(1) of the Social Security 
Act, not to exceed $121,130,000 is available for carrying out special 
projects of regional and national significance pursuant to section 
501(a)(2) of such Act: Provided further, That $70,488,000 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 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 in addition to amounts provided herein for 
abstinence education to adolescents, $4,500,000 shall be available from 
amounts available under section 241 of the Public Health Service Act to 
carry out evaluations (including longitudinal evaluations) of adolescent 
pregnancy prevention approaches]. (Division E, H.R. 2673, Consolidated 
Appropriations Bill, FY 2004.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0350-0-1-550      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.02 Loan guarantee subsidy............           1           1           1
00.10 Health centers....................       1,465       1,573       1,791
00.11 National Health Service Corps.....          46          46          46
00.12 National Health Service Corps 
        recruitment.....................         125         124         159
00.13 Hansen's disease center...........          18          17          17
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............          20          27          32
00.17 Health professions................         402         409         126
00.18 Maternal and child health block 
        grant...........................         731         730         730
00.19 Healthy start.....................          98          98          98
00.20 Poison control centers............          22          24          24
00.21 EMS for children..................          19          20          20
00.22 Universal newborn hearing 
        screening.......................          10          10
00.23 HIV/AIDS..........................       1,993       2,020       2,055
00.24 Organ transplantation.............          25          25          25
00.25 Bone marrow donor registry........          22          23          23
00.26 Rural health policy development...          11           9           9
00.27 Rural health outreach grants......          58          40          11
00.28 Rural health flexibility grants...          40          39
00.29 Denali Commission.................          27          35          22
00.30 Telehealth........................          27           4           4
00.31 Program management................         157         149         151
00.32 Family planning...................         273         278         278
00.33 Abstinence education..............          44          25
00.36 Health centers tort claim fund....          23          45          45
00.37 Trauma EMS........................           3           3
00.39 Childrens' GME....................         290         303         303
00.41 Community based abstinence grants.          55          70
00.42 State offices of rural health.....           8           8           8
00.43 Community access program..........         104         104          10
00.44 State planning grant program......          15          15
00.45 Rural access to emergency devices.          12          11           2
00.46 Radiation Exposure Compensation 
        Act.............................           2           2           2
00.47 Traumatic brain injury............           9           9           9
00.48 Health care facilities............         294
00.49 Public health improvement projects                     372
00.50 Cord blood stem cell bank.........                      10          10
00.52 Free clinic medical malpractice...                       5           5
                                           ---------   ---------  ----------

[[Page 424]]


03.00   Total direct programs...........       6,457       6,691       6,024
09.01 Reimbursable program..............         143         169         170
                                           ---------   ---------  ----------
10.00   Total new obligations...........       6,600       6,860       6,194
    Budgetary resources available for obligation:
21.40 Unobligated balance carried 
        forward, start of year..........          39          64          64
22.00 New budget authority (gross)......       6,629       6,858       6,196
22.10 Resources available from 
        recoveries of prior year 
        obligations.....................           3
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......       6,671       6,922       6,260
23.95 Total new obligations.............      -6,600      -6,860      -6,194
23.98 Unobligated balance expiring or 
        withdrawn.......................          -6
24.40 Unobligated balance carried 
        forward, end of year............          64          64          66
    New budget authority (gross), detail:
      Discretionary:

40.00   Appropriation...................       6,473       6,705       6,023
40.35   Appropriation permanently 
          reduced.......................         -42         -41
                                           ---------   ---------  ----------
43.00     Appropriation (total 
            discretionary)..............       6,431       6,664       6,023
      Mandatory:

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

        Discretionary:
68.00     Offsetting collections (cash).          87         122         123
68.10     Change in uncollected customer 
            payments from Federal 
            sources (unexpired).........          30
                                           ---------   ---------  ----------
68.90       Spending authority from 
              offsetting collections 
              (total discretionary).....         117         122         123
      Mandatory:

69.00   Offsetting collections 
          (cash)(HPSL&NSL)..............          31          47          50
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................       6,629       6,858       6,196
    Change in obligated balances:
72.40 Obligated balance, start of year..       5,054       5,484       5,812
73.10 Total new obligations.............       6,600       6,860       6,194
73.20 Total outlays (gross).............      -6,103      -6,532      -6,527
73.40 Adjustments in expired accounts 
        (net)...........................         -35
73.45 Recoveries of prior year 
        obligations.....................          -3
74.00 Change in uncollected customer 
        payments from Federal sources 
        (unexpired).....................         -30
74.10 Change in uncollected customer 
        payments from Federal sources 
        (expired).......................           1
74.40 Obligated balance, end of year....       5,484       5,812       5,481
    Outlays (gross), detail:
86.90 Outlays from new discretionary 
        authority.......................       2,344       2,445       2,316
86.93 Outlays from discretionary 
        balances........................       3,677       4,004       4,142
86.97 Outlays from new mandatory 
        authority.......................          45          54          50
86.98 Outlays from mandatory balances...          37          29          19
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........       6,103       6,532       6,527
    Offsets:
      Against gross budget authority and outlays:

        Offsetting collections (cash) 
            from:
88.00     Federal sources...............         -98        -102        -104
88.40     Non-Federal sources...........         -21         -20         -19
88.45     Offsetting governmental 
            collections (from non-
            Federal sources)............                     -47         -50
                                           ---------   ---------  ----------
88.90       Total, offsetting 
              collections (cash)........        -119        -169        -173
      Against gross budget authority only:

88.95   Change in uncollected customer 
          payments from Federal sources 
          (unexpired)...................         -30
88.96   Portion of offsetting 
          collections (cash) credited to 
          expired accounts..............           1
    Net budget authority and outlays:
89.00 Budget authority..................       6,481       6,689       6,023
90.00 Outlays...........................       5,984       6,363       6,354
---------------------------------------------------------------------------

                 Summary of Budget Authority and Outlays

                        (in millions of dollars)

                                     2003 actual  2004 est.   2005 est.
Enacted/requested:
  Budget Authority..................       6,481       6,689       6,023
  Outlays...........................       5,984       6,363       6,354
Legislative proposal, subject to 
    PAYGO:
  Budget Authority..................                      25
  Outlays...........................                       9
                                    ------------------------------------
Total:
  Budget Authority..................       6,481       6,714       6,023
  Outlays...........................       5,984       6,372       6,354
                                    ====================================

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

----------------------------------------------------------------------------
Identification code 75-0350-0-1-550      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
    Guaranteed loan levels supportable by subsidy 
                budget authority:
215001Health centers: Facilities 
        renovation loan guarantee levels           4          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.......           4          17          17
    Guaranteed loan subsidy (in percent):
232001Health centers: Facilities 
        renovation loan guarantee levels        3.65        3.52        3.57
232002Health centers: Managed care 
        network development loan 
        guarantee levels................        0.00        9.28        9.28
232003Health centers: Managed care plan 
        loan guarantee levels...........        0.00        7.77        7.33
                                           ---------   ---------  ----------
232901Weighted average subsidy rate.....        3.65        4.68        5.64
    Guaranteed loan subsidy budget authority:
233001Health centers: Facilities 
        renovation loan guarantee levels           1           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           1
    Guaranteed loan subsidy outlays:
234001Health centers: Facilities 
        renovation loan guarantee levels           1           1           1
234002Health centers: Managed care 
        network development loan 
        guarantee levels................
234003Health centers: Managed care plan 
        loan guarantee levels...........
                                           ---------   ---------  ----------
234901Total subsidy outlays.............           1           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. Abstinence 
education activities formerly administered by HRSA have been transferred 
to the Administration for Children and Families.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0350-0-1-550      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

      Direct obligations:

        Personnel compensation:
11.1      Full-time permanent...........          99         101         100
11.3      Other than full-time permanent           3           3           3
11.5      Other personnel compensation..           2           2           2
11.7      Military personnel............          22          26          26
                                           ---------   ---------  ----------
11.9        Total personnel compensation         126         132         131
12.1    Civilian personnel benefits.....          23          23          23
12.2    Military personnel benefits.....          11          13          13
13.0    Benefits for former personnel...           3           3           3
21.0    Travel and transportation of 
          persons.......................           4           3           3
23.1    Rental payments to GSA..........          13          13          13
23.3    Communications, utilities, and 
          miscellaneous charges.........           4           4           4
24.0    Printing and reproduction.......           1           1           1
25.1    Advisory and assistance services          63          64          58
25.2    Other services..................          95          95          88
25.3    Other purchases of goods and 
          services from Government 
          accounts......................         149         149         132

[[Page 425]]

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           4           4
26.0    Supplies and materials..........           2           2           2
31.0    Equipment.......................           1           1           1
33.0    Investments and loans...........           3           5           5
41.0    Grants, subsidies, and 
          contributions.................       5,930       6,127       5,491
42.0    Insurance claims and indemnities          23          50          50
                                           ---------   ---------  ----------
99.0      Direct obligations............       6,457       6,691       6,024
99.0  Reimbursable obligations..........         143         169         170
                                           ---------   ---------  ----------
99.9    Total new obligations...........       6,600       6,860       6,194
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-0350-0-1-550      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
    Direct:
      Total compensable workyears:

1001    Civilian full-time equivalent 
          employment....................       1,382       1,383       1,366
1101    Military full-time equivalent 
          employment....................         286         269         244
    Reimbursable:
      Total compensable workyears:

2001    Civilian full-time equivalent 
          employment....................         105          73          73
2101    Military full-time equivalent 
          employment....................           6          84          84
    Allocation account:
      Total compensable workyears:

3001    Civilian full-time equivalent 
          employment....................          12          16          16
3101    Military full-time equivalent 
          employment....................          11          20          22
---------------------------------------------------------------------------

                                

                      Health Resources and Services

                (Legislative Proposal, Subject to PAYGO)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0350-4-1-550      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.33 Abstinence education..............                      25
                                           ---------   ---------  ----------
10.00   Total new obligations (object 
          class 41.0)...................                      25
    Budgetary resources available for obligation:
22.00 New budget authority (gross)......                      25
23.95 Total new obligations.............                     -25
    New budget authority (gross), detail:
      Mandatory:

60.00   Appropriation...................                      25
    Change in obligated balances:
72.40 Obligated balance, start of year..                                  16
73.10 Total new obligations.............                      25
73.20 Total outlays (gross).............                      -9
73.31 Obligated balance transferred to 
        other accounts..................                                 -16
74.40 Obligated balance, end of year....                      16
    Outlays (gross), detail:
86.97 Outlays from new mandatory 
        authority.......................                       9
    Net budget authority and outlays:
89.00 Budget authority..................                      25
90.00 Outlays...........................                       9
---------------------------------------------------------------------------

    The budget proposes full-year funding in FY 2004 for the state-based 
abstinence education program.

                                

                       Vaccine Injury Compensation

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0320-0-1-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Direct program activity...........          11
                                           ---------   ---------  ----------
10.00   Total new obligations...........          11
    Budgetary resources available for obligation:
21.40 Unobligated balance carried 
        forward, start of year..........           8           2
22.00 New budget authority (gross)......           3
22.10 Resources available from 
        recoveries of prior year 
        obligations.....................           3
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......          14           2
23.95 Total new obligations.............         -11
24.40 Unobligated balance carried 
        forward, end of year............           2
    New budget authority (gross), detail:
      Mandatory:

69.00   Offsetting collections (cash)...           3
    Change in obligated balances:
72.40 Obligated balance, start of year..           3                      -9
73.10 Total new obligations.............          11
73.20 Total outlays (gross).............         -11          -9
73.45 Recoveries of prior year 
        obligations.....................          -3
74.40 Obligated balance, end of year....                      -9          -9
    Outlays (gross), detail:
86.98 Outlays from mandatory balances...          11           9
    Offsets:
      Against gross budget authority and outlays:

88.00   Offsetting collections (cash) 
          from: Federal sources.........          -3
    Net budget authority and outlays:
89.00 Budget authority..................
90.00 Outlays...........................           9           9
---------------------------------------------------------------------------

    The Vaccine Injury Compensation 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 2005 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      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
42.0  Direct obligations: Insurance 
        claims and indemnities..........           8
99.0  Reimbursable obligations: 
        Reimbursable obligations........           3
                                           ---------   ---------  ----------
99.9    Total new obligations...........          11
---------------------------------------------------------------------------

                                

Credit accounts:

             Health Center Guaranteed Loan Financing Account

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-4442-0-3-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

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

[[Page 426]]



             Status of Guaranteed Loans (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-4442-0-3-551      2003 actual   2004 est.   2005 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.........................         138         134         117
2143  Uncommitted limitation carried 
        forward.........................        -134        -117        -100
                                           ---------   ---------  ----------
2150    Total guaranteed loan 
          commitments...................           4          17          17
2199  Guaranteed amount of guaranteed 
        loan commitments................           3          10          10
----------------------------------------------------------------------------

    Cumulative balance of guaranteed loans 
                outstanding:
2210  Outstanding, start of year........          13          10          27
2231  Disbursements of new guaranteed 
        loans...........................           4          17          17
2251  Repayments and prepayments........          -4
2264  Adjustments: Other adjustments, 
        net.............................          -3
                                           ---------   ---------  ----------
2290    Outstanding, end of year........          10          27          44
----------------------------------------------------------------------------

    Memorandum:
2299  Guaranteed amount of guaranteed 
        loans outstanding, end of year..           8          27          43
---------------------------------------------------------------------------

    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. 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    2002 actual    2003 actual     2004 est.      2005 est.
-----------------------------------------------------------------------------------------------
    ASSETS:
1101  Federal assets: Fund balances with 
        Treasury........................           1              1
                                        ------------ --------------  ------------  -------------
1999    Total assets....................           1              1
    LIABILITIES:
2204  Non-Federal liabilities: 
        Liabilities for loan guarantees.           1              1
                                        ------------ --------------  ------------  -------------
2999    Total liabilities...............           1              1
    NET POSITION:
3300  Cumulative results of operations..
                                        ------------ --------------  ------------  -------------
3999    Total net position..............
                                        ------------ --------------  ------------  -------------
4999  Total liabilities and net position           1              1
-----------------------------------------------------------------------------------------------
    Note: Consistent with Government-wide practice, information for 2004 
and 2005 was not required to be collected.

                                

            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] $3,270,000. (Division E, H.R. 2673, Consolidated 
Appropriations Bill, FY 2004.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0340-0-1-552      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.02 Guarantee loan subsidy............          16          25
00.07 Reestimates of Subsidy............         101           1
00.08 Interest on Reestimates...........          25           1
00.09 Administrative expenses...........           4           3           3
                                           ---------   ---------  ----------
10.00   Total new obligations...........         146          30           3
    Budgetary resources available for obligation:
22.00 New budget authority (gross)......         146          28           3
23.95 Total new obligations.............        -146         -30          -3
    New budget authority (gross), detail:
      Discretionary:

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

60.00   Appropriation...................         142          25
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................         146          28           3
    Change in obligated balances:
72.40 Obligated balance, start of year..           1           2           4
73.10 Total new obligations.............         146          30           3
73.20 Total outlays (gross).............        -146         -28          -3
74.40 Obligated balance, end of year....           2           4           4
    Outlays (gross), detail:
86.90 Outlays from new discretionary 
        authority.......................           4           3           3
86.97 Outlays from new mandatory 
        authority.......................         142          25
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........         146          28           3
    Net budget authority and outlays:
89.00 Budget authority..................         146          28           3
90.00 Outlays...........................         144          28           3
---------------------------------------------------------------------------

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

----------------------------------------------------------------------------
Identification code 75-0340-0-1-552      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
    Guaranteed loan levels supportable by subsidy 
                budget authority:
215001HEAL Loan guarantee...............         100         150
                                           ---------   ---------  ----------
215901Total loan guarantee levels.......         100         150
    Guaranteed loan subsidy (in percent):
232001HEAL Loan guarantee...............       15.76       16.48        0.00
                                           ---------   ---------  ----------
232901Weighted average subsidy rate.....       15.76       16.48        0.00
    Guaranteed loan subsidy budget authority:
233001HEAL Loan guarantee...............          16          25
                                           ---------   ---------  ----------
233901Total subsidy budget authority....          16          25
    Guaranteed loan subsidy outlays:
234001HEAL Loan guarantee...............          16          25
                                           ---------   ---------  ----------
234901Total subsidy outlays.............          16          25
    Guaranteed loan upward reestimate subsidy 
                budget authority:
235001HEAL Loan guarantee...............         126           2
                                           ---------   ---------  ----------
235901Total upward reestimate budget 
        authority.......................         126           2
    Guaranteed loan downward reestimate subsidy 
                budget authority:
237001HEAL Loan guarantee...............        -209         -49
                                           ---------   ---------  ----------
237901Total downward reestimate subsidy 
        budget authority................        -209         -49
----------------------------------------------------------------------------

    Administrative expense data:
351001Budget authority..................           4           3           3
358001Outlays from balances.............
359001Outlays from new authority........           4           3           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      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
11.1  Personnel compensation: Full-time 
        permanent.......................           2           1           1
25.3  Other purchases of goods and 
        services from Government 
        accounts........................           2           2           2

[[Page 427]]

41.0  Grants, subsidies, and 
        contributions...................         142          27
                                           ---------   ---------  ----------
99.9    Total new obligations...........         146          30           3
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-0340-0-1-552      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
    Direct:
      Total compensable workyears:

1001    Civilian full-time equivalent 
          employment....................          17          15          15
1101    Military full-time equivalent 
          employment....................           2           2           2
---------------------------------------------------------------------------

                                

           Health Education Assistance Loans Financing Account

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-4304-0-3-552      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Death and disability claims.......           2           2           2
00.02 Default claims....................          31          31          31
                                           ---------   ---------  ----------
00.91   Subtotal........................          33          33          33
08.02 Payment of downward reestimate to 
        receipt account.................         106          38
08.04 Payment of interest on downward 
        reestimate to receipt account...         103          11
                                           ---------   ---------  ----------
08.91   Subtotal (reestimates)..........         209          49
                                           ---------   ---------  ----------
10.00   Total new obligations...........         242          82          33
    Budgetary resources available for obligation:
21.40 Unobligated balance carried 
        forward, start of year..........         345         249         203
22.00 New financing authority (gross)...         146          36           9
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......         491         285         212
23.95 Total new obligations.............        -242         -82         -33
24.40 Unobligated balance carried 
        forward, end of year............         249         203         179
    New financing authority (gross), detail:
      Mandatory:

69.00   Offsetting collections (cash)...         146          36           9
    Change in obligated balances:
72.40 Obligated balance, start of year..                                  41
73.10 Total new obligations.............         242          82          33
73.20 Total financing disbursements 
        (gross).........................        -242         -41         -42
74.40 Obligated balance, end of year....                      41          33
87.00 Total financing disbursements 
        (gross).........................         242          41          42
    Offsets:
      Against gross financing authority and 
          financing disbursements:

        Offsetting collections (cash) 
            from:
88.00     Federal sources...............        -142         -27
88.25     Interest on uninvested funds..                      -3          -3
88.40     Recoveries of defaulted loans.          -4          -6          -6
                                           ---------   ---------  ----------
88.90       Total, offsetting 
              collections (cash)........        -146         -36          -9
    Net financing authority and financing 
        disbursements:
89.00 Financing authority...............
90.00 Financing disbursements...........          96           5          33
---------------------------------------------------------------------------

             Status of Guaranteed Loans (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-4304-0-3-552      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
    Position with respect to appropriations act 
                limitation on commitments:
2111  Limitation on guaranteed loans 
        made by private lenders.........         160         150
                                           ---------   ---------  ----------
2150    Total guaranteed loan 
          commitments...................         160         150
2199  Guaranteed amount of guaranteed 
        loan commitments................         160         150
----------------------------------------------------------------------------

    Cumulative balance of guaranteed loans 
                outstanding:
2210  Outstanding, start of year........       1,646       1,760       1,860
2231  Disbursements of new guaranteed 
        loans...........................         160         150
2251  Repayments and prepayments........          -6          -6          -7
      Adjustments:

2261    Terminations for default that 
          result in loans receivable....         -38         -41         -42
2263    Terminations for default that 
          result in claim payments......          -2          -3          -4
                                           ---------   ---------  ----------
2290    Outstanding, end of year........       1,760       1,860       1,807
----------------------------------------------------------------------------

    Memorandum:
2299  Guaranteed amount of guaranteed 
        loans outstanding, end of year..       1,760       1,860       1,807
----------------------------------------------------------------------------

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

2310    Outstanding, start of year......         391         423         458
2331    Disbursements for guaranteed 
          loan claims...................          38          41          42
2351    Repayments of loans receivable..          -6          -6          -6
                                           ---------   ---------  ----------
2390      Outstanding, end of year......         423         458         494
---------------------------------------------------------------------------

    This account records all cash flows to and from the Government 
resulting from HEAL loan guarantees committed between 1992 and 2004. No 
new loan guarantees will be issued after 2004.

                             Balance Sheet (in millions of dollars)

-----------------------------------------------------------------------------------------------
Identification code   75-4304-0-3-552    2002 actual    2003 actual     2004 est.      2005 est.
-----------------------------------------------------------------------------------------------
    ASSETS:
1101  Federal assets: Fund balances with 
        Treasury........................         345            340
1206  Non-Federal assets: Receivables, 
        net.............................          67             67
                                        ------------ --------------  ------------  -------------
1999    Total assets....................         412            407
    LIABILITIES:
2204  Non-Federal liabilities: 
        Liabilities for loan guarantees.         412            407
                                        ------------ --------------  ------------  -------------
2999    Total liabilities...............         412            407
    NET POSITION:
3300  Cumulative results of operations..
                                        ------------ --------------  ------------  -------------
3999    Total net position..............
                                        ------------ --------------  ------------  -------------
4999  Total liabilities and net position         412            407
-----------------------------------------------------------------------------------------------
    Note: Consistent with Government-wide practice, information for 2004 
and 2005 was not required to be collected.

                                

          Health Education Assistance Loans Liquidating Account

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-4305-0-3-552      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Death and disability claims.......           3           3           3
00.02 Defaulted loans...................          12          15          15
00.03 Debt collection...................           6           6           6
                                           ---------   ---------  ----------
10.00   Total new obligations...........          21          24          24
    Budgetary resources available for obligation:
22.00 New budget authority (gross)......          21          24          24
23.95 Total new obligations.............         -21         -24         -24
    New budget authority (gross), detail:
      Mandatory:

60.00   Appropriation...................                       4           4
69.00 Offsetting collections (cash).....          21          20          20
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................          21          24          24
    Change in obligated balances:
72.40 Obligated balance, start of year..           4           5           3
73.10 Total new obligations.............          21          24          24
73.20 Total outlays (gross).............         -21         -24         -24
74.40 Obligated balance, end of year....           5           3           3
    Outlays (gross), detail:
86.97 Outlays from new mandatory 
        authority.......................          21          24          24
    Offsets:
      Against gross budget authority and outlays:

88.00   Offsetting collections (cash) 
          from: Federal sources.........         -21         -20         -20
    Net budget authority and outlays:
89.00 Budget authority..................                       4           4
90.00 Outlays...........................                       4           4
---------------------------------------------------------------------------

[[Page 428]]



             Status of Guaranteed Loans (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-4305-0-3-552      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
    Cumulative balance of guaranteed loans 
                outstanding:
2210  Outstanding, start of year........         619         585         556
2251  Repayments and prepayments........         -15         -15         -15
      Adjustments:

2261    Terminations for default that 
          result in loans receivable....         -14         -12         -10
2263    Terminations for default that 
          result in claim payments......          -2          -2          -2
2264    Other adjustments, net..........          -3
                                           ---------   ---------  ----------
2290    Outstanding, end of year........         585         556         529
----------------------------------------------------------------------------

    Memorandum:
2299  Guaranteed amount of guaranteed 
        loans outstanding, end of year..         585         556         529
----------------------------------------------------------------------------

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

2310    Outstanding, start of year......         493         468         442
2331    Disbursements for guaranteed 
          loan claims...................          14          12          10
2351    Repayments of loans receivable..         -13         -14         -15
2361    Write-offs of loans receivable..         -26         -24         -24
                                           ---------   ---------  ----------
2390      Outstanding, end of year......         468         442         413
---------------------------------------------------------------------------
    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.

                             Balance Sheet (in millions of dollars)

-----------------------------------------------------------------------------------------------
Identification code   75-4305-0-3-552    2002 actual    2003 actual     2004 est.      2005 est.
-----------------------------------------------------------------------------------------------
    ASSETS:
1101  Federal assets: Fund balances with 
        Treasury........................           4              4
1206  Non-Federal assets: Receivables, 
        net.............................         303            376
                                        ------------ --------------  ------------  -------------
1999    Total assets....................         307            380
    LIABILITIES:
2204  Non-Federal liabilities: 
        Liabilities for loan guarantees.         307            380
                                        ------------ --------------  ------------  -------------
2999    Total liabilities...............         307            380
    NET POSITION:
3300  Cumulative results of operations..
                                        ------------ --------------  ------------  -------------
3999    Total net position..............
                                        ------------ --------------  ------------  -------------
4999  Total liabilities and net position         307            380
-----------------------------------------------------------------------------------------------
    Note: Consistent with Government-wide practice, information for 2004 
and 2005 was not required to be collected.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-4305-0-3-552      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
25.2  Other services....................           6           6           6
42.0  Insurance claims and indemnities..          15          18          18
                                           ---------   ---------  ----------
99.9    Total new obligations...........          21          24          24
---------------------------------------------------------------------------

                                

               Medical Facilities Guarantee and Loan Fund

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-9931-0-3-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Budgetary resources available for obligation:
21.40 Unobligated balance carried 
        forward, start of year..........          68          68          68
24.40 Unobligated balance carried 
        forward, end of year............          68          68          68
    Change in obligated balances:
72.40 Obligated balance, start of year..           1           1           1
74.40 Obligated balance, end of year....           1           1           1
    Net budget authority and outlays:
89.00 Budget authority..................
90.00 Outlays...........................
---------------------------------------------------------------------------

               Status of Direct Loans (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-9931-0-3-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
    Cumulative balance of direct loans 
                outstanding:
1210  Outstanding, start of year........           8           7           3
1251  Repayments: Repayments and 
        prepayments.....................          -1          -4          -2
                                           ---------   ---------  ----------
1290    Outstanding, end of year........           7           3           1
---------------------------------------------------------------------------

             Status of Guaranteed Loans (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-9931-0-3-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
    Cumulative balance of guaranteed loans 
                outstanding:
2210  Outstanding, start of year........          16          13           6
2251  Repayments and prepayments........          -3          -7          -4
                                           ---------   ---------  ----------
2290    Outstanding, end of year........          13           6           2
----------------------------------------------------------------------------

    Memorandum:
2299  Guaranteed amount of guaranteed 
        loans outstanding, end of year..          13           6           2
---------------------------------------------------------------------------

    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 [$3,222,000] 
$3,176,000 shall be available from the Trust Fund to the Secretary of 
Health and Human Services. (Division E, H.R. 2673, Consolidated 
Appropriations Bill, FY 2004.)

