Appendix - Department of Health and Human Services

For necessary expenses of the Food and Drug Administration, including hire and purchase of passenger motor vehicles; for payment of space rental and related costs pursuant to Public Law 92–313 for programs and activities of the Food and Drug Administration which are included in this Act; for rental of special purpose space in the District of Columbia or elsewhere; for miscellaneous and emergency expenses of enforcement activities, authorized and approved by the Secretary and to be accounted for solely on the Secretary's certificate, not to exceed $25,000; and notwithstanding section 521 of Public Law 107–188; [$3,083,408,000:]$3,957,738,000: Provided, That, of the amount provided under this heading, [$30,530,000]$760,000,000 shall be derived from [animal]prescription drug user fees authorized by [section 740 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 379j–12)]21 U.S.C. 379h, and shall be credited to this account and remain available until expended; [$7,595,000] $114,833,000 shall be derived from [animal generic drug] medical device user fees authorized by [section 741 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 379j-21)]21 U.S.C. 379j, and shall be credited to this account and shall remain available until expended; [$505,000,000] $534,000,000 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[; $12,925,000 shall be derived from food and feed recall fees authorized by section 743 of the Federal Food, Drug, and Cosmetic Act (Public Law 75–717), as amended by the Food Safety Modernization Act (Public Law 111–353), and shall be credited to this account and remain available until expended; $15,367,000 shall be derived from food reinspection fees authorized by section 743 of the Federal Food, Drug, and Cosmetic Act (Public Law 75–717), as amended by the Food Safety Modernization Act (Public Law 111–353), and shall be credited to this account and remain available until expended; and amounts derived from voluntary qualified importer program fees authorized by section 743 of the Federal Food, Drug, and Cosmetic Act (Public Law 75–717), as amended by the Food Safety Modernization Act (Public Law 111–353), and shall be credited to this account and remain available until expended]: Provided further, That, in addition to and notwithstanding any other provision under this heading, amounts collected for [animal] prescription drug user fees and [animal generic drug]medical device user fees that exceed the respective fiscal year [2013]2014 limitations are appropriated and shall be credited to this account and remain available until expended: Provided further, That fees derived from [animal drug and animal generic drug] prescription drug, medical device, human generic drug, and biosimilar biological product assessments for fiscal year [2013 received during fiscal year 2013]2014, including any such fees [assessed] collected prior to fiscal year [2013] 2014 but credited for fiscal year [2013]2014, shall be subject to the fiscal year [2013]2014 limitations: Provided further, That 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]during fiscal year [2013 shall not be included in amounts provided] 2014 of user fees specified under this heading and authorized for fiscal year 2015, and that amounts of such fiscal year 2015 fees for which the Secretary accepts payment during fiscal year 2014 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.

In addition, human generic drug user fees authorized by 21 U.S.C. 379j-42, biosimilar biological product fees authorized by 21 U.S.C. 379j-52, 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]and food and feed recall and reinspection fees authorized by 21 U.S.C. 379j-31 shall be credited to this account, to remain available until expended.

For plans, construction, repair, improvement, extension, alteration, and purchase of fixed equipment or facilities of or used by the Food and Drug Administration, where not otherwise provided, [$5,320,000]$8,788,000, to remain available until expended. Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.


Identification code 75–9911–0–1–554		2012 actual	2013 CR	2014 est.

0100	Balance, start of year
	Receipts:
0220	Cooperative Research and Development Agreements, FDA	2	2	2

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

0799	Balance, end of year


Identification code 75–9911–0–1–554		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Foods	866	864	883
0002	Drugs	828	481	466
0003	Devices and radiological products	323	325	321
0004	National Center for Toxicological Research	60	60	59
0005	Other activities	154	163	173
0006	Other rent and rent related activities	106	107	133
0007	Rental payments	160	161	162
0008	Buildings and facilities	9	9	9
0009	CRADAs	2	2	2
0010	Animal Drugs and Feed		138	141
0011	Biologics		213	211

0799	Total direct obligations	2,508	2,523	2,560
0801	Reimbursable program (User fees)	1,086	1,686	1,788
0802	Reimbursable program (Federal sources)		49	49

0899	Total reimbursable obligations	1,086	1,735	1,837

0900	Total new obligations	3,594	4,258	4,397

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	581	854	854
1001	Discretionary unobligated balance brought fwd, Oct 1	581	854
1021	Recoveries of prior year unpaid obligations	1

1050	Unobligated balance (total)	582	854	854
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	2,506	2,521	2,558

1160	Appropriation, discretionary (total)	2,506	2,521	2,558
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	2	2	2

1260	Appropriations, mandatory (total)	2	2	2
	Spending authority from offsetting collections, discretionary:
1700	Collected	1,275	1,416	1,837
1701	Change in uncollected payments, Federal sources	19
1702	Offsetting collections (previously unavailable)	388	324	333
1725	Spending authority from offsetting collections precluded from obligation (limitation on obligations)	–324	–324	–333

1750	Spending auth from offsetting collections, disc (total)	1,358	1,416	1,837
	Spending authority from offsetting collections, mandatory:
1800	Collected		319

1850	Spending auth from offsetting collections, mand (total)		319
1900	Budget authority (total)	3,866	4,258	4,397
1930	Total budgetary resources available	4,448	5,112	5,251
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	854	854	854

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1,459	1,663	1,641
3010	Obligations incurred, unexpired accounts	3,594	4,258	4,397
3011	Obligations incurred, expired accounts	5
3020	Outlays (gross)	–3,330	–4,280	–4,354
3040	Recoveries of prior year unpaid obligations, unexpired	–1
3041	Recoveries of prior year unpaid obligations, expired	–64

3050	Unpaid obligations, end of year	1,663	1,641	1,684
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–46	–44	–44
3070	Change in uncollected pymts, Fed sources, unexpired	–19
3071	Change in uncollected pymts, Fed sources, expired	21

3090	Uncollected pymts, Fed sources, end of year	–44	–44	–44
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1,413	1,619	1,597
3200	Obligated balance, end of year	1,619	1,597	1,640

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	3,864	3,937	4,395
	Outlays, gross:
4010	Outlays from new discretionary authority	2,420	2,888	3,331
4011	Outlays from discretionary balances	908	1,071	1,021

4020	Outlays, gross (total)	3,328	3,959	4,352
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–49	–49	–49
4033	Non-Federal sources	–1,252	–1,367	–1,788

4040	Offsets against gross budget authority and outlays (total)	–1,301	–1,416	–1,837
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–19
4052	Offsetting collections credited to expired accounts	26

4060	Additional offsets against budget authority only (total)	7

4070	Budget authority, net (discretionary)	2,570	2,521	2,558
4080	Outlays, net (discretionary)	2,027	2,543	2,515
	Mandatory:
4090	Budget authority, gross	2	321	2
	Outlays, gross:
4100	Outlays from new mandatory authority	2	321	2
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources		–319
4180	Budget authority, net (total)	2,572	2,523	2,560
4190	Outlays, net (total)	2,029	2,545	2,517

	Memorandum (non-add) entries:
5090	Unavailable balance, SOY: Offsetting collections	413	349	349
5091	Unavailable balance, EOY: Offsetting collections	349	349	349


	2012	2013	2014

Distribution of discretionary budget authority by account:
Salaries and expenses	2497	2512	2549
Buildings and facilities	9	9	9
Distribution of discretionary outlays by account:
Salaries and expenses	2018	2534	2506
Buildings and facilities	9	9	9

The Food and Drug Administration (FDA) is responsible for protecting the public health by ensuring the safety, effectiveness, and security of human and veterinary drugs, biological products and medical devices; ensuring the safety of foods, cosmetics, and radiation-emitting products; and regulating tobacco products. FDA also advances public health by helping to speed innovations that make medicines and devices safer and more effective. The agency strives to provide the public with accurate, science-based information necessary to use medical products and foods to maintain and improve their health. FDA also has responsibility for regulating the manufacturing, marketing and distribution of tobacco products to protect the public health and to reduce tobacco use by minors. Finally, FDA plays a significant role in the Nations counterterrorism efforts. FDA fulfills this responsibility by ensuring the security of the food supply and by fostering the development of medical products to respond to intentional and natural public health threats. The Budget includes funding for counterterrorism activities that specifically relate to the protection of products or therapies regulated by the FDA (such as drugs, vaccines, foods, and animal feed), and the availability of medical products for public health preparedness in the event of an attack. Specifically, the Budget requests funding for food protection, drug safety, medical device review and safety, developing medical countermeasures, and headquarters consolidation in White Oak, Maryland.


Identification code 75–9911–0–1–554		2012 actual	2013 CR	2014 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	757	719	787
11.3	Other than full-time permanent	101	97	106
11.5	Other personnel compensation	54	51	56
11.7	Military personnel	60	57	61
11.8	Special personal services payments	1	1	1

11.9	Total personnel compensation	973	925	1,011
12.1	Civilian personnel benefits	267	254	278
12.2	Military personnel benefits	32	30	32
21.0	Travel and transportation of persons	47	51	49
22.0	Transportation of things	4	5	5
23.1	Rental payments to GSA	161	161	162
23.2	Rental payments to others	3	3	3
23.3	Communications, utilities, and miscellaneous charges	37	40	38
24.0	Printing and reproduction	3	3	3
25.1	Advisory and assistance services	47	50	48
25.2	Other services from non-Federal sources	359	384	340
25.3	Other goods and services from Federal sources	226	242	233
25.4	Operation and maintenance of facilities	57	61	59
25.5	Research and development contracts	33	35	34
25.7	Operation and maintenance of equipment	48	52	50
26.0	Supplies and materials	42	46	44
31.0	Equipment	54	58	56
32.0	Land and structures	4	5	5
41.0	Grants, subsidies, and contributions	110	117	109
42.0	Insurance claims and indemnities	1	1	1

99.0	Direct obligations	2,508	2,523	2,560
99.0	Reimbursable obligations	1,086	1,735	1,837

99.9	Total new obligations	3,594	4,258	4,397


Identification code 75–9911–0–1–554		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment	8,974	10,025	10,316
1101	Direct military average strength employment	690	690	690
2001	Reimbursable civilian full-time equivalent employment	3,514	3,477	3,580
2101	Reimbursable military average strength employment	270	270	270
3001	Allocation account civilian full-time equivalent employment	53	72	74
3101	Allocation account military average strength employment	1	1	1

In addition, contingent upon the enactment of authorizing legislation, the Secretary shall assess a fee with respect to animal drugs and animal generic drugs: Provided, That fees of $23,600,000 with respect to animal drugs shall be credited to this account and remain available until expended; and $7,328,000 with respect to animal generic drugs shall be credited to this account and remain available until expended: Provided further, That in addition to and notwithstanding any other provision under this heading, amounts collected for such animal drug user fees and animal generic drug user fees that exceed the respective fiscal year 2014 limitations are appropriated and shall be credited to this account and remain available until expended: Provided further, That fees derived from such animal drugs and animal generic drugs assessments for fiscal year 2014, including any such fees collected prior to fiscal year 2014 but credited for fiscal 2014, shall be subject to the fiscal year 2014 limitations: Provided further, That the Secretary may, prior to the due date for such animal drug and animal generic drug user fees, accept payment during fiscal year 2014 of such fees authorized for fiscal year 2015, and that amounts of such fiscal year 2015 fees for which the Secretary accepts payment during fiscal year 2014 shall not be included in amounts provided under this heading.

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


Identification code 75–9911–2–1–554		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0801	ADUFA			23
0802	AGDUFA			7
0803	Med.Prod.Reinspect			15
0804	Intl.Courier			6
0805	Food Reg.and Inspect			59
0806	Food Import			166
0807	Cosmetics			19
0808	Food Contact			5

0900	Total new obligations			300

	Budgetary Resources:
	Budget authority:
	Spending authority from offsetting collections, discretionary:
1700	Collected			300

1750	Spending auth from offsetting collections, disc (total)			300
1900	Budget authority (total)			300
1930	Total budgetary resources available			300

	Change in obligated balance:
	Unpaid obligations:
3010	Obligations incurred, unexpired accounts			300
3020	Outlays (gross)			–300

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross			300
	Outlays, gross:
4010	Outlays from new discretionary authority			300
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4033	Non-Federal sources			–300

The 2014 Budget includes a number of new user fees. Legislation will be proposed to allow FDA to collect fees for food facility registration and inspection as well as for food import to implement the requirements of the FDA Food Safety Modernization Act (FSMA). The additional resources, estimated at $59 million for the food facility registration and inspection program, would enable FDA to target new and improved activities required by FSMA to modernize the food safety system and support improvements in food safety science and risk analysis to prevent food safety outbreaks. The fees collected for the food import program, estimated at $166 million, would support FDA's food safety efforts to modernize the import system. The Budget also reproposes user fees to support activities related to cosmetics and food contact notification activities and user fees to support inspection-related activities at domestic courier facilities and reinspections at medical product facilities.

The FDA transmitted proposed legislation to reauthorize the Animal Drug User Fee Act and the Animal Generic Drug User Fee Act to Congress on February 25, 2012. The proposed legislation authorizes the collection and spending of these fees subject to appropriations.


Identification code 75–9911–2–1–554		2012 actual	2013 CR	2014 est.

99.9	Total new obligations			300


Identification code 75–9911–2–1–554		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment
1101	Direct military average strength employment
2001	Reimbursable civilian full-time equivalent employment			612
2101	Reimbursable military average strength employment
3001	Allocation account civilian full-time equivalent employment
3101	Allocation account military average strength employment


Identification code 75–4309–0–3–554		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0801	Reimbursable program	7	8	8

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	2	3	3
	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	11	11
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	3	3	3

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	3	3	2
3010	Obligations incurred, unexpired accounts	7	8	8
3020	Outlays (gross)	–7	–9	–9

3050	Unpaid obligations, end of year	3	2	1
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	3	3	2
3200	Obligated balance, end of year	3	2	1

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	8	8	8
	Outlays, gross:
4100	Outlays from new mandatory authority	2	8	8
4101	Outlays from mandatory balances	5	1	1

4110	Outlays, gross (total)	7	9	9
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–8	–8	–8
4190	Outlays, net (total)	–1	1	1

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


Identification code 75–4309–0–3–554		2012 actual	2013 CR	2014 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

99.9	Total new obligations	7	8	8


Identification code 75–4309–0–3–554		2012 actual	2013 CR	2014 est.

2001	Reimbursable civilian full-time equivalent employment	36	37	37

Federal Funds

For carrying out titles II and III of the Public Health Service Act (referred to in this Act as the "PHS Act'') with respect to primary health care and the Native Hawaiian Health Care Act of 1988, [$1,579,975,000, of which $127,000 shall be available until expended for facilities renovations at the Gillis W. Long Hansen's Disease Center]$1,566,932,000: 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 $94,893,000 shall be available until expended for carrying out the provisions of Public Law 104–73 and for expenses incurred by the Department of Health and Human Services (referred to in this Act as "HHS'') pertaining to administrative claims made under such law. Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.

For carrying out titles III, VII, and VIII of the PHS Act with respect to the health workforce, section 1128E and 1921(b) of the Social Security Act, and the Health Care Quality Improvement Act of 1986, [$522,187,000]$540,804,000: Provided, That sections 747(c)(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 in addition to fees authorized by section 427(b) of the Health Care Quality Improvement Act of 1986, fees shall be collected for the full disclosure of information under such Act sufficient to recover the full costs of operating the National Practitioner Data Bank and shall remain available until expended to carry out that Act: Provided further, That fees collected for the full disclosure of information under the "Health Care Fraud and Abuse Data Collection Program'', authorized by section 1128E(d)(2) of the Social Security Act, shall be sufficient to recover the full costs of operating the program, and shall remain available until expended to carry out that Act: Provided further, That fees collected for the disclosure of information under the information reporting requirement program authorized by section 1921 of the Social Security Act shall be sufficient to recover the full costs of operating the program and shall remain available until expended to carry out that Act: Provided further, That funds transferred to this account to carry out section 846 and subpart 3 of part D of title III of the PHS Act may be used to make prior year adjustments to awards made under such sections: [Provided further, That, in addition to amounts appropriated under this heading, $35,000,000 shall be available under section 241 of the PHS Act to carry out titles VII and VIII of the PHS Act:] Provided further, That, of the amount appropriated under this heading, $88,000,000 shall be for payments to children's hospitals pursuant to section 340E of the PHS Act, all of which shall be for payments for direct graduate medical education as described in section 340E(c).

For carrying out titles III, XI, XII, and XIX of the PHS Act with respect to maternal and child health, title V of the Social Security Act, and section 712 of the American Jobs Creation Act of 2004, [$854,807,000]$824,861,000: Provided, That notwithstanding sections 502(a)(1) and 502(b)(1) of the Social Security Act, not more than $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 $10,276,000 shall be available for projects described in paragraphs (A) through (F) of section 501(a)(3) of such Act.

For carrying out title XXVI of the PHS Act with respect to the Ryan White HIV/AIDS program, [$2,446,772,000]$2,387,178,000, of which [$2,093,599,000] $2,036,898,000 shall remain available to the Secretary through September 30, [2014]2016, for parts A and B of title XXVI of the PHS Act: Provided, That of the funds available for parts A and B of title XXVI of the PHS Act, not less than [$1,000,000,000] $943,299,000 shall be for State AIDS Drug Assistance Programs pursuant to section 2616 or 311(c) of such Act: Provided further, That in addition to amounts provided herein, $25,000,000 shall be available from amounts available under section 241 of the PHS Act to carry out parts A, B, C, and D of title XXVI of the PHS Act to fund Special Projects of National Significance under section 2691.

For carrying out titles III and XII of the PHS Act with respect to health care systems, and the Stem Cell Therapeutic and Research Act of 2005, [$82,534,000]$83,836,000, of which $127,000 shall be available until expended for facilities renovations at the Gillis W. Long Hansen's Disease Center: 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,] the Secretary based on sales data that shall be submitted by drug manufacturers and shall be credited to this account, to remain available until expended.

For carrying out titles III and IV of the PHS Act with respect to rural health, section 427(a) of the Federal Coal Mine Health and Safety Act, the Cardiac Arrest Survival Act of 2000, and sections 711 and 1820 of the Social Security Act, $122,232,000, of which $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, $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, $10,036,000 shall be available for State Offices of Rural Health.

For carrying out the program under title X of the PHS Act to provide for voluntary family planning projects, [$296,838,000]$327,402,000: Provided, That amounts provided to said projects under such title shall not be expended for abortions, that all pregnancy counseling shall be nondirective, and that such amounts shall not be expended for any activity (including the publication or distribution of literature) that in any way tends to promote public support or opposition to any legislative proposal or candidate for public office.

For program support in the Health Resources and Services Administration, [$162,517,000]$161,794,000: 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. Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.


Identification code 75–0350–0–1–550		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0010	Health Centers	1,472	1,492	1,472
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	83	84	83
0017	Health Professions	376	383	363
0018	Maternal and Child Health Block Grant	639	649	639
0019	Healthy Start	104	105	104
0020	Poison Control Centers	19	19
0021	EMS for Children	21	21	21
0022	Universal Newborn Hearing Screening	19	19
0023	HIV/AIDS	2,367	2,337	2,387
0024	Organ Transplantation	24	25	26
0025	Bone Marrow Donor Registry	23	23	23
0026	Rural Health Policy Development	10	10	10
0027	Rural Health Outreach Grants	55	56	56
0028	Rural Health Flexibility Grants	41	41	26
0030	Telehealth	11	12	12
0031	Program Management	160	162	162
0032	Family Planning	294	299	327
0033	Loan Repayment/Faculty Fellowship	1	1	1
0035	Health Centers Tort Claim Fund	75	133	95
0036	Heritable Disorders	10	10
0038	Childrens' GME	265	270	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	47	48	47
0046	Cord Blood Stem Cell Bank	12	12	12
0048	Sickle Cell	5	5	5
0049	Drug Pricing Program	4	4	4
0050	Family to Family Health Information Centers ACA	5	5
0067	Prevention Fund	37		57
0073	Health Centers ACA	1,171	1,220	1,246
0074	Health Centers Construction ACA	741	10	7
0075	National Health Service Corps ACA	297	300	305
0076	School Based Health Centers ACA	19	83
0077	GME Payments THC ACA	17	50	73
0079	Rural Health AED	1	3
0080	Pediatric Loan Repayment			5

0300	Total direct programs	8,472	7,938	7,703

0799	Total direct obligations	8,472	7,938	7,703
0801	Reimbursable program	75	71	77
0802	Reimbursable program: PHS evaluation	22	25	25

0899	Total reimbursable obligations	97	96	102

0900	Total new obligations	8,569	8,034	7,805

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	1,061	381	531
1001	Discretionary unobligated balance brought fwd, Oct 1	58	83
1021	Recoveries of prior year unpaid obligations	8

1050	Unobligated balance (total)	1,069	381	531
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	6,206	6,232	6,015
1121	Appropriations transferred from other accts [75–9915]	9
1121	Appropriations transferred from other accts [75–0943]	1
1121	Appropriations transferred from other accts [75–1362]	1
1130	Appropriations permanently reduced	–12

1160	Appropriation, discretionary (total)	6,205	6,232	6,015
	Appropriations, mandatory:
1200	Appropriation	1,550	1,855	2,505
1221	Appropriations transferred from other accts [75–0116]	37		57

1260	Appropriations, mandatory (total)	1,587	1,855	2,562
	Spending authority from offsetting collections, discretionary:
1700	Collected	33	81	87
1701	Change in uncollected payments, Federal sources	45

1750	Spending auth from offsetting collections, disc (total)	78	81	87
	Spending authority from offsetting collections, mandatory:
1800	Offsetting collections (cash)(HPSL&NSL)	14	16	16

1850	Spending auth from offsetting collections, mand (total)	14	16	16
1900	Budget authority (total)	7,884	8,184	8,680
1930	Total budgetary resources available	8,953	8,565	9,211
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–3
1941	Unexpired unobligated balance, end of year	381	531	1,406

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	6,836	6,681	6,186
3010	Obligations incurred, unexpired accounts	8,569	8,034	7,805
3011	Obligations incurred, expired accounts	15
3020	Outlays (gross)	–8,638	–8,529	–8,272
3040	Recoveries of prior year unpaid obligations, unexpired	–8
3041	Recoveries of prior year unpaid obligations, expired	–93

3050	Unpaid obligations, end of year	6,681	6,186	5,719
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–42	–80	–80
3070	Change in uncollected pymts, Fed sources, unexpired	–45
3071	Change in uncollected pymts, Fed sources, expired	7

3090	Uncollected pymts, Fed sources, end of year	–80	–80	–80
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	6,794	6,601	6,106
3200	Obligated balance, end of year	6,601	6,106	5,639

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	6,283	6,313	6,102
	Outlays, gross:
4010	Outlays from new discretionary authority	2,515	2,549	2,460
4011	Outlays from discretionary balances	4,277	3,764	3,721

4020	Outlays, gross (total)	6,792	6,313	6,181
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–16	–52	–53
4033	Non-Federal sources	–29	–29	–28
4033	Non-Federal sources			–6

4040	Offsets against gross budget authority and outlays (total)	–45	–81	–87
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–45
4052	Offsetting collections credited to expired accounts	12

4060	Additional offsets against budget authority only (total)	–33

4070	Budget authority, net (discretionary)	6,205	6,232	6,015
4080	Outlays, net (discretionary)	6,747	6,232	6,094
	Mandatory:
4090	Budget authority, gross	1,601	1,871	2,578
	Outlays, gross:
4100	Outlays from new mandatory authority	801	850	855
4101	Outlays from mandatory balances	1,045	1,366	1,236

4110	Outlays, gross (total)	1,846	2,216	2,091
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–14	–16	–16
4180	Budget authority, net (total)	7,792	8,087	8,577
4190	Outlays, net (total)	8,579	8,432	8,169

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


Identification code 75–0350–0–1–550		2012 actual	2013 CR	2014 est.

	Guaranteed loan levels supportable by subsidy budget authority:
215001	Health centers: Facilities renovation loan guarantee levels	10	8	4
215002	Health centers: Managed care network development loan guarantee		1	1
215003	Health centers: Managed care plan loan guarantee levels		3	1

215999	Total loan guarantee levels	10	12	6
	Guaranteed loan subsidy (in percent):
232001	Health centers: Facilities renovation loan guarantee levels	2.67	2.69	2.81
232002	Health centers: Managed care network development loan guarantee	9.62	9.73	10.10
232003	Health centers: Managed care plan loan guarantee levels	5.76	5.79	5.86

232999	Weighted average subsidy rate	2.67	4.05	4.53

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 2014 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 2011–2012 data reported in the Annual Operating Report.


Program	Account Balance

HPSL	$378,701,815
NSL	$171,324,184
PCL	$246,664,915

LDS	$130,836,447


Total	$927,527,361


Identification code 75–0350–0–1–550		2012 actual	2013 CR	2014 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	150	150	151
11.3	Other than full-time permanent	6	6	6
11.5	Other personnel compensation	3	3	4
11.7	Military personnel	20	20	20
11.8	Special personal services payments	1	1

11.9	Total personnel compensation	180	180	181
12.1	Civilian personnel benefits	45	45	44
12.2	Military personnel benefits	11	11	11
21.0	Travel and transportation of persons	3	3	4
23.1	Rental payments to GSA	23	23	23
23.2	Rental payments to others	1	1	1
23.3	Communications, utilities, and miscellaneous charges	2	2	1
24.0	Printing and reproduction			1
25.1	Advisory and assistance services	13	13	38
25.2	Other services from non-Federal sources	181	176	156
25.3	Other goods and services from Federal sources	202	201	197
25.4	Operation and maintenance of facilities	1	1	1
25.6	Medical care	3	3	3
25.7	Operation and maintenance of equipment	13	13	14
26.0	Supplies and materials	2	2	1
31.0	Equipment	6	6	4
41.0	Grants, subsidies, and contributions	7,718	7,131	6,934
42.0	Insurance claims and indemnities	68	127	89

99.0	Direct obligations	8,472	7,938	7,703
99.0	Reimbursable obligations	97	96	102

99.9	Total new obligations	8,569	8,034	7,805


Identification code 75–0350–0–1–550		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment	1,564	1,556	1,547
1101	Direct military average strength employment	200	200	200
2001	Reimbursable civilian full-time equivalent employment	79	85	85
2101	Reimbursable military average strength employment	8	8	8


Identification code 75–0320–0–1–551		2012 actual	2013 CR	2014 est.

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	12	16	16
	Budget authority:
	Spending authority from offsetting collections, mandatory:
1800	Collected	4

1850	Spending auth from offsetting collections, mand (total)	4
1900	Budget authority (total)	4
1930	Total budgetary resources available	16	16	16
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	16	16	16

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	4
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–4
4190	Outlays, net (total)	–4

The Vaccine Injury Compensation Program was established pursuant to Public Law 99–660 and Public Law 100–203, and serves as a source of funds to pay claims for compensation for vaccine related injury or death. Payment of claims associated with vaccine related injury or death occurring before October 1, 1988 are financed from the General Fund and are reflected in this account. Given sufficient carry-over funds from prior years' appropriations to pay for the balance of the pre-1988 claims yet to be adjudicated, no appropriation is requested to cover payment of pre-1988 claims. By statute, no new claims are accepted for this account. Payment of claims associated with vaccine related injury or death occurring after October 1, 1988 are reflected in the Vaccine Injury Compensation Program trust fund account.


Identification code 75–0343–0–1–551		2012 actual	2013 CR	2014 est.

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

0900	Total new obligations	2	5	4

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

1050	Unobligated balance (total)	5	6	4
1930	Total budgetary resources available	5	6	4
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	3	1

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	2	1	6
3010	Obligations incurred, unexpired accounts	2	5	4
3020	Outlays (gross)	–3

3050	Unpaid obligations, end of year	1	6	10
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	2	1	6
3200	Obligated balance, end of year	1	6	10

	Budget authority and outlays, net:
	Discretionary:
	Outlays, gross:
4011	Outlays from discretionary balances	3
4190	Outlays, net (total)	3

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


Identification code 75–0343–0–1–551		2012 actual	2013 CR	2014 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	2	3	3
42.0	Insurance claims and indemnities		2	1

99.9	Total new obligations	2	5	4


Identification code 75–0343–0–1–551		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment	4	4	4
1101	Direct military average strength employment	3	3	3


Identification code 75–0321–0–1–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0010	Maternal, Infant, and Early Childhood Home Visiting Programs	344	400	406

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		13	13
1012	Unobligated balance transfers between expired and unexpired accounts	7

1050	Unobligated balance (total)	7	13	13
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	350	400	400

1260	Appropriations, mandatory (total)	350	400	400
1930	Total budgetary resources available	357	413	413
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	13	13	7

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	313	528	527
3010	Obligations incurred, unexpired accounts	344	400	406
3020	Outlays (gross)	–122	–401	–318
3041	Recoveries of prior year unpaid obligations, expired	–7

3050	Unpaid obligations, end of year	528	527	615
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	313	528	527
3200	Obligated balance, end of year	528	527	615

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	350	400	400
	Outlays, gross:
4100	Outlays from new mandatory authority	19	120	120
4101	Outlays from mandatory balances	103	281	198

4110	Outlays, gross (total)	122	401	318
4180	Budget authority, net (total)	350	400	400
4190	Outlays, net (total)	122	401	318

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


Identification code 75–0321–0–1–551		2012 actual	2013 CR	2014 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	3	2	2
12.1	Civilian personnel benefits	1	1	1
25.1	Advisory and assistance services	18	15	15
41.0	Grants, subsidies, and contributions	322	382	388

99.9	Total new obligations	344	400	406


Identification code 75–0321–0–1–551		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment	19	21	21
1101	Direct military average strength employment	4	4	4


Identification code 75–4442–0–3–551		2012 actual	2013 CR	2014 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	3	3	2
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:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1			1
3010	Obligations incurred, unexpired accounts		1	1

3050	Unpaid obligations, end of year		1	2
	Memorandum (non-add) entries:
3100	Obligated balance, start of year			1
3200	Obligated balance, end of year		1	2


Identification code 75–4442–0–3–551		2012 actual	2013 CR	2014 est.

	Position with respect to appropriations act limitation on commitments:
2121	Limitation available from carry-forward	28	18	6
2143	Uncommitted limitation carried forward	–18	–6

2150	Total guaranteed loan commitments	10	12	6
2199	Guaranteed amount of guaranteed loan commitments	8	10	5

	Cumulative balance of guaranteed loans outstanding:
2210	Outstanding, start of year	80	77	77
2231	Disbursements of new guaranteed loans	8	11	5
2251	Repayments and prepayments	–10	–10	–10
2263	Adjustments: Terminations for default that result in claim payments	–1	–1	–1

2290	Outstanding, end of year	77	77	71

	Memorandum:
2299	Guaranteed amount of guaranteed loans outstanding, end of year	70	65	60

P.L. 104–299 and P.L. 104–208 authorize Health Resources and Services Administration (HRSA) to guarantee up to $160 million in private loans to health centers for the costs of developing and operating managed care networks or plans and for the construction, renovation and modernization of medical facilities. As required by the Federal Credit Reform Act of 1990, this financing account records all cash flows to and from the Government resulting from the Health Center Loan Guarantee program. The program account for this activity is displayed in the Health Resources and Services account (75–0350) as a line in the program and financing schedule.


Identification code 75–4442–0–3–551		2011 actual	2012 actual

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

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

4999	Total liabilities and net position	3	3

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

In addition, for administrative expenses to carry out the guaranteed loan program, including section 709 of the PHS Act, [$2,807,000]$2,807,000. Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.


Identification code 75–0340–0–1–552		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
	Credit program obligations:
0707	Reestimates of loan guarantee subsidy		25
0708	Interest on reestimates of loan guarantee subsidy		31
0709	Administrative expenses	3	3

0900	Total new obligations	3	59

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

1160	Appropriation, discretionary (total)	3	3
	Appropriations, mandatory:
1200	Appropriation		56

1260	Appropriations, mandatory (total)		56
1900	Budget authority (total)	3	59
1930	Total budgetary resources available	3	59

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	2	1	1
3010	Obligations incurred, unexpired accounts	3	59
3020	Outlays (gross)	–3	–59
3041	Recoveries of prior year unpaid obligations, expired	–1

3050	Unpaid obligations, end of year	1	1	1
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	2	1	1
3200	Obligated balance, end of year	1	1	1

	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		56
	Outlays, gross:
4100	Outlays from new mandatory authority		56
4180	Budget authority, net (total)	3	59
4190	Outlays, net (total)	3	59

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


Identification code 75–0340–0–1–552		2012 actual	2013 CR	2014 est.

	Guaranteed loan upward reestimates:
235001	HEAL Loan guarantee		56

235999	Total upward reestimate budget authority		56
	Guaranteed loan downward reestimates:
237001	HEAL Loan guarantee	–12

237999	Total downward reestimate subsidy budget authority	–12

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

In 2014 the Department of Education will assume responsibility for the program. Legislative language that would effect this transfer is included under General Provisions. The authority to administer, service, collect, and enforce the program as well as the functions, assets, and liabilities of the Secretary of Health and Human Services will be permanently transferred to the Secretary of Education.


Identification code 75–0340–0–1–552		2012 actual	2013 CR	2014 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	2	2
25.3	Other goods and services from Federal sources	1	1
41.0	Grants, subsidies, and contributions		56

99.9	Total new obligations	3	59


Identification code 75–0340–0–1–552		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment	13	13


Identification code 75–4304–0–3–552		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
	Credit program obligations:
0711	Default claim payments on principal	19	13
0742	Downward reestimate paid to receipt account	5
0743	Interest on downward reestimates	7

0900	Total new obligations	31	13

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	69	49	99
1010	Unobligated balance transfer to other accts [91–4300]			–99

1050	Unobligated balance (total)	69	49
	Financing authority:
	Spending authority from offsetting collections, mandatory:
1800	Collected	11	63

1850	Spending auth from offsetting collections, mand (total)	11	63
1930	Total budgetary resources available	80	112
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	49	99

	Change in obligated balance:
	Unpaid obligations:
3010	Obligations incurred, unexpired accounts	31	13
3020	Financing disbursements (gross)	–31	–13

	Financing authority and disbursements, net:
	Mandatory:
4090	Financing authority, gross	11	63
	Financing disbursements:
4110	Financing disbursements, gross	31	13
	Offsets against gross financing authority and disbursements:
	Offsetting collections (collected) from:
4120	Federal sources-upward estimate and interest		–56
4122	Interest on uninvested funds	–4	–3
4123	Recoveries of defaulted loans	–7	–4

4130	Offsets against gross financing auth and disbursements (total)	–11	–63
4170	Financing disbursements, net (mandatory)	20	–50
4190	Financing disbursements, net (total)	20	–50


Identification code 75–4304–0–3–552		2012 actual	2013 CR	2014 est.

