Appendix - Department of Health and Human Services

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; [$3,788,336,000] $3,083,408,000: Provided, That, of the amount provided under this heading, [$702,172,000 shall be derived from prescription drug user fees authorized by 21 U.S.C. 379h shall be credited to this account and remain available until expended, and shall not include any fees pursuant to 21 U.S.C. 379h(a)(2) and (a)(3) assessed for fiscal year 2013 but collected in fiscal year 2012; $57,605,000 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; $21,768,000] $30,530,000 shall be derived from animal drug user fees authorized by section 740 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 379j-12), and shall be credited to this account and remain available until expended; [$5,706,000] $7,595,000 shall be derived from animal generic drug user fees authorized by section 741 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 379j-21), and shall be credited to this account and shall remain available until expended; [$477,000,000] $505,000,000 shall be derived from tobacco product user fees authorized by 21 U.S.C. 387s and shall be credited to this account and remain available until expended; [$12,364,000] $12,925,000 shall be derived from food and feed recall fees authorized by section 743 of the Federal Food, Drug, and Cosmetic Act (Public Law 75–717), as amended by the Food Safety Modernization Act (Public Law 111–353), and shall be credited to this account and remain available until expended; [$14,700,000] $15,367,000 shall be derived from food reinspection fees authorized by section 743 of the Federal Food, Drug, and Cosmetic Act (Public Law 75–717), as amended by the Food Safety Modernization Act (Public Law 111–353), and shall be credited to this account and remain available until expended; and amounts derived from voluntary qualified importer program fees authorized by section 743 of the Federal Food, Drug, and Cosmetic Act (Public Law 75–717), as amended by the Food Safety Modernization Act (Public Law 111–353), and shall be credited to this account and remain available until expended: Provided further, That, in addition and notwithstanding any other provision under this heading, amounts collected for [prescription drug] animal drug user fees and animal generic drug user fees that exceed the respective fiscal year [2012] 2013 limitations are appropriated and shall be credited to this account and remain available until expended: Provided further, That fees derived from [prescription drug, medical device,] animal drug [,] and animal generic drug[, and tobacco product] assessments for fiscal year [2012] 2013 received during fiscal year [2012] 2013, including any such fees assessed prior to fiscal year [2012] 2013 but credited for fiscal year [2012] 2013, shall be subject to the fiscal year [2012] 2013 limitations: 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) $882,747,000 shall be for the Center for Food Safety and Applied Nutrition and related field activities in the Office of Regulatory Affairs; (2) $978,705,000 shall be for the Center for Drug Evaluation and Research and related field activities in the Office of Regulatory Affairs, of which no less than $52,947,000 shall be available for the Office of Generic Drugs; (3) $329,136,000 shall be for the Center for Biologics Evaluation and Research and for related field activities in the Office of Regulatory Affairs; (4) $166,365,000 shall be for the Center for Veterinary Medicine and for related field activities in the Office of Regulatory Affairs; (5) $356,909,000 shall be for the Center for Devices and Radiological Health and for related field activities in the Office of Regulatory Affairs; (6) $60,039,000 shall be for the National Center for Toxicological Research; (7) $454,751,000 shall be for the Center for Tobacco Products and for related field activities in the Office of Regulatory Affairs; (8) not to exceed $131,639,000 shall be for Rent and Related activities, of which $43,981,000 is for White Oak Consolidation, other than the amounts paid to the General Services Administration for rent; (9) not to exceed $205,472,000 shall be for payments to the General Services Administration for rent; and (10) $222,573,000 shall be for other activities, including the Office of the Commissioner of Food and Drugs, the Office of Foods, the Office of Medical and Tobacco Products, the Office of Global and Regulatory Policy, the Office of Operations, the Office of the Chief Scientist, and central services for these offices:] the Secretary may, prior to the due date for such fees, accept payment of animal drug user fees and animal generic drug user fees authorized for fiscal year 2014, and that amounts of such fees assessed for fiscal year 2014 for which the Secretary accepts payment in fiscal year 2013 shall not be included in amounts provided under this heading: Provided further, That not to exceed $25,000 of this amount shall be for official reception and representation expenses, not otherwise provided for, as determined by the Commissioner[: 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, export certification user fees authorized by 21 U.S.C. 381, and priority review user fees authorized by 21 U.S.C. 360n may be credited to this account, to remain available until expended.

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, [$8,788,000] $5,320,000, to remain available until expended. (Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriations Act, 2012.)


Identification code 75–9911–0–1–554		2011 actual	2012 est.	2013 est.

0100	Balance, start of year			1
	Receipts:
0220	Cooperative Research and Development Agreements, FDA	1	3	3

0400	Total: Balances and collections	1	3	4
	Appropriations:
0500	Salaries and Expenses	–1	–2	–2

0799	Balance, end of year		1	2


Identification code 75–9911–0–1–554		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Foods	836	1,004	992
0002	Drugs	829	690	683
0003	Devices and radiological products	322	322	319
0004	National Center for Toxicological Research	61	60	60
0005	Other activities	149	154	163
0006	Other rent and rent related activities	99	106	127
0007	Rental payments	151	161	169
0008	Buildings and facilities	13	9	5
0009	CRADAs	2	3	3

0799	Total direct obligations	2,462	2,509	2,521
0801	Reimbursable program	919	1,321	675

0900	Total new obligations	3,381	3,830	3,196

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	587	582	814
1020	Adjustment of unobligated bal brought forward, Oct 1	–293

1050	Unobligated balance (total)	294	582	814
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	2,462	2,506	2,517
1130	Appropriations permanently reduced	–5

1160	Appropriation, discretionary (total)	2,457	2,506	2,517
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	1	2	2

1260	Appropriations, mandatory (total)	1	2	2
	Spending authority from offsetting collections, discretionary:
1700	Collected	1,239	1,554	675
1701	Change in uncollected payments, Federal sources	26
1702	Offsetting collections (previously unavailable)	386	333	333
1725	Spending authority from offsetting collections precluded from obligation (limitation on obligations)	–440	–333	–333

1750	Spending auth from offsetting collections, disc (total)	1,211	1,554	675
1900	Budget authority (total)	3,669	4,062	3,194
1930	Total budgetary resources available	3,963	4,644	4,008
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	582	814	812

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	1,363	1,460	1,163
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–52	–46	–46

3020	Obligated balance, start of year (net)	1,311	1,414	1,117
3030	Obligations incurred, unexpired accounts	3,381	3,830	3,196
3031	Obligations incurred, expired accounts	9
3040	Outlays (gross)	–3,253	–4,127	–3,173
3050	Change in uncollected pymts, Fed sources, unexpired	–26
3051	Change in uncollected pymts, Fed sources, expired	32
3081	Recoveries of prior year unpaid obligations, expired	–40
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	1,460	1,163	1,186
3091	Uncollected pymts, Fed sources, end of year	–46	–46	–46

3100	Obligated balance, end of year (net)	1,414	1,117	1,140

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	3,668	4,060	3,192
	Outlays, gross:
4010	Outlays from new discretionary authority	2,398	3,158	2,286
4011	Outlays from discretionary balances	854	967	885

4020	Outlays, gross (total)	3,252	4,125	3,171
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–81	–67	–67
4033	Non-Federal sources	–1,187	–1,487	–608

4040	Offsets against gross budget authority and outlays (total)	–1,268	–1,554	–675
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–26
4052	Offsetting collections credited to expired accounts	29

4060	Additional offsets against budget authority only (total)	3

4070	Budget authority, net (discretionary)	2,403	2,506	2,517
4080	Outlays, net (discretionary)	1,984	2,571	2,496
	Mandatory:
4090	Budget authority, gross	1	2	2
	Outlays, gross:
4100	Outlays from new mandatory authority	1	2	2
4180	Budget authority, net (total)	2,404	2,508	2,519
4190	Outlays, net (total)	1,985	2,573	2,498

	Memorandum (non-add) entries:
5090	Unavailable balance, SOY: Offsetting collections	65	119	119
5091	Unavailable balance, EOY: Offsetting collections	119	119	119


	2011	2012	2013

Distribution of discretionary budget authority by account:
Salaries and expenses	2447	2497	2511
Buildings and facilities	10	9	5
Distribution of discretionary outlays by account:
Salaries and expenses	1975	2563	2491
Buildings and facilities	9	8	4

The Food and Drug Administration (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 more effective, safer, and more affordable; and helping to provide the public accurate, science-based information about medicines and foods to improve their health. FDA decisions affect Americans on a daily basis. 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 funding for food protection, drug safety, medical device review and safety, developing medical countermeasures, and headquarters consolidation in White Oak, Maryland.


Identification code 75–9911–0–1–554		2011 actual	2012 est.	2013 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	749	760	764
11.3	Other than full-time permanent	105	106	107
11.5	Other personnel compensation	59	60	60
11.7	Military personnel	58	59	61
11.8	Special personal services payments	1	1	1

11.9	Total personnel compensation	972	986	993
12.1	Civilian personnel benefits	260	264	265
12.2	Military personnel benefits	29	30	31
13.0	Benefits for former personnel	2
21.0	Travel and transportation of persons	50	51	51
22.0	Transportation of things	5	5	5
23.1	Rental payments to GSA	151	161	169
23.2	Rental payments to others	2	2	2
23.3	Communications, utilities, and miscellaneous charges	56	57	57
24.0	Printing and reproduction	2	2	2
25.1	Advisory and assistance services	42	43	43
25.2	Other services from non-Federal sources	423	434	430
25.3	Other goods and services from Federal sources	113	114	113
25.4	Operation and maintenance of facilities	106	107	107
25.5	Research and development contracts	34	34	34
25.7	Operation and maintenance of equipment	31	31	31
26.0	Supplies and materials	46	46	46
31.0	Equipment	57	57	57
32.0	Land and structures	6	6	6
41.0	Grants, subsidies, and contributions	75	77	77
42.0	Insurance claims and indemnities		2	2

99.0	Direct obligations	2,462	2,509	2,521
99.0	Reimbursable obligations	919	1,321	675

99.9	Total new obligations	3,381	3,830	3,196


Identification code 75–9911–0–1–554		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment	9,103	9,335	7,584
1101	Direct military average strength employment	692	692	492
2001	Reimbursable civilian full-time equivalent employment	3,191	3,300	2,621
2101	Reimbursable military average strength employment	243	243	172
3001	Allocation account civilian full-time equivalent employment	65	67	54
3101	Allocation account military average strength employment	1	1	1

Contingent upon the enactment of legislation authorizing user fees with respect to biosimilar biological products and human generic drugs, such fees shall be credited to this account and remain available until expended: Provided, That, with respect to such fees authorized for fiscal year 2014, the Secretary may, prior to the due date for such fees, accept payment of such fees and such payments shall be credited to this account for fiscal year 2014.

In addition, contingent upon the enactment of legislation authorizing user fees with respect to food inspections and food facility registrations, food contact notification activities, reinspection of medical product facilities, cosmetic activities, and international express courier import activities, such fees shall be credited to this account and remain available until expended.

In addition, contingent upon the enactment of authorizing legislation, the Secretary shall charge a fee for prescription drug review activities and medical device review activities: Provided, That fees of $712,808,000, for prescription drug reviews, shall be credited to this account and remain available until expended; and $69,700,000, for medical device reviews, shall be credited to this account and remain available until expended: Provided further, That, in addition and notwithstanding any other provision under this heading, amounts collected for prescription drug user fees and medical device user fees that exceed the respective fiscal year 2013 limitations are appropriated and shall be credited to this account and remain available until expended: Provided further, That fees derived from prescription drug reviews and medical device reviews for fiscal year 2013 received during fiscal year 2013, including any such fees assessed prior to fiscal year 2013 but credited for fiscal year 2013, shall be subject to the fiscal year 2013 limitations: Provided further, That the Secretary may, prior to the due date for such fees, accept payment of prescription drug user fees and medical device user fees authorized for fiscal year 2014, and that amounts of such fees assessed for fiscal year 2014 for which the Secretary accepts payment in fiscal year 2013 shall not be included in amounts provided under this heading.


Identification code 75–9911–2–1–554		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0801	PDUFA			713
0802	MDUFMA			70
0803	Generic Drug User Fee			299
0804	Biosimilar User Fees			20
0805	Reinspection (Drugs)			15
0806	Food Inspection and Registration Fee			220
0807	International Courier User Fee			6
0808	Cosmetic and Food Contact Notification User Fee			5
0810	Cosmetic User Fee			19

0900	Total new obligations			1,367

	Budgetary Resources:
	Budget authority:
	Spending authority from offsetting collections, discretionary:
1700	Collected			1,367

1750	Spending auth from offsetting collections, disc (total)			1,367
1930	Total budgetary resources available			1,367

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts			1,367
3040	Outlays (gross)			–1,367

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross			1,367
	Outlays, gross:
4010	Outlays from new discretionary authority			1,367
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4033	Non-Federal sources			–1,367

The 2013 Budget includes a number of new and current user fees. Legislation will be proposed to allow FDA to collect fees to support human generic drug review as well as for the evaluation of biosimilar biological product applications. The additional resources, estimated at $299 million for the human generic drug program, would enable FDA to reduce review times and respond to the growing number of generic drug applications. The fees collected for biosimilars would ensure sound funding for the review of biosimilar applications including the development-phase FDA consultation and review work. The Budget also proposes user fees to support activities related to cosmetics and food contact notification activities. In addition, the Budget reproposes user fees to support inspection-related activities at domestic courier facilities and reinspections at medical product facilities.

Lastly, the Budget includes a total of $712 million in prescription drug user fees and $70 million in medical device user fees. The FDA transmitted proposed legislation to reauthorize PDUFA and establish new generic drug and biosimilar user fees to Congress on January 13, 2012. The proposed legislation authorizes the collection and spending of these fees subject to appropriations.


Identification code 75–9911–2–1–554		2011 actual	2012 est.	2013 est.

99.9	Total new obligations			1,367


Identification code 75–9911–2–1–554		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment			2,648
1101	Direct military average strength employment			200
2001	Reimbursable civilian full-time equivalent employment			928
2101	Reimbursable military average strength employment			71
3001	Allocation account civilian full-time equivalent employment			19
3101	Allocation account military average strength employment


Identification code 75–4309–0–3–554		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0801	Reimbursable program	8	8	8

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	2	2	2
	Budget authority:
	Spending authority from offsetting collections, mandatory:
1800	Collected	8	8	8

1850	Spending auth from offsetting collections, mand (total)	8	8	8
1930	Total budgetary resources available	10	10	10
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	2	2	2

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	3	3	2
3030	Obligations incurred, unexpired accounts	8	8	8
3040	Outlays (gross)	–8	–9	–9
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	3	2	1

3100	Obligated balance, end of year (net)	3	2	1

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	8	8	8
	Outlays, gross:
4100	Outlays from new mandatory authority	8	8	8
4101	Outlays from mandatory balances		1	1

4110	Outlays, gross (total)	8	9	9
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–8	–8	–8
4190	Outlays, net (total)		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.


Identification code 75–4309–0–3–554		2011 actual	2012 est.	2013 est.

	Reimbursable obligations:
11.1	Personnel compensation: Full-time permanent	4	4	4
12.1	Civilian personnel benefits	1	1	1
23.1	Rental payments to GSA	1	1	1
25.2	Other services from non-Federal sources	1	1	1
26.0	Supplies and materials	1	1	1

99.9	Total new obligations	8	8	8


Identification code 75–4309–0–3–554		2011 actual	2012 est.	2013 est.

2001	Reimbursable civilian full-time equivalent employment	37	37	38

Federal Funds

For carrying out titles II and III of the Public Health Service Act (referred to in this Act as the "PHS Act'') with respect to primary health care and the Native Hawaiian Health Care Act of 1988, [$1,598,957,000] $1,579,975,000, of which [$129,000] $127,000 shall be available until expended for facilities renovations at the Gillis W. Long Hansen's Disease Center: Provided, That no more than $40,000 shall be available until expended for carrying out the provisions of section 224(o) of the PHS Act, including associated administrative expenses and relevant evaluations: Provided further, That no more than [$95,073,000] $94,893,000 shall be available until expended for carrying out the provisions of Public Law 104–73 and for expenses incurred by the Department of Health and Human Services (referred to in this Act as "HHS'') pertaining to administrative claims made under such law.

For carrying out titles III, VII, and VIII of the PHS Act with respect to the health workforce, section 1128E and 1921(b) of the Social Security Act, and the Health Care Quality Improvement Act of 1986, [$734,402,000] $522,187,000: Provided, That sections 747(c)(2), [751(j)(2)] 340G-1(b) and (d), and the proportional funding amounts in paragraphs (1) through (4) of section 756(e) of the PHS Act shall not apply to funds made available under this heading: [Provided further, That for any program operating under section 751 of the PHS Act on or before January 1, 2009, the Secretary of Health and Human Services (referred to in this title as "Secretary'') may waive any of the requirements contained in sections 751(d)(2)(A) and 751(d)(2)(B) of such Act for the full project period of a grant under such section: Provided further, That no funds shall be available for section 340G-1 of the PHS Act:] 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 such 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 fees collected for the disclosure of information under the information reporting requirement program authorized by section 1921 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 funds transferred to this account to carry out section 846 and subpart 3 of part D of title III of the PHS Act may be used to make prior year adjustments to awards made under such sections: Provided further, That, in addition to amounts appropriated under this heading, $35,000,000 shall be available under section 241 of the PHS Act to carry out titles VII and VIII of the PHS Act: Provided further, That, of the amount appropriated under this heading, $88,000,000 shall be for payments to children's hospitals pursuant to section 340E of the PHS Act, all of which shall be for payments for direct graduate medical education as described in section 340E(c).

For carrying out titles III, XI, XII, and XIX of the PHS Act with respect to maternal and child health, title V of the Social Security Act, and section 712 of the American Jobs Creation Act of 2004, [$863,607,000] $854,807,000: Provided, That notwithstanding sections 502(a)(1) and 502(b)(1) of the Social Security Act, not more than [$79,586,000] $78,641,000 shall be available for carrying out special projects of regional and national significance pursuant to section 501(a)(2) of such Act and [$10,400,000] $10,276,000 shall be available for projects described in paragraphs (A) through (F) of section 501(a)(3) of such Act.

For carrying out title XXVI of the PHS Act with respect to the Ryan White HIV/AIDS program, [$2,326,665,000] $2,446,772,000, of which [$1,995,670,000] $2,093,599,000 shall remain available to the Secretary [of Health and Human Services] through September 30, 2014, for parts A and B of title XXVI of the PHS Act[, and of which] : Provided, That of the funds available for parts A and B of title XXVI of the PHS Act, not less than [$900,000,000] $1,000,000,000 shall be for State AIDS Drug Assistance Programs [under the authority of] pursuant to section 2616 or 311(c) of such Act: Provided further, That in addition to amounts provided herein, $25,000,000 shall be available from amounts available under section 241 of the PHS Act to carry out parts A, B, C, and D of title XXVI of the PHS Act to fund Special Projects of National Significance under section 2691.

For carrying out titles III and XII of the PHS Act with respect to health care systems, and the Stem Cell Therapeutic and Research Act of 2005, [$83,526,000] $82,534,000: Provided, That the Secretary may collect a fee of 0.1 percent of each purchase of 340B drugs from entities participating in the Drug Pricing Program pursuant to section 340B of the PHS Act to pay for the operating costs of such program: Provided further, That fees pursuant to the 340B Drug Pricing Program shall be collected by manufacturers at the time of sale, and shall be credited to this account, to remain available until expended.

For carrying out titles III and IV of the PHS Act with respect to rural health, section 427(a) of the Federal Coal Mine Health and Safety Act, the Cardiac Arrest Survival Act of 2000, and sections 711 and 1820 of the Social Security Act, [$139,832,000] $122,232,000, of which [$41,118,000] $26,200,000 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: Provided, That, of the funds made available under this heading for Medicare rural hospital flexibility grants, [$15,000,000 shall be available for the Small Rural Hospital Improvement Grant Program for quality improvement and adoption of health information technology and] $1,000,000 shall be to carry out section 1820(g)(6) of the Social Security Act, with funds provided for grants under section 1820(g)(6) available for the purchase and implementation of telehealth services, including pilots and demonstrations on the use of electronic health records to coordinate rural veterans care between rural providers and the Department of Veterans Affairs electronic health record system: Provided further, That notwithstanding section 338J(k) of the PHS Act, [$10,055,000] $10,036,000 shall be available for State Offices of Rural Health.

For carrying out the program under title X of the PHS Act to provide for voluntary family planning projects, [$297,400,000] $296,838,000: Provided, 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.

For program support in the Health Resources and Services Administration, [$161,815,000] $162,517,000: Provided, That funds made available under this heading may be used to supplement program support funding provided under the headings "Primary Health Care'', "Health Workforce'', "Maternal and Child Health'', "Ryan White HIV/AIDS Program'', "Health Care Systems'', and "Rural Health'': Provided further, That the Administrator may transfer funds between any of the accounts of HRSA with notification to the Committees on Appropriations of both Houses of Congress at least 15 days in advance of any transfer, but no such account shall be decreased by more than 3 percent by any such transfer. (Department of Health and Human Services Appropriations Act, 2012.)


Identification code 75–0350–0–1–550		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0010	Health Centers	1,481	1,467	1,467
0012	National Health Service Corps Recruitment	25
0013	Hansen's Disease Center	16	16	16
0014	Payment to Hawaii for the Treatment of Hansen's Disease	2	2	2
0015	Black Lung Clinics	7	7	7
0016	Nursing Education Loan Repayment and Scholarships	93	83	83
0017	Health Professions	405	376	345
0018	Maternal and Child Health Block Grant	656	639	640
0019	Healthy Start	104	103	103
0020	Poison Control Centers	22	19	19
0021	EMS for Children	21	21	21
0022	Universal Newborn Hearing Screening	19	19	19
0023	HIV/AIDS	2,310	2,375	2,447
0024	Organ Transplantation	25	24	24
0025	Bone Marrow Donor Registry	23	23	23
0026	Rural Health Policy Development	10	10	10
0027	Rural Health Outreach Grants	56	56	56
0028	Rural Health Flexibility Grants	41	41	26
0030	Telehealth	12	12	12
0031	Program Management	162	160	162
0032	Family Planning	298	294	297
0033	Loan Repayment/Faculty Fellowship	1	1	1
0035	Health Centers Tort Claim Fund	89	113	95
0036	Heritable Disorders	10	10	10
0038	Childrens' GME	268	265	88
0041	State Offices of Rural Health	10	10	10
0043	Radiogenic Diseases	2	2	2
0044	Traumatic Brain Injury	10	10	10
0045	Autism and Other Developmental Disorders	48	47	47
0046	Cord Blood Stem Cell Bank	12	12	12
0047	Free Clinics Medical Malpractice	1	2
0048	Sickle Cell	5	5	5
0049	Drug Pricing Program	4	4	4
0050	Family to Family Health Information Centers ACA	5	5
0052	Health Center Loan Subsidy	1
0067	Prevention Fund	20	75	10
0071	ARRA	74
0072	Infrastructure to Expand Access to Care ACA	100
0073	Health Centers ACA	998	1,150	1,200
0074	Health Centers Construction ACA	742	758
0075	National Health Service Corps ACA	289	296	300
0076	School Based Health Centers ACA	98	15	87
0077	GME Payments THC ACA	4	18	43
0079	Rural Health AED		1
0080	Pediatric Loan Repayment			5

0300	Total direct programs	8,579	8,546	7,708

0799	Total direct obligations	8,579	8,546	7,708
0801	Reimbursable program	62	66	72
0802	Reimbursable program: PHS evaluation	22	25	60

0899	Total reimbursable obligations	84	91	132

0900	Total new obligations	8,663	8,637	7,840

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	272	1,060	345
1021	Recoveries of prior year unpaid obligations	3

1050	Unobligated balance (total)	275	1,060	345
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	6,275	6,207	6,068
1121	Appropriations transferred from other accts [75–9915]		9
1121	Appropriations transferred from other accts [75–1362]		1
1121	Appropriations transferred from other accts [75–0943]		1
1130	Appropriations permanently reduced	–13
1143	Approp permanently reduced (Sec 527, HR 2055)		–12

1160	Appropriation, discretionary (total)	6,262	6,206	6,068
	Appropriations, mandatory:
1200	Appropriation	3,075	1,550	1,850
1221	Appropriations transferred from other accts [75–0116]	20	75	10

1260	Appropriations, mandatory (total)	3,095	1,625	1,860
	Spending authority from offsetting collections, discretionary:
1700	Collected	54	75	116
1701	Change in uncollected payments, Federal sources	24

1750	Spending auth from offsetting collections, disc (total)	78	75	116
	Spending authority from offsetting collections, mandatory:
1800	Offsetting collections (cash)(HPSL&NSL)	16	16	16

1850	Spending auth from offsetting collections, mand (total)	16	16	16
1900	Budget authority (total)	9,451	7,922	8,060
1930	Total budgetary resources available	9,726	8,982	8,405
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–3
1941	Unexpired unobligated balance, end of year	1,060	345	565

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	6,864	6,837	6,598
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–50	–42	–42

3020	Obligated balance, start of year (net)	6,814	6,795	6,556
3030	Obligations incurred, unexpired accounts	8,663	8,637	7,840
3031	Obligations incurred, expired accounts	1
3040	Outlays (gross)	–8,582	–8,876	–8,168
3050	Change in uncollected pymts, Fed sources, unexpired	–24
3051	Change in uncollected pymts, Fed sources, expired	32
3080	Recoveries of prior year unpaid obligations, unexpired	–3
3081	Recoveries of prior year unpaid obligations, expired	–106
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	6,837	6,598	6,270
3091	Uncollected pymts, Fed sources, end of year	–42	–42	–42

3100	Obligated balance, end of year (net)	6,795	6,556	6,228

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	6,340	6,281	6,184
	Outlays, gross:
4010	Outlays from new discretionary authority	2,589	2,521	2,508
4011	Outlays from discretionary balances	5,120	4,139	3,821

4020	Outlays, gross (total)	7,709	6,660	6,329
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–52	–52	–82
4033	Non-Federal sources	–28	–23	–34

4040	Offsets against gross budget authority and outlays (total)	–80	–75	–116
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–24
4052	Offsetting collections credited to expired accounts	26

4060	Additional offsets against budget authority only (total)	2

4070	Budget authority, net (discretionary)	6,262	6,206	6,068
4080	Outlays, net (discretionary)	7,629	6,585	6,213
	Mandatory:
4090	Budget authority, gross	3,111	1,641	1,876
	Outlays, gross:
4100	Outlays from new mandatory authority	818	863	870
4101	Outlays from mandatory balances	55	1,353	969

4110	Outlays, gross (total)	873	2,216	1,839
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–16	–16	–16
4180	Budget authority, net (total)	9,357	7,831	7,928
4190	Outlays, net (total)	8,486	8,785	8,036

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


Identification code 75–0350–0–1–550		2011 actual	2012 est.	2013 est.

	Guaranteed loan levels supportable by subsidy budget authority:
215001	Health centers: Facilities renovation loan guarantee levels	32	8	8
215002	Health centers: Managed care network development loan guarantee		2	1
215003	Health centers: Managed care plan loan guarantee levels		5	3

215999	Total loan guarantee levels	32	15	12
	Guaranteed loan subsidy (in percent):
232001	Health centers: Facilities renovation loan guarantee levels	2.72	2.67	2.16
232002	Health centers: Managed care network development loan guarantee	0.00	9.62	9.73
232003	Health centers: Managed care plan loan guarantee levels	0.00	5.76	5.79

232999	Weighted average subsidy rate	2.72	4.63	3.70
	Guaranteed loan subsidy budget authority:
233001	Health centers: Facilities renovation loan guarantee levels	1

233999	Total subsidy budget authority	1
	Guaranteed loan subsidy outlays:
234001	Health centers: Facilities renovation loan guarantee levels	1

234999	Total subsidy outlays	1

Resources displayed here support categorical grants and contracts managed by Health Resources and Services Administration (HRSA). These activities include support for Federally Qualified Health Centers, treatment and care for those living with HIV/AIDS, health professions training, maternal and child health care services, promotion of organ and bone marrow donation, and the medical malpractice claims funds, which pay malpractice claims filed against employees of federally-supported health centers and free clinics. HRSA is also responsible for oversight of the 340B Drug Discount Program. The FY 2013 Budget proposes a new user fee for this program to improve administration and oversight of this activity.

HRSA administers the following revolving loan programs: Health Professions Student Loans (HPSL), Nursing Student Loans (NSL), Primary Care Loans (PCL) and Loans for Disadvantaged Students (LDS). These programs are financed through revolving accounts (Federal Capital Contribution) and do not receive annual appropriations. Through these revolving fund accounts, funds are awarded to institutions that in turn provide loans to individual students. As borrowers pay back loans the programs revolving account gets replenished, and the collected funds are then used to give out new loans in the following academic years. If the programs revolving account has excess funds that will not be used to provide new loans, these excess funds are returned to HRSA. Funds returned to HRSA are then awarded to programs that are in need of additional funds. The information below reflects Academic Year 2010–2011 data reported in the Annual Operating Report.


Program	Account Balance

HPSL	$370,561,960
NSL	$168,761,018
PCL	$249,867,755

LDS	$129,792,459


Total	$918,984,192


Identification code 75–0350–0–1–550		2011 actual	2012 est.	2013 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	148	147	151
11.3	Other than full-time permanent	5	6	6
11.5	Other personnel compensation	4	4	4
11.7	Military personnel	19	20	20
11.8	Special personal services payments	1

11.9	Total personnel compensation	177	177	181
12.1	Civilian personnel benefits	45	42	44
12.2	Military personnel benefits	8	11	11
21.0	Travel and transportation of persons	4	4	4
23.1	Rental payments to GSA	25	25	25
23.2	Rental payments to others	1	2	2
23.3	Communications, utilities, and miscellaneous charges	2	1	1
24.0	Printing and reproduction	1	1	1
25.1	Advisory and assistance services	38	38	38
25.2	Other services from non-Federal sources	180	156	156
25.3	Other goods and services from Federal sources	182	197	197
25.4	Operation and maintenance of facilities	2	1	1
25.6	Medical care	3	3	3
25.7	Operation and maintenance of equipment	13	14	14
26.0	Supplies and materials	1	1	1
31.0	Equipment	4	4	4
41.0	Grants, subsidies, and contributions	7,810	7,780	6,936
42.0	Insurance claims and indemnities	83	89	89

99.0	Direct obligations	8,579	8,546	7,708
99.0	Reimbursable obligations	84	91	132

99.9	Total new obligations	8,663	8,637	7,840


Identification code 75–0350–0–1–550		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment	1,539	1,528	1,505
1101	Direct military average strength employment	202	202	202
2001	Reimbursable civilian full-time equivalent employment	76	76	82
2101	Reimbursable military average strength employment	6	6	6


Identification code 75–0320–0–1–551		2011 actual	2012 est.	2013 est.

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	12	12	12
1930	Total budgetary resources available	12	12	12
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	12	12	12

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 claims yet to be adjudicated, no appropriation is requested in 2012 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 Injury Compensation Program trust fund account.


Identification code 75–0343–0–1–551		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Claims		2	1
0103	Admin Expense	3	3	4

0900	Total new obligations	3	5	5

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		2
1011	Unobligated balance transfer from other accts [75–0140]	5	3	5

1050	Unobligated balance (total)	5	5	5
1930	Total budgetary resources available	5	5	5
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	2

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)		2	7
3030	Obligations incurred, unexpired accounts	3	5	5
3040	Outlays (gross)	–1
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	2	7	12

3100	Obligated balance, end of year (net)	2	7	12

	Budget authority and outlays, net:
	Discretionary:
	Outlays, gross:
4011	Outlays from discretionary balances	1
4190	Outlays, net (total)	1

The Covered Countermeasure Process Fund is established pursuant to the PHS Act, as amended by Division C of Public Law 109–148, to serve as a source of funds to pay for compensation for injuries, illnesses or death, or losses resulting from the administration to or use by an individual of a covered countermeasure for which a Secretarial Declaration has been issued, pursuant to section 319F-3(b) of the Public Health Service Act. Additionally, authority is provided to address any unexpected claims that may arise under the Smallpox Emergency Personal Protection Act of 2003.


Identification code 75–0343–0–1–551		2011 actual	2012 est.	2013 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	1	1	1
25.3	Other goods and services from Federal sources	2	2	2
42.0	Insurance claims and indemnities		2	2

99.9	Total new obligations	3	5	5


Identification code 75–0343–0–1–551		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment	4	4	4
1101	Direct military average strength employment	1	1	1


Identification code 75–0321–0–1–551		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0010	Maternal, Infant, and Early Childhood Home Visiting Programs	250	350	400

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	250	350	400

1260	Appropriations, mandatory (total)	250	350	400
1930	Total budgetary resources available	250	350	400

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	99	313	577
3030	Obligations incurred, unexpired accounts	250	350	400
3040	Outlays (gross)	–36	–86	–359
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	313	577	618

3100	Obligated balance, end of year (net)	313	577	618

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	250	350	400
	Outlays, gross:
4100	Outlays from new mandatory authority	17	25	28
4101	Outlays from mandatory balances	19	61	331

4110	Outlays, gross (total)	36	86	359
4180	Budget authority, net (total)	250	350	400
4190	Outlays, net (total)	36	86	359

P.L. 111–148 provides resources to Maternal, Infant and Early Childhood Home Visiting Program through FY 2014 to provide comprehensive services for at risk communities. These activities are administered by HRSA.


Identification code 75–0321–0–1–551		2011 actual	2012 est.	2013 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	2	2	2
12.1	Civilian personnel benefits	1	1	1
25.1	Advisory and assistance services	15	15	15
41.0	Grants, subsidies, and contributions	232	332	382

99.9	Total new obligations	250	350	400


Identification code 75–0321–0–1–551		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment	16	16	16
1101	Direct military average strength employment	3	3	3


Identification code 75–4442–0–3–551		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
	Credit program obligations:
0711	Default claim payments on principal		1	1

0900	Total new obligations		1	1

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	2	3	2
	Financing authority:
	Spending authority from offsetting collections, mandatory:
1800	Collected	1

1850	Spending auth from offsetting collections, mand (total)	1
1930	Total budgetary resources available	3	3	2
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	3	2	1

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)			1
3030	Obligations incurred, unexpired accounts		1	1
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)		1	2

3100	Obligated balance, end of year (net)		1	2

	Financing authority and disbursements, net:
	Mandatory:
4090	Financing authority, gross	1
	Offsets against gross financing authority and disbursements:
	Offsetting collections (collected) from:
4120	Federal sources	–1
4190	Financing disbursements, net (total)	–1


Identification code 75–4442–0–3–551		2011 actual	2012 est.	2013 est.

	Position with respect to appropriations act limitation on commitments:
2121	Limitation available from carry-forward	60	28	13
2143	Uncommitted limitation carried forward	–28	–13

2150	Total guaranteed loan commitments	32	15	13
2199	Guaranteed amount of guaranteed loan commitments	26	13	10

	Cumulative balance of guaranteed loans outstanding:
2210	Outstanding, start of year	65	80	82
2231	Disbursements of new guaranteed loans	25	13	10
2251	Repayments and prepayments	–10	–10	–10
2263	Adjustments: Terminations for default that result in claim payments		–1	–1

2290	Outstanding, end of year	80	82	81

	Memorandum:
2299	Guaranteed amount of guaranteed loans outstanding, end of year	72	69	68

P.L. 104–299 and P.L. 104–208 authorize Health Resources and Services Administration (HRSA) to guarantee up to $160 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.


Identification code 75–4442–0–3–551		2010 actual	2011 actual

	ASSETS:
1101	Federal assets: Fund balances with Treasury	4	3

1999	Total assets	4	3
	LIABILITIES:
2204	Non-Federal liabilities: Liabilities for loan guarantees	4	3

4999	Total liabilities and net position	4	3

Such sums as may be necessary to carry out the purpose of the program, as authorized by title VII of the PHS Act.

In addition, [For] for administrative expenses to carry out the guaranteed loan program, including section 709 of the PHS Act, [$2,841,000] $2,807,000. (Department of Health and Human Services Appropriations Act, 2012.)


Identification code 75–0340–0–1–552		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
	Credit program obligations:
0707	Reestimates of loan guarantee subsidy	13
0708	Interest on reestimates of loan guarantee subsidy	14
0709	Administrative expenses	2	3

0900	Total new obligations	29	3

	Budgetary Resources:
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	3	3	3
1120	Appropriations transferred to other accts [91–0202]			–3

1160	Appropriation, discretionary (total)	3	3
	Appropriations, mandatory:
1200	Appropriation	26

1260	Appropriations, mandatory (total)	26
1900	Budget authority (total)	29	3
1930	Total budgetary resources available	29	3

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	2	2	2
3030	Obligations incurred, unexpired accounts	29	3
3040	Outlays (gross)	–29	–3
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	2	2	2

3100	Obligated balance, end of year (net)	2	2	2

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	3	3
	Outlays, gross:
4010	Outlays from new discretionary authority	2	3
4011	Outlays from discretionary balances	1

4020	Outlays, gross (total)	3	3
	Mandatory:
4090	Budget authority, gross	26
	Outlays, gross:
4100	Outlays from new mandatory authority	26
4180	Budget authority, net (total)	29	3
4190	Outlays, net (total)	29	3

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


Identification code 75–0340–0–1–552		2011 actual	2012 est.	2013 est.

	Guaranteed loan upward reestimates:
235001	HEAL Loan guarantee	26

235999	Total upward reestimate budget authority	26
	Guaranteed loan downward reestimates:
237001	HEAL Loan guarantee		–12

237999	Total downward reestimate subsidy budget authority		–12

	Administrative expense data:
3510	Budget authority	3	3
3590	Outlays from new authority	3

In FY 2013 the Department of Education will assume responsibility for the program. Legislative language that would effect this transfer is included under General Provisions. The authority to administer, service, collect, and enforce the program as well as the functions, assets, and liabilities of the Secretary of Health and Human Services will be permanently transferred to the Secretary of Education.