                Unavailable Receipts (in millions of dollars)

----------------------------------------------------------------------------
Identification code 20-8175-0-7-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
01.99 Balance, start of year............       1,759       1,759       1,915
    Receipts:
02.00 Deposits, Vaccine injury 
        compensation trust fund.........         138         127         128
02.40 Interest and profits on 
        investments, Vaccine injury 
        compensation....................          86         105         114
                                           ---------   ---------  ----------
02.99   Total receipts and collections..         224         232         242
                                           ---------   ---------  ----------
04.00 Total: Balances and collections...       1,983       1,991       2,157
    Appropriations:
05.00 Vaccine injury compensation 
        program trust fund..............          -9         -10         -13

[[Page 429]]

05.01 Vaccine injury compensation 
        program trust fund..............        -215         -66         -66
                                           ---------   ---------  ----------
05.99   Total appropriations............        -224         -76         -79
                                           ---------   ---------  ----------
07.99 Balance, end of year..............       1,759       1,915       2,078
---------------------------------------------------------------------------

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 20-8175-0-7-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Compensation: Claims for post--FY 
        1989 injuries...................          75          66          66
      Administrative expenses:

01.03   Claims processing (Claims Court)           2           3           4
01.04   Claims processing (Public Health 
          Service)......................           3           3           3
01.05   Claims processing (Dept. of 
          Justice)......................           4           4           6
                                           ---------   ---------  ----------
01.91     Total, administrative expenses           9          10          13
                                           ---------   ---------  ----------
10.00   Total new obligations...........          84          76          79
    Budgetary resources available for obligation:
21.40 Unobligated balance carried 
        forward, start of year..........       1,761       1,901       1,901
22.00 New budget authority (gross)......         224          76          79
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......       1,985       1,977       1,980
23.95 Total new obligations.............         -84         -76         -79
24.40 Unobligated balance carried 
        forward, end of year............       1,901       1,901       1,901
    New budget authority (gross), detail:
      Discretionary:

40.26   Appropriation (trust fund)......           9          10          13
      Mandatory:

60.26   Appropriation (trust fund)......         215          66          66
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................         224          76          79
    Change in obligated balances:
72.40 Obligated balance, start of year..                       1           1
73.10 Total new obligations.............          84          76          79
73.20 Total outlays (gross).............         -84         -76         -79
74.40 Obligated balance, end of year....           1           1           1
    Outlays (gross), detail:
86.90 Outlays from new discretionary 
        authority.......................           9          10          13
86.97 Outlays from new mandatory 
        authority.......................          75          66          66
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........          84          76          79
    Net budget authority and outlays:
89.00 Budget authority..................         224          76          79
90.00 Outlays...........................          84          76          79
    Memorandum (non-add) entries:
92.01 Total investments, start of year: 
        Federal securities: Par value...       1,758       1,896       2,294
92.02 Total investments, end of year: 
        Federal securities: Par value...       1,896       2,294       2,460
---------------------------------------------------------------------------

    The Vaccine injury compensation 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      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
25.2  Other services....................          14           3           3
25.3  Other purchases of goods and 
        services from Government 
        accounts........................           7           7          10
42.0  Insurance claims and indemnities..          63          66          66
                                           ---------   ---------  ----------
99.9    Total new obligations...........          84          76          79
---------------------------------------------------------------------------

                                

                    Ricky Ray Hemophilia Relief Fund

                Unavailable Receipts (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-8074-0-7-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
01.99 Balance, start of year............
    Receipts:
02.40 Interest on investments, Ricky Ray 
        hemophilia relief fund..........           1
                                           ---------   ---------  ----------
04.00 Total: Balances and collections...           1
    Appropriations:
05.00 Ricky Ray hemophilia relief fund..          -1
                                           ---------   ---------  ----------
07.99 Balance, end of year..............
---------------------------------------------------------------------------

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-8074-0-7-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Compensation--claims..............           6           1
00.02 Administrative expenses subject to 
        limitation......................           1           1
                                           ---------   ---------  ----------
10.00   Total new obligations...........           7           2
    Budgetary resources available for obligation:
21.40 Unobligated balance carried 
        forward, start of year..........          97          91
22.00 New budget authority (gross)......           1
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......          98          91
23.95 Total new obligations.............          -7          -2
23.98 Unobligated balance expiring or 
        withdrawn.......................                     -89
24.40 Unobligated balance carried 
        forward, end of year............          91
    New budget authority (gross), detail:
      Mandatory:

60.26   Appropriation (trust fund)......           1
    Change in obligated balances:
72.40 Obligated balance, start of year..           1           1
73.10 Total new obligations.............           7           2
73.20 Total outlays (gross).............          -8          -3
74.40 Obligated balance, end of year....           1
    Outlays (gross), detail:
86.98 Outlays from mandatory balances...           8           3
    Net budget authority and outlays:
89.00 Budget authority..................           1
90.00 Outlays...........................           7           3
    Memorandum (non-add) entries:
92.01 Total investments, start of year: 
        Federal securities: Par value...          91          89
92.02 Total investments, end of year: 
        Federal securities: Par value...          89
---------------------------------------------------------------------------

    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. By law the fund terminated November 12, 2003, 
five years after the date of enactment. All unobligated balances are to 
be returned to the Treasury.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-8074-0-7-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
11.1  Personnel compensation: Full-time 
        permanent.......................           1
25.2  Other services....................                       1
42.0  Insurance claims and indemnities..           6           1
                                           ---------   ---------  ----------
99.9    Total new obligations...........           7           2
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-8074-0-7-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
    Direct:
      Total compensable workyears:

1001    Civilian full-time equivalent 
          employment....................          12           4
1101    Military full-time equivalent 
          employment....................           1
---------------------------------------------------------------------------

                                


 
                          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

[[Page 430]]

Care Improvement Act, and titles II and III of the Public Health Service 
Act with respect to the Indian Health Service, [$2,561,932,000] 
$2,612,824,000, 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 [$467,046,000] $479,085,000 for 
contract medical care shall remain available for obligation until 
September 30, [2005] 2006: 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 one-year contracts and grants which are to be 
performed in two fiscal years, so long as the total obligation is 
recorded in the year for which the funds are appropriated: Provided 
further, That the amounts collected by the Secretary of Health and Human 
Services under the authority of title IV of the Indian Health Care 
Improvement Act shall remain available until expended for the purpose of 
achieving compliance with the applicable conditions and requirements of 
titles XVIII and XIX of the Social Security Act (exclusive of planning, 
design, or construction of new facilities): Provided further, That 
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] $267,398,000 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] 2005, 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[: 
Provided further, That of the amounts provided to the Indian Health 
Service, $15,000,000 is provided for alcohol control, enforcement, 
prevention, treatment, sobriety and wellness, and education in Alaska to 
be distributed as direct lump sum payments as follows: (a) $2,000,000 to 
the State of Alaska for regional distribution to hire and equip 
additional Village Public Safety Officers to engage primarily in 
bootlegging prevention and enforcement activities; (b) $5,000,000 to the 
Alaska Native Tribal Health Consortium, which shall be allocated for: 
(1) substance abuse and behavioral health counselors through the 
Counselor in Every Village program; and (2) comprehensive substance 
abuse training programs for counselors and others delivering substance 
abuse services; (c) $6,000,000 to be divided as follows among the 
following Alaska Native regional organizations to provide substance 
abuse treatment and prevention programs: (1) $2,500,000 for Southcentral 
Foundation's Pathway Home; (2) $1,500,000 for Cook Inlet Tribal 
Council's substance abuse prevention and treatment programs; (3) 
$1,500,000 for Yukon-Kuskokwim Health Corporation's Tundra Swan Inhalant 
Abuse Center; and (4) $500,000 for the Southeast Alaska Regional Health 
Consortium for its Deilee Hitt program; and (d) $2,000,000 for RuralCap 
for alcohol treatment and related transitional housing for homeless 
chronic inebriates in Anchorage, AK: Provided further, That none of the 
funds may be used for tribal courts or tribal ordinance programs or any 
program that is not directly related to alcohol control, enforcement, 
prevention, treatment, or sobriety: Provided further, That no more than 
10 percent may be used by any entity receiving funding for 
administrative overhead including indirect costs: Provided further, That 
the State of Alaska must maintain its existing level of effort and must 
use these funds to enhance or expand existing efforts or initiate new 
projects or programs and may not use such funds to supplant existing 
programs]. (Department of the Interior and Related Agencies 
Appropriations Act, 2004.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0390-0-1-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
      Direct program:

00.01   Clinical services...............       1,902       2,024       2,101
00.02   Preventive health...............         103         107         112
00.03   Urban health....................          31          32          32
00.04   Indian health professions.......          31          31          31
00.05   Tribal management...............           2           2           2
00.06   Direct operations...............          60          61          62
00.07   Self-governance.................           6           6           6
00.08   Contract support costs..........         269         267         267
00.09   Diabetes funds..................         105         150         150
09.01 Reimbursable program..............         782         789         789
                                           ---------   ---------  ----------
10.00   Total new obligations...........       3,291       3,469       3,552
    Budgetary resources available for obligation:
21.40 Unobligated balance carried 
        forward, start of year..........         240         300         300
22.00 New budget authority (gross)......       3,358       3,469       3,552
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......       3,598       3,769       3,852
23.95 Total new obligations.............      -3,291      -3,469      -3,552
23.98 Unobligated balance expiring or 
        withdrawn.......................          -6
24.40 Unobligated balance carried 
        forward, end of year............         300         300         300
    New budget authority (gross), detail:
      Discretionary:

40.00   Appropriation...................       2,492       2,562       2,613
40.35   Appropriation permanently 
          reduced.......................         -16         -32
                                           ---------   ---------  ----------
43.00     Appropriation (total 
            discretionary)..............       2,476       2,530       2,613
      Mandatory:

60.00   Appropriation...................         100         150         150
      Spending authority from offsetting 
          collections:

        Discretionary:
68.00     Offsetting collections (cash).         780         789         789
68.10     Change in uncollected customer 
            payments from Federal 
            sources (unexpired).........           2
                                           ---------   ---------  ----------
68.90       Spending authority from 
              offsetting collections 
              (total discretionary).....         782         789         789
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................       3,358       3,469       3,552
    Change in obligated balances:
72.40 Obligated balance, start of year..         605         496         592
73.10 Total new obligations.............       3,291       3,469       3,552
73.20 Total outlays (gross).............      -3,365      -3,373      -3,619
73.40 Adjustments in expired accounts 
        (net)...........................         -31
74.00 Change in uncollected customer 
        payments from Federal sources 
        (unexpired).....................          -2
74.10 Change in uncollected customer 
        payments from Federal sources 
        (expired).......................          -3
74.40 Obligated balance, end of year....         496         592         525
    Outlays (gross), detail:
86.90 Outlays from new discretionary 
        authority.......................       2,960       3,015       3,088
86.93 Outlays from discretionary 
        balances........................         309         249         382
86.97 Outlays from new mandatory 
        authority.......................          20          30          30
86.98 Outlays from mandatory balances...          76          79         119
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........       3,365       3,373       3,619
    Offsets:
      Against gross budget authority and outlays:

        Offsetting collections (cash) 
            from:
88.00     Federal sources...............        -456        -457        -457
88.40     Non-Federal sources...........        -326        -332        -332
                                           ---------   ---------  ----------
88.90       Total, offsetting 
              collections (cash)........        -782        -789        -789
      Against gross budget authority only:

88.95   Change in uncollected customer 
          payments from Federal sources 
          (unexpired)...................          -2
88.96   Portion of offsetting 
          collections (cash) credited to 
          expired accounts..............           2
    Net budget authority and outlays:
89.00 Budget authority..................       2,576       2,680       2,763
90.00 Outlays...........................       2,583       2,584       2,830
---------------------------------------------------------------------------

    The Indian health services account provides medical care, public 
health services, and health professions training oppor

[[Page 431]]

tunities to American Indians and Alaska Natives. An estimated $1,623 
million will be administered by tribal governments under self-
determination contracts and self-governance compacts in 2005.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0390-0-1-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

      Direct obligations:

        Personnel compensation:
11.1      Full-time permanent...........         308         359         375
11.3      Other than full-time permanent          15          16          17
11.5      Other personnel compensation..          29          33          34
11.7      Military personnel............          70          80          84
                                           ---------   ---------  ----------
11.9        Total personnel compensation         422         488         510
12.1    Civilian personnel benefits.....          88         102         106
12.2    Military personnel benefits.....          30          35          36
13.0    Benefits for former personnel...           7           8           8
21.0    Travel and transportation of 
          persons.......................          10          10          10
21.0    Patient Travel..................          17          17          17
22.0    Transportation of things........           9           8           8
23.1    Rental payments to GSA..........          11          10          10
23.2    Rental payments to others.......           2           2           2
23.3    Communications, utilities, and 
          miscellaneous charges.........          15          14          14
24.0    Printing and reproduction.......           2           1           1
25.1    Advisory and assistance services           5           4           6
25.2    Other services..................          86          49          50
25.3    Other purchases of goods and 
          services from Government 
          accounts......................          31          16          20
25.4    Operation and maintenance of 
          facilities....................           4           3           3
25.6    Medical care....................         201         204         219
25.7    Operation and maintenance of 
          equipment.....................           5           5           5
25.8    Subsistence and support of 
          persons.......................           2           2           2
26.0    Supplies and materials..........         100          91          91
31.0    Equipment.......................          15          15          15
32.0    Land and structures.............           1           1           1
41.0    Grants, subsidies, and 
          contributions.................       1,445       1,594       1,628
42.0    Insurance claims and indemnities           1           1           1
                                           ---------   ---------  ----------
99.0      Direct obligations............       2,509       2,680       2,763
99.0  Reimbursable obligations..........         782         789         789
                                           ---------   ---------  ----------
99.9    Total new obligations...........       3,291       3,469       3,552
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-0390-0-1-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
    Direct:
      Total compensable workyears:

1001    Civilian full-time equivalent 
          employment....................       7,117       7,982       8,060
1101    Military full-time equivalent 
          employment....................       1,137       1,274       1,287
    Reimbursable:
      Total compensable workyears:

2001    Civilian full-time equivalent 
          employment....................       4,720       4,720       4,720
2101    Military full-time equivalent 
          employment....................         754         754         754
---------------------------------------------------------------------------

                                

                        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, [$396,232,000] $354,448,000, 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 from the funds appropriated herein, $5,000,000 shall be 
designated by the Indian Health Service as a contribution to the Yukon-
Kuskokwim Health Corporation (YKHC) to complete a priority project for 
the acquisition of land, planning, design and construction of 79 staff 
quarters in the Bethel service area, pursuant to the negotiated project 
agreement between the YKHC and the Indian Health Service: Provided 
further, That this project shall not be subject to the construction 
provisions of the Indian Self-Determination and Education Assistance Act 
and shall be removed from the Indian Health Service priority list upon 
completion: Provided further, That the Federal Government shall not be 
liable for any property damages or other construction claims that may 
arise from YKHC undertaking this project: Provided further, That the 
land shall be owned or leased by the YKHC and title to quarters shall 
remain vested with the YKHC:] 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 none of the 
funds appropriated to the Indian Health Service may be used for 
sanitation facilities construction for new homes funded with grants by 
the housing programs of the United States Department of Housing and 
Urban Development: Provided further, That not to exceed $1,000,000 from 
this account and the ``Indian Health Services'' account 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. 
(Department of the Interior and Related Agencies Appropriations Act, 
2004.)

                Unavailable Receipts (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0391-0-1-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
01.99 Balance, start of year............
    Receipts:
02.20 Rent and charges for quarters, 
        Indian Health Service...........           3           6           6
                                           ---------   ---------  ----------
04.00 Total: Balances and collections...           3           6           6
    Appropriations:
05.00 Indian health facilities..........          -3          -6          -6
                                           ---------   ---------  ----------
07.99 Balance, end of year..............
---------------------------------------------------------------------------

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0391-0-1-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
      Direct program:

00.01   Sanitation and health facilities         119         187         145
00.02   Maintenance.....................          38          55          55
00.03   Facilities and environmental 
          health........................         129         138         143
00.04   Equipment.......................          16          17          17
                                           ---------   ---------  ----------
01.00     Total direct program..........         302         397         360
09.01 Reimbursable program..............           3           6           6
                                           ---------   ---------  ----------
10.00   Total new obligations...........         305         403         366
    Budgetary resources available for obligation:
21.40 Unobligated balance carried 
        forward, start of year..........         142         227         227
22.00 New budget authority (gross)......         391         403         366
22.10 Resources available from 
        recoveries of prior year 
        obligations.....................           1
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......         534         630         593
23.95 Total new obligations.............        -305        -403        -366
24.40 Unobligated balance carried 
        forward, end of year............         227         227         227
    New budget authority (gross), detail:
      Discretionary:

40.00   Appropriation...................         376         396         354
40.35   Appropriation permanently 
          reduced.......................          -2          -5
                                           ---------   ---------  ----------
43.00     Appropriation (total 
            discretionary)..............         374         391         354
      Mandatory:

60.20   Appropriation (special fund)....           3           6           6
      Discretionary:

68.00   Spending authority from 
          offsetting collections: 
          Offsetting collections (cash).          14           6           6
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................         391         403         366
    Change in obligated balances:
72.40 Obligated balance, start of year..         323         252         328
73.10 Total new obligations.............         305         403         366

[[Page 432]]

73.20 Total outlays (gross).............        -376        -327        -384
73.45 Recoveries of prior year 
        obligations.....................          -1
74.40 Obligated balance, end of year....         252         328         310
    Outlays (gross), detail:
86.90 Outlays from new discretionary 
        authority.......................         126         123         112
86.93 Outlays from discretionary 
        balances........................         247         198         266
86.97 Outlays from new mandatory 
        authority.......................           3           6           6
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........         376         327         384
    Offsets:
      Against gross budget authority and outlays:

88.00   Offsetting collections (cash) 
          from: Federal sources.........         -14          -6          -6
    Net budget authority and outlays:
89.00 Budget authority..................         377         397         360
90.00 Outlays...........................         362         321         378
---------------------------------------------------------------------------

    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      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

      Direct obligations:

        Personnel compensation:
11.1      Full-time permanent...........          34          36          37
11.3      Other than full-time permanent          -3           2           2
11.5      Other personnel compensation..           1           1           1
11.7      Military personnel............          18          20          21
                                           ---------   ---------  ----------
11.9        Total personnel compensation          50          59          61
12.1    Civilian personnel benefits.....           8          10          10
12.2    Military personnel benefits.....           6           7           7
21.0    Travel and transportation of 
          persons.......................           2           2           2
22.0    Transportation of things........           3           3           2
23.3    Communications, utilities, and 
          miscellaneous charges.........           1          11          11
25.1    Advisory and assistance services           3           4           4
25.2    Other services..................         100         113         113
25.3    Other purchases of goods and 
          services from Government 
          accounts......................           2           3           2
25.4    Operation and maintenance of 
          facilities....................           5           7           7
25.8    Subsistence and support of 
          persons.......................          -1
26.0    Supplies and materials..........           5           6           5
31.0    Equipment.......................          10          14          13
32.0    Land and structures.............          13          47          12
41.0    Grants, subsidies, and 
          contributions.................          95         111         111
                                           ---------   ---------  ----------
99.0      Direct obligations............         302         397         360
99.0  Reimbursable obligations..........           3           6           6
                                           ---------   ---------  ----------
99.9    Total new obligations...........         305         403         366
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-0391-0-1-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
    Direct:
      Total compensable workyears:

1001    Civilian full-time equivalent 
          employment....................       1,096       1,205       1,218
1101    Military full-time equivalent 
          employment....................         178         192         194
---------------------------------------------------------------------------

                                

            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.
    [None of the funds made available to the Indian Health Service in 
this Act shall be used for any assessments or charges by the Department 
of Health and Human Services unless identified in the budget 
justification and provided in this Act, or approved by the House and 
Senate Committees on Appropriations through the reprogramming process. 
Personnel ceilings may not be imposed on the Indian Health Service nor 
may any action be taken to reduce the full time equivalent level of the 
Indian Health Service below the level in fiscal year 2002 adjusted 
upward for the staffing of new and expanded facilities, funding provided 
for staffing at the Lawton, Oklahoma hospital in fiscal years 2003 and 
2004, critical positions not filled in fiscal year 2002, and staffing 
necessary to carry out the intent of Congress with regard to program 
increases.]
    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.
    The appropriation structure for the Indian Health Service may not be 
altered without advance [approval of] notice submitted to the House and 
Senate Committees on Appropriations. (Department of the Interior and 
Related Agencies Appropriations Act, 2004.)

                                


 
               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,

[[Page 433]]

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 purchase and 
insurance of official motor vehicles in foreign countries; and purchase, 
hire, maintenance, and operation of aircraft, [$4,545,472,000] 
$4,213,554,000, of which [$262,000,000] $81,500,000 shall remain 
available until expended for equipment, and construction and renovation 
of facilities, and of which [$293,569,000] $142,808,000 for 
international HIV/AIDS shall remain available until September 30, [2005, 
including $150,000,000, to remain available until expended for the 
``International Mother and Child HIV Prevention Initiative.''] 2006. 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, [$14,000,000] the following amounts shall be available 
from amounts available under section 241 of the Public Health Service 
Act (1) $14,000,000 to carry out the National Immunization Surveys[: 
Provided further, That in addition to amounts provided herein, 
$127,634,000 shall be available from amounts available under section 241 
of the Public Health Service Act]; (2) $149,600,000 to carry out the 
National Center for Health Statistics surveys[: Provided further, That 
in addition to amounts provided herein,]; (3) $28,600,000 [shall be 
available from amounts available under section 241 of the Public Health 
Service Act] to carry out information systems standards development and 
architecture and applications-based research used at local public health 
levels[: Provided further, That in addition to amounts provided 
herein,]; (4) $15,000,000 to carry out Public Health Research; and (5) 
$41,900,000 [shall be available from amounts available under section 241 
of the Public Health Service Act] to carry out Research Tools and 
Approaches activities within the National Occupational Research Agenda: 
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, in whole or in part, 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 $12,500,000 may be 
available for making grants under section 1509 of the Public Health 
Service Act to not more than 15 States, tribes, or tribal organizations: 
Provided further, That without regard to existing statute, funds 
appropriated may be used to proceed, at the discretion of the Centers 
for Disease Control and Prevention, with property acquisition, including 
a long-term ground lease for construction on non-Federal land, to 
support the construction of a replacement laboratory in the Fort 
Collins, Colorado area[: Provided further, That notwithstanding any 
other provision of law, a single contract or related contracts for 
development and construction of facilities may be employed which 
collectively include the full scope of the project: Provided further, 
That the solicitation and contract shall contain the clause 
``availability of funds'' found at 48 CFR 52.232-18]. (Division E, H.R. 
2673, Consolidated Appropriations Bill, FY 2004.)

                Unavailable Receipts (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0943-0-1-999      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
01.99 Balance, start of year............
    Receipts:
02.20 Cooperative research and 
        development agreements, Centers 
        for Disease Control.............           1           1           1
                                           ---------   ---------  ----------
04.00 Total: Balances and collections...           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      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
      Direct program:

00.19   Birth defects/developmental 
          disabilities/disability and 
          health........................          98         113         113
00.20   Chronic disease prev & health 
          promotion.....................         790         853         915
00.21   Environmental health............         186         183         184
00.22   Epidemic services and response..          77          92          92
00.24   HIV/AIDS, STD and TB prevention.       1,166       1,291       1,143
00.25   Immunization....................         636         629         630
00.26   Infectious disease control......         360         370         401
00.27   Injury prevention and control...         148         154         154
00.28   Occupational safety and health..         235         235         237
00.29   Preventive health and heath 
          service block grant...........         134         133         133
00.30   Public health improvement.......         124         144          70
00.31   Building and facilities.........         185         260          82
00.32   Office of the Director..........          53          59          60
      Reimbursable program:

09.01   Health statistics...............         126         128         150
09.02   Other reimbursable program......         248         234         249
                                           ---------   ---------  ----------
09.09     Subtotal, reimbursable 
            programs....................         374         362         399
                                           ---------   ---------  ----------
10.00   Total new obligations...........       4,566       4,878       4,613
    Budgetary resources available for obligation:
21.40 Unobligated balance carried 
        forward, start of year..........          66         165         166
22.00 New budget authority (gross)......       4,663       4,879       4,614
22.10 Resources available from 
        recoveries of prior year 
        obligations.....................           3
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......       4,732       5,044       4,780
23.95 Total new obligations.............      -4,566      -4,878      -4,613
23.98 Unobligated balance expiring or 
        withdrawn.......................          -1
24.40 Unobligated balance carried 
        forward, end of year............         165         166         167
    New budget authority (gross), detail:
      Discretionary:

40.00   Appropriation...................       4,313       4,547       4,214
40.35   Appropriation permanently 
          reduced.......................         -28         -31
                                           ---------   ---------  ----------
43.00     Appropriation (total 
            discretionary)..............       4,285       4,516       4,214
      Mandatory:

60.20   Appropriation (special fund)....           1           1           1
65.00   Advance appropriation...........           3
      Spending authority from offsetting 
          collections:

        Discretionary:
68.00     Offsetting collections (cash).         260         362         399
68.10     Change in uncollected customer 
            payments from Federal 
            sources (unexpired).........         114
                                           ---------   ---------  ----------
68.90       Spending authority from 
              offsetting collections 
              (total discretionary).....         374         362         399
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................       4,663       4,879       4,614
    Change in obligated balances:
72.40 Obligated balance, start of year..       3,970       3,583       3,928
73.10 Total new obligations.............       4,566       4,878       4,613
73.20 Total outlays (gross).............      -4,894      -4,533      -4,806
73.40 Adjustments in expired accounts 
        (net)...........................         -59
73.45 Recoveries of prior year 
        obligations.....................          -3
74.00 Change in uncollected customer 
        payments from Federal sources 
        (unexpired).....................        -114
74.10 Change in uncollected customer 
        payments from Federal sources 
        (expired).......................         117
74.40 Obligated balance, end of year....       3,583       3,928       3,735
    Outlays (gross), detail:
86.90 Outlays from new discretionary 
        authority.......................       1,988       1,853       1,789
86.93 Outlays from discretionary 
        balances........................       2,902       2,679       3,016
86.97 Outlays from new mandatory 
        authority.......................           4           1           1
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........       4,894       4,533       4,806
    Offsets:
      Against gross budget authority and outlays:

        Offsetting collections (cash) 
            from:
88.00     Federal sources...............        -142        -299        -349
88.40     Non-Federal sources...........        -229         -63         -50
                                           ---------   ---------  ----------
88.90       Total, offsetting 
              collections (cash)........        -371        -362        -399
      Against gross budget authority only:

88.95   Change in uncollected customer 
          payments from Federal sources 
          (unexpired)...................        -114
88.96   Portion of offsetting 
          collections (cash) credited to 
          expired accounts..............         111
    Net budget authority and outlays:
89.00 Budget authority..................       4,289       4,517       4,215
90.00 Outlays...........................       4,523       4,171       4,407
---------------------------------------------------------------------------

                 Summary of Budget Authority and Outlays

                        (in millions of dollars)

                                     2003 actual  2004 est.   2005 est.
Enacted/requested:
  Budget Authority..................       4,289       4,517       4,215
  Outlays...........................       4,523       4,171       4,407
Legislative proposal, not subject to 
    PAYGO:
  Budget Authority..................                                -110

[[Page 434]]

  Outlays...........................                                 -36
                                    ------------------------------------
Total:
  Budget Authority..................       4,289       4,517       4,105
  Outlays...........................       4,523       4,171       4,371
                                    ====================================

    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      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

      Direct obligations:

        Personnel compensation:
11.1      Full-time permanent...........         319         331         341
11.3      Other than full-time permanent          36          37          39
11.5      Other personnel compensation..          18          19          19
11.7      Military personnel............          48          50          51
11.8      Special personal services 
            payments....................           1           1           1
                                           ---------   ---------  ----------
11.9        Total personnel compensation         422         438         451
12.1    Civilian personnel benefits.....         109         113         116
12.2    Military personnel benefits.....          32          32          33
21.0    Travel and transportation of 
          persons.......................          39          45          39
22.0    Transportation of things........           8          12           8
23.1    Rental payments to GSA..........          23          28          29
23.2    Rental payments to others.......           2           2           2
23.3    Communications, utilities, and 
          miscellaneous charges.........          20          24          23
24.0    Printing and reproduction.......           6           8           7
25.1    Advisory and assistance services         221         256         249
25.2    Other services..................          96          87          72
25.3    Other purchases of goods and 
          services from Government 
          accounts......................         179         255         164
25.4    Operation and maintenance of 
          facilities....................          16          21          20
25.5    Research and development 
          contracts.....................         231         220         207
25.6    Medical care....................           1           1           1
25.7    Operation and maintenance of 
          equipment.....................          17          25          24
26.0    Supplies and materials..........          28          30          27
31.0    Equipment.......................          55          61          60
32.0    Land and structures.............         180         257          77
41.0    Grants, subsidies, and 
          contributions.................       2,507       2,601       2,605
                                           ---------   ---------  ----------
99.0      Direct obligations............       4,192       4,516       4,214
99.0  Reimbursable obligations..........         374         362         399
                                           ---------   ---------  ----------
99.9    Total new obligations...........       4,566       4,878       4,613
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-0943-0-1-999      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
    Direct:
      Total compensable workyears:

1001    Civilian full-time equivalent 
          employment....................       5,816       5,717       5,717
1101    Military full-time equivalent 
          employment....................         767         602         602
    Reimbursable:
      Total compensable workyears:

2001    Civilian full-time equivalent 
          employment....................       1,028       1,028       1,028
2101    Military full-time equivalent 
          employment....................         257         257         257
    Allocation account:
3001  Total compensable workyears: 
        Civilian full-time equivalent 
        employment......................         529         529         529
---------------------------------------------------------------------------

                                

                 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      2003 actual   2004 est.   2005 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).............                                  36
74.40 Obligated balance, end of year....                                 -74
    Outlays (gross), detail:
86.90 Outlays from new discretionary 
        authority.......................                                 -36
    Net budget authority and outlays:
89.00 Budget authority..................                                -110
90.00 Outlays...........................                                 -36
---------------------------------------------------------------------------

    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, which may be derived 
to the extent funds are available from the Hazardous Substance Superfund 
Trust Fund pursuant to section 517(a) of SARA (26 U.S.C. 9507)] 
$76,654,000: 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. (Division G, H.R. 2673, Consolidated Appropriations Bill, 
FY 2004.)