	Cumulative balance of guaranteed loans outstanding:
2210	Outstanding, start of year	526	430	402
2251	Repayments and prepayments	–77	–15
	Adjustments:
2261	Terminations for default that result in loans receivable	–18	–9
2263	Terminations for default that result in claim payments	–1	–4
2264	Other adjustments, net			–402

2290	Outstanding, end of year	430	402

	Memorandum:
2299	Guaranteed amount of guaranteed loans outstanding, end of year	430

	Addendum:
	Cumulative balance of defaulted guaranteed loans that result in loans receivable:
2310	Outstanding, start of year	175	184	190
2331	Disbursements for guaranteed loan claims	16	10
2361	Write-offs of loans receivable	–7	–4
2364	Other adjustments, net			–190

2390	Outstanding, end of year	184	190


Identification code 75–4304–0–3–552		2011 actual	2012 actual

	ASSETS:
1101	Federal assets: Fund balances with Treasury	70	50
	Net value of assets related to post-1991 acquired defaulted guaranteed loans receivable:
1501	Defaulted guaranteed loans receivable, gross	175	184
1505	Allowance for subsidy cost (-)	–126	–126

1599	Net present value of assets related to defaulted guaranteed loans	49	58

1999	Total assets	119	108
	LIABILITIES:
2204	Non-Federal liabilities: Liabilities for loan guarantees	119	108

4999	Total liabilities and net position	119	108


Identification code 75–4305–0–3–552		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
	Credit program obligations:
0711	Default claim payments on principal	4	3

0900	Total new obligations (object class 33.0)	4	3

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

1260	Appropriations, mandatory (total)	1	1
	Spending authority from offsetting collections, mandatory:
1800	Collected	8	7
1820	Capital transfer of spending authority from offsetting collections to general fund	–5	–5

1850	Spending auth from offsetting collections, mand (total)	3	2
1900	Budget authority (total)	4	3
1930	Total budgetary resources available	4	3

	Change in obligated balance:
	Unpaid obligations:
3010	Obligations incurred, unexpired accounts	4	3
3020	Outlays (gross)	–4	–3

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	4	3
	Outlays, gross:
4100	Outlays from new mandatory authority	4	3
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–8	–7
4180	Budget authority, net (total)	–4	–4
4190	Outlays, net (total)	–4	–4


Identification code 75–4305–0–3–552		2012 actual	2013 CR	2014 est.

	Cumulative balance of guaranteed loans outstanding:
2210	Outstanding, start of year	83	64	53
2251	Repayments and prepayments	–15	–8
	Adjustments:
2261	Terminations for default that result in loans receivable	–4	–3
2264	Other adjustments, net			–53

2290	Outstanding, end of year	64	53

	Memorandum:
2299	Guaranteed amount of guaranteed loans outstanding, end of year	64	53

	Addendum:
	Cumulative balance of defaulted guaranteed loans that result in loans receivable:
2310	Outstanding, start of year	362	346	324
2331	Disbursements for guaranteed loan claims	3	3
2351	Repayments of loans receivable	–8	–7
2361	Write-offs of loans receivable	–21	–18
2364	Other adjustments, net	10		–324

2390	Outstanding, end of year	346	324


Identification code 75–4305–0–3–552		2011 actual	2012 actual

	ASSETS:
1101	Federal assets: Fund balances with Treasury	1	1
1701	Defaulted guaranteed loans, gross	362	346
1703	Allowance for estimated uncollectible loans and interest (-)	–238	–238

1799	Value of assets related to loan guarantees	124	108

1999	Total assets	125	109
	LIABILITIES:
2104	Federal liabilities: Resources payable to Treasury	119	109
2204	Non-Federal liabilities: Liabilities for loan guarantees	6

2999	Total liabilities	125	109

4999	Total liabilities and net position	125	109


Identification code 75–9931–0–3–551		2012 actual	2013 CR	2014 est.

	Budgetary Resources:
	Unobligated balance:
1021	Recoveries of prior year unpaid obligations	1
1022	Capital transfer of unobligated balances to general fund	–1

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1
3040	Recoveries of prior year unpaid obligations, unexpired	–1
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1


Identification code 75–9931–0–3–551		2012 actual	2013 CR	2014 est.

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

1290	Outstanding, end of year	7	7	7

Titles VI and XVI of the Public Health Service Act established a loan and loan guarantee fund for medical facilities with a maximum amount allowable for the Government's liability. Direct loans were made available for public facilities and guaranteed loans for private, nonprofit facilities. Funds under this authority were established in the amount of $50 million for use in fulfilling guarantees in event of default, $30 million as a revolving fund for direct loans and an amount for interest subsidy payments on guaranteed loans.


Identification code 75–9931–0–3–551		2011 actual	2012 actual

	ASSETS:
1601	Direct loans, gross	7	7

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

4999	Total liabilities and net position	7	7

Trust Funds

For payments from the Vaccine Injury Compensation Program Trust Fund ("Trust Fund''), such sums as may be necessary for claims associated with vaccine-related injury or death with respect to vaccines administered after September 30, 1988, pursuant to subtitle 2 of title XXI of the PHS Act, to remain available until expended: Provided, That for necessary administrative expenses, not to exceed [$6,477,000] $6,477,000 shall be available from the Trust Fund to the Secretary. Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.


Identification code 75–8175–0–7–551		2012 actual	2013 CR	2014 est.

0100	Balance, start of year	3,115	3,214	3,289
	Receipts:
0200	Deposits, Vaccine Injury Compensation Trust Fund	254	262	271
0240	Interest and Profits on Investments, Vaccine Injury Compensation Trust Fund	49	74	121

0299	Total receipts and collections	303	336	392

0400	Total: Balances and collections	3,418	3,550	3,681
	Appropriations:
0500	Vaccine Injury Compensation Program Trust Fund	–19	–19	–19
0501	Vaccine Injury Compensation Program Trust Fund	–185	–242	–242

0599	Total appropriations	–204	–261	–261

0799	Balance, end of year	3,214	3,289	3,420


Identification code 75–8175–0–7–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Compensation: Claims for post - FY 1989 injuries	185	242	242
0103	Claims processing (Claims Court)	5	5	5
0104	Claims processing (HRSA)	6	6	6
0105	Claims processing (Dept. of Justice)	8	8	8

0191	Total, administrative expenses	19	19	19

0799	Total direct obligations	204	261	261
0801	Reimbursable program activity (claims)	1

0900	Total new obligations	205	261	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)	185	242	242

1260	Appropriations, mandatory (total)	185	242	242
	Spending authority from offsetting collections, mandatory:
1800	Collected	1

1850	Spending auth from offsetting collections, mand (total)	1
1900	Budget authority (total)	205	261	261
1930	Total budgetary resources available	205	261	261

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	19	19
3001	Adjustments to unpaid obligations, brought forward, Oct 1	2
3010	Obligations incurred, unexpired accounts	205	261	261
3020	Outlays (gross)	–207	–280	–261

3050	Unpaid obligations, end of year	19
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	21	19
3200	Obligated balance, end of year	19

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

4020	Outlays, gross (total)	20	38	19
	Mandatory:
4090	Budget authority, gross	186	242	242
	Outlays, gross:
4100	Outlays from new mandatory authority	2	242	242
4101	Outlays from mandatory balances	185

4110	Outlays, gross (total)	187	242	242
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–1
4180	Budget authority, net (total)	204	261	261
4190	Outlays, net (total)	206	280	261

	Memorandum (non-add) entries:
5000	Total investments, SOY: Federal securities: Par value	3,108	3,194	3,287
5001	Total investments, EOY: Federal securities: Par value	3,194	3,287	3,433

The Vaccine Injury Compensation Program was established pursuant to P.L. 99–660 and P.L. 100–203 and serves as a source of funds to pay claims for compensation for vaccine-related injury or death. This account reflects payments for claims for vaccine-related injury or death occurring after October 1, 1988.


Identification code 75–8175–0–7–551		2012 actual	2013 CR	2014 est.

	Direct obligations:
25.3	Other goods and services from Federal sources	19	19	19
42.0	Insurance claims and indemnities	185	242	242

99.0	Direct obligations	204	261	261
99.0	Reimbursable obligations	1

99.9	Total new obligations	205	261	261

Federal Funds

For expenses necessary to carry out the Act of August 5, 1954 (68 Stat. 674), the Indian Self-Determination Act, the Indian Health Care Improvement Act, and titles II and III of the Public Health Service Act with respect to the Indian Health Service, [$3,978,974,000]$3,505,293,000, 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, [$897,562,000]$878,575,000 for [contract medical care] Purchased/Referred 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 $476,446,000 shall be for payments to tribes and tribal organizations for contract or grant support costs associated with contracts, grants, self-governance compacts, or annual funding agreements between the Indian Health Service and a tribe or tribal organization pursuant to the Indian Self-Determination Act of 1975, as amended, prior to or during fiscal year 2012, of which not to exceed $10,000,000 may be used for contract support costs associated with new or expanded self-determination contracts, grants, self-governance compacts, or annual funding agreements:]Provided further, That the Bureau of Indian Affairs may collect from the Indian Health Service, tribes and tribal organizations operating health facilities pursuant to Public Law 93–638, such individually identifiable health information relating to disabled children as may be necessary for the purpose of carrying out its functions under the Individuals with Disabilities Education Act (20 U.S.C. 1400, et seq.): Provided further, That the Indian Health Care Improvement Fund may be used, as needed, to carry out activities typically funded under the Indian Health Facilities account. Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.


Identification code 75–0390–0–1–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Clinical services	3,153	3,177	3,189
0002	Preventive health	147	148	152
0003	Urban health	43	43	43
0004	Indian health professions	41	41	41
0005	Tribal management	3	3	3
0006	Direct operations	72	72	72
0007	Self-governance	6	6	6
0008	Contract support costs	471	476
0009	Diabetes funds	187	187	150

0799	Total direct obligations	4,123	4,153	3,656
0801	Reimbursable program	1,100	1,102	1,100

0900	Total new obligations	5,223	5,255	4,756

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	745	560	510
1001	Discretionary unobligated balance brought fwd, Oct 1	700	514
1021	Recoveries of prior year unpaid obligations	118

1050	Unobligated balance (total)	863	560	510
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	3,872	3,890	3,505
1120	Appropriations transferred to other accts [75–0390]	–69
1121	Appropriations transferred from other accts [75–0390]	69
1130	Appropriations permanently reduced	–6

1160	Appropriation, discretionary (total)	3,866	3,890	3,505
	Appropriations, mandatory:
1200	Appropriation	150	150	150

1260	Appropriations, mandatory (total)	150	150	150
	Spending authority from offsetting collections, discretionary:
1700	Collected	1,147	1,165	1,165
1701	Change in uncollected payments, Federal sources	–242

1750	Spending auth from offsetting collections, disc (total)	905	1,165	1,165
1900	Budget authority (total)	4,921	5,205	4,820
1930	Total budgetary resources available	5,784	5,765	5,330
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–1
1941	Unexpired unobligated balance, end of year	560	510	574

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	866	844	768
3010	Obligations incurred, unexpired accounts	5,223	5,255	4,756
3011	Obligations incurred, expired accounts	30
3020	Outlays (gross)	–5,138	–5,331	–5,010
3040	Recoveries of prior year unpaid obligations, unexpired	–118
3041	Recoveries of prior year unpaid obligations, expired	–19

3050	Unpaid obligations, end of year	844	768	514
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–332	–82	–82
3070	Change in uncollected pymts, Fed sources, unexpired	242
3071	Change in uncollected pymts, Fed sources, expired	8

3090	Uncollected pymts, Fed sources, end of year	–82	–82	–82
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	534	762	686
3200	Obligated balance, end of year	762	686	432

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	4,771	5,055	4,670
	Outlays, gross:
4010	Outlays from new discretionary authority	4,307	4,355	4,039
4011	Outlays from discretionary balances	721	820	815

4020	Outlays, gross (total)	5,028	5,175	4,854
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–324	–368	–368
4033	Non-Federal sources	–823	–797	–797

4040	Offsets against gross budget authority and outlays (total)	–1,147	–1,165	–1,165
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	242

4070	Budget authority, net (discretionary)	3,866	3,890	3,505
4080	Outlays, net (discretionary)	3,881	4,010	3,689
	Mandatory:
4090	Budget authority, gross	150	150	150
	Outlays, gross:
4100	Outlays from new mandatory authority	49	144	144
4101	Outlays from mandatory balances	61	12	12

4110	Outlays, gross (total)	110	156	156
4180	Budget authority, net (total)	4,016	4,040	3,655
4190	Outlays, net (total)	3,991	4,166	3,845

The Indian Health Services account provides medical care, public health services, and health professions training opportunities to American Indians and Alaska Natives. An estimated $2.403 billion primarily through self determination contracts and compacts, will be administered by tribal governments in 2014.


Identification code 75–0390–0–1–551		2012 actual	2013 CR	2014 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	413	413	409
11.3	Other than full-time permanent	21	21	20
11.5	Other personnel compensation	58	58	58
11.7	Military personnel	76	76	75

11.9	Total personnel compensation	568	568	562
12.1	Civilian personnel benefits	148	148	147
12.2	Military personnel benefits	35	35	34
13.0	Benefits for former personnel	9	9	9
21.0	Travel and transportation of persons	8	8	8
21.0	Patient travel	35	35	37
22.0	Transportation of things	7	7	7
23.1	Rental payments to GSA	9	9	9
23.2	Rental payments to others	1	1	1
23.3	Communications, utilities, and miscellaneous charges	12	12	12
25.1	Advisory and assistance services	9	9	4
25.2	Other services from non-Federal sources	123	125	121
25.3	Other goods and services from Federal sources	48	48	48
25.4	Operation and maintenance of facilities	8	8	8
25.6	Medical care	328	333	343
25.7	Operation and maintenance of equipment	18	18	19
25.8	Subsistence and support of persons	3	3	4
26.0	Supplies and materials	109	111	114
31.0	Equipment	12	12	12
41.0	Grants, subsidies, and contributions	2,633	2,654	2,157

99.0	Direct obligations	4,123	4,153	3,656
99.0	Reimbursable obligations	1,100	1,102	1,100

99.9	Total new obligations	5,223	5,255	4,756


Identification code 75–0390–0–1–551		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment	7,013	7,128	7,128
1101	Direct military average strength employment	1,085	1,103	1,103
2001	Reimbursable civilian full-time equivalent employment	5,272	5,291	5,291
2101	Reimbursable military average strength employment	816	819	819

For payments of contract support costs associated with ongoing Indian Self-Determination Act agreements with the Indian Health Service for fiscal or calendar year 2014, not to exceed $477,205,000: Provided, That, notwithstanding any other provision of law, the amount available for contract support costs associated with each ongoing Indian Self-Determination Act agreement with the Indian Health Service for fiscal or calendar year 2014 shall not exceed the amount identified in the Indian Health Service Contract Support Costs table submitted by the Secretary of Health and Human Services to the House and Senate Committees on Appropriations.

In addition, not to exceed $500,000 shall be available for payments for contract support costs associated with new or expanded Indian Self-Determination Act agreements with the Indian Health Service for fiscal or calendar year 2014.


Identification code 75–3920–0–1–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Contract Support Costs			477

0900	Total new obligations (object class 41.0)			477

	Budgetary Resources:
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation			477

1160	Appropriation, discretionary (total)			477
1930	Total budgetary resources available			477

	Change in obligated balance:
	Unpaid obligations:
3010	Obligations incurred, unexpired accounts			477
3020	Outlays (gross)			–391

3050	Unpaid obligations, end of year			86
	Memorandum (non-add) entries:
3200	Obligated balance, end of year			86

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross			477
	Outlays, gross:
4010	Outlays from new discretionary authority			391
4180	Budget authority, net (total)			477
4190	Outlays, net (total)			391

The Indian Health Service Contract Support Costs (CSC) account supports federal government payments to tribes for certain administrative costs associated with executing tribal self-governance contracts and compacts under the Indian Self Determination and Education Assistance Act (ISDEAA), P.L. 93–638, that are not otherwise funded under the contract or compact. The Bureau of Indian Affairs is also required to pay CSC under ISDEAA. Payments are available for direct and indirect contract support costs. Indirect contract support costs are those incurred for a Tribe's or tribal organization's common services, including, but not limited to, insurance and audits. Direct contract costs include program-specific costs such as unemployment taxes and workers compensation insurance. The account also supports the costs associated with executing or administering new and/or expanded self-determination contracts.

For construction, repair, maintenance, improvement, and equipment of health and related auxiliary facilities, including quarters for personnel; preparation of plans, specifications, and drawings; acquisition of sites, purchase and erection of modular buildings, and purchases of trailers; and for provision of domestic and community sanitation facilities for Indians, as authorized by section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a), the Indian Self-Determination Act, and the Indian Health Care Improvement Act, and for expenses necessary to carry out such Acts and titles II and III of the Public Health Service Act with respect to environmental health and facilities support activities of the Indian Health Service, [$443,502,000]$448,139,000 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. Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.


Identification code 75–0391–0–1–551		2012 actual	2013 CR	2014 est.

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

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

0799	Balance, end of year


Identification code 75–0391–0–1–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Sanitation and health facilities	175	176	164
0002	Maintenance	63	63	54
0003	Facilities and environmental health	203	205	207
0004	Equipment	26	26	23

0100	Total direct program	467	470	448

0799	Total direct obligations	467	470	448
0801	Reimbursable program	39	39	39

0900	Total new obligations	506	509	487

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	216	167	115
1001	Discretionary unobligated balance brought fwd, Oct 1	216	167
1021	Recoveries of prior year unpaid obligations	7

1050	Unobligated balance (total)	223	167	115
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	441	443	448
1130	Appropriations permanently reduced	–1

1160	Appropriation, discretionary (total)	440	443	448
	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	18	6	6
1701	Change in uncollected payments, Federal sources	–16

1750	Spending auth from offsetting collections, disc (total)	2	6	6
1900	Budget authority (total)	450	457	462
1930	Total budgetary resources available	673	624	577
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	167	115	90

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	578	526	540
3010	Obligations incurred, unexpired accounts	506	509	487
3011	Obligations incurred, expired accounts	1
3020	Outlays (gross)	–551	–495	–491
3040	Recoveries of prior year unpaid obligations, unexpired	–7
3041	Recoveries of prior year unpaid obligations, expired	–1

3050	Unpaid obligations, end of year	526	540	536
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–21	–6	–6
3070	Change in uncollected pymts, Fed sources, unexpired	16
3071	Change in uncollected pymts, Fed sources, expired	–1

3090	Uncollected pymts, Fed sources, end of year	–6	–6	–6
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	557	520	534
3200	Obligated balance, end of year	520	534	530

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	442	449	454
	Outlays, gross:
4010	Outlays from new discretionary authority	283	139	141
4011	Outlays from discretionary balances	263	348	342

4020	Outlays, gross (total)	546	487	483
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–18	–6	–6
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	16

4070	Budget authority, net (discretionary)	440	443	448
4080	Outlays, net (discretionary)	528	481	477
	Mandatory:
4090	Budget authority, gross	8	8	8
	Outlays, gross:
4100	Outlays from new mandatory authority	2	8	8
4101	Outlays from mandatory balances	3

4110	Outlays, gross (total)	5	8	8
4180	Budget authority, net (total)	448	451	456
4190	Outlays, net (total)	533	489	485

The Indian Health Facilities account supports construction, repair and improvement, equipment, and environmental health and facilities support for the Indian Health Service. An estimated $208.8 million primarily through self determination contracts and compacts, will be administered by tribal governments in 2014.


Identification code 75–0391–0–1–551		2012 actual	2013 CR	2014 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	47	47	47
11.3	Other than full-time permanent	2	2	2
11.5	Other personnel compensation	2	2	2
11.7	Military personnel	23	23	24

11.9	Total personnel compensation	74	74	75
12.1	Civilian personnel benefits	15	15	14
12.2	Military personnel benefits	8	8	8
21.0	Travel and transportation of persons	2	2	2
22.0	Transportation of things	4	4	4
23.1	Rental payments to GSA	1	1	1
23.3	Communications, utilities, and miscellaneous charges	16	16	16
25.1	Advisory and assistance services	2	2	2
25.2	Other services from non-Federal sources	81	82	71
25.3	Other goods and services from Federal sources	4	4	4
25.4	Operation and maintenance of facilities	8	8	6
25.7	Operation and maintenance of equipment	4	4	4
25.8	Subsistence and support of persons	1	1	1
26.0	Supplies and materials	8	8	7
31.0	Equipment	14	14	13
32.0	Land and structures	42	43	41
41.0	Grants, subsidies, and contributions	183	184	179

99.0	Direct obligations	467	470	448
99.0	Reimbursable obligations	39	39	39

99.9	Total new obligations	506	509	487


Identification code 75–0391–0–1–551		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment	1,021	1,021	1,021
1101	Direct military average strength employment	170	170	170
2001	Reimbursable civilian full-time equivalent employment	32	32	32

Appropriations provided in this Act to the Indian Health Service shall be available for services as authorized by 5 U.S.C. 3109 at rates not to exceed the per diem rate equivalent to the maximum rate payable for senior-level positions under 5 U.S.C. 5376; hire of passenger motor vehicles and aircraft; purchase of medical equipment; purchase of reprints; purchase, renovation and erection of modular buildings and renovation of existing facilities; payments for telephone service in private residences in the field, when authorized under regulations approved by the Secretary; uniforms or allowances therefor as authorized by 5 U.S.C. 5901–5902; and for expenses of attendance at meetings that relate to the functions or activities of the Indian Health Service: Provided, That in accordance with the provisions of the Indian Health Care Improvement Act, non-Indian patients may be extended health care at all tribally administered or Indian Health Service facilities, subject to charges, and the proceeds along with funds recovered under the Federal Medical Care Recovery Act (42 U.S.C. 2651–2653) shall be credited to the account of the facility providing the service and shall be available without fiscal year limitation: Provided further, That notwithstanding any other law or regulation, funds transferred from the Department of Housing and Urban Development to the Indian Health Service shall be administered under Public Law 86–121, the Indian Sanitation Facilities Act and Public Law 93–638, as amended: Provided further, That funds appropriated to the Indian Health Service in this Act, except those used for administrative and program direction purposes, shall not be subject to limitations directed at curtailing Federal travel and transportation: Provided further, That none of the funds made available to the Indian Health Service in this Act shall be used for any assessments or charges by the Department of Health and Human Services unless identified in the budget justification and provided in this Act, or approved by the House and Senate Committees on Appropriations through the reprogramming process: Provided further, That notwithstanding any other provision of law, funds previously or herein made available to a tribe or tribal organization through a contract, grant, or agreement authorized by title I or title V of the Indian Self-Determination and Education Assistance Act of 1975 (25 U.S.C. 450), may be deobligated and reobligated to a self-determination contract under title I, or a self-governance agreement under title V of such Act and thereafter shall remain available to the tribe or tribal organization without fiscal year limitation: Provided further, That none of the funds made available to the Indian Health Service in this Act shall be used to implement the final rule published in the Federal Register on September 16, 1987, by the Department of Health and Human Services, relating to the eligibility for the health care services of the Indian Health Service until the Indian Health Service has submitted a budget request reflecting the increased costs associated with the proposed final rule, and such request has been included in an appropriations Act and enacted into law: Provided further, That with respect to functions transferred by the Indian Health Service to tribes or tribal organizations, the Indian Health Service is authorized to provide goods and services to those entities on a reimbursable basis, including payments in advance with subsequent adjustment, and the reimbursements received therefrom, along with the funds received from those entities pursuant to the Indian Self-Determination Act, may be credited to the same or subsequent appropriation account from which the funds were originally derived, with such amounts to remain available until expended: Provided further, That reimbursements for training, technical assistance, or services provided by the Indian Health Service will contain total costs, including direct, administrative, and overhead associated with the provision of goods, services, or technical assistance: Provided further, That the appropriation structure for the Indian Health Service may not be altered without advance notification to the House and Senate Committees on Appropriations.

Federal Funds

For carrying out titles II, III, [VII,] XVII, and XXI, and section 2821 of the PHS Act, titles II and IV of the Immigration and Nationality Act, and section 501 of the Refugee Education Assistance Act, with respect to immunization and respiratory diseases, [$583,855,000]$668,696,000: Provided, That in addition to amounts provided herein, [$13,765,000]$12,864,000 shall be available from amounts available under section 241 of the PHS Act to carry out the National Immunization Surveys. Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.

For carrying out titles II, III, [VII,] XVII, and XXIII[, and XXVI] of the PHS Act with respect to HIV/AIDS, viral hepatitis, sexually transmitted diseases, and tuberculosis prevention, [$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]$1,173,942,000: Provided, That in addition to the amounts provided herein, $3,000,000 shall be available from amounts available under section 241 of the PHS Act to carry out the evaluation of HIV school health activities.

For carrying out titles II, III, [VII,] and XVII, and section 2821 of the PHS Act, titles II and IV of the Immigration and Nationality Act, and section 501 of the Refugee Education Assistance Act, with respect to emerging and zoonotic infectious diseases, [$279,477,000]$380,664,000, of which $1,000,000 shall remain available until expended to pay for the transportation, medical care, treatment, and other related costs of persons quarantined or isolated under federal or state quarantine laws.

For carrying out titles II, III, [VII,] XI, XV, and XVII [, and XIX] of the PHS Act and [section 4201 of the Patient Protection and Affordable Care Act,] Public Law 111–148 with respect to chronic disease prevention and health promotion, [$608,019,000]$620,189,000: 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:] Centers for Disease Control and Prevention and State grant recipients may reallocate up to five percent of grant funds received for diabetes, heart disease and stroke, obesity, and school health activities to address cross-cutting chronic disease issues: 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 reallocate such funds: Provided further, That funds appropriated under this account may be available for making grants under section 1509 of the PHS Act for up to 21 States, tribes, or tribal organizations: Provided further, That the Secretary may grant up to ten waivers under section 1503(d) of the PHS Act.

For carrying out titles II, III, [VII,] XI, and XVII of the PHS Act with respect to birth defects, developmental disabilities, disabilities and health, [$18,476,000]$67,148,000.

For carrying out titles II, [and] III, and XVII of the PHS Act and Public Law 111–148 with respect to health statistics, surveillance, health informatics, and workforce development, [$35,695,000]$144,416,000: Provided, That in addition to amounts provided herein, [$379,374,000]$324,889,000 shall be available from amounts available under section 241 of the PHS Act to carry out Public Health Scientific Services.

For carrying out titles II, III, [VII,] and XVII of the PHS Act with respect to environmental health, [$103,672,000]$126,126,000.

For carrying out titles II, III, [VII,] and XVII of the PHS Act with respect to injury prevention and control, [$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]$176,585,000: Provided, that in addition to the amounts provided herein, $5,000,000 shall be available from amounts under section 241 of the PHS Act to carry out the evaluation of Rape Prevention and Education programs authorized by the Violence Against Women Act.

For carrying out titles II, III, [VII,] and XVII of the PHS Act, sections 101, 102, 103, 201, 202, 203, 301, 501, and 514 of the Federal Mine Safety and Health Act, section 13 of the Mine Improvement and New Emergency Response Act, and sections 20, 21, and 22 of the Occupational Safety and Health Act, with respect to occupational safety and health, [$249,364,000]$271,911,000 shall be available from amounts available under section 241 of the PHS Act.

For necessary expenses to administer the Energy Employees Occupational Illness Compensation Program Act, [$55,358,000]$55,358,000 to remain available until expended: Provided, That this amount shall be available consistent with the provision regarding administrative expenses in section 151(b) of division B, title I of Public Law 106–554.

For carrying out titles II, III, [VII] and XVII of the PHS Act with respect to global health, [$362,889,000]$393,024,000 of which [$117,156,000]$131,942,000 for international HIV/AIDS shall remain available through September 30, [2014]2015: Provided, That funds may be used for purchase and insurance of official motor vehicles in foreign countries.

For carrying out titles II, III, [VII,] and XVII of the PHS Act with respect to public health preparedness and response, and for expenses necessary to support activities related to countering potential biological, nuclear, radiological, and chemical threats to civilian populations, [$1,228,360,000]$1,334,316,000, of which [$439,444,000] $510,278,000 shall remain available until expended for the Strategic National Stockpile[pursuant to section 319F-2 of the PHS Act].

For carrying out titles II, III, [VII,] and 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, [$487,648,000] $131,403,000, of which [$368,529,000]$14,591,000 shall be available until [September 30, 2014, for business services: 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'')]expended for equipment, construction, and renovation of facilities: Provided[further], That 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") 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, [2014]2015: Provided further, That of the funds made available under this heading and in all other accounts of CDC, up to $1,000 per eligible employee of CDC shall be made available until expended for Individual Learning Accounts: 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. Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.


Identification code 75–0943–0–1–999		2012 actual	2013 CR	2014 est.

0100	Balance, start of year
	Receipts:
0220	Cooperative Research and Development Agreements, Centers for Disease Control	3	2	2

0400	Total: Balances and collections	3	2	2
	Appropriations:
0500	CDC-Wide Activities and Program Support	–3	–2	–2

0799	Balance, end of year


Identification code 75–0943–0–1–999		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Birth Defects, Developmental Disabilities, Disability and Health (BA & Prevention Fund) (0958)	137	138	142
0002	CDC Wide Activities and Program Support (0943)	659	622	173
0004	Chronic Disease Prevention and Health Promotion (0948)	1,167	761	1,036
0005	Emerging and Zoonotic Infectious Diseases (0949)	304	254	432
0006	Energy Employee Illness Occupational Compensation Program Act (EEOICPA) (0954)	54		55
0007	Environmental Health (0947)	140	106	155
0008	Global Health (0955)	348	350	393
0012	HIV/AIDS, Viral Hepatitis, STD and TB Prevention (0950)	1,110	1,107	1,177
0013	Immunization and Respiratory Diseases (0951)	779	593	754
0015	Injury Prevention and Control (0952)	138	139	182
0016	Occupational Safety and Health (0953)	293	294	272
0019	Public Health Preparedness & Response (0956)	1,299	1,308	1,334
0020	Public Health Scientific Services (0959)	462	394	539
0021	Cooperative Research and Development Agreements (CRADA) (5146)	2	2	2

0799	Total direct obligations	6,892	6,068	6,646
0802	Other Reimbursable Programs	273	273	273

0809	Reimbursable program activities, subtotal	273	273	273

0900	Total new obligations	7,165	6,341	6,919

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	193	182
1001	Discretionary unobligated balance brought fwd, Oct 1	96	96
1021	Recoveries of prior year unpaid obligations	7

1050	Unobligated balance (total)	200	182
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	5,688	5,692	5,217
1120	Appropriations transferred to other accts [75–0350]	–1
1130	Appropriations permanently reduced	–31

1160	Appropriation, discretionary (total)	5,656	5,692	5,217
	Appropriations, mandatory:
1200	Appropriation	55		55
1201	Appropriation (special or trust fund)	3	2	2
1221	Appropriations transferred from other accts [75–0116]	809		755

1260	Appropriations, mandatory (total)	867	2	812
	Spending authority from offsetting collections, discretionary:
1700	Collected	326	465	890
1701	Change in uncollected payments, Federal sources	307

1750	Spending auth from offsetting collections, disc (total)	633	465	890
1900	Budget authority (total)	7,156	6,159	6,919
1930	Total budgetary resources available	7,356	6,341	6,919
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–9
1941	Unexpired unobligated balance, end of year	182

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	6,452	6,314	5,830
3010	Obligations incurred, unexpired accounts	7,165	6,341	6,919
3011	Obligations incurred, expired accounts	28
3020	Outlays (gross)	–7,243	–6,825	–6,809
3040	Recoveries of prior year unpaid obligations, unexpired	–7
3041	Recoveries of prior year unpaid obligations, expired	–81

3050	Unpaid obligations, end of year	6,314	5,830	5,940
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–468	–460	–460
3070	Change in uncollected pymts, Fed sources, unexpired	–307
3071	Change in uncollected pymts, Fed sources, expired	315

3090	Uncollected pymts, Fed sources, end of year	–460	–460	–460
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	5,984	5,854	5,370
3200	Obligated balance, end of year	5,854	5,370	5,480

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	6,289	6,157	6,107
	Outlays, gross:
4010	Outlays from new discretionary authority	2,497	2,415	2,702
4011	Outlays from discretionary balances	4,183	3,994	3,723

4020	Outlays, gross (total)	6,680	6,409	6,425
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–629	–458	–881
4033	Non-Federal sources	–7	–7	–9

4040	Offsets against gross budget authority and outlays (total)	–636	–465	–890
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–307
4052	Offsetting collections credited to expired accounts	310

4060	Additional offsets against budget authority only (total)	3

4070	Budget authority, net (discretionary)	5,656	5,692	5,217
4080	Outlays, net (discretionary)	6,044	5,944	5,535
	Mandatory:
4090	Budget authority, gross	867	2	812
	Outlays, gross:
4100	Outlays from new mandatory authority	207	2	303
4101	Outlays from mandatory balances	356	414	81

4110	Outlays, gross (total)	563	416	384
4180	Budget authority, net (total)	6,523	5,694	6,029
4190	Outlays, net (total)	6,607	6,360	5,919

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 and respiratory diseases, HIV/AIDS, Hepatitis, STDs, and Tuberculosis prevention, emerging and zoonotic infectious diseases, chronic disease prevention and health promotion, occupational safety and health, public health and scientific services, 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, and emergency response. The 2012 and 2013 levels in MAX are not comparable with the 2014 Budget levels. The 2014 Budget realigns business support services from the prior fiscal to the program budget lines based on previous consumption data.


Identification code 75–0943–0–1–999		2012 actual	2013 CR	2014 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	696	737	742
11.3	Other than full-time permanent	95	92	92
11.5	Other personnel compensation	31	39	39
11.7	Military personnel	68	67	69
11.8	Special personal services payments	1	1	1

11.9	Total personnel compensation	891	936	943
12.1	Civilian personnel benefits	247	252	254
12.2	Military personnel benefits	46	48	48
21.0	Travel and transportation of persons	46	41	41
22.0	Transportation of things	20	15	15
23.1	Rental payments to GSA	25	52	52
23.2	Rental payments to others	2	1	1
23.3	Communications, utilities, and miscellaneous charges	51	34	34
24.0	Printing and reproduction	3	5	5
25.1	Advisory and assistance services	634	448	448
25.2	Other services from non-Federal sources	226	193	193
25.3	Other goods and services from Federal sources	386	371	371
25.4	Operation and maintenance of facilities	74	47	47
25.5	Research and development contracts	84	63	63
25.6	Medical care	36	28	28
25.7	Operation and maintenance of equipment	40	33	33
25.8	Subsistence and support of persons (Includes 1259)	41	30	30
26.0	Supplies and materials	646	528	528
31.0	Equipment	94	56	56
32.0	Land and structures	15	8	8
41.0	Grants, subsidies, and contributions	3,285	2,879	3,448

99.0	Direct obligations	6,892	6,068	6,646
99.0	Reimbursable obligations	273	273	273

99.9	Total new obligations	7,165	6,341	6,919


Identification code 75–0943–0–1–999		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment	8,676	8,623	8,623
1101	Direct military average strength employment	805	805	805
2001	Reimbursable civilian full-time equivalent employment	1,018	1,018	1,018
2101	Reimbursable military average strength employment	72	72	72

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

For necessary expenses for the Agency for Toxic Substances and Disease Registry (ATSDR) in carrying out activities set forth in sections 104(i) and 111(c)(4) of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA), as amended; [section 118(f) of the Superfund Amendments and Reauthorization Act of 1986 (SARA), as amended;] and section 3019 of the Solid Waste Disposal Act, as amended, [$76,300,000]$76,215,000 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]i) of CERCLA during fiscal year [2013]2014, and existing profiles may be updated as necessary. Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.