Identification code 75–0340–0–1–552		2011 actual	2012 est.	2013 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	2	3
25.3	Other goods and services from Federal sources	1
41.0	Grants, subsidies, and contributions	26

99.9	Total new obligations	29	3


Identification code 75–0340–0–1–552		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment	13	13


Identification code 75–4304–0–3–552		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
	Credit program obligations:
0711	Default claim payments on principal	15	14
0742	Downward reestimate paid to receipt account		5
0743	Interest on downward reestimates		7

0900	Total new obligations	15	26

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	49	70	52
1010	Unobligated balance transfer to other accts [91–4300]			–52

1050	Unobligated balance (total)	49	70
	Financing authority:
	Spending authority from offsetting collections, mandatory:
1800	Collected	36	8

1850	Spending auth from offsetting collections, mand (total)	36	8
1900	Financing authority(total)	36	8
1930	Total budgetary resources available	85	78
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	70	52

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts	15	26
3040	Financing disbursements (gross)	–15	–26

	Financing authority and disbursements, net:
	Mandatory:
4090	Financing authority, gross	36	8
	Financing disbursements:
4110	Financing disbursements, gross	15	26
	Offsets against gross financing authority and disbursements:
	Offsetting collections (collected) from:
4120	Federal sources - upward reestimates and interest	–26
4122	Interest on uninvested funds	–4	–4
4123	Recoveries of defaulted loans	–6	–4

4130	Offsets against gross financing auth and disbursements (total)	–36	–8
4170	Financing disbursements, net (mandatory)	–21	18
4190	Financing disbursements, net (total)	–21	18


Identification code 75–4304–0–3–552		2011 actual	2012 est.	2013 est.

	Cumulative balance of guaranteed loans outstanding:
2210	Outstanding, start of year	627	526	499
2251	Repayments and prepayments	–86	–13
	Adjustments:
2261	Terminations for default that result in loans receivable	–14	–10
2263	Terminations for default that result in claim payments	–1	–4
2264	Other adjustments, net			–499

2290	Outstanding, end of year	526	499

	Memorandum:
2299	Guaranteed amount of guaranteed loans outstanding, end of year	526	499

	Addendum:
	Cumulative balance of defaulted guaranteed loans that result in loans receivable:
2310	Outstanding, start of year	171	175	181
2331	Disbursements for guaranteed loan claims	14	10
2351	Repayments of loans receivable	–6	–4
2361	Write-offs of loans receivable	–1
2364	Other adjustments, net	–3		–181

2390	Outstanding, end of year	175	181


Identification code 75–4304–0–3–552		2010 actual	2011 actual

	ASSETS:
1101	Federal assets: Fund balances with Treasury	49	70
	Net value of assets related to post-1991 acquired defaulted guaranteed loans receivable:
1501	Defaulted guaranteed loans receivable, gross	171	175
1505	Allowance for subsidy cost (-)	–126	–126

1599	Net present value of assets related to defaulted guaranteed loans	45	49

1999	Total assets	94	119
	LIABILITIES:
2204	Non-Federal liabilities: Liabilities for loan guarantees	94	119

4999	Total liabilities and net position	94	119


Identification code 75–4305–0–3–552		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
	Credit program obligations:
0711	Default claim payments on principal	3	2

0900	Total new obligations (object class 33.0)	3	2

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	1	1

1260	Appropriations, mandatory (total)	1	1
	Spending authority from offsetting collections, mandatory:
1800	Collected	9	10
1820	Capital transfer of spending authority from offsetting collections to general fund	–7	–9

1850	Spending auth from offsetting collections, mand (total)	2	1
1900	Budget authority (total)	3	2
1930	Total budgetary resources available	3	2

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts	3	2
3040	Outlays (gross)	–3	–2

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	3	2
	Outlays, gross:
4100	Outlays from new mandatory authority	3	2
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–9	–10
4180	Budget authority, net (total)	–6	–8
4190	Outlays, net (total)	–6	–8


Identification code 75–4305–0–3–552		2011 actual	2012 est.	2013 est.

	Cumulative balance of guaranteed loans outstanding:
2210	Outstanding, start of year	103	83	69
2251	Repayments and prepayments	–17	–12
	Adjustments:
2261	Terminations for default that result in loans receivable	–3	–2
2264	Other adjustments, net			–69

2290	Outstanding, end of year	83	69

	Memorandum:
2299	Guaranteed amount of guaranteed loans outstanding, end of year	83	68

	Addendum:
	Cumulative balance of defaulted guaranteed loans that result in loans receivable:
2310	Outstanding, start of year	379	362	346
2331	Disbursements for guaranteed loan claims	3	3
2351	Repayments of loans receivable	–9	–8
2361	Write-offs of loans receivable	–21	–21
2364	Other adjustments, net	10	10	–346

2390	Outstanding, end of year	362	346


Identification code 75–4305–0–3–552		2010 actual	2011 actual

	ASSETS:
1101	Federal assets: Fund balances with Treasury	1	1
1701	Defaulted guaranteed loans, gross	379	362
1703	Allowance for estimated uncollectible loans and interest (-)	–250	–238

1799	Value of assets related to loan guarantees	129	124

1999	Total assets	130	125
	LIABILITIES:
2104	Federal liabilities: Resources payable to Treasury	122	119
2204	Non-Federal liabilities: Liabilities for loan guarantees	8	6

2999	Total liabilities	130	125

4999	Total liabilities and net position	130	125


Identification code 75–9931–0–3–551		2011 actual	2012 est.	2013 est.

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	1	1	1
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	1	1	1

3100	Obligated balance, end of year (net)	1	1	1


Identification code 75–9931–0–3–551		2011 actual	2012 est.	2013 est.

	Cumulative balance of direct loans outstanding:
1210	Outstanding, start of year	7	7	7
1251	Repayments: Repayments and prepayments

1290	Outstanding, end of year	7	7	7

Titles VI and 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.


Identification code 75–9931–0–3–551		2010 actual	2011 actual

	ASSETS:
1601	Direct loans, gross	7	7

1999	Total assets	7	7
	LIABILITIES:
2201	Non-Federal liabilities: Accounts payable	7	7

4999	Total liabilities and net position	7	7

Trust Funds

For payments from the Vaccine Injury Compensation Program Trust Fund ("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 PHS Act, to remain available until expended: Provided, That for necessary administrative expenses, not to exceed [$6,489,000] $6,477,000 shall be available from the Trust Fund to the Secretary. (Department of Health and Human Services Appropriations Act, 2012.)


Identification code 75–8175–0–7–551		2011 actual	2012 est.	2013 est.

0100	Balance, start of year	2,960	3,115	3,205
	Adjustments:
0190	Adjustment - rounding	–1

0199	Balance, start of year	2,959	3,115	3,205
	Receipts:
0200	Deposits, Vaccine Injury Compensation Trust Fund	278	274	283
0240	Interest and Profits on Investments, Vaccine Injury Compensation Trust Fund	126	70	74

0299	Total receipts and collections	404	344	357

0400	Total: Balances and collections	3,363	3,459	3,562
	Appropriations:
0500	Vaccine Injury Compensation Program Trust Fund	–19	–19	–19
0501	Vaccine Injury Compensation Program Trust Fund	–229	–235	–242

0599	Total appropriations	–248	–254	–261

0799	Balance, end of year	3,115	3,205	3,301


Identification code 75–8175–0–7–551		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Compensation: Claims for post - FY 1989 injuries	231	235	242
0103	Claims processing (Claims Court)	5	5	5
0104	Claims processing (HRSA)	6	6	6
0105	Claims processing (Dept. of Justice)	6	8	8

0191	Total, administrative expenses	17	19	19

0799	Total direct obligations	248	254	261
0801	Reimbursable program activity (claims)	3

0900	Total new obligations	251	254	261

	Budgetary Resources:
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust fund)	19	19	19

1160	Appropriation, discretionary (total)	19	19	19
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	229	235	242

1260	Appropriations, mandatory (total)	229	235	242
	Spending authority from offsetting collections, mandatory:
1800	Collected	3

1850	Spending auth from offsetting collections, mand (total)	3
1900	Budget authority (total)	251	254	261
1930	Total budgetary resources available	251	254	261

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	16	19	9
3030	Obligations incurred, unexpired accounts	251	254	261
3040	Outlays (gross)	–248	–264	–269
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	19	9	1

3100	Obligated balance, end of year (net)	19	9	1

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	19	19	19
	Outlays, gross:
4010	Outlays from new discretionary authority		19	19
4011	Outlays from discretionary balances	13	10	8

4020	Outlays, gross (total)	13	29	27
	Mandatory:
4090	Budget authority, gross	232	235	242
	Outlays, gross:
4100	Outlays from new mandatory authority	232	235	242
4101	Outlays from mandatory balances	3

4110	Outlays, gross (total)	235	235	242
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–3
4180	Budget authority, net (total)	248	254	261
4190	Outlays, net (total)	245	264	269

	Memorandum (non-add) entries:
5000	Total investments, SOY: Federal securities: Par value	2,939	3,108	3,452
5001	Total investments, EOY: Federal securities: Par value	3,108	3,452	3,809

The Vaccine Injury Compensation Program was established pursuant to P.L. 99–660 and P.L. 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.


Identification code 75–8175–0–7–551		2011 actual	2012 est.	2013 est.

	Direct obligations:
25.3	Other goods and services from Federal sources	17	19	19
42.0	Insurance claims and indemnities	231	235	242

99.0	Direct obligations	248	254	261
99.0	Reimbursable obligations	3

99.9	Total new obligations	251	254	261

Federal Funds

For expenses necessary to carry out the Act of August 5, 1954 (68 Stat. 674), the Indian Self-Determination Act, the Indian Health Care Improvement Act, and titles II and III of the Public Health Service Act with respect to the Indian Health Service, [$3,872,377,000,] $3,978,974,000, together with payments received during the fiscal year pursuant to 42 U.S.C. 238(b) and 238b 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 [$844,927,000] $897,562,000 for contract medical care, including $51,500,000 for the Indian Catastrophic Health Emergency Fund, shall remain available until expended: Provided further, That of the funding provided for information technology activities and, notwithstanding any other provision of law, $4,000,000 shall be allocated at the discretion of the Director of the Indian Health Service: Provided further, That of the funds provided, up to $36,000,000 shall remain available until expended for implementation of the loan repayment program under section 108 of the Indian Health Care Improvement Act: Provided further, That the amounts collected by the Federal Government as authorized by sections 104 and 108 of the Indian Health Care Improvement Act (25 U.S.C. 1613a and 1616a) during the preceding fiscal year for breach of contracts shall be deposited to the Fund authorized by section 108A of the Act (25 U.S.C. 1616a-1) and shall remain available until expended and, notwithstanding section 108A(c) of the Act (25 U.S.C. 1616a-1(c)), funds shall be available to make new awards under the loan repayment and scholarship programs under sections 104 and 108 of the Act (25 U.S.C. 1613a and 1616a): Provided further, That notwithstanding any other provision of law, the amounts made available within this account for the methamphetamine and suicide prevention and treatment initiative and for the domestic violence prevention initiative shall be allocated at the discretion of the Director of the Indian Health Service and shall remain available until expended: Provided further, That funds provided in this Act may be used for annual contracts and grants that fall within 2 fiscal years, provided the total obligation is recorded in the year 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, except for those related to the planning, design, or construction of new facilities: Provided further, That funding contained herein 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 [$472,193,000] $476,446,000 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 2012, of which not to exceed $10,000,000 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 the Bureau of Indian Affairs may collect from the Indian Health Service, tribes and tribal organizations operating health facilities pursuant to Public Law 93–638, such individually identifiable health information relating to disabled children as may be necessary for the purpose of carrying out its functions under the Individuals with Disabilities Education Act (20 U.S.C. 1400, et seq.): Provided further, That the Indian Health Care Improvement Fund may be used, as needed, to carry out activities typically funded under the Indian Health Facilities account. (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2012.)


Identification code 75–0390–0–1–551		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Clinical services	2,987	3,084	3,187
0002	Preventive health	144	147	151
0003	Urban health	43	43	43
0004	Indian health professions	41	41	41
0005	Tribal management	3	3	3
0006	Direct operations	69	72	73
0007	Self-governance	6	6	6
0008	Contract support costs	398	471	476
0009	Diabetes funds	121	150	150

0799	Total direct obligations	3,812	4,017	4,130
0801	Reimbursable program	1,125	1,132	1,132

0900	Total new obligations	4,937	5,149	5,262

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	434	744	776
1021	Recoveries of prior year unpaid obligations	179

1050	Unobligated balance (total)	613	744	776
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	3,673	3,872	3,979
1120	Transferred to other accounts [75–0390]	–43
1121	Transferred from other accounts [75–0390]	43
1130	Appropriations permanently reduced	–7
1141	Approp permanently reduced (Sec 436, HR 2055)		–6

1160	Appropriation, discretionary (total)	3,666	3,866	3,979
	Appropriations, mandatory:
1200	Appropriation	150	150	150

1260	Appropriations, mandatory (total)	150	150	150
	Spending authority from offsetting collections, discretionary:
1700	Collected	1,155	1,165	1,165
1701	Change in uncollected payments, Federal sources	103

1750	Spending auth from offsetting collections, disc (total)	1,258	1,165	1,165
1900	Budget authority (total)	5,074	5,181	5,294
1930	Total budgetary resources available	5,687	5,925	6,070
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–6
1941	Unexpired unobligated balance, end of year	744	776	808

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	1,076	866	459
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–233	–331	–331

3020	Obligated balance, start of year (net)	843	535	128
3030	Obligations incurred, unexpired accounts	4,937	5,149	5,262
3031	Obligations incurred, expired accounts	22
3040	Outlays (gross)	–4,973	–5,556	–5,482
3050	Change in uncollected pymts, Fed sources, unexpired	–103
3051	Change in uncollected pymts, Fed sources, expired	5
3080	Recoveries of prior year unpaid obligations, unexpired	–179
3081	Recoveries of prior year unpaid obligations, expired	–17
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	866	459	239
3091	Uncollected pymts, Fed sources, end of year	–331	–331	–331

3100	Obligated balance, end of year (net)	535	128	–92

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	4,924	5,031	5,144
	Outlays, gross:
4010	Outlays from new discretionary authority	4,078	4,335	4,428
4011	Outlays from discretionary balances	839	1,068	898

4020	Outlays, gross (total)	4,917	5,403	5,326
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–366	–368	–368
4033	Non-Federal sources	–792	–797	–797

4040	Offsets against gross budget authority and outlays (total)	–1,158	–1,165	–1,165
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–103
4052	Offsetting collections credited to expired accounts	3

4060	Additional offsets against budget authority only (total)	–100

4070	Budget authority, net (discretionary)	3,666	3,866	3,979
4080	Outlays, net (discretionary)	3,759	4,238	4,161
	Mandatory:
4090	Budget authority, gross	150	150	150
	Outlays, gross:
4100	Outlays from new mandatory authority	56	144	144
4101	Outlays from mandatory balances		9	12

4110	Outlays, gross (total)	56	153	156
4180	Budget authority, net (total)	3,816	4,016	4,129
4190	Outlays, net (total)	3,815	4,391	4,317

The Indian Health Services account provides medical care, public health services, and health professions training opportunities to American Indians and Alaska Natives. An estimated $2.653 billion primarily through self determination contracts and compacts, will be administered by tribal governments in 2012.


Identification code 75–0390–0–1–551		2011 actual	2012 est.	2013 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	388	390	396
11.3	Other than full-time permanent	21	21	21
11.5	Other personnel compensation	57	58	58
11.7	Military personnel	78	79	82

11.9	Total personnel compensation	544	548	557
12.1	Civilian personnel benefits	136	137	139
12.2	Military personnel benefits	34	34	36
13.0	Benefits for former personnel	10	10	10
21.0	Travel and transportation of persons	12	11	13
21.0	Patient travel	30	30	30
22.0	Transportation of things	7	7	7
23.1	Rental payments to GSA	12	12	13
23.2	Rental payments to others	1	1	1
23.3	Communications, utilities, and miscellaneous charges	11	11	12
24.0	Printing and reproduction	1
25.1	Advisory and assistance services	13	10	10
25.2	Other services from non-Federal sources	80	102	114
25.3	Other goods and services from Federal sources	62	62	63
25.4	Operation and maintenance of facilities		4	4
25.6	Medical care	342	459	499
25.7	Operation and maintenance of equipment	12	12	12
25.8	Subsistence and support of persons	3	3	3
26.0	Supplies and materials	136	142	146
31.0	Equipment	14	14	14
32.0	Land and structures		1	1
41.0	Grants, subsidies, and contributions	2,351	2,406	2,446
42.0	Insurance claims and indemnities	1	1

99.0	Direct obligations	3,812	4,017	4,130
99.0	Reimbursable obligations	1,125	1,132	1,132

99.9	Total new obligations	4,937	5,149	5,262


Identification code 75–0390–0–1–551		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment	6,982	7,127	7,249
1101	Direct military average strength employment	1,090	1,103	1,112
2001	Reimbursable civilian full-time equivalent employment	5,349	5,356	5,362
2101	Reimbursable military average strength employment	835	828	822

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, [$441,052,000] $443,502,000, to remain available until expended: Provided, That notwithstanding any other provision of law, funds appropriated for the planning, design, construction, renovation or expansion of health facilities for the benefit of an Indian tribe or tribes may be used to purchase land on which such facilities will be located: 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 $2,700,000 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, to remain available until expended, and be used by the Indian Health Service for the demolition of Federal buildings. (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2012.)


Identification code 75–0391–0–1–551		2011 actual	2012 est.	2013 est.

0100	Balance, start of year
	Receipts:
0220	Rent and Charges for Quarters, Indian Health Service	8	8	8

0400	Total: Balances and collections	8	8	8
	Appropriations:
0500	Indian Health Facilities	–8	–8	–8

0799	Balance, end of year


Identification code 75–0391–0–1–551		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Sanitation and health facilities	154	165	161
0002	Maintenance	54	54	55
0003	Facilities and environmental health	193	199	205
0004	Equipment	23	23	23

0100	Total direct program	424	441	444

0799	Total direct obligations	424	441	444
0801	Reimbursable program	183	183	183

0900	Total new obligations	607	624	627

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	181	215	243
1021	Recoveries of prior year unpaid obligations	25

1050	Unobligated balance (total)	206	215	243
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	405	441	444
1130	Appropriations permanently reduced	–1
1141	Approp permanently reduced (Sec 436, HR 2055)		–1

1160	Appropriation, discretionary (total)	404	440	444
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	8	8	8

1260	Appropriations, mandatory (total)	8	8	8
	Spending authority from offsetting collections, discretionary:
1700	Collected	191	191	6
1701	Change in uncollected payments, Federal sources	13	13

1750	Spending auth from offsetting collections, disc (total)	204	204	6
1900	Budget authority (total)	616	652	458
1930	Total budgetary resources available	822	867	701
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	215	243	74

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	550	580	432
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–8	–21	–34

3020	Obligated balance, start of year (net)	542	559	398
3030	Obligations incurred, unexpired accounts	607	624	627
3040	Outlays (gross)	–552	–772	–411
3050	Change in uncollected pymts, Fed sources, unexpired	–13	–13
3080	Recoveries of prior year unpaid obligations, unexpired	–25
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	580	432	648
3091	Uncollected pymts, Fed sources, end of year	–21	–34	–34

3100	Obligated balance, end of year (net)	559	398	614

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	608	644	450
	Outlays, gross:
4010	Outlays from new discretionary authority	260	336	139
4011	Outlays from discretionary balances	287	428	264

4020	Outlays, gross (total)	547	764	403
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–190	–190	–6
4033	Non-Federal sources	–1	–1

4040	Offsets against gross budget authority and outlays (total)	–191	–191	–6
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–13	–13

4070	Budget authority, net (discretionary)	404	440	444
4080	Outlays, net (discretionary)	356	573	397
	Mandatory:
4090	Budget authority, gross	8	8	8
	Outlays, gross:
4100	Outlays from new mandatory authority	3	8	8
4101	Outlays from mandatory balances	2

4110	Outlays, gross (total)	5	8	8
4180	Budget authority, net (total)	412	448	452
4190	Outlays, net (total)	361	581	405

The Indian Health Facilities account supports construction, repair and improvement, equipment, and environmental health and facilities support for the Indian Health Service.


Identification code 75–0391–0–1–551		2011 actual	2012 est.	2013 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	47	49	51
11.3	Other than full-time permanent	4	4	4
11.5	Other personnel compensation	3	3	3
11.7	Military personnel	22	23	24

11.9	Total personnel compensation	76	79	82
12.1	Civilian personnel benefits	15	16	16
12.2	Military personnel benefits	8	8	8
21.0	Travel and transportation of persons	3	3	3
22.0	Transportation of things	3	3	3
23.1	Rental payments to GSA	2	2	2
23.3	Communications, utilities, and miscellaneous charges	14	16	16
25.1	Advisory and assistance services	2	2	2
25.2	Other services from non-Federal sources	64	55	55
25.3	Other goods and services from Federal sources	1	1	2
25.4	Operation and maintenance of facilities	6	7	8
25.7	Operation and maintenance of equipment	3	3	4
25.8	Subsistence and support of persons	11	11	11
26.0	Supplies and materials	7	8	8
31.0	Equipment	8	9	9
32.0	Land and structures	23	17	17
41.0	Grants, subsidies, and contributions	178	201	198

99.0	Direct obligations	424	441	444
99.0	Reimbursable obligations	183	183	183

99.9	Total new obligations	607	624	627


Identification code 75–0391–0–1–551		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment	1,036	1,008	1,011
1101	Direct military average strength employment	168	167	169
2001	Reimbursable civilian full-time equivalent employment	25	25	25

Appropriations provided in this Act to the Indian Health Service shall be available for services as authorized by 5 U.S.C. 3109 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; uniforms or allowances therefor as authorized by 5 U.S.C. 5901–5902; and for expenses of attendance at meetings that relate to the functions or activities of the Indian Health Service: Provided, That in accordance with the provisions of the Indian Health Care Improvement Act, non-Indian patients may be extended health care at all tribally administered or Indian Health Service facilities, subject to charges, and the proceeds along with funds recovered under the Federal Medical Care Recovery Act (42 U.S.C. 2651–2653) shall be credited to the account of the facility providing the service and shall be available without fiscal year limitation: Provided further, That notwithstanding any other law or regulation, funds transferred from the Department of Housing and Urban Development to the Indian Health Service shall be administered under Public Law 86–121, the Indian Sanitation Facilities Act and Public Law 93–638, as amended: Provided further, That funds appropriated to the Indian Health Service in this Act, except those used for administrative and program direction purposes, shall not be subject to limitations directed at curtailing Federal travel and transportation: Provided further, That 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: Provided further, That notwithstanding any other provision of law, funds previously or herein made available to a tribe or tribal organization through a contract, grant, or agreement authorized by title I or title V 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 V of such Act and thereafter shall remain available to the tribe or tribal organization without fiscal year limitation: Provided further, That none of the funds made available to the Indian Health Service in this Act shall be used to implement the final rule published in the Federal Register on September 16, 1987, by the Department of Health and Human Services, relating to the eligibility for the health care services of the Indian Health Service until the Indian Health Service has submitted a budget request reflecting the increased costs associated with the proposed final rule, and such request has been included in an appropriations Act and enacted into law: Provided further, That 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 payments in advance with subsequent adjustment, and the reimbursements received therefrom, along with the funds received from those entities pursuant to the Indian Self-Determination Act, may be credited to the same or subsequent appropriation account from which the funds were originally derived, with such amounts to remain available until expended: Provided further, That reimbursements for training, technical assistance, or services provided by the Indian Health Service will contain total costs, including direct, administrative, and overhead associated with the provision of goods, services, or technical assistance: Provided further, That the appropriation structure for the Indian Health Service may not be altered without advance notification to the House and Senate Committees on Appropriations. (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2012.)

Federal Funds

For carrying out titles II, III, VII, XVII, and XXI, and section 2821 of the PHS Act, titles II and IV of the Immigration and Nationality Act, and section 501 of the Refugee Education Assistance Act, with respect to immunization and respiratory diseases, [$579,375,000] $583,855,000: Provided, That in addition to amounts provided herein, [$12,864,000] $13,765,000 shall be available from amounts available under section 241 of the PHS Act to carry out the National Immunization Surveys.

For carrying out titles II, III, VII, XVII, XXIII, and XXVI of the PHS Act with respect to HIV/AIDS, viral hepatitis, sexually transmitted diseases, and tuberculosis prevention, [$1,105,995,000] $1,145,678,000: Provided, That Centers for Disease Control and Prevention and State grant recipients may transfer up to ten percent of funds appropriated for Centers for Disease Control and Prevention HIV/AIDS, sexually transmitted disease, hepatitis, and tuberculosis activities to address the overlapping epidemics of these diseases by improving program collaboration and providing integrated services in accordance with priorities identified by the Centers for Disease Control and Prevention: Provided further, That with respect to the previous proviso, grantees shall submit a plan in writing to the Centers for Disease Control and Prevention and obtain the approval of the Centers for Disease Control and Prevention to transfer such funds.

For carrying out titles II, III, VII, and XVII, and section 2821 of the PHS Act, titles II and IV of the Immigration and Nationality Act, and section 501 of the Refugee Education Assistance Act, with respect to emerging and zoonotic infectious diseases, [$253,919,000] $279,477,000, of which $1,000,000 shall remain available until expended to pay for the transportation, medical care, treatment, and other related costs of persons quarantined or isolated under federal or state quarantine laws.

For carrying out titles II, III, VII, XI, XV, XVII, and XIX of the PHS Act and section 4201 of the Patient Protection and Affordable Care Act, with respect to chronic disease prevention and health promotion, [$760,700,000] $608,019,000: Provided, That, in addition to amounts provided herein, $25,000,000 shall be available from amounts available under section 241 of the PHS Act to carry out the Prevention Research Centers: Provided further, That funds appropriated under this account may be available for making grants under section 1509 of the PHS Act for [not less than] up to 21 States, tribes, or tribal organizations.

For carrying out titles II, III, VII, XI, and XVII of the PHS Act with respect to birth defects, developmental disabilities, disabilities and health, [$138,072,000] $18,476,000.

For carrying out titles II and III of the PHS Act with respect to health statistics, surveillance, informatics, and workforce development, [$144,795,000] $35,695,000: Provided, That in addition to amounts provided herein, [$247,769,000] $379,374,000 shall be available from amounts available under section 241 of the PHS Act to carry out Public Health Scientific Services.

For carrying out titles II, III, VII, and XVII of the PHS Act with respect to environmental health, [$105,598,000] $103,672,000.

For carrying out titles II, III, VII, and XVII of the PHS Act with respect to injury prevention and control, [$138,480,000] $137,754,000: Provided, That funds appropriated under this heading may be used to fund evaluation, research, and pilot programs for sexual violence prevention programs.

For carrying out titles II, III, VII, and XVII of the PHS Act, sections 101, 102, 103, 201, 202, 203, 301, 501, and 514 of the Federal Mine Safety and Health Act, section 13 of the Mine Improvement and New Emergency Response Act, and sections 20, 21, and 22 of the Occupational Safety and Health Act, with respect to occupational safety and health, [$182,903,000: Provided, That in addition to amounts provided herein, $110,724,000] $249,364,000 shall be available from amounts available under section 241 of the PHS Act.

For necessary expenses to administer the Energy Employees Occupational Illness Compensation Program Act, $55,358,000, to remain available until expended[, of which $4,500,000 shall be for use by or in support of the Advisory Board on Radiation and Worker Health ("Board'') to carry out its statutory responsibilities, including obtaining audits, technical assistance, and other support from the Board's audit contractor with regard to radiation dose estimation and reconstruction efforts, site profiles, procedures, and review of Special Exposure Cohort petitions and evaluation reports]: Provided, That this amount shall be available consistent with the provision regarding administrative expenses in section 151(b) of division B, title I of Public Law 106–554.

For carrying out titles II, III, VII and XVII of the PHS Act with respect to global health, [$349,547,000] $362,889,000, of which [$118,023,000] $117,156,000 for international HIV/AIDS shall remain available through September 30, [2013] 2014: Provided, That funds may be used for purchase and insurance of official motor vehicles in foreign countries.

For carrying out titles II, III, VII, and XVII of the PHS Act with respect to public health preparedness and response, and for expenses necessary to support activities related to countering potential biological, nuclear, radiological, and chemical threats to civilian populations, [$1,306,906,000] $1,228,360,000, of which [$509,486,000] $439,444,000 shall remain available until expended for the Strategic National Stockpile [under] pursuant to section 319F-2 of the PHS Act.

For carrying out titles II, III, VII, XVII and XIX, and section 2821 of the PHS Act and for cross-cutting activities and program support that supplement activities funded under the headings "Immunization and Respiratory Diseases'', "HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention'', "Emerging and Zoonotic Infectious Diseases'', "Chronic Disease Prevention and Health Promotion'', "Birth Defects, Developmental Disabilities, Disabilities and Health'', "Environmental Health'', "Injury Prevention and Control'', "National Institute for Occupational Safety and Health'', "Employees Occupational Illness Compensation Program Act'', "Global Health'', "Public Health Preparedness and Response'', and "Public Health Scientific Services'', and for carrying out section 4001 of the Patient Protection and Affordable Care Act, [$621,445,000] $487,648,000 of which [$30,000,000] $368,529,000 shall be available until September 30, [2013] 2014, for business services[, of which $25,000,000 shall be available until September 30, 2016, for equipment, construction and renovation of facilities, and of which $80,000,000 shall be for the Preventive Health and Health Services Block Grant Program]: Provided, That paragraphs (1) through (3) of subsection (b) of section 2821 of the PHS Act shall not apply to funds appropriated under this heading and in all other accounts of the Centers for Disease Control and Prevention (referred to in this title as "CDC''): Provided further, That funds appropriated under this heading and in all other accounts of CDC may be used to support the purchase, hire, maintenance, and operation of aircraft for use and support of the activities of CDC: Provided further, That employees of CDC or the Public Health Service, both civilian and commissioned officers, detailed to States, municipalities, or other organizations under authority of section 214 of the PHS Act, or in overseas assignments, 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 HHS during the period of detail or assignment: Provided further, That CDC may use up to $10,000 from amounts appropriated to CDC in this Act for official reception and representation expenses when specifically approved by the Director of CDC: Provided further, That in addition, such sums as may be derived from authorized user fees, which shall be credited to the appropriation charged with the cost thereof: Provided further, That with respect to the previous proviso, authorized user fees from the Vessel Sanitation Program shall be available through September 30, [2013] 2014: Provided further, That of the funds made available under this heading, up to $1,000 per eligible employee of CDC shall be made available until expended for Individual Learning Accounts: [Provided further, That CDC may establish a Working Capital Fund, with the authorities equivalent to those provided in 42 U.S.C. 231, to improve the provision of supplies and service] Provided further, That the Director may transfer funds between any of the accounts of CDC with notification to the Committees on Appropriations of both Houses of Congress at least 15 days in advance of any transfer, but no such account shall be decreased by more than 3 percent by any such transfer. (Department of Health and Human Services Appropriations Act, 2012.)


Identification code 75–0943–0–1–999		2011 actual	2012 est.	2013 est.

0100	Balance, start of year
	Receipts:
0220	Cooperative Research and Development Agreements, Centers for Disease Control	2	2	2

0400	Total: Balances and collections	2	2	2
	Appropriations:
0500	CDC-Wide Activities and Program Support	–2	–2	–2

0799	Balance, end of year


Identification code 75–0943–0–1–999		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Birth Defects, Developmental Disabilities, Disability and Health (BA & Prevention Fund)	136	137	125
0002	Buildings and Facilities	58	25
0003	Business Services Support	361	395	369
0004	Chronic Disease Prevention and Health Promotion	813	756	608
0005	Emerging and Zoonotic Infectious Diseases	252	252	280
0006	Energy Employee Illness Occupational Compensation Program Act (EEOICPA)	57	55	55
0007	Environmental Health	134	105	104
0008	Global Health	365	348	363
0009	Pandemic Influenza Supplemental (H1N1)	18
0010	Healthcare Reform Prevention and Public Health Fund, Other Activities	611	805	796
0011	Health Reform - Chronic Disease Prevention and Health Promotion	7
0012	HIV/AIDS, Viral Hepatitis, STD and TB Prevention	1,075	1,100	1,146
0013	Immunization and Respiratory Diseases	478	576	584
0014	Individual Learning Accounts (ILAs)	7
0015	Injury Prevention and Control	143	138	138
0016	Occupational Safety and Health	230	182
0017	Preventive Health & Health Services Block Grants	80	79
0018	Public Health Leadership & Support	120	119	119
0019	Public Health Preparedness & Response	1,321	1,300	1,228
0020	Public Health Scientific Services	147	144	35

0799	Total direct obligations	6,413	6,516	5,950
0802	Other Reimbursable Programs	622	749	749

0809	Reimbursable program activities, subtotal	622	749	749

0900	Total new obligations	7,035	7,265	6,699

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	283	192	161
1021	Recoveries of prior year unpaid obligations	20	4

1050	Unobligated balance (total)	303	196	161
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	5,660	5,668	4,992
1120	Appropriations transferred to other accts [75–0350]		–1
1130	Appropriations permanently reduced	–11
1143	Approp permanently reduced (Sec 527, HR 2055)		–11

1160	Appropriation, discretionary (total)	5,649	5,656	4,992
	Appropriations, mandatory:
1200	Appropriation	55	55	55
1201	Appropriation (special or trust fund)	2	2	2
1221	Appropriations transferred from other accts [75–0116]	611	805	903

1260	Appropriations, mandatory (total)	668	862	960
	Spending authority from offsetting collections, discretionary:
1700	Collected	310	712	712
1701	Change in uncollected payments, Federal sources	300

1750	Spending auth from offsetting collections, disc (total)	610	712	712
1900	Budget authority (total)	6,927	7,230	6,664
1930	Total budgetary resources available	7,230	7,426	6,825
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–3
1941	Unexpired unobligated balance, end of year	192	161	126

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	6,850	6,451	6,487
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–486	–468	–468

3020	Obligated balance, start of year (net)	6,364	5,983	6,019
3030	Obligations incurred, unexpired accounts	7,035	7,265	6,699
3031	Obligations incurred, expired accounts	31
3040	Outlays (gross)	–7,277	–7,225	–6,866
3050	Change in uncollected pymts, Fed sources, unexpired	–300
3051	Change in uncollected pymts, Fed sources, expired	318
3080	Recoveries of prior year unpaid obligations, unexpired	–20	–4
3081	Recoveries of prior year unpaid obligations, expired	–168
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	6,451	6,487	6,320
3091	Uncollected pymts, Fed sources, end of year	–468	–468	–468

3100	Obligated balance, end of year (net)	5,983	6,019	5,852

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	6,259	6,368	5,704
	Outlays, gross:
4010	Outlays from new discretionary authority	2,550	2,453	2,124
4011	Outlays from discretionary balances	4,519	4,441	3,975

4020	Outlays, gross (total)	7,069	6,894	6,099
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–606	–703	–703
4033	Non-Federal sources	–13	–9	–9

4040	Offsets against gross budget authority and outlays (total)	–619	–712	–712
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–300
4052	Offsetting collections credited to expired accounts	309

4060	Additional offsets against budget authority only (total)	9

4070	Budget authority, net (discretionary)	5,649	5,656	4,992
4080	Outlays, net (discretionary)	6,450	6,182	5,387
	Mandatory:
4090	Budget authority, gross	668	862	960
	Outlays, gross:
4100	Outlays from new mandatory authority	120	320	353
4101	Outlays from mandatory balances	88	11	414

4110	Outlays, gross (total)	208	331	767
4180	Budget authority, net (total)	6,317	6,518	5,952
4190	Outlays, net (total)	6,658	6,513	6,154

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 activities include immunization, HIV prevention, emerging and zoonotic infectious diseases, chronic disease prevention and health promotion, occupational safety and health, injury prevention and control, environmental health, global health, programs that reduce the occurrence of birth defects and developmental disabilities, and CDC-Wide Activities and Program Support. CDC also supports bioterrorism, emergency response, and pandemic influenza preparedness activities. The CDC Stockpile activities include resources directed at enhancing preparedness. The Budget will finance a portion of these ongoing activities through unobligated balances available from P.L. 111–32, the Supplemental Appropriations Act of 2009. P.L. 111–32 appropriated $7.65 billion to the Public Health and Social Services Emergency Fund for pandemic influenza preparedness and response activities.


Identification code 75–0943–0–1–999		2011 actual	2012 est.	2013 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	674	801	723
11.3	Other than full-time permanent	81	100	90
11.5	Other personnel compensation	38	43	38
11.7	Military personnel	62	71	66
11.8	Special personal services payments	1	1	1

11.9	Total personnel compensation	856	1,016	918
12.1	Civilian personnel benefits	231	273	247
12.2	Military personnel benefits	44	50	47
21.0	Travel and transportation of persons	49	49	40
22.0	Transportation of things	17	16	15
23.1	Rental payments to GSA	10	52	51
23.2	Rental payments to others	1	1	1
23.3	Communications, utilities, and miscellaneous charges	38	36	33
24.0	Printing and reproduction	5	6	5
25.1	Advisory and assistance services	581	498	439
25.2	Other services from non-Federal sources	237	211	189
25.3	Other goods and services from Federal sources	396	390	364
25.4	Operation and maintenance of facilities	74	50	46
25.5	Research and development contracts	51	68	62
25.6	Medical care	3	29	27
25.7	Operation and maintenance of equipment	33	35	32
25.8	Subsistence and support of persons (Includes 1259)	31	33	30
26.0	Supplies and materials	560	518	518
31.0	Equipment	58	55	55
32.0	Land and structures	41	9	8
41.0	Grants, subsidies, and contributions	3,097	3,121	2,823

99.0	Direct obligations	6,413	6,516	5,950
99.0	Reimbursable obligations	622	749	749

99.9	Total new obligations	7,035	7,265	6,699


Identification code 75–0943–0–1–999		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment	8,432	8,379	8,370
1101	Direct military average strength employment	814	771	771
2001	Reimbursable civilian full-time equivalent employment	1,077	1,082	1,081
2101	Reimbursable military average strength employment	38	81	81

The Consolidated Appropriations Bill, 2012 (P.L. 112–74, Division F) provided authorities equivalent to those provided in 42 U.S.C 231 for CDC to begin creating a Working Capital Fund. The Working Capital Fund will be used by CDC to achieve greater cost efficiencies across the administrative operations of the agency.

