[Appendix]
[Detailed Budget Estimates by Agency]
[Department of Health and Human Services]
[From the U.S. Government Printing Office, www.gpo.gov]



   
      
      
         DEPARTMENT OF HEALTH AND HUMAN SERVICES                                                                                  
            
         
      
      
   
   
      DEPARTMENT OF HEALTH AND HUMAN SERVICES                                                                                  
         
      
         Food and Drug Administration                                                                                             
            
         Federal Funds
         Salaries and ExpensesFor 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 92â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 107â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 75â717), as amended by the Food Safety Modernization Act (Public Law 111â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 75â717), as amended by the Food Safety Modernization Act (Public Law 111â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 75â717), as amended by the Food Safety Modernization Act (Public
         Law 111â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.  
         Buildings and FacilitiesFor 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.)
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9911â0â1â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
                  â1
                  â2
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Balance, end of year
                  
                  1
                  2
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9911â0â1â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
                  â293
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  294
                  582
                  814
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  2,462
                  2,506
                  2,517
               
               
                  1130
                  Appropriations permanently reduced
                  â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)
                  â440
                  â333
                  â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
                  â52
                  â46
                  â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)
                  â3,253
                  â4,127
                  â3,173
               
               
                  3050
                  Change in uncollected pymts, Fed sources, unexpired
                  â26
                  
                  
               
               
                  3051
                  Change in uncollected pymts, Fed sources, expired
                  32
                  
                  
               
               
                  3081
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â46
                  â46
                  â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
                  â81
                  â67
                  â67
               
               
                  4033
                  Non-Federal sources
                  â1,187
                  â1,487
                  â608
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â1,268
                  â1,554
                  â675
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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
               
               
                  
                     
                  
               
            
         
      
      
         [In millions of dollars]
         
            
               
                  
                     
                        
                     
                  
                  
                     
                     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.
         
          
          
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9911â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9911â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Salaries and Expenses
         (Legislative proposal, not subject to PAYGO)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.  
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9911â2â1â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)
                  
                  
                  â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
                  
                  
                  â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.  
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9911â2â1â554
                  2011 actual
                  2012 est.
                  2013 est.
               
               
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  
                  
                  1,367
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9911â2â1â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
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
         Revolving Fund for Certification and Other Services                                                                      
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4309â0â3â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)
                  â8
                  â9
                  â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
                  â8
                  â8
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4309â0â3â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4309â0â3â554
                  2011 actual
                  2012 est.
                  2013 est.
               
               
                  
                     
                  
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  37
                  37
                  38
               
               
                  
                     
                  
               
            
         
      
         Health Resources and Services Administration                                                                             
            
         Federal Funds
         Health Resources and Services
         Primary Health CareFor 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 104â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.  
         Health WorkforceFor 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).  
         Maternal and Child HealthFor 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.  
         Ryan White Hiv/Aids ProgramFor 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.  
         Health Care SystemsFor 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.  
         Rural HealthFor 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.  
         Family PlanningFor 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.  
         Program ManagementFor 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.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0350â0â1â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 [75â9915]
                  
                  9
                  
               
               
                  1121
                  Appropriations transferred from other accts [75â1362]
                  
                  1
                  
               
               
                  1121
                  Appropriations transferred from other accts [75â0943]
                  
                  1
                  
               
               
                  1130
                  Appropriations permanently reduced
                  â13
                  
                  
               
               
                  1143
                  Approp permanently reduced (Sec 527, HR 2055)
                  
                  â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 [75â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
                  â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
                  â50
                  â42
                  â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)
                  â8,582
                  â8,876
                  â8,168
               
               
                  3050
                  Change in uncollected pymts, Fed sources, unexpired
                  â24
                  
                  
               
               
                  3051
                  Change in uncollected pymts, Fed sources, expired
                  32
                  
                  
               
               
                  3080
                  Recoveries of prior year unpaid obligations, unexpired
                  â3
                  
                  
               
               
                  3081
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â42
                  â42
                  â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
                  â52
                  â52
                  â82
               
               
                  4033
                  Non-Federal sources
                  â28
                  â23
                  â34
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â80
                  â75
                  â116
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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
                  â16
                  â16
                  â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 75â0350â0â1â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 2010â2011 data reported in the Annual Operating Report.
         
         Health Professions Revolving Loan Programs Federal Capital Contribution 
         
            
               
                  
                     
                        
                     
                  
                  
                     Program
                     Account Balance
                  
                  
                     
                        
                     
                  
                  
                     HPSL
                     $370,561,960
                  
                  
                     NSL
                     $168,761,018
                  
                  
                     PCL
                     $249,867,755
                  
                  
                     
                        
                     
                  
                  
                     LDS
                     $129,792,459
                  
                  
                     
                     
                        
                     
                  
                  
                     
                        
                     
                  
                  
                     Total
                     $918,984,192
                  
                  
                     
                     
                        
                     
                  
                  
                     
                        
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0350â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0350â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Vaccine Injury Compensation                                                                                              
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0320â0â1â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 99â660 and Public Law 100â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.
         
      
         Covered Countermeasure Process Fund                                                                                      
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0343â0â1â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 [75â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)
                  â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 109â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0343â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0343â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Maternal, Infant, and Early Childhood Home Visiting Programs                                                             
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0321â0â1â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)
                  â36
                  â86
                  â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. 111â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0321â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0321â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Health Center Guaranteed Loan Financing Account                                                                          
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4442â0â3â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
                  â1
                  
                  
               
               
                  4190
                  Financing disbursements, net (total)
                  â1
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Status of Guaranteed Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4442â0â3â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
                  â28
                  â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
                  â10
                  â10
                  â10
               
               
                  2263
                  Adjustments: Terminations for default that result in claim payments
                  
                  â1
                  â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. 104â299 and P.L. 104â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 (75â0350) as a line in the program and financing
            schedule. 
         
      
      Balance Sheet (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4442â0â3â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
               
               
                  
                     
                  
               
            
         
      
         Health Education Assistance Loans Program AccountSuch 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.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0340â0â1â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 [91â0202]
                  
                  
                  â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)
                  â29
                  â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 75â0340â0â1â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
                  
                  â12
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  237999
                  Total downward reestimate subsidy budget authority
                  
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0340â0â1â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
                  
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0340â0â1â552
                  2011 actual
                  2012 est.
                  2013 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  13
                  13
                  
               
               
                  
                     
                  
               
            
         
      
         Health Education Assistance Loans Financing Account                                                                      
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4304â0â3â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 [91â4300]
                  
                  
                  â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)
                  â15
                  â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
                  â26
                  
                  
               
               
                  4122
                  Interest on uninvested funds
                  â4
                  â4
                  
               
               
                  4123
                  Recoveries of defaulted loans
                  â6
                  â4
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross financing auth and disbursements (total)
                  â36
                  â8
                  
               
               
                  4170
                  Financing disbursements, net (mandatory)
                  â21
                  18
                  
               
               
                  4190
                  Financing disbursements, net (total)
                  â21
                  18
                  
               
               
                  
                     
                  
               
            
         
      
      Status of Guaranteed Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4304â0â3â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
                  â86
                  â13
                  
               
               
                  
                  Adjustments:
               
               
                  2261
                  Terminations for default that result in loans receivable
                  â14
                  â10
                  
               
               
                  2263
                  Terminations for default that result in claim payments
                  â1
                  â4
                  
               
               
                  2264
                  Other adjustments, net
                  
                  
                  â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
                  â6
                  â4
                  
               
               
                  2361
                  Write-offs of loans receivable
                  â1
                  
                  
               
               
                  2364
                  Other adjustments, net
                  â3
                  
                  â181
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2390
                  Outstanding, end of year
                  175
                  181
                  
               
               
                  
                     
                  
               
            
         
      
      
         
      
      Balance Sheet (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4304â0â3â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 (-)
                  â126
                  â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
               
               
                  
                     
                  
               
            
         
      
         Health Education Assistance Loans Liquidating Account                                                                    
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4305â0â3â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
                  â7
                  â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)
                  â3
                  â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
                  â9
                  â10
                  
               
               
                  4180
                  Budget authority, net (total)
                  â6
                  â8
                  
               
               
                  4190
                  Outlays, net (total)
                  â6
                  â8
                  
               
               
                  
                     
                  
               
            
         
      
      Status of Guaranteed Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4305â0â3â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
                  â17
                  â12
                  
               
               
                  
                  Adjustments:
               
               
                  2261
                  Terminations for default that result in loans receivable
                  â3
                  â2
                  
               
               
                  2264
                  Other adjustments, net
                  
                  
                  â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
                  â9
                  â8
                  
               
               
                  2361
                  Write-offs of loans receivable
                  â21
                  â21
                  
               
               
                  2364
                  Other adjustments, net
                  10
                  10
                  â346
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2390
                  Outstanding, end of year
                  362
                  346
                  
               
               
                  
                     
                  
               
            
         
      
      
         
      
      Balance Sheet (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4305â0â3â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 (-)
                  â250
                  â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
               
               
                  
                     
                  
               
            
         
      
         Medical Facilities Guarantee and Loan Fund                                                                               
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9931â0â3â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
               
               
                  
                     
                  
               
            
         
      
      Status of Direct Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9931â0â3â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. 
         