Identification code 75–0944–0–1–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Direct program	79	77	76
0801	Reimbursable program	11	10	10

0900	Total new obligations	90	87	86

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	20	17	17
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	76	77	76

1160	Appropriation, discretionary (total)	76	77	76
	Spending authority from offsetting collections, discretionary:
1700	Collected	4	10	10
1701	Change in uncollected payments, Federal sources	7

1750	Spending auth from offsetting collections, disc (total)	11	10	10
1900	Budget authority (total)	87	87	86
1930	Total budgetary resources available	107	104	103
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	17	17	17

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	48	52	26
3010	Obligations incurred, unexpired accounts	90	87	86
3020	Outlays (gross)	–85	–113	–81
3041	Recoveries of prior year unpaid obligations, expired	–1

3050	Unpaid obligations, end of year	52	26	31
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–13	–14	–14
3070	Change in uncollected pymts, Fed sources, unexpired	–7
3071	Change in uncollected pymts, Fed sources, expired	6

3090	Uncollected pymts, Fed sources, end of year	–14	–14	–14
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	35	38	12
3200	Obligated balance, end of year	38	12	17

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	87	87	86
	Outlays, gross:
4010	Outlays from new discretionary authority	53	64	63
4011	Outlays from discretionary balances	29	38	15

4020	Outlays, gross (total)	82	102	78
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–9	–10	–10
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–7
4052	Offsetting collections credited to expired accounts	5

4060	Additional offsets against budget authority only (total)	–2

4070	Budget authority, net (discretionary)	76	77	76
4080	Outlays, net (discretionary)	73	92	68
	Mandatory:
	Outlays, gross:
4101	Outlays from mandatory balances	3	11	3
4180	Budget authority, net (total)	76	77	76
4190	Outlays, net (total)	76	103	71

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


Identification code 75–0944–0–1–551		2012 actual	2013 CR	2014 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	22	22	22
11.3	Other than full-time permanent	1	1	1
11.5	Other personnel compensation	1	1	1
11.7	Military personnel	3	4	4

11.9	Total personnel compensation	27	28	28
12.1	Civilian personnel benefits	7	7	7
12.2	Military personnel benefits	1	2	2
21.0	Travel and transportation of persons	1
25.1	Advisory and assistance services	4	4	4
25.2	Other services from non-Federal sources	7	7	7
25.3	Other goods and services from Federal sources	14	11	11
31.0	Equipment	1	1	1
41.0	Grants, subsidies, and contributions	17	17	15

99.0	Direct obligations	79	77	75
99.0	Reimbursable obligations	11	10	11

99.9	Total new obligations	90	87	86


Identification code 75–0944–0–1–551		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment	249	250	250
1101	Direct military average strength employment	37	35	35
2001	Reimbursable civilian full-time equivalent employment	10	10	10


Identification code 75–0946–0–1–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Federal Share	187	231	241
0002	NYC	21	26	26

0900	Total new obligations	208	257	267

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation (WTC (CDC Direct))	187	231	241
1200	Appropriation (WTC—NYC DHSS—CDC)	18	26	26

1260	Appropriations, mandatory (total)	205	257	267
	Spending authority from offsetting collections, mandatory:
1800	Collected	3

1850	Spending auth from offsetting collections, mand (total)	3
1900	Budget authority (total)	208	257	267
1930	Total budgetary resources available	208	257	267

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	68	113	137
3010	Obligations incurred, unexpired accounts	208	257	267
3020	Outlays (gross)	–146	–233	–226
3041	Recoveries of prior year unpaid obligations, expired	–17

3050	Unpaid obligations, end of year	113	137	178
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	68	113	137
3200	Obligated balance, end of year	113	137	178

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	208	257	267
	Outlays, gross:
4100	Outlays from new mandatory authority	106	129	134
4101	Outlays from mandatory balances	40	104	92

4110	Outlays, gross (total)	146	233	226
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–6
	Additional offsets against gross budget authority only:
4142	Offsetting collections credited to expired accounts	3

4160	Budget authority, net (mandatory)	205	257	267
4170	Outlays, net (mandatory)	140	233	226
4180	Budget authority, net (total)	205	257	267
4190	Outlays, net (total)	140	233	226

HHS along with CDC began implementing provisions of The James Zadroga 9/11 Health and Compensation Act of 2010 (P.L. 111–347) on July 1, 2011, to provide monitoring and treatment benefits to eligible responders and survivors. CDC/NIOSH serves as the Program Administrator for the WTC Health Program. The WTC Health Program provides quality care for WTC-related health conditions, conducts WTC research, and maintains a health registry to collect data on victims of the September 11, 2001, terrorist attacks. The amounts included for 2013 and 2014 Budget reflect estimated Federal obligations for the WTC Health Program.


Identification code 75–0946–0–1–551		2012 actual	2013 CR	2014 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	2	2	2
11.7	Military personnel	1	1	1

11.9	Total personnel compensation	3	3	3
25.1	Advisory and assistance services	3	20	20
25.2	Other services from non-Federal sources		33	33
25.3	Other goods and services from Federal sources	77	4	4
25.6	Medical care	106	177	187
41.0	Grants, subsidies, and contributions	19	20	20

99.9	Total new obligations	208	257	267


Identification code 75–0946–0–1–551		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment	8	8	8
1101	Direct military average strength employment	2	2	2

Federal Funds

For carrying out section 301 and title IV of the PHS Act with respect to cancer, [$5,068,864,000,]$5,125,951,000, of which up to $8,000,000 may be used for facilities repairs and improvements at the National Cancer Institute[—]–Frederick Federally Funded Research and Development Center in Frederick, Maryland.

For carrying out section 301 and title IV of the PHS Act with respect to cardiovascular, lung, and blood diseases, and blood and blood products, [$3,076,067,000] $3,098,508,000.

For carrying out section 301 and title IV of the PHS Act with respect to dental and craniofacial diseases, [$408,212,000]$411,515,000.

For carrying out section 301 and title IV of the PHS Act with respect to diabetes and digestive and kidney disease, [$1,792,107,000]$1,811,786,000.

For carrying out section 301 and title IV of the PHS Act with respect to neurological disorders and stroke, [$1,624,707,000]$1,642,619,000.

For carrying out section 301 and title IV of the PHS Act with respect to allergy and infectious diseases, [$4,495,307,000]$4,578,813,000.

For carrying out section 301 and title IV of the PHS Act with respect to general medical sciences, [$2,378,835,000]$2,401,011,000.

For carrying out section 301 and title IV of the PHS Act with respect to child health and human development, [$1,320,600,000]$1,339,360,000.

For carrying out section 301 and title IV of the PHS Act with respect to eye diseases and visual disorders, [$693,015,000]$699,216,000.

For carrying out section 301 and title IV of the PHS Act with respect to environmental health sciences, $691,348,000.

For necessary expenses for the National Institute of Environmental Health Sciences in carrying out activities set forth in section 311(a) of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980[, as amended,] and section 126(g) of the Superfund Amendments and Reauthorization Act of 1986, [$78,928,000]$79,411,000.

For carrying out section 301 and title IV of the PHS Act with respect to aging, [$1,102,650,000]$1,193,370,000.

For carrying out section 301 and title IV of the PHS Act with respect to arthritis and musculoskeletal and skin diseases, [$535,610,000]$540,993,000.

For carrying out section 301 and title IV of the PHS Act with respect to deafness and other communication disorders, [$417,297,000]$422,936,000.

For carrying out section 301 and title IV of the PHS Act with respect to nursing research, [$144,153,000]$146,244,000.

For carrying out section 301 and title IV of the PHS Act with respect to alcohol abuse and alcoholism, [$457,104,000]$463,848,000.

For carrying out section 301 and title IV of the PHS Act with respect to drug abuse, [$1,054,001,000]$1,071,612,000.

For carrying out section 301 and title IV of the PHS Act with respect to mental health, [$1,479,204,000]$1,465,782,000.

For carrying out section 301 and title IV of the PHS Act with respect to human genome research, [$511,370,000]$517,319,000.

For carrying out section 301 and title IV of the PHS Act with respect to biomedical imaging and bioengineering research, [$336,896,000]$338,892,000.

For carrying out section 301 and title IV of the PHS Act with respect to complementary and alternative medicine, [$127,930,000]$129,041,000.

For carrying out section 301 and title IV of the PHS Act with respect to minority health and health disparities research, [$279,389,000]$283,299,000.

For carrying out the activities of the John E. Fogarty International Center (described in subpart 2 of part E of title IV of the PHS Act), [$69,758,000]$72,864,000.

For carrying out section 301 and title IV of the PHS Act with respect to health information communications, [$372,651,000]$382,252,000, of which $4,000,000 shall be available until September 30, [2014]2015, for improvement of information systems: Provided, That in fiscal year [2013]2014, 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 information services.

For carrying out section 301 and title IV of the PHS Act with respect to translational sciences, [$639,033,000]$665,688,000: Provided, That up to $50,000,000 shall be available to implement section [402C]480 of the PHS Act, relating to the Cures Acceleration Network.

For carrying out the responsibilities of the Office of the Director, NIH, [$1,429,161,000]$1,473,398,000, of which up to $25,000,000 shall be used to carry out section [212]211 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 [$544,930,000]$572,948,000 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.

For the study of, construction of, renovation of, and acquisition of equipment for, facilities of or used by NIH, including the acquisition of real property, [$125,308,000]$126,111,000, to remain available until expended. Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.


Identification code 75–9915–0–1–552		2012 actual	2013 CR	2014 est.

0100	Balance, start of year
	Receipts:
0220	Cooperative Research and Development Agreements, NIH	16	17	17

0400	Total: Balances and collections	16	17	17
	Appropriations:
0500	National Institutes of Health	–16	–17	–17

0799	Balance, end of year


Identification code 75–9915–0–1–552		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	National Cancer Institute (0849)	5,068	5,103	5,126
0002	National Heart, Lung, and Blood Institute (0872)	3,052	3,098	3,099
0003	National Institute of Dental and Craniofacial Research (0873)	410	413	412
0004	National Institute of Diabetes and Digestive and Kidney Disease (0884)	1,795	1,808	1,812
0005	National Institute of Neurological Disorders and Stroke (0886)	1,625	1,636	1,643
0006	National Institute of Allergy and Infectious Diseases (0885)	4,487	4,518	4,579
0007	National Institute of General Medical Sciences (0851)	2,428	2,445	2,401
0008	National Institute of Child Health and Human Development (0844)	1,320	1,329	1,339
0009	National Eye Institute (0887)	702	707	699
0010	National Institute of Environmental Health Sciences (0862)	764	769	771
0011	National Institute on Aging (0843)	1,121	1,110	1,193
0012	National Institute of Arthritis and Musculoskeletal and Skin Disease (0888)	535	539	541
0013	National Institute on Deafness and Other Communication Disorder (0890)	416	419	423
0014	National Institute of Mental Health (0892)	1,479	1,489	1,466
0015	National Institute on Drug Abuse (0893)	1,052	1,060	1,072
0016	National Institute on Alcohol Abuse and Alcoholism (0894)	459	462	464
0017	National Institute of Nursing Research (0889)	145	146	146
0018	National Human Genome Research Institute (0891)	513	516	517
0019	National Institute of Biomedical Imaging and Bioengineering (0898)	338	340	339
0021	National Center for Complementary and Alternative Medicine (0896)	128	129	129
0022	National Institute on Minority Health and Health Disparities (0897)	276	278	283
0023	John E. Fogarty International Center (0819)	70	70	73
0024	National Library of Medicine (0807)	337	340	382
0025	Office of the Director (0846)	1,458	1,468	1,473
0026	Buildings and facilities (0838)	99	126	126
0027	Cooperative Research and Development Agreements	18	17	17
0028	National Center for Advancing Translational Sciences (0875)	575	579	666
0031	Type 1 Diabetes	150	150	150

0799	Total direct obligations	30,820	31,064	31,341
0801	Reimbursable program activity	3,166	3,168	3,377
0802	Royalties	87	88	88

0809	Reimbursable program activities, subtotal	3,253	3,256	3,465

0899	Total reimbursable obligations	3,253	3,256	3,465

0900	Total new obligations	34,073	34,320	34,806

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	374	457	371
1001	Discretionary unobligated balance brought fwd, Oct 1	342	420
1021	Recoveries of prior year unpaid obligations	52

1050	Unobligated balance (total)	426	457	371
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	30,769	30,899	31,173
1120	Appropriations transferred to other accts [75–0350]	–9
1130	Appropriations permanently reduced	–58

1160	Appropriation, discretionary (total)	30,702	30,899	31,173
	Appropriations, mandatory:
1200	Appropriation	150	150	150
1201	Appropriation (special or trust fund)	16	17	17

1260	Appropriations, mandatory (total)	166	167	167
	Spending authority from offsetting collections, discretionary:
1700	Collected	2,733	3,168	3,377
1701	Change in uncollected payments, Federal sources	530

1750	Spending auth from offsetting collections, disc (total)	3,263	3,168	3,377
1900	Budget authority (total)	34,131	34,234	34,717
1930	Total budgetary resources available	34,557	34,691	35,088
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–27
1941	Unexpired unobligated balance, end of year	457	371	282

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	35,624	33,051	32,411
3010	Obligations incurred, unexpired accounts	34,073	34,320	34,806
3011	Obligations incurred, expired accounts	926
3020	Outlays (gross)	–36,568	–34,960	–34,713
3040	Recoveries of prior year unpaid obligations, unexpired	–52
3041	Recoveries of prior year unpaid obligations, expired	–952

3050	Unpaid obligations, end of year	33,051	32,411	32,504
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–1,151	–938	–938
3070	Change in uncollected pymts, Fed sources, unexpired	–530
3071	Change in uncollected pymts, Fed sources, expired	743

3090	Uncollected pymts, Fed sources, end of year	–938	–938	–938
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	34,473	32,113	31,473
3200	Obligated balance, end of year	32,113	31,473	31,566

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	33,965	34,067	34,550
	Outlays, gross:
4010	Outlays from new discretionary authority	10,769	11,512	11,794
4011	Outlays from discretionary balances	25,653	23,140	22,750

4020	Outlays, gross (total)	36,422	34,652	34,544
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–3,675	–3,168	–3,377
4033	Non-Federal sources	–112

4040	Offsets against gross budget authority and outlays (total)	–3,787	–3,168	–3,377
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–530
4052	Offsetting collections credited to expired accounts	1,054

4060	Additional offsets against budget authority only (total)	524

4070	Budget authority, net (discretionary)	30,702	30,899	31,173
4080	Outlays, net (discretionary)	32,635	31,484	31,167
	Mandatory:
4090	Budget authority, gross	166	167	167
	Outlays, gross:
4100	Outlays from new mandatory authority	10	52	53
4101	Outlays from mandatory balances	136	256	116

4110	Outlays, gross (total)	146	308	169
4180	Budget authority, net (total)	30,868	31,066	31,340
4190	Outlays, net (total)	32,781	31,792	31,336

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


	2012	20131	2014

Distribution of budget authority by account:
National Cancer Institute	5,072	5,103	5,126
National Heart, Lung, and Blood Institute	3,079	3,098	3,099
National Institute of Dental and Craniofacial Research	411	413	412
National Institute of Diabetes and Digestive and Kidney Diseases	1,947	1,958	1,962
National Institute of Neurological Disorder and Stroke	1,626	1,636	1,643
National Institute of Allergy and Infectious Diseases	4,491	4,518	4,579
National Institute of General Medical Sciences	2,430	2,445	2,401
Eunice Kennedy Shriver National Institute of Child Health and Human Development	1,321	1,329	1,339
National Eye Institute	703	707	699
National Institute of Environmental Health Sciences	764	769	771
National Institute on Aging	1,103	1,110	1,193
National Institute of Arthritis and Musculoskeletal and Skin Diseases	536	539	541
National Institute on Deafness and Other Communication Disorders	416	419	423
National Institute of Mental Health	1,480	1,489	1,466
National Institute on Drug Abuse	1,053	1,060	1,072
National Institute on Alcohol Abuse and Alcoholism	460	462	464
National Institute of Nursing Research	145	146	146
National Center for Research Resources	0	0	0
National Human Genome Research Institute	513	516	517
National Institute of Biomedical Imaging and Bioengineering	338	340	339
National Institute on Minority Health and Health Disparities	276	278	283
National Center for Complementary and Alternative Medicine	128	129	129
National Center for Advancing Translational Sciences	575	579	666
John E. Fogarty International Center	70	70	73
National Library of Medicine	338	340	382
Office of the Director	1,459	1,468	1,473
Buildings and Facilities	125	126	126

ARRA Funds	0	0	0

Subtotal	30,861	31,049	31,323

Cooperative Research and Development Agreements	17	17	17


Total Budget Authority, NIH	30,878	31,066	31,340


	2012	2013	2014

Distribution of outlays by account:
National Cancer Institute	5,154	4,909	5,102
National Heart, Lung, and Blood Institute	3,151	2,925	3,089
National Institute of Dental and Craniofacial Research	403	423	412
National Institute of Diabetes and Digestive and Kidney Diseases	1,927	2,342	1,956
National Institute of Neurological Disorders and Stroke	1,593	1,715	1,636
National Institute of Allergy and Infectious Diseases	4,569	4,340	4,527
National Institute of General Medical Sciences	1,824	2,668	2,427
Eunice Kennedy Shriver National Institute of Child Health and Human Development	1,289	1,359	1,331
National Eye Institute	699	707	704
National Institute of Environmental Health Sciences	1,049	490	769
National Institute on Aging	1,101	1,081	1,131
National Institute of Arthritis and Musculoskeletal and Skin Diseases	531	527	539
National Institute on Deafness and Other Communication Disorders	417	420	419
National Institute of Mental Health	1,490	1,435	1,481
National Institute on Drug Abuse	1,090	962	1,061
National Institute on Alcohol Abuse and Alcoholism	467	460	462
National Institute of Nursing Research	145	137	146
National Center for Research Resources	910	406	77
National Human Genome Research Institute	498	537	516
National Institute of Biomedical Imaging and Bioengineering	318	331	339
National Institute on Minority Health and Health Disparities	227	243	274
National Center for Complementary and Alternative Medicine	123	126	129
National Center for Advancing Translational Sciences	98	326	554
John E. Fogarty International Center	65	72	71
National Library of Medicine	341	328	362
Office of the Director	1,341	1,359	1,439
Buildings and Facilities	112	130	90
ARRA Funds	1,880	1,020	277
Management Fund/Service and Supply Fund	–46	0	0
Subtotal Outlays	32,769	31,777	31,318

Cooperative Research and Development Agreements	13	16	16


Total Outlays, NIH	32,782	31,792	31,336

This program funds biomedical research and research training. These accounts will continue to be appropriated separately, and are displayed in a consolidated format to improve the readability of the presentation. Detailed information is available through the Department of Health and Human Services.


Identification code 75–9915–0–1–552		2012 actual	2013 CR	2014 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	879	933	944
11.3	Other than full-time permanent	475	487	496
11.5	Other personnel compensation	30	32	33
11.7	Military personnel	21	22	22
11.8	Special personal services payments	162	163	166

11.9	Total personnel compensation	1,567	1,637	1,661
12.1	Civilian personnel benefits	411	430	435
12.2	Military personnel benefits	15	16	16
21.0	Travel and transportation of persons	50	49	49
22.0	Transportation of things	5	5	5
23.1	Rental payments to GSA	1	2	2
23.2	Rental payments to others	1	1	1
23.3	Communications, utilities, and miscellaneous charges	27	27	27
24.0	Printing and reproduction	3	3	3
25.1	Advisory and assistance services	125	115	115
25.2	Other services from non-Federal sources	819	702	725
25.3	Other goods and services from Federal sources	3,171	3,126	3,273
25.4	Operation and maintenance of facilities	45	45	45
25.5	Research and development contracts	1,996	1,984	1,905
25.6	Medical care	20	20	20
25.7	Operation and maintenance of equipment	88	86	86
26.0	Supplies and materials	193	190	189
31.0	Equipment	154	142	144
32.0	Land and structures		126	126
41.0	Grants, subsidies, and contributions	22,130	22,358	22,514

99.0	Direct obligations	30,821	31,064	31,341
99.0	Reimbursable obligations	3,252	3,256	3,465

99.9	Total new obligations	34,073	34,320	34,806


Identification code 75–9915–0–1–552		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment	13,048	13,604	13,607
1101	Direct military average strength employment	201	201	198
2001	Reimbursable civilian full-time equivalent employment	5,137	4,581	4,581
2101	Reimbursable military average strength employment	107	107	107

Federal Funds

For carrying out titles III, V, and XIX of the PHS Act with respect to mental health, and the Protection and Advocacy for Individuals with Mental Illness Act, [$902,856,000]$990,341,000 of which $438,717,000 shall be for carrying out Section 1911 of the PHS Act: 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 [2013]2014: Provided further, That notwithstanding section 565(b)(1) of the PHS Act, technical assistance may be provided to communities that wish to establish such programs irrespective of whether the communities have a grant under section 561(a): Provided further, That States shall expend at least 3 percent of the amount for carrying out section 1911 of the PHS Act to award competitive subawards that assist providers in building capacity to bill third party insurance or assist individuals to enroll in insurance for which they are eligible: Provided further, That States shall expend at least 5 percent of the amount for carrying out section 1911 of the PHS Act to award competitive subawards that support effective evidence-based mental health prevention and treatment practices: Provided further, That any State receiving 2 percent or more of the total amount distributed for carrying out section 1911 of the PHS Act shall expend the amounts described in the two immediately preceding provisos through competitive subawards.

For carrying out titles III, V, and XIX of the PHS Act with respect to substance abuse treatment [, $1,711,045,000]and section 1922(a) of the PHS Act with respect to substance abuse prevention, $2,052,926,000 of which $1,748,132,000 shall be for carrying out Section 1921 of the PHS Act: Provided, That in addition to amounts provided herein, [$71,724,000]$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: Provided further, That [section 1922(a)(1) of the PHS Act shall not apply to amounts provided herein]States shall expend at least 3 percent of the amount for carrying out section 1921 of the PHS Act to award competitive subawards that assist providers in building capacity to bill third party insurance or assist individuals to enroll in insurance for which they are eligible: Provided further, That any State receiving 1 percent or more of the total amount distributed for carrying out section 1921 of the PHS Act shall expend the amounts described in the immediately preceding proviso through competitive subawards.

For carrying out titles III and V of the PHS Act with respect to substance abuse prevention, [$463,378,000]$175,560,000.

For program support and cross-cutting activities that supplement activities funded under the headings "Mental Health'', "Substance Abuse Treatment'', and "Substance Abuse Prevention'' in carrying out titles III, V, and XIX of the PHS Act and the Protection and Advocacy for Individuals with Mental Illness Act in the Substance Abuse and Mental Health Services Administration, [$74,229,000]$129,124,000: Provided, That in addition to amounts provided herein, [$71,995,000]$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] of 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. Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.


Identification code 75–1362–0–1–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0006	Mental Health	978	934	990
0007	Substance Abuse Treatment	2,148	2,132	2,053
0008	Substance Abuse Prevention	186	187	176
0009	Health Surveillance and Program Support	126	115	129

0100	Total, direct program	3,438	3,368	3,348

0799	Total direct obligations	3,438	3,368	3,348
0802	Reimbursable program: PHS Evaluation	248	253	257

0900	Total new obligations	3,686	3,621	3,605

	Budgetary Resources:
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	3,354	3,368	3,348
1120	Appropriations transferred to other accts [75–0350]	–1
1130	Appropriations permanently reduced	–6

1160	Appropriation, discretionary (total)	3,347	3,368	3,348
	Appropriations, mandatory:
1221	Appropriations transferred from the Prevention and Public Health Fund [75–0116]	92		58

1260	Appropriations, mandatory (total)	92		58
	Spending authority from offsetting collections, discretionary:
1700	Collected	238	253	259
1701	Change in uncollected payments, Federal sources	10

1750	Spending auth from offsetting collections, disc (total)	248	253	259
1900	Budget authority (total)	3,687	3,621	3,665
1930	Total budgetary resources available	3,687	3,621	3,665
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–1
1941	Unexpired unobligated balance, end of year			60

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	2,965	3,125	2,899
3010	Obligations incurred, unexpired accounts	3,686	3,621	3,605
3011	Obligations incurred, expired accounts	5
3020	Outlays (gross)	–3,487	–3,847	–3,669
3041	Recoveries of prior year unpaid obligations, expired	–44

3050	Unpaid obligations, end of year	3,125	2,899	2,835
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–241	–22	–22
3070	Change in uncollected pymts, Fed sources, unexpired	–10
3071	Change in uncollected pymts, Fed sources, expired	229

3090	Uncollected pymts, Fed sources, end of year	–22	–22	–22
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	2,724	3,103	2,877
3200	Obligated balance, end of year	3,103	2,877	2,813

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	3,595	3,621	3,607
	Outlays, gross:
4010	Outlays from new discretionary authority	1,359	1,469	1,468
4011	Outlays from discretionary balances	2,118	2,295	2,150

4020	Outlays, gross (total)	3,477	3,764	3,618
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–471	–253	–257
4033	Non-Federal sources			–2

4040	Offsets against gross budget authority and outlays (total)	–471	–253	–259
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–10
4052	Offsetting collections credited to expired accounts	233

4060	Additional offsets against budget authority only (total)	223

4070	Budget authority, net (discretionary)	3,347	3,368	3,348
4080	Outlays, net (discretionary)	3,006	3,511	3,359
	Mandatory:
4090	Budget authority, gross	92		58
	Outlays, gross:
4100	Outlays from new mandatory authority	10
4101	Outlays from mandatory balances		83	51

4110	Outlays, gross (total)	10	83	51
4180	Budget authority, net (total)	3,439	3,368	3,406
4190	Outlays, net (total)	3,016	3,594	3,410

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.


Identification code 75–1362–0–1–551		2012 actual	2013 CR	2014 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	46	54	57
11.3	Other than full-time permanent	2	3	4
11.5	Other personnel compensation	1	4	4
11.7	Military personnel	4	4	4

11.9	Total personnel compensation	53	65	69
12.1	Civilian personnel benefits	12	15	16
12.2	Military personnel benefits	2	2	2
21.0	Travel and transportation of persons	2	1	1
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	2	2
25.1	Advisory and assistance services	26	55	49
25.2	Other services from non-Federal sources	201	173	166
25.3	Other goods and services from Federal sources	90	41	32
25.7	Operation and maintenance of equipment	1	1	1
41.0	Grants, subsidies, and contributions	3,039	3,005	3,002
42.0	Insurance claims and indemnities	1

99.0	Direct obligations	3,438	3,368	3,348
99.0	Reimbursable obligations	248	253	257

99.9	Total new obligations	3,686	3,621	3,605


Identification code 75–1362–0–1–551		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment	498	533	552
1101	Direct military average strength employment	44	48	48
2001	Reimbursable civilian full-time equivalent employment	40	43	48
2101	Reimbursable military average strength employment	8	7	7

Federal Funds

For carrying out titles III and IX of the PHS Act, part A of title XI of the Social Security Act, and section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, [$334,357,000]$333,697,000 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 expended. Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.


Identification code 75–1700–0–1–552		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0003	Prevention and Public Health Fund	12
0801	Reimbursable program	15	15	15
0802	Reimbursable program: PHS evaluation	366	371	334

0899	Total reimbursable obligations	381	386	349

0900	Total new obligations	393	386	349

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	4	5	5
1001	Discretionary unobligated balance brought fwd, Oct 1	4	5
	Budget authority:
	Appropriations, mandatory:
1221	Appropriations transferred from other accts [75–0116]	12

1260	Appropriations, mandatory (total)	12
	Spending authority from offsetting collections, discretionary:
1700	Collected	187	386	349
1701	Change in uncollected payments, Federal sources	195

1750	Spending auth from offsetting collections, disc (total)	382	386	349
1900	Budget authority (total)	394	386	349
1930	Total budgetary resources available	398	391	354
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	5	5	5

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	989	726	68
3010	Obligations incurred, unexpired accounts	393	386	349
3020	Outlays (gross)	–647	–1,044	–375
3041	Recoveries of prior year unpaid obligations, expired	–9

3050	Unpaid obligations, end of year	726	68	42
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–382	–293	–293
3070	Change in uncollected pymts, Fed sources, unexpired	–195
3071	Change in uncollected pymts, Fed sources, expired	284

3090	Uncollected pymts, Fed sources, end of year	–293	–293	–293
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	607	433	–225
3200	Obligated balance, end of year	433	–225	–251

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	382	386	349
	Outlays, gross:
4010	Outlays from new discretionary authority	124	386	349
4011	Outlays from discretionary balances	517	651	21

4020	Outlays, gross (total)	641	1,037	370
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–463	–839	–349
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–195
4052	Offsetting collections credited to expired accounts	276	453

4060	Additional offsets against budget authority only (total)	81	453
4080	Outlays, net (discretionary)	178	198	21
	Mandatory:
4090	Budget authority, gross	12
	Outlays, gross:
4101	Outlays from mandatory balances	6	7	5
4180	Budget authority, net (total)	12
4190	Outlays, net (total)	184	205	26

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


Identification code 75–1700–0–1–552		2012 actual	2013 CR	2014 est.

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

99.0	Direct obligations	12
99.0	Reimbursable obligations	381	386	349

99.9	Total new obligations	393	386	349


Identification code 75–1700–0–1–552		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment
2001	Reimbursable civilian full-time equivalent employment	295	299	294
2101	Reimbursable military average strength employment	9	9	9
3001	Allocation account civilian full-time equivalent employment	4	12	20

Federal Funds

For carrying out, except as otherwise provided, titles XI and XIX of the Social Security Act, [$178,791,197,000]$177,872,985,000, to remain available until expended.

For making, after May 31, [2013]2014, 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 [2013]2014 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 [2014, $106,335,631,000]2015, $103,472,323,000, 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. Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.


Identification code 75–0512–0–1–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Medicaid vendor payments	248,004	246,797	283,045
0002	State and local administration	17,216	16,182	16,453
0003	Vaccines for Children	4,000	3,607	4,293
0004	Incurred by providers but not yet reported	1,092	1,959	2,369

0799	Total direct obligations	270,312	268,545	306,160
0801	Medicare Part B premiums	602	645	300

0900	Total new obligations	270,914	269,190	306,460

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	408	21,091	21,951
1021	Recoveries of prior year unpaid obligations	20,186

1050	Unobligated balance (total)	20,594	21,091	21,951
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation Medicaid	184,279	178,791	177,873

1260	Appropriations, mandatory (total)	184,279	178,791	177,873
	Advance appropriations, mandatory:
1270	Advance appropriation	86,445	90,614	106,336

1280	Advanced appropriation, mandatory (total)	86,445	90,614	106,336
	Spending authority from offsetting collections, mandatory:
1800	Collected	687	645	300

1850	Spending auth from offsetting collections, mand (total)	687	645	300
1900	Budget authority (total)	271,411	270,050	284,509
1930	Total budgetary resources available	292,005	291,141	306,460
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	21,091	21,951

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	28,392	27,899	29,858
3010	Obligations incurred, unexpired accounts	270,914	269,190	306,460
3020	Outlays (gross)	–251,221	–267,231	–304,091
3040	Recoveries of prior year unpaid obligations, unexpired	–20,186

3050	Unpaid obligations, end of year	27,899	29,858	32,227
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	28,392	27,899	29,858
3200	Obligated balance, end of year	27,899	29,858	32,227

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	271,411	270,050	284,509
	Outlays, gross:
4100	Outlays from new mandatory authority	226,477	232,191	267,211
4101	Outlays from mandatory balances	24,744	35,040	36,880

4110	Outlays, gross (total)	251,221	267,231	304,091
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–602	–645	–300
4123	Non-Federal sources	–85

4130	Offsets against gross budget authority and outlays (total)	–687	–645	–300

4160	Budget authority, net (mandatory)	270,724	269,405	284,209
4170	Outlays, net (mandatory)	250,534	266,586	303,791
4180	Budget authority, net (total)	270,724	269,405	284,209
4190	Outlays, net (total)	250,534	266,586	303,791


		2012 actual	2013 CR	2014 est.

Enacted/requested:
	Budget Authority	270,724	269,405	284,209
	Outlays	250,534	266,586	303,791
Legislative proposal, not subject to PAYGO:
	Budget Authority		–21	–436
	Outlays		–21	–436
Legislative proposal, subject to PAYGO:
	Budget Authority			279
	Outlays			279
Total:
	Budget Authority	270,724	269,384	284,052
	Outlays	250,534	266,565	303,634

Medicaid assists States in providing medical care to their low-income populations by granting Federal matching payments under title XIX of the Social Security Act to States with approved plans.

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

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


Obligations	2012	2013	2014

Vaccine Purchase	3,703	3,335	3,996
Vaccine Stockpile	137	137	137
Ordering, Distribution, and Operations	117	92	117
Vaccine Management Contract Support	2	1	0

Evaluation Activities	41	42	43

Total Obligations	4,000	3,607	4,293


Identification code 75–0512–0–1–551		2012 actual	2013 CR	2014 est.

41.0	Direct obligations: Grants, subsidies, and contributions	270,312	268,545	306,160
99.0	Reimbursable obligations	602	645	300

99.9	Total new obligations	270,914	269,190	306,460


Identification code 75–0512–2–1–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Medicaid vendor payments		–21	–31

0900	Total new obligations (object class 41.0)		–21	–31

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation		–21	–31

1260	Appropriations, mandatory (total)		–21	–31
1930	Total budgetary resources available		–21	–31

	Change in obligated balance:
	Unpaid obligations:
3010	Obligations incurred, unexpired accounts		–21	–31
3020	Outlays (gross)		21	31

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross		–21	–31
	Outlays, gross:
4100	Outlays from new mandatory authority		–21	–31
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources			–405
4180	Budget authority, net (total)		–21	–436
4190	Outlays, net (total)		–21	–436

Please see the narratives in the Program Integrity Administrative Expenses (Social Security Administration) and Health Care Fraud and Abuse Control accounts for a description of the program integrity estimates reflected here. This schedule also reflects the offsetting collections from Medicare Part B for the extension of the Qualified Individuals (QI) program.