For necessary expenses for the Agency for Toxic Substances and Disease Registry (ATSDR) in carrying out activities set forth in sections 104(i) and 111(c)(4) 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, [$76,337,000] $76,300,000, of which up to $1,000 per eligible employee of the Agency for Toxic Substances and Disease Registry shall remain available until expended for Individual Learning Accounts: 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 healthcare 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 [2012] 2013, and existing profiles may be updated as necessary. (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2012.)


Identification code 75–0944–0–1–551		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Direct program	76	76	76
0002	Direct program - health reform	3

0799	Total direct obligations	79	76	76
0801	Reimbursable program	10	10	10

0900	Total new obligations	89	86	86

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	23	21	21
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	77	76	76

1160	Appropriation, discretionary (total)	77	76	76
	Spending authority from offsetting collections, discretionary:
1700	Collected	3	3	10
1701	Change in uncollected payments, Federal sources	7	7

1750	Spending auth from offsetting collections, disc (total)	10	10	10
1900	Budget authority (total)	87	86	86
1930	Total budgetary resources available	110	107	107
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	21	21	21

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	43	47	14
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–13	–13	–20

3020	Obligated balance, start of year (net)	30	34	–6
3030	Obligations incurred, unexpired accounts	89	86	86
3040	Outlays (gross)	–81	–119	–95
3050	Change in uncollected pymts, Fed sources, unexpired	–7	–7
3051	Change in uncollected pymts, Fed sources, expired	7
3081	Recoveries of prior year unpaid obligations, expired	–4
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	47	14	5
3091	Uncollected pymts, Fed sources, end of year	–13	–20	–20

3100	Obligated balance, end of year (net)	34	–6	–15

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	87	86	86
	Outlays, gross:
4010	Outlays from new discretionary authority	55	84	84
4011	Outlays from discretionary balances	26	26	3

4020	Outlays, gross (total)	81	110	87
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–10	–3	–10
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–7	–7
4052	Offsetting collections credited to expired accounts	7

4060	Additional offsets against budget authority only (total)		–7

4070	Budget authority, net (discretionary)	77	76	76
4080	Outlays, net (discretionary)	71	107	77
	Mandatory:
	Outlays, gross:
4101	Outlays from mandatory balances		9	8
4180	Budget authority, net (total)	77	76	76
4190	Outlays, net (total)	71	116	85

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.


Identification code 75–0944–0–1–551		2011 actual	2012 est.	2013 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	23	22	22
11.3	Other than full-time permanent	1	1	1
11.5	Other personnel compensation	1	1	1
11.7	Military personnel	4	4	4

11.9	Total personnel compensation	29	28	28
12.1	Civilian personnel benefits	7	7	7
12.2	Military personnel benefits	2	2	2
25.1	Advisory and assistance services	5	4	4
25.2	Other services from non-Federal sources	7	7	7
25.3	Other goods and services from Federal sources	11	11	11
26.0	Supplies and materials		1	1
31.0	Equipment		1	1
41.0	Grants, subsidies, and contributions	18	15	15

99.0	Direct obligations	79	76	76
99.0	Reimbursable obligations	10	10	10

99.9	Total new obligations	89	86	86


Identification code 75–0944–0–1–551		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment	259	258	258
1101	Direct military average strength employment	39	39	39
2001	Reimbursable civilian full-time equivalent employment	13	13	13


Identification code 75–0946–0–1–551		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Federal Share	71	174	171
0002	NYC	8	19	19

0900	Total new obligations	79	193	190

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation (WTC (CDC Direct))	79	174	171
1200	Appropriation (WTC—NYC DHSS—CDC)		19	19

1260	Appropriations, mandatory (total)	79	193	190
1930	Total budgetary resources available	79	193	190

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)		68	131
3030	Obligations incurred, unexpired accounts	79	193	190
3040	Outlays (gross)	–11	–130	–161
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	68	131	160

3100	Obligated balance, end of year (net)	68	131	160

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	79	193	190
	Outlays, gross:
4100	Outlays from new mandatory authority	11	65	64
4101	Outlays from mandatory balances		65	97

4110	Outlays, gross (total)	11	130	161
4180	Budget authority, net (total)	79	193	190
4190	Outlays, net (total)	11	130	161

HHS along with CDC began implementing provisions of The James Zadroga 9/11 Health and Compensation Act of 2010 (P.L.111–347) on July 1, 2011, to provide monitoring and treatment benefits to eligible responders and survivors. CDC/NIOSH serves as the Program Administrator for the WTC Health Program. The WTC Health Program provides quality care for WTC-related health conditions, conducts WTC research, and maintains a health registry to collect data on victims of the September 11, 2001, terrorist attacks. The amounts included for FY 2012 and FY 2013 Budget reflect estimated Federal obligations for the WTC Health Program.


Identification code 75–0946–0–1–551		2011 actual	2012 est.	2013 est.

	Direct obligations:
25.1	Advisory and assistance services	8	20	19
25.2	Other services from non-Federal sources	33	80	79
25.3	Other goods and services from Federal sources	2	10	10
25.6	Medical care	34	79	78
41.0	Grants, subsidies, and contributions	2	4	4

99.9	Total new obligations	79	193	190

Federal Funds

For carrying out section 301 and title IV of the PHS Act with respect to cancer, [$5,081,788,000] $5,068,864,000, of which up to $8,000,000 may be used for facilities repairs and improvements at the National Cancer Institute—Frederick Federally Funded Research and Development Center in Frederick, Maryland. (Department of Health and Human Services Appropriations Act, 2012.)

For carrying out section 301 and title IV of the PHS Act with respect to cardiovascular, lung, and blood diseases, and blood and blood products, [$3,084,851,000] $3,076,067,000. (Department of Health and Human Services Appropriations Act, 2012.)

For carrying out section 301 and title IV of the PHS Act with respect to dental and craniofacial diseases, [$411,488,000] $408,212,000. (Department of Health and Human Services Appropriations Act, 2012.)

For carrying out section 301 and title IV of the PHS Act with respect to diabetes and digestive and kidney disease, [$1,800,447,000] $1,792,107,000. (Department of Health and Human Services Appropriations Act, 2012.)

For carrying out section 301 and title IV of the PHS Act with respect to neurological disorders and stroke, [$1,629,445,000] $1,624,707,000. (Department of Health and Human Services Appropriations Act, 2012.)

For carrying out section 301 and title IV of the PHS Act with respect to allergy and infectious diseases, [$4,499,215,000] $4,495,307,000. (Department of Health and Human Services Appropriations Act, 2012.)

For carrying out section 301 and title IV of the PHS Act with respect to general medical sciences, [$2,434,637,000: Provided, That not less than $276,480,000 is provided for the Institutional Development Awards program] $2,378,835,000. (Department of Health and Human Services Appropriations Act, 2012.)

For carrying out section 301 and title IV of the PHS Act with respect to child health and human development, [$1,323,900,000] $1,320,600,000. (Department of Health and Human Services Appropriations Act, 2012.)

For carrying out section 301 and title IV of the PHS Act with respect to eye diseases and visual disorders, [$704,043,000] $693,015,000. (Department of Health and Human Services Appropriations Act, 2012.)

For carrying out section 301 and title IV of the PHS Act with respect to environmental health sciences, [$686,869,000] $684,030,000. (Department of Health and Human Services Appropriations Act, 2012.)

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, [$79,054,000] $78,928,000. (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2012.)

For carrying out section 301 and title IV of the PHS Act with respect to aging, [$1,105,530,000] $1,102,650,000. (Department of Health and Human Services Appropriations Act, 2012.)

For carrying out section 301 and title IV of the PHS Act with respect to arthritis and musculoskeletal and skin diseases, [$536,801,000] $535,610,000. (Department of Health and Human Services Appropriations Act, 2012.)

For carrying out section 301 and title IV of the PHS Act with respect to deafness and other communication disorders, [$417,061,000] $417,297,000. (Department of Health and Human Services Appropriations Act, 2012.)

For carrying out section 301 and title IV of the PHS Act with respect to nursing research, [$145,043,000] $144,153,000. (Department of Health and Human Services Appropriations Act, 2012.)

For carrying out section 301 and title IV of the PHS Act with respect to alcohol abuse and alcoholism, [$460,389,000] $457,104,000. (Department of Health and Human Services Appropriations Act, 2012.)

For carrying out section 301 and title IV of the PHS Act with respect to drug abuse, [$1,055,362,000] $1,054,001,000. (Department of Health and Human Services Appropriations Act, 2012.)

For carrying out section 301 and title IV of the PHS Act with respect to mental health, [$1,483,068,000] $1,479,204,000. (Department of Health and Human Services Appropriations Act, 2012.)

For carrying out section 301 and title IV of the PHS Act with respect to human genome research, [$513,844,000] $511,370,000. (Department of Health and Human Services Appropriations Act, 2012.)

For carrying out section 301 and title IV of the PHS Act with respect to biomedical imaging and bioengineering research, [$338,998,000] $336,896,000. (Department of Health and Human Services Appropriations Act, 2012.)

For carrying out section 301 and title IV of the PHS Act with respect to complementary and alternative medicine, [$128,299,000] $127,930,000. (Department of Health and Human Services Appropriations Act, 2012.)

For carrying out section 301 and title IV of the PHS Act with respect to minority health and health disparities research, [$276,963,000] $279,389,000. (Department of Health and Human Services Appropriations Act, 2012.)

For carrying out the activities of the John E. Fogarty International Center (described in subpart 2 of part E of title IV of the PHS Act), [$69,754,000] $69,758,000. (Department of Health and Human Services Appropriations Act, 2012.)

For carrying out section 301 and title IV of the PHS Act with respect to health information communications, [$338,278,000] $372,651,000, of which $4,000,000 shall be available until September 30, [2013] 2014, for improvement of information systems: Provided, That in fiscal year [2012] 2013, the National Library of Medicine 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 (referred to in this title as "NIH''): Provided further, That in addition to amounts provided herein, $8,200,000 shall be available from amounts available under section 241 of the PHS Act to carry out the purposes of the National Information Center on Health Services Research and Health Care Technology established under section 478A of the PHS Act and related health services. (Department of Health and Human Services Appropriations Act, 2012.)

For carrying out section 301 and title IV of the PHS Act with respect to translational sciences, [$576,456,000] $639,033,000: Provided, That up to [$10,000,000] $50,000,000 shall be available to implement section 402C of the PHS Act, relating to the Cures Acceleration Network[: Provided further, That funds appropriated may be used to support the reorganization and activities required to eliminate the National Center for Research Resources: Provided further, That the Director of the NIH shall ensure that, of all funds made available to Institute, Center, and Office of the Director accounts within "Department of Health and Human Services, National Institutes of Health'', at least $487,767,000 is provided to the Clinical and Translational Sciences Awards program]. (Department of Health and Human Services Appropriations Act, 2012.)

For carrying out the responsibilities of the Office of the Director, NIH, [$1,461,880,000] $1,429,161,000, of which up to $25,000,000 shall be used to carry out section 213 of this Act: Provided, That funding shall be available for the purchase of not to exceed 29 passenger motor vehicles for replacement only: Provided further, That NIH is authorized to collect third-party payments for the cost of clinical services that are incurred in NIH research facilities and that such payments shall be credited to the NIH Management Fund: Provided further, That all funds credited to the NIH Management Fund shall remain available for one fiscal year after the fiscal year in which they are deposited: [Provided further, That $193,880,000 shall be available for continuation of the National Children's Study:] Provided further, That [$545,962,000] $544,930,000 shall be available for the Common Fund established under section 402A(c)(1) of the PHS Act: Provided further, That of the funds provided $10,000 shall be for official reception and representation expenses when specifically approved by the Director of the NIH: Provided further, That the Office of AIDS Research within the Office of the Director of the NIH may spend up to $8,000,000 to make grants for construction or renovation of facilities as provided for in section 2354(a)(5)(B) of the PHS Act: Provided further, That the Director may direct up to 1 percent of the total made available in this or any other Act to all National Institutes of Health appropriations to activities that 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. (Department of Health and Human Services Appropriations Act, 2012.)

For the study of, construction of, renovation of, and acquisition of equipment for, facilities of or used by NIH, including the acquisition of real property, [$125,581,000] $125,308,000, to remain available until [September 30, 2016] expended. (Department of Health and Human Services Appropriations Act, 2012.)


Identification code 75–9915–0–1–552		2011 actual	2012 est.	2013 est.

0100	Balance, start of year
	Receipts:
0220	Cooperative Research and Development Agreements, NIH	17	17	17

0400	Total: Balances and collections	17	17	17
	Appropriations:
0500	National Institutes of Health	–17	–17	–17

0799	Balance, end of year


Identification code 75–9915–0–1–552		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	National Cancer Institute (0849)	5,059	5,071	5,069
0002	National Heart, Lung, and Blood Institute (0872)	3,070	3,078	3,076
0003	National Institute of Dental and Craniofacial Research (0873)	409	411	408
0004	National Institute of Diabetes and Digestive and Kidney Disease (0884)	1,792	1,797	1,792
0005	National Institute of Neurological Disorders and Stroke (0886)	1,622	1,626	1,625
0006	National Institute of Allergy and Infectious Diseases (0885)	4,478	4,489	4,495
0007	National Institute of General Medical Sciences (0851)	2,034	2,429	2,379
0008	National Institute of Child Health and Human Development (0844)	1,318	1,321	1,321
0009	National Eye Institute (0887)	701	703	693
0010	National Institute of Environmental Health Sciences (0862)	763	764	763
0011	National Institute on Aging (0843)	1,100	1,103	1,103
0012	National Institute of Arthritis and Musculoskeletal and Skin Disease (0888)	534	536	536
0013	National Institute on Deafness and Other Communication Disorder (0890)	415	416	417
0014	National Institute of Mental Health (0892)	1,477	1,480	1,479
0015	National Institute on Drug Abuse (0893)	1,050	1,053	1,054
0016	National Institute on Alcohol Abuse and Alcoholism (0894)	458	459	457
0017	National Institute of Nursing Research (0889)	144	145	144
0018	National Human Genome Research Institute (0891)	511	513	511
0019	National Institute of Biomedical Imaging and Bioengineering (0898)	314	338	337
0020	National Center for Research Resources (0848)	1,258
0021	National Center for Complementary and Alternative Medicine (0896)	128	128	128
0022	National Institute on Minority Health and Health Disparities (0897)	210	276	279
0023	John E. Fogarty International Center (0819)	69	70	70
0024	National Library of Medicine (0807)	337	338	373
0025	Office of the Director (0846)	1,167	1,459	1,429
0026	Buildings and facilities (0838)	62	125	125
0027	Cooperative Research and Development Agreements	12	17	17
0028	National Center for Advancing Translational Sciences (0875)		575	639
0031	Type 1 Diabetes	150	150	150

0799	Total direct obligations	30,642	30,870	30,869
0801	Reimbursable program activity	3,190	3,201	3,294
0802	Royalties	88	88	88

0809	Reimbursable program activities, subtotal	3,278	3,289	3,382

0899	Total reimbursable obligations	3,278	3,289	3,382

0900	Total new obligations	33,920	34,159	34,251

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	345	376	375
1020	Adjustment of unobligated bal brought forward, Oct 1	–6
1021	Recoveries of prior year unpaid obligations	46

1050	Unobligated balance (total)	385	376	375
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	30,828	30,769	30,702
1120	Transferred to other accounts [72–1028]	–297
1120	Appropriations transferred to other accts [75–0350]		–9
1121	Transferred from other accounts [75–9912]	1
1130	Appropriations permanently reduced	–62
1143	Approp permanently reduced (Sec 527, HR 2055)		–58

1160	Appropriation, discretionary (total)	30,470	30,702	30,702
	Appropriations, mandatory:
1200	Appropriation	150	150	150
1201	Appropriation (special or trust fund)	17	17	17

1260	Appropriations, mandatory (total)	167	167	167
	Spending authority from offsetting collections, discretionary:
1700	Collected	2,734	3,289	3,382
1701	Change in uncollected payments, Federal sources	544

1750	Spending auth from offsetting collections, disc (total)	3,278	3,289	3,382
1900	Budget authority (total)	33,915	34,158	34,251
1930	Total budgetary resources available	34,300	34,534	34,626
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–4
1941	Unexpired unobligated balance, end of year	376	375	375

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	39,712	35,622	34,908
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–1,247	–1,151	–1,151
3011	Adjustments to uncollected pymts, Fed sources, brought forward, Oct 1	6

3020	Obligated balance, start of year (net)	38,471	34,471	33,757
3030	Obligations incurred, unexpired accounts	33,920	34,159	34,251
3031	Obligations incurred, expired accounts	857
3040	Outlays (gross)	–37,715	–34,873	–33,863
3050	Change in uncollected pymts, Fed sources, unexpired	–544
3051	Change in uncollected pymts, Fed sources, expired	634
3080	Recoveries of prior year unpaid obligations, unexpired	–46
3081	Recoveries of prior year unpaid obligations, expired	–1,106
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	35,622	34,908	35,296
3091	Uncollected pymts, Fed sources, end of year	–1,151	–1,151	–1,151

3100	Obligated balance, end of year (net)	34,471	33,757	34,145

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	33,748	33,991	34,084
	Outlays, gross:
4010	Outlays from new discretionary authority	10,751	11,150	11,243
4011	Outlays from discretionary balances	26,695	23,556	22,453

4020	Outlays, gross (total)	37,446	34,706	33,696
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–3,246	–3,289	–3,382
4033	Non-Federal sources	–99

4040	Offsets against gross budget authority and outlays (total)	–3,345	–3,289	–3,382
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–544
4052	Offsetting collections credited to expired accounts	611

4060	Additional offsets against budget authority only (total)	67

4070	Budget authority, net (discretionary)	30,470	30,702	30,702
4080	Outlays, net (discretionary)	34,101	31,417	30,314
	Mandatory:
4090	Budget authority, gross	167	167	167
	Outlays, gross:
4100	Outlays from new mandatory authority	1	53	53
4101	Outlays from mandatory balances	268	114	114

4110	Outlays, gross (total)	269	167	167
4180	Budget authority, net (total)	30,637	30,869	30,869
4190	Outlays, net (total)	34,370	31,584	30,481

DISTRIBUTION OF BUDGET AUTHORITY AND OUTLAYS BY ACCOUNT (in millions of dollars)


	2011	20121	2013

Distribution of budget authority by account:
National Cancer Institute	5,059	5,071	5,069
National Heart, Lung, and Blood Institute	3,070	3,078	3,076
National Institute of Dental and Craniofacial Research	409	411	408
National Institute of Diabetes and Digestive and Kidney Diseases	1,942	1,947	1,942
National Institute of Neurological Disorder and Stroke	1,622	1,626	1,625
National Institute of Allergy and Infectious Diseases	4,7762	4,4892	4,495
National Institute of General Medical Sciences	2,034	2,429	2,379
Eunice Kennedy Shriver National Institute of Child Health and Human Development	1,318	1,321	1,321
National Eye Institute	701	703	693
National Institute of Environmental Health Sciences	763	764	763
National Institute on Aging	1,100	1,103	1,103
National Institute of Arthritis and Musculoskeletal and Skin Diseases	534	536	536
National Institute on Deafness and Other Communication Disorders	415	416	417
National Institute of Mental Health	1,477	1,480	1,479
National Institute on Drug Abuse	1,050	1,053	1,054
National Institute on Alcohol Abuse and Alcoholism	458	459	457
National Institute of Nursing Research	144	145	144
National Center for Research Resources	1,265	0	0
National Human Genome Research Institute	511	513	511
National Institute of Biomedical Imaging and Bioengineering	314	338	337
National Institute on Minority Health and Health Disparities	210	276	279
National Center for Complementary and Alternative Medicine	119	128	128
National Center for Advancing Translational Sciences	0	575	639
John E. Fogarty International Center	69	70	70
National Library of Medicine	337	338	373
Office of the Director	1,167	1,459	1,429
Buildings and Facilities	50	125	125

ARRA Funds	0	0	0

Subtotal	30,914	30,852	30,852

Cooperative Research and Development Agreements	12	17	17


Total Budget Authority, NIH	30,926	30,869	30,869


	2011	2012	2013

Distribution of outlays by account:
National Cancer Institute	5,096	4,704	5,018
National Heart, Lung, and Blood Institute	3,088	3,034	3,045
National Institute of Dental and Craniofacial Research	410	425	415
National Institute of Diabetes and Digestive and Kidney Diseases	1,905	1,893	1,960
National Institute of Neurological Disorders and Stroke	1,580	1,671	1,641
National Institute of Allergy and Infectious Diseases	4,467	4,135	4,526
National Institute of General Medical Sciences	1,985	2,136	2,060
Eunice Kennedy Shriver National Institute of Child Health and Human Development	1,274	1,347	1,335
National Eye Institute	693	680	709
National Institute of Environmental Health Sciences	769	770	773
National Institute on Aging	1,099	1,053	1,135
National Institute of Arthritis and Musculoskeletal and Skin Diseases	532	512	540
National Institute on Deafness and Other Communication Disorders	407	422	420
National Institute of Mental Health	1,492	1,452	1,496
National Institute on Drug Abuse	1,069	976	1,054
National Institute on Alcohol Abuse and Alcoholism	457	463	463
National Institute of Nursing Research	145	131	146
National Center for Research Resources	1,217	788	1,268
National Human Genome Research Institute	506	495	520
National Institute of Biomedical Imaging and Bioengineering	309	307	320
National Institute on Minority Health and Health Disparities	211	202	216
National Center for Complementary and Alternative Medicine	131	106	133
National Center for Advancing Translational Sciences	0	92	453
John E. Fogarty International Center	71	68	71
National Library of Medicine	334	315	363
Office of the Director	1,196	1,423	1,193
Buildings and Facilities	115	146	113

ARRA Funds	3,844	1,864	1,095

Subtotal Outlays	34,402	31,610	32,481

Cooperative Research and Development Agreements	17	17	17


Total Outlays, NIH	34,419	31,627	32,498

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.


Identification code 75–9915–0–1–552		2011 actual	2012 est.	2013 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	878	885	889
11.3	Other than full-time permanent	477	483	494
11.5	Other personnel compensation	44	43	43
11.7	Military personnel	22	22	23
11.8	Special personal services payments	166	170	169

11.9	Total personnel compensation	1,587	1,603	1,618
12.1	Civilian personnel benefits	403	409	412
12.2	Military personnel benefits	16	16	16
21.0	Travel and transportation of persons	56	55	54
22.0	Transportation of things	5	6	5
23.1	Rental payments to GSA	1	1	1
23.2	Rental payments to others	1	1	1
23.3	Communications, utilities, and miscellaneous charges	26	27	26
24.0	Printing and reproduction	8	4	7
25.1	Advisory and assistance services	112	117	132
25.2	Other services from non-Federal sources	714	718	725
25.3	Other goods and services from Federal sources	3,054	3,056	3,246
25.4	Operation and maintenance of facilities	126	83	77
25.5	Research and development contracts	2,117	2,157	1,968
25.6	Medical care	18	18	17
25.7	Operation and maintenance of equipment	83	85	82
25.8	Subsistence and support of persons	2
26.0	Supplies and materials	194	204	196
31.0	Equipment	120	125	119
32.0	Land and structures		126	125
41.0	Grants, subsidies, and contributions	21,999	22,059	22,042

99.0	Direct obligations	30,642	30,870	30,869
99.0	Reimbursable obligations	3,278	3,289	3,382

99.9	Total new obligations	33,920	34,159	34,251


Identification code 75–9915–0–1–552		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment	13,292	13,292	13,157
1101	Direct military average strength employment	238	238	238
2001	Reimbursable civilian full-time equivalent employment	4,950	4,950	4,899
2101	Reimbursable military average strength employment	89	89	89

Federal Funds

For carrying out titles III, V, and XIX of the PHS Act with respect to mental health, and the Protection and Advocacy for Individuals with Mental Illness Act, [$934,853,000] $902,856,000: Provided, That notwithstanding section 520A(f)(2) of the PHS Act, no funds appropriated for carrying out section 520A shall be available for carrying out section 1971 of the PHS Act: Provided further, That in addition to amounts provided herein, [$21,039,000] $21,039,000 shall be available under section 241 of the PHS Act to carry out subpart I of part B of title XIX of the PHS Act to fund section 1920(b) technical assistance, national data, data collection and 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 section 520E(b)(2) of the PHS Act shall not apply to funds appropriated under this Act for fiscal year [2012: Provided further, That of the amount appropriated under this heading, $45,800,000 shall be for the National Child Traumatic Stress Initiative as described in section 582 of the PHS Act] 2013.

For carrying out titles III, V, and XIX of the PHS Act with respect to substance abuse treatment [and section 1922(a) of the PHS Act with respect to substance abuse prevention], [$2,123,993,000] $1,711,045,000: Provided, That in addition to amounts provided herein, [the following amounts shall be available under section 241 of the PHS Act: (1) $79,200,000] $71,724,000 shall be available under section 241 of the PHS Act to carry out subpart II of part B of title XIX of the PHS 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 part B of title XIX[; and (2) $2,000,000 to evaluate substance abuse treatment programs]: Provided further, That [no funds shall be available for the National All Schedules Prescription Reporting system] section 1922(a)(1) of the PHS Act shall not apply to amounts provided herein.

For carrying out titles III and V of the PHS Act with respect to substance abuse prevention, [$186,361,000] $463,378,000.

For program support and cross-cutting activities that supplement activities funded under the headings "Mental Health'', "Substance Abuse Treatment'', and "Substance Abuse Prevention'' in carrying out titles III, V, and XIX of the PHS Act and the Protection and Advocacy for Individuals with Mental Illness Act in the Substance Abuse and Mental Health Services Administration, [$109,106,000] $74,229,000: Provided, That in addition to amounts provided herein, [$27,428,000] $71,995,000 shall be available under section 241 of the PHS Act to supplement funds available to carry out national surveys on drug abuse and mental health, to collect and analyze program data, and to conduct public awareness and technical assistance activities: Provided further, That, in addition, fees may be collected for the costs associated with additional publications, data, data tabulations, and data analysis completed under title V of the PHS Act and provided to a public or private entity upon request, which shall be credited to this appropriation and shall remain available until expended for such purposes: Provided further, That funds made available under this heading may be used to supplement program support funding provided under the headings "Mental Health'', "Substance Abuse Treatment'', and "Substance Abuse Prevention'': Provided further, That the Administrator may transfer funds between any of the accounts of SAMHSA with notification to the Committees on Appropriations of both Houses of Congress at least 15 days in advance of any transfer, but no such account shall be decreased by more than 3 percent by any such transfer. (Department of Health and Human Services Appropriations Act, 2012.)


Identification code 75–1362–0–1–551		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0002	Mental Health Block Grant	420
0003	Substance Abuse Block Grant	1,442
0004	State Prevention Grants	475
0005	Program Management	120
0006	Mental Health		933	903
0007	Substance Abuse Treatment		1,775	1,711
0008	Substance Abuse Prevention		530	464
0009	Health Surveillance and Program Support		109	74
0010	Children's Mental Health	118
0011	PATH Homeless State Grants	65
0012	Protection and Advocacy	36
0013	Innovation and Emerging Issues	680
0014	Public Education and Support	14
0022	Performance and Quality Information Systems	38
0023	Regulatory and Oversight Functions	53

0100	Total, direct program	3,461	3,347	3,152

0799	Total direct obligations	3,461	3,347	3,152
0802	Reimbursable program: PHS Evaluation	256	255	292

0900	Total new obligations	3,717	3,602	3,444

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1			88
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	3,386	3,354	3,152
1120	Appropriations transferred to other accts [75–0350]		–1
1130	Appropriations permanently reduced	–7
1143	Approp permanently reduced (Sec 527, HR 2055)		–6

1160	Appropriation, discretionary (total)	3,379	3,347	3,152
	Appropriations, mandatory:
1221	Appropriations transferred from the Prevention and Public Health Fund [75–0116]	88	88	105

1260	Appropriations, mandatory (total)	88	88	105
	Spending authority from offsetting collections, discretionary:
1700	Collected	144	255	292
1700	Collected			2
1701	Change in uncollected payments, Federal sources	106

1750	Spending auth from offsetting collections, disc (total)	250	255	294
1900	Budget authority (total)	3,717	3,690	3,551
1930	Total budgetary resources available	3,717	3,690	3,639
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year		88	195

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	2,828	2,964	2,877
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–151	–239	–239

3020	Obligated balance, start of year (net)	2,677	2,725	2,638
3030	Obligations incurred, unexpired accounts	3,717	3,602	3,444
3040	Outlays (gross)	–3,557	–3,689	–3,699
3050	Change in uncollected pymts, Fed sources, unexpired	–106
3051	Change in uncollected pymts, Fed sources, expired	18
3081	Recoveries of prior year unpaid obligations, expired	–24
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	2,964	2,877	2,622
3091	Uncollected pymts, Fed sources, end of year	–239	–239	–239

3100	Obligated balance, end of year (net)	2,725	2,638	2,383

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	3,629	3,602	3,446
	Outlays, gross:
4010	Outlays from new discretionary authority	1,465	1,594	1,555
4011	Outlays from discretionary balances	2,083	2,042	2,047

4020	Outlays, gross (total)	3,548	3,636	3,602
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–144	–255	–292
4033	Non-Federal sources			–2

4040	Offsets against gross budget authority and outlays (total)	–144	–255	–294
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–106

4070	Budget authority, net (discretionary)	3,379	3,347	3,152
4080	Outlays, net (discretionary)	3,404	3,381	3,308
	Mandatory:
4090	Budget authority, gross	88	88	105
	Outlays, gross:
4100	Outlays from new mandatory authority		1	1
4101	Outlays from mandatory balances	9	52	96

4110	Outlays, gross (total)	9	53	97
4180	Budget authority, net (total)	3,467	3,435	3,257
4190	Outlays, net (total)	3,413	3,434	3,405

This program provides Federal support to strengthen the capacity of the Nation's health care delivery system to provide effective 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, tribal and private not-for-profit organizations to enhance health and reduce the adverse impact of substance abuse and mental illness on America's communities. The Consolidated Appropriations Act of 2012 (P.L. 112–74) restructured the appropriation accounts for SAMHSA, which is continued in FY 2013.


Identification code 75–1362–0–1–551		2011 actual	2012 est.	2013 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	47	46	46
11.3	Other than full-time permanent	2	2	2
11.5	Other personnel compensation	1	1	1
11.7	Military personnel	4	4	4

11.9	Total personnel compensation	54	53	53
12.1	Civilian personnel benefits	12	12	12
12.2	Military personnel benefits	2	2	2
21.0	Travel and transportation of persons	1	2	2
23.1	Rental payments to GSA	7	7	7
23.3	Communications, utilities, and miscellaneous charges	1	1	1
24.0	Printing and reproduction	3	3	3
25.1	Advisory and assistance services	29	26	17
25.2	Other services from non-Federal sources	229	201	130
25.3	Other goods and services from Federal sources	87	90	58
25.7	Operation and maintenance of equipment	1	1	1
41.0	Grants, subsidies, and contributions	3,034	2,948	2,865
42.0	Insurance claims and indemnities	1	1	1

99.0	Direct obligations	3,461	3,347	3,152
99.0	Reimbursable obligations	256	255	292

99.9	Total new obligations	3,717	3,602	3,444


Identification code 75–1362–0–1–551		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment	472	496	496
1101	Direct military average strength employment	52	54	54
2001	Reimbursable civilian full-time equivalent employment	19	20	20
2101	Reimbursable military average strength employment	4	4	4

Federal Funds

For carrying out titles III and IX of the PHS Act, part A of title XI of the Social Security Act, and section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, [$369,053,000] $334,357,000 shall be available from amounts available under section 241 of the PHS Act, notwithstanding subsection 947(c) of such Act: Provided, That in addition, 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 [September 30, 2013] expended. (Department of Health and Human Services Appropriations Act, 2012.)


Identification code 75–1700–0–1–552		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0003	Prevention and Public Health Fund	12	12	12
0801	Reimbursable program	17	17	17
0802	Reimbursable program: PHS evaluation	371	369	334

0899	Total reimbursable obligations	388	386	351

0900	Total new obligations	400	398	363

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	6	4	4
	Budget authority:
	Appropriations, mandatory:
1221	Appropriations transferred from other accts [75–0116]	12	12	12

1260	Appropriations, mandatory (total)	12	12	12
	Spending authority from offsetting collections, discretionary:
1700	Collected	159	386	351
1701	Change in uncollected payments, Federal sources	227

1750	Spending auth from offsetting collections, disc (total)	386	386	351
1900	Budget authority (total)	398	398	363
1930	Total budgetary resources available	404	402	367
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	4	4	4

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	1,165	988	324
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–451	–382	–382

3020	Obligated balance, start of year (net)	714	606	–58
3030	Obligations incurred, unexpired accounts	400	398	363
3031	Obligations incurred, expired accounts	2
3040	Outlays (gross)	–566	–1,062	–533
3050	Change in uncollected pymts, Fed sources, unexpired	–227
3051	Change in uncollected pymts, Fed sources, expired	296
3081	Recoveries of prior year unpaid obligations, expired	–13
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	988	324	154
3091	Uncollected pymts, Fed sources, end of year	–382	–382	–382

3100	Obligated balance, end of year (net)	606	–58	–228

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	386	386	351
	Outlays, gross:
4010	Outlays from new discretionary authority	126	386	351
4011	Outlays from discretionary balances	435	673	175

4020	Outlays, gross (total)	561	1,059	526
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–451	–768	–388
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–227
4052	Offsetting collections credited to expired accounts	292	382	37

4060	Additional offsets against budget authority only (total)	65	382	37
4080	Outlays, net (discretionary)	110	291	138
	Mandatory:
4090	Budget authority, gross	12	12	12
	Outlays, gross:
4100	Outlays from new mandatory authority	1
4101	Outlays from mandatory balances	4	3	7

4110	Outlays, gross (total)	5	3	7
4180	Budget authority, net (total)	12	12	12
4190	Outlays, net (total)	115	294	145

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.


Identification code 75–1700–0–1–552		2011 actual	2012 est.	2013 est.

	Direct obligations:
25.5	Research and development contracts	8	8	8
41.0	Grants, subsidies, and contributions	4	4	4

99.0	Direct obligations	12	12	12
99.0	Reimbursable obligations	388	386	351

99.9	Total new obligations	400	398	363


Identification code 75–1700–0–1–552		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment	3	3	3
2001	Reimbursable civilian full-time equivalent employment	300	300	300
2101	Reimbursable military average strength employment	10	10	10

Federal Funds

For carrying out, except as otherwise provided, titles XI and XIX of the Social Security Act, [$184,279,110,000] $178,791,197,000, to remain available until expended.

For making, after May 31, [2012] 2013, payments to States under title XIX or in the case of section 1928 on behalf of States under title XIX of the Social Security Act for the last quarter of fiscal year [2012] 2013 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 [2013, $90,614,082,000] 2014, $106,335,631,000, to remain available until expended.

Payment under such title XIX may be made for any quarter with respect to a State plan or plan amendment in effect during such quarter, if submitted in or prior to such quarter and approved in that or any subsequent quarter. (Department of Health and Human Services Appropriations Act, 2012.)


Identification code 75–0512–0–1–551		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Medicaid vendor payments	276,980	245,689	263,693
0002	State and local administration	14,083	14,885	14,735
0003	Vaccines for Children	3,953	4,009	4,271
0004	Incurred by providers but not yet reported	117	1,360	1,360

0799	Total direct obligations	295,133	265,943	284,059
0801	Medicare Part B premiums	703	320

0900	Total new obligations	295,836	266,263	284,059

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	17,008	408	14,654
1021	Recoveries of prior year unpaid obligations	20,039	9,465

1050	Unobligated balance (total)	37,047	9,873	14,654
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation Medicaid		184,279	178,791
1200	Appropriation Medicaid, Indefinite	171,576

1260	Appropriations, mandatory (total)	171,576	184,279	178,791
	Advance appropriations, mandatory:
1270	Advance appropriation	86,789	86,445	90,614

1280	Advanced appropriation, mandatory (total)	86,789	86,445	90,614
	Spending authority from offsetting collections, mandatory:
1800	Collected	832	320

1850	Spending auth from offsetting collections, mand (total)	832	320
1900	Budget authority (total)	259,197	271,044	269,405
1930	Total budgetary resources available	296,244	280,917	284,059
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	408	14,654

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	28,391	28,392	29,751
3030	Obligations incurred, unexpired accounts	295,836	266,263	284,059
3040	Outlays (gross)	–275,796	–255,439	–282,699
3080	Recoveries of prior year unpaid obligations, unexpired	–20,039	–9,465
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	28,392	29,751	31,111

3100	Obligated balance, end of year (net)	28,392	29,751	31,111

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	259,197	271,044	269,405
	Outlays, gross:
4100	Outlays from new mandatory authority	259,197	237,457	267,961
4101	Outlays from mandatory balances	16,599	17,982	14,738

4110	Outlays, gross (total)	275,796	255,439	282,699
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–703	–320
4123	Non-Federal sources	–129

4130	Offsets against gross budget authority and outlays (total)	–832	–320

4160	Budget authority, net (mandatory)	258,365	270,724	269,405
4170	Outlays, net (mandatory)	274,964	255,119	282,699
4180	Budget authority, net (total)	258,365	270,724	269,405
4190	Outlays, net (total)	274,964	255,119	282,699


		2011 actual	2012 est.	2013 est.