      
      Balance Sheet (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9931â0â3â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
         Vaccine Injury Compensation Program Trust FundFor 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.)
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8175â0â7â551
                  2011 actual
                  2012 est.
                  2013 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  2,960
                  3,115
                  3,205
               
               
                  
                  Adjustments:
               
               
                  0190
                  Adjustment - rounding
                  â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
                  â19
                  â19
                  â19
               
               
                  0501
                  Vaccine Injury Compensation Program Trust Fund
                  â229
                  â235
                  â242
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0599
                  Total appropriations
                  â248
                  â254
                  â261
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Balance, end of year
                  3,115
                  3,205
                  3,301
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8175â0â7â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)
                  â248
                  â264
                  â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
                  â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. 99â660 and P.L. 100â203 and serves as a source of
            funds to pay claims for compensation for vaccine-related injury or death. This account reflects payments for claims for vaccine-related
            injury or death occurring after October 1, 1988.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8175â0â7â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
               
               
                  
                     
                  
               
            
         
      
         Indian Health Service                                                                                                    
            
         Federal Funds
         Indian Health ServiceFor 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 93â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.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0390â0â1â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 [75â0390]
                  â43
                  
                  
               
               
                  1121
                  Transferred from other accounts [75â0390]
                  43
                  
                  
               
               
                  1130
                  Appropriations permanently reduced
                  â7
                  
                  
               
               
                  1141
                  Approp permanently reduced (Sec 436, HR 2055)
                  
                  â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
                  â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
                  â233
                  â331
                  â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)
                  â4,973
                  â5,556
                  â5,482
               
               
                  3050
                  Change in uncollected pymts, Fed sources, unexpired
                  â103
                  
                  
               
               
                  3051
                  Change in uncollected pymts, Fed sources, expired
                  5
                  
                  
               
               
                  3080
                  Recoveries of prior year unpaid obligations, unexpired
                  â179
                  
                  
               
               
                  3081
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â331
                  â331
                  â331
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3100
                  Obligated balance, end of year (net)
                  535
                  128
                  â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
                  â366
                  â368
                  â368
               
               
                  4033
                  Non-Federal sources
                  â792
                  â797
                  â797
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â1,158
                  â1,165
                  â1,165
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â103
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0390â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0390â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Indian Health FacilitiesFor 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.)
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0391â0â1â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
                  â8
                  â8
                  â8
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0391â0â1â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
                  â1
                  
                  
               
               
                  1141
                  Approp permanently reduced (Sec 436, HR 2055)
                  
                  â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
                  â8
                  â21
                  â34
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3020
                  Obligated balance, start of year (net)
                  542
                  559
                  398
               
               
                  3030
                  Obligations incurred, unexpired accounts
                  607
                  624
                  627
               
               
                  3040
                  Outlays (gross)
                  â552
                  â772
                  â411
               
               
                  3050
                  Change in uncollected pymts, Fed sources, unexpired
                  â13
                  â13
                  
               
               
                  3080
                  Recoveries of prior year unpaid obligations, unexpired
                  â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
                  â21
                  â34
                  â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
                  â190
                  â190
                  â6
               
               
                  4033
                  Non-Federal sources
                  â1
                  â1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â191
                  â191
                  â6
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â13
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0391â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0391â0â1â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
               
               
                  
                     
                  
               
            
         
      
         ADMINISTRATIVE PROVISIONS                                                                                                
            
         
         Administrative ProvisionsâIndian Health ServiceAppropriations 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. 5901â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. 2651â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 86â121, the Indian Sanitation Facilities Act and Public
         Law 93â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.)
         Centers for Disease Control and Prevention                                                                               
            
         Federal Funds
         CDC-Wide Activities and Program Support
         Immunization and Respiratory DiseasesFor 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.  
         HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis PreventionFor 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.  
         Emerging and Zoonotic Infectious DiseasesFor 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.  
         Chronic Disease Prevention and Health PromotionFor 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.  
         Birth Defects, Developmental Disabilities, Disabilities and HealthFor 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.  
         Public Health Scientific ServicesFor 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.  
         Environmental HealthFor carrying out titles II, III, VII, and XVII of the PHS Act with respect to environmental health, [$105,598,000] $103,672,000.  
         Injury Prevention and ControlFor 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.  
         National Institute for Occupational Safety and HealthFor 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.  
         Energy Employees Occupational Illness Compensation Program
         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 106â554.  
         Global HealthFor 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.  
         Public Health Preparedness and ResponseFor 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.  
         CDC-Wide Activities and Program SupportFor 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.)
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0943â0â1â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
                  â2
                  â2
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0943â0â1â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 [75â0350]
                  
                  â1
                  
               
               
                  1130
                  Appropriations permanently reduced
                  â11
                  
                  
               
               
                  1143
                  Approp permanently reduced (Sec 527, HR 2055)
                  
                  â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 [75â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
                  â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
                  â486
                  â468
                  â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)
                  â7,277
                  â7,225
                  â6,866
               
               
                  3050
                  Change in uncollected pymts, Fed sources, unexpired
                  â300
                  
                  
               
               
                  3051
                  Change in uncollected pymts, Fed sources, expired
                  318
                  
                  
               
               
                  3080
                  Recoveries of prior year unpaid obligations, unexpired
                  â20
                  â4
                  
               
               
                  3081
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â468
                  â468
                  â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
                  â606
                  â703
                  â703
               
               
                  4033
                  Non-Federal sources
                  â13
                  â9
                  â9
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â619
                  â712
                  â712
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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. 111â32, the Supplemental Appropriations
            Act of 2009.  P.L. 111â32 appropriated $7.65 billion to the Public Health and Social Services Emergency Fund for pandemic
            influenza preparedness and response activities.  
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0943â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0943â0â1â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
               
               
                  
                     
                  
               
            
         
      
         CDC Working Capital Fund                                                                                                 
            
         
         The Consolidated Appropriations Bill, 2012 (P.L. 112â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.
         
      
         Agency for Toxic Substances and Disease Registry
         toxic substances and environmental public healthFor 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.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0944â0â1â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
                  â13
                  â13
                  â20
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3020
                  Obligated balance, start of year (net)
                  30
                  34
                  â6
               
               
                  3030
                  Obligations incurred, unexpired accounts
                  89
                  86
                  86
               
               
                  3040
                  Outlays (gross)
                  â81
                  â119
                  â95
               
               
                  3050
                  Change in uncollected pymts, Fed sources, unexpired
                  â7
                  â7
                  
               
               
                  3051
                  Change in uncollected pymts, Fed sources, expired
                  7
                  
                  
               
               
                  3081
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â13
                  â20
                  â20
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3100
                  Obligated balance, end of year (net)
                  34
                  â6
                  â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
                  â10
                  â3
                  â10
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â7
                  â7
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  7
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0944â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0944â0â1â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
               
               
                  
                     
                  
               
            
         
      
         World Trade Center Health Program Fund                                                                                   
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0946â0â1â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 (WTCâNYC DHSSâ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)
                  â11
                  â130
                  â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.111â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. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0946â0â1â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
               
               
                  
                     
                  
               
            
         
      
         National Institutes of Health                                                                                            
            
         Federal Funds
         National Cancer InstituteFor 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 InstituteâFrederick
         Federally Funded Research and Development Center in Frederick, Maryland.  (Department of Health and Human Services Appropriations Act, 2012.)
         National Heart, Lung, and Blood InstituteFor 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.)
         National Institute of Dental and Craniofacial ResearchFor 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.)
         National Institute of Diabetes and Digestive and Kidney DiseasesFor 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.)
         National Institute of Neurological Disorders and StrokeFor 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.)
         National Institute of Allergy and Infectious DiseasesFor 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.)
         National Institute of General Medical SciencesFor 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.)
         Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentFor 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.)
         National Eye InstituteFor 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.)
         National Institute of Environmental Health SciencesFor 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.)
         National Institute on AgingFor 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.)
         National Institute of Arthritis and Musculoskeletal and Skin DiseasesFor 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.)
         National Institute on Deafness and Other Communication DisordersFor 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.)
         National Institute of Nursing ResearchFor 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.)
         National Institute on Alcohol Abuse and AlcoholismFor 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.)
         National Institute on Drug AbuseFor 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.)
         National Institute of Mental HealthFor 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.)
         National Human Genome Research InstituteFor 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.)
         National Institute of Biomedical Imaging and BioengineeringFor 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.)
         National Center for Complementary and Alternative MedicineFor 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.)
         National Institute on Minority Health and Health DisparitiesFor 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.)
         John E. Fogarty International CenterFor 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.)
         National Library of MedicineFor 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.)
         National Center for Advancing Translational SciencesFor 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.)
         Office of the DirectorFor 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.)
         Buildings and FacilitiesFor 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.)
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9915â0â1â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
                  â17
                  â17
                  â17
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9915â0â1â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
                  â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 [72â1028]
                  â297
                  
                  
               
               
                  1120
                  Appropriations transferred to other accts [75â0350]
                  
                  â9
                  
               
               
                  1121
                  Transferred from other accounts [75â9912]
                  1
                  
                  
               
               
                  1130
                  Appropriations permanently reduced
                  â62
                  
                  
               
               
                  1143
                  Approp permanently reduced (Sec 527, HR 2055)
                  
                  â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
                  â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
                  â1,247
                  â1,151
                  â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)
                  â37,715
                  â34,873
                  â33,863
               
               
                  3050
                  Change in uncollected pymts, Fed sources, unexpired
                  â544
                  
                  
               
               
                  3051
                  Change in uncollected pymts, Fed sources, expired
                  634
                  
                  
               
               
                  3080
                  Recoveries of prior year unpaid obligations, unexpired
                  â46
                  
                  
               
               
                  3081
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â1,151
                  â1,151
                  â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
                  â3,246
                  â3,289
                  â3,382
               
               
                  4033
                  Non-Federal sources
                  â99
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â3,345
                  â3,289
                  â3,382
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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
                  
                  
                     
                     
                        
                     
                     
                        
                     
                     
                        
                     
                  
                  
                     
                        
                     
                  
               
            
         1Funding provided in the Consolidated Appropriations Act, 2012, reflects a reorganization of the National Institutes of Health
         that created the new National Center for Advancing Translational Sciences (NCATS) and abolished the National Center for Research
         Resources (NCRR).  The translational functions of NCRR were moved to NCATS, and the remaining non-translational functions
         were moved to the National Institute of General Medical Sciences, the National Institute of Biomedical Imaging and Bioengineering,
         the National Institute on Minority Health and Health Disparities, the National Heart, Lung, and Blood Institute, and the Office
         of the Director.2The Department of Defense and Full-Year Continuing Appropriations Act, 2011, included $297,300,000 in the National Institute
         of Allergy and Infectious Diseases for transfer to the Global Fund to Fight HIV/AIDS, Malaria, and Tuberculosis.  The Consolidated
         Appropriations Act, 2012, did not include such a transfer.
         (in millions of dollars)
         