Identification code 75–0512–4–1–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Medicaid Proposals			–126
0801	Medicare Part B premiums			405

0900	Total new obligations			279

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation Medicaid			–126

1260	Appropriations, mandatory (total)			–126
	Spending authority from offsetting collections, mandatory:
1800	Collected			405

1850	Spending auth from offsetting collections, mand (total)			405
1900	Budget authority (total)			279
1930	Total budgetary resources available			279

	Change in obligated balance:
	Unpaid obligations:
3010	Obligations incurred, unexpired accounts			279
3020	Outlays (gross)			–279

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			279
	Outlays, gross:
4100	Outlays from new mandatory authority			279
4180	Budget authority, net (total)			279
4190	Outlays, net (total)			279


Identification code 75–0512–4–1–551		2012 actual	2013 CR	2014 est.

41.0	Direct obligations: Grants, subsidies, and contributions			–126
99.0	Reimbursable obligations			405

99.9	Total new obligations			279


Identification code 75–0516–0–1–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0010	Ticket to Work grants	1
0011	Emergency health services for undocumented aliens	22	16	5
0012	Medicaid integrity program	63	96	86
0018	Money follows the person (MFP) demonstration	296	434	434
0019	MFP evaluations and technical support	1	1	1
0023	Grants to improve outreach and enrollment	3	39	2
0024	Application of Prospective Payment System	1
0025	Medicaid emergency psychiatric demonstration	1	28	26
0026	Incentives for prevention of chronic diseases in Medicaid	28	22	22

0900	Total new obligations	416	636	576

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	1,303	1,459	1,353
1021	Recoveries of prior year unpaid obligations	44

1050	Unobligated balance (total)	1,347	1,459	1,353
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation (Money follows the person (MFP) demonstration)	449	449	449
1200	Appropriation (MFP research & evaluation)	1	1	1
1200	Appropriation (Medicaid integrity program)	78	80	82

1260	Appropriations, mandatory (total)	528	530	532
1930	Total budgetary resources available	1,875	1,989	1,885
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	1,459	1,353	1,309

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	881	764	612
3010	Obligations incurred, unexpired accounts	416	636	576
3011	Obligations incurred, expired accounts	12
3020	Outlays (gross)	–480	–788	–749
3040	Recoveries of prior year unpaid obligations, unexpired	–44
3041	Recoveries of prior year unpaid obligations, expired	–21

3050	Unpaid obligations, end of year	764	612	439
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	881	764	612
3200	Obligated balance, end of year	764	612	439

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	528	530	532
	Outlays, gross:
4100	Outlays from new mandatory authority		81	133
4101	Outlays from mandatory balances	480	707	616

4110	Outlays, gross (total)	480	788	749
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–3
	Additional offsets against gross budget authority only:
4142	Offsetting collections credited to expired accounts	3

4160	Budget authority, net (mandatory)	528	530	532
4170	Outlays, net (mandatory)	477	788	749
4180	Budget authority, net (total)	528	530	532
4190	Outlays, net (total)	477	788	749

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

The Budget includes an unobligated balance of $129 million for activities authorized by Section 204 of the Ticket to Work and Work Incentives Improvement Act. Thus, pursuant to 31 U.S.C. 1555, any remaining balance (whether obligated or unobligated) will be withdrawn and returned to the Treasury two years after there has been no disbursement made against the appropriation.


Identification code 75–0516–0–1–551		2012 actual	2013 CR	2014 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	1
41.0	Grants, subsidies, and contributions - Emergency services for undocumented aliens	22	16	5
41.0	Grants, subsidies, and contributions - Medicaid Integrity Program	48	81	71
41.0	Grants, subsidies, and contributions - Money follows the person (MFP) demonstration	296	434	434
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	3	39	2
41.0	Grants, subsidies, and contributions - Application of Prospective Payment System	1
41.0	Grants, subsidies, and contributions - Medicaid emergency psychiatric demonstration	1	28	26
41.0	Grants, subsidies, and contributions - Incentives for prevention of chronic diseases in Medicaid	28	22	22

99.9	Total new obligations	416	636	576


Identification code 75–0516–0–1–551		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment	80	97	102

For payment to the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund, as provided under sections 217(g), 1844, and 1860D-16 of the Social Security Act, sections 103(c) and 111(d) of the Social Security Amendments of 1965, section 278(d)(3) of Public Law 97–248, and for administrative expenses incurred pursuant to section 201(g) of the Social Security Act, [$251,359,000,000] $255,185,000,000.

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. Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.


Identification code 75–0580–0–1–571		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Federal contribution to match premiums (SMI)	165,254	181,351	194,565
0002	Part D benefits (Rx Drug)	44,875	51,245	58,596
0003	Part D Federal administration (Rx Drug)	394	382	373
0004	General Fund Transfers to HI	485	1,104	1,651
0006	Federal Bureau of Investigation (HCFAC)	132	135	138
0007	Federal payments from taxation of OASDI benefits (HI)	18,643	14,387	18,877
0008	Criminal fines (HCFAC)	1,389	1,126	1,141
0009	Civil monetary penalties and damages (HCFAC - DOJ and CMS administration)	18	20	21
0010	Asset Forfeiture	20	23	23

0900	Total new obligations	231,210	249,773	275,385

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1			184
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation (definite, annual)	230,741	234,266	255,321
1200	Appropriation (indefinite, permanent)	18,643	14,387	18,877
1200	Appropriation (HCFAC for FBI)	132	135	138
1200	Appropriation (indefinite for HCFAC)	1,428	1,169	1,049

1260	Appropriations, mandatory (total)	250,944	249,957	275,385
1930	Total budgetary resources available	250,944	249,957	275,569
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–19,734
1941	Unexpired unobligated balance, end of year		184	184

	Change in obligated balance:
	Unpaid obligations:
3010	Obligations incurred, unexpired accounts	231,210	249,773	275,385
3011	Obligations incurred, expired accounts	171
3020	Outlays (gross)	–231,381	–249,773	–275,385

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	250,944	249,957	275,385
	Outlays, gross:
4100	Outlays from new mandatory authority	231,210	249,773	275,385
4101	Outlays from mandatory balances	171

4110	Outlays, gross (total)	231,381	249,773	275,385
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–14
	Additional offsets against gross budget authority only:
4142	Offsetting collections credited to expired accounts	14

4160	Budget authority, net (mandatory)	250,944	249,957	275,385
4170	Outlays, net (mandatory)	231,367	249,773	275,385
4180	Budget authority, net (total)	250,944	249,957	275,385
4190	Outlays, net (total)	231,367	249,773	275,385


		2012 actual	2013 CR	2014 est.

Enacted/requested:
	Budget Authority	250,944	249,957	275,385
	Outlays	231,367	249,773	275,385
Amounts included in the adjusted baseline:
	Budget Authority			2,007
	Outlays			2,007
Legislative proposal, not subject to PAYGO:
	Budget Authority			136
	Outlays		127	136
Total:
	Budget Authority	250,944	249,957	277,528
	Outlays	231,367	249,900	277,528

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


Identification code 75–0580–0–1–571		2012 actual	2013 CR	2014 est.

	Direct obligations:
41.0	Grants, subsidies, and contributions	230,181	248,413	273,625
42.0	Insurance claims and indemnities	262	228	204
94.0	Financial transfers (Federal admin)	767	1,132	1,556

99.9	Total new obligations	231,210	249,773	275,385


Identification code 75–0580–7–1–571		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Federal contribution to match premiums (SMI)			2,007

0900	Total new obligations (object class 41.0)			2,007

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation (definite annual)			2,007

1260	Appropriations, mandatory (total)			2,007
1930	Total budgetary resources available			2,007

	Change in obligated balance:
	Unpaid obligations:
3010	Obligations incurred, unexpired accounts			2,007
3020	Outlays (gross)			–2,007

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			2,007
	Outlays, gross:
4100	Outlays from new mandatory authority			2,007
4180	Budget authority, net (total)			2,007
4190	Outlays, net (total)			2,007


Identification code 75–0580–2–1–571		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0004	General Fund Transfers to HI		127	136

0900	Total new obligations (object class 41.0)		127	136

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation (definite annual)			136

1260	Appropriations, mandatory (total)			136
1930	Total budgetary resources available			136
	Memorandum (non-add) entries:
1940	Unobligated balance expiring		127

	Change in obligated balance:
	Unpaid obligations:
3010	Obligations incurred, unexpired accounts		127	136
3020	Outlays (gross)		–127	–136

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			136
	Outlays, gross:
4100	Outlays from new mandatory authority		127	136
4180	Budget authority, net (total)			136
4190	Outlays, net (total)		127	136


Identification code 75–0519–0–1–571		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	QIO contracts	147	173	270
0002	QIO support contracts	226	286	108

0900	Total new obligations	373	459	378

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1			69
	Budget authority:
	Spending authority from offsetting collections, mandatory:
1800	Collected	40	528	628
1801	Change in uncollected payments, Federal sources	472

1850	Spending auth from offsetting collections, mand (total)	512	528	628
1930	Total budgetary resources available	512	528	697
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–139
1941	Unexpired unobligated balance, end of year		69	319

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	825	766	697
3010	Obligations incurred, unexpired accounts	373	459	378
3011	Obligations incurred, expired accounts	3
3020	Outlays (gross)	–429	–528	–628
3041	Recoveries of prior year unpaid obligations, expired	–6

3050	Unpaid obligations, end of year	766	697	447
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–999	–1,100	–1,100
3070	Change in uncollected pymts, Fed sources, unexpired	–472
3071	Change in uncollected pymts, Fed sources, expired	371

3090	Uncollected pymts, Fed sources, end of year	–1,100	–1,100	–1,100
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	–174	–334	–403
3200	Obligated balance, end of year	–334	–403	–653

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	512	528	628
	Outlays, gross:
4100	Outlays from new mandatory authority	50	56	207
4101	Outlays from mandatory balances	379	472	421

4110	Outlays, gross (total)	429	528	628
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Baseline Program [Text]	–411	–528	–628
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–472
4142	Offsetting collections credited to expired accounts	371

4150	Additional offsets against budget authority only (total)	–101
4170	Outlays, net (mandatory)	18
4190	Outlays, net (total)	18

Part B of Title XI of the Social Security Act, as amended by the Peer Review Improvement Act of 1982, provides the statutory authority for the Medicare Quality Improvement Organization (QIO) Program. The mission of the program is to promote the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries and to ensure that those services are reasonable and necessary. The program is funded through transfers from the Medicare Hospital Insurance Trust Fund and the Medicare Supplementary Medical Insurance Trust Fund. In FY 2012, a Treasury account specific to the QIO program was established to improve budgetary operations.


Identification code 75–0519–0–1–571		2012 actual	2013 CR	2014 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	20	28	28
25.2	Other services from non-Federal sources	353	342	342
25.3	Other goods and services from Federal sources		89	8

99.9	Total new obligations	373	459	378


Identification code 75–0519–0–1–571		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment	138	174	182

For carrying out, except as otherwise provided, titles XI, XVIII, XIX, and XXI of the Social Security Act, titles XIII and XXVII of the PHS Act, the Clinical Laboratory Improvement Amendments of 1988, and other responsibilities of the Centers for Medicare [and] & Medicaid Services, not to exceed [$4,820,808,000] $5,217,357,000, 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 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 $11,150,000, to remain available through September 30, 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 [2013] 2014 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. Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.


Identification code 75–0511–0–1–550		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Program operations	2,856	2,773	4,034
0002	Federal administration	780	942	866
0003	State survey and certification	386	415	450
0004	Research, demonstrations, and evaluation projects	33	623	56
0006	High-risk pool grants	44	44	22
0007	ARRA Medicare/Medicaid HIT	142	166	140
0008	Consumer Assistance Grants	2	2

0100	Total direct program	4,243	4,965	5,568

0799	Total direct obligations	4,243	4,965	5,568
0801	Clinical laboratory improvement amendments	55	50	50
0802	Sale of data	11	7	7
0803	Coordination of benefits	33	35	35
0804	Medicare advantage/Prescription drug plan	107	70	71
0805	Provider enrollment	2	28	28
0806	Recovery audit contractors	228	310	310
0807	Other reimbursable program activity	35
0808	Marketplace User Fee			450

0809	Reimbursable program activities, subtotal	471	500	951

0899	Total reimbursable obligations	471	500	951

0900	Total new obligations	4,714	5,465	6,519

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	1,349	1,296	525
1001	Discretionary unobligated balance brought fwd, Oct 1	217	195
1021	Recoveries of prior year unpaid obligations	20

1050	Unobligated balance (total)	1,369	1,296	525
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	253	253	253

1260	Appropriations, mandatory (total)	253	253	253
	Spending authority from offsetting collections, discretionary:
1700	Collected	2,024	4,369	5,224
1701	Change in uncollected payments, Federal sources	2,303

1750	Spending auth from offsetting collections, disc (total)	4,327	4,369	5,224
	Spending authority from offsetting collections, mandatory:
1800	Collected	103	72	970
1801	Change in uncollected payments, Federal sources	31

1850	Spending auth from offsetting collections, mand (total)	134	72	970
1900	Budget authority (total)	4,714	4,694	6,447
1930	Total budgetary resources available	6,083	5,990	6,972
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–73
1941	Unexpired unobligated balance, end of year	1,296	525	453

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	2,824	3,436	3,157
3010	Obligations incurred, unexpired accounts	4,714	5,465	6,519
3011	Obligations incurred, expired accounts	133
3020	Outlays (gross)	–4,035	–5,744	–6,519
3040	Recoveries of prior year unpaid obligations, unexpired	–20
3041	Recoveries of prior year unpaid obligations, expired	–180

3050	Unpaid obligations, end of year	3,436	3,157	3,157
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–3,623	–4,251	–4,251
3070	Change in uncollected pymts, Fed sources, unexpired	–2,334
3071	Change in uncollected pymts, Fed sources, expired	1,706

3090	Uncollected pymts, Fed sources, end of year	–4,251	–4,251	–4,251
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	–799	–815	–1,094
3200	Obligated balance, end of year	–815	–1,094	–1,094

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	4,327	4,369	5,224
	Outlays, gross:
4010	Outlays from new discretionary authority	1,935	4,369	5,224
4011	Outlays from discretionary balances	1,726

4020	Outlays, gross (total)	3,661	4,369	5,224
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–3,240	–3,896	–5,217
4033	Non-Federal sources	–356	–473	–7

4040	Offsets against gross budget authority and outlays (total)	–3,596	–4,369	–5,224
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–2,303
4052	Offsetting collections credited to expired accounts	1,572

4060	Additional offsets against budget authority only (total)	–731
4080	Outlays, net (discretionary)	65
	Mandatory:
4090	Budget authority, gross	387	325	1,223
	Outlays, gross:
4100	Outlays from new mandatory authority	9	75	989
4101	Outlays from mandatory balances	365	1,300	306

4110	Outlays, gross (total)	374	1,375	1,295
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–119	–44	–26
4123	Non-Federal sources	–30	–28	–944

4130	Offsets against gross budget authority and outlays (total)	–149	–72	–970
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–31
4142	Offsetting collections credited to expired accounts	46

4150	Additional offsets against budget authority only (total)	15

4160	Budget authority, net (mandatory)	253	253	253
4170	Outlays, net (mandatory)	225	1,303	325
4180	Budget authority, net (total)	253	253	253
4190	Outlays, net (total)	290	1,303	325

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


Identification code 75–0511–0–1–550		2012 actual	2013 CR	2014 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	433	489	487
11.3	Other than full-time permanent	14	12	12
11.5	Other personnel compensation	6	8	8
11.7	Military personnel	9	12	13

11.9	Total personnel compensation	462	521	520
12.1	Civilian personnel benefits	133	133	136
12.2	Military personnel benefits	4	7	6
21.0	Travel and transportation of persons	6	7	7
22.0	Transportation of things	1
23.1	Rental payments to GSA	17	34	35
23.3	Communications, utilities, and miscellaneous charges	62
24.0	Printing and reproduction	30	3	3
25.1	Advisory and assistance services	79	8	8
25.2	Other services from non-Federal sources	2,180	2,586	3,172
25.3	Other goods and services from Federal sources	137	19	11
25.5	Research and development contracts	21	21
25.6	Medical care	808	1,338	1,412
25.7	Operation and maintenance of equipment	151	16	16
26.0	Supplies and materials	2	1	1
31.0	Equipment	28
32.0	Land and structures		11	11
41.0	Grants, subsidies, and contributions	120	260	230
42.0	Insurance claims and indemnities	2

99.0	Direct obligations	4,243	4,965	5,568
99.0	Reimbursable obligations	471	500	951

99.9	Total new obligations	4,714	5,465	6,519


Identification code 75–0511–0–1–550		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment	4,241	4,622	4,511
1001	Direct civilian full-time equivalent employment	156	190	204
1101	Direct military average strength employment	114	124	124
2001	Reimbursable civilian full-time equivalent employment	103	124	124


Identification code 75–0515–0–1–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Grants to States and U.S. territories	8,971	8,939	9,306
0002	Performance bonus payments	352	330	340
0003	Child health quality improvement	39	47	52

0900	Total new obligations (object class 41.0)	9,362	9,316	9,698

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	7,527	860	2,627
1012	Unobligated balance transfers between expired and unexpired accounts	80
1020	Adjustment of unobligated bal brought forward, Oct 1	–34
1021	Recoveries of prior year unpaid obligations	1

1050	Unobligated balance (total)	7,574	860	2,627
	Budget authority:
	Appropriations, discretionary:
1130	Appropriations permanently reduced		–6,368	–3,779

1160	Appropriation, discretionary (total)		–6,368	–3,779
	Appropriations, mandatory:
1200	Appropriation	14,982	17,406	19,147
1200	Appropriation	45	45
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–6,368

1260	Appropriations, mandatory (total)	8,659	17,451	19,147
1900	Budget authority (total)	8,659	11,083	15,368
1930	Total budgetary resources available	16,233	11,943	17,995
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–6,011
1941	Unexpired unobligated balance, end of year	860	2,627	8,297

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	7,106	6,474	5,893
3010	Obligations incurred, unexpired accounts	9,362	9,316	9,698
3011	Obligations incurred, expired accounts	215
3020	Outlays (gross)	–9,065	–9,897	–9,992
3040	Recoveries of prior year unpaid obligations, unexpired	–1
3041	Recoveries of prior year unpaid obligations, expired	–1,143

3050	Unpaid obligations, end of year	6,474	5,893	5,599
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	7,106	6,474	5,893
3200	Obligated balance, end of year	6,474	5,893	5,599

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross		–6,368	–3,779
	Mandatory:
4090	Budget authority, gross	8,659	17,451	19,147
	Outlays, gross:
4100	Outlays from new mandatory authority	3,073	2,045	1,500
4101	Outlays from mandatory balances	5,992	7,852	8,492

4110	Outlays, gross (total)	9,065	9,897	9,992
4180	Budget authority, net (total)	8,659	11,083	15,368
4190	Outlays, net (total)	9,065	9,897	9,992

The Balanced Budget Act of 1997 established the Children's Health Insurance Program (CHIP) under Title XXI of the Social Security Act. Title XXI provides Federal matching funds to States to enable them to extend coverage to uninsured children from low-income families. States are able to use Title XXI funds for obtaining health benefit coverage for uninsured children through a separate CHIP program, a CHIP Medicaid expansion program, or a combination of both. The Children's Health Insurance Program Reauthorization Act of 2009 (P.L. 111–3, CHIPRA) reauthorized the CHIP program and appropriated funding for CHIP through 2013. CHIPRA made some modifications to the program including increased funding for States and territories, bonus payments for States that exceed Medicaid child enrollment targets, and support for child health quality and outreach activities. A contingency fund to assist States who project spending above their available allocated CHIP funds was also created by CHIPRA and funding is included in a separate account. The Patient Protection and Affordable Care Act of 2010 (P.L. 111–148) extended funding for CHIP, providing appropriations through 2015.


Identification code 75–0522–0–1–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Administration	71	151	155
0002	Innovation Activities	713	1,162	1,257

0900	Total new obligations	784	1,313	1,412

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	9,910	9,129	7,816
1021	Recoveries of prior year unpaid obligations	3

1050	Unobligated balance (total)	9,913	9,129	7,816
1930	Total budgetary resources available	9,913	9,129	7,816
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	9,129	7,816	6,404

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	84	647	967
3010	Obligations incurred, unexpired accounts	784	1,313	1,412
3020	Outlays (gross)	–218	–993	–1,339
3040	Recoveries of prior year unpaid obligations, unexpired	–3

3050	Unpaid obligations, end of year	647	967	1,040
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	84	647	967
3200	Obligated balance, end of year	647	967	1,040

	Budget authority and outlays, net:
	Mandatory:
	Outlays, gross:
4101	Outlays from mandatory balances	218	993	1,339
4190	Outlays, net (total)	218	993	1,339

The Center for Medicare and Medicaid Innovation ("Innovation Center") was established by section 1115A of the Social Security Act (as added by section 3021 of the Affordable Care Act). The Innovation Center is tasked with testing innovative payment and service delivery models to reduce program expenditures while preserving or enhancing the quality of care provided to individuals under Medicare, Medicaid, or Children's Health Insurance Program (CHIP). The statute provides $10 billion in mandatory funding for these purposes in fiscal year 2011 through 2019.


Identification code 75–0522–0–1–551		2012 actual	2013 CR	2014 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	17	47	51
12.1	Civilian personnel benefits	5	13	14
25.2	Other services from non-Federal sources	713	1,162	1,257
25.3	Other goods and services from Federal sources	49	91	90

99.9	Total new obligations	784	1,313	1,412


Identification code 75–0522–0–1–551		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment	163	309	347


Identification code 75–5551–0–2–551		2012 actual	2013 CR	2014 est.

0100	Balance, start of year
	Receipts:
0240	Interest, Child Enrollment Contingency Fund		3	4

0400	Total: Balances and collections		3	4
	Appropriations:
0500	Child Enrollment Contingency Fund		–3	–4

0799	Balance, end of year


Identification code 75–5551–0–2–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Grants to States and US Territories	1	100	100

0900	Total new obligations (object class 41.0)	1	100	100

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	2,093	2,092	1,995
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)		3	4

1260	Appropriations, mandatory (total)		3	4
1930	Total budgetary resources available	2,093	2,095	1,999
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	2,092	1,995	1,899

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	25	26	1
3010	Obligations incurred, unexpired accounts	1	100	100
3020	Outlays (gross)		–125	–100

3050	Unpaid obligations, end of year	26	1	1
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	25	26	1
3200	Obligated balance, end of year	26	1	1

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross		3	4
	Outlays, gross:
4101	Outlays from mandatory balances		125	100
4180	Budget authority, net (total)		3	4
4190	Outlays, net (total)		125	100

	Memorandum (non-add) entries:
5000	Total investments, SOY: Federal securities: Par value	2,093	2,096	1,996
5001	Total investments, EOY: Federal securities: Par value	2,096	1,996	1,899

The Children's Health Insurance Program Reauthorization Act of 2009 (P.L. 111–3, CHIPRA) established the Child Enrollment Contingency Fund under Title XXI of the Social Security Act. Beginning in 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 (P.L. 111–148) extended the contingency fund through 2015.

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


Identification code 75–0508–0–1–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0801	Incentive payments to hospitals	2,560	2,920	2,670
0802	Incentive payments to eligible professionals	1,620	1,640	2,790

0900	Total new obligations (object class 42.0)	4,180	4,560	5,460

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	1,659	1,070	1,070
	Budget authority:
	Spending authority from offsetting collections, mandatory:
1800	Collected from the HI Trust Fund	2,111	2,920	2,670
1800	Collected from the SMI Trust Fund	1,421	1,640	2,790
1801	Change in uncollected payments, Federal sources	59

1850	Spending auth from offsetting collections, mand (total)	3,591	4,560	5,460
1930	Total budgetary resources available	5,250	5,630	6,530
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	1,070	1,070	1,070

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	90	448	448
3010	Obligations incurred, unexpired accounts	4,180	4,560	5,460
3020	Outlays (gross)	–3,822	–4,560	–5,460

3050	Unpaid obligations, end of year	448	448	448
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–1,839	–1,898	–1,898
3070	Change in uncollected pymts, Fed sources, unexpired	–59

3090	Uncollected pymts, Fed sources, end of year	–1,898	–1,898	–1,898
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	–1,749	–1,450	–1,450
3200	Obligated balance, end of year	–1,450	–1,450	–1,450

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	3,591	4,560	5,460
	Outlays, gross:
4100	Outlays from new mandatory authority	2,164	4,114	5,460
4101	Outlays from mandatory balances	1,658	446

4110	Outlays, gross (total)	3,822	4,560	5,460
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–3,532	–4,560	–5,460
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–59
4170	Outlays, net (mandatory)	290
4190	Outlays, net (total)	290


Identification code 75–0112–0–1–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Premium rate review grants	8	90

0900	Total new obligations (object class 41.0)	8	90

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	91	90
1021	Recoveries of prior year unpaid obligations	7

1050	Unobligated balance (total)	98	90
1930	Total budgetary resources available	98	90
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	90

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	147	126	116
3010	Obligations incurred, unexpired accounts	8	90
3020	Outlays (gross)	–22	–100	–80
3040	Recoveries of prior year unpaid obligations, unexpired	–7

3050	Unpaid obligations, end of year	126	116	36
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	147	126	116
3200	Obligated balance, end of year	126	116	36

	Budget authority and outlays, net:
	Mandatory:
	Outlays, gross:
4101	Outlays from mandatory balances	22	100	80
4190	Outlays, net (total)	22	100	80

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


Identification code 75–0113–0–1–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Direct program activity	2,131	1,520	312
0801	Premiums from Fallback States	98	199	46

0900	Total new obligations	2,229	1,719	358

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	3,961	1,832	312
1021	Recoveries of prior year unpaid obligations	2

1050	Unobligated balance (total)	3,963	1,832	312
	Budget authority:
	Spending authority from offsetting collections, mandatory:
1800	Collected	98	199	46

1850	Spending auth from offsetting collections, mand (total)	98	199	46
1900	Budget authority (total)	98	199	46
1930	Total budgetary resources available	4,061	2,031	358
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	1,832	312

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	633	1,261	625
3010	Obligations incurred, unexpired accounts	2,229	1,719	358
3020	Outlays (gross)	–1,599	–2,355	–983
3040	Recoveries of prior year unpaid obligations, unexpired	–2

3050	Unpaid obligations, end of year	1,261	625
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	633	1,261	625
3200	Obligated balance, end of year	1,261	625

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	98	199	46
	Outlays, gross:
4100	Outlays from new mandatory authority	63	199	46
4101	Outlays from mandatory balances	1,536	2,156	937

4110	Outlays, gross (total)	1,599	2,355	983
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–98	–199	–46
4190	Outlays, net (total)	1,501	2,156	937

This account funds the Pre-Existing Condition Insurance Plan Program (PCIP), which makes health insurance available to people who have been unable to get insurance due to a pre-existing condition. Enrollees pay monthly premiums similar to those charged in the commercial individual market, and the Federal government pays for remaining costs that exceed enrollee contributions. The funding for this program, including operating costs, was provided in the FY 2010 appropriation by the Affordable Care Act (P.L. 111–148). The FY 2014 President's Budget obligation and outlays projections are based on policy assumptions to manage costs in the program to the $5 billion appropriation and continue coverage for current enrollees.


Identification code 75–0113–0–1–551		2012 actual	2013 CR	2014 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	4	5	5
25.2	Other services from non-Federal sources	28	21	21
41.0	Grants, subsidies, and contributions	2,099	1,494	286

99.0	Direct obligations	2,131	1,520	312
99.0	Reimbursable obligations	98	199	46

99.9	Total new obligations	2,229	1,719	358


Identification code 75–0113–0–1–551		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment	18	16	16


Identification code 75–0114–0–1–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Subsidies for early retirees	1,907	41
0002	Administration	27	24	8

0799	Total direct obligations	1,934	65	8
0801	Reimbursable program activity	24	75

0900	Total new obligations	1,958	140	8

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	1,998	74	9
1021	Recoveries of prior year unpaid obligations	10

1050	Unobligated balance (total)	2,008	74	9
	Budget authority:
	Spending authority from offsetting collections, mandatory:
1800	Collected	24	75

1850	Spending auth from offsetting collections, mand (total)	24	75
1900	Budget authority (total)	24	75
1930	Total budgetary resources available	2,032	149	9
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	74	9	1

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	26	24	17
3010	Obligations incurred, unexpired accounts	1,958	140	8
3020	Outlays (gross)	–1,950	–147	–23
3040	Recoveries of prior year unpaid obligations, unexpired	–10

3050	Unpaid obligations, end of year	24	17	2
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	26	24	17
3200	Obligated balance, end of year	24	17	2

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	24	75
	Outlays, gross:
4100	Outlays from new mandatory authority		75
4101	Outlays from mandatory balances	1,950	72	23

4110	Outlays, gross (total)	1,950	147	23
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–24	–75
4190	Outlays, net (total)	1,926	72	23

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


Identification code 75–0114–0–1–551		2012 actual	2013 CR	2014 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	1	1	1
25.2	Other services from non-Federal sources	26	23	7
42.0	Insurance claims and indemnities	1,907	41

99.0	Direct obligations	1,934	65	8
99.0	Reimbursable obligations	24	75

99.9	Total new obligations	1,958	140	8


Identification code 75–0114–0–1–551		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment	4	12	12


Identification code 75–0115–0–1–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Planning and establishment grants	1,626	2,700	1,292
0002	Administration	29	51	51

0900	Total new obligations	1,655	2,751	1,343

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	1,655	2,751	1,343

1260	Appropriations, mandatory (total)	1,655	2,751	1,343
1930	Total budgetary resources available	1,655	2,751	1,343

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	503	1,900	3,194
3010	Obligations incurred, unexpired accounts	1,655	2,751	1,343
3020	Outlays (gross)	–167	–1,457	–2,061
3041	Recoveries of prior year unpaid obligations, expired	–91

3050	Unpaid obligations, end of year	1,900	3,194	2,476
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	503	1,900	3,194
3200	Obligated balance, end of year	1,900	3,194	2,476

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	1,655	2,751	1,343
	Outlays, gross:
4100	Outlays from new mandatory authority	37	275	134
4101	Outlays from mandatory balances	130	1,182	1,927

4110	Outlays, gross (total)	167	1,457	2,061
4180	Budget authority, net (total)	1,655	2,751	1,343
4190	Outlays, net (total)	167	1,457	2,061

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


Identification code 75–0115–0–1–551		2012 actual	2013 CR	2014 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	8	8	8
25.2	Other services from non-Federal sources	21	43	43
41.0	Grants, subsidies, and contributions	1,626	2,700	1,292

99.9	Total new obligations	1,655	2,751	1,343


Identification code 75–0115–0–1–551		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment	44	62	63

For carrying out, except as otherwise provided, sections 1402 and 1412 of the Patient Protection and Affordable Care Act (Public Law 111–148), such sums as necessary.

For carrying out, except as otherwise provided, such sections in the first quarter of fiscal year 2015 (including upward adjustments to prior year payments), $1,420,000,000.


Identification code 75–0126–0–1–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Benefit payments			3,978

0900	Total new obligations (object class 42.0)			3,978

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			3,978

1260	Appropriations, mandatory (total)			3,978
1930	Total budgetary resources available			3,978

	Change in obligated balance:
	Unpaid obligations:
3010	Obligations incurred, unexpired accounts			3,978
3020	Outlays (gross)			–3,978

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			3,978
	Outlays, gross:
4100	Outlays from new mandatory authority			3,978
4180	Budget authority, net (total)			3,978
4190	Outlays, net (total)			3,978

Section 1402 of the Patient Protection and Affordable Care Act (P.L. 111–148) provides for reductions in cost sharing for certain individuals enrolled in qualified health plans purchased on the Exchanges, and section 1412 of the Patient Protection and Affordable Care Act (P.L. 111–148) provides for the advance payment of these reductions to issuers. This assistance helps eligible low- and moderate-income qualified individuals and families afford the out-of-pocket spending associated with health care services provided through Exchange-based qualified health plan coverage.


Identification code 75–0524–0–1–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
	Credit program obligations:
0701	Direct loan subsidy		68
0709	Administrative expenses		17	17

0900	Total new obligations		85	17

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1			168
1011	Unobligated balance transfer from other accts [75–0118]		253

1050	Unobligated balance (total)		253	168
1930	Total budgetary resources available		253	168
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year		168	151

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1			55
3010	Obligations incurred, unexpired accounts		85	17
3020	Outlays (gross)		–30	–55

3050	Unpaid obligations, end of year		55	17
	Memorandum (non-add) entries:
3100	Obligated balance, start of year			55
3200	Obligated balance, end of year		55	17

	Budget authority and outlays, net:
	Mandatory:
	Outlays, gross:
4101	Outlays from mandatory balances		30	55
4190	Outlays, net (total)		30	55

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


Identification code 75–0524–0–1–551		2012 actual	2013 CR	2014 est.

	Direct loan levels supportable by subsidy budget authority:
115001	Contingency Fund Loans		180

115999	Total direct loan levels		180
	Direct loan subsidy (in percent):
132001	Contingency Fund Loans		37.66	0.00

132999	Weighted average subsidy rate		37.66	0.00
	Direct loan subsidy budget authority:
133001	Contingency Fund Loans		68

133999	Total subsidy budget authority		68
	Direct loan subsidy outlays:
134001	Contingency Fund Loans		25	39

134999	Total subsidy outlays		25	39
	Direct loan downward reestimates:

	Administrative expense data:
3580	Outlays from balances		5	16

The Consumer Operated and Oriented Plan Contingency Fund was established by the American Taxpayer Relief Act of 2012 (P.L. 112–240). This fund provides assistance and oversight to qualified nonprofit health insurance issuers that have been awarded loans or grants under section 1322 of the Affordable Care Act (P.L. 111–148).


Identification code 75–0524–0–1–551		2012 actual	2013 CR	2014 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent		5	5
25.2	Other services from non-Federal sources		12	12
41.0	Grants, subsidies, and contributions		68

99.9	Total new obligations		85	17


Identification code 75–0524–0–1–551		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment		25	22


Identification code 75–0118–0–1–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
	Credit program obligations:
0701	Direct loan subsidy	726	122
0703	Subsidy for modifications of direct loans		5
0705	Reestimates of direct loan subsidy		3
0709	Administrative expenses	12	1

0900	Total new obligations	738	131

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	3,797	2,659
1010	Unobligated balance transfer to other accts [75–0524]		–253

1050	Unobligated balance (total)	3,797	2,406
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation		3
1230	Appropriations and/or unobligated balance of appropriations permanently reduced	–400	–2,278

1260	Appropriations, mandatory (total)	–400	–2,275
1930	Total budgetary resources available	3,397	131
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	2,659

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	3	703	580
3010	Obligations incurred, unexpired accounts	738	131
3020	Outlays (gross)	–38	–254	–175

3050	Unpaid obligations, end of year	703	580	405
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	3	703	580
3200	Obligated balance, end of year	703	580	405

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	–400	–2,275
	Outlays, gross:
4101	Outlays from mandatory balances	38	254	175
4180	Budget authority, net (total)	–400	–2,275
4190	Outlays, net (total)	38	254	175

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


Identification code 75–0118–0–1–551		2012 actual	2013 CR	2014 est.