Enacted/requested:
	Budget Authority	258,365	270,724	269,405
	Outlays	274,964	255,119	282,699
Amounts included in the adjusted baseline:
	Budget Authority		–11	–70
	Outlays		–11	–70
Legislative proposal, not subject to PAYGO:
	Budget Authority		–215	–695
	Outlays		–215	–695
Legislative proposal, subject to PAYGO:
	Budget Authority		370	885
	Outlays		370	885
Total:
	Budget Authority	258,365	270,868	269,525
	Outlays	274,964	255,263	282,819

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.

Medicaid estimates assume budget authority for expenses that are incurred but not reported (IBNR).

Authorized as part of Title XIX, Vaccines for Children (VFC) finances the purchase of vaccines for low-income, eligible children. VFC is administered by the Centers for Disease Control and Prevention and is funded entirely by the Federal Government.


Obligations	2011	2012	2013

Vaccine Purchase	3,663	3,703	3,972
Vaccine Stockpile	138	137	137
Ordering, Distribution, and Operations	108	126	119
Vaccine Management Contract Support	4	2	1

Evaluation Activities	40	41	42

Total Obligations	3,953	4,009	4,271


Identification code 75–0512–0–1–551		2011 actual	2012 est.	2013 est.

41.0	Direct obligations: Grants, subsidies, and contributions	295,133	265,943	284,059
99.0	Reimbursable obligations	703	320

99.9	Total new obligations	295,836	266,263	284,059


Identification code 75–0512–7–1–551		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Medicaid vendor payments		–11	–70

0900	Total new obligations (object class 41.0)		–11	–70

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation		–11	–70

1260	Appropriations, mandatory (total)		–11	–70
1930	Total budgetary resources available		–11	–70

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts		–11	–70
3040	Outlays (gross)		11	70

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross		–11	–70
	Outlays, gross:
4100	Outlays from new mandatory authority		–11	–70
4180	Budget authority, net (total)		–11	–70
4190	Outlays, net (total)		–11	–70

Please see the narratives in the Limitation on Administrative Expenses and Health Care Fraud and Abuse Control accounts for a description of the program integrity estimates reflected here.


Identification code 75–0512–2–1–551		2011 actual	2012 est.	2013 est.

	Budget authority and outlays, net:
	Mandatory:
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources		–215	–695
4180	Budget authority, net (total)		–215	–695
4190	Outlays, net (total)		–215	–695

This schedule reflects the offsetting collections from Medicare Part B for the extension of the Qualified Individual (QI) program.


Identification code 75–0512–4–1–551		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Program Integrity			–151
0003	Other Proposals		155	341

0799	Total direct obligations		155	190
0801	Medicare Part B premiums		215	695

0900	Total new obligations		370	885

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation Medicaid		155	190

1260	Appropriations, mandatory (total)		155	190
	Spending authority from offsetting collections, mandatory:
1800	Collected		215	695

1850	Spending auth from offsetting collections, mand (total)		215	695
1900	Budget authority (total)		370	885
1930	Total budgetary resources available		370	885

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts		370	885
3040	Outlays (gross)		–370	–885

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross		370	885
	Outlays, gross:
4100	Outlays from new mandatory authority		370	885
4180	Budget authority, net (total)		370	885
4190	Outlays, net (total)		370	885


Identification code 75–0512–4–1–551		2011 actual	2012 est.	2013 est.

41.0	Direct obligations: Grants, subsidies, and contributions		155	190
99.0	Reimbursable obligations		215	695

99.9	Total new obligations		370	885


Identification code 75–0516–0–1–551		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0010	Ticket to Work grants	75
0011	Emergency health services for undocumented aliens	88	22	18
0012	Medicaid integrity program	77	96	80
0015	Partnerships for long-term care	3
0017	Psychiatric residential treatment demonstration	148
0018	Money follows the person (MFP) demonstration	298	410	403
0019	MFP evaluations and technical support	1	1	1
0023	Grants to improve outreach and enrollment	43	7	34
0024	Application of Prospective Payment System		3
0025	Medicaid emergency psychiatric demonstration	1	23	24
0026	Incentives for prevention of chronic diseases in Medicaid	18	29	22

0799	Total direct obligations	752	591	582
0801	Reimbursable program activity	6

0900	Total new obligations	758	591	582

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	1,206	1,304	1,241
1021	Recoveries of prior year unpaid obligations	47

1050	Unobligated balance (total)	1,253	1,304	1,241
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation (Ticket to Work)	47
1200	Appropriation (Expansion of long-term care partnerships)	3
1200	Appropriation (Psychiatric residential treatment demonstration)	57
1200	Appropriation (Money follows the person (MFP) demonstration)	449	449	449
1200	Appropriation (MFP research & evaluation)	1	1	1
1200	Appropriation (Medicaid integrity program)	76	78	80
1200	Appropriation (Medicaid Emergency Psychiatric Demo)	75
1200	Appropriation (Incentives for Prevention of Chronic Diseases in Medicaid)	100

1260	Appropriations, mandatory (total)	808	528	530
	Spending authority from offsetting collections, mandatory:
1800	Collected	6

1850	Spending auth from offsetting collections, mand (total)	6
1900	Budget authority (total)	814	528	530
1930	Total budgetary resources available	2,067	1,832	1,771
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–5
1941	Unexpired unobligated balance, end of year	1,304	1,241	1,189

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	738	881	868
3030	Obligations incurred, unexpired accounts	758	591	582
3040	Outlays (gross)	–568	–604	–474
3080	Recoveries of prior year unpaid obligations, unexpired	–47
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	881	868	976

3100	Obligated balance, end of year (net)	881	868	976

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	814	528	530
	Outlays, gross:
4100	Outlays from new mandatory authority	57	79	80
4101	Outlays from mandatory balances	511	525	394

4110	Outlays, gross (total)	568	604	474
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–6
4180	Budget authority, net (total)	808	528	530
4190	Outlays, net (total)	562	604	474

State Grants and Demonstrations includes funding for grant programs enacted in several legislative authorities, including the Ticket to Work and Work Incentives Improvement Act of 1999 (P.L. 106–170), the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (P.L. 108–173), the Deficit Reduction Act of 2005 (P.L. 109–171), the Children's Health Insurance Program Reauthorization Act of 2009 (P.L. 111–3), the Patient Protection and Affordable Care Act (P.L. 111–148), and the Health Care and Education Reconciliation Act of 2010 (P.L. 111–152).

The Budget includes an unobligated balance of $125 million for activities authorized by Section 204 of the Ticket to Work and Work Incentives Improvement Act. Thus, pursuant to 31 U.S.C. 1555, any remaining balance (whether obligated or unobligated) will be withdrawn and returned to the Treasury two years after there has been no disbursement made against the appropriation.


Identification code 75–0516–0–1–551		2011 actual	2012 est.	2013 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent - Medicaid Integrity Program	9	9	9
12.1	Civilian personnel benefits - Medicaid Integrity Program	6	6	6
41.0	Grants, subsidies, and contributions - Ticket to Work	75
41.0	Grants, subsidies, and contributions - Emergency services for undocumented aliens	88	22	18
41.0	Grants, subsidies, and contributions - Medicaid Integrity Program	62	81	65
41.0	Grants, subsidies, and contributions - Partnership for long-term care	3
41.0	Grants, subsidies, and contributions - Psychiatric residential treatment demonstration	148
41.0	Grants, subsidies, and contributions - Money follows the person (MFP) demonstration	298	410	403
41.0	Grants, subsidies, and contributions - MFP evaluations and technical support	1	1	1
41.0	Grants, subsidies, and contributions - Grants to improve outreach and enrollment	43	7	34
41.0	Grants, subsidies, and contributions - Application of Prospective Payment System	1	3
41.0	Grants, subsidies, and contributions - Medicaid emergency psychiatric demonstration	18	23	24
41.0	Grants, subsidies, and contributions - Incentives for prevention of chronic diseases in Medicaid		29	22

99.0	Direct obligations	752	591	582
99.0	Reimbursable obligations	6

99.9	Total new obligations	758	591	582


Identification code 75–0516–0–1–551		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment	81	100	102

For payment to the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund, as provided under sections 217(g), 1844, and 1860D-16 of the Social Security Act, sections 103(c) and 111(d) of the Social Security Amendments of 1965, section 278(d)(3) of Public Law 97–248, and for administrative expenses incurred pursuant to section 201(g) of the Social Security Act, [$230,741,378,000] $251,359,000,000.

In addition, for making matching payments under section 1844 and benefit payments under section 1860D-16 of the Social Security Act that were not anticipated in budget estimates, such sums as may be necessary. (Department of Health and Human Services Appropriations Act, 2012.)


Identification code 75–0580–0–1–571		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Federal contribution to match premiums (SMI)	168,849	167,184	189,520
0002	Part D benefits (Rx Drug)	55,929	47,282	60,744
0003	Part D Federal administration (Rx Drug)	373	405	424
0004	General Fund Transfers to HI	489	603	671
0006	Federal Bureau of Investigation (HCFAC)	128	132	135
0007	Federal payments from taxation of OASDI benefits (HI)	15,143	18,443	20,811
0008	Criminal fines (HCFAC)	1,196	1,045	1,127
0009	Civil monetary penalties and damages (HCFAC - DOJ and CMS administration)	18	20	20
0010	Asset Forfeiture	22

0900	Total new obligations	242,147	235,114	273,452

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation (definite, annual)	229,464	230,741	251,359
1200	Appropriation (indefinite, permanent)	15,143	18,443	20,811
1200	Appropriation (HCFAC for FBI)	128	132	135
1200	Appropriation (indefinite for HCFAC)	1,236	1,065	1,147

1260	Appropriations, mandatory (total)	245,971	250,381	273,452
1930	Total budgetary resources available	245,971	250,381	273,452
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–3,824	–15,267

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts	242,147	235,114	273,452
3031	Obligations incurred, expired accounts	46
3040	Outlays (gross)	–242,193	–235,114	–273,452

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	245,971	250,381	273,452
	Outlays, gross:
4100	Outlays from new mandatory authority	242,147	235,114	273,452
4101	Outlays from mandatory balances	46

4110	Outlays, gross (total)	242,193	235,114	273,452
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–19
	Additional offsets against gross budget authority only:
4142	Offsetting collections credited to expired accounts	19

4160	Budget authority, net (mandatory)	245,971	250,381	273,452
4170	Outlays, net (mandatory)	242,174	235,114	273,452
4180	Budget authority, net (total)	245,971	250,381	273,452
4190	Outlays, net (total)	242,174	235,114	273,452


		2011 actual	2012 est.	2013 est.

Enacted/requested:
	Budget Authority	245,971	250,381	273,452
	Outlays	242,174	235,114	273,452
Amounts included in the adjusted baseline:
	Budget Authority			4,514
	Outlays			4,514
Legislative proposal, not subject to PAYGO:
	Budget Authority			–4,565
	Outlays			–4,565
Increased funding for BBEDCA program integrity adjustments:
	Outlays		114
Total:
	Budget Authority	245,971	250,381	273,401
	Outlays	242,174	235,228	273,401

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.


Identification code 75–0580–0–1–571		2011 actual	2012 est.	2013 est.

	Direct obligations:
41.0	Grants, subsidies, and contributions	241,139	234,106	272,357
42.0	Insurance claims and indemnities	275	262	228
94.0	Financial transfers (Federal admin)	733	746	867

99.9	Total new obligations	242,147	235,114	273,452


Identification code 75–0580–7–1–571		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Federal contribution to match premiums (SMI)			4,514

0900	Total new obligations (object class 41.0)			4,514

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation (definite annuall)			4,514

1260	Appropriations, mandatory (total)			4,514
1930	Total budgetary resources available			4,514

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts			4,514
3040	Outlays (gross)			–4,514

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			4,514
	Outlays, gross:
4100	Outlays from new mandatory authority			4,514
4180	Budget authority, net (total)			4,514
4190	Outlays, net (total)			4,514


Identification code 75–0580–2–1–571		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Federal contribution to match premiums (SMI)			–15
0002	Part D benefits (Rx Drug)			–4,550

0900	Total new obligations (object class 41.0)			–4,565

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation (definite, annual)			–4,565

1260	Appropriations, mandatory (total)			–4,565
1930	Total budgetary resources available			–4,565

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts			–4,565
3040	Outlays (gross)			4,565

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			–4,565
	Outlays, gross:
4100	Outlays from new mandatory authority			–4,565
4180	Budget authority, net (total)			–4,565
4190	Outlays, net (total)			–4,565


Identification code 75–0519–0–1–571		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	QIO contracts	612	315	270
0002	QIO support contracts	244	125	108

0900	Total new obligations	856	440	378

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1			387
	Budget authority:
	Spending authority from offsetting collections, mandatory:
1800	Collected	20	827	528
1801	Change in uncollected payments, Federal sources	999

1850	Spending auth from offsetting collections, mand (total)	1,019	827	528
1930	Total budgetary resources available	1,019	827	915
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–163
1941	Unexpired unobligated balance, end of year		387	537

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)		824	437
3010	Uncollected pymts, Fed sources, brought forward, Oct 1		–999	–999

3020	Obligated balance, start of year (net)		–175	–562
3030	Obligations incurred, unexpired accounts	856	440	378
3040	Outlays (gross)	–32	–827	–528
3050	Change in uncollected pymts, Fed sources, unexpired	–999
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	824	437	287
3091	Uncollected pymts, Fed sources, end of year	–999	–999	–999

3100	Obligated balance, end of year (net)	–175	–562	–712

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	1,019	827	528
	Outlays, gross:
4100	Outlays from new mandatory authority	32	66	56
4101	Outlays from mandatory balances		761	472

4110	Outlays, gross (total)	32	827	528
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–20	–827	–528
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–999
4170	Outlays, net (mandatory)	12
4190	Outlays, net (total)	12


Identification code 75–0519–0–1–571		2011 actual	2012 est.	2013 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent		28	28
25.2	Other services from non-Federal sources	848	404	342
25.3	Other goods and services from Federal sources	8	8	8

99.9	Total new obligations	856	440	378


Identification code 75–0519–0–1–571		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment		164	164

For carrying out, except as otherwise provided, titles XI, XVIII, XIX, and XXI of the Social Security Act, titles XIII and XXVII of the PHS Act, the Clinical Laboratory Improvement Amendments of 1988, and other responsibilities of the Centers for Medicare and Medicaid Services, not to exceed [$3,879,476,000,] $4,820,808,000, to be transferred from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund, as authorized by section 201(g) of the Social Security Act; together with all funds collected in accordance with section 353 of the PHS Act and section 1857(e)(2) of the Social Security Act, funds retained by the Secretary pursuant to section 302 of the Tax Relief and Health Care Act of 2006; and such sums as may be collected from authorized user fees and the sale of data, which shall be credited to this account and remain available until [September 30, 2017] expended: Provided, That all funds derived in accordance with 31 U.S.C. 9701 from organizations established under title XIII of the PHS Act shall be credited to and available for carrying out the purposes of this appropriation: Provided further, That [$34,000,000,] $11,150,000, to remain available through September 30, [2013] 2014, shall be for contract costs for the Healthcare Integrated General Ledger Accounting System: Provided further, That the Secretary is directed to collect fees in fiscal year [2012] 2013 from Medicare Advantage 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 $44,000,000 shall be available for the State high-risk health insurance pool program as authorized by the State High Risk Pool Funding Extension Act of 2006]. (Department of Health and Human Services Appropriations Act, 2012.)


Identification code 75–0511–0–1–550		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Program operations	2,592	2,922	3,641
0002	Federal administration	687	960	870
0003	State survey and certification	390	444	408
0004	Research, demonstrations, and evaluation projects	48	632	59
0006	High-risk pool grants	55	44	22
0007	ARRA Medicare/Medicaid HIT	160	195	193
0008	Consumer Assistance Grants	27	2

0100	Total direct program	3,959	5,199	5,193

0799	Total direct obligations	3,959	5,199	5,193
0801	Clinical laboratory improvement amendments	53	43	43
0802	Sale of data	12	7	7
0803	Coordination of benefits	34	48	35
0804	Medicare advantage/Prescription drug plan	34	70	70
0805	Provider enrollment		72	72
0806	Recovery audit contractors	130	310	310
0807	Other reimbursable program activity	18

0809	Reimbursable program activities, subtotal	281	550	537

0899	Total reimbursable obligations	281	550	537

0900	Total new obligations	4,240	5,749	5,730

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	850	1,349	339
1021	Recoveries of prior year unpaid obligations	11

1050	Unobligated balance (total)	861	1,349	339
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	403	253	253

1260	Appropriations, mandatory (total)	403	253	253
	Spending authority from offsetting collections, discretionary:
1700	Collected	1,965	4,306	5,286
1701	Change in uncollected payments, Federal sources	1,805

1750	Spending auth from offsetting collections, disc (total)	3,770	4,306	5,286
	Spending authority from offsetting collections, mandatory:
1800	Collected	71	180	101
1801	Change in uncollected payments, Federal sources	547

1850	Spending auth from offsetting collections, mand (total)	618	180	101
1900	Budget authority (total)	4,791	4,739	5,640
1930	Total budgetary resources available	5,652	6,088	5,979
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–63
1941	Unexpired unobligated balance, end of year	1,349	339	249

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	2,480	2,825	2,587
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–2,867	–3,623	–3,623

3020	Obligated balance, start of year (net)	–387	–798	–1,036
3030	Obligations incurred, unexpired accounts	4,240	5,749	5,730
3031	Obligations incurred, expired accounts	90
3040	Outlays (gross)	–3,786	–5,987	–5,755
3050	Change in uncollected pymts, Fed sources, unexpired	–2,352
3051	Change in uncollected pymts, Fed sources, expired	1,596
3080	Recoveries of prior year unpaid obligations, unexpired	–11
3081	Recoveries of prior year unpaid obligations, expired	–188
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	2,825	2,587	2,562
3091	Uncollected pymts, Fed sources, end of year	–3,623	–3,623	–3,623

3100	Obligated balance, end of year (net)	–798	–1,036	–1,061

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	3,770	4,306	5,286
	Outlays, gross:
4010	Outlays from new discretionary authority	1,813	4,306	5,286
4011	Outlays from discretionary balances	1,605

4020	Outlays, gross (total)	3,418	4,306	5,286
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–3,154	–3,828	–4,821
4033	Non-Federal sources	–313	–478	–465

4040	Offsets against gross budget authority and outlays (total)	–3,467	–4,306	–5,286
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–1,805
4052	Offsetting collections credited to expired accounts	1,502

4060	Additional offsets against budget authority only (total)	–303
4080	Outlays, net (discretionary)	–49
	Mandatory:
4090	Budget authority, gross	1,021	433	354
	Outlays, gross:
4100	Outlays from new mandatory authority	73	275	213
4101	Outlays from mandatory balances	295	1,406	256

4110	Outlays, gross (total)	368	1,681	469
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–83	–108	–29
4123	Non-Federal sources	–5	–72	–72

4130	Offsets against gross budget authority and outlays (total)	–88	–180	–101
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–547
4142	Offsetting collections credited to expired accounts	17

4150	Additional offsets against budget authority only (total)	–530

4160	Budget authority, net (mandatory)	403	253	253
4170	Outlays, net (mandatory)	280	1,501	368
4180	Budget authority, net (total)	403	253	253
4190	Outlays, net (total)	231	1,501	368


		2011 actual	2012 est.	2013 est.

Enacted/requested:
	Budget Authority	403	253	253
	Outlays	231	1,501	368
Legislative proposal, subject to PAYGO:
	Budget Authority			400
	Outlays			100
Total:
	Budget Authority	403	253	653
	Outlays	231	1,501	468

Program management activities include funding for program operations, survey and certification, State high-risk pools, Clinical Laboratory Improvement Amendments (CLIA), Medicare Advantage, Medicare Part D coordination of benefits, recovery audit contracts and other administrative costs.


Identification code 75–0511–0–1–550		2011 actual	2012 est.	2013 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	418	474	493
11.3	Other than full-time permanent	14	11	11
11.5	Other personnel compensation	9	8	8
11.7	Military personnel	9	10	10

11.9	Total personnel compensation	450	503	522
12.1	Civilian personnel benefits	120	122	131
12.2	Military personnel benefits	4	5	5
21.0	Travel and transportation of persons	9	16	12
22.0	Transportation of things	1
23.1	Rental payments to GSA	15	24	25
23.3	Communications, utilities, and miscellaneous charges	55
24.0	Printing and reproduction	35	4	4
25.1	Advisory and assistance services	16
25.2	Other services from non-Federal sources	1,607	2,271	2,904
25.3	Other goods and services from Federal sources	77	11	7
25.5	Research and development contracts	32	669	82
25.6	Medical care	1,228	1,306	1,387
25.7	Operation and maintenance of equipment	132
26.0	Supplies and materials	13	1	1
31.0	Equipment	8
32.0	Land and structures		11	11
41.0	Grants, subsidies, and contributions	157	256	102

99.0	Direct obligations	3,959	5,199	5,193
99.0	Reimbursable obligations	281	550	537

99.9	Total new obligations	4,240	5,749	5,730


Identification code 75–0511–0–1–550		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment	4,086	4,591	4,726
1001	Direct civilian full-time equivalent employment	14	35	35
1101	Direct military average strength employment	107	107	107
2001	Reimbursable civilian full-time equivalent employment	105	123	124


Identification code 75–0511–4–1–550		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Program operations			400

0100	Total direct program			400

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			400

1260	Appropriations, mandatory (total)			400
1930	Total budgetary resources available			400

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts			400
3040	Outlays (gross)			–100
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)			300

3100	Obligated balance, end of year (net)			300

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			400
	Outlays, gross:
4100	Outlays from new mandatory authority			100
4180	Budget authority, net (total)			400
4190	Outlays, net (total)			100

The budget includes a package of proposals that improve Medicaid's finances, Medicare's sustainability, and slow the growth of Part D net expenditures. To achieve the reforms proposed, HHS will need to implement significant administrative changes to its systems and processes.


Identification code 75–0511–4–1–550		2011 actual	2012 est.	2013 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent			2
12.1	Civilian personnel benefits			1
25.2	Other services from non-Federal sources			397

99.9	Total new obligations			400


Identification code 75–0511–4–1–550		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment			20


Identification code 75–0515–0–1–551		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Grants to States and U.S. territories	8,479	8,914	9,700
0002	Performance bonus payments	217	296	380
0003	Child health quality improvement	44	51	47

0900	Total new obligations (object class 41.0)	8,740	9,261	10,127

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	4,330	7,527	6,925
1012	Unobligated balance transfers between expired and unexpired accounts	1,917
1021	Recoveries of prior year unpaid obligations	16

1050	Unobligated balance (total)	6,263	7,527	6,925
	Budget authority:
	Appropriations, discretionary:
1131	Unobligated balance of appropriations permanently reduced			–6,706

1160	Appropriation, discretionary (total)			–6,706
	Appropriations, mandatory:
1200	Appropriation	13,504	14,982	17,406
1200	Appropriation		45	45
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–3,500	–6,368

1260	Appropriations, mandatory (total)	10,004	8,659	17,451
1900	Budget authority (total)	10,004	8,659	10,745
1930	Total budgetary resources available	16,267	16,186	17,670
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	7,527	6,925	7,543

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	8,195	7,107	6,590
3030	Obligations incurred, unexpired accounts	8,740	9,261	10,127
3031	Obligations incurred, expired accounts	46
3040	Outlays (gross)	–8,629	–9,778	–10,027
3080	Recoveries of prior year unpaid obligations, unexpired	–16
3081	Recoveries of prior year unpaid obligations, expired	–1,229
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	7,107	6,590	6,690

3100	Obligated balance, end of year (net)	7,107	6,590	6,690

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross			–6,706
	Mandatory:
4090	Budget authority, gross	10,004	8,659	17,451
	Outlays, gross:
4100	Outlays from new mandatory authority	2,718	4,445	4,045
4101	Outlays from mandatory balances	5,911	5,333	5,982

4110	Outlays, gross (total)	8,629	9,778	10,027
4180	Budget authority, net (total)	10,004	8,659	10,745
4190	Outlays, net (total)	8,629	9,778	10,027

The Balanced Budget Act of 1997 established the Children's Health Insurance Program (CHIP) 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 separate CHIP program, a CHIP Medicaid expansion program, or a combination of both. The Children's Health Insurance Program Reauthorization Act of 2009 (P.L. 111–3) reauthorized the CHIP program through FY 2013 and made some modifications to the program including increased funding for States and territories, bonus payments for States that exceed Medicaid child enrollment targets, and support for child health quality and outreach activities. A contingency fund to assist States who project spending above their available allocated CHIP funds was also created by CHIPRA and funding is included in a separate account. The Patient Protection and Affordable Care Act of 2010 (P.L. 111–148) extended funding for CHIP, providing appropriations through FY 2015.


Identification code 75–0522–0–1–551		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Administration	43	112	155
0002	Innovation Activities	52	1,581	1,207

0900	Total new obligations	95	1,693	1,362

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	5	9,910	8,217
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	10,000

1260	Appropriations, mandatory (total)	10,000
1930	Total budgetary resources available	10,005	9,910	8,217
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	9,910	8,217	6,855

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)		84	1,044
3030	Obligations incurred, unexpired accounts	95	1,693	1,362
3040	Outlays (gross)	–11	–733	–1,090
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	84	1,044	1,316

3100	Obligated balance, end of year (net)	84	1,044	1,316

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	10,000
	Outlays, gross:
4100	Outlays from new mandatory authority	11
4101	Outlays from mandatory balances		733	1,090

4110	Outlays, gross (total)	11	733	1,090
4180	Budget authority, net (total)	10,000
4190	Outlays, net (total)	11	733	1,090


Identification code 75–0522–0–1–551		2011 actual	2012 est.	2013 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	5	11	11
12.1	Civilian personnel benefits	1	3	3
25.2	Other services from non-Federal sources	77	1,581	1,207
25.3	Other goods and services from Federal sources	8	98	141
31.0	Equipment	4

99.9	Total new obligations	95	1,693	1,362


Identification code 75–0522–0–1–551		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment	68	204	265


Identification code 75–5551–0–2–551		2011 actual	2012 est.	2013 est.

0100	Balance, start of year
	Receipts:
0240	Interest, Child Enrollment Contingency Fund	8	7	13

0400	Total: Balances and collections	8	7	13
	Appropriations:
0500	Child Enrollment Contingency Fund	–8	–7	–13

0799	Balance, end of year


Identification code 75–5551–0–2–551		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Grants to States and US Territories	29	100	200

0900	Total new obligations (object class 41.0)	29	100	200

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	2,115	2,094	2,001
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	8	7	13

1260	Appropriations, mandatory (total)	8	7	13
1930	Total budgetary resources available	2,123	2,101	2,014
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	2,094	2,001	1,814

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)		25
3030	Obligations incurred, unexpired accounts	29	100	200
3040	Outlays (gross)	–4	–125	–200
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	25

3100	Obligated balance, end of year (net)	25

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	8	7	13
	Outlays, gross:
4100	Outlays from new mandatory authority	4
4101	Outlays from mandatory balances		125	200

4110	Outlays, gross (total)	4	125	200
4180	Budget authority, net (total)	8	7	13
4190	Outlays, net (total)	4	125	200

	Memorandum (non-add) entries:
5000	Total investments, SOY: Federal securities: Par value	2,119	2,093	2,001
5001	Total investments, EOY: Federal securities: Par value	2,093	2,001	1,814

The Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009 established the Child Enrollment Contingency Fund under Title XXI. Beginning in FY 2009, a State may qualify for a contingency fund payment if it projects a funding shortfall for the fiscal year and if its average monthly child enrollment exceeds its target average number of enrollees for the fiscal year. The Patient Protection and Affordable Care Act of 2010 extended the contingency fund through FY 2015.

The fund received an initial appropriation equal to 20 percent of the FY 2009 national allotment ($2.1 billion). In fiscal years 2010 through 2015, the statute appropriates the amount necessary to make payments to eligible States, but not to exceed 20 percent of the total annual appropriation for CHIP allotments to States. Any amounts in excess of this aggregate cap will be made available for CHIP performance bonus payments. The contingency fund is invested in interest bearing securities of the United States, and the income derived from these investments constitutes a part of the fund.


Identification code 75–0508–0–1–551		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0801	Incentive payments to hospitals	356	950	860
0802	Incentive payments to eligible professionals	97	690	930

0900	Total new obligations (object class 42.0)	453	1,640	1,790

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		1,658	1,658
	Budget authority:
	Spending authority from offsetting collections, mandatory:
1800	Collected from the HI Trust Fund	227	950	860
1800	Collected from the SMI Trust Fund	45	690	930
1801	Change in uncollected payments, Federal sources	1,839

1850	Spending auth from offsetting collections, mand (total)	2,111	1,640	1,790
1930	Total budgetary resources available	2,111	3,298	3,448
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	1,658	1,658	1,658

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)		91	91
3010	Uncollected pymts, Fed sources, brought forward, Oct 1		–1,839	–1,839

3020	Obligated balance, start of year (net)		–1,748	–1,748
3030	Obligations incurred, unexpired accounts	453	1,640	1,790
3040	Outlays (gross)	–362	–1,640	–1,790
3050	Change in uncollected pymts, Fed sources, unexpired	–1,839
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	91	91	91
3091	Uncollected pymts, Fed sources, end of year	–1,839	–1,839	–1,839

3100	Obligated balance, end of year (net)	–1,748	–1,748	–1,748

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	2,111	1,640	1,790
	Outlays, gross:
4100	Outlays from new mandatory authority	362	1,640	1,790
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–272	–1,640	–1,790
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–1,839
4170	Outlays, net (mandatory)	90
4190	Outlays, net (total)	90


Identification code 75–0112–0–1–551		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Premium rate review grants	114	63	28

0900	Total new obligations (object class 41.0)	114	63	28

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	204	91	30
1021	Recoveries of prior year unpaid obligations	1	2

1050	Unobligated balance (total)	205	93	30
1930	Total budgetary resources available	205	93	30
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	91	30	2

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	46	147	128
3030	Obligations incurred, unexpired accounts	114	63	28
3040	Outlays (gross)	–12	–80	–80
3080	Recoveries of prior year unpaid obligations, unexpired	–1	–2
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	147	128	76

3100	Obligated balance, end of year (net)	147	128	76

	Budget authority and outlays, net:
	Mandatory:
	Outlays, gross:
4101	Outlays from mandatory balances	12	80	80
4190	Outlays, net (total)	12	80	80

The Affordable Care Act (P.L. 111–148) amends Section 2794 of the Public Health Service Act and provides that the Secretary shall carry out a program to award grants to States for a five year period beginning in fiscal year 2010. The Grants to States for Health Insurance Premium Review program provides funding to help States develop or enhance their current rate review activities. The program provides $250,000,000 over the five year period beginning with fiscal year 2010. States may receive no less than $1,000,000 and no more than $5,000,000 in any one grant year. Grant recipients are required to submit data to the Secretary on health insurance rate trends.


Identification code 75–0113–0–1–551		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Direct program activity	817	1,463	1,525
0801	Premiums from Fallback States	27	72	91

0900	Total new obligations	844	1,535	1,616

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	4,778	3,961	2,498
	Budget authority:
	Spending authority from offsetting collections, mandatory:
1800	Collected	27	72	91

1850	Spending auth from offsetting collections, mand (total)	27	72	91
1900	Budget authority (total)	27	72	91
1930	Total budgetary resources available	4,805	4,033	2,589
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	3,961	2,498	973

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	218	633	531
3030	Obligations incurred, unexpired accounts	844	1,535	1,616
3040	Outlays (gross)	–429	–1,637	–2,146
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	633	531	1

3100	Obligated balance, end of year (net)	633	531	1

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	27	72	91
	Outlays, gross:
4100	Outlays from new mandatory authority	27	72	91
4101	Outlays from mandatory balances	402	1,565	2,055

4110	Outlays, gross (total)	429	1,637	2,146
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–27	–72	–91
4190	Outlays, net (total)	402	1,565	2,055

This account funds the Pre-Existing Condition Insurance Plan Program (PCIP), which makes health insurance available to people who have been unable to get insurance due to a pre-existing condition. Enrollees pay monthly premiums similar to those charged in the commercial individual market, and the Federal government pays for remaining costs that exceed enrollee contributions. The funding for this program, including operating costs, was provided in the FY 2010 appropriation by the Affordable Care Act (P.L. 111–148).


Identification code 75–0113–0–1–551		2011 actual	2012 est.	2013 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	2	2	2
25.2	Other services from non-Federal sources	5	29	31
41.0	Grants, subsidies, and contributions	810	1,432	1,492

99.0	Direct obligations	817	1,463	1,525
99.0	Reimbursable obligations	27	72	91

99.9	Total new obligations	844	1,535	1,616


Identification code 75–0113–0–1–551		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment	13	14	16


Identification code 75–0114–0–1–551		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Subsidies for early retirees	2,944	1,936
0002	Administration	22	29	25

0900	Total new obligations	2,966	1,965	25

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	4,374	1,998	33
1021	Recoveries of prior year unpaid obligations	590

1050	Unobligated balance (total)	4,964	1,998	33
1930	Total budgetary resources available	4,964	1,998	33
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	1,998	33	8

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	625	26	18
3030	Obligations incurred, unexpired accounts	2,966	1,965	25
3040	Outlays (gross)	–2,975	–1,973	–28
3080	Recoveries of prior year unpaid obligations, unexpired	–590
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	26	18	15

3100	Obligated balance, end of year (net)	26	18	15

	Budget authority and outlays, net:
	Mandatory:
	Outlays, gross:
4101	Outlays from mandatory balances	2,975	1,973	28
4190	Outlays, net (total)	2,975	1,973	28

The Affordable Care Act (P.L. 111–148) authorized and appropriated $5 billion for the Early Retiree Reinsurance Program (ERRP). ERRP provides reimbursement to participating sponsors of certified plans that provide health benefits to early retirees (age 55 and older and not eligible for Medicare), their spouses, and surviving spouses and dependents. Reimbursement is equal to 80 percent of the actual cost of health expenses paid for an individual (net of price concessions) between a cost threshold of $15,000 and cost limit of $90,000 beginning in 2010. The cost threshold and cost limit are adjusted for inflation each year based on the Medical Care Component of the consumer price index for all urban consumers. Reimbursements to sponsors shall be used to reduce the sponsor's health benefit or premium costs, provide premium and cost sharing relief to plan participants, or both.


Identification code 75–0114–0–1–551		2011 actual	2012 est.	2013 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent		1	1
25.2	Other services from non-Federal sources	22	27	23
42.0	Insurance claims and indemnities	2,944	1,936

99.0	Direct obligations	2,966	1,964	24
99.5	Below reporting threshold		1	1

99.9	Total new obligations	2,966	1,965	25


Identification code 75–0114–0–1–551		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment	2	10	10


Identification code 75–0115–0–1–551		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Planning and establishment grants	467	1,092	820
0002	Administration	11	48	48

0900	Total new obligations	478	1,140	868

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	478	1,140	868

1260	Appropriations, mandatory (total)	478	1,140	868
1930	Total budgetary resources available	478	1,140	868

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	49	503	737
3030	Obligations incurred, unexpired accounts	478	1,140	868
3040	Outlays (gross)	–24	–906	–1,087
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	503	737	518

3100	Obligated balance, end of year (net)	503	737	518

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	478	1,140	868
	Outlays, gross:
4100	Outlays from new mandatory authority	9	580	444
4101	Outlays from mandatory balances	15	326	643

4110	Outlays, gross (total)	24	906	1,087
4180	Budget authority, net (total)	478	1,140	868
4190	Outlays, net (total)	24	906	1,087

The American Health Benefit Exchange Program, commonly known as the Affordable Insurance Exchanges, provides funding for Planning and Establishment Grants to States to for their activities to implement Exchanges. The Exchanges will facilitate the purchase of qualified health plans in the individual market and provide for the establishment of a Small Business Health Options Program to allow small businesses to offer qualified health plans to their employees. Section 1311 of the Patient Protection and Affordable Care Act (P.L. 111–148) provides amounts necessary to enable the Secretary to award grants to States beginning no later than March 23, 2011, and allows for renewal grants through January 1, 2015.


Identification code 75–0115–0–1–551		2011 actual	2012 est.	2013 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	4	6	6
12.1	Civilian personnel benefits	1	2	2
25.2	Other services from non-Federal sources	5	40	40
25.3	Other goods and services from Federal sources	1
41.0	Grants, subsidies, and contributions	467	1,092	820

99.9	Total new obligations	478	1,140	868


Identification code 75–0115–0–1–551		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment	28	63	63


Identification code 75–0118–0–1–551		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
	Credit program obligations:
0701	Direct loan subsidy		2,431	699
0709	Administrative expenses	3	15	15

0900	Total new obligations	3	2,446	714

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	6,000	3,797	951
	Budget authority:
	Appropriations, mandatory:
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–2,200	–400

1260	Appropriations, mandatory (total)	–2,200	–400
1930	Total budgetary resources available	3,800	3,397	951
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	3,797	951	237

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)		3	2,356
3030	Obligations incurred, unexpired accounts	3	2,446	714
3040	Outlays (gross)		–93	–803
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	3	2,356	2,267

3100	Obligated balance, end of year (net)	3	2,356	2,267

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	–2,200	–400
	Outlays, gross:
4101	Outlays from mandatory balances		93	803
4180	Budget authority, net (total)	–2,200	–400
4190	Outlays, net (total)		93	803

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


Identification code 75–0118–0–1–551		2011 actual	2012 est.	2013 est.