            
               
                  
                     
                        
                     
                  
                  
                     
                     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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9915â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9915â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Substance Abuse and Mental Health Services Administration                                                                
            
         Federal Funds
         Mental HealthFor 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.  
          Substance Abuse TreatmentFor 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.  
          Substance Abuse PreventionFor carrying out titles III and V of the PHS Act with respect to substance abuse prevention, [$186,361,000] $463,378,000.  
         Health Surveillance and Program SupportFor 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.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1362â0â1â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 [75â0350]
                  
                  â1
                  
               
               
                  1130
                  Appropriations permanently reduced
                  â7
                  
                  
               
               
                  1143
                  Approp permanently reduced (Sec 527, HR 2055)
                  
                  â6
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  3,379
                  3,347
                  3,152
               
               
                  
                  Appropriations, mandatory:
               
               
                  1221
                  Appropriations transferred from the Prevention and Public Health Fund [75â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
                  â151
                  â239
                  â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)
                  â3,557
                  â3,689
                  â3,699
               
               
                  3050
                  Change in uncollected pymts, Fed sources, unexpired
                  â106
                  
                  
               
               
                  3051
                  Change in uncollected pymts, Fed sources, expired
                  18
                  
                  
               
               
                  3081
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â239
                  â239
                  â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
                  â144
                  â255
                  â292
               
               
                  4033
                  Non-Federal sources
                  
                  
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â144
                  â255
                  â294
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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. 112â74) restructured the appropriation accounts for SAMHSA, which is continued in FY 2013.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1362â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1362â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Agency for Healthcare Research and Quality                                                                               
            
         Federal Funds
         Healthcare Research and QualityFor 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.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1700â0â1â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 [75â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
                  â451
                  â382
                  â382
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3020
                  Obligated balance, start of year (net)
                  714
                  606
                  â58
               
               
                  3030
                  Obligations incurred, unexpired accounts
                  400
                  398
                  363
               
               
                  3031
                  Obligations incurred, expired accounts
                  2
                  
                  
               
               
                  3040
                  Outlays (gross)
                  â566
                  â1,062
                  â533
               
               
                  3050
                  Change in uncollected pymts, Fed sources, unexpired
                  â227
                  
                  
               
               
                  3051
                  Change in uncollected pymts, Fed sources, expired
                  296
                  
                  
               
               
                  3081
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â382
                  â382
                  â382
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3100
                  Obligated balance, end of year (net)
                  606
                  â58
                  â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
                  â451
                  â768
                  â388
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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.  
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1700â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1700â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Centers for Medicare and Medicaid Services                                                                               
            
         Federal Funds
         Grants to States for MedicaidFor 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.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0512â0â1â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)
                  â275,796
                  â255,439
                  â282,699
               
               
                  3080
                  Recoveries of prior year unpaid obligations, unexpired
                  â20,039
                  â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
                  â703
                  â320
                  
               
               
                  4123
                  Non-Federal sources
                  â129
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â832
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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
                  
                  â11
                  â70
               
               
                  
                  Outlays
                  
                  â11
                  â70
               
               
                  Legislative proposal, not subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  â215
                  â695
               
               
                  
                  Outlays
                  
                  â215
                  â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.
         
         Vaccines for Children (in millions of dollars)
         
            
               
                  
                     
                        
                     
                  
                  
                     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
                  
                  
                     
                        
                     
                  
               
            
          
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0512â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Grants to States for Medicaid                                                                                            
            
         
         (Amounts included in the adjusted baseline)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0512â7â1â551
                  2011 actual
                  2012 est.
                  2013 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Medicaid vendor payments
                  
                  â11
                  â70
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  
                  â11
                  â70
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  â11
                  â70
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  â11
                  â70
               
               
                  1930
                  Total budgetary resources available
                  
                  â11
                  â70
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  3030
                  Obligations incurred, unexpired accounts
                  
                  â11
                  â70
               
               
                  3040
                  Outlays (gross)
                  
                  11
                  70
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  â11
                  â70
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  â11
                  â70
               
               
                  4180
                  Budget authority, net (total)
                  
                  â11
                  â70
               
               
                  4190
                  Outlays, net (total)
                  
                  â11
                  â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.
         
      
         Grants to States for Medicaid                                                                                            
            
         
         (Legislative proposal, not subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0512â2â1â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
                  
                  â215
                  â695
               
               
                  4180
                  Budget authority, net (total)
                  
                  â215
                  â695
               
               
                  4190
                  Outlays, net (total)
                  
                  â215
                  â695
               
               
                  
                     
                  
               
            
         
      
      
         This schedule reflects the offsetting collections from Medicare Part B for the extension of the Qualified Individual (QI)
            program.
         
      
         Grants to States for Medicaid                                                                                            
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0512â4â1â551
                  2011 actual
                  2012 est.
                  2013 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Program Integrity
                  
                  
                  â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)
                  
                  â370
                  â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
               
               
                  
                     
                  
               
            
         
      
      
         This schedule reflects the Administration's Medicaid proposals.
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0512â4â1â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
               
               
                  
                     
                  
               
            
         
      
         State Grants and Demonstrations                                                                                          
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0516â0â1â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
                  â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)
                  â568
                  â604
                  â474
               
               
                  3080
                  Recoveries of prior year unpaid obligations, unexpired
                  â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
                  â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. 106â170), the Medicare Prescription Drug, Improvement,
            and Modernization Act of 2003 (P.L. 108â173), the Deficit Reduction Act of 2005 (P.L. 109â171), the Children's Health Insurance
            Program Reauthorization Act of 2009 (P.L. 111â3), the Patient Protection and Affordable Care Act (P.L. 111â148), and the Health
            Care and Education Reconciliation Act of 2010 (P.L. 111â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0516â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0516â0â1â551
                  2011 actual
                  2012 est.
                  2013 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  81
                  100
                  102
               
               
                  
                     
                  
               
            
         
      
         Payments to Health Care Trust FundsFor 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 97â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.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0580â0â1â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
                  â3,824
                  â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)
                  â242,193
                  â235,114
                  â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
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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
                  
                  
                  â4,565
               
               
                  
                  Outlays
                  
                  
                  â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.
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0580â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Payments to Health Care Trust Funds                                                                                      
            
         
         (Amounts included in the adjusted baseline)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0580â7â1â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)
                  
                  
                  â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
               
               
                  
                     
                  
               
            
         
      
         Payments to Health Care Trust Funds                                                                                      
            
         
         (Legislative proposal, not subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0580â2â1â571
                  2011 actual
                  2012 est.
                  2013 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Federal contribution to match premiums (SMI)
                  
                  
                  â15
               
               
                  0002
                  Part D benefits (Rx Drug)
                  
                  
                  â4,550
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  
                  
                  â4,565
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation (definite, annual)
                  
                  
                  â4,565
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  â4,565
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â4,565
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  3030
                  Obligations incurred, unexpired accounts
                  
                  
                  â4,565
               
               
                  3040
                  Outlays (gross)
                  
                  
                  4,565
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â4,565
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â4,565
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â4,565
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â4,565
               
               
                  
                     
                  
               
            
         
      
         Quality Improvements Organizations                                                                                       
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0519â0â1â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
                  â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
                  
                  â999
                  â999
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3020
                  Obligated balance, start of year (net)
                  
                  â175
                  â562
               
               
                  3030
                  Obligations incurred, unexpired accounts
                  856
                  440
                  378
               
               
                  3040
                  Outlays (gross)
                  â32
                  â827
                  â528
               
               
                  3050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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
                  â999
                  â999
                  â999
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3100
                  Obligated balance, end of year (net)
                  â175
                  â562
                  â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
                  â20
                  â827
                  â528
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â999
                  
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  12
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  12
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0519â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0519â0â1â571
                  2011 actual
                  2012 est.
                  2013 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  164
                  164
               
               
                  
                     
                  
               
            
         
      
         Program ManagementFor 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.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0511â0â1â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
                  â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
                  â2,867
                  â3,623
                  â3,623
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3020
                  Obligated balance, start of year (net)
                  â387
                  â798
                  â1,036
               
               
                  3030
                  Obligations incurred, unexpired accounts
                  4,240
                  5,749
                  5,730
               
               
                  3031
                  Obligations incurred, expired accounts
                  90
                  
                  
               
               
                  3040
                  Outlays (gross)
                  â3,786
                  â5,987
                  â5,755
               
               
                  3050
                  Change in uncollected pymts, Fed sources, unexpired
                  â2,352
                  
                  
               
               
                  3051
                  Change in uncollected pymts, Fed sources, expired
                  1,596
                  
                  
               
               
                  3080
                  Recoveries of prior year unpaid obligations, unexpired
                  â11
                  
                  
               
               
                  3081
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â3,623
                  â3,623
                  â3,623
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3100
                  Obligated balance, end of year (net)
                  â798
                  â1,036
                  â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
                  â3,154
                  â3,828
                  â4,821
               
               
                  4033
                  Non-Federal sources
                  â313
                  â478
                  â465
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â3,467
                  â4,306
                  â5,286
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â1,805
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  1,502
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â303
                  
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  â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
                  â83
                  â108
                  â29
               
               
                  4123
                  Non-Federal sources
                  â5
                  â72
                  â72
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â88
                  â180
                  â101
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â547
                  
                  
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  17
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0511â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0511â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Program Management                                                                                                       
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0511â4â1â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)
                  
                  
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0511â4â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0511â4â1â550
                  2011 actual
                  2012 est.
                  2013 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  
                  20
               
               
                  
                     
                  
               
            
         
      
         Children's Health Insurance Fund                                                                                         
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0515â0â1â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
                  
                  
                  â6,706
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  
                  
                  â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
                  â3,500
                  â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)
                  â8,629
                  â9,778
                  â10,027
               
               
                  3080
                  Recoveries of prior year unpaid obligations, unexpired
                  â16
                  
                  
               
               
                  3081
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  
                  
                  â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. 111â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. 111â148) extended funding for CHIP, providing appropriations through FY 2015.
         