	Direct loan levels supportable by subsidy budget authority:
115002	Startup Loans	281	38
115003	Solvency	1,410	257

115999	Total direct loan levels	1,691	295
	Direct loan subsidy (in percent):
132002	Startup Loans	37.51	37.66	0.00
132003	Solvency	43.99	41.90	0.00

132999	Weighted average subsidy rate	42.91	41.35	0.00
	Direct loan subsidy budget authority:
133002	Startup Loans	105	14
133003	Solvency	620	108

133999	Total subsidy budget authority	725	122
	Direct loan subsidy outlays:
134002	Startup Loans	34	65	19
134003	Solvency		176	155

134999	Total subsidy outlays	34	241	174
	Direct loan upward reestimates:
135002	Startup Loans		3

135999	Total upward reestimate budget authority		3
	Direct loan downward reestimates:

	Administrative expense data:
3510	Budget authority	12	1
3580	Outlays from balances	4	10	1

Section 1322 of the Affordable Care Act (P.L. 111–148) authorized and appropriated funding for the Consumer Operated and Oriented Plan (CO-OP) Program. 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.

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


Identification code 75–0118–0–1–551		2012 actual	2013 CR	2014 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	1
25.2	Other services from non-Federal sources	11	1
41.0	Grants, subsidies, and contributions	726	130

99.9	Total new obligations	738	131


Identification code 75–0118–0–1–551		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment	6


Identification code 75–4418–0–3–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
	Credit program obligations:
0710	Direct loan obligations	1,691	295
0713	Payment of interest to Treasury	4	14	18

0900	Total new obligations	1,695	309	18

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		2,228
1020	Adjustment of unobligated bal brought forward, Oct 1		–2,228
	Financing authority:
	Borrowing authority, mandatory:
1400	Borrowing authority	3,194	182	18

1440	Borrowing authority, mandatory (total)	3,194	182	18
	Spending authority from offsetting collections, mandatory:
1800	Collected	37	244	174
1801	Change in uncollected payments, Federal sources	692	–114	–174
1825	Spending authority from offsetting collections applied to repay debt		–3

1850	Spending auth from offsetting collections, mand (total)	729	127
1900	Financing authority (total)	3,923	309	18
1930	Total budgetary resources available	3,923	309	18
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	2,228

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1		1,601	1,326
3010	Obligations incurred, unexpired accounts	1,695	309	18
3020	Financing disbursements (gross)	–94	–584	–422

3050	Unpaid obligations, end of year	1,601	1,326	922
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1		–692	–578
3070	Change in uncollected pymts, Fed sources, unexpired	–692	114	174

3090	Uncollected pymts, Fed sources, end of year	–692	–578	–404
	Memorandum (non-add) entries:
3100	Obligated balance, start of year		909	748
3200	Obligated balance, end of year	909	748	518

	Financing authority and disbursements, net:
	Mandatory:
4090	Financing authority, gross	3,923	309	18
	Financing disbursements:
4110	Financing disbursements, gross	94	584	422
	Offsets against gross financing authority and disbursements:
	Offsetting collections (collected) from:
4120	Federal sources	–34	–244	–174
4122	Interest on uninvested funds	–3

4130	Offsets against gross financing auth and disbursements (total)	–37	–244	–174
	Additional offsets against financing authority only (total):
4140	Change in uncollected pymts, Fed sources, unexpired	–692	114	174

4160	Financing authority, net (mandatory)	3,194	179	18
4170	Financing disbursements, net (mandatory)	57	340	248
4180	Financing authority, net (total)	3,194	179	18
4190	Financing disbursements, net (total)	57	340	248


Identification code 75–4418–0–3–551		2012 actual	2013 CR	2014 est.

	Position with respect to appropriations act limitation on obligations:
1131	Direct loan obligations exempt from limitation	1,691	295

1150	Total direct loan obligations	1,691	295

	Cumulative balance of direct loans outstanding:
1210	Outstanding, start of year		90	660
1231	Disbursements: Direct loan disbursements	90	570	404
1251	Repayments: Repayments and prepayments
1263	Write-offs for default: Direct loans

1290	Outstanding, end of year	90	660	1,064

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.


Identification code 75–4418–0–3–551		2011 actual	2012 actual

	Group heading

	ASSETS:
	Net value of assets related to post-1991 direct loans receivable:
1401	Direct loans receivable, gross		90
1405	Allowance for subsidy cost (-)		–34

1499	Net present value of assets related to direct loans		56

1999	Total assets		56
	LIABILITIES:
2103	Federal liabilities: Debt		56

4999	Total liabilities and net position		56


Identification code 75–4482–0–3–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
	Credit program obligations:
0710	Direct loan obligations		180
0713	Payment of interest to Treasury		1	2

0900	Total new obligations		181	2

	Budgetary Resources:
	Financing authority:
	Borrowing authority, mandatory:
1400	Borrowing authority		113	2

1440	Borrowing authority, mandatory (total)		113	2
	Spending authority from offsetting collections, mandatory:
1800	Collected		25	39
1801	Change in uncollected payments, Federal sources		43	–39

1850	Spending auth from offsetting collections, mand (total)		68
1900	Financing authority (total)		181	2
1930	Total budgetary resources available		181	2

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1			114
3010	Obligations incurred, unexpired accounts		181	2
3020	Financing disbursements (gross)		–67	–106

3050	Unpaid obligations, end of year		114	10
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1			–43
3070	Change in uncollected pymts, Fed sources, unexpired		–43	39

3090	Uncollected pymts, Fed sources, end of year		–43	–4
	Memorandum (non-add) entries:
3100	Obligated balance, start of year			71
3200	Obligated balance, end of year		71	6

	Financing authority and disbursements, net:
	Mandatory:
4090	Financing authority, gross		181	2
	Financing disbursements:
4110	Financing disbursements, gross		67	106
	Offsets against gross financing authority and disbursements:
	Offsetting collections (collected) from:
4120	Federal sources		–25	–39
	Additional offsets against financing authority only (total):
4140	Change in uncollected pymts, Fed sources, unexpired		–43	39

4160	Financing authority, net (mandatory)		113	2
4170	Financing disbursements, net (mandatory)		42	67
4180	Financing authority, net (total)		113	2
4190	Financing disbursements, net (total)		42	67


Identification code 75–4482–0–3–551		2012 actual	2013 CR	2014 est.

	Position with respect to appropriations act limitation on obligations:
1131	Direct loan obligations exempt from limitation		180

1150	Total direct loan obligations		180

	Cumulative balance of direct loans outstanding:
1210	Outstanding, start of year			66
1231	Disbursements: Direct loan disbursements		66	104
1251	Repayments: Repayments and prepayments
1263	Write-offs for default: Direct loans

1290	Outstanding, end of year		66	170

As required by the Federal Credit Reform Act of 1990, this non-budgetary account records all cash flows to and from the federal treasury 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 only and are not included in the budget totals.

Trust Funds


Identification code 75–8005–0–7–571		2012 actual	2013 CR	2014 est.

0100	Balance, start of year	212,203	203,744	175,265
	Adjustments:
0190	Adjustment - rounding issues over several years.	2
0191	Adjustment - HCFAC - Small Jobs Act	100

0199	Balance, start of year	212,305	203,744	175,265
	Receipts:
0200	FHI Trust Fund, Transfers from General Fund (FICA Taxes)	186,773	191,684	205,563
0201	FHI Trust Fund, Transfers from General Fund (FICA Taxes)		7	224
0202	FHI Trust Fund, Receipts from Railroad Retirement Board	484	508	546
0203	FHI Trust Fund, Transfers from General Fund (SECA Taxes)	13,886	16,220	17,465
0204	FHI Trust Fund, Civil Penalties and Damages	602	675	663
0220	FHI Trust Fund, Other Proprietary Interest from the Public	3	2	2
0221	FHI Trust Fund, Basic Premium, Medicare Advantage	234	258	248
0222	FHI Trust Fund, Basic Premium, Medicare Advantage			5
0223	FHI Trust Fund, Medicare Refunds	7,115	5,800	6,000
0224	FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible	3,400	3,529	3,507
0240	FHI Trust Fund, Federal Employer Contributions (FICA)	3,510	3,586	3,690
0241	FHI Trust Fund, Postal Service Employer Contributions (FICA)	583	595	623
0242	FHI Trust Fund, Interest Received by Trust Funds	11,270	9,972	8,787
0243	FHI Trust Fund, Taxation on OASDI Benefits	18,643	14,387	18,877
0244	FHI Trust Fund, Payment from the General Fund for Health Care Fraud and Abuse Control Account	132	135	138
0245	FHI Trust Fund, Transfers from General Fund (criminal Fines)	1,389	1,126	1,141
0246	FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)	16	22	23
0247	FHI Trust Fund, Transfers from General Fund (asset Forfeitures)	20	23	23
0248	FHI Trust Fund, Interest Payments by Railroad Retirement Board	27	25	27
0249	FHI Trust Fund, Payments from the General Fund (uninsured and Program Management)	657	1,105	1,652
0250	FHI Trust Fund, Payments from the General Fund (uninsured and Program Management)		127	136

0299	Total receipts and collections	248,744	249,786	269,340

0400	Total: Balances and collections	461,049	453,530	444,605
	Appropriations:
0500	Federal Hospital Insurance Trust Fund	–2,441	–2,573	–3,954
0501	Federal Hospital Insurance Trust Fund	5
0502	Federal Hospital Insurance Trust Fund	–244,733	–245,479	–263,389
0503	Federal Hospital Insurance Trust Fund	–8,646	–28,828	–15,596
0504	Federal Hospital Insurance Trust Fund		–600	–821
0505	Federal Hospital Insurance Trust Fund		600	821
0506	Federal Hospital Insurance Trust Fund		303	329
0507	Federal Hospital Insurance Trust Fund		–303	–329
0508	Federal Hospital Insurance Trust Fund			324
0509	Federal Hospital Insurance Trust Fund			–806
0510	Health Care Fraud and Abuse Control Account	–310	–312	–311
0511	Health Care Fraud and Abuse Control Account	–1,290	–1,243	–1,219
0512	Health Care Fraud and Abuse Control Account		473	685
0513	Health Care Fraud and Abuse Control Account		–303	–329

0599	Total appropriations	–257,415	–278,265	–284,595
0610	Federal Hospital Insurance Trust Fund	1
0611	Health Care Fraud and Abuse Control Account	26
0620	Federal Hospital Insurance Trust Fund	83

0799	Balance, end of year	203,744	175,265	160,010


Identification code 75–8005–0–7–571		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Benefit payments, HI	251,139	270,814	275,461
0002	HIT Incentive Payments	2,135	2,920	2,670
0003	Administration, HI	2,612	2,773	4,180
0004	Quality improvement organizations, HI	419	367	628

0900	Total new obligations	256,305	276,874	282,939

	Budgetary Resources:
	Unobligated balance:
1021	Recoveries of prior year unpaid obligations	436
1026	Adjustment for change in allocation of trust fund limitation or foreign exchange valuation	–83
1029	Other balances withdrawn	–1

1050	Unobligated balance (total)	352
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust fund)	2,441	2,573	3,954
1130	Appropriations permanently reduced		–6
1132	Appropriations temporarily reduced	–5

1160	Appropriation, discretionary (total)	2,436	2,567	3,954
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	244,733	245,479	263,389
1203	Appropriation (previously unavailable)	8,646	28,828	15,596

1260	Appropriations, mandatory (total)	253,379	274,307	278,985
	Spending authority from offsetting collections, mandatory:
1800	Collected	138

1850	Spending auth from offsetting collections, mand (total)	138
1900	Budget authority (total)	255,953	276,874	282,939
1930	Total budgetary resources available	256,305	276,874	282,939
	Memorandum (non-add) entries:
	Special and non-revolving trust funds:
1950	Other balances withdrawn	1

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	32,195	24,209	24,178
3010	Obligations incurred, unexpired accounts	256,305	276,874	282,939
3020	Outlays (gross)	–263,855	–276,905	–282,186
3040	Recoveries of prior year unpaid obligations, unexpired	–436

3050	Unpaid obligations, end of year	24,209	24,178	24,931
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–1	–1	–1

3090	Uncollected pymts, Fed sources, end of year	–1	–1	–1
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	32,194	24,208	24,177
3200	Obligated balance, end of year	24,208	24,177	24,930

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	2,436	2,567	3,954
	Outlays, gross:
4010	Outlays from new discretionary authority	1,619	1,936	2,694
4011	Outlays from discretionary balances	365	540	585

4020	Outlays, gross (total)	1,984	2,476	3,279
	Mandatory:
4090	Budget authority, gross	253,517	274,307	278,985
	Outlays, gross:
4100	Outlays from new mandatory authority	232,676	251,666	252,523
4101	Outlays from mandatory balances	29,195	22,763	26,384

4110	Outlays, gross (total)	261,871	274,429	278,907
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–138
4180	Budget authority, net (total)	255,815	276,874	282,939
4190	Outlays, net (total)	263,717	276,905	282,186

	Memorandum (non-add) entries:
5000	Total investments, SOY: Federal securities: Par value	245,939	228,292	199,923
5001	Total investments, EOY: Federal securities: Par value	228,292	199,923	185,039


		2012 actual	2013 CR	2014 est.

Enacted/requested:
	Budget Authority	255,815	276,874	282,939
	Outlays	263,717	276,905	282,186
Amounts included in the adjusted baseline:
	Budget Authority			482
	Outlays			482
Total:
	Budget Authority	255,815	276,874	283,421
	Outlays	263,717	276,905	282,668

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

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


Identification code 75–8005–0–7–571		2012 actual	2013 CR	2014 est.

	Unexpended balance, start of year:
0100	Balance, start of year	245,698	229,337	200,668
	Adjustments:
0190	Adjustment - HCFAC - Small Jobs Act	100

0199	Total balance, start of year	245,798	229,337	200,668
	Cash income during the year:
	Current law:
	Receipts:
1200	FHI Trust Fund, Transfers from General Fund (FICA Taxes)	186,773	191,684	205,563
1202	FHI Trust Fund, Receipts from Railroad Retirement Board	484	508	546
1203	FHI Trust Fund, Transfers from General Fund (SECA Taxes)	13,886	16,220	17,465
1204	FHI Trust Fund, Civil Penalties and Damages	602	675	663
	Offsetting receipts (proprietary):
1220	FHI Trust Fund, Other Proprietary Interest from the Public	3	2	2
1221	FHI Trust Fund, Basic Premium, Medicare Advantage	234	258	248
1222	FHI Trust Fund, Basic Premium, Medicare Advantage			5
1223	FHI Trust Fund, Medicare Refunds	7,115	5,800	6,000
1224	FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible	3,400	3,529	3,507
	Offsetting receipts (intragovernmental):
1240	FHI Trust Fund, Federal Employer Contributions (FICA)	3,510	3,586	3,690
1241	FHI Trust Fund, Postal Service Employer Contributions (FICA)	583	595	623
1242	FHI Trust Fund, Interest Received by Trust Funds	11,270	9,972	8,787
1243	FHI Trust Fund, Taxation on OASDI Benefits	18,643	14,387	18,877
1244	FHI Trust Fund, Payment from the General Fund for Health Care Fraud and Abuse Control Account	132	135	138
1245	FHI Trust Fund, Transfers from General Fund (criminal Fines)	1,389	1,126	1,141
1246	FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)	16	22	23
1247	FHI Trust Fund, Transfers from General Fund (asset Forfeitures)	20	23	23
1248	FHI Trust Fund, Interest Payments by Railroad Retirement Board	27	25	27
1249	FHI Trust Fund, Payments from the General Fund (uninsured and Program Management)	657	1,105	1,652
	Offsetting collections:
1280	Federal Hospital Insurance Trust Fund	138
1299	Income under present law	248,882	249,652	268,980
	Proposed legislation:
	Receipts:
2201	FHI Trust Fund, Transfers from General Fund (FICA Taxes)		7	224
	Offsetting receipts (intragovernmental):
2250	FHI Trust Fund, Payments from the General Fund (uninsured and Program Management)		127	136
2299	Income under proposed legislation		134	360

3299	Total cash income	248,882	249,786	269,340
	Cash outgo during year:
	Current law:
4500	Federal Hospital Insurance Trust Fund	–263,855	–276,905	–282,186
4500	Health Care Fraud and Abuse Control Account	–1,488	–1,714	–1,614
4500	Federal Hospital Insurance Trust Fund			–482
4599	Outgo under current law (-)	–265,343	–278,619	–284,282
	Proposed legislation:
5500	Health Care Fraud and Abuse Control Account		–303	–329
5500	Health Care Fraud and Abuse Control Account		473	685
5599	Outgo under proposed legislation (-)		170	356

6599	Total cash outgo (-)	–265,343	–278,449	–283,926
7625	Federal Hospital Insurance Trust Fund		–6

7699	Total adjustments		–6
	Unexpended balance, end of year:
8700	Uninvested balance (net), end of year	1,045	745	1,043
8701	Federal Hospital Insurance Trust Fund	228,292	199,923	185,039

8799	Total balance, end of year	229,337	200,668	186,082


Identification code 75–8005–0–7–571		2012 actual	2013 CR	2014 est.

	Direct obligations:
41.0	Payment for Quality Improvement Organization (QIO) activities	419	367	628
42.0	Insurance claims and indemnities (benefits)	253,274	273,734	278,131
94.0	Financial transfers	2,612	2,773	4,180

99.9	Total new obligations	256,305	276,874	282,939


Identification code 75–8005–7–7–571		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Benefit payments, HI			482

0900	Total new obligations (object class 42.0)			482

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)			–324
1203	Appropriation (previously unavailable)			806

1260	Appropriations, mandatory (total)			482
1900	Budget authority (total)			482
1930	Total budgetary resources available			482

	Change in obligated balance:
	Unpaid obligations:
3010	Obligations incurred, unexpired accounts			482
3020	Outlays (gross)			–482

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			482
	Outlays, gross:
4100	Outlays from new mandatory authority			482
4180	Budget authority, net (total)			482
4190	Outlays, net (total)			482


Identification code 75–8005–2–7–571		2012 actual	2013 CR	2014 est.

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)		600	821
1203	Appropriation (previously unavailable)		–600	–821


Identification code 75–8005–4–7–571		2012 actual	2013 CR	2014 est.

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)		–303	–329
1203	Appropriation (previously unavailable)		303	329

In addition to amounts otherwise available for program integrity and program management, [$610,000,000]$311,000,000, to remain available through September 30, [2014]2015, 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 [$409,697,693]$251,420,650 shall be for 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 and the Medicare Prescription Drug Program authorized in title XVIII of the Social Security Act and for activities described in section 1893 of such Act and for Medicaid and Children's Health Insurance Program ("CHIP") program integrity activities, of which [$102,499,971]$29,789,675 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, and of which [$97,802,336]$29,789,675 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 [2013]2014 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. Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.


Identification code 75–8393–0–7–571		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Medicare integrity program	854	864	882
0002	FBI fraud and abuse control	131	135	138
0003	Other fraud and abuse control	323	295	300
0004	Predictive Modeling	39	30	3

0091	Total Mandatory	1,347	1,324	1,323
0101	CMS discretionary	269	252	251
0102	Other discretionary	78	60	60

0191	Total Discretionary	347	312	311

0900	Total new obligations	1,694	1,636	1,634

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	241	185	104
1001	Discretionary unobligated balance brought fwd, Oct 1	74	55
1021	Recoveries of prior year unpaid obligations	41

1050	Unobligated balance (total)	282	185	104
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust fund)	310	312	311

1160	Appropriation, discretionary (total)	310	312	311
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	1,290	1,243	1,219

1260	Appropriations, mandatory (total)	1,290	1,243	1,219
1900	Budget authority (total)	1,600	1,555	1,530
1930	Total budgetary resources available	1,882	1,740	1,634
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–3
1941	Unexpired unobligated balance, end of year	185	104
	Special and non-revolving trust funds:
1951	Unobligated balance expiring	3
1952	Expired unobligated balance, start of year	41	44	44
1953	Expired unobligated balance, end of year	41	44	44
1954	Unobligated balance canceling	26

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1,018	1,157	1,079
3010	Obligations incurred, unexpired accounts	1,694	1,636	1,634
3011	Obligations incurred, expired accounts	1
3020	Outlays (gross)	–1,488	–1,714	–1,614
3040	Recoveries of prior year unpaid obligations, unexpired	–41
3041	Recoveries of prior year unpaid obligations, expired	–27

3050	Unpaid obligations, end of year	1,157	1,079	1,099
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1,018	1,157	1,079
3200	Obligated balance, end of year	1,157	1,079	1,099

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	310	312	311
	Outlays, gross:
4010	Outlays from new discretionary authority	58	312	311
4011	Outlays from discretionary balances	233

4020	Outlays, gross (total)	291	312	311
	Mandatory:
4090	Budget authority, gross	1,290	1,243	1,219
	Outlays, gross:
4100	Outlays from new mandatory authority	436	841	808
4101	Outlays from mandatory balances	761	561	495

4110	Outlays, gross (total)	1,197	1,402	1,303
4180	Budget authority, net (total)	1,600	1,555	1,530
4190	Outlays, net (total)	1,488	1,714	1,614


		2012 actual	2013 CR	2014 est.

Enacted/requested:
	Budget Authority	1,600	1,555	1,530
	Outlays	1,488	1,714	1,614
Legislative proposal, not subject to PAYGO:
	Budget Authority		–473	–685
	Outlays		–473	–685
Legislative proposal, subject to PAYGO:
	Budget Authority		303	329
	Outlays		303	329
Total:
	Budget Authority	1,600	1,385	1,174
	Outlays	1,488	1,544	1,258

The Health Insurance Portability and Accountability Act of 1996 (P.L. 104–191) established the Health Care Fraud and Abuse Control (HCFAC) account within the Federal Hospital Insurance Trust Fund and appropriated funds from the Trust Fund to the HCFAC account for specified health care fraud and abuse control activities of the Department of Health and Human Services (HHS), the Department of Justice, and other agencies.

The Budget includes a discretionary request for efforts to safeguard Medicare, Medicaid, and CHIP that will supplement the mandatory funds made available by P.L. 104–191 and subsequent Acts. See additional discussion in the Budget Process chapter in the Analytical Perspectives volume.


Identification code 75–8393–0–7–571		2012 actual	2013 CR	2014 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent (CMS)	45	42	42
12.1	Civilian personnel benefits (CMS)	13	13	12
23.3	Communications, utilities, and miscellaneous charges	12	11	11
25.1	Advisory and assistance services (predictive modeling)	39	30	3
25.2	Other services (CMS/Medicaid)	46	29	29
25.3	Other purchases of goods and services from Government accounts (HHS/DOJ)	110	91	92
25.3	Other purchases of goods and services from Government accounts (HHS/OIG)	233	226	230
25.3	Other purchases of goods and services from Government accounts (HHS/AoA)	11	11	11
25.3	Other purchases of goods and services from Government accounts (HHS/OGC)	9	9	9
25.3	Other goods and services from Federal sources (HHS/CMS)	26	15	15
25.3	Other goods and services from Government accounts (HHS/FDA)	6	3	3
25.6	Medical care (CMS)	1,005	1,021	1,039
94.0	Financial transfers (FBI)	139	135	138

99.9	Total new obligations	1,694	1,636	1,634


Identification code 75–8393–0–7–571		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment	333	405	405


Identification code 75–8393–2–7–571		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Medicare Program Integrity savings		–430	–476
0002	SSA Program integrity savings		–43	–209

0900	Total new obligations (object class 25.6)		–473	–685

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)		–473	–685

1260	Appropriations, mandatory (total)		–473	–685
1930	Total budgetary resources available		–473	–685

	Change in obligated balance:
	Unpaid obligations:
3010	Obligations incurred, unexpired accounts		–473	–685
3020	Outlays (gross)		473	685

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross		–473	–685
	Outlays, gross:
4100	Outlays from new mandatory authority		–473	–685
4180	Budget authority, net (total)		–473	–685
4190	Outlays, net (total)		–473	–685

The mandatory proposal included in the Budget is estimated to achieve additional savings.


Identification code 75–8393–4–7–571		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	CMS program integrity		162	221
0002	Other program integrity		141	108

0900	Total new obligations		303	329

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)		303	329

1260	Appropriations, mandatory (total)		303	329
1930	Total budgetary resources available		303	329

	Change in obligated balance:
	Unpaid obligations:
3010	Obligations incurred, unexpired accounts		303	329
3020	Outlays (gross)		–303	–329

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross		303	329
	Outlays, gross:
4100	Outlays from new mandatory authority		303	329
4180	Budget authority, net (total)		303	329
4190	Outlays, net (total)		303	329

Despite enactment of multi-year discretionary cap adjustments in the Budget Control Act (BCA) of 2011, annual appropriations bills have not provided the full amount of program integrity funding authorized in law. Billions of dollars in deficit savings over the next ten years from curtailing improper payments will not be realized if the administrative expenses for program integrity envisioned by the Balanced Budget and Emergency Deficit Control Act (BBEDCA), as amended by the BCA, are not provided in each year. As a result, the Budget is proposing to repeal the discretionary cap adjustments beginning in 2013 for HCFAC and instead provide a dedicated, dependable source of mandatory funding that will ensure the Department of Health and Human Services (HHS) and the Department of Justice (DOJ) have the resources they need to conduct necessary program integrity activities and make certain that only the right people receive the right payment for the right reason at the right time. Providing additional mandatory funding for HCFAC will also eliminate delays in annual appropriations that make it difficult for the agencies to execute their budget plans and achieve targeted results in each year. For 2014, the Budget proposes to continue to provide the base funding ($311 million for HHS and DOJ) through discretionary appropriations. After 2014, no discretionary funding is being proposed for this purpose. In addition, an annual reduction to the discretionary spending limits in section 251(c) of the BBEDCA, as amended, is proposed beginning in 2015 to offset the cost of shifting the base funding from discretionary to mandatory. The more stable mandatory program integrity funding will produce new net deficit savings of over $2 billion over 11 years.



($Mil)	FY 2013	FY 2014


HHS-CMS	161	178
HHS-OIG	73	78
DOJ	69	73



Total Additional Mandatory Funding	303	329


Identification code 75–8393–4–7–571		2012 actual	2013 CR	2014 est.

	Direct obligations:
25.2	Other services (CMS/Medicaid)		16	25
25.3	Other purchases of goods and services from Government accounts (HHS/DOJ)		68	53
25.3	Other purchases of goods and services from Government accounts (HHS/OIG)		73	55
25.3	Other goods and services from Federal sources (HHS/CMS)		146	196

99.9	Total new obligations		303	329


Identification code 75–8004–0–7–571		2012 actual	2013 CR	2014 est.

0100	Balance, start of year	42,930	41,270	39,454
	Receipts:
0200	Fee on Branded Prescription Pharmaceutical Manufacturers and Importers, SMI	2,808	4,207	2,960
0220	Other Proprietary Interest from the Public, FSMI Fund	1	3	3
0221	Premiums Collected for Medicare Prescription Drug Account, FSMI	2,955	3,432	3,843
0222	Payments from States, Medicare Prescription Drug Account, FSMI	8,324	8,766	9,036
0223	Basic Premium, Medicare Advantage, FSMI Trust Fund	208	233	242
0224	Basic Premium, Medicare Advantage, FSMI Trust Fund			19
0225	Medicare Refunds, SMI	4,989	4,400	4,500
0226	Premiums Collected for the Aged, FSMI Fund	48,297	52,481	53,997
0227	Premiums Collected for the Aged, FSMI Fund			545
0228	Premiums Collected for the Disabled, FSMI Fund	9,592	9,707	10,031
0229	Premiums Collected for the Disabled, FSMI Fund			101
0240	Federal Contributions, FSMI Fund	165,254	181,351	194,565
0241	Federal Contributions, FSMI Fund			2,007
0242	Interest Received by Trust Fund, FSMI Fund	2,941	2,074	3,077
0243	Interest Received by Trust Fund, FSMI Fund			–123
0244	Interest, Medicare Prescription Drug Account, FSMI	6	6	8
0245	Federal Contribution for Admin. Contribution for Admin. Costs, Prescription Drug Account, FSMI	380	382	373
0246	Federal Contributions for Benefits, Prescription Drug Account, SMI	44,874	51,245	58,596
0247	Miscellaneous Federal Payments, Federal Supplementary Medical Insurance Trust Fund	1	1	1

0299	Total receipts and collections	290,630	318,288	343,781

0400	Total: Balances and collections	333,560	359,558	383,235
	Appropriations:
0500	Federal Supplementary Medical Insurance Trust Fund	–3,270	–3,148	–3,042
0501	Federal Supplementary Medical Insurance Trust Fund	6
0502	Federal Supplementary Medical Insurance Trust Fund	–231,232	–251,238	–266,390
0503	Federal Supplementary Medical Insurance Trust Fund	–1,860	–1,812
0504	Federal Supplementary Medical Insurance Trust Fund			11,898
0505	Federal Supplementary Medical Insurance Trust Fund			–2,550
0506	Federal Supplementary Medical Insurance Trust Fund			–13,037
0507	Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund	–302	–361	–328
0508	Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund	–55,745	–63,545	–71,471

0599	Total appropriations	–292,403	–320,104	–344,920
0610	Federal Supplementary Medical Insurance Trust Fund	1
0620	Federal Supplementary Medical Insurance Trust Fund	76
0795	Adjustment- expired accounts, receipts withdrawn.	36

0799	Balance, end of year	41,270	39,454	38,315


Identification code 75–8004–0–7–571		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Benefit payments, SMI	230,916	250,593	251,160
0002	Transfer to Medicaid for payment of SMI premiums	602	645	300
0003	HIT Incentive Payments	1,456	1,640	2,790
0004	Administration, SMI	3,328	3,224	3,127
0005	Quality Improvement Organizations, SMI	93	92	157

0799	Total direct obligations	236,395	256,194	257,534
0801	Reimbursable program activity	17

0900	Total new obligations	236,412	256,194	257,534

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		1	1
1021	Recoveries of prior year unpaid obligations	117
1026	Adjustment for change in allocation of trust fund limitation or foreign exchange valuation	–76
1029	Other balances withdrawn	–1

1050	Unobligated balance (total)	40	1	1
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust fund)	3,270	3,148	3,042
1130	Appropriations permanently reduced		–4
1132	Appropriations temporarily reduced	–6

1160	Appropriation, discretionary (total)	3,264	3,144	3,042
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	231,232	251,238	266,390
1203	Appropriation (previously unavailable)	1,860	1,812
1235	Appropriations precluded from obligation			–11,898

1260	Appropriations, mandatory (total)	233,092	253,050	254,492
	Spending authority from offsetting collections, mandatory:
1800	Collected	17

1850	Spending auth from offsetting collections, mand (total)	17
1900	Budget authority (total)	236,373	256,194	257,534
1930	Total budgetary resources available	236,413	256,195	257,535
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	1	1	1
	Special and non-revolving trust funds:
1950	Other balances withdrawn	1

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	24,063	24,403	24,369
3010	Obligations incurred, unexpired accounts	236,412	256,194	257,534
3020	Outlays (gross)	–235,955	–256,228	–257,570
3040	Recoveries of prior year unpaid obligations, unexpired	–117

3050	Unpaid obligations, end of year	24,403	24,369	24,333
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	24,063	24,403	24,369
3200	Obligated balance, end of year	24,403	24,369	24,333

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	3,264	3,144	3,042
	Outlays, gross:
4010	Outlays from new discretionary authority	1,830	2,162	2,086
4011	Outlays from discretionary balances	1,294	935	959

4020	Outlays, gross (total)	3,124	3,097	3,045
	Mandatory:
4090	Budget authority, gross	233,109	253,050	254,492
	Outlays, gross:
4100	Outlays from new mandatory authority	211,941	231,342	230,373
4101	Outlays from mandatory balances	20,890	21,789	24,152

4110	Outlays, gross (total)	232,831	253,131	254,525
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–17
4180	Budget authority, net (total)	236,356	256,194	257,534
4190	Outlays, net (total)	235,938	256,228	257,570

	Memorandum (non-add) entries:
5000	Total investments, SOY: Federal securities: Par value	70,446	69,324	67,876
5001	Total investments, EOY: Federal securities: Par value	69,324	67,876	66,660


		2012 actual	2013 CR	2014 est.

Enacted/requested:
	Budget Authority	236,356	256,194	257,534
	Outlays	235,938	256,228	257,570
Amounts included in the adjusted baseline:
	Budget Authority			15,587
	Outlays			15,587
Total:
	Budget Authority	236,356	256,194	273,121
	Outlays	235,938	256,228	273,157

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


Identification code 75–8004–0–7–571		2012 actual	2013 CR	2014 est.

	Unexpended balance, start of year:
0100	Balance, start of year	72,780	71,728	69,862

0199	Total balance, start of year	72,780	71,728	69,862
	Cash income during the year:
	Current law:
	Receipts:
1200	Fee on Branded Prescription Pharmaceutical Manufacturers and Importers, SMI	2,808	4,207	2,960
	Offsetting receipts (proprietary):
1220	Other Proprietary Interest from the Public, FSMI Fund	1	3	3
1221	Premiums Collected for Medicare Prescription Drug Account, FSMI	2,955	3,432	3,843
1222	Payments from States, Medicare Prescription Drug Account, FSMI	8,324	8,766	9,036
1223	Basic Premium, Medicare Advantage, FSMI Trust Fund	208	233	242
1224	Basic Premium, Medicare Advantage, FSMI Trust Fund			19
1225	Medicare Refunds, SMI	4,989	4,400	4,500
1226	Premiums Collected for the Aged, FSMI Fund	48,297	52,481	53,997
1227	Premiums Collected for the Aged, FSMI Fund			545
1228	Premiums Collected for the Disabled, FSMI Fund	9,592	9,707	10,031
1229	Premiums Collected for the Disabled, FSMI Fund			101
	Offsetting receipts (intragovernmental):
1240	Federal Contributions, FSMI Fund	165,254	181,351	194,565
1241	Federal Contributions, FSMI Fund			2,007
1242	Interest Received by Trust Fund, FSMI Fund	2,941	2,074	3,077
1243	Interest Received by Trust Fund, FSMI Fund			–123
1244	Interest, Medicare Prescription Drug Account, FSMI	6	6	8
1245	Federal Contribution for Admin. Contribution for Admin. Costs, Prescription Drug Account, FSMI	380	382	373
1246	Federal Contributions for Benefits, Prescription Drug Account, SMI	44,874	51,245	58,596
1247	Miscellaneous Federal Payments, Federal Supplementary Medical Insurance Trust Fund	1	1	1
	Offsetting collections:
1280	Federal Supplementary Medical Insurance Trust Fund	17
1281	Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund	2,216
1299	Income under present law	292,863	318,288	343,781

3299	Total cash income	292,863	318,288	343,781
	Cash outgo during year:
	Current law:
4500	Federal Supplementary Medical Insurance Trust Fund	–235,955	–256,228	–257,570
4500	Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund	–57,960	–63,922	–71,839
4500	Federal Supplementary Medical Insurance Trust Fund			–15,587
4599	Outgo under current law (-)	–293,915	–320,150	–344,996

6599	Total cash outgo (-)	–293,915	–320,150	–344,996
7625	Federal Supplementary Medical Insurance Trust Fund		–4

7699	Total adjustments		–4
	Unexpended balance, end of year:
8700	Uninvested balance (net), end of year	2,404	1,986	1,987
8701	Federal Supplementary Medical Insurance Trust Fund	69,324	67,876	66,660

8799	Total balance, end of year	71,728	69,862	68,647


Identification code 75–8004–0–7–571		2012 actual	2013 CR	2014 est.