[[Page 435]]

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0944-0-1-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Direct program....................                      73          77
09.01 Reimbursable program..............                      25          25
                                           ---------   ---------  ----------
10.00   Total new obligations...........                      98         102
    Budgetary resources available for obligation:
22.00 New budget authority (gross)......                      98         102
23.95 Total new obligations.............                     -98        -102
    New budget authority (gross), detail:
      Discretionary:

40.00   Appropriation...................                      73          77
68.00 Spending authority from offsetting 
        collections: Offsetting 
        collections (cash)..............                      25          25
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................                      98         102
    Change in obligated balances:
72.40 Obligated balance, start of year..                                  11
73.10 Total new obligations.............                      98         102
73.20 Total outlays (gross).............                     -87         -94
74.40 Obligated balance, end of year....                      11          18
    Outlays (gross), detail:
86.90 Outlays from new discretionary 
        authority.......................                      87          90
86.93 Outlays from discretionary 
        balances........................                                   4
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........                      87          94
    Offsets:
      Against gross budget authority and outlays:

88.00   Offsetting collections (cash) 
          from: Federal sources.........                     -25         -25
    Net budget authority and outlays:
89.00 Budget authority..................                      73          77
90.00 Outlays...........................                      62          69
---------------------------------------------------------------------------

    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.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0944-0-1-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

      Direct obligations:

        Personnel compensation:
11.1      Full-time permanent...........                      23          24
11.3      Other than full-time permanent                       1           1
11.5      Other personnel compensation..                       1           1
11.7      Military personnel............                       4           4
                                           ---------   ---------  ----------
11.9        Total personnel compensation                      29          30
12.1    Civilian personnel benefits.....                       6           6
12.2    Military personnel benefits.....                       2           2
21.0    Travel and transportation of 
          persons.......................                       1           1
23.3    Communications, utilities, and 
          miscellaneous charges.........                       1           1
25.1    Advisory and assistance services                       6           6
25.2    Other services..................                       2           2
25.3    Other purchases of goods and 
          services from Government 
          accounts......................                       7           7
25.5    Research and development 
          contracts.....................                       1           1
31.0    Equipment.......................                       1           1
41.0    Grants, subsidies, and 
          contributions.................                      17          20
                                           ---------   ---------  ----------
99.0      Direct obligations............                      73          77
99.0  Reimbursable obligations..........                      25          25
                                           ---------   ---------  ----------
99.9    Total new obligations...........                      98         102
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-0944-0-1-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
    Direct:
      Total compensable workyears:

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

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

                                

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-8252-0-7-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Direct program....................          82
09.01 Reimbursable program..............          18
                                           ---------   ---------  ----------
10.00   Total new obligations...........         100
    Budgetary resources available for obligation:
22.00 New budget authority (gross)......         100
23.95 Total new obligations.............        -100
    New budget authority (gross), detail:
      Discretionary:

40.26   Appropriation (trust fund)......          83
40.37   Appropriation temporarily 
          reduced.......................          -1
                                           ---------   ---------  ----------
43.00     Appropriation (total 
            discretionary)..............          82
      Spending authority from offsetting 
          collections:

68.00   Offsetting collections (cash)...          10
68.10   Change in uncollected customer 
          payments from Federal sources 
          (unexpired)...................           8
                                           ---------   ---------  ----------
68.90     Spending authority from 
            offsetting collections 
            (total discretionary).......          18
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................         100
    Change in obligated balances:
72.40 Obligated balance, start of year..          44          55          42
73.10 Total new obligations.............         100
73.20 Total outlays (gross).............         -93         -13          -7
73.40 Adjustments in expired accounts 
        (net)...........................          -4
74.00 Change in uncollected customer 
        payments from Federal sources 
        (unexpired).....................          -8
74.10 Change in uncollected customer 
        payments from Federal sources 
        (expired).......................          16
74.40 Obligated balance, end of year....          55          42          35
    Outlays (gross), detail:
86.90 Outlays from new discretionary 
        authority.......................          68
86.93 Outlays from discretionary 
        balances........................          25          13           7
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........          93          13           7
    Offsets:
      Against gross budget authority and outlays:

88.00   Offsetting collections (cash) 
          from: Federal sources.........         -22
      Against gross budget authority only:

88.95   Change in uncollected customer 
          payments from Federal sources 
          (unexpired)...................          -8
88.96   Portion of offsetting 
          collections (cash) credited to 
          expired accounts..............          12
    Net budget authority and outlays:
89.00 Budget authority..................          82
90.00 Outlays...........................          71          13           7
---------------------------------------------------------------------------

    The Agency for Toxic Substances and Disease Registry (ATSDR) 
received appropriations solely from the Hazardous Substance Superfund 
trust fund until 2004, when ATSDR received an appropriation from the 
general fund, depending on any available balances from the trust fund. 
The budget requests that ATSDR's appropriation come only from the 
general fund in 2005, without regard to any available balances in the 
trust fund.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-8252-0-7-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

      Direct obligations:

        Personnel compensation:
11.1      Full-time permanent...........          22
11.3      Other than full-time permanent           1
11.5      Other personnel compensation..           1
11.7      Military personnel............           4
                                           ---------   ---------  ----------
11.9        Total personnel compensation          28

[[Page 436]]

12.1    Civilian personnel benefits.....           6
12.2    Military personnel benefits.....           2
21.0    Travel and transportation of 
          persons.......................           1
23.3    Communications, utilities, and 
          miscellaneous charges.........           2
25.1    Advisory and assistance services           8
25.2    Other services..................           3
25.3    Other purchases of goods and 
          services from Government 
          accounts......................          11
31.0    Equipment.......................           2
41.0    Grants, subsidies, and 
          contributions.................          19
                                           ---------   ---------  ----------
99.0      Direct obligations............          82
99.0  Reimbursable obligations..........          18
                                           ---------   ---------  ----------
99.9    Total new obligations...........         100
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-8252-0-7-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
    Direct:
      Total compensable workyears:

1001    Civilian full-time equivalent 
          employment....................         302
1101    Military full-time equivalent 
          employment....................          67
    Reimbursable:
      Total compensable workyears:

2001    Civilian full-time equivalent 
          employment....................          57
2101    Military full-time equivalent 
          employment....................           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] $4,870,025,000, of 
which up to $8,000,000 may be used for facilities repairs and 
improvements at the NCI-Frederick Federally Funded Research and 
Development Center in Frederick, Maryland. (Division E, H.R. 2673, 
Consolidated Appropriations Bill, FY 2004.)

                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, [$2,897,145,000] $2,963,953,000. (Division 
E, H.R. 2673, Consolidated Appropriations Bill, FY 2004.)

         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, [$385,796,000] $394,080,000. 
(Division E, H.R. 2673, Consolidated Appropriations Bill, FY 2004.)

    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, 
[$1,682,457,000] $1,726,196,000. (Division E, H.R. 2673, Consolidated 
Appropriations Bill, FY 2004.)

         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, 
[$1,510,776,000] $1,545,623,000. (Division E, H.R. 2673, Consolidated 
Appropriations Bill, FY 2004.)

          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, 
[$4,335,155,000] $4,425,507,000: Provided, That [$150,000,000] 
$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: Provided further, That up to $150,000,000 
shall be for extramural facilities construction grants to enhance the 
Nation's capability to do research on biological and other agents. 
(Division E, H.R. 2673, Consolidated Appropriations Bill, FY 2004.)

             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, [$1,916,333,000] 
$1,959,810,000. (Division E, H.R. 2673, Consolidated Appropriations 
Bill, FY 2004.)

        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, 
[$1,250,585,000] $1,280,915,000. (Division E, H.R. 2673, Consolidated 
Appropriations Bill, FY 2004.)

                         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, 
[$657,199,000] $671,578,000. (Division E, H.R. 2673, Consolidated 
Appropriations Bill, FY 2004.)

           National Institute of Environmental Health Sciences

    For carrying out sections 301 and 311 and title IV of the Public 
Health Service Act with respect to environmental health sciences, 
[$636,974,000] $650,027,000. (Division E, H.R. 2673, Consolidated 
Appropriations Bill, FY 2004.)
    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, $80,486,000. (Division G, H.R. 2673, 
Consolidated Appropriations Bill, FY 2004.)

                       National Institute on Aging

    For carrying out section 301 and title IV of the Public Health 
Service Act with respect to aging, [$1,031,311,000] $1,055,666,000. 
(Division E, H.R. 2673, Consolidated Appropriations Bill, FY 2004.)

  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, [$504,300,000] $515,378,000. (Division E, H.R. 2673, 
Consolidated Appropriations Bill, FY 2004.)

    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, 
[$384,477,000] $393,507,000. (Division E, H.R. 2673, Consolidated 
Appropriations Bill, FY 2004.)

                 National Institute of Nursing Research

    For carrying out section 301 and title IV of the Public Health 
Service Act with respect to nursing research, [$135,555,000] 
$139,198,000. (Division E, H.R. 2673, Consolidated Appropriations Bill, 
FY 2004.)

           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, [$431,471,000] 
$441,911,000. (Division E, H.R. 2673, Consolidated Appropriations Bill, 
FY 2004.)

                    National Institute on Drug Abuse

    For carrying out section 301 and title IV of the Public Health 
Service Act with respect to drug abuse, [$997,414,000] $1,019,060,000. 
(Division E, H.R. 2673, Consolidated Appropriations Bill, FY 2004.)

[[Page 437]]

                   National Institute of Mental Health

    For carrying out section 301 and title IV of the Public Health 
Service Act with respect to mental health, [$1,390,714,000] 
$1,420,609,000. (Division E, H.R. 2673, Consolidated Appropriations 
Bill, FY 2004.)

                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, [$482,222,000] 
$492,670,000. (Division E, H.R. 2673, Consolidated Appropriations Bill, 
FY 2004.)

       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, [$288,900,000] $297,647,000. (Division E, H.R. 2673, 
Consolidated Appropriations Bill, FY 2004.)

                 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, [$1,186,183,000] $1,094,141,000: Provided, That none of 
these funds shall be used to pay recipients of the general research 
support grants program any amount for indirect expenses in connection 
with such grants[: Provided further, That $119,220,000 shall be for 
extramural facilities construction grants]. (Division E, H.R. 2673, 
Consolidated Appropriations Bill, FY 2004.)

       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, 
[$117,752,000] $121,116,000. (Division E, H.R. 2673, Consolidated 
Appropriations Bill, FY 2004.)

        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] $196,780,000. (Division E, H.R. 2673, 
Consolidated Appropriations Bill, FY 2004.)

                  John E. Fogarty International Center

    For carrying out the activities at the John E. Fogarty International 
Center, [$65,800,000] $67,182,000. (Division E, H.R. 2673, Consolidated 
Appropriations Bill, FY 2004.)

                      National Library of Medicine

    For carrying out section 301 and title IV of the Public Health 
Service Act with respect to health information communications, 
[$311,635,000] $325,147,000, of which $4,000,000 shall be available 
until expended for improvement of information systems: Provided, That in 
fiscal year [2004] 2005, 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[: Provided further, That in addition to amounts provided herein, 
$8,200,000 shall be available from amounts available under section 241 
of the Public Health Service Act to carry out National Information 
Center on Health Services Research and Health Care Technology and 
related health services]. (Division E, H.R. 2673, Consolidated 
Appropriations Bill, FY 2004.)

                         Office of the Director

                      (including transfer of funds)

    For carrying out the responsibilities of the Office of the Director, 
National Institutes of Health, [$329,707,000, of which up to $7,500,000 
shall be used to carry out section 221 of this Act] $359,645,000: 
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 1 fiscal year after the 
fiscal year in which they are deposited[: Provided further, That up to 
$500,000 shall be available to carry out section 499 of the Public 
Health Service Act]. (Division E, H.R. 2673, Consolidated Appropriations 
Bill, FY 2004.)

                        buildings and facilities

                      (including transfer of funds)

    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, [$89,500,000] 
$99,500,000, to remain available until expended[: Provided, That 
notwithstanding any other provision of law, single contracts or related 
contracts, which collectively include the full scope of the project, may 
be employed for the development and construction of the first and second 
phases of the John Edward Porter Neuroscience Research Center: Provided 
further, That the solicitations and contracts shall contain the clause 
``availability of funds'' found at 48 CFR 52.232-18]. (Division E, H.R. 
2673, Consolidated Appropriations Bill, FY 2004.)

                Unavailable Receipts (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-9915-0-1-552      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
01.99 Balance, start of year............
    Receipts:
02.20 Cooperative research and 
        development agreements, NIH.....          16          16          16
                                           ---------   ---------  ----------
04.00 Total: Balances and collections...          16          16          16
    Appropriations:
05.00 National Institutes of Health.....         -16         -16         -16
                                           ---------   ---------  ----------
07.99 Balance, end of year..............
---------------------------------------------------------------------------

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-9915-0-1-552      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
      Direct program:

00.01   National Cancer Institute.......       4,595       4,739       4,870
00.02   National Heart, Lung, and Blood 
          Institute.....................       2,794       2,879       2,964
00.03   National Institute of Dental and 
          Craniofacial Research.........         372         383         394
00.04   National Institute of Diabetes 
          and Digestive and Kidney 
          Disease.......................       1,712       1,822       1,876
00.05   National Institute of 
          Neurological Disorders and 
          Stroke........................       1,456       1,501       1,545
00.06   National Institute of Allergy 
          and Infectious Diseases.......       3,607       4,304       4,426
00.07   National Institute of General 
          Medical Sciences..............       1,847       1,905       1,960
00.08   National Institute of Child 
          Health and Human Development..       1,206       1,242       1,281
00.09   National Eye Institute..........         633         653         672
00.10   National Institute of 
          Environmental Health Sciences.         698         711         730
00.11   National Institute on Aging.....         994       1,025       1,055
00.12   National Institute of Arthritis 
          and Musculoskeletal and Skin 
          Disease.......................         486         501         515
00.13   National Institute on Deafness 
          and Other Communication 
          Disorder......................         370         382         394
00.14   National Institute of Mental 
          Health........................       1,341       1,382       1,421
00.15   National Institute on Drug Abuse         966         991       1,019
00.16   Natinal Institute on Alcohol 
          Abuse and Alcoholism..........         416         429         442
00.17   National Institute of Nursing 
          Research......................         131         135         139
00.18   National Human Genome Research 
          Institute.....................         465         479         492
00.19   National Institute of Biomedical 
          Imaging and Bioengineering....         278         287         298
00.20   National Center for Research 
          Resources.....................       1,139       1,179       1,094
00.21   National Center for 
          Complementary and Alternative 
          Medicine......................         113         117         121
00.22   National Center on Minority 
          Health and Health Disparities.         186         191         197
00.23   John E. Fogarty International 
          Center........................          63          65          67
00.24   National Library of Medicine....         300         309         325
00.25   Office of the Director..........         266         328         360
00.26   Buildings and facilities........         306         599         100
00.27   Cooperative Research and 
          Development Agreements........          10          16          16
00.28   Royalities......................          32
09.00 Reimbursable program..............       2,054       2,377       2,478
                                           ---------   ---------  ----------
10.00   Total new obligations...........      28,836      30,931      31,251

[[Page 438]]

    Budgetary resources available for obligation:
21.40 Unobligated balance carried 
        forward, start of year..........         466         649         139
22.00 New budget authority (gross)......      29,028      30,421      31,251
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......      29,494      31,070      31,390
23.95 Total new obligations.............     -28,836     -30,931     -31,251
23.98 Unobligated balance expiring or 
        withdrawn.......................          -9
24.40 Unobligated balance carried 
        forward, end of year............         649         139         139
    New budget authority (gross), detail:
      Discretionary:

40.00   Appropriation...................      27,243      28,061      28,607
40.35   Appropriation permanently 
          reduced.......................        -177        -183
41.00   Transferred to other accounts...         -99
42.00   Transferred from other accounts.           4
                                           ---------   ---------  ----------
43.00     Appropriation (total 
            discretionary)..............      26,971      27,878      28,607
      Mandatory:

60.00   Appropriation...................          97         150         150
60.20   Appropriation (special fund)....          16          16          16
                                           ---------   ---------  ----------
62.50     Appropriation (total 
            mandatory)..................         113         166         166
      Spending authority from offsetting 
          collections:

        Discretionary:
68.00     Offsetting collections (cash).       1,693       2,377       2,478
68.10     Change in uncollected customer 
            payments from Federal 
            sources (unexpired).........         251
                                           ---------   ---------  ----------
68.90       Spending authority from 
              offsetting collections 
              (total discretionary).....       1,944       2,377       2,478
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................      29,028      30,421      31,251
    Change in obligated balances:
72.40 Obligated balance, start of year..      21,686      25,607      28,231
73.10 Total new obligations.............      28,836      30,931      31,251
73.20 Total outlays (gross).............     -24,655     -28,306     -30,477
73.40 Adjustments in expired accounts 
        (net)...........................        -145
74.00 Change in uncollected customer 
        payments from Federal sources 
        (unexpired).....................        -251
74.10 Change in uncollected customer 
        payments from Federal sources 
        (expired).......................         136
74.40 Obligated balance, end of year....      25,607      28,231      29,004
    Outlays (gross), detail:
86.90 Outlays from new discretionary 
        authority.......................       8,406       9,299       9,704
86.93 Outlays from discretionary 
        balances........................      16,153      18,892      20,620
86.97 Outlays from new mandatory 
        authority.......................          25          41          42
86.98 Outlays from mandatory balances...          71          74         111
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........      24,655      28,306      30,477
    Offsets:
      Against gross budget authority and outlays:

        Offsetting collections (cash) 
            from:
88.00     Federal sources...............      -1,775      -2,377      -2,478
88.40     Non-Federal sources...........         -46
                                           ---------   ---------  ----------
88.90       Total, offsetting 
              collections (cash)........      -1,821      -2,377      -2,478
      Against gross budget authority only:

88.95   Change in uncollected customer 
          payments from Federal sources 
          (unexpired)...................        -251
88.96   Portion of offsetting 
          collections (cash) credited to 
          expired accounts..............         128
    Net budget authority and outlays:
89.00 Budget authority..................      27,084      28,044      28,773
90.00 Outlays...........................      22,834      25,929      27,999
---------------------------------------------------------------------------

         DISTRIBUTION OF BUDGET AUTHORITY AND OUTLAYS BY ACCOUNT

                          [Dollars in millions]

                                        2003         2004        2005
Distribution of budget authority by 
    account:
  National Cancer Institute.........       4,592       4,739       4,870
  National Heart, Lung, and Blood 
    Institute.......................       2,794       2,879       2,964
  National Institute of Dental and 
    Craniofacial Research...........         372         383         394
  National Institute of Diabetes and 
    Digestive and Kidney Diseases...       1,720       1,822       1,876
  National Institute of Neurological 
    Disorder and Stroke.............       1,456       1,501       1,546
  National Institute of Allergy and 
    Infectious Diseases.............       3,607       4,304       4,426
  National Institute of General 
    Medical Sciences................       1,847       1,905       1,960
  National Institute of Child Health 
    and Human Development...........       1,206       1,242       1,281
  National Eye Institute............         633         653         672
  National Institute of 
    Environmental Health Sciences...         698         711         731
  National Institute on Aging.......         994       1,025       1,056
  National Institute of Arthritis 
    and Musculoskeletal and Skin 
    Diseases........................         486         501         515
  National Institute on Deafness and 
    Other Communication Disorders...         370         382         394
  National Institute of Nursing 
    Research........................         131         135         139
  National Institute on Alcohol 
    Abuse and Alcoholism............         416         429         442
  National Institute on Drug Abuse..         966         991       1,019
  National Institute of Mental 
    Health..........................       1,341       1,382       1,421
  National Center for Research 
    Resources.......................       1,139       1,179       1,094
  National Human Genome Research 
    Institute.......................         465         479         493
  National Institute of Biomedical 
    Imaging and Bioengineering......         278         287         298
  National Center for Complementary 
    and Alternative Medicine........         113         117         121
  National Center for Minority 
    Health and Health Disparities...         186         191         197
  John E. Fogarty International 
    Center..........................          63          65          67
  National Library of Medicine......         300         309         325
  Office of the Director............         266         328         360
  Buildings and facilities..........         629          89         100
                                    ------------------------------------
      Subtotal......................      27,068      28,028      28,757
  Cooperative Research and 
    Development Agreements..........          16          16          16
                                    ------------------------------------
      Total Budget Authority, NIH...      27,084      28,044      28,773
                                    ====================================

                          [Dollars in millions]

                                        2003         2004        2005
Distribution of outlays by account:
  National Cancerse Institute.......       4,112       4,494       4,744
  National Heart, Lung, and Blood 
    Institute.......................       2,498       2,684       2,853
  National Institute of Dental and 
    Craniofacial Research...........         335         365         383
  National Institute of Diabetes and 
    Digestive and Kidney Diseases...       1,526       1,654       1,802
  National Institute of Neurological 
    Disorders and Stroke............       1,312       1,407       1,497
  National Institute of Allergy and 
    Infectious Diseases.............       2,463       3,532       4,160
  National Institute of General 
    Medical Sciences................       1,711       1,819       1,897
  National Institute of Child Health 
    and Human Development...........       1,078       1,170       1,242
  National Eye Institute............         576         618         653
  National Institute of 
    Environmental Health Sciences...         640         680         713
  National Institute on Aging.......         857         959       1,020
  National Institute of Arthritis 
    and Musculoskeletal and Skin 
    Diseases........................         419         477         499
  National Institute on Deafness and 
    Other Communication Disorders...         336         359         381
  National Institute of Nursing 
    Research........................         114         124         134
  National Institute on Alcohol 
    Abuse and Alcoholism............         384         403         428
  National Institute on Drug Abuse..         834         937         984
  National Institute of Mental 
    Health..........................       1,229       1,311       1,378
  National Center for Research 
    Resources.......................         926       1,107       1,138
  National Human Genome Research 
    Institute.......................         400         470         483
  National Institute of Biomedical 
    Imaging and Bioengineering......         112         232         276
  National Center for Complementary 
    and Alternative Medicine........         104         107         116
  National Center for Minority 
    Health and Health Disparities...         138         167         183
  John E. Fogarty International 
    Center..........................          64          59          65
  National Library of Medicine......         280         296         315
  Office of the Director............         267         263         322
  Buildings and Facilities..........         202         226         323
  Service and Supply Fund/Management 
    Fund............................         -92           0           0
                                    ------------------------------------
      Subtotal Outlays..............      22,825      25,920      27,989
  Cooperative Research and 
    Development Agreements..........           9          10          10
                                    ------------------------------------
      Total Outlays, NIH............      22,834      25,930      27,999
                                    ====================================

    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.

    NIH will continue to implement strategies and policies in 2005 and 
beyond to maximize budgetary and management flexibility in the future. 
Such strategies include funding the total costs of grants in the grant's 
first year and managing grant average cost increases.


[[Page 439]]



               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-9915-0-1-552      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

      Direct obligations:

        Personnel compensation:
11.1      Full-time permanent...........         633         662         686
11.3      Other than full-time permanent         310         323         335
11.5      Other personnel compensation..          38          29          30
11.7      Military personnel............          25          27          28
11.8      Special personal services 
            payments....................         133         138         142
                                           ---------   ---------  ----------
11.9        Total personnel compensation       1,139       1,179       1,221
12.1    Civilian personnel benefits.....         249         262         271
12.2    Military personnel benefits.....          16          17          18
21.0    Travel and transportation of 
          persons.......................          50          52          54
22.0    Transportation of things........           6           8           7
23.1    Rental payments to GSA..........           5           7           7
23.2    Rental payments to others.......          14          21          22
23.3    Communications, utilities, and 
          miscellaneous charges.........          30          30          31
24.0    Printing and reproduction.......          14          15          15
25.1    Advisory and assistance services         100          90          94
25.2    Other services..................         587         526         558
25.3    Other purchases of goods and 
          services from Government 
          accounts......................       2,163       2,114       2,173
25.4    Operation and maintenance of 
          facilities....................         355         838         341
25.5    Research and development 
          contracts.....................       1,803       2,421       2,284
25.6    Medical care....................          16          16          16
25.7    Operation and maintenance of 
          equipment.....................          60          64          65
26.0    Supplies and materials..........         215         223         230
31.0    Equipment.......................         200         212         221
41.0    Grants, subsidies, and 
          contributions.................      19,760      20,459      21,145
                                           ---------   ---------  ----------
99.0      Direct obligations............      26,782      28,554      28,773
99.0  Reimbursable obligations..........       2,054       2,377       2,478
                                           ---------   ---------  ----------
99.9    Total new obligations...........      28,836      30,931      31,251
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-9915-0-1-552      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
    Direct:
      Total compensable workyears:

1001    Civilian full-time equivalent 
          employment....................      12,577      12,521      12,518
1101    Military full-time equivalent 
          employment....................         326         324         324
    Reimbursable:
      Total compensable workyears:

2001    Civilian full-time equivalent 
          employment....................       4,567       4,551       4,551
2101    Military full-time equivalent 
          employment....................         118         117         117
---------------------------------------------------------------------------

                                


 
        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 with Mental 
Illness Act [of 1986], and section 301 of the Public Health Service Act 
with respect to program management, [$3,253,763,000] $3,418,939,000: 
Provided, That in addition to amounts provided herein, [$79,200,000] the 
following amount shall be available from amounts available under section 
241 of the Public Health Service Act (1) $79,200,000 to carry out 
subpart II of title XIX of the Public Health Service Act to fund section 
1935(b) technical assistance, national data, data collection and 
evaluation activities, and further that the total available under this 
Act for section 1935(b) activities shall not exceed 5 percent of the 
amounts appropriated for subpart II of title XIX[: Provided further, 
That in addition to the amounts provided herein, $21,850,000 shall be 
available from amounts available under Section 241 of the Public Health 
Service Act]: (2); $21,803,000 to carry out subpart I of Part B of title 
XIX of the Public Health Service Act to fund section 1920(b) technical 
assistance, data collection and program evaluation activities, and 
further that the total available under this Act for section 1920(b) 
activities shall not exceed 5 percent of the amounts appropriated for 
subpart I of Part B of title XIX[: Provided further, That in addition to 
amounts provided herein,]; (3) $16,000,000 [shall be made available from 
amounts available under section 241 of the Public Health Service Act] to 
carry out national surveys on drug abuse; and (4) $4,300,000 to evaluate 
substance abuse treatment programs. (Division E, H.R. 2673, Consolidated 
Appropriations Bill, FY 2004.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1362-0-1-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
      Direct program:

00.01   Mental health and substance 
          abuse activities..............         930       1,045       1,176
00.02   Mental health partnership.......         437         413         414
00.03   Substance abuse partnership.....       1,695       1,700       1,753
00.05   Program management..............          80          76          76
09.01 Reimbursable program..............         176         121         126
                                           ---------   ---------  ----------
10.00   Total new obligations...........       3,318       3,355       3,545
    Budgetary resources available for obligation:
21.40 Unobligated balance carried 
        forward, start of year..........           6           1           1
22.00 New budget authority (gross)......       3,314       3,355       3,545
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......       3,320       3,356       3,546
23.95 Total new obligations.............      -3,318      -3,355      -3,545
23.98 Unobligated balance expiring or 
        withdrawn.......................          -1
24.40 Unobligated balance carried 
        forward, end of year............           1           1           1
    New budget authority (gross), detail:
      Discretionary:

40.00   Appropriation...................       3,158       3,254       3,419
40.35   Appropriation permanently 
          reduced.......................         -20         -20
                                           ---------   ---------  ----------
43.00     Appropriation (total 
            discretionary)..............       3,138       3,234       3,419
      Spending authority from offsetting 
          collections:

68.00   Offsetting collections (cash)...         116         121         126
68.10   Change in uncollected customer 
          payments from Federal sources 
          (unexpired)...................          60
                                           ---------   ---------  ----------
68.90     Spending authority from 
            offsetting collections 
            (total discretionary).......         176         121         126
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................       3,314       3,355       3,545
    Change in obligated balances:
72.40 Obligated balance, start of year..       2,385       2,465       2,566
73.10 Total new obligations.............       3,318       3,355       3,545
73.20 Total outlays (gross).............      -3,155      -3,254      -3,417
73.40 Adjustments in expired accounts 
        (net)...........................         -26
74.00 Change in uncollected customer 
        payments from Federal sources 
        (unexpired).....................         -60
74.10 Change in uncollected customer 
        payments from Federal sources 
        (expired).......................           5
74.40 Obligated balance, end of year....       2,465       2,566       2,694
    Outlays (gross), detail:
86.90 Outlays from new discretionary 
        authority.......................       1,337       1,382       1,460
86.93 Outlays from discretionary 
        balances........................       1,818       1,872       1,957
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........       3,155       3,254       3,417
    Offsets:
      Against gross budget authority and outlays:

88.00   Offsetting collections (cash) 
          from: Federal sources.........        -117        -121        -126
      Against gross budget authority only:

88.95   Change in uncollected customer 
          payments from Federal sources 
          (unexpired)...................         -60
88.96   Portion of offsetting 
          collections (cash) credited to 
          expired accounts..............           1
    Net budget authority and outlays:
89.00 Budget authority..................       3,138       3,234       3,419
90.00 Outlays...........................       3,038       3,133       3,291
---------------------------------------------------------------------------

                 Summary of Budget Authority and Outlays

                        (in millions of dollars)

                                     2003 actual  2004 est.   2005 est.
Enacted/requested:
  Budget Authority..................       3,138       3,234       3,419
  Outlays...........................       3,038       3,133       3,291
Legislative proposal, not subject to 
    PAYGO:
  Budget Authority..................                                  10
  Outlays...........................                                   4
                                    ------------------------------------
Total:
  Budget Authority..................       3,138       3,234       3,429
  Outlays...........................       3,038       3,133       3,295
                                    ====================================

                                                            

[[Page 440]]



    This program provides Federal support to strengthen the capacity of 
the Nation's health care delivery system to provide substance abuse 
prevention, addiction treatment, and mental health services, for people 
at risk for or experiencing substance abuse or mental illness. SAMHSA 
builds partnerships with states, communities, and private organizations 
to address the needs of individuals with substance abuse disorders and/
or mental illness and to identify and respond to the community risk 
factors that contribute to these illnesses.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1362-0-1-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

      Direct obligations:

        Personnel compensation:
11.1      Full-time permanent...........          40          40          41
11.3      Other than full-time permanent           2           2           2
11.5      Other personnel compensation..           1                       1
11.7      Military personnel............                       2           2
                                           ---------   ---------  ----------
11.9        Total personnel compensation          43          44          46
12.1    Civilian personnel benefits.....          10           9           9
21.0    Travel and transportation of 
          persons.......................           2           2           2
23.1    Rental payments to GSA..........           5           5           6
23.3    Communications, utilities, and 
          miscellaneous charges.........           2           3           3
24.0    Printing and reproduction.......           4           3           3
25.1    Advisory and assistance services          19          18          15
25.2    Other services..................         201         185         191
25.3    Other purchases of goods and 
          services from Government 
          accounts......................         115         114         116
31.0    Equipment.......................           1           1
41.0    Grants, subsidies, and 
          contributions.................       2,738       2,848       3,026
42.0    Insurance claims and indemnities           2           2           2
                                           ---------   ---------  ----------
99.0      Direct obligations............       3,142       3,234       3,419
99.0  Reimbursable obligations..........         176         121         126
                                           ---------   ---------  ----------
99.9    Total new obligations...........       3,318       3,355       3,545
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-1362-0-1-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
    Direct:
      Total compensable workyears:

1001    Civilian full-time equivalent 
          employment....................         479         474         474
1101    Military full-time equivalent 
          employment....................          21          21          21
    Reimbursable:
      Total compensable workyears:

2001    Civilian full-time equivalent 
          employment....................           2          19          19
2101    Military full-time equivalent 
          employment....................          32          32          32
---------------------------------------------------------------------------

                                

               Substance Abuse and Mental Health Services

              (Legislative proposal, not subject to PAYGO)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1362-2-1-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
      Direct program:

00.01   Samaritan initiative............                                  10
                                           ---------   ---------  ----------
10.00   Total new obligations...........                                  10
    Budgetary resources available for obligation:
22.00 New budget authority (gross)......                                  10
23.95 Total new obligations.............                                 -10
    New budget authority (gross), detail:
      Discretionary:

40.00   Appropriation...................                                  10
    Change in obligated balances:
73.10 Total new obligations.............                                  10
73.20 Total outlays (gross).............                                  -4
74.40 Obligated balance, end of year....                                   6
    Outlays (gross), detail:
86.90 Outlays from new discretionary 
        authority.......................                                   4
    Net budget authority and outlays:
89.00 Budget authority..................                                  10
90.00 Outlays...........................                                   4
---------------------------------------------------------------------------