      
         Center for Medicare and Medicaid Innovation                                                                              
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0522â0â1â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)
                  â11
                  â733
                  â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
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0522â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0522â0â1â551
                  2011 actual
                  2012 est.
                  2013 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  68
                  204
                  265
               
               
                  
                     
                  
               
            
         
      
         Child Enrollment Contingency Fund                                                                                        
            
         Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â5551â0â2â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
                  â8
                  â7
                  â13
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â5551â0â2â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)
                  â4
                  â125
                  â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.  
         
      
         Medicare Health Information Technology Incentive Payments, Recovery Act                                                  
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0508â0â1â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
                  
                  â1,839
                  â1,839
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3020
                  Obligated balance, start of year (net)
                  
                  â1,748
                  â1,748
               
               
                  3030
                  Obligations incurred, unexpired accounts
                  453
                  1,640
                  1,790
               
               
                  3040
                  Outlays (gross)
                  â362
                  â1,640
                  â1,790
               
               
                  3050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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
                  â1,839
                  â1,839
                  â1,839
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3100
                  Obligated balance, end of year (net)
                  â1,748
                  â1,748
                  â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
                  â272
                  â1,640
                  â1,790
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â1,839
                  
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  90
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  90
                  
                  
               
               
                  
                     
                  
               
            
         
      
         Rate Review Grants                                                                                                       
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0112â0â1â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)
                  â12
                  â80
                  â80
               
               
                  3080
                  Recoveries of prior year unpaid obligations, unexpired
                  â1
                  â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. 111â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. 
         
      
         Pre-Existing Condition Insurance Plan Program                                                                            
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0113â0â1â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)
                  â429
                  â1,637
                  â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
                  â27
                  â72
                  â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. 111â148).
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0113â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0113â0â1â551
                  2011 actual
                  2012 est.
                  2013 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  13
                  14
                  16
               
               
                  
                     
                  
               
            
         
      
         Early Retiree Reinsurance Program                                                                                        
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0114â0â1â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)
                  â2,975
                  â1,973
                  â28
               
               
                  3080
                  Recoveries of prior year unpaid obligations, unexpired
                  â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. 111â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. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0114â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0114â0â1â551
                  2011 actual
                  2012 est.
                  2013 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  2
                  10
                  10
               
               
                  
                     
                  
               
            
         
      
         Affordable Insurance Exchange Grants                                                                                     
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0115â0â1â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)
                  â24
                  â906
                  â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. 111â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0115â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0115â0â1â551
                  2011 actual
                  2012 est.
                  2013 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  28
                  63
                  63
               
               
                  
                     
                  
               
            
         
      
         Consumer Operated and Oriented Plan Program Account                                                                      
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0118â0â1â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
                  â2,200
                  â400
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  â2,200
                  â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)
                  
                  â93
                  â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
                  â2,200
                  â400
                  
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  
                  93
                  803
               
               
                  4180
                  Budget authority, net (total)
                  â2,200
                  â400
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  93
                  803
               
               
                  
                     
                  
               
            
         
      
      Summary of Loan Levels, Subsidy Budget Authority and Outlays by Program (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0118â0â1â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. 111â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. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0118â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0118â0â1â551
                  2011 actual
                  2012 est.
                  2013 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  1
                  19
                  19
               
               
                  
                     
                  
               
            
         
      
         Consumer Operated and Oriented Plan Financing Account                                                                    
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4418â0â3â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
                  â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
                  
                  
                  â2,347
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3020
                  Obligated balance, start of year (net)
                  
                  
                  3,053
               
               
                  3030
                  Obligations incurred, unexpired accounts
                  
                  5,627
                  1,647
               
               
                  3040
                  Financing disbursements (gross)
                  
                  â227
                  â1,866
               
               
                  3050
                  Change in uncollected pymts, Fed sources, unexpired
                  
                  â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
                  
                  â2,347
                  â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
                  
                  â84
                  â782
               
               
                  
                  Additional offsets against financing authority only (total):
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  
                  â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
               
               
                  
                     
                  
               
            
         
      
      Status of Direct Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4418â0â3â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
         Federal Hospital Insurance Trust Fund                                                                                    
            
         Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8005â0â7â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
                  â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)
                  
                  
                  â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
                  â2,299
                  â2,185
                  â2,327
               
               
                  0501
                  Federal Hospital Insurance Trust Fund
                  27
                  
                  
               
               
                  0502
                  Federal Hospital Insurance Trust Fund
                  
                  5
                  
               
               
                  0503
                  Federal Hospital Insurance Trust Fund
                  â227,694
                  â244,229
                  â256,999
               
               
                  0504
                  Federal Hospital Insurance Trust Fund
                  â42,424
                  â19,619
                  â24,346
               
               
                  0505
                  Federal Hospital Insurance Trust Fund
                  5
                  
                  
               
               
                  0506
                  Federal Hospital Insurance Trust Fund
                  
                  â2
                  â23
               
               
                  0507
                  Federal Hospital Insurance Trust Fund
                  
                  2
                  23
               
               
                  0508
                  Federal Hospital Insurance Trust Fund
                  
                  â18
                  â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
                  
                  
                  â972
               
               
                  0513
                  Health Care Fraud and Abuse Control Account
                  â310
                  â311
                  â610
               
               
                  0514
                  Health Care Fraud and Abuse Control Account
                  
                  1
                  
               
               
                  0515
                  Health Care Fraud and Abuse Control Account
                  â1,422
                  â1,224
                  â1,167
               
               
                  0516
                  Health Care Fraud and Abuse Control Account
                  
                  â272
                  
               
               
                  0517
                  Health Care Fraud and Abuse Control Account
                  
                  1
                  
               
               
                  0518
                  Health Care Fraud and Abuse Control Account
                  
                  414
                  551
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0599
                  Total appropriations
                  â274,117
                  â267,418
                  â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
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8005â0â7â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
                  â142
                  
                  
               
               
                  1029
                  Other balances withdrawn
                  â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
                  â27
                  
                  
               
               
                  1144
                  Approp temporarily reduced (Sec 527, HR 2055)
                  
                  â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
                  â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
                  â1
                  â1
                  â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)
                  â265,280
                  â266,336
                  â283,733
               
               
                  3080
                  Recoveries of prior year unpaid obligations, unexpired
                  â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
                  â1
                  â1
                  â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
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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
                  
                  
                  â1,020
               
               
                  
                  Outlays
                  
                  
                  â1,020
               
               
                  Increased funding for BBEDCA program integrity adjustments:
               
               
                  
                  Budget Authority
                  
                  â1
                  
               
               
                  
                  Outlays
                  
                  â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.
         
      
      Status of Funds (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8005â0â7â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
                  â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)
                  
                  
                  â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
                  â265,280
                  â266,336
                  â283,733
               
               
                  4500
                  Health Care Fraud and Abuse Control Account
                  
                  
                  â900
               
               
                  4500
                  Federal Hospital Insurance Trust Fund
                  â1,359
                  â1,527
                  â1,928
               
               
                  4500
                  Health Care Fraud and Abuse Control Account
                  
                  413
                  551
               
               
                  4599
                  Outgo under current law (-)
                  â266,639
                  â267,450
                  â286,010
               
               
                  
                  Proposed legislation:
               
               
                  5500
                  Health Care Fraud and Abuse Control Account
                  
                  â271
                  
               
               
                  5500
                  Federal Hospital Insurance Trust Fund
                  
                  1
                  
               
               
                  5500
                  Federal Hospital Insurance Trust Fund
                  
                  
                  1,020
               
               
                  5599
                  Outgo under proposed legislation (-)
                  
                  â270
                  1,020
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  6599
                  Total cash outgo (-)
                  â266,639
                  â267,720
                  â284,990
               
               
                  
                  Unexpended balance, end of year:
               
               
                  8700
                  Uninvested balance (net), end of year
                  â241
                  â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
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8005â0â7â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
               
               
                  
                     
                  
               
            
         
      
         Federal Hospital Insurance Trust Fund                                                                                    
            
         
         (Amounts included in the adjusted baseline)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8005â7â7â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)
                  
                  
                  â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)
                  
                  
                  â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
               
               
                  
                     
                  
               
            
         
      
         Federal Hospital Insurance Trust Fund                                                                                    
            
         
         (Legislative proposal, not subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8005â2â7â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)
                  
                  â2
                  â23
               
               
                  
                     
                  
               
            
         
      
         Federal Hospital Insurance Trust Fund                                                                                    
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8005â4â7â571
                  2011 actual
                  2012 est.
                  2013 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Benefit payments, HI
                  
                  
                  â1,020
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 42.0)
                  
                  
                  â1,020
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  18
                  88
               
               
                  1203
                  Appropriation (previously unavailable)
                  
                  â18
                  â1,108
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  â1,020
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â1,020
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  3030
                  Obligations incurred, unexpired accounts
                  
                  
                  â1,020
               
               
                  3040
                  Outlays (gross)
                  
                  
                  1,020
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â1,020
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â1,020
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â1,020
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â1,020
               
               
                  
                     
                  
               
            
         
      
         Health Care Fraud and Abuse Control AccountIn 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.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8393â0â7â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)
                  
                  â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
                  â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)
                  â1,359
                  â1,527
                  â1,928
               
               
                  3080
                  Recoveries of prior year unpaid obligations, unexpired
                  â46
                  
                  
               
               
                  3081
                  Recoveries of prior year unpaid obligations, expired
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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
                  
                  â414
                  â551
               
               
                  
                  Outlays
                  
                  â413
                  â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. 104â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. 104â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. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8393â0â7â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8393â0â7â571
                  2011 actual
                  2012 est.
                  2013 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  162
                  325
                  360
               
               
                  
                     
                  
               
            
         
      
         Health Care Fraud and Abuse Control Account                                                                              
            
         
         (Amounts included in the adjusted baseline)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8393â7â7â571
                  2011 actual
                  2012 est.
                  2013 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  
                  â414
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  â414
                  â551
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  â414
                  â551
               
               
                  1900
                  Budget authority (total)
                  
                  â414
                  â551
               
               
                  1930
                  Total budgetary resources available
                  
                  â414
                  â965
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  â414
                  â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
                  
                  â414
                  â551
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  â413
                  â551
               
               
                  4180
                  Budget authority, net (total)
                  
                  â414
                  â551
               
               
                  4190
                  Outlays, net (total)
                  
                  â413
                  â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.
         