	Direct loan levels supportable by subsidy budget authority:
115002	Startup Loans		675	195
115003	Solvency		4,950	1,430

115999	Total direct loan levels		5,625	1,625
	Direct loan subsidy (in percent):
132002	Startup Loans	0.00	37.51	37.66
132003	Solvency	0.00	43.99	43.78

132999	Weighted average subsidy rate	0.00	43.21	43.05
	Direct loan subsidy budget authority:
133002	Startup Loans		253	73
133003	Solvency		2,178	626

133999	Total subsidy budget authority		2,431	699
	Direct loan subsidy outlays:
134002	Startup Loans		84	168
134003	Solvency			614

134999	Total subsidy outlays		84	782
	Direct loan downward reestimates:

	Administrative expense data:
3510	Budget authority	3	15	15
3580	Outlays from balances		9	21

The Consumer Operated and Oriented Plan (CO-OP) Program was authorized in Section 1322 of the Affordable Care Act (P.L. 111–148). The CO-OP Program fosters the creation of qualified nonprofit health insurance issuers that operate with a strong consumer focus to offer qualified health plans in the individual and small group markets in the States. The Secretary shall award loans to qualified nonprofit issuers to fund start-up costs and reserves which enable qualified issuers to meet state solvency requirements. The Secretary may also award loans for the purposes of encouraging the establishment of CO-OPs in states where no issuer applies to be a qualified nonprofit issuer under Section 1322. $3.4 billion has been appropriated to carry out Section 1322 of the Affordable Care Act.

As required by the Federal Credit Reform Act of 1990, this account records, for this program, the subsidy costs associated with CO-OP Program grants and loans, as well as administrative expenses of this program. The subsidy amounts are estimated on a present value basis; the administrative expenses are estimated on a cash basis.


Identification code 75–0118–0–1–551		2011 actual	2012 est.	2013 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent		2	2
12.1	Civilian personnel benefits		1	1
25.2	Other services from non-Federal sources	3	12	12
41.0	Grants, subsidies, and contributions		2,431	699

99.9	Total new obligations	3	2,446	714


Identification code 75–0118–0–1–551		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment	1	19	19


Identification code 75–4418–0–3–551		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
	Credit program obligations:
0710	Direct loan obligations		5,625	1,625
0713	Payment of interest to Treasury		2	22

0900	Total new obligations		5,627	1,647

	Budgetary Resources:
	Financing authority:
	Borrowing authority, mandatory:
1400	Borrowing authority		3,196	948

1440	Borrowing authority, mandatory (total)		3,196	948
	Spending authority from offsetting collections, mandatory:
1800	Collected		84	782
1801	Change in uncollected payments, Federal sources		2,347	–83

1850	Spending auth from offsetting collections, mand (total)		2,431	699
1900	Financing authority(total)		5,627	1,647
1930	Total budgetary resources available		5,627	1,647

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)			5,400
3010	Uncollected pymts, Fed sources, brought forward, Oct 1			–2,347

3020	Obligated balance, start of year (net)			3,053
3030	Obligations incurred, unexpired accounts		5,627	1,647
3040	Financing disbursements (gross)		–227	–1,866
3050	Change in uncollected pymts, Fed sources, unexpired		–2,347	83
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)		5,400	5,181
3091	Uncollected pymts, Fed sources, end of year		–2,347	–2,264

3100	Obligated balance, end of year (net)		3,053	2,917

	Financing authority and disbursements, net:
	Mandatory:
4090	Financing authority, gross		5,627	1,647
	Financing disbursements:
4110	Financing disbursements, gross		227	1,866
	Offsets against gross financing authority and disbursements:
	Offsetting collections (collected) from:
4120	Federal sources		–84	–782
	Additional offsets against financing authority only (total):
4140	Change in uncollected pymts, Fed sources, unexpired		–2,347	83

4160	Financing authority, net (mandatory)		3,196	948
4170	Financing disbursements, net (mandatory)		143	1,084
4180	Financing authority, net (total)		3,196	948
4190	Financing disbursements, net (total)		143	1,084


Identification code 75–4418–0–3–551		2011 actual	2012 est.	2013 est.

	Position with respect to appropriations act limitation on obligations:
1131	Direct loan obligations exempt from limitation		5,625	1,625

1150	Total direct loan obligations		5,625	1,625

	Cumulative balance of direct loans outstanding:
1210	Outstanding, start of year			226
1231	Disbursements: Direct loan disbursements		225	1,844
1251	Repayments: Repayments and prepayments
1261	Adjustments: Capitalized interest		1	4
1263	Write-offs for default: Direct loans

1290	Outstanding, end of year		226	2,074

As required by the Federal Credit Reform Act of 1990, this non-budgetary account records all cash flows to and from the Government resulting from direct loans obligated in 1992 and beyond (including modifications of direct loans that resulted from obligations in any year). The amounts in this account are a means of financing and are not included in the budget totals.

Trust Funds


Identification code 75–8005–0–7–571		2011 actual	2012 est.	2013 est.

0100	Balance, start of year	255,722	212,203	193,121
	Adjustments:
0191	Adjustment - to correct for prior budget entry	–1,254

0199	Balance, start of year	254,468	212,203	193,121
	Receipts:
0200	FHI Trust Fund, Transfers from General Fund (FICA Taxes)	175,094	188,041	198,016
0201	FHI Trust Fund, Transfers from General Fund (FICA Taxes)		18	86
0202	FHI Trust Fund, Transfers from General Fund (FICA Taxes)			–72
0203	FHI Trust Fund, Receipts from Railroad Retirement Board	452	499	519
0204	FHI Trust Fund, Transfers from General Fund (SECA Taxes)	12,944	13,989	15,394
0205	FHI Trust Fund, Civil Penalties and Damages	578	630	675
0220	FHI Trust Fund, Other Proprietary Interest from the Public		2	2
0221	FHI Trust Fund, Basic Premium, Medicare Advantage	222	222	225
0222	FHI Trust Fund, Medicare Refunds	5,176	5,700	5,800
0223	FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible	3,273	3,446	3,550
0224	FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible			2
0240	FHI Trust Fund, Federal Employer Contributions (FICA)	3,384	3,516	3,649
0241	FHI Trust Fund, Postal Service Employer Contributions (FICA)	641	583	590
0242	FHI Trust Fund, Interest Received by Trust Funds	12,877	11,304	10,019
0243	FHI Trust Fund, Interest Received by Trust Funds		2	23
0244	FHI Trust Fund, Taxation on OASDI Benefits	15,143	18,443	20,811
0245	FHI Trust Fund, Payment from the General Fund for Health Care Fraud and Abuse Control Account	128	131	134
0246	FHI Trust Fund, Transfers from General Fund (criminal Fines)	1,196	1,045	1,126
0247	FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)	16	21	2
0248	FHI Trust Fund, Transfers from General Fund (asset Forfeitures)	22
0249	FHI Trust Fund, Interest Payments by Railroad Retirement Board	25	26	26
0250	FHI Trust Fund, Payments from the General Fund (uninsured and Program Management)	490	604	672
0251	FHI Trust Fund, Payments from the General Fund (uninsured and Program Management)		114

0299	Total receipts and collections	231,661	248,336	261,249

0400	Total: Balances and collections	486,129	460,539	454,370
	Appropriations:
0500	Federal Hospital Insurance Trust Fund	–2,299	–2,185	–2,327
0501	Federal Hospital Insurance Trust Fund	27
0502	Federal Hospital Insurance Trust Fund		5
0503	Federal Hospital Insurance Trust Fund	–227,694	–244,229	–256,999
0504	Federal Hospital Insurance Trust Fund	–42,424	–19,619	–24,346
0505	Federal Hospital Insurance Trust Fund	5
0506	Federal Hospital Insurance Trust Fund		–2	–23
0507	Federal Hospital Insurance Trust Fund		2	23
0508	Federal Hospital Insurance Trust Fund		–18	–88
0509	Federal Hospital Insurance Trust Fund		18	1,108
0510	Federal Hospital Insurance Trust Fund		1
0511	Federal Hospital Insurance Trust Fund			72
0512	Federal Hospital Insurance Trust Fund			–972
0513	Health Care Fraud and Abuse Control Account	–310	–311	–610
0514	Health Care Fraud and Abuse Control Account		1
0515	Health Care Fraud and Abuse Control Account	–1,422	–1,224	–1,167
0516	Health Care Fraud and Abuse Control Account		–272
0517	Health Care Fraud and Abuse Control Account		1
0518	Health Care Fraud and Abuse Control Account		414	551

0599	Total appropriations	–274,117	–267,418	–284,778
0610	Federal Hospital Insurance Trust Fund	2
0611	Health Care Fraud and Abuse Control Account	23
0620	Federal Hospital Insurance Trust Fund	142
0795	Adjustment - for expired accounts, trust fund receipts returned	24

0799	Balance, end of year	212,203	193,121	169,592


Identification code 75–8005–0–7–571		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Benefit payments, HI	267,607	262,334	279,982
0002	HIT Incentive Payments	1,621	950	860
0003	Administration, HI	2,681	2,392	2,528
0004	Quality improvement organizations, HI	833	352	302

0799	Total direct obligations	272,742	266,028	283,672
0812	Reimbursable program activity	1,811

0900	Total new obligations	274,553	266,028	283,672

	Budgetary Resources:
	Unobligated balance:
1021	Recoveries of prior year unpaid obligations	501
1026	Adjustment for change in allocation of trust fund limitation or foreign exchange valuation	–142
1029	Other balances withdrawn	–2

1050	Unobligated balance (total)	357
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust fund)	2,299	2,185	2,327
1132	Appropriations temporarily reduced	–27
1144	Approp temporarily reduced (Sec 527, HR 2055)		–5

1160	Appropriation, discretionary (total)	2,272	2,180	2,327
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	227,694	244,229	256,999
1203	Appropriation (previously unavailable)	42,424	19,619	24,346
1235	Appropriations precluded from obligation	–5

1260	Appropriations, mandatory (total)	270,113	263,848	281,345
	Spending authority from offsetting collections, mandatory:
1800	Collected	1,811

1850	Spending auth from offsetting collections, mand (total)	1,811
1900	Budget authority (total)	274,196	266,028	283,672
1930	Total budgetary resources available	274,553	266,028	283,672
	Memorandum (non-add) entries:
	Special and non-revolving trust funds:
1950	Other balances withdrawn	2

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	23,423	32,195	31,887
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–1	–1	–1

3020	Obligated balance, start of year (net)	23,422	32,194	31,886
3030	Obligations incurred, unexpired accounts	274,553	266,028	283,672
3040	Outlays (gross)	–265,280	–266,336	–283,733
3080	Recoveries of prior year unpaid obligations, unexpired	–501
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	32,195	31,887	31,826
3091	Uncollected pymts, Fed sources, end of year	–1	–1	–1

3100	Obligated balance, end of year (net)	32,194	31,886	31,825

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	2,272	2,180	2,327
	Outlays, gross:
4010	Outlays from new discretionary authority	1,663	1,734	1,801
4011	Outlays from discretionary balances	737	405	394

4020	Outlays, gross (total)	2,400	2,139	2,195
	Mandatory:
4090	Budget authority, gross	271,924	263,848	281,345
	Outlays, gross:
4100	Outlays from new mandatory authority	241,076	237,514	256,088
4101	Outlays from mandatory balances	21,804	26,683	25,450

4110	Outlays, gross (total)	262,880	264,197	281,538
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–1,811
4180	Budget authority, net (total)	272,385	266,028	283,672
4190	Outlays, net (total)	263,469	266,336	283,733

	Memorandum (non-add) entries:
5000	Total investments, SOY: Federal securities: Par value	279,475	245,939	226,320
5001	Total investments, EOY: Federal securities: Par value	245,939	226,320	201,974


		2011 actual	2012 est.	2013 est.

Enacted/requested:
	Budget Authority	272,385	266,028	283,672
	Outlays	263,469	266,336	283,733
Amounts included in the adjusted baseline:
	Budget Authority			900
	Outlays			900
Legislative proposal, subject to PAYGO:
	Budget Authority			–1,020
	Outlays			–1,020
Increased funding for BBEDCA program integrity adjustments:
	Budget Authority		–1
	Outlays		–1
Total:
	Budget Authority	272,385	266,027	283,552
	Outlays	263,469	266,335	283,613

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. In addition, the Budget includes a package of proposals that improve Medicare's sustainability by promoting high-quality, efficient care; aligning payments with the costs of providing care; encouraging beneficiaries to seek high-value services; and reducing the Federal subsidy of Medicare costs for those beneficiaries who can most afford them.


Identification code 75–8005–0–7–571		2011 actual	2012 est.	2013 est.

	Unexpended balance, start of year:
0100	Balance, start of year	280,119	245,698	226,314
	Adjustments:
0190	Adjustment - to correct for prior budget entry	–1,254

0199	Total balance, start of year	278,865	245,698	226,314
	Cash income during the year:
	Current law:
	Receipts:
1200	FHI Trust Fund, Transfers from General Fund (FICA Taxes)	175,094	188,041	198,016
1202	FHI Trust Fund, Transfers from General Fund (FICA Taxes)			–72
1203	FHI Trust Fund, Receipts from Railroad Retirement Board	452	499	519
1204	FHI Trust Fund, Transfers from General Fund (SECA Taxes)	12,944	13,989	15,394
1205	FHI Trust Fund, Civil Penalties and Damages	578	630	675
	Offsetting receipts (proprietary):
1220	FHI Trust Fund, Other Proprietary Interest from the Public		2	2
1221	FHI Trust Fund, Basic Premium, Medicare Advantage	222	222	225
1222	FHI Trust Fund, Medicare Refunds	5,176	5,700	5,800
1223	FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible	3,273	3,446	3,550
	Offsetting receipts (intragovernmental):
1240	FHI Trust Fund, Federal Employer Contributions (FICA)	3,384	3,516	3,649
1241	FHI Trust Fund, Postal Service Employer Contributions (FICA)	641	583	590
1242	FHI Trust Fund, Interest Received by Trust Funds	12,877	11,304	10,019
1244	FHI Trust Fund, Taxation on OASDI Benefits	15,143	18,443	20,811
1245	FHI Trust Fund, Payment from the General Fund for Health Care Fraud and Abuse Control Account	128	131	134
1246	FHI Trust Fund, Transfers from General Fund (criminal Fines)	1,196	1,045	1,126
1247	FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)	16	21	2
1248	FHI Trust Fund, Transfers from General Fund (asset Forfeitures)	22
1249	FHI Trust Fund, Interest Payments by Railroad Retirement Board	25	26	26
1250	FHI Trust Fund, Payments from the General Fund (uninsured and Program Management)	490	604	672
	Offsetting collections:
1280	Federal Hospital Insurance Trust Fund	1,811
1299	Income under present law	233,472	248,202	261,138
	Proposed legislation:
	Receipts:
2201	FHI Trust Fund, Transfers from General Fund (FICA Taxes)		18	86
	Offsetting receipts (proprietary receipts):
2224	FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible			2
	Offsetting receipts (intragovernmental):
2243	FHI Trust Fund, Interest Received by Trust Funds		2	23
2251	FHI Trust Fund, Payments from the General Fund (uninsured and Program Management)		114
2299	Income under proposed legislation		134	111

3299	Total cash income	233,472	248,336	261,249
	Cash outgo during year:
	Current law:
4500	Federal Hospital Insurance Trust Fund	–265,280	–266,336	–283,733
4500	Health Care Fraud and Abuse Control Account			–900
4500	Federal Hospital Insurance Trust Fund	–1,359	–1,527	–1,928
4500	Health Care Fraud and Abuse Control Account		413	551
4599	Outgo under current law (-)	–266,639	–267,450	–286,010
	Proposed legislation:
5500	Health Care Fraud and Abuse Control Account		–271
5500	Federal Hospital Insurance Trust Fund		1
5500	Federal Hospital Insurance Trust Fund			1,020
5599	Outgo under proposed legislation (-)		–270	1,020

6599	Total cash outgo (-)	–266,639	–267,720	–284,990
	Unexpended balance, end of year:
8700	Uninvested balance (net), end of year	–241	–6	599
8701	Federal Hospital Insurance Trust Fund	245,939	226,320	201,974

8799	Total balance, end of year	245,698	226,314	202,573


Identification code 75–8005–0–7–571		2011 actual	2012 est.	2013 est.

	Direct obligations:
41.0	Payment for Quality Improvement Organization (QIO) activities	833	352	302
42.0	Insurance claims and indemnities (benefits)	267,607	263,284	280,842
94.0	Financial transfers	4,302	2,392	2,528

99.0	Direct obligations	272,742	266,028	283,672
42.0	Allocation Account - reimbursable: Insurance claims and indemnities	1,811

99.9	Total new obligations	274,553	266,028	283,672


Identification code 75–8005–7–7–571		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Benefit payments, HI			900

0900	Total new obligations (object class 42.0)			900

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)			–72
1203	Appropriation (previously unavailable)			972

1260	Appropriations, mandatory (total)			900
1900	Budget authority (total)			900
1930	Total budgetary resources available			900

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts			900
3040	Outlays (gross)			–900

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			900
	Outlays, gross:
4100	Outlays from new mandatory authority			900
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4180	Budget authority, net (total)			900
4190	Outlays, net (total)			900


Identification code 75–8005–2–7–571		2011 actual	2012 est.	2013 est.

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)		2	23
1203	Appropriation (previously unavailable)		–2	–23


Identification code 75–8005–4–7–571		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Benefit payments, HI			–1,020

0900	Total new obligations (object class 42.0)			–1,020

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)		18	88
1203	Appropriation (previously unavailable)		–18	–1,108

1260	Appropriations, mandatory (total)			–1,020
1930	Total budgetary resources available			–1,020

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts			–1,020
3040	Outlays (gross)			1,020

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			–1,020
	Outlays, gross:
4100	Outlays from new mandatory authority			–1,020
4180	Budget authority, net (total)			–1,020
4190	Outlays, net (total)			–1,020

In addition to amounts otherwise available for program integrity and program management, [$310,377,000] $610,000,000, to remain available through September 30, [2013] 2014, to be transferred from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund, as authorized by section 201(g) of the Social Security Act, of which [$219,879,000] $409,697,693 shall be for [the Medicare Integrity Program at] the Centers for Medicare and Medicaid Services Program Integrity Activities, including administrative costs, to conduct oversight activities for the Medicare program including, but not limited to, Medicare Advantage [under Part C] and the Medicare Prescription Drug Program [under Part D of the] authorized in title XVIII of the Social Security Act and for activities described in section 1893[(b)] of such Act and for Medicaid and Children's Health Insurance Program ("CHIP") program integrity activities, of which [$29,730,000] $102,499,971 shall be for the Department of Health and Human Services Office of Inspector General to carry out fraud and abuse activities authorized by section 1817(k)(3) of such Act, [of which $31,038,000 shall be for the Medicaid and Children's Health Insurance Program ("CHIP'') program integrity activities,] and of which [$29,730,000] $97,802,336 shall be for the Department of Justice to carry out fraud and abuse activities authorized by section 1817(k)(3) of such Act: Provided, That of the amount provided under this heading, $311,000,000 is provided to meet the terms of section 251(b)(2)(C)(ii) of the Balanced Budget and Emergency Deficit Control Act of 1985, as amended, and $299,000,000 is additional new budget authority specified for purposes of section 251(b)(2)(C) of such Act: Provided further, That the report required by section 1817(k)(5) of the Social Security Act for fiscal year [2012] 2013 shall include measures of the operational efficiency and impact on fraud, waste, and abuse in the Medicare, Medicaid, and CHIP programs for the funds provided by this appropriation. (Department of Health and Human Services Appropriations Act, 2012.)


Identification code 75–8393–0–7–571		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Medicare integrity program	822	863	866
0002	FBI fraud and abuse control	135	132	135
0003	Other fraud and abuse control	299	295	296
0004	Predictive Modeling	27

0091	Total Mandatory	1,283	1,290	1,297
0101	CMS discretionary BASE	229	250	410
0102	Other discretionary BASE	88	60	200

0191	Total Discretionary	317	310	610

0900	Total new obligations	1,600	1,600	1,907

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	65	241	175
1021	Recoveries of prior year unpaid obligations	46

1050	Unobligated balance (total)	111	241	175
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust fund)	310	311	610
1144	Approp temporarily reduced (Sec 527, HR 2055)		–1

1160	Appropriation, discretionary (total)	310	310	610
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	1,422	1,224	1,167

1260	Appropriations, mandatory (total)	1,422	1,224	1,167
1900	Budget authority (total)	1,732	1,534	1,777
1930	Total budgetary resources available	1,843	1,775	1,952
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–2
1941	Unexpired unobligated balance, end of year	241	175	45
	Special and non-revolving trust funds:
1951	Unobligated balance expiring	2
1952	Expired unobligated balance, start of year	36	41	41
1953	Expired unobligated balance, end of year	39	41	41
1954	Unobligated balance canceling	23

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	873	1,018	1,091
3030	Obligations incurred, unexpired accounts	1,600	1,600	1,907
3031	Obligations incurred, expired accounts	6
3040	Outlays (gross)	–1,359	–1,527	–1,928
3080	Recoveries of prior year unpaid obligations, unexpired	–46
3081	Recoveries of prior year unpaid obligations, expired	–56
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	1,018	1,091	1,070

3100	Obligated balance, end of year (net)	1,018	1,091	1,070

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	310	310	610
	Outlays, gross:
4010	Outlays from new discretionary authority	44	310	610
4011	Outlays from discretionary balances	178

4020	Outlays, gross (total)	222	310	610
	Mandatory:
4090	Budget authority, gross	1,422	1,224	1,167
	Outlays, gross:
4100	Outlays from new mandatory authority	747	831	764
4101	Outlays from mandatory balances	390	386	554

4110	Outlays, gross (total)	1,137	1,217	1,318
4180	Budget authority, net (total)	1,732	1,534	1,777
4190	Outlays, net (total)	1,359	1,527	1,928


		2011 actual	2012 est.	2013 est.

Enacted/requested:
	Budget Authority	1,732	1,534	1,777
	Outlays	1,359	1,527	1,928
Amounts included in the adjusted baseline:
	Budget Authority		–414	–551
	Outlays		–413	–551
Increased funding for BBEDCA program integrity adjustments:
	Budget Authority		271
	Outlays		271
Total:
	Budget Authority	1,732	1,391	1,226
	Outlays	1,359	1,385	1,377

P.L. 104–191 established the Health Care Fraud and Abuse Control (HCFAC) account within the Federal Hospital Insurance Trust Fund and appropriated funds, 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.

The Budget includes a discretionary request for efforts to safeguard Medicare, Medicaid, and CHIP that will supplement the mandatory funds made available by P.L. 104–191 and subsequent Acts. The 2013 discretionary investment is a part of a multi-year fraud and abuse plan specified for 2012 through 2021 in the Balanced Budget and Emergency Deficit Control Act (BBEDCA) of 1985, as amended by the Budget Control Act of 2011. In 2013, the BBEDCA exempts up to $299 million from the new discretionary caps. This exemption is only permissible if the base level of $311 million is fully funded and the use of these funds is clearly restricted to the specified purposes. This Budget assumes that in each year both the base level and the cap adjustments are funded at the maximum levels allowed by section 251(b)(2)(C) of BBEDCA. See additional discussion in the Budget Process chapter in the Analytical Perspectives volume.

The HCFAC entities will develop a comprehensive plan for Medicare, Medicaid, and CHIP program integrity activities. The plan will indicate how program integrity appropriations from all sources will be allocated to address program integrity priorities. These priorities include fraud prevention, reducing the improper payment rate, identifying and recouping excessive payments, pinpointing potential weaknesses in program integrity oversight, and establishing new processes and safeguards to correct programmatic vulnerabilities.


Identification code 75–8393–0–7–571		2011 actual	2012 est.	2013 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent (CMS)	11	38	38
12.1	Civilian personnel benefits (CMS)	2	8	8
23.3	Communications, utilities, and miscellaneous charges	2	8	8
25.1	Advisory and assistance services (predictive modeling)	27
25.2	Other services (CMS/Medicaid)	17	45	47
25.3	Other purchases of goods and services from Government accounts (HHS/DOJ)	109	91	159
25.3	Other purchases of goods and services from Government accounts (HHS/OIG)	244	226	299
25.3	Other purchases of goods and services from Government accounts (HHS/AoA)	4	13
25.3	Other purchases of goods and services from Government accounts (HHS/OGC)	9	9
25.3	Other goods and services from Federal sources (HHS/CMS)	2	2	2
25.3	Other goods and services from Government accounts (HHS/FDA)	4	2
25.3	Other goods and services from Government accounts (HHS/ASPA)	1
25.6	Medical care (CMS)	1,033	1,026	1,211
94.0	Financial transfers (FBI)	135	132	135

99.9	Total new obligations	1,600	1,600	1,907


Identification code 75–8393–0–7–571		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment	162	325	360


Identification code 75–8393–7–7–571		2011 actual	2012 est.	2013 est.

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1			–414
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)		–414	–551

1260	Appropriations, mandatory (total)		–414	–551
1900	Budget authority (total)		–414	–551
1930	Total budgetary resources available		–414	–965
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year		–414	–965

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)			413
3040	Outlays (gross)		413	551
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)		413	964

3100	Obligated balance, end of year (net)		413	964

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross		–414	–551
	Outlays, gross:
4100	Outlays from new mandatory authority		–413	–551
4180	Budget authority, net (total)		–414	–551
4190	Outlays, net (total)		–413	–551

The Balanced Budget and Emergency Deficit Control Act (BBEDCA) of 1985, as amended, exempts up to $299 million in 2013 from the discretionary caps enacted in the Act. Funding the discretionary cap up to the adjustment level permitted by the BBEDCA is estimated to achieve an additional $450 million in savings.


Identification code 75–8004–0–7–571		2011 actual	2012 est.	2013 est.

0100	Balance, start of year	45,630	42,930	37,621
	Receipts:
0200	Fee on Branded Prescription Pharmaceutical Manufacturers and Importers, SMI	1,876	2,944	2,800
0220	Other Proprietary Interest from the Public, FSMI Fund	2	3	3
0221	Premiums Collected for Medicare Prescription Drug Account, FSMI	2,631	3,126	4,004
0222	Premiums Collected for Medicare Prescription Drug Account, FSMI			78
0223	Payments from States, Medicare Prescription Drug Account, FSMI	6,536	8,047	8,795
0224	Payments from States, Medicare Prescription Drug Account, FSMI			190
0225	Basic Premium, Medicare Advantage, FSMI Trust Fund	197	211	215
0226	Medicare Refunds, SMI	4,637	4,300	4,400
0227	Premiums Collected for the Aged, FSMI Fund	47,277	48,977	53,326
0228	Premiums Collected for the Aged, FSMI Fund			1,409
0229	Manufacturer Rebates			5,870
0230	Premiums Collected for the Disabled, FSMI Fund	9,750	9,367	10,243
0231	Premiums Collected for the Disabled, FSMI Fund			270
0240	Federal Contributions, FSMI Fund	168,849	167,184	189,520
0241	Federal Contributions, FSMI Fund			–15
0242	Federal Contributions, FSMI Fund			4,514
0243	Interest Received by Trust Fund, FSMI Fund	3,221	3,288	3,535
0244	Interest Received by Trust Fund, FSMI Fund		–342	–974
0245	Interest, Medicare Prescription Drug Account, FSMI	10	9	10
0246	Federal Contribution for Admin. Contribution for Admin. Costs, Prescription Drug Account, FSMI	400	405	424
0247	Federal Contributions for Benefits, Prescription Drug Account, SMI	55,929	47,282	60,744
0248	Federal Contributions for Benefits, Prescription Drug Account, SMI			–4,550
0249	Miscellaneous Federal Payments, Federal Supplementary Medical Insurance Trust Fund	1	1	1

0299	Total receipts and collections	301,316	294,802	344,812

0400	Total: Balances and collections	346,946	337,732	382,433
	Appropriations:
0500	Federal Supplementary Medical Insurance Trust Fund	–3,051	–3,432	–4,175
0501	Federal Supplementary Medical Insurance Trust Fund	32
0502	Federal Supplementary Medical Insurance Trust Fund		6
0503	Federal Supplementary Medical Insurance Trust Fund	–230,483	–233,528	–259,914
0504	Federal Supplementary Medical Insurance Trust Fund	–2,802
0505	Federal Supplementary Medical Insurance Trust Fund		4,485	22,770
0506	Federal Supplementary Medical Insurance Trust Fund			4,565
0507	Federal Supplementary Medical Insurance Trust Fund		–215	–5,260
0508	Federal Supplementary Medical Insurance Trust Fund			–4,550
0509	Federal Supplementary Medical Insurance Trust Fund			4,580
0510	Federal Supplementary Medical Insurance Trust Fund		342	–5,220
0511	Federal Supplementary Medical Insurance Trust Fund		–9,579	–21,205
0512	Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund	–402	–397	–418
0513	Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund		1
0514	Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund	–67,454	–57,794	–73,512
0515	Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund			–1,588

0599	Total appropriations	–304,160	–300,111	–343,927
0610	Federal Supplementary Medical Insurance Trust Fund	1
0620	Federal Supplementary Medical Insurance Trust Fund	150
0795	Adjustment - for expired accounts, trust fund receipts withdrawn	–7

0799	Balance, end of year	42,930	37,621	38,506


Identification code 75–8004–0–7–571		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Benefit payments, SMI	231,760	227,880	236,075
0002	Transfer to Medicaid for payment of SMI premiums	703	320
0003	HIT Incentive Payments	490	690	930
0004	Administration, SMI	3,361	3,491	4,238
0005	Quality Improvement Organizations, SMI	186	88	76

0799	Total direct obligations	236,500	232,469	241,319
0801	Reimbursable program activity	11

0900	Total new obligations	236,511	232,469	241,319

	Budgetary Resources:
	Unobligated balance:
1021	Recoveries of prior year unpaid obligations	347
1026	Adjustment for change in allocation of trust fund limitation or foreign exchange valuation	–150
1029	Other balances withdrawn	–1

1050	Unobligated balance (total)	196
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust fund)	3,051	3,432	4,175
1132	Appropriations temporarily reduced	–32
1144	Approp temporarily reduced (Sec 527, HR 2055)		–6

1160	Appropriation, discretionary (total)	3,019	3,426	4,175
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	230,483	233,528	259,914
1203	Appropriation (previously unavailable)	2,802
1235	Appropriations precluded from obligation		–4,485	–22,770

1260	Appropriations, mandatory (total)	233,285	229,043	237,144
	Spending authority from offsetting collections, mandatory:
1800	Collected	11

1850	Spending auth from offsetting collections, mand (total)	11
1900	Budget authority (total)	236,315	232,469	241,319
1930	Total budgetary resources available	236,511	232,469	241,319
	Memorandum (non-add) entries:
	Special and non-revolving trust funds:
1950	Other balances withdrawn	1

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	22,184	24,063	24,023
3030	Obligations incurred, unexpired accounts	236,511	232,469	241,319
3040	Outlays (gross)	–234,285	–232,509	–241,007
3080	Recoveries of prior year unpaid obligations, unexpired	–347
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	24,063	24,023	24,335

3100	Obligated balance, end of year (net)	24,063	24,023	24,335

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	3,019	3,426	4,175
	Outlays, gross:
4010	Outlays from new discretionary authority	1,704	2,326	2,728
4011	Outlays from discretionary balances	1,007	994	1,033

4020	Outlays, gross (total)	2,711	3,320	3,761
	Mandatory:
4090	Budget authority, gross	233,296	229,043	237,144
	Outlays, gross:
4100	Outlays from new mandatory authority	209,811	207,468	214,076
4101	Outlays from mandatory balances	21,763	21,721	23,170

4110	Outlays, gross (total)	231,574	229,189	237,246
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–11
4180	Budget authority, net (total)	236,304	232,469	241,319
4190	Outlays, net (total)	234,274	232,509	241,007

	Memorandum (non-add) entries:
5000	Total investments, SOY: Federal securities: Par value	70,982	70,446	66,500
5001	Total investments, EOY: Federal securities: Par value	70,446	66,500	67,635


		2011 actual	2012 est.	2013 est.

Enacted/requested:
	Budget Authority	236,304	232,469	241,319
	Outlays	234,274	232,509	241,007
Amounts included in the adjusted baseline:
	Budget Authority		9,237	26,425
	Outlays		9,237	26,425
Legislative proposal, not subject to PAYGO:
	Budget Authority		215	695
	Outlays		215	695
Legislative proposal, subject to PAYGO:
	Budget Authority			–30
	Outlays			–30
Total:
	Budget Authority	236,304	241,921	268,409
	Outlays	234,274	241,961	268,097

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 generally financed by premium payments from enrollees and contributions from the general revenues.


Identification code 75–8004–0–7–571		2011 actual	2012 est.	2013 est.

	Unexpended balance, start of year:
0100	Balance, start of year	71,977	72,780	67,422
	Adjustments:
0190	Adjustment - rounding	–1

0199	Total balance, start of year	71,976	72,780	67,422
	Cash income during the year:
	Current law:
	Receipts:
1200	Fee on Branded Prescription Pharmaceutical Manufacturers and Importers, SMI	1,876	2,944	2,800
	Offsetting receipts (proprietary):
1220	Other Proprietary Interest from the Public, FSMI Fund	2	3	3
1221	Premiums Collected for Medicare Prescription Drug Account, FSMI	2,631	3,126	4,004
1223	Payments from States, Medicare Prescription Drug Account, FSMI	6,536	8,047	8,795
1225	Basic Premium, Medicare Advantage, FSMI Trust Fund	197	211	215
1226	Medicare Refunds, SMI	4,637	4,300	4,400
1227	Premiums Collected for the Aged, FSMI Fund	47,277	48,977	53,326
1228	Premiums Collected for the Aged, FSMI Fund			1,409
1230	Premiums Collected for the Disabled, FSMI Fund	9,750	9,367	10,243
1231	Premiums Collected for the Disabled, FSMI Fund			270
	Offsetting receipts (intragovernmental):
1240	Federal Contributions, FSMI Fund	168,849	167,184	189,520
1242	Federal Contributions, FSMI Fund			4,514
1243	Interest Received by Trust Fund, FSMI Fund	3,221	3,288	3,535
1244	Interest Received by Trust Fund, FSMI Fund		–342	–974
1245	Interest, Medicare Prescription Drug Account, FSMI	10	9	10
1246	Federal Contribution for Admin. Contribution for Admin. Costs, Prescription Drug Account, FSMI	400	405	424
1247	Federal Contributions for Benefits, Prescription Drug Account, SMI	55,929	47,282	60,744
1249	Miscellaneous Federal Payments, Federal Supplementary Medical Insurance Trust Fund	1	1	1
	Offsetting collections:
1280	Federal Supplementary Medical Insurance Trust Fund	11
1281	Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund	1,612
1299	Income under present law	302,939	294,802	343,239
	Proposed legislation:
	Offsetting receipts (proprietary receipts):
2222	Premiums Collected for Medicare Prescription Drug Account, FSMI			78
2224	Payments from States, Medicare Prescription Drug Account, FSMI			190
2229	Manufacturer Rebates			5,870
	Offsetting receipts (intragovernmental):
2241	Federal Contributions, FSMI Fund			–15
2248	Federal Contributions for Benefits, Prescription Drug Account, SMI			–4,550
2299	Income under proposed legislation			1,573

3299	Total cash income	302,939	294,802	344,812
	Cash outgo during year:
	Current law:
4500	Federal Supplementary Medical Insurance Trust Fund	–234,285	–232,509	–241,007
4500	Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund		–9,237	–26,425
4500	Federal Supplementary Medical Insurance Trust Fund	–67,850	–58,199	–73,930
4599	Outgo under current law (-)	–302,135	–299,945	–341,362
	Proposed legislation:
5500	Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund			–1,588
5500	Federal Supplementary Medical Insurance Trust Fund		–215	–695
5500	Federal Supplementary Medical Insurance Trust Fund			30
5599	Outgo under proposed legislation (-)		–215	–2,253

6599	Total cash outgo (-)	–302,135	–300,160	–343,615
	Unexpended balance, end of year:
8700	Uninvested balance (net), end of year	2,334	922	984
8701	Federal Supplementary Medical Insurance Trust Fund	70,446	66,500	67,635

8799	Total balance, end of year	72,780	67,422	68,619


Identification code 75–8004–0–7–571		2011 actual	2012 est.	2013 est.

	Direct obligations:
41.0	Payment for Quality Improvement Organization (QIO) activity	186	88	76
42.0	Insurance claims and indemnities	232,953	228,890	237,005
94.0	Financial transfers	3,361	3,491	4,238

99.0	Direct obligations	236,500	232,469	241,319
42.0	Allocation Account - reimbursable: Insurance claims and indemnities	11

99.9	Total new obligations	236,511	232,469	241,319


Identification code 75–8004–7–7–571		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Benefits		9,237	26,425

0900	Total new obligations (object class 42.0)		9,237	26,425

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)		–342	5,220
1235	Appropriations precluded from obligation		9,579	21,205

1260	Appropriations, mandatory (total)		9,237	26,425
1900	Budget authority (total)		9,237	26,425
1930	Total budgetary resources available		9,237	26,425

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts		9,237	26,425
3040	Outlays (gross)		–9,237	–26,425

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross		9,237	26,425
	Outlays, gross:
4100	Outlays from new mandatory authority		9,237	26,425
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4180	Budget authority, net (total)		9,237	26,425
4190	Outlays, net (total)		9,237	26,425


Identification code 75–8004–2–7–571		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0002	Transfer to Medicaid for payment of SMI premiums		215	695

0900	Total new obligations (object class 42.0)		215	695

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)			–4,565
1235	Appropriations precluded from obligation		215	5,260

1260	Appropriations, mandatory (total)		215	695
1900	Budget authority (total)		215	695
1930	Total budgetary resources available		215	695

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts		215	695
3040	Outlays (gross)		–215	–695

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross		215	695
	Outlays, gross:
4100	Outlays from new mandatory authority		215	695
4180	Budget authority, net (total)		215	695
4190	Outlays, net (total)		215	695


Identification code 75–8004–4–7–571		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Benefit payments, SMI			–30

0900	Total new obligations (object class 42.0)			–30

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)			4,550
1235	Appropriations precluded from obligation			–4,580

1260	Appropriations, mandatory (total)			–30
1900	Budget authority (total)			–30
1930	Total budgetary resources available			–30

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts			–30
3040	Outlays (gross)			30

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			–30
	Outlays, gross:
4100	Outlays from new mandatory authority			–30
4180	Budget authority, net (total)			–30
4190	Outlays, net (total)			–30


Identification code 75–8308–0–7–571		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Prescription Drug Benefits	67,673	57,789	73,507
0002	Administrative Costs	268	401	423

0799	Total direct obligations	67,941	58,190	73,930
0801	Reimbursable program (Prescription Drug Benefits)	1,612

0900	Total new obligations	69,553	58,190	73,930

	Budgetary Resources:
	Unobligated balance:
1021	Recoveries of prior year unpaid obligations	221

1050	Unobligated balance (total)	221
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust fund)	402	397	418
1144	Approp temporarily reduced (Sec 527, HR 2055)		–1

1160	Appropriation, discretionary (total)	402	396	418
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	67,454	57,794	73,512

1260	Appropriations, mandatory (total)	67,454	57,794	73,512
	Spending authority from offsetting collections, mandatory:
1800	Collected	1,612

1850	Spending auth from offsetting collections, mand (total)	1,612
1900	Budget authority (total)	69,468	58,190	73,930
1930	Total budgetary resources available	69,689	58,190	73,930
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–136
	Special and non-revolving trust funds:
1951	Unobligated balance expiring	136
1952	Expired unobligated balance, start of year	536	572	571
1953	Expired unobligated balance, end of year	436	571	571

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	3,626	5,216	5,207
3030	Obligations incurred, unexpired accounts	69,553	58,190	73,930
3031	Obligations incurred, expired accounts	151
3040	Outlays (gross)	–67,850	–58,199	–73,930
3080	Recoveries of prior year unpaid obligations, unexpired	–221
3081	Recoveries of prior year unpaid obligations, expired	–43
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	5,216	5,207	5,207

3100	Obligated balance, end of year (net)	5,216	5,207	5,207

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	402	396	418
	Outlays, gross:
4010	Outlays from new discretionary authority	254	310	321
4011	Outlays from discretionary balances	144	81	78

4020	Outlays, gross (total)	398	391	399
	Mandatory:
4090	Budget authority, gross	69,066	57,794	73,512
	Outlays, gross:
4100	Outlays from new mandatory authority	65,840	52,955	69,912
4101	Outlays from mandatory balances	1,612	4,853	3,619

4110	Outlays, gross (total)	67,452	57,808	73,531
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–1,612
4180	Budget authority, net (total)	67,856	58,190	73,930
4190	Outlays, net (total)	66,238	58,199	73,930


		2011 actual	2012 est.	2013 est.