    The Administration will submit legislation for the Samaritan 
initiative, a new competitive grant program that supports the 
Administration's efforts to end chronic homelessness within a decade. 
The budget includes $10 million in the Department of Health and Human 
Services for this proposal. Together with the Department of Housing and 
Urban Development (HUD) and the Department of Veterans Affairs (VA), HHS 
will support the most promising local collaborative strategies to move 
chronically homeless persons from the streets to safe, permanent housing 
with supportive services. HHS funds provided for the Samaritan 
initiative will support the services component of grantee projects, 
including substance abuse treatment and mental health services 
integrated with primary health care.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1362-2-1-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
25.2  Other services....................                                   1
41.0  Grants, subsidies, and 
        contributions...................                                   9
                                           ---------   ---------  ----------
99.9    Total new obligations...........                                  10
---------------------------------------------------------------------------

                                


 
               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 $303,695,000[: Provided further, That, of the funds 
made available under this heading, $12,000,000 shall be for the conduct 
of research on the comparative clinical effectiveness, cost-
effectiveness, and safety of drugs, biological products, and devices]. 
(Division E, H.R. 2673, Consolidated Appropriations Bill, FY 2004.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1700-0-1-552      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
09.00 Reimbursable program..............         327         327         327
                                           ---------   ---------  ----------
10.00   Total new obligations...........         327         327         327
    Budgetary resources available for obligation:
21.40 Unobligated balance carried 
        forward, start of year..........          15          19          19
22.00 New budget authority (gross)......         329         327         327
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......         344         346         346
23.95 Total new obligations.............        -327        -327        -327
24.40 Unobligated balance carried 
        forward, end of year............          19          19          19
    New budget authority (gross), detail:
      Spending authority from offsetting 
          collections:

        Discretionary:
68.00     Offsetting collections (cash).         110         327         327
68.10     Change in uncollected customer 
            payments from Federal 
            sources (unexpired).........         219
                                           ---------   ---------  ----------
68.90       Spending authority from 
              offsetting collections 
              (total discretionary).....         329         327         327
    Change in obligated balances:
72.40 Obligated balance, start of year..         337         131         131
73.10 Total new obligations.............         327         327         327

[[Page 441]]

73.20 Total outlays (gross).............        -314        -327        -327
73.40 Adjustments in expired accounts 
        (net)...........................          -1
74.00 Change in uncollected customer 
        payments from Federal sources 
        (unexpired).....................        -219
74.10 Change in uncollected customer 
        payments from Federal sources 
        (expired).......................           1
74.40 Obligated balance, end of year....         131         131         131
    Outlays (gross), detail:
86.90 Outlays from new discretionary 
        authority.......................          93         327         327
86.93 Outlays from discretionary 
        balances........................         221
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........         314         327         327
    Offsets:
      Against gross budget authority and outlays:

88.00   Offsetting collections (cash) 
          from: Federal sources.........        -111        -327        -327
      Against gross budget authority only:

88.95   Change in uncollected customer 
          payments from Federal sources 
          (unexpired)...................        -219
88.96   Portion of offsetting 
          collections (cash) credited to 
          expired accounts..............           1
    Net budget authority and outlays:
89.00 Budget authority..................
90.00 Outlays...........................         202
---------------------------------------------------------------------------

    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      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
99.0  Reimbursable obligations: 
        Reimbursable obligations........         327         327         327
                                           ---------   ---------  ----------
99.9    Total new obligations...........         327         327         327
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-1700-0-1-552      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
    Reimbursable:
      Total compensable workyears:

2001    Civilian full-time equivalent 
          employment....................         277         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, [$130,892,197,000] $119,124,488,000, to remain 
available until expended: Provided, That for fiscal year 2005, the 
Secretary shall reduce the amount paid under section 1903(a)(7) to each 
State according to the proportion established under section 16(k)(2)(B) 
of the Food Stamp Act of 1977 (7 U.S.C. 2025(k)(2)(B)) by a total amount 
of $300,000,000: Provided further, That for Medicaid claims attributable 
to the design, development, or installation of mechanized claims 
processing and information retrieval systems as described in section 
1903(a)(3)(A)(i), the Secretary shall pay 75 percent to each State which 
has a plan approved under title XIX.
    For making, after May 31, [2004] 2005, payments to States under 
title XIX of the Social Security Act for the last quarter of fiscal year 
[2004] 2005 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] 2006, 
$58,517,290,000, 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. (Division E, H.R. 2673, Consolidated Appropriations 
Bill, FY 2004.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0512-0-1-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Medicaid vendor payments..........     158,871     167,031     172,670
00.02 State and local administration....       9,070       8,868       9,319
00.03 Vaccine purchases.................       1,164       1,208       1,208
09.01 Medicare Part B premiums..........                     125
09.02 Reimbursable program: Medicare 
        prescription drug eligibility...                                 106
                                           ---------   ---------  ----------
10.00   Total new obligations...........     169,105     177,232     183,303
    Budgetary resources available for obligation:
21.40 Unobligated balance carried 
        forward, start of year..........           7          10       5,656
22.00 New budget authority (gross)......     164,663     182,878     177,647
22.10 Resources available from 
        recoveries of prior year 
        obligations.....................       4,446
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......     169,116     182,888     183,303
23.95 Total new obligations.............    -169,105    -177,232    -183,303
24.40 Unobligated balance carried 
        forward, end of year............          10       5,656
    New budget authority (gross), detail:
      Mandatory:

60.00   Appropriation...................     117,949     130,892     119,125
60.00   Appropriation...................
                                           ---------   ---------  ----------
62.50     Appropriation (total 
            mandatory)..................     117,949     130,892     119,125
65.00   Advance appropriation...........      46,602      51,861      58,416
69.00 Offsetting collections (cash).....         112         125         106
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................     164,663     182,878     177,647
    Change in obligated balances:
72.40 Obligated balance, start of year..       5,557       9,412       9,412
73.10 Total new obligations.............     169,105     177,232     183,303
73.20 Total outlays (gross).............    -160,805    -177,232    -183,303
73.45 Recoveries of prior year 
        obligations.....................      -4,446
74.40 Obligated balance, end of year....       9,412       9,412       9,412
    Outlays (gross), detail:
86.97 Outlays from new mandatory 
        authority.......................     160,242     176,232     177,647
86.98 Outlays from mandatory balances...         563       1,000       5,656
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........     160,805     177,232     183,303
    Offsets:
      Against gross budget authority and outlays:

88.00   Offsetting collections (cash) 
          from: Federal sources.........        -112        -125        -106
    Net budget authority and outlays:
89.00 Budget authority..................     164,551     182,753     177,541
90.00 Outlays...........................     160,693     177,107     183,197
---------------------------------------------------------------------------

                 Summary of Budget Authority and Outlays

                        (in millions of dollars)

                                     2003 actual  2004 est.   2005 est.
Enacted/requested:
  Budget Authority..................     164,551     182,753     177,541
  Outlays...........................     160,693     177,107     183,197
Legislative proposal, not subject to 
    PAYGO:
  Budget Authority..................                                -516
  Outlays...........................                                -516
Legislative proposal, subject to 
    PAYGO:
  Budget Authority..................                     175        -617
  Outlays...........................                     175        -617
                                    ------------------------------------
Total:
  Budget Authority..................     164,551     182,928     176,408
  Outlays...........................     160,693     177,282     182,064
                                    ====================================

    Medicaid assists States in providing medical care to their low-
income populations 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      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
41.0  Direct obligations: Grants, 
        subsidies, and contributions....     169,105     177,107     183,197
99.0  Reimbursable obligations: 
        Reimbursable obligations........                     125         106
                                           ---------   ---------  ----------
99.9    Total new obligations...........     169,105     177,232     183,303
---------------------------------------------------------------------------

[[Page 442]]



                                

                      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      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Reduce FMAP/TANF block grants.....                                -380
                                           ---------   ---------  ----------
10.00   Total new obligations (object 
          class 41.0)...................                                -380
    Budgetary resources available for obligation:
22.00 New budget authority (gross)......                                -380
23.95 Total new obligations.............                                 380
    New budget authority (gross), detail:
      Discretionary:

40.00   Appropriation...................                                -380
    Change in obligated balances:
73.10 Total new obligations.............                                -380
73.20 Total outlays (gross).............                                 380
    Outlays (gross), detail:
86.90 Outlays from new discretionary 
        authority.......................                                -380
    Offsets:
      Against gross budget authority and outlays:

88.00   Offsetting collections (cash) 
          from: Federal sources.........                                -136
    Net budget authority and outlays:
89.00 Budget authority..................                                -516
90.00 Outlays...........................                                -516
---------------------------------------------------------------------------

    This schedule reflects the Administration's Medicaid proposals.

                                

                      Grants to States for Medicaid

                (Legislative proposal, subject to PAYGO)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0512-4-1-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Disability/long term care.........                                  30
00.02 Vaccines for children.............                                 165
00.03 Transitional medical assistance...                     175         558
00.04 Program integrity.................                              -1,542
00.06 Other proposal....................                                  36
09.00 Reimbursable program..............                                 136
                                           ---------   ---------  ----------
10.00   Total new obligations...........                     175        -617
    Budgetary resources available for obligation:
22.00 New budget authority (gross)......                     175        -617
23.95 Total new obligations.............                    -175         617
    New budget authority (gross), detail:
      Mandatory:

60.00   Appropriation...................                     175        -753
69.00 Offsetting collections (cash).....                                 136
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................                     175        -617
    Change in obligated balances:
73.10 Total new obligations.............                     175        -617
73.20 Total outlays (gross).............                    -175         617
    Outlays (gross), detail:
86.97 Outlays from new mandatory 
        authority.......................                     175        -617
    Net budget authority and outlays:
89.00 Budget authority..................                     175        -617
90.00 Outlays...........................                     175        -617
---------------------------------------------------------------------------

    This schedule reflects the Administration's Medicaid proposals.

                                

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0512-4-1-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
41.0  Direct obligations: Grants, 
        subsidies, and contributions....                     175        -753
99.0  Reimbursable obligations: 
        Reimbursable obligations........                                 136
                                           ---------   ---------  ----------
99.9    Total new obligations...........                     175        -617
---------------------------------------------------------------------------

                                

                     State Grants and Demonstrations

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0516-0-1-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 TWWIIA--grants....................          20          33          40
00.02 High-risk pools--grants...........           1          47          40
00.03 Federal reimbursement of emergency 
        health services--undocumented 
        aliens..........................                                 250
                                           ---------   ---------  ----------
10.00   Total new obligations...........          21          80         330
    Budgetary resources available for obligation:
21.40 Unobligated balance carried 
        forward, start of year..........          83         194         231
22.00 New budget authority (gross)......         132         117         331
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......         215         311         562
23.95 Total new obligations.............         -21         -80        -330
23.98 Unobligated balance expiring or 
        withdrawn.......................                                 -12
24.40 Unobligated balance carried 
        forward, end of year............         194         231         220
    New budget authority (gross), detail:
      Mandatory:

60.00   Appropriation--(P.L. 106-170, 
          Sections 203 & 204)...........          72          77          81
60.00   Appropriation--(P.L. 107-210)...          60          40
60.00   Appropriation--(P. L. 108-173)..                                 250
                                           ---------   ---------  ----------
62.50     Appropriation (total 
            mandatory)..................         132         117         331
    Change in obligated balances:
72.40 Obligated balance, start of year..          34          39          72
73.10 Total new obligations.............          21          80         330
73.20 Total outlays (gross).............         -15         -47        -304
74.40 Obligated balance, end of year....          39          72          98
    Outlays (gross), detail:
86.97 Outlays from new mandatory 
        authority.......................           1          18         262
86.98 Outlays from mandatory balances...          14          29          42
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........          15          47         304
    Net budget authority and outlays:
89.00 Budget authority..................         132         117         331
90.00 Outlays...........................          15          47         304
---------------------------------------------------------------------------

    State Grants and Demonstrations provides funding for grant programs 
established under several legislative authorities. Title II of the 
Ticket to Work and Work Incentives Improvement Act of 1999 (P.L. 106-
170), established two grant programs. Section 203 provides funding for 
Medicaid 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 and (2) grants to states for operation of qualified high-risk 
pools.

    Part of Title X of the Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 (P.L. 108-173) makes funding available for 
States to reimburse eligible providers for furnishing emergency health 
services to undocumented aliens.

[[Page 443]]

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0516-0-1-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
41.0  Grants, subsidies, and 
        contributions--Ticket to Work...          20          33          40
41.0  Grants, subsidies, and 
        contributions--High-Risk Pools..           1          47          40
41.0  Grants, subsidies, and 
        contributions--Fed'l Reimb.--
        Emer Svcs, Undoc. Aliens........                                 250
                                           ---------   ---------  ----------
99.9    Total new obligations...........          21          80         330
---------------------------------------------------------------------------

                                

 Payment to Health Care Trust Funds for Post-1956 Military Service Wage 
                                 Credits

              (Legislative proposal, not subject to PAYGO)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0517-2-1-054      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Military wage credits (HI)........                                 181
                                           ---------   ---------  ----------
10.00   Total new obligations (object 
          class 41.0)...................                                 181
    Budgetary resources available for obligation:
22.00 New budget authority (gross)......                                 181
23.95 Total new obligations.............                                -181
    New budget authority (gross), detail:
      Mandatory:

60.00   Appropriation...................                                 181
    Change in obligated balances:
73.10 Total new obligations.............                                 181
73.20 Total outlays (gross).............                                -181
    Outlays (gross), detail:
86.97 Outlays from new mandatory 
        authority.......................                                 181
    Net budget authority and outlays:
89.00 Budget authority..................                                 181
90.00 Outlays...........................                                 181
---------------------------------------------------------------------------

    The budget proposes to compensate the Hospital Insurance Trust Fund 
for the equivalent of payroll taxes on deemed wages posted to the Social 
Security earnings of uniformed services personnel in 2000 and 2001. The 
budget also reflects known adjustments needed for other years.

                                

                   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, 1860D-16, and 1860D-31 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] 
$114,608,900,000. To ensure prompt payments of Medicare prescription 
drug benefits as provided under section 1860 D-16 of the Social Security 
Act, $5,216,900,000, to become available on October 1, 2005 for fiscal 
year 2006. (Division E, H.R. 2673, Consolidated Appropriations Bill, FY 
2004.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0580-0-1-571      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Supplementary medical insurance 
        (SMI)...........................      80,905      94,518     114,002
00.02 Hospital insurance for uninsured 
        (HI)............................         225         197          87
00.03 Federal uninsured payment (HI)....         168         168         199
00.04 Program management (HI)...........         120         201         215
00.05 FHI trust fund, Transfers from 
        general fund (civil monetary 
        penalties)......................           7           7           7
00.06 Federal payments from taxation of 
        OASDI benefits (HI).............       8,318       7,743       9,052
00.07 Fraud and abuse control, FBI......         114         114         114
00.08 Fraud and abuse control, criminal 
        fines...........................           2           3           3
00.09 Federal contributions, Drug 
        account State low-income 
        determinations..................                                 106
00.10 Federal contributions, 
        Transitional assistance account.                   2,321       2,788
                                           ---------   ---------  ----------
10.00   Total new obligations...........      89,860     105,272     126,573
    Budgetary resources available for obligation:
22.00 New budget authority (gross)......      89,904     105,272     126,573
23.95 Total new obligations.............     -89,860    -105,272    -126,573
23.98 Unobligated balance expiring or 
        withdrawn.......................         -45
    New budget authority (gross), detail:
      Mandatory:

60.00   Appropriation...................       8,318       7,743       9,052
60.00   Appropriation...................          10          10          10
60.00   Appropriation...................      81,463      95,084     114,503
60.00   Appropriation...................         114         114         114
60.00   Appropriation...................                   2,321       2,788
60.00   Appropriation...................                                 106
                                           ---------   ---------  ----------
62.50     Appropriation (total 
            mandatory)..................      89,905     105,272     126,573
    Change in obligated balances:
73.10 Total new obligations.............      89,860     105,272     126,573
73.20 Total outlays (gross).............     -89,860    -105,272    -126,573
    Outlays (gross), detail:
86.97 Outlays from new mandatory 
        authority.......................      89,860     105,272     126,573
    Net budget authority and outlays:
89.00 Budget authority..................      89,904     105,272     126,573
90.00 Outlays...........................      89,860     105,272     126,573
---------------------------------------------------------------------------

                 Summary of Budget Authority and Outlays

                        (in millions of dollars)

                                     2003 actual  2004 est.   2005 est.
Enacted/requested:
  Budget Authority..................      89,905     105,272     126,573
  Outlays...........................      89,860     105,272     126,573
Legislative proposal, not subject to 
    PAYGO:
  Budget Authority..................                                -118
  Outlays...........................                                -118
                                    ------------------------------------
Total:
  Budget Authority..................      89,905     105,272     126,455
  Outlays...........................      89,860     105,272     126,455
                                    ====================================

    Payments are made to the Federal Hospital Insurance and Federal 
Supplementary Medical Insurance trust funds from the general fund of the 
Treasury to finance Medicare's medical and drug benefits for 
beneficiaries and certain other qualified individuals.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0580-0-1-571      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
41.0  Grants, subsidies, and 
        contributions...................      89,347     104,706     126,072
42.0  Insurance claims and indemnities..         393         365         286
94.0  Financial transfers...............         120         201         215
                                           ---------   ---------  ----------
99.0      Direct obligations............      89,860     105,272     126,573
                                           ---------   ---------  ----------
99.9    Total new obligations...........      89,860     105,272     126,573
---------------------------------------------------------------------------

                                

                   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      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Supplementary medical insurance 
        (SMI)...........................                                -118
                                           ---------   ---------  ----------
10.00   Total new obligations (object 
          class 41.0)...................                                -118
    Budgetary resources available for obligation:
22.00 New budget authority (gross)......                                -118
23.95 Total new obligations.............                                 118
    New budget authority (gross), detail:
      Mandatory:

60.00   Appropriation...................                                -118
    Change in obligated balances:
73.10 Total new obligations.............                                -118
73.20 Total outlays (gross).............                                 118
    Outlays (gross), detail:
86.97 Outlays from new mandatory 
        authority.......................                                -118
    Net budget authority and outlays:
89.00 Budget authority..................                                -118

[[Page 444]]

90.00 Outlays...........................                                -118
---------------------------------------------------------------------------

    The budget proposes to provide an appropriation in 2006 to pay 
benefits and administrative expenses for the new Medicare prescription 
drug benefit. This appropriation is authorized in the Medicare 
Prescription Drug, Improvement, and Modernization Act, and is necessary 
to provide operating funds for the early months of the program. The 
funds necessary for the remainder of the year will be requested in the 
2006 budget.

                                

                           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 [$2,664,994,000] $2,746,127,000, 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 [$30,000,000] $24,400,000, to remain available until 
September 30, [2005] 2006, is for contract costs for CMS's Systems 
Revitalization Plan: Provided further, That [$56,991,000] $78,300,000, 
to remain available until September 30, [2005] 2006, is for contract 
costs for the Healthcare Integrated General Ledger Accounting System: 
Provided further, That [of the amounts made available for research, 
demonstration and evaluation, $100,000 is available for Advocate Health 
Care in Oak Brook, Illinois for health education programs and services 
to the deaf and hard-of-hearing, $1,750,000 is available for AIDS 
Healthcare Foundation in Los Angeles for a demonstration of residential 
and outpatient treatment facilities, $250,000 is available for Berwick 
Hospital Center, Berwick, Pennsylvania for stabilizing the workforce for 
patient care, $163,000 is available for Bloomsburg Hospital, Bloomsburg, 
Pennsylvania for stabilizing the workforce for patient care, $275,000 is 
available for Cheyenne River Sioux Tribe in Eagle Butte, South Dakota to 
establish a nursing home, $778,000 is available for Community Medical 
Center, Scranton, Pennsylvania for stabilizing the workforce for patient 
care, $150,000 is available for Cook County (Illinois) Bureau of Health 
Services to improve the management of vulnerable patients with poorly 
controlled diabetes, $178,000 is available for Divine Providence 
Hospital, Williamsport, Pennsylvania for stabilizing the workforce for 
patient care, $267,000 is available for Geisinger Wyoming Valley Medical 
Center, Wilkes-Barre, Pennsylvania for stabilizing the workforce for 
patient care, $237,000 is available for Hazleton General Hospital, 
Hazleton, Pennsylvania for stabilizing the workforce for patient care, 
$25,000 is available for Hope Worldwide, Philadelphia, Pennsylvania to 
maintain clinical care for recovering drug and alcohol addicts, $825,000 
is available for Illinois Primary Health Care Association for the Shared 
Integrated Management Information System, Springfield, Illinois, 
$250,000 is available for James S. Taylor Memorial Home, Louisville, 
Kentucky, $100,000 is available for Jefferson Area Board for Aging, 
Charlottesville, Virginia, for the Nursing Assistant Institute, $85,000 
is available for Jersey Shore Hospital, Jersey Shore, Pennsylvania for 
stabilizing the workforce for patient care, $179,000 is available for 
Marian Community Hospital, Carbondale, Pennsylvania for stabilizing the 
workforce for patient care, $200,000 is available for Medical Care for 
Children Partnership, Fairfax, Virginia to provide outreach to increase 
access to medical and dental care for children, $393,000 is available 
for Mercy Health Partners, Scranton, Pennsylvania for stabilizing the 
workforce for patient care, $571,000 is available for Mercy Hospital, 
Wilkes-Barre, Pennsylvania for stabilizing the workforce for patient 
care, $63,000 is available for Mid-Valley Hospital, Peckville, 
Pennsylvania for stabilizing the workforce for patient care, $510,000 is 
available for Moses Taylor Hospital, Scranton, Pennsylvania for 
stabilizing the workforce for patient care, $109,000 is available for 
Muncy Valley Hospital, Muncy, Pennsylvania for stabilizing the workforce 
for patient care, $225,000 is available for Muskegon Community Health 
Project, Muskegon, Michigan, for the Access Health program, $75,000 is 
available for North Penn Visiting Nurse Association, Lansdale, 
Pennsylvania to provide low-cost or free health care to children who do 
not have health insurance, $122,000 is available for Patient Advocate 
Foundation, Newport News, Virginia to provide direct intervention 
assistance to patients throughout the United States who are experiencing 
difficulty in accessing quality health care services, $100,000 is 
available for Rhode Island Hospital-Medical Simulation Center of 
Providence, Rhode Island for the creation of a transportable simulation-
based training curriculum and validated human performance measurement 
system, $256,000 is available for Saint Joseph Medical Center, Hazleton, 
Pennsylvania for stabilizing the workforce for patient care, $100,000 is 
available for Santa Clara County, California, for its Children's Health 
Initiative program to provide outreach and enrollment assistance for 
families under 300 percent of federal poverty level, $664,000 is 
available for Sharon Regional Health System, Sharon, Pennsylvania for 
stabilizing the workforce for patient care, $25,000 is available for 
Sickle Cell Medical Treatment & Education Center, St. Louis Children's 
Hospital, St. Louis, Missouri, to improve the academic achievement of 
children with Sickle Cell Disease with specific cognitive 
rehabilitation, $111,000 is available for Tyler Memorial Hospital, 
Tunkhannock, Pennsylvania for stabilizing the workforce for patient 
care, $174,000 is available for United Community Hospital, Grove City, 
Pennsylvania for stabilizing the workforce for patient care, $503,000 is 
available for UPMC Horizon, Farrell, Pennsylvania for stabilizing the 
workforce for patient care, $613,000 is available for Williamsport 
Hospital & Medical Center, Williamsport, Pennsylvania for stabilizing 
the workforce for patient care, and $965,000 is available for Wyoming 
Valley Health Care System, Wilkes-Barre, Pennsylvania for stabilizing 
the workforce for patient care:] not less than $129,000,000 shall be for 
proceessing Medicare appeals, of which $50,000,000 shall be transferred 
to the Social Security Administration for processing Medicare appeals: 
Provided further, That the Secretary of Health and Human Services is 
directed to collect fees in fiscal year [2004] 2005 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: 
Provided further, that to [the extent Medicare claims processing unit 
costs are projected by the Centers for Medicare & Medicaid Services to 
exceed $0.87 for Part A claims and/or $0.65 for Part B claims, up to an 
additional $18,000,000 may be available for obligation for every $0.04 
increase in Medicare claims processing unit costs from the Federal 
Hospital Insurance and the Federal Supplementary Medical Insurance Trust 
Funds. The calculation of projected unit costs shall be derived in the 
same manner in which the estimated unit costs were calculated for the 
Federal budget estimate for the fiscal year] identify Secondary Payer 
Situations, as described in section 1862(b)(5) of the Social Security 
Act, the Administrator of the Centers for Medicare and Medicaid Services 
shall enter into a memorandum of understanding with the Administrator of 
the Administration for Children and Families, to provide quarterly wage 
information on individual employees pursuant to section 453 of the 
Social Security Act. (Division E, H.R. 2673, Consolidated Appropriations 
Bill, FY 2004.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0511-0-1-550      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
      Direct program:

00.01   Medicare operations.............       1,665       1,701       1,794
00.02   Federal administration..........         567         577         589
00.03   State survey and certification..         252         251         270
00.04   Research, demonstrations, and 
          evaluation projects...........          74          78          68
00.05   Revitalization plan.............                      30          25
00.06   Medicare reform.................                     595         405
                                           ---------   ---------  ----------
01.00   Total direct program............       2,558       3,232       3,151
09.01 CLIA..............................          37          43          43

[[Page 445]]

09.03 Other reimbursements..............           8           2           2
09.06 Medicare+Choice...................          14          14          14
                                           ---------   ---------  ----------
09.09   Total reimbursable program......          59          59          59
                                           ---------   ---------  ----------
10.00   Total new obligations...........       2,617       3,291       3,210
    Budgetary resources available for obligation:
21.40 Unobligated balance carried 
        forward, start of year..........          99         106         511
22.00 New budget authority (gross)......       2,629       3,696       2,805
22.10 Resources available from 
        recoveries of prior year 
        obligations.....................           5
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......       2,733       3,802       3,616
23.95 Total new obligations.............      -2,617      -3,291      -3,210
23.98 Unobligated balance expiring or 
        withdrawn.......................         -10
24.40 Unobligated balance carried 
        forward, end of year............         106         511         106
    New budget authority (gross), detail:
      Spending authority from offsetting 
          collections:

        Discretionary:
68.00     Offsetting collections (cash).       1,924       2,696       2,805
68.00     Offsetting collections (cash).                     536         423
68.10     Change in uncollected customer 
            payments from Federal 
            sources (unexpired).........         705         464        -423
68.26     From offsetting collections 
            (unavailable balances)......          17          28
68.37     Portion temporarily reduced...         -17         -28
                                           ---------   ---------  ----------
68.90       Spending authority from 
              offsetting collections 
              (total discretionary).....       2,629       3,696       2,805
    Change in obligated balances:
72.40 Obligated balance, start of year..        -219        -186        -591
73.10 Total new obligations.............       2,617       3,291       3,210
73.20 Total outlays (gross).............      -2,497      -3,232      -3,228
73.40 Adjustments in expired accounts 
        (net)...........................         -36
73.45 Recoveries of prior year 
        obligations.....................          -5
74.00 Change in uncollected customer 
        payments from Federal sources 
        (unexpired).....................        -705        -464         423
74.10 Change in uncollected customer 
        payments from Federal sources 
        (expired).......................         657
74.40 Obligated balance, end of year....        -186        -591        -186
    Outlays (gross), detail:
86.90 Outlays from new discretionary 
        authority.......................       1,912       3,232       2,805
86.93 Outlays from discretionary 
        balances........................         585                     423
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........       2,497       3,232       3,228
    Offsets:
      Against gross budget authority and outlays:

        Offsetting collections (cash) 
            from:
88.00     Federal sources...............      -2,492      -2,637      -2,746
88.00     Federal sources...............                    -536        -423
88.40     Non-Federal sources...........         -57         -59         -59
                                           ---------   ---------  ----------
88.90       Total, offsetting 
              collections (cash)........      -2,549      -3,232      -3,228
      Against gross budget authority only:

88.95   Change in uncollected customer 
          payments from Federal sources 
          (unexpired)...................        -705        -464         423
88.96   Portion of offsetting 
          collections (cash) credited to 
          expired accounts..............         625
    Net budget authority and outlays:
89.00 Budget authority..................
90.00 Outlays...........................         -52
---------------------------------------------------------------------------

                 Summary of Budget Authority and Outlays

                        (in millions of dollars)

                                     2003 actual  2004 est.   2005 est.
Enacted/requested:
  Budget Authority..................
  Outlays...........................         -52
Legislative proposal, not subject to 
    PAYGO:
  Budget Authority..................
  Outlays...........................
                                    ------------------------------------
Total:
  Budget Authority..................
  Outlays...........................         -52
                                    ====================================

    Program management activities include funding for research, Medicare 
operations, survey and certification, CLIA, Medicare+Choice, the CMS 
systems revitalization plan, and administrative costs. Program 
management activities also include funding for the implementation of the 
Medicare Prescription Drug, Improvement, and Modernization Act of 2003.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0511-0-1-550      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

      Direct obligations:

        Personnel compensation:
11.1      Full-time permanent...........         325         340         351
11.3      Other than full-time permanent           7          10          10
11.5      Other personnel compensation..           6           4           4
11.7      Military personnel............          10           8           9
                                           ---------   ---------  ----------
11.9        Total personnel compensation         348         362         374
12.1    Civilian personnel benefits.....          75          75          79
12.2    Military personnel benefits.....           2           2           2
13.0    Benefits for former personnel...           1
21.0    Travel and transportation of 
          persons.......................           9           9           9
22.0    Transportation of things........           1
23.1    Rental payments to GSA..........          29          19          19
23.3    Communications, utilities, and 
          miscellaneous charges.........          36           3           3
24.0    Printing and reproduction.......           9           3           3
25.1    Advisory and assistance services          15
25.2    Other services..................         220         393         411
25.3    Other purchases of goods and 
          services from Government 
          accounts......................          54           2           2
25.5    Research and development 
          contracts.....................          24
25.6    Medical care....................       1,401       2,295       2,198
25.7    Operation and maintenance of 
          equipment.....................         267
26.0    Supplies and materials..........           1           1           1
31.0    Equipment.......................           3
32.0    Land and structures.............                      10          10
41.0    Grants, subsidies, and 
          contributions.................          63          58          40
                                           ---------   ---------  ----------
99.0      Direct obligations............       2,558       3,232       3,151
99.0  Reimbursable obligations..........          59          59          59
                                           ---------   ---------  ----------
99.9    Total new obligations...........       2,617       3,291       3,210
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-0511-0-1-550      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
    Direct:
      Total compensable workyears:

1001    Civilian full-time equivalent 
          employment....................       4,475       4,324       4,318
1101    Military full-time equivalent 
          employment....................          86          84          90
    Reimbursable:
2001  Total compensable workyears: 
        Civilian full-time equivalent 
        employment......................          80          78          72
---------------------------------------------------------------------------
    The FTEs displayed above do not include FTEs attributable to the 
Medicare Prescription Drug, Improvement, and Modernization Act of 2003. 
These FTEs will be displayed in future tables as the details become 
available.