      
         Federal Supplementary Medical Insurance Trust Fund                                                                       
            
         Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8004â0â7â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
                  
                  
                  â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
                  
                  â342
                  â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
                  
                  
                  â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
                  â3,051
                  â3,432
                  â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
                  â230,483
                  â233,528
                  â259,914
               
               
                  0504
                  Federal Supplementary Medical Insurance Trust Fund
                  â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
                  
                  â215
                  â5,260
               
               
                  0508
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  
                  â4,550
               
               
                  0509
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  
                  4,580
               
               
                  0510
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  342
                  â5,220
               
               
                  0511
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  â9,579
                  â21,205
               
               
                  0512
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  â402
                  â397
                  â418
               
               
                  0513
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  
                  1
                  
               
               
                  0514
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  â67,454
                  â57,794
                  â73,512
               
               
                  0515
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  
                  
                  â1,588
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0599
                  Total appropriations
                  â304,160
                  â300,111
                  â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
                  â7
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Balance, end of year
                  42,930
                  37,621
                  38,506
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8004â0â7â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
                  â150
                  
                  
               
               
                  1029
                  Other balances withdrawn
                  â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
                  â32
                  
                  
               
               
                  1144
                  Approp temporarily reduced (Sec 527, HR 2055)
                  
                  â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
                  
                  â4,485
                  â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)
                  â234,285
                  â232,509
                  â241,007
               
               
                  3080
                  Recoveries of prior year unpaid obligations, unexpired
                  â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
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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
                  
                  
                  â30
               
               
                  
                  Outlays
                  
                  
                  â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.  
         
         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.  
         
      
      Status of Funds (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8004â0â7â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
                  â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
                  
                  â342
                  â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
                  
                  
                  â15
               
               
                  2248
                  Federal Contributions for Benefits, Prescription Drug Account, SMI
                  
                  
                  â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
                  â234,285
                  â232,509
                  â241,007
               
               
                  4500
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  
                  â9,237
                  â26,425
               
               
                  4500
                  Federal Supplementary Medical Insurance Trust Fund
                  â67,850
                  â58,199
                  â73,930
               
               
                  4599
                  Outgo under current law (-)
                  â302,135
                  â299,945
                  â341,362
               
               
                  
                  Proposed legislation:
               
               
                  5500
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  
                  
                  â1,588
               
               
                  5500
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  â215
                  â695
               
               
                  5500
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  
                  30
               
               
                  5599
                  Outgo under proposed legislation (-)
                  
                  â215
                  â2,253
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  6599
                  Total cash outgo (-)
                  â302,135
                  â300,160
                  â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
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8004â0â7â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
               
               
                  
                     
                  
               
            
         
      
         Federal Supplementary Medical Insurance Trust Fund                                                                       
            
         
         (Amounts included in the adjusted baseline)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8004â7â7â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)
                  
                  â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)
                  
                  â9,237
                  â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
               
               
                  
                     
                  
               
            
         
      
         Federal Supplementary Medical Insurance Trust Fund                                                                       
            
         
         (Legislative proposal, not subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8004â2â7â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)
                  
                  
                  â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)
                  
                  â215
                  â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
               
               
                  
                     
                  
               
            
         
      
         Federal Supplementary Medical Insurance Trust Fund                                                                       
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8004â4â7â571
                  2011 actual
                  2012 est.
                  2013 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Benefit payments, SMI
                  
                  
                  â30
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 42.0)
                  
                  
                  â30
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  
                  4,550
               
               
                  1235
                  Appropriations precluded from obligation
                  
                  
                  â4,580
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  â30
               
               
                  1900
                  Budget authority (total)
                  
                  
                  â30
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â30
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  3030
                  Obligations incurred, unexpired accounts
                  
                  
                  â30
               
               
                  3040
                  Outlays (gross)
                  
                  
                  30
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â30
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â30
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â30
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â30
               
               
                  
                     
                  
               
            
         
      
         Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund                                           
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8308â0â7â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)
                  
                  â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
                  â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)
                  â67,850
                  â58,199
                  â73,930
               
               
                  3080
                  Recoveries of prior year unpaid obligations, unexpired
                  â221
                  
                  
               
               
                  3081
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â1,612
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  67,856
                  58,190
                  73,930
               
               
                  4190
                  Outlays, net (total)
                  66,238
                  58,199
                  73,930
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8308â0â7â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
               
               
                  
                     
                  
               
            
         
      
         Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund                                           
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8308â4â7â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)
                  
                  
                  â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
               
               
                  
                     
                  
               
            
         
      
         Allocations Received from Other Accounts                                                                                 
            
         
         Note.âObligations incurred under allocations from other accounts are included in the schedule of the parent appropriation
            as follows: Centers for Medicare and Medicaid Services "Health Care Fraud and Abuse Control Account."
         
      
         Administration for Children and Families                                                                                 
            
         Federal Funds
         Temporary Assistance for Needy Families                                                                                  
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1552â0â1â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
                  â16
                  â15
                  â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)
                  â17,116
                  â16,538
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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. 104â193), as amended by the Deficit Reduction
            Act of 2005 (P.L. 109â171), the Claims Resolution Act of 2010 (P.L. 111â291), the Short Term TANF Extension Act (P.L. 112â35),
            and the Temporary Payroll Tax Cut Continuation Act of 2011 (P.L. 112â78)
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1552â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1552â0â1â609
                  2011 actual
                  2012 est.
                  2013 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  18
                  18
                  18
               
               
                  
                     
                  
               
            
         
      
         Temporary Assistance for Needy Families                                                                                  
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1552â4â1â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)
                  
                  
                  â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.
         
      
         Contingency Fund                                                                                                         
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1522â0â1â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
                  â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)
                  â1,956
                  â1,317
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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
                  
                  
                  â319
               
               
                  
                  Outlays
                  
                  
                  â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.
         
      
         Contingency Fund                                                                                                         
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1522â4â1â609
                  2011 actual
                  2012 est.
                  2013 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Contingency fund
                  
                  
                  â319
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  
                  
                  â319
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  â319
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  â319
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â319
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  3030
                  Obligations incurred, unexpired accounts
                  
                  
                  â319
               
               
                  3040
                  Outlays (gross)
                  
                  
                  289
               
               
                  
                  Obligated balance, end of year (net):
               
               
                  3090
                  Unpaid obligations, end of year (gross)
                  
                  
                  â30
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3100
                  Obligated balance, end of year (net)
                  
                  
                  â30
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â319
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â289
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â319
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â289
               
               
                  
                     
                  
               
            
         
      
         Payments to States for Child Support Enforcement and Family Support ProgramsFor 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.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1501â0â1â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)
                  â4,185
                  â3,872
                  â3,865
               
               
                  3080
                  Recoveries of prior year unpaid obligations, unexpired
                  â509
                  â300
                  â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
                  â3
                  â3
                  â3
               
               
                  4180
                  Budget authority, net (total)
                  4,159
                  4,048
                  3,856
               
               
                  4190
                  Outlays, net (total)
                  4,182
                  3,869
                  3,862
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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.  
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1501â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Payments to States for Child Support Enforcement and Family Support Programs                                             
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1501â4â1â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)
                  
                  
                  â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
               
               
                  
                     
                  
               
            
         
      
         Low Income Home Energy AssistanceFor 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.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1502â0â1â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
                  â9
                  
                  
               
               
                  1143
                  Approp permanently reduced (Sec 527, HR 2055)
                  
                  â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)
                  â4,419
                  â3,726
                  â3,338
               
               
                  3081
                  Recoveries of prior year unpaid obligations, expired
                  â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.
         
      
         Refugee and Entrant AssistanceFor 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.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1503â0â1â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
                  â2
                  
                  
               
               
                  1131
                  Unobligated balance of appropriations permanently reduced
                  â25
                  
                  
               
               
                  1143
                  Approp permanently reduced (Sec 527, HR 2055)
                  
                  â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)
                  â753
                  â658
                  â830
               
               
                  3080
                  Recoveries of prior year unpaid obligations, unexpired
                  â2
                  
                  
               
               
                  3081
                  Recoveries of prior year unpaid obligations, expired
                  â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. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1503â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1503â0â1â609
                  2011 actual
                  2012 est.
                  2013 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  44
                  44
                  44
               
               
                  
                     
                  
               
            
         
      
         Promoting Safe and Stable FamiliesFor 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.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1512â0â1â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
                  
                  
                  â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
                  â12
                  â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)
                  â479
                  â632
                  â542
               
               
                  3080
                  Recoveries of prior year unpaid obligations, unexpired
                  â3
                  
                  
               
               
                  3081
                  Recoveries of prior year unpaid obligations, expired
                  â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. 111â148). This account also includes
            a new initiative to prevent pregnancy among youth in foster care.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1512â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1512â0â1â506
                  2011 actual
                  2012 est.
                  2013 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  5
                  5
                  5
               
               
                  
                     
                  
               
            
         
      
         Child Care Entitlement to States                                                                                         
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1550â0â1â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
                  â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)
                  â3,100
                  â2,868
                  â2,877
               
               
                  3081
                  Recoveries of prior year unpaid obligations, expired
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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. 104â193), as amended by the Deficit Reduction Act of 2005 (P.L. 109â171),
            the Claims Resolution Act of 2010 (P.L. 111â291), the Short Term TANF Extension Act (P.L. 112â35), and the Temporary Payroll
            Tax Cut Continuation Act of 2011 (P.L. 112â78).
         
          
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1550â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Child Care Entitlement to States                                                                                         
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1550â4â1â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)
                  
                  
                  â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
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1550â4â1â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
               
               
                  
                     
                  
               
            
         
      
         Payments to States for the Child Care and Development Block GrantFor 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.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1515â0â1â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
                  â4
                  
                  
               
               
                  1143
                  Approp permanently reduced (Sec 527, HR 2055)
                  
                  â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)
                  â2,984
                  â2,299
                  â2,461
               
               
                  3081
                  Recoveries of prior year unpaid obligations, expired
                  â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.
         