Enacted/requested:
	Budget Authority	67,856	58,190	73,930
	Outlays	66,238	58,199	73,930
Legislative proposal, subject to PAYGO:
	Budget Authority			1,588
	Outlays			1,588
Total:
	Budget Authority	67,856	58,190	75,518
	Outlays	66,238	58,199	75,518

Since January 2006, Medicare beneficiaries have had the opportunity to enroll in a comprehensive voluntary prescription drug benefit. The Budget includes a package of proposals that slow the growth of Part D net expenditures by allowing Medicare to benefit from the same rebates that Medicaid receives for drugs provided to low-income beneficiaries and by increasing the availability of generic drugs.


Identification code 75–8308–0–7–571		2011 actual	2012 est.	2013 est.

	Direct obligations:
25.2	Other services from non-Federal sources	268	401	423
42.0	Insurance claims and indemnities	67,673	57,789	73,507

99.0	Direct obligations	67,941	58,190	73,930
42.0	Allocation Account - reimbursable: Insurance claims and indemnities	1,612

99.9	Total new obligations	69,553	58,190	73,930


Identification code 75–8308–4–7–571		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Prescription Drug Benefits			1,588

0900	Total new obligations (object class 25.2)			1,588

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)			1,588

1260	Appropriations, mandatory (total)			1,588
1930	Total budgetary resources available			1,588

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts			1,588
3040	Outlays (gross)			–1,588

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			1,588
	Outlays, gross:
4100	Outlays from new mandatory authority			1,588
4180	Budget authority, net (total)			1,588
4190	Outlays, net (total)			1,588

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."

Federal Funds


Identification code 75–1552–0–1–609		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	State family assistance grant	16,491	16,488	16,488
0002	Territories - family assistance grants	77	78	78
0004	Supplemental Grants 2011	211
0006	Tribal work programs	5	8	8
0009	Healthy marriage and responsible fatherhood grants	150	150	150

0900	Total new obligations	16,934	16,724	16,724

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	16,950	16,739	16,739

1260	Appropriations, mandatory (total)	16,950	16,739	16,739
1930	Total budgetary resources available	16,950	16,739	16,739
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–16	–15	–15

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	4,776	4,594	4,780
3030	Obligations incurred, unexpired accounts	16,934	16,724	16,724
3040	Outlays (gross)	–17,116	–16,538	–17,017
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	4,594	4,780	4,487

3100	Obligated balance, end of year (net)	4,594	4,780	4,487

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	16,950	16,739	16,739
	Outlays, gross:
4100	Outlays from new mandatory authority	14,039	13,377	13,378
4101	Outlays from mandatory balances	3,077	3,161	3,639

4110	Outlays, gross (total)	17,116	16,538	17,017
4180	Budget authority, net (total)	16,950	16,739	16,739
4190	Outlays, net (total)	17,116	16,538	17,017


		2011 actual	2012 est.	2013 est.

Enacted/requested:
	Budget Authority	16,950	16,739	16,739
	Outlays	17,116	16,538	17,017
Legislative proposal, subject to PAYGO:
	Budget Authority			319
	Outlays			289
Total:
	Budget Authority	16,950	16,739	17,058
	Outlays	17,116	16,538	17,306

This account provides funding for the Temporary Assistance for Needy Families block grant and related activities authorized by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104–193), as amended by the Deficit Reduction Act of 2005 (P.L. 109–171), the Claims Resolution Act of 2010 (P.L. 111–291), the Short Term TANF Extension Act (P.L. 112–35), and the Temporary Payroll Tax Cut Continuation Act of 2011 (P.L. 112–78)


Identification code 75–1552–0–1–609		2011 actual	2012 est.	2013 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	2	2	2
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	23	21	21
25.3	Other goods and services from Federal sources	3	3	3
41.0	Grants, subsidies, and contributions	16,906	16,695	16,695

99.9	Total new obligations	16,934	16,724	16,724


Identification code 75–1552–0–1–609		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment	18	18	18


Identification code 75–1552–4–1–609		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0004	Supplemental Grants			319

0900	Total new obligations (object class 41.0)			319

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			319

1260	Appropriations, mandatory (total)			319
1930	Total budgetary resources available			319

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts			319
3040	Outlays (gross)			–289
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)			30

3100	Obligated balance, end of year (net)			30

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			319
	Outlays, gross:
4100	Outlays from new mandatory authority			289
4180	Budget authority, net (total)			319
4190	Outlays, net (total)			289

The Budget proposes to permanently fund the TANF Supplemental Grants for Population Increases by redirecting TANF Contingency Fund resources to support these grants.


Identification code 75–1522–0–1–609		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Contingency fund	334	612	612

0900	Total new obligations (object class 41.0)	334	612	612

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	506	612	612
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–172

1260	Appropriations, mandatory (total)	334	612	612
1930	Total budgetary resources available	334	612	612

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	2,454	832	127
3030	Obligations incurred, unexpired accounts	334	612	612
3040	Outlays (gross)	–1,956	–1,317	–682
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	832	127	57

3100	Obligated balance, end of year (net)	832	127	57

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	334	612	612
	Outlays, gross:
4100	Outlays from new mandatory authority	249	555	555
4101	Outlays from mandatory balances	1,707	762	127

4110	Outlays, gross (total)	1,956	1,317	682
4180	Budget authority, net (total)	334	612	612
4190	Outlays, net (total)	1,956	1,317	682


		2011 actual	2012 est.	2013 est.

Enacted/requested:
	Budget Authority	334	612	612
	Outlays	1,956	1,317	682
Legislative proposal, subject to PAYGO:
	Budget Authority			–319
	Outlays			–289
Total:
	Budget Authority	334	612	293
	Outlays	1,956	1,317	393

This account provides funding for the TANF Contingency Fund authorized by section 403(b) of the Social Security Act that currently provides money to qualifying States (but not Territories or Tribes) during an economic downturn.


Identification code 75–1522–4–1–609		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Contingency fund			–319

0900	Total new obligations (object class 41.0)			–319

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			–319

1260	Appropriations, mandatory (total)			–319
1930	Total budgetary resources available			–319

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts			–319
3040	Outlays (gross)			289
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)			–30

3100	Obligated balance, end of year (net)			–30

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			–319
	Outlays, gross:
4100	Outlays from new mandatory authority			–289
4180	Budget authority, net (total)			–319
4190	Outlays, net (total)			–289

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, [$2,305,035,000] $2,756,485,000, to remain available until expended; and for such purposes for the first quarter of fiscal year [2013] 2014, $1,100,000,000, 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 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, 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. (Department of Health and Human Services Appropriations Act, 2012.)


Identification code 75–1501–0–1–609		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	State child support administrative costs	4,161	3,778	3,572
0002	Child support incentive payments	466	526	540
0003	Access and visitation grants	10	10	10

0091	Subtotal, child support enforcement	4,637	4,314	4,122
0102	Payments to territories	30	33	33
0103	Repatriation	1	1	1

0191	Subtotal, other payments	31	34	34

0799	Total direct obligations	4,668	4,348	4,156
0801	Offset obligations (CSE grants to States)	3	3	3

0900	Total new obligations	4,671	4,351	4,159

	Budgetary Resources:
	Unobligated balance:
1021	Recoveries of prior year unpaid obligations	509	300	300

1050	Unobligated balance (total)	509	300	300
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	3,059	2,848	2,756

1260	Appropriations, mandatory (total)	3,059	2,848	2,756
	Advance appropriations, mandatory:
1270	Advance appropriation	1,100	1,200	1,100

1280	Advanced appropriation, mandatory (total)	1,100	1,200	1,100
	Spending authority from offsetting collections, mandatory:
1800	Collected	3	3	3

1850	Spending auth from offsetting collections, mand (total)	3	3	3
1900	Budget authority (total)	4,162	4,051	3,859
1930	Total budgetary resources available	4,671	4,351	4,159

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	1,130	1,107	1,286
3030	Obligations incurred, unexpired accounts	4,671	4,351	4,159
3040	Outlays (gross)	–4,185	–3,872	–3,865
3080	Recoveries of prior year unpaid obligations, unexpired	–509	–300	–300
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	1,107	1,286	1,280

3100	Obligated balance, end of year (net)	1,107	1,286	1,280

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	4,162	4,051	3,859
	Outlays, gross:
4100	Outlays from new mandatory authority	3,318	3,001	2,895
4101	Outlays from mandatory balances	867	871	970

4110	Outlays, gross (total)	4,185	3,872	3,865
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–3	–3	–3
4180	Budget authority, net (total)	4,159	4,048	3,856
4190	Outlays, net (total)	4,182	3,869	3,862


		2011 actual	2012 est.	2013 est.

Enacted/requested:
	Budget Authority	4,159	4,048	3,856
	Outlays	4,182	3,869	3,862
Legislative proposal, subject to PAYGO:
	Budget Authority			11
	Outlays			11
Total:
	Budget Authority	4,159	4,048	3,867
	Outlays	4,182	3,869	3,873

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. This request proposes a Child Support and Fatherhood Initiative, a comprehensive set of proposals which promotes using child support payments in the best interest of the child; supports noncustodial parents becoming and staying involved in their children's lives; and improves establishment and enforcement procedures by closing loopholes and improving federal processes.


Identification code 75–1501–0–1–609		2011 actual	2012 est.	2013 est.

41.0	Direct obligations: Grants, subsidies, and contributions	4,668	4,348	4,156
99.0	Reimbursable obligations	3	3	3

99.9	Total new obligations	4,671	4,351	4,159


Identification code 75–1501–4–1–609		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	State child support administrative costs			11

0900	Total new obligations (object class 41.0)			11

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			11

1260	Appropriations, mandatory (total)			11
1900	Budget authority (total)			11
1930	Total budgetary resources available			11

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts			11
3040	Outlays (gross)			–11

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			11
	Outlays, gross:
4100	Outlays from new mandatory authority			11
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4180	Budget authority, net (total)			11
4190	Outlays, net (total)			11

For making payments under subsections (b), [and] (d), and (e) of section 2602 of the Low Income Home Energy Assistance Act of 1981, [$3,478,246,000] $3,020,000,000, of which $2,820,000,000 shall be for payments under subsections (b) and (d) of such section; and of which $200,000,000 shall be for making payments under subsection (e) of such section, to be made notwithstanding the designation requirements of such subsection: Provided, That all but [$497,000,000] $403,000,000 of [such funds] the amount provided in this section for subsections (b) and (d) shall be allocated as though the total appropriation for such payments for fiscal year [2012] 2013 was less than $1,975,000,000: Provided further, That notwithstanding section 2609A(a), of the amounts appropriated under section 2602(b), not more than $3,000,000 of such amounts may be reserved by the Secretary for technical assistance, training, and monitoring of program activities for compliance with internal controls, policies and procedures. (Department of Health and Human Services Appropriations Act, 2012.)


Identification code 75–1502–0–1–609		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	LIHEAP	4,701	3,472	3,020

0900	Total new obligations (object class 41.0)	4,701	3,472	3,020

	Budgetary Resources:
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	4,710	3,479	3,020
1130	Appropriations permanently reduced	–9
1143	Approp permanently reduced (Sec 527, HR 2055)		–7

1160	Appropriation, discretionary (total)	4,701	3,472	3,020
1930	Total budgetary resources available	4,701	3,472	3,020

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	1,715	1,992	1,738
3030	Obligations incurred, unexpired accounts	4,701	3,472	3,020
3040	Outlays (gross)	–4,419	–3,726	–3,338
3081	Recoveries of prior year unpaid obligations, expired	–5
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	1,992	1,738	1,420

3100	Obligated balance, end of year (net)	1,992	1,738	1,420

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	4,701	3,472	3,020
	Outlays, gross:
4010	Outlays from new discretionary authority	2,978	2,326	2,027
4011	Outlays from discretionary balances	1,441	1,400	1,311

4020	Outlays, gross (total)	4,419	3,726	3,338
4180	Budget authority, net (total)	4,701	3,472	3,020
4190	Outlays, net (total)	4,419	3,726	3,338

This program makes grants to States and Indian Tribes to aid low-income households with high energy costs through payments to eligible households, energy suppliers, and weatherization providers. Obligation estimates for the contingency fund assume that all funds will be released in response to expected high prices for home delivered fuels and other weather related events.

For necessary expenses for refugee and entrant assistance activities authorized by section 414 of the Immigration and Nationality Act and section 501 of the Refugee Education Assistance Act of 1980, for carrying out section 462 of the Homeland Security Act of 2002, section 235 of the William Wilberforce Trafficking Victims Protection Reauthorization Act of 2008, and the Trafficking Victims Protection Act of 2000, for costs associated with the care and placement of unaccompanied alien children, and for carrying out the Torture Victims Relief Act of 1998, [$769,789,000] $805,358,000, of which up to [$9,794,000] $9,775,000 shall be available to carry out the Trafficking Victims Protection Act of 2000: Provided, That funds appropriated under this heading pursuant to section 414(a) of the Immigration and Nationality Act, section 462 of the Homeland Security Act of 2002, section 235 of the William Wilberforce Trafficking Victims Protection Reauthorization Act of 2008, and the Trafficking Victims Protection Act of 2000 for fiscal year [2012] 2013 shall be available for the costs of assistance provided and other activities to remain available through September 30, [2014] 2015. (Department of Health and Human Services Appropriations Act, 2012.)


Identification code 75–1503–0–1–609		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Refugee and entrant assistance	574	605	619
0002	Assistance for treatment of torture victims	11	11	11
0003	Unaccompanied alien children	175	175	175

0900	Total new obligations	760	791	805

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	77	23
1021	Recoveries of prior year unpaid obligations	2

1050	Unobligated balance (total)	79	23
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	731	769	805
1130	Appropriations permanently reduced	–2
1131	Unobligated balance of appropriations permanently reduced	–25
1143	Approp permanently reduced (Sec 527, HR 2055)		–1

1160	Appropriation, discretionary (total)	704	768	805
1930	Total budgetary resources available	783	791	805
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	23

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	576	566	699
3030	Obligations incurred, unexpired accounts	760	791	805
3040	Outlays (gross)	–753	–658	–830
3080	Recoveries of prior year unpaid obligations, unexpired	–2
3081	Recoveries of prior year unpaid obligations, expired	–15
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	566	699	674

3100	Obligated balance, end of year (net)	566	699	674

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	704	768	805
	Outlays, gross:
4010	Outlays from new discretionary authority	347	307	322
4011	Outlays from discretionary balances	406	351	508

4020	Outlays, gross (total)	753	658	830
4180	Budget authority, net (total)	704	768	805
4190	Outlays, net (total)	753	658	830

This program provides funds to States and non-governmental organizations for administering the refugee and entrant assistance program. Funds also are provided to assist in the rehabilitation of victims of torture, trafficking victims, and the care and placement of unaccompanied alien children.


Identification code 75–1503–0–1–609		2011 actual	2012 est.	2013 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	4	4	4
12.1	Civilian personnel benefits	1	1	1
23.1	Rental payments to GSA	2	2	2
25.1	Advisory and assistance services	31	29	29
25.3	Other goods and services from Federal sources	8	16	16
41.0	Grants, subsidies, and contributions	714	739	753

99.9	Total new obligations	760	791	805


Identification code 75–1503–0–1–609		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment	44	44	44

For carrying out section 436 of the Social Security Act, $345,000,000 and, in addition, for carrying out section 437 of such Act, [$63,184,000] $63,065,000. (Department of Health and Human Services Appropriations Act, 2012.)


Identification code 75–1512–0–1–506		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Grants to States and Tribes	388	368	368
0002	Research, training and technical assistance	8	8	8
0003	State court improvement activities	32	32	32
0004	Family Connection Grants	15	15	15
0005	PREP	72	100	75
0006	Abstinence Education	38	37	37

0900	Total new obligations	553	560	535

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	19	25
1021	Recoveries of prior year unpaid obligations	3

1050	Unobligated balance (total)	22	25
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	63	63	76
1130	Appropriations permanently reduced			–13

1160	Appropriation, discretionary (total)	63	63	63
	Appropriations, mandatory:
1200	Appropriation	505	485	485

1260	Appropriations, mandatory (total)	505	485	485
1900	Budget authority (total)	568	548	548
1930	Total budgetary resources available	590	573	548
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–12	–13
1941	Unexpired unobligated balance, end of year	25		13

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	552	614	542
3030	Obligations incurred, unexpired accounts	553	560	535
3040	Outlays (gross)	–479	–632	–542
3080	Recoveries of prior year unpaid obligations, unexpired	–3
3081	Recoveries of prior year unpaid obligations, expired	–9
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	614	542	535

3100	Obligated balance, end of year (net)	614	542	535

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	63	63	63
	Outlays, gross:
4010	Outlays from new discretionary authority	21	19	19
4011	Outlays from discretionary balances	45	41	45

4020	Outlays, gross (total)	66	60	64
	Mandatory:
4090	Budget authority, gross	505	485	485
	Outlays, gross:
4100	Outlays from new mandatory authority	104	158	158
4101	Outlays from mandatory balances	309	414	320

4110	Outlays, gross (total)	413	572	478
4180	Budget authority, net (total)	568	548	548
4190	Outlays, net (total)	479	632	542

This account provides funds for a broad range of child welfare services, including family preservation and family support services. Additionally, this account includes funding for the Personal Responsibility Education Program (PREP) and Abstinence Education which were made available by the Patient Protection and Affordable Care Act (P.L. 111–148). This account also includes a new initiative to prevent pregnancy among youth in foster care.


Identification code 75–1512–0–1–506		2011 actual	2012 est.	2013 est.

	Direct obligations:
25.1	Advisory and assistance services	12	12	12
25.3	Other goods and services from Federal sources	2	2	2
41.0	Grants, subsidies, and contributions	539	546	521

99.9	Total new obligations	553	560	535


Identification code 75–1512–0–1–506		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment	5	5	5


Identification code 75–1550–0–1–609		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Mandatory child care	1,178	1,178	1,178
0002	Matching child care	1,686	1,674	1,674
0003	Training and technical assistance	7	7	7
0004	Child care tribal grants	58	58	58

0900	Total new obligations	2,929	2,917	2,917

	Budgetary Resources:
	Unobligated balance:
1012	Unobligated balance transfers between expired and unexpired accounts	25
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	2,917	2,917	2,917

1260	Appropriations, mandatory (total)	2,917	2,917	2,917
1900	Budget authority (total)	2,917	2,917	2,917
1930	Total budgetary resources available	2,942	2,917	2,917
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–13

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	806	609	658
3030	Obligations incurred, unexpired accounts	2,929	2,917	2,917
3040	Outlays (gross)	–3,100	–2,868	–2,877
3081	Recoveries of prior year unpaid obligations, expired	–26
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	609	658	698

3100	Obligated balance, end of year (net)	609	658	698

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	2,917	2,917	2,917
	Outlays, gross:
4100	Outlays from new mandatory authority	2,382	2,357	2,357
4101	Outlays from mandatory balances	718	511	520

4110	Outlays, gross (total)	3,100	2,868	2,877
4180	Budget authority, net (total)	2,917	2,917	2,917
4190	Outlays, net (total)	3,100	2,868	2,877


		2011 actual	2012 est.	2013 est.

Enacted/requested:
	Budget Authority	2,917	2,917	2,917
	Outlays	3,100	2,868	2,877
Legislative proposal, subject to PAYGO:
	Budget Authority			500
	Outlays			409
Total:
	Budget Authority	2,917	2,917	3,417
	Outlays	3,100	2,868	3,286

This account provides child care subsidies for low-income working families and was established by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104–193), as amended by the Deficit Reduction Act of 2005 (P.L. 109–171), the Claims Resolution Act of 2010 (P.L. 111–291), the Short Term TANF Extension Act (P.L. 112–35), and the Temporary Payroll Tax Cut Continuation Act of 2011 (P.L. 112–78).


Identification code 75–1550–0–1–609		2011 actual	2012 est.	2013 est.

	Direct obligations:
25.1	Advisory and assistance services		1	1
25.2	Other services from non-Federal sources	7	6	6
41.0	Grants, subsidies, and contributions	2,922	2,910	2,910

99.9	Total new obligations	2,929	2,917	2,917


Identification code 75–1550–4–1–609		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0002	Matching child care			480
0003	Training and technical assistance			10
0004	Child care tribal grants			10

0900	Total new obligations			500

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			500

1260	Appropriations, mandatory (total)			500
1900	Budget authority (total)			500
1930	Total budgetary resources available			500

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts			500
3040	Outlays (gross)			–409
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)			91

3100	Obligated balance, end of year (net)			91

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			500
	Outlays, gross:
4100	Outlays from new mandatory authority			397
4101	Outlays from mandatory balances			12

4110	Outlays, gross (total)			409
4180	Budget authority, net (total)			500
4190	Outlays, net (total)			409


Identification code 75–1550–4–1–609		2011 actual	2012 est.	2013 est.

	Direct obligations:
25.2	Other services from non-Federal sources			10
41.0	Grants, subsidies, and contributions			490

99.9	Total new obligations			500

For carrying out the Child Care and Development Block Grant Act of 1990, [$2,282,627,000] $2,303,313,000 shall be used to supplement, not supplant State general revenue funds for child care assistance for low-income families: Provided, That [$19,433,000] $19,609,000 shall be available for child care resource and referral and school-aged child care activities, of which $1,000,000 shall be available to the Secretary for a competitive grant for the operation of a national toll free hotline and Web site to develop and disseminate child care consumer education information for parents and help parents access child care in their local community: Provided further, That, in addition to the amounts required to be reserved by the States under section 658G, [$291,248,000] $293,887,000 shall be reserved by the States for activities authorized under section 658G, of which [$106,813,000] $107,781,000 shall be for activities that improve the quality of infant and toddler care: Provided further, That [$9,890,000] $9,871,000 shall be for use by the Secretary for child care research, demonstration, and evaluation activities.

In addition, $300,000,000, for grants to States to improve the quality of child care and for the Federal costs of carrying out evaluations. (Department of Health and Human Services Appropriations Act, 2012.)


Identification code 75–1515–0–1–609		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Block grant payments to States	2,213	2,268	2,593
0004	Research and evaluation fund	10	10	10

0900	Total new obligations	2,223	2,278	2,603

	Budgetary Resources:
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	2,227	2,282	2,603
1130	Appropriations permanently reduced	–4
1143	Approp permanently reduced (Sec 527, HR 2055)		–4

1160	Appropriation, discretionary (total)	2,223	2,278	2,603
1930	Total budgetary resources available	2,223	2,278	2,603

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	1,240	478	457
3030	Obligations incurred, unexpired accounts	2,223	2,278	2,603
3040	Outlays (gross)	–2,984	–2,299	–2,461
3081	Recoveries of prior year unpaid obligations, expired	–1
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	478	457	599

3100	Obligated balance, end of year (net)	478	457	599

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	2,223	2,278	2,603
	Outlays, gross:
4010	Outlays from new discretionary authority	1,825	1,845	2,108
4011	Outlays from discretionary balances	1,159	454	353

4020	Outlays, gross (total)	2,984	2,299	2,461
4180	Budget authority, net (total)	2,223	2,278	2,603
4190	Outlays, net (total)	2,984	2,299	2,461

This program provides grants to States for child care subsidies for low-income working families and activities to improve child care quality.


Identification code 75–1515–0–1–609		2011 actual	2012 est.	2013 est.

	Direct obligations:
25.1	Advisory and assistance services	14	5	11
25.3	Other goods and services from Federal sources	1	1	1
25.5	Research and development contracts		10	10
41.0	Grants, subsidies, and contributions	2,208	2,262	2,581

99.9	Total new obligations	2,223	2,278	2,603

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-A of such Act shall be 10 percent. (Department of Health and Human Services Appropriations Act, 2012.)


Identification code 75–1534–0–1–506		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Social Services Block Grant	1,700	1,700	1,700
0002	Health Profession Opportunity Grants	85	85	85

0900	Total new obligations	1,785	1,785	1,785

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	30	30	30
1021	Recoveries of prior year unpaid obligations		66
1029	Other balances withdrawn		–66

1050	Unobligated balance (total)	30	30	30
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	1,785	1,785	1,785

1260	Appropriations, mandatory (total)	1,785	1,785	1,785
1930	Total budgetary resources available	1,815	1,815	1,815
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	30	30	30

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	610	580	391
3030	Obligations incurred, unexpired accounts	1,785	1,785	1,785
3040	Outlays (gross)	–1,787	–1,908	–1,792
3080	Recoveries of prior year unpaid obligations, unexpired		–66
3081	Recoveries of prior year unpaid obligations, expired	–28
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	580	391	384

3100	Obligated balance, end of year (net)	580	391	384

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	1,785	1,785	1,785
	Outlays, gross:
4100	Outlays from new mandatory authority	1,393	1,483	1,483
4101	Outlays from mandatory balances	394	425	309

4110	Outlays, gross (total)	1,787	1,908	1,792
4180	Budget authority, net (total)	1,785	1,785	1,785
4190	Outlays, net (total)	1,787	1,908	1,792


Identification code 75–1534–0–1–506		2011 actual	2012 est.	2013 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	1	1	1
25.1	Advisory and assistance services	15	16	16
41.0	Grants, subsidies, and contributions	1,769	1,768	1,768

99.9	Total new obligations	1,785	1,785	1,785


Identification code 75–1534–0–1–506		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment	6	6	6

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 303 and 313 of the Family Violence Prevention and Services Act, the Native American Programs Act of 1974, title II of the Child Abuse Prevention and Treatment and Adoption Reform Act of 1978 (adoption opportunities), the Abandoned Infants Assistance Act of 1988, section 291 of the Help America Vote Act of 2002, part B-1 of title IV and sections 413, 1110, and 1115 of the Social Security Act; for making payments under the Community Services Block Grant Act ("CSBG Act''), sections [439(i),] 473B[,] and 477(i) of the Social Security Act, and the Assets for Independence Act; and for necessary administrative expenses to carry out such Acts and titles I, IV, V, X, XI, XIV, XVI, and XX of the Social Security Act, the Act of July 5, 1960, the Low Income Home Energy Assistance Act of 1981, title IV of the Immigration and Nationality Act, and section 501 of the Refugee Education Assistance Act of 1980, [$9,926,709,000] $9,688,767,000, of which [$39,421,000] $39,346,000, to remain available through September 30, [2013] 2014, shall be for grants to States for adoption incentive payments, as authorized by section 473A of the Social Security Act and may be made for adoptions completed before September 30, [2012] 2013: Provided, That [$7,983,633,000] $8,054,000,000 shall be for making payments under the Head Start Act: Provided further, That of the amount in the previous proviso, $7,968,543,933 shall be available for payments under section 640 of the Head Start Act at the same level of such payments for FY 2012; of which $40,000,000 shall be available through fiscal year 2014 for allocation by the Secretary to supplement activities described in paragraphs (7)(B) and (9) of section 641(c) of such Act under the Designation Renewal System, established under the authority of sections 641(c)(7), 645A(b)(12) and 645A(d) of such Act; and of which $45,456,067 shall be available for carrying out the cost of living adjustment described in section 640(a)(3)(A)(ii)(II)(aa) of such Act: Provided further, That amounts allocated to Head Start grantees at the discretion of the Secretary to supplement activities pursuant to the previous proviso shall not be included in the calculation of the "base grant" in subsequent fiscal years, as such term is used in section 640(a)(7)(A) of the Head Start Act:[for purposes of allocating funds described by the immediately preceding proviso, the term "base grant'' as used in subsection (a)(7)(A) of section 640 of such Act with respect to funding provided to a Head Start agency (including each Early Head Start agency) for fiscal year 2011 shall be calculated as described in such subsection and to which amount shall be added 50 percent of the amount of funds appropriated under the heading "Department of Health and Human Services, Administration for Children and Families, Children and Family Services Programs'' in Public Law 111–5 and provided to such agency for carrying out expansion of Head Start programs, as that phrase is used in subsection (a)(4)(D) of such section 640, and provided to such agency as the ongoing funding level for operations in the 12-month period beginning in fiscal year 2010:] Provided further, That [$713,630,000] $379,943,000 shall be for making payments under the CSBG Act: Provided further, That [$35,340,000] $30,293,000 shall be for sections 680 and 678E(b)(2) of the CSBG Act, of which not less than [$30,000,000] $29,943,000 shall be for section 680(a)(2) [and not less than $4,990,000 shall be for section 680(a)(3)(B)] of such Act: Provided further, That, to the extent funds for the Assets for Independence Act are distributed as grant funds to a qualified entity and have not been expended by such entity within three years after the date of award, such funds may be recaptured and reallocated among other qualified entities, to remain available for five years: Provided further, That, notwithstanding section 414(e) of the Assets for Independence Act, the Secretary may award up to $1,000,000 to support evidence-based research to evaluate the demonstration project: Provided further, That amounts provided herein to carry out section 1110 of the Social Security Act shall remain available until expended: Provided further, That, in addition to amounts provided herein, $5,762,000 shall be available from amounts available under section 241 of the PHS 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 CSBG 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 assets and program income that permit such assets acquired with, and program income derived from, grant funds authorized under section 680 of the CSBG Act to become the sole property of such grantees after a period of not more than 12 years after the end of the grant period for any activity consistent with section 680(a)(2)(A) of the CSBG Act: Provided further, That intangible assets in the form of loans, equity investments and other debt instruments, and program income may be used by grantees for any eligible purpose consistent with section 680(a)(2)(A) of the CSBG Act: Provided further, That these procedures shall apply to such grant funds made available after November 29, 1999: Provided further, That funds appropriated for section 680(a)(2) of the CSBG Act shall be available for financing construction and rehabilitation and loans or investments in private business enterprises owned by community development corporations: Provided further, That [$5,245,000] $5,235,000 shall be for activities authorized by section 291 of the Help America Vote Act of 2002: Provided further, That $1,996,000 shall be for a human services case management system for federally declared disasters, to include a comprehensive national case management contract and Federal costs of administering the system: Provided further, That section 303 (a)(2)(A)(i) of the Family Violence Prevention and Services Act shall not apply to amounts provided herein: Provided further, That up to $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. (Department of Health and Human Services Appropriations Act, 2012.)


Identification code 75–1536–0–1–506		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0101	Head start	7,559	7,969	8,054
0103	Runaway and homeless youth (basic centers)	54	53	53
0104	Transitional living	44	44	44
0106	Education grants to reduce sexual abuse of runaway youth	18	18	18
0109	Child abuse State grants	26	26	26
0110	Child abuse discretionary activities	26	26	26
0111	Community-based child abuse prevention	42	42	42
0112	Child welfare services	281	281	281
0113	Child welfare training, research, or demonstration projects	27	26	31
0114	Adoption opportunities	39	39	39
0115	Abandoned infants assistance	12	11	11
0116	Adoption incentives	39	42	39
0117	Independent living training vouchers	45	45	45
0119	State councils on developmental disabilities	75	75	75
0120	Protection and advocacy	41	41	41
0121	Projects of national significance	14	8	8
0122	University centers for excellence	39	39	39
0123	Voting access for individuals with disabilities	17	5	5
0124	Native American programs	49	49	49
0125	Social services and income maintenance research			3
0128	Federal administration	207	204	212
0129	Center for faith-based and community initiatives	1	1	1
0131	Disaster human services case management	2	2	2

0191	Subtotal	8,657	9,046	9,144
0301	Community services block grant	678	677	350
0303	Rural community facilities	5	5
0304	Community services discretionary (JOLI & CED)	20	30	30
0306	Assets for independence	24	20	20
0308	Domestic violence hotline	3	3	5
0309	Family violence prevention and services	130	130	135
0310	Disconnected Youth			5

0391	Subtotal	860	865	545

0400	Total, direct program	9,517	9,911	9,689

0799	Total direct obligations	9,517	9,911	9,689
0801	Reimbursable program	21	25	25

0809	Reimbursable program activities, subtotal	21	25	25

0900	Total new obligations	9,538	9,936	9,714

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	2	2	2
1021	Recoveries of prior year unpaid obligations		3

1050	Unobligated balance (total)	2	5	2
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	9,538	9,927	9,689
1130	Appropriations permanently reduced	–19
1143	Approp permanently reduced (Sec 527, HR 2055)		–19

1160	Appropriation, discretionary (total)	9,519	9,908	9,689
	Spending authority from offsetting collections, discretionary:
1700	Collected	18	24	24
1701	Change in uncollected payments, Federal sources	2

1750	Spending auth from offsetting collections, disc (total)	20	24	24
	Spending authority from offsetting collections, mandatory:
1800	Collected	1	1	1
1801	Change in uncollected payments, Federal sources	1

1850	Spending auth from offsetting collections, mand (total)	2	1	1
1900	Budget authority (total)	9,541	9,933	9,714
1930	Total budgetary resources available	9,543	9,938	9,716
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–3
1941	Unexpired unobligated balance, end of year	2	2	2

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	7,810	6,702	6,554
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–15	–7	–7

3020	Obligated balance, start of year (net)	7,795	6,695	6,547
3030	Obligations incurred, unexpired accounts	9,538	9,936	9,714
3040	Outlays (gross)	–10,551	–10,081	–9,868
3050	Change in uncollected pymts, Fed sources, unexpired	–3
3051	Change in uncollected pymts, Fed sources, expired	11
3080	Recoveries of prior year unpaid obligations, unexpired		–3
3081	Recoveries of prior year unpaid obligations, expired	–95
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	6,702	6,554	6,400
3091	Uncollected pymts, Fed sources, end of year	–7	–7	–7

3100	Obligated balance, end of year (net)	6,695	6,547	6,393

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	9,539	9,932	9,713
	Outlays, gross:
4010	Outlays from new discretionary authority	3,962	4,187	4,095
4011	Outlays from discretionary balances	6,585	5,892	5,771

4020	Outlays, gross (total)	10,547	10,079	9,866
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–21	–18	–18
4033	Non-Federal sources	–8	–6	–6

4040	Offsets against gross budget authority and outlays (total)	–29	–24	–24
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–2
4052	Offsetting collections credited to expired accounts	11

4060	Additional offsets against budget authority only (total)	9

4070	Budget authority, net (discretionary)	9,519	9,908	9,689
4080	Outlays, net (discretionary)	10,518	10,055	9,842
	Mandatory:
4090	Budget authority, gross	2	1	1
	Outlays, gross:
4100	Outlays from new mandatory authority	2	1	1
4101	Outlays from mandatory balances	2	1	1

4110	Outlays, gross (total)	4	2	2
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–1	–1	–1
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–1
4170	Outlays, net (mandatory)	3	1	1
4180	Budget authority, net (total)	9,519	9,908	9,689
4190	Outlays, net (total)	10,521	10,056	9,843

The request prioritizes investments in early learning to improve outcomes for children. A total of $8.054 billion is requested to maintain the number of children served in Head Start and support implementation of Head Start recompetition. This Budget also requests an additional $7 million for family violence prevention, $5 million for an interagency effort to improve outcomes for disconnected youth, and $5 million to enhance efforts to prevent domestic trafficking.