                                

                           Program Management

              (Legislative proposal, not subject to PAYGO)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0511-2-1-550      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
      Direct program:

00.01   Medicare operations.............                                -205
                                           ---------   ---------  ----------
01.00   Total direct program............                                -205
09.03 Other reimbursements..............                                 205
                                           ---------   ---------  ----------
09.09   Total reimbursable program......                                 205
                                           ---------   ---------  ----------
10.00   Total new obligations...........
    Change in obligated balances:
73.10 Total new obligations.............
    Offsets:
      Against gross budget authority and outlays:

        Offsetting collections (cash) 
            from:
88.00     Federal sources...............                                 205
88.40     Non-Federal sources...........                                -205
                                           ---------   ---------  ----------
88.90       Total, offsetting 
              collections (cash)........
    Net budget authority and outlays:
89.00 Budget authority..................
90.00 Outlays...........................
---------------------------------------------------------------------------



[[Page 446]]



    The budget includes $205 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 authorize the collection and spending of fees 
subject to the 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 
$205 million. For FY 2005, the budget proposes a new mechanism to 
identify instances where Medicare should be the secondary payer for 
health care--paying only after another insurer paid first.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0511-2-1-550      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
25.6  Direct obligations: Medical care..                                -205
99.0  Reimbursable obligations: 
        Reimbursable obligations........                                 205
                                           ---------   ---------  ----------
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      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Grants, subsidies, and 
        contributions...................       5,382       3,175       4,082
                                           ---------   ---------  ----------
10.00   Total new obligations (object 
          class 41.0)...................       5,382       3,175       4,082
    Budgetary resources available for obligation:
22.00 New budget authority (gross)......       5,381       3,175       4,082
23.95 Total new obligations.............      -5,382      -3,175      -4,082
    New budget authority (gross), detail:
      Mandatory:

60.00   Appropriation, BBA..............       3,150       3,150       4,050
60.00   Appropriation, BBRA for 
          territories...................          25          25          32
                                           ---------   ---------  ----------
62.50     Appropriation (total 
            mandatory)..................       3,175       3,175       4,082
63.00   Reappropriation.................       2,206
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................       5,381       3,175       4,082
    Change in obligated balances:
72.40 Obligated balance, start of year..      10,934       9,755       7,697
73.10 Total new obligations.............       5,382       3,175       4,082
73.20 Total outlays (gross).............      -4,355      -5,232      -5,299
73.40 Adjustments in expired accounts 
        (net)...........................      -2,206                     -63
74.40 Obligated balance, end of year....       9,755       7,697       6,418
    Outlays (gross), detail:
86.97 Outlays from new mandatory 
        authority.......................         424          63         289
86.98 Outlays from mandatory balances...       3,931       5,169       5,010
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........       4,355       5,232       5,299
    Net budget authority and outlays:
89.00 Budget authority..................       5,381       3,175       4,082
90.00 Outlays...........................       4,355       5,232       5,299
---------------------------------------------------------------------------

    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.

                                

      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] 2005, 
no commitments for direct loans or loan guarantees shall be made. 
(Division E, H.R. 2673, Consolidated Appropriations Bill, FY 2004.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-4420-0-3-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

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

                                

                               Trust Funds

                  Federal Hospital Insurance Trust Fund

                Unavailable Receipts (in millions of dollars)

----------------------------------------------------------------------------
Identification code 20-8005-0-7-571      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
01.99 Balance, start of year............     227,932     249,613     259,300
    Receipts:
02.00 FHI trust fund, Transfers from 
        general fund (FICA taxes).......     136,885     139,208     153,069
02.01 FHI trust fund, Transfers from 
        general fund (SECA taxes).......       9,905      10,941      11,707
02.02 FHI trust fund, Receipts from 
        Railroad Retirement Board.......         396         391         397
02.03 FHI trust fund, Civil penalties 
        and damages.....................         233         233         233
02.20 FHI trust fund, Premiums collected 
        for uninsured individuals not...       1,598       1,712       1,892
02.21 FHI trust fund, Other proprietary 
        receipts from the public........          -2
02.40 FHI trust fund, Federal employer 
        contributions (FICA)............       2,355       2,551       2,646
02.41 FHI trust fund, Postal Service 
        employer contributions (FICA)...         694         706         730
02.42 FHI trust fund, Payments from the 
        general fund (uninsured and pr..         514         566         501
02.43 FHI trust fund, Taxation on OASDI 
        benefits........................       8,318       7,743       9,052
02.44 FHI trust fund, Interest payments 
        by Railroad Retirement Board....          31          28          28
02.45 FHI trust fund, Interest received 
        by trust funds..................      14,760      14,725      14,620
02.46 FHI trust fund, Payment from the 
        general fund for health care fr.         114         114         114
02.47 FHI trust fund, Transfers from 
        general fund (criminal fines)...           2           2           2
02.48 FHI trust fund, Transfers from 
        general fund (civil monetary 
        pena............................           7           7           7
02.49 Transfers from DOD, HI............           4
02.50 Proposed legislation..............                                 181
                                           ---------   ---------  ----------
02.99   Total receipts and collections..     175,814     178,927     195,179
                                           ---------   ---------  ----------
04.00 Total: Balances and collections...     403,746     428,540     454,479
    Appropriations:
05.00 Federal hospital insurance trust 
        fund............................      -1,480      -1,853      -1,677
05.01 Federal hospital insurance trust 
        fund............................    -175,803    -177,323    -193,295
05.02 Federal hospital insurance trust 
        fund............................      24,216      10,997      11,604
05.03 Health care fraud and abuse 
        control account.................      -1,077      -1,075      -1,075
05.04 Appropriation temporarily reduced.          11          14
05.06 Federal hospital insurance trust 
        fund............................                                  45
05.07 Federal hospital insurance trust 
        fund............................                                -229
05.08 Federal hospital insurance trust 
        fund............................                                 229
                                           ---------   ---------  ----------
05.99   Total appropriations............    -154,133    -169,240    -184,398
                                           ---------   ---------  ----------
07.99 Balance, end of year..............     249,613     259,300     270,081
---------------------------------------------------------------------------

[[Page 447]]



               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 20-8005-0-7-571      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Benefit payments, HI..............     150,970     166,182     181,350
00.02 Administration, HI................       1,467       1,600       1,686
00.03 Quality improvement organizations, 
        HI..............................         559          85         276
00.04 Research, HI......................          60          63          55
00.05 Medicare Prescription Drug, 
        Improvement, and Modernization 
        Act: admin costs................                     235
                                           ---------   ---------  ----------
10.00   Total new obligations...........     153,056     168,165     183,367
    Budgetary resources available for obligation:
22.00 New budget authority (gross)......     153,056     168,165     183,368
23.95 Total new obligations.............    -153,056    -168,165    -183,367
    New budget authority (gross), detail:
      Discretionary:

40.26   Appropriation (trust fund)......       1,480       1,853       1,677
40.37   Appropriation temporarily 
          reduced.......................         -11         -14
                                           ---------   ---------  ----------
43.00     Appropriation (total 
            discretionary)..............       1,469       1,839       1,677
      Mandatory:

60.26   Appropriation (trust fund)......     175,803     177,323     193,295
60.45   Portion precluded from balances.     -24,216     -10,997     -11,604
                                           ---------   ---------  ----------
62.50     Appropriation (total 
            mandatory)..................     151,587     166,326     181,691
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................     153,056     168,165     183,368
    Change in obligated balances:
72.40 Obligated balance, start of year..         965       1,228       1,138
73.10 Total new obligations.............     153,056     168,165     183,367
73.20 Total outlays (gross).............    -152,793    -168,255    -183,516
74.40 Obligated balance, end of year....       1,228       1,138         990
    Outlays (gross), detail:
86.90 Outlays from new discretionary 
        authority.......................       1,455       1,710       1,677
86.93 Outlays from discretionary 
        balances........................          30          13         123
86.97 Outlays from new mandatory 
        authority.......................     151,099     166,258     181,429
86.98 Outlays from mandatory balances...         209         274         287
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........     152,793     168,255     183,516
    Net budget authority and outlays:
89.00 Budget authority..................     153,056     168,165     183,368
90.00 Outlays...........................     152,793     168,255     183,516
    Memorandum (non-add) entries:
92.01 Total investments, start of year: 
        Federal securities: Par value...     228,908     251,297     260,688
92.02 Total investments, end of year: 
        Federal securities: Par value...     251,297     260,688     271,092
---------------------------------------------------------------------------

                 Summary of Budget Authority and Outlays

                        (in millions of dollars)

                                     2003 actual  2004 est.   2005 est.
Enacted/requested:
  Budget Authority..................     153,056     168,165     183,368
  Outlays...........................     152,793     168,255     183,516
Legislative proposal, not subject to 
    PAYGO:
  Budget Authority..................                                 -45
  Outlays...........................                                 -45
                                    ------------------------------------
Total:
  Budget Authority..................     153,056     168,165     183,323
  Outlays...........................     152,793     168,255     183,471
                                    ====================================

    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      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
    Unexpended balance, start of year:
0100  Treasury balance..................         202        -206
0101  U.S. Securities: Par value........     228,908     251,297     260,688
                                           ---------   ---------  ----------
0199    Total balance, start of year....     229,110     251,091     260,688
    Cash income during the year:
      Current law:

        Receipts:
1200      FHI trust fund, transfers from 
            general fund (FICA taxes)...     136,885     139,208     153,069
1201      FHI trust fund, transfers from 
            general fund (SECA taxes)...       9,905      10,941      11,707
1202      FHI trust fund, receipts from 
            Railroad Retirement Board...         396         391         397
1203      HCFAC: Civil penalties and 
            damages.....................         233         233         233
        Offsetting receipts 
            (proprietary):
1220      FHI trust fund, premiums 
            collected for uninsured 
            individuals not otherwise 
            eligible....................       1,598       1,712       1,892
1221      Other proprietary receipts....          -2
        Offsetting receipts 
            (intragovernmental):
1240      FHI trust fund, Federal 
            employer contributions 
            (FICA)......................       2,355       2,551       2,646
1241      FHI trust fund, Postal Service 
            employer contributions 
            (FICA)......................         694         706         730
1242      FHI trust fund, Federal 
            payment for transitional 
            coverage for uninsured 
            Federal employees...........         168         168         199
1242      FHI trust fund, Federal 
            payment for transitional 
            coverage for the uninsured..         225         197          87
1242      FHI trust fund, general fund 
            transfer, program management 
            (HI)........................         120         201         215
1243      FHI trust fund, Federal 
            payments for OASDI taxes....       8,318       7,743       9,052
1244      FHI trust fund, interest 
            payment from Railroad 
            Retirement Board............          31          28          28
1245      FHI trust fund, interest on 
            investments.................      14,760      14,725      14,617
1247      HCFAC: FBI....................         114         114         114
1248      HCFAC: Criminal fines.........           2           2           2
1249      HCFAC: Civil monetary 
            penalties...................           7           7           7
1250      Other intragovernmental 
            transactions................           4
        Offsetting collections:
1281      HCFAC user fees...............           3
1299    Income under present law........     175,817     178,927     194,995
      Proposed legislation:

        Offsetting receipts 
            (intragovernmental):
2245      Interest on investments, 
            legislative proposal not 
            subject to PAYGO............                                   3
2246      Offsetting receipts 
            (intragovernmental).........                                 181
2299    Income under proposed 
          legislation...................                                 184
                                           ---------   ---------  ----------
3299    Total cash income...............     175,817     178,927     195,179
    Cash outgo during year:
      Current law:

4500    Benefit Payments................    -150,970    -166,182    -181,350
4500    Administration..................      -1,485      -1,696      -1,792
4500    Quality Improvement 
          Organizations.................        -280        -291        -301
4500    Research........................         -58         -86         -73
4501    HCFAC...........................      -1,030      -1,075      -1,075
4599    Outgo under current law (-).....    -153,823    -169,330    -184,591
      Proposed legislation:

5500    Administration, legislative 
          proposal not subject to PAYGO.                                  45
                                           ---------   ---------  ----------
6599    Total cash outgo (-)............    -153,823    -169,330    -184,546
    Unexpended balance, end of year:
8700  Uninvested balance................        -206
8701  Federal securities: Par value.....     251,297     260,688     271,321
                                           ---------   ---------  ----------
8799    Total balance, end of year......     251,091     260,688     271,321
---------------------------------------------------------------------------

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 20-8005-0-7-571      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
41.0  Payment for Quality Improvement 
        Organization (QIO) activities...         559          85         276
42.0  Insurance claims and indemnities 
        (benefits)......................     150,970     166,182     181,350
94.0  Financial transfers...............       1,527         235
94.0  Financial transfers...............                   1,663       1,741
                                           ---------   ---------  ----------
99.0      Direct obligations............     153,056     168,165     183,367
                                           ---------   ---------  ----------
99.9    Total new obligations...........     153,056     168,165     183,367
---------------------------------------------------------------------------

                                

                  Federal Hospital Insurance Trust Fund

              (Legislative proposal, not subject to PAYGO)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 20-8005-2-7-571      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Benefit payments, HI..............                                 -10
00.02 Administration, HI................                                 -35
                                           ---------   ---------  ----------
10.00   Total new obligations...........                                 -45

[[Page 448]]

    Budgetary resources available for obligation:
22.00 New budget authority (gross)......                                 -45
23.95 Total new obligations.............                                  45
    New budget authority (gross), detail:
      Discretionary:

40.26   Appropriation (trust fund)......                                 -45
      Mandatory:

60.26   Appropriation (trust fund)......                                 229
60.45   Portion precluded from 
          obligation....................                                -229
                                           ---------   ---------  ----------
62.50     Appropriation (total 
            mandatory)..................
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................                                 -45
    Change in obligated balances:
73.10 Total new obligations.............                                 -45
73.20 Total outlays (gross).............                                  45
    Outlays (gross), detail:
86.90 Outlays from new discretionary 
        authority.......................                                 -45
    Net budget authority and outlays:
89.00 Budget authority..................                                 -45
90.00 Outlays...........................                                 -45
    Memorandum (non-add) entries:
92.01 Total investments, start of year: 
        Federal securities: Par value...
92.02 Total investments, end of year: 
        Federal securities: Par value...                                 229
---------------------------------------------------------------------------

    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. For FY 2005, the budget also proposes 
a new mechanism to identify instances where Medicare should be the 
secondary payer for health care--paying only after another insurer paid 
first.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 20-8005-2-7-571      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
42.0  Insurance claims and indemnities 
        (benefits)......................                                 -10
94.0  Financial transfers...............                                 -35
                                           ---------   ---------  ----------
99.9    Total new obligations...........                                 -45
---------------------------------------------------------------------------

                                

               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      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Medicare integrity program........         720         720         720
00.02 FBI fraud and abuse control.......         114         114         114
00.03 Other fraud and abuse control.....         238         241         241
09.01 Reimbursable (OIG)................           5
                                           ---------   ---------  ----------
10.00   Total new obligations...........       1,077       1,075       1,075
    Budgetary resources available for obligation:
22.00 New budget authority (gross)......       1,080       1,075       1,075
23.95 Total new obligations.............      -1,077      -1,075      -1,075
23.98 Unobligated balance expiring or 
        withdrawn.......................          -5
    New budget authority (gross), detail:
      Mandatory:

60.28   Appropriation (unavailable 
          balances).....................       1,077       1,075       1,075
69.00 Offsetting collections (cash).....           3
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................       1,080       1,075       1,075
    Change in obligated balances:
72.40 Obligated balance, start of year..         213         250         250
73.10 Total new obligations.............       1,077       1,075       1,075
73.20 Total outlays (gross).............      -1,030      -1,075      -1,075
73.40 Adjustments in expired accounts 
        (net)...........................         -10
74.40 Obligated balance, end of year....         250         250         250
    Outlays (gross), detail:
86.97 Outlays from new mandatory 
        authority.......................       1,030       1,075       1,075
    Offsets:
      Against gross budget authority and outlays:

88.00   Offsetting collections (cash) 
          from: Federal sources.........          -3
    Net budget authority and outlays:
89.00 Budget authority..................       1,077       1,075       1,075
90.00 Outlays...........................       1,028       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 
2004 and 2005. As required by statute, actual 2004 and 2005 agency 
distributions will be determined by the Secretary of HHS and the 
Attorney General consistent with the Administration's priorities.

                                     2003 actual  2004 est.   2005 est.
Department of Justice, DOJ..........          50          49          49
Office of the Inspector General, HHS         160         160         160
Centers for Medicare and Medicaid 
Services, Medicaid/SCHIP Program 
Integrity, HHS......................          10          20          20
Centers for Medicare and Medicaid 
Services, Other HHS.................          13           4           4
Office of the General Counsel, HHS..           5           5           5
Other HHS...........................           3           3           3
                                    ------------------------------------
      Total.........................         241         241         241
                                    ====================================

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-8393-0-7-571      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

      Direct obligations:

11.1    Personnel compensation: Full-
          time permanent (CMS 100 FTEs).                       8           8
12.1    Civilian personnel benefits 
          (CMS).........................                       2           2
25.1    Advisory and assistance services 
          (CMS).........................          12           5           5
25.2    Other services (CMS)............           2           5           5
25.3    Other purchases of goods and 
          services from Government 
          accounts (DoJ)................          50          49          49
25.3    Other purchases of goods and 
          services from Government 
          accounts (HHS/OIG)............         160         160         160
25.3    Other purchases of goods and 
          services from Government 
          accounts (HHS/AoA)............           3           2           2
25.3    Other purchases of goods and 
          services from Government 
          accounts (HHS/OGC)............           6           5           5
25.6    Medical care (CMS)..............         720         720         720
41.0    Grants, subsidies, and 
          contributions (CMS)...........           5           5           5
94.0    Financial transfers.............         114         114         114
                                           ---------   ---------  ----------
99.0      Direct obligations............       1,072       1,075       1,075
99.0  Reimbursable obligations..........           5
                                           ---------   ---------  ----------
99.9    Total new obligations...........       1,077       1,075       1,075
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-8393-0-7-571      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
    Direct:
1001  Total compensable workyears: 
        Civilian full-time equivalent 
        employment......................                     100         100
---------------------------------------------------------------------------

                                

           Federal Supplementary Medical Insurance Trust Fund

                Unavailable Receipts (in millions of dollars)

----------------------------------------------------------------------------
Identification code 20-8004-0-7-571      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
01.99 Balance, start of year............      37,744      23,729      19,073

[[Page 449]]

    Receipts:
02.20 Premiums collected for the aged, 
        FSMI Fund.......................      23,115      26,117      29,824
02.21 Premiums collected for the 
        disabled, FSMI Fund.............       3,720       4,340       5,123
02.22 Premiums collected for Medicare 
        prescription drug account, FSMI.
02.23 Payments from States, Medicare 
        prescription drug account, FSMI.
02.24 Offsetting receipts (proprietary), 
        proposed legislation............                                 -31
02.25 Offsetting receipts, proposed 
        legislation (proprietary).......                                  -5
02.27 Other proprietary receipts from 
        the public, FSMI Fund...........          -1
02.40 Federal contributions, FSMI Fund..      80,905      94,518     114,002
02.41 Interest received by trust fund, 
        FSMI Fund.......................       2,452       2,002       2,016
02.42 Transfers from DOD, SMI...........           4
02.43 Interest, transitional assistance 
        account, FSMI...................                       4           5
02.44 Federal contributions, Medicare 
        prescription drug account, FSMI.                                 106
02.45 Interest, Medicare prescription 
        drug account, FSMI..............
02.46 Federal contributions, 
        Transitional assistance account, 
        FSMI............................                   2,321       2,788
02.47 Offsetting receipts 
        (intragovernmental, proposed 
        legislation)....................                                -118
02.52 Miscellaneous Federal payments, 
        Federal supplementary medical in           1
                                           ---------   ---------  ----------
02.99   Total receipts and collections..     110,196     129,302     153,710
                                           ---------   ---------  ----------
04.00 Total: Balances and collections...     147,940     153,031     172,783
    Appropriations:
05.00 Federal supplementary medical 
        insurance trust fund............      -2,341      -2,454      -2,375
05.01 Federal supplementary medical 
        insurance trust fund............    -107,854    -124,548    -148,590
05.02 Federal supplementary medical 
        insurance trust fund............     -14,031      -3,579
05.03 Federal supplementary medical 
        insurance trust fund............          15          25
05.04 Transitional drug assistance, 
        Federal supplementary medical 
        insu............................                  -2,321      -2,792
05.05 Medicare prescription drug 
        account, Federal supplementary 
        insura..........................                                -106
05.06 Transitional drug assistance, 
        Federal supplementary medical 
        insu............................                    -138
05.07 Medicare prescription drug 
        account, Federal supplementary 
        insura..........................                    -943        -100
05.08 Federal supplementary medical 
        insurance trust fund............                                 310
05.11 Federal supplementary medical 
        insurance trust fund............                               7,811
05.12 Federal supplementary medical 
        insurance trust fund............                                -136
                                           ---------   ---------  ----------
05.99   Total appropriations............    -124,211    -133,958    -145,978
                                           ---------   ---------  ----------
07.99 Balance, end of year..............      23,729      19,073      26,805
---------------------------------------------------------------------------

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 20-8004-0-7-571      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Benefit payments, SMI.............     121,624     127,786     140,455
00.02 Administration, SMI...............       2,318       2,235       2,367
00.03 Quality improvement organizations, 
        SMI.............................         143          21          69
00.04 Research, SMI.....................          14          15          13
00.06 Transfer to Medicaid for payment 
        of SMI premiums.................         112         125
00.07 MPDIMA Adminstration..............                     184
00.08 MPDIMA Drug Demonstration.........                     190         250
                                           ---------   ---------  ----------
10.00   Total new obligations...........     124,211     130,556     143,154
    Budgetary resources available for obligation:
22.00 New budget authority (gross)......     124,211     130,556     143,154
23.95 Total new obligations.............    -124,211    -130,556    -143,154
    New budget authority (gross), detail:
      Discretionary:

40.26   Appropriation (trust fund)......       2,341       2,454       2,375
40.37   Appropriation temporarily 
          reduced.......................         -15         -25
                                           ---------   ---------  ----------
43.00     Appropriation (total 
            discretionary)..............       2,326       2,429       2,375
      Mandatory:

60.26   Appropriation (trust fund)......     107,854     124,548     148,590
60.28   Appropriation (unavailable 
          balances).....................      14,031       3,579
60.45   Portion precluded from 
          obligation....................                              -7,811
                                           ---------   ---------  ----------
62.50     Appropriation (total 
            mandatory)..................     121,885     128,127     140,779
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................     124,211     130,556     143,154
    Change in obligated balances:
72.40 Obligated balance, start of year..         916       1,072       1,142
73.10 Total new obligations.............     124,211     130,556     143,154
73.20 Total outlays (gross).............    -124,055    -130,486    -143,237
74.40 Obligated balance, end of year....       1,072       1,142       1,059
    Outlays (gross), detail:
86.90 Outlays from new discretionary 
        authority.......................       2,239       2,304       2,357
86.93 Outlays from discretionary 
        balances........................                                  92
86.97 Outlays from new mandatory 
        authority.......................     121,376     128,110     140,713
86.98 Outlays from mandatory balances...         440          72          75
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........     124,055     130,486     143,237
    Net budget authority and outlays:
89.00 Budget authority..................     124,211     130,556     143,154
90.00 Outlays...........................     124,055     130,486     143,237
    Memorandum (non-add) entries:
92.01 Total investments, start of year: 
        Federal securities: Par value...      38,804      24,849      21,292
92.02 Total investments, end of year: 
        Federal securities: Par value...      24,849      21,292      29,020
---------------------------------------------------------------------------

                 Summary of Budget Authority and Outlays

                        (in millions of dollars)

                                     2003 actual  2004 est.   2005 est.
Enacted/requested:
  Budget Authority..................     124,211     130,556     143,154
  Outlays...........................     124,055     130,486     143,237
Legislative proposal, not subject to 
    PAYGO:
  Budget Authority..................                                -174
  Outlays...........................                                -174
                                    ------------------------------------
Total:
  Budget Authority..................     124,211     130,556     142,980
  Outlays...........................     124,055     130,486     143,063
                                    ====================================

    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      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
    Unexpended balance, start of year:
0100  Treasury balance..................        -145         -49
0101  U.S. Securities: Par value........      38,804      24,849      20,814
                                           ---------   ---------  ----------
0199    Total balance, start of year....      38,660      24,801      20,814
    Cash income during the year:
      Current law:

        Offsetting receipts 
            (proprietary):
1220      Premiums collected for the 
            aged, FSMI fund.............      23,115      26,117      29,824
1221      Premiums collected for the 
            disabled, FSMI fund.........       3,720       4,340       5,123
1222      Other proprietary receipts....          -1
        Offsetting receipts 
            (intragovernmental):
1240      Federal contributions, FSMI 
            fund........................      80,905      94,518     114,002
1241      Interest received by trust 
            fund, FSMI fund.............       2,452       2,002       2,016
1242      Intragovernmental transactions           4
1245      Offsetting receipts 
            (intragovernmental).........           1
1246      Offsetting receipts 
            (intragovernmental).........                       4           5
1248      Offsetting receipts 
            (intragovernmental).........                                 106
1250      Offsetting receipts 
            (intragovernmental).........                   2,321       2,788
1299    Income under present law........     110,196     129,302     153,864
      Proposed legislation:

        Offsetting receipts (proprietary 
            receipts):
2220      Premiums collected for the 
            aged, FSMI fund.............                                 -31
2221      Premiums collected for the 
            disabled, FSMI fund.........                                  -5
        Offsetting receipts 
            (intragovernmental):
2240      Federal contributions, 
            legislative proposal not 
            subject to PAYGO............                                -118
2299    Income under proposed 
          legislation...................                                -154
                                           ---------   ---------  ----------
3299    Total cash income...............     110,196     129,302     153,710
    Cash outgo during year:
      Current law:

4500    Benefit payments & ESRD.........    -121,629    -127,976    -140,705
4500    Administration..................      -2,230      -2,289      -2,437
4500    Quality Improvement 
          Organizations.................         -70         -76         -78
4500    Research........................         -14         -20         -17
4500    Transfer to Medicaid for payment 
          of SMI premiums...............        -112        -125
4502    Transitional Drug Assistance, 
          FSMI..........................                  -2,402      -2,844
4503    Medicare Prescription Drug 
          Account, FSMI.................                    -401        -598
4599    Outgo under current law (-).....    -124,055    -133,289    -146,679
      Proposed legislation:

5500    Administration, legislative 
          proposal not subject to PAYGO.                                 174
                                           ---------   ---------  ----------
6599    Total cash outgo (-)............    -124,055    -133,289    -146,505

[[Page 450]]

    Unexpended balance, end of year:
8700  Uninvested balance................         -49
8701  Federal securities: Par value.....      24,849      20,814      28,019
                                           ---------   ---------  ----------
8799    Total balance, end of year......      24,801      20,814      28,019
---------------------------------------------------------------------------

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 20-8004-0-7-571      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
41.0  Payment for Quality Improvement 
        Organization (QIO) activity.....         143          21          69
42.0  Insurance claims and indemnities..     121,736     128,101     140,705
94.0  Financial transfers...............       2,332       2,434       2,380
                                           ---------   ---------  ----------
99.0      Direct obligations............     124,211     130,556     143,154
                                           ---------   ---------  ----------
99.9    Total new obligations...........     124,211     130,556     143,154
---------------------------------------------------------------------------

                                

           Federal Supplementary Medical Insurance Trust Fund

              (Legislative proposal, not subject to PAYGO)

    In the case of durable medical equipment described in section 
1834(a)(7)(A) of the Social Security Act, a supplier shall transfer 
title to the item to the individual patient on the first day that begins 
after the 13th continuous month during which payment is made for the 
rental of the item under this section.