          
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1515â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Social Services Block GrantFor 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.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1534â0â1â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
                  
                  â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)
                  â1,787
                  â1,908
                  â1,792
               
               
                  3080
                  Recoveries of prior year unpaid obligations, unexpired
                  
                  â66
                  
               
               
                  3081
                  Recoveries of prior year unpaid obligations, expired
                  â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
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1534â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1534â0â1â506
                  2011 actual
                  2012 est.
                  2013 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  6
                  6
                  6
               
               
                  
                     
                  
               
            
         
      
         Children and Families Services ProgramsFor 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 111â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.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1536â0â1â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
                  â19
                  
                  
               
               
                  1143
                  Approp permanently reduced (Sec 527, HR 2055)
                  
                  â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
                  â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
                  â15
                  â7
                  â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)
                  â10,551
                  â10,081
                  â9,868
               
               
                  3050
                  Change in uncollected pymts, Fed sources, unexpired
                  â3
                  
                  
               
               
                  3051
                  Change in uncollected pymts, Fed sources, expired
                  11
                  
                  
               
               
                  3080
                  Recoveries of prior year unpaid obligations, unexpired
                  
                  â3
                  
               
               
                  3081
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â7
                  â7
                  â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
                  â21
                  â18
                  â18
               
               
                  4033
                  Non-Federal sources
                  â8
                  â6
                  â6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â29
                  â24
                  â24
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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
                  â1
                  â1
                  â1
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â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. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1536â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1536â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Children's Research and Technical Assistance                                                                             
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1553â0â1â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
                  â1
                  â1
                  â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
                  â6
                  â5
                  â4
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3020
                  Obligated balance, start of year (net)
                  51
                  55
                  50
               
               
                  3030
                  Obligations incurred, unexpired accounts
                  82
                  78
                  78
               
               
                  3040
                  Outlays (gross)
                  â75
                  â84
                  â94
               
               
                  3050
                  Change in uncollected pymts, Fed sources, unexpired
                  1
                  1
                  1
               
               
                  3080
                  Recoveries of prior year unpaid obligations, unexpired
                  â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
                  â5
                  â4
                  â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
                  â24
                  â5
                  â5
               
               
                  4123
                  Non-Federal sources
                  
                  â24
                  â24
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â24
                  â29
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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. 104â193), as amended by the Deficit Reduction Act of 2005 (P.L. 109â171),
            the Claims Resolution Act of 2010 (P.L. 111â291), the Short Term TANF Extension Act (P.L. 112â35), and the Temporary Payroll
            Tax Cut Continuation Act of 2011 (P.L. 112â78). 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1553â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1553â0â1â609
                  2011 actual
                  2012 est.
                  2013 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  64
                  64
                  64
               
               
                  
                     
                  
               
            
         
      
         Children's Research and Technical Assistance                                                                             
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1553â4â1â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)
                  
                  â1
                  â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
               
               
                  
                     
                  
               
            
         
      
         Payments for Foster Care and PermanencyFor 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.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1545â0â1â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
                  
                  â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)
                  â6,860
                  â6,795
                  â6,948
               
               
                  3081
                  Recoveries of prior year unpaid obligations, expired
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1545â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1545â0â1â609
                  2011 actual
                  2012 est.
                  2013 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  4
                  4
                  4
               
               
                  
                     
                  
               
            
         
      
         Payments for Foster Care and Permanency                                                                                  
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1545â4â1â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)
                  
                  
                  â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.
         
      
         Administration on Aging                                                                                                  
            
         Federal Funds
         Aging Services Programs
         (including transfer of 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 111â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.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0142â0â1â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 [12â3507]
                  
                  â2
                  
               
               
                  1130
                  Appropriations permanently reduced
                  â3
                  
                  
               
               
                  1143
                  Approp permanently reduced (Sec 527, HR 2055)
                  
                  â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 [75â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
                  â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
                  â48
                  â37
                  â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)
                  â1,573
                  â1,502
                  â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
                  â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
                  â37
                  â37
                  â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
                  â1
                  
                  â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
                  â17
                  â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.â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. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0142â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0142â0â1â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
         Class Independence Fund                                                                                                  
            
         
         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.
         
      
         Departmental Management                                                                                                  
            
         Federal Funds
         Office of the Secretary
         general departmental managementFor 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.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9912â0â1â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 [75â9915]
                  â1
                  
                  
               
               
                  1130
                  Appropriations permanently reduced (Rescission)
                  â1
                  
                  
               
               
                  1143
                  Approp permanently reduced (Sec 527, HR 2055)
                  
                  â1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  650
                  474
                  306
               
               
                  
                  Appropriations, mandatory:
               
               
                  1221
                  Appropriations transferred from other accts [75â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
                  â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
                  â344
                  â225
                  â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)
                  â749
                  â904
                  â753
               
               
                  3050
                  Change in uncollected pymts, Fed sources, unexpired
                  â76
                  
                  
               
               
                  3051
                  Change in uncollected pymts, Fed sources, expired
                  195
                  
                  
               
               
                  3081
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â225
                  â225
                  â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
                  â375
                  â242
                  â287
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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
                  
                  â9
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â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.â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. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9912â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9912â0â1â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
                  
                  
               
               
                  
                     
                  
               
            
         
      
         Office for Civil RightsFor expenses necessary for the Office for Civil Rights, [$41,016,000] $38,966,000.  (Department of Health and Human Services Appropriations Act, 2012.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0135â0â1â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)
                  â41
                  â42
                  â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
                  â3
                  
                  
               
               
                  4033
                  Non-Federal sources
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0135â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0135â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Office of the National Coordinator for Health Information TechnologyFor 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.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0130â0â1â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
                  â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
                  â34
                  â44
                  â44
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3020
                  Obligated balance, start of year (net)
                  1,779
                  1,509
                  559
               
               
                  3030
                  Obligations incurred, unexpired accounts
                  236
                  73
                  73
               
               
                  3040
                  Outlays (gross)
                  â493
                  â1,023
                  â466
               
               
                  3050
                  Change in uncollected pymts, Fed sources, unexpired
                  â30
                  
                  
               
               
                  3051
                  Change in uncollected pymts, Fed sources, expired
                  20
                  
                  
               
               
                  3080
                  Recoveries of prior year unpaid obligations, unexpired
                  â1
                  
                  
               
               
                  3081
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â44
                  â44
                  â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
                  â23
                  â52
                  â47
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â30
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  20
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â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
                  â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. 111â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.  
         
          
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0130â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0130â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Office of Medicare Hearings and AppealsFor 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.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0139â0â1â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
                  â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)
                  â72
                  â87
                  â84
               
               
                  3081
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â71
                  â72
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0139â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0139â0â1â551
                  2011 actual
                  2012 est.
                  2013 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  418
                  466
                  518
               
               
                  
                     
                  
               
            
         
      
         Public Health and Social Services Emergency Fund
         (including transfer of funds)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 111â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.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0140â0â1â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 [75â0343]
                  â5
                  â3
                  â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
                  â1
                  
                  
               
               
                  1131
                  Unobligated balance of appropriations permanently reduced
                  â1,259
                  
                  
               
               
                  1143
                  Approp permanently reduced (Sec 527, HR 2055)
                  
                  â1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  â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)
                  â570
                  628
                  702
               
               
                  1930
                  Total budgetary resources available
                  6,114
                  4,039
                  2,019
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â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
                  â461
                  â289
                  â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)
                  â1,778
                  â1,958
                  â1,941
               
               
                  3050
                  Change in uncollected pymts, Fed sources, unexpired
                  â12
                  
                  
               
               
                  3051
                  Change in uncollected pymts, Fed sources, expired
                  184
                  
                  
               
               
                  3080
                  Recoveries of prior year unpaid obligations, unexpired
                  â71
                  
                  
               
               
                  3081
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â289
                  â289
                  â289
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3100
                  Obligated balance, end of year (net)
                  4,321
                  5,080
                  4,412
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  â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
                  â76
                  â60
                  â60
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â12
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  74
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  62
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  â584
                  568
                  642
               
               
                  4080
                  Outlays, net (discretionary)
                  1,702
                  1,898
                  1,881
               
               
                  4180
                  Budget authority, net (total)
                  â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.
         
          
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0140â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0140â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Transfers from the Patient-Centered Outcomes Research Trust Fund                                                         
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0145â0â1â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)
                  
                  â9
                  â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
                  â10
                  â30
                  â78
               
               
                  4190
                  Outlays, net (total)
                  â10
                  â21
                  â51
               
               
                  
                     
                  
               
            
         
      
      
         Public Law 111â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.  
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0145â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0145â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Prevention and Wellness Fund, Recovery Act                                                                               
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0144â0â1â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)
                  â22
                  â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. 111â5).  The
            Prevention and Wellness Fund administers evidence-based clinical and community-based prevention and wellness strategies. 
            
         
      
         Nonrecurring Expenses Fund                                                                                               
            
         
         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.
         
      
         Health Insurance Reform Implementation Fund                                                                              
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0119â0â1â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 [75â0119]
                  â231
                  
                  
               
               
                  1011
                  Unobligated balance transfer from other accts [75â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)
                  â208
                  â411
                  â344
               
               
                  3080
                  Recoveries of prior year unpaid obligations, unexpired
                  â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. 111â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. 111â148) and the Health Care and Education Reconciliation Act of 2010.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0119â0â1â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
                  
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0119â0â1â551
                  2011 actual
                  2012 est.
                  2013 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  164
                  
                  
               
               
                  
                     
                  
               
            
         
      
         Prevention and Public Health Fund                                                                                        
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0116â0â1â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 [75â0142]
                  
                  â10
                  â10
               
               
                  1220
                  Appropriations transferred to other accts [75â1700]
                  â12
                  â12
                  â12
               
               
                  1220
                  Appropriations transferred to other accts [75â0943]
                  â611
                  â805
                  â903
               
               
                  1220
                  Appropriations transferred to other accts [75â9912]
                  â19
                  â10
                  â210
               
               
                  1220
                  Appropriations transferred to other accts [75â0350]
                  â20
                  â75
                  â10
               
               
                  1220
                  Appropriations transferred to other accts [75â1362]
                  â88
                  â88
                  â105
               
               
                  
                     
                  
               
            
         
      
      
         The Patient Protection and Affordable Care Act, (P.L. 111â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. 
         