	Direct obligations:
41.0	Payment for Quality Improvement Organization (QIO) activity	93	92	157
42.0	Insurance claims and indemnities	232,974	252,878	254,250
94.0	Financial transfers	3,328	3,224	3,127

99.0	Direct obligations	236,395	256,194	257,534
42.0	Allocation Account - reimbursable: Insurance claims and indemnities	17

99.9	Total new obligations	236,412	256,194	257,534


Identification code 75–8004–7–7–571		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Benefits			15,587

0900	Total new obligations (object class 42.0)			15,587

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)			2,550
1235	Appropriations precluded from obligation			13,037

1260	Appropriations, mandatory (total)			15,587
1900	Budget authority (total)			15,587
1930	Total budgetary resources available			15,587

	Change in obligated balance:
	Unpaid obligations:
3010	Obligations incurred, unexpired accounts			15,587
3020	Outlays (gross)			–15,587

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			15,587
	Outlays, gross:
4100	Outlays from new mandatory authority			15,587
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4180	Budget authority, net (total)			15,587
4190	Outlays, net (total)			15,587


Identification code 75–8308–0–7–571		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Prescription Drug Benefits	58,365	63,540	71,467
0002	Administrative Costs	306	366	332

0900	Total new obligations	58,671	63,906	71,799

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		1	1
1021	Recoveries of prior year unpaid obligations	409

1050	Unobligated balance (total)	409	1	1
	Budget authority:
	Appropriations, discretionary:
1101	Appropriation (special or trust fund)	302	361	328

1160	Appropriation, discretionary (total)	302	361	328
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	55,745	63,545	71,471

1260	Appropriations, mandatory (total)	55,745	63,545	71,471
	Spending authority from offsetting collections, mandatory:
1800	Collected	2,216

1850	Spending auth from offsetting collections, mand (total)	2,216
1900	Budget authority (total)	58,263	63,906	71,799
1930	Total budgetary resources available	58,672	63,907	71,800
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	1	1	1
	Special and non-revolving trust funds:
1952	Expired unobligated balance, start of year	572	449	449
1953	Expired unobligated balance, end of year	449	449	449

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	5,216	5,606	5,590
3010	Obligations incurred, unexpired accounts	58,671	63,906	71,799
3011	Obligations incurred, expired accounts	120
3020	Outlays (gross)	–57,960	–63,922	–71,839
3040	Recoveries of prior year unpaid obligations, unexpired	–409
3041	Recoveries of prior year unpaid obligations, expired	–32

3050	Unpaid obligations, end of year	5,606	5,590	5,550
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	5,216	5,606	5,590
3200	Obligated balance, end of year	5,606	5,590	5,550

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	302	361	328
	Outlays, gross:
4010	Outlays from new discretionary authority	276	286	259
4011	Outlays from discretionary balances	100	73	72

4020	Outlays, gross (total)	376	359	331
	Mandatory:
4090	Budget authority, gross	57,961	63,545	71,471
	Outlays, gross:
4100	Outlays from new mandatory authority	55,335	59,916	67,771
4101	Outlays from mandatory balances	2,249	3,647	3,737

4110	Outlays, gross (total)	57,584	63,563	71,508
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–2,216
4180	Budget authority, net (total)	56,047	63,906	71,799
4190	Outlays, net (total)	55,744	63,922	71,839

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.


Identification code 75–8308–0–7–571		2012 actual	2013 CR	2014 est.

	Direct obligations:
25.2	Other services from non-Federal sources	306	366	332
42.0	Insurance claims and indemnities	58,365	63,540	71,467

99.9	Total new obligations	58,671	63,906	71,799

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

Federal Funds


Identification code 75–1552–0–1–609		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	State family assistance grant	16,488	16,486	16,486
0002	Territories - family assistance grants	75	78	78
0006	Tribal work programs	8	8	8
0009	Healthy marriage and responsible fatherhood grants	150	150	150

0900	Total new obligations	16,721	16,722	16,722

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1			2
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	16,739	16,739	16,739

1260	Appropriations, mandatory (total)	16,739	16,739	16,739
1930	Total budgetary resources available	16,739	16,739	16,741
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–18	–15	–15
1941	Unexpired unobligated balance, end of year		2	4

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	4,595	5,180	5,054
3010	Obligations incurred, unexpired accounts	16,721	16,722	16,722
3020	Outlays (gross)	–16,136	–16,848	–16,982

3050	Unpaid obligations, end of year	5,180	5,054	4,794
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	4,595	5,180	5,054
3200	Obligated balance, end of year	5,180	5,054	4,794

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	16,739	16,739	16,739
	Outlays, gross:
4100	Outlays from new mandatory authority	13,210	13,379	13,379
4101	Outlays from mandatory balances	2,926	3,469	3,603

4110	Outlays, gross (total)	16,136	16,848	16,982
4180	Budget authority, net (total)	16,739	16,739	16,739
4190	Outlays, net (total)	16,136	16,848	16,982


		2012 actual	2013 CR	2014 est.

Enacted/requested:
	Budget Authority	16,739	16,739	16,739
	Outlays	16,136	16,848	16,982
Legislative proposal, subject to PAYGO:
	Budget Authority			319
	Outlays			289
Total:
	Budget Authority	16,739	16,739	17,058
	Outlays	16,136	16,848	17,271

This account provides funding for the Temporary Assistance for Needy Families block grant and related activities authorized by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104–193), as amended by the Deficit Reduction Act of 2005 (P.L. 109–171). Since 2010, this account has been temporarily reauthorized by a series of Acts and at the time the Budget was prepared was operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175).


Identification code 75–1552–0–1–609		2012 actual	2013 CR	2014 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	2	1	1
12.1	Civilian personnel benefits	1	1	1
21.0	Travel and transportation of persons	1	1	1
23.1	Rental payments to GSA	1	1	1
25.1	Advisory and assistance services	23	23	23
25.2	Other services from non-Federal sources	15	15	15
25.3	Other goods and services from Federal sources	1	1	1
41.0	Grants, subsidies, and contributions	16,677	16,679	16,679

99.9	Total new obligations	16,721	16,722	16,722


Identification code 75–1552–0–1–609		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment	15	15	15


Identification code 75–1552–4–1–609		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0007	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:
	Unpaid obligations:
3010	Obligations incurred, unexpired accounts			319
3020	Outlays (gross)			–289

3050	Unpaid obligations, end of year			30
	Memorandum (non-add) entries:
3200	Obligated balance, end of year			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


Identification code 75–1522–0–1–609		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Contingency fund	612	612	612

0900	Total new obligations (object class 41.0)	612	612	612

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	612	612	612

1260	Appropriations, mandatory (total)	612	612	612
1930	Total budgetary resources available	612	612	612

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	832	595	331
3010	Obligations incurred, unexpired accounts	612	612	612
3020	Outlays (gross)	–678	–876	–776
3041	Recoveries of prior year unpaid obligations, expired	–171

3050	Unpaid obligations, end of year	595	331	167
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	832	595	331
3200	Obligated balance, end of year	595	331	167

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	612	612	612
	Outlays, gross:
4100	Outlays from new mandatory authority	473	555	555
4101	Outlays from mandatory balances	205	321	221

4110	Outlays, gross (total)	678	876	776
4180	Budget authority, net (total)	612	612	612
4190	Outlays, net (total)	678	876	776


		2012 actual	2013 CR	2014 est.

Enacted/requested:
	Budget Authority	612	612	612
	Outlays	678	876	776
Legislative proposal, subject to PAYGO:
	Budget Authority			–319
	Outlays			–289
Total:
	Budget Authority	612	612	293
	Outlays	678	876	487

This account provides funding for the TANF Contingency Fund authorized by section 403(b) of the Social Security Act that currently provides money to qualifying States (but not Territories or Tribes) during an economic downturn.


Identification code 75–1522–4–1–609		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Contingency fund			–319

0900	Total new obligations (object class 41.0)			–319

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			–319

1260	Appropriations, mandatory (total)			–319
1930	Total budgetary resources available			–319

	Change in obligated balance:
	Unpaid obligations:
3010	Obligations incurred, unexpired accounts			–319
3020	Outlays (gross)			289

3050	Unpaid obligations, end of year			–30
	Memorandum (non-add) entries:
3200	Obligated balance, end of year			–30

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			–319
	Outlays, gross:
4100	Outlays from new mandatory authority			–289
4180	Budget authority, net (total)			–319
4190	Outlays, net (total)			–289

For [making payments to States or other non-Federal entities under] carrying out, except as otherwise provided, titles I, IV-D, X, XI, XIV, and XVI of the Social Security Act and the Act of July 5, 1960, [$2,756,485,000] $2,965,245,000, to remain available until expended; and for such purposes for the first quarter of fiscal year [2014] 2015, [$1,100,000,000] $1,250,000,000, 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. Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.


Identification code 75–1501–0–1–609		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	State child support administrative costs	3,626	3,730	3,780
0002	Child support incentive payments	508	530	541
0003	Access and visitation grants	10	10	10

0091	Subtotal, child support enforcement	4,144	4,270	4,331
0102	Payments to territories	32	33	33
0103	Repatriation	1	1	1

0191	Subtotal, other payments	33	34	34

0799	Total direct obligations	4,177	4,304	4,365
0801	Offset obligations (CSE grants to States)	2	8	8

0900	Total new obligations	4,179	4,312	4,373

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		1
1021	Recoveries of prior year unpaid obligations	341	300	300

1050	Unobligated balance (total)	341	301	300
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	2,636	2,904	2,965

1260	Appropriations, mandatory (total)	2,636	2,904	2,965
	Advance appropriations, mandatory:
1270	Advance appropriation	1,200	1,100	1,100

1280	Advanced appropriation, mandatory (total)	1,200	1,100	1,100
	Spending authority from offsetting collections, mandatory:
1800	Collected	3	7	8

1850	Spending auth from offsetting collections, mand (total)	3	7	8
1900	Budget authority (total)	3,839	4,011	4,073
1930	Total budgetary resources available	4,180	4,312	4,373
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	1

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1,108	986	997
3010	Obligations incurred, unexpired accounts	4,179	4,312	4,373
3020	Outlays (gross)	–3,960	–4,001	–4,043
3040	Recoveries of prior year unpaid obligations, unexpired	–341	–300	–300

3050	Unpaid obligations, end of year	986	997	1,027
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1,108	986	997
3200	Obligated balance, end of year	986	997	1,027

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	3,839	4,011	4,073
	Outlays, gross:
4100	Outlays from new mandatory authority	3,627	3,702	3,751
4101	Outlays from mandatory balances	333	299	292

4110	Outlays, gross (total)	3,960	4,001	4,043
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4123	Non-Federal sources	–3	–7	–8
4180	Budget authority, net (total)	3,836	4,004	4,065
4190	Outlays, net (total)	3,957	3,994	4,035


		2012 actual	2013 CR	2014 est.

Enacted/requested:
	Budget Authority	3,836	4,004	4,065
	Outlays	3,957	3,994	4,035
Legislative proposal, subject to PAYGO:
	Budget Authority			10
	Outlays			10
Total:
	Budget Authority	3,836	4,004	4,075
	Outlays	3,957	3,994	4,045

This account provides for payments to States for child support enforcement and other family support programs, including access and visitation programs for families. The Federal share of child support collections is returned to the Treasury in a receipt account. This request proposes a Child Support and Fatherhood Initiative, a comprehensive set of proposals which promotes using child support payments in the best interest of the child; supports noncustodial parents becoming and staying involved in their children's lives; and improves establishment and enforcement procedures by closing loopholes and improving federal processes.


Identification code 75–1501–0–1–609		2012 actual	2013 CR	2014 est.

41.0	Direct obligations: Grants, subsidies, and contributions	4,177	4,304	4,365
99.0	Reimbursable obligations	2	8	8

99.9	Total new obligations	4,179	4,312	4,373


Identification code 75–1501–4–1–609		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	State child support administrative costs			10

0900	Total new obligations (object class 41.0)			10

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			10

1260	Appropriations, mandatory (total)			10
1930	Total budgetary resources available			10

	Change in obligated balance:
	Unpaid obligations:
3010	Obligations incurred, unexpired accounts			10
3020	Outlays (gross)			–10

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			10
	Outlays, gross:
4100	Outlays from new mandatory authority			10
4180	Budget authority, net (total)			10
4190	Outlays, net (total)			10

For making payments under subsections (b), (d), and (e) of section 2602 of the Low Income Home Energy Assistance Act of 1981, [$3,020,000,000] $2,970,000,000, of which $2,820,000,000 shall be for making payments under subsections (b) and (d) of such section; and of which [$200,000,000] $150,000,000 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 $403,000,000 of 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 [2013] 2014 was less than $1,975,000,000: Provided further, That notwithstanding section 2609A(a), the Secretary may reserve up to $3,000,000 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 and may, in addition to the authorities provided in section 2609A(a)(1), use such funds through contracts with private entities that do not qualify as nonprofit organizations.

For making competitive grants to assist low-income households in reducing household energy burdens and for conducting a national evaluation of such grants, $50,000,000. Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.


Identification code 75–1502–0–1–609		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	LIHEAP Block Grant	3,472	3,493	2,820
0002	Contingency Fund			150
0003	Energy Burden Reduction Grants			50

0900	Total new obligations	3,472	3,493	3,020

	Budgetary Resources:
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	3,478	3,493	3,020
1130	Appropriations permanently reduced	–6

1160	Appropriation, discretionary (total)	3,472	3,493	3,020
1930	Total budgetary resources available	3,472	3,493	3,020

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1,991	1,642	1,431
3010	Obligations incurred, unexpired accounts	3,472	3,493	3,020
3020	Outlays (gross)	–3,817	–3,704	–2,936
3041	Recoveries of prior year unpaid obligations, expired	–4

3050	Unpaid obligations, end of year	1,642	1,431	1,515
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1,991	1,642	1,431
3200	Obligated balance, end of year	1,642	1,431	1,515

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	3,472	3,493	3,020
	Outlays, gross:
4010	Outlays from new discretionary authority	2,191	2,201	1,905
4011	Outlays from discretionary balances	1,626	1,503	1,031

4020	Outlays, gross (total)	3,817	3,704	2,936
4180	Budget authority, net (total)	3,472	3,493	3,020
4190	Outlays, net (total)	3,817	3,704	2,936

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 emergencies such as extreme weather related events and high fuel prices. The Budget proposes new competitive grants to reduce household energy burdens for low-income households.


Identification code 75–1502–0–1–609		2012 actual	2013 CR	2014 est.

	Direct obligations:
25.1	Advisory and assistance services	2	2	2
25.3	Other goods and services from Federal sources	1	1	1
41.0	Grants, subsidies, and contributions	3,469	3,490	3,017

99.9	Total new obligations	3,472	3,493	3,020

For necessary expenses for refugee and entrant assistance activities authorized by section 414 of the Immigration and Nationality Act and section 501 of the Refugee Education Assistance Act of 1980, and for carrying out section 462 of the Homeland Security Act of 2002, the Torture Victims Relief Act of 1998, the Trafficking Victims Protection Act of 2000 (TVPA), section 203 of the Trafficking Victims Protection Reauthorization Act of 2005, and 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, $805,358,000] $1,123,432,000, to remain available through September 30, 2016: Provided, That [of which] up to [$9,775,000] $19,775,000 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 2013 shall be available for the costs of assistance provided and other activities to remain available through September 30, 2015] last three Acts cited above, of which $300,000 of such amount shall be available for research and evaluation under sections 107(f) and 112A of the TVPA, as amended, notwithstanding any limitations or earmarks in such sections. Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.


Identification code 75–1503–0–1–609		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Refugee and entrant assistance	507	587	607
0002	Assistance for treatment of torture victims	11	11	11
0003	Unaccompanied alien children	274	302	495
0005	Domestic Trafficking Victims program			10

0900	Total new obligations	792	900	1,123

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	24	1	1
1021	Recoveries of prior year unpaid obligations	1

1050	Unobligated balance (total)	25	1	1
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	769	900	1,123
1130	Appropriations permanently reduced	–1

1160	Appropriation, discretionary (total)	768	900	1,123
1930	Total budgetary resources available	793	901	1,124
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	1	1	1

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	567	544	552
3010	Obligations incurred, unexpired accounts	792	900	1,123
3011	Obligations incurred, expired accounts	1
3020	Outlays (gross)	–802	–892	–952
3040	Recoveries of prior year unpaid obligations, unexpired	–1
3041	Recoveries of prior year unpaid obligations, expired	–13

3050	Unpaid obligations, end of year	544	552	723
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	567	544	552
3200	Obligated balance, end of year	544	552	723

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	768	900	1,123
	Outlays, gross:
4010	Outlays from new discretionary authority	435	450	562
4011	Outlays from discretionary balances	367	442	390

4020	Outlays, gross (total)	802	892	952
4180	Budget authority, net (total)	768	900	1,123
4190	Outlays, net (total)	802	892	952

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. Additional funding is included to address the increase in unaccompanied alien children and for a new initiative aimed at preventing human trafficking and providing direct services to domestic victims.


Identification code 75–1503–0–1–609		2012 actual	2013 CR	2014 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	4	5	6
12.1	Civilian personnel benefits	1	1	2
23.1	Rental payments to GSA	2	2	2
25.1	Advisory and assistance services	35	20	31
25.2	Other services from non-Federal sources	5	6	7
25.3	Other goods and services from Federal sources	4	24	30
41.0	Grants, subsidies, and contributions	741	842	1,045

99.9	Total new obligations	792	900	1,123


Identification code 75–1503–0–1–609		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment	45	54	64

For carrying out, except as otherwise provided, section 436 of the Social Security Act, $345,000,000 and, in addition, for carrying out, except as otherwise provided, section 437 of such Act, $63,065,000. Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.


Identification code 75–1512–0–1–506		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Grants to States and Tribes	368	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
0005	PREP	84	84	82
0006	Abstinence Education	39	37	37

0900	Total new obligations	546	544	527

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	25	16	20
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	63	63	75
1130	Appropriations permanently reduced			–12

1160	Appropriation, discretionary (total)	63	63	63
	Appropriations, mandatory:
1200	Appropriation	485	485	470

1260	Appropriations, mandatory (total)	485	485	470
1900	Budget authority (total)	548	548	533
1930	Total budgetary resources available	573	564	553
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–11
1941	Unexpired unobligated balance, end of year	16	20	26

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	614	678	708
3010	Obligations incurred, unexpired accounts	546	544	527
3020	Outlays (gross)	–476	–511	–525
3041	Recoveries of prior year unpaid obligations, expired	–6	–3

3050	Unpaid obligations, end of year	678	708	710
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	614	678	708
3200	Obligated balance, end of year	678	708	710

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	63	63	63
	Outlays, gross:
4010	Outlays from new discretionary authority	19	20	24
4011	Outlays from discretionary balances	38	43	44

4020	Outlays, gross (total)	57	63	68
	Mandatory:
4090	Budget authority, gross	485	485	470
	Outlays, gross:
4100	Outlays from new mandatory authority	91	98	98
4101	Outlays from mandatory balances	328	350	359

4110	Outlays, gross (total)	419	448	457
4180	Budget authority, net (total)	548	548	533
4190	Outlays, net (total)	476	511	525


		2012 actual	2013 CR	2014 est.

Enacted/requested:
	Budget Authority	548	548	533
	Outlays	476	511	525
Legislative proposal, subject to PAYGO:
	Budget Authority			15
Total:
	Budget Authority	548	548	548
	Outlays	476	511	525

This account provides funds for a broad range of child welfare services, including family preservation and family support services. Additionally, this account includes funding for the Personal Responsibility Education Program (PREP) and Abstinence Education which were made available by the Patient Protection and Affordable Care Act (P.L. 111–148). This account also includes a new initiative to prevent pregnancy among youth in foster care.


Identification code 75–1512–0–1–506		2012 actual	2013 CR	2014 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	1	1	1
25.1	Advisory and assistance services	12	11	11
25.3	Other goods and services from Federal sources	2	3	2
41.0	Grants, subsidies, and contributions	531	529	513

99.9	Total new obligations	546	544	527


Identification code 75–1512–0–1–506		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment	10	10	10


Identification code 75–1512–4–1–506		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0004	Family Connection Grants			15

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			15

1260	Appropriations, mandatory (total)			15
1900	Budget authority (total)			15
1930	Total budgetary resources available			15

	Change in obligated balance:
	Unpaid obligations:
3010	Obligations incurred, unexpired accounts			15

3050	Unpaid obligations, end of year			15
	Memorandum (non-add) entries:
3200	Obligated balance, end of year			15

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			15
4180	Budget authority, net (total)			15


Identification code 75–1512–4–1–506		2012 actual	2013 CR	2014 est.

	Direct obligations:
25.1	Advisory and assistance services			1
41.0	Grants, subsidies, and contributions			14

99.9	Total new obligations			15


Identification code 75–1550–0–1–609		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Mandatory child care	1,178	1,178	1,178
0002	Matching child care	1,697	1,674	1,674
0003	Training and technical assistance	7	7	7
0004	Child care tribal grants	58	58	58

0900	Total new obligations	2,940	2,917	2,917

	Budgetary Resources:
	Unobligated balance:
1012	Unobligated balance transfers between expired and unexpired accounts	23

1050	Unobligated balance (total)	23
	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	2,940	2,917	2,917

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	609	710	719
3010	Obligations incurred, unexpired accounts	2,940	2,917	2,917
3020	Outlays (gross)	–2,828	–2,908	–2,916
3041	Recoveries of prior year unpaid obligations, expired	–11

3050	Unpaid obligations, end of year	710	719	720
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	609	710	719
3200	Obligated balance, end of year	710	719	720

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	2,917	2,917	2,917
	Outlays, gross:
4100	Outlays from new mandatory authority	2,291	2,363	2,363
4101	Outlays from mandatory balances	537	545	553

4110	Outlays, gross (total)	2,828	2,908	2,916
4180	Budget authority, net (total)	2,917	2,917	2,917
4190	Outlays, net (total)	2,828	2,908	2,916


		2012 actual	2013 CR	2014 est.

Enacted/requested:
	Budget Authority	2,917	2,917	2,917
	Outlays	2,828	2,908	2,916
Legislative proposal, subject to PAYGO:
	Budget Authority			500
	Outlays			406
Total:
	Budget Authority	2,917	2,917	3,417
	Outlays	2,828	2,908	3,322

This account provides child care subsidies for low-income working families and was established by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104–193), as amended by the Deficit Reduction Act of 2005 (P.L. 109–171). Since 2010, this account has been temporarily reauthorized by a series of Acts and at the time the Budget was prepared was operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175).


Identification code 75–1550–0–1–609		2012 actual	2013 CR	2014 est.

	Direct obligations:
25.1	Advisory and assistance services	7	1	1
25.2	Other services from non-Federal sources	11	6	6
41.0	Grants, subsidies, and contributions	2,922	2,910	2,910

99.9	Total new obligations	2,940	2,917	2,917


Identification code 75–1550–4–1–609		2012 actual	2013 CR	2014 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:
	Unpaid obligations:
3010	Obligations incurred, unexpired accounts			500
3020	Outlays (gross)			–406

3050	Unpaid obligations, end of year			94
	Memorandum (non-add) entries:
3200	Obligated balance, end of year			94

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			500
	Outlays, gross:
4100	Outlays from new mandatory authority			406
4180	Budget authority, net (total)			500
4190	Outlays, net (total)			406


Identification code 75–1550–4–1–609		2012 actual	2013 CR	2014 est.

	Direct obligations:
25.2	Other services from non-Federal sources			10
41.0	Grants, subsidies, and contributions			490

99.9	Total new obligations			500

For carrying out the Child Care and Development Block Grant Act of 1990, [$2,303,313,000] $2,278,313,000 shall be used to supplement, not supplant State general revenue funds for child care assistance for low-income families: Provided, That [$19,609,000] $19,396,000 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, [$293,887,000] $290,698,000 shall be reserved by the States for activities authorized under section 658G, of which [$107,781,000] $106,611,000 shall be for activities that improve the quality of infant and toddler care: Provided further, That $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] $200,000,000, to be allocated by the Secretary for discretionary grants to States to improve the quality of child care, including health and safety measures, under section 658I(a)(1) of such Act. Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.


Identification code 75–1515–0–1–609		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Block grant payments to States	2,268	2,282	2,468
0004	Research and evaluation fund	10	10	10

0900	Total new obligations	2,278	2,292	2,478

	Budgetary Resources:
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	2,282	2,292	2,478
1130	Appropriations permanently reduced	–4

1160	Appropriation, discretionary (total)	2,278	2,292	2,478
1930	Total budgetary resources available	2,278	2,292	2,478

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	478	555	561
3010	Obligations incurred, unexpired accounts	2,278	2,292	2,478
3020	Outlays (gross)	–2,200	–2,286	–2,442
3041	Recoveries of prior year unpaid obligations, expired	–1

3050	Unpaid obligations, end of year	555	561	597
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	478	555	561
3200	Obligated balance, end of year	555	561	597

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	2,278	2,292	2,478
	Outlays, gross:
4010	Outlays from new discretionary authority	1,788	1,857	2,007
4011	Outlays from discretionary balances	412	429	435

4020	Outlays, gross (total)	2,200	2,286	2,442
4180	Budget authority, net (total)	2,278	2,292	2,478
4190	Outlays, net (total)	2,200	2,286	2,442

This program provides grants to States for child care subsidies for low-income working families and activities to improve child care quality. In FY 2014, it includes a new initiative to improve the quality of child care, including healthy and safety measures.


Identification code 75–1515–0–1–609		2012 actual	2013 CR	2014 est.

	Direct obligations:
25.1	Advisory and assistance services	14	13	13
25.2	Other services from non-Federal sources	10
25.3	Other goods and services from Federal sources	1	1	1
41.0	Grants, subsidies, and contributions	2,253	2,278	2,464

99.9	Total new obligations	2,278	2,292	2,478

For making grants to States pursuant to section 2002 of the Social Security Act, $1,700,000,000: Provided, That notwithstanding subparagraph (B) of section 404(d)(2) of such Act, the applicable percent specified under such subparagraph for a State to carry out State programs pursuant to title XX-A of such Act shall be 10 percent. Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.


Identification code 75–1534–0–1–506		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Social Services Block Grant	1,700	1,700	1,700
0002	Health Profession Opportunity Grants	85	85	85
0003	Emergency Funding		500

0900	Total new obligations	1,785	2,285	1,785

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	30	30	30
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	1,785	1,785	1,785
1221	Appropriations transferred from other accts [75–0140]		500

1260	Appropriations, mandatory (total)	1,785	2,285	1,785
1930	Total budgetary resources available	1,815	2,315	1,815
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	30	30	30

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	580	572	893
3010	Obligations incurred, unexpired accounts	1,785	2,285	1,785
3020	Outlays (gross)	–1,715	–1,964	–2,062
3041	Recoveries of prior year unpaid obligations, expired	–78

3050	Unpaid obligations, end of year	572	893	616
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	580	572	893
3200	Obligated balance, end of year	572	893	616

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	1,785	2,285	1,785
	Outlays, gross:
4100	Outlays from new mandatory authority	1,359	1,498	1,398
4101	Outlays from mandatory balances	356	466	664

4110	Outlays, gross (total)	1,715	1,964	2,062
4180	Budget authority, net (total)	1,785	2,285	1,785
4190	Outlays, net (total)	1,715	1,964	2,062


Identification code 75–1534–0–1–506		2012 actual	2013 CR	2014 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	1	1	1
25.1	Advisory and assistance services	16	16	16
41.0	Grants, subsidies, and contributions	1,768	2,268	1,768

99.9	Total new obligations	1,785	2,285	1,785


Identification code 75–1534–0–1–506		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment	7	7	7

For carrying out, except as otherwise provided, the Runaway and Homeless Youth Act, [the Developmental Disabilities Assistance and Bill of Rights Act,] the Head Start Act, the Child Abuse Prevention and Treatment Act, sections 303 and 313 of the Family Violence Prevention and Services Act, the Native American Programs Act of 1974, title II of the Child Abuse Prevention and Treatment and Adoption Reform Act of 1978 (adoption opportunities), the Abandoned Infants Assistance Act of 1988, [section 291 of the Help America Vote Act of 2002,] part B-1 of title IV and sections 413, 1110, and 1115 of the Social Security Act; for making payments under the Community Services Block Grant Act ("CSBG Act''), sections 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, and for the administration of prior year obligations made by the Administration for Children and Families under the Developmental Disabilities Assistance and Bill of Rights Act and the Help America Vote Act of 2002, [$9,688,767,000]$11,083,182,000, of which $39,346,000, to remain available through September 30, [2014]2015, 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, [2013]2014: Provided, That [$8,054,000,000]$9,621,070,000 shall be for making payments under the Head Start Act: Provided further, That of the amount in the previous proviso, [$7,968,543,933]$8,190,694,000 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]$25,000,000 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: Provided further, That notwithstanding section 640 of the Head Start Act, of the amount described in the first proviso, $1,430,376,000 shall be available to entities defined as eligible under section 645A(d) of such Act for expansion of Early Head Start programs as described in section 645(A) of such Act, for conversion of Head Start services to Early Head Start services as described in section 645(a)(5)(A) of such Act, and for new discretionary grants for high quality infant and toddler care through Early Head Start-Child Care Partnerships, and, notwithstanding section 645A(c)(2) of such Act, these funds are available to serve children under age 4: Provided further, That of the amount made available in the immediately preceding proviso, up to $15,000,000 shall be available for the Federal costs of administration and evaluation activities of the program described in such proviso: Provided further, That an Early Head Start agency awarded funds for an Early Head Start-Child Care Partnership after October 1, 2014, shall not be subject to the requirements of the system for designation renewal as defined by section 641 of the Head Start Act, for this award only, prior to 18 months after the date of such award: Provided further, That [$379,943,000]$350,000,000 shall be for making payments under the CSBG Act: Provided further, That [$30,293,000 shall be for sections 680 and 678E(b)(2) of the CSBG Act, of which not less than $29,943,000 shall be for section 680(a)(2) of such Act]no more than $350,000 shall be reserved under section 674(b)(3) of the CSBG Act, all of which shall be available solely for carrying out section 678E(b)(2) 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 amounts provided under this heading to carry out section 1110 of the Social Security Act, other than amounts made available for that purpose under the immediately preceeding proviso, shall remain available until expended; 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 $5,235,000 shall be for activities authorized by section 291 of the Help America Vote Act of 2002:] Provided further, That [$1,996,000]$1,992,000 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. Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution as well as amounts from P.L. 113–2, the Disaster Relief Appropriations Act, 2013 (no language shown).


Identification code 75–1536–0–1–506		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0101	Head start	7,968	8,017	9,621
0102	Head Start Emergency Hurricane Sandy funding		15	50
0103	Runaway and homeless youth (basic centers)	53	54	53
0104	Transitional living	44	44	44
0105	Prevalence, Needs and Characteristics of Homeless Youth			3
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	282	281
0113	Child welfare training, research, or demonstration projects	26	26	26
0114	Adoption opportunities	39	40	39
0115	Abandoned infants assistance	12	12	11
0116	Adoption incentives	42	40	39
0117	Independent living training vouchers	45	45	45
0119	State councils on developmental disabilities	75	75
0120	Protection and advocacy	41	41
0121	Projects of national significance	8	9
0122	University centers for excellence	39	39
0123	Voting access for individuals with disabilities	5	5
0124	Native American programs	49	49	49
0125	Social services and income maintenance research			44
0128	Federal administration	199	205	204
0129	Center for faith-based and community initiatives	1	1	1
0131	Disaster human services case management	2	2	2

0191	Direct program activities, subtotal	9,041	9,113	10,624
0301	Community services block grant	677	682	350
0303	Rural community facilities	5	5
0304	Community services discretionary (JOLI & CED)	30	30
0306	Assets for independence	20	20	19
0308	Domestic violence hotline	3	3	5
0309	Family violence prevention and services	129	131	135

0391	Direct program activities, subtotal	864	871	509

0400	Total, direct program	9,905	9,984	11,133

0799	Total direct obligations	9,905	9,984	11,133
0801	Reimbursable program	53	25	25

0809	Reimbursable program activities, subtotal	53	25	25

0900	Total new obligations	9,958	10,009	11,158

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	2	3	88
1001	Discretionary unobligated balance brought fwd, Oct 1	2	3
1021	Recoveries of prior year unpaid obligations	3

1050	Unobligated balance (total)	5	3	88
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	9,927	9,969	11,083
1121	Discretionary Emergency pursuant to 2011 Budget Control Act [75–0140]		100
1130	Appropriations permanently reduced	–19

1160	Appropriation, discretionary (total)	9,908	10,069	11,083
	Spending authority from offsetting collections, discretionary:
1700	Collected	46	24	24
1701	Change in uncollected payments, Federal sources	5

1750	Spending auth from offsetting collections, disc (total)	51	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)	9,961	10,094	11,108
1930	Total budgetary resources available	9,966	10,097	11,196
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–5
1941	Unexpired unobligated balance, end of year	3	88	38

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	6,703	6,626	6,793
3010	Obligations incurred, unexpired accounts	9,958	10,009	11,158
3020	Outlays (gross)	–9,909	–9,842	–10,461
3040	Recoveries of prior year unpaid obligations, unexpired	–3
3041	Recoveries of prior year unpaid obligations, expired	–123

3050	Unpaid obligations, end of year	6,626	6,793	7,490
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–7	–10	–10
3070	Change in uncollected pymts, Fed sources, unexpired	–6
3071	Change in uncollected pymts, Fed sources, expired	3

3090	Uncollected pymts, Fed sources, end of year	–10	–10	–10
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	6,696	6,616	6,783
3200	Obligated balance, end of year	6,616	6,783	7,480

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	9,959	10,093	11,107
	Outlays, gross:
4010	Outlays from new discretionary authority	4,180	4,217	4,681
4011	Outlays from discretionary balances	5,726	5,623	5,778

4020	Outlays, gross (total)	9,906	9,840	10,459
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–49	–18	–18
4033	Non-Federal sources		–6	–6

4040	Offsets against gross budget authority and outlays (total)	–49	–24	–24
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–5
4052	Offsetting collections credited to expired accounts	3

4060	Additional offsets against budget authority only (total)	–2

4070	Budget authority, net (discretionary)	9,908	10,069	11,083
4080	Outlays, net (discretionary)	9,857	9,816	10,435
	Mandatory:
4090	Budget authority, gross	2	1	1
	Outlays, gross:
4100	Outlays from new mandatory authority	2	1	1
4101	Outlays from mandatory balances	1	1	1

4110	Outlays, gross (total)	3	2	2
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–1	–1	–1
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–1
4170	Outlays, net (mandatory)	2	1	1
4180	Budget authority, net (total)	9,908	10,069	11,083
4190	Outlays, net (total)	9,859	9,817	10,436

The request prioritizes investments in early learning to improve outcomes for children. A total of $9.6 billion is requested to support an early learning initiative to expand access to high quality infant and toddler care, maintain the number of children served in Head Start, and support the transition between new and incumbent Head Start grantees in the Designation Renewal System. This Budget also requests an additional $7 million for family violence prevention, $35 million for an initiative to address marriage disincentives, and $3 million to study the prevalence, needs and characteristics of homeless youth. This request discontinues funding for the Rural Communities Facilities and the Community Economic Development programs.