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 20-8004-2-7-571      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Benefit payments, SMI.............                                -140
00.02 Administration, SMI...............                                -170
00.06 Transfer to Medicaid for payment 
        of SMI premiums.................                                 136
                                           ---------   ---------  ----------
10.00   Total new obligations...........                                -174
    Budgetary resources available for obligation:
22.00 New budget authority (gross)......                                -174
23.95 Total new obligations.............                                 174
    New budget authority (gross), detail:
      Discretionary:

40.26   Appropriation (trust fund)......                                -310
      Mandatory:

60.45   Portion precluded from 
          obligation....................                                 136
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................                                -174
    Change in obligated balances:
73.10 Total new obligations.............                                -174
73.20 Total outlays (gross).............                                 174
    Outlays (gross), detail:
86.90 Outlays from new discretionary 
        authority.......................                                -310
86.97 Outlays from new mandatory 
        authority.......................                                 136
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........                                -174
    Net budget authority and outlays:
89.00 Budget authority..................                                -174
90.00 Outlays...........................                                -174
    Memorandum (non-add) entries:
92.01 Total investments, start of year: 
        Federal securities: Par value...
92.02 Total investments, end of year: 
        Federal securities: Par value...                                  20
---------------------------------------------------------------------------

    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. For 
FY 2005, the budget proposes a new mechanism to identify instances where 
Medicare should be the secondary payer for health care--paying only 
after another insurer paid first. Also, the budget proposes to reduce 
excessive rental payments for durable medical equipment by the Medicare 
program and its beneficiaries.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 20-8004-2-7-571      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
42.0  Insurance claims and indemnities..                                  -4
94.0  Financial transfers...............                                -170
                                           ---------   ---------  ----------
99.9    Total new obligations...........                                -174
---------------------------------------------------------------------------

                                

 Transitional Drug Assistance, Federal Supplementary Medical Insurance 
                               Trust Fund

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-8307-0-7-571      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Benefit payments, transitional 
        drug assistance.................                   2,321       2,792
00.02 Program management (CMS)..........                     128
00.03 Limitation on administrative 
        expenses (SSA)..................                      10
                                           ---------   ---------  ----------
10.00   Total new obligations...........                   2,459       2,792
    Budgetary resources available for obligation:
22.00 New budget authority (gross)......                   2,459       2,792
23.95 Total new obligations.............                  -2,459      -2,792
    New budget authority (gross), detail:
      Discretionary:

40.26   Appropriation (trust fund)......                     138
      Mandatory:

60.26   Appropriation (trust fund)......                   2,321       2,792
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................                   2,459       2,792
    Change in obligated balances:
72.40 Obligated balance, start of year..                                  57
73.10 Total new obligations.............                   2,459       2,792
73.20 Total outlays (gross).............                  -2,402      -2,844
74.40 Obligated balance, end of year....                      57           5
    Outlays (gross), detail:
86.90 Outlays from new discretionary 
        authority.......................                      81
86.93 Outlays from discretionary 
        balances........................                                  52
86.97 Outlays from new mandatory 
        authority.......................                   2,321       2,792
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........                   2,402       2,844
    Net budget authority and outlays:
89.00 Budget authority..................                   2,459       2,792
90.00 Outlays...........................                   2,402       2,844
    Memorandum (non-add) entries:
92.01 Total investments, start of year: 
        Federal securities: Par value...                                 -77
92.02 Total investments, end of year: 
        Federal securities: Par value...                     -77        -128
---------------------------------------------------------------------------

    The Medicare Transitional Drug Assistance program provides low-
income beneficiaries with $600 per year to help them pay for their 
prescription drugs.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-8307-0-7-571      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
25.2  Other services....................                     138
42.0  Insurance claims and indemnities..                   2,321       2,792
                                           ---------   ---------  ----------
99.9    Total new obligations...........                   2,459       2,792
---------------------------------------------------------------------------

[[Page 451]]



                                

   Medicare Prescription Drug Account, Federal Supplementary Medical 
                          Insurance Trust Fund

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-8308-0-7-571      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Program management (CMS)..........                     453
00.02 Limitation on administrative 
        expenses (SSA)..................                     490         100
00.03 Low-income determinations 
        (Medicaid)......................                                 106
                                           ---------   ---------  ----------
10.00   Total new obligations (object 
          class 25.2)...................                     943         206
    Budgetary resources available for obligation:
22.00 New budget authority (gross)......                     943         206
23.95 Total new obligations.............                    -943        -206
    New budget authority (gross), detail:
      Discretionary:

40.26   Appropriation (trust fund)......                     943         100
      Mandatory:

60.26   Appropriation (trust fund)......                                 106
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................                     943         206
    Change in obligated balances:
72.40 Obligated balance, start of year..                                 542
73.10 Total new obligations.............                     943         206
73.20 Total outlays (gross).............                    -401        -598
74.40 Obligated balance, end of year....                     542         150
    Outlays (gross), detail:
86.90 Outlays from new discretionary 
        authority.......................                     401
86.93 Outlays from discretionary 
        balances........................                                 492
86.97 Outlays from new mandatory 
        authority.......................                                 106
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........                     401         598
    Net budget authority and outlays:
89.00 Budget authority..................                     943         206
90.00 Outlays...........................                     401         598
    Memorandum (non-add) entries:
92.01 Total investments, start of year: 
        Federal securities: Par value...                                -401
92.02 Total investments, end of year: 
        Federal securities: Par value...                    -401        -893
---------------------------------------------------------------------------

    Beginning in 2006, Medicare beneficiaries will have the opportunity 
to enroll in a comprehensive prescription drug benefit. This schedule 
currently reflects start-up cost associated with implementing the 
benefit.

                                

                 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      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 State family assistance grant.....      16,488      16,489      16,489
00.02 Territories--family assistance 
        grants..........................          73          78          78
00.03 Matching grants to territories....           4           6           6
00.04 Supplemental grants for population 
        increases.......................         319         191
00.05 Bonus to reward decrease in 
        illegitimacy....................         100         100         100
00.06 Tribal work programs..............           8           8           8
00.07 Bonus to reward high performance 
        States..........................         400         200         200
                                           ---------   ---------  ----------
10.00   Total new obligations (object 
          class 41.0)...................      17,392      17,072      16,881
    Budgetary resources available for obligation:
21.40 Unobligated balance carried 
        forward, start of year..........         400                     800
22.00 New budget authority (gross)......      17,009      17,881      16,689
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......      17,409      17,881      17,489
23.95 Total new obligations.............     -17,392     -17,072     -16,881
23.98 Unobligated balance expiring or 
        withdrawn.......................         -17          -9          -9
24.40 Unobligated balance carried 
        forward, end of year............                     800         600
    New budget authority (gross), detail:
      Mandatory:

60.00   Appropriation...................      17,009      17,881      16,689
    Change in obligated balances:
72.40 Obligated balance, start of year..       8,977       7,016       5,200
73.10 Total new obligations.............      17,392      17,072      16,881
73.20 Total outlays (gross).............     -19,352     -18,888     -18,148
74.40 Obligated balance, end of year....       7,016       5,200       3,933
    Outlays (gross), detail:
86.97 Outlays from new mandatory 
        authority.......................      13,160      13,467      13,820
86.98 Outlays from mandatory balances...       6,192       5,421       4,328
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........      19,352      18,888      18,148
    Net budget authority and outlays:
89.00 Budget authority..................      17,009      17,881      16,689
90.00 Outlays...........................      19,352      18,888      18,148
---------------------------------------------------------------------------

                 Summary of Budget Authority and Outlays

                        (in millions of dollars)

                                     2003 actual  2004 est.   2005 est.
Enacted/requested:
  Budget Authority..................      17,009      17,881      16,689
  Outlays...........................      19,352      18,888      18,148
Legislative proposal, subject to 
    PAYGO:
  Budget Authority..................                    -272         459
  Outlays...........................                     -22         207
                                    ------------------------------------
Total:
  Budget Authority..................      17,009      17,609      17,148
  Outlays...........................      19,352      18,866      18,355
                                    ====================================

    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      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.04 Supplemental grants for population 
        increases........................
        .................................
        ................................                     128         319
00.05 Elimination of illegitimacy 
        bonus...........................                    -100        -100
00.07 Redirect high performance 
        bonus...........................                    -100        -100
00.08 Promotion of healthy marriage and 
        family formation 
        grants...........................
        ................................                     100         120
00.09 Family formation, research, 
        demonstration and technical 
        assistance 
        activities.......................
        ................................                     100         120
                                           ---------   ---------  ----------
10.00   Total new obligations (object 
          class 41.0)...................                     128         359
    Budgetary resources available for obligation:
21.40 Unobligated balance carried 
        forward, start of year..........                                -400
22.00 New budget authority (gross)......                    -272         459
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......                    -272          59
23.95 Total new obligations.............                    -128        -359
24.40 Unobligated balance carried 
        forward, end of year............                    -400        -300
    New budget authority (gross), detail:
      Mandatory:

60.00   Appropriation...................                    -272         459
    Change in obligated balances:
72.40 Obligated balance, start of year..                                 150
73.10 Total new obligations.............                     128         359
73.20 Total outlays (gross).............                      22        -207
74.40 Obligated balance, end of year....                     150         302
    Outlays (gross), detail:
86.97 Outlays from new mandatory 
        authority.......................                     -22         126
86.98 Outlays from mandatory balances...                                  81
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........                     -22         207

[[Page 452]]

    Net budget authority and outlays:
89.00 Budget authority..................                    -272         459
90.00 Outlays...........................                     -22         207
---------------------------------------------------------------------------

    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 support 
healthy marriages and family formation.

                                

                            Contingency Fund

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1522-0-1-609      2003 actual   2004 est.   2005 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).............                                  -2
    Outlays (gross), detail:
86.98 Outlays from mandatory balances...                                   2
    Net budget authority and outlays:
89.00 Budget authority..................       1,958       1,958
90.00 Outlays...........................                                   2
---------------------------------------------------------------------------

                 Summary of Budget Authority and Outlays

                        (in millions of dollars)

                                     2003 actual  2004 est.   2005 est.
Enacted/requested:
  Budget Authority..................       1,958       1,958
  Outlays...........................                                   2
Legislative proposal, subject to 
    PAYGO:
  Budget Authority..................                      42
  Outlays...........................                                   7
                                    ------------------------------------
Total:
  Budget Authority..................       1,958       2,000
  Outlays...........................                                   9
                                    ====================================

                                

                            Contingency Fund

                (Legislative proposal, subject to PAYGO)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1522-4-1-609      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Program activity..................                                   7
                                           ---------   ---------  ----------
10.00   Total new obligations (object 
          class 41.0)...................                                   7
    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
23.95 Total new obligations.............                                  -7
24.40 Unobligated balance carried 
        forward, end of year............                      42          35
    New budget authority (gross), detail:
      Mandatory:

60.00   Appropriation...................                      42
    Change in obligated balances:
73.10 Total new obligations.............                                   7
73.20 Total outlays (gross).............                                  -7
    Outlays (gross), detail:
86.98 Outlays from mandatory balances...                                   7
    Net budget authority and outlays:
89.00 Budget authority..................                      42
90.00 Outlays...........................                                   7
---------------------------------------------------------------------------

    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] $2,873,802,000, 
to remain available until expended; and for such purposes for the first 
quarter of fiscal year [2005] 2006, $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 for 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. (Division E, H.R. 2673, Consolidated Appropriations 
Bill, FY 2004.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1501-0-1-609      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

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

        Benefit payments:
00.01     State child support 
            administrative costs........       3,357       3,703       3,796
00.02     Child support incentive 
            payments....................         461         454         446
00.03     Access and visitation grants..          10          10          10
                                           ---------   ---------  ----------
00.91   Subtotal, child support 
          enforcement...................       3,828       4,167       4,252
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...........                      20
09.01 Offset obligations (cse grants to 
        states).........................         235         195         195
                                           ---------   ---------  ----------
10.00   Total new obligations...........       4,087       4,406       4,471
    Budgetary resources available for obligation:
21.40 Unobligated balance carried 
        forward, start of year..........                                 202
22.00 New budget authority (gross)......       4,080       4,608       4,269
22.10 Resources available from 
        recoveries of prior year 
        obligations.....................           7
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......       4,087       4,608       4,471
23.95 Total new obligations.............      -4,087      -4,406      -4,471
24.40 Unobligated balance carried 
        forward, end of year............                     202
    New budget authority (gross), detail:
      Mandatory:

60.00   Appropriation...................       2,745       3,313       2,874

[[Page 453]]

65.00   Advance appropriation...........       1,100       1,100       1,200
69.00 Offsetting collections (cash).....         235         195         195
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................       4,080       4,608       4,269
    Change in obligated balances:
72.40 Obligated balance, start of year..         740         797         910
73.10 Total new obligations.............       4,087       4,406       4,471
73.20 Total outlays (gross).............      -4,023      -4,293      -4,462
73.45 Recoveries of prior year 
        obligations.....................          -7
74.40 Obligated balance, end of year....         797         910         919
    Outlays (gross), detail:
86.97 Outlays from new mandatory 
        authority.......................       3,583       3,838       3,909
86.98 Outlays from mandatory balances...         440         455         553
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........       4,023       4,293       4,462
    Offsets:
      Against gross budget authority and outlays:

88.45   Offsetting collections (cash) 
          from: Offsetting governmental 
          collections (from non-Federal 
          sources)......................        -235        -195        -195
    Net budget authority and outlays:
89.00 Budget authority..................       3,845       4,413       4,074
90.00 Outlays...........................       3,788       4,098       4,267
---------------------------------------------------------------------------

                 Summary of Budget Authority and Outlays

                        (in millions of dollars)

                                     2003 actual  2004 est.   2005 est.
Enacted/requested:
  Budget Authority..................       3,845       4,413       4,074
  Outlays...........................       3,788       4,098       4,267
Legislative proposal, subject to 
    PAYGO:
  Budget Authority..................                                 -48
  Outlays...........................                                 -48
                                    ------------------------------------
Total:
  Budget Authority..................       3,845       4,413       4,026
  Outlays...........................       3,788       4,098       4,219
                                    ====================================

    This account provides for payments to States for child support 
enforcement and other family support programs, including access and 
visitation programs for families. The Federal share of child support 
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)

                                        2003         2004        2005
Gross Federal share of collections..      -1,102      -1,147      -1,189
Federal incentive payments to States         461         454         446
Hold harmless payments..............          10           0           0
State child support administrative 
costs...............................       3,582       3,898       3,941
Access and visitation grants........          10          10          12
                                    ------------------------------------
    Total...........................       2,961       3,215       3,210
                                    ====================================

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1501-0-1-609      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
41.0  Direct obligations: Grants, 
        subsidies, and contributions....       3,852       4,211       4,276
99.0  Reimbursable obligations: 
        Reimbursable obligations........         235         195         195
                                           ---------   ---------  ----------
99.9    Total new obligations...........       4,087       4,406       4,471
---------------------------------------------------------------------------

                                

  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      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

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

        Benefit payments:
00.01     State child support 
            administrative costs........                                 -50
00.03     Access and visitation grants..                                   2
                                           ---------   ---------  ----------
10.00   Total new obligations (object 
          class 41.0)...................                                 -48
    Budgetary resources available for obligation:
22.00 New budget authority (gross)......                                 -48
23.95 Total new obligations.............                                  48
    New budget authority (gross), detail:
      Mandatory:

60.00   Appropriation...................                                 -48
    Change in obligated balances:
73.10 Total new obligations.............                                 -48
73.20 Total outlays (gross).............                                  48
    Outlays (gross), detail:
86.97 Outlays from new mandatory 
        authority.......................                                 -48
    Net budget authority and outlays:
89.00 Budget authority..................                                 -48
90.00 Outlays...........................                                 -48
---------------------------------------------------------------------------

    This legislative package reproposes provisions from the President's 
2003 and 2004 Budgets, including proposals to increase child support 
collections and to direct more of these payments to families. Also 
included are provisions to increase and improve medical child support 
collections on behalf of children.

                                

                    Low Income Home Energy Assistance

    For making payments under title XXVI of the Omnibus Budget 
Reconciliation Act of 1981, [$1,800,000,000] $1,800,500,000, of which 
$500,000 will be available for evaluation purposes.
    For making payments under title XXVI of the Omnibus Budget 
Reconciliation Act of 1981, [$100,000,000] $200,000,000, to remain 
available until expended: 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). (Division E, H.R. 2673, 
Consolidated Appropriations Bill, FY 2004.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1502-0-1-609      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Direct program activity...........       1,988       1,889       2,001
                                           ---------   ---------  ----------
10.00   Total new obligations...........       1,988       1,889       2,001
    Budgetary resources available for obligation:
21.40 Unobligated balance carried 
        forward, start of year..........         300
22.00 New budget authority (gross)......       1,688       1,889       2,001
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......       1,988       1,889       2,001
23.95 Total new obligations.............      -1,988      -1,889      -2,001
    New budget authority (gross), detail:
      Discretionary:

40.00   Appropriation...................       1,800       1,800       1,801
40.00   Appropriation...................                     100         200
40.35   Appropriation permanently 
          reduced.......................        -112         -11
                                           ---------   ---------  ----------
43.00     Appropriation (total 
            discretionary)..............       1,688       1,889       2,001
    Change in obligated balances:
72.40 Obligated balance, start of year..         537         492         486
73.10 Total new obligations.............       1,988       1,889       2,001
73.20 Total outlays (gross).............      -2,030      -1,892      -1,965
73.40 Adjustments in expired accounts 
        (net)...........................          -3          -3
74.40 Obligated balance, end of year....         492         486         522
    Outlays (gross), detail:
86.90 Outlays from new discretionary 
        authority.......................       1,318       1,452       1,535
86.93 Outlays from discretionary 
        balances........................         712         440         430
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........       2,030       1,892       1,965
    Net budget authority and outlays:
89.00 Budget authority..................       1,688       1,889       2,001
90.00 Outlays...........................       2,030       1,892       1,965
---------------------------------------------------------------------------

    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 weath

[[Page 454]]

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

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1502-0-1-609      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
25.2  Other services....................                                   1
41.0  Grants, subsidies, and 
        contributions...................       1,988       1,889       2,000
                                           ---------   ---------  ----------
99.9    Total new obligations...........       1,988       1,889       2,001
---------------------------------------------------------------------------

                                

                     Refugee and Entrant Assistance

    For necessary expenses for refugee and entrant assistance activities 
and for costs associated with the care and placement of unaccompanied 
alien children 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), for carrying out section 462 of the Homeland 
Security Act of 2002 (Public Law 107-296), and for carrying out [section 
5 of] the Torture Victims Relief Act of [1998 (Public Law 105-320)] 2003 
(Public Law 108-179), [$450,276,000] $473,239,000, of which up to 
[$9,968,000] $10,000,000 shall be available to carry out the Trafficking 
Victims Protection Act of [2000 (Public Law 106-386; division A)] 2003 
(Public Law 108-193): Provided, That funds appropriated under this 
heading pursuant to section 414(a) of the Immigration and Nationality 
Act and section 462 of the Homeland Security Act of 2002 for fiscal year 
[2004] 2005 shall be available for the costs of assistance provided and 
other activities, to remain available through September 30, [2006] 2007. 
(Division E, H.R. 2673, Consolidated Appropriations Bill, FY 2004.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1503-0-1-609      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Refugee and entrant assistance....         444         398         424
00.02 Assistance for treatment of 
        torture victims.................          10          10          10
00.03 Unaccompanied alien children......          37          53          54
                                           ---------   ---------  ----------
10.00   Total new obligations...........         491         461         488
    Budgetary resources available for obligation:
21.40 Unobligated balance carried 
        forward, start of year..........          24          28          15
22.00 New budget authority (gross)......         481         448         473
22.10 Resources available from 
        recoveries of prior year 
        obligations.....................          14
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......         519         476         488
23.95 Total new obligations.............        -491        -461        -488
23.98 Unobligated balance expiring or 
        withdrawn.......................          -3
24.40 Unobligated balance carried 
        forward, end of year............          28          15
    New budget authority (gross), detail:
      Discretionary:

40.00   Appropriation...................         484         451         473
40.35   Appropriation permanently 
          reduced.......................          -3          -3
                                           ---------   ---------  ----------
43.00     Appropriation (total 
            discretionary)..............         481         448         473
    Change in obligated balances:
72.40 Obligated balance, start of year..         544         556         558
73.10 Total new obligations.............         491         461         488
73.20 Total outlays (gross).............        -452        -459        -474
73.40 Adjustments in expired accounts 
        (net)...........................         -14
73.45 Recoveries of prior year 
        obligations.....................         -14
74.10 Change in uncollected customer 
        payments from Federal sources 
        (expired).......................           2
74.40 Obligated balance, end of year....         556         558         572
    Outlays (gross), detail:
86.90 Outlays from new discretionary 
        authority.......................         138         134         142
86.93 Outlays from discretionary 
        balances........................         314         325         332
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........         452         459         474
    Net budget authority and outlays:
89.00 Budget authority..................         481         448         473
90.00 Outlays...........................         452         459         474
---------------------------------------------------------------------------

    States are subsidized for administering the refugee assistance 
program. Funds are also provided to assist in the rehabilitation of 
victims of torture, trafficking victims, and the care and placement of 
unaccompanied alien children.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1503-0-1-609      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
11.1  Personnel compensation: Full-time 
        permanent.......................           1           1           1
25.1  Advisory and assistance services..           7           5           7
25.2  Other services....................                      10           8
25.3  Other purchases of goods and 
        services from Government 
        accounts........................           7           6           6
41.0  Grants, subsidies, and 
        contributions...................         476         439         466
                                           ---------   ---------  ----------
99.9    Total new obligations...........         491         461         488
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-1503-0-1-609      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
    Direct:
1001  Total compensable workyears: 
        Civilian full-time equivalent 
        employment......................          10          12          13
---------------------------------------------------------------------------

                                

                   Promoting Safe and Stable Families

    For carrying out section 436 of the Social Security Act, 
$305,000,000 and for section 437, [$100,000,000] $200,000,000. (Division 
E, H.R. 2673, Consolidated Appropriations Bill, FY 2004.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1512-0-1-506      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Grants to States and Tribes.......         382         382         475
00.02 Research, training and technical 
        assistance......................           9           9          13
00.03 State court assessment activities.          13          13          17
                                           ---------   ---------  ----------
10.00   Total new obligations...........         404         404         505
    Budgetary resources available for obligation:
22.00 New budget authority (gross)......         404         404         505
23.95 Total new obligations.............        -404        -404        -505
    New budget authority (gross), detail:
      Discretionary:

40.00   Appropriation...................         100         100         200
40.35   Appropriation permanently 
          reduced.......................          -1          -1
                                           ---------   ---------  ----------
43.00     Appropriation (total 
            discretionary)..............          99          99         200
      Mandatory:

60.00   Appropriation...................         305         305         305
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................         404         404         505
    Change in obligated balances:
72.40 Obligated balance, start of year..         402         463         454
73.10 Total new obligations.............         404         404         505
73.20 Total outlays (gross).............        -339        -414        -432
73.40 Adjustments in expired accounts 
        (net)...........................          -4
74.40 Obligated balance, end of year....         463         454         526
    Outlays (gross), detail:
86.90 Outlays from new discretionary 
        authority.......................          21          21          42
86.93 Outlays from discretionary 
        balances........................          38          67          74
86.97 Outlays from new mandatory 
        authority.......................          67          64          64
86.98 Outlays from mandatory balances...         213         262         252
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........         339         414         432
    Net budget authority and outlays:
89.00 Budget authority..................         404         404         505
90.00 Outlays...........................         339         414         432
---------------------------------------------------------------------------

    This program provides funds for a broad range of child welfare 
services, including family preservation and family support services.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1512-0-1-506      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
25.1  Advisory and assistance services..           2           3           3

[[Page 455]]

25.3  Other purchases of goods and 
        services from Government 
        accounts........................           1           1           1
41.0  Grants, subsidies, and 
        contributions...................         401         400         501
                                           ---------   ---------  ----------
99.9    Total new obligations...........         404         404         505
---------------------------------------------------------------------------

                                

                    Child Care Entitlement to States

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1550-0-1-609      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Mandatory child care..............       1,178       1,178       1,178
00.02 Matching child care...............       1,501       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...........       2,740       2,717       2,717
    Budgetary resources available for obligation:
22.00 New budget authority (gross)......       2,740       2,717       2,717
23.95 Total new obligations.............      -2,740      -2,717      -2,717
    New budget authority (gross), detail:
      Mandatory:

60.00   Appropriation...................       2,717       2,717       2,717
63.00   Reappropriation.................          23
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................       2,740       2,717       2,717
    Change in obligated balances:
72.40 Obligated balance, start of year..       1,144         965         816
73.10 Total new obligations.............       2,740       2,717       2,717
73.20 Total outlays (gross).............      -2,883      -2,866      -2,719
73.40 Adjustments in expired accounts 
        (net)...........................         -36
74.40 Obligated balance, end of year....         965         816         814
    Outlays (gross), detail:
86.97 Outlays from new mandatory 
        authority.......................       1,971       2,038       2,038
86.98 Outlays from mandatory balances...         912         828         681
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........       2,883       2,866       2,719
    Net budget authority and outlays:
89.00 Budget authority..................       2,740       2,717       2,717
90.00 Outlays...........................       2,883       2,866       2,719
---------------------------------------------------------------------------

    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      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
25.1  Advisory and assistance services..           7           7           7
41.0  Grants, subsidies, and 
        contributions...................       2,733       2,710       2,710
                                           ---------   ---------  ----------
99.9    Total new obligations...........       2,740       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. (Division E, H.R. 2673, Consolidated Appropriations Bill, FY 
2004.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1515-0-1-609      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Block grant payments to States....       2,076       2,077       2,090
00.04 Research and evaluation fund......          10          10          10
                                           ---------   ---------  ----------
10.00   Total new obligations...........       2,086       2,087       2,100
    Budgetary resources available for obligation:
22.00 New budget authority (gross)......       2,086       2,087       2,100
23.95 Total new obligations.............      -2,086      -2,087      -2,100
    New budget authority (gross), detail:
      Discretionary:

40.00   Appropriation...................       2,100       2,099       2,100
40.35   Appropriation permanently 
          reduced.......................         -14         -12
                                           ---------   ---------  ----------
43.00     Appropriation (total 
            discretionary)..............       2,086       2,087       2,100
    Change in obligated balances:
72.40 Obligated balance, start of year..       1,044         805         655
73.10 Total new obligations.............       2,086       2,087       2,100
73.20 Total outlays (gross).............      -2,320      -2,237      -2,168
73.40 Adjustments in expired accounts 
        (net)...........................          -5
74.40 Obligated balance, end of year....         805         655         587
    Outlays (gross), detail:
86.90 Outlays from new discretionary 
        authority.......................       1,495       1,565       1,575
86.93 Outlays from discretionary 
        balances........................         825         672         593
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........       2,320       2,237       2,168
    Net budget authority and outlays:
89.00 Budget authority..................       2,086       2,087       2,100
90.00 Outlays...........................       2,320       2,237       2,168
---------------------------------------------------------------------------

    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      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
21.0  Travel and transportation of 
        persons.........................           2           2           2
25.1  Advisory and assistance services..           4           4           4
25.3  Other purchases of goods and 
        services from Government 
        accounts........................           1           1           1
41.0  Grants, subsidies, and 
        contributions...................       2,079       2,080       2,093
                                           ---------   ---------  ----------
99.9    Total new obligations...........       2,086       2,087       2,100
---------------------------------------------------------------------------

                                

                       Social Services Block Grant

    For making grants to States pursuant to section 2002 of the Social 
Security Act, $1,700,000,000: Provided, That notwithstanding 
subparagraph (B) of section 404(d)(2) of such Act, the applicable 
percent specified under such subparagraph for a State to carry out State 
programs pursuant to title XX of such Act shall be 10 percent. (Division 
E, H.R. 2673, Consolidated Appropriations Bill, FY 2004.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1534-0-1-506      2003 actual   2004 est.   2005 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           4           4
22.00 New budget authority (gross)......       1,700       1,700       1,700
22.10 Resources available from 
        recoveries of prior year 
        obligations.....................           3
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......       1,704       1,704       1,704
23.95 Total new obligations.............      -1,700      -1,700      -1,700
24.40 Unobligated balance carried 
        forward, end of year............           4           4           4
    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..         665         618         551

[[Page 456]]

73.10 Total new obligations.............       1,700       1,700       1,700
73.20 Total outlays (gross).............      -1,740      -1,767      -1,769
73.40 Adjustments in expired accounts 
        (net)...........................          -4
73.45 Recoveries of prior year 
        obligations.....................          -3
74.40 Obligated balance, end of year....         618         551         482
    Outlays (gross), detail:
86.97 Outlays from new mandatory 
        authority.......................       1,410       1,394       1,394
86.98 Outlays from mandatory balances...         330         373         375
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........       1,740       1,767       1,769
    Net budget authority and outlays:
89.00 Budget authority..................       1,700       1,700       1,700
90.00 Outlays...........................       1,740       1,767       1,769
---------------------------------------------------------------------------

                                

                 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 261 and 291 of the Help America Vote Act of 2002, [the 
Early Learning Opportunities Act], part B(1) of title IV and 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, sections 439(h), 473A, [and 
477(i)] 474, and 477(i) 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, V, 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, [$8,816,097,000] 
$9,056,025,000, of which [$7,500,000] $32,103,000, to remain available 
until September 30, [2005] 2006, 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: Provided, That funds 
appropriated in Public Law 108-7 for grants to States as authorized by 
section 473A of title IV of the Social Security Act shall also be 
available for adoption incentive payments for adoptions completed before 
September 30, 2004:] 2005 Provided further, That [$6,815,570,000] 
$6,943,580,000 shall be for making payments under the Head Start Act, of 
which $1,400,000,000 shall become available October 1, [2004] 2005 and 
remain available through September 30, [2005] 2006: Provided further, 
That notwithstanding section 640 of the Head Start Act, of funds 
appropriated to Head Start, $45,000,000 shall be available as grants to 
States that directly administer the Head Start program: Provided 
further, That [$735,686,000] $552,350,000 shall be for making payments 
under the Community Services Block Grant Act: [Provided further, That 
not less than $7,227,000 shall be for section 680(3)(B) of the Community 
Services Block Grant Act, as amended: Provided further, That in addition 
to amounts provided herein, $6,000,000 shall be available from amounts 
available under section 241 of the Public Health Service Act to carry 
out the provisions of section 1110 of the Social Security Act:] Provided 
further, That to the extent Community Services Block Grant funds are 
distributed as grant funds by a State to an eligible entity as provided 
under the Act, and have not been expended by such entity, they shall 
remain with such entity for carryover into the next fiscal year for 
expenditure by such entity consistent with program purposes: 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: [Provided further, That $89,978,000 shall be 
for activities authorized by the Runaway and Homeless Youth Act, 
notwithstanding the allocation requirements of section 388(a) of such 
Act, of which $40,505,000 is for the transitional living program:] 
Provided further, That [$48,000,000] $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 
[$15,000,000] $14,912,000 shall be for activities authorized by the Help 
America Vote Act of 2002, of which [$10,000,000] $9,941,000 shall be for 
payments to States to promote [disabled voter] access for voters with 
disabilities, and of which [$5,000,000] $4,971,000 shall be for payments 
to States for [disabled voters] protection and advocacy systems for 
voters with disabilities: Provided further, That $181,926,000 is only 
for making competitive grants to provide abstinence education (as 
defined by section 510(b)(2) of the Social Security Act) to adolescents, 
and for Federal costs of administering the grant: 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 in addition to amounts provided herein for abstinence 
education to adolescents, $4,500,000 shall be available from amounts 
available under section 241 of the Public Health Services Act to carry 
out evaluations (including longitudinal evaluations) of adolescent 
pregnancy prevention approaches: Provided further, That $2,000,000 shall 
be for improving the Public Assistance Reporting Information System, 
including grants to States to support data collection for a study of the 
system's effectiveness. (Division E, H.R. 2673, Consolidated 
Appropriations Bill, FY 2004.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1536-0-1-506      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Head start........................       6,667       6,775       6,944
      Runaway and homeless youth:

01.03   Runaway and homeless youth......          49          49          49
01.04   Transitional living.............          41          40          40
01.05   Education grants to reduce 
          sexual abuse of runaway youth.          15          15          15
01.06 Abstinence education..............                                 182
      Child abuse programs:

01.07   Child abuse State grants........          22          22          42
01.08   Child abuse discretionary 
          activities....................          33          34          26
01.09   Community based resource centers          33          33          66
01.10 Maternity group homes.............                                  10
      Child welfare programs:

01.11   Child welfare services..........         291         290         292
01.12   Child welfare training..........           7           7           7
01.15   Abandoned infants...............          12          12          12
01.16   Adoption incentives.............          15          35          32
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............          29          13           6
01.20 Native American programs..........          45          45          45
01.21 Compassion capital fund...........          35          48         100
      Developmental disabilities programs:

01.24   Protection and advocacy.........          36          38          39
01.25   Projects of national 
          significance..................          12          12          12
01.26   Centers for excellence..........          25          27          27
01.27   State grants....................          71          73          73
01.28 Federal administration............         171         179         190
01.29 Faith-based center................           1           1           1
01.30 Mentoring children of prisoners...          10          50          50
01.31 Early learning opportunities fund.          33          33
01.32 Independent training vouchers.....          42          45          60

[[Page 457]]

01.33 Voting access for individuals with 
        disabilities....................                      15          15
                                           ---------   ---------  ----------
01.91   Subtotal........................       1,068       1,156       1,431
      Community services programs:

03.01   Community services block grants.         646         642         495
03.03   Rural communtiy facilities......           7           7
03.04   Community services discretionary 
          (JOLI & CED)..................          33          32          32
03.05   Community food and nutrition....           7           7
03.06 Individual development accounts...          23          25          25
03.07 National youth sports.............          17          18
03.08 Domestic violence hotline.........           3           3           3
03.09 Grants for battered women's 
        shelters........................         126         126         126
                                           ---------   ---------  ----------
03.91   Subtotal........................         862         860         681
                                           ---------   ---------  ----------
04.00   Total, direct program...........       8,597       8,791       9,056
09.01 Reimbursable program..............          21          15          15
                                           ---------   ---------  ----------
10.00   Total new obligations...........       8,618       8,806       9,071
    Budgetary resources available for obligation:
21.40 Unobligated balance carried 
        forward, start of year..........           4          29           1
22.00 New budget authority (gross)......       8,651       8,778       9,071
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......       8,655       8,807       9,072
23.95 Total new obligations.............      -8,618      -8,806      -9,071
23.98 Unobligated balance expiring or 
        withdrawn.......................          -9
24.40 Unobligated balance carried 
        forward, end of year............          29           1           1
    New budget authority (gross), detail:
      Discretionary:

40.00   Appropriation...................       7,243       7,425       7,656
40.35   Appropriation permanently 
          reduced.......................         -13         -54
                                           ---------   ---------  ----------
43.00     Appropriation (total 
            discretionary)..............       7,230       7,371       7,656
55.00   Advance appropriation...........       1,400       1,392       1,400
      Spending authority from offsetting 
          collections:

68.00   Offsetting collections (cash)...          18          15          15
68.10   Change in uncollected customer 
          payments from Federal sources 
          (unexpired)...................           3
                                           ---------   ---------  ----------
68.90     Spending authority from 
            offsetting collections 
            (total discretionary).......          21          15          15
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................       8,651       8,778       9,071
    Change in obligated balances:
72.40 Obligated balance, start of year..       4,693       4,752       4,962
73.10 Total new obligations.............       8,618       8,806       9,071
73.20 Total outlays (gross).............      -8,490      -8,596      -8,829
73.40 Adjustments in expired accounts 
        (net)...........................         -66
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....       4,752       4,962       5,204
    Outlays (gross), detail:
86.90 Outlays from new discretionary 
        authority.......................       4,560       4,552       4,650
86.93 Outlays from discretionary 
        balances........................       3,930       4,044       4,179
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........       8,490       8,596       8,829
    Offsets:
      Against gross budget authority and outlays:

88.00   Offsetting collections (cash) 
          from: Federal sources.........         -20         -15         -15
      Against gross budget authority only:

88.95   Change in uncollected customer 
          payments from Federal sources 
          (unexpired)...................          -3
88.96   Portion of offsetting 
          collections (cash) credited to 
          expired accounts..............           2
    Net budget authority and outlays:
89.00 Budget authority..................       8,630       8,763       9,056
90.00 Outlays...........................       8,470       8,581       8,814
---------------------------------------------------------------------------

                 Summary of Budget Authority and Outlays

                        (in millions of dollars)

                                     2003 actual  2004 est.   2005 est.
Enacted/requested:
  Budget Authority..................       8,630       8,763       9,056
  Outlays...........................       8,470       8,581       8,814
Legislative proposal, not subject to 
    PAYGO:
  Budget Authority..................                                  50
  Outlays...........................                                  18
Legislative proposal, subject to 
    PAYGO:
  Budget Authority..................                                  50
  Outlays...........................                                  30
                                    ------------------------------------
Total:
  Budget Authority..................       8,630       8,763       9,156
  Outlays...........................       8,470       8,581       8,862
                                    ====================================

    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. 
Provides funding for community-based abstinence education grants. These 
grants, formerly administered by the Health Resources and Services 
Administration, have been transferred to the Administration for Children 
and Families.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1536-0-1-506      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

      Direct obligations:

        Personnel compensation:
11.1      Full-time permanent...........         104         110         102
11.3      Other than full-time permanent           1           2           2
11.5      Other personnel compensation..           1           1           1
                                           ---------   ---------  ----------
11.9        Total personnel compensation         106         113         105
12.1    Civilian personnel benefits.....          20          22          20
21.0    Travel and transportation of 
          persons.......................           3           5           5
23.1    Rental payments to GSA..........          14          16          16
23.2    Rental payments to others.......           3
23.3    Communications, utilities, and 
          miscellaneous charges.........           2           2           2
24.0    Printing and reproduction.......           2           3           3
25.1    Advisory and assistance services         138         124         124
25.2    Other services..................           8          41          41
25.3    Other purchases of goods and 
          services from Government 
          accounts......................          80          30          31
25.7    Operation and maintenance of 
          equipment.....................           1           1           1
26.0    Supplies and materials..........           1           2           2
31.0    Equipment.......................           1           1           1
41.0    Grants, subsidies, and 
          contributions.................       8,218       8,431       8,705
                                           ---------   ---------  ----------
99.0      Direct obligations............       8,597       8,791       9,056
99.0  Reimbursable obligations..........          21          15          15
                                           ---------   ---------  ----------
99.9    Total new obligations...........       8,618       8,806       9,071
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-1536-0-1-506      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
    Direct:
1001  Total compensable workyears: 
        Civilian full-time equivalent 
        employment......................       1,375       1,333       1,337
---------------------------------------------------------------------------

                                

                 Children and Families Services Programs

              (Legislative proposal, not subject to PAYGO)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1536-2-1-506      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
01.35 Promotion of responsible 
        fatherhood and healthy marriage.                                  50
                                           ---------   ---------  ----------
04.00   Total, direct program...........                                  50
                                           ---------   ---------  ----------
10.00   Total new obligations...........                                  50
    Budgetary resources available for obligation:
22.00 New budget authority (gross)......                                  50
23.95 Total new obligations.............                                 -50
    New budget authority (gross), detail:
      Discretionary:

40.00   Appropriation...................                                  50
    Change in obligated balances:
73.10 Total new obligations.............                                  50
73.20 Total outlays (gross).............                                 -18
74.40 Obligated balance, end of year....                                  32
    Outlays (gross), detail:
86.90 Outlays from new discretionary 
        authority.......................                                  18
    Net budget authority and outlays:
89.00 Budget authority..................                                  50
90.00 Outlays...........................                                  18
---------------------------------------------------------------------------

[[Page 458]]



    This legislative proposal establishes the Responsible Fatherhood and 
Healthy Marriage programs. The budget provides grants to faith-based and 
community organizations to assist non-custodial fathers to become more 
involved in the lives of their children.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1536-2-1-506      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
25.3  Other purchases of goods and 
        services from Government 
        accounts........................                                   6
41.0  Grants, subsidies, and 
        contributions...................                                  44
                                           ---------   ---------  ----------
99.9    Total new obligations...........                                  50
---------------------------------------------------------------------------

                                

                 Children and Families Services Programs

                 (Legislative proposal subject to PAYGO)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1536-4-1-506      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
01.34 State-based abstinence education..                                  50
                                           ---------   ---------  ----------
04.00   Total, direct program...........                                  50
                                           ---------   ---------  ----------
10.00   Total new obligations (object 
          class 41.0)...................                                  50
    Budgetary resources available for obligation:
22.00 New budget authority (gross)......                                  50
23.95 Total new obligations.............                                 -50
    New budget authority (gross), detail:
      Mandatory:

60.00   Appropriation...................                                  50
    Change in obligated balances:
73.10 Total new obligations.............                                  50
73.20 Total outlays (gross).............                                 -30
73.32 Obligated balance transferred from 
        other accounts..................                                  16
74.40 Obligated balance, end of year....                                  36
    Outlays (gross), detail:
86.97 Outlays from new mandatory 
        authority.......................                                  18
86.98 Outlays from mandatory balances...                                  12
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........                                  30
    Net budget authority and outlays:
89.00 Budget authority..................                                  50
90.00 Outlays...........................                                  30
---------------------------------------------------------------------------

    The budget extends funding for State-based abstinence education 
activities for five years. These activities formerly administered by the 
Health Resources and Services Adminstration, have been transfered to the 
Administration for Children and Families.

                                

                    Violent Crime Reduction Programs

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-8605-0-1-754      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Change in obligated balances:
72.40 Obligated balance, start of year..          15           6           3
73.20 Total outlays (gross).............          -6          -3
73.40 Adjustments in expired accounts 
        (net)...........................          -3
74.40 Obligated balance, end of year....           6           3           3
    Outlays (gross), detail:
86.93 Outlays from discretionary 
        balances........................           6           3
    Net budget authority and outlays:
89.00 Budget authority..................
90.00 Outlays...........................           6           3
---------------------------------------------------------------------------

                                

              Children's Research and Technical Assistance

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1553-0-1-609      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Training and technical assistance.          12          13          11
00.02 Federal parent locator service....          23          23          23
00.03 Child welfare study...............                       3
00.04 Welfare research..................                       8
09.01 Reimbursable program..............           9          11          11
                                           ---------   ---------  ----------
10.00   Total new obligations...........          44          58          45
    Budgetary resources available for obligation:
21.40 Unobligated balance carried 
        forward, start of year..........           1           2
22.00 New budget authority (gross)......          44          56          45
22.10 Resources available from 
        recoveries of prior year 
        obligations.....................           1
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......          46          58          45
23.95 Total new obligations.............         -44         -58         -45
24.40 Unobligated balance carried 
        forward, end of year............           2
    New budget authority (gross), detail:
      Mandatory:

60.00   Appropriation...................          35          45          34
69.00 Offsetting collections (cash).....           9          11          11
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................          44          56          45
    Change in obligated balances:
72.40 Obligated balance, start of year..          32          29          33
73.10 Total new obligations.............          44          58          45
73.20 Total outlays (gross).............         -47         -54         -51
73.40 Adjustments in expired accounts 
        (net)...........................           1
73.45 Recoveries of prior year 
        obligations.....................          -1
74.40 Obligated balance, end of year....          29          33          27
    Outlays (gross), detail:
86.97 Outlays from new mandatory 
        authority.......................          25          32          29
86.98 Outlays from mandatory balances...          22          22          22
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........          47          54          51
    Offsets:
      Against gross budget authority and outlays:

        Offsetting collections (cash) 
            from:
88.00     Federal sources...............          -3          -4          -4
88.40     Non-Federal sources...........          -6          -7          -7
                                           ---------   ---------  ----------
88.90       Total, offsetting 
              collections (cash)........          -9         -11         -11
    Net budget authority and outlays:
89.00 Budget authority..................          35          45          34
90.00 Outlays...........................          38          43          40
---------------------------------------------------------------------------

                 Summary of Budget Authority and Outlays

                        (in millions of dollars)

                                     2003 actual  2004 est.   2005 est.
Enacted/requested:
  Budget Authority..................          35          45          34
  Outlays...........................          38          43          40
Legislative proposal, subject to 
    PAYGO:
  Budget Authority..................                       7          15
  Outlays...........................                       1           7
                                    ------------------------------------
Total:
  Budget Authority..................          35          52          49
  Outlays...........................          38          44          47
                                    ====================================

    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      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

      Direct obligations:

11.1    Personnel compensation: Full-
          time permanent................                       7           7
12.1    Civilian personnel benefits.....                       1           1
21.0    Travel and transportation of 
          persons.......................                       1           1
23.1    Rental payments to GSA..........                       1           1
25.1    Advisory and assistance services          18          15          14

[[Page 459]]

25.2    Other services..................           5           3           3
25.3    Other purchases of goods and 
          services from Government 
          accounts......................          10           6           5
41.0    Grants, subsidies, and 
          contributions.................           2          13           2
                                           ---------   ---------  ----------
99.0      Direct obligations............          35          47          34
99.0  Reimbursable obligations..........           9          11          11
                                           ---------   ---------  ----------
99.9    Total new obligations...........          44          58          45
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-1553-0-1-609      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
    Direct:
1001  Total compensable workyears: 
        Civilian full-time equivalent 
        employment......................                      74          74
---------------------------------------------------------------------------

                                

              Children's Research and Technical Assistance

                (Legislative proposal, subject to PAYGO)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1553-4-1-609      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.04 Welfare research..................                       7          15
                                           ---------   ---------  ----------
10.00   Total new obligations...........                       7          15
    Budgetary resources available for obligation:
22.00 New budget authority (gross)......                       7          15
23.95 Total new obligations.............                      -7         -15
    New budget authority (gross), detail:
      Mandatory:

60.00   Appropriation...................                       7          15
    Change in obligated balances:
72.40 Obligated balance, start of year..                                   6
73.10 Total new obligations.............                       7          15
73.20 Total outlays (gross).............                      -1          -7
74.40 Obligated balance, end of year....                       6          14
    Outlays (gross), detail:
86.97 Outlays from new mandatory 
        authority.......................                       1           1
86.98 Outlays from mandatory balances...                                   6
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........                       1           7
    Net budget authority and outlays:
89.00 Budget authority..................                       7          15
90.00 Outlays...........................                       1           7
---------------------------------------------------------------------------

    This schedule includes funds for welfare research activities to be 
included in the reauthorization of the Temporary Assistance for Needy 
Families program.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1553-4-1-609      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
25.5  Research and development contracts                       3           7
41.0  Grants, subsidies, and 
        contributions...................                       4           8
                                           ---------   ---------  ----------
99.9    Total new obligations...........                       7          15
---------------------------------------------------------------------------

                                

                         Disabled Voter Services

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1533-0-1-808      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.10 Disabled voter services...........          15
                                           ---------   ---------  ----------
10.00   Total new obligations (object 
          class 41.0)...................          15
    Budgetary resources available for obligation:
22.00 New budget authority (gross)......          15
23.95 Total new obligations.............         -15
    New budget authority (gross), detail:
      Discretionary:

40.00   Appropriation...................          15
    Change in obligated balances:
72.40 Obligated balance, start of year..                      15          10
73.10 Total new obligations.............          15
73.20 Total outlays (gross).............                      -5          -8
74.40 Obligated balance, end of year....          15          10           2
    Outlays (gross), detail:
86.93 Outlays from discretionary 
        balances........................                       5           8
    Net budget authority and outlays:
89.00 Budget authority..................          15
90.00 Outlays...........................                       5           8
---------------------------------------------------------------------------

                                

       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, [$5,068,300,000] $5,037,900,000.
    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] 2006, 
[$1,767,700,000] $1,767,200,000.
    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. (Division E, H.R. 2673, Consolidated Appropriations Bill, FY 
2004.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1545-0-1-609      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Foster care.......................       4,573       4,685       4,896
00.02 Independent living................         140         140         140
00.04 Adoption assistance...............       1,482       1,623       1,770
                                           ---------   ---------  ----------
10.00   Total new obligations...........       6,195       6,448       6,806
    Budgetary resources available for obligation:
22.00 New budget authority (gross)......       6,609       6,814       6,806
23.95 Total new obligations.............      -6,195      -6,448      -6,806
23.98 Unobligated balance expiring or 
        withdrawn.......................        -414        -366
    New budget authority (gross), detail:
      Mandatory:

60.00   Appropriation...................       4,855       5,068       5,038
65.00   Advance appropriation...........       1,754       1,746       1,768
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................       6,609       6,814       6,806
    Change in obligated balances:
72.40 Obligated balance, start of year..       1,117       1,167       1,173
73.10 Total new obligations.............       6,195       6,448       6,806
73.20 Total outlays (gross).............      -6,124      -6,442      -6,753
73.40 Adjustments in expired accounts 
        (net)...........................         -20
74.40 Obligated balance, end of year....       1,167       1,173       1,225
    Outlays (gross), detail:
86.97 Outlays from new mandatory 
        authority.......................       5,340       5,556       5,866
86.98 Outlays from mandatory balances...         784         886         887
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........       6,124       6,442       6,753
    Net budget authority and outlays:
89.00 Budget authority..................       6,609       6,814       6,806
90.00 Outlays...........................       6,124       6,442       6,753
---------------------------------------------------------------------------

                 Summary of Budget Authority and Outlays

                        (in millions of dollars)

                                     2003 actual  2004 est.   2005 est.
Enacted/requested:
  Budget Authority..................       6,609       6,814       6,806
  Outlays...........................       6,124       6,442       6,753
Legislative proposal, subject to 
    PAYGO:
  Budget Authority..................                                 -41
  Outlays...........................                                 -60
                                    ------------------------------------
Total:
  Budget Authority..................       6,609       6,814       6,765
  Outlays...........................       6,124       6,442       6,693
                                    ====================================

    Foster care.--The proposed level will support eligible low-income 
children who must be placed outside the home. An average of 233,000 
children per month will be served in 2005.

    Adoption assistance.--The proposed funding level will support 
subsidies for families adopting eligible low-income chil

[[Page 460]]

dren with special needs. An average of 375,900 children per month will 
be served in 2005.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1545-0-1-609      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
25.1  Advisory and assistance services..          12          12          13
41.0  Grants, subsidies, and 
        contributions...................       6,183       6,436       6,793
                                           ---------   ---------  ----------
99.9    Total new obligations...........       6,195       6,448       6,806
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-1545-0-1-609      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
    Direct:
1001  Total compensable workyears: 
        Civilian full-time equivalent 
        employment......................                       1           1
---------------------------------------------------------------------------

                                

       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      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Foster care.......................                                 -41
                                           ---------   ---------  ----------
10.00   Total new obligations...........                                 -41
    Budgetary resources available for obligation:
22.00 New budget authority (gross)......                                 -41
23.95 Total new obligations.............                                  41
    New budget authority (gross), detail:
      Mandatory:

60.00   Appropriation...................                                 -41
    Change in obligated balances:
73.10 Total new obligations.............                                 -41
73.20 Total outlays (gross).............                                  60
74.40 Obligated balance, end of year....                                  19
    Outlays (gross), detail:
86.97 Outlays from new mandatory 
        authority.......................                                 -60
    Net budget authority and outlays:
89.00 Budget authority..................                                 -41
90.00 Outlays...........................                                 -60
---------------------------------------------------------------------------

    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. Also included is a legislative change to clarify the process for 
determining Title IV-E eligibility in the Foster Care program. 

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-1545-4-1-609      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
25.1  Advisory and assistance services..                                   2
25.5  Research and development contracts                                   2
41.0  Grants, subsidies, and 
        contributions...................                                 -45
                                           ---------   ---------  ----------
99.9    Total new obligations...........                                 -41
---------------------------------------------------------------------------

                                


 
                         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, [$1,381,689,000] $1,376,527,000, of which $5,500,000 shall 
be available for activities regarding medication management, screening, 
and education to prevent incorrect medication and adverse drug 
reactions; and of which [$2,842,000] $4,558,000 shall remain available 
until September 30, [2006] 2007, for the White House Conference on 
Aging. (Division E, H.R. 2673, Consolidated Appropriations Bill, FY 
2004.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0142-0-1-506      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
01.01 Home and community-based 
        supportive services.............         356         354         357
01.02 Preventive health.................          22          22          22
01.03 National family caregiver support 
        program.........................         155         159         162
01.05 Congregate nutrition services.....         385         386         389
01.06 Home-delivered nutrition services.         181         180         181
01.07 Nutrition services incentive 
        program.........................          91         148         149
01.08 Grants for Native Americans.......          27          27          27
01.09 Program innovations...............          41          34          24
01.10 Aging network support activities..           2          13          13
01.11 Federal administration............          18          17          18
01.13 Alzheimer's disease demonstration 
        grants..........................          13          12          12
01.14 Protection of vulnerable older 
        Americans.......................          18          19          18
01.15 White House Conference on Aging...                       3           5
                                           ---------   ---------  ----------
02.00   Total, direct program...........       1,309       1,374       1,377
09.01 Reimbursable program..............           3           3           3
                                           ---------   ---------  ----------
10.00   Total new obligations...........       1,312       1,377       1,380
    Budgetary resources available for obligation:
21.40 Unobligated balance carried 
        forward, start of year..........           1
22.00 New budget authority (gross)......       1,312       1,377       1,380
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......       1,313       1,377       1,380
23.95 Total new obligations.............      -1,312      -1,377      -1,380
    New budget authority (gross), detail:
      Discretionary:

40.00   Appropriation...................       1,376       1,382       1,377
40.35   Appropriation permanently 
          reduced.......................          -9          -8
41.00   Transferred to other accounts...         -58
                                           ---------   ---------  ----------
43.00     Appropriation (total 
            discretionary)..............       1,309       1,374       1,377
      Mandatory:

69.00   Offsetting collections (cash)...                       3           3
69.10   Change in uncollected customer 
          payments from Federal sources 
          (unexpired)...................           3
                                           ---------   ---------  ----------
69.90     Spending authority from 
            offsetting collections 
            (total mandatory)...........           3           3           3
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................       1,312       1,377       1,380
    Change in obligated balances:
72.40 Obligated balance, start of year..         548         542         603
73.10 Total new obligations.............       1,312       1,377       1,380
73.20 Total outlays (gross).............      -1,309      -1,316      -1,380
73.40 Adjustments in expired accounts 
        (net)...........................          -5
74.00 Change in uncollected customer 
        payments from Federal sources 
        (unexpired).....................          -3
74.40 Obligated balance, end of year....         542         603         603
    Outlays (gross), detail:
86.90 Outlays from new discretionary 
        authority.......................         840         858         866
86.93 Outlays from discretionary 
        balances........................         469         455         511
86.97 Outlays from new mandatory 
        authority.......................                       3           3
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........       1,309       1,316       1,380
    Offsets:
      Against gross budget authority and outlays:

88.00   Offsetting collections (cash) 
          from: Federal sources.........                      -3          -3
      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..................       1,309       1,374       1,377

[[Page 461]]

90.00 Outlays...........................       1,309       1,313       1,377
---------------------------------------------------------------------------
    Note.--The reimbursable program (HCFAC) in the Administration on 
Aging (AoA) reflects the estimated distribution of the allocation 
account for 2004 and 2005. Actual 2004 and 2005 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. These programs are part of a comprehensive system of support 
for older people and their families.

    The proposed budget will also provide additional support for the 
Department's efforts to create a more balanced system of long term care 
and build partnerships to enhance the delivery of an integrated, 
consumer-oriented, and cost effective system of health and social 
supports to seniors and their family caregivers. Rebalancing the long-
term care system will provide older Americans more choices and 
opportunities for independence. The proposed level also includes funding 
for the White House Conference on Aging.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0142-0-1-506      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

      Direct obligations:

11.1    Personnel compensation: Full-
          time permanent................           9          10          10
12.1    Civilian personnel benefits.....           2           2           2
23.1    Rental payments to GSA..........           2           2           2
25.1    Advisory and assistance services           5           5           5
25.2    Other services..................                       1           1
25.3    Other purchases of goods and 
          services from Government 
          accounts......................           8           9          12
41.0    Grants, subsidies, and 
          contributions.................       1,283       1,345       1,345
                                           ---------   ---------  ----------
99.0      Direct obligations............       1,309       1,374       1,377
99.0  Reimbursable obligations..........           3           3           3
                                           ---------   ---------  ----------
99.9    Total new obligations...........       1,312       1,377       1,380
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-0142-0-1-506      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
    Direct:
1001  Total compensable workyears: 
        Civilian full-time equivalent 
        employment......................         109         113         113
    Reimbursable:
2001  Total compensable workyears: 
        Civilian full-time equivalent 
        employment......................           8           7           7
---------------------------------------------------------------------------

                                


 
                         DEPARTMENTAL MANAGEMENT

                              Federal Funds

General and special funds:

                         Office of the Secretary

                     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, XX, and XXI of the Public Health Service Act, and 
the United States-Mexico Border Health Commission Act, [$357,358,000] 
$431,971,000, 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] $26,240,000 shall be for activities specified under 
section 2003(b)(2), all 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, $49,838,000]; $52,838,000 is for minority AIDS prevention and 
treatment activities; [and $15,000,000] $50,000,000 is for advancing 
health care information technology nationally, including demonstration 
project grants; $18,400,000 [shall be] is for an Information Technology 
Security and Innovation Fund for Department-wide activities involving 
cybersecurity, information technology security, and related innovation 
projects[,]; $10,000,000 is for a national abstinence education 
campaign; 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] $32,043,000, 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, [$20,750,000] $28,750,000, which 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, 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, nuclear, radiological and chemical 
threats to civilian populations, [$1,726,846,000] $1,725,058,000: 
Provided, That this amount is distributed as follows: Centers for 
Disease Control and Prevention, [$1,116,156,000] $1,109,571,000; Office 
of the Secretary, [$64,820,000] $64,438,000; National Institutes of 
Health, $47,400,000; and Health Resources and Services Administration, 
[$545,870,000: Provided further, That at the discretion of the Secretary 
of Health and Human Services, these amounts may be transferred between 
categories subject to normal reprogramming procedures: Provided further, 
That employees of the Centers for Disease Control and Prevention or the 
Public Health Service, both civilian and Commissioned Officers, detailed 
to States, municipalities, or other organizations under authority of 
section 214 of the Public Health Service Act for purposes related to 
homeland security, shall be treated as non-Federal employees for 
reporting purposes only and shall not be included within any personnel 
ceiling applicable to the Agency, Service, or the Department of Health 
and Human Services during the period of detail or assignment] 
$503,649,000.
    In addition, $400,000,000, to remain available until expended, for 
the Strategic National Stockpile; Provided, That this amount may be 
increased by up to $70,000,000 from amounts under this heading otherwise 
available for use by the Centers for Disease Control and Prevention: 
Provided further, That, subject to 31 U.S.C. 1531, there shall be 
transferred to the Secretary of Health and Human Services the functions, 
assets, unexpended balances (including those from appropriations 
authorized under section 121(e) of Public Law 107-188 and prior 
authorities), and liabilities of the Strategic National Stockpile, 
including the functions of the Secretary of Homeland Security relating 
thereto: Provided further, That the stockpile shall be deployed as 
deemed appropriate by the Secretary, or when requested by the Secretary 
of Homeland Security.
    In addition, for activities to ensure a year-round influenza vaccine 
production capacity and the development and implementation of rapidly 
expandable influenza vaccine production technologies, [$50,000,000] 
$100,000,000, to remain available until expended. (Division E, H.R. 
2673, Consolidated Appropriations Bill, FY 2004.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-9912-0-1-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
      Direct activities:

00.01   General departmental management.         355         356         372
00.02   Office for Civil Rights.........          30          31          32
00.03   Policy research.................           2
00.04   Public health and social 
          services emergency fund.......       2,324       2,275       2,225
00.05   Health care information 
          technology....................                                  50
00.06   National abstinence education 
          campaign......................                                  10
09.01 Reimbursable program..............         182         196         227
09.02 Reimbursable program (HCFAC)......           5           5           5
                                           ---------   ---------  ----------
10.00   Total new obligations...........       2,898       2,863       2,921

[[Page 462]]

    Budgetary resources available for obligation:
21.40 Unobligated balance carried 
        forward, start of year..........         285         244         131
22.00 New budget authority (gross)......       2,860       2,750       2,921
22.10 Resources available from 
        recoveries of prior year 
        obligations.....................           1
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......       3,146       2,994       3,052
23.95 Total new obligations.............      -2,898      -2,863      -2,921
23.98 Unobligated balance expiring or 
        withdrawn.......................          -4
24.40 Unobligated balance carried 
        forward, end of year............         244         131         131
    New budget authority (gross), detail:
      Discretionary:

40.00   Appropriation...................       2,681       2,563       2,689
40.35   Appropriation permanently 
          reduced.......................         -17         -14
42.00   Transferred from other accounts.           9
                                           ---------   ---------  ----------
43.00     Appropriation (total 
            discretionary)..............       2,673       2,549       2,689
      Spending authority from offsetting 
          collections:

68.00   Offsetting collections (cash)...          57         196         227
68.00   Offsetting collections (cash) 
          HCFAC.........................           5           5           5
68.10   Change in uncollected customer 
          payments from Federal sources 
          (unexpired)...................         125
                                           ---------   ---------  ----------
68.90     Spending authority from 
            offsetting collections 
            (total discretionary).......         187         201         232
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................       2,860       2,750       2,921
    Change in obligated balances:
72.40 Obligated balance, start of year..       2,270       3,204       3,184
73.10 Total new obligations.............       2,898       2,863       2,921
73.20 Total outlays (gross).............      -1,884      -2,883      -2,875
73.40 Adjustments in expired accounts 
        (net)...........................          -6
73.45 Recoveries of prior year 
        obligations.....................          -1
74.00 Change in uncollected customer 
        payments from Federal sources 
        (unexpired).....................        -125
74.10 Change in uncollected customer 
        payments from Federal sources 
        (expired).......................          52
74.40 Obligated balance, end of year....       3,204       3,184       3,230
    Outlays (gross), detail:
86.90 Outlays from new discretionary 
        authority.......................         372         623         696
86.93 Outlays from discretionary 
        balances........................       1,512       2,260       2,179
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........       1,884       2,883       2,875
    Offsets:
      Against gross budget authority and outlays:

88.00   Offsetting collections (cash) 
          from: Federal sources.........        -114        -201        -232
      Against gross budget authority only:

88.95   Change in uncollected customer 
          payments from Federal sources 
          (unexpired)...................        -125
88.96   Portion of offsetting 
          collections (cash) credited to 
          expired accounts..............          52
    Net budget authority and outlays:
89.00 Budget authority..................       2,673       2,549       2,689
90.00 Outlays...........................       1,770       2,682       2,643
---------------------------------------------------------------------------
    Note.--The reimbursable program (HCFAC) in Departmental Management 
reflects the estimated distribution from the allocation account for 2004 
and 2005. Actual 2004 and 2005 distributions will be determined by the 
Secretary of HHS and the Attorney General.