      
         Pregnancy Assistance Fund                                                                                                
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0117â0â1â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)
                  â7
                  â22
                  â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.
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0117â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Program Support Center                                                                                                   
            
         Federal Funds
         Retirement Pay and Medical Benefits for Commissioned OfficersFor 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.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0379â0â1â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)
                  â497
                  â502
                  â527
               
               
                  3081
                  Recoveries of prior year unpaid obligations, expired
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2011 actual
                  2012 est.
                  2013 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  467
                  497
                  528
               
               
                  
                  Outlays
                  497
                  502
                  527
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  â1
               
               
                  
                  Outlays
                  
                  
                  â1
               
               
                  Total:
               
               
                  
                  Budget Authority
                  467
                  497
                  527
               
               
                  
                  Outlays
                  497
                  502
                  526
               
               
                  
                     
                  
               
            
         
      
      
         The number of beneficiaries using the Commissioned Corps system is estimated as follows:
         Retirement Pay, Survivor Benefits, and Medical Benefits
         
            
               
                  
                     
                        
                     
                  
                  
                     
                     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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0379â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Retirement Pay and Medical Benefits for Commissioned Officers                                                            
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0379â4â1â551
                  2011 actual
                  2012 est.
                  2013 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Direct program activity
                  
                  
                  â1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 25.6)
                  
                  
                  â1
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  â1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  â1
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â1
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  3030
                  Obligations incurred, unexpired accounts
                  
                  
                  â1
               
               
                  3040
                  Outlays (gross)
                  
                  
                  1
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â1
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â1
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â1
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â1
               
               
                  
                     
                  
               
            
         
      
         HHS Accrual Contribution to the Uniformed Services Retiree Health Care Fund                                              
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0170â0â1â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)
                  â38
                  â36
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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
                  
                  
                  â3
               
               
                  
                  Outlays
                  
                  
                  â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. 108â375, section 725).
         
      
         HHS Accrual Contribution to the Uniformed Services Retiree Health Care Fund                                              
            
         
         (Legislative proposal, not subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0170â2â1â551
                  2011 actual
                  2012 est.
                  2013 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Direct program activity
                  
                  
                  â3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 12.2)
                  
                  
                  â3
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  
                  
                  â3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  
                  
                  â3
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â3
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  3030
                  Obligations incurred, unexpired accounts
                  
                  
                  â3
               
               
                  3040
                  Outlays (gross)
                  
                  
                  3
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  
                  
                  â3
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  
                  
                  â3
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â3
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â3
               
               
                  
                     
                  
               
            
         
      
         Health Activities Funds                                                                                                  
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9913â0â1â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.
         
      
         HHS Service and Supply Fund                                                                                              
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9941â0â4â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
                  â439
                  â481
                  â481
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3020
                  Obligated balance, start of year (net)
                  â56
                  â65
                  â459
               
               
                  3030
                  Obligations incurred, unexpired accounts
                  976
                  1,078
                  1,131
               
               
                  3040
                  Outlays (gross)
                  â904
                  â1,472
                  â1,131
               
               
                  3050
                  Change in uncollected pymts, Fed sources, unexpired
                  â42
                  
                  
               
               
                  3080
                  Recoveries of prior year unpaid obligations, unexpired
                  â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
                  â481
                  â481
                  â481
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3100
                  Obligated balance, end of year (net)
                  â65
                  â459
                  â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
                  â925
                  â1,078
                  â1,131
               
               
                  4033
                  Non-Federal sources
                  â4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â929
                  â1,078
                  â1,131
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â42
                  
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  â25
                  394
                  
               
               
                  4190
                  Outlays, net (total)
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9941â0â4â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9941â0â4â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
         Miscellaneous Trust Funds                                                                                                
            
         Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9971â0â7â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
                  â51
                  â74
                  â83
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9971â0â7â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
                  â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)
                  â191
                  â77
                  â69
               
               
                  3080
                  Recoveries of prior year unpaid obligations, unexpired
                  â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
               
               
                  
                     
                  
               
            
         
      
      
         (in millions of dollars)
         
            
               
                  
                     
                        
                     
                  
                  
                     
                     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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9971â0â7â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9971â0â7â551
                  2011 actual
                  2012 est.
                  2013 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  28
                  27
                  27
               
               
                  
                     
                  
               
            
         
      
         Office of the Inspector General                                                                                          
            
         Federal Funds
         Office of Inspector GeneralFor 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.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0128â0â1â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
                  â8
                  â7
                  â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
                  â41
                  â74
                  â74
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3020
                  Obligated balance, start of year (net)
                  35
                  â13
                  â8
               
               
                  3030
                  Obligations incurred, unexpired accounts
                  342
                  346
                  395
               
               
                  3031
                  Obligations incurred, expired accounts
                  3
                  
                  
               
               
                  3040
                  Outlays (gross)
                  â346
                  â341
                  â396
               
               
                  3050
                  Change in uncollected pymts, Fed sources, unexpired
                  â50
                  
                  
               
               
                  3051
                  Change in uncollected pymts, Fed sources, expired
                  17
                  
                  
               
               
                  3081
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â74
                  â74
                  â74
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3100
                  Obligated balance, end of year (net)
                  â13
                  â8
                  â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
                  â31
                  â58
                  â127
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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
                  â219
                  â196
                  â197
               
               
                  4123
                  Non-Federal sources
                  â2
                  â12
                  â12
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â221
                  â208
                  â209
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â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:
         
         (in millions of dollars)
         
            
               
                  
                     
                        
                     
                  
                  
                     
                     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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0128â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0128â0â1â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
                  
                  
               
               
                  
                     
                  
               
            
         
      
                                                                                                                                  
            
         
         GENERAL FUND RECEIPT ACCOUNTS                                                                                            
            
         (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2011 actual
                  2012 est.
                  2013 est.
               
               
                  
                     
                  
               
               
                  Offsetting receipts from the public:
               
               
                  75â143500
                  General Fund Proprietary Interest Receipts, not Otherwise Classified
                  77
                  89
                  90
               
               
                  75â274530
                  Health Education Assistance Loans, Downward Reestimates of Subsidies
                  
                  12
                  
               
               
                  75â310700
                  Federal Share of Child Support Collections
                  940
                  1,049
                  1,040
               
               
                  Legislative proposal, subject to PAYGO
                  
                  
                  5
               
               
                  75â322000
                  All Other General Fund Proprietary Receipts Including Budget Clearing Accounts
                  â198
                  56
                  56
               
               
                  General Fund Offsetting receipts from the public
                  819
                  1,206
                  1,191
               
               
                  
                     
                  
               
               
                  
               
               
                  Intragovernmental payments:
               
               
                  75â388500
                  Undistributed Intragovernmental Payments and Receivables from Cancelled Accounts
                  353
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  General Fund Intragovernmental payments
                  353
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         
      
         Allocations Received from Other Accounts                                                                                 
            
         
         Note.âObligations incurred under allocations from other accounts are included in the schedules of the parent appropriations
            as follows: Centers for Medicare and Medicaid Services "Health Care Fraud and Abuse Control Account."
         
      
         GENERAL PROVISIONS                                                                                                       
            
         SEC. 201.  Funds appropriated in this title shall be available for not to exceed $50,000 for official reception and representation expenses
      when specifically approved by the Secretary.SEC. 202.  The Secretary shall make available through assignment not more than 60 employees of the Public Health Service to assist in
      child survival activities and to work in AIDS programs through and with funds provided by the Agency for International Development,
      the United Nations International Children's Emergency Fund or the World Health Organization.SEC. 203.  None of the funds appropriated in this [title] Act for the National Institutes of Health, the Agency for Healthcare Research and Quality, and the Substance Abuse and Mental
         Health Services Administration shall be used to pay the salary of an individual, through a grant or other extramural mechanism, at a rate in excess of Executive
      Level II.[SEC. 204.  None of the funds appropriated in this Act may be expended pursuant to section 241 of the PHS Act, except for funds specifically
      provided for in this Act, or for other taps and assessments made by any office located in HHS, prior to the preparation and
      submission of a report by the Secretary to the Committees on Appropriations of the House of Representatives and the Senate
      detailing the planned uses of such funds.]SEC. [205]204.  Notwithstanding section 241(a) of the PHS Act, such portion as the Secretary shall determine, but not more than [2.5] 3.2 percent, of any amounts appropriated for programs authorized under such Act shall be made available for the evaluation (directly,
      or by grants or contracts) of the implementation and effectiveness of such programs.'
      			
      (transfer of funds)SEC. [206]205.  Not to exceed 1 percent of any discretionary funds (pursuant to the Balanced Budget and Emergency Deficit Control Act of
      1985) which are appropriated for the current fiscal year for HHS in this Act may be transferred between appropriations, but
      no such appropriation shall be increased by more than 3 percent by any such transfer: Provided, That the transfer authority granted by this section shall not be used to create any new program or to fund any project or
      activity for which no funds are provided in this Act: Provided further, That the Committees on Appropriations of the House of Representatives and the Senate are notified at least 15 days in advance
      of any transfer.'
      			
      (transfer of funds)SEC. [207]206.  The Director of the NIH, jointly with the Director of the Office of AIDS Research, may transfer up to 3 percent among institutes
      and centers from the total amounts identified by these two Directors as funding for research pertaining to the human immunodeficiency
      virus: Provided, That the Committees on Appropriations of the House of Representatives and the Senate are notified at least 15 days in advance
      of any transfer.'
      			