Identification code 75–1536–0–1–506		2012 actual	2013 CR	2014 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	110	116	121
11.3	Other than full-time permanent	4	5	5
11.5	Other personnel compensation	2	2	2

11.9	Total personnel compensation	116	123	128
12.1	Civilian personnel benefits	30	32	33
21.0	Travel and transportation of persons	4	4	4
23.1	Rental payments to GSA	13	14	14
23.2	Rental payments to others	1	1	1
23.3	Communications, utilities, and miscellaneous charges	4	4	4
24.0	Printing and reproduction	1	1	1
25.1	Advisory and assistance services	234	241	246
25.2	Other services from non-Federal sources	5	4	4
25.3	Other goods and services from Federal sources	47	49	49
25.4	Operation and maintenance of facilities	2	2	2
25.5	Research and development contracts	1	1	1
26.0	Supplies and materials	1	1	1
41.0	Grants, subsidies, and contributions	9,446	9,507	10,645

99.0	Direct obligations	9,905	9,984	11,133
99.0	Reimbursable obligations	53	25	25

99.9	Total new obligations	9,958	10,009	11,158


Identification code 75–1536–0–1–506		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment	1,145	1,203	1,243
1101	Direct military average strength employment	4	6	6
2001	Reimbursable civilian full-time equivalent employment	10	10	10


Identification code 75–1553–0–1–609		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Training and technical assistance	14	12	12
0002	Federal parent locator service	25	25	25
0004	Welfare research	15	15	15

0799	Total direct obligations	54	52	52
0801	Reimbursable program FPLS REIMB	21	26	26

0900	Total new obligations	75	78	78

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	7	7	7
1021	Recoveries of prior year unpaid obligations	3

1050	Unobligated balance (total)	10	7	7
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	52	52	52

1260	Appropriations, mandatory (total)	52	52	52
	Spending authority from offsetting collections, mandatory:
1800	Collected	20	26	26

1850	Spending auth from offsetting collections, mand (total)	20	26	26
1900	Budget authority (total)	72	78	78
1930	Total budgetary resources available	82	85	85
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	7	7	7

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	61	60	52
3010	Obligations incurred, unexpired accounts	75	78	78
3020	Outlays (gross)	–73	–86	–84
3040	Recoveries of prior year unpaid obligations, unexpired	–3

3050	Unpaid obligations, end of year	60	52	46
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–5	–5	–5

3090	Uncollected pymts, Fed sources, end of year	–5	–5	–5
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	56	55	47
3200	Obligated balance, end of year	55	47	41

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	72	78	78
	Outlays, gross:
4100	Outlays from new mandatory authority	29	15	15
4101	Outlays from mandatory balances	44	71	69

4110	Outlays, gross (total)	73	86	84
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–19	–25	–25
4123	Non-Federal sources	–1	–1	–1

4130	Offsets against gross budget authority and outlays (total)	–20	–26	–26

4160	Budget authority, net (mandatory)	52	52	52
4170	Outlays, net (mandatory)	53	60	58
4180	Budget authority, net (total)	52	52	52
4190	Outlays, net (total)	53	60	58

This account provides funding for research and technical assistance activities established by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104–193), as amended by the Deficit Reduction Act of 2005 (P.L. 109–171). Since 2010, Welfare Research has been temporarily reauthorized by a series of Acts and is currently authorized through March 27, 2013, in the Continuing Appropriations Resolution, 2013 (P.L. 112–175).


Identification code 75–1553–0–1–609		2012 actual	2013 CR	2014 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	13	11	11
25.2	Other services from non-Federal sources	15	13	13
25.3	Other goods and services from Federal sources	7	6	6
25.7	Operation and maintenance of equipment	4	7	7
41.0	Grants, subsidies, and contributions	2	2	2

99.0	Direct obligations	54	52	52
99.0	Reimbursable obligations	21	26	26

99.9	Total new obligations	75	78	78


Identification code 75–1553–0–1–609		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment	62	70	70

For [making payments to States or other non-Federal entities under] carrying out, except as otherwise provided, title IV-E of the Social Security Act, [$4,810,000,000] $4,806,000,0000.

For [making payments to States or other non-Federal entities under] carrying out, except as otherwise provided, title IV-E of the Social Security Act, for the first quarter of fiscal year [2014] 2015, $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. Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.


Identification code 75–1545–0–1–609		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Foster care	4,180	4,286	4,279
0002	Independent living	140	140	140
0004	Adoption assistance	2,296	2,369	2,463
0005	Guardianship	74	123	124
0006	Tribal T&TA	3	3	3

0900	Total new obligations	6,693	6,921	7,009

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	5,156	4,821	4,809

1260	Appropriations, mandatory (total)	5,156	4,821	4,809
	Advance appropriations, mandatory:
1270	Advance appropriation	1,850	2,100	2,200

1280	Advanced appropriation, mandatory (total)	1,850	2,100	2,200
1900	Budget authority (total)	7,006	6,921	7,009
1930	Total budgetary resources available	7,006	6,921	7,009
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–313

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1,218	979	1,153
3010	Obligations incurred, unexpired accounts	6,693	6,921	7,009
3011	Obligations incurred, expired accounts	2
3020	Outlays (gross)	–6,847	–6,744	–6,899
3041	Recoveries of prior year unpaid obligations, expired	–87	–3	–4

3050	Unpaid obligations, end of year	979	1,153	1,259
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1,218	979	1,153
3200	Obligated balance, end of year	979	1,153	1,259

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	7,006	6,921	7,009
	Outlays, gross:
4100	Outlays from new mandatory authority	5,878	6,027	6,113
4101	Outlays from mandatory balances	969	717	786

4110	Outlays, gross (total)	6,847	6,744	6,899
4180	Budget authority, net (total)	7,006	6,921	7,009
4190	Outlays, net (total)	6,847	6,744	6,899


		2012 actual	2013 CR	2014 est.

Enacted/requested:
	Budget Authority	7,006	6,921	7,009
	Outlays	6,847	6,744	6,899
Legislative proposal, subject to PAYGO:
	Budget Authority			2
	Outlays			2
Total:
	Budget Authority	7,006	6,921	7,011
	Outlays	6,847	6,744	6,901

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 147,300 children per month are estimated to be served in FY 2014.

Adoption Assistance.—The proposed funding level will support subsidies for families adopting eligible low-income children with special needs. An average of 450,700 children per month are estimated to be served in FY 2014.

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 24,200 children per month are estimated to be served in FY 2014.


Identification code 75–1545–0–1–609		2012 actual	2013 CR	2014 est.

	Direct obligations:
23.1	Rental payments to GSA	1	1	1
25.1	Advisory and assistance services	15	17	22
25.3	Other goods and services from Federal sources	1
41.0	Grants, subsidies, and contributions	6,676	6,903	6,986

99.9	Total new obligations	6,693	6,921	7,009


Identification code 75–1545–0–1–609		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment	4	4	4


Identification code 75–1545–4–1–609		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Foster care			2

0900	Total new obligations (object class 41.0)			2

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation			2

1260	Appropriations, mandatory (total)			2
1900	Budget authority (total)			2
1930	Total budgetary resources available			2

	Change in obligated balance:
	Unpaid obligations:
3010	Obligations incurred, unexpired accounts			2
3020	Outlays (gross)			–2

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross			2
	Outlays, gross:
4100	Outlays from new mandatory authority			2
4180	Budget authority, net (total)			2
4190	Outlays, net (total)			2

This request continues support for the proposal to require that child support payments made on behalf of youth in foster care are used in the best interest of the child, rather than as an offset to state and federal child welfare costs.

Federal Funds

For carrying out, to the extent not otherwise provided, the Older Americans Act of 1965 ("OAA''), [section 398 and title] titles III and XXIX of the PHS Act, section 119 of the Medicare Improvements for Patients and Providers Act of 2008, section 6021(d) of the Deficit Reduction Act of 2005, [and] title XX-B of the Social Security Act, the Developmental Disabilities Assistance and Bill of Rights Act, parts 2 and 5 of subtitle D of title II of the Help America Vote Act of 2002, and for department-wide coordination of policy and program activities that assist individuals with disabilities, [$1,926,434,000] $2,042,640,000, together with [$51,902,000] $52,115,000 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]Reconciliation 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 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] $380,000,000 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] 2015, and may be recaptured and reobligated in accordance with section 517(c) of the OAA. Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.


Identification code 75–0142–0–1–506		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0101	Home and community-based supportive services	367	369	367
0102	Preventive health services	21	21	21
0103	National family caregiver support program	154	155	154
0104	Native American caregiver support program	6	6	6
0105	Congregate nutrition services	439	442	439
0106	Home-delivered nutrition services	217	218	217
0107	Nutrition services incentive program	158	159	160
0108	Native American nutrition and supportive services	28	28	28
0110	Aging network support activities	8	8	8
0111	Long-term care ombudsmen program	17	17	17
0112	Prevention of elder abuse and neglect	5	5	5
0113	Alzheimer's disease demonstration grants	4	4	9
0114	Program administration	23	23	30
0115	Lifespan respite care program	2	2	2
0117	Aging and Disability Resource Centers (ADRC)	16	16	10
0118	Chronic Disease Self-Management Education Program	10		10
0121	Senior Medicare Patrol program	9	9	9
0122	Elder Rights Support Activities	4	4	4
0126	National Clearinghouse Long-Term Care Information	3		3
0127	Alzheimer's Disease Awareness and Education	4		4
0128	Adult Protective Services	6		8
0129	Senior Community Service Employment Program			380
0131	State Health Insurance Assistance Program			26
0133	Alzheimer's Disease Initiative - Services			11
0135	Paralysis Resource Center			7
0136	Voting Access for People With Disabilities			5
0138	State Councils on Developmental Disabilities			75
0139	Protection and Advocacy			41
0141	University Centers for Excellence in Developmental Disabilities			39
0142	Projects of National Significance			8

0300	Total, direct program	1,501	1,486	2,103

0799	Total direct obligations	1,501	1,486	2,103
0801	Reimbursable program - HCFAC and Other	11	11	11
0802	ADRC's - MIPPA (TRA)		5
0803	Area Agencies on Aging - MIPPA (TRA)		8
0804	MIPPA - Natl Center Benefits Outreach Enrollment		5
0805	SHIPs			26

0899	Total reimbursable obligations	11	29	37

0900	Total new obligations	1,512	1,515	2,140

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1		1	5
1021	Recoveries of prior year unpaid obligations	2

1050	Unobligated balance (total)	2	1	5
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	1,474	1,480	2,043
1120	Appropriations transferred to other accts [12–3507]	–2
1130	Appropriations permanently reduced	–3

1160	Appropriation, discretionary (total)	1,469	1,480	2,043
	Appropriations, mandatory:
1200	Appropriation	13	10	10
1221	PPHF Appropriations transferred from other accounts [75–0116]	20		25

1260	Appropriations, mandatory (total)	33	10	35
	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	22	29	11
1801	Change in uncollected payments, Federal sources	–12

1850	Spending auth from offsetting collections, mand (total)	10	29	11
1900	Budget authority (total)	1,512	1,519	2,141
1930	Total budgetary resources available	1,514	1,520	2,146
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–1
1941	Unexpired unobligated balance, end of year	1	5	6

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	679	691	707
3010	Obligations incurred, unexpired accounts	1,512	1,515	2,140
3020	Outlays (gross)	–1,493	–1,499	–1,889
3040	Recoveries of prior year unpaid obligations, unexpired	–2
3041	Recoveries of prior year unpaid obligations, expired	–5

3050	Unpaid obligations, end of year	691	707	958
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–37	–18	–18
3070	Change in uncollected pymts, Fed sources, unexpired	12
3071	Change in uncollected pymts, Fed sources, expired	7

3090	Uncollected pymts, Fed sources, end of year	–18	–18	–18
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	642	673	689
3200	Obligated balance, end of year	673	689	940

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	1,469	1,480	2,095
	Outlays, gross:
4010	Outlays from new discretionary authority	936	903	1,298
4011	Outlays from discretionary balances	522	554	567

4020	Outlays, gross (total)	1,458	1,457	1,865
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources			–52
	Mandatory:
4090	Budget authority, gross	43	39	46
	Outlays, gross:
4100	Outlays from new mandatory authority	3	30	15
4101	Outlays from mandatory balances	32	12	9

4110	Outlays, gross (total)	35	42	24
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–28	–29	–11
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	12
4142	Offsetting collections credited to expired accounts	6

4150	Additional offsets against budget authority only (total)	18

4160	Budget authority, net (mandatory)	33	10	35
4170	Outlays, net (mandatory)	7	13	13
4180	Budget authority, net (total)	1,502	1,490	2,078
4190	Outlays, net (total)	1,465	1,470	1,826

Note.—The reimbursable program (HCFAC) in the Administration on Aging (AoA) reflects the actual distribution of the allocation account for 2012. Future allocations will be determined annually, and are not estimated in the current budget.

This account provides funding for formula grant programs that provide nutrition, supportive services and caregiver support services through a network of aging-related organizations to help predominantly older Americans, with the assistance of their caregivers, maintain their dignity and independence in their homes and communities. The Budget proposes to transfer the Senior Community Services Employment Program (SCSEP), authorized under title V of the Older Americans Act, from the Department of Labor to the Department of Health and Human Services (HHS), 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. As a part of the proposed transfer to HHS, the Department will make improving program performance, including targeting the SCSEP program to people with the greatest need, a priority. This process is expected to include better aligning the program's eligibility, income, and other requirements with those of other HHS income maintenance programs


Identification code 75–0142–0–1–506		2012 actual	2013 CR	2014 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	12	12	19
12.1	Civilian personnel benefits	3	3	5
23.1	Rental payments to GSA	2	2	4
25.1	Advisory and assistance services	18	13	28
25.3	Other goods and services from Federal sources	8	7	9
41.0	Grants, subsidies, and contributions	1,458	1,449	2,038

99.0	Direct obligations	1,501	1,486	2,103
99.0	Reimbursable obligations	11	29	37

99.9	Total new obligations	1,512	1,515	2,140


Identification code 75–0142–0–1–506		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment	111	111	188
2001	Reimbursable civilian full-time equivalent employment	8	8	8

Federal Funds

For necessary expenses, not otherwise provided, for general departmental management, including hire of passenger motor vehicles, and for carrying out titles II, 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, [$306,320,000] $301,435,000, together with [$116,841,000] $119,841,000 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 the funds made available under this heading, [$3,500,000] $1,750,000 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.)] 41 U.S.C. 1703: 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, no less than [$4,232,000] $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. Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.


Identification code 75–9912–0–1–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	General Departmental Management	475	477	301
0004	Prevention & Public Health Fund (PPHF) (MAND)	30		105

0799	Total direct obligations	505	477	406
0801	GDM (PHS Evaluation & Collected)	166	166	166
0802	HCFAC (Mandatory)	9	9	9
0803	PHS Evaluation (Collected)	69	70	120

0899	Total reimbursable obligations	244	245	295

0900	Total new obligations	749	722	701

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	2	3	2
1021	Recoveries of prior year unpaid obligations	1

1050	Unobligated balance (total)	3	3	2
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	475	477	301
1130	Appropriations permanently reduced (Rescission)	–1

1160	Appropriation, discretionary (total)	474	477	301
	Appropriations, mandatory:
1221	Appropriations transferred from other accts [75–0116]	30		105

1260	Appropriations, mandatory (total)	30		105
	Spending authority from offsetting collections, discretionary:
1700	Collected (PHS Evaluation & Collected)	113	235	286
1701	Change in uncollected payments, Federal sources (PHS Evaluation & Collected)	125

1750	Spending auth from offsetting collections, disc (total)	238	235	286
	Spending authority from offsetting collections, mandatory:
1800	Collected HCFAC (Mandatory)		9	9
1801	Change in uncollected payments, Federal sources	9

1850	Spending auth from offsetting collections, mand (total)	9	9	9
1900	Budget authority (total)	751	721	701
1930	Total budgetary resources available	754	724	703
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–2
1941	Unexpired unobligated balance, end of year	3	2	2

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	717	623	710
3010	Obligations incurred, unexpired accounts	749	722	701
3011	Obligations incurred, expired accounts	49
3020	Outlays (gross)	–860	–635	–815
3040	Recoveries of prior year unpaid obligations, unexpired	–1
3041	Recoveries of prior year unpaid obligations, expired	–31

3050	Unpaid obligations, end of year	623	710	596
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–226	–233	–233
3070	Change in uncollected pymts, Fed sources, unexpired	–134
3071	Change in uncollected pymts, Fed sources, expired	127

3090	Uncollected pymts, Fed sources, end of year	–233	–233	–233
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	491	390	477
3200	Obligated balance, end of year	390	477	363

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	712	712	587
	Outlays, gross:
4010	Outlays from new discretionary authority	340	339	289
4011	Outlays from discretionary balances	485	271	490

4020	Outlays, gross (total)	825	610	779
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources (PHS Evaluation & Collected)	–219	–235	–286
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–125
4052	Offsetting collections credited to expired accounts	106

4060	Additional offsets against budget authority only (total)	–19

4070	Budget authority, net (discretionary)	474	477	301
4080	Outlays, net (discretionary)	606	375	493
	Mandatory:
4090	Budget authority, gross	39	9	114
	Outlays, gross:
4100	Outlays from new mandatory authority	16	9	23
4101	Outlays from mandatory balances	19	16	13

4110	Outlays, gross (total)	35	25	36
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources (HCFAC Mandatory)	–34	–9	–9
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–9
4142	Offsetting collections credited to expired accounts	34

4150	Additional offsets against budget authority only (total)	25

4160	Budget authority, net (mandatory)	30		105
4170	Outlays, net (mandatory)	1	16	27
4180	Budget authority, net (total)	504	477	406
4190	Outlays, net (total)	607	391	520

Note.—The reimbursable program (HCFAC) in the General Department Management (GDM) account reflects the actual distribution of the allocation account for 2012. Future allocation will be determined annually, and are not estimated in the current budget.

General Departmental Management (GDM) funds activities that provide leadership, policy, legal, and administrative guidance to HHS components, and support research to develop policy initiatives and improve existing HHS programs. GDM also funds the activities of the Office of the Assistant Secretary for Health, including adolescent health, disease prevention and health promotion, physical fitness and sports, minority health, research integrity, women's health, and programs funded through the Prevention and Public Health Fund. This includes funding the continuation of grants for medically accurate and age appropriate programs to reduce teen pregnancy, including funds for research, demonstration grants, and replication of programs that have been proven effective through rigorous evaluation to reduce teen pregnancy.


Identification code 75–9912–0–1–551		2012 actual	2013 CR	2014 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	92	92	94
11.3	Other than full-time permanent	12	12	12
11.5	Other personnel compensation	3	3	3
11.7	Military personnel	4	4	4

11.9	Total personnel compensation	111	111	113
12.1	Civilian personnel benefits	28	29	28
12.2	Military personnel benefits	2	2	2
21.0	Travel and transportation of persons	5	5	4
23.1	Rental payments to GSA	18	18	19
23.3	Communications, utilities, and miscellaneous charges	4	4	3
24.0	Printing and reproduction	1	1	1
25.1	Advisory and assistance services	59	30	23
25.2	Other services from non-Federal sources	39	40	31
25.3	Other goods and services from Federal sources	75	75	48
25.4	Operation and maintenance of facilities	7	7	5
25.7	Operation and maintenance of equipment	4	4	4
26.0	Supplies and materials	1	1	1
31.0	Equipment	1		1
41.0	Grants, subsidies, and contributions	150	150	123

99.0	Direct obligations	505	477	406
99.0	Reimbursable obligations	244	245	295

99.9	Total new obligations	749	722	701


Identification code 75–9912–0–1–551		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment	1,043	1,054	1,035
1101	Direct military average strength employment	40	37	37
2001	Reimbursable civilian full-time equivalent employment	485	418	434
2101	Reimbursable military average strength employment	27	17	17

For expenses necessary for the Office for Civil Rights, [$38,966,000] $42,205,000. Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.


Identification code 75–0135–0–1–751		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Direct program activity	41	41	42
0801	Reimbursable program activity	4	6	7

0900	Total new obligations	45	47	49

	Budgetary Resources:
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	41	41	42

1160	Appropriation, discretionary (total)	41	41	42
	Spending authority from offsetting collections, discretionary:
1700	Collected	4	6	7

1750	Spending auth from offsetting collections, disc (total)	4	6	7
1900	Budget authority (total)	45	47	49
1930	Total budgetary resources available	45	47	49

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	12	12	11
3010	Obligations incurred, unexpired accounts	45	47	49
3020	Outlays (gross)	–44	–48	–49
3041	Recoveries of prior year unpaid obligations, expired	–1

3050	Unpaid obligations, end of year	12	11	11
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–1
3071	Change in uncollected pymts, Fed sources, expired	1
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	11	12	11
3200	Obligated balance, end of year	12	11	11

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	45	47	49
	Outlays, gross:
4010	Outlays from new discretionary authority	37	39	41
4011	Outlays from discretionary balances	7	9	8

4020	Outlays, gross (total)	44	48	49
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–1
4033	Non-Federal sources	–4	–6	–7

4040	Offsets against gross budget authority and outlays (total)	–5	–6	–7
	Additional offsets against gross budget authority only:
4052	Offsetting collections credited to expired accounts	1

4070	Budget authority, net (discretionary)	41	41	42
4080	Outlays, net (discretionary)	39	42	42
4180	Budget authority, net (total)	41	41	42
4190	Outlays, net (total)	39	42	42

The Office for Civil Rights funds activities that carry out the Department's civil rights nondiscrimination and health information privacy and security compliance programs.


Identification code 75–0135–0–1–751		2012 actual	2013 CR	2014 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	21	22	23
11.3	Other than full-time permanent	1	1	1

11.9	Total personnel compensation	22	23	24
12.1	Civilian personnel benefits	6	5	6
23.1	Rental payments to GSA	3	3	3
25.2	Other services from non-Federal sources	3	2	2
25.3	Other goods and services from Federal sources	5	6	5
25.4	Operation and maintenance of facilities	1	1	1
25.7	Operation and maintenance of equipment	1	1	1

99.0	Direct obligations	41	41	42
99.0	Reimbursable obligations	4	6	7

99.9	Total new obligations	45	47	49


Identification code 75–0135–0–1–751		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment	223	220	228
1101	Direct military average strength employment	1	2	2
2001	Reimbursable civilian full-time equivalent employment	2	3	3

For expenses necessary for the Office of the National Coordinator for Health Information Technology, including grants, contracts, and cooperative agreements for the development and advancement of interoperable health information technology, [$26,246,000] $20,576,000: Provided, That in addition to amounts provided herein, [$40,011,000] $56,307,000 shall be available from amounts available under section 241 of the PHS Act: Provided further, That health information technology user fees collected in FY 2014, as provided in this Act, shall be credited to this account as offsetting collections, to remain available until expended. Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.


Identification code 75–0130–0–1–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Health information technology	16	17	21
0002	Recovery Act activities	33

0799	Total direct obligations	49	17	21
0801	Reimbursable program	12	7	7
0802	Reimbursable program: PHS evaluation	44	45	57
0803	Reimbursable program activity: User Fee			1

0899	Total reimbursable obligations	56	52	65

0900	Total new obligations	105	69	86

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	5	1	1
1021	Recoveries of prior year unpaid obligations	30

1050	Unobligated balance (total)	35	1	1
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	16	17	21

1160	Appropriation, discretionary (total)	16	17	21
	Spending authority from offsetting collections, discretionary:
1700	PHS and Other	47	52	64
1700	User Fee			1
1701	Change in uncollected payments, Federal sources	9

1750	Spending auth from offsetting collections, disc (total)	56	52	65
1900	Budget authority (total)	72	69	86
1930	Total budgetary resources available	107	70	87
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–1
1941	Unexpired unobligated balance, end of year	1	1	1

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1,553	977	414
3010	Obligations incurred, unexpired accounts	105	69	86
3011	Obligations incurred, expired accounts	1
3020	Outlays (gross)	–648	–632	–441
3040	Recoveries of prior year unpaid obligations, unexpired	–30
3041	Recoveries of prior year unpaid obligations, expired	–4

3050	Unpaid obligations, end of year	977	414	59
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–44	–23	–3
3070	Change in uncollected pymts, Fed sources, unexpired	–9
3071	Change in uncollected pymts, Fed sources, expired	30	20

3090	Uncollected pymts, Fed sources, end of year	–23	–3	–3
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1,509	954	411
3200	Obligated balance, end of year	954	411	56

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	72	69	86
	Outlays, gross:
4010	Outlays from new discretionary authority	46	66	83
4011	Outlays from discretionary balances	599	563	358

4020	Outlays, gross (total)	645	629	441
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–78	–52	–64
4033	Non-Federal sources			–1

4040	Offsets against gross budget authority and outlays (total)	–78	–52	–65
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–9
4052	Offsetting collections credited to expired accounts	31

4060	Additional offsets against budget authority only (total)	22

4070	Budget authority, net (discretionary)	16	17	21
4080	Outlays, net (discretionary)	567	577	376
	Mandatory:
	Outlays, gross:
4101	Outlays from mandatory balances	3	3
4180	Budget authority, net (total)	16	17	21
4190	Outlays, net (total)	570	580	376

This program supports coordination, leadership, and development of Federal health information technology activities and Federal initiatives for the nationwide advancement of private and secure interoperable health information technology, in cooperation with participants in the health sector. The Office of the National Coordinator for Health Information Technology was established in the Health Information Technology for Economic and Clinical Health Act (P.L. 111–5, Title XIII), for the purpose of addressing strategic planning, coordination, and the analysis of key technical, economic and other issues related to the public and private adoption of health information technology.


Identification code 75–0130–0–1–551		2012 actual	2013 CR	2014 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	3
12.1	Civilian personnel benefits	1
23.1	Rental payments to GSA	3	2	3
25.1	Advisory and assistance services		1	1
25.2	Other services from non-Federal sources	5	6	8
25.3	Other goods and services from Federal sources	6	7	8
25.4	Operation and maintenance of facilities	2	1	1
41.0	Grants, subsidies, and contributions	29

99.0	Direct obligations	49	17	21
99.0	Reimbursable obligations	56	52	65

99.9	Total new obligations	105	69	86


Identification code 75–0130–0–1–551		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment	158	190	190
1101	Direct military average strength employment	1	1	1

For expenses necessary for [administrative law judges responsible for hearing cases under title XVIII of the Social Security Act (and related provisions of title XI of such Act), $84,234,000] the Office of Medicare Hearings and Appeals, $82,381,000, to be transferred in appropriate part from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund. Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.


Identification code 75–0139–0–1–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Direct program activity	71	72	82

	Budgetary Resources:
	Budget authority:
	Spending authority from offsetting collections, discretionary:
1700	Collected	72	72	82

1750	Spending auth from offsetting collections, disc (total)	72	72	82
1930	Total budgetary resources available	72	72	82
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–1

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	15	14
3010	Obligations incurred, unexpired accounts	71	72	82
3011	Obligations incurred, expired accounts	1
3020	Outlays (gross)	–70	–86	–82
3041	Recoveries of prior year unpaid obligations, expired	–3

3050	Unpaid obligations, end of year	14
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	15	14
3200	Obligated balance, end of year	14

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	72	72	82
	Outlays, gross:
4010	Outlays from new discretionary authority	62	72	82
4011	Outlays from discretionary balances	8	14

4020	Outlays, gross (total)	70	86	82
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–72	–72	–82
4190	Outlays, net (total)	–2	14

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 an independent and impartial forum for the adjudication of claims brought by or on behalf of Medicare beneficiaries related to their benefits and care.


Identification code 75–0139–0–1–551		2012 actual	2013 CR	2014 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	39	42	45
12.1	Civilian personnel benefits	12	13	14
22.0	Transportation of things			1
23.1	Rental payments to GSA	7	6	7
23.3	Communications, utilities, and miscellaneous charges	1	3	4
25.1	Advisory and assistance services	1
25.2	Other services from non-Federal sources	1	1	1
25.3	Other goods and services from Federal sources	9	5	5
25.4	Operation and maintenance of facilities		1	1
25.7	Operation and maintenance of equipment			1
26.0	Supplies and materials	1		1
31.0	Equipment		1	2

99.9	Total new obligations	71	72	82


Identification code 75–0139–0–1–551		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment	466	490	514

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, [$625,262,000; of which $5,000,000 shall remain available until expended to support emergency operations and] $858,521,000, of which [$50,000,000] $415,130,000 shall remain available [until expended] through September 30, 2015, 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, and of which up to $5,000,000 shall remain available through September 30, 2016, to support the delivery of medical countermeasures and shall be in addition to any other amounts available for such purpose: Provided, That funds provided under this heading for the purpose of acquisition of security countermeasures 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: Provided further, That $5,000,000 of the amounts made available to support emergency operations shall remain available through September 30, 2016: Provided further, That of the amounts made available to support advanced research and development, $20,000,000 shall remain available through September 30, 2015, for the purposes of establishing and funding, using for either such purpose contracts, grants, cooperative agreements, or other transactions as described in section 319L of the PHS Act (42 U.S.C. 247d-7e), a strategic investment corporation [established] , which shall not be deemed to be a Federal agency for any purpose, to further the purposes of such 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].

For necessary expenses for procuring security countermeasures (as defined in section 319F-2(c)(1)(B) of the PHS Act), $250,000,000, to remain available until expended.

For expenses necessary to prepare for and respond to an influenza pandemic, $140,009,000; of which $108,000,000 shall be available until expended, for activities including the development and purchase of vaccine, antivirals, necessary medical supplies, diagnostics, and other surveillance tools: Provided further, That notwithstanding section 496(b) of the PHS Act, funds may be used for the construction or renovation of privately owned facilities for the production of pandemic influenza vaccines and other biologics, if the Secretary finds such construction or renovation necessary to secure sufficient supplies of such vaccines or biologics: Provided further, That funds appropriated in this paragraph may be transferred to other appropriation accounts of the Department of Health and Human Services, as determined by the Secretary to be appropriate, to be used for the purposes specified in this paragraph.

[From funds transferred to this account pursuant to the fourth paragraph under this heading in Public Law 111–117, up to $415,000,000 shall be available for expenses necessary to support advanced research and development pursuant to section 319L of the PHS Act, and other administrative expenses of the Biomedical Advanced Research and Development Authority to support additional advanced research and development: Provided, That funds provided under this heading for the purpose of acquisition of security countermeasures may be used and shall be in addition to any other funds available for such purpose: Provided further, That products purchased with funds provided under this heading may, at the discretion of the Secretary, be deposited in the Strategic National Stockpile pursuant to section 319F-2 of the PHS Act.]

In addition, for expenses necessary for replacement of building leases and associated renovation costs for Public Health Service agencies and other components of the Department of Health and Human Services, including relocation and fit-out costs, [$17,000,000] $41,000,000, to remain available until expended. Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution as well as amounts from P.L. 113–2, the Disaster Relief Appropriations Act, 2013 (no language shown).


Identification code 75–0140–0–1–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Public Health and Social Services Emergency Fund	1,749	2,305	881
0801	Reimbursable program	36	60	60

0900	Total new obligations	1,785	2,365	941

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	3,414	2,349	808
1010	Unobligated balance transfer to other accts [75–0343]	–3	–3	–3
1021	Recoveries of prior year unpaid obligations	120

1050	Unobligated balance (total)	3,531	2,346	805
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	569	1,372	1,290
1120	Appropriations transferred to other accts [75–1534]		–500
1120	Appropriations transferred to other accts [75–1536]		–100
1120	Appropriations transferred to other accts [75–0128]		–5
1130	Appropriations permanently reduced	–1

1160	Appropriation, discretionary (total)	568	767	1,290
	Spending authority from offsetting collections, discretionary:
1700	Collected	1	60	60
1701	Change in uncollected payments, Federal sources	35

1750	Spending auth from offsetting collections, disc (total)	36	60	60
1900	Budget authority (total)	604	827	1,350
1930	Total budgetary resources available	4,135	3,173	2,155
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–1
1941	Unexpired unobligated balance, end of year	2,349	808	1,214

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	4,611	4,455	4,931
3010	Obligations incurred, unexpired accounts	1,785	2,365	941
3011	Obligations incurred, expired accounts	2
3020	Outlays (gross)	–1,795	–1,889	–1,999
3040	Recoveries of prior year unpaid obligations, unexpired	–120
3041	Recoveries of prior year unpaid obligations, expired	–28

3050	Unpaid obligations, end of year	4,455	4,931	3,873
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–290	–241	–241
3070	Change in uncollected pymts, Fed sources, unexpired	–35
3071	Change in uncollected pymts, Fed sources, expired	84

3090	Uncollected pymts, Fed sources, end of year	–241	–241	–241
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	4,321	4,214	4,690
3200	Obligated balance, end of year	4,214	4,690	3,632

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	604	827	1,350
	Outlays, gross:
4010	Outlays from new discretionary authority	147	248	431
4011	Outlays from discretionary balances	1,648	1,641	1,568

4020	Outlays, gross (total)	1,795	1,889	1,999
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–81	–60	–60
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–35
4052	Offsetting collections credited to expired accounts	80

4060	Additional offsets against budget authority only (total)	45

4070	Budget authority, net (discretionary)	568	767	1,290
4080	Outlays, net (discretionary)	1,714	1,829	1,939
4180	Budget authority, net (total)	568	767	1,290
4190	Outlays, net (total)	1,714	1,829	1,939

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 and procurement of biodefense and pandemic influenza countermeasures.

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.

Resources are also being provided for the Department's consolidation of lease replacements and renovation costs for the National Capital Region.