                          (Dollars in millions)

                                     2003 actual  2004 est.   2005 est.
Distribution of budget authority by 
    account:
  General Departmental Management...         354         354         432
  Office for Civil Rights...........          30          31          32
  Policy Research...................           2           0           0
  Public Health and Social Services 
    Emergency Fund..................       2,287       2,164       2,225
Distribution of outlays by account:
  General Departmental Management...         353         336         340
  Office for Civil Rights...........          28          31          31
  Policy research...................           2           0           0
  Public Health and Social Services 
    Emergency Fund..................       1,387       2,315       2,240

    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. The 
2005 Budget reflects the Administration's proposal to return funding for 
the Strategic National Stockpile from the Department of Homeland 
Security to HHS. The Administration intends to pursue enactment of this 
transfer in authorizing legislation.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-9912-0-1-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

      Direct obligations:

        Personnel compensation:
11.1      Full-time permanent...........         108         121         126
11.3      Other than full-time permanent           3           3           3
11.5      Other personnel compensation..           2           2           2
11.7      Military personnel............           4           4           5
                                           ---------   ---------  ----------
11.9        Total personnel compensation         117         130         136
12.1    Civilian personnel benefits.....          24          28          29
12.2    Military personnel benefits.....           1           1           1
21.0    Travel and transportation of 
          persons.......................           2           5           5
23.1    Rental payments to GSA..........          18          21          20
23.3    Communications, utilities, and 
          miscellaneous charges.........           7           6           4
24.0    Printing and reproduction.......           2           2           2
25.1    Advisory and assistance services          15           2           6
25.2    Other services..................          37          96          71
25.3    Other purchases of goods and 
          services from Government 
          accounts......................          71          30          34
25.4    Operation and maintenance of 
          facilities....................          17           3           3
25.5    Research and development 
          contracts.....................           2
25.7    Operation and maintenance of 
          equipment.....................          11          23          23
26.0    Supplies and materials..........           3           3           3
31.0    Equipment.......................           8           4           4
41.0    Grants, subsidies, and 
          contributions.................         120         122         187
                                           ---------   ---------  ----------
99.0      Direct obligations............         455         476         528
99.0  Reimbursable obligations..........         187         201         232
      Allocation Account:

        Personnel compensation:
11.1      Full-time permanent...........          37          42          41
11.3      Other than full-time permanent           3           3           3
11.5      Other personnel compensation..           4           4           4
11.7      Military personnel............                       1           1
                                           ---------   ---------  ----------
11.9        Total personnel compensation          44          50          49
12.1    Civilian personnel benefits.....          13          13          14
12.2    Military personnel benefits.....                       1           1
21.0    Travel and transportation of 
          persons.......................           5           3           3
23.3    Communications, utilities, and 
          miscellaneous charges.........          10           9           9
24.0    Printing and reproduction.......           1           1           1
25.1    Advisory and assistance services          30          24          18
25.2    Other services..................          35          31         173
25.3    Other purchases of goods and 
          services from Government 
          accounts......................         329         359         428
25.4    Operation and maintenance of 
          facilities....................          23          57
25.5    Research and development 
          contracts.....................          54         144          94
25.7    Operation and maintenance of 
          equipment.....................          25          24          24
26.0    Supplies and materials..........          14          10           8
31.0    Equipment.......................          33          28          27
32.0    Land and structures.............          23           6
41.0    Grants, subsidies, and 
          contributions.................       1,617       1,426       1,312
                                           ---------   ---------  ----------
99.0      Allocation account............       2,256       2,186       2,161
                                           ---------   ---------  ----------
99.9    Total new obligations...........       2,898       2,863       2,921
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-9912-0-1-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
    Direct:
      Total compensable workyears:

1001    Civilian full-time equivalent 
          employment....................       1,292       1,398       1,418
1101    Military full-time equivalent 
          employment....................          83         110         110

[[Page 463]]

    Reimbursable:
2001  Total compensable workyears: 
        Civilian full-time equivalent 
        employment......................         283         305         303
---------------------------------------------------------------------------

                                

                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.''

                                


 
                         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, 
for medical care of dependents and retired personnel under the 
Dependents' Medical Care Act (10 U.S.C. ch. 55 and 56), and for payments 
pursuant to section 229(b) of the Social Security Act (42 U.S.C. 
429(b)), such amounts as may be required during the current fiscal year. 
The following are definitions for the medical benefits of the Public 
Health Service Commissioned Officers that apply to 10 U.S.C. chapter 56, 
section 1116(c). The source of funds for the monthly accrual payments 
into the Department of Defense Medicare-Eligible Retiree Health Care 
Fund shall be the Retirement Pay and Medical Benefits for Commissioned 
Officers account. For purposes of this Act, the term ``pay of members'' 
shall be construed to be synonymous with retirement payments to United 
States Public Health Service officers who are retired for age, 
disability, or length of service; payments to survivors of deceased 
officers; medical care to active duty and retired members and dependents 
and beneficiaries; and for payments to the Social Security 
Administration for military service credits; all of which payments are 
provided for by the Retirement Pay and Medical Benefits for Commissioned 
Officers account. (Division E, H.R. 2673, Consolidated Appropriations 
Bill, FY 2004.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0379-0-1-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Retirement payments...............         214         228         241
00.02 Survivors' benefits...............          13          14          15
00.03 Medical care......................          64          80          75
                                           ---------   ---------  ----------
10.00   Total new obligations...........         291         322         331
    Budgetary resources available for obligation:
22.00 New budget authority (gross)......         311         322         331
23.95 Total new obligations.............        -291        -322        -331
23.98 Unobligated balance expiring or 
        withdrawn.......................         -19
    New budget authority (gross), detail:
      Mandatory:

60.00   Appropriation...................         311         322         331
    Change in obligated balances:
72.40 Obligated balance, start of year..          45          30          32
73.10 Total new obligations.............         291         322         331
73.20 Total outlays (gross).............        -305        -320        -330
73.40 Adjustments in expired accounts 
        (net)...........................          -1
74.40 Obligated balance, end of year....          30          32          33
    Outlays (gross), detail:
86.97 Outlays from new mandatory 
        authority.......................         265         290         298
86.98 Outlays from mandatory balances...          40          30          32
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........         305         320         330
    Net budget authority and outlays:
89.00 Budget authority..................         311         322         331
90.00 Outlays...........................         304         320         330
---------------------------------------------------------------------------

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

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0379-0-1-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
13.0  Benefits for former personnel.....         227         242         256
25.6  Medical care......................          64          80          75
                                           ---------   ---------  ----------
99.9    Total new obligations...........         291         322         331
---------------------------------------------------------------------------

                                

                         Health Activities Funds

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-9913-0-1-552      2003 actual   2004 est.   2005 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
    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      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
09.01 Program support center............         456         517         544
09.02 OS activities.....................           8          40          47
                                           ---------   ---------  ----------
10.00   Total new obligations...........         464         557         591
    Budgetary resources available for obligation:
21.40 Unobligated balance carried 
        forward, start of year..........          89          67          67
22.00 New budget authority (gross)......         439         557         591
22.10 Resources available from 
        recoveries of prior year 
        obligations.....................           4
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......         532         624         658
23.95 Total new obligations.............        -464        -557        -591
24.40 Unobligated balance carried 
        forward, end of year............          67          67          67
    New budget authority (gross), detail:
      Mandatory:

69.00   Offsetting collections (cash)...         447         557         591
69.10   Change in uncollected customer 
          payments from Federal sources 
          (unexpired)...................          -8
                                           ---------   ---------  ----------
69.90     Spending authority from 
            offsetting collections 
            (total mandatory)...........         439         557         591
    Change in obligated balances:
72.40 Obligated balance, start of year..         -46         -35         -35
73.10 Total new obligations.............         464         557         591
73.20 Total outlays (gross).............        -457        -557        -591
73.45 Recoveries of prior year 
        obligations.....................          -4
74.00 Change in uncollected customer 
        payments from Federal sources 
        (unexpired).....................           8
74.40 Obligated balance, end of year....         -35         -35         -35
    Outlays (gross), detail:
86.97 Outlays from new mandatory 
        authority.......................         439         557         591
86.98 Outlays from mandatory balances...          18
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........         457         557         591
    Offsets:
      Against gross budget authority and outlays:

88.00   Offsetting collections (cash) 
          from: Federal sources.........        -447        -557        -591
      Against gross budget authority only:

88.95   Change in uncollected customer 
          payments from Federal sources 
          (unexpired)...................           8
    Net budget authority and outlays:
89.00 Budget authority..................

[[Page 464]]

90.00 Outlays...........................          10
---------------------------------------------------------------------------

    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, 
telecommunication services, medical supplies repackaging and 
distribution services, and the Federal Occupational Health Service. The 
Office of Secretary activities line includes the fund manager, 
departmental contracts, audit resolutions, Commissioned Corps force 
management, and information technology.

    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 personnel summary shows the total number of these 
detailed FTE.

               Object Classification (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-9941-0-4-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

      Personnel compensation:

11.1    Full-time permanent.............          64          90          93
11.3    Other than full-time permanent..           3           5           5
11.5    Other personnel compensation....           3           4           5
11.7    Military personnel..............           8          12          12
                                           ---------   ---------  ----------
11.9      Total personnel compensation..          78         111         115
12.1  Civilian personnel benefits.......          19          27          29
12.2  Military personnel benefits.......           4           5           6
13.0  Benefits for former personnel.....           2
21.0  Travel and transportation of 
        persons.........................           2           3           3
22.0  Transportation of things..........           3           3           3
23.1  Rental payments to GSA............          12          16          17
23.3  Communications, utilities, and 
        miscellaneous charges...........           6          16          18
24.0  Printing and reproduction.........           1           1           1
25.1  Advisory and assistance services..          16          16          17
25.2  Other services....................         136         165         174
25.3  Other purchases of goods and 
        services from Government 
        accounts........................          31          32          35
25.4  Operation and maintenance of 
        facilities......................          18          19          21
25.6  Medical care......................          34          35          37
26.0  Supplies and materials............          92          90          92
31.0  Equipment.........................          10          18          23
                                           ---------   ---------  ----------
99.9    Total new obligations...........         464         557         591
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-9941-0-4-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
    Reimbursable:
      Total compensable workyears:

2001    Civilian full-time equivalent 
          employment....................       1,020       1,410       1,410
2101    Military full-time equivalent 
          employment....................          89          89          89
    Allocation account:
3101  Total compensable workyears: 
        Military full-time equivalent 
        employment......................       1,171       1,179       1,179
---------------------------------------------------------------------------

                                

  

                               Trust Funds

                        Miscellaneous Trust Funds

                Unavailable Receipts (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-9971-0-7-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
01.99 Balance, start of year............
    Receipts:
02.00 Gifts and contributions, 
        Miscellaneous trust funds.......          35          37          37
02.20 Contributions, Indian health 
        facilities......................          34          34          34
02.40 Interest, Miscellaneous trust 
        funds...........................
                                           ---------   ---------  ----------
02.99   Total receipts and collections..          69          71          71
                                           ---------   ---------  ----------
04.00 Total: Balances and collections...          69          71          71
    Appropriations:
05.00 Miscellaneous trust funds.........         -69         -71         -71
                                           ---------   ---------  ----------
07.99 Balance, end of year..............
---------------------------------------------------------------------------

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-9971-0-7-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.02 Gifts.............................          35          37          37
00.03 Contributions, Indian health 
        facilities......................          39          34          34
                                           ---------   ---------  ----------
10.00   Total new obligations...........          74          71          71
    Budgetary resources available for obligation:
21.40 Unobligated balance carried 
        forward, start of year..........         101          98          98
22.00 New budget authority (gross)......          69          71          71
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......         170         169         169
23.95 Total new obligations.............         -74         -71         -71
24.40 Unobligated balance carried 
        forward, end of year............          98          98          98
    New budget authority (gross), detail:
      Mandatory:

60.26   Appropriation (trust fund)......          69          71          71
    Change in obligated balances:
72.40 Obligated balance, start of year..          99         104         105
73.10 Total new obligations.............          74          71          71
73.20 Total outlays (gross).............         -68         -70         -73
74.40 Obligated balance, end of year....         104         105         103
    Outlays (gross), detail:
86.97 Outlays from new mandatory 
        authority.......................          68          15          15
86.98 Outlays from mandatory balances...                      55          58
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........          68          70          73
    Net budget authority and outlays:
89.00 Budget authority..................          69          71          71
90.00 Outlays...........................          68          70          73
    Memorandum (non-add) entries:
92.01 Total investments, start of year: 
        Federal securities: Par value...          30          25          30
92.02 Total investments, end of year: 
        Federal securities: Par value...          25          30          30
---------------------------------------------------------------------------

                          [Dollars in millions]

                                        2003         2004        2005
Distribution of budget authority by 
    account:
  Gifts.............................          35          37          37
  Contributions, Indian health 
    facilities......................          34          34          34
Distribution of outlays by account:
  Gifts.............................          36          37          38
  Contributions, Indian health 
    facilities......................          32          33          35

    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      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

      Personnel compensation:

11.1    Full-time permanent.............           2           2           2
11.3    Other than full-time permanent..           1           1           1
                                           ---------   ---------  ----------
11.9      Total personnel compensation..           3           3           3
21.0  Travel and transportation of 
        persons.........................           1           1           1
25.1  Advisory and assistance services..           2           1           1
25.2  Other services....................          10          14          14
25.3  Other purchases of goods and 
        services from Government 
        accounts........................           1           1           1
25.4  Operation and maintenance of 
        facilities......................          14           1           1
25.5  Research and development contracts           5          11          11
25.7  Operation and maintenance of 
        equipment.......................          15          15          15

[[Page 465]]

26.0  Supplies and materials............           2           1           1
31.0  Equipment.........................           1           1           1
41.0  Grants, subsidies, and 
        contributions...................          20          22          22
                                           ---------   ---------  ----------
99.9    Total new obligations...........          74          71          71
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-9971-0-7-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
    Direct:
1001  Total compensable workyears: 
        Civilian full-time equivalent 
        employment......................          36          36          36
---------------------------------------------------------------------------

                                


 
                     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] including the hire of passenger motor vehicles 
for investigations, $40,323,000: 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. (Division E, H.R. 
2673, Consolidated Appropriations Bill, FY 2004.)

               Program and Financing (in millions of dollars)

----------------------------------------------------------------------------
Identification code 75-0128-0-1-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

    Obligations by program activity:
00.01 Direct program....................          37          39          40
09.01 HCFAC reimbursable program........         166         164         164
09.02 Reimbursable program..............          16          17          17
                                           ---------   ---------  ----------
10.00   Total new obligations...........         219         220         221
    Budgetary resources available for obligation:
21.40 Unobligated balance carried 
        forward, start of year..........           1           1           1
22.00 New budget authority (gross)......         219         220         221
                                           ---------   ---------  ----------
23.90   Total budgetary resources 
          available for obligation......         220         221         222
23.95 Total new obligations.............        -219        -220        -221
24.40 Unobligated balance carried 
        forward, end of year............           1           1           1
    New budget authority (gross), detail:
      Discretionary:

40.00   Appropriation...................          37          39          40
      Spending authority from offsetting 
          collections:

68.00   Offsetting collections (cash)...           7          17          17
68.10   Change in uncollected customer 
          payments from Federal sources 
          (unexpired)...................           9
                                           ---------   ---------  ----------
68.90     Spending authority from 
            offsetting collections 
            (total discretionary).......          16          17          17
      Mandatory:

69.00   Offsetting collections (cash)...         155         164         164
69.10   Change in uncollected customer 
          payments from Federal sources 
          (unexpired)...................          11
                                           ---------   ---------  ----------
69.90     Spending authority from 
            offsetting collections 
            (total mandatory)...........         166         164         164
                                           ---------   ---------  ----------
70.00   Total new budget authority 
          (gross).......................         219         220         221
    Change in obligated balances:
72.40 Obligated balance, start of year..                      15          12
73.10 Total new obligations.............         219         220         221
73.20 Total outlays (gross).............        -195        -223        -221
74.00 Change in uncollected customer 
        payments from Federal sources 
        (unexpired).....................         -20
74.10 Change in uncollected customer 
        payments from Federal sources 
        (expired).......................          11
74.40 Obligated balance, end of year....          15          12          11
    Outlays (gross), detail:
86.90 Outlays from new discretionary 
        authority.......................          32          52          53
86.93 Outlays from discretionary 
        balances........................           2           7           4
86.97 Outlays from new mandatory 
        authority.......................         161         164         164
                                           ---------   ---------  ----------
87.00   Total outlays (gross)...........         195         223         221
    Offsets:
      Against gross budget authority and outlays:

88.00   Offsetting collections (cash) 
          from: Federal sources.........        -173        -181        -181
      Against gross budget authority only:

88.95   Change in uncollected customer 
          payments from Federal sources 
          (unexpired)...................         -20
88.96   Portion of offsetting 
          collections (cash) credited to 
          expired accounts..............          11
    Net budget authority and outlays:
89.00 Budget authority..................          37          39          40
90.00 Outlays...........................          22          42          40
---------------------------------------------------------------------------

    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)

                                         2003 actual   2004 est.   2005 est.
Budget Authority:
  Discretionary appropriations..........          37          39          40
  Mandatory (HCFAC Account).............         160         160         160
                                           ---------   ---------  ----------
      Total.............................         197         199         200
    Note.--The reimbursable program (HCFAC) in the Office of the 
Inspector General reflects the estimated distribution of the allocation 
account for 2004 and 2005. Actual 2004 and 2005 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      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------

      Direct obligations:

        Personnel compensation:
11.1      Full-time permanent...........          19          21          22
11.5      Other personnel compensation..           1           1           1
                                           ---------   ---------  ----------
11.9        Total personnel compensation          20          22          23
12.1    Civilian personnel benefits.....           7           7           7
21.0    Travel and transportation of 
          persons.......................           1           1           1
23.1    Rental payments to GSA..........           3           3           3
23.3    Communications, utilities, and 
          miscellaneous charges.........           1           1           1
25.3    Other purchases of goods and 
          services from Government 
          accounts......................           4           4           4
31.0    Equipment.......................           1           1           1
                                           ---------   ---------  ----------
99.0      Direct obligations............          37          39          40
99.0  Reimbursable obligations..........         182         181         181
                                           ---------   ---------  ----------
99.9    Total new obligations...........         219         220         221
---------------------------------------------------------------------------

                              Personnel Summary

----------------------------------------------------------------------------
Identification code 75-0128-0-1-551      2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
    Direct:
      Total compensable workyears:

1001    Civilian full-time equivalent 
          employment....................         286         287         286
1101    Military full-time equivalent 
          employment....................           1           1           1
    Reimbursable:
2001  Total compensable workyears: 
        Civilian full-time equivalent 
        employment......................       1,295       1,261       1,215
---------------------------------------------------------------------------

                                

                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.''

[[Page 466]]

                                


 
                      GENERAL FUND RECEIPT ACCOUNTS

                           (in millions of dollars)

----------------------------------------------------------------------------
                                         2003 actual   2004 est.   2005 est.
----------------------------------------------------------------------------
Offsetting receipts from the public:
  75-274530  Health education assistance 
    loans, downward reestimates of 
    subsidies...........................         210          49
  75-310700  Federal share of child 
    support collections.................       1,102       1,147       1,174
    Legislative proposal, subject to 
      PAYGO.............................                                  15
                                           ---------   ---------  ----------
General Fund Offsetting receipts from 
 the public.............................       1,312       1,196       1,189
---------------------------------------------------------------------------

                                


 
                           GENERAL PROVISIONS

    Sec. 201. Funds appropriated in this title shall be available for 
not to exceed $50,000 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 [I] II.
    [Sec. 205. None of the funds appropriated in this Act may be 
expended pursuant to section 241 of the Public Health Service Act, 
except for funds specifically provided for in this Act, or for other 
taps and assessments made by any office located in the Department of 
Health and Human Services, prior to the Secretary's preparation and 
submission of a report to the Committee on Appropriations of the Senate 
and of the House detailing the planned uses of such funds.]
    Sec. [206] 205. Notwithstanding section 241(a) of the Public Health 
Service Act, such portion as the Secretary shall determine, but not more 
than [2.2] 2.3 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. [207] 206. Not to exceed [1] 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 Act may be 
transferred between appropriations, but no such appropriation shall be 
increased by more than 3 percent by any such transfer: Provided, That an 
appropriation may be increased by up to an additional 2 percent [subject 
to approval by] after notification of the House and Senate Committees on 
Appropriations: Provided further, That the Appropriations Committees of 
both Houses of Congress are notified at least 15 days in advance of any 
transfer.
    Sec. [208] 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. [209] 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. [210] 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. [211] 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.
    Sec. [212] 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. 213. The Foreign Operations, Export Financing, and Related 
Programs Appropriations Act, 1990 (Public Law 101-167) is amended--
        (1) in section 599D (8 U.S.C. 1157 note)--
                (A) in subsection (b)(3), by striking ``1997, 1998, 
            1999, 2000, 2001, 2002, and 2003'' and inserting ``1997, 
            1998, 1999, 2000, 2001, 2002, 2003, and 2004''; and
                (B) in subsection (e), by striking ``October 1, 2003'' 
            each place it appears and inserting ``October 1, 2004'';
                (C) in subsection (b)(1)--
    (i) in subparagraph (A), by striking ``and'' at the end;
    (ii) in subparagraph (B), by striking the period and inserting ``; 
and''; and
    (iii) by adding at the end the following:
        ``(C) one or more categories of aliens who are or were nationals 
    and residents of the Islamic Republic or Iran who, as members of a 
    religious minority in Iran, share common characteristics that 
    identify them as targets of persecution in that state on account of 
    race, religion, nationality, membership in a particular social 
    group, or political opinion.''; and
        (2) in section 599E (8 U.S.C. 1255 note) in subsection (b)(2), 
    by striking ``September 30, 2003'' and inserting ``September 30, 
    2004''.]
    Sec. [214] 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] 2005 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] 2005 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] 2004, 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] 2004 State 
expenditures and all fiscal year [2004] 2005 obligations for tobacco 
prevention and compliance activities by program activity by July 31, 
[2004] 2005.
    (d) The Secretary shall exercise discretion in enforcing the timing 
of the State obligation of the additional funds required by the 
certification described in subsection (a) as late as July 31, [2004] 
2005.
    (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.

[[Page 467]]

    Sec. [215] 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] 2005, the 
Secretary of Health and Human Services--
        (1) may exercise authority equivalent to that available to the 
    Secretary of State in section 2(c) of the State Department Basic 
    Authorities Act of 1956 (22 U.S.C. 2669(c)). The Secretary of Health 
    and Human Services shall consult with the Secretary of State and 
    relevant Chief of Mission to ensure that the authority provided in 
    this section is exercised in a manner consistent with section 207 of 
    the Foreign Service Act of 1980 (22 U.S.C. 3927) and other 
    applicable statutes administered by the Department of State, and
        (2) is authorized to provide such funds by advance or 
    reimbursement to the Secretary of State as may be necessary to pay 
    the costs of acquisition, lease, alteration, renovation, and 
    management of facilities outside of the United States for the use of 
    the Department of Health and Human Services. The Department of State 
    shall cooperate fully with the Secretary of Health and Human 
    Services to ensure that the Department of Health and Human Services 
    has secure, safe, functional facilities that comply with applicable 
    regulation governing location, setback, and other facilities 
    requirements and serve the purposes established by this Act. The 
    Secretary of Health and Human Services is authorized, in 
    consultation with the Secretary of State, through grant or 
    cooperative agreement, to make available to public or nonprofit 
    private institutions or agencies in participating foreign countries, 
    funds to acquire, lease, alter, or renovate facilities in those 
    countries as necessary to conduct programs of assistance for 
    international health activities, including activities relating to 
    HIV/AIDS and other infectious diseases, chronic and environmental 
    diseases, and other health activities abroad.
    Sec. [216] 214. The Division of Federal Occupational Health may 
utilize personal services contracting to employ professional management/
administrative and occupational health professionals.
    [Sec. 217. Notwithstanding section 409B(c) of the Public Health 
Service Act regarding a limitation on the number of such grants, funds 
appropriated in this Act and Acts in fiscal years thereafter may be 
expended by the Director of the National Institutes of Health to award 
Core Center Grants to encourage the development of innovative 
multidisciplinary research and provide training concerning Parkinson's 
disease. Each center funded under such grants shall be designated as a 
Morris K. Udall Center for Research on Parkinson's Disease.]
    [Sec. 218. Not later than 90 days after the date of enactment of 
this Act, the Director of the National Institutes of Health shall submit 
to the appropriate committees of Congress a report that shall--
        (1) contain the recommendations of the Director concerning the 
    role of the National Institutes of Health in promoting the 
    affordability of inventions and products developed with Federal 
    funds; and
        (2) specify whether any circumstances exist to prevent the 
    Director from promoting the affordability of inventions and products 
    developed with Federal funds.]
    [Sec. 219. Notwithstanding any other provisions of law, funds made 
available under this heading may be used to continue operating the 
Council on Graduate Medical Education established by section 301 of 
Public Law 102-408.]
    [Sec.  220. Designation of Senator Paul D. Wellstone NIH MDCRC 
Program. (a) Findings.--Congress finds the following:
        (1) On December 18, 2001, Public Law 107-84, otherwise known as 
    the Muscular Dystrophy Community Assistance, Research and Education 
    Amendments of 2001, or the MD CARE Act, was signed into law to 
    provide for research and education with respect to various forms of 
    muscular dystrophy, including Duchenne, Becker, limb girdle, 
    congenital, facioscapulohumeral, myotonic, oculopharyngeal, distal, 
    and EmeryDreifuss muscular dystrophies.
        (2) In response to the MD CARE Act of 2001, in September 2002, 
    the National Institutes of Health (NIH) announced its intention to 
    establish the Muscular Dystrophy Cooperative Research Centers 
    (MDCRC) program.
        (3) Senator Paul D. Wellstone was a driving force behind 
    enactment of the MD CARE Act, which led to the establishment of the 
    MDCRC program.
    (b) Designation.--The NIH Muscular Dystrophy Cooperative Research 
Centers (MDCRC) program shall be known and designated as the ``Senator 
Paul D. Wellstone Muscular Dystrophy Cooperative Research Centers'', in 
honor of Senator Paul D. Wellstone who was deceased on October 25, 2002.
    (c) References.--Any reference in a law, regulation, document, 
paper, or other record of the United States to the NIH program of 
Muscular Dystrophy Cooperative Research Centers shall be deemed to be a 
reference to the ``Senator Paul D. Wellstone Muscular Dystrophy 
Cooperative Research Centers.]
    Sec. [221] 215. (a) Authority.--Notwithstanding any other provision 
of law, the Director of the National Institutes of Health may use funds 
available under section 402(i) of the Public Health Service Act (42 
U.S.C. 282(i)) to enter into transactions (other than contracts, 
cooperative agreements, or grants) to carry out research in support of 
the NIH Roadmap Initiative of the Director.
    (b) Peer Review.--In entering into transactions under subsection 
(a), the Director of the National Institutes of Health may utilize such 
peer review procedures (including consultation with appropriate 
scientific experts) as the Director determines to be appropriate to 
obtain assessments of scientific and technical merit. Such procedures 
shall apply to such transactions in lieu of the peer review and advisory 
council review procedures that would otherwise be required under 
sections 301(a)(3), 405(b)(1)(B), 405(b)(2), 406(a)(3)(A), 492, and 494 
of the Public Health Service Act (42 U.S.C. 241, 284(b)(1)(B), 
284(b)(2), 284a(a)(3)(A), 289a, and 289c).
    Sec. 216. With the funds appropriated to the National Institutes of 
Health in this Act, NIH is authorized to obligate in fiscal year 2005 
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.
    [Sec. 222. Section 307(c) of the Denali Commission Act of 1998 (42 
U.S.C. 3121 note) is amended by striking ``is authorized to make 
grants'' and inserting ``is authorized to make interagency transfers''.] 
(Division E, H.R. 2673, Consolidated Appropriations Bill, FY 2004.)

                                

    Note: Section 167, Division H, HR 2673, Consolidated Appropriations 
Bill, 2004, appropriates additional amounts for the Department of Health 
and Human Services for 2004. The language is presented with the 
Government-wide general provisions.
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