      (transfer of funds)SEC. [208]207.  Of the amounts made available in this Act for NIH, the amount for research related to the human immunodeficiency virus, as
      jointly determined by the Director of NIH and the Director of the Office of AIDS Research, shall be made available to the
      "Office of AIDS Research'' account. The Director of the Office of AIDS Research shall transfer from such account amounts necessary
      to carry out section 2353(d)(3) of the PHS Act.SEC. [209]208.  None of the funds appropriated in this Act may be made available to any entity under title X of the PHS Act unless the applicant
      for the award certifies to the Secretary that it encourages family participation in the decision of minors to seek family
      planning services and that it provides counseling to minors on how to resist attempts to coerce minors into engaging in sexual
      activities.SEC. [210]209.  Notwithstanding any other provision of law, no provider of services under title X of the PHS Act shall be exempt from any
      State law requiring notification or the reporting of child abuse, child molestation, sexual abuse, rape, or incest.SEC. [211]210.  None of the funds appropriated by this Act (including funds appropriated to any trust fund) may be used to carry out the
      Medicare Advantage program if the Secretary denies participation in such program to an otherwise eligible entity (including
      a Provider Sponsored Organization) because the entity informs the Secretary that it will not provide, pay for, provide coverage
      of, or provide referrals for abortions: Provided, That the Secretary shall make appropriate prospective adjustments to the capitation payment to such an entity (based on
      an actuarially sound estimate of the expected costs of providing the service to such entity's enrollees): Provided further, That nothing in this section shall be construed to change the Medicare program's coverage for such services and a Medicare
      Advantage organization described in this section shall be responsible for informing enrollees where to obtain information
      about all Medicare covered services.SEC. [212]211.  In order for HHS to carry out international health activities, including HIV/AIDS and other infectious disease, chronic and
      environmental disease, and other health activities abroad during fiscal year [2012] 2013:
      (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.
      SEC. [213]212. (a) Authority.âNotwithstanding any other provision of law, the Director of NIH ("Director'') may use funds available under section 402(b)(7)
      or 402(b)(12) of the PHS Act to enter into transactions (other than contracts, cooperative agreements, or grants) to carry
      out research identified pursuant to such section 402(b)(7) (pertaining to the Common Fund) or research and activities described
      in such section 402(b)(12).
      (b) Peer Review.â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.
      SEC. [214]213.  Funds which are available for Individual Learning Accounts for employees of CDC and the Agency for Toxic Substances and Disease
      Registry ("ATSDR'') may be transferred to appropriate accounts of CDC, to be available only for Individual Learning Accounts:
      Provided, That such funds may be used for any individual full-time equivalent employee while such employee is employed either by CDC
      or ATSDR.SEC. [215]214.  Notwithstanding any other provisions of law, discretionary funds made available in this Act may be used to continue operating
      the Council on Graduate Medical Education established by section 301 of Public Law 102â408.SEC. [216]215.  Not to exceed $45,000,000 of funds appropriated by this Act to the institutes and centers of the National Institutes of Health
      may be used for alteration, repair, or improvement of facilities, as necessary for the proper and efficient conduct of the
      activities authorized herein, at not to exceed $3,500,000 per project.'
      			
      (transfer of funds)SEC. [217]216.  Of the amounts made available for NIH, 1 percent of the amount made available for National Research Service Awards ("NRSA'')
      shall be made available to the Administrator of the Health Resources and Services Administration to make NRSA awards for research
      in primary medical care to individuals affiliated with entities who have received grants or contracts under section 747 of
      the PHS Act, and 1 percent of the amount made available for NRSA shall be made available to the Director of the Agency for
      Healthcare Research and Quality to make NRSA awards for health service research.[SEC. 218.  None of the funds made available in this title may be used, in whole or in part, to advocate or promote gun control.][SEC. 219.  None of the funds appropriated or otherwise made available in this Act may be expended to advance the creation of a Federally
      Funded Research and Development Center at the Centers for Medicare and Medicaid Services, prior to a Federal Register notice
      being issued that outlines: how this proposal would meet the specific requirements identified in FAR 35.017â2; agency procedures
      that ensure small business competitiveness is maintained; and the outline of a transparent award and governance process to
      be employed.][SEC. 220. (a)  The Secretary shall establish a publicly accessible website to provide information regarding the uses of funds made available
      under section 4002 of Public Law 111â148.
      (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.]
      [SEC. 221. (a) Establishment of National Center for Advancing Translational Sciences; Elimination of National Center for Research Resources.â
      (1) In general.âSubpart 1 of part E of title IV of the Public Health Service Act (42 U.S.C. 287 et seq.) is amendedâ
         (A)  in the subpart heading, by striking "National Center for Research Resources'' and inserting "National Center for Advancing
            Translational Sciences'';
         
         (B)  by striking sections 480 and 481; and
         (C)  by amending section 479 to read as follows:]
      
      ["SEC. 479. NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES."(a)Purpose.âThe purpose of the National Center for Advancing Translational Sciences (in this subpart referred to as the 'Center') is
         to advance translational sciences, including byâ
         "(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.
         "(b)Clinical Trial Activities.â
         "(1)In general.â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.â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 asâ
         
         "(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)Annual Report.âThe Center shall publish an annual report that, with respect to all research supported by the Center, includes a complete
         list ofâ
         "(1) the molecules being studied;
         "(2) clinical trial activities being conducted;
         "(3) the methods and tools in development;
         "(4) ongoing partnerships, includingâ
         "(A) the rationale for each partnership;
         "(B) the status of each partnership;
         "(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.â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.â
         (1) Biomedical and behavioral research facilities.âSection 481A of the Public Health Service Act (42 U.S.C. 287a-2)â
            (A)  is redesignated as section 404I and is moved to follow section 404H of such Act (42 U.S.C. 283j); and
            (B)  is amendedâ
               (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,'';
               
               (vi)  in subsection (b)â]
            
         
      [(I) in paragraph (1)(A), by striking "within the Center''; and][(II) in paragraph (2)â][(aa) in subparagraph (A), by striking "and the advisory council established under section 480 (in this section referred to
      as the 'Advisory Council')'' and inserting "and the Council of Councils established under section 402(l) (in this section
      referred to as the 'Council')''; and][(bb) in subparagraphs (B), (C), and (D), by striking "Advisory'' each place it appears; and
      (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.âSection 481B of the Public Health Service Act (42 U.S.C. 287a-3)â
         (A)  is redesignated as section 404J and is moved to follow section 404I, as redesignated by paragraph (1); and
         (B)  in subsection (a), is amendedâ
            (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
            
            (ii)  by striking "481A'' and inserting "404I''.
         
      
      (3) Sanctuary system for surplus chimpanzees.âSection 481C of the Public Health Service Act (42 U.S.C. 287a-3a)â
         (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.âSection 305 of the Public Health Improvement Act (42 U.S.C. 287 note)â
         (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
         
         (B)  is amendedâ
            (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
            
            (iv)  in subsection (b), as so redesignatedâ]
         
      [(I) by striking "in subsection (a)'' and inserting "in subsection (a), the''; and][(II) by striking "of the Public Health Service Act (42 U.S.C. 289a)''.
      (5) Institutional development award program.âTitle IV of the Public Health Service Act (42 U.S.C. 281 et seq.) is amendedâ
         (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.â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
      
      (C)  in section 461(b), as so redesignatedâ
         (i)  by striking "(b)(1)(A) In the case of'' and inserting the following:]
      
      ["(b)Institutional Development Award Program.â
         "(1)(A) In the case of'';
      
      (ii)  by moving two ems to the rightâ][(I) subparagraphs (B) and (C) of paragraph (1);][(II) clauses (i), (ii), and (iii) of such subparagraph (C); and][(III) paragraph (2); 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''.
      
      (c) Assignment of Certain Offices and Functions to National Center for Advancing Translational Sciences.â
         (1) Cures acceleration network.âSection 402C of the Public Health Service Act (42 U.S.C. 282d)â
            (A)  is redesignated as section 480 and is moved to follow section 479;
            (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'';
            
            (C)  by striking "Director of NIH'' each place it appears and inserting "Director of the Center''; and
            (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.âTitle IV of the Public Health Service Act (42 U.S.C. 281 et seq.) is amendedâ
            (A)  in section 404Fâ
               (i)  by redesignating such section as section 481 and moving such section to follow section 480, as redesignated by paragraph
                  (1);
               
               (ii)  in subsection (a)â]
            
         
      [(I) by striking "within the Office of the Director of NIH'' and inserting "within the Center''; and][(II) by striking "Director of NIH'' and inserting "Director of the Center''; and
      (iii)  in subsection (b)(1)(C), by striking "404G'' and inserting "481A''; and
      (B)  in section 401(c)(2)(A), by striking "the Office of Rare Diseases,''.
      (3) Rare disease regional centers of excellence.â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.âSection 481D of the Public Health Service Act (42 U.S.C. 287a-4)â
         (A)  is redesignated as section 481B; and
         (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.âTitle IV of the Public Health Service Act (42 U.S.C. 281 et seq.) is amendedâ
         (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'';
         (3)  in section 464z-3(i)(1) (42 U.S.C. 285t(i)(1))â
            (A)  by striking "Director of National Institute for Research Resources'' and inserting "Director of NIH'';
            (B)  by striking "481(c)(3)'' and inserting "404I(c)(2)''; and
            (C)  by inserting "under such section'' after "Institutions of Emerging Excellence'';
         
         (4)  in section 499(c)(1)(E) (42 U.S.C. 290b(c)(1)(E)), by striking "section 402C'' and inserting "section 480''.]
      [SEC. 222.  The discretionary appropriation for CDC is hereby reduced by $20,000,000: Provided, That the reduction should be taken from contracting and administrative costs in each of the CDC accounts.]SEC. 217.  Such portion as the Secretary shall determine, but not more than 1 percent, of any discretionary funds which are appropriated
            in this Act for the current fiscal year for domestic HIV/AIDS activities in any program, project, or activity carried out
            by the Department of Health and Human Services shall be made available to the Office of the Assistant Secretary for Health
            to support the National HIV/AIDS Strategy: Provided, That such support may be provided directly, or by grants or contracts,
            on a reimbursable basis.  SEC. 218. 
      (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 Appropriations Act, 2012.)