Identification code 75–1536–0–1–506		2011 actual	2012 est.	2013 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	113	113	117
11.3	Other than full-time permanent	5	5	5
11.5	Other personnel compensation	3	3	3

11.9	Total personnel compensation	121	121	125
12.1	Civilian personnel benefits	30	30	31
21.0	Travel and transportation of persons	5	4	4
23.1	Rental payments to GSA	20	20	20
23.2	Rental payments to others	1	1	1
23.3	Communications, utilities, and miscellaneous charges	5	5	5
24.0	Printing and reproduction	2	2	2
25.1	Advisory and assistance services	248	251	251
25.2	Other services from non-Federal sources	15	15	15
25.3	Other goods and services from Federal sources	49	49	49
25.4	Operation and maintenance of facilities	3	3	3
25.5	Research and development contracts	1	1	1
26.0	Supplies and materials	1	1	1
41.0	Grants, subsidies, and contributions	9,016	9,408	9,181

99.0	Direct obligations	9,517	9,911	9,689
99.0	Reimbursable obligations	21	25	25

99.9	Total new obligations	9,538	9,936	9,714


Identification code 75–1536–0–1–506		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment	1,193	1,193	1,217
1101	Direct military average strength employment	4	4	4


Identification code 75–1553–0–1–609		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Training and technical assistance	12	12	12
0002	Federal parent locator service	25	25	25
0003	Child welfare study	6
0004	Welfare research	15	15	15

0799	Total direct obligations	58	52	52
0801	Reimbursable program	24	26	26

0900	Total new obligations	82	78	78

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	5	8	10
1021	Recoveries of prior year unpaid obligations	4

1050	Unobligated balance (total)	9	8	10
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	58	52	52

1260	Appropriations, mandatory (total)	58	52	52
	Spending authority from offsetting collections, mandatory:
1800	Collected	24	29	29
1801	Change in uncollected payments, Federal sources	–1	–1	–1

1850	Spending auth from offsetting collections, mand (total)	23	28	28
1900	Budget authority (total)	81	80	80
1930	Total budgetary resources available	90	88	90
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	8	10	12

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	57	60	54
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–6	–5	–4

3020	Obligated balance, start of year (net)	51	55	50
3030	Obligations incurred, unexpired accounts	82	78	78
3040	Outlays (gross)	–75	–84	–94
3050	Change in uncollected pymts, Fed sources, unexpired	1	1	1
3080	Recoveries of prior year unpaid obligations, unexpired	–4
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	60	54	38
3091	Uncollected pymts, Fed sources, end of year	–5	–4	–3

3100	Obligated balance, end of year (net)	55	50	35

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	81	80	80
	Outlays, gross:
4100	Outlays from new mandatory authority	33	38	37
4101	Outlays from mandatory balances	42	46	57

4110	Outlays, gross (total)	75	84	94
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–24	–5	–5
4123	Non-Federal sources		–24	–24

4130	Offsets against gross budget authority and outlays (total)	–24	–29	–29
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	1	1	1

4160	Budget authority, net (mandatory)	58	52	52
4170	Outlays, net (mandatory)	51	55	65
4180	Budget authority, net (total)	58	52	52
4190	Outlays, net (total)	51	55	65


		2011 actual	2012 est.	2013 est.

Enacted/requested:
	Budget Authority	58	52	52
	Outlays	51	55	65
Legislative proposal, subject to PAYGO:
	Budget Authority		6	6
	Outlays		1	3
Total:
	Budget Authority	58	58	58
	Outlays	51	56	68

This account provides funding for research and technical assistance activities established by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104–193), as amended by the Deficit Reduction Act of 2005 (P.L. 109–171), the Claims Resolution Act of 2010 (P.L. 111–291), the Short Term TANF Extension Act (P.L. 112–35), and the Temporary Payroll Tax Cut Continuation Act of 2011 (P.L. 112–78).


Identification code 75–1553–0–1–609		2011 actual	2012 est.	2013 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	7	7	7
12.1	Civilian personnel benefits	2	2	2
21.0	Travel and transportation of persons	1	1	1
23.1	Rental payments to GSA	3	3	3
25.1	Advisory and assistance services	21	19	19
25.2	Other services from non-Federal sources	14	5	5
25.3	Other goods and services from Federal sources	5	6	6
25.7	Operation and maintenance of equipment	3	7	7
41.0	Grants, subsidies, and contributions	2	2	2

99.0	Direct obligations	58	52	52
99.0	Reimbursable obligations	24	26	26

99.9	Total new obligations	82	78	78


Identification code 75–1553–0–1–609		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment	64	64	64


Identification code 75–1553–4–1–609		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0003	Child welfare study		6	6

0900	Total new obligations (object class 25.2)		6	6

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation		6	6

1260	Appropriations, mandatory (total)		6	6
1900	Budget authority (total)		6	6
1930	Total budgetary resources available		6	6

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)			5
3030	Obligations incurred, unexpired accounts		6	6
3040	Outlays (gross)		–1	–3
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)		5	8

3100	Obligated balance, end of year (net)		5	8

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross		6	6
	Outlays, gross:
4100	Outlays from new mandatory authority		1	1
4101	Outlays from mandatory balances			2

4110	Outlays, gross (total)		1	3
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4180	Budget authority, net (total)		6	6
4190	Outlays, net (total)		1	3

For making payments to States or other non-Federal entities under title IV-E of the Social Security Act, [$5,153,000,000] $4,810,000,000.

For making payments to States or other non-Federal entities under title IV-E of the Social Security Act, for the first quarter of fiscal year [2013, $2,100,000,000]2014, $2,200,000,000.

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 of the Social Security Act, 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. (Department of Health and Human Services Appropriations Act, 2012.)


Identification code 75–1545–0–1–609		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Foster care	4,456	4,107	4,143
0002	Independent living	140	140	140
0004	Adoption assistance	2,362	2,415	2,537
0005	Guardianship	29	86	90
0006	Tribal T&TA	3	3	3

0900	Total new obligations	6,990	6,751	6,913

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	5,140	5,156	4,813

1260	Appropriations, mandatory (total)	5,140	5,156	4,813
	Advance appropriations, mandatory:
1270	Advance appropriation	1,850	1,850	2,100

1280	Advanced appropriation, mandatory (total)	1,850	1,850	2,100
1900	Budget authority (total)	6,990	7,006	6,913
1930	Total budgetary resources available	6,990	7,006	6,913
	Memorandum (non-add) entries:
1940	Unobligated balance expiring		–255

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	1,216	1,218	1,174
3030	Obligations incurred, unexpired accounts	6,990	6,751	6,913
3031	Obligations incurred, expired accounts	11
3040	Outlays (gross)	–6,860	–6,795	–6,948
3081	Recoveries of prior year unpaid obligations, expired	–139
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	1,218	1,174	1,139

3100	Obligated balance, end of year (net)	1,218	1,174	1,139

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	6,990	7,006	6,913
	Outlays, gross:
4100	Outlays from new mandatory authority	6,030	5,883	6,035
4101	Outlays from mandatory balances	830	912	913

4110	Outlays, gross (total)	6,860	6,795	6,948
4180	Budget authority, net (total)	6,990	7,006	6,913
4190	Outlays, net (total)	6,860	6,795	6,948


		2011 actual	2012 est.	2013 est.

Enacted/requested:
	Budget Authority	6,990	7,006	6,913
	Outlays	6,860	6,795	6,948
Legislative proposal, subject to PAYGO:
	Budget Authority			252
	Outlays			222
Total:
	Budget Authority	6,990	7,006	7,165
	Outlays	6,860	6,795	7,170

This account provides formula grants for Foster Care, Adoption Assistance, Guardianship Assistance, and the Chafee Foster Care Independence Program as well as technical assistance and implementation services for Tribal programs.

Foster care._The proposed level will support eligible low-income children who must be placed outside the home. An average of 165,000 children per month are estimated to be served in FY 2013.

Adoption assistance._The proposed funding level will support subsidies for families adopting eligible low-income children with special needs. An average of 459,500 children per month are estimated to be served in FY 2013.

Guardianship Assistance._The proposed funding level will provide payments for relatives taking legal guardianship of eligible children who have been in foster care. An average of 14,000 children per month are estimated to be served in FY 2013.


Identification code 75–1545–0–1–609		2011 actual	2012 est.	2013 est.

	Direct obligations:
23.1	Rental payments to GSA	1	1	1
25.1	Advisory and assistance services	18	22	22
25.3	Other goods and services from Federal sources	2	1	1
41.0	Grants, subsidies, and contributions	6,969	6,727	6,889

99.9	Total new obligations	6,990	6,751	6,913


Identification code 75–1545–0–1–609		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment	4	4	4


Identification code 75–1545–4–1–609		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Foster care			252

0900	Total new obligations (object class 41.0)			252

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			252

1260	Appropriations, mandatory (total)			252
1900	Budget authority (total)			252
1930	Total budgetary resources available			252

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts			252
3040	Outlays (gross)			–222
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)			30

3100	Obligated balance, end of year (net)			30

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			252
	Outlays, gross:
4100	Outlays from new mandatory authority			222
4180	Budget authority, net (total)			252
4190	Outlays, net (total)			222

The legislative proposals provide financial incentives to improve the child welfare system, and require that child support payments made on behalf of children in foster care be used in the best interest of the child.

Federal Funds

For carrying out, to the extent not otherwise provided, the Older Americans Act of 1965 ("OAA''), section 398 and title XXIX of the PHS Act, section 119 of the Medicare Improvements for Patients and Providers Act of 2008, [$1,473,703,000] and title XX-B of the Social Security Act, $1,926,434,000, together with $51,902,000 to be transferred from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund to carry out section 4360 of the Omnibus Budget Reconcilliation Act of 1990: Provided, That amounts appropriated under this heading may be used for grants to States under section 361 of the OAA only for disease prevention and health promotion programs and activities which have been demonstrated through rigorous evaluation to be evidence-based and effective: Provided further, That, notwithstanding section 206(g) of the OAA, up to one percent of amounts appropriated to carry out programs authorized under title III of such Act shall be available for conducting evaluations, training and technical assistance: Provided further, That none of the funds provided shall be used to carry out sections 1701 and 1703 of the PHS Act (with respect to chronic disease self-management activity grants), except that such funds may be used for necessary expenses associated with administering any such grants awarded prior to the date of the enactment of this Act: [Provided further, That the total amount available for fiscal year 2012 under this and any other Act to carry out activities related to Aging and Disability Resource Centers under subsections (a)(20)(B)(iii) and (b)(8) of section 202 of the OAA shall not exceed the amount obligated for such purposes for fiscal year 2010 from funds available under Public Law 111–117:] Provided further, That notwithstanding any other provision of this Act, funds made available under this heading to carry out section 311 of the OAA may be transferred to the Secretary of Agriculture in accordance with such section: Provided further, That, of the amounts provided under this heading, $448,251,000 shall be available for carrying out title V of the OAA: Provided further, That, with respect to the previous proviso, such funds shall be available through June 30, 2014, and may be recaptured and reobligated in accordance with section 517(c) of the OAA. (Department of Health and Human Services Appropriations Act, 2012.)


Identification code 75–0142–0–1–506		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0101	Home and community-based supportive services	369	367	367
0102	Preventive health services	21	21	21
0103	National family caregiver support program	154	154	154
0104	Native American caregiver support program	6	6	6
0105	Congregate nutrition services	441	440	440
0106	Home-delivered nutrition services	218	217	217
0107	Nutrition services incentive program	161	158	160
0108	Native American nutrition and supportive services	28	28	28
0109	Program innovations	12
0110	Aging network support activities	33	8	8
0111	Long-term care ombudsmen program	16	17	17
0112	Prevention of elder abuse and neglect	5	5	5
0113	Alzheimer's disease demonstration grants	11	4	9
0114	Program administration	20	23	23
0115	Lifespan respite care program	2	2	2
0117	Aging and Disability Resource Centers (ADRC)	10	16	10
0118	Chronic Disease Self-Management Program		10	10
0120	Adult Protective Services			8
0121	Senior Medicare Patrol program		9	9
0122	Elder Rights Support Activities		4	4
0125	Community Service Employment for Older Americans			448
0126	National Clearinghouse Long-Term Care Information		3	3

0300	Total, direct program	1,507	1,492	1,949

0799	Total direct obligations	1,507	1,492	1,949
0801	Reimbursable program - HCFAC and Other	6	11
0802	Reimbursable - SHIPs HI/SMI Trust Fund Transfer			52

0899	Total reimbursable obligations	6	11	52

0900	Total new obligations	1,513	1,503	2,001

	Budgetary Resources:
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	1,500	1,474	1,926
1120	Appropriations transferred to other accts [12–3507]		–2
1130	Appropriations permanently reduced	–3
1143	Approp permanently reduced (Sec 527, HR 2055)		–3

1160	Appropriation, discretionary (total)	1,497	1,469	1,926
	Appropriations, mandatory:
1200	Appropriation	10	13	13
1221	CDSMP Appropriations transferred from other accounts [75–0116]		10	10

1260	Appropriations, mandatory (total)	10	23	23
	Spending authority from offsetting collections, discretionary:
1700	Collected			52

1750	Spending auth from offsetting collections, disc (total)			52
	Spending authority from offsetting collections, mandatory:
1800	Collected	12	11
1801	Change in uncollected payments, Federal sources	–6

1850	Spending auth from offsetting collections, mand (total)	6	11
1900	Budget authority (total)	1,513	1,503	2,001
1930	Total budgetary resources available	1,513	1,503	2,001

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	746	678	679
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–48	–37	–37

3020	Obligated balance, start of year (net)	698	641	642
3030	Obligations incurred, unexpired accounts	1,513	1,503	2,001
3040	Outlays (gross)	–1,573	–1,502	–1,804
3050	Change in uncollected pymts, Fed sources, unexpired	6
3051	Change in uncollected pymts, Fed sources, expired	5
3081	Recoveries of prior year unpaid obligations, expired	–8
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	678	679	876
3091	Uncollected pymts, Fed sources, end of year	–37	–37	–37

3100	Obligated balance, end of year (net)	641	642	839

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	1,497	1,469	1,978
	Outlays, gross:
4010	Outlays from new discretionary authority	953	896	1,227
4011	Outlays from discretionary balances	600	584	554

4020	Outlays, gross (total)	1,553	1,480	1,781
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–1		–52
	Additional offsets against gross budget authority only:
4052	Offsetting collections credited to expired accounts	1

4070	Budget authority, net (discretionary)	1,497	1,469	1,926
4080	Outlays, net (discretionary)	1,552	1,480	1,729
	Mandatory:
4090	Budget authority, gross	16	34	23
	Outlays, gross:
4100	Outlays from new mandatory authority	3	13	2
4101	Outlays from mandatory balances	17	9	21

4110	Outlays, gross (total)	20	22	23
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–17	–11
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	6
4142	Offsetting collections credited to expired accounts	5

4150	Additional offsets against budget authority only (total)	11

4160	Budget authority, net (mandatory)	10	23	23
4170	Outlays, net (mandatory)	3	11	23
4180	Budget authority, net (total)	1,507	1,492	1,949
4190	Outlays, net (total)	1,555	1,491	1,752

Note.—The reimbursable program (HCFAC) in the Administration on Aging (AoA) reflects the actual distribution of the allocation account for 2012. Future allocations will be determined annually, and are not estimated in the current budget.

This account provides funding for formula grant programs that provide nutrition, supportive services and caregiver support services through a network of aging-related organizations to help predominantly older Americans, with the assistance of their caregivers, maintain their dignity and independence in their homes and communities. The Budget proposes to transfer the Senior Community Services Employment Program (SCSEP), authorized under title V of the Older Americans Act, from the Department of Labor to the Department of Health and Human Services, which administers the remainder of the Older Americans Act. SCSEP offers participants work-based community service training so that they can gain on-the-job experience and prepare to enter or to re-enter the workforce.


Identification code 75–0142–0–1–506		2011 actual	2012 est.	2013 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	11	12	14
12.1	Civilian personnel benefits	3	3	4
23.1	Rental payments to GSA	2	2	4
25.1	Advisory and assistance services	11	13	14
25.3	Other goods and services from Federal sources	7	9	7
41.0	Grants, subsidies, and contributions	1,473	1,453	1,906

99.0	Direct obligations	1,507	1,492	1,949
99.0	Reimbursable obligations	6	11	52

99.9	Total new obligations	1,513	1,503	2,001


Identification code 75–0142–0–1–506		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment	114	112	122
2001	Reimbursable civilian full-time equivalent employment	1	8	13

Trust Funds

Per the Secretary of Health and Human Services' announcement on October 14, 2011, the President's 2013 Budget does not project CLASS enrollment or the associated premiums and benefit outlays in the 10-year budget window or in the long-term budget outlook.

Federal Funds

For necessary expenses, not otherwise provided, for general departmental management, including hire of [six] passenger motor vehicles, and for carrying out titles III, XVII, and XXI of the PHS Act, the United States-Mexico Border Health Commission Act, and research studies under section 1110 of the Social Security Act, [$475,221,000] $306,320,000, together with [$69,211,000] $116,841,000 from the amounts available under section 241 of the PHS Act to carry out national health or human services research and evaluation activities: Provided, [That of this amount, $53,783,000 shall be for minority AIDS prevention and treatment activities: Provided further, That of the funds made available under this heading, $104,790,000 shall be for making competitive contracts and grants to public and private entities to fund medically accurate and age appropriate programs that reduce teen pregnancy and for the Federal costs associated with administering and evaluating such contracts and grants, of which not less than $75,000,000 shall be for replicating programs that have been proven effective through rigorous evaluation to reduce teenage pregnancy, behavioral risk factors underlying teenage pregnancy, or other associated risk factors, of which not less than $25,000,000 shall be available for research and demonstration grants to develop, replicate, refine, and test additional models and innovative strategies for preventing teenage pregnancy, and of which any remaining amounts shall be available for training and technical assistance, evaluation, outreach, and additional program support activities: Provided further,] That of the funds made available under this heading, $3,500,000 is for strengthening the Department's acquisition workforce capacity and capabilities: Provided further, That with respect to the previous proviso, such funds shall be available for training, recruitment, retention and hiring members of the acquisition workforce as defined by the Office of Federal Procurement Policy Act, as amended (41 U.S.C. 401 et seq.): Provided further, That, with respect to the second proviso, such funds shall be available for information technology in support of acquisition workforce effectiveness or for management solutions to improve acquisition management: Provided further, That of the amounts provided under this heading from amounts available under section 241 of the PHS Act, [$8,455,000] no less than $4,232,000 shall be available to carry out evaluations (including longitudinal evaluations) of teenage pregnancy prevention approaches, and $53,891,000 shall be for minority AIDS prevention and treatment activities[: Provided further, That of the funds made available under this heading, $5,000,000 shall be for making competitive grants to provide abstinence education (as defined by section 510(b)(2)(A)-(H) of the Social Security Act) to adolescents, and for Federal costs of administering the grant: Provided further, That grants made under the authority of section 510(b)(2)(A)-(H) of the Social Security Act shall be made only to public and private entities that 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 abstinence education was provided: Provided further, That funds provided in this Act for embryo adoption activities may be used to provide to individuals adopting embryos, through grants and other mechanisms, medical and administrative services deemed necessary for such adoptions: Provided further, That such services shall be provided consistent with 42 CFR 59.5(a)(4)]. (Department of Health and Human Services Appropriations Act, 2012.)


Identification code 75–9912–0–1–551		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	General departmental management	652	475	306
0004	Prevention and Public Health Fund (Mandatory)	19	10	120
0005	Prevention and Public Health Fund (Mandatory, Alzheimer's)			90

0799	Total direct obligations	671	485	516
0801	General departmental management	174	172	170
0802	HCFAC (Mandatory)	9	9
0803	PHS evaluation	65	69	117

0899	Total reimbursable obligations	248	250	287

0900	Total new obligations	919	735	803

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	14
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	652	475	306
1120	Appropriations transferred to other accts [75–9915]	–1
1130	Appropriations permanently reduced (Rescission)	–1
1143	Approp permanently reduced (Sec 527, HR 2055)		–1

1160	Appropriation, discretionary (total)	650	474	306
	Appropriations, mandatory:
1221	Appropriations transferred from other accts [75–0116]	19	10	210

1260	Appropriations, mandatory (total)	19	10	210
	Spending authority from offsetting collections, discretionary:
1700	Collected (PHS & Reimburseable)	161	242	287
1701	Change in uncollected payments, Federal sources (PHS Evaluation & Reimb.)	67

1750	Spending auth from offsetting collections, disc (total)	228	242	287
	Spending authority from offsetting collections, mandatory:
1800	Collected		9
1801	Change in uncollected payments, Federal sources	9

1850	Spending auth from offsetting collections, mand (total)	9	9
1900	Budget authority (total)	906	735	803
1930	Total budgetary resources available	920	735	803
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–1

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	543	718	549
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–344	–225	–225

3020	Obligated balance, start of year (net)	199	493	324
3030	Obligations incurred, unexpired accounts	919	735	803
3031	Obligations incurred, expired accounts	10
3040	Outlays (gross)	–749	–904	–753
3050	Change in uncollected pymts, Fed sources, unexpired	–76
3051	Change in uncollected pymts, Fed sources, expired	195
3081	Recoveries of prior year unpaid obligations, expired	–5
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	718	549	599
3091	Uncollected pymts, Fed sources, end of year	–225	–225	–225

3100	Obligated balance, end of year (net)	493	324	374

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	878	716	593
	Outlays, gross:
4010	Outlays from new discretionary authority	384	323	280
4011	Outlays from discretionary balances	347	571	443

4020	Outlays, gross (total)	731	894	723
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–375	–242	–287
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–67
4052	Offsetting collections credited to expired accounts	214

4060	Additional offsets against budget authority only (total)	147

4070	Budget authority, net (discretionary)	650	474	306
4080	Outlays, net (discretionary)	356	652	436
	Mandatory:
4090	Budget authority, gross	28	19	210
	Outlays, gross:
4100	Outlays from new mandatory authority	12	10	27
4101	Outlays from mandatory balances	6		3

4110	Outlays, gross (total)	18	10	30
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources		–9
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–9

4160	Budget authority, net (mandatory)	19	10	210
4170	Outlays, net (mandatory)	18	1	30
4180	Budget authority, net (total)	669	484	516
4190	Outlays, net (total)	374	653	466

Note.—The reimbursable program (HCFAC) in the General Department Management (GDM) account reflects the actual distribution of the allocation account for 2012. Future allocation will be determined annually, and are not estimated in the current budget.

General Departmental Management (GDM) funds activities that provide leadership, policy, legal, and administrative guidance to HHS components, and support research to develop policy initiatives and improve existing HHS programs. GDM also funds the activities of the Office of the Assistant Secretary for Health, including adolescent health, disease prevention and health promotion, physical fitness and sports, minority health, research integrity, women's health, and programs funded through the Prevention and Public Health Fund. This includes funding the continuation of grants for medically accurate and age appropriate programs to reduce teen pregnancy, including funds for research, demonstration grants, and replication of programs that have been proven effective through rigorous evaluation to reduce teen pregnancy.


Identification code 75–9912–0–1–551		2011 actual	2012 est.	2013 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	87	96	96
11.3	Other than full-time permanent	8	3	2
11.5	Other personnel compensation	9	3	2
11.7	Military personnel	7	5	5

11.9	Total personnel compensation	111	107	105
12.1	Civilian personnel benefits	26	24	24
12.2	Military personnel benefits	5	1	2
21.0	Travel and transportation of persons	4	4	3
23.1	Rental payments to GSA	15	17	17
23.3	Communications, utilities, and miscellaneous charges	1	4	4
24.0	Printing and reproduction	1	1	1
25.1	Advisory and assistance services	38	36	29
25.2	Other services from non-Federal sources	160	85	144
25.3	Other goods and services from Federal sources	70	51	144
25.4	Operation and maintenance of facilities	3	5	4
25.7	Operation and maintenance of equipment	1	4	3
26.0	Supplies and materials	2	6	6
31.0	Equipment	3	4	5
41.0	Grants, subsidies, and contributions	159	136	25

99.0	Direct obligations	599	485	516
99.0	Reimbursable obligations	248	250	287
	Allocation Account - direct:
11.1	Personnel compensation: Full-time permanent	60
12.1	Civilian personnel benefits	12

99.0	Allocation account - direct	72

99.9	Total new obligations	919	735	803


Identification code 75–9912–0–1–551		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment	957	1,072	1,074
1101	Direct military average strength employment	48	50	45
2001	Reimbursable civilian full-time equivalent employment	458	314	317
2101	Reimbursable military average strength employment	11	10	10
3001	Allocation account civilian full-time equivalent employment	498

For expenses necessary for the Office for Civil Rights, [$41,016,000] $38,966,000. (Department of Health and Human Services Appropriations Act, 2012.)


Identification code 75–0135–0–1–751		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Direct program activity	38	41	39
0801	Reimbursable program activity	5

0900	Total new obligations	43	41	39

	Budgetary Resources:
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	38	41	39

1160	Appropriation, discretionary (total)	38	41	39
	Spending authority from offsetting collections, discretionary:
1700	Collected	5

1750	Spending auth from offsetting collections, disc (total)	5
1900	Budget authority (total)	43	41	39
1930	Total budgetary resources available	43	41	39

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	11	13	12
3030	Obligations incurred, unexpired accounts	43	41	39
3040	Outlays (gross)	–41	–42	–40
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	13	12	11

3100	Obligated balance, end of year (net)	13	12	11

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	43	41	39
	Outlays, gross:
4010	Outlays from new discretionary authority	34	33	31
4011	Outlays from discretionary balances	7	9	9

4020	Outlays, gross (total)	41	42	40
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–3
4033	Non-Federal sources	–2

4040	Offsets against gross budget authority and outlays (total)	–5

4070	Budget authority, net (discretionary)	38	41	39
4080	Outlays, net (discretionary)	36	42	40
4180	Budget authority, net (total)	38	41	39
4190	Outlays, net (total)	36	42	40

The Office for Civil Rights funds activities that carry out the Department's civil rights nondiscrimination and health information privacy and security compliance programs.


Identification code 75–0135–0–1–751		2011 actual	2012 est.	2013 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	23	23	22
11.3	Other than full-time permanent		1	1
11.5	Other personnel compensation		1	1

11.9	Total personnel compensation	23	25	24
12.1	Civilian personnel benefits	6	6	6
23.1	Rental payments to GSA	3	3	3
25.2	Other services from non-Federal sources	8
25.2	Other services from non-Federal sources		2	2
25.3	Other goods and services from Federal sources		2	2
25.4	Operation and maintenance of facilities		1	1
25.7	Operation and maintenance of equipment		2	1

99.0	Direct obligations	40	41	39
99.0	Reimbursable obligations	3

99.9	Total new obligations	43	41	39


Identification code 75–0135–0–1–751		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment	262	262	252
1101	Direct military average strength employment	1	1	1
2001	Reimbursable civilian full-time equivalent employment	3	3	3

For expenses necessary for the Office of the National Coordinator for Health Information Technology, including grants, contracts, and cooperative agreements for the development and advancement of interoperable health information technology, [$16,446,000] $26,246,000: Provided, That in addition to amounts provided herein, [$44,811,000] $40,011,000 shall be available from amounts available under section 241 of the PHS Act. (Department of Health and Human Services Appropriations Act, 2012.)


Identification code 75–0130–0–1–551		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Health information technology	41	16	26
0002	Recovery Act activities	157	5

0799	Total direct obligations	198	21	26
0801	Reimbursable program	19	7	7
0802	Reimbursable program: PHS evaluation	19	45	40

0899	Total reimbursable obligations	38	52	47

0900	Total new obligations	236	73	73

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	159	5
1021	Recoveries of prior year unpaid obligations	1

1050	Unobligated balance (total)	160	5
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	42	16	26

1160	Appropriation, discretionary (total)	42	16	26
	Spending authority from offsetting collections, discretionary:
1700	Collected	3	52	47
1701	Change in uncollected payments, Federal sources	30

1750	Spending auth from offsetting collections, disc (total)	33	52	47
	Spending authority from offsetting collections, mandatory:
1800	Collected	7

1850	Spending auth from offsetting collections, mand (total)	7
1900	Budget authority (total)	82	68	73
1930	Total budgetary resources available	242	73	73
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–1
1941	Unexpired unobligated balance, end of year	5

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	1,813	1,553	603
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–34	–44	–44

3020	Obligated balance, start of year (net)	1,779	1,509	559
3030	Obligations incurred, unexpired accounts	236	73	73
3040	Outlays (gross)	–493	–1,023	–466
3050	Change in uncollected pymts, Fed sources, unexpired	–30
3051	Change in uncollected pymts, Fed sources, expired	20
3080	Recoveries of prior year unpaid obligations, unexpired	–1
3081	Recoveries of prior year unpaid obligations, expired	–2
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	1,553	603	210
3091	Uncollected pymts, Fed sources, end of year	–44	–44	–44

3100	Obligated balance, end of year (net)	1,509	559	166

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	75	68	73
	Outlays, gross:
4010	Outlays from new discretionary authority	47	66	69
4011	Outlays from discretionary balances	446	951	396

4020	Outlays, gross (total)	493	1,017	465
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–23	–52	–47
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–30
4052	Offsetting collections credited to expired accounts	20

4060	Additional offsets against budget authority only (total)	–10

4070	Budget authority, net (discretionary)	42	16	26
4080	Outlays, net (discretionary)	470	965	418
	Mandatory:
4090	Budget authority, gross	7
	Outlays, gross:
4101	Outlays from mandatory balances		6	1
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–7
4180	Budget authority, net (total)	42	16	26
4190	Outlays, net (total)	463	971	419

This program supports coordination, leadership, and development of Federal health information technology activities and Federal initiatives for the nationwide advancement of private and secure interoperable health information technology, in cooperation with participants in the health sector. The Office of the National Coordinator for Health Information Technology was established in the Health Information Technology for Economic and Clinical Health Act (P.L. 111–5, Title XIII), for the purpose of addressing strategic planning, coordination, and the analysis of key technical, economic and other issues related to the public and private adoption of health information technology.


Identification code 75–0130–0–1–551		2011 actual	2012 est.	2013 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	15	4
12.1	Civilian personnel benefits	4	1
21.0	Travel and transportation of persons	1
23.1	Rental payments to GSA	2	2	2
25.1	Advisory and assistance services	3		2
25.2	Other services from non-Federal sources	69	2	9
25.3	Other goods and services from Federal sources	7	10	10
25.4	Operation and maintenance of facilities		2	2
31.0	Equipment	4		1
41.0	Grants, subsidies, and contributions	94

99.0	Direct obligations	199	21	26
99.0	Reimbursable obligations	37	52	47

99.9	Total new obligations	236	73	73


Identification code 75–0130–0–1–551		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment	146	171	190
1101	Direct military average strength employment	1	1	1

For expenses necessary for administrative law judges responsible for hearing cases under title XVIII of the Social Security Act (and related provisions of title XI of such Act), [$72,147,000] $84,234,000, to be transferred in appropriate part from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund. (Department of Health and Human Services Appropriations Act, 2012.)


Identification code 75–0139–0–1–551		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Direct program activity	70	72	84

	Budgetary Resources:
	Budget authority:
	Spending authority from offsetting collections, discretionary:
1700	Collected	71	72	84

1750	Spending auth from offsetting collections, disc (total)	71	72	84
1930	Total budgetary resources available	71	72	84
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–1

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	20	15
3030	Obligations incurred, unexpired accounts	70	72	84
3040	Outlays (gross)	–72	–87	–84
3081	Recoveries of prior year unpaid obligations, expired	–3
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	15

3100	Obligated balance, end of year (net)	15

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	71	72	84
	Outlays, gross:
4010	Outlays from new discretionary authority	63	72	84
4011	Outlays from discretionary balances	9	15

4020	Outlays, gross (total)	72	87	84
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–71	–72	–84
4190	Outlays, net (total)	1	15

This appropriation funds the operations of the Office of Medicare Hearings and Appeals (OMHA), as authorized by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. OMHA provides the forum through which individuals and organizations who are dissatisfied with Medicare determinations affecting their rights to, or their participation in, the Medicare program may administratively appeal those determinations, in accordance with the requirements of the Administrative Procedures Act and the Social Security Act.


Identification code 75–0139–0–1–551		2011 actual	2012 est.	2013 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	36	43	47
12.1	Civilian personnel benefits	10	13	14
23.1	Rental payments to GSA	6	6	7
23.3	Communications, utilities, and miscellaneous charges	1	1	2
25.1	Advisory and assistance services	7	1	1
25.2	Other services from non-Federal sources	3	1	2
25.3	Other goods and services from Federal sources	6	7	9
25.4	Operation and maintenance of facilities			1
26.0	Supplies and materials	1
31.0	Equipment			1

99.9	Total new obligations	70	72	84


Identification code 75–0139–0–1–551		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment	418	466	518

For expenses necessary to support activities related to countering potential biological, nuclear, radiological, chemical, and cybersecurity threats to civilian populations, and for other public health emergencies, [$569,452,000] $625,262,000; of which [$10,000,000] $5,000,000 shall remain available until [September 30, 2014,] expended to support emergency operations and of which $50,000,000 shall remain available until expended for the purpose of funding a strategic investment corporation established to further the purposes of section 319L of the PHS Act (42 U.S.C. 247d-7e) to foster innovation in the development of medical countermeasures; and of which up to $5,000,000 shall remain available through September 30, 2015 to support the delivery of medical countermeasures.

From funds transferred to this account pursuant to the fourth paragraph under this heading in Public Law 111–117, up to $415,000,000 shall be available for expenses necessary to support advanced research and development pursuant to section 319L of the PHS Act, and other administrative expenses of the Biomedical Advanced Research and Development Authority to support additional advanced research and development: Provided, That funds provided under this heading for the purpose of acquisition of security countermeasures may be used and shall be in addition to any other funds available for such purpose: Provided further, That products purchased with funds provided under this heading may, at the discretion of the Secretary, be deposited in the Strategic National Stockpile pursuant to section 319F-2 of the PHS Act.

In addition, for expenses necessary for replacement of building leases and associated renovation costs for Public Health Service agencies and other components of the Department of Health and Human Services, including relocation and fit-out costs, $17,000,000, to remain available until expended. (Department of Health and Human Services Appropriations Act, 2012.)


Identification code 75–0140–0–1–551		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Public Health and Social Services Emergency Fund	2,685	2,657	1,213
0801	Reimbursable program	14	60	60

0900	Total new obligations	2,699	2,717	1,273

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	6,618	3,414	1,322
1010	Unobligated balance transfer to other accts [75–0343]	–5	–3	–5
1021	Recoveries of prior year unpaid obligations	71

1050	Unobligated balance (total)	6,684	3,411	1,317
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	676	569	642
1130	Appropriations permanently reduced	–1
1131	Unobligated balance of appropriations permanently reduced	–1,259
1143	Approp permanently reduced (Sec 527, HR 2055)		–1

1160	Appropriation, discretionary (total)	–584	568	642
	Spending authority from offsetting collections, discretionary:
1700	Collected	2	60	60
1701	Change in uncollected payments, Federal sources	12

1750	Spending auth from offsetting collections, disc (total)	14	60	60
1900	Budget authority (total)	–570	628	702
1930	Total budgetary resources available	6,114	4,039	2,019
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–1
1941	Unexpired unobligated balance, end of year	3,414	1,322	746

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	3,835	4,610	5,369
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–461	–289	–289

3020	Obligated balance, start of year (net)	3,374	4,321	5,080
3030	Obligations incurred, unexpired accounts	2,699	2,717	1,273
3031	Obligations incurred, expired accounts	10
3040	Outlays (gross)	–1,778	–1,958	–1,941
3050	Change in uncollected pymts, Fed sources, unexpired	–12
3051	Change in uncollected pymts, Fed sources, expired	184
3080	Recoveries of prior year unpaid obligations, unexpired	–71
3081	Recoveries of prior year unpaid obligations, expired	–85
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	4,610	5,369	4,701
3091	Uncollected pymts, Fed sources, end of year	–289	–289	–289

3100	Obligated balance, end of year (net)	4,321	5,080	4,412

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	–570	628	702
	Outlays, gross:
4010	Outlays from new discretionary authority	149	217	294
4011	Outlays from discretionary balances	1,629	1,741	1,647

4020	Outlays, gross (total)	1,778	1,958	1,941
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–76	–60	–60
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–12
4052	Offsetting collections credited to expired accounts	74

4060	Additional offsets against budget authority only (total)	62

4070	Budget authority, net (discretionary)	–584	568	642
4080	Outlays, net (discretionary)	1,702	1,898	1,881
4180	Budget authority, net (total)	–584	568	642
4190	Outlays, net (total)	1,702	1,898	1,881

The Public Health and Social Services Emergency Fund (PHSSEF) provides resources to support a comprehensive program to prepare for the health and medical consequences of bioterrorism or other public health emergencies. This account includes funding for the Office of the Assistant Secretary for Preparedness and Response (ASPR), as authorized by the Pandemic and All-Hazards Preparedness Act. Funds will be used for hospital preparedness and other emergency preparedness activities including the National Disaster Medical System. The PHSSEF also supports the HHS Cyber Security and Security and Strategic Information programs, and the Medical Reserve Corps.

The PHSSEF also continues to support the advanced development of biodefense countermeasures. These resources will in part be derived from available funds appropriated for the BioShield Special Reserve Fund.

Resources are also being provided to consolidate the offices of the Assistant Secretary for Preparedness and Response.

A Strategic Investor corporation will be created to make investments in the private sector with specific focus on disruptive technologies including novel antimicrobials and multi-use platform technologies for diagnostics and medical countermeasures.


Identification code 75–0140–0–1–551		2011 actual	2012 est.	2013 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	54	57	57
11.3	Other than full-time permanent	14	14	14
11.7	Military personnel	9	9	9

11.9	Total personnel compensation	77	80	80
12.1	Civilian personnel benefits	14	16	16
12.2	Military personnel benefits	4	4	4
21.0	Travel and transportation of persons	11	9	9
22.0	Transportation of things	1	1	1
23.1	Rental payments to GSA	13	13	13
23.3	Communications, utilities, and miscellaneous charges	5	5	4
25.1	Advisory and assistance services	141	145	90
25.2	Other services from non-Federal sources	56	60	40
25.3	Other goods and services from Federal sources	200	244	182
25.4	Operation and maintenance of facilities	1	3	3
25.5	Research and development contracts	1,179	1,172	260
25.6	Medical care	14
25.7	Operation and maintenance of equipment	15	19	16
26.0	Supplies and materials	100	160	127
31.0	Equipment	15	14	14
32.0	Land and structures	475	351	125
41.0	Grants, subsidies, and contributions	364	361	229

99.0	Direct obligations	2,685	2,657	1,213
99.0	Reimbursable obligations	14	60	60

99.9	Total new obligations	2,699	2,717	1,273


Identification code 75–0140–0–1–551		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment	538	541	541
1101	Direct military average strength employment	87	87	87


Identification code 75–0145–0–1–552		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0801	AHRQ		32	62
0802	Office of the Secretary	1	7	16

0900	Total new obligations	1	39	78

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		9
	Budget authority:
	Spending authority from offsetting collections, mandatory:
1800	Collected	10	30	78

1850	Spending auth from offsetting collections, mand (total)	10	30	78
1930	Total budgetary resources available	10	39	78
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	9

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)		1	31
3030	Obligations incurred, unexpired accounts	1	39	78
3040	Outlays (gross)		–9	–27
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	1	31	82

3100	Obligated balance, end of year (net)	1	31	82

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	10	30	78
	Outlays, gross:
4100	Outlays from new mandatory authority		5	12
4101	Outlays from mandatory balances		4	15

4110	Outlays, gross (total)		9	27
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–10	–30	–78
4190	Outlays, net (total)	–10	–21	–51

Public Law 111–148 established the Patient-Centered Outcomes Research Trust Fund (PCORTF). Beginning in FY 2011, a total of 20 percent of the funds appropriated or credited to the PCORTF will be transferred each year to the Department of Health and Human Services (HHS). As authorized in section 937 of the Public Health Service Act, HHS will disseminate research findings from the Patient-Centered Outcomes Research Institute and other government-funded comparative clinical effectiveness research and build research and data capacity for comparative clinical effectiveness research. Transferred funds will be distributed to the Secretary of HHS and the Agency for Healthcare Research and Quality to carry out these activities.


Identification code 75–0145–0–1–552		2011 actual	2012 est.	2013 est.

99.0	Reimbursable obligations	1	7	16
	Allocation Account - reimbursable:
11.1	Personnel compensation: Full-time permanent		1	2
25.5	Research and development contracts		31	60

99.0	Allocation account - reimbursable		32	62

99.9	Total new obligations	1	39	78


Identification code 75–0145–0–1–552		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment		2	4
3001	Allocation account civilian full-time equivalent employment		12	20


Identification code 75–0144–0–1–551		2011 actual	2012 est.	2013 est.

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	40	18
3040	Outlays (gross)	–22	–18
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	18

3100	Obligated balance, end of year (net)	18

	Budget authority and outlays, net:
	Discretionary:
	Outlays, gross:
4011	Outlays from discretionary balances	22	18
4190	Outlays, net (total)	22	18

The Prevention and Wellness Fund is authorized under the American Recovery and Reinvestment Act (ARRA), (P.L. 111–5). The Prevention and Wellness Fund administers evidence-based clinical and community-based prevention and wellness strategies.

The Nonrecurring Expenses Fund is a no-year account that captures expired unobligated balances from discretionary accounts prior to cancellation. The Fund will be used for nonrecurring expenses that are difficult to accomodate or arise outside of the normal budget process. Beginning with 2008 appropriations, transfers will occur up to five years after expiration, when it is certain that original obligations have been fully paid and closed out. Advance notification of a proposed use of the Fund will be submitted to the relevant Committees on Appropriations of the House of Representatives and the Senate, with justification for the proposed areas/projects.


Identification code 75–0119–0–1–551		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Direct program activity	312	565

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	872	565
1010	Unobligated balance transfer to other accts [75–0119]	–231
1011	Unobligated balance transfer from other accts [75–0119]	231
1021	Recoveries of prior year unpaid obligations	5

1050	Unobligated balance (total)	877	565
1930	Total budgetary resources available	877	565
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	565

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	106	205	359
3030	Obligations incurred, unexpired accounts	312	565
3040	Outlays (gross)	–208	–411	–344
3080	Recoveries of prior year unpaid obligations, unexpired	–5
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	205	359	15

3100	Obligated balance, end of year (net)	205	359	15

	Budget authority and outlays, net:
	Mandatory:
	Outlays, gross:
4101	Outlays from mandatory balances	208	411	344
4190	Outlays, net (total)	208	411	344

Section 1005 of the Health Care and Education Reconciliation Act of 2010 (P.L. 111–152) appropriated $1,000,000,000 to the Health Insurance Reform Implementation Fund within the Department of Health and Human Services. The Fund shall be used for Federal administrative expenses necessary to carry out the requirements of the Patient Protection and Affordable Care Act of 2010 (P.L. 111–148) and the Health Care and Education Reconciliation Act of 2010.


Identification code 75–0119–0–1–551		2011 actual	2012 est.	2013 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	17
12.1	Civilian personnel benefits	5
23.1	Rental payments to GSA	1	1
25.1	Advisory and assistance services	27	83
25.2	Other services from non-Federal sources	87	304

99.0	Direct obligations	137	388
	Allocation Account - direct:
11.1	Personnel compensation: Full-time permanent	55	55
12.1	Civilian personnel benefits	15	15
21.0	Travel and transportation of persons	4	4
23.1	Rental payments to GSA	1	1
25.1	Advisory and assistance services	80	82
25.2	Other services from non-Federal sources	8	8
25.3	Other goods and services from Federal sources	3	3
31.0	Equipment	6	6

99.0	Allocation account - direct	172	174
99.5	Below reporting threshold	3	3

99.9	Total new obligations	312	565


Identification code 75–0119–0–1–551		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment	164


Identification code 75–0116–0–1–551		2011 actual	2012 est.	2013 est.

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	750	1,000	1,250
1220	Appropriations transferred to other accts [75–0142]		–10	–10
1220	Appropriations transferred to other accts [75–1700]	–12	–12	–12
1220	Appropriations transferred to other accts [75–0943]	–611	–805	–903
1220	Appropriations transferred to other accts [75–9912]	–19	–10	–210
1220	Appropriations transferred to other accts [75–0350]	–20	–75	–10
1220	Appropriations transferred to other accts [75–1362]	–88	–88	–105

The Patient Protection and Affordable Care Act, (P.L. 111–148) establishes the Prevention and Public Health Fund as a mandatory appropriation for prevention and public health activities. For FY 2013, the law appropriates $1.25 billion into the Fund, which the Secretary then has authority to transfer to accounts within HHS. The Prevention and Public Health Fund increases and sustains investments in a range of public health efforts intended to prevent disease and reduce health care costs.


Identification code 75–0117–0–1–551		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Direct program activity	25	25	25

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	25	25	25

1260	Appropriations, mandatory (total)	25	25	25
1930	Total budgetary resources available	25	25	25

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	22	40	43
3030	Obligations incurred, unexpired accounts	25	25	25
3040	Outlays (gross)	–7	–22	–25
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	40	43	43

3100	Obligated balance, end of year (net)	40	43	43

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	25	25	25
	Outlays, gross:
4100	Outlays from new mandatory authority		2	2
4101	Outlays from mandatory balances	7	20	23

4110	Outlays, gross (total)	7	22	25
4180	Budget authority, net (total)	25	25	25
4190	Outlays, net (total)	7	22	25

For awarding competitive grants to States to assist pregnant and parenting teens and women.


Identification code 75–0117–0–1–551		2011 actual	2012 est.	2013 est.

	Direct obligations:
25.3	Other goods and services from Federal sources	1	1	1
41.0	Grants, subsidies, and contributions	24	24	24

99.9	Total new obligations	25	25	25

Federal Funds

For retirement pay and medical benefits of Public Health Service Commissioned Officers as authorized by law, for payments under the Retired Serviceman's Family Protection Plan and Survivor Benefit Plan, and for medical care of dependents and retired personnel under the Dependents' Medical Care Act, such amounts as may be required during the current fiscal year. (Department of Health and Human Services Appropriations Act, 2012.)


Identification code 75–0379–0–1–551		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Retirement payments	355	375	396
0002	Survivors' benefits	26	28	31
0003	Medical care	86	94	101

0900	Total new obligations	467	497	528

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	467	497	528

1260	Appropriations, mandatory (total)	467	497	528
1930	Total budgetary resources available	467	497	528

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	43	30	25
3001	Adjustments to unpaid obligations, brought forward, Oct 1	20

3020	Obligated balance, start of year (net)	63	30	25
3030	Obligations incurred, unexpired accounts	467	497	528
3031	Obligations incurred, expired accounts	2
3040	Outlays (gross)	–497	–502	–527
3081	Recoveries of prior year unpaid obligations, expired	–5
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	30	25	26

3100	Obligated balance, end of year (net)	30	25	26

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	467	497	528
	Outlays, gross:
4100	Outlays from new mandatory authority	445	472	502
4101	Outlays from mandatory balances	52	30	25

4110	Outlays, gross (total)	497	502	527
4180	Budget authority, net (total)	467	497	528
4190	Outlays, net (total)	497	502	527


		2011 actual	2012 est.	2013 est.

Enacted/requested:
	Budget Authority	467	497	528
	Outlays	497	502	527
Legislative proposal, subject to PAYGO:
	Budget Authority			–1
	Outlays			–1
Total:
	Budget Authority	467	497	527
	Outlays	497	502	526

The number of beneficiaries using the Commissioned Corps system is estimated as follows:


	2011	2012	2013

Active Duty:
HHS	4890	4890	4890
DOJ, BOP	776	769	769
Homeland Security	464	471	471
EPA	76	76	76

All Other	316	316	316

Total Active Duty	6522	6522	6522

Retirees & Survivors:
Retirees	5308	5430	5475

Retiree family members and survivors	948	979	985

Total Retirement Pay	6256	6409	6460

Total Beneficiaries (active duty, retirees, survivors)	12778	12931	12982

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


Identification code 75–0379–0–1–551		2011 actual	2012 est.	2013 est.

	Direct obligations:
13.0	Benefits for former personnel	381	403	427
25.6	Medical care	86	94	101

99.9	Total new obligations	467	497	528


Identification code 75–0379–4–1–551		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Direct program activity			–1

0900	Total new obligations (object class 25.6)			–1

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			–1

1260	Appropriations, mandatory (total)			–1
1930	Total budgetary resources available			–1

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts			–1
3040	Outlays (gross)			1

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			–1
	Outlays, gross:
4100	Outlays from new mandatory authority			–1
4180	Budget authority, net (total)			–1
4190	Outlays, net (total)			–1


Identification code 75–0170–0–1–551		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Medicare eligible accruals	38	36	29

0900	Total new obligations (object class 12.2)	38	36	29

	Budgetary Resources:
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	38	36	29

1160	Appropriation, discretionary (total)	38	36	29
1930	Total budgetary resources available	38	36	29

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts	38	36	29
3040	Outlays (gross)	–38	–36	–29

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	38	36	29
	Outlays, gross:
4010	Outlays from new discretionary authority	38	36	29
4180	Budget authority, net (total)	38	36	29
4190	Outlays, net (total)	38	36	29


		2011 actual	2012 est.	2013 est.

Enacted/requested:
	Budget Authority	38	36	29
	Outlays	38	36	29
Legislative proposal, not subject to PAYGO:
	Budget Authority			–3
	Outlays			–3
Total:
	Budget Authority	38	36	26
	Outlays	38	36	26

The cost of medical benefits for Medicare-eligible beneficiaries is paid from the Department of Defense Medicare-Eligible Retiree Health Care Fund (10 U.S.C., ch. 56). Beginning in 2006, permanent indefinite authority is provided for a discretionary appropriation of the annual accrual payment into this fund (P.L. No. 108–375, section 725).


Identification code 75–0170–2–1–551		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Direct program activity			–3

0900	Total new obligations (object class 12.2)			–3

	Budgetary Resources:
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation			–3

1160	Appropriation, discretionary (total)			–3
1930	Total budgetary resources available			–3

	Change in obligated balance:
3030	Obligations incurred, unexpired accounts			–3
3040	Outlays (gross)			3

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross			–3
	Outlays, gross:
4010	Outlays from new discretionary authority			–3
4180	Budget authority, net (total)			–3
4190	Outlays, net (total)			–3


Identification code 75–9913–0–1–552		2011 actual	2012 est.	2013 est.

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	1	1	1
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	1	1	1

3100	Obligated balance, end of year (net)	1	1	1

This display shows activities in support of scientific activities overseas that were supported by foreign currencies by the United States abroad.


Identification code 75–9941–0–4–551		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0801	Program Support Center	924	947	1,004
0802	OS activities	52	131	127

0900	Total new obligations	976	1,078	1,131

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	181	215	215
1021	Recoveries of prior year unpaid obligations	39

1050	Unobligated balance (total)	220	215	215
	Budget authority:
	Spending authority from offsetting collections, discretionary:
1700	Collected	929	1,078	1,131
1701	Change in uncollected payments, Federal sources	42

1750	Spending auth from offsetting collections, disc (total)	971	1,078	1,131
1930	Total budgetary resources available	1,191	1,293	1,346
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	215	215	215

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	383	416	22
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–439	–481	–481

3020	Obligated balance, start of year (net)	–56	–65	–459
3030	Obligations incurred, unexpired accounts	976	1,078	1,131
3040	Outlays (gross)	–904	–1,472	–1,131
3050	Change in uncollected pymts, Fed sources, unexpired	–42
3080	Recoveries of prior year unpaid obligations, unexpired	–39
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	416	22	22
3091	Uncollected pymts, Fed sources, end of year	–481	–481	–481

3100	Obligated balance, end of year (net)	–65	–459	–459

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	971	1,078	1,131
	Outlays, gross:
4010	Outlays from new discretionary authority	667	1,078	1,131
4011	Outlays from discretionary balances	237	394

4020	Outlays, gross (total)	904	1,472	1,131
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–925	–1,078	–1,131
4033	Non-Federal sources	–4

4040	Offsets against gross budget authority and outlays (total)	–929	–1,078	–1,131
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–42
4080	Outlays, net (discretionary)	–25	394
4190	Outlays, net (total)	–25	394

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 includes activities such as personnel and payroll support, information technology, 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 include the fund manager, departmental contracts, audit resolutions, Commissioned Corps force management, web management, claims, acquisition integration and modernization, small business, grants tracking, the physical access aspects of the Department's implementation of Homeland Security Presidential Directive 12, and commercial services management.

Most Commissioned Corps officers work for agencies in the Department of Health and Human Services and are reflected in the agencies' personnel summaries. However, some officers are assigned to other Federal agencies. The allocation account section in the following personnel summary shows officers assigned to other agencies, which are paid directly by that agency, either through an allocation account or by directly citing that agency's appropriation.


Identification code 75–9941–0–4–551		2011 actual	2012 est.	2013 est.

	Reimbursable obligations:
	Personnel compensation:
11.1	Full-time permanent	114	131	131
11.3	Other than full-time permanent	4	6	6
11.5	Other personnel compensation	3	5	5
11.7	Military personnel	8	7	7
11.8	Special personal services payments	14	7

11.9	Total personnel compensation	143	156	149
12.1	Civilian personnel benefits	32	41	41
12.2	Military personnel benefits	4	6	4
21.0	Travel and transportation of persons	3	2	2
22.0	Transportation of things	3	5	3
23.1	Rental payments to GSA	27	15	22
23.3	Communications, utilities, and miscellaneous charges	34	7	6
24.0	Printing and reproduction	1	1	1
25.1	Advisory and assistance services	42	32	38
25.2	Other services from non-Federal sources	480	624	685
25.3	Other goods and services from Federal sources	62	49	47
25.4	Operation and maintenance of facilities	5	6	7
25.6	Medical care	22	22	19
25.7	Operation and maintenance of equipment	75	72	70
26.0	Supplies and materials	35	36	33
31.0	Equipment	4	4	4
41.0	Grants, subsidies, and contributions	4

99.9	Total new obligations	976	1,078	1,131


Identification code 75–9941–0–4–551		2011 actual	2012 est.	2013 est.

2001	Reimbursable civilian full-time equivalent employment	1,346	1,440	1,391
2101	Reimbursable military average strength employment	105	98	98
3101	Allocation account military average strength employment	776	769	769
3101	Allocation account military average strength employment	780	787	787

Trust Funds


Identification code 75–9971–0–7–551		2011 actual	2012 est.	2013 est.

0100	Balance, start of year
	Receipts:
0220	Contributions, Indian Health Facilities	9	33	33
0221	Contributions, N.I.H., Unconditional Gift Fund	5	5	7
0222	Centers for Disease Control, Gifts and Donations	9	6	6
0223	Contributions, N.I.H., Conditional Gift Fund	27	27	34
0224	Contributions to the Indian Health Service Gift Fund	1	1	1
0240	Interest, Miscellaneous Trust Funds		2	2

0299	Total receipts and collections	51	74	83

0400	Total: Balances and collections	51	74	83
	Appropriations:
0500	Miscellaneous Trust Funds	–51	–74	–83

0799	Balance, end of year


Identification code 75–9971–0–7–551		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0002	Gifts	62	41	50
0003	Contributions, Indian Health Facilities	11	33	33
0004	Reclassification of reimbursable activity	133

0900	Total new obligations	206	74	83

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	148	112	112
1020	Adjustment of unobligated bal brought forward, Oct 1	–6
1021	Recoveries of prior year unpaid obligations	125

1050	Unobligated balance (total)	267	112	112
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	51	74	83

1260	Appropriations, mandatory (total)	51	74	83
1930	Total budgetary resources available	318	186	195
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	112	112	112

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	172	62	59
3030	Obligations incurred, unexpired accounts	206	74	83
3040	Outlays (gross)	–191	–77	–69
3080	Recoveries of prior year unpaid obligations, unexpired	–125
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	62	59	73

3100	Obligated balance, end of year (net)	62	59	73

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	51	74	83
	Outlays, gross:
4100	Outlays from new mandatory authority	51	7	8
4101	Outlays from mandatory balances	140	70	61

4110	Outlays, gross (total)	191	77	69
4180	Budget authority, net (total)	51	74	83
4190	Outlays, net (total)	191	77	69

	Memorandum (non-add) entries:
5000	Total investments, SOY: Federal securities: Par value	39	28	30
5001	Total investments, EOY: Federal securities: Par value	28	30	32


	2011	2012	2013

Distribution of budget authority by account:
Gifts	62	41	50
Contributions, Indian Health Facilities	11	33	33
Distribution of outlays by account:
Gifts	115	46	41
Contributions, Indian Health Facilities	76	31	28

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.


Identification code 75–9971–0–7–551		2011 actual	2012 est.	2013 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	2	2	2
11.3	Other than full-time permanent	1	1	1
11.8	Special personal services payments	3	1	1

11.9	Total personnel compensation	6	4	4
12.1	Civilian personnel benefits	1	1	1
21.0	Travel and transportation of persons	2	1	1
25.1	Advisory and assistance services	3	3	3
25.2	Other services from non-Federal sources	11	12	13
25.3	Other goods and services from Federal sources	10	10	12
25.5	Research and development contracts	6	7	8
25.6	Medical care	1	1	1
26.0	Supplies and materials	6	6	6
31.0	Equipment	4	4	5
41.0	Grants, subsidies, and contributions	23	25	29
44.0	Refunds	133

99.9	Total new obligations	206	74	83


Identification code 75–9971–0–7–551		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment	28	27	27

Federal Funds

For expenses necessary for the Office of Inspector General, including the hire of passenger motor vehicles for investigations, in carrying out the provisions of the Inspector General Act of 1978, [$50,178,000] $58,579,000: Provided, That of such amount, necessary sums shall be available for providing protective services to the Secretary of Health and Human Services and investigating non-payment of child support cases for which non-payment is a Federal offense under 18 U.S.C. 228[: Provided further, That at least 40 percent of the funds provided in this Act for the Office of Inspector General shall be used only for investigations, audits, and evaluations pertaining to the discretionary programs funded in this Act]. (Department of Health and Human Services Appropriations Act, 2012.)


Identification code 75–0128–0–1–551		2011 actual	2012 est.	2013 est.

	Obligations by program activity:
0001	Direct program	93	76	59
0801	HCFAC Reimbursable program	196	212	209
0802	Direct Reimbursable program	17	24	24
0803	HCFAC Discretionary allocation adjustment	36	34	103

0899	Total reimbursable obligations	249	270	336

0900	Total new obligations	342	346	395

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	69	43	13
1012	Unobligated balance transfers between expired and unexpired accounts	9	7	7

1050	Unobligated balance (total)	78	50	20
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	50	50	59

1160	Appropriation, discretionary (total)	50	50	59
	Spending authority from offsetting collections, discretionary:
1700	Collected	31	58	127
1701	Change in uncollected payments, Federal sources	22

1750	Spending auth from offsetting collections, disc (total)	53	58	127
	Spending authority from offsetting collections, mandatory:
1800	Collected	184	208	209
1801	Change in uncollected payments, Federal sources	28

1850	Spending auth from offsetting collections, mand (total)	212	208	209
1900	Budget authority (total)	315	316	395
1930	Total budgetary resources available	393	366	415
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–8	–7	–7
1941	Unexpired unobligated balance, end of year	43	13	13

	Change in obligated balance:
	Obligated balance, start of year (net):
3000	Unpaid obligations, brought forward, Oct 1 (gross)	76	61	66
3010	Uncollected pymts, Fed sources, brought forward, Oct 1	–41	–74	–74

3020	Obligated balance, start of year (net)	35	–13	–8
3030	Obligations incurred, unexpired accounts	342	346	395
3031	Obligations incurred, expired accounts	3
3040	Outlays (gross)	–346	–341	–396
3050	Change in uncollected pymts, Fed sources, unexpired	–50
3051	Change in uncollected pymts, Fed sources, expired	17
3081	Recoveries of prior year unpaid obligations, expired	–14
	Obligated balance, end of year (net):
3090	Unpaid obligations, end of year (gross)	61	66	65
3091	Uncollected pymts, Fed sources, end of year	–74	–74	–74

3100	Obligated balance, end of year (net)	–13	–8	–9

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	103	108	186
	Outlays, gross:
4010	Outlays from new discretionary authority	79	101	177
4011	Outlays from discretionary balances	25	12	7

4020	Outlays, gross (total)	104	113	184
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–31	–58	–127
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–22

4070	Budget authority, net (discretionary)	50	50	59
4080	Outlays, net (discretionary)	73	55	57
	Mandatory:
4090	Budget authority, gross	212	208	209
	Outlays, gross:
4100	Outlays from new mandatory authority	166	208	209
4101	Outlays from mandatory balances	76	20	3

4110	Outlays, gross (total)	242	228	212
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–219	–196	–197
4123	Non-Federal sources	–2	–12	–12

4130	Offsets against gross budget authority and outlays (total)	–221	–208	–209
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–28
4142	Offsetting collections credited to expired accounts	37

4150	Additional offsets against budget authority only (total)	9
4170	Outlays, net (mandatory)	21	20	3
4180	Budget authority, net (total)	50	50	59
4190	Outlays, net (total)	94	75	60

The Office of Inspector General (OIG) is an independent oversight organization within the U.S. Department of Health and Human Services (HHS) that promotes economy, efficiency, and effectiveness through the elimination of fraud, waste, and abuse in the Department's programs and operations. OIG fulfills its mission through a broad range of audits, evaluations, investigations, and enforcement and compliance activities. In addition to discretionary appropriations, OIG receives funds through the Health Care Fraud and Abuse Control (HCFAC) account created by the Health Insurance Portability and Accountability Act of 1996. The following table shows total appropriated funding for OIG:


	2011 actual	2012 est.	2013 est.

Discretionary Appropriation	50	50	59
HCFAC - Mandatory	198	196	197

HCFAC - Discretionary	30	98	103

Total	278	344	359

The President's Budget proposes to increase the 2012 HCFAC Discretionary base funding to $311 million (which is fully offset) and to provide the additional $270 million in funding allowed by the cap adjustment, consistent with section 251(b)(2)(C) of the Balanced Budget and Emergency Deficit Control Act of 1985, as amended. OIG's allocation of these adjustments is displayed above.


Identification code 75–0128–0–1–551		2011 actual	2012 est.	2013 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	50	36	28
11.3	Other than full-time permanent	1	1	1
11.5	Other personnel compensation	1	1	1

11.9	Total personnel compensation	52	38	30
12.1	Civilian personnel benefits	17	13	10
21.0	Travel and transportation of persons	3	4	3
22.0	Transportation of things	1	1	1
23.1	Rental payments to GSA	4	4	3
23.3	Communications, utilities, and miscellaneous charges	1	1	1
25.2	Other services from non-Federal sources	2	2	1
25.3	Other goods and services from Federal sources	6	6	5
25.4	Operation and maintenance of facilities	3	1	2
25.7	Operation and maintenance of equipment	1	1	1
31.0	Equipment	3	5	2

99.0	Direct obligations	93	76	59
99.0	Reimbursable obligations	249	270	336

99.9	Total new obligations	342	346	395


Identification code 75–0128–0–1–551		2011 actual	2012 est.	2013 est.

1001	Direct civilian full-time equivalent employment	556	397	301
1101	Direct military average strength employment
2001	Reimbursable civilian full-time equivalent employment	1,188	1,356	1,673
2101	Reimbursable military average strength employment	1


		2011 actual	2012 est.	2013 est.

Offsetting receipts from the public:
75–143500	General Fund Proprietary Interest Receipts, not Otherwise Classified	77	89	90
75–274530	Health Education Assistance Loans, Downward Reestimates of Subsidies		12
75–310700	Federal Share of Child Support Collections	940	1,049	1,040
Legislative proposal, subject to PAYGO				5
75–322000	All Other General Fund Proprietary Receipts Including Budget Clearing Accounts	–198	56	56
General Fund Offsetting receipts from the public		819	1,206	1,191


Intragovernmental payments:
75–388500	Undistributed Intragovernmental Payments and Receivables from Cancelled Accounts	353

General Fund Intragovernmental payments		353

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."

(1) The Secretary 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. The Secretary 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 and other applicable statutes administered by the Department of State.

(2) The Secretary 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 HHS. The Department of State shall cooperate fully with the Secretary to ensure that HHS 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 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.

(3) The Secretary is authorized to provide to personnel appointed or assigned by the Secretary to serve abroad, allowances and benefits similar to those provided under chapter 9 of title I of the Foreign Service Act of 1980, and 22 U.S.C. 4081 through 4086 and subject to such regulations prescribed by the Secretary. The Secretary is further authorized to provide locality-based comparability payments (stated as a percentage) up to the amount of the locality-based comparability payment (stated as a percentage) that would be payable to such personnel under section 5304 of title 5, United States Code if such personnel's official duty station were in the District of Columbia. Leaves of absence for personnel under this subsection shall be on the same basis as that provided under subchapter I of chapter 63 of title 5, United States Code, or section 903 of the Foreign Service Act of 1980, to individuals serving in the Foreign Service.

(b) Peer Review.—In entering into transactions under subsection (a), the Director 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 PHS Act.

(b) With respect to funds provided for fiscal year 2012, the Secretary shall include on the website established under subsection (a) at a minimum the following information:

(1) In the case of each transfer of funds under section 4002(c), a statement indicating the program or activity receiving funds, the operating division or office that will administer the funds, and the planned uses of the funds, to be posted not later than the day after the transfer is made.

(2) Identification (along with a link to the full text) of each funding opportunity announcement, request for proposals, or other announcement or solicitation of proposals for grants, cooperative agreements, or contracts intended to be awarded using such funds, to be posted not later than the day after the announcement or solicitation is issued.

(3) Identification of each grant, cooperative agreement, or contract with a value of $25,000 or more awarded using such funds, including the purpose of the award and the identity of the recipient, to be posted not later than 5 days after the award is made.

(4) A report detailing the uses of all funds transferred under section 4002(c) during the fiscal year, to be posted not later than 90 days after the end of the fiscal year.

(5) Semi-annual reports from each entity awarded a grant, cooperative agreement, or contract from such funds with a value of $25,000 or more, summarizing the activities undertaken and identifying any sub-grants or sub-contracts awarded (including the purpose of the award and the identity of the recipient), to be posted not later than 30 days after the end of each 6-month period.]

(1) In general.—Subpart 1 of part E of title IV of the Public Health Service Act (42 U.S.C. 287 et seq.) is amended—

(A) in the subpart heading, by striking "National Center for Research Resources'' and inserting "National Center for Advancing Translational Sciences'';

["SEC. 479. NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES."(a)Purpose.—The purpose of the National Center for Advancing Translational Sciences (in this subpart referred to as the 'Center') is to advance translational sciences, including by—

"(1) coordinating and developing resources that leverage basic research in support of translational science; and

"(2) developing partnerships and working cooperatively to foster synergy in ways that do not create duplication, redundancy, and competition with industry activities.

"(1)In general.—The Center may develop and provide infrastructure and resources for all phases of clinical trials research. Except as provided in paragraph (2), the Center may support clinical trials only through the end of phase IIA.

"(2)Exception.—The Center may support clinical trial activities through the end of phase IIB for a treatment for a rare disease or condition (as defined in section 526 of the Federal Food, Drug, and Cosmetic Act) so long as—

"(A) the Center gives public notice for a period of at least 120 days of the Center's intention to support the clinical trial activities in phase IIB;

"(B) no public or private organization provides credible written intent to the Center that the organization has timely plans to further the clinical trial activities or conduct clinical trials of a similar nature beyond phase IIA; and

"(C) the Center ensures that support of the clinical trial activities in phase IIB will not increase the Federal Government's liability beyond the award value of the Center's support.

"(C) the funding provided by the Center to other entities pursuant to each partnership, and

"(D) the activities which have been transferred to industry pursuant to each partnership; and

"(5) known research activity of other entities that is or will expand upon research activity of the Center.''.

(2) List of institutes and centers.—Section 401(b)(21) of the Public Health Service Act (42 U.S.C. 281(b)(21)) is amended by striking "National Center for Research Resources'' and inserting "National Center for Advancing Translational Sciences''.

(b) Assignment of Certain Functions of Former National Center for Research Resources.—

(1) Biomedical and behavioral research facilities.—Section 481A of the Public Health Service Act (42 U.S.C. 287a-2)—

(A) is redesignated as section 404I and is moved to follow section 404H of such Act (42 U.S.C. 283j); and

(i) in subsection (a)(1), by striking "acting through the Director of the Center or the Director of the National Institute of Allergy and Infectious Diseases'' and inserting "acting through the Office of the Director of NIH or the Director of the National Institute of Allergy and Infectious Diseases'';

(ii) in subsections (c), (d), (e), and (f)(2), by striking "Director of the Center or the Director of the National Institute of Allergy and Infectious Diseases'' each place it appears and inserting "Director of NIH, acting through the Office of the Director of NIH or the National Institute of Allergy and Infectious Diseases,'';

(iii) in subsection (b)(2), by striking "Director of the Center'' each place it appears and inserting "Director of NIH'';

(iv) in subsections (b)(3)(A), (f)(1), and (g), by striking the comma at the end of "Director of the Center,'' each place it appears;

(v) by striking "Director of the Center'' each place it appears and inserting "Director of NIH, acting through the Office of the Director of NIH,'';

(vii) in subsection (g), by striking "after consultation with the Advisory Council'' and inserting "after consultation with the Council''.

(2) Construction of regional centers for research on primates.—Section 481B of the Public Health Service Act (42 U.S.C. 287a-3)—

(A) is redesignated as section 404J and is moved to follow section 404I, as redesignated by paragraph (1); and

(i) by striking "by the National Center for Research Resources'' and inserting "by the Director of NIH, acting through the Office of the Director of NIH,''; and

(3) Sanctuary system for surplus chimpanzees.—Section 481C of the Public Health Service Act (42 U.S.C. 287a-3a)—

(A) is redesignated as section 404K and is moved to follow section 404J, as redesignated by paragraph (2); and

(B) in subsection (d)(4)(A)(ii), is amended by striking "that is carried out by the National Center for Research Resources'' and inserting "that is carried out by the Director of NIH, acting through the Office of the Director of NIH,''.

(4) Shared instrumentation grant program.—Section 305 of the Public Health Improvement Act (42 U.S.C. 287 note)—

(A) is redesignated as section 404L of the Public Health Service Act and is moved to follow section 404K of that Act, as redesignated by paragraph (3); and

(i) by striking subsection (a) and redesignating subsections (b) and (c) as subsections (a) and (b), respectively;

(ii) in subsection (a), as so redesignated, by striking "under the program described in subsection (a)'' and inserting "under the Shared Instrumentation Grant Program'';

(iii) by striking "Director of the National Center for Research Resources'' each place it appears and inserting "Director of NIH, acting through the Office of the Director of NIH,''; and

(5) Institutional development award program.—Title IV of the Public Health Service Act (42 U.S.C. 281 et seq.) is amended—

(A) in section 461, by striking the section heading and designation and all that follows through "The general purpose'' and inserting the following:]

["SEC. 461. NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES."(a)General Purpose.—The general purpose'';

(B) by moving subsection (g) of section 402 to the end of section 461, as amended, and redesignating that subsection as subsection (b); and

(iii) in paragraph (1)(A), by striking "acting through the Director of the National Center for Research Resources'' and inserting "acting through the Director of the National Institute of General Medical Sciences''.

(1) Cures acceleration network.—Section 402C of the Public Health Service Act (42 U.S.C. 282d)—

(B) in subsection (b), is amended in the matter that precedes paragraph (1) by striking "within the Office of the Director of NIH'' and inserting "within the Center'';

(D) in the headings of subsections (d)(4) and (d)(4)(B), by striking "Director of nih'' each place it appears and inserting "Director of the center''.

(2) Office of rare diseases.—Title IV of the Public Health Service Act (42 U.S.C. 281 et seq.) is amended—

(i) by redesignating such section as section 481 and moving such section to follow section 480, as redesignated by paragraph (1);

(3) Rare disease regional centers of excellence.—Section 404G of the Public Health Service Act (42 U.S.C. 283i) is redesignated as section 481A and is moved to follow section 481, as redesignated by paragraph (2).

(4) General clinical research centers.—Section 481D of the Public Health Service Act (42 U.S.C. 287a-4)—

(B) in subsection (a), is amended by striking "Director of the National Center for Research Resources'' and inserting "Director of the Center''.

(d) Conforming Amendments.—Title IV of the Public Health Service Act (42 U.S.C. 281 et seq.) is amended—

(1) in section 402(b)(24) (42 U.S.C. 282(b)(24)), by striking "402C'' and inserting "480'';

(2) in section 404C(e)(3)(A) (42 U.S.C. 283e(e)(3)(A)), by striking "and the Director of the Center for Research Resources'';

(A) by striking "Director of National Institute for Research Resources'' and inserting "Director of NIH'';

(4) in section 499(c)(1)(E) (42 U.S.C. 290b(c)(1)(E)), by striking "section 402C'' and inserting "section 480''.]

(a) A state shall be entitled to receive a grant under section 510 of the Social Security Act (42 U.S.C. 710) for fiscal year 2013 only if the Department of Health and Human Services receives an application under section 505(a) of such Act (42 U.S.C. 705(a)) for such fiscal year by no later than September 20, 2013.

(b) CANCELLATION. The remaining unobligated balances of the amount appropriated for fiscal year 2013 by section 510(d) of such Act (42 U.S.C. 710(d)) for which no application has been received by September 20, 2013, shall be permanently cancelled as of September 27, 2013.

(c) APPROPRIATION. There is appropriated to the Department of Health and Human Services, to become available on September 27, 2013, and to remain available through September 30, 2014, an amount equal to the unobligated balances cancelled pursuant to subsection (b), for carrying out (in addition to any other funds that may be available for such purpose) a program of competitive contracts and grants to State and local governments to develop approaches to reduce pregnancy among youth in foster care and to fund age appropriate evidence-based programs that reduce teenage pregnancy, behavioral risk factors underlying teen pregnancy, or other associated risk factors among youth in foster care and for the Federal costs associated with administering and evaluating such contracts and grants.

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Food and Drug Administration

Federal Funds

Salaries and Expenses

Buildings and Facilities

Salaries and Expenses

(Legislative proposal, not subject to PAYGO)

Revolving Fund for Certification and Other Services

Health Resources and Services Administration

Federal Funds

Health Resources and Services

Primary Health Care

Health Workforce

Maternal and Child Health

Ryan White Hiv/Aids Program

Health Care Systems

Rural Health

Family Planning

Program Management

Vaccine Injury Compensation

Covered Countermeasure Process Fund

Maternal, Infant, and Early Childhood Home Visiting Programs

Health Center Guaranteed Loan Financing Account

Health Education Assistance Loans Program Account

Health Education Assistance Loans Financing Account

Health Education Assistance Loans Liquidating Account

Medical Facilities Guarantee and Loan Fund

Trust Funds

Vaccine Injury Compensation Program Trust Fund

Indian Health Service

Federal Funds

Indian Health Service

Indian Health Facilities

ADMINISTRATIVE PROVISIONS

Administrative Provisions—Indian Health Service

Centers for Disease Control and Prevention

Federal Funds

CDC-Wide Activities and Program Support

Immunization and Respiratory Diseases

HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention

Emerging and Zoonotic Infectious Diseases

Chronic Disease Prevention and Health Promotion

Birth Defects, Developmental Disabilities, Disabilities and Health

Public Health Scientific Services

Environmental Health

Injury Prevention and Control

National Institute for Occupational Safety and Health

Energy Employees Occupational Illness Compensation Program

Global Health

Public Health Preparedness and Response

CDC-Wide Activities and Program Support

CDC Working Capital Fund

Agency for Toxic Substances and Disease Registry

toxic substances and environmental public health

World Trade Center Health Program Fund

National Institutes of Health

Federal Funds

National Cancer Institute

National Heart, Lung, and Blood Institute

National Institute of Dental and Craniofacial Research

National Institute of Diabetes and Digestive and Kidney Diseases

National Institute of Neurological Disorders and Stroke

National Institute of Allergy and Infectious Diseases

National Institute of General Medical Sciences

Eunice Kennedy Shriver National Institute of Child Health and Human Development

National Eye Institute

National Institute of Environmental Health Sciences

National Institute on Aging

National Institute of Arthritis and Musculoskeletal and Skin Diseases

National Institute on Deafness and Other Communication Disorders

National Institute of Nursing Research

National Institute on Alcohol Abuse and Alcoholism

National Institute on Drug Abuse

National Institute of Mental Health

National Human Genome Research Institute

National Institute of Biomedical Imaging and Bioengineering

National Center for Complementary and Alternative Medicine

National Institute on Minority Health and Health Disparities

John E. Fogarty International Center

National Library of Medicine