Identification code 75–0140–0–1–551		2012 actual	2013 CR	2014 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	57	57	58
11.3	Other than full-time permanent	14	14	15
11.7	Military personnel	9	9	9

11.9	Total personnel compensation	80	80	82
12.1	Civilian personnel benefits	21	21	21
12.2	Military personnel benefits	4	4	4
21.0	Travel and transportation of persons	8	6	3
22.0	Transportation of things	10	9	7
23.1	Rental payments to GSA	11	10	10
23.3	Communications, utilities, and miscellaneous charges	5	5	4
25.1	Advisory and assistance services	281	279	62
25.2	Other services from non-Federal sources	37	36	26
25.3	Other goods and services from Federal sources	525	498	103
25.4	Operation and maintenance of facilities	3	3	3
25.5	Research and development contracts	176	786	226
25.7	Operation and maintenance of equipment	43	43	31
26.0	Supplies and materials	48	40	17
31.0	Equipment	32	30	24
32.0	Land and structures	25	15	15
41.0	Grants, subsidies, and contributions	440	440	243

99.0	Direct obligations	1,749	2,305	881
99.0	Reimbursable obligations	36	60	60

99.9	Total new obligations	1,785	2,365	941


Identification code 75–0140–0–1–551		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment	551	567	608
1101	Direct military average strength employment	75	83	83


Identification code 75–0145–0–1–552		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0801	AHRQ	8	43	75
0802	Office of the Secretary	3	19	25

0900	Total new obligations	11	62	100

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	9	28	42
	Budget authority:
	Spending authority from offsetting collections, mandatory:
1800	Collected	30	76	125

1850	Spending auth from offsetting collections, mand (total)	30	76	125
1930	Total budgetary resources available	39	104	167
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	28	42	67

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1	9	61
3010	Obligations incurred, unexpired accounts	11	62	100
3020	Outlays (gross)	–3	–10	–35

3050	Unpaid obligations, end of year	9	61	126
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1	9	61
3200	Obligated balance, end of year	9	61	126

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	30	76	125
	Outlays, gross:
4100	Outlays from new mandatory authority	1	2	4
4101	Outlays from mandatory balances	2	8	31

4110	Outlays, gross (total)	3	10	35
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–30	–76	–125
4190	Outlays, net (total)	–27	–66	–90

Public Law 111–148 established the Patient-Centered Outcomes Research Trust Fund (PCORTF). Beginning in FY 2011, a total of 20 percent of the funds appropriated or credited to the PCORTF will be transferred each year to the Department of Health and Human Services (HHS). As authorized in section 937 of the Public Health Service Act, HHS will disseminate research findings from the Patient-Centered Outcomes Research Institute and other government-funded comparative clinical effectiveness research and build research and data capacity for comparative clinical effectiveness research. Transferred funds will be distributed to the Secretary of HHS and the Agency for Healthcare Research and Quality to carry out these activities.


Identification code 75–0145–0–1–552		2012 actual	2013 CR	2014 est.

99.0	Reimbursable obligations	3	19	25
	Allocation Account - reimbursable:
11.1	Personnel compensation: Full-time permanent		2	3
25.5	Research and development contracts	8	41	72

99.0	Allocation account - reimbursable	8	43	75

99.9	Total new obligations	11	62	100


Identification code 75–0145–0–1–552		2012 actual	2013 CR	2014 est.

2001	Reimbursable civilian full-time equivalent employment	1	2	2


Identification code 75–0144–0–1–551		2012 actual	2013 CR	2014 est.

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	18	2	2
3020	Outlays (gross)	–14
3041	Recoveries of prior year unpaid obligations, expired	–2

3050	Unpaid obligations, end of year	2	2	2
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	18	2	2
3200	Obligated balance, end of year	2	2	2

	Budget authority and outlays, net:
	Discretionary:
	Outlays, gross:
4011	Outlays from discretionary balances	14
4190	Outlays, net (total)	14

The Prevention and Wellness Fund is authorized under the American Recovery and Reinvestment Act (ARRA), (P.L. 111–5). The Prevention and Wellness Fund administers evidence-based clinical and community-based prevention and wellness strategies.

The Nonrecurring Expenses Fund is a no-year account that captures expired unobligated balances from discretionary accounts prior to cancellation. The Fund will be used for capital acquisition, including facilities infrastructure and information technology infrastructure.


Identification code 75–0119–0–1–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Direct program activity	333	241

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	565	241
1021	Recoveries of prior year unpaid obligations	9

1050	Unobligated balance (total)	574	241
1930	Total budgetary resources available	574	241
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	241

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	205	265	188
3010	Obligations incurred, unexpired accounts	333	241
3020	Outlays (gross)	–264	–318	–163
3040	Recoveries of prior year unpaid obligations, unexpired	–9

3050	Unpaid obligations, end of year	265	188	25
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	205	265	188
3200	Obligated balance, end of year	265	188	25

	Budget authority and outlays, net:
	Mandatory:
	Outlays, gross:
4101	Outlays from mandatory balances	264	318	163
4190	Outlays, net (total)	264	318	163

Section 1005 of the Health Care and Education Reconciliation Act of 2010 (P.L. 111–152) appropriated $1,000,000,000 to the Health Insurance Reform Implementation Fund within the Department of Health and Human Services. The Fund shall be used for Federal administrative expenses necessary to carry out the requirements of the Patient Protection and Affordable Care Act of 2010 (P.L. 111–148) and the Health Care and Education Reconciliation Act of 2010.


Identification code 75–0119–0–1–551		2012 actual	2013 CR	2014 est.

	Direct obligations:
11.1	Personnel compensation: Full-time permanent	1
12.1	Civilian personnel benefits	1
25.2	Other services from non-Federal sources	25	237
25.3	Other goods and services from Federal sources		4

99.0	Direct obligations	27	241
	Allocation Account - direct:
	Personnel compensation:
11.1	Full-time permanent	71
11.3	Other than full-time permanent	1
11.5	Other personnel compensation	1

11.9	Total personnel compensation	73
12.1	Civilian personnel benefits	20
21.0	Travel and transportation of persons	2
25.1	Advisory and assistance services	181
25.2	Other services from non-Federal sources	9
31.0	Equipment	20

99.0	Allocation account - direct	305
99.5	Below reporting threshold	1

99.9	Total new obligations	333	241


Identification code 75–0119–0–1–551		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment	16


Identification code 75–0116–0–1–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Direct program activity		1,000

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	1,000	1,250	1,250
1220	Appropriations transferred to other accts [75–0142]	–20		–25
1220	Appropriations transferred to other accts [75–1700]	–12
1220	Appropriations transferred to other accts [75–0943]	–809		–755
1220	Appropriations transferred to other accts [75–9912]	–30		–105
1220	Appropriations transferred to other accts [75–0350]	–37		–57
1220	Appropriations transferred to other accts [75–1362]	–92		–58
1230	Appropriations and/or unobligated balance of appropriations permanently reduced		–250	–250

1260	Appropriations, mandatory (total)		1,000
1930	Total budgetary resources available		1,000

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1			890
3010	Obligations incurred, unexpired accounts		1,000
3020	Outlays (gross)		–110	–800

3050	Unpaid obligations, end of year		890	90
	Memorandum (non-add) entries:
3100	Obligated balance, start of year			890
3200	Obligated balance, end of year		890	90

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross		1,000
	Outlays, gross:
4100	Outlays from new mandatory authority		110
4101	Outlays from mandatory balances			800

4110	Outlays, gross (total)		110	800
4180	Budget authority, net (total)		1,000
4190	Outlays, net (total)		110	800

The Affordable Care Act, (P.L. 111–148) establishes the Prevention and Public Health Fund as a mandatory appropriation for prevention and public health activities. For FY 2014, $1.00 billion is available within the Fund to support a range of public health efforts intended to prevent disease and reduce health care costs. The Secretary has authority to transfer to accounts within HHS.


Identification code 75–0116–0–1–551		2012 actual	2013 CR	2014 est.

	Direct obligations:
25.2	Other services from non-Federal sources		250
41.0	Grants, subsidies, and contributions		750

99.9	Total new obligations		1,000


Identification code 75–0117–0–1–551		2012 actual	2013 CR	2014 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:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	40	39	39
3010	Obligations incurred, unexpired accounts	25	25	25
3020	Outlays (gross)	–26	–25	–21

3050	Unpaid obligations, end of year	39	39	43
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	40	39	39
3200	Obligated balance, end of year	39	39	43

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	25	25	25
	Outlays, gross:
4100	Outlays from new mandatory authority	1	2	2
4101	Outlays from mandatory balances	25	23	19

4110	Outlays, gross (total)	26	25	21
4180	Budget authority, net (total)	25	25	25
4190	Outlays, net (total)	26	25	21

For awarding competitive grants to States to assist pregnant and parenting teens and women.


Identification code 75–0117–0–1–551		2012 actual	2013 CR	2014 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


Identification code 75–3902–0–1–552		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0801	Reimbursable program activity		530	1,331

0809	Reimbursable program activities, subtotal		530	1,331

0900	Total new obligations (object class 25.3)		530	1,331

	Budgetary Resources:
	Budget authority:
	Spending authority from offsetting collections, discretionary:
1700	Collected		530	1,331

1750	Spending auth from offsetting collections, disc (total)		530	1,331
1930	Total budgetary resources available		530	1,331

	Change in obligated balance:
	Unpaid obligations:
3010	Obligations incurred, unexpired accounts		530	1,331
3020	Outlays (gross)		–530	–1,331

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross		530	1,331
	Outlays, gross:
4010	Outlays from new discretionary authority		530	1,331
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources		–530	–1,331

The Public Health Service Act (PHS) Evaluation Transactions account supports the execution of section 241 of the PHS Act.


Identification code 75–3902–0–1–552		2012 actual	2013 CR	2014 est.

99.0	Reimbursable obligations		530	1,331

Federal Funds

For retirement pay and medical benefits of Public Health Service Commissioned Officers as authorized by law, for payments under the Retired Serviceman's Family Protection Plan and Survivor Benefit Plan, and for medical care of dependents and retired personnel under the Dependents' Medical Care Act, such amounts as may be required during the current fiscal year. Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.


Identification code 75–0379–0–1–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Retirement payments	405	394	415
0002	Survivors' benefits	25	27	28
0003	Medical care	94	101	108

0900	Total new obligations	524	522	551

	Budgetary Resources:
	Budget authority:
	Appropriations, mandatory:
1200	Appropriation	524	522	551

1260	Appropriations, mandatory (total)	524	522	551
1930	Total budgetary resources available	524	522	551

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	29	101	31
3001	Adjustments to unpaid obligations, brought forward, Oct 1		–31
3010	Obligations incurred, unexpired accounts	524	522	551
3011	Obligations incurred, expired accounts	10
3020	Outlays (gross)	–453	–561	–549
3041	Recoveries of prior year unpaid obligations, expired	–9

3050	Unpaid obligations, end of year	101	31	33
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	29	70	31
3200	Obligated balance, end of year	101	31	33

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	524	522	551
	Outlays, gross:
4100	Outlays from new mandatory authority	440	496	523
4101	Outlays from mandatory balances	13	65	26

4110	Outlays, gross (total)	453	561	549
4180	Budget authority, net (total)	524	522	551
4190	Outlays, net (total)	453	561	549


		2012 actual	2013 CR	2014 est.

Enacted/requested:
	Budget Authority	524	522	551
	Outlays	453	561	549
Legislative proposal, subject to PAYGO:
	Budget Authority			–1
	Outlays			–1
Total:
	Budget Authority	524	522	550
	Outlays	453	561	548

The number of beneficiaries using the Commissioned Corps system is estimated as follows:


	2012	2013	2014

Active Duty:
HHS	4888	4935	4938
DOJ, BOP	812	845	845
Homeland Security	474	509	509
EPA	74	70	70

All Other	380	407	407

Total Active Duty	6628	6766	6769

Retirees & Survivors:
Retirees	5430	5565	5700

Retiree family members and survivors	979	1000	1021

Total Retirement Pay	6409	6565	6721

Total Beneficiaries (active duty, retirees, survivors)	13037	13331	13490

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


Identification code 75–0379–0–1–551		2012 actual	2013 CR	2014 est.

	Direct obligations:
13.0	Benefits for former personnel	430	421	443
25.6	Medical care	94	101	108

99.9	Total new obligations	524	522	551


Identification code 75–0379–4–1–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Direct program activity			–1

0900	Total new obligations (object class 25.6)			–1

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

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

	Change in obligated balance:
	Unpaid obligations:
3010	Obligations incurred, unexpired accounts			–1
3020	Outlays (gross)			1

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


Identification code 75–0170–0–1–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Medicare eligible accruals	36	29	28

0900	Total new obligations (object class 12.2)	36	29	28

	Budgetary Resources:
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	36	29	28

1160	Appropriation, discretionary (total)	36	29	28
1930	Total budgetary resources available	36	29	28

	Change in obligated balance:
	Unpaid obligations:
3010	Obligations incurred, unexpired accounts	36	29	28
3020	Outlays (gross)	–36	–29	–28

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	36	29	28
	Outlays, gross:
4010	Outlays from new discretionary authority	36	29	28
4180	Budget authority, net (total)	36	29	28
4190	Outlays, net (total)	36	29	28


		2012 actual	2013 CR	2014 est.

Enacted/requested:
	Budget Authority	36	29	28
	Outlays	36	29	28
Legislative proposal, not subject to PAYGO:
	Budget Authority			–2
	Outlays			–2
Total:
	Budget Authority	36	29	26
	Outlays	36	29	26

The cost of medical benefits for Medicare-eligible beneficiaries is paid from the Department of Defense Medicare-Eligible Retiree Health Care Fund (10 U.S.C., ch. 56). Beginning in 2006, permanent indefinite authority is provided for a discretionary appropriation of the annual accrual payment into this fund (P.L. No. 108–375, section 725).


Identification code 75–0170–2–1–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Direct Program Activity			–2

0900	Total new obligations (object class 12.2)			–2

	Budgetary Resources:
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation			–2

1160	Appropriation, discretionary (total)			–2
1930	Total budgetary resources available			–2

	Change in obligated balance:
	Unpaid obligations:
3010	Obligations incurred, unexpired accounts			–2
3020	Outlays (gross)			2

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross			–2
	Outlays, gross:
4010	Outlays from new discretionary authority			–2
4180	Budget authority, net (total)			–2
4190	Outlays, net (total)			–2


Identification code 75–9913–0–1–552		2012 actual	2013 CR	2014 est.

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	1	1	1

3050	Unpaid obligations, end of year	1	1	1
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	1	1	1
3200	Obligated balance, end of year	1	1	1

This display shows activities in support of scientific activities overseas that were supported by foreign currencies by the United States abroad.


Identification code 75–9941–0–4–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0801	Program Support Center	887	775	785
0802	OS activities	116	309	318

0900	Total new obligations	1,003	1,084	1,103

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	216	103	103
1021	Recoveries of prior year unpaid obligations	67

1050	Unobligated balance (total)	283	103	103
	Budget authority:
	Spending authority from offsetting collections, discretionary:
1700	Collected	1,019	1,084	1,103
1701	Change in uncollected payments, Federal sources	–196

1750	Spending auth from offsetting collections, disc (total)	823	1,084	1,103
1930	Total budgetary resources available	1,106	1,187	1,206
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	103	103	103

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	415	509	25
3010	Obligations incurred, unexpired accounts	1,003	1,084	1,103
3020	Outlays (gross)	–842	–1,568	–1,103
3040	Recoveries of prior year unpaid obligations, unexpired	–67

3050	Unpaid obligations, end of year	509	25	25
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–481	–285	–285
3070	Change in uncollected pymts, Fed sources, unexpired	196

3090	Uncollected pymts, Fed sources, end of year	–285	–285	–285
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	–66	224	–260
3200	Obligated balance, end of year	224	–260	–260

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	823	1,084	1,103
	Outlays, gross:
4010	Outlays from new discretionary authority	600	1,084	1,103
4011	Outlays from discretionary balances	242	484

4020	Outlays, gross (total)	842	1,568	1,103
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–1,012	–1,084	–1,103
4033	Non-Federal sources	–7

4040	Offsets against gross budget authority and outlays (total)	–1,019	–1,084	–1,103
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	196
4080	Outlays, net (discretionary)	–177	484
4190	Outlays, net (total)	–177	484

HHS Service and Supply Fund (SSF) provides a wide range of logistical and support services to components of the Department and other Federal agencies. The Program Support Center includes activities such as personnel and payroll support, information technology, financial management operations, and administrative services, including acquisitions management, building and property management, telecommunication services, medical supplies repackaging and distribution services, and the Federal Occupational Health Service. The Office of Secretary activities include the fund manager, departmental contracts, audit resolutions, Commissioned Corps force management, web management, claims, acquisition integration and modernization, small business, grants tracking, the physical access aspects of the Department's implementation of Homeland Security Presidential Directive 12, and commercial services management.

Most Commissioned Corps officers work for agencies in the Department of Health and Human Services and are reflected in the agencies' personnel summaries. However, some officers are assigned to other Federal agencies. The allocation account section in the following personnel summary shows officers assigned to other agencies, which are paid directly by that agency, either through an allocation account or by directly citing that agency's appropriation.


Identification code 75–9941–0–4–551		2012 actual	2013 CR	2014 est.

	Reimbursable obligations:
	Personnel compensation:
11.1	Full-time permanent	110	103	103
11.3	Other than full-time permanent	4	2	2
11.5	Other personnel compensation	2	3	3
11.7	Military personnel	8	10	10
11.8	Special personal services payments	10

11.9	Total personnel compensation	134	118	118
12.1	Civilian personnel benefits	32	29	29
12.2	Military personnel benefits	4	2	2
21.0	Travel and transportation of persons	2	2	2
22.0	Transportation of things	3	4	4
23.1	Rental payments to GSA	25	22	22
23.3	Communications, utilities, and miscellaneous charges	32	6	6
24.0	Printing and reproduction	2	3	3
25.1	Advisory and assistance services	36	56	57
25.2	Other services from non-Federal sources	480	612	625
25.3	Other goods and services from Federal sources	127	69	71
25.4	Operation and maintenance of facilities	18	7	7
25.6	Medical care	14	29	29
25.7	Operation and maintenance of equipment	51	92	94
26.0	Supplies and materials	41	31	32
31.0	Equipment	2	2	2

99.9	Total new obligations	1,003	1,084	1,103


Identification code 75–9941–0–4–551		2012 actual	2013 CR	2014 est.

2001	Reimbursable civilian full-time equivalent employment	1,280	1,166	1,168
2101	Reimbursable military average strength employment	94	94	94
3101	Allocation account military average strength employment	1,665	1,761	1,761

Trust Funds


Identification code 75–9971–0–7–551		2012 actual	2013 CR	2014 est.

0100	Balance, start of year			3
	Receipts:
0220	Contributions, Indian Health Facilities	48	48	48
0221	Contributions, N.I.H., Unconditional Gift Fund	3	3	3
0222	Centers for Disease Control, Gifts and Donations	15	15	15
0223	Contributions, N.I.H., Conditional Gift Fund	27	27	27
0224	Contributions to the Indian Health Service Gift Fund	1	1	1

0299	Total receipts and collections	94	94	94

0400	Total: Balances and collections	94	94	97
	Appropriations:
0500	Miscellaneous Trust Funds	–94	–91	–91

0799	Balance, end of year		3	6


Identification code 75–9971–0–7–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0002	Gifts	55	57	57
0003	Contributions, Indian Health Facilities	33	35	35

0900	Total new obligations	88	92	92

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	114	133	132
1021	Recoveries of prior year unpaid obligations	13

1050	Unobligated balance (total)	127	133	132
	Budget authority:
	Appropriations, mandatory:
1201	Appropriation (special or trust fund)	94	91	91

1260	Appropriations, mandatory (total)	94	91	91
1930	Total budgetary resources available	221	224	223
	Memorandum (non-add) entries:
1941	Unexpired unobligated balance, end of year	133	132	131

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	61	76	127
3010	Obligations incurred, unexpired accounts	88	92	92
3020	Outlays (gross)	–60	–41	–56
3040	Recoveries of prior year unpaid obligations, unexpired	–13

3050	Unpaid obligations, end of year	76	127	163
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	61	76	127
3200	Obligated balance, end of year	76	127	163

	Budget authority and outlays, net:
	Mandatory:
4090	Budget authority, gross	94	91	91
	Outlays, gross:
4100	Outlays from new mandatory authority	22	9	9
4101	Outlays from mandatory balances	38	32	47

4110	Outlays, gross (total)	60	41	56
4180	Budget authority, net (total)	94	91	91
4190	Outlays, net (total)	60	41	56

	Memorandum (non-add) entries:
5000	Total investments, SOY: Federal securities: Par value	28	25	25
5001	Total investments, EOY: Federal securities: Par value	25	25	25


	2012	2013	2014

Distribution of budget authority by account:
Gifts	55	57	57
Contributions, Indian Health Facilities	33	35	35
Distribution of outlays by account:
Gifts	30	21	28
Contributions, Indian Health Facilities	30	20	28

Gifts to the Public Health Service are for the benefit of patients and for research. Contributions are made for the construction, improvement, extension, and provision of sanitation facilities.


Identification code 75–9971–0–7–551		2012 actual	2013 CR	2014 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	1

11.9	Total personnel compensation	4	3	3
12.1	Civilian personnel benefits	1	1	1
21.0	Travel and transportation of persons	1	1	1
25.1	Advisory and assistance services	3	3	3
25.2	Other services from non-Federal sources	13	13	13
25.3	Other goods and services from Federal sources	14	14	14
25.5	Research and development contracts	8	8	8
25.6	Medical care	1	1	1
26.0	Supplies and materials	6	6	6
31.0	Equipment	5	6	6
41.0	Grants, subsidies, and contributions	32	36	36

99.9	Total new obligations	88	92	92


Identification code 75–9971–0–7–551		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment	27	27	27

Federal Funds

For expenses necessary for the Office of Inspector General, including the hire of passenger motor vehicles for investigations, in carrying out the provisions of the Inspector General Act of 1978, [$58,579,000]$68,879,000: 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. Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution as well as amounts from P.L. 113–2, the Disaster Relief Appropriations Act, 2013 (no language shown).


Identification code 75–0128–0–1–551		2012 actual	2013 CR	2014 est.

	Obligations by program activity:
0001	Direct program	74	53	70
0801	HCFAC Reimbursable program	216	222	214
0802	Direct Reimbursable program	19	24	24
0803	HCFAC Discretionary allocation adjustment	24	103	114

0899	Total reimbursable obligations	259	349	352

0900	Total new obligations	333	402	422

	Budgetary Resources:
	Unobligated balance:
1000	Unobligated balance brought forward, Oct 1	44	9	25
1001	Discretionary unobligated balance brought fwd, Oct 1	5
1012	Unobligated balance transfers between expired and unexpired accounts	7	10
1021	Recoveries of prior year unpaid obligations	1

1050	Unobligated balance (total)	52	19	25
	Budget authority:
	Appropriations, discretionary:
1100	Appropriation	50	50	69
1121	Appropriations transferred from other accts [75–0140]		5

1160	Appropriation, discretionary (total)	50	55	69
	Spending authority from offsetting collections, discretionary:
1700	Collected	29	140	132
1701	Change in uncollected payments, Federal sources	14

1750	Spending auth from offsetting collections, disc (total)	43	140	132
	Spending authority from offsetting collections, mandatory:
1800	Collected	195	213	212
1801	Change in uncollected payments, Federal sources	13

1850	Spending auth from offsetting collections, mand (total)	208	213	212
1900	Budget authority (total)	301	408	413
1930	Total budgetary resources available	353	427	438
	Memorandum (non-add) entries:
1940	Unobligated balance expiring	–11
1941	Unexpired unobligated balance, end of year	9	25	16

	Change in obligated balance:
	Unpaid obligations:
3000	Unpaid obligations, brought forward, Oct 1	61	56	51
3010	Obligations incurred, unexpired accounts	333	402	422
3011	Obligations incurred, expired accounts	4
3020	Outlays (gross)	–336	–407	–412
3040	Recoveries of prior year unpaid obligations, unexpired	–1
3041	Recoveries of prior year unpaid obligations, expired	–5

3050	Unpaid obligations, end of year	56	51	61
	Uncollected payments:
3060	Uncollected pymts, Fed sources, brought forward, Oct 1	–73	–61	–61
3070	Change in uncollected pymts, Fed sources, unexpired	–27
3071	Change in uncollected pymts, Fed sources, expired	39

3090	Uncollected pymts, Fed sources, end of year	–61	–61	–61
	Memorandum (non-add) entries:
3100	Obligated balance, start of year	–12	–5	–10
3200	Obligated balance, end of year	–5	–10

	Budget authority and outlays, net:
	Discretionary:
4000	Budget authority, gross	93	195	201
	Outlays, gross:
4010	Outlays from new discretionary authority	82	184	191
4011	Outlays from discretionary balances	19	7	9

4020	Outlays, gross (total)	101	191	200
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4030	Federal sources	–66	–140	–132
	Additional offsets against gross budget authority only:
4050	Change in uncollected pymts, Fed sources, unexpired	–14
4052	Offsetting collections credited to expired accounts	37

4060	Additional offsets against budget authority only (total)	23

4070	Budget authority, net (discretionary)	50	55	69
4080	Outlays, net (discretionary)	35	51	68
	Mandatory:
4090	Budget authority, gross	208	213	212
	Outlays, gross:
4100	Outlays from new mandatory authority	177	213	212
4101	Outlays from mandatory balances	58	3

4110	Outlays, gross (total)	235	216	212
	Offsets against gross budget authority and outlays:
	Offsetting collections (collected) from:
4120	Federal sources	–157	–201	–200
4123	Non-Federal sources	–20	–12	–12

4130	Offsets against gross budget authority and outlays (total)	–177	–213	–212
	Additional offsets against gross budget authority only:
4140	Change in uncollected pymts, Fed sources, unexpired	–13
4142	Offsetting collections credited to expired accounts	–18

4150	Additional offsets against budget authority only (total)	–31
4170	Outlays, net (mandatory)	58	3
4180	Budget authority, net (total)	50	55	69
4190	Outlays, net (total)	93	54	68

The Office of Inspector General (OIG) is an independent and objective oversight unit of the U.S. Department of Health and Human Services (HHS) that promotes economy, efficiency, and effectiveness through preventing and detecting 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.


Identification code 75–0128–0–1–551		2012 actual	2013 CR	2014 est.

	Direct obligations:
	Personnel compensation:
11.1	Full-time permanent	40	28	36
11.3	Other than full-time permanent	1	1	1

11.9	Total personnel compensation	41	29	37
12.1	Civilian personnel benefits	14	10	13
21.0	Travel and transportation of persons	2	1	2
22.0	Transportation of things	1		1
23.1	Rental payments to GSA	3	5	3
23.3	Communications, utilities, and miscellaneous charges	1	1	1
25.2	Other services from non-Federal sources	2	1	3
25.3	Other goods and services from Federal sources	5	4	7
25.4	Operation and maintenance of facilities	2	1	1
25.7	Operation and maintenance of equipment	1
26.0	Supplies and materials	1
31.0	Equipment	1	1	2

99.0	Direct obligations	74	53	70
99.0	Reimbursable obligations	259	349	352

99.9	Total new obligations	333	402	422


Identification code 75–0128–0–1–551		2012 actual	2013 CR	2014 est.

1001	Direct civilian full-time equivalent employment	404	273	346
2001	Reimbursable civilian full-time equivalent employment	1,369	1,610	1,684

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


		2012 actual	2013 CR	2014 est.

Offsetting receipts from the public:
75–143500	General Fund Proprietary Interest Receipts, not Otherwise Classified	93	90	90
75–274530	Health Education Assistance Loans, Downward Reestimates of Subsidies	12
75–310700	Federal Share of Child Support Collections	789	852	831
Legislative proposal, subject to PAYGO				4
75–322000	All Other General Fund Proprietary Receipts Including Budget Clearing Accounts	34	34	34
General Fund Offsetting receipts from the public		928	976	959


Intragovernmental payments:
75–388500	Undistributed Intragovernmental Payments and Receivables from Cancelled Accounts	–27

General Fund Intragovernmental payments		–27

(1) The Secretary may exercise authority equivalent to that available to the Secretary of State in section 2(c) of the State Department Basic Authorities Act of 1956. The Secretary shall consult with the Secretary of State and relevant Chief of Mission to ensure that the authority provided in this section is exercised in a manner consistent with section 207 of the Foreign Service Act of 1980 and other applicable statutes administered by the Department of State.

(2) The Secretary is authorized to provide such funds by advance or reimbursement to the Secretary of State as may be necessary to pay the costs of acquisition, lease, alteration, renovation, and management of facilities outside of the United States for the use of HHS. The Department of State shall cooperate fully with the Secretary to ensure that HHS has secure, safe, functional facilities that comply with applicable regulation governing location, setback, and other facilities requirements and serve the purposes established by this Act. The Secretary is authorized, in consultation with the Secretary of State, through grant or cooperative agreement, to make available to public or nonprofit private institutions or agencies in participating foreign countries, funds to acquire, lease, alter, or renovate facilities in those countries as necessary to conduct programs of assistance for international health activities, including activities relating to HIV/AIDS and other infectious diseases, chronic and environmental diseases, and other health activities abroad.

(3) The Secretary is authorized to provide to personnel appointed or assigned by the Secretary to serve abroad, allowances and benefits similar to those provided under chapter 9 of title I of the Foreign Service Act of 1980, and 22 U.S.C. 4081 through 4086 and subject to such regulations prescribed by the Secretary. The Secretary is further authorized to provide locality-based comparability payments (stated as a percentage) up to the amount of the locality-based comparability payment (stated as a percentage) that would be payable to such personnel under section 5304 of title 5, United States Code if such personnel's official duty station were in the District of Columbia. Leaves of absence for personnel under this subsection shall be on the same basis as that provided under subchapter I of chapter 63 of title 5, United States Code, or section 903 of the Foreign Service Act of 1980, to individuals serving in the Foreign Service.

(b) Peer Review.—In entering into transactions under subsection (a), the Director may utilize such peer review procedures (including consultation with appropriate scientific experts) as the Director determines to be appropriate to obtain assessments of scientific and technical merit. Such procedures shall apply to such transactions in lieu of the peer review and advisory council review procedures that would otherwise be required under sections 301(a)(3), 405(b)(1)(B), 405(b)(2), 406(a)(3)(A), 492, and 494 of the PHS Act.

(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] 2014 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] 2014.

(b) CANCELLATION.—The remaining unobligated balances of the amount appropriated for fiscal year [2013] 2014 by section 510(d) of such Act (42 U.S.C. 710(d)) for which no application has been received by September 20, [2013] 2014, shall be permanently cancelled as of September 27, [2013] 2014.

(c) APPROPRIATION.—There is appropriated to the Department of Health and Human Services, to become available on September 27, [2013] 2014, and to remain available through September 30, [2014] 2015, 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.

(a) The Secretary of HHS shall prescribe by regulation, for application in the current fiscal year and in subsequent fiscal years, a schedule of fees for certification of health information technology as established by Section 300jj-11(c)(5) of Title 42. The fees shall be paid by health information technology vendors based on the fee structure established by the Secretary and published in the Federal Register. The Secretary shall periodically update this schedule of fees through a notice in the Federal Register. This fee structure shall be designed to be sufficient to recover costs associated with the administration of certification programs authorized by Section 300jj-11(c)(5) of Title 42, including the costs for health information technology standards, testing and certification, and other related costs for improving the efficiency of certification programs.

(b) Collection Procedures.—The Secretary shall prescribe procedures to collect the fees. The Secretary may, for the purpose of collecting fees, use the services of a department, agency, or instrumentality authorized by the National Coordinator to perform the certification of health information technology in accordance with Section 300jj-11(c)(5) of Title 42, and may reimburse such department, agency, or instrumentality a reasonable amount for its services.

(c) Collection, Deposit, and Use.—(1) Fees collected under this section shall be deposited in the HHS Office of the National Coordinator for Health Information Technology account as offsetting collections.

(2) Such fees shall be collected and available only to the extent and in such amounts as provided in advance in appropriations acts.

(A) for the full period of the contract or for the first fiscal year in which the contract is in effect; and

(B) for the estimated costs associated with a necessary termination of the contract; and

(2) the Secretary determines that a multi-year contract will serve the best interests of the Federal Government by encouraging full and open competition or promoting economy in administration, performance, and operation of BARDA's programs.

(1) shall include a termination clause as described by subsection (c) of section 3903 of title 41, United States Code; and

(2) shall be subject to the congressional notice requirement stated in subsection (d) of such section.

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Food and Drug Administration

Federal Funds

Salaries and Expenses

Buildings and Facilities

Salaries and Expenses

(Legislative proposal, not subject to PAYGO)

Revolving Fund for Certification and Other Services

Health Resources and Services Administration

Federal Funds

Health Resources and Services

Primary Health Care

Health Workforce

Maternal and Child Health

Ryan White HIV/AIDS Program

Health Care Systems

Rural Health

Family Planning

Program Management

Vaccine Injury Compensation

Covered Countermeasure Process Fund

Maternal, Infant, and Early Childhood Home Visiting Programs

Health Center Guaranteed Loan Financing Account

Health Education Assistance Loans Program Account

Health Education Assistance Loans Financing Account

Health Education Assistance Loans Liquidating Account

Medical Facilities Guarantee and Loan Fund

Trust Funds

Vaccine Injury Compensation Program Trust Fund

Indian Health Service

Federal Funds

Indian Health Service

Indian Health Contract Support Costs

Indian Health Facilities

ADMINISTRATIVE PROVISIONS

Administrative Provisions—Indian Health Service

Centers for Disease Control and Prevention

Federal Funds

CDC-Wide Activities and Program Support

Immunization and Respiratory Diseases

HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention

Emerging and Zoonotic Infectious Diseases

Chronic Disease Prevention and Health Promotion

Birth Defects, Developmental Disabilities, Disabilities and Health

Public Health Scientific Services

Environmental Health

Injury Prevention and Control

National Institute for Occupational Safety and Health

Energy Employees Occupational Illness Compensation Program

Global Health

Public Health Preparedness and Response

CDC-Wide Activities and Program Support

CDC Working Capital Fund

Agency for Toxic Substances and Disease Registry

toxic substances and environmental public health

World Trade Center Health Program Fund

National Institutes of Health

Federal Funds

National Cancer Institute

National Heart, Lung, and Blood Institute

National Institute of Dental and Craniofacial Research

National Institute of Diabetes and Digestive and Kidney Diseases

National Institute of Neurological Disorders and Stroke

National Institute of Allergy and Infectious Diseases

National Institute of General Medical Sciences

Eunice Kennedy Shriver National Institute of Child Health and Human Development

National Eye Institute

National Institute of Environment Health Sciences

National Institute on Aging

National Institute of Arthritis and Musculoskeletal and Skin Diseases

National Institute on Deafness and Other Communication Disorders

National Institute of Nursing Research

National Institute on Alcohol Abuse and Alcoholism

National Institute on Drug Abuse

National Institute of Mental Health

National Human Genome Research Institute

National Institute of Biomedical Imaging and Bioengineering

National Center for Complementary and Alternative Medicine

National Institute on Minority Health and Health Disparities

John E. Fogarty